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The continuing global increase in the prevalence of overweight and obesity, particularly amongst children, attracts widespread public and political attention. Obesity is a complex condition, with multi‐faceted determinants, and prevention strategies require consideration of dietary and lifestyle patterns alongside a range of environmental factors. Reduction in intake of sugar‐sweetened beverages and foods is advised around the world as part of healthier dietary patterns to help reduce energy intakes, obesity risk and obesity‐related disorders. Current intakes indicate that this is challenging and will likely require a concerted approach with a broad range of interventions including fiscal measures. In recent years, after some notable success with salt and trans fats, there has been considerable focus on food reformulation to support the reduction in population intakes of free sugars from manufactured foods, often without need for consumer behaviour change. In some products, particularly sugar‐sweetened beverages, reformulation is relatively easy and has been widely achieved, as the sweetness of sugars can be replaced with low‐calorie sweeteners. However, other products, in which sugar delivers a variety of functional properties, are more challenging to reformulate to maintain consumer acceptance and achieve a reduction in energy, alongside sugar, content. This paper will look at current definitions and recommendations for free (or added) sugars, as well as key dietary sources and trends in intakes, and explore various strategies to promote population reductions in intake of sugars for public health, including the opportunities and challenges presented by reformulation using low‐calorie sweeteners. Ultimately strategies to promote sugar reduction, including reformulation, should adopt a holistic approach that considers wider dietary recommendations. [ABSTRACT FROM AUTHOR]

Accessible summary: Children with learning disabilities often have problems with their eyesight.We tested the eyes of nine children and checked whether they needed glasses or bigger print.We found that when they got what they needed to see better, their behaviour improved.This is important because children with learning disabilities need to be able to see as well as anyone else. Background: Children with identified special educational needs are at higher risk than other children of having visual needs that are not adequately met. This paper evaluates the impact of addressing the visual needs of these children on behaviour and academic achievements in a number of case studies. Method: Nine children (4–11 years of age, from four classrooms), who attended a special school in a medium‐sized town in the UK, took part in the case studies reported here. The children were part of the Special Education Eyecare (SEE) Project. Six of the children were selected because they had unmet visual needs at baseline and required bespoke interventions to meet these needs; the other three children were selected because their visual needs had been met prior to the study and no further adjustments were needed. Repeated direct observations were conducted to assess the impact of the intervention on the children's behaviour in the classroom. The observer was "blind" with regard to the visual needs of the participants. Parents and teachers completed the Strength and Difficulties Questionnaire (SDQ) for each child, before and after the intervention. School files were analysed to assess effects on academic achievement. Findings: Subsequent to the implementation of bespoke visual adjustments, for example prescription of spectacles or changed seating in classroom, significant and sustained changes were observed with regard to the children's behaviour (i.e., increased engagement with peers and/or teachers and decreased off‐task behaviour). Strength and Difficulties Questionnaire scores showed improvements regarding total difficulties, emotional difficulties, hyperactivity and prosocial (kind and helpful) behaviour. Due to highly variable data in school files, the effects on academic achievement were inconclusive. Discussion: The case studies reported here explored changes in behaviour of children with identified special educational needs after their visual needs were met. Findings show a positive overall effect on the behaviour of these children. [ABSTRACT FROM AUTHOR]

Vocal fold nodules present the voice clinic team with a number of clinical dilemmas which are not as simple as previously thought. The definition, aetiology, prevalence and diagnosis are all poorly understood. Furthermore, treatment evidence for both behavioural and surgical approaches is weak. This paper reviews the published evidence pertaining to all of these aspects. Specific areas of uncertainty that remain include poorly defined nomenclature, the natural history of paediatric vocal nodules, the establishment of criteria to measure successful treatment, optimal configuration of speech therapy regimens and the rationale for surgical intervention. The authors suggest the development of evidence‐based guidelines for UK practice. [ABSTRACT FROM AUTHOR]

Accessible Summary: Lots of people with intellectual disabilities in the UK are given medication to manage their behaviours and the NHS wants this to stop. In Cornwall, we wanted to see how often we give medication to people instead of other health care such as communication or occupational assessments etc. We found that around half the people we work with because of their behaviours get medication to manage their feelings and many do not get other assessments. We want to change this in Cornwall and stop over medicating people by learning from this study. Abstract: Background: The use of psychotropic medication to manage challenging behaviours of people with intellectual disabilities is a contentious issue which NHS England has now focused on. This paper looks to evaluate this within the multidisciplinary context. Method: Records of clients (n = 106) open to a Community Intellectual Disabilities team for care relating to challenging behaviours were examined. Those recommended psychotropic medications in the absence of a mental health diagnosis were scrutinised for supporting MDT assessments. Results: Over half the clients with challenging behaviours were being prescribed psychotropic medications and many of those had very few MDT assessments to inform care. Conclusions: This study demonstrates the extent psychotropics are used in the absence of MDT informed support for people with intellectual disabilities and behaviours that challenge. A vision to simply withdraw such medication might be simplistic. Local MDT plans are in development to systematically reduce reliance on this type of restrictive practice. [ABSTRACT FROM AUTHOR]

