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Supplementary Data: This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content. Data supplement 1 available at: https://bmjopenrespres.bmj.com/highwire/filestream/140550/field_highwire_adjunct_files/0/bmjresp-2022-001414supp001_data_supplement.pdf Copyright © 2022 Author(s) (or their employer(s)). Introduction: Breathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based singing exercises have been shown to improve quality of life for individuals with respiratory conditions and may also be beneficial for individuals living with BPD. No study has previously compared these participatory interventions in the treatment of people living with BPD. Methods and analysis: This is a study protocol for an assessor blinded 1:1 randomised controlled trial and qualitative interview study. Forty participants aged 18–40 years who score at least 19 on the Nijmegen Questionnaire (NQ) and do not have any underlying respiratory conditions will be recruited. Participants will be randomised to receive either physiotherapy-led or music therapy-led breathing exercises for 6 weeks. The primary outcome will be between-group difference in NQ post-intervention. Semistructured interviews with a purposive sample of participants will be performed. Qualitative data will be analysed using thematic analysis to better understand participants’ intervention and trial experiences. Ethics and dissemination: This study has received ethical approval by Brunel University London College of Health, Medicine and Life Science’s Research Ethics Committee (32483-MHR-Mar/2022-38624-3). The anonymised completed dataset will be made available as an open-access file via Brunel University London Figshare and the manuscript containing anonymised patient data will be published in an open-access journal. Trial registration number This trial is registered on the Open Science Framework Registry (https://osf.io/u3ncw). Brunel University London Internal grant scheme called BRIEF (award number: 12207107).

Dysfunctional breathing (DB) is common among people with and without primary respiratory pathology. While anxiety contributes to DB, the underpinning mechanism is unclear. One explanation is that anxiety induces excessive conscious monitoring of breathing, disrupting ‘automatic’ breathing mechanics. We validated a new tool that quantifies such breathing-related ‘hypervigilance’: the Breathing Vigilance Questionnaire (Breathe-VQ).Three-hundred-and-forty healthy adults (Mage=27.3 years, range: 18-71; 161 men) were recruited online. We developed an initial Breathe-VQ (11 items, 1-5 Likert scale) based on the Pain Vigilance and Awareness Scale, using feedback from the target population and clinicians. At baseline, participants completed the Breathe-VQ, Nijmegen Questionnaire (NQ), State-Trait Anxiety Inventory (form 2), and Movement-Specific Reinvestment Scale (assessing general conscious processing). Eighty-three people repeated the Breathe-VQ two weeks later.We removed five items based on item-level analysis. The resulting six-item Breathe-VQ questionnaire (score range: 6-30) has excellent internal (alpha=.892) and test-retest reliability (ICC=.810), a minimal detectable change of 6.5, and no floor/ceiling effects. Concurrent validity was evidenced by significant positive correlations with trait anxiety and conscious processing scores (r’s=.35-.46). Participants at high-risk of having DB (NQ>23; N=76) had significantly higher Breathe-VQ score (M=19.1±5.0) than low-risk peers (N=225; M=13.8±5.4;pp=.005), even when controlling for risk factors (e.g., trait anxiety).The Breathe-VQ is a valid and reliable tool to measure breathing vigilance. Breathing vigilance may contribute to DB, and could represent a therapeutic target. Further research is warranted to further test the Breathe-VQ’s prognostic value, and assess intervention effects.Key Findings– Dysfunctional breathing (DB) is highly prevalent in the general population as well as in people with respiratory conditions.– Anxiety is identified as a key factor contributing to DB, potentially because it induces conscious, anxious monitoring of breathing.– We developed a short self-reported outcome measure of such breathing-specific vigilance, the Breathe-VQ.– The Breathe-VQ was found to be a valid and reliable tool for use in the general population.– Breathe-VQ scores were positively associated with self-reported breathing problems, after correcting for known risk factors such as trait-anxiety.

