Relationship of increased fruit/vegetable intake with reduced consumption of sweets: Psychological mechanisms and associated weight loss in women within behavioral obesity treatments.

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants' change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants' changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

Raising the bar of care for older people in Ontario emergency departments.

AIM: To describe the role of geriatric emergency management nurses as a catalyst for culture change in emergency department processes with the goal to improve care and outcomes of older people. BACKGROUND: The changing context and literature has called for a culture change within emergency department care to integrate principles of older people care into care delivery. There is a paucity of reports describing how geriatric emergency care models bring about a broader change in culture within the entire emergency department. METHODS: The Ontario Ministry of Health and Long-term Care in Canada established a programme to place geriatric emergency management nurses into emergency departments with the goal to improve delivery of care through development of unique, site-appropriate solutions. RESULTS: Geriatric emergency management nurses incorporate capacity building into their role to develop and strengthen the skills, instincts, abilities, process and resources of the emergency department. Care processes focus on areas of staffing, mobilization, comfort, medication, hygiene, nutrition/hydration, cognition, environment, equipment and stimulation. Multi-modal educational strategies and advocacy promote appropriate person-centred care. Improved communication among care providers at key patient transition points remains a priority system-level improvement. CONCLUSION: Geriatric emergency management nurses work collaboratively with the emergency department team to facilitate change in the way that emergency department care is provided to the older person experiencing health emergencies. IMPLICATIONS FOR PRACTICE: Known strategies that have been effective in improving outcomes for older people within the hospital and residential care setting can be generalized into emergency department care. Further research into the effectiveness of these strategies in this environment is recommended.

A unique practice model for Nurse Practitioners in long-term care homes.

AIM: This paper is a report of a study examining a practice model for Nurse Practitioners (NPs) working in long-term care (LTC) homes and its impact on staff confidence, preventing hospital admission, and promoting early hospital discharge. BACKGROUND: The recent introduction of NPs in LTC homes in Ontario, Canada, provided an opportunity to explore unique practice models. In a pilot project, two full-time equivalent NPs provided primary care to a consortium of 22 homes serving approximately 2900 residents. The practice model was based on the specific needs of the homes and residents. METHODS: The NPs working in this project prospectively collected data (from July 2003 until June 2004) on their clinical activities and resident outcomes. Directors of Care (n = 18) of the participating homes completed a questionnaire (March 2004) assessing the impact on prevention of hospitalization and staff confidence. FINDINGS: The NPs had 2315 clinical contacts in the 1-year period; the majority (64%) were follow-up contacts. Many contacts were for uncomplicated medical problems or more complex but straightforward medical issues, and had positive outcomes. Hospital admission was prevented in 39-43% of cases. NPs had a positive impact on improving staff confidence, but no impact on facilitating early discharge from hospital. CONCLUSION: Practice models designed to meet the distinctive needs of LTC homes and residents can enhance quality of care, even with low NP:resident ratios. Participation of key stakeholders in the identification of care priorities and planning contributed to the success of this model.

Medication safety: just a label away.

In perioperative settings, medications are removed from manufacturers' identifying containers; therefore, scrub personnel should label medications placed on the sterile field. Compliance with medication labeling practices with the use of both blank and preprinted labels was tested in the OR at a Houston, Texas, hospital. Scrub personnel were more likely to label medications and medication-delivery devices when preprinted medication labels were provided. Data obtained from this project influenced the hospital's management team to supply preprinted labels for all procedures to improve safety for surgical patients.