Comparing and contrasting knowledge of pressure ulcer assessment, prevention and management in people with spinal cord injury among nursing staff working in two metropolitan spinal units and rehabilitation medicine training specialists in a three-way comparison.

AIM: To assess for differences in knowledge of pressure ulcer (PU) prevention and management among nurses working in two metropolitan spinal cord injury (SCI) units, and between nurses and rehabilitation registrars (doctors). BACKGROUND: There is anecdotal evidence of wide variation in PU management. An understanding of current knowledge is fundamental to evidence-based practice implementation. METHODS: This was a prospective survey, using a multiple choice question format developed with nurse wound specialists. A total of 10 questions assessed PU prevention and 10 assessed management. It was distributed to nurses working at the spinal units and rehabilitation registrars. The results from the groups were analysed for similarities and differences using one- and two-way analysis of variance (ANOVA) tests and tests for significance of specific linear combinations of group means. RESULTS: The response rate was 79% (19/24) and 71% (20/ 28) from the two SCI units, and 46% (13/28) from doctors. Doctors performed better than nurses on prevention questions (P<0.005) but worse on management (P<0.05). There was a significant difference in management knowledge (P<0.001) between nurses working in the two units but not in prevention knowledge (P<0.5) and interestingly years of experience did not correlate with performance (P<0.2 for prevention and P<0.5 for management questions). CONCLUSIONS: Rehabilitation registrars score better in prevention questions, but poorer in management questions, which reflects academic rather than experiential knowledge. There are also differences in management knowledge among nurses, based on work area rather than years of experience. Although knowledge does not necessarily reflect practice, this calls for better standardisation and implementation of wound management pathways.

The impact of operations competitive priorities on hospital performance.

A notable lack of empirical analysis exists on hospital operations strategy in spite of widespread debate on quality, cost, and service delivery-issues which are widely included within the realm of operations competitive priorities. We empirically examine the degree of emphasis placed by administrators on competitive priorities and what impact this might have on performance of not-for-profit, general hospitals. Performance is defined as a composite of financial and operational performance. Our research shows that management's emphasis of cost containment and service delivery consistently results in superior business performance. Quality programs are found to be the most preferred competitive priority initiative, yet show relatively low relation with performance. This suggests that quality programs are a necessary, though not sufficient, component of hospital operations strategy. The competitive dimension of flexibility is being employed, but on a less universal scale. We conclude that administrators are not yet sufficiently skilled in the flexibility priority to make this dimension consistently result in superior business performance.

Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients.

OBJECTIVE: Relationships among different dimensions of patient satisfaction and selected demographic, clinical, and outcome variables were explored in a sample of severely ill people receiving inpatient psychiatric services. METHOD: The sample consisted of 81 patients admitted to and discharged from an inpatient psychiatric unit at a midwestern Veterans Affairs medical center. Stepwise multiple regression was used to examine the relationship between patient satisfaction and self-reported changes in quality of life, symptomatology, and level of functioning as measured by the Treatment Outcome Profile. Other variables such as diagnosis, length of stay, employment, living situation, and prior psychiatric and substance abuse treatment were also considered. A subsample of the most satisfied and dissatisfied patients was chosen to further explore variables contributing to satisfaction with services. RESULTS: Patient satisfaction was related to initial level of functioning, certain diagnoses, and treatment gains. Clinicians were highly accurate in identifying patients who were satisfied, based on blind chart reviews. CONCLUSIONS: This study underscores the significant relationships between patient satisfaction, psychiatric diagnosis, and other outcome measures, and argues for the validity and utility of patient satisfaction measures in assessing the efficacy of inpatient care.

De Clérambault syndrome (erotomania) in the criminal justice system: another look at this recurring problem.

While de Clérambault syndrome (erotomania) has long been a subject of scientific study, it has only recently become a frequent topic of media attention. A series of five individuals who were arrested for crimes related to their erotomanic delusion are presented. The psychiatric findings from this sample have potential social policy implication.

Economic motivation for smoking cessation in chronic psychotic patients.

For many chronic psychotic patients the sole motivation to discontinue tobacco smoking may involve economic reasons. As institutions increasingly adopt no-smoking policies, economic motives for smoking cessation may take on added importance in assisting this population with smoking cessation.