Cardiovascular disease ( CVD) prevalence at a global level is predicted to increase substantially over the next decade due to the increasing ageing population and incidence of obesity. Hence, there is an urgent requirement to focus on modifiable contributors to CVD risk, including a high dietary intake of saturated fatty acids ( SFA). As an important source of SFA in the UK diet, milk and dairy products are often targeted for SFA reduction. The current paper acknowledges that milk is a complex food and that simply focusing on the link between SFA and CVD risk overlooks the other beneficial nutrients of dairy foods. The body of existing prospective evidence exploring the impact of milk and dairy consumption on risk factors for CVD is reviewed. The current paper highlights that high milk consumption may be beneficial to cardiovascular health, while illustrating that the evidence is less clear for cheese and butter intake. The option of manipulating the fatty acid profile of ruminant milk is discussed as a potential dietary strategy for lowering SFA intake at a population level. The review highlights that there is a necessity to perform more well-controlled human intervention-based research that provides a more holistic evaluation of fat-reduced and fat-modified dairy consumption on CVD risk factors including vascular function, arterial stiffness, postprandial lipaemia and markers of inflammation. Additionally, further research is required to investigate the impact of different dairy products and the effect of the specific food matrix on CVD development. [ABSTRACT FROM AUTHOR]

The progressive nature of Type 2 diabetes necessitates treatment intensification over time in order to maintain glycaemic control, with many patients ultimately requiring insulin therapy. While insulin has unlimited potential efficacy, its initiation is often delayed and improvements in glycaemic control are typically accompanied by weight gain and an increased risk of hypoglycaemia, particularly as HbA1c approaches and falls below target levels. This may account for the sub-optimal control often achieved after insulin initiation. Combining insulin with antihyperglycaemic therapies that have a low risk of hypoglycaemia and are weight-neutral or result in weight loss is a therapeutic strategy with the potential to improve Type 2 diabetes management. Although the effects differ with each individual class of therapy, clinical trials have shown that adding a glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor or sodium-glucose co-transporter-2 inhibitor to insulin regimens can offer a significant reduction in HbA1c without substantially increasing hypoglycaemia risk, or weight. The evidence and merit of each approach are reviewed in this paper. Once-daily co-formulations of a basal insulin and a glucagon-like peptide-1 receptor agonist have been developed (insulin degludec/liraglutide) or are under development (lixisenatide/insulin glargine). Insulin degludec/liraglutide phase III trials and a lixisenatide/insulin glargine phase II trial have shown robust HbA1c reductions, with weight loss and a low risk of hypoglycaemia. With insulin degludec/liraglutide now approved in Europe, an important consideration will be the types of patients who may benefit most from a fixed-ratio combination; this is discussed in the present review, and we also take a look toward future developments in the field. [ABSTRACT FROM AUTHOR]

Effective therapies for the long-term care of individuals with bipolar disorder feature medication management and an interactional component between patients and care providers. In this paper, we discuss the effectiveness of applying a collaborative practice model to the long-term care of individuals with bipolar disorder who receive outpatient treatment. The model emphasizes that patients are co-managers of their illness and successful outcomes are enhanced within a supportive social environment. Key elements include joint patient-provider treatment planning and decision making. Several controlled trials have demonstrated that when the model is adopted, significant improvements in clinical and functional outcomes can be achieved. The paper concludes with a case study, which illustrates that the model can be successfully implemented in a clinical setting. Given that the clinical and research evidence demonstrates the effectiveness of the model, we suggest that advanced practice psychiatric nurses apply key elements of the collaborative practice model in their work with clients with bipolar disorder. [ABSTRACT FROM AUTHOR]

Backgound: This paper considers some economic aspects of a therapy and support service for people with stroke and aphasia. This material was part of a broader evaluation of the service, which is reported elsewhere (van der Gaag et al. 2005, van der Gaag and Mowles 2005). Aims: The purpose of this part of the study was to investigate the feasibility of undertaking economic appraisal in a voluntary sector service providing therapy for people with aphasia and their families. Methods & Procedures: The costs of delivering therapy and support services were calculated. These costs were compared with the costs of equivalent services in the National Health Service (NHS). The EQ-5D health-related quality of life instrument was used to calculate quality-adjusted life years (QALYs). Outcomes & Results: The cost of delivering therapy was lower than expected for a customized service of this nature. The study generated cost data for delivering therapy services, allowing some comparisons to be made with equivalent services in NHS settings. QALY data were generated for a sample of 25 clients on one of the programmes. Conclusions: The economics of speech and language therapy service delivery have received scant attention in the published literature. The paper argues that decision-making about methods of service delivery can be aided by the explicit consideration of the costs and consequences of different programmes. [ABSTRACT FROM AUTHOR]

