Aim: To assess the feasibility and acceptability of swimming pool-based exercise as pulmonary rehabilitation (PR) for COPD sufferers.Method: 101 patients with mild or moderate COPD registered with a South London general practice were invited to a swimming poolbased PR programme. Participants completed spirometry, the Chronic Respiratory Questionnaire (CRQ-SR), and the Incremental Shuttle Walk Test (ISWT) before and after the programme. A qualitative interview was used to assess participants' views.Results: 24 patients (24%) expressed interest; 18 were recruited and 16 (16%) completed the PR programme. Their mean age was 69 yrs, seven were female, and mean % predicted FEV1 was 59%. The mean number of sessions attended was 10.6 out of 12. Significant improvements in dyspnoea score (difference 4.9; 95% CI -8.27 to -1.48) and walking distance (difference 32 metres; 95% CI -52.63 to -11.36) were observed, and all other findings were in the direction of improvement. Most patients enjoyed being in the water, were happy to expose themselves in swimsuits, overcame their fears, valued learning about COPD and socialising with fellow sufferers, and were positive about their physical improvement. Conclusion:The swimming pool is a feasible and positive alternative venue for PR for COPD patients in primary care.

A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.

A Back Management Service can provide useful diagnostic reassessment of patients with chronic low back pain, and can focus therapeutic effort for the effective management of their pain.

This paper validates an approach to the design and development of VR applications that are integrated into the curricula and address fundamental student needs. To accomplish this, a case study describing the process undertaken to create Nursing XR, a wound dressing scenario where the patient is discharged home and requires follow up care and treatment by a nurse. The aim of the VR application is to support nursing students in developing their communication, risk assessment, holistic assessment, and person-centred clinical decision-making skills. To design Nursing XR, needs and initial requirements were collected via a workshop with student nurses. The workshop, which involved 10 student nurses and two lecturers in nursing from two Universities (Co-Is) and was led by the PI, supported by the learning technologist and the head developer of the company used for development of the software. Results from the workshop identified two major needs for the students: the need to undertake practical applications of the procedures learned in the lectures and the need to build confidence in the skills required of a nursing student. These needs were the foundations for the design process, which followed an artefact-based approach. The artefacts generated during the design were also used to elicit additional interaction and software requirements from the nursing lecturers. An iterative lean development process was followed by the company for the software implementation. Throughout the development, students and lecturers were involved as user testes ensuring that the user experience of the application was satisfactory, and the application fit for purpose.In this paper, we describe the high-level design and development process followed by the multidisciplinary team to develop Nursing XR and report initial qualitative findings from the workshop focus group.

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