Stroke mortality audit using the Structured Judgement Review method.

Mortality data provided by the Sentinel Stroke National Audit Programme demonstrated the Royal Cornwall Hospitals Trust (RCHT) to have a higher than national average mortality ratio.1 In response to this, the RCHT stroke department undertook a mortality review of patients admitted with stroke making use of the Structured Judgement Review (SJR) process.2The review found all patients were deemed as receiving adequate, good or excellent care. There were no cases where death was deemed as definitely avoidable. The team found the SJR to be a useful, validated tool for mortality review though recognised specific limitations to its use and wider limitations within our review process. Focused areas for improvement derived from the review included improving compliance with local palliative care guides, improved documentation, links with primary care via Care Quality Commission atrial fibrillation group and consideration of improved scanning facilities. We also acknowledged wider unaccounted factors which may impact stroke mortality and thus influence perceived mortality ratios.

Unique Outcomes in the Narratives of Young Adults Who Experienced Dating Violence as Adolescents.

BACKGROUND: Narrative therapy, an approach based on the reauthoring of life narratives, may be a useful psychotherapeutic strategy for youth who have experienced dating violence. OBJECTIVE: A cornerstone of narrative therapy is the concept of unique outcomes, which are moments that stand in contrast to a client's otherwise problem-saturated narratives. The purpose of this study was to identify and categorize unique outcomes embedded in narratives about adolescent dating violence. DESIGN: Text units representing unique outcomes were extracted from transcripts of interviews with 88 young adults who had experienced dating violence and were categorized using standard content analytic techniques. RESULTS: Six categories of unique outcome stories were identified: facing-facts stories, standing-up-for-myself stories, cutting-it-off stories, cutting-'em-loose stories, getting-back-on-track stories, and changing-it-up stories. CONCLUSION: This typology of unique outcomes can inform clinicians who work with clients who have a history of adolescent dating violence.