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Aim To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151). Methods All centres in theUK, providing pump services tochildren and young peoplewere invited to participate in anonline audit. Audit metrics were aligned to NICE Technology Appraisal 151 and an electronic data collection tool was used. Results Of the 176 UK centres identified as providing pump services, 166 (94.3%) participated in the study. A total of 5094 children and young people were identified as using continuous subcutaneous insulin infusion (19% of all paediatric patients with Type 1 diabetes), with a median (range) of 16.9 (0.67-69.4)% per centre. Units had a median of 0.58 consultant sessions, 0.43 full-time equivalent diabetic specialist nurses, and 0.1 full-time equivalent dieticians delivering the pump service. The majority of this time was not formally funded. Families could access 24-h clinical and technical support (83% units), although the delivery varied between consultant, diabetic specialist nurse and company representatives. Only 53% of units ran, or accessed, structured education programmes for continuous subcutaneous insulin infusion use. Most units (86%) allowed continuous subcutaneous insulin infusion use for paediatric inpatients, but only 56% had written guidelines for this scenario. Nine percent of units had encountered funding refusal for a patient fulfilling NICE (Technology Appraisal 151) criteria. Conclusion The number of children and young people on continuous subcutaneous insulin infusion therapy is consistent with numbers estimated by NICE. There is a worrying lack of funded healthcare professional time. The audit also identified gaps in the provision of structured education and absence of written inpatient guidelines. [ABSTRACT FROM AUTHOR]

Background Compounds other than macronutrients have been shown to influence blood glucose concentrations and insulin sensitivity in people with diabetes, with caffeine being one such substance. The present study systematically reviewed the evidence of the effects of caffeine on blood glucose concentrations and/or insulin sensitivity in people with diabetes. Methods Four databases, including MEDLINE and EMBASE, were searched up to 1 February 2012. Randomised controlled trials ( RCTs) investigating the effects of caffeine on blood glucose and/or insulin sensitivity in humans, diagnosed with type I, type II or gestational diabetes mellitus ( GDM), were included. Quality assessment and data extraction were conducted and agreed by both authors. Results Of 253 articles retrieved, nine trials (134 participants) were identified. Trials in people with type II diabetes demonstrated that the ingestion of caffeine (approximately 200-500 mg) significantly increased blood glucose concentrations by 16-28% of the area under the curve ( AUC) and insulin concentrations by 19-48% of the AUC when taken prior to a glucose load, at the same time as decreasing insulin sensitivity by 14-37%. In type I diabetes, trials indicated enhanced recognition and a reduced duration of hypoglycaemic episodes following ingestion of 400-500 mg caffeine, without altering glycated haemoglobin. In GDM, a single trial demonstrated that approximately 200 mg of caffeine induced a decrease in insulin sensitivity by 18% and a subsequent increase in blood glucose concentrations by 19% of the AUC. Conclusions Evidence indicates a negative effect of caffeine intake on blood glucose control in individuals with type II diabetes, as replicated in a single trial in GDM. Larger-scale RCTs of longer duration are needed to determine the effects of timing and dose. Early indications of a reduced duration and an improved awareness of hypoglycaemia in type I diabetes require further confirmation. [ABSTRACT FROM AUTHOR]

Focuses on the implications of informed consent on doctors and patients participating in randomized clinical trials in Great Britain. Comparison of alternative treatments; Ethical obligation of physicians; Proposals for improvement of informed consent.

• ppFEV 1 declines annually by −1.5% in CF pancreatic insufficient adults in the UK. • People with pancreatic sufficiency have a slower rate of decline in ppFEV 1. • Younger adults, especially females, have a higher rate of decline. Rate of change in lung function is used as a measure of disease progression and a predictor of mortality in individuals with cystic fibrosis (CF). The aim of this study was to determine the national rate of decline in percent predicted Forced Expiratory Volume in 1 second (ppFEV 1) in adults in the UK accounting for age, sex and pancreatic status. Data on ppFEV 1 for adults with CF, excluding those post lung transplantation, was extracted from the UK CF registry between 2015 and 2017. Multilevel modelling was conducted to calculate the annual rate of change in ppFEV 1 accounting for age, sex and pancreatic status. Overall annual ppFEV 1 decline was -1.52% (95% CI: -1.66 to -1.38%) and -0.55% (95% CI: -0.86 to -0.23%) in pancreatic insufficient (PI) and sufficient (PS) adults respectively. In PI individuals, females had a greater rate of decline in ppFEV 1. There were differences between age groups. The fastest rate of decline was observed in the 18–28 years group, declining -1.76% (95% CI: -2.06 to -1.46) and -1.61% (95% CI: -1.91 to -1.31) per year in PI females and males respectively. The pattern between the sexes and age categories was more inconsistent in the PS group. The average annual rates of decline in lung function in adults with CF in the UK are similar to reports from other large international cohorts. Pancreatic status has a marked impact on average rate of decline. Younger adults, especially females, have a faster rate of decline and need close monitoring. [ABSTRACT FROM AUTHOR]

