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Background: Alcohol consumption places a significant burden on the NHS and is an important risk factor for cancer, associated with 12 800 UK cases/year. New alcohol guidelines were published in 2016, taking into account the increasing evidence of the health harms of alcohol., Methods: A survey of the UK drinker population (n = 972) was conducted 1 week before and 1 month after the release of the guidelines to capture drinking habits, guideline awareness and intended behaviour change., Results: Overall, 71% were aware of the new alcohol guidelines, however, just 8% knew what the recommended limits were. Higher socioeconomic groups were more likely to know these limits (ABC1 = 9% versus C2DE = 4%, P = 0.009). Participants who recognized the message that alcohol causes cancer were more likely to correctly identify the new guidelines (message recognition = 12% versus no recognition = 6%, P = 0.004); and were more likely to self-report an intention to reduce their alcohol consumption (message recognition = 10% versus no recognition = 6%, P = 0.01)., Conclusion: The majority of the population knew the guidelines had been updated, however, communication of the new limits needs to be improved. Raising awareness of the links between alcohol and cancer may improve understanding of alcohol guidelines and could prompt behaviour change for those motivated to reduce their alcohol consumption.

Aims: Promotion of lower risk drinking guidelines is a commonly used public health intervention with various purposes, including communicating alcohol consumption risks, informing drinkers' decision-making and, potentially, changing behaviour. UK drinking guidelines were revised in 2016. To inform potential promotion of the new guidelines, we aimed to examine public knowledge and use of the previous drinking guidelines, including by population subgroup., Methods: A demographically representative, cross-sectional online survey of 2100 adults living in England in July 2015 (i.e. two decades after adoption of previous guidelines and prior to introduction of new guidelines). Univariate and multivariate logistic regressions examined associations between demographic variables, alcohol consumption (AUDIT-C), smoking, and knowledge of health conditions and self-reported knowledge and use of drinking guidelines. Multinomial logistic regression examined the same set of variables in relation to accurate knowledge of drinking guidelines (underestimation, accurate-estimation, overestimation)., Results: In total, 37.8% of drinkers self-reported knowing their own-gender drinking guideline, of whom 66.2% gave an accurate estimate. Compared to accurate estimation, underestimation was associated with male gender, lower education and AUDIT-C score, while overestimation was associated with smoking. Few (20.8%) reported using guidelines to monitor drinking at least sometimes. Drinking guideline use was associated with higher education, overestimating guidelines and lower AUDIT-C. Correctly endorsing a greater number of health conditions as alcohol-related was associated with self-reported knowledge of guidelines, but was not consistently associated with accurate estimation or use to monitor drinking., Conclusions: Two decades after their introduction, previous UK drinking guidelines were not well known or used by current drinkers. Those who reported using them tended to overestimate recommended daily limits., Short Summary: We examined public knowledge and use of UK drinking guidelines just before new guidelines were released (2016). Despite previous guidelines being in place for two decades, only one in four drinkers accurately estimated these, with even fewer using guidelines to monitor drinking. Approximately 8% of drinkers overestimated maximum daily limits.

Background: Globally, alcohol is causally related to 2.5 million deaths per year and 12.5% of these are due to cancer. Previous research has indicated that public awareness of alcohol as a risk factor for cancer is low and this may contribute to a lack of public support for alcohol policies. The aim of this study was to investigate the relationship between awareness of the alcohol-cancer link and support for a range of alcohol policies in an English sample and policy context., Methods: A cross-sectional survey of 2100 adult residents in England was conducted in which respondents answered questions regarding awareness of the link between alcohol and cancer and support for 21 policy proposals. Principal component analysis (PCA) was used to reduce the 21 policy proposals down to a set of underlying factors. Multiple regression analyses were conducted to estimate the relationship between awareness of the alcohol-cancer link and each of these policy factors., Results: Thirteen per cent of the sample were aware of the alcohol-cancer link unprompted, a further 34% were aware when prompted and 53% were not aware of the link. PCA reduced the policy items to four policy factors, which were named price and availability, marketing and information, harm reduction and drink driving. Awareness of the alcohol-cancer link unprompted was associated with increased support for each of four underlying policy factors: price and availability (Beta: 0.06, 95% CI: 0.01, 0.10), marketing and information (Beta: 0.05, 95% CI: 0.00, 0.09), harm reduction (Beta: 0.09, 95% CI: 0.05, 0.14), and drink driving (Beta: 0.16, 95% CI: 0.11, 0.20)., Conclusions: Support for alcohol policies is greater among individuals who are aware of the link between alcohol and cancer. At the same time, a large proportion of people are unaware of the alcohol-cancer link and so increasing awareness may be an effective approach to increasing support for alcohol policies.

