Barriers to healthy eating in the nursing profession: Part 2.

AIM: This is the second of two articles that report on work commissioned by the NHS Executive North West, to explore the perceived barriers to healthy eating within the nursing profession. METHOD: Observations were made of catering facilities within eight healthcare sites (six acute hospitals, an NHS walk-in centre and an NHS Direct site) across the North West region. Twenty four unstructured interviews were conducted with nurses and three were sampled from each healthcare site. RESULTS: Four main themes emerged as barriers to healthy eating: availability; variety; distance from catering facilities; and breaks/staffing levels/workload issues CONCLUSION: Respondents in this study do not consider their working environments to be conducive to healthy eating practices.

Cognitive therapy: looking backward, looking forward.

This article reviews some of the historical factors associated with the unprecedented strength and popularity of cognitive therapy, and offers predictions for the next half-century of this approach to treatment. It is predicted that the future will bring with it increased demands on cognitive therapy for evaluation of processes of change (including identification of therapeutic specifics and nonspecifics, technical specification of the process of therapy, and examination of therapist and patient predictors of change), and accountability and efficiency in the public and private sectors. With the increase in personal autonomy, globalization, and technology, the demands from the general public also will increase. One possible risk of the trend towards increased technology is that cognitive therapy may become overly technical. Although specific therapy techniques are crucial to delivering effective treatment, it is also the "nonspecifics" of therapy that add to the "art" of psychotherapy. The final challenge of cognitive therapy also may be the most difficult--to continue to be an empirically based science while maintaining its role in the art of healing.

A cost-effective method for the automatic quantitative analysis of fibroblastic colony-forming units.

A great deal of the work characterizing stromal cell precursors in the bone marrow has been performed using the fibroblastic colony-forming unit (CFU-f) assay. However, the assay is limited in its usefulness by the necessity for manual colony counting which means that assay quantitation is highly subjective, time consuming, and much information regarding the colony size is lost. To rectify this, we have developed a computer-automated method for the analysis of CFU-f. Bone marrow cells were cultured at low density and treated with either prostaglandin E(2) (PGE(2)), basic fibroblast growth factor (bFGF), or dexamethasone, and colony formation was assessed by staining with methylene blue. After staining, the dishes were photographed over a light box using a digital camera and the image was then analyzed using Bioimage "Intelligent Quantifier" image analysis software which automatically locates and quantifies each individual colony. The data can then be imported to a spreadsheet program and processed. We have shown that this system can accurately identify, assign coordinates, and quantitate each individual colony. Colony numbers obtained with this method and manually counting showed a linear relationship with a correlation coefficient of 0.99. In addition, using the colony intensity and surface area data, the colony size can be calculated. With this methodology, we have shown that dexamethasone, PGE(2), and bFGF can all modulate total cell numbers in bone marrow stromal cells (BMSC) cultures but modulating both colony number and colony size.

Eliminating needless testing in intensive care--an information-based team management approach.

OBJECTIVE: To determine if the application of an information-based management system in adult intensive care units (ICU) can produce sustained decreases in the use of laboratory resources and costs. DESIGN: Interventional study with prospective data collection on consecutive patients admitted during three time periods. SETTING: A 10-bed adult surgical ICU and an eight-bed adult medical ICU in a tertiary care hospital. PATIENTS: All patients admitted to an ICU during a 7-month baseline period (n = 647), a 1-yr intervention period (n = 1236), and a 2-yr follow-up period (n = 2349). INTERVENTIONS: Using a management database to track the use of 123 laboratory investigations during the baseline period, nine frequently ordered investigations (determination of blood gases, glucose, potassium, electrocardiogram, chest radiograph, sodium, chloride, complete blood count with differential, and serum osmolality) were targeted for reduction. Specific policies were developed by a multidisciplinary committee within the ICU to reduce the utilization of these laboratory, radiology, and cardiology tests. The policies were applied to all patients admitted during the 1-yr intervention period and during the 2-yr follow-up period. MEASUREMENTS AND MAIN RESULTS: A 25% reduction was observed in the frequency of all 123 monitored tests during the intervention period. The most dramatic reductions occurred in the nine targeted tests (range 19% to 46%) (p < .001). There were significant reductions in only 13 of the untargeted 114 investigations during this period. Potential annual cost savings were > $150,000 Canadian. No increases in ICU mortality rate, length of stay, or cost of medication were observed, and the reductions in the frequency of targeted tests were maintained during the 2-yr follow-up period. CONCLUSIONS: Application of an information-based multidisciplinary management system in the ICU can produce marked and sustained reductions in unnecessary testing in a cost-effective manner. Although rationing of intensive care services may be necessary, reducing needless testing can be a safe and effective cost-containment strategy in the ICU.

Economic impact of a documented case of reovirus infection in broiler breeders.

The following parameters were used to calculate the economic impact to a commercial broiler company of a pathogenic reovirus infection in broiler breeders during egg production: hatchability, selling of eggs, vaccination, mortality, medication, slowing of line speed at processing, and downgrading and trimming at processing. The cost due to reovirus infection in one flock of broiler breeders was approximately $48,000.

Syringes versus minibags as an intravenous admixture system: a comparison of cost and nursing preference.

The implementation of centralized intravenous admixture programs in Canadian hospitals has been hindered by the high costs associated with such programs. The most popular system uses minibags as an admixture base but other less expensive alternatives are being investigated. This study examines the material and labour costs associated with preparing admixtures in either minibags or polypropylene syringes. The minibag admixtures were administered by nursing staff using secondary medication administration sets. Standard volume-control sets were used for diluting and administering the intravenous admixtures supplied in syringes. The results indicated a major cost advantage for the syringe-based program. Furthermore, evaluation of the two systems by nursing staff indicated a strong preference for the syringe-based system.