Blood Sugar and Lipid Profile: Effects of Garlic and Ginger

Blood Sugar and Lipid Profile: Effects of Garlic and Ginger Comparative Efficacy of Garlic and Ginger on Blood Sugar and Lipid Profile of Alloxan Induced Diabetic Mice Amna Masroor Allium sativum and Zingiber officinale are vegetables used for seasoning, flavoring, culinary and in herbal remedies as they hold insulinotropic properties playing significant role in maintaining ÃŽÂ ² cells helpful to lower blood glucose level in diabetes. Both are also siginificant in lowering blood lipid levels. The experimental trial of 4 week is planned to investigate the comparative effect of ginger and garlic on blood sugar level and lipid profile in alloxan induced diabetic mice. 25 male mice rats weighing between 40 and 50 g will be used for the study. Diabetes will be induced in fasted mice (12hrs) by a single dose intraperitoneal injection of 40 mg/kg body weight of alloxan. The diabetic state will be assessed by measuring the non-fasting plasma glucose concentration 72hrs after alloxan treatment. The rats with a plasma glucose level above 180mg/dl will be selected for the experiment and considered as diabetics. Mice will be divided into 5 groups having 5 in each as: No rmal Control (group 1), Diabetic control (group 2), Diabetic+ garlic (30g/100g diet group 3), Diabetic + ginger (30mg/kg diet group 4) and Diabetic + ginger and garlic (30g/ 100g group 5). In the end of trial the blood sugar and lipid parameters will be checked and compared. INTRODUCTION: Diabetes mellitus and its allied discrepancies is one of the prominent menaces of developing economics. Pakistan is at 6th position however, at the end of the year 2030; approximately 376 million people will be suffered (Wild et al., 2004). Diabetes is a metabolic syndrome that steadily affects different physiological systems of the human body. It is one of the leading causes of mortality in worldwide and, if uncontrolled, can threat multi-organs system (Zakir et al., 2008). Uncontrolled blood glucose is believed to be the cardinal feature in the onset of diabetic difficulties of both type 1 and type 2 (American Association of Diabetic Educators, 2002). Most common type is Type 2 category, while Type 1 diabetes develops in early childhood. Main reasons include sedentary lifestyles, energy rich diet, lack of physical exercise and obesity (Yajnik, 2001). Diabetes is mainly characterized by relative deficiency in insulin secretion or insulin action associated with hyperglycemia and malfunctioning in the metabolism of carbohydrate, lipid and protein. It may also leads to various other complications like cardiovascular disorders, oxidative stress and immune dysfunction may develop (Nogichi, 2007; Rana et al., 2007).Cardiovascular complications are the major cause of morbidity and mortality all across the globe. Increased cholesterol level and LDL oxidation trigger events that initiate atherosclerosis (Matsuura et al., 2008; Andican et al., 2008; Whale and Heys, 2008). To cope with this situation a number of herbal medicines for diabetes mellitus and its allied diseases have been emerged (Alarcon-Aguilara et al., 1998; Marles and Farnsworth, 1995). Drug treatment is obligatory nevertheless, accompanied by various side effects and their effectiveness decreases with the passage of time (Zakir et al., 2008; Lapshina et al., 2006). Physical exercise and diet selection is one of the significant strategies to manage diabetes and its allied complications including immune dysfunction, degenerative and cardiovascular disorder. Allium sativum, Zingiber officinale and their bioactive constituents hold insulinotropic properties playing significant role in maintaining ÃŽÂ ² cells helpful to address the menace. Garlic (Allium sativum) is an essential vegetable that has been widely utilized as seasoning, flavoring, culinary and in herbal remedies (Rivlin, 2001). Garlic has been shown to have diverse biological activities including antidiabetic, antithrombotic, anticarcinogenic, antiatherosclerotic, antitumorigenetic and various other biological actions (Augusti, 1996).Scientific investigations have depicted that it contains 65% water, 30% carbohydrates along with 5 % of other bioactive components mainly sulfur containing compounds (Milner, 2001). Its important constituents are classified as; sulfur containing compounds and non sulfur containing compounds. Among these organosulphur compounds particularly cysteine sulfoxides and thiosulfinates have greater importance (Tapiero et al., 2004). Allicin (diallylthiosulfinate) and S-allay cysteine are the main thiosulfinates out of which 