Uropathogen resistance, fluoroquinolone-resistance (FQR), and extended spectrum beta-lactamase (ESBL), has been observed to be emerging worldwide with prevalences above recommended thresholds for routine empirical treatment. The primary aim of our study was to determine the prevalence of FQR from a geographically diverse sample of United States emergency departments (EDs).We conducted a multi-center, observational cohort study using a network of 15 geographically diverse US EDs. All patients ≥18 years of age with the primary or secondary diagnosis of urinary tract infection (UTI) in the ED identified using International Classification of Diseases (ICD-10) diagnosis code of cystitis, pyelonephritis, or UTI from 2018 to 2020 were included. We calculated descriptive statistics for uropathogens and susceptibilities. Logistic regression analysis was used to identify antimicrobial resistance risk factors associated with FQR Escherichia coli.Among 3779 patients who met inclusion criteria, median age was 62.9 years (interquartile range [IQR]: 41-77.6) and 76.3% were female. The most common diagnoses were complicated (41.2%) and uncomplicated cystitis (40.3%). E. coli was the most common pathogen (63.2%), followed by Klebsiella pneumoniae (13.2%) and Enterococcus species (5.8%). Across all sites, overall E. coli FQ-resistance prevalence was 22.1%, ranging from 10.5 to 29.7% by site. The prevalence of ESBL-producing uropathogen was 7.4%, ranging from 3.6% to 11.6% by site. Previous IV or oral antimicrobial use in the past 90-days and history of a multi-drug resistant pathogen were associated with FQ-resistant E. coli (odds ratio [OR] 2.68, 95% confidence interval [CI]: 2.04-3.51, and OR 6.93, 95% CI: 4.95-9.70, respectively). Of the patients who had FQ-resistant E. coli or an ESBL-producing uropathogen isolated, 116 (37.1%) and 61 (36.7%) did not have any documented risk factors for resistance.FQ-resistant E. coli is widely prevalent across US sites highlighting the need for ongoing monitoring of antimicrobial resistance and, at some locations, modification of empirical treatments.

Background The unprecedented increase in critically ill patients due to the COVID-19 pandemic mandated rapid training in critical care for redeployed staff to work safely in intensive care units (ICU). Methods The COVID-19 ICU Remote-Learning Course (CIRLC) is a remote delivery course developed in response to the pandemic. This was a one-day course focused on the fundamentals of Intensive Care. The course used blended learning with recorded lectures and interactive tutorials delivered by shielding and frontline ICU trained professionals. The course was developed within one week and piloted at three NHS Trusts. It was then made publicly available free of charge to redeployed healthcare professionals across the UK and Ireland. An iterative cycle of improvement was used to update the course content weekly. A course confidence questionnaire with quantitative and qualitative questions was used to evaluate effectiveness. Data is reported as n (%), means (SD) and thematic analysis was used for the open questions. Results 1,269 candidates from 171 organisations completed the course, with 99 volunteer trainers. 96% of respondents rated the course as very or extremely useful. 86% rated the online platform as excellent. Overall confidence improved from 2.7/5 to 3.9/5. Qualitative data showed that the course was pitched at the appropriate level, accessible and built clinicians confidence to work in intensive care. Conclusion This model of educational delivery with a rapid iteration cycle was a pragmatic, effective solution to knowledge-based training under social distancing measures. Whilst full course evaluation was not possible, we believe that this work demonstrates practical guidance on educational response in a pandemic as well as highlighting the altruistic nature of the critical care community.

Background Airway clearance techniques (ACTs) are integral to cystic fibrosis (CF) management. However, there is no consensus as to which outcome measures (OMs) are best for assessing ACT efficacy. Objectives: To summarise OMs that have been assessed for their clinimetric properties (including validity, feasibility, reliability & reproducibility) within the context of ACT research. MethodsEligibility Criteria - Any parallel or cross-over randomised controlled trial (RCT) investigating outcome measures for ACT in the CF population. Information sources: Five medical databases; clinicaltrials.gov; abstracts from international CF conferences. Risk of Bias - The authors planned to independently assess study quality and risk of bias using the COSMIN risk of bias checklist with external validity assessment based upon study details (participants and study intervention).Synthesis of Results – Two review authors (GS and MJ) independently screened search results against inclusion criteria, further data extraction was planned but not required.ResultsIncluded studies - No completed RCTs from the 187 studies identified met inclusion criteria for the primary or post-hoc secondary objective. Two ongoing trials were identified.DiscussionLimitations of evidence: The search strategy may have missed some lesser-known terms for ACT or manuscripts reporting clinimetric properties solely within text. Studies validating outcome measures for use in other aspects of CF, which may be relevant to ACT, are not included.Interpretation - High-quality RCTs are urgently needed to investigate & validate the clinimetric properties of OMs used to assess ACT efficacy. With the changing demographics of CF combined with the introduction of CFTR modulator therapies, an accurate assessment of the current benefit of ACT or the effect of ACT withdrawal is a high priority for clinical practice and future research and OMs which have been validated for this purpose are essential.OtherFunding: NIHR/HEE Clinical Doctoral Fellowship grant for GS (reference CDRF-2014-05-055).Systematic review registration number - PROSPERO no.CRD42020206033

Researchers from disciplines of education, health communication, law and risk management, medicine, nursing, and pharmacy examined communication tensions among interprofessional (IP) health care providers regarding medical error disclosure utilizing patient simulation. Using relational dialectics theory, we examined how communication tensions manifested in both individual-provided medical error disclosure and IP team-based disclosure. Two dialectical tensions that health care providers experienced in disclosure conversations were identified: (a) leadership and support, and (b) transparency and protectionism. Whereas these tensions were identified in an IP education setting using simulation, findings support the need for future research in clinical practice, which may inform best practices for various disclosure models. Identifying dialectical tensions in disclosure conversations may enable health communication experts to effectively engage health care providers, risk management, and patient care teams in terms of support and education related to communicating about medical errors.