The movement of complementary therapy training and education into higher education in the United Kingdom (UK) and the interest in alternative therapeutic approaches within the health professions presents an ideal opportunity for multidisciplinary teaching and shared learning. The diversity and similarities of complementary therapies and areas of convergence with conventional healthcare practice can be explored. The recent publication of the House of Lords Select Committee on Science and Technology report on complementary and alternative medicine (HL Paper 123) provides a broader context for discussion and makes specific recommendations about regulation, education and research in the UK. This paper considers the appropriateness of integrating complementary therapies into education for conventional healthcare practitioners, what we should integrate, and when might be the most appropriate time in the education of healthcare practitioners to introduce different therapeutic modalities and their respective philosophical languages. Rather than present a range of solutions, the paper raises some fundamental issues that are central to the integration of complementary therapeutic approaches. If these issues are neglected as we hurry to incorporate different 'techniques' into our conventional practice, we may simply be left with additional tools that we are ill equipped to use. [ABSTRACT FROM AUTHOR]

A repeated dose of an oral triptan has been shown in randomized controlled trials (RCTs) to be ineffective as a treatment for no or partial response 2 hours after initial dosing but effective as treatment for headache recurrence. In the official prescription information in the United States, the United Kingdom, and Denmark repeated dosing of all seven oral triptans are recommended for headache recurrence but some triptans are also recommended for no or partial response, a use of a triptan deemed to be not beneficial in European and Canadian migraine guidelines. In summary, not all recommendations are based on evidence from RCTs. In addition, some recommendations are ambiguous and patients need clearer instructions. An example of such a clear British instruction in a patient leaflet instruction is presented at the end of the paper. [ABSTRACT FROM AUTHOR]

SHIFT has been one of the largest RCTs in the field of systemic family therapy in the UK. The study took place over five years, including three major centres with fifteen Trusts and twenty‐five family therapists who worked with a manualized treatment in CAMHS with adolescents who self‐harmed. While the results are not available at the time of this publication, this paper will briefly describe the pre‐ existing factors which were helpful in developing a successful bid, clinical and managerial elements of ‘real world research’ of complex psychological processes and the construction of the manualized systemic family therapy. It also offers examples of some of the unanticipated events in the life of such a large trial. Practitioner Points: Large trials develop from small studies and clinicians are urged to look for opportunities for research partnershipsInvestment in time for consideration of difficult issues as they arise is essential for effective trial managementThe balance between research rigour and ‘real life’ practice is an inevitable area of tension and requires consideration of both immediate and outcome consequences 尝试和痛苦 – 一种随机对照试验对比下的把干预当作惯常和在实施过程中出现的重要事件上的反思的家庭治疗 人工家庭治疗 摘要: SHIFT目前是英国家庭治疗领域最大的随机对照试验之一。本研究历时5年, 囊括了三个主要的中心在内的15个信托, 25位曾在CAMHS对自残青少年进行人工治疗的家庭治疗师。因为在发表这篇文章的时候, 结果还没有出来, 本文将简短地描述1）有助发展成功bid的已经存在的因素, 2）临床以及管理方面的复杂心理过程的”真实情况研究”元素, 3）以及人工系统家庭治理的建构。本文还提供了生活在这样一种大的的尝试下的一些意想不到事件的例子。 对实践者有用的几点建议: 大的尝试发展自小的研究, 临床工作者急需寻找研究合作者的机会困难事件需要及时解决, 不然就会对有效尝试管理产生重要影响研究活力和”真实生活”实践的平衡是一种不可避免的引起紧张的领域, 这需要对当下和结果的同时考虑 关键词：实证实践, 研究, 儿童和青少年精神健康, 培训 [ABSTRACT FROM AUTHOR]

