New approaches to the treatment of venous leg ulcers.

Increased understanding of the pathology of leg ulcers has made the differences in the pathologies of leg ulcers between patients more apparent. This article examines some areas of research that are advancing our understanding of the pathology of venous leg ulcers. The impact that this information is having on the development of new therapies and the implications for nursing practice are discussed.

Overcoming the barriers: national to European to G7.

An information revolution is underway which will have an impact on all sectors of society. It will fundamentally change national and international health systems. The global Internet is a key influence and will change the balance of power within and between healthcare professions, and between them and the general public.

Primary care. Life after LIZ (London Initiative Zone).

A survey of primary care initiatives in casualty departments in North Thames found confusion over aims and managerial accountability. Nurses and GPs staffing these projects often overrode the triage decisions made by casualty staff. The schemes lacked the information systems required for a full analysis of costs and benefits.

Clinical specialty and organizational features of acute hospital wards.

Ward clinical specialty is a variable which has been largely ignored in studies of nursing organization and effectiveness. Analysis of data collected from a nationally representative sample of 83 acute medical, surgical and orthopaedic hospital wards demonstrates that while wards had similar staffing resources, differences exist in the likelihood of adopting a nursing organizational system with devolved authority, in nurses' views of prevailing hierarchical attitudes, and their perceived influence over a range of organizational features of the ward. Medical wards were more likely to have developed organizational practices associated with increasing nursing autonomy.

Evidence-based medicine.

Evidence-based medicine (EBM) is advocated by its protagonists as prototypical of, and therefore normative for, 'best professional practice', a position which has precipitated visceral anti-EBM sentiments within the international medical press. This article examines the nomenclature, claims, principles and practice of EBM, the matters of authority and competence in defining evidence for practice and how selective utilization of EBM findings will be employed by health service managers in an attempt to manage clinical decision making and ration the medical care of patients and populations.

Photophobia and phonophobia in migraineurs between attacks.

This study investigated whether migraineurs are more sensitive to light and sound while headache-free than are healthy people. Fifty-two migraineurs (mean age 39 years) were selected using the International Headache Society diagnostic criteria for migraine. Forty-eight healthy controls were matched for age, sex, and race (mean age 36 years).

The development of an approach to evaluate NHS manager's competence in medical informatics.

This paper describes the research and development of Checkpoint, a self-assessment instrument. It outlines how the instrument has helped managers in the NHS identify their strengths and weaknesses with respect to their management and use of informatics. The paper presents trends and feedback from the use of Checkpoint and the implications for future education and training of managers in the NHS.

Telephone assessment and advice: a training programme.

Nurses have become increasingly involved in providing telephone assessment and advice, and telephone triage is emerging as an important part of the everyday role that nurses can play in A&E, general practice and other community settings. This article describes a project to prepare staff to fulfil this role.

Italian ideals.

Many reports have been published in the UK about the reform movement in the Italian mental health system, but there has been a relative dearth of information on the practice of psychiatric nursing. Here the author reflects on differences and similarities with Italian colleagues and calls for greater dialogue between psychiatric nurses in the two countries.

Representing the assessment process for psychodynamic psychotherapy within a computerized model of human classification.

This research describes a computerized model of human classification which has been constructed to represent the process by which assessments are made for psychodynamic psychotherapy. The model assigns membership grades (MGs) to clients so that the most suitable ones have high values in the therapy category. Categories consist of a hierarchy of components, one of which, ego strength, is analysed in detail to demonstrate the way it has captured the psychotherapist's knowledge.

Developing a symptom distress scale for terminal malignant disease.

Symptom control is an important component of palliative care. The degree of distress caused by symptoms is individual. Instruments to measure symptom distress in patients with cancer have been developed, but have been poorly validated in the terminally ill.

Informal family caregiving to older people with dementia: research priorities for community psychiatric nursing.

The paper reviews the literature relating to the provision of community psychiatric nursing to demented elderly people and their informal family caregivers, and develops priorities for research in that particular area of nursing. Initially, the development of community psychiatric nursing with elderly demented people is examined. Various theoretical models articulating the family's experience of dementia are examined as a basis for identifying various priorities for research in the area.

A descriptive study of the work of community psychiatric nurses with elderly demented people.

This study examines the work of community psychiatric nurses (CPNs) with elderly demented people. A total of 14 cases, taken from the caseloads of four CPNs, were examined by direct observation of CPNs' practice and in-depth interviews. The data were analysed using a method suggested by Dey (1993).

Central dimensions of clinical practice evaluation: efficiency, appropriateness and effectiveness--II.

That a treatment selected for a given condition works, or that it works better than alternative treatments, or that it was selected because it works as well as but is cheaper than alternative treatments, should be of pivotal concern to clinicians and is of central concern to patients and to health care managers. Attempts to address these concerns have resulted in what is now widely termed the 'effectiveness movement'. The protagonists of the movement have been concerned to create a culture of evaluation and inquiry within which the formulation of evidence-based clinical guidelines and their introduction into routine practice have played a prominent part.

Kitwood's approach to dementia and dementia care: a critical but appreciative review.

This paper critically examines the recent work of Tom Kitwood and his colleagues at the Bradford Dementia Group. After initial details relating to Kitwood's early work and the development of the research group, the paper sets out Kitwood's ideas regarding the nature of dementia and dementia care. Four areas of contribution made by Kitwood are outlined.

The Total Health Care Audit System: a systematic methodology for clinical practice evaluation and development in NHS provider organizations.

Writing in Medical Education in 1982, Fowkes (1982) noted the lack of general agreement within the medical profession on methods of audit, a deficiency previously articulated by Shaw (1980) and later emphasized by McIntyre (1985). More recently, a study by Black & Thompson (1993) of consultant and junior medical staff in four London district general hospitals revealed that 'many doctors did not understand how to undertake audit', and major research by both Hopkins (1993, 1994) and Buttery et al. (1994) described a multiplicity of methodological deficiencies in the general approaches to audit adopted by clinicians since the promulgation of the White Paper definition in 1989.

Clinical audit in the National Health Service: fact or fiction?

It is increasingly recognized that the repeated rhetorical emphasis from 1989 to date on achieving measurable benefits to patients from audit, in the face of inattention to the development of methodologies with which to realize such benefits in operational practice, has represented a serious deficiency in strategic planning and direction and a consequent failure to establish functional clinical audit within the NHS. A grand revision of strategy is therefore necessary, and this should begin with the development of a research-based method of audit, the training of clinicians and audit support staff in its use and a subsequent trial of its effectiveness prior to its implementation within the NHS. Only then will measurable improvements become possible, value for money be assured and clinicians' attitudes to audit change.

Information sources used in decision making: considerations for simulation development.

Simulation tasks, together with think aloud techniques are often used to research the cognitive processes individuals go through when making a decision or solving a problem. They have been utilised to a certain degree within nursing. A study was carried out to try and identify the sources of information nurses in acute medical and surgical wards used to make assessment judgements.

Express delivery.

It is against the law in this country for anyone other than a midwife or a registered medical practitioner to contract with a woman to deliver her baby ( 1 ). It is not unknown, however, for babies to arrive suddenly, without allowing enough time for the midwife to arrive or the woman to get to a hospital in time for the contract to be fulfilled. It is only in a case of sudden or urgent necessity' that an exception is made.