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This chapter has been co-written by a parent, a family support worker and an academic. Playfulness in children with profound and multiple learning disabilities (PMLD) is discussed from various viewpoints. It is asserted that playfulness is an essential part of all childhoods and that children with PMLD express this in many different and sometimes subtle ways. The support they need to access their playfulness has to take into account the various competing demands that are placed upon families. By encouraging playfulness, we are also supporting children with PMLD to show strengths that are often not acknowledged elsewhere.

Schools in England have a statutory duty to contribute to the spiritual, moral, social and cultural (SMSC) development of children. This paper reviews its historical background before considering the judgements of Office for Standards in Education (Ofsted) inspections undertaken in the three academic years 2008–2011 of this aspect of the responsibilities in both primary and secondary schools. There are variations in the inspectors’ assessment of pupils’ spiritual, moral and cultural development across different school sectors and phases. The proportion of Catholic schools judged to be outstanding or good in this aspect of pupils’ learning is noticeably higher compared to that of ‘other’ schools in both primary and secondary phases. Secondary schools are judged as more effective than primary schools in both sectors. While this paper does not attempt an exhaustive analysis of the nature of SMSC development or critique its understanding by Ofsted, it does review the ways in which Ofsted inspectors come to th...

The drive toward evidence-based healthcare aims to promote effectiveness and thereby improve quality. The challenge for cancer nursing is to continually evaluate what it does, retaining effective interventions and working to develop new ones and refine those interventions that require improvement, thereby enhancing both practice and patient outcomes. The aim of the project was to assimilate an evidence base to support the development, delivery, and evaluation of cancer nursing services in the United Kingdom. It was believed that determining the extent of the current United Kingdom evidence base through a review of the literature and current and recent research endeavors would allow for comparison with current priorities and facilitate informed strategic planning regarding the process of research commissioning. A rigorous, explicit, and thorough literature review was undertaken of all United Kingdom literature pertaining to cancer nursing and related issues published between 1980 and 2000. Fourteen individual databases were searched using specific keywords, thesaurus terms, and additional search terms. Data were extracted from each individual publication and stored in a purpose-designed database. Current and recent United Kingdom cancer nursing research projects were identified through a mailed survey questionnaire sent to people and organizations involved in cancer-related research. Research projects were categorized according to Royal College of Nursing research priority themes: Care and Caring Practices, Healthcare Environment, Organization and Management of Care, and Healthcare Workforce. Four-hundred forty-six pieces of literature were considered appropriate for inclusion in the review. Two-hundred sixty-four pieces of evidence were included in the Care and Caring Practices theme, which also had the greatest number of current and recent research projects (48%, n = 50). The Healthcare Environment theme included 80 pieces of evidence but only 3% (n = 3) of the current and recent research projects. Thirty-two percent (n = 33) of the current/recent research projects fell into the third theme of Organization and Management of Care, which contained a total of 104 pieces of evidence. The final theme, Healthcare Workforce, included 17% (n = 18) of the current and recent research projects, and the literature review incorporated 49 pieces of evidence in this theme. A number of recommendations have been drawn, which focus on methodological challenges, research considerations, and gaps in the evidence base. The drive toward evidence-based practice is essential for cancer nurses to establish who they are, what they do, and what effect they have on patient outcomes. Currently, although the United Kingdom evidence base for practice is vast, it frequently lacks depth. Although evaluating national evidence for practice is valuable, a more global approach to evidence synthesis is required. Through such endeavors, cancer nurses should realize their potential, support the strategic development of cancer nursing research, and so generate an evidence base that supports their unique contribution to patient outcomes.

STUDY DESIGN: A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months. OBJECTIVES: To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group. SUMMARY OF BACKGROUND DATA: Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache. METHODS: In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture. RESULTS: There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P < 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant. CONCLUSION: Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained.

The reorganization of cancer services in recent years has presented cancer nursing with a range of organisational and developmental challenges. It is therefore encouraging to note that the specialty has evolved to the extent that an efficient and effective cancer nursing workforce is now acknowledged as a prerequisite for the provision of high-quality cancer care (Department of Health, 1995; 2000a; 2000b). However, despite the advances there has been little evaluation of the critical issues faced by specialist cancer nurses. This project was undertaken as part of a larger scoping exercise designed to assimilate an evidence base to support the development, delivery and evaluation of UK cancer nursing services. This element of the project aimed to provide information to support the development and organisation of cancer nursing services by focusing on specific aspects of care (DoH, 2000a). The results indicate that lead cancer nurses are striving to ensure that patients are provided with the best quality care through nurses' participation in collaborative endeavours, for example with the primary care and the voluntary sectors. There is still much to be achieved, primarily in the areas of workforce planning, the skill development of non-specialist nurses, and research and development. The evidence demonstrates that cancer nursing will continue to accept the challenges of changing practice, working to ensure that patients receive a high-quality service.

