A range of issues surrounding admission to either residential or nursing home care are considered from the perspectives of older people and their family carers. Drawing on the literature and a number of studies conducted by the authors, the processes and perceptions that shape and influence admission to care are identified. On the basis of the interaction of these factors a four-stage typology of admission is suggested: the positive choice, the rationalized alternative, the discredited option, and the fait accompli. The characteristics of each admission type are discussed and the implications for professionals, particularly nurses, working with older people and their carers are addressed.

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Evidence-based care has become the new mantra within the NHS, despite the fact that the concept of applying research to practice has been promoted for several decades. However, literature on the subject suggests that formidable obstacles remain to the integration of research into care delivery. This article describes a study which used Funk et al's (1991a,b) Barriers Scale with a population of nurses in a large teaching hospital in the UK. This scale was specifically developed to identify barriers to the introduction of research into practice, and modified for a UK context. The results suggest that a complex array of barriers exist but that foremost among these is the nature of the organizations within which nurses work. Comparisons are made with data from the USA, and the need to create time for nurses to implement change, and to empower them to do so, is stressed.

BackgroundThe ME/CFS Disease Register is one of six subprojects within the National ME/CFS Observatory, a research programme funded by the Big Lottery Fund and sponsored by Action for ME. A pilot study in East Anglia, East Yorkshire, and London aimed to address the problem of identifying representative groups of subjects for research, in order to be able to draw conclusions applicable to the whole ME/CFS population.While not aiming for comprehensive population coverage, this pilot register sought to recruit participants with ME/CFS in an unbiased way from a large population base. Those recruited are constituting a cohort for long-term follow-up to shed light on prognosis, and a sampling frame for other studies.FindingsPatients with unidentified chronic fatigue were identified in GP databases using a READ-code based algorithm, and conformity to certain case definitions for ME/CFS determined. 29 practices, covering a population aged 18 to 64 of 143,153, participated.510 patients with unexplained chronic fatigue were identified. 265 of these conformed to one or more case definitions. 216 were invited to join the register; 160 agreed. 96.9% of participants conformed to the CDC 1994 (Fukuda) definition; the Canadian definition defined more precisely a subset of these. The addition of an epidemiological case definition increased case ascertainment by approximately 4%. A small-scale study in a specialist referral service in East Anglia was also undertaken.There was little difference in pattern of conformity to case definitions, age or sex among disease register participants compared with subjects in a parallel epidemiological study who declined to participate.One-year follow-up of 50 subjects showed little change in pain or fatigue scores. There were some changes in conformity to case definitions.ConclusionsObjective evaluation indicated that the aim of recruiting participants with ME/CFS to a Disease Register had been fulfilled, and confirmed the feasibility of our approach to case identification, data processing, transmission, storage, and analysis. Future developments should include expansion of the ME/CFS Register and its linkage to a tissue sample bank and post mortem tissue archive, to facilitate support for further research studies.

As federal legislators moved closer to enacting significant healthcare reform during fall 1994, it was apparent to the college health community that campus health programs could be significantly affected. Uncertainty over the impending legislation led college health directors to consider two important questions: What is the federal government going to do? and What could college health directors do to position their organizations more effectively to respond to pending reform? The former question was debated on a daily basis throughout the United States with no resolution in sight. The latter question was the ultimate focus of this survey research involving 56 of 79 schools (71% response rate from institutions in 38 states). Half of the schools had enrollments between 15,001-25,000 students; 86% used prepaid fees as their primary financing mechanism. Survey results identified college health directors' preferences for 27 different organizational strategies in response to possible healthcare reform initiatives.