Variation in National Clinical Audit Data Capture:Is Using Routine Data the Answer?

National Clinical Audit (NCA) data are collected from all National Health Service providers in the UK, to measure the quality of care and stimulate quality improvement initatives. As part of a larger study we explored how NHS providers currently collect NCA data and the resources involved. Study results highlight a dependence on manual data entry and use of professional resources, which could be improved by exploring how routine clinical data could be captured more effectively

Complex interventions in midwifery care: Reflections on the design and evaluation of an algorithm for the diagnosis of labour

Randomised controlled trials are the ‘gold standard’ for evaluating the effectiveness of interventions in health-care settings. However, in midwifery care, many interventions are ‘complex’, comprising a number of different elements which may have an effect on the impact of the intervention in health-care settings. In this paper we reflect on our experience of designing and evaluating a complex intervention (a decision tool to assist with the diagnosis of labour in midwifery care), examining some of the issues that our study raises for future research in complex interventions

Developing a pressure ulcer risk factor minimum data set and risk assessment framework

AIM: To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.BACKGROUND: A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.DESIGN: Consensus study.METHOD: A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.FINDINGS: The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.CONCLUSION: The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework

Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools.

BACKGROUND: There is evidence of under-detection and poor management of pain in patients with dementia, in both long-term and acute care. Accurate assessment of pain in people with dementia is challenging and pain assessment tools have received considerable attention over the years, with an increasing number of tools made available. Systematic reviews on the evidence of their validity and utility mostly compare different sets of tools. This review of systematic reviews analyses and summarises evidence concerning the psychometric properties and clinical utility of pain assessment tools in adults with dementia or cognitive impairment. METHODS: We searched for systematic reviews of pain assessment tools providing evidence of reliability, validity and clinical utility. Two reviewers independently assessed each review and extracted data from them, with a third reviewer mediating when consensus was not reached. Analysis of the data was carried out collaboratively. The reviews were synthesised using a narrative synthesis approach. RESULTS: We retrieved 441 potentially eligible reviews, 23 met the criteria for inclusion and 8 provided data for extraction. Each review evaluated between 8 and 13 tools, in aggregate providing evidence on a total of 28 tools. The quality of the reviews varied and the reporting often lacked sufficient methodological detail for quality assessment. The 28 tools appear to have been studied in a variety of settings and with varied types of patients. The reviews identified several methodological limitations across the original studies. The lack of a 'gold standard' significantly hinders the evaluation of tools' validity. Most importantly, the samples were small providing limited evidence for use of any of the tools across settings or populations. CONCLUSIONS: There are a considerable number of pain assessment tools available for use with the elderly cognitive impaired population. However there is limited evidence about their reliability, validity and clinical utility. On the basis of this review no one tool can be recommended given the existing evidence

Accounting and taxation aspects of financial leasing in a trading company

The objective of the thesis is to examine and appraise the accounting and taxation aspects of financial leasing in a particular trading company until valid rules of law within the territory of the Czech Republic. All the information gained was elaborated mainly by the combination of text and open excerption methods. Also methods of synthesis and deduction were used. The text of the thesis is joined by charts, model examples and a diagram which illustrates specialization of the leasing within the Czech Republic. Financial leasing is considered as a very flexible instrument for funding of the long term company requisites. Financial leasing is usually translated as a lease which is followed by surrender of a hired object when the period of lease is over. For a leaseholder financial leasing represents a long term commitment, usually a fixed one. The practical section of the thesis is focused on investigation of accounting and taxation aspects and their impact on a business unit. The cost development of financial leasing, bank credit and cash buying is compared among others

Making the diagnosis of labour:midwives' diagnostic judgement and management decisions

AIM This paper reports a study examining midwives' perceptions of the way in which they diagnose labour. BACKGROUND Diagnosis of active labour is often problematic. A midwifery workforce planning tool identified that up to 30% of women admitted to United Kingdom labour wards subsequently turned out not to have been in labour. There is evidence that if a woman is admitted to a labour ward in early labour, she is more likely to have some form of medical intervention. However, despite the impact of misdiagnosis, there is little research on the process of decision-making by midwives in relation to diagnosis of labour. METHODS This was a qualitative study, employing focus group methods. Participants were a convenience sample of midwives working in a maternity unit in the North of England during 2002. They were asked to discuss their experience of admission of women in labour. Data were analysed using latent content analysis. FINDINGS Thirteen midwives participated in one of two groups. They described using information cues, which could be separated into two categories: those arising from the woman (Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution (Midwifery care, Organizational factors and Justifying actions). Midwives' decision-making process could be divided into two stages. The diagnostic judgement was based on the physical signs of labour: the management decision would then be made by considering the diagnostic judgement as well as cues such as how the woman was coping, her expectations and those of her family and the requirements of the institution. CONCLUSIONS Midwives may experience more difficulty with the management decision than with the initial diagnosis. It may be that the number of inappropriate admissions to labour wards could be reduced by supporting midwives to negotiate the complex management hurdles, which accompany diagnosis of labour