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Abstract: Aims/background: The retention of student nurses continues to concern the education sector internationally. Evidence shows that individual factors are correlated with a high risk of attrition, including age, disability, entry qualifications, financial issues, and placement experience. This paper is a report of a study that aimed to examine factors connected to progression and attrition by mapping student characteristics against Year 1 progression data. Method: The study used a retrospective cohort design. Students within five cohorts in a single University in the north of England were invited to be included (n =807). Quantitative data were collected from the University''s information system (October 2009–January 2010). Of the total potential participants, 695 were included (13.8% excluded). Multinomial logistic regression was used to ascertain factors that predicted progression. Results: As age on entry increased, the likelihood of non-progression from year one became less: i.e. older students appeared to be more likely to progress than their younger counterparts (p <0.001, likelihood ratio chi-square test). Students who lived away from the local area outside term-time were significantly less likely to progress than those whose term-time and holiday domicile were the same (p =0.007, likelihood ratio chi-square test). Students with dependents or previous care experience seemed more likely to progress than those without, although this was not statistically significant in a multivariable regression model. Conclusion: With the changing demographic profile of students, the new ‘all-graduate’ programmes need to consider student characteristics that are correlated with likelihood of progression and not just focus on those that precipitate exit. [Copyright &y& Elsevier]

Abstract: Background: Achieving asthma control is central to optimising patient quality of life and clinical outcome. Contemporary models of chronic disease management across a variety of countries point to the importance of micro, meso and macro level influences on patient care and outcome. However, asthma outcomes research has almost invariably concentrated on identifying and addressing patient predictors. Little is known about higher level organisational influences. Objective: This paper explores the contribution of organisational factors on poor asthma control, allowing for patient factors, at three organisational levels: the individual patient, local service deliverers, and strategic regional providers. Design, setting and participants: Prospective cross-sectional observational cohort study of 64,929 people with asthma from 1205 primary care practices spread throughout the United Kingdom (UK). Patient clinical data were recorded during a routine asthma review. Method: Data were analysed using simple descriptive, multiple regression and complex multi-level modelling techniques, accounting for practice clustering of patients. Results: Poor asthma control was associated with areas of higher deprivation [regression coefficient 0.026 (95% confidence intervals 0.006; 0.046)] and urban practice [−0.155 (−0.275; −0.035)] but not all local and regional variation was explained by the data. In contrast, patient level predictors of poor control were: short acting bronchodilator overuse [2.129 (2.091; 2.164)], days-off due to asthma [1.203 (1.148; 1.258)], PEFR<80 [0.76 (0.666; 0.854)], non-use of a self-management plan (SMP) [0.554 (0.515; 0.593)], poor inhaler technique [0.53 (0.475; 0.585)], poor medication compliance [0.385 (−0.007; 0.777)], and gender [0.314 (0.281; 0.347)]. Pattern of medication use, smoking history, age, body mass index (BMI), and health service resource use were also significant factors for predicting control. Conclusions: Targeting of health service resource requires knowledge of the factors associated with poor control of asthma symptoms. In the UK the contribution of local and regional structures appears minimal in explaining variation in asthma outcomes. However, unexplained variation in the data suggests other unrecorded factors may play a part. While patient personal characteristics (including self-management plan use, inhaler technique, medication compliance) appear to be the predominant influence the complex nature of the disease means that some, perhaps more subtle, influences are affecting the variability at all levels and this variance needs to be explored. Further research in other international contexts is required to identify the likely applicability of these findings to other health care systems. [Copyright &y& Elsevier]