Walsall College

<h3>Background</h3> Muscle strength/Grip strength (GS) is not routinely assessed as part of the Cardiac Rehab (CR) assessment. This is despite resistance training being recommended as part of CR exercise programs. The National Audit of Cardiac Rehab (NACR) records exercise test data and MET scores but do not include GS. A recent EPG study day presentation highlighted the opportunity for Frailty to be assessed during CR assessments, which included the assessment of GS. <h3>Aim</h3> To evaluate GS assessment data and its practical application. <h3>Methods</h3> Patient records across a 5-year period were reviewed to assess the GS data outcomes. Outcomes were recorded at baseline assessment (A1) and following an 8-week supervised exercise programme (A2). A total of 2030 individual records were reviewed. The CR program followed BACPR guidelines with resistance training offered at the appropriate point in relation to diagnosis. GS data was analysed for all patients with a recorded GS at both A1 and A2. Results were further evaluated in relation to the cut off points for Frailty assessment of &lt;16 kg for Females and &lt;27 kg for Males. T-Test was used to evaluate statistical significance. <h3>Results</h3> GS was measured pre and post CR in 976 patients. Average GS improved 9% from 28.6 kg (A1) to 31.2 kg (A2) (p&lt;0.0001) with a range of 4.9 kg to 63.9 kg over both assessments. 71% of patients had an improvement in GS upon completion. 75 females had a GS &lt;16 kg at A1, Average GS was 13.3 kg (A1) and improved 52% to 20.2 kg (A2) (p&lt;0.0001). 205 Males had a GS &lt;27 kg at A1, Average GS was 24.4 kg (A1) and improved 27% to 31 kg (A2) (p&lt;0.0001). 38 (51%) Females and 88 (43%) males moved above the Frailty threshold upon completion (table 1). <h3>Conclusion</h3> These findings highlight the importance of GS assessment in evaluating the effectiveness of the CR intervention. They also demonstrate that CR can play an important role in the identification and reduction of Frailty risk in those patients with low muscle strength.

Neck lumps are commonly encountered by GPs, with 15% of all patients presenting to GPs having an upper respiratory tract or head and neck complaint. In addition, between 1990 and 2006, the incidence of cancers relating to the head and neck increased. These include primary malignancies of the oral cavity, salivary glands, oropharyngeal mucosa and thyroid gland. It is therefore important that GPs are able to recognise red flag symptoms and signs suggestive of these cancers, as well as being able to effectively manage the more common conditions that may present with head or neck lumps that do not require urgent referral to secondary care. This article will consider this as well as the learning outcomes detailed in the curriculum box to provide a base of information that GPs can draw on to aid in the diagnosis of neck lumps.

Ros Bayley on why we must allow children to take risks and how we can encourage them to make decisions for themselves.

I was greatly encouraged toread 'Clinical governance fornurses: smoking cessationinterventions' (art&science June 20), at lastacknowledging the value ofthe quality of serviceprovided to smokers whowant to quit.

I was saddened to read the letter from Teresa Burgess (Letters December 8) in which she showed little sympathy for the problems faced by our student colleagues. We must recognise that these issues affect all of us, but the vast majority of student nurses are under the increased burden of an unrealistic bursary.

of the 15th Annual Meeting of the ESHRE, Tours, France 1999 donor.Some countries like France legally require donors to be fathers and to be part of a stable heterosexual relatonship.

I am co-ordinating the formation of a practice nurses' group for the Walsall area. Our inaugural meeting will be in October. Any practice nurse who would like more information please contact me at the following address.

This examination of Lanval and Graelent presents telling evidence of the existence in twelfth century French literature of number systems involving the total of lines used in discrete segments of text. The fundamental similarity between the two poems allows a very precise comparison of the two narratives on the basis of the constituent narrative blocks, whose presence can be verified simply and accurately. Most important are the opening lines of sections which allow the reader to see exactly where the corresponding segments of the two poems begin. The status of these segments as discrete units is then confirmed by the narrative functions they perform, each with an inherent unity of time, place and action, like the scenes in a French classical drama, and sometimes stylistic features set up contrasts with neighbouring sections. Once the essential unity of each section is established underlying arithmetical patterns emerge: Lanval is composed in 17×38, Graelent in 9×84.1 These numerical systems are moreover, applied with considerable sophistication, with halves, single and double units, and short-term excesses and shortfalls of two or three couplets are carefully balanced out over long spans of text. Structure and number can, therefore, be seen as tightly integrated and the techniques of medieval composition as circumscribed and disciplined, imposing upon the poet the need to express himself, like the craftsman, within a mould whose dimensions were known from the outset.

An empirical study of sociology leaching in a large English comprehensive school is reported which focuses on pupils' perspectives and the hidden curriculum of the sociology classroom. The concept of hidden curriculum is briefly discussed and specifically related to the sociology classroom. Hidden curriculum is seen to be important to attempts to articulate both macro and micro analyses within the sociology of education. Utilizing both structural and interactionist concepts of the hidden curriculum, this empirical study asks to what extent sociology in the school either provided an “oppositional” curriculum or simply became part of “normal school” for its pupils, not therefore noticeably different from other subjects or noticeably more relevant to the world outside the classroom. The study indicates something of the difficulties teachers face in attempting to deviate from the hidden curriculum of the status quo, and concludes that for most students sociology lessons have formed part of their “normal school.” A series of questions are presented in conclusion which may be faced by teachers about classroom teaching and the hidden curriculum.