Current policy in UK health services emphasizes that, where possible, people with intellectual disabilities should access the same services as people without intellectual disabilities. One of the barriers to this is the confidence of clinicians and therapists. In this paper, we report on the development of a scale to describe the confidence of therapists in working with people with intellectual disabilities (the Therapy Confidence Scale-Intellectual Disabilities [TCS-ID]). One-hundred and eighty-one therapists who provided talking therapies but who did not work primarily with people with intellectual disabilities completed the scale; 43 people completed the scale twice for test-retest reliability purposes. One-hundred and seven people also completed a scale of general therapy self-efficacy. The TCS-ID has a single factor structure accounting for 62% of the variance, Cronbach's alpha for the scale is 0.93 and test-retest reliability is 0.83. There are significant differences in confidence based upon participants experience in working with people with intellectual disabilities and their therapeutic orientation, and there is a significant association between the TCS-ID and the General Therapy Self-efficacy Scale. Sixty clinicians working in mainstream mental health services received training on adapting their therapeutic approaches to meet the needs of people with intellectual disabilities. The TCS-ID was used pre-training and post-training and demonstrated a significant increase in confidence for all group. We suggest that the scale has good psychometric properties and can be used to develop an understanding of the impact of training for mainstream therapist in working with people with intellectual disabilities. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message There is increasing emphasis on people with intellectual disabilities receiving services from mainstream mental health services., There is no research describing the experiences and outcomes of people with intellectual disabilities receiving mainstream talking therapy services., The confidence that clinicians have in working with people with intellectual disabilities may be a barrier to them receiving mainstream services., The Therapy Confidence Scale-Intellectual Disabilities is a psychometrically sound scale for measuring the confidence of therapists in working with people with intellectual disabilities and is a useful outcome measure for training clinicians to work with people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Joint hypermobility syndrome (JHS) is a heritable disorder associated with excessive joint range of motion and pain in the absence of inflammatory joint disease. It is a relatively common cause of musculoskeletal pain but is generally understood to be under-recognized and poorly managed in clinical practice. The present study therefore aimed to identify how JHS is diagnosed, managed and assessed in routine physiotherapy practice. A survey tool was developed from similar physiotherapy surveys of musculoskeletal practice, a review of the literature, and consultation with researchers and clinicians. Paper copies of the final survey were sent to 201 randomly selected secondary care organizations across the UK and an electronic version was advertised through physiotherapy professional networks. A total of 66 responses (80% women) were received from physiotherapists, with a wide range of clinical experience. Only 32% of respondents reported that they had received formal training in JHS management. The Brighton diagnostic criteria for JHS were not often used (only 31% of respondents). The stated aims of physiotherapy and the specific interventions employed seem well matched, with a focus on advice, education, exercise and self-management. Although pain relief was not reported as a high priority in terms of treatment aims, pain was most often assessed as an outcome, suggesting a mismatch between what clinicians aim to achieve and what they measure. The results suggest that reported management strategies are broadly appropriate to long-term musculoskeletal conditions but additional training specific to JHS may be required, particularly in diagnosis and assessment. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Mindfulness-based interventions have been shown to be effective in the treatment of a range of health and psychological disorders in adults and young people without intellectual disabilities ( ID). Clinical studies are emerging reporting on the efficacy of mindfulness-based interventions as a stand-alone treatment for common clinical disorders in adults with ID. Method This paper aims to evaluate the efficacy of an innovative structured mindfulness-based cognitive therapy ( MBCT) group programme adapted for adults with ID with a diagnosis of either recurrent depression, anxiety or both clinical conditions and a history of deliberate self-harm behaviour. Two groups ran consecutively consisting of a total of fifteen participants and seven carers. All participants were recorded as having either a borderline, mild, or moderate ID. The group programme ran over a period of 9 weeks with a follow-up session at 6 weeks post group intervention. Outcome measures included the Hospital Anxiety and Depression Scale and two sub-scales from the Self- Compassion Scale administered at baseline, post therapy and at 6-week follow-up. Results The evaluation showed that participants reported an improvement in their experience of depression, anxiety, self-compassion and compassion for others. The most significant impact was in the reduced levels of anxiety reported. Improvements across all outcomes were maintained at 6-week follow-up. Conclusion The results of the evaluation suggest that people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 6-week follow-up. [ABSTRACT FROM AUTHOR]

The article features a set of abstracts of various research papers presented at the meeting of Royal Society of Medicine, London on November 23, 2003. Some of the papers presented are Sacral nerve stimulation (SNS) for faecal incontinence in the Great Britain; Fatigability of the external anal sphincter in faecal incontinence; Treatment of persistent perineal sinus with pedicled flap: experience of a single colorectal surgeon etc. SNS is safe effective in the medium to long term for treatment of faecal incontinence when conservative treatment has failed.