60-80% is allicin (Lawson et al., 2001).Garlic and its various preparations have potential to lower total plasma cholesterol, reduction in blood pressure and alleviation of blood glucose level (Sterling and Eagling, 2001). Some studies confirmed anti hyperglycemic effects of garlic (Eidi et al., 2006). Garlic may act on blood glucose through various mechanisms and therefore directly lowers blood glucose level by exciting glycogenisis and preventing glycogenolysis and gluconeogenisis in muscles and hepatic (Ebomoyi et al., 2010). The fiber of garlic may also hamper carbohydrate absorption; thereby affecting blood glucose (Gholamali A Jelodar, 2005). Antioxidant property of garlic is another possible mechanism that makes it a contender as antidiabetic agent (Queiroz et al., 2009; Lee et al., 2009). Antioxidant effect of S-allyl cysteine sulfoxide, isolated product from garlic is considered to have antiglycation properties. Different supplementations of garlic hold remarkable effect on cholesterol level, LDL cholesterol and HDL cholesterol. Consumption of garlic and garlic preparations are very useful in regulating plasma lipid levels (Lau, 2006), plasma anticoagulant activity (Pierre et al., 2005; Lawson et al., 1992) and also contributed toward the prevention of atherosclerosis process (Rehman and Lowe, 2006).Ginger is also very effective for lowering blood sugar, cholesterol and triglyceride levels (Bhandari et al., 1998). Ginger (Zingiber Officinale) commonly called Adrak belongs to family Zingiberaceae (Joshi, 2000). It is used in both ways as food additives (Flavor) or as a medicine and it is useful in preventing or treating a variety of human ailments including migraine headache, elevated cholesterol level, hepatotoxicity, burns, peptic ulcers, nausea, vomiting and motion sickness (Robbers and Tyler, 2002).Chemical constituents of ginger are camphene, cineol, zingiberine, gingerol and ÃŽÂ ²-ph ellandrene (Shinwari et al., 2006). Ethyl acetate extract of ginger produces significant reduction in glucose concentration and also decreases lipid level (Goyal and Kadnur, 2006). Acute dose of aqueous extracts of Z. Officinale rhizome shows hypoglycaemic activity (Kalejaiye et al., 2002). Ginger promotes glucose clearances in insulin responsive peripheral tissues, which is vital in maintaining blood glucose homeostasis (Li et al., 2012). Ginger treatment considerably reduces the both serum cholesterol and triglycerides (Akhani et al., 2004). The ethanolic extract of ginger also appreciably reduces serum total cholesterol and triglycerides and elevates the HDL-cholesterol levels; also, the extract can protects tissues from lipid peroxidation and shows a significant lipid lowering activity in diabetic rats. Objective: The present study is designed to investigate and explore the hypoglycemic and hypolipidemic perspectives of raw garlic and ginger using alloxan induced biabetic mice modeling. Review of Literature: Ahmed and Sharma, (1997) studied on adult Wister rats were fed diet containing 0.5% ginger (group 3) and combination of ginger and garlic (group 4).Their results showed that the combination of garlic and ginger was much more effective in reducing blood serum cholesterol and blood glucose and in increasing HDL cholesterol. Hence a combination of garlic and ginger is much more effective in reducing blood glucose and serum lipids. Bhandari et al. (1998) studied the effect of ginger on cholesterol fed rabbits, after ten weeks, cholesterol fed rabbits had increased cholesterol, serum triglycerides, serum lipoproteins and phospholipids. When extract of ginger was given the remarkably reduction in the cholesterol, serum triglyceride and serum lipid proteins and phospholipids was observed. Ahmed et al. (2000) examined the dietary effect of ginger on antioxidant dependent system in rats, and his results showed that ginger (Zingiber Officinale; 1% w/w) significantly lowered lipid peroxidation by maintaining the activities of the antioxidant enzymes-superoxide dismutase, catalase and glutathione peroxidase in rats. Ackermann et al. (2001) conducted a study to see the effect of garlic on lipid profile and results indicated that garlic preparations had comparatively lower declines (1.2-17.3 mg/dl and 12.4-25.4 mg/dl) in total cholesterol level as compared to whole garlic after 1 and 3 month correspondingly. Bhandari et al. (2005) discovered that ethanolic extract of ginger significantly reduced serum total cholesterol and triglycerides levels and increased HDL-cholesterol level as compared to diabetic rats, and the extract showed a significant lipid lowering activity and