Objectives: To evaluate short-term effects of publishing revised lower risk national drinking guidelines on related awareness and knowledge. To examine where drinkers heard about guidelines over the same period., Design: Trend analysis of the Alcohol Toolkit Study, a monthly repeat cross-sectional national survey., Setting: England, November 2015 to May 2016., Participants: A total of 11 845 adults (18+) living in private households in England., Intervention: Publication of revised national drinking guidelines in January 2016 which reduced the male guideline by approximately one-third to 14 units per week., Measurements: Whether drinkers (1) had heard of drinking guidelines (awareness), (2) stated the guideline was above, exactly or below 14 units (knowledge) and (3) reported seeing the stated guideline number of units in the last month in each of 11 locations (exposure). Sociodemographics: sex, age (18-34, 35-64, 65+), social grade (AB, C1C2, DE). Alcohol consumption derived from graduated frequency questions: low risk (<14 units/week), increasing/high risk (14+ units/week)., Results: Following publication of the guidelines, the proportion of drinkers aware of guidelines did not increase from its baseline level of 85.1% (CI 82.7% to 87.1%). However, the proportion of male drinkers saying the guideline was 14 units or less increased from 22.6% (CI 18.9% to 26.7%) in December to 43.3% (CI 38.9% to 47.8%) in January and was at 35.6% (CI 31.6% to 39.9%) in May. Last month exposure to the guidelines was below 25% in all locations except television/radio where exposure increased from 33% (CI 28.8% to 36.2%) in December to 65% (CI 61.2% to 68.3%) in January. Awareness and knowledge of guidelines was lowest in social grade DE and this gap remained after publication., Conclusions: Publication of new or revised lower risk drinking guidelines can improve drinkers' knowledge of these guidelines within all sociodemographic groups; however, in the absence of sustained promotional activity, positive effects may not be maintained and social inequalities in awareness and knowledge of guidelines are likely to persist., Competing Interests: JH and PM were advisors to (and were previously members of) the UK Chief Medical Officers' Guidelines Development Group. JH, PM and PB were commissioned by Public Health England to provide an epidemiological modelling report which informed development of the new UK lower risk drinking guidelines and, at the time of writing, continue to provide advice to the UK Department of Health, Public Health England and the Guideline Development Group on matters relating to this report. JB and EB have received unrestricted research funding from Pfizer for studies relating to smoking cessation., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Public knowledge of the association between alcohol and cancer is reported to be low. We aimed to provide up-to-date evidence for England regarding awareness of the link between alcohol and different cancers and to determine whether awareness differs by demographic characteristics, alcohol use, and geographic region., Methods: A representative sample of 2100 adults completed an online survey in July 2015. Respondents were asked to identify which health outcomes, including specific cancers, may be caused by alcohol consumption. Logistic regressions explored whether demographic, alcohol use, and geographic characteristics predicted correctly identifying alcohol-related cancer risk., Results: Unprompted, 12.9% of respondents identified cancer as a potential health outcome of alcohol consumption. This rose to 47% when prompted (compared to 95% for liver disease and 73% for heart disease). Knowledge of the link between alcohol and specific cancers varied between 18% (breast) and 80% (liver). Respondents identified the following cancers as alcohol-related where no such evidence exists: bladder (54%), brain (32%), ovarian (17%). Significant predictors of awareness of the link between alcohol and cancer were being female, more highly educated, and living in North-East England., Conclusion: There is generally low awareness of the relationship between alcohol consumption and cancer, particularly breast cancer. Greater awareness of the relationship between alcohol and breast cancer in North-East England, where a mass media campaign highlighted this relationship, suggests that population awareness can be influenced by social marketing.

