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Introduction All doctors in training should be exposed to appropriate leadership developmental opportunities throughout their training in line with the GMC Generic Professional Capabilities framework. Leadership learning is a process of participation in increasingly complex and personally informative tasks rather than just acquisition of a pre-determined set of knowledge and skills. As part of the 70:20:10 model of leadership development we need to move learning from the classroom into the workplace providing leadership initiatives and development at every level of training. Intervention Health Education England South West developed a Clinical Leadership Mentor (CLM) programme in 2018. The CLM is responsible for overseeing the process and progress of leadership development amongst the trainees of their Trust, creating a portfolio of leadership and management development in partnership with other stakeholders. Strategy for Improvement CLMs required funding, support, development, and network opportunities. Financial support for 2 year pilot across all 19 Trusts in the South West supported by Regional Director HEE-SW with annual report by each CLM; achievements aligned against measured outcomes of key responsibilities. CLM network and developmental days with regional NHS Leadership Academy (NHSLA). Annual reports collated and shared within CLM network and HEE-SW. Sponsored evaluation of CLM by the NHSLA conducted by the University of Birmingham (UoB) Impact Formal evaluation (UoB) was encouraging; CLM role perceptions were positive and appreciated by trainees and Educational Supervisors alike. Medical Managers were also committed to the role. Excellent CLM network developed across HEE-SW. Outstanding achievements in the annual reports enabled funding secured for third year. CLM development publicised as an area of Good Practice - Leads Leadership Webinar #Leadersaloud.

Most evaluation studies of continuing education (CE) programs have concentrated on the assessment of learner knowledge and satisfaction and/or learner perceptions of change in professional competence and patient care, rather than on actual changes in nursing practice and patient outcomes. This study aimed to measure and compare frequency of nursing interventions and patient outcomes before and after a high-dependency (HD) CE program. A retrospective review of all HD patient records (n = 92) over the same 2-month periods in 1994 (n = 39) and 1995 (n = 53) was undertaken. Outcome variables were measured by assessing the incidence of cardiorespiratory complications, HD patient admission rates to critical care areas and process measures of nursing interventions with predetermined practice patterns. The before and after groups of patients were similar in age (mean 69 years), severity of illness (mean APACHE II = .12) and HD length of stay (mean 2.6 days). While the average number of critical events per patient was similar in both groups (before 2.03; after 1.96), complications resulting from critical events were 8 per cent fewer in the after group. The implementation and documentation of appropriate nursing interventions improved by 30 per cent following the introduction of the CE program (chi 2 = 25.53, df = 1, p < 0.001, 95 per cent CI 0.1804 to 0.4196, point estimate 0.3). The study revealed that there was a strong association between implementing the HD CE program and improved nursing practice. This may be related to the observed improvement in patient outcomes.

Soft drink and fast food are energy dense foodstuffs that are heavily marketed to adolescents, and are likely to be important in terms of risk of obesity. This study sought to examine the influences on soft drink and fast food consumption among adolescents as part of a cross-sectional survey of 2,719 adolescents (aged 11-16) from 93 randomly selected schools in New South Wales, Australia. Students provided information on soft drink and fast food consumption, and responded to statements examining influences over consumption. Over half of the boys and more than one third of the girls reported drinking soft drink daily, and consumption peaked in Grade 8 students. A quarter of students reported choosing soft drinks instead of water or milk, and around 40% agreed that soft drink was usually available in their homes. Availability in the home and drinking soft drinks with meals was most strongly associated with consumption in all age groups. Fast food consumption was higher among boys than girls in all age groups. Convenience and value for money yielded the strongest associations with fast food consumption in boys, while preferring fast food to meals at home and preferring to "upsize" meals were most strongly associated with consumption in girls. Interventions to reduce consumption of soft drinks should target availability in both the home and school environment by removing soft drinks and replacing them with more nutritive beverages. Fast food outlets should be encouraged to provide a greater range of healthy and competitively priced options in reasonable portions.

A case history of abdominal swelling of psychological origin is described. The clinical presentation and psychogenic pathogenesis of the disorder provide a differentiation from pseudocyesis. The psychodynamics of this case are discussed emphasizing the conflict involving strong elements of pre-oedipal aggressivity towards the father image.