protect the tissues from lipid peroxidation. Goyal and Kadnur, (2006) reported that goldthioglucose cause a significant increase in body weight, glucose insulin level and lipid level in mice and when methanol and ethyl acetate extract of ginger were given to mice for eight weeks that produced significant reduction in glucose concentration and lipid level. Amin et al. (2006) studied the hypoglycemic potential of ginger.The aqueous extract ofraw ginger (500mg/kg) was given to the streptozitocin (STZ) induced diabetic rats for seven weeks. Fasting blood serum was examined and results indicated that the raw ginger was very effective in lowering the serum glucose. Afshari et al. (2007) estimated the effect of ginger powder on nephropathy induced by diabetes, and measured the changes in plasma lipid peroxidation, Wistar rats were treated after the grouping of 3 rats in each. Blood sample was collected from the heart of each rat. The results showed that ginger powder caused decrease in lipid peroxidation. Al-Qattan et al. (2008) reported that in STZ-induced diabetic rats which were injected intraperitoneally with ginger extract for seven weeks, the serum glucose was significantly lowered, and the urine protein reduced to the same level as the normal group. Histological examination clearly depicted that ginger effectively reduced the progression of structural nephropathy in diabetic rats. Islam and Choi, (2008) compared the anti-diabetic effects of dietary ginger and garlic in STZ induced Diabetic rats. In this trial 5-week-old male Sprague-Dawley rats were fed a high-fat (HF) diet (22% fat) for 2 weeks and then randomly divided into six groups of eight animals: Normal Control (NC), Diabetic Control (DBC), Ginger Low (GNL), Ginger High (GNH), Garlic Low (GRL), and Garlic High (GRH) groups. Low and High indicate addition of 0.5% and 2.0% freeze-dried ginger or garlic powder in their respective diets.After 4 weeks data of this study suggested that ginger and garlic are insulinotropic rather than hypoglycemic while overall anti-diabetic effects of ginger are better than those of garlic. Shariatzadeh et al. (2008) exhibited the effect of garlic on lowering blood sugar and preventing and curing nephropathy in STZ induced diabetic rats. 32 male Wister rats were randomly divided into control, control+extract, diabetic and diabetic+extract groups (n=8).Treatment with aqueous-ethanolic extract of garlic (50mg/ kg/day) was followed for 4 weeks. The results revealed that there was significant decrease in blood sugar and increase in weight of kidney and volume of cortex,medulla and kidney. Abd-Elraheem et al. (2009) depicted the effect of ginger extract consumption on levels of blood glucose, lipid profile and kidney functions in alloxan induced-diabetic rats. In this study rats (130-150gm) were divided into 4 groups; normal control rats, diabetic control rats, diabetic rats post-treated with ginger and diabetic rats pretreated with ginger. Ginger extract was administered orally for 6 weeks to post-treated and pre-treated rats, and they were compared with the normal and diabetic groups, respectively. Plasma glucose, plasma lipid,plasma creatinine, urea and uric acid levels were reduced significantly in both post-treated and pretreated groups. Bing et al. (2011) conducted a study to evaluate the hypolipidemic effect of enteric-coated ginger and garlic essence tablet on lipid profile of rats fed high-fat diet and hyperlipidemic subjects. One experimental group having hyperlipidemic rats was assigned to orally expose to three different doses of essence tablet for 30 consecutive days. In addition other experimental group of hyperlipidemic subjects received one piece of ginger and garlic essence tablet twice daily. After 30 days the data of serum lipid profile of both group was obtained which depicted that enteric-coated ginger and garlic tablet remarkably improved blood lipid profile in rats fed high-fat diet and hyperlipidemic subjects. Eyo et al. (2011) revealed the comparative hypoglycemic effect of the hypoglycemic increasing dosages of A. cepa, A. sativum and Z. officinale aqueous extract on alloxan -induced diabetic rats. Increasing dosages (200, 250 and 300mg/kg bw ip) of A. cepa, A. sativum and Z. officinale aqueous extracts were given to the diabetic rats for six weeks and after six weeks blood glucose levels were determined and concluded that A. sativum, A. cepa and Z. officinale significantly decreased blood glucose as 79.7%, 75.4% and 56.7% respectively. Ashour et al. (2011) conducted a study was to investigate the short term effect of garlic oil on the antioxidant status