Palliative treatment of an enterorectal fistula with a covered metallic stent.

In patients with recurrent colorectal cancer, the development of fistulae presents a difficult therapeutic problem. The traditional surgical approach of resection and intestinal diversion may not always be appropriate in those with disseminated or terminal disease. We present the successful use of a covered esophageal stent to occlude an enterorectal rectal fistula in a patient with recurrent inoperable colonic carcinoma.

Prospective evaluation of ultrasound in distal ileal and colonic obstruction.

Aim: To evaluate prospectively the usefulness of ultrasound in determining the site and cause of distal small bowel and colonic obstruction.

Materials And Methods: Ultrasound findings in 60 consecutive patients with suspected distal ileal or colonic obstruction were correlated with final surgical and radiological diagnoses. The diagnostic value of ultrasound was compared with plain abdominal radiography (AXR) for the presence and level of obstruction.

Implementing change in the National Health Service.

This paper will outline the current changes being imposed on the National Health Service. The literature on change management will be employed to propose some guidelines for health service managers. The National Health Service (NHS) spent much of the 1980s and 1990s learning about the transition from administration to management and must now make the transition from management to leadership.

Caring together: clinical supervision.

Clinical supervision is an effective learning and development tool which nurses, and other healthcare professionals, can use to promote and maintain high standards of patient care. This Unit explains the concept behind clinical supervision and looks at the work carried out nationally to develop its use in practice. Clinical supervision has been shown to offer many benefits for the individual practitioner, the supervisor and the organisation and these are discussed in detail; as are the various methods and models which can be employed to implement clinical supervision.

Student supervision: myth or reality?

This paper is based on the early findings of a qualitative longitudinal study using a grounded theory approach to analysis. A cohort of Project 2000 students and their clinical supervisors were observed in 10 different ward settings and interviewed prior to leaving the setting. A non-participant observation technique was utilized, noting the students' interactions with their deemed supervisors.

The problem of motivating teaching staff in a complex amalgamation.

This paper addresses some of the problems brought about by the merger of a number of schools of nursing into a new complex amalgamation. A very real concern in the new colleges of nursing and midwifery in the United Kingdom is the effect of amalgamation on management systems and staff morale. The main focus of this paper is the motivation of staff during this time of change.

Nothing left.

There have been many letters and much comment in the Nursing Standard arid national newspapers on the subject of nurses' pay, including special duty payments.