We are all faced with uncertainty about the future, but we can get the measure of some uncertainties in terms of probabilities. Probabilities are notoriously difficult to communicate effectively to lay audiences, and in this review we examine current practice for communicating uncertainties visually, using examples drawn from sport, weather, climate, health, economics, and politics. Despite the burgeoning interest in infographics, there is limited experimental evidence on how different types of visualizations are processed and understood, although the effectiveness of some graphics clearly depends on the relative numeracy of an audience. Fortunately, it is increasingly easy to present data in the form of interactive visualizations and in multiple types of representation that can be adjusted to user needs and capabilities. Nonetheless, communicating deeper uncertainties resulting from incomplete or disputed knowledge--or from essential indeterminacy about the future--remains a challenge.

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV 1 , forced expiratory volume in 1 second; LOS, length of stay 837 www.thoraxjnl.com

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Background-Chronic cough is associated with an increased sensitivity to inhaled capsaicin in a number of conditions but there are no data for patients with more severe asthma or chronic obstructive pulmonary disease (COPD). Moreover, the relationships between the capsaicin response (expressed as the concentration of capsaicin provoking five coughs, C5), self-reported cough, and routine medication is not known. Methods-The cough response to capsaicin in 53 subjects with asthma, 56 subjects with COPD, and 96 healthy individuals was recorded and compared with a number of subjective measures of selfreported cough, measures of airway obstruction, and prescribed medication. In asthmatic subjects the relationships between the cough response to capsaicin and mean daily peak flow variability and nonspecific bronchial hyperresponsiveness to histamine were also examined. Results-Subjects with asthma (median C5 = 62 mM) and COPD (median C5 = 31 mM) were similarly sensitive to capsaicin and both were more reactive than normal subjects (median C5 >500 mM). Capsaicin sensitivity was related to symptomatic cough as measured by the diary card score in both asthma and COPD (r = -0.38 and r = -0.44, respectively), but only in asthma and not COPD when measured using a visual analogue score (r = -0.32 and r = -0.05, respectively). Capsaicin sensitivity was independent of the degree of airway obstruction and in asthmatics was not related to PEF variability or PC 20 for histamine. The response to capsaicin was not related to treatment with inhaled corticosteroids but was increased in those using anticholinergic agents in both conditions. Conclusions-These data suggest that an increased cough reflex, as measured by capsaicin responsiveness, is an important contributor to the presence of cough in asthma and COPD, rather than cough being simply secondary to excessive airway secretions. The lack of any relationship between capsaicin responsiveness and airflow limitation as measured by the FEV 1 suggests that the mechanisms producing cough are likely to be diVerent from those causing airways obstruction, at least in patients with COPD. (Thorax 2000;55:643-649)

There were large variations between centres for many of the variables studied. A forced expiratory volume in one second measurement was found in only 53% of cases. Of the investigations recommended in the acute management arterial blood gases were performed in 79% (interhospital range 40 -100%) of admissions and oxygen was formally prescribed in only 64% (range 9 -94%). Of those cases with acidosis and hypercapnia 35% had no further blood gas analysis and only 13% received ventilatory support. Long-term management was also deficient with 246 cases known to be severely hypoxic on admission yet two-thirds had no confirmation that oxygen levels had returned to levels above the requirements for long-term oxygen therapy. Only 30% of current smokers had cessation advice documented.To conclude, the median standards of care observed fell below those recommended by the guidelines. The lowest levels of performance were for patients not under the respiratory specialists, but specialists also have room for improvement. The substantial variation in the process of care between hospitals is strong evidence that it is possible for other centres with poorer performance to improve their levels of care. Chronic obstructive pulmonary disease (COPD) has a high prevalence and is one of the most common causes of emergency medical admission with a respiratory disorder in the UK [1,2]. Several national and international Thoracic Bodies have produced management guidelines [3 -7] but relatively little is known about the standards of care of COPD as practised. Published studies encompass few hospitals, small patient numbers, and are not measured against nationally agreed standards. For example data from a sample of l00 cases from the West of Scotland suggested that care by respiratory specialists was better than that given by generalists [8]. A study from a single New Zealand hospital concluded that process of care was "adequate" measured against a local consensus view [9]. Following the launch of the British guidelines [7] the British Thoracic Society (BTS) performed an audit of the clinical practise of hospital care of patients admitted with acute exacerbations of COPD. The aims of the audit were to establish data on the current management of acute COPD in UK hospitals judged against the British guidelines and to identify differences in management between respiratory and nonrespiratory specialists. MethodsHospitals within the UK with acute Respiratory Medicine Departments were approached to participate in the study. All were asked to complete retrospective audit sheets from information held in case-note records on 40 consecutive admissions from September 1, 1997 with a clinical diagnosis of acute exacerbation of COPD as the admission criterion. The audit proforma developed by the BTS audit group, comprised 38 questions some with two or more stems covering the following areas of care: 1) background information and history prior to admission; 2) assessment and measurements on admission; 3) initial management; 4) continuing management and ...

