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A major feature of foundation degrees, which were introduced as a new development in February 2000, is the high proportion of work-based learning and the concept of 'earn and learn'. Concurrent with this development was the increasing acknowledgement of the need to provide more flexible education for the NHS workforce. A key feature of the development of foundation degrees was employer involvement in the design and delivery of the programmes, which provided an ideal opportunity to develop a health-care programme that met service needs. Bradford University was successful in obtaining funding to develop a foundation degree in health and social care as part of the pilot phase. One particular pathway of this programme was aimed at meeting the needs of rehabilitation assistants. This article describes how the course meets the demands of the modernization agenda and outlines the challenges faced and future developments. Developments are focussed on short course provision for rehabilitation assistants and a certificate in rehabilitation within the foundation degree framework. Additional support for the transition to learning in the University setting will be offered as part of this provision, to promote access to higher education for this valuable sector of the workforce. INSETS: KEY POINTS;COMMENTARIES. [ABSTRACT FROM AUTHOR]

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a reclarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. [ABSTRACT FROM AUTHOR]

Literature relating to the management of prolapsed lumber intervertebral discs was reviewed in order to assess the effectiveness of current medical care. Five aspects of care were addressed: the effectiveness of alternative forms of conservative treatment, the length of time necessary for a satisfactory trial of conservative management, the usefulness or otherwise of routine lumber spine X-rays, the type of investigation best suited to confirm the nature and level of the lesion in cases where surgical intervention is considered and the form of intervention that provides the best outcome for the patient. Plain lumber spine X-rays were found to be unnecessary as a routine investigation. All conservative treatment options were found to offer at most short-term benefit only and did not affect the long-term outcome. Computerized tomographic scans or magnetic responce imaging are most suitable for providing confirmation of the level of the lesion. Myelograms should not be used routinely. Minimally invaslve surgery appears to have the best outcomes and to be the most acceptable to the patient. [ABSTRACT FROM AUTHOR]

This paper reports on the perception of changing body image and well-being for patients who had undergone plastic surgery following massive weight loss. The exploratory, qualitative study was undertaken with 20 patients from one teaching hospital in the south of England. Semi-structured interviews were carried out and a thematic analysis of the data undertaken. The results provide important insights regarding body contouring influencing body image change and the adjustment process involved. The ability to pursue self-esteem and the accruing social benefits is emphasized in the interrelated sub themes including social acceptance, undoing depression and sexual vitality. Body contouring surgery following massive weight loss appears to facilitate improvement in body image and well-being. Adjustment to the changing body image is both empowering and challenging. Supportive educational programmes need to be developed to assist this transition to a more positive body image and appreciation; these could usefully include access to and involvement with patient support groups.

Objective: To assess the effectiveness of enhanced communication therapy in the first four months after stroke compared with an attention control (unstructured social contact)., Design: Externally randomised, pragmatic, parallel, superiority trial with blinded outcome assessment., Setting: Twelve UK hospital and community stroke services., Participants: 170 adults (mean age 70 years) randomised within two weeks of admission to hospital with stroke (December 2006 to January 2010) whom speech and language therapists deemed eligible, and 135 carers., Interventions: Enhanced, agreed best practice, communication therapy specific to aphasia or dysarthria, offered by speech and language therapists according to participants' needs for up to four months, with continuity from hospital to community. Comparison was with similarly resourced social contact (without communication therapy) from employed visitors., Outcome Measures: Primary outcome was blinded, functional communicative ability at six months on the Therapy Outcome Measure (TOM) activity subscale. Secondary outcomes (unblinded, six months): participants' perceptions on the Communication Outcomes After Stroke scale (COAST); carers' perceptions of participants from part of the Carer COAST; carers' wellbeing on Carers of Older People in Europe Index and quality of life items from Carer COAST; and serious adverse events., Results: Therapist and visitor contact both had good uptake from service users. An average 22 contacts (intervention or control) over 13 weeks were accepted by users. Impairment focused therapy was the approach most often used by the speech and language therapists. Visitors most often provided general conversation. In total, 81/85 of the intervention group and 72/85 of the control group completed the primary outcome measure. Both groups improved on the TOM activity subscale. The estimated six months group difference was not statistically significant, with 0.25 (95% CI -0.19 to 0.69) points in favour of therapy. Sensitivity analyses that adjusted for chance baseline imbalance further reduced this difference. Per protocol analyses rejected a possible dilution of treatment effect from controls declining their allocation and receiving usual care. There was no added benefit of therapy on secondary outcome measures, subgroup analyses (such as aphasia), or serious adverse events, although the latter were less common after intervention (odds ratio 0.42 (95% CI 0.16 to 1.1))., Conclusions: Communication therapy had no added benefit beyond that from everyday communication in the first four months after stroke. Future research should evaluate reorganised services that support functional communication practice early in the stroke pathway. This project was funded by the NIHR Health Technology Assessment programme (project No 02/11/04) and is published in full in Health Technology Assessment 2012;16(26):1-160., Trial Registration: ISRCTN78617680.