IntroductionAirway clearance techniques (ACTs) are a gold standard of cystic fibrosis management; however, the majority of research evidence for their efficacy is of low standard; often attributed to the lack of sensitivity from outcome measures (OMs) used historically. This randomised controlled trial (RCT) investigates these standard OMs (sputum weight, forced expiratory volume in 1 s) and new OMs (electrical impedance tomography (EIT), multiple breath washout (MBW) and impulse oscillometry (IOS)) to determine the most useful measures of ACT.Methods and analysisThis is a single-centre RCT with crossover design. Participants perform MBW, IOS and spirometry, and then are randomised to either rest or supervised ACT lasting 30–60 min. MBW, IOS and spirometry are repeated immediately afterwards. EIT and sputum are collected during rest/ACT. On a separate day, the OMs are performed with the other intervention. Primary endpoint is difference in change in OMs before and after ACT/rest. Sample size was calculated with 80% power and significance of 5% for each OM (target n=64).Ethics and disseminationEthics approval was gained from the London–Chelsea Research Ethics Committee (reference 16/LO/0995, project ID 154635). Dissemination will involve scientific conference presentation and publication in a peer-reviewed journal.Trial registration numbersISRCTN11220163 and NCT02721498.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of interventions to enhance adherence to airway clearance treatment and exercise therapy in people with CF and their effects on health outcomes, such as pulmonary exacerbations, exercise capacity, health-related QoL and healthcare costs. This systematic review was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Cochrane Cystic Fibrosis and Genetic Disorders Group.

Introduction The best outcome measure (OM) for airway clearance (AC) in CF is unknown. Our National Institute for Health Research funded RCT compares standard OMs (sputum weight, FEV1) to new OMs (electronic impedance tomography (EIT), lung clearance index (LCI), impulse oscillometry (IOS)) to determine the most effective measure of AC. Here we describe our ongoing AC trial, present the challenges related to recruitment, baseline characteristics and OM reproducibility. Methods Subjects complete the OMs of LCI, IOS and FEV1 then are randomised to either supervised AC intervention or rest for 30 minutes. LCI, IOS and FEV1 are repeated straight afterwards. EIT, oxygen saturations and sputum are collected during the rest/AC period. At a subsequent visit the OMs are completed with the other intervention. Sequence allocation is blinded to the research team. Difference in change in the OMs pre- and post- AC/rest is the primary endpoint. Target sample is 96, the sample was calculated with 80% power and significance of 5% for each OM. Results Recruitment to date (after 19 months): 241 patients pre-screened, 12 await first visit, 6 enrolled, 31 completed (66% of target to date (TTD)). Completed subjects’ demographics: 19 male; median age 38yrs (IQR 19.5); 45% F508del/F508del; median FEV1 70%pred (IQR 29.5). Scheduled visits are at 155% of TTD, but completed visits are at 76% of TTD. The high cancellation rate is primarily caused by patient illness. Median visit length 205 minutes (IQR 47). LCI has the longest duration; ICCs of pre-intervention OMs are good between visits (table). Conclusion Completion of study visits is challenging, especially due to inclusion/exclusion criteria and requiring patient stability. Recruitment has improved recently with enhanced communication and strategic overbooking. The newer OMs of LCI, IOS and EIT are reproducible and feasible; however, the long duration of LCI may inhibit future use in this cohort. We believe this RCT is the first to evaluate these OMs for use in CF AC trials. The need to identify a more robust OM for AC effect remains paramount for future scientific research and for the application of personalized therapy not only for CF but for other supperative chest diseases.

