A national survey of computerized decision support systems available to nurses in England

Aim  To examine the characteristics of computerized decision support systems (CDSS) currently available to nurses working in the National Health Service (NHS) in England.
Method  A questionnaire survey sent to a stratified random sample of 50% of all NHS care providers (Trusts) in England, asking respondents to provide information on CDSS currently used by nurses.
Results  Responses were received from 108 of the 277 Trusts included in the sample. Electronic patient record systems were the most common type of CDSS reported by Trusts ( n  = 61) but they were least likely to have features that have been associated with improved clinical outcomes.
Conclusions  The availability of CDSS with features that have been associated with improved patient outcomes for nurses in the NHS in England is limited. There is some evidence that the nature of the Trust affects whether or not nurses have access to CDSS to assist their decision making.
Implications for nursing management  The implementation of CDSS is increasing throughout the NHS. Many CDSS are introduced without adequate evidence to support its introduction and there is little evaluation of the benefits once they are implemented. Policy makers and nursing management should consider whether the introduction of CDSS aids nurse decision making and benefits patient outcomes.     

Modulation of m-Dinitrobenzene and m-Nitrosonitrobenzene Toxicity in Rat Sertoli-Germ Cell Cocultures

Modulation of m-Dinitrobenzene and m-Nitrosonitrobenzene Toxicityin Rat Sertoli-Germ Cell Cocultures. CAVE, D. A., AND FOSTER,P. M. D. (1990). Fundam. Appl. Toxicol. 14, 199–207. Previouswork has shown that m-dinitrobenzene is a testicular toxicantin rats In vivo, and in vitro produces comparable morphologicalchanges in rat testicular Sertoli-germ cell cocultures. m-Dinitrobenzeneis metabolized both In vivo and in the in vitro system to m-nitroani-lineand m-nitroacetanilide. These metabolites do not provoke testiculartoxicity In vivo or in vitro. We have therefore proposed a pathwayfor the metabolism of m-dinitrobenzene to m-nitroaniline andm-nitroacetanilide, which involved the intermediate m-nitrosonitrobenzene(1 -nitroso-3-nitrobenzene, NNB). When tested, m-nitrosonitrobenzene,at equimolar doses to m-dinitrobenzene, produced similar morphologicalchanges in the culture system to those exhibited by m-dinitrobenzene.However, m-nitrosonitrobenzene produced a greater toxicity thandid m-dinitrobenzene (as measured by germ cell detachment).When the intracellular thiol levels were reduced in the coculturespretreated with diethyl maleate, the toxicity of both m-dinitrobenzeneand m-nitrosonitrobenzene was enhanced. In contrast, pretreatmentof cocultures with agents known to increase cellular thiol (cysteamine)or scavenge reactive intermediates (cyste-amine or ascorbate)reduced the toxicity of m-dinitrobenzene and m-nitrosonitrobenzene.We propose that m-dinitrobenzene requires metabolic activationbefore it can exert its toxicity to Sertoli cells, and it appearsthat the toxic species is m-nitrosonitrobenzene or a furthermetabolite of m-nitrosonitrobenzene.     

PROVISION OF MEDICAL AND COMMUNITY SERVICES TO PEOPLE WITH SEVERE ARTHRITIS; AN AUDIT

We have identified severely disabled arthritics who live inthe community through social service records. All had eitherrheumatoid arthritis (RA) or osteoarthritis (OA). The diagnosisinfluenced referral to hospital, those with RA being referredwhile only half of those with OA had been referred. Referralwas important for both surgical and environmental intervention.Provision of social services and community occupational therapyservices was greater if the patients had been seen in hospitaldepartments irrespective of the diagnosis. Recipients of jointsurgery had all gained temporary benefit although progessionof arthritis or other disabling disease compromised this afterseveral years. There was a sub stantial minority of people withsevere OA living in the community who had not been consideredfor joint replacement and did not have optimal provision ofaids, appliances and environmental adaptation. KEY WORDS: RA, OA, Disability, HAQ, Joint surgery, Occupational therapy, Community support, Outcome     

RETINOPATHY IN MICE WITH EXPERIMENTAL SCRAPIE

Scrapie is a naturally occurring neurological disease of adult sheep and goats with an incubation period of several years. Some strains of the causal agent can infect laboratory mice in which the incubation period, as well as the severity and distribution of vacuolar degeneration in the brain, varies according to the strain of the agent and the genotype of the mouse. Retinopathy, involving the partial or complete loss of the photoreceptor layer, was observed in a number of murine scrapie models but was absent in others. The severity of retinopathy depended on both the strain of scrapie and the genotype of mouse used. Some scrapie strains (22C, 87A and 87V) produced minimal or no retinal pathology, others (ME7, 22A and 22L) produced changes in the retinae of only certain mouse genotypes, while the strains 79A and 139A produced degeneration of the photoreceptor layer in every mouse genotype investigated. The severity of retinopathy in the various models did not correlate with the overall intensity of vacuolar degeneration in the brain, with the severity of vacuolation in the centres in the brain controlling pupillary constriction, or with the incubation period.     

1992 and the Consumer

This paper summarises the journey so far towards the ‘single market’. Consumers may expect to benefit from increased choice and cheaper prices but the possibility that quality, as judged by % of characterising ingredient, will be lowered, is a cause for concern. The consumer will have to rely increasingly on labels, assuming that the label information is adequate. Quantitative ingredient information is desirable but provides technical difficulties for manufacturers. A voluntary ‘quality mark’ scheme could be a satisfactory replacement for compositional standards but would have to be carefully controlled by independent assessors. The abolition of frontier controls creates a dilemma between the desire to have free trade within the community and the need to give a high priority to public health.     

The efficacy of Dementia Care Mapping as an audit tool: Report of a 3-year British NHS evaluation

Dementia Care Mapping (DCM, Kitwood & Bredin, 1994a) was incorporated into the Quality Assurance Strategy of an urban British Mental Health (NHS) Trust. Its role as an audit of the outcome of the care process in formal dementia care settings was evaluated. DCM was used in two day hospitals, an assessment ward, two respite care units and four continuing care units over three annual evaluation cycles. This equated to approximately 1,614 hours of mapping over the three cycles. The way in which DCM was used is described in detail. The results were generally very positive with improvements in the quality of care practice being demonstrated. Although anxious about the observational nature of DCM, staff viewed it as a positive means of improving quality of care. DCM is seen as being a highly appropriate audit tool to use in NHS formal dementia care settings. Information on the experience of managing a DCM project is shared.