An assessment of failure to rescue derived from routine NHS data as a nursing sensitive patient safety indicator (report to Policy Research Programme)

Objectives: This study aims to assess the potential for deriving 2 mortality based failure to rescue indicators and a proxy measure, based on exceptionally long length of stay, from English hospital administrative data by exploring change in coding practice over time and measuring associations between failure to rescue and factors which would suggest indicators derived from these data are valid.Design: Cross sectional observational study of routinely collected administrative data.Setting: 146 general acute hospital trusts in England.Participants: Discharge data from 66,100,672 surgical admissions (1997 to 2009).Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/8 to 40% in 2008/9. The failure to rescue rate for a hospital appears to be relatively stable over time: inter-year correlations between 2007/8 and 2008/9 were r=0.92 to r=0.94. No failure to rescue indicator was significantly correlated with average number of secondary diagnoses coded per hospital. Regression analyses showed that failure to rescue was significantly associated (p<0.05) with several hospital characteristics previously associated with quality including staffing levels. Higher medical staffing (doctors + nurses) per bed and more doctors relative to the number of nurses were associated with lower failure to rescue. Conclusion: Coding practice has improved, and failure to rescue can be derived from English administrative data. The suggestion that it is particularly sensitive to nursing is not clearly supported. Although the patient population is more homogenous than for other mortality measures, risk adjustment is still required

Visualising London's Suburbs

2 - 4 April 200

Do the suburbs exist? Discovering complexity and specificity in suburban built form

In human geography cities are routinely acknowledged as complex and dynamic built environments. This description is rarely extended to the suburbs, which are generally regarded as epiphenomena of the urbs and therefore of little intrinsic theoretical interest in themselves. This article presents a detailed critique of this widely held assumption by showing how the idea of 'the suburban' as an essentially non-problematic domain has been perpetuated from a range of contrasting disciplinary perspectives, including those that directly address suburban subject matter. The result has been that attempts to articulate the complex social possibilities of suburban space are easily caught between theories of urbanisation that are insensitive to suburban specificity and competing representations of the suburb that rarely move beyond the culturally specific to consider their generic significance. This article proposes that the development of a distinctively suburban theory would help to undermine one-dimensional approaches to the built environment by focusing on the relationship between social organisation and the dynamics of emergent built form

A multi-disciplinary perspective on the built environment: Space Syntax and cartography – the communication challenge

8-11 June 2009

Efficient Refocussing of One Spin and Two Spin Interactions for NMR Quantum Computation

The use of spin echoes to refocus one spin interactions (chemical shifts) and two spin interactions (spin-spin couplings) plays a central role in both conventional NMR experiments and NMR quantum computation. Here we describe schemes for efficient refocussing of such interactions in both fully and partially coupled spin systems.Comment: 4 pages, RevTeX, including 4 LaTeX figure

Romance, narrative vision, and elect community in seventeenth-century England

My dissertation examines the intersections of romance, religion, and politics in England between 1588 and 1688, reading across the divide between centuries to enable a fuller understanding of romance during the English Civil War and its aftermath. In the decades that witnessed Charles I's fall and his son's restoration, royalists and republicans alike found solace, and grounds for resistance, in romance's formal promise that suffering and disappointment would yield to the restoration of a story's true champions. Although historicist efforts to contextualize seventeenth-century romance have productively complicated the structuralist view of it as a basic archetype, such studies are fraught with their own simplifications: romance is often depicted as a continental trend briefly embraced by midcentury royalists, especially women. While a few scholars have noted the artificiality of some of these limits, we have yet to come to terms with seventeenth-century romance's long English tradition, its ability to penetrate other genres, and its hold over male and female writers and readers of diverse ideologies. To this end, my project traces two interwoven threads. First, I argue that the potent subjectivity offered by romance correlated with the widespread Protestant belief in divine election, inviting seventeenth-century subjects to locate themselves and their allies within a providentially protected community. Far from being a royalist fad, romance became a battleground between royalists and Puritan republicans: both sides denigrated their enemies' manipulation of the genre while tacitly or openly reclaiming it for themselves. Second, I consider how writers of romance contended with recurring problems of form, genre, and gender: due to the length of romantic plot and the related issue of multiple subjectivities, they found innovative ways to represent the friction between providential romance and national or personal tragedy, as well as the tension between gendered narrative perspectives. As England struggled to recuperate from its civil conflicts, writers also turned to romance not merely to represent elect community, but to reconstruct it, thinking critically about whether the genre might breach and repair the very perspectival divides in politics, religion, gender, and identity that it had been so instrumental in maintaining

Back to the floor Friday: evaluation of the impact on the patient experience.

Aim  The aim of the study was to evaluate the Back to the floor Friday (BtfF) initiative, whereby senior nurses returned to the floor, in particular its impact on patient experience and patient care. Background  Propositions were that improvements would result from strengthened visible clinical leadership through monitoring standards, supporting staff, resolving problems, acting as advocates and implementing change. Method  Participatory action research: BtfF population surveyed; five focus groups comprising 20 multi-professional staff; interviews with nine therapists, 45 nurses, one nurse specialist and four patients. Data analysed using qualitative content analysis. Results  Empowerment, learning together, professional networking, communication, championing change and ‘Matron Power’ were positive themes and perceived staff benefits arising from BtfF. Staff provided anecdotal examples of patient benefits but tangible evidence of improvements were more difficult to identify. Conclusions  Long-term evaluation of the impact of BtfF on patients is needed. Nurse specialists, matrons and clinical educators felt that the initiative did not impact significantly on day-to-day roles. Nurses across the workforce needed clarity around propositions behind the change. Implications for nursing management  Enablers to the initiative were supportive line management, senior leadership and peer support. Clarity of purpose is important to drive effective change