The implications of Project 2000 and the formation of links with higher education for the professional and academic needs of nurse teachers in the United Kingdom

A national study was conducted between 1991 and 1994 to explore and describe the changing role of the nurse teacher following the introduction of Project 2000 pre-registration nursing courses. Multiple methods were used to collect data from a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). This paper presents the findings relating to the impact of Project 2000 and the move into higher education on the continuing educational needs of nurse teachers. Views on college strategies for staff development, the changing nature of teachers'academic and professional development needs and the problems of the conflicting demands experienced are reported. The research highlights the need for clinical credibility to be clearly defined in relation to nurse teachers and for educational institutions to place more emphasis on teachers'clinical development if the rhetoric of policy is to become a reality.     

Attitudes of College Football Officials Regarding NCAA Mouthguard Regulations and Player Compliance

The National Collegiate Athletic Association (NCAA) mandates the use of brightly colored, intraoral mouth- guards by football players to reduce the frequency and severity of craniofacial and intraoral morbidity and mortality, and to enhance the ability of officials to observe player compliance. The purpose of this 12-question mail survey was to determine the attitudes of on-Held game officials regarding current NCAA mouthguard regulations and patterns of utilization by college football players. The sample consisted of all 50 Big East Football Conference officials; a response rate of 100 percent was achieved. Only 42 percent of the officials reported observing all players in compliance, and quarterbacks were identified by others as the least compliant group (52%). The majority (88%) indicated that the 1990 rule for brightly colored mouthguards had been beneficial to them in determining player compliance, and 52 percent reported that this rule had resulted in more frequent use by these athletes. Nearly all officials (96%) indicated that they would issue a warning for noncompliance to the player or coach, rather than charging a timeout for a violation as prescribed by NCAA regulations. The majority (70%) believe current enforcement is appropriate, but expressed the opinion that coaches should be held more accountable for player compliance.     

Alcohol Use among Drug Abusers: Treatment Outcomes in a Therapeutic Community

Male and female dropouts and graduates (N = 248) from a traditional drug-free therapeutic community were followed 2 years after treatment. A 4-hr face-to-face interview traced the social adjustment one year pre-, through all years posttreatment. Results showed that (a) success (no crime and no opioid and/or no use of nonopioid primary drug) was maintained through 2 years of follow-up by 34% of the dropouts and 68% of the graduates; (b) success rates were highest among opioid abusers and the lowest among primary alcohol abusers; (c) among the latter, however, abstinence rates were significantly increased and daily use of alcohol significantly decreased as did criminal involvement; (d) among the opioid abstinent group, alcohol use increased posttreatment but heavy drinking was not prominent indicating no significant shift in substance dependency. Overall, the therapeutic community appears most effective for opioid abusers but has a clear impact on a considerable number of those primarily involved with alcohol and other substance use.     

Management of appendiceal masses.

OBJECTIVE: To evaluate the outcome of patients treated for appendiceal abscess, and managed either conservatively or surgically, and to describe the short and long-term outcome as well as incidence of interval appendicectomy in those treated conservatively. DESIGN: Retrospective study. SETTING: University hospital, Sweden. PATIENTS: Ninety-three patients with the diagnosis of appendiceal abscess, 50 treated conservatively and 43 who were operated on, with a mean age of 46 (14-93) years. Mean (range) follow-up for patients operated on was 65 (11-135) and for those treated conservatively 66 (6-136) months. MAIN OUTCOME MEASURES: Course of acute disease, recorded complications, recurrence of appendicitis and incidence of interval appendicectomy during follow-up. RESULTS: The duration of pain before admission was 4 (0.5-82) days for those operated on and 7 (2-60) days for those treated conservatively. A palpable mass was more common in the conservatively managed group. Complications were common among patients who were operated on. No interval appendicectomies were done during the second half of the study period. 4 of the patients treated conservatively (8%) had an underlying tumour diagnosed at follow-up. CONCLUSIONS: Operative management of patients with appendiceal masses seems to be associated with a high risk of postoperative complications and the risk of a more extensive surgical procedure. If possible, a conservative approach should be advocated. Because of inaccurate radiological imaging during the acute phase and the risk of an underlying malignancy, routine follow-up is necessary. Routine interval appendicectomy cannot be recommended.     

Health-related quality of life and pressure ulceration assessment in patients treated in the community

Little is known of the impact of pressure ulceration on adult patients' health-related quality of life. The purpose of this study was to determine the impact pressure ulceration has on pressure ulcer patients cared for in the community. A case control study design was used by drawing a random sample from patients receiving community nursing care, stratified by the presence of pressure ulceration. In all, 75 patients with pressure ulcers were compared with 100 controls without ulcers using the four-point ulcer grading scale described by United Kingdom consensus guidelines. Patients were interviewed using the Short Form-36 (SF-36) questionnaire and activities of daily living assessed using the modified Barthel scale. Patients with pressure ulcers had significantly poorer physical function (mean difference (d) = 37.6, 95% CI 28.6-46.6, p < 0.001) and social functioning (d = 33.9, 95 % CI 24.0-43.9, p < 0.001) than published age- and sex-matched normative data from the United Kingdom. The difference between cases and controls was much smaller in these domains, with neither approaching statistical significance. After adjustment for age and gender, scores for bodily pain were poorer in patients with no ulceration (d = -10.5, 95% CI - 20.6 to - 0.4, p = 0.042) indicating greater pain in these patients compared with the cases with ulceration. Activities of daily living determined by the modified Barthel scale showed reduced self-care (d = -7.6, 95% CI -12.5 to - 2.7, p = 0.010) and mobility (d = -9.2, 95% CI -14.6 to - 3.8, p = 0.001) in patients with pressure ulceration. The overall ability to perform these activities was also significantly poorer in this group (d = -16.3, 95% CI -27.3 to -5.3, p = 0.004). While patients with pressure ulceration experience some deficits in their health-related quality of life compared with a normal population, these differences are similar to those experienced by other patients receiving community nursing care.     

The Environmental Context of Patient Safety and Medical Errors

The environmental context of patient safety and medical errors was explored with specific interest in rural settings. Special attention was paid to unique features of rural: healthcare organizations and their environment that relate to the patient safety issue and medical errors (including the distribution of patients, types of adverse events associated with learning, information flows, triage and transfer decisions, and culture of safety). Relevant organizational theories and strategies fo medical error reduction and prevention in rural health care settings were identified. Financial and technical assistance are needed to support the systematic collection of data from rural hospitals and other entities and to enhance relevant patient safety practices for rural America.