Current predictions suggest that by 2050 over half of the adult population will be classified as obese (Foresight Report, 2007). The media is a known platform for nutrition education and research indicates that health magazines specifically are highly influential in terms of their impact on health and diet (Hill, 2006). Whilst studies have examined the influence of magazine advertising on food choice, none have analysed the nutritional content of magazine diets in relation to healthy eating guidelines, or their influence over healthy dietary behaviours. The aim of this study was to identify whether the diets published in magazines adhere to national healthy eating guidelines as depicted by the Eatwell Plate (Food Standards Agency, 2007). The 15 best selling diet and health magazines were identified from national sales data and purchased from a single retailer in December 2009, with the cost of each magazine noted. Inclusion criteria were defined as the presence of a health theme, target audience within 18-54 years and incorporation of a 7-day diet plan. Diet plans were analysed using content analysis. Food lists were devised and coded through a deductive approach by cross referencing against the Eatwell Plate and previous content analysis studies. Associated word lists to determine subconscious influence were devised and coded using inductive content analysis. Each diet was analysed for food or word references which were counted against the relevant codes. References were collated as a total across all magazines and presented as the number cited by category as a percentage of the total. Descriptive statistics were used to present the data. Ethical approval was gained from Leeds Metropolitan University Research Ethics Committee. Ten magazines (seven women's; three men's) met the inclusion criteria, representing a full target age range and varied cost (£2.60-£3.95). In total 1155 food references and 266 word references were cited. Fruit and vegetables were referenced most frequently (37.7%), exceeding the Eatwell Plate recommendation (33.3%); carbohydrates were referenced poorly (20.5%), below the 33.3% recommendation; protein (22.3%) was above the 13% recommendation; dairy foods (13.5%) met the Eatwell Plate recommendation (13%). No magazine represented an accurate depiction of the Eatwell Plate model. The associated words attracting most references were for fluid (15%), fat (14.3%), protein (11.3%) and energy (10.5%) with protein referenced more often in men's magazines and calories more often in women's. The lack of evidenced based and balanced dietary information in magazine diets was of concern and contradicted government health promotion strategies. The magazines promoted popular dietary trends as opposed to evidence based healthy eating guidance. The evident repetition of words relating to calories and fat does little to promote healthy dietary behaviours and little emphasis was placed on multi-component dietary and lifestyle approaches. The magazine diets did not meet the Eatwell Plate guidelines , highlighting the need for furthercollaboration between the media and health professionals in order to improve public understanding and help shape the future of public health in relation to obesity prevention. Food Standards Agency (FSA) (2007) The Eatwell Plate. United Kingdom, Government. Available from: <> [Accessed on 27 January 2010]. Foresight Report (2007) Tackling obesities: Future Choices, Project Report, 2nd edn. London: Government Office for Science. Hill, A. (2006) Motivation for eating behaviour in adolescent girls: the body beautiful. Proc. Nutr. Soc. , 376-384. [ABSTRACT FROM AUTHOR]

People with Learning Disabilities (LD) are one of the most vulnerable groups in Britain (DOH, 2001). The Disability Rights Commission (2006) found that one in three people with LD are obese compared with one in five of the general population. As the learning disability population move from institutional care into community residences, nutrition is an increasingly important issue. Food is no longer prepared in kitchens by catering staff and clients are more dependent on support workers for the provision of their food. Several studies have examined nutritional education and the impact this has on service users although few have assessed the nutritional knowledge of learning disability support workers. The aim of this study was to assess the nutritional knowledge of learning disability support workers in the community setting. In this cross-sectional survey, managers of seven community homes within a locality of Manchester were approached and agreed for staff to participate in the study. In total 60 questionnaires were distributed. The questionnaire was adapted from a validated assessment tool (Pamenter and Wardle, 1999) with the addition of questions that assessed knowledge of the Eatwell plate, food groups and food labelling. Questionnaires were collected 2 weeks after distribution. All data were coded and analysed using SPSS 16 (SPSS Inc., Chicago, IL, USA). Descriptive statistics of incidence and % correct response were used to examine the data. Independent t-tests were used to compare differences between the answers of those who had received previous training and those who had not. Ethical approval was gained from Leeds Metropolitan University research ethics committee. The response rate was 42% ( n = 25) and of this group 44% ( n = 11) had received previous nutrition training. The questionnaire revealed a lack of nutritional knowledge, the most notable of which was knowledge of the Eatwell plate (8% were aware of the plate model and 4% correctly stated all food groups); food portion sizes (36% correctly stated the portion size of fruit, vegetables and dairy foods and 32% the portion size of meat); food labelling (28% correctly stating the saturated fat content regarded as 'high'). There was no statistical significant difference between the answers of those who had previous training and those who did not. Of respondents, 88% indicated that they would benefit from nutritional training and 48% did not feel confident with their current nutritional knowledge. Lack of nutritional knowledge of key workers within the care setting is of concern. Service users frequently rely on their support workers for menu planning and food provision. Coronary heart disease is the second most common cause of death in people with LD and lack of knowledge of fat recommendations is an important area of focus for the future. Support workers themselves welcomed further input and the apparent lack of difference in nutritional knowledge between those who have received previous training compared to those without, suggests that this should be ongoing. The nutritional knowledge of learning disability support workers in the community setting is poor and nutritional education programmes are now required to develop the nutritional knowledge of staff and evaluate their subsequent impact on clients with learning disability. Department of Health (2001) Valuing People: a New Strategy for Learning Disability for the 21st Century. London. The Stationary Office. Disability Rights Commission (2006) Equal Treatment: Closing the gap. Available from: <> [Accessed on 9 June 2010]. Pamenter, K. & Wardle, J. (1999) Development of a general nutrition knowledge questionnaire for adults. Eur. J. Clin. Nutr., 298-308. [ABSTRACT FROM AUTHOR]

