Educational booklet reinforces knowledge of osteoporosis and influences intentions to improve bone health in previously diagnosed and treated patients

We examined individuals' experiences using an educational booklet developed by the Ontario Osteoporosis Strategy. The booklet appeared to motivate individuals to make changes to their existing management of their bone health and served as a reference tool reaffirming current practices and beliefs for others.

INTRODUCTION

The purpose of this study was to examine individuals' experiences of the educational booklet and explore the influence of the booklet on individuals' beliefs and actions regarding their bone health.

METHODS

Eligible individuals were those who had been prescribed medication to treat low bone mass. One-on-one telephone interviews were conducted over an 18-month period. Participants were interviewed for approximately 1 hour and asked to provide their feedback on the booklet, and to discuss what they were doing with respect to the recommendations made in the booklet.

RESULTS

We interviewed 50 participants who ranged in age from 58 to 89. The overall impression of the booklet was positive. Participants described the language in the booklet as clear and easy to understand. Participants stated that they would have appreciated receiving this tool at the onset of their diagnosis. Forty-two participants had already taken action, or expressed an intention to make changes, to their existing routines to improve their bone health. In contrast, eight participants used the booklet to reaffirm current practices and beliefs. For these individuals, the recommendations made in the booklet were consistent with what they had already been doing.

CONCLUSION

The booklet can engage patients in discussions about bone health. The booklet appeared to motivate individuals to make changes to their existing routines in an effort to achieve better health outcomes for their bone health. Providing a tool like this to people recently diagnosed with a bone health issue may prove to be beneficial.

Is a 'healthy diet' and a 'calcium-rich diet' the same thing? Qualitative study examining perceptions of a calcium-rich diet in individuals who have received bone health education

BACKGROUND

In the present study, we aimed to (i) examine perceptions of achieving calcium and vitamin D recommended dietary allowance (RDA) and (ii) determine how participants talked about food in relation to RDA recommendations.

METHODS

Participants aged ≥50 years who were prescribed osteoporosis medication and received two modes of bone health education were eligible. Relying on a qualitative description design, we interviewed participants 1 month after they had attended an education session and received a self-management booklet. Calcium and vitamin D intakes were estimated by in-depth questions about diet and supplements and compared with perceptions of achieved RDA levels. Interview transcripts were analysed based on an analytic hierarchical process.

RESULTS

Forty-five participants (29 reporting previous fragility fractures) were included. Calcium and vitamin D RDA appeared to be potentially achieved by 64% and 93% of participants, respectively, primarily because of reliance on supplements. Few participants talked about vitamin D in relation to food intake and 49% of participants were unclear about the calcium content of food. Most considered that a healthy diet was equivalent to a calcium-rich diet. We noted no differences in our findings in the subset of individuals with fragility fractures.

CONCLUSIONS

Despite reporting a prescription for osteoporosis medication and receiving bone health education, a substantial number of individuals appeared to have sub-optimal calcium levels. This may be attributed to the challenge of achieving RDA with diet alone and the misconception of a healthy diet as a calcium-rich diet.

MASSIVE TRANSFUSION PROTOCOL: STANDARDIZING CARE TO IMPROVE PATIENT OUTCOMES

Providing rapid response is a primary goal when caring for surgical patients with injuries involving massive blood loss. Massive transfusion protocols have been developed in some tertiary care health care facilities to ensure a rapid and efficient response in the provision of care to patients with a massive and uncontrolled hemorrhage. The purpose of this article is to discuss a massive transfusion protocol and to describe the process used to implement a massive transfusion protocol at Winnipeg's Health Sciences Centre (the site) as well as to describe its impact in the operating room department.

Intraoperative MRI: the challenges of providing a safe environment for patients and personnel

Real-time intraoperative magnetic resonance imaging (iMRI) provides a tremendous benefit to patients undergoing brain tumour surgery. This paper will discuss the Winnipeg Health Sciences Centre's experience implementing a new iMRI program in a new neurosurgery operating room suite. It will review MRI technology and discuss related safety considerations for patients and personnel.

Evacuating an OR is a complex process: who does what?

It became necessary, following the relocation of the entire Winnipeg Health Sciences Centre Adult OR department in 2007 and in consideration of fire code regulations, to re-evaluate and modify the existing evacuation plan and to simulate, and test, these modifications in the new environment. Planning a fire evacuation simulation for a large tertiary OR is a very complex process and involves a great deal of planning and attention to detail. It requires a multidisciplinary approach as it involves many departments. Learning about one site's experiences may benefit others. The goal of this article is to provide some planning examples and guidelines for use by sites that are beginning to undertake this important process.