Fish plays a useful role in a healthy and balanced diet, and its consumption has long been associated with several health benefits. Fish provides a variety of nutrients, including protein and long-chain omega-3 polyunsaturated fatty acids ( n-3 PUFAs), as well as micronutrients including selenium, iodine, potassium, vitamin D and B-vitamins. Intakes of some of these micronutrients, including iodine and vitamin D, are low in some population groups in the UK, which makes fish a valuable contributor to intakes of these. The long-chain n-3 PUFA eicosapentaenoic acid ( EPA) and docosahexaenoic acid ( DHA), present in oil-rich fish and fish oil, have been suggested to be associated with beneficial health outcomes. In this paper, we review the evidence associating fish and long-chain n-3 PUFAs with various health outcomes. Evidence from observational studies shows a protective effect of fish intake on risk of cardiovascular disease ( CVD; including stroke). Eating at least two portions of fish per week has been associated with a 23-25% lower risk of death from coronary heart disease ( CHD) compared with those eating no or very little fish; eating fish once a week has been associated with a 15% lower risk of CHD death. Fish intake seems only moderately associated with lower risk of stroke, with results from meta-analyses showing a risk reduction of between 6% and 18% in those eating fish 2-4 times per week compared with those eating none. There have been some inconsistencies in study findings relating to fish intake and risk of CVD. Differences in habitual fish intakes of the study populations may account for some of this inconsistency. Evidence from randomised controlled trials ( RCTs) on the effect of long-chain n-3 PUFA supplementation on CVD risk has come mainly from secondary prevention studies and is inconsistent. While early studies support a protective effect, recent studies do not support the hypothesis that long-chain n-3 PUFA supplementation is beneficial in secondary prevention of CVD. Different study outcomes have been influenced by variations in study design and the characteristics of the study populations. Furthermore, the increased use of modern treatments for cardiovascular risk factors ( e.g. statins) may not have been sufficiently controlled for in more recent studies. Treatment doses of long-chain n-3 PUFA also varied substantially between studies, ranging from 0.3 to 6.9 g/day. Current evidence suggests that there is no association between fish consumption and risk of type 2 diabetes. We also found no evidence to suggest that fish intake has a protective effect on several types of cancer (pancreas, prostate, bladder, stomach and ovaries). However, studies do suggest that maternal fish intake during pregnancy may reduce the risk of eczema and asthma in her baby, the evidence being somewhat more consistent for eczema. There may also be a link between fish intake during infancy and childhood and the risk of developing asthma and eczema later in childhood, although the evidence is inconsistent and more studies are needed to clarify the situation. The long-chain fatty acid DHA is crucial for development of the brain and the central nervous system in early life. While studies suggest that fish intake in early life contributes to cognitive development, supplementation with EPA and DHA does not seem to have a beneficial effect on cognitive function in childhood. The European Food Safety Authority ( EFSA) suggests that pregnant and breastfeeding women increase their intake of preformed DHA by 100-200 g/day in addition to the suggested average intake level of long-chain n-3 PUFA for adults (250 mg EPA + DHA combined). EFSA proposes that an intake of 1-2 portions of oil-rich fish per week should be compatible with an adequate DHA supply during pregnancy and lactation. There is some evidence to suggest that higher fish intake, dietary DHA intake and DHA levels in the blood among older adults may be positively associated with a lower risk of dementia and Alzheimer's disease ( AD). In some prospective studies, risk of AD and dementia in those having the highest fish intake, or the highest blood DHA levels, was about half that of those who ate a little or no fish or had a low blood DHA level. In one prospective study, eating fish once a week was associated with a 60% lower risk of AD compared with those who rarely or never ate fish. However, some studies have found no association, and more evidence will be needed to draw reliable conclusions. Fish intake may be associated with slower cognitive decline, but the evidence is very limited and more studies are needed. Data from RCTs do not suggest that long-chain n-3 PUFA supplements are effective in preventing cognitive decline. There is some evidence from cohort and cross-sectional studies that fish intake may be associated with better bone health, but not all studies have found such an association. Oil-rich fish, in particular, is an important dietary source of vitamin D, which is important for bone health, and fish consumed with soft bones are a good source of calcium, which is the most abundant mineral in the skeleton. When making recommendations on fish intake, consideration has to be given to the sustainability of fish supplies. Much work has been done already to ensure that fish stocks are not depleted and more efforts will be required to ensure supplies of fish for future generations. Overall, it is evident that including fish in the diet is associated with several health benefits. The extent to which long-chain n-3 PUFA per se contributes to these various effects has yet to be established. It is likely that other components in fish, such as selenium, potassium, vitamin D or B-vitamins, and other dietary aspects ( i.e. foods typically eaten with fish or foods displaced by fish) contribute to the positive health effects. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Incorporating user's perspectives in healthcare delivery is important. Simple questionnaires may not capture these as well as a discrete choice experiment (DCE) which enables the exploration of users' trade-offs between different service attributes. Qualitative methods are increasingly used to improve a DCE's face validity, but few studies adequately describe them. This paper describes the qualitative investigations in the development of a DCE questionnaire to elicit parents' perspectives on centralized services for children with cleft lip and palate. METHODS: Semi-structured telephone interviews were conducted with 16 parents from across the UK, except Wales. Data analysis was carried out by the constant comparative method. RESULTS: Five attributes and their levels were inductively identified: usefulness and amount of information (four levels); staff attitude at cleft centres (two levels); continuity of care (two levels); personal costs of attending appointments (four levels); and cleft centres facilities (two levels). An unexpected finding was that parents' sense of responsibility towards their child made a 'willingness-to-travel' attribute unacceptable to them, but they were receptive to a 'willingness-to-pay' attribute. CONCLUSION: Using qualitative methods with service users in attribute development for a DCE helps to uncover issues that may not be apparent to researchers or health service staff. [ABSTRACT FROM AUTHOR]

