Revalidation: The professional development discussion.

The professional development discussion (PDD) will be an essential component of revalidation with the Nursing and Midwifery Council. The Unite/CPHVA professional officers who participated in the pilot found the PDD to be the most beneficial part of the revalidation process. This article explores the experience of a PDD from both the revalidatee and the fellow registrant perspective. It goes on to make recommendations for ensuring an effective PDD.

A randomised controlled trial to compare a range of commercial or primary care led weight reduction programmes with a minimal intervention control for weight loss in obesity: the Lighten Up trial.

BACKGROUND: Developed countries are facing a huge rise in the prevalence of obesity and its associated chronic medical problems. In the UK Primary Care Trusts are charged with addressing this in the populations they serve, but evidence about the most effective ways of delivering services is not available. The aim of this study is to determine the effectiveness of a range of weight loss programmes for obese patients in primary care and to determine the characteristics of patients who respond to an invitation to a free weight management programme. METHODS/DESIGN: Lighten Up is a randomised controlled trial comparing a range of 12-week commercial and NHS weight reduction programmes with a comparator group who are provided with 12 vouchers enabling free entrance to a local leisure centre. The weight reduction programmes are: (i) Weight Watchers, (ii) Slimming World, (iii) Rosemary Conley, (iv) a group-based dietetics-led programme (Size Down), (v) general practice one-to-one counselling, (vi) pharmacy-led one-to-one counselling, (vii) choice of any of the 6 programmes. People with obesity or overweight with a co-morbid disorder are invited to take part by a letter from their general practitioner. The sample size is 740 participants.The primary outcome is weight loss at programme-end (3 months). Secondary outcomes are weight-loss at one year, self-reported physical activity at 3 and 12 months follow-up and percentage weight-loss at 3 months and one year. DISCUSSION: This trial will provide evidence about the effectiveness of a range of different weight management programmes in a primary care population. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25072883.

Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten Up randomised controlled trial.

OBJECTIVE: To assess the effectiveness of a range of weight management programmes in terms of weight loss. DESIGN: Eight arm randomised controlled trial. SETTING: Primary care trust in Birmingham, England. PARTICIPANTS: 740 obese or overweight men and women with a comorbid disorder identified from general practice records. INTERVENTIONS: Weight loss programmes of 12 weeks' duration: Weight Watchers; Slimming World; Rosemary Conley; group based, dietetics led programme; general practice one to one counselling; pharmacy led one to one counselling; choice of any of the six programmes. The comparator group was provided with 12 vouchers enabling free entrance to a local leisure (fitness) centre. MAIN OUTCOME MEASURES: The primary outcome was weight loss at programme end (12 weeks). Secondary outcomes were weight loss at one year, self reported physical activity, and percentage weight loss at programme end and one year. RESULTS: Follow-up data were available for 658 (88.9%) participants at programme end and 522 (70.5%) at one year. All programmes achieved significant weight loss from baseline to programme end (range 1.37 kg (general practice) to 4.43 kg (Weight Watchers)), and all except general practice and pharmacy provision resulted in significant weight loss at one year. At one year, only the Weight Watchers group had significantly greater weight loss than did the comparator group (2.5 (95% confidence interval 0.8 to 4.2) kg greater loss,). The commercial programmes achieved significantly greater weight loss than did the primary care programmes at programme end (mean difference 2.3 (1.3 to 3.4) kg). The primary care programmes were the most costly to provide. Participants allocated to the choice arm did not have better outcomes than those randomly allocated to a programme. CONCLUSIONS: Commercially provided weight management services are more effective and cheaper than primary care based services led by specially trained staff, which are ineffective. Trial registration Current Controlled Trials ISRCTN25072883.

Early childhood programs and the education system.

Policy makers, advocates and experts agree that the current delivery of early childhood development programs is fragmented. Many point to the education system as a better alternative for a more coherent approach that has the necessary infrastructure in place in communities, and is well placed to meet the needs of all young children and their families. In other jurisdictions, early childhood development programs have moved into education. In Canada, provincial and local school authorities are taking on more early childhood programs.