Bowmere Hospital

Low back pain (LBP) is the most prevalent musculoskeletal condition. Guidelines advocate a multimodal approach, including prescription of medications. Advanced Physiotherapy Practitioners (APPs) are well placed to manage LBP. To date no trial has evaluated the efficacy of physiotherapist-prescribing for LBP. To evaluate the feasibility, suitability and acceptability of assessing the effectiveness of physiotherapist-prescribing for LBP in primary care; informing the design of a future definitive stepped-wedged cluster trial (SWcRCT). Mixed-methods, single-arm feasibility design with two components. 1) Trial component: participants with medium-risk LBP +/-leg pain were recruited across 3 sites. Outcome measures (primary outcome measures-Pain/RMDQ) were completed at baseline, 6 and 12 weeks Physical activity/sedentary behaviour were assessed over 7 days using accelerometery. A CONSORT diagram analysed recruitment/follow-up rates. Descriptive analysis evaluated procedure/floor-effects. 2) Embedded qualitative component: focus groups (n = 6) and semi-structured interviews (n = 3) evaluated the views/experiences of patients and APPs about feasibility/suitability/acceptability of the proposed trial. Thematic analysis synthesised the qualitative data. Findings were evaluated against a priori success criteria. n = 29 participants were recruited. 90% of success criteria were met. Loss to follow-up at 12 weeks (65.5%) did not satisfy success criteria. Primary and secondary outcome measures were suitable and acceptable with no floor effects. The addition of a sleep assessment tool was advised. Accelerometer use was acceptable with 100% adherence. APPs felt all patients presenting with non-specific LBP +/- leg pain and capture data representative of the full scope of physiotherapist independent prescribing should be included. Data collection methods were acceptable to APPs and patients. APPs advocated necessity for using research assistants owing to time limitations. Methods evaluated are feasible, suitable and acceptable for a definitive SWcRCT, with modification of eligibility criteria, and use of research assistants to overcome limited clinician capacity. A definitive SWcRCT is feasible with minor modifications. ISRCTN15516596.

This paper describes a high-resolution optical filter (HRF) suitable for narrow bandwidth filtering in LIDAR applications. The filter is composed of a broadband interference filter and a narrowband Fabry-Perot etalon based on the capacitance stabilised concept. The key requirements for the HRF were a bandwidth of less than 40 pm, a tuneable range of over 6 nm and a transmission greater than 50%. These requirements combined with the need for very high out-of-band rejection (greater than 50 dB in the range 300 nm to 1200 nm) drive the design of the filter towards a combination of high transmission broadband filter and high performance tuneable, narrowband filter.

Will allowing residents and relatives to rate care homes improve care?

Will paying GPs £55 to diagnose dementia help improve care?

Should hospitals have to display their Care Quality Commission inspection rating publicly?

Should cannabis be legalised for medicinal purposes?

Are you in favour of legislation to set minimum nurse-to-patient ratios?

Warfarin-induced tissue necrosis is a rare and serious side effect associated with warfarin treatment. A case study of a patient with warfarin-induced tissue necrosis taken from clinical practice illustrates the importance of timely diagnosis and treatment to avoid the devastating consequences of this adverse drug reaction. Nurse prescribers must be alert to and aware of potential adverse drug reactions that may be caused by any prescribing decision, and should be able to take appropriate action when such an event occurs.

Power to inform Should the makers of television dramas and reality shows attempt to educate the public about mental health problems?