Is stainless steel really "stainless"?

Initial purchase and replacement costs for surgical instrumentation are significant components in today's operating room budgets. OR staff and medical device reprocessing personnel work together as a team to ensure effective management of this valuable commodity. The purpose of this article is to discuss the composition of stainless steel surgical instruments, to identify processes to minimize damage to instruments caused by staining, corrosion, and pitting, and to utilize that information to describe effective measures to manage instrumentation in both the OR and reprocessing areas.

Code blue: what to do?

Cardiac arrest may occur intraoperatively at any time. The purpose of this article is to help the reader recognize and assist in the management of an intraoperative cardiac arrest. Patients who are at risk for cardiac arrest in the OR are identified and different types of pulseless arrythmias are identified. Roles of perioperative personnel are suggested and documentation during the code is discussed.

Oh, by the way, the patient is pregnant!

Approximately one to three per cent of pregnant women undergo surgery that is unrelated to their pregnancy. In Canada this represents about 5,000 patients each year that present unique challenges to the perioperative nurse and the entire surgical team. Approximately five to ten per cent of these patients are involved in trauma, which causes 46.3% of maternal deaths. A small percentage of elective procedures are carried out in the first trimester, before the patient herself is aware of the procedure. The majority of procedures are required for urgent and emergent conditions that require surgery despite the risks to the mother and fetus. This article will discuss perioperative care of the non-obstetric pregnant patient and to introduce a nursing care guideline that can be used as a quick-reference tool. The care discussed in the appended Guideline focuses on the pregnant condition and is to be used in conjunction with routine perioperative care practices. Semi-elective and urgent surgery is not contraindicated by pregnancy, although anesthetic and surgical approaches must be modified to promote the safety of mother and her fetus. If possible, the surgery should be postponed to the second trimester. By this time major systems of the fetus are formed and the uterus does not yet infringe on abdominal structures and manipulation may be kept to a minimum. In the first trimester, spontaneous abortion is the greatest risk at 12%. This decreases to less than five per cent in the second and third trimesters. Pre-term labor presents the greatest risk in the second and third trimesters. The most common need for surgery in pregnancy is associated with appendicitis, biliary tract disease, intestinal obstruction, urinary calculi and trauma.

Performance appraisals in the OR: everyone's business

Performance appraisals affect everyone. Perioperative nurses often participate in staff orientations and act as preceptors for other learners. Nurses also participate in their own performance appraisal process. This article discusses performance appraisal forms and performance interview processes. Examples of a performance appraisal form design and performance indicators for perioperative nurses are included. Potential problems with performance appraisals are identified and the impact of Canadian law on performance appraisals is discussed.

Don't tip the scales! Care for patients involved in a police investigation

Occasionally perioperative nurses are involved in the complex role of caring for medical-legal evidence while also advocating for the patient's right for privacy. Appropriate management of evidence may be the deciding factor in the outcome of a criminal investigation. Understanding the importance of evidence is the first step in learning how to prevent its unintentional destruction during the surgical procedure. Our first consideration with every patient is to provide safe and efficient care. In the OR, cooperation with the police is balanced with the patient's right to privacy and confidentiality of their health care information. This is not always an easy task. Perioperative nurses have a responsibility to their patients as well as to investigators to do what is appropriate, since our actions can have direct effects on the outcomes of criminal investigations. Understanding the importance of evidence is the first step in learning how to keep evidence from being destroyed. Hospital documentation is often accepted in a court of law without challenge.

Surgical counts can be risky business!

The surgical count plays a vital role in enabling perioperative nurses to provide a safe environment to surgical patients. Counting errors are preventable. Although national standards of care provide excellent guidelines for developing effective count protocols, counting procedures are often modified according to individual health care policy. This article will discuss the risk factors for retained items, rate of occurrence, what objects are being left in patients, role of x-rays and consequences of leaving an object in a patient. It will also highlight points to be considered when implementing new count policies.