Dysfunctional breathing (DB) is a respiratory condition characterized by irregular breathing patterns that occur either in the absence of concurrent diseases or secondary to cardiopulmonary diseases. Although the primary symptom is often dyspnea or “air hunger”, DB is also associated with nonrespiratory symptoms such as dizziness and palpitations. DB has been identified across all ages. Its prevalence among adults in primary care in the United Kingdom is approximately 9.5%. In addition, among individuals with asthma, a positive diagnosis of DB is found in a third of women and a fifth of men. Although DB has been investigated for decades, it remains poorly understood because of a paucity of high-quality clinical trials and validated outcome measures specific to this population. Accordingly, DB is often underdiagnosed or misdiagnosed, given the similarity of its associated symptoms (dyspnea, tachycardia, and dizziness) to those of other common cardiopulmonary diseases such as COPD and asthma. The high rates of misdiagnosis of DB suggest that health care professionals do not fully understand this condition and may therefore fail to provide patients with an appropriate treatment. Given the multifarious, psychophysiological nature of DB, a holistic, multidimensional assessment would seem the most appropriate way to enhance understanding and diagnostic accuracy. The present narrative review was developed as a means of summarizing the available evidence about DB, as well as improving understanding of the condition by researchers and practitioners. RESUMO A disfunção respiratória (DR) é um quadro respiratório caracterizado por padrões respiratórios irregulares que ocorrem na ausência de doenças concomitantes ou secundariamente a doenças cardiopulmonares. Embora o principal sintoma seja frequentemente dispneia ou “fome por ar”, a DR também está associada a sintomas não respiratórios, como vertigem e palpitações. A DR pode ser identificada em todas as idades. Sua prevalência entre adultos na atenção primária no Reino Unido é de aproximadamente 9,5%. Além disso, entre indivíduos com asma, um diagnóstico positivo de DR é encontrado em um terço das mulheres e um quinto dos homens. Embora a DR tenha sido investigada por décadas, ela permanece pouco compreendida devido a uma escassez de ensaios clínicos de alta qualidade e de variáveis de desfecho validadas especificamente para essa população. Assim, a DR é frequentemente subdiagnosticada ou diagnosticada incorretamente, devido à similaridade de seus sintomas associados (dispneia, taquicardia e vertigem) aos de outras doenças cardiopulmonares comuns, como DPOC e asma. As altas taxas de diagnóstico incorreto de DR sugerem que os profissionais de saúde não entendam completamente esse quadro e possam, portanto, não fornecer aos pacientes um tratamento adequado. Dada à natureza multifatorial e psicofisiológica da DR, uma avaliação holística e multidimensional parece ser a maneira mais apropriada de melhorar a compreensão e a precisão do diagnóstico. A presente revisão foi desenvolvida como um meio de resumir as evidências disponíveis sobre DB, bem como de melhorar a compreensão do quadro por pesquisadores e profissionais.

Aims: The treatment of prostate cancer has evolved markedly over the last 40 years, including radiotherapy, notably with escalated dose and targeting. However, the optimal treatment for localised disease has not been established in comparative randomised trials. The aim of this article is to describe the history ofprostate radiotherapy trials, including their quality assurance processes, and to compare these with the ProtecT trial.Materials and methods: The UK ProtecT randomised trial compares external beam conformal radiotherapy, surgery and active monitoring for clinically localized prostate cancer and will report on the primary outcome (disease-specific mortality) in 2016 following recruitment between 1999 and 2009. The embedded quality assurance programme consists of on-site machine dosimetry at the nine trial centres, a retrospective review of outlining and adherence to dose constraints based on the trial protocol in 54 participants (randomly selected, around 10% of the total randomised to radiotherapy, n ¼ 545). These quality assurance processes and results were compared with prostate radiotherapy trials of a comparable era.Results: There has been an increasingly sophisticated quality assurance programme in UK prostate radiotherapy trials over the last 15 years, reflecting dose escalation and treatment complexity. In ProtecT, machine dosimetry results were comparable between trial centres and with the UK RT01 trial. The outliningreview showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of theprostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints inProtecT was considered acceptable, with 80% of randomised participants having two or less deviations and planning target volume coverage was excellent.Conclusion: The ProtecT trial quality assurance results were satisfactory and comparable with trials of its era. Future trials should aim to standardise treatment protocols and quality assurance programmes where possible to reduce complexities for centres involved in multiple trials. 2016 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Objectives To describe the impact of a faculty development program on faculty's confidence and ability to facilitate interprofessional learning. Methods Faculty members from the Colleges of Pharmacy and Health Sciences (n = 12) participated in a training program for interprofessional education (IPE). Students evaluated faculty learners using the interprofessional facilitation skills (IPFS) survey by Sargeant, Hill, and Breau (2010). Faculty completed the IPFS survey pre and post intervention for self-assessment of interprofessional facilitation efficacy. Results Most faculty (78%) had limited prior IPE experience; 55% went on to facilitate the University's year-long interprofessional core curriculum. Faculty IPFS self-assessment scores improved following program completion ( p p Conclusions This program effectively prepared faculty to facilitate IPE and positively impacted their desire to participate in future activities.

The profession of pharmacy and standards directing the education of student pharmacists are constantly evolving. The profession continues to emphasize patient-centered practice as a model for the future. The US health care system is faced with an impending shortage of primary care providers, which will affect the ability of patients to access the health care system. The pharmacy profession should position itself to contribute to meeting this need. The explicit instruction of differential diagnosis within Doctor of Pharmacy degree programs is a critical consideration in advancing pharmacy practice and potential contributions to the primary care gap.

Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil

Background Dysfunctional breathing (DB) is an umbrella term used to describe an abnormal breathing pattern which can be psychologically or physiologically based. DB has been shown to be exacerbated at times of increased stress and to be related to anxiety disorders; both factors are common within a university setting, particularly around exam time. Personality types, specifically type A personality, share common risk factors with DB, suggesting a possible association. The prevalence of DB within a university population has not been previously investigated. Aims To investigate the prevalence of dysfunctional breathing within a university population and assess any association between DB and type A personality. Methods A cross sectional study was undertaken involving participants recruited at Brunel University. The primary outcome measure was the Nijmegen questionnaire (validated diagnostic tool for DB), and the secondary outcome measure was the breath hold test (BHT) (clinical diagnostic tool for DB). Additionally, the Behaviour Pattern Scale was used to classify participants as type A or type B personality. Results 40 participants completed the study. 17.5% (7/40) were positive for DB on the Nijmegen questionnaire (≥23/64). Positive scores only occurred in women; consistent with previous data on gender and DB. 7.5% (3/40) had a positive result using the BHT ( Conclusion Dysfunctional breathing may affect a significant percentage of people in a university population; and a significant association with type A personality type has been shown. Raising awareness of DB in the university population may lead to earlier diagnosis and timely referral to physiotherapy or counselling services as appropriate. A larger study is needed to further validate these findings.

Objective To determine which skills are essential for pharmacy students in the United States as reported by advanced pharmacy practice experience preceptors. Methods Pharmacy faculty developed a survey used to collect demographic and other information regarding essential skills for pharmacy graduates. Survey responses were evaluated qualitatively and reported quantitatively. Results Communication was identified as an essential skill for pharmacy graduates. Graduates should also be able to prepare sterile and nonsterile compounds, evaluate patient and prescription information as well as vital signs and laboratory values. Graduates should be able to independently identify and solve problems using critical thinking. Appropriate dress and personal hygiene and the ability and willingness to collaborate were also important. Conclusion Pharmacy graduates must be able to communicate. In addition, they should maintain a professional appearance and possess a wide variety of practical pharmacy skills.

Objectives An interprofessional group of health colleges' faculty created and piloted the Barriers to Error Disclosure Assessment tool as an instrument to measure barriers to medical error disclosure among health care providers. Methods A review of the literature guided the creation of items describing influences on the decision to disclose a medical error. Local and national experts in error disclosure used a modified Delphi process to gain consensus on the items included in the pilot. After receiving university institutional review board approval, researchers distributed the tool to a convenience sample of physicians (n = 19), pharmacists (n = 20), and nurses (n = 20) from an academic medical center. Means and SDs were used to describe the sample. Intraclass correlation coefficients were used to examine test-retest correspondence between the continuous items on the scale. Factor analysis with varimax rotation was used to determine factor loadings and examine internal consistency reliability. Cronbach α coefficients were calculated during initial and subsequent administrations to assess test-retest reliability. Results After omitting 2 items with intraclass correlation coefficient of less than 0.40, intraclass correlation coefficients ranged from 0.43 to 0.70, indicating fair to good test-retest correspondence between the continuous items on the final draft. Factor analysis revealed the following factors during the initial administration: confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers to medical error disclosure. α Coefficients of 0.85 to 0.93 at time 1 and 0.82 to 0.95 at time 2 supported test-retest reliability. Conclusions The final version of the 31-item tool can be used to measure perceptions about abilities for disclosing, impressions regarding institutional policies and climate, and specific barriers that inhibit disclosure by health care providers. Preliminary evidence supports the tool's validity and reliability for measuring disclosure variables.

Objective: Compare physical examination instruction and competency expectations between US pharmacy schools. Methods: Pharmacy Practice Department Chairs or their equivalents at all US pharmacy schools were surveyed regarding physical exam instruction and evaluation within their respective curricula. Opinions were also gathered regarding physical exam competency expectations and the need to formally evaluate this skill prior to graduation and for purposes of US licensure and federal healthcare provider recognition. The survey instrument was pretested prior to dissemination. Results: The survey response rate was 56%. Instructional and assessment methods used in teaching and evaluating physical exam skills were similar among responding US pharmacy programs. However, there is variability in the extent of physical exam instruction and evaluation as well as opinions related to physical exam competency expectations prior to graduation and for purposes of US pharmacy licensure and federal healthcare provider credentialing. Overall, 83% of programs require students to demonstrate correct exam techniques via a competency exam; however, only 52% of schools require students to apply physical findings to therapeutic decision-making. Respondents from new schools were more likely to support formal competency evaluation of physical exam skills via objective structured clinical exam for purposes of US licensure and healthcare provider credentialing compared to established schools (p o 0.05). Conclusion: Differences in competency expectations and the extent of physical exam instruction and evaluation in US pharmacy schools illustrate the need for a minimum national standard for this pharmacy practice skill.

