3 Addington-Hall JM, Karlsen S. Age is not the crucial factor in determining how the palliative care needs of people who die from cancer diVer from those of people who die from other causes. J Palliat Care 1999;15:13-9. 4 Lupu D. Hospice inpatient care: an overview of NHO's 1995 inpatient survey results.

This study reports on the third in an annual series of surveys covering England, Wales, Scotland and Northern Ireland on the activity of palliative care services. This report concentrates on inpatient (hospice and hospital) services. All 640 known UK palliative services were sent a standardized questionnaire asking about the characteristics and numbers of patients cared for. Results were analysed for those services primarily for adults. From the 189 inpatient units (2955 beds) there was an 84% response rate in total, but the response to many of the questions was lower than this. Sixty per cent of services recorded 24,362 new patients, and about 50% provided details showing that 96.7% patients had cancer, and one-third were aged under 65 years. This is higher than the national distribution of cancer deaths where 24% are under 65 years. Conversely, only 7% were in the over 84 age group, which has 14% of cancer deaths. Most patients (73%) were admitted from their own home. Half of the admissions ended in death, and the majority of discharges were to the patient's own home. The mean length of stay was 13.1 days, with larger units tending to have a longer length of stay. Forty per cent of admissions were for one week or less (2.3% of patients died on the day of admission) and 15% were for more than three weeks. Bed occupancy varied between 99.7 and 48.9%. Responses were received from 74% of the 326 hospital support services, although again many questions were answered by less than half of those eligible to do so. Details of 37,194 new patients were reported (5.9% did not have cancer, although there was a wide range between services). Patients typically had four contacts with the service, although almost a quarter were single contacts. Three-quarters of the contacts were by a clinical nurse specialist. National estimates suggest that of the 155,000 patients dying of cancer in the UK each year 27,600 (18%) die in a hospice. There are 39,000 new hospice admissions each year and about 100,000 patients have contact with a hospital support service. Overall, the national provision of palliative care is increasing but there are groups who still appear to be missing out on palliative care, especially older people. Increasingly, patients appear to be admitted to a hospice earlier in care and are discharged home.

The objective of this study was to repeat part of a survey carried out the previous year and to describe and quantify the hospice and palliative care inpatient units throughout Great Britain and Ireland for the year 1991, this also to include a survey of palliative care day centres and hospital support services. Questionnaires were sent to 346 hospice and palliative care services in Great Britain and Ireland. Replies were analysed by the Hospice Information Service. A total of 293 replies were received (84% response). The report details bed usage, length of stay and admissions, deaths and discharges in inpatients units. It also describes provision of day centre places and types of services offered. An initial assessment is made of the different types of hospital palliative care support services available. An estimate of the number of patients receiving palliative care in inpatient units and in day care centres is made.

A survey of the inpatient palliative care services throughout Great Britain and Ireland was undertaken, enquiring about activity for the year 1993. This is one in a series of annual surveys of the various aspects of palliative care. Questionnaires were sent out at the end of April 1994, and 174 replies were received from 200 initially sent (87%). Replies were analysed by the Hospice Information Service. The report gives details of admissions, deaths and discharges and considers length of patient stay and bed occupancy. A discussion of the apparent discrepancies in the reported statistics is included. Palliative care for children is separately considered, and admissions of noncancer patients are detailed.

Lengthy review times for institutional review boards (IRBs) are a well-known barrier to research. In response to numerous calls to reduce review times, we devised "Real-Time IRB," a process that drastically reduces IRB review time. In this, investigators and study staff attend the IRB meeting and make changes to the protocol while the IRB continues its meeting, so that final approval can be issued at the meeting. This achieved an overall reduction in time from submission to the IRB to final approval of 40%. While this process is time and resource intensive, and cannot address all delays in research, it shows great promise for increasing the pace by which research is translated to patient care.