Disturbed sleep can affect personal wellbeing and impede the rehabilitation and recovery of older people from illness. This paper reports the findings of a pilot study which included examination of sleep quality and sleep patterns of older people in community hospital and nursing home settings. A marked proportion of older people reported sleeping well in nursing care settings, and those in nursing homes slept better than those in the community hospital. The main causes of sleep disturbance in both settings were: needing to go to the toilet, noise, pain, and discomfort; a similar pattern was seen across the different settings. No discernible difference was found in quality of sleep and whether patients felt rested or not between those patients on hypnotic medication and those who were not. The implications of the findings for practice and future research are discussed.

Judgements on the effectiveness of psoriasis management are based on clinical criteria employed by dermatologists, and how they take account of patients' experiences in the process of history taking. In this study the aim was to gain the in-depth patients' perspective and investigate the criteria that they employ when making judgements about the effectiveness of their therapy. These findings were then compared with the clinical and research literature on the clinical effectiveness of psoriasis treatments. The study design is exploratory-descriptive, using a qualitative ethnographic approach. In-depth interviews were undertaken in an outpatient department dermatology clinic. A purposive sample of 20 adult patients currently attending represented the following types of psoriasis: guttate, chronic plaque and scalp. A key comparable finding between the literature and the interview data is that dermatologists emphasize observable criteria of effectiveness, such as clearance of the lesion, whereas patients emphasis focuses on the subjective concerns, such as suppleness, softness and alleviation of itch. This discrepancy needs to be considered during history taking, in relation to its impact on therapy concordance and in the use and development of outcome measures used for clinical assessment and evaluations of psoriasis therapy.

This paper examines the measurement of sleep in nursing care settings, within the context of a pilot study which aimed to assess the effect of therapeutic back massage by nurses on the quality and pattern of sleep in older people in nursing homes and a community hospital. Sleep is an important factor in effective recovery and rehabilitation from illness and for the quality of life of older people in care settings. Issues are raised concerning the measurement of the sleep of older people for the purposes of evaluation research. New instruments are introduced, some building on existing tools. The value of self-reported and observed sleep data are discussed. Issues of the feasibility and rigour of these instruments are examined and recommendations are made for their further refinement and use.

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Use of traditional ecological knowledge (TEK) is now a requirement of many environmental review panels. It was in the remit for the investigation into uranium mining in northern Saskatchewan, but there was a mismatch between the narrow, often technical, treatment of TEK and the broader, more cultural comments of the Dene Aboriginal intervenors. It is essential to recognize when a developmentproposal'splanning needs and social issues exceed the scope of environmental assessment (EA). TEK can relate to EA on three levels: detailed information from localpeople on the environment and wildlife; gaining insight in to socio-cultural effects of a project; and changes to a landscape or a people's relationship with it that may threaten their deep identification with their environment. The last may not be a part of an ordinary EA.