This paper considers both the difficulties and the opportunities created by the mounting political pressures on UK universities to increase the ‘employability’ of undergraduate students. Using the subject of criminology as an example, the paper considers tensions that can be created when practitioners are brought into the academy to contribute directly in the curriculum. The paper advocates that whilst such difficulties cannot be underestimated, academic engagement in this agenda can be beneficial. Using a brief example it will be argued that creative use of practitioner discourses not only empowers students in their career planning but can be used to facilitate student understanding of the links between critical theory and practice. Consideration is also given to the argument that staying out of the debate risks the marginalisation of academic influence.

Forty faculty members from eight schools participated in a year-long National Faculty Development Program (NFDP) conducted in 2012-2013, aimed at developing faculty knowledge and skills for interprofessional education (IPE). The NFDP included two live conferences. Between conferences, faculty teams implemented self-selected IPE projects at their home institutions and participated in coaching and peer-support conference calls. This paper describes program outcomes. A mixed methods approach was adopted. Data were gathered through online surveys and semi-structured interviews. The study explored whether faculty were satisfied with the program, believed the program was effective in developing knowledge and skills in designing, implementing, and evaluating IPE, and planned to continue newly-implemented IPE and faculty development (FD). Peer support and networking were two of the greatest perceived benefits. Further, this multi-institutional program appears to have facilitated early organizational change by bringing greater contextual understanding to assumptions made at the local level that in turn could influence hidden curricula and networking. These findings may guide program planning for future FD to support IPE.

Current healthcare policy in the UK advocates that healthcare professionals should work as effective multidisciplinary team members. However, while the healthcare assistant (HCA) role is being extended, there is little evidence of it being formally recognised within the multidisciplinary team. Indeed most articles do not even refer to the role of the HCA in the context of the multidisciplinary team. Most HCAs have daily contact with patients and as such, have a good understanding of their health and social care needs. Therefore it is essential that they feel able to discuss and share information about the patient with other team members. The issue is whether HCAs are equipped with the appropriate skills? More over what are the current challenges in clinical practice and how can they be resolved.

Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB.Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n = 30) or breathing retraining plus MT (intervention; n = 30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed.At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p = 0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p = 0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (-1.1, 6.6) p = 0.162), or any secondary outcomes (Hospital AnxietyDepression Score, spirometry or exercise tolerance).Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.Dysfunctional breathing (DB) is associated with significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources. Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB. However, the results of this study suggest that MT provides no further benefit and cannot be recommended in the clinical management of this condition.

Dysfunctional breathing is described as chronic or recurrent changes in breathing pattern causing respiratory and non-respiratory symptoms. It is an umbrella term that encompasses hyperventilation syndrome and vocal cord dysfunction. Dysfunctional breathing affects 10% of the general population. Symptoms include dyspnoea, chest tightness, sighing and chest pain which arise secondary to alterations in respiratory pattern and rate. Little is known about dysfunctional breathing in children. Preliminary data suggest 5.3% or more of children with asthma have dysfunctional breathing and that, unlike in adults, it is associated with poorer asthma control. It is not known what proportion of the general paediatric population is affected. Breathing training is recommended as a first-line treatment for adults with dysfunctional breathing (with or without asthma) but no similar recommendations are available for the management of children. As such, breathing retraining is adapted from adult regimens based on the age and ability of the child.To determine whether breathing retraining in children with dysfunctional breathing has beneficial effects as measured by quality of life indices.To determine whether there are any adverse effects of breathing retraining in young people with dysfunctional breathing.We identified trials for consideration using both electronic and manual search strategies. We searched CENTRAL, MEDLINE and EMBASE. We searched the National Research Register (NRR) Archive, Health Services Research Projects in Progress (HSRProj), Current Controlled Trials register (incorporating the metaRegister of Controlled Trials and the International Standard Randomised Controlled Trial Number (ISRCTN) to identify research in progress and unpublished research. The latest search was undertaken in October 2013.We planned to include randomised, quasi-randomised or cluster-randomised controlled trials. We excluded observational studies, case studies and studies utilising a cross-over design. The cross-over design was considered inappropriate due to the purported long-lasting effects of breathing retraining. Children up to the age of 18 years with a clinical diagnosis of dysfunctional breathing were eligible for inclusion. We planned to include children with a primary diagnosis of asthma with the intention of undertaking a subgroup analysis. Children with symptoms secondary to cardiac or metabolic disease were excluded.We considered any type of breathing retraining exercise for inclusion in this review, such as breathing control, diaphragmatic breathing, yoga breathing, Buteyko breathing, biofeedback-guided breathing modification and yawn/sigh suppression. We considered programmes where exercises were either supervised (by parents or a health professional, or both) or unsupervised. We also considered relaxation techniques and acute episode management as long as it was clear that breathing exercises were a component of the intervention.Any intervention without breathing exercises or where breathing exercises were not key to the intervention were excluded.We planned that two authors (NJB and MJ) would extract data independently using a standardised form. Any discrepancies would be resolved by consensus. Where agreement could not be reached a third review author (MLE) would have considered the paper.We identified 264 potential trials and reviews from the search. Following removal of duplicates, we screened 224 papers based on title and abstract. We retrieved six full-text papers and further evaluated them but they did not meet the inclusion criteria. There were, therefore, no studies suitable for inclusion in this review.The results of this systematic review cannot inform clinical practice as no suitable trials were identified for inclusion. Therefore, it is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others. Given that breathing exercises are frequently used to treat dysfunctional breathing/hyperventilation syndrome, there is an urgent need for well-designed clinical trials in this area. Future trials should conform to the CONSORT statement for standards of reporting and use validated outcome measures. Trial reports should also ensure full disclosure of data for all important clinical outcomes.

