Explaining variation in GP referral rates for x-rays for back pain.

Background: Despite the availability of clinical guidelines for the management of low back pain (LBP), there continues to be wide variation in general practitioners' (GPs') referral rates for lumbar spine x-ray (LSX). This study aims to explain variation in GPs' referral rates for LSX from their accounts of the management of patients with low back pain.

Methods: Qualitative, semi-structured interviews with 29 GPs with high and low referral rates for LSX in North East England.

Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: a cohort study.

Background: The pathology literature suggests three types of pressure ulcer with six possible mechanisms leading to tissue breakdown. A limitation of current evidence is the difficulty in replicating the clinical situation and in determining the point at which a tissue assault becomes irreversible and results in tissue breakdown. In particular clinical observations of alteration in darkly pigmented skin, blanching erythema, non-blanching erythema and non-blanching erythema with other skin changes including induration, oedema, pain, warmth or discolouration have not been assessed in relation to subsequent skin/tissue loss and their pathophysiological and aetiological importance is not fully understood.

Pathology, diagnosis, and classification of pressure ulcers: comparing clinical and imaging techniques.

Pressure ulcer classification systems are based on the clinical manifestations of the skin and tissue layer affected rather than underlying pathology. The objective of this study was to compare the validity of the clinical grading of erythema (blanching and nonblanching) with a measurement of skin perfusion. Therefore, an exploratory study comparing erythema with laser Doppler imaging of the sacrum and buttock skin areas was undertaken.

Promoting brief alcohol intervention by nurses in primary care: a cluster randomised controlled trial.

This trial evaluated the clinical impact and cost-effectiveness of strategies promoting screening and brief alcohol intervention (SBI) by nurses in primary care. Randomisation was at the level of the practice and the interventions were: written guidelines (controls, n=76); outreach training (n=68); and training plus telephone-based support (n=68). After 3 months, just 39% of controls implemented the SBI programme compared to 74% of nurses in trained practices and 71% in trained and supported practices.

Organization of nursing care as a determinant of job satisfaction among hospital nurses.

This study examined the relationship between methods of organizing nursing and employee satisfaction. Data were collected from 26 ward sisters and 568 nurses working in 26 bed wards with different stabilized nursing models. Methods of organizing nursing, such as primary, modular, team and functional nursing, were associated with job satisfaction.

Staffing in acute hospital wards: part 2. Relationships between grade mix, staff stability and features of ward organizational environment.

This paper explores relationships between grade mix, staff stability, care organization and nursing practice. The data were collected in the mid-1990s from a nationally representative sample of 100 acute hospital wards and 825 nurses. Analyses provides important insights for managers seeking to achieve the strategic aims set out in consecutive National Health Service (NHS) human resource management policies.

Staffing in acute hospital wards: part 1. The relationship between number of nurses and ward organizational environment.

This paper is one of two that explores relationships between nursing staff resources, ward organizational practice and nurses' perceptions of ward environments. Here we examine relationships between staff numbers, care organization and nursing practice. A subsequent paper examines the effects of grade mix and staff stability.

The relationship of perceived control to outcomes in older women undergoing surgery for fractured neck of femur.

This paper examines the relationship between internal locus of control and recovery from surgery for fractured neck of femur in women over the age of 65 years, in order to inform strategies for nursing care. Structured interviews were carried out at 5 and 30 days postsurgery with 112 women (mean age 78.6 years) in five general hospitals in the North of England.

A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care.

Background: Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs.

Aims: This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited.

Patient-held records in cancer and palliative care: a randomized, prospective trialt.

Objectives: To evaluate prospectively the introduction of a patient-held record (PHR) in the management of patients with advanced cancer and palliative care needs.

Design: a) A prospective, parallel group, randomized controlled trial. b) A postal survey of the opinions of health professionals whose patients had a PHR.