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Self-management is becoming an important part of treatment for patients with chronic obstructive pulmonary disease (COPD). We conducted a longitudinal survey of patients with COPD who attended a 7-week group-based lay and clinician co-delivered COPD self-management programme (SMP)to see whether they became more activated, enjoyed better health status, and quality of life, were less psychologically distressed and improved their self-management abilities. The main analysis was a per-protocol analysis (N = 131), which included only patients who attended ≥5 SMP sessions and who returned a 6-month follow-up questionnaires. Changes in the mean values of the patient outcomes were compared over time using paired t tests and general linear model for repeated measures. Patient activation significantly improved 6 months after the SMP (p < 0.001). There were also significant improvements in COPD mastery (p = 0.001) and significant improvements in a range of self-management abilities (self-monitoring and insight p = 0.03), constructive attitude shift (p = 0.04), skills and technique acquisition, (p < 0.001)). This study showed that a lay and clinician-led SMP for patients with COPD has the potential to produce improvements in important outcomes such as activation, mastery and self-management abilities.

Objective: To appraise critically the relevance and value of the evidence base to promote and support the duration of breast-feeding, with a specific focus on disadvantaged groups. Design: A systematic review was conducted of intervention studies relevant to enhancing the duration of breast-feeding; topics included public health, public policy, clinical issues, and education, training and practice change. A systematic search was conducted. Eighty studies met the inclusion criteria. Data were systematically extracted and analysed. Full results and recommendations are reported elsewhere. Here a critique of the evidence base -topics, quality and gaps -is reported.Results: Many studies were substantially methodologically flawed, with problems including small sample sizes, inconsistent definitions of breast-feeding and lack of appropriate outcomes. Few were based on relevant theory. Only a small number of included studies (10%) were conducted in the UK. Very few targeted disadvantaged subgroups of women. No studies of policy initiatives or of community interventions were identified. There were virtually no robust studies of interventions to prevent and treat common clinical problems, or of strategies related to women's health issues. Studies of health professional education and practice change were limited. Costeffectiveness studies were rare. Conclusions: Policy goals both in the UK and internationally support exclusive breastfeeding until 6 months of age. The evidence base to enable women to continue to breast-feed needs to be strengthened to include robust evaluations of policies and practices related to breast-feeding; a step change is needed in the quality and quantity of research funded.

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