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Aims: For smokers unmotivated to quit, we assessed the effectiveness and cost‐effectiveness of behavioural support to reduce smoking and increase physical activity on prolonged abstinence and related outcomes. Design: A multi‐centred pragmatic two‐arm parallel randomised controlled trial. Setting: Primary care and the community across four United Kingdom sites. Participants: Nine hundred and fifteen adult smokers (55% female, 85% White), recruited via primary and secondary care and the community, who wished to reduce their smoking but not quit. Interventions: Participants were randomised to support as usual (SAU) (n = 458) versus multi‐component community‐based behavioural support (n = 457), involving up to eight weekly person‐centred face‐to‐face or phone sessions with additional 6‐week support for those wishing to quit. Measurements Ideally, cessation follows smoking reduction so the primary pre‐defined outcome was biochemically verified 6‐month prolonged abstinence (from 3–9 months, with a secondary endpoint also considering abstinence between 9 and 15 months). Secondary outcomes included biochemically verified 12‐month prolonged abstinence and point prevalent biochemically verified and self‐reported abstinence, quit attempts, number of cigarettes smoked, pharmacological aids used, SF12, EQ‐5D and moderate‐to‐vigorous physical activity (MVPA) at 3 and 9 months. Intervention costs were assessed for a cost‐effectiveness analysis. Findings Assuming missing data at follow‐up implied continued smoking, nine (2.0%) intervention participants and four (0.9%) SAU participants achieved the primary outcome (adjusted odds ratio, 2.30; 95% confidence interval [CI] = 0.70–7.56, P = 0.169). At 3 and 9 months, the proportions self‐reporting reducing cigarettes smoked from baseline by ≥50%, for intervention versus SAU, were 18.9% versus 10.5% (P = 0.009) and 14.4% versus 10% (P = 0.044), respectively. Mean difference in weekly MVPA at 3 months was 81.6 minutes in favour of the intervention group (95% CI = 28.75, 134.47: P = 0.003), but there was no significant difference at 9 months (23.70, 95% CI = −33.07, 80.47: P = 0.143). Changes in MVPA did not mediate changes in smoking outcomes. The intervention cost was £239.18 per person, with no evidence of cost‐effectiveness. Conclusions: For United Kingdom smokers wanting to reduce but not quit smoking, behavioural support to reduce smoking and increase physical activity improved some short‐term smoking cessation and reduction outcomes and moderate‐to‐vigorous physical activity, but had no long‐term effects on smoking cessation or physical activity. [ABSTRACT FROM AUTHOR]

A list of articles to appear in future issues of "Journal of Renal Care" is presented. Articles mentioned include "Needle stick injury: a novel intervention to reduce the occupational health and safety risk in the haemodialysis setting," by Josephine Chow, "Implementing the Buttonhole method using the Biohole peg in a busy dialysis unit: a review," by Jennie King, and "Assessing and training patients on Peritoneal Dialysis in their own homes can influence better practice," by Rumeyza Kazancioglu.

A total of two hundred ninety-nine 4- to 9-year-old maltreated and nonmaltreated children of comparable socioeconomic status and ethnicity judged whether children should or would disclose unspecified transgressions of adults (instigators) to other adults (recipients) in scenarios varying the identity of the instigator (stranger or parent), the identity of the recipient (parent, police, or teacher), and the severity of the transgression ('something really bad' or 'something just a little bad'). Children endorsed more disclosure against stranger than parent instigators and less disclosure to teacher than parent and police recipients. The youngest maltreated children endorsed less disclosure than nonmaltreated children, but the opposite was true among the oldest children. Older maltreated children distinguished less than nonmaltreated children between parents and other types of instigators and recipients. [ABSTRACT FROM AUTHOR]

