Clin Med
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Little research has been performed to determine how a stroke unit should be staffed and what the links are between patient dependency and staffing. For this study, 140 stroke units were randomly selected--35 from each of the four quartiles of performance in the National Sentinel Audit of Stroke. A questionnaire was sent to each of the units to collect data on patient numbers and dependency, staffing numbers and therapy, and nursing contact times on a single weekday. ⋯ Of the patients, 74% received physiotherapy, 46% occupational therapy and 25% speech and language therapy during the day with median contact times being 170 minutes for nursing, 40 minutes for physiotherapy, 45 minutes for occupational therapy and 30 minutes for speech therapy. There was a weak correlation between patient dependency and contact time with nurses and therapists. Stroke patients in England receive relatively little rehabilitation from therapists and there is a wide variation in the amount of nursing time each patient receives.
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Despite a sustained and massive increase in spending with the NHS, the evidence that care has improved, other than in areas of performance that have been intensively managed or rewarded by additional cash bonuses, is poor to non-existent. This failure to achieve across-the-board improvement is attributable to the fact that the outcomes of healthcare are 'system properties' and are unlikely to improve as a result of more work being put through the same system, and instead will only improve if healthcare providers at all levels are actively encouraged to redesign the system to improve on current performance. ⋯ Examples are given from the centre-specific analyses published by the UK Renal Registry, a fully electronic registry that analyses data extracted direct from renal information technology systems used in each primary care trust that provides renal replacement therapy, and from other national and regional quality improvement programmes. The NHS has unrivalled opportunities to learn from high performance and to use this learning to narrow the gap between best and worst.
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Progress in complex disorders requires clear thinking facilitated by clear language. Clinicians and scientists occasionally become captive to inaccurate language or meaningless terminology and this generates lazy thinking and impedes progress. ⋯ Among other FGIDs, the situation is more serious; imprecision and lack of consistency in terminology continue to mar progress. This article reviews the chequered history of terminology in this area and concludes that removing the obfuscation generated by poor usage of language should be the first step towards understanding the pathogenesis and improving the management of these, and similar, disorders.