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People living with stroke and neurological conditions access rehabilitation at different times but self-management is often viewed as what happens post-discharge. Personalised models that integrate self-management support within everyday care are now advocated but this may require practitioners to change their behaviour to adopt and sustain new ways of working. The People1st project evaluated integration of an existing Supported Self-Management programme ("Bridges") across varied stroke and neurorehabilitation service contexts. Mixed-method evaluation of training for groups of healthcare practitioners across 24 UK National Health Service (NHS) Trusts, exploring how learning from Bridges was assimilated and enacted in practice, on an individual and collective basis. Staff growth in confidence and skill around supported self-management was demonstrated. Transformations to practice included changes to: the structure of, and language used in, patient interactions; induction/training processes to increase potential for sustainability; and sharing of successes. Bridges helped practitioners make changes that brought them closer to their professional ideals. Engaged leadership was considered important for successful integration. Bridges was successfully integrated within a wide range of stroke and neurorehabilitation service contexts, enabled by an approach in line with practitioners' values-based motivations. Further work is required to explore sustainability and impact on service users. Personalised models of care and support for self-management are advocated for people living with stroke and neurological conditions; this requires practitioners to be supported to change behaviour and practices to adopt and sustain new ways of working. Staff from a wide variety of backgrounds in neurorehabilitation and stroke can learn collaboratively about self-management practices via the Bridges programme and can integrate those practices into their service contexts. Bridges can take practitioners closer to their professional ideals of caring and making a difference and empowers them to initiate change. Organisational commitment and engaged leadership are required to facilitate a culture of support for self-management in practice. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence demonstrates that measures are needed to optimise therapy and improve administration of medicines in care homes for older people. The aim of this study is to determine the clinical and cost effectiveness of a novel model of multi-professional medication review. Methods A cluster randomised controlled trial design, involving thirty care homes. In line with current practice in medication reviews, recruitment and consent will be sought from general practitioners and care homes, rather than individual residents. Care homes will be segmented according to size and resident mix and allocated to the intervention arm (15 homes) or control arm (15 homes) sequentially using minimisation. Intervention homes will receive a multi-professional medication review at baseline and at 6 months, with follow-up at 12 months. Control homes will receive usual care (support they currently receive from the National Health Service), with data collection at baseline and 12 months. The novelty of the intervention is a review of medications by a multi-disciplinary team. Primary outcome measures are number of falls and potentially inappropriate prescribing. Secondary outcome measures include medication costs, health care resource use, hospitalisations and mortality. The null hypothesis proposes no difference in primary outcomes between intervention and control patients. The primary outcome variable (number of falls) will be analysed using a linear mixed model, with the intervention specified as a fixed effect and care homes included as a random effect. Analyses will be at the level of the care home. The economic evaluation will estimate the cost-effectiveness of the intervention compared to usual care from a National Health Service and personal social services perspective. The study is not measuring the impact of the intervention on professional working relationships, the medicines culture in care homes or the generic health-related quality of life of residents. Discussion This study will establish the effectiveness of a new model of multi-professional clinical medication reviews in care homes, using novel approaches to recruitment and consent. It is the first study to undertake an examination of direct patient outcomes, together with an economic analysis. Trial Registration ISRCTN: ISRCTN90761620

Food allergy is an increasing problem worldwide. Allergy to peanuts is a particular concern, given that this is rarely outgrown and may be associated with life-threatening anaphylaxis. However, it is unclear what factors are responsible for a perceived increase in prevalence rates. One matter on which scientists agree, however, is that exposure to peanuts early in life is significant - although whether early exposure protects or sensitizes to allergy is unclear. There is no significant research that currently records differences in early life exposure either within or between populations. This exploratory study makes a first step in this direction using focus groups conducted in four countries with disparate 'peanut experiences' to characterize early exposure in these. The ultimate aim is to help in the development of a survey instrument to attain nationally representative samples of consumers and hence to use the results from this to compare with allergy prevalence data collected in other parts of the European Union-funded ' EuroPrevall' project. The results in this study not only reveal considerable similarities across countries (e.g. in terms of lack of knowledge of guidelines; lack of changes in feeding behaviour during/after pregnancy, feelings that diet variety in children is important) but also one or two interesting and potentially important differences, such as increased consumption in Bulgarian (and some Spanish) breastfeeding mothers because of the ability of peanuts to facilitate lactation. Study limitations and future study intentions are also discussed. [ABSTRACT FROM AUTHOR]