Ordered Landmarks in Planning

Many known planning tasks have inherent constraints concerning the best order in which to achieve the goals. A number of research efforts have been made to detect such constraints and to use them for guiding search, in the hope of speeding up the planning process. We go beyond the previous approaches by considering ordering constraints not only over the (top-level) goals, but also over the sub-goals that will necessarily arise during planning. Landmarks are facts that must be true at some point in every valid solution plan. We extend Koehler and Hoffmann's definition of reasonable orders between top level goals to the more general case of landmarks. We show how landmarks can be found, how their reasonable orders can be approximated, and how this information can be used to decompose a given planning task into several smaller sub-tasks. Our methodology is completely domain- and planner-independent. The implementation demonstrates that the approach can yield significant runtime performance improvements when used as a control loop around state-of-the-art sub-optimal planning systems, as exemplified by FF and LPG.

Artificial nails... very real risks

The current social trend towards personal esthetics has come into conflict with safe perioperative care practices. While artificial nails have become very popular they pose a significant risk to patients. Surgical personnel who scrub while wearing artificial nails are putting their patients at higher risk for post-surgical wound infection. Artificial nails harbour microbes and cannot be cleaned as effectively as short, natural nails. We cannot rely on surgical gloves to always contain these hand organisms. There are reported cases where artificial nails have been the cause of post-surgical infections and even death. OR personnel who scrub should not wear artificial nails.

Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus

The combination of a 4% tea tree oil nasal ointment and 5% tea tree oil body wash was compared with a standard 2% mupirocin nasal ointment and triclosan body wash for the eradication of methicillin-resistant Staphylococcus aureus carriage. The tea tree oil combination appeared to perform better than the standard combination, although the difference was not statistically significant due to the small number of patients.

The cross cultural context of obesity: an INCLEN multicentre collaborative study

Associations between obesity and cardiovascular disease have been documented in the Developed World and have been linked with levels of 'development' in Developing World countries. This study aimed to explore the sociocultural influences on attitudes towards obesity, physical activity and dietary change using a four level conceptual framework (from personal to societal influences). Focus group discussions were conducted in: India, Indonesia, Cameroon, Egypt and Australia. The results of these discussions were analysed to reveal emergent themes. The interpretation of the qualitative data emphasised the need to incorporate influences beyond the individual in efforts to reverse or prevent obesity related disease.

Prevalence of rheumatic heart disease among school children in Addis Ababa

OBJECTIVE

To determine the prevalence of rheumatic heart disease (RHD), and the impact of potential risk factors on its occurrence among school children in Addis Ababa.

DESIGN

Cross-sectional survey of school children for the presence or absence of RHD.

SETTING

Randomly selected ten government and five private schools from the list of all government and private schools in Addis Ababa teaching grades 7 and 8.

SUBJECTS

All school children attending grades 7 and 8 in the randomly selected schools.

MAIN OUTCOME MEASURES

Clinical findings suggestive of RHD confirmed by echocardiographic and Doppler studies.

RESULTS

Out of the 10,053 school children selected for the study 9,388 (93%) were examined. Sixty of the 9,388 school children examined were subsequently confirmed to have RHD giving an overall prevalence rate of 6.4 per 1000 children. The prevalence for government and private schools representing low and high socio-economic groups were 7.1 and 1 per 1000 children respectively (Fisher's exact = 0.019). Crowding conditions at home, in schools and in the bedrooms were not associated with the risk of RHD (chi 2 = 4.968; p > or = 0.174).

CONCLUSION

This study confirmed that the prevalence of RHD, at least in the low socio-economic group is among the highest in the world. This evidence highlights the need for an urgent control programme.

Rheumatic heart disease among school children in Addis Ababa City: awareness and adequacy of its prophylaxis

One of the objectives of this large scale cross-sectional study of school children of the Addis Ababa city was to assess the status of rheumatic heart disease (RHD) prophylaxis among rheumatic heart disease patients identified during the survey. Awareness about the presence of the illness in those affected and reasons for poor coverage, when detected, were also assessed. Sixty of the 9388 school children surveyed were found to have rheumatic heart disease. On interviewing parents of the children with rheumatic heart disease, ten acknowledged being informed of their children's cardiac illness. Of these parents, 15% (or 9/60) had some idea that their children had heart disease related to some form of infection. However, only two of the nine (22%) children whose parents had some idea about their disease were on regular monthly benzathine penicillin prophylaxis in the previous 12 months preceding the interview. Three (33%) of the nine children had six or fewer injections in the 12 months preceding the interview. The remaining 4 parents (44%) reported that their children took treatment that included injections only at the time of initial diagnosis several years earlier and had not had any follow up since then. Their reasons for not seeking medical care for their children included lack of information on prophylaxis, inability to pay for the treatment and distance of the health facilities. The lack of awareness and the extremely low rate of regular prophylaxis, therefore, highlight the need for an urgent control programme that takes active case detection, treatment access and health education into consideration.

