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• A media campaign aimed to increase public awareness of drug deaths and naloxone. • There was relatively high levels of campaign recall and recognition by the public. • Exposure to campaign materials was associated with higher levels of overdose knowledge. • Exposure was not associated with overdose response knowledge or readiness to intervene. Take home naloxone (THN) programmes are effective at reducing opioid related mortality, but require high levels of distribution, including to the general public. Mass media campaigns can be effective in improving public understanding of a topic and encouraging behavior change. Whilst mass media campaigns focusing on naloxone have been developed internationally, there is a lack of research on their potential impact. We investigated the effects of components of a recent national mass media campaign (Scotland, UK) designed to improve public awareness of drug related deaths, and readiness to intervene. We undertook a cross-sectional online experimental study with a randomized design, conducted with a nationally representative sample. Participants (N = 1551; 52.6% female; age 46.1±16.5 years) were assessed on overdose knowledge and readiness to intervene after presentation of eight combinations of campaign components. Compared to a basic campaign description, exposure to all types of campaign component were associated with higher overdose knowledge (p <.001), but not knowledge of what to do in response to an overdose (p =.374), or readiness to intervene (p =.286). The greatest effects were associated with a media rich audio-visual resource (animated video with a popular song on the soundtrack, and narrated by a well-known actor). Our data suggest that harm reduction is an appropriate topic for large-scale mass media campaigns. However, effects may be limited to knowledge and awareness raising in the general public, and may be related to the types of media used. Audience segmentation is important and more general messaging about drug related deaths may be more appropriate for the majority of audiences. [ABSTRACT FROM AUTHOR]

One of the elements of the health reform plan, as agreed to by Australian state and federal governments, is to introduce a 4-h National Access Target, to reduce emergency department (ED) waiting times. This article highlights the flawed rationale behind the 4-h rule, the UK experience of this rule and discusses the potential dangers it poses to Australian patients. An alternative solution proposed is the separation of elective and emergency surgical streams to reduce the variability in demand for inpatient services. [ABSTRACT FROM AUTHOR]

Doctrine of ultra vires in companies prevents the business community to dissipate the corporate capital in those objects which are not contained in the objects clause of memorandum of association of the company. Its application in companies was for the first time demonstrated by House of lords in Ashbury's case. However the Directors of the companies have been attempting to evade this doctrine since long time and the Courts have applied ejusdem Genris rule while interpreting the objects clause. In 1945 cohen committee and in 1967 jenkin committee in England recommended its abolition / protection to third party dealing with company which were not accepted. However the European community act 1972 incorporated in English companies act 1985 protects an outsider dealing with company in good faith. Hence there is need in our country also to carry out necessary amendment in our companies act 1956. [ABSTRACT FROM AUTHOR]

The nature of United Kingdom (UK) nursing education has changed significantly as the responsibility has been transferred from hospitals to the University sector. More information is needed on the outcome of the Project 2000 diploma and degree courses given the rapidly changing health care context. This paper focuses on the role socialization of graduate and diploma nurses. As part of a larger study, this research investigated the role orientations of 52 nursing graduates and 28 diplomates from two different universities at three time points; on graduation and at 6 and 12 months postgraduation. The Corwin Role Orientation Scale was selected and modified for the study. It comprised of three separate scales measuring professional, bureaucratic and service orientation. The data from the two groups of nurses were examined to identify nurses' ideal role orientations and role discrepancies over the transitionary period from graduate to qualified nurse. Although the results showed observed differences between the groups over time, none of these differences were statistically significant. The findings raise a number of questions about the value of the instrument as a measure in the contemporary nursing context. Furthermore, each of the Corwin subscales had a low internal reliability. A possible explanation may be that the instrument, which was developed in the United States of America (USA) in the 1960s, and modified, for this study, has little relevance for contemporary UK nursing. The study findings are also limited by the small size of the sample. In spite of these limitations, the study suggests there are few differences between the role orientations and socialization experiences of UK nursing graduates and diplomates. Indeed, both programmes commonly take place in university settings and students receive the same amount of clinical experience. Further instrument development and exploratory research is recommended to identify the role socialization and orientations of UK nurses through larger national studies. [ABSTRACT FROM AUTHOR]