Since the discipline expanded during 1970-1990, the number of UK consultant clinical pharmacologists has fallen. This paper describes the results of a questionnaire survey of the work patterns of 53 UK consultant clinical pharmacologists, including 35 (66%) employed by universities and 13 (25%) employed by the National Health Service (NHS). The range of activities undertaken includes: teaching medical students and others the principles of clinical pharmacology and practical therapeutics; research in a wide range of pharmacological and therapeutic areas; patient care, mostly in acute and general hospital medicine and in out-patient clinics; service both locally and nationally on a wide range of committees related to drug therapy; editorial work on learned journals and preparation of written teaching materials, including journal articles, didactic textbooks, reference books, and e-learning materials. The median amount of time that a UK consultant clinical pharmacologist spends on these activities is 50 hours per week; several work more than that. The time is spent as follows: teaching 10%; research 40%; clinical work 30%; policy and administration 12%; editorial work and writing 8%. The numbers of physicians who have been newly registered with the General Medical Council as clinical pharmacologists each year has so far been undiminished, but the number of consultant posts has fallen in 1990-2010. Many trainees therefore leave the discipline when they become consultants. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Reilly R, Paranjothy S, Beer H, Brooks C, Fielder H, Lyons R. Birth outcomes following treatment for precancerous changes to the cervix: a population-based record linkage study. BJOG 2012;119:236-244. Objective To examine whether treatments for precancerous changes to the cervix are associated with adverse birth outcomes in subsequent pregnancies. Design Population-based retrospective cohort study using electronic linkage of data from the Welsh cervical screening programme and a national routine child health database. Setting Wales. Population A total of 174 325 women aged 20-39 years who received cervical screening between April 2001 and March 2004. Methods Logistic regression was used to compare the odds of each birth outcome between women who had negative cervical smears and women who received either colposcopy ± punch biopsy only or colposcopy and excisional or ablative treatments, adjusted for confounding factors (e.g. age, social deprivation and smoking). Main outcome measures Preterm birth (before 37, 32 and 28 weeks of gestation), and low birthweight (<2500 g). Results Compared with women who had negative cervical smears, the odds ratio for preterm birth (<37 weeks) was significantly increased in women who had colposcopy only (adjusted odds ratio 1.54, 95% CI 1.32-1.80) and single excisional treatment (adjusted odds ratio 1.77, 95% CI 1.47-2.13). Similar results were observed for preterm birth at <32 weeks of gestation. There was no increased risk of preterm birth or low birthweight for women who had treatment compared with women who had colposcopy only. Conclusion Women who were referred for colposcopy had an increased risk of preterm births regardless of whether or not they received treatment to the cervix. This increased risk could be the result of common risk factors for abnormal smears and preterm birth. [ABSTRACT FROM AUTHOR]

Background: Adventure therapy is a short-term experiential psychotherapeutic approach that utilises adventurous activities and being in natural environments in order to facilitate therapeutic change in clients. The present paper examines how students with self-reported anxiety and depression experienced participating in an innovative intervention that combined individual therapy with an adventurous outdoor experience. Clients participating in the Adventure Therapy Project received between 10-15 one-to-one counselling sessions prior to the outdoor experience, as well as ongoing counselling following it. Method: Interpretative Phenomenological Analysis was used in order to record and analyse the experiences of three male and three female students who presented at a major UK university student counselling service with self-reported depression and anxiety. Findings: Twelve themes emerged which were categorised into four major domains: enhancing intrapersonal relationships; improving interpersonal relationships; providing an experiential outdoor venue for achieving therapeutic change; offering a secure, personal place for achieving inner healing. The intervention was perceived to improve the ways in which interviewees related towards themselves and other people. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing. Conclusions: Outdoor experiences offer an experiential venue for achieving personal change and, it appears enhance the therapeutic process. Prior and subsequent individual therapy increases the benefits of such experiences. [ABSTRACT FROM AUTHOR]

