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Background Health care staff should be given the opportunity to participate in research, but recruiting clinicians via their employing organisation is not always straightforward or quick in the UK. Unlike many countries outside the UK, very low-risk survey, interview or focus group studies can be subject to some of the same governance approval procedures as interventional studies. An exemplar study carried out by the NIHR funded Palliative Care Research Partnership North West Coast is used to highlight the challenges still faced by researchers and health care organisations when setting up a low-risk staff study across multiple NHS and non-NHS sites. Methods A study database was created and information was collected on the first point of contact with the clinical site, Health Research Authority (HRA) and local organisational approval times, time from trust or hospice agreement to the first survey participant recruited and overall site survey recruitment numbers. Descriptive statistics (median, range) were used to analyse these data. Results Across participating NHS trusts, it took a median of 147.5 days (range 99–195) from initial contact with the local collaborator to recruitment of the first survey participant and hospice sites mirrored these lengthy timescales (median 142 days, range 110–202). The lengthiest delays in the HRA approval process were the period between asking NHS trusts to assess whether they had capacity and capability to support the research and them granting local agreement. Local approval times varied between trusts and settings which may indicate organisations are applying national complex guidance differently. Conclusions There is the potential for HRA processes to use more NHS resources than the research study itself when recruiting to a low-risk staff study across multiple organisations. There is a need to reduce unnecessary administrative burden and bureaucracy to give clinicians and research staff more opportunities to participate in research, and to free up NHS R&D departments, research nurses and clinicians to focus on more demanding and patient focused research studies. Hospices need standardised guidance on how to assess the risk of being involved in low-risk research without adopting the unnecessarily complex systems that are currently used within the NHS.

AimThis qualitative study explores with health professionals the provision of, and challenges for, postdischarge stroke care, focussing on eating, drinking and psychological support across India.DesignQualitative semistructured interviews.SettingSeven geographically diverse hospitals taking part in a Global Health Research Programme on Improving Stroke Care in India.ParticipantsA purposive sample of healthcare professionals with current experience of working with patients who had a stroke.ResultsInterviews with 66 healthcare professionals (23 nurses (14 staff nurses; 7 senior nurse officers; 1 intensive care unit nurse; 1 palliative care nurse)); 16 doctors (10 neurologists; 6 physicians); 10 physiotherapists; 5 speech and language therapists; 4 occupational therapists; 4 dieticians; 2 psychiatrists; and 2 social workers resulted in three main themes: integrated inpatient discharge care planning processes; postdischarge patient and caregiver role and challenges; patient and caregiver engagement post discharge.ConclusionsDischarge planning was integrated and customised, although resources were limited in some sites. Task shifting compensated for a lack of specialists but was limited by staff education and training. Caregivers faced challenges in accessing and providing postdischarge care. Postdischarge care was mainly hospital based, supported by teleservices, especially for rural populations. Further research is needed to understand postdischarge care provision and the needs of stroke survivors and their caregivers.

In June, the University of Central Lancashire opened its clinical trials unit, where staff will run complex intervention trials in a range of care areas, including stroke, musculoskeletal health, public health and mental health. One of the first trials looks at how hospital nursing policies in the first 24 hours after patients have had stroke affect their subsequent survival and disabilities. Known as HeadPoST, the study will recruit 20,000 patients globally, with the 6,000 UK research participants managed by Lancashire. This article explores the role of emergency nurses in supporting the research.

Comment on the need for UK-wide training and defined career pathways for stroke specialist nurses. The development of the Stroke-Specific Education Framework (SSEF), which lists the knowledge and skills required for each of 16 specific roles on the stroke pathway regardless of work setting, is described. [(BNI unique abstract)] 1 references

Formal screening for depression can be time consuming, but nurses may consider asking patients if during the past month they have often been bothered by feeling down, depressed or hopeless or if they have had little interest or pleasure in doing things. The criteria and patterns of referral will vary considerably from area to area, but may include GP, stroke liaison, clinical psychology, or Improving Access to Psychological Therapies services.

In acute stroke care, urgent specialist assessment and treatment are essential to reduce the risk of death and disability. However, many patients do not receive them due to a lack of specialist services. One solution is to use telemedicine. This can give all patients with acute stroke symptoms access to immediate expert assessment and advice, regardless of when and where they present to hospital. This article describes a telemedicine system developed and implemented in Lancashire and Cumbria. In its first year of operation, 319 patients received a telestroke video assessment with a consultant stroke physician; 131 of these patients were given thrombolysis. We discuss how the service was designed, staff training and development, and the implications for nursing practice. The development of a standardised telemedicine toolkit that may facilitate future telemedicine projects is also discussed.

Regarding Long Island Power Authority Chairman Richard Kessel's letter justifying high executive pay at LIPA [\"LIPA's salaries aren't too high,\" Letters, May 28]: Kessel argues that LIPA's executive pay should be compared \"in context\" to the executive compensation rates of other utilities. This argument misses the point. Newsday published LIPA's high salaries not in the context of an internal utility industry comparison of executive compensation, but, rather, in the context of the high cost of living on Long Island. Viewed in this context, ratepayers' anger over high executive compensation at LIPA is justified. Newsday again is showing its bias against Israel by printing another unsubstantiated, opinionated letter blaming Israel for the trouble in \"Palestine\" [\"Clouding Israeli-Palestinian issue,\" Letters, June 1]. Israel isn't sending fanatical men, women and children with bombs strapped to their bodies to kill innocent people at weddings, restaurants or parties. The Arab-world-backed Palestinians are.