UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared.

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IntroductionPublished evidence suggests that dance may be of benefit to people with Parkinson’s disease. Following a suggestion from a service-user, our hospice set up a pilot dance programme for people with Parkinson’s disease comprising six fortnightly 1.5 hour dance classes over 12 weeks.AimTo share our experience of setting up a hospice Parkinson’s dance programme and evaluate the impact on participants.MethodsParkinson’s Disease Questionnaire (PDQ-39), a validated quality of life measure for Parkinson’s disease was completed at baseline and 12 weeks. Goal Attainment Scaling (GAS) captured the difficulty and importance of participants’ goals and the extent to which they were achieved. Mean PDQ-39 and GAS T-scores were compared using a paired sample t-test. Many participants volunteered qualitative feedback and gave permission for their (anonymised) quotes to be included in the evaluation.ResultsOf the initial 10 participants, seven completed the evaluation (one died and two had prolonged hospital admissions). 6/7 participants had a positive change in their GAS T-scores. Mean change in GAS T-scores was 22.3 (p=0.01). The mean PDQ-39 Summary Index reduced between baseline and 12 weeks but this was not significant (p=0.541). Informal qualitative feedback was positive (e.g., ‘[I feel] terrific. Supported and less isolated. Mentally and physically better’).ConclusionsAlthough we did not demonstrate a significant improvement in quality of life of participants (possibly due to small sample size), they did appear to achieve their individual goals from the dance programme and informal feedback was positive. Our experience is that it is feasible to run a Parkinson’s dance programme in a hospice and it served as a gentle introduction to hospice services for some participants. Dance programmes for people with Parkinson’s disease may fit well with the idea of enabling people to live well until they die, a core part of palliative care.

IntroductionWith increasing referrals to specialist palliative care (SPC) services at a time of limited resources, effective triage systems are essential. This community SPC service uses a ‘RAG’ triage system, whereby a multidisciplinary team (MDT) decides daily if referrals should be categorised as ‘Red’ (seen within 24 hours), ‘Amber’ (3 days), or ‘Green’ (10 days).AimsTo assess if the MDT correctly prioritises referrals according to palliative care need.MethodsReferrals between 1/1/16 and 12/5/16 were examined retrospectively. Patients were RAG rated at referral. The Integrated Palliative Care Outcome Scale (iPOS) and phase of illness (POI) were recorded at the first visit. Higher iPOS scores, ‘Unstable/deteriorating/dying’ POI or shorter time between first and second contacts were taken as proxies of greater palliative care need, with lower iPOS scores, ‘Stable’ POI or longer time between contacts indicating lower need. One way ANOVA compared RAG to total iPOS scores and time between contacts. Chi-Square tested the association between RAG and POI (‘stable’ versus ‘unstable/deteriorating/dying’).Results296 patients received a RAG rating. Of these, 217 had an iPOS and 207 had a POI completed at the first visit. Red patients had a mean iPOS score of 21, Amber 18 and Green 15 (p=0.001). The mean number of days between initial contacts was 3 for Red, 8 for Amber and 11 for Green (p=0.001). There was a significant association between RAG triage category and POI (Chi-Square=36.9, p=0.000). This was in the expected direction with 67% of patients triaged as Green assessed as ‘Stable’ at the first visit, compared with 46% of Ambers and 3% of Reds. 97% of Red patients were ‘unstable/deteriorating/dying’ at first visit, compared with 54% of Ambers and 33% of Greens.ConclusionsThese findings support the RAG triage system as a way of prioritising new referrals to a SPC service.

Science, University of Cambridge. ENVIRONMENT for the biologist is the medium within which the effect of any particular gene is developed. It includes all those chemical and physical factors which influence development from without, and also the modifying tendencies of the other genes which by their presence influence the conditions within the organism. These two aspects of the environment arc known as external and internal respectively. In mammals the external environment covers both ante-natal and post-natal influences. It operates through factors involved in nutrition, protection, play, instruction and affection. It is by such means that tradition, whether family or racial, serves in some measure to shape the growing organism. In man these formative influences are made the more potent by the long period of infancy, with its imitative play and dependence upon family provision, and by the responsiveness of the human nervous system in developing new habit patterns in relation to external circumstances. Nature or Nurture? . Reflection will make it evident that the relationship of environment to heredity, and the reverse, is so intimate that the one is meaningless without the other. In extreme instances the influence of the one may appear to override completely that of the other. Thus eye colour is but little influenced by environment, whilst the contraction of-infectious disease is to a large extent determined by the chances of environment.Nevertheless eye colour is somewhat dependent upon the general state of health and upon age, whilst infection can only develop vvithin a body, the resisting powers of which, as we shall see later, are in some measure expressive of hereditary condition. It is thus unrealistic, as well as unfortunate, when the relationship is presented as nature (heredity) versus nurture (environment). Practice based upon such an attitude will lead to the extremism of the eugenic hereditarians, or of the uncritical kind of social reformer. The biologist will seek to ascertain and analyse the complete system of causation in order to arrive at an estimate of the degree of control that will result from improvement in breeding and in upbringing respectively. The means by which to achieve any given change in the quality of human kind will then be known, though action will still be subject to agreement upon the desirability of the change in question. A few examples of the interaction of heredity and environment will now be examined in this light.