An assessment of nurses' perceived and actual household emergency preparedness

Nurses' household preparedness is critical if they are to avoid role conflict and report for duty during an emergency. To date, the alignment between nurses' perceived and actual household preparedness remains under examined. Investigating one of these variables in isolation fails to consider that perceived and actual household preparedness must be high and aligned. If misaligned, vulnerabilities could surface during emergencies, like concerns about family safety, potentially impacting a nurse's commitment to duty during a crisis, or nurses may lack the actual preparedness to continue working long hours during an emergency. An online questionnaire was distributed to registered nurses in Ireland. The questionnaire was informed by a review of the literature and captured nurses' perceived and actual household preparedness, attitudes towards and exposure to a range of emergencies, and pertinent demographic characteristics. The results showed a relationship between how nurses view their household preparedness and their actual preparedness. Regression analyses indicate that while there is an overlap, the factors associated with how prepared nurses think they are and how prepared they are can differ. This means that strategies to boost actual preparedness may differ from those needed to boost perceived preparedness. This finding underscores the importance of psychosocial preparedness. Feeling prepared is crucial as it can influence how one responds in an emergency. Considering both the perceived and actual aspects of household preparedness can lead to a more effective response during emergencies.

Osteochondral transfer using a transmalleolar approach for arthroscopic management of talus posteromedial lesions

Characterizing osteochondral lesions of the talus has enabled the strategies of surgical management to be better specified. The main technical problem is one of access for arthroscopy instruments to posteromedial lesions. A range of techniques and approaches has been described in ankle arthroscopy in general, and a transmalleolar approach provides reliable and efficient access in these cases. It is frequently used for transchondral drilling, but also enables satisfactory implant positioning in autologous osteochondral mosaicplasty procedures. We report our technique and results on five cases with a minimum 1.2 years' follow-up.

Management of massive traumatic compound defects of the foot

The management of high-energy trauma to the foot often requires multiple tissues reconstructive procedures with various technical options. The authors report the case of a patient presenting an extensive defect of the medioplantar region of the right foot involving an almost complete (90%) medial cuneiform bone loss. A deferred operation with saphenous cross-leg flap and interposition of a cement spacer was first performed. Reconstruction of the bone defect with corticocancellous iliac bone graft was subsequently carried out at two months post-trauma. At four months follow-up, the bone and soft tissues healing were good. At 24 months follow-up, the patient could return to normal professional and sports activities. The saphenous cross-leg flap has proven to be a reliable reconstructive procedure. The use of the modified Masquelet technique ensured an anatomical reconstruction and a satisfying final functional outcome.

[Degenerative changes of the metatarso-sesamoido-phalangeal complex]

OBJECTS

The aim of this work was to determine the frequency and the location of the degenerative lesions of the hallucal metatarsophalangeal joint in an elderly population. Our results help us to precise the anatomic characteristics of that articular complex.

METHODS

Our material comprised 21 feet from embalmed cadaver specimens. We studied the morphometrical parameters for the anatomic description of the first metatarsophalangeal joint of the forefoot. After complete dissection, a specific articular zone-mapping was made with a quantitative evaluation of the chondral lesions.

MAIN RESULTS

The measurements of the morphometrical parameters were in accordance with the literature data. The sesamoidal chondral lesions were more frequent for the medial sesamoid and at the proximal zone of the articular surface. The plantar metatarsal lesions were very frequent with diffuse or distal groove damage, and crista damage linked to the sesamoidal strap dislocation. The lesions involving the metatarsophalangeal compartment were less frequent and rather at the dorsal zone.

CONCLUSIONS

The degenerative lesions of the metatarso-sesamoido-phalangeal complex are nearly systematic in n elderly population. The morphological aspect of these lesions is very characteristic of the articular function and allows us to precise the biomechanic constraints.

The role of quality standards--accreditation in redressing asymmetry of information in health care markets

Asymmetry of information presents major difficulties for the efficient operation of markets in health care. The use of accreditation schemes may reduce these difficulties by enhancing the availability of reliable, accessible information on aspects of service quality considered important by service users and their agents. The UK's Patients' Charter with its associated Charter Marks has the potential to perform such a function in respect of inpatient services. In as much as it refers to aspects of service valued by service users which are specified in contracts by service procurers and appear not to be negatively correlated with other aspects of service quality, it can be seen to provide unambiguous signals of service quality. Given the Charter is currently under review, it seems appropriate that such attributes are borne in mind by policy makers in their deliberations as to its future.

Issues in cost function specification for neonatal care: the Fordham case

BACKGROUND

Econometric techniques have been used to examine the relationship between costs of provision, case mix and unit size for health care providers. Estimation of cost functions in a health care context is complicated by poor understanding of the underlying production relationship and the constraints under which production takes place. Different results and policy implications can follow from different model specifications. This underscores the need for care in the construction of such functions and the interpretation of their results.

METHODS

Cost and activity data from a study of neonatal care for an English Regional Health Authority are re-examined. Cost functions are estimated using alternative functional forms, and average cost per day is estimated and compared for two of these functions [one produced by Fordham et al. (J Publ Hlth Med 1992; 14(2): 127-130) and the other based more explicitly in economic and econometric theory].

RESULTS

It is shown that estimates of average cost per day are sensitive to model specification. Such are the differences in cost that significantly different policy implications could follow from the different models.

CONCLUSION

We conclude that care must be taken in the construction and estimation of cost functions and that the assumptions upon which they rest be made explicit so that results can be properly interpreted.