Immunisation decision making is not a straightforward process for parents. Many factors influence parental decision making on whether they immunise their child with the measles, mumps and rubella (MMR) vaccine. The feasibility study described in this article provides insight into influencing factors associated with decisions regarding the immunisation of children by parents. The study findings suggest that the practice nurse is a credible source of information for parents seeking informed decision making. At a time when the incidence of measles and mumps is rising in the UK, the provision of appropriate information by the practice nurse has the potential to increase uptake of the MMR vaccine.

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Aim: The aim of this study was to explore which aspects of their role practice nurses perceive to be most influential and the strategies they employ to promote the MMR vaccine. Design: Qualitative study employing in depth interviews. Method: Fifteen London based practice nurses, nine in 2014 and six in 2018, took part in semi-structured interviews that were audio recorded and transcribed verbatim. Qualitative content analysis was used to systematically manage, analyse, and identify themes. Results: Analysis of data identified aspects of their role practice nurses perceived to be most influential (the themes) including: promoting vaccination, assisting parents' to make informed decisions, and provided insight into how they used specific strategies to achieve these in practice. These themes were consistent over both phases of the study. Conclusion: The findings provide an understanding of: (i) the practice nurses perceptions of the most important aspects of their role when promoting the measles, mumps, and rubella vaccine; and (ii) the strategies they implemented in practice to achieve these. The latter included assisting parents in their immunization decisions and was facilitated by practice nurses engaging with parents to provide relevant evidence to address parent queries, dispel misconceptions and tailor strategies to promote the measles, mumps, and rubella vaccine. Impact: This study addresses the paucity of literature available that specifically explores practice nurses' perceptions of their role concerning the measles, mumps, and rubella vaccine. The findings reveal how practice nurses promote the measles, mumps, and rubella vaccine by identifying strategies to enable parents to make informed decisions. At a time of an increasing incidence of measles, practice nurses have an important public health role in achieving herd immunity levels for measles, mumps, and rubella.

Several gaps were identified among leaders in plastic surgery including predominance of male sex, limitations in formal leadership training and requisite skill set, as well as compensation and human resources management (emotional intelligence). Leadership and managerial skills are key core competencies, not only for trainees, but certainly for those in a position of leadership. The present study provides evidence that academic departments, universities and medical centres may benefit by re-evaluating how they train, promote and support their leaders in plastic surgery.

Immunization training and annual updates are essential for practice nurses to keep abreast with the evidence base underpinning national immunization programmes.

Alison Bell, Carol Cox and Marie Hill consider physical inactivity as a risk factor of coronary heart disease (CHD) and discuss how individualized care plans can encourage self-management

A competent manager is an individual who produces predictability and order through planning and organization, whereas an effective leader is someone who stimulates change through motivation and alignment of people through inspiring a new direction and purpose (1). Academic medical centres have evolved immensely over the past generation (2). While the traditional pillars of academic medicine rested on excellence in clinical care, research and teaching, in the current paradigm, over and above this foundation, the success of academic departments and medical centres hinge on quality, outcomes and fiscal prudence for which effective leadership and management skills are paramount. This point is especially germane in the setting of the fiscal 'crunch' that medicine also must be accountable for because health care in the United States currently accounts for almost 18% of gross domestic product (GDP), while in Canada, almost 12% of GDP (3). Furthermore, the corporate suites of medical centres cannot manage the stewardship of this financial burden alone because it has been estimated that although physician salaries/compensation consume 12% to 16% of direct health care costs, the decisions physicians make comprise 70% to 80% of indirect health care costs (4). Although trained for a career in plastic surgery, academic surgeons must also become proficient in the arenas of teaching and research, original artiCle ©2014 Canadian Society of Plastic Surgeons. All rights reserved JS Arneja, CW McInnes, NJ Carr, et al. Do plastic surgery division heads and program directors have the necessary tools to provide effective leadership?

New clinical roles are being developed in the NHS across existing professional boundaries. This paper considers the similarities and differences between three roles in primary care: the new roles of physician assistant and advanced nurse practitioner, and the established role of GP. It draws on a process evaluation of a pilot conducted by a primary care trust developing the physician assistant role. Semi-structured interviews with trainee physician assistants revealed different perceptions of the use of nursing and medical models in the physician assistant role. Physician assistant trainees emphasized the similarities of medical and nursing models, while GP mentors emphasized the new skills that physician assistants needed: lateral thinking, rapid differential diagnoses and treatment plans. One view was that intuition (rapid access of tacit knowledge) is important but cannot be acquired quickly. In the future, physician assistant trainees will be science graduates rather than, as in this pilot, nurses. The physician assistant role will therefore help the NHS address workforce shortages by drawing on a larger segment of the labour market than at present.