The effects of traffic light labelling versus cartoon labelling on food and beverage purchases in a children's hospital setting.

This study's purpose was to examine changes in healthy and unhealthy items purchased following the implementation of traffic light and cartoon labelling in a small retail food venue (Café Bay) in a children's hospital in eastern North Carolina. Between October 2015 and March 2016, daily food and beverage sales from Café Bay were obtained during baseline, traffic light labelling, a washout period, cartoon labelling (on healthy foods only) and a final washout period. Pearson chi-squared tests and multiple linear regressions were used to examine effects of labelling strategies, controlling for the holidays. In unadjusted analyses, traffic light labelling was associated with significant decreases in purchases of unhealthy items purchased, while cartoon labelling was associated with increases in unhealthy items purchased. In adjusted linear regression analysis, traffic light labelling was associated with fewer unhealthy purchases and thus may have potential to decrease the amount of unhealthy items purchased in a children's hospital food retail venue.

Self-inflating bags versus T-piece resuscitator to deliver sustained inflations in a preterm lamb model.

OBJECTIVE: In neonatal resuscitation, the use of a sustained inflation (SI) may facilitate lung aeration. Previous studies comparing different resuscitation devices have shown that one model of self-inflating bag (SIB) could not deliver an SI. We aimed to compare the delivery of an SI using four SIBs with that of a T-piece. STUDY DESIGN: In intubated preterm lambs, we compared four models of SIB fitted with a positive end expiratory pressure (PEEP) valve to a T-piece using a gas flow of 8 L/min. Four operators aimed to deliver three SIs of 20 cm H2O for 30 s. The study was repeated with the PEEP valve removed and again with no flow. We measured duration of SI, average inflation pressure (IP) and analysed the shape of the pressure curves. RESULTS: 204 combinations were analysed. Mean (SD) duration of SI was Ambu 6(2)s, Laerdal 14(8)s, Parker Healthcare 5(1)s, Mayo Healthcare 33(2)s and T-piece 33(1)s. Mean (SD) average IP was Ambu 17(3)cm H2O, Laerdal 17(3)cm H2O, Parker Healthcare 12(5)cm H2O, Mayo Healthcare 21(2)cm H2O and T-piece 20(0)cm H2O. Duration of SI and average IP was significantly different between SIBs (all p<0.001). The findings were substantially unchanged when PEEP valve and flow were removed (all p>0.05). Only the Mayo system delivered SIs with duration and average IP not significantly different from the T-piece (p>0.05). CONCLUSIONS: The performance of the four SIBs tested varied considerably. Some are able to deliver an SI even in the absence of gas flow. This may be useful in a resource-limited setting with no gas supply.

Nursing the tropics: nurses as agents of imperial hygiene.

BACKGROUND: Mrs Francis Piggott proposed the Colonial Nursing Association in 1895 as a means of supplying Britain's colonies and dominions with trained professional nurses, who would support the health of white colonists abroad. Over 8400 nurses were placed between 1896 and the Association's end in 1966. Despite the burgeoning of scholarship on gender and empire over the last few decades, there is still more research to be done examining nurses as professional, working women, who present a fascinating variation on the figure of the woman traveler. METHODS: This essay focuses on 1896-1927, exploring how nurses were prepared for their labor abroad and how these skills were challenged and adapted within a foreign environment. We contextualize this discussion with examples from literary tales of exploration and adventure and discourses of empire. RESULTS/CONCLUSIONS: Though the sources of disease against which nurses fought changed during this period, we assert that the underlying role of the nurse continued the same: she was meant to use the tools of personal as well as public 'hygiene' to create both physical and cultural boundaries around her white patients and herself, setting colonists apart from their colonial setting.

Cochlear implantation in older patients: outcomes and comparisons.