Background: Several options are advocated by policy experts to mitigate alcohol-related harms, although the most effective strategies often have the least public support. While knowledge of tobacco-related health risks predicts support for relevant public health measures, it is not known whether knowledge of alcohol health risks is similarly associated with the acceptability of policies intended to reduce alcohol consumption and related harms. This study aims to gauge public support for a range of alcohol policies and to determine whether or not support is associated with knowledge of a long-term health risk of alcohol consumption, specifically cancer., Methods: 2482 adults in New South Wales (NSW), Australia, participated in an online survey. Logistic regression analysis was used to examine the association between demographic data, alcohol consumption, smoking status, knowledge of alcohol as a risk factor for cancer and support for alcohol-related policies., Results: Most participants were supportive of health warnings, restricting access to internet alcohol advertising to young people, and requiring information on national drinking guidelines on alcohol containers. Almost half of participants supported a ban on sport sponsorship, while less than 41% supported price increases, volumetric taxation, or reducing the number of retail outlets. Only 47% of participants identified drinking too much alcohol as a risk factor for cancer. Knowledge of alcohol as a risk factor for cancer was a significant predictor of support for all policies, while level of alcohol consumption had a significant inverse relationship with policy support., Conclusion: The finding that support for alcohol management policies is associated with awareness that drinking too much alcohol may contribute to cancer could assist in the planning of future public health interventions. Improving awareness of the long term health risks of alcohol consumption may be one avenue to increasing public support for effective alcohol harm-reduction policies., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. WHAT IS KNOWN ABOUT THIS TOPIC?: Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. WHAT DOES THIS PAPER ADD?: Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services.

Objective: Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance., Methods: An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data., Findings: The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario., Conclusion: Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation., (Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Aim: This is a report of a study investigating processes used by final-year nursing students to recognize and act on clinical cues of deterioration in a simulated environment., Background: Initial decisions about patients who are deteriorating in medical and surgical wards are often made by newly qualified nurses and doctors, increasing the risk of clinical error. There has been an emphasis on the use of teams in simulation; however, signs of deterioration are missed by individual clinicians., Methods: During July 2008, final-year undergraduate nursing students in Australia attended a simulation laboratory for 1·5 hours and completed a knowledge questionnaire and two (mannequin-based) scenarios simulating deteriorating patients with hypovolaemic and septic shock. Scenarios were video-recorded and reflective interviews conducted. Additionally, scenarios were stopped around the midpoint to ascertain students' level of Situation Awareness., Results: Fifty-one students participated in the study, providing a total of 102 videoed scenarios and 51 interviews. Thematic analysis of video data and reflective interviews identified considerable differences in processes used by students to identify cues. Four aspects of cue recognition were evident: initial response, differential recognition of cues, accumulation of signs and diversionary activity., Conclusion: Nursing skills training should emphasize the importance of trends in identifying and acting on deterioration and the need for systematic assessment in stressful situations. Nursing curricula should focus on enhancing the ability to piece information together, including linking pathophysiology with patient assessment, and identify trends, rather than seeing observations as parallel to each other., (© 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.)

Aim: To examine, in a simulated environment, the ability of final-year nursing students to assess, identify and respond to patients either deteriorating or at risk of deterioration., Background: The early identification and management of patient deterioration has a major impact on patient outcomes. 'Failure to rescue' is of international concern, with significant concerns over nurses' ability to detect deterioration, the reasons for which are unknown., Design: Mixed methods incorporating quantitative measures of performance (knowledge, skill and situation awareness) and, to be reported at a later date, a qualitative reflective review of decision processes., Methods: Fifty-one final-year, final-semester student nurses attended a simulation laboratory. Students completed a knowledge questionnaire and two video-recorded simulated scenarios (mannequin based) to assess skill performance. The scenarios simulated deteriorating patients with hypovolaemic and septic shock. Situation awareness was measured by randomly stopping each scenario and asking a series of questions relating to the situation., Results: The mean knowledge score was 74% (range 46-100%) and the mean skill performance score across both scenarios was 60% (range 30-78%). Skill performance improved significantly (p < 0.01) by the second scenario. However, skill performance declined significantly in both scenarios as the patient's condition deteriorated (hypovolaemia scenario: p = 0.012, septic scenario: p = 0.000). The mean situation awareness score across both scenarios was 59% (range 38-82%). Participants tended to identify physiological indicators of deterioration (77%) but had low comprehension scores (44%)., Conclusion: Knowledge scores suggest, on average, a satisfactory academic preparation, but this study identified significant deficits in students' ability to manage patient deterioration., Relevance to Clinical Practice: This study suggests that student nurses, at the point of qualification, may be inadequately prepared to identify and manage deteriorating patients in the clinical setting.