Hand hygiene posters: motivators or mixed messages?

Poster campaigns regarding hand hygiene are commonly used by infection control teams to improve practice, yet little is known of the extent to which they are based on established theory or research. This study reports on the content analysis of hand hygiene posters (N=69) and their messages (N=75) using message-framing theory. The results showed that posters seldom drew on knowledge about effective ways to frame messages. Frequently, they simply conveyed information 'telling' rather than 'selling' and some of this was confusing. Most posters were not designed to motivate, and some conveyed mixed messages. Few used fear appeals. Hand hygiene posters could have a greater impact if principles of message framing were utilized in their design. Suggestions for gain-framed messages are offered, but these need to be tested empirically.

Hand hygiene posters: selling the message

This literature review was undertaken to determine the established theory and research that might be utilized to inform the construction of persuasive messages on hand hygiene posters. It discusses the principles of message framing and the use of fear appeals. Current theory suggests that the most effective messages for health promotion behaviours should be framed in terms of gains rather than losses for the individual. However, as clinical hand hygiene is largely for the benefit of others (i.e. patients), messages should also invoke a sense of personal responsibility and appeal to altruistic behaviour. The use of repeated minimal fear appeals have their place. Posters that simply convey training messages are not effective persuaders.

Gene expression profiling of bone cells on smooth and rough titanium surfaces

Titanium (Ti) and Ti alloys are widely used as dental and orthopaedic implants, but the effects of the surface characteristics of these materials on the response of cells and target tissues is not well understood. The present study has therefore examined the effects of a rough Ti (RT) and a smooth Ti (ST) surface on human bone cells in vitro. Scanning electron microscopy showed attachment and spreading of cells on both surfaces. Expression profiling using ATLAS gene arrays showed marked differences in gene responses after 3 h of culture. A number of osteoblast genes were identified as "roughness response" genes on the basis of changes in expression on the RT compared with the ST surfaces. The surface roughness of Ti was thus found to have a profound effect on the profile of genes expressed by the bone cells, and suggests that improvements in the biological activity and possibly the clinical efficacy of these materials could be achieved by selective regulation of gene expression mediated by controlled modification of Ti surface.

Interaction of kappa-carrageenan with nickel, cobalt, and iron hydroxides

In a previous paper, it was shown that the functional polysaccharide kappa-carrageenan acts as an efficient stabilizer to prevent the precipitation of iron oxides and hydroxides up to very high pH values (Jones, et al. Colloid Polym. Sci. 2000, 278, 491-501). Here, this process was investigated for its application to synthesize stable cobalt and nickel oxide particles. Nickel hydroxide nanoparticles were well stabilized for long periods, while the hydroxide of cobalt(II), although initially stable at pH 13, progressively showed some complex structure rearrangement, invoked by alkaline oxidation of the primary particles. The final product of this oxidation/self-assembly process are spherical, fluffy superstructures of cobalt(III) oxide platelets with an overall diameter of 12 microns, in coexistence with 65-75% of free kappa-carrageenan.

Donor milk: what's in it and what's not

Breastfeeding and human milk are widely recognized as optimal for human infants. However, if donor milk is used when mother's own milk is not available, some questions arise concerning the effects of storage, handling, and heat processing on the unique components of human milk. Holder pasteurization (62.5 degrees C for 30 minutes) of banked human milk is the method of choice to eliminate potential viral contaminants such as human immunodeficiency virus, human T-lymphoma virus, and cytomegalovirus, as well as tuberculosis and other bacterial contaminants, while maintaining the greatest possible complement of its unique bioactive factors. This article reviews some of the critical components of human milk and what is currently known about the effects of Holder pasteurization on their biological activity.

Hepatosplenic Candidiasis, its Treatment and Effect on Remission Status in Patients with Acute Leukaemia-a Report of Five Cases

Hepatosplenic candidiasis is an increasingly encountered complication of treatment of patients with acute leukaemia [[1] Clin. Infect. Dis. 24 (1997) 375]. Management is difficult as delay in further chemotherapy may allow relapse of the leukaemia while the infection may progress if chemotherapy is continued [[2] Anticancer Res. 19 (1999) 757]. We report five cases of suspected hepatosplenic candidiasis in a single haematology unit over a 30-month period. All patients were treated with oral fluconazole following intravenous amphotericin or liposomal amphotericin B lipid complex. Chemotherapy was withheld during treatment of infection. Two patients remain in haematological remission despite suboptimal therapy for their leukaemia. One patient died from progressive fungal infection, 1 patient of cardiac disease and 1 patient has had recent relapse of their leukaemia. We demonstrate that hepatosplenic candidiasis may be treated with oral fluconazole while chemotherapy is discontinued and also suggest that this infection or its treatment may have had a beneficial immunomodulatory affect on the leukaemic process in the surviving patients.

Separation of aniline from aqueous solutions using emulsion liquid membranes

An emulsion liquid membrane process is developed to separate aniline from dilute aqueous solution. Aniline (amino-benzene) is a carcinogenic chemical common in industry and industrial wastewater. Due to aniline's high boiling point (183 degrees C) and low concentration in wastewater, more traditional methods of separation such as distillation are very energy intensive. This emulsion process is offered as a low energy alternative. All separations occur in a Rushton stirred tank. The membrane phase consists of kerosene and the surfactant sorbitan monooleate (span 80). Hydrogen chloride solution is the internal phase. This study also examines the effects of HCl concentration, aniline concentration, and the amount of emulsion on separation. Up to 99.5% of the aniline is removed from solutions containing 5000 ppm in as little as 4 min depending on process conditions. Leakage is minimal and swelling is only about 3% after 5 min of processing. Approximately 98% of the membrane phase (both kerosene and span 80) is successfully recovered and recycled by using heat and/or adding 2-propanol for demulsification.