OBJECTIVES: A review of adults receiving cochlear implants (Cls) at the Yorkshire Cochlear Implant Service (YCIS) was performed to assess whether age affects use or outcomes. METHODS: A retrospective analysis of all patients over the age of 50 implanted and habilitated at the YCIS was undertaken. Outcome measures included quality of life (QoL) questionnaires and speech perception tests: CUNY sentences and BKB sentences. Comparisons were made between patients implanted age 50 to 59 (A), 60 to 69 (B) and 70 and over (C). Patients with English as a second language and those implanted for less than 9 months were excluded. Data was analysed using a repeated measure regression model. RESULTS: 80 adults were included; A, 31; B, 29; C, 20. Significant improvements were seen in speech perception scores in all groups from pre-implant to 3 months. No statistically significant difference was found between the 3 groups in any outcome measure. QoL scores overall showed increased independence and greater participation in social activities with all patients feeling their implant had been successful. DISCUSSION: Increased life expectancy and availability of cochlear implants (Cls) has led to greater numbers of older patients being eligible for implantation. Our results show improved speech perception and QoL outcomes in all groups. The lack of statistically significant differences between age groups supports the benefits of Cls in the older population. Older age should not be a discriminating factor in candidacy for cochlear implantation and referral of older patients to implant centres should be encouraged.

Retrospective, cross-sectional review of delayed discharge after paediatric tracheostomy.

OBJECTIVES: To investigate reasons for prolonged hospitalisation of children with tracheostomies once they are medically fit for discharge. METHODS: Retrospective, cross-sectional study of 101 children undergoing tracheostomy between 2000 and 2010. RESULTS: Of the study patients, 44.6 per cent did not spend any time in hospital once medically fit, 19.8 per cent spent up to two weeks, 12.9 per cent spent between two weeks and one month, and 22.8 per cent spent over one month. Of the 56 cases with delayed discharge, the majority (22 children, 39.3 per cent) were delayed due to time taken obtaining parental competencies in tracheostomy management. A number of external factors were identified in these delays: parental substance abuse; single parenting; concerns about parenting ability, and English not being the parents' first language. CONCLUSION: Paediatric tracheostomy may lead to prolonged hospitalisation, but this is often influenced by social factors. Better use of dedicated specialist paediatric tracheostomy nurses may reduce unnecessary hospitalisation.

Does the location of colorectal carcinoma differ between screened and unscreened populations?

AIM: Screening for colorectal malignancy using faecal occult blood testing is established across the UK. In NHS Grampian the programme was introduced in 2007. Previous studies have reported no difference in anatomical locations of cancers detected by screening programmes compared with those in unscreened populations. This study aims to review the location of tumours detected in an established screening programme compared with those diagnosed through symptomatic presentation within the same population. METHOD: All patients discussed at the regional multidisciplinary meeting between June 2007 and August 2011 were included. Data were collated prospectively from multidisciplinary team records while site of tumour was documented from radiology, endoscopy, operative and pathology reports. Comparative statistics (χ(2) ) were performed using spss 19. RESULTS: Of 1487 patients included 255 were detected via the screening programme and 1232 from symptomatic presentation. More left sided tumours (splenic flexure to rectosigmoid) were detected via screening (P=0.005). Of non-screened patients (n=1232), 456 (37%) tumours were right sided (caecum to distal transverse colon), 419 (34%) were left sided and 357 (29%) were in the rectum. This compares with the screened group (n=255): right sided 74 (29%), left sided 113 (44%) and rectal 68 (27%). CONCLUSION: More left sided tumours appear to be detected in screened patients compared with symptomatic presentation, contrary to previously published work. These results may be worthy of further consideration given the ongoing debate on the optimal means of screening.

The use of ice-lollies for pain relief post-paediatric tonsillectomy. A single-blinded, randomised, controlled trial.

OBJECTIVES: To assess whether the use of ice-lollies after tonsillectomy with or without adenoidectomy in children aged 2-12 reduces pain in the immediate postoperative period. DESIGN: A prospective, randomised, single-blinded study design consisting of two groups with an intention to treat analysis. SETTING: Tertiary referral centre. PARTICIPANTS: Children aged 2-12 undergoing tonsillectomy with or without adenoidectomy. MAIN OUTCOME MEASURES: Pain assessment by nursing staff in the form of the validated modified Children's Hospital of Eastern Ontario Pain Scale at 15, 30 and 60 min and 4 h. RESULTS: Ninety-two patients were recruited into the study with 46 allocated to receive an ice-lolly and 41 not to receive an ice-lolly after exclusion of those with incomplete data. The two groups were comparable for number, age, sex and diagnosis. The pain score at every time interval was lower in the group that had received the ice-lolly compared with the group that had not. This was statistically significant at 30 (P = 0.008) and 60 min (P = 0.049). CONCLUSION: Our data suggest that ice-lollies are a cheap, effective and safe method of reducing postoperative pain up to one hour following paediatric tonsillectomy.