as well as insulin level in streptozotocin (STZ) induced diabetic rats. In diabetic rats (two groups), one treated by garlic oil (200 mg/kg b.wt) and the other group treated by vehicle (corn oil; 2 ml / kg b. wt,) for 8 weeks. Results showed the significant increase in levels of superoxide dismutase (SOD), catalase, GPx, C-peptide and insulin on oral administrations of the garlic oil in the diabetic rats. Prasad et al. (2012) investigated hypolipidimic effects of ginger-juice in rat. Albino rats (n=6-12) were administered G.J at single dose (4ml/rat, p.o) as a chronic treatment over period of 21 days. After the 21 days the lipid profile parameters were checked and which indicated that treatment with ginger-juice in rats significantly reduced the total serum cholesterol level and significantly increased the serum HDL-cholesterol. So it was concluded that ginger juice has hypolipidemic effect. Sanghal et al. (2012) conducted a trial to check the comparative efficacy of ginger and garlic on hypertension and hyperlipidemia in rats. In this study total 18 rats were taken and equally divided into three (control, ginger and garlic) groups by random selection. Ginger and garlic (500 mg/kg orally) were given to two separate groups of rats fed on high fat diet for a period of 7 weeks. Blood pressure and lipid profile were measured on day 0 and after 7 weeks. Comparative results depicted that ginger has better although not significant preventive effect on systolic blood pressure and garlic has better preventive effect on lipid levels. MATERIAL AND METHODS: This experiment will be conducted to investigate the comparative effect of garlic and ginger on blood sugar level and lipid profile of alloxan induced diabetic mice. Plant Material: The A. sativum and Z. officinale used for the experiment will be purchased from the Ayub Agricultural Research Institute, Faisalabad. Animal Model: 25 mice weighing 30-35g will be purchased from National Institute of Health, Islamabad and kept in the animal house of the National Institute of Food Science and Technology (NIFSAT), University of Agriculture Faisalabad. They will be maintained at a temperature of 25  ± 1 °C and relative humidity of 45 to 55% under 12-h light: 12-h dark cycle. They will be fed with normal diet and water ad libitum. Induction of Diabetes Mellitus: Diabetes will be induced in mice by a single intraperitoneal injection of aqueous alloxan monohydrate (40 mg/kg, i.v.) solution. After 72 hrs animals showing serum glucose level above 180 mg/dl (diabetic) will be chosen for the study. Experimental Protocol: The experimental animals will be divided into 5 groups; each group will contain 5 animals: Control group G1 (normal without treatment), diabetic control group G2 (injected with 40mg/kg b.w. of alloxan), diabetic mice treated with 30g/100g diet of garlic for 4 weeks G3, diabetic mice treated with 30g/100g diet of ginger for 4 weeks G4 and diabetic mice treated with 30g/100g diet containing mixture of garlic and ginger G5. Data Collection: Data will be collected for different parameters for body weight, feed and water intake. Collection of Blood Samples: At the end of 4 weeks blood samples will be collected by sacrificing the animals for determination of blood glucose and lipid profile. Proximate Analysis: The proximate analysis of garlic and ginger for moisture, total ash content, crude protein, fat, crude fiber and nitrogen free extract will be done by using the method given by AOAC (1990). Statistical Analysis: The resulting data will be subjected to some appropriate statistical techniques. Reflection | Physiotherapy Placement Reflection | Physiotherapy Placement The Department of Health (DoH) (2003) highlighted the importance for all professions currently regulated by the Health Professions Council to demonstrate competence through continuing professional development (CPD). CPD is a systematic, ongoing, structured process that encourages the development and maintenance of knowledge, skills and competency that assists us in becoming better practitioners (Chartered Society of Physiotherapy (CSP), 2003). As a result of the Health Act (1999) and for registration with the Health Professions Council (HPC), CPD is a legal requirement (HPC Standards of Proficiency, 2007) that must be completed in accordance with the (HPC) Standards of Continuing Professional Development (HPC, 2006). This essay allows for demonstration of life-long learning using evidence from clinical practice and critical evaluation to contribute to my CPD. Learning outcome 5 will be demonstrated throughout this essay. Throughout this essay the reader is