A report outlining experience gained from the practice of introducing the buttonhole (BH) method of arteriovenous cannulation using the Biohole device, a polycarbonate sterile peg, to form the tunnel tracks. The author's findings are discussed informally and compared with current published literature to provide encouragement to nursing colleagues who are interested in introducing this method of needling, using the peg, into a typically busy haemodialysis unit. [ABSTRACT FROM AUTHOR]

Aims. The purpose of this study was to develop a validated Congenital Adrenal Hyperplasia Knowledge Assessment Questionnaire (CAHKAQ) that can be used to identify deficits in the knowledge of families living with CAH regarding the disease and its management. Background. Management of CAH requires good parental and/or patient knowledge and understanding of the disorder, and the action required when clinical problems arise. Effective education initiatives are important in helping families to manage the disorder. However, there are currently no established questionnaires available to assess the knowledge of CAH. Method. An extensive survey of the literature was conducted to develop a list of questions about CAH. The Delphi technique was used to develop and determine content validity of the CAHKAQ using a panel of 15 nursing and medical experts in endocrinology. The instrument was piloted to test for item variation, meaning and redundancy, and to determine instrument unidimensionality and internal consistency. The questionnaire was distributed to a convenience sample of family members ( n = 98) of 36 children/adults with CAH recorded on the database of a large children's hospital endocrine clinic. Results. Three Delphi rounds were required to achieve final consensus for content validity. The resulting questionnaire contained 22 multiple-choice items and had a Flesch Reading Ease score of 67. Statistical analysis found the instrument to be internally consistent and unidimensional with a reported Cronbach's coefficient alpha of 0·67. Conclusion. The CAHKAQ is a valid and reliable questionnaire suitable for use in conjunction with education about CAH. Relevance to clinical practice. The CAHKAQ will be invaluable in assessing parental and patient knowledge and understanding of the disorder and identifying deficits that can be addressed through education. Further research is required to determine whether the underlying factors of the instrument are consistent with components of CAH knowledge. [ABSTRACT FROM AUTHOR]

The paper discussed during autumn 2007 was a report entitled ‘Cannulating in haemodialysis: rope-ladder or buttonhole technique?’ published in Nephrology Dialysis Transplantation. The authors agreed to follow the discussion and respond to points raised. Twenty-three expert contributors from 13 different countries provided evidence, opinion and historical insights into vascular access techniques for chronic haemodialysis patients. All contributors who had introduced the buttonhole technique for patients with native arterio-venous fistulas (AVFs) had found benefits for patients in terms of ease of cannulation, reduced pain and even reduced aneurysm formation. The discussion included expert advice on needling protocols, track formation and the sharp versus blunt needles debate. The buttonhole technique is virtually unheard of in some countries and the discussion covered some of the potential barriers to its introduction and offered advice on also how to overcome some of these issues. [ABSTRACT FROM AUTHOR]

The aim of this study was to find out if offering specialist renal training courses enhanced staff recruitment and retention. An audit of staff with specialist renal skills acquired through training was completed. Analysis of the records available in this Trust since 2003, reporting on staff retention and increased nurse satisfaction following renal course attendance, were used in this study. The research used semi-structured interviews gaining qualitative data. The participants were all staff who had undertaken renal courses provided by this Trust. The results showed that when the interviews were thematically analysed, key themes emerged, which displayed enhanced insight, confidence and increased skill base. The quantitative data concerning staff retention, staff movement and staff sickness, helped to identify that not only do staff actually stay longer but also appear to develop advanced skills and knowledge as well as more positive attitudes. In summary, it was shown that by offering specialist training there is an increased number of skilled renal nurses presenting for employment attracted by the opportunity of undertaking specialist renal courses. They in return, benefit from the advanced renal programme, which enables them to deliver better quality of care with increased job satisfaction. [ABSTRACT FROM AUTHOR]

The article lists the medical professionals that the editorial board of the "Journal of Renal Care" would like to thank including Dr. Fouad Al-Baaj, Dr. Georgios Aperis, and Dr. Paul Bennett.