Background: Communication and swallowing changes are prominent in Parkinson's disease, but there remains a lack of information regarding the experiences and expectations of people with Parkinson's disease in respect of speech-language therapy (SLT) services. Aims: To conduct a survey of people with Parkinson's disease and their carers in the United Kingdom to elicit their views concerning communication and swallowing changes in Parkinson's disease and the support they envisage in helping with these changes. Methods & Procedures: A national survey utilizing a questionnaire developed for the project, accessible by people with Parkinson's disease in web-based, e-mail or paper forms. Outcomes & Results: A total of 168 people with Parkinson's disease (median = 7 years since diagnosis, range = 0.5-30) and 47 carers who provided their impression of the experience of the PwPD responded. Of these 215, 92 (43%) had no contact with SLT services. In general those who had seen an SLT found it a positive experience. Pointers for improvement centred around timing, intensity, duration and access to SLT as well as issues around transfer and maintenance of gains outside of clinic and (lack of) attention to psychosocial dimensions. Availability of ongoing support as the situation evolved and access to SLT when it was needed were two prominent features desired of a responsive service. Conclusions & Implications: Responses suggest that when SLT is available it offers positive support, but respondents felt (re)access when and where SLT is needed could improve, as well as what aspects of swallowing and communication were addressed in assessment and therapy. We reflect on possible recommendations to address the challenges for SLT services in considering organization and content of provision. [ABSTRACT FROM AUTHOR]

Background: The paper illustrates the MST treatment model with three types of presenting problem in young people aged 14–15. Method: The MST model is described and then illustrated with detailed case material from a violent young person convicted of robbery, a young person with a history of serious self-harming behaviour and hospitalisation, and a young person persistently smoking cannabis. Results: All three cases improved after the MST intervention despite disparate presenting problems that included re-offending, the elimination of self-harming behaviour and a significant reduction in the use of cannabis. The three young people were re-integrated into the education system. Conclusion: This case series illustrates the potential uses of the MST model in CAMHS although RCT data are needed to replicate the effectiveness of MST in the British context. [ABSTRACT FROM AUTHOR]

Background: It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. Aims: This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to identify the direction of the development of services for people with aphasia in Scotland. It examines the views both of those who provide and of those who receive those services. Methods & Procedures: The study integrated findings from a questionnaire to all speech and language therapists treating people with aphasia across Scotland with findings from focus groups with service users and aphasia practitioners. Outcomes & Results: Three themes were identified: (1) public and professional awareness of the impact of aphasia on the individual and their family; (2) current service provision and gaps in services; and (3) directions for the future development of services and barriers to change. Although the impact of aphasia is well recognized amongst most professionals (that is, not just speech and language therapists), considerable concern was expressed about the level of knowledge amongst professionals who do not specialize in stroke care and about public awareness of aphasia. Service providers indicated a shift in the model of service delivery of which the service users were largely unaware. Although the majority of speech and language therapists spend most of their time providing one-to-one therapy, and this is valued by service users, there is undoubtedly an emerging shift towards a focus on broader social function and the inclusion of the person with aphasia in supportive social networks. This creates tensions because of the existing pressure for individualized models of delivery. Concern was expressed by practitioners, although not echoed by patients, about the transition from the acute sector to primary care. Practitioners also expressed concern about the introduction of more recent services like NHS 24 and e-health initiatives, which rely on means of communication that may be particularly challenging for people with aphasia. Conclusions & Implications: The findings from this study indicate that although there are clearly common perspectives, the views of people with aphasia about services do not necessarily coincide with those of service providers. This is an important consideration when initiating consultation and highlights the need for clarity on the part of practitioners in identifying the aims and objectives of their ervices as far as people with aphasia are concerned. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Junior doctors feel poorly prepared by their training in Clinical Pharmacology and Therapeutics and commonly make prescribing errors. • Since 1993 the General Medical Council's guidance on undergraduate medical education ‘Tomorrow's Doctors’ has emphasized the integration of Clinical Pharmacology and Therapeutics teaching within the medical curriculum. • With the publication of a new version of Tomorrow's Doctors in 2009, medical schools will be further revising their Clinical Pharmacology and Therapeutics teaching. WHAT THIS STUDY ADDS • Although we know what the recommendations for undergraduate teaching of Clinical Pharmacology and Therapeutics teaching are, there are no published data describing what is currently happening in UK medical schools. • This paper describes the course structures, volume and range of teaching and assessment of Clinical Pharmacology and Therapeutics in the UK in 2009. • Our data provide a foundation for schools looking to revise the Clinical Pharmacology and Therapeutics Teaching in the light of Tomorrow's Doctors 2009. AIM To describe the current structure, delivery and assessment of Clinical Pharmacology and Therapeutics (CPT) teaching in UK medical schools. METHODS An online questionnaire was distributed to the person with overall responsibility for CPT teaching at all UK medical schools in June 2009. RESULTS Thirty of the 32 UK medical schools responded. 60% of schools have a CPT course although in 72% this was an integrated vertical theme. At 70% of schools pharmacologists have overall responsibility for CPT teaching (clinical 67%, non-clinical 33%); at 20% teaching is run by a non-specialist clinician and at 7% by a pharmacist. Teaching is commonly delivered by NHS clinicians (87%) and clinical pharmacists (80%) using lectures (90%) but additionally 50% of schools use e-Learning and 63% have a student formulary. CPT is assessed throughout the curriculum at many schools through written, practical examinations and course work. 90% of schools have specific CPT content in their written examinations. 90% of respondents believed that their students were ‘fairly’ to ‘well’ prepared for the foundation year but only 37% of schools gather data on the competence of their graduates. CONCLUSIONS CPT teaching in UK medical schools is very diverse. Most schools do not assess the performance of their graduates as prescribers and there is a lack of evidence that many of the teaching approaches employed are suitable for the development of prescribing skills. It is vital that developments in CPT teaching are driven by validated, real-world assessments of the prescribing skills of medical students and newly qualified doctors. [ABSTRACT FROM AUTHOR]