Whose diet has changed?

The same questions about diet were asked in two community-based surveys conducted in the Hunter Region of New South Wales in 1983 and 1994. There were substantial changes in diet over the period; for example, the proportion of respondents who reported using low-fat or skim milk increased from 25 per cent to 51 per cent, the proportion eating meat fewer than five times a week doubled from 21 per cent to 42 per cent and the proportion eating fewer than three eggs per week increased from 55 per cent to 80 per cent. In both surveys, women reported eating a healthier diet than men, and older people and those of higher socioeconomic status reported better diets than younger people or people with less education or lower status occupations. The surprising finding was that over the 11-year period the changes in patterns of food consumption were remarkably similar across all strata of the population. The conclusions are that wide-spread dietary change is possible. However, the changes in the last decade related mainly to reducing the risk of cardiovascular disease; similar behavioural changes to reduce the risk of diet-related cancer are required.

Dietary trends: estimates from food supply and survey data

OBJECTIVE

To illustrate methodological issues involved in estimating dietary trends in populations using data obtained from various sources in Australia in the 1980s and 1990s.

METHODS

Estimates of absolute and relative change in consumption of selected food items were calculated using national data published annually on the national food supply for 1982-83 to 1992-93 and responses to food frequency questions in two population based risk factor surveys in 1983 and 1994 in the Hunter Region of New South Wales, Australia. The validity of estimated food quantities obtained from these inexpensive sources at the beginning of the period was assessed by comparison with data from a national dietary survey conducted in 1983 using 24 h recall.

RESULTS

Trend estimates from the food supply data and risk factor survey data were in good agreement for increases in consumption of fresh fruit, vegetables and breakfast food and decreases in butter, margarine, sugar and alcohol. Estimates for trends in milk, eggs and bread consumption, however, were inconsistent.

CONCLUSIONS

Both data sources can be used for monitoring progress towards national nutrition goals based on selected food items provided that some limitations are recognized. While data collection methods should be consistent over time they also need to allow for changes in the food supply (for example the introduction of new varieties such as low-fat dairy products). From time to time the trends derived from these inexpensive data sources should be compared with data derived from more detailed and quantitative estimates of dietary intake.

Bowel technique in the O.R. Is it really necessary?

Existing inconsistencies in the practice of bowel technique prompted a study to validate this operating room procedure. Minimal reference to intra-operative bowel technique was found in the literature. Needle drivers and tissue forceps utilized to anastomose large bowel were cultured, and the results were analysed. Needle drivers and tissue forceps used to anastomose small bowel were also cultured and used as a control group. Only elective bowel surgery cases were included in the study. The study demonstrated that there was consistent contamination to those instruments used for bowel anastomosis, with significantly greater contamination for large bowel resections. These results indicate that isolating those instruments and equipment which come into direct contact with the bowel lumen is a perioperative practice which will reduce the surgical patient's risk of postoperative wound infection.

Acceptability of high-fibre diets in diabetic patients

Twenty-five diabetic patients were selected from Oxford Diabetic Clinics to assess their dietary compliance (Group A). All had been taught to follow diets rich in dietary fibre in which carbohydrate provided 50% of total energy. The results were compared with those obtained previously from a similar group of patients (Group B) all of whom had been instructed to follow a diet in which carbohydrate provided 40% of total energy. The patients of Group A had a significantly greater intake of carbohydrate (45.1% vs 34.7% of total energy) and dietary fibre (33.1 g vs 18.7 g) and a lower intake of fat (33.5% vs 42.1% of total energy) than the patients of Group B. The results of dietary assessment obtained from a third group of patients (Group C), who had been advised to follow a high-fibre diet before the widespread availability of dietary teaching aids and recipe books, showed that carbohydrate and fat provided 37.5% and 41.0% of total energy, with a dietary fibre intake of 25.6 g. The results suggest that patients are willing and able to change their dietary habits towards a distribution of food constituents likely to improve diabetic control and reduce the risk of coronary heart disease when given enthusiastic instruction and support in diabetic clinics.