Public support for the use of newborn screening dried blood spots in health research.

OBJECTIVES: The level of support among Michigan adults for the use of residual newborn screening dried blood spots (DBS) was investigated. METHODS: We analyzed data from 4 questions on the 2008 Michigan Behavioral Risk Factor Surveillance System (n = 3,108). The questions asked about general support for the use of DBS for research and for research investigating childhood diseases, adult diseases and diseases related to environmental exposures. RESULTS: The majority of adults (72.3%) favored the use of DBS for research intended to benefit the health of residents. With more question specificity, a higher proportion of adults (84.2%-86.8%) were found to favor the use of DBS for research, and a lower proportion had no opinion. The odds of favoring use were higher among those who were younger, female, white, healthy, or with at least a high school degree. CONCLUSIONS: This is the first population survey of adult attitudes regarding use of DBS for different types of health research, with results showing considerable public support. The findings are being used in community outreach efforts and highlight the need to investigate opposition in vulnerable populations.

Can laryngectomees smell? Considerations regarding olfactory rehabilitation following total laryngectomy.

Total laryngectomy is performed for patients with advanced malignancy of the larynx and pharynx, and disconnects the nose and mouth from the lower respiratory tract. Rehabilitation of olfactory function in these patients is often neglected, despite recognition that anosmia and hyposmia are common and can readily be addressed. This paper reviews the literature concerning olfactory loss post-laryngectomy, methods of olfactory rehabilitation, assessment of olfactory function and quality of life issues.

Impact of organisation and management factors on infection control in hospitals: a scoping review.

This scoping review sought evidence about organisational and management factors affecting infection control in general hospital settings. A literature search yielded a wide range of studies, systematic reviews and reports, but high quality direct evidence was scant. The majority of studies were observational and the standard of reporting was generally inadequate. Positive leadership at ward level and above appears to be a prerequisite for effective action to control infection, although the benefits of good clinical leadership are diffused by supervision of large numbers of staff. Senior clinical leaders need a highly visible presence and clear role boundaries and responsibilities. Team stability and morale are linked to improved patient outcomes. Organisational mechanisms for supporting training, appraisal and clinical governance are important determinants of effective practice and successful change. Rates of infection have been linked to workload, in terms of nurse staffing, bed occupancy and patient turnover. The organisational characteristics identified in the review should be considered risk factors for infection. They cannot always be eliminated or avoided completely, but appropriate assessment will enable targeted action to protect patients.

Management of the narrow nose.

Nasal obstruction is one of the most common complaints in the otolaryngology clinic. It can be a complex problem and may be multifactorial. Nasal valve dysfunction can be a cause of nasal obstruction, particularly in patients who have undergone previous reduction rhinoplasty. The exact site of the nasal valve is contentious and is frequently subdivided into the internal and external nasal valves. Accurate assessment is crucial for correct diagnosis and management planning. Various surgical and non-surgical techniques for addressing the problem of nasal valve collapse have been described in the literature. The choice of technique will depend on the causative pathology, availability of graft material, surgical experience and patient preference.

Night emergency cover for ENT in England: a national survey.