Background: There has been relatively little research into therapeutic alliance in child and adolescent mental health and virtually no incorporation of alliance measures as a variable in treatment trials in Child and Adolescent Mental Health Services (CAMHS). Method: A selective literature review on studies in therapeutic alliance in adulthood and childhood along with a theoretical formulation of possible mechanisms of alliance. Results: Therapeutic alliance is reliably measurable both by observation and questionnaire methods at all points in the treatment cycle. In both adult and child studies it shows a consistent, albeit modest, association with treatment outcome. In specific adult studies it has shown a high predictive validity in relation to outcome compared to other variables. In child studies alliance is particularly salient in externalising disorder and predicts outcome of inpatient treatment. Child alliance and parental alliance are independent factors. Theoretical models of alliance outlined in this paper suggest testable hypotheses regarding predictors for positive and negative alliance. Conclusions: Therapeutic alliance in CAMHS is measurable and worth measuring. It is likely to be an important variable for treatment outcome studies and should be included in future trial designs. [ABSTRACT FROM AUTHOR]

Researching sensitive topics, such as the treatment of men with intellectual disabilities and sexually abusive behaviour, present a number of ethical issues for researchers. This paper describes our experiences in working with Multi-Centre Research Ethics Committees on a research proposal designed to assess the efficacy of cognitive behaviour therapy for men with intellectual disabilities who are at risk of sexual offending. After submitting to three Multi-Centre Research Ethics Committees and spending a year trying to get ethical approval, we questioned whether: [ABSTRACT FROM AUTHOR]

Members of the British False Memory Society (BFMS) were sent a detailed questionnaire concerning accused families and 282 (70%) replied. In this paper the author focuses on the nature, circumstances, and consequences of the accusations for the accused, as well as the role of therapy. The great majority (87%) of the accusers were female and most of the accusations were directed against the biological father. Only four per cent involved stepfathers. Often the accusations were non-specific and not all were reported as being associated with recovered memories. The accusations appear to have arisen primarily within the context of a therapeutic relationship. Depression, followed by eating disorder, were the most common reasons for seeking therapy. Significant relationship problems were reported as the most common stress factor prior to the accusations being made. The author emphasizes the complex nature of the accusations and distinguishes between beliefs and memories within the context of recovered memories. The reported consequences of the accusations were discontinued contact with the family (59%), legal proceedings being instigated (14%), and the accused person having to seek psychological or psychiatric help because of the stress involved (29%). © 1997 by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents the author's insights on the paper by S. Pridgeon and colleagues which examines the incidence of lower limb compartment syndrome in Great Britain for patients experiencing robot-assisted radical prostatectomy (RARP). The author notes the surgical procedure described in the paper, emphasizing the significance of operative duration in robot-assisted surgery. Moreover, the author cites the involvement of primary surgeons in the robotic fellowship.

The article presents papers about diabetes management. Topics mentioned include the best timing of injections of prandial insulin for the management of type 1 diabetes to match the supply of carbohydrate from the gastrointestinal tract and the correct levels of glucose for the treatment of hypoglycemia.