The workplace has been identified as an environment in which primary prevention and secondary weight management strategies can be promoted (DH, 2008). Workplace weight management programmes have had limited success showing minimal weight loss, poor recruitment and high attrition rates (Stunkard et al., 1989). Team weight loss competitions have proved more promising although studies are predominantly American and have had methodological limitations (Cohen et al., 1987; Stunkard et al., 1989). The current investigation was a pilot study to determine if team based competition (without incentive) was more effective than traditional workplace education and behavioural programmes in achieving weight loss. Two established self-help diet groups were recruited from separate office workplaces within Lancashire. Each group attended a Healthy Lifestyle Workshop led by the lead researcher consisting of two components; a structured workshop incorporating an interactive presentation of a balanced diet, weight loss techniques, exercise and behaviour change and a worksheet on which participants identified personal goals and individual objectives. One office was randomly assigned to complete this on an individual basis (Group A), and the remaining office was assigned to a team based competition intervention (Group B), through random allocation into two teams, and encouraged to compete against each other to achieve the greatest collective team weight loss. No winning incentive was provided. The lead researcher recorded baseline age, weight and body mass index (BMI) and subsequent weight, BMI weekly for 3 weeks using the same set of calibrated scales. Independent t-tests were used to compare the final percentage weight loss between competing and non-competing groups and differences in weight and BMI at baseline and 3 weeks. Ethical approval was gained from Leeds Metropolitan University Research Ethics Committee. A total of 42 individuals participated in the study [Group A: n = 17 (seven male, 12 female); and Group B: n = 23 (5 male, 18 female)] There were no differences between groups for age [29(8) years (Group A) versus 31(9) years (Group B) P = 0.55], baseline weight [81(17.9) kg (Group A) versus 75.6(16.5) kg (Group B) P = 0.32] or BMI [27.9(6.7) kg m (Group A) versus 27.1(5.3) kg m (Group B) P = 0.69]. The competing group (Group B) achieved significantly greater percentage weight loss after 3 weeks than the group participating as individuals (Group A) [2.6 (2)% v 1.1(2.1)%, P = 0.025]. Over a 3-week period, a team based weight-loss competition was found to have a more beneficial effect on weight-loss than traditional work place interventions and, provides new evidence to suggest that unlike incentive based programmes (Schuessier L et al., 2007) this can be achieved through competition alone. Methodological limitations prevent an understanding of the dynamics of the competitive effect on weight loss, although it is likely that the competitive element improves motivation to succeed. Limitations of this pilot study include small sample size and a short time scale compared to recommendations for weight management programmes. However, this study provides valuable preliminary data in this area. Team weight loss competitions should be considered in addition to educational and behavioural functions when designing an effective workplace programme and require fuller evaluation through adequately sized controlled trial to fully evaluate their long-term effect. Cohen, R., Felix, M.R.J. & Stunkard, A.J. (1987) Comparison of Three Worksite Weight-Loss Competitions. J. Behav. Med. , 467-479. Department of Health (2008) Healthy Weight, Healthy Lives; A Cross Government Strategy for England. Available from: . [Accessed on 8 June 2010]. Schuessler, L., Beyer, J. & Mischler, E. (2007) Successful Weight Management in a Corporate Environment. Disease Management(Suppl. 1), 12-17. Stunkard, A.J., Cohen, R. & Felix, M.R.J. (1989) Weight Loss Competitions at the Worksite: How They Work and How Well. Prev. Med. , 460-474. [ABSTRACT FROM AUTHOR]

Thoracic ultrasound training has become part of the respiratory medicine curriculum. Data on training, access to teaching and achievement of competency in thoracic ultrasound by respiratory specialty trainees are scarce. Using the web-based kwiksurveys, we surveyed current respiratory specialty trainees (STs) in the UK. 177 responses were recorded. Nearly three-quarters of trainees had access to bedside ultrasound but only 15.3% had regular ultrasound training. Overall, 28.8% had achieved level 1 competency but only 44.4% of trainees at ST6 and above were level 1 competent. The majority of respiratory trainees have access to thoracic ultrasound but structured training is limited, with only a small proportion of trainees attaining level 1. More structured training and mentoring is needed to enable trainees to achieve the required competencies. [ABSTRACT FROM AUTHOR]