The rate of evolution of cancer nursing in the UK has been remarkable over the past 20 years. Legislative changes and reform have provided the impetus for a range of developments in practice, research and education, and the push to achieve evidence-based practice has also driven the profession. There is a collective aspiration that all patients with cancer should expect to be supported by a cancer nursing service that is skilled, caring and competent. Demonstrating the value of nursing in terms of its effects on patients has never been so important. This project, commissioned by the Department of Health, was designed as a scoping exercise to assess the current state of the evidence base to support the development, delivery and evaluation of cancer nursing services in the United Kingdom. Three distinct elements were implemented concurrently to achieve this. The first was a review of UK literature centred around aspects of developing, delivering and evaluating cancer nursing and cancer nurses. The second was the development of a research directory profiling recently completed, currently under way and planned UK research concerned with cancer nursing and cancer nurses. The final element was a review of the organisation of cancer nursing services in England. This paper will report on the first two elements. The results of the third element will be published separately.

This study evaluates the ability of thermography to i) detect temperature changes in a lactating breast in response to the application of therapeutic ultrasound; ii) identify an area of raised temperature in a breast affected by mastitis; and iii) detect temperature changes in the affected area in response to the application of ultrasound. An area of raised temperature (38 degrees C), corresponding with the area of inflammation, was identified in a mastitic breast. Eighty-seveen per cent of this area had returned to normal resting breast temperature (33 degrees C) within 30 minutes of application of pulsed ultrasound. The use of thermography to evaluate temperature changes in mastitic breast tissue before and after the application of ultrasound is supported.

BACKGROUND: Revalidation will be introduced for pharmacy professionals in Great Britain. However, what pharmacists and technicians understand about it as a process remains unexplored. OBJECTIVES: This study aimed to explore the views of pharmacists and technicians about the revalidation of fitness to practice. Views were gathered on the sources of evidence that could be used, assessment methods, who should undertake the assessment, and how often it should occur. METHODS: A multiple methods study was conducted with community and hospital pharmacists and technicians. It included 6 focus groups, 14 one-to-one interviews, and a postal survey sent in March 2009 to a 10% randomly selected sample of 4640 practising pharmacists and 738 technicians working in England, Scotland, and Wales. RESULTS: Twenty-nine pharmacists and 16 technicians participated in the focus groups and interviews; 1206 (26.4%) pharmacists and 240 (32.8%) technicians returned a completed questionnaire. A large majority of both pharmacists (86%) and technicians (81%) were in favor of continuing professional development (CPD) records being used as evidence to inform revalidation, but only a small proportion of both groups agreed that patient feedback should be used. Evidence from appraisals and peers/colleagues was also well supported. Technicians were significantly more likely than pharmacists to indicate that their assessment for revalidation should be undertaken by their main employer. Although most technicians (49%) believed that revalidation should take place every 2-3 years, most pharmacists (58%) believed that it should occur only every 5 years. CONCLUSIONS: Pharmacists and technicians do not share the same views on all aspects of revalidation, suggesting that 1 single model may not be desirable or practicable. Both groups identified CPD, appraisal, and feedback from peers as possible components of revalidation, but concerns about impartiality and independence of assessors were raised.

This article describes an NTResearch survey which outlines how UK cancer nursing services have evolved over the past seven years in response to changes in government policy.

The presence of painful upper cervical joint dysfunction is a diagnostic criterion for cervicogenic headache. This preliminary study investigated whether independent examiners for a planned multicentre study of treatment of cervicogenic headache sufferers would agree on the presence or not of joint dysfunction for inclusion/exclusion of subjects into the trial. Ten subjects with or without neck pain and headache were recruited in each of four centres (total 40 subjects). Examiners manually assessed subjects' upper cervical regions in a single blind manner. There was excellent to complete agreement between each pair of examiners on which subjects should be allowed to enter the study and 70 per cent agreement between examiners on the two most dysfunctional joints in symptomatic subjects. There can be confidence that an homogenous headache group will enter the planned trial.