OBJECTIVES: To evaluate the quality of out-of-hours ENT on-call cover by junior doctors, in view of the European Working Time Directive and the recent changes in the National Health Service workforce due to the 'Modernising Medical Careers' initiative, in England. METHODS: We performed a national survey of first-on-call doctors for ENT, using a telephone questionnaire. Hospital contact details were sourced from the National Health Service website. The inclusion criterion was hospitals providing acute ENT facilities overnight in England. RESULTS: One hundred and nineteen hospitals were contacted; 91 were eligible, and 83 interviews were conducted. The grade of the first-on-call ENT doctor ranged from foundation year two (19 per cent) to registrar level or above (13 per cent). Forty-nine respondents (68 per cent) reported having no previous ENT experience. Fifty-three respondents (74 per cent) covered more than one speciality at night, with seven (10 per cent) covering four or more specialities. The second-on-call doctor was non-resident in 63 cases (88 per cent). Thirty respondents (42 per cent) stated that they did not feel comfortable managing common ENT emergencies as the first doctor on call. Otorhinolaryngology induction courses were offered in 37 of the respondents' hospitals (51 per cent), these courses were of varying duration. CONCLUSION: Night-time ENT care is often provided by junior doctors with little experience of the speciality, who are often also responsible for covering multiple specialities. Many reported not feeling comfortable managing common ENT emergencies. Structured induction programmes would help to provide basic knowledge and should be mandatory for all doctors covering ENT.

Properties of zirconia-toughened-alumina prepared via powder processing and colloidal processing routes.

Alumina-zirconia composites were prepared by two routes: powder processing, and colloidal processing. Unstabilised zirconia powder was added to alumina in 5 wt%, 10 wt% and 20 wt% quantities. For the colloidal method, zirconium(IV) propoxide solution was added to alumina powder, also in 5 wt%, 10 wt% and 20 wt% quantities. Additions of glacial acetic acid were needed to form stable suspensions. Suspension stability was verified by pH measurements and sedimentation testing. For the powder processed samples Vickers hardness decreased indefinitely with increasing ZrO(2) additions, but for colloidal samples the hardness at first decreased but then increased again above >10 wt% ZrO(2). Elastic modulus (E) values decreased with ZrO(2) additions. However, samples containing 20 wt% zirconia prepared via a colloidal method exhibited a much higher modulus than the powder processed equivalent. This was due to the homogeneous dispersion of zirconia yielding a sample which was less prone to microcracking.

Acute B-cell lymphoblastic leukaemia in a 5-month-old boar.

CASE HISTORY: A 5-month-old mixed-breed boar presented with lethargy, weakness and anorexia of 1 week's duration. CLINICAL FINDINGS AND DIAGNOSIS: The boar had an elevated heart rate, slow capillary refill time and cyanotic skin over the ears; it was also severely anaemic. A necropsy revealed scattered petechial haemorrhages, small subcapsular white nodules on the kidneys, a nodule in the parenchyma of one testis, creamy-white bone marrow, a preputial diverticulum, and an ulcer of the pars oesophagea of the stomach. Cytology of peripheral blood and bone marrow identified large numbers of lymphoblasts, which were demonstrated using immunocytochemistry to be of B-cell origin. Histological examination of multiple organs also showed lymphoblastic infiltration. DIAGNOSIS: B-cell lymphoblastic leukaemia with secondary infiltration of lymphoid organs, kidneys, testis and preputial skin. CLINICAL RELEVANCE: This is the fi rst known reported case of acute B-cell lymphoblastic leukaemia in swine.

Are teamwork and professional autonomy compatible, and do they result in improved hospital care?

A postal questionnaire survey of 10 022 staff nurses in 32 hospitals in England was undertaken to explore the relationship between interdisciplinary teamwork and nurse autonomy on patient and nurse outcomes and nurse assessed quality of care. The key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision making were found to correlate with one another as well as having a relationship with nurse assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Analysis of team working by job characteristics showed a small but significant difference in the level of teamwork between full time and part time nurses. No significant differences were found by type of contract (permanent v short term), speciality of ward/unit, shift length, or job title. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy and were more involved in decision making. A strong association was found between teamwork and autonomy; this interaction suggests synergy rather than conflict. Organisations should therefore be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.

Nurses' reports on hospital care in five countries.

The current nursing shortage, high hospital nurse job dissatisfaction, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998-1999. Nurses in countries with distinctly different health care systems report similar shortcomings in their work environments and the quality of hospital care. While the competence of and relation between nurses and physicians appear satisfactory, core problems in work design and workforce management threaten the provision of care. Resolving these issues, which are amenable to managerial intervention, is essential to preserving patient safety and care of consistently high quality.