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Background: Developing research capability and capacity within the healthcare professions is a challenge throughout diverse international settings. Within England, the National Institute for Health Research aimed to address these challenges through the Integrated Clinical Academic (ICA) research careers escalator for nurses, midwives and allied health professionals. Poor academic progression has been identified in the advanced stages of the pathway, though progression from the earlier entry point (Internship) has not previously been investigated. A national evaluation of four completed Internship cohorts was undertaken to explore stakeholder perspectives and progression beyond the Internship programme.Methods: A mixed methods project used sequential qualitative and quantitative data collection phases commencing with two stakeholder focus groups (n = 10); the findings informed the development of an online survey distributed to previous cohorts of interns (n = 104), their managers (n = 12) and academic mentors (n = 36). Eight semi-structured interviews subsequently explored the challenges and opportunities afforded by the internships. Thematic analysis was used to review qualitative data from focus groups and interviews, with survey data analysed and displayed using descriptive statistics. Synthesis of data from each phase is displayed within the four level evaluation framework outlined within the New World Kirkpatrick® Training Evaluation Model.Results: Important regional differences exist yet the internships are highly valued by all stakeholders. Representation varied between different professions, with nursing and some service-based professions poorly represented. All interns successfully completed the programme (n = 104), with evidence of positive impacts on interns, colleagues and patient care. Balancing research commitments with clinical activity was challenging; middle managers were seen as gatekeepers to programme success. Progression to the next stage of the ICA pathway is highly competitive and was achieved by only a quarter of interns; access to mentors outside of the funded programme is vital for a successful transition.Conclusions: The Internship programme succeeds in providing a range of important early experiences in research, though progression beyond the programme is challenging due, in part, to a widening gap between Internship and the next level of the ICA framework. Vital mentorship support to bridge this gap is threatened by a lack of time and funding; therefore, the pursuit of a clinical-academic career will continue to be elusive for many nurses and allied health professionals. A partnership approach to clinical academic support at institutional level is needed with several international models offering alternative strategies for consideration. [ABSTRACT FROM AUTHOR]

Introduction: Employer led apprenticeship trailblazer groups develop the occupational standard and end point assessment associated with a particular job or occupation. All degree apprenticeship programmes within England must align to these and for allied health professions, this is a new concept. Exploring stakeholder motivations for being part of the trailblazer groups is essential to inform subsequent curriculum design and implementation for this new model of education., Methods: Eighteen semi-structured interviews were undertaken across the three radiography related (diagnostic, therapeutic and sonography) trailblazer groups using a pragmatic constructivist approach., Results: Strong themes emerged around professional recognition, and conflicts between being 'educated' or 'trained', and between vocational and academic components of radiography training. Even within these pioneer groups there was a lack of understanding around degree apprenticeship programmes and their potential impact upon the workforce. Whilst the benefits on recruitment and retention of staff through widening participation were acknowledged, there were concerns around apprentice pay and mentorship. Evidence of professional protectionism was uncovered, balanced by professional pride and a strong desire for team working within and between institutions., Conclusion: The study highlighted an urgent need for further research and awareness raising for employers and practitioners, prior to implementation of radiography-related degree apprenticeships., Implications for Practice: This is the first evaluation of stakeholder motivations related to the development of degree apprenticeships within the allied health professions. The results and recommendations for practise will inform the imminent implementation of degree apprenticeships for the three radiography related professions, facilitating a smooth transition to apprenticeships for clinical and education departments., (Copyright © 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background: Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks' immobilisation in a below-knee cast., Method/design: We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included., Discussion: The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external validity. Accordingly, if significant clinical benefits and cost-effectiveness are demonstrated, EMADE should become a worthwhile treatment option. A larger-scale, multicentre trial may be required to influence national guidelines., Trial Registration: ISRCTN, ID: ISRCTN11212729 . Registered retrospectively on 20 March 2017.

Introduction: Adalimumab is effective in inducing and maintaining response/remission in patients with Crohn's disease either naive to biological therapies or after secondary failure of infliximab., Aim: To present the first 'real-life' survey data from England and Ireland on the use of adalimumab., Method: A retrospective audit conducted through a web-based questionnaire in England/Ireland., Results: We analysed data on 61 patients (35 female, 26 male) with a median age of 33 years (range 17-71 years) and an average follow-up of 8 months. The maximal maintenance dose was 40 mg every other week in 84% of patients, 40 mg weekly in 13% and 80 mg weekly in 3%. Maintenance adalimumab achieved remission in 57% of patients. The ongoing response rate was 83.6%. An additional 8% had a secondary loss of response after an average of 8.4 months (range 2-17). Adverse effects were observed in 23% of patients: of which there was local pain in 29%, infection in 36%, headaches in 14%, leucopenia (on azathioprine) in 7%, a painful rash in 7% and serum-sickness-type reaction in 7%. Adverse events led to discontinuation in two patients., Conclusion: This English/Irish audit shows an acceptable response/remission and safety profile of adalimumab in the treatment of Crohn's disease. In contrast to earlier data from Scotland, dose escalation was only observed in 16% of patients. The majority of responders were steroid-free at follow-up.

The colour tagging of medical records and age-sex cards is described. The system of eight colour tags originally recommended by the Royal College of General Practitioners was used as a basis but was modified and the number of colour tags extended to 13. These tags were applied to medical records and age-sex cards. The colour-coded age-sex registers thus serve as effective chronic morbidity and at-risk registers.