directed to the appendices to support theory with evidence of practice. I considered my motivations for undertaking CPD before writing this essay and reflected upon them again on completion (Appendix 1). Demonstrate professional behaviour with an understanding of the fundamental, legal and ethical boundaries of professional practice Beauchamp and Childress (2001) identify four ethical principles; Autonomy, Beneficence, Non-maleficence and Justice. These ethical principles can be used to morally reason whether an action or decision is right or wrong when used in conjunction with a set of guidelines (Kohlberg et al, 1983). Professional codes of conduct are developed within moral, ethical and legal frameworks to help guide and regulate practice (Hope et al, 2008). Every practitioner has clinical autonomy, therefore they are professionally and legally accountable for their actions. The following will discuss the importance of consent and duty of care for both legal and ethical reasons with regards to case 1 (Appendix 2), encounterd on practice placement 6 (PP6). Rule 9 of the HPC standards of conduct, performance and ethics (2008) states you must gain valid consent from a patient for any treatment you may perform or else you could face trial for assault, battery or negligence under civil or criminal law (Hendrick, 2002). It is a fundamental ethical priniciple that every person has a right to exercise autonomy (Article 9; Human Rights Act, 1998) and is reflected in the Core Standards of Physiotherapy Practice (CSP, 2005). Performing a procedure without gaining consent, undermines the moral priniciple of respect for patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s autonomy and human dignity (Sim, 1986). However, inability for Patient X to conform to the Mental Capacity Act (2005) meant he was treated in his best intrest in adherance to section 1.5 of this act and Rule 1 of the HPC (2008) standards of conduct, performance and ethics. Assuming the medical management of Patient X, a legal and professional duty of care was established (Rule 6; HPC, 2008). As part of this duty and in accordance with standard 2 of the CSP Core Standards of Physiotherapy, all interventions were explained to patient X despite his inability to consent. Had I not treated Patient X on the basis he had swine flu, this would have been failing to do justice to him, acting outside of the Disability Discrimination Act (2005) which states everyone should have equitable access to and utilisation of services regardless of disability and also Article 14 of the Human Rights Act (1998) in that no one should be discriminated against based on their health status. The Bolam Test (1957, cited in Dimond, 1999) states if duty of care to a client is breached and subsequent harm to the patient occurs, professional standards have not been kept and therefore negligence can be assumed. Although not legally binding, the CSP rules of professional conduct effectiv ely have the same status as law and failure to comply with them means they may not only be used in disciplinary hearings but also in legal proceeding as a civil case under the tort law of negligence (Dimond, 1999; Hendrick, 2002). In summary, a sound understanding of the legal implications surrounding consent and duty of care can help avoid unwanted litigation, however they should not undermine the ethical implications. Appendix 3 demonstrates how I have learnt from this experience. Assess the needs of a range of service users and, with reference to current professional knowledge and relevant research, apply, evaluate and modified physiotherapeutic intervention A service users is anyone who utilises or is affected by a registrants service (HPC, 2008). The complex needs of a service user encompass a range of issues including social, environmental, emotional and health related, the extent of which varies from person to person. For the purpose of this essay, the physiotherapeutic management of two patients treated whilst on PP6 with differing severities of chronic obstructive pulmonary disease (COPD) exacerbations (Appendix 4) will be discussed. The National Institue for Health and Clinical Excellence (NICE) guidelines (NICE, 2004) in conjuntion with the guidelines for physiotherapy in respiratory care (British Thoracic Society (BST), 2008) advocates the use of active cycle of breathing technique (ACBT) with expiratory vibrations on the chest wall for the treatment of COPD to help aid airway clearance. Inability for patient A to comply with ACBT indicated the use of manual hyperinflation (MHI) to passively inflate the lungs and aid mucocillary transport (Ntoumenopoulos, 2005). As identified by Finer et al (1979), atelectasis is a common problem observed in mechanically ventilated patients for which MHI has been found to be beneficial in reducing it in a well controlled clinical trial by Stiller et al (1996), scoring a PEDro rating of 6/10. Absence of a cough reflex in patient A, resulted in sputum retention and the increased risk of infection indicating the use of suctioning (Pryor and Prasad, 2002) by which, copious amounts of viscous secretions were cleared. Shorten et al (1991) supports the use of saline instilation to loosen secretions prior to suctioining however, conflicting arguments by Blackwood (1999) and Kinloch (1999) question its effectiveness. Patient Bà ¢Ã¢â€š ¬Ã¢â€ž ¢s compliance with ACBT replaced the need for MHI and suctioning. Patient A developed bilateral shoulder subluxations due to his lengthy intubation for which subluxation cuffs were applied, as suggest by Zorowitz et al (1995) with positive effect. Despite this study being on stroke patients, the results can be generalised to other patient groups as proved. The importance of mobilising patients with regards to respiratory function is highlighted by Ciesla (1996), however mobilisation of critically ill patients is restricted as they are often non-ambulatory. A high quality, randomised control trial using fifty-six participants by Mackay et al (2005), identified mobilisation as superior to other respiratory techniques, therefore Patient B was encouraged to sit out and treated using a graduated walking program. In the case of Patient B, mobilisation constitutes any change in position therefore the use of postural drainage positions and positioning into the cardiac chair setting on the bed were used (BTS, 2008). The range of problems service users present with means practitioners need to be adaptable, drawing on current evidence, professional knowledge from different fields of physiotherpy practice and experiences through CPD to deliever indiviualised patient-centred care. Appraise self management of a caseload and modify practice accordingly, demonstarating effective teamwork and communication skills Caseload management typically refers to the number of cases handled in a certain timeframe by an individual for which they have a duty of care towards (Scottish Executive, 2006). It is the management of time effectively through appropriate priority-setting, delegation, and allocation of resources to meet the service demand of its users (Curtis, 2002). Self-management of a caseload and adaptability to changing circumstances is expected of a registrant (HPC, 2008). Well developed time management skills can make a workload more manageable and improve the effectiveness of treatments and quality of time with patients. Prioritising patients to the order in which they will be seen based on their needs is encouraged by SARRAH (2010), however Nord (2002) argues whether it can be justified to prioritise those in most need if their potential benefit may not be as great as those in less need. In my experience prioritisation is dependant on a variety of factors for example, the trust where PP6 was completed, enforced protected meal times which did not run alongside staff meal times. Therefore, to prevent there being a void in the day, patients were still prioritised according to need but considertation had to be given to see patients that would be eating first and treat those that would not be during protected meal times. It is essential to consider that a therapists workload includes not only patient care, but also admistrative and research tasks in which delegation to others can be a valuable stratergy to assist with workload mangement. Curtis, (1999), identifies the need for practioners to show greater awareness of other disciplines competancies so delegation can be more effective. Feedback systems should be enforced to ensure task completion and objectives are being met (Curtis, 2002). Inter-professional collaboration refers to the process by which different disciplines work together to improve healthcare (Zwarenstein et al, 2009). Poor collaboration amongst healthcare professionals contributes to problems in quality of patient care and consequently poorer outcomes (Zwarenstein and Byrant, 1997). Liaison with members of the multi-disciplinary team (MDT) is encouraged by Shortell and Singer (2008) as practitioners are less likely to work off their own autonomy, ensuring patient safety, as demonstrated during handover in (Appendix 5). The learning objectives on PP6 to develop MDT collaboration and caseload management have been achieved as demonstrated