The BCW is a time consuming process, however, it provides a useful and comprehensive framework for intervention development and greater control over intervention replication and evaluation.

This model of service delivery is not effective in improving the outcome of asthma in the community. Further development is required if cost effective management of asthma is to be introduced.

The intervention is acceptable, practical and improves delivery of very brief advice on physical activity by nurses to cancer patients in the short-term. Both face-to-face and online delivery should be considered.

A great deal of the care of patients with asthma takes place in general practices. The aim of the present study was to describe the impact of asthma in the community and to identify current asthma self-management practices.A two-part questionnaire survey was conducted in a random sample (23%; n= 24,398) of persons aged 16-50 yrs, registered with one of the 41 general practices in Greenwich, London, UK. The two parts were: a screening questionnaire identifying persons with current asthma (defined as waking with shortness of breath in the last 12 months, attack of asthma in the last 12 months, or currently taking treatment for asthma); and an asthma questionnaire (completed by those with asthma) assessing quality of life, frequency of asthma symptoms, possession and use of self-management tools, and action in the event of an exacerbation of asthma. The crude response rate was 51%, but this may be an underestimate due to errors in the sampling frame.The prevalences of wheeze and asthma in the past 12 months were 26% and 14%, respectively. Among asthma patients: 43% reported symptoms occurring three or more times per week, and 20% were woken by asthma symptoms on three or more nights per week; most had asthma with a mild impact on quality of life; 26% used inhaled steroids on most days in the preceding month; 16% had a peak flow meter at home; and 7% had oral steroids available. Of the 44% of subjects with asthma, who could identify an exacerbation of asthma in the preceding 6 months: 19% had used a peak flow meter during the episode; 19% had changed their treatment without first being told to do so by a doctor; and 50% had sought urgent medical help. Smokers used less appropriate asthma management and subjects whose asthma had a severe impact on quality of life used more treatment and peak flow monitoring.In conclusion, the prevalence of asthma among adults in Greenwich, UK, has increased since a similar survey in 1986. Many people have fairly mild asthma and a smaller number have severe disease. Much remains to be done to promote appropriate strategies for self-management of asthma exacerbations.

Traditionally the continued professional development of healthcare professionals is completed through classroom based educational courses, workshops, and conferences. These can prove costly and time intensive. Online learning is becoming increasingly common, is easy to access, and can save learners time which is important in a healthcare system where job demands are high and study leave is limited. Well-designed internetbased learning has been shown to be as effective as traditional classroom based learning in the skill and knowledge development of healthcare professionals, 1 however the reach, adoption, and effectiveness of such training is largely underreported in the literature.This short communication reports on evaluation data from delivery of a 60 minute online training session to healthcare professionals, between January and November 2016.

ABSTRACr A randomised, double-blind trial of atropine, atropine plus papaveretum, and atropine plus diazepam given intramuscularly as premedication for fibreoptic bronchoscopy in 60 patients showed no difference between the three regimens as assessed by bronchoscopist or patient. Bronchoscopists frequently attributed a sedative action to atropine alone and their assessment of tolerance and sedation was more optimistic than that of the patients. In a second study comparing intravenous diazepam (10 mg) with saline, after prior intramuscular atropine (0.6 mg), both the bronchoscopists and the patients noted a significant sedative effect of diazepam, and coughing was reduced by diazepam.Premedication for fibreoptic bronchoscopy frequently consists of an intramuscular injection of an anticholinergic agent and an opiate or benzodiazepine 30-60 minutes before the procedure. The anticholinergic agent is necessary to prevent vasovagal phenomena,' reflex bronchoconstriction, and bradycardia. It also helps to decrease secretions in the pharynx and airways. Opiates are given both for their antitussive effect and for sedation and a combination of anticholinergic agent and opiate is often used as premedication before general anaesthesia.Because of dissatisfaction with this regimen we compared the effects of atropine alone and in combination with either diazepam or papaveretum in 60 consecutive patients undergoing fibreoptic bronchoscopy. Since the study showed that none of these three combinations was satisfactory, we went on to assess the use of diazepam given intravenously at the time of the bronchoscopy. < 50 kg, 15 mg 50-70 kg or > 65 years, 20 mg > 70 kg and < 65 years). All drugs were given intramuscularly 20-40 minutes before patients came to the bronchoscopy suite. Patients and bronchoscopists were unaware of the premedication given, the order being randomised and chosen from a set of sealed envelopes. Topical anaesthesia was used for the oropharynx, larynx, and airways in the usual manner.2 The nasal route was used when possible, and was always attempted first. Bronchoscopy was performed with the patient supine. The same two experienced bronchoscopists performed the procedures and the assessments in both studies and in all cases an assistant was present.Immediately after the bronchoscopy the bronchoscopist answered three questions on the sedative effect of the premedication, the extent of coughing, and the patient's tolerance. Two bronchoscopists were concerned in the assessment and each question had four possible answers (table 1). Between one and three hours after the bronchoscopy the patient completed questions on the sedative effect of the premedication and tolerance of the procedure (table 1). Patients were also asked for their opinion on the worst part of the procedure. Assessment of premedication in the first few hours after bronchoscopy has been shown to reflect accurately the subsequent attitude of the patients.3The three premedications were compared in pairs by the Kolomgorov-Smirnov two-sample test.4INTRA...

Introduction: This study explored changes in therapeutic radiographers' (TRs) self-reported knowledge and skills to engage in conversations about physical activity and diet with people living with and beyond cancer following completion of publicly available online courses. Methods: Participants were randomly assigned to two of five online courses that aim to support health professionals to engage in conversations about physical activity and diet in the oncology setting. Participants rated their agreement with 18 statements related to the COM-B (capability, opportunity and motivation-behaviour) model components following completion of an online course on healthy diet (n ¼ 16) and physical activity (n ¼ 21). Semi-structured telephone interviews (n ¼ 21) were also conducted. Analysis of the interviews was guided by the Theoretical Domains Framework. Results: Overall, the online courses were acceptable and the TRs in this study self-reported improved COM to deliver advice on physical activity and diet. The inclusion of the evidence and scientific rationale on the benefits of diet and physical activity, and also guidance on how to start conversations with patients were highlighted as important features of the courses. Suggestions for adaptations to the nutrition courses included the need for content that accounts for the side effects cancer patients experience while undergoing treatment. To support the implementation of training and the delivery of advice on these topics, multi-disciplinary working, organisational support and guidance around professional role boundaries were highlighted as important. Conclusion: Current publicly available online courses on physical activity and diet for oncology health professionals can reduce some barriers among TRs to providing advice to those living with and beyond cancer. Implications for practice: Existing online training courses could be used to support TRs to deliver physical activity and dietary advice in practice. Findings show that these courses can be disseminated within radiotherapy departments. The results also highlight a number of important considerations for the implementation of brief health behaviour advice and online training interventions on physical activity and diet within cancer care.

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