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Early diagnosis and intervention, and the use of targeted cancer treatments, have significantly reduced mortality from breast cancer. Emotional distress following a diagnosis of cancer is a normal and anticipated, but it may manifest in some individuals at some point as a level of anxiety or depression that significantly affects quality of life and coping. In extreme cases, these feelings can move from physical symptoms of low energy and an inability to complete basic tasks to despair and hopelessness. Confronting a cancer diagnosis is a life-changing experience, bringing a sense of vulnerability. This may create or precipitate a crisis that threatens to overwhelm a person, resulting in a negative impact on established coping mechanisms. There appears to be a paucity of literature on suicide or suicide attempts by people living with and beyond a cancer diagnosis. A literature search identified 19 papers on suicide and or suicide ideation in patients who had had a cancer diagnosis, which were included in the review. Two clear themes emerged from the literature: that a cancer diagnosis with or without pre-existing mental health comorbidities is a risk factor for suicide; and that there is a significant incidence and prevalence of anxiety and depression in cancer patient populations. The literature identifies multiple variables that impact on prevalence of mental health disorders after a breast cancer diagnosis. Despite this, there appears to be a lack of guidance at national level for screening for mental health comorbidities in patients with a cancer diagnosis.

It may be argued that altruism, or the selfless concern for others, was fundamental to the discipline of nursing; however, with the evolution of nursing, there has been debate within the profession and among service users about whether this element has been lost. Nurses deal with increasingly complex and stressful situations, both patient and performance related. Additionally, demands on the service and capacity constraints continue to place a significant burden on nurses and other health professionals. There are concerns that the cost of caring has had an impact at a personal and performance level within the nursing profession, highlighted particularly by the negative experiences described by NHS service users in the Francis report. Debate continues about the definition of ‘compassionate care’ and how we measure its delivery. Resolving these concerns is a high priority for recruitment and retention strategies within both the NHS and private sector healthcare organisations.

Background: empirical evidence suggests that anxiety and depression in cancer patients is underdiagnosed and subsequently this patient population receives little or no support or intervention to address their psychosocial needs. It is often difficult to distinguish between normal emotional distress experienced following a cancer diagnosis and anxiety and depression, which can have a significant impact on coping mechanisms and subsequent outcomes. Aim: a qualitative study using the Hospital Anxiety and Depression Scale (HADS) was undertaken in the National Centre for Cancer Care and Research in Qatar. The driver for change was to provide evidence of the need for an assessment to be incorporated into the nursing admission process as a means of early detection and onward referral for more formal interventions if required. The sample size was 57. Findings: the evidence from the outcome data supported the hypothesis that anxiety and depression were present in a significant number of the sample group. This would support the proposal of early screening and onward referral. A number of patients surveyed expressed moderate to severe depression, which may impact negatively on outcomes. Conclusion: screening for anxiety and depression in adult cancer patients should form part of an early nursing assessment to identify those who may benefit from more structured interventions. HADS is a useful screening tool; however, further research is required on validating tools used to screen for anxiety and depression in cancer and chronic disease in different cultures to ensure validity and reliability of outcome data.

In the current economic climate within the NHS, behavioural-change interventions in chronic disease such as exercise programmes will be time-limited within acute hospital facilities. The challenge is to deliver cost-effective, participatory, population-specific health interventions that result in measurable benefits. Methodology: A mixed-methods study was undertaken to assess the benefits of participation in a structured exercise programme for patients with heart failure. Primary outcomes were improvements in functional capacity and quality of life. Secondary outcome measures related to patient satisfaction and sustainability of the intervention post study. Results: Overall significant improvements were not found in quality of life or functional capacity; some participants demonstrated significant improvements with others showing minor improvement or no improvement in one or both domains. Conclusions: Anecdotal evidence of perceived benefit was expressed in participant satisfaction responses. Secondary outcomes were met in relation to sustainability with commissioning of hospital- and community-based programmes on completion of the study.

Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in environments. Methods: A cross center mixed methodology study looking at back pain in nurses working in critical care environments data collection included demographic, occupational, and health characteristics and a Likert questionnaire. This comprised of 10 questions relating to manual handling education, equipment, staffing levels and ergonomics and was distributed in critical care and emergency departments across five hospital sites responses rate n = 450. Results: Outcome data identified 65% of the respondents reported experiencing back pain over the last year with subsequent negative impact on quality of life. There was statically significant association between gender and quality of life p = 0.001; with more women verbalizing a negative impact on quality of life secondary to back pain. There were also statically significant relationships between age with younger age group reporting negative impact on quality of life p = 0.001 and length of time employed in HMC with respondents who have been employed between 1–5 years experiencing the greatest impact p = 0.001. Conclusions: Back pain is an under reported occupational health concern that impacts on productivity and quality of life. Mandatory training in manual handling should feature in corporate educational agenda. Occupational health initiatives' are essential in the management of chronic health conditions.

A combination of quantitative and qualitative research was used to determine the effectiveness of a cardiac rehabilitation (CR) programme in a cohort of patients referred to the service at a London hospital. Quantitative data analysis provided evidence of effectiveness of participation in CR in reduced hospital readmission rates and use of recognised pharmacological management strategies. Self-reported physical activity levels and quality of life (QOL) in individuals who participated in the cardiac rehabilitation programme were qualitatively measured with questionnaires. Results provided evidence of benefit in continued participation in exercise. However, there was no evidence of benefit to QOL status post participation at 1 year. A p-value of 0.001 provided significant statistical evidence supporting the hypothesis of benefit in continued participation in exercise in participants following attendance at a cardiac rehabilitation programme. QOL status; a statistically significant p-value of 0.001 rejected the hypothesis (H1) of benefit. This would imply that participation CR programmes does not appear to provide sustained benefits in QOL. A number of moderating variables were suggested as explaining the finding such as homogeneity of respondents, age, mood bias and the timeframe of 1 year between participation in rehabilitation and self-reporting. CR appears to be an effective but time-limited intervention in relation to improvements in QOL. Collaborative working partnerships between specialist interventions, such as CR with chronic disease management strategies may provide greater sustainability of benefits gained from participation in cardiac rehabilitation programmes.

Fiona Milligan discusses some of the interventions that have been implemented in a bid to curb the UK's rising obesity levels

This article describes a self-reflective exercise on how non-medical prescribers consult, and if patients are satisfied. This was carried out as part of continuing professional development by non-medical prescribers using informal audit and patient satisfaction tools to assess their prescribing practice and potential benefits of non-medical prescribing to patient care. The exercise found that non-medical prescribers provide appropriate and pertinent information relating to medications, and that if no prescription is issued, the prescriber offers information on why a prescription is not needed. It also found that non-medical prescribers prescribe appropriately and safely, therefore meeting consultation and prescribing guidance provided by the Nursing and Midwifery Countil (NMC). It also found that there is a high level of patient satisfaction with non-medical prescribing, and with the information provided to patients during the consultation. The author concludes that with the evolving role of the autonomous practitioner, non-medical prescribing contributes to the provision of a holistic and seamless care pathway.

Fiona Milligan discusses how barriers to healthy eating and exercise are being tackled in Qatar with consideration for cultural and belief system influences

This is a two-part unit on childhood obesity. Part 1 explored its prevalence and various causes. This second part examines the effectiveness of current interventions to halt childhood obesity.

This is a two-part unit on childhood obesity, which is a major public health concern. With rising levels of the condition it is increasingly obvious that early intervention is key to halting this trend. This first part outlines the prevalence and definition of obesity, and also explores its causes and possible interventions.

Government initiatives such as The NHS Plan and the National Service Framework for Coronary Heart Disease have set standards and guidelines for the provision of cardiac care, with the aim of ensuring equitable access to quality care across the country. One requirement is for groups of patients with cardiac disease to be offered access to cardiac rehabilitation programmes. An evaluation of one such service found gaps in service provision, and steps were taken to address these gaps. In many cases, further resources will be required for services to achieve their targets.

Commentary on: M Wake, LA Baur, B Gerner, et al.. Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial. BMJ2009;339:b3308.