in the feedback from my educator (Appendix 6) which identifies that improvement in self confidence will allow further development of the skills discussed. Demonstrate partnership with more junior students and/or appropriate others through the development of mentoring skills Mentoring is a process aimed at transfering knowledge, skills and psycological support from a more experienced person to a less experienced person, where the desired outcome is for both persons to achieve personal and professional growth (Anderson, 1987). An effective mentor facilitates, guides and empowers the mentee in becoming an independent learner (Coles, 1996) in which the relationships developed are based upon mutal respect, trust, confidentiality and shared beliefs and values (Lyons et al, 1990). The CSP (2005) acknowledges the importance of intergrating mentorship into CPD, in which the mentor develops a range of skills transferable to other CPD activities. This section focuses on peer mentoring as a concept, its practice and clinical application on an informal basis. Having identified the characteristics of a mentor (CSP, 2005), a SWOT analysis (Appendix 7) was completed to assist recognition of my personal learning needs. There are four stages to the mentoring life cycle (Appendix 8), in which the mentor needs to adopt and develop new skills to accommodate the mentee and guide them through the process. A qualitative study using a moderate sample size by Chan and Wai-Tong (2000) encourages the use of learning contracts (Appendix 9) to help establish rapports and facilitate autonomous learning which aids progression to stage two of the cycle. This is further supported in a recent review of the literature by Sambunjak et al (2009). Gopee (2008) recognises the importance of analysing the menteeà ¢Ã¢â€š ¬Ã¢â€ž ¢s needs. Foster-Turner (2006) states that different people approach the learning process in different ways therefore, matching the learning styles of the mentor and mentee will produce a more productive and successful relationship (Mumford, 1995; Hale, 2000). Honey and Mumford (1992) suggested people tend to have a predominant learning style and can be classified as activists, reflectors, theorists or pragmatists (Appendix 10). Boud (1999) identifies raising self-awareness as an essential tool used in lifelong leaning and through analysis of learning styles using Honey and Mumfordà ¢Ã¢â€š ¬Ã¢â€ž ¢s (1992) questionnaire, this allowed for reflection on the style of learning that would best suit the mentee to help meet their learning needs (Foster-Turner, 2006) (Appendix 11). As identified by the learning style inventory, the mentee and myself were both reflective learners, therefore we arranged sessions where we could dreflect on a clinical experience and discuss how new learning could be applied to future events. A feedback form from the mentee (Appendix 12) an a SWOT analysis (Appendix 13) demonstrates how through increased self-awareness and review of the literature, I have developed a better understanding of the mentoring process, the skills required and its application in into clinical practice. Developing others is central to current and desired practice (DoH, 2000a, 2000b, 2001, 2002) in which mentorship offers all the key attributes to the process. Preparation of an individual for this role, through self assessment, is central to its success, in which the skills developed are lifelong and can enable development into management and leadership roles later on in life. Demonstrate skills of career-long learning Lifelong learning is used synonymously with CPD and is concerned with practitioners critically reviewing their skills and knowledgebase with the ultimate goal of providing a better standard of care to all service users (French and Dowds, 2008). A recent inquest into a practitioner who did not maintain his competencies, demonstrates the possible consequences of poor CPD (Appendix 14). Appendix 15 details a range of formal and informal activities that can be undertaken to contribute towards CPD, evidence of which can be documented in a portfolio. The importance of staff development is recognised by the DoH documents (2000a, 2000b, 2001, 2002) which sets out the Governments vision of an NHS that prepares allied health professionals with the skills to take advantage of wider career opportunities and realise their potential. By using the competency based framework; The NHS Knowledge and Skills Framework (2004), physiotherapists can participate in development reviews which identify development opportunities and contribute to the fulfilment of personal development plans.