A mixed-methods evaluation of the effectiveness of tailored smoking cessation training for healthcare practitioners who work with older people.

BACKGROUND: Older people who smoke derive significant health benefits from stopping smoking in later life. Healthcare practitioners have an important role to play in raising the issue of smoking cessation with this client group; however, they often fail to do so. AIM: To assess the effectiveness of smoking cessation training for healthcare practitioners who have regular contact with older adults. METHODS: Mixed-methods were used to explore satisfaction with the training, the participants' learning and any resultant changes in behaviour. The effectiveness of the training was assessed using a two-group parallel design randomised controlled trial, followed by semistructured qualitative interviews. Participants (n = 57) were recruited from a cohort of community nurses and allied health professionals (e.g., occupational therapists) working in Scotland. The intervention was 1-day brief intervention smoking cessation training. Validated measures of knowledge, attitudes and practice, were used to assess learning and behaviour at baseline, 1 week and 3 months post training. Data were analysed using two-factor repeated measure analysis of variance, where the factors were "group" and "time." Qualitative data were gathered from members of the intervention group during semistructured interviews (n = 8) and were analysed thematically. RESULTS/FINDINGS: Levels of satisfaction with the training were high. There was a statistically significant improvement in the knowledge and attitudes of the intervention group following the training, with a noticeable, but nonsignificant, improvement in practice. The qualitative findings demonstrate how the training impacted positively on practice. CONCLUSIONS: Smoking cessation interventions in later life are important, as older smokers generally have long-term conditions caused or complicated by smoking. The delivery of brief smoking cessation interventions is known to be highly cost-effective; however, research demonstrates that practitioners often fail to raise the issue of smoking cessation with older adults. This study has demonstrated the effectiveness of a 1-day training course for practitioners. Further research is recommended.

Presence and significance of Bacillus cereus in dehydrated potato products.

Dehydrated potato contains Bacillus cereus at a prevalences of 10 to 40% and at numbers usually less than 10(3) CFU g(-1). B. cereus in dehydrated potato is likely to be present as spores that are able to survive drying of the raw vegetable and may represent a significant inoculum in the reconstituted (rehydrated) product where conditions favor germination of, and outgrowth from, spores. Holding rehydrated mashed potato alone, or as part of another product (e.g., potato-topped pie), at temperatures above 10 degrees C and below 60 degrees C may allow growth of vegetative B. cereus. Levels exceeding 10(4) CFU g(-1) are considered hazardous to human health and may be reached within a few hours if stored inappropriately between these temperatures. Foods incorporating mashed potato prepared from dehydrated potato flakes have been implicated in B. cereus foodborne illness. This review is a summary of the information available concerning the prevalence and numbers of B. cereus in dehydrated potato flakes and the rate at which growth might occur in the rehydrated product.

Nurses' opportunistic interventions with patients in relation to smoking.

AIM: This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients. BACKGROUND: Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care. METHODS: A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'. FINDINGS: Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress. CONCLUSIONS: Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.

Presence and growth of Bacillus cereus in dehydrated potato flakes and hot-held, ready-to-eat potato products purchased in New Zealand.

Potato products prepared from dehydrated potato flakes have been implicated in foodborne illness incidents involving Bacillus cereus intoxications. B. cereus can survive as spores in potato flakes and can germinate and multiply in the rehydrated product. This study assessed the frequency and concentration of B. cereus in dehydrated potato flakes and hot-held, ready-to-eat mashed potato products. Of 50 packets of potato flakes tested, eight contained greater than 100 CFU/g B. cereus (maximum 370 CFU/g). The temperature of the potato portion of 44 hot-held food products was measured immediately after purchase, and 86% were below the safe hot-holding temperature of 60 degrees C. The potato portions were subsequently tested for B. cereus. Only two of the potato portions contained B. cereus at greater than 100 CFU/g, a potato-topped pastry (1000 CFU/g) and a container of potato and gravy (120 CFU/g). To assess multiplication of B. cereus in this food, we held rehydrated potato flakes with naturally occurring B. cereus at 37, 42, and 50 degrees C and tested them over 6 h. By 6 h, the number of B. cereus in potato stored at 37 degrees C had exceeded 10(3) CFU/g, was greater than 10(4) CFU/g at 50 degrees C, and was close to 10(6) CFU/g at 42 degrees C. Growth data were compared to predictions from the U.S. Department of Agriculture Pathogen Modeling Program (PMP 7.0). The PMP predictions were found to simulate the measured growth better at 42 degrees C than at 37 degrees C. Hot-held potato products should be safe for consumption if held at 60 degrees C or above or discarded within 2 h.

Survey of student nurses and midwives: smoking and alcohol use.

This article presents findings from a survey of 186 first year nursing and midwifery students that relate to their smoking and alcohol consumption. Of the students sampled, 28% were cigarette smokers. This is higher than the smoking rate of 25% for the adult population in the UK. The majority of the students who smoked said that they would like to stop smoking. Most of the students (86.5%) reported having drunk alcohol on at least one occasion during the previous week, with 26.5% having had a drink on three or four days. The amount consumed over the week ranged from no drinks to 90, with the mean being 13.72.Worryingly, 74% had exceeded the daily benchmarks for low-risk drinking on at least one occasion during the week for which consumption was reported, and 55% were drinking at binge levels. The findings raise concerns for the future health of many of our students and for their roles as health promoters.

Outbreak of campylobacteriosis following pre-cooked sausage consumption.

OBJECTIVES: A small outbreak of campylobacteriosis involving three cases was investigated in terms of Campylobacter types present in the suspect food (pre-cooked sausages) and clinical samples from the cases. METHOD: Foods and faecal samples from people involved in the incident, which occurred in Christchurch, New Zealand, were tested for the presence of Campylobacter and identification of the species made. Isolates were typed by Penner serotyping and macrorestriction analysis using pulsed-field gel electrophoresis (PFGE). Investigations were conducted as to whether the contamination was on the surface or the interior of the sausages. RESULTS: All isolates from food and faecal samples were identified as C. jejuni and were indistinguishable from one another by the typing methods employed. Only the surfaces of the sausages were contaminated. Three other isolates of an indistinguishable subtype were isolated from campylobacteriosis cases in Christchurch occurring over approximately the same period. CONCLUSIONS AND IMPLICATIONS: Given the rarity of the subtype isolated from the three family members and the three other cases, it is possible that the outbreak was larger than the initial investigation revealed. It is likely that the sausages were contaminated after they had been cooked by the retailer and were not reheated prior to consumption. This report illustrates the role of cross-contamination in an outbreak with an unusual food vehicle for campylobacteriosis. Physical separation of cooked and raw product is necessary to prevent recurrences of outbreaks similar to the one described here.

Developing research methods in qualitative research: using a radio microphone in a pilot study.

The diploma of higher education in nursing aims to produce a first level registered nurse with the necessary knowledge and skills to work safely as a competent practitioner. Implicit in this aim is the requirement for the nurse to be an effective commmunicator of diverse and sometimes complex information requiring application of knowledge and skill. The diploma incorporates health as a major theme in the curriculum.