This paper reviews the literature on nursing competence measurement and reports the results of a comparative quantitative study of the competencies of Project 2000 diplomates and BA (Hons) Adult Nursing graduates from two UK nursing programmes. The findings reveal that graduates appear to overcome any initial limitations and become more competent than the diplomates in certain areas. Attention to social awareness and participation is necessary in both pre-registration programmes, whilst greater attention could be given to graduates' leadership and management development. Diplomates need support in their professional development if they are to achieve the same level of competence as graduates during the first post-qualifying year. There are implications for the level of support afforded to qualifying nurses in their first staff positions; preceptorship programmes could be an important means of assisting newly qualified staff to gain confidence. More research on nurse competencies with larger samples drawn from programmes across the UK is needed. [ABSTRACT FROM AUTHOR]

Background Liver injury is known in patients on methotrexate (MTX). We retrospectively reviewed records of patients who had liver biopsy for suspected MTX induced liver injury and identify risk factors if any. Methods Children (≤ 16 years) referred to us from 2002 to 2015 with suspected MTX induced liver injury were identified and data related to their underlying diagnosis, biochemical parameters, Body Mass Index (BMI), dose and duration of MTX at the time of liver biopsy, use of concomitant drugs, duration and other causes for elevated transaminases, liver histology including clinical decisions to continue or stop MTX were extracted from the data base. All the liver biopsies were re-analysed for this study and scored using the Roenigk classification by a single histopathologist blinded to patient characteristics. Results Seventeen liver biopsies were performed in 14 children (3 had repeat biopsies) who were referred for frequent/persistent transaminitis (> 2 times upper limit normal). The base line bilirubin, transaminases and synthetic liver function were normal in all prior to MTX therapy. All were on MTX at the time of biopsy except two who had been off the drug for 3 and 8 months following frequent transaminitis. They had liver biopsy to guide reintroduction of MTX in their treatment regime. None of the patients had renal impairment, diabetes or underlying liver disease. Thirteen biopsies (82 %) had none (n = 6) to mild liver injury (n = 7) and were advised to continue MTX. Four biopsies (18%) showed significant liver injury (grade 3b and 4). Of these 3 patients were advised to stop MTX while one was advised to continue and repeat liver biopsy in 6 months. He however, stopped MTX soon thereafter. All biopsies of children (n = 3) with BMI ≥ 91st centile had liver damage. Two of thirteen biopsies with BMI < 91 centile had moderate-severe damage. No correlation was seen between the histologic findings or their severity with dose or duration of MTX, concomitant use of other drugs, severity/highest transaminase peak, total duration of transaminase abnormality, longest single episode of transaminase abnormality or frequency/number of peaks of abnormal transaminases. Of the 3 with repeat biopsies, fibrosis had progressed in 2, necessitating discontinuation of MTX in 1. Conclusion The finding of significant liver injury in our cohort is not entirely in keeping with previous paediatric studies which report non-significant fibrosis or cirrhosis. We could not identify any risk factors though children with BMI ≥ 91st centile seemed more likely to have liver injury. This finding is similar to adult studies implicating obesity as risk factor though it is difficult to draw definitive conclusions given the small size of our cohort. Other limitations include the retrospective nature of the study, bias as MTX dose modifications and referral were at the discretion of the rheumatologist and no information on alcohol intake in the teenagers. This study emphasises the need for careful monitoring to prevent severe fibrosis and cirrhosis. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Paramedics Experiences and Expectations Concerning Advance Directives: A Prospective, Questionnaire-Based, Bi-Centre Study'" in the September 2012 issue is presented.

Examines the effectiveness of palliative care teams in Great Britain, using `grey literature' as sources. Assessment of the suitability of grey literature; Types of grey literature used.