Background Dysfunctional breathing is described as chronic or recurrent changes in breathing pattern causing respiratory and non-respiratory symptoms. It is an umbrella term that encompasses hyperventilation syndrome and vocal cord dysfunction. Dysfunctional breathing affects 10% of the general population. Symptoms include dyspnoea, chest tightness, sighing and chest pain which arise secondary to alterations in respiratory pattern and rate. Little is known about dysfunctional breathing in children. Preliminary data suggest 5.3% or more of children with asthma have dysfunctional breathing and that, unlike in adults, it is associated with poorer asthma control. It is not known what proportion of the general paediatric population is affected. Breathing training is recommended as a first-line treatment for adults with dysfunctional breathing (with or without asthma) but no similar recommendations are available for the management of children. As such, breathing retraining is adapted from adult regimens based on the age and ability of the child. Objectives To determine whether breathing retraining in children with dysfunctional breathing has beneficial effects as measured by quality of life indices.To determine whether there are any adverse effects of breathing retraining in young people with dysfunctional breathing. Search methods We identified trials for consideration using both electronic and manual search strategies. We searched CENTRAL, MEDLINE and EMBASE. We searched the National Research Register (NRR) Archive, Health Services Research Projects in Progress (HSRProj), Current Controlled Trials register (incorporating the metaRegister of Controlled Trials and the International Standard Randomised Controlled Trial Number (ISRCTN) to identify research in progress and unpublished research. The latest search was undertaken in October 2013. Selection criteria We planned to include randomised, quasi-randomised or cluster-randomised controlled trials. We excluded observational studies, case studies and studies utilising a cross-over design. The cross-over design was considered inappropriate due to the purported long-lasting effects of breathing retraining. Children up to the age of 18 years with a clinical diagnosis of dysfunctional breathing were eligible for inclusion. We planned to include children with a primary diagnosis of asthma with the intention of undertaking a subgroup analysis. Children with symptoms secondary to cardiac or metabolic disease were excluded.We considered any type of breathing retraining exercise for inclusion in this review, such as breathing control, diaphragmatic breathing, yoga breathing, Buteyko breathing, biofeedback-guided breathing modification and yawn/sigh suppression. We considered programmes where exercises were either supervised (by parents or a health professional, or both) or unsupervised. We also considered relaxation techniques and acute episode management as long as it was clear that breathing exercises were a component of the intervention.Any intervention without breathing exercises or where breathing exercises were not key to the intervention were excluded. Data collection and analysis We planned that two authors (NJB and MJ) would extract data independently using a standardised form. Any discrepancies would be resolved by consensus. Where agreement could not be reached a third review author (MLE) would have considered the paper. Main results We identified 264 potential trials and reviews from the search. Following removal of duplicates, we screened 224 papers based on title and abstract. We retrieved six full-text papers and further evaluated them but they did not meet the inclusion criteria. There were, therefore, no studies suitable for inclusion in this review. Authors' conclusions The results of this systematic review cannot inform clinical practice as no suitable trials were identified for inclusion. Therefore, it is currently unknown whether these interventions offer any added value in this patient group or whether specific types of breathing exercise demonstrate superiority over others. Given that breathing exercises are frequently used to treat dysfunctional breathing/hyperventilation syndrome, there is an urgent need for well-designed clinical trials in this area. Future trials should conform to the CONSORT statement for standards of reporting and use validated outcome measures. Trial reports should also ensure full disclosure of data for all important clinical outcomes.

