What is known?d People from ethnic minority groups with diabetes have poorer access to healthcare services.d People from ethnic minority groups with diabetes have poorer reported self-management of diabetes.d Culturally adapted programmes may improve outcomes -glycaemic control and service uptake -for patients from ethnic minority groups.What the study adds d A broad and systematic review of studies using mixed methods points to persistent barriers in patient access and self-management of diabetes, particularly for ethnic minority groups with low literacy.d A 'whole systems' approach, targeted at patient, professional and organisational levels, is required to improve patient self-management.d A multidimensional model of 'access', incorporating broader sociocultural factors, is more instructive than a focus on service utilisation alone. AbstractA higher risk of diabetes mellitus in South Asian and Black African populations combined with lower reported access and self-management-related health outcomes informed the aims of this study. Our aims were to synthesise and evaluate evidence relating to patient self-management and access to healthcare services for ethnic minority groups living with diabetes. A comprehensive search strategy was developed capturing a full range of study types from 1995-2010, including relevant hand-searched literature pre-dating 1995. Systematic database searches of MEDLINE, Cochrane, DARE, HTA and NHSEED, the British Nursing Index, CAB abstracts, EMBASE, Global Health, Health Management Information Consortium and PsychInfo were conducted, yielding 21 288 abstracts. Following search strategy refinement and the application of review eligibility criteria; 11 randomised controlled trials (RCTs), 18 qualitative studies and 18 quantitative studies were evaluated and principal results extracted. Results suggest that self-management practices are in need of targeted intervention in terms of patients' knowledge and understanding of their illness, inadequacy of information and language and communication difficulties arising from cultural differences. Access to health-care is similarly hindered by a lack of cultural sensitivity in service provision and under use of clinic-based interpreters and community-based services. Recommendations for practice and subsequent intervention primarily rest at the service level but key barriers at patient and provider levels are also identified.Keywords: access to health-care, diabetes, ethnic minorities, self-management AimsThe aims of the review are to synthesise and evaluate evidence relating to barriers and facilitators in accessing healthcare services and optimising self-management by ethnic minority groups living with diabetes. The review incorporates studies of mixed methods and key findings, which will contribute towards the development and ª

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Birth injuries are a diverse set of traumas afflicting a newborn during labor and/or delivery. These range from temporary paralysis to hematomas. Herein, a comprehensive review of the birth injuries is presented, including the risk factors, classification of various paralyzes and nerve damage, as well as bleeding complications. The predicted outcomes and complications, as well as the treatment options for various birth injuries, are also discussed.

District Nurses are with patients during their last weeks of life. While other colleagues can avoid breaking bad news of transition to dying, District Nurses have no choice if they are to provide optimal end of life care. While ideally placed to carry out this work, it is complex and they are unprepared for it. They urgently need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care.

Significantly poorer outcomes for those scoring '1' on the F-Score suggest that only those scoring '0' should constitute a 'good' outcome in GBS.