Study objectives: to determine whether access to high-quality stroke care is affected by the age or gender of the patient or by weekend admission. Design: data were collected as part of the National Sentinel Audit of stroke in 2004, both on the organisation of in-patient stroke care and the process of care to hospitals managing stroke patients. Setting: two hundred and forty-six hospitals from England, Wales and Northern Ireland took part in the 2004 National Stroke Audit, a response rate of 100%. These sites audited the care of 8,718 patients. Audit Tool: Royal College of Physicians Intercollegiate Working Party Stroke Audit Tool. Results: overall standards of care for cases of stroke in England, Wales and Northern Ireland are low. Older patients are less likely to be treated in a stroke unit than younger patients (risk ratio comparing 85+ years with those <65 years 0.82 (95% CI 0.75-0.90). Seventy-one per cent of patients under 65 years were scanned within 24 h compared to 51% aged over 85 years. Older patients were also less likely than younger ones to receive secondary prevention and some aspects of rehabilitation, especially around higher functioning. Standards were consistently better for patients of all ages managed in stroke units compared to general wards. At weekends, patients were less likely to be admitted directly to a stroke unit (risk ratio 0.77 95% CI 0.69-0.86) and brain imaging was performed less often for older (85+ years) patients (weekday 56%, weekend 40%). There was little evidence of differences in standards of care between males and females. Conclusion: there is clear evidence of an age effect on the delivery of stroke care in England, Wales, and Northern Ireland, with older patients being less likely to receive care in line with current clinical guidelines. Quality of acute care is also less good for patients admitted at weekends. No systematic evidence for sexism was identified.

ObjectivesAbout 100 000 people present to hospitals each year in England with an epileptic seizure. How they are managed is unknown; thus, the National Audit of Seizure management in Hospitals (NASH) set out to assess prior care, management of the acute event and follow-up of these patients. This paper describes the data from the second audit conducted in 2013.Setting154 emergency departments (EDs) across the UK.ParticipantsData from 4544 attendances (median age of 45 years, 57% men) showed that 61% had a prior diagnosis of epilepsy, 12% other neurological problems and 22% were first seizure cases. Each ED identified 30 consecutive adult cases presenting due to a seizure.Primary and secondary outcome measuresDetails were recorded of the patient's prior care, management at hospital and onward referral to neurological specialists onto an online database. Descriptive results are reported at national level.ResultsOf those with epilepsy, 498 (18%) were on no antiepileptic drug therapy and 1330 (48%) were on monotherapy. Assessments were often incomplete and witness histories were sought in only 759 (75%) of first seizure patients, 58% were seen by a senior doctor and 57% were admitted. For first seizure patients, advice on further seizure management was given to 264 (27%) and only 55% were referred to a neurologist or epilepsy specialist. For each variable, there was wide variability among sites that was not explicable. For the sites who partook in both audits, there was a trend towards better care in 2013, but this was small and dwarfed by the intersite variability.ConclusionsThese results have parallels with the Sentinel Audit of Stroke performed a decade earlier. There is wide intersite variability in care covering the entire care pathway, and a need for better organised and accessible care for these patients.

this national study of lung cancer care in the UK has shown large age-related differences in management and survival in patients with lung cancer, largely independent of case-mix factors. The reasons for this are complex but such under-treatment in the elderly may be one factor underlying the poor outcomes in lung cancer patients in the UK.