This paper presents a critical reflection of the rhetoric of choice offered in the current system of HE. The theoretical foundation of the discussion draws on the work of Bauman (2007) as a support for a critical stance on the implementation of the recent reviews of HE, for instance by Browne (2010) and Dearing (1997). The concept and agenda of the student as ‘producer’, versus the student as consumer or even student as commodity, are further evaluated in the context of the ‘free’ market and the apparent 'industrialisation’ of HE, which has arguably brought graduate ‘employability’ to centre stage. The work goes on to discuss how student choice of course appears to go beyond judgments about potential job prospects. Along with this, it is argued that the values espoused by consumerism may well have a detrimental effect on the way that students develop the types of skills that employers say they want. Counteracting this, the student as producer is investigated as a means by which students become active producers of themselves as enterprising citizens, which also has benefit in respect of their future employability.

This is the post-print version of the final paper published in Physiotherapy. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V. Objectives - To explore the preparedness of final-year physiotherapy students for their progression into employment, and identify what universities can do to facilitate a smooth transition. Design - A single-cohort study, utilising a qualitative design incorporating a survey followed by transcribed and coded semi-structured interviews. Setting - Interviews were held in the Placement and Careers Centre at Brunel University, London. Participants - Sixty final-year full- and part-time students participated in the survey, and 12 final-year full- and part-time students participated in the semi-structured interviews. Methods - Sixty students completed a questionnaire which explored their preparedness for employment. Questions related to the current job situation, the application process and the student's ideal first post. Responses from the questionnaire were analysed and discussed further through a digitally recorded interview. Twelve students were interviewed by an experienced interviewer from a non-physiotherapy background. Results - Students felt unprepared for employment. Forty-seven per cent wanted a rotational post, but 26% would only spend 6 months and 39% would only spend 1 year looking for a job. Seventy-one percent would change career and 99% would work abroad if they were unable to secure a post in the UK. Most importantly, students could not identify transferable skills required by potential employers; only 25% cited effective communications, and 10% cited flexible working as a transferable skill. Self-management skills (e.g. prioritisation, time management and documentation) were not perceived as essential for employment. Conclusions - The job market requires physiotherapy graduates to possess transferable skills which can be applied to any situation. Many are integral to the profession and the undergraduate curriculum; however, analysis and assimilation of these skills cannot be assumed. Universities should reflect on their curriculum delivery to produce graduates who meet employers’ expectations and make a smooth transition into the workplace.

Question For patients at high risk of respiratory failure after extubation, does the early implementation of non-invasive positive pressure ventilation (NPPV) avert respiratory failure and reduce mortality? Design Randomised, controlled trial with concealed allocation. Setting Participants were recruited from two intensive care units. Patients Patients intubated for at least 48 hours who tolerated a spontaneous breathing trial were eligible if they had at least one of the following risk factors for postextubation respiratory failure: age over 65 years; cardiac failure as the cause of intubation; an Acute Physiology and Chronic Health Evaluation (APACHE)-II score greater than 12 on the day of extubation. Exclusion criteria were contraindications to NPPV and orders against resuscitation. Eight eligible patients refused to participate. The remaining 162 were randomised to intervention (n = 79) or control (n = 83) groups. Interventions Immediately after extubation, the intervention group received NPPV for 24 hours, followed by oxygen via a Venturi mask. The control group received oxygen via a Venturi mask after extubation. Both groups were otherwise managed according to the clinical protocols of each unit. Outcomes Respiratory failure in the first three days, mortality in the intensive care unit, and 90-day survival. Respiratory failure was defined as at least two of the following: respiratory acidosis; hypoxaemia at an inspired oxygen fraction of 0.5 or more; respiratory rate > 35/minute; decreased consciousness, agitation or diaphoresis; and respiratory muscle fatigue or increased work of breathing. A subgroup analysis was performed based on the presence of hypercapnia during the spontaneous breathing trial. Results Compared with the control group, respiratory failure was less frequent (Relative Risk 0.5, 95% confidence interval (CI) 0.3 to 0.9). This indicates that the number of patients that needed to be treated (NNT) with early NPPV to prevent one case of respiratory failure was 6 (95% CI 3 to 36). Mortality in the intensive care unit was significantly lower in the NPPV group, with the NNT to prevent one death being 8 (95% CI 5 to 30). In the subgroup analysis of those with hypercapnia during the spontaneous breathing trial, this benefit was greater (NNT 6, 95% CI 3 to 61). Survival to 90 days showed no significant difference between the NPPV and control groups overall. Among the subgroup with hypercapnia during the spontaneous breathing trial, however, the difference in survival was significant (NPPV 85% vs control 50%, p = 0.006). Conclusion NPPV for 24 hours post-extubation in patients at high risk of respiratory failure reduced the risk of early respiratory failure and mortality. [Relative Risk and NNT calculated by CAP Editor from data in paper.]

Giventhelonghistoryof our profession, it is startling that in 2013 we find our-selves still advocating for “recognition” as healthcareproviders, even within the confines of bureaucratic fed-eral processes. A corollary and perhaps more long andwindingroadhasbeenthebattleforpharmacistprescrip-tiveprivilegesacrosstheUnitedStates.