Essence of care involving nursing students

In 2001 the Department of Health published The Essence of Care, which aims to improve patient care by identifying and measuring good practice benchmarks. Educators and trainers need to integrate such initiatives into course curricula and develop innovative approaches to enable the contribution of nursing students. This paper describes the initial phase of collaborative work between the University of Southampton's School of Nursing and Midwifery and the local NHS trust which was designed to achieve these aims, including the development of a good practice evaluation tool which students complete at the end of their clinical placements.     

Legal issues in alternative health care

This article reviews the use of alternative and complementary health care practices by orthodox medical practitioners. Many alternative modalities such as chiropractic, acupuncture, naturopathic, and homeopathic treatments are available, and modern patients who are increasingly "consumer-oriented" and educated may inquire about these treatments. The article examines issues of informed consent, standards, procedures, and liability as they relate to a medical practice that opts to provide alternative treatments.     

Predictors of door-to-balloon delay in primary angioplasty

In the treatment of acute myocardial infarction, delayed reperfusion therapy is associated with increased mortality. Predictors of delay have been described for fibrinolysis but not for primary percutaneous transluminal coronary angioplasty (pPTCA). Therefore, we studied 40,017 consecutive patients with acute myocardial infarction who underwent pPTCA in the National Registry of Myocardial Infarction between June 1994 and April 2000. Median door-to-balloon times were calculated, and factors independently associated with a delay of >120 minutes were determined by logistic regression. The median door-to-balloon time among all patients was 111 minutes (interquartile range 84 to 152). The proportion of patients with a delay of >2 hours was greater among those aged > or = 65 years (49% vs 41%), women (50% vs 42%), patients with contraindications to fibrinolysis (60% vs 41%), and those without chest pain on admission (61% vs 43%, all p <0.0001). Delay was also more common with transfer from another hospital (87% vs 38%), with presentation outside the hours of 8 A.M. to 4 P.M. (51% vs 38%), and in hospitals performing <49 pPTCAs/year (47% vs 41%, all p <0.0001). The strongest independent predictor of delay was hospital transfer, along with non-daytime presentation and low-volume centers. Older age, female sex, and non-white race were weaker predictors. Both patient and hospital factors are associated with delay in pPTCA after presentation. These findings may help design treatment algorithms to minimize delay, thus improving the survival benefit of pPTCA. These results may also help design trials of combination reperfusion strategies.