An empirically-derived clinical placement evaluation tool: a 3-country study.

We report the development of a brief and simple-to-complete clinical placement evaluation scale. Unlike many previous attempts to develop such tools, the one reported here gives reliable numerical scores with a firm empirical foundation. The scoring correlates well between three European countries: UK, Finland, and Germany.

Postoperative wound blistering: is there a link with dressing usage?

Practitioners on an orthopaedic ward used three different types of dressing on two groups of 100 patients who had undergone hip or knee operations, and compared the number of blisters that resulted. They describe their findings.

Smoking--do vascular surgeons practise what they preach?

Smoking is a major health problem in Great Britain and cigarette consumption is rising. Although there are studies concerning the smoking habits of hospital physicians, nurses and oral and maxillofacial surgeons, little is known about the smoking habits of vascular surgeons and the advice given by them to their patients. A questionnaire survey was conducted involving 422 members of the Vascular Surgical Society of Great Britain and Ireland. The response rate was 74%. The median age of responders was 51 years (range, 32-69 years) of whom 98% were men. Of responders, 98% routinely advise patients to stop smoking, 10% advise nicotine gum/patch, 39% provide antismoking information sheets, 11% are involved in an antismoking clinic/group and 74% check to see whether patients continue to smoke. The majority of responders would be prepared to offer revascularisation in patients who continue to smoke. Only 8 surgeons (3%) would not advise revascularisation in this group of patients. Only 10% of respondents were current smokers, 37% were ex-smokers and 53% had never smoked. Vascular surgeons, therefore, seem to practise what they preach.

Mortality from ruptured abdominal aortic aneurysm in Wales.

BACKGROUND: The aim of this study was to identify the incidence of, and mortality in, patients with a ruptured abdominal aortic aneurysm (AAA) reaching hospital alive in Wales. METHODS: Patients who presented with a ruptured AAA between September 1996 and August 1997 were analysed. Data were collected prospectively by an independent body, observing strict confidentiality. RESULTS: Some 233 patients with a confirmed ruptured AAA were identified, giving an incidence of eight per 100 000 total population. Some 133 patients (57 per cent) underwent attempted operative repair; 85 (64 per cent) of these died within 30 days. Of the 233 patients, 92 were admitted under the care of a vascular surgeon and 141 under a non-vascular surgeon. Vascular surgeons operated on 82 patients (89 per cent), of whom 50 (61 per cent) died, whereas non-vascular surgeons operated on 51 patients (36 per cent), of whom 35 (69 per cent) died. DISCUSSION: This study is unique as it is an independent prospective study of mortality in patients with a ruptured AAA who reached hospital alive. Mortality was independent of the operating surgeon, but vascular surgeons turned down significantly fewer patients than non-vascular surgeons (11 versus 64 per cent, P < 0.001).

Can feedback be individualised, useful, and economical?

An important, but often neglected, part of any research or audit exercise is the reporting back to participants of the results of that exercise. When feedback is made, it is often of a general, aggregated nature. Considerations of cost and psychological factors usually preclude feedback to individuals. As part of a larger study we have developed a prototype mechanism for providing such individual feedback. This was done by writing a computer program which automatically generated the report, using rules on how to interpret different patterns of responses to a questionnaire. Previous qualitative evaluation had shown a positive response from participating nurses. The current small-scale study reports a more formal evaluation. Participants who received reports on the degree to which their ward was practising primary nursing overwhelmingly found the reports readable, informative, encouraging, accurate and useful.

Applying lexical and semantic analysis to the exploration of free-text data.

A substantial study of primary nursing involving the authors ( 1 , 2 ) generated, in addition to the pre-coded data, a large number of free-text responses. We decided to investigate whether these less structured data could help to categorise and understand the leadership styles of ward sisters in the sample.

Research-based measurement tools in the audit process: issues of use, validity and reliability.

The National Health Service is in a period of extensive reform. Value for money is now a key objective. As a consequence, audit has become a widely used concept and activity. There has been some discussion in the literature of the use of tools for measurement in audit. These tools have mainly been used to measure outcomes. When they are used in isolation from other measures, an incomplete picture can result. Closs and Tierney ( 1 ) have noted that the current vogue for outcomes in NHS research has resulted in a less than complete evaluation of the phenomena under study, largely because the structures and processes are not being measured in parallel with the outcomes. Thomas and Bond ( 2 ) also noted that research has tended to concentrate on the outcomes of care, and that structures and processes are left assumed and undefined, thus making it impossible to link outcomes (favourable or unfavourable) to specific features of nursing input in particular. This has meant that the actual processes have tended to remain somewhat obscure.

Automating ward evaluations: a tentative first step.

Auditing nursing practice is a time-consuming, error-prone task. Feedback to individuals is highly desirable but usually is not offered. This is particularly difficult in large-scale studies. In this study of 654 wards a new method was attempted. Structured questionnaires were analysed by a computer program and feedback reports generated automatically. Informal evaluations by the initial recipients are positive and the method seems worthy of future development.

Handedness and hand injuries.

Data are reported from a study of 1,003 patients attending with hand injuries at an Accident and Emergency Department. Among both left- and right-handers, injuries to the right hand were more common than to the left hand, except for accidents to right-handers at work. For this group there were more injuries to the left hand. Male and female patients differ in the frequency with which they present for medical attention but show similar types of injury.

Good relations: the use of a relational database for large-scale data analysis.

This paper reports our experience of analysing what may well be one of the largest datasets gathered on nursing practice in the United Kingdom. The study produced both quantitative and qualitative data and a method had to be devised both for analysing each form of data and for relating the two. An inexpensive relational database was chosen for the purpose, and experience of using it is reported. Detailed examples are given. We look at the strengths and weaknesses of such a tool, and in general it received a positive evaluation. For many nursing research projects, it offers some advantages over a conventional statistical package, especially in the following areas: offering ease of use, and hence control of the data, by the domain (nursing) specialist; facilitating the analysis of free-text data; allowing the linking of free-text and structured questionnaire data; permitting the testing of conjectures which arise during analysis; handling varying amounts of data per case; providing non-redundant storage of data; permitting the association of machine-readable codes and human-readable labels; and encouraging an exploratory rather than merely analytical approach.

Anxiety and the measurement of handedness.

University students completed Annett's (1970) Handedness Inventory (n = 254) and the Trait Scale of the Spielberger Anxiety Questionnaire (n = 247). No relationship was found between anxiety and the hand preference classes distinguished by Annett (1970). Discrepancies between these findings and others reported in the literature are attributed to methodological factors concerning the measurement of handedness.