Findings indicate the importance of cultural change, compared with simply an environmental change, giving all staff and consumers the confidence to utilise a variety of sensory-based methods during times of need. Further Australian research is required to explore the positive contribution sensory modulation can potentially make across the spectrum of psychiatric settings.

1. To examine e ectiveness/outcomes of best supportive care interventions versus cancer therapies for gastrointestinal cancer trials; 2. To determine whether trials containing best supportive care include a definition of this. Search methodsElectronic databases, grey literature sources, citation searching and reference checking, handsearches of journals and discussion with experts were used to identify potentially eligible trials from both published and unpublished sources up to July 2009. Selection criteriaRCTs comparing BSC/SC versus anticancer therapies in patients with gastrointestinal cancers. Data collection and analysisFour RCTs were found and reviewed. Because of the heterogeneity of studies, a meta-analysis was not attempted. Data were extracted from the included studies and the quality of each was assessed. Main resultsData from four studies (483 participants) were included. Due to the heterogeneity of studies (in terms of populations studied, the interventions used, the variety of outcomes and assessments used) it was not possible to make direct comparisons between the studies.

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Background In July 2010 NICE developed guidance on the use of non-invasive ventilation (NIV) in patients with Motor Neuron Disease (MND). In the North West of England the University Hospital of South Manchester (UHSM) provides a tertiary Long Term Ventilation Service (LTVS) which establishes NIV for patients in the region. The NICE guidance means increasing numbers of MND patients are being commenced on NIV and subsequently the number of patients reaching the end of their life on NIV is increasing. Method As part of the service review UHSM LTVS carried out a postal survey of GP's whose patient's died between July 2010 and December 2010 to evaluate the end of life care of MND patients on NIV. Results 12 GP's were contacted and 8 returned feedback. •Place of death: 5 at home 2 in hospital 1 in a hospice •There were multiple professionals involved in the patients' deaths; 5/8 of the patients had 3 or more professional disciplines involved. •5/8 patients had an Advance Decision to Refuse Treatment (ADRT); 3/5 related to the patient's ventilation – 2 relating to withdrawal and 1 stating a wish to die on NIV •5/8 patients died on NIV (including 2 with an ADRT for NIV withdrawal) •GP's confidence in dealing with NIV was variable. Conclusion There is increasing number of MND patients reaching the end of their lives dependent on NIV. The confidence of GP's is variable and the number of healthcare professionals involved with these patients is substantial. Although the majority of patients had ADRTs, these did not always relate to NIV. Even if it did, NIV was still continued. In light of these findings UHSM LTVS has recognised the need to develop multi-disciplinary ‘end of life care’ guidelines for patients with MND who are using NIV.

The term 'Health Services Research' (HSR) has achieved only recent currency in the UK. The purpose of this short article is to explain what it is, to say how it differs from clinical research even when using similar methods, and to argue that it is likely to become of rapidly increasing importance to health policy-makers and managers.