ObjectivesTo identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs).DesignSystematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations.Eligibility criteriaIncluded MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.Data sourcesFour scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories.Results6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work.ConclusionThese 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.

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Student mental health: how can psychiatrists better support the work of university medical centres and university counselling services?ABSTRACT Student psychiatric morbidity is rising. Whilst the influence of university counselling services is widely reported, NHS involvement by psychiatrists and general practitioners is not so well described. Counselling and mental health service providers for students at the University of Leeds were approached for numerical data and a university Group on Student Mental Health discussed the findings. The Student Counselling Centre, the University Medical Practice and a dedicated student psychiatric clinic have all seen a rise in referral rates. The University Medical Practice has also seen a rise in the prescribing of psychoactive medication. Collaborative links at the University of Leeds are explored and options for the future discussed. These include self-help over the internet, a research project to assess student mental health needs and the provision of a dedicated NHS psychiatric team for the university.

When most people think of branding, they automatically think of high-profile product brands like Coke and Nike. Service brands, such as those in financial services, telecommunications, or utilities receive somewhat less attention. However, these are the brands for which communication is changing the face of customer relationships, changing the way in which information secures-and more important, retains-customers and market share.Service brands operate essentially on the promise of an experience, and consumers choose one brand over another in the expectation that the experience it delivers will be a good one. In many service sectors, there is no difference between the products themselves; they are commodities, such as phone calls, supplies of gas or water, or bank accounts. The technologies these sectors rely on are mature. It is not a novelty to have a phone that works, everyone wants to give you a credit card, and in most societies electricity can be relied upon. For service brands, therefore, the key differentiator is the quality of the relationship promised to the customer. Because this promise is extended through information communicated through print or digital media, or the spoken word, that information becomes a huge determinant of the quality of the relationship. It might make sense, then, to think of service industries as information industries, because, although product brands tend to represent a trade between money and objects, service industries are a trade that is based mainly on money and information. MARKETING F ocusing on a critical aspect in the relationship with consumers,Rob Waller and Judy Delin urge designers to create "cooperative" communications-media that are relevant, clear, concise, truthful, and informative. These attributes strengthen brand and build loyalty. Ignoring them causes confusion and doubt, weakening the connection with customers. Violating them-a "final straw" experience-can end the customer relationship.