Statistical discrimination in the presence of selection effects.

Discrimination between diseases is a complex task. Cases may present contradictory information and diseases can present with unusual or atypical symptoms. In many diagnostic problems the recorded diagnosis is either a true diagnosis, based on hard evidence, or a working diagnosis, not necessarily equivalent to the true underlying disease with an associated level of uncertainty.

Implementing the Essence of Care benchmark for pressure ulcers.

Since The Essence of Care (Department of Health, 2001) was launched there have been many publications about the document and the process of benchmarking. This paper will focus specifically on the implementation of the benchmark for pressure ulcers.

Development of clinical guidelines for prone positioning in critically ill adults.

Literature reveals evidence that prone positioning can improve the oxygenation of critically ill patients suffering from acute lung injury or acute respiratory distress syndrome. Multicentre evidence, however, does not support the claim that it improves patients' outcome. The implementation of multiprofessional guidelines by which to direct the manoeuvre will facilitate the safe and effective management of patients in the prone position.

Venography at insertion of tunnelled internal jugular vein dialysis catheters reveals significant occult stenosis.

Background: Tunnelled catheters are widely used to provide vascular access for haemodialysis. Percutaneous insertion of these catheters requires large calibre tissue dilators with the potential to cause trauma to central veins, particularly if anatomical abnormalities are present.

Methods: We evaluated the use of venography to identify central vein anatomical abnormalities in 69 consecutive patients undergoing percutaneous placement of tunnelled right internal jugular vein catheters.

A pilot randomized trial assessing the effects of autogenic training in early stage cancer patients in relation to psychological status and immune system responses.

Autogenic training (AT) is a type of meditation usually used for reducing stress. This pilot study describes how AT was used on a group of early stage cancer patients and the observed effect on stress-related behaviours and immune system responses. This was a randomized trial with 31 early stage breast cancer women, having received a lumpectomy and adjuvant radiotherapy.

Patient involvement. The Derby Theatre Project experience.

Patient involvement adds power and value to service redesign. Patient views can be extremely powerful when influencing clinical staff. They also provide a strong management case for change.

Advanced practitioners within the operating theatre.

While the role of the nurse within theatre is yet to be defined (NATN has set up a working party to define this), some theatre practitioners are being described as advanced practitioners and certain types of theatre practice are being labelled as advanced or extended. What constitutes advanced practice has implications for theatre practitioners, their professional development, their competency-based salaries and how they are viewed by other nurses outside their specialism.

Recruitment and retention. The Derby Theatre Project experience.

The National Theatre Project was set up in March 2001 by the Modernisation Agency to improve the patient and carer experience, improve employee satisfaction, optimise theatre utilisation and reduce cancelled operations. This is the second article in the series where David Ainsworth, manager of a pilot site project in Derby, describes issues around the Theatre Project. This month the focus is on recruitment, retention and staff morale.

Managing a national pilot site project. The Derby Theatre Project experience.

The National Theatre Project was set up in March 2001 by the Modernization Agency to improve the patient and carer experience, improve employee satisfaction, optimise theatre utilisation and reduce cancelled operations. This is the first in a series of four articles, looking at issues involved in managing a national project, improving operating theatre performance and how to engage the organisation in innovation and change.

Early warning system scores and response times: an audit.

In response to NHS reforms within critical care, the surgical directorate of the Southern Derbyshire Acute Hospitals NHS Trust developed and introduced a modified early warning system (DMEWS). Anecdotal evidence from nursing staff indicated that response times by doctors, when triggered by use of the DMEWS, were outside the established timescale. An audit was undertaken to determine the response times to calls for assistance triggered by use of the DMEWS and to identify any disparity between response times.

A clinical evaluation of ophthalmic assessment in children with sensori-neural deafness.

Background: Since 1991, children with sensori-neural deafness and their families within Southern Derbyshire have been supported by a multiagency approach to their diagnosis and management.

Results: One hundred and twenty-two children were seen at the Child Development Centre for an holistic assessment, and 110 of these children have had an ophthalmic assessment, of whom 48 (43.6%) were found to have ophthalmic abnormalities.

Temperature taking: children's preferences.

Children aged between six and 15 years on two paediatric wards of one NHS trust were invited to take part in a study to find out whether they preferred digital underarm thermometry or tympanic thermometry. The study was conducted as part of the Nursing and Midwifery Research and Practice Development Project for the Southern Derbyshire Acute Hospitals NHS Trust. In the six to ten year age group (n = 39), 74 per cent of the children preferred the tympanic thermometer, as did 91 per cent in the 11-15 year age group (n = 44).

Percutaneous endoscopic gastrostomy (PEG): change in practice since 1988.

Background And Aims: We previously reported a 30-day mortality following percutaneous endoscopic gastrostomy (PEG) of 8% (1988-92). Concerns over increasing mortality rates prompted us to survey current practice compared with 1988-92: assess case mix, outcome, risk factors for early death, and review practice guidelines.

Methods: 78 consecutive adults were referred for PEG over 7 months.

Improvements in total mortality and lipid levels after acute myocardial infarction in an English health district (1995-1999).

Objectives: To quantify changes in 30 day and one year mortality among patients with acute myocardial infarction in southern Derbyshire (population 560 000) in each of five consecutive years (1995-1999) before the publication of the National Service Framework for coronary heart disease, and to assess the proportion of one year survivors in whom serum lipids were measured and were below target values.

Design: All hospital admissions coded on the patient administration system (PAS) as "AMI" (ICD codes I-21, I-22, and I-23) and with a creatine kinase measurement in the pathology database were identified over a five year period (n = 4912). All deaths in the district are automatically notified to the PAS.

Clinical efficacy of Comfeel Plus Transparent Dressing.

Hydrocolloid dressings have been in use for more than 20 years. They are indicated for the treatment of granulating, superficial wounds with low to moderate exudates. There are a number of hydrocolloid dressings available, one of which is Comfeel Plus Ulcer Dressing.

Microvascular vasodilator response to acetylcholine is increased in women with pre-eclampsia.

Objectives: To evaluate in vivo microvascular responses to incremental doses of the endothelial-dependent vasodilator, acetylcholine, and the endothelial-independent vasodilator, sodium nitroprusside, in women with pre-eclampsia and gestation-matched normotensive pregnant controls.

Design: Prospective clinical study.

Setting: Southern Derbyshire Acute Hospitals Trust, and University of Nottingham Division of Vascular Medicine.

Co-existence of lysosomal storage diseases in a consanguineous family.

Lysosomal storage diseases are rare and coexistence of more than one in a family can present a diagnostic challenge as illustrated by this study. The index case born to consanguineous Asian parents presented with developmental delay. Investigations led to an incidental finding of Fabry disease.

Dynamic foot orthoses. Principles and application.

Previous research has identified areas under the foot where stimulation evokes specific tonic reflexes. The term "tonic" is used because these reflex movements occur slowly, as if tonus or tension were accumulating, in contrast to the abrupt phasic response of a tendon jerk. The concept of tonic reactions has now been incorporated into the design of dynamic foot orthoses to help provide improved orthotic treatment with a better functional outcome.