Extramedullary gastric plasmacytoma

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Intra-abdominal hypertension is an independent cause of postoperative renal impairment

HYPOTHESIS

Intra-abdominal hypertension exerts an effect on renal function independent of other confounding variables.

DESIGN

A prospective study of all patients admitted to an intensive care unit following abdominal surgery was undertaken between September 1, 1994, and July 31, 1997, in a single university hospital.

MAIN OUTCOME MEASURES

Intra-abdominal pressure (IAP) was measured every 8 hours (normal IAP, 0-17 mm Hg); 18 mm Hg or higher was considered increased. Forward stepwise logistic regression determined whether intra-abdominal hypertension is an independent cause of renal impairment.

RESULTS

A total of 263 patients (174 after emergency surgery), whose mean +/- SD age was 61.0 +/- 18.7 years and Acute Physiology and Chronic Health Evaluation II score was 14.6 +/- 7.7, were studied. Intra-abdominal pressure was increased in 107 (40.7%) of the 263 patients. Renal impairment occurred in 35 (32.7%) of the 107 patients with intra-abdominal hypertension and in 22 (14.1%) of the 156 with a normal IAP (odds ratio, 1.62-5.42). Using the Wald maximizing model, renal impairment was independently associated with 4 antecedent factors: hypotension (P= .09), sepsis (P = .006), age older than 60 years (P = .03), and increased IAP (P = .004).

CONCLUSIONS

To our knowledge, for the first time in a large clinical study, IAP has been shown to be an independent cause of renal impairment, and it ranks in importance after hypotension, sepsis, and age older than 60 years. Surgeons need to be aware of the importance of intra-abdominal hypertension in patients postoperatively.

Sensitivity, specificity, and predictive values of three Salmonella rapid detection kits using fresh and frozen poultry environmental samples versus those of standard plating

To reduce human exposure to Salmonella spp. in poultry products, broiler chicken flocks have been tested by culture methods. Since the standard techniques may take 3 to 5 days, rapid detection methods have been developed. In this study we tested the performance of three rapid tests originally developed for food samples by using environmental samples obtained from poultry houses. These rapid tests were Reveal, an enzyme-linked immunosorbent assay from Neogen Corp.; BIND, a bacterial ice nucleation detection method from Idetek Corp.; and a filter monitor method from Future Medical Technologies, Inc. For the standard culture, brilliant green with novabiocin and xylose-lysine-tergitol-4 agar were used for presumptive identification, and identities were confirmed by using poly-O antisera. Environmental samples were collected from farms belonging to an integrated poultry company prior to chick placement and 1 week before slaughter. Sensitivities, specificities, and predictive values with 95% confidence intervals were calculated. Statistical differences were determined by using McNemar's chi square test. The sensitivities of the different tests were not stable, varying widely between sample times, and were affected by freezing of the samples. All of the rapid tests had low sensitivities, which led to many false-negative results. All tests were able to detect Salmonella spp. at a concentration of 10 CFU/ml in at least one of four trials. The BIND and Reveal tests were simple to use with multiple samples and reduced laboratory time by up to 1 day. Based on our results, we do not recommend that any of these rapid tests, in their present state of development, be utilized with environmental samples collected with drag swabs.

The accuracy of predicting functional recovery in patients following a stroke, by physiotherapists and patients

BACKGROUND AND PURPOSE

The potential for post-stroke recovery and the range of predictive variables has been studied extensively. Knowledge of these variables alongside other factors, such as performance in therapy and professional experience, enable ongoing predictions to be made by members of the rehabilitation team. Patients' own predictions for their recovery has yet to receive much attention in this area of research. The aim of this study was to compare the predictive accuracy of the physiotherapist and the stroke patient with regard to functional change during a period 6-12 weeks post-stroke.

METHOD

The stroke sample (N = 29) came from two National Health Service Trusts as did the physiotherapists (N = 4). No comparisons were made between the hospitals and data was coded for anonymity. Estimations were made by both physiotherapists and patients regarding items on each of the three sections of The Rivermead Motor Assessment (RMA). Intra-class correlation coefficients (ICCs) were used to describe agreement of each set of predictions with the achieved RMA scores. The results reported here represent the main emphasis of the research; however, other areas were also screened (for example, change in cognition, language and quality of life) by use of basic standardized measures. Recovery was also compared to other known predictive variables, such as age, severity of stroke and urinary incontinence.

RESULTS

At follow-up assessment it was found that both physiotherapists' and patients' predictions demonstrated high and significant agreement with the achieved RMA scores at 12 weeks (ICCs ranging from 0.727 to 0.968). Physiotherapists' predictions demonstrated marginally higher levels of agreement than patients' predictions.

CONCLUSIONS

The degree of accuracy demonstrated by both physiotherapists and patients was considerable. The patient group was perhaps the more notable as no subject had had prior knowledge of a stroke. The implications in respect of lay persons' involvement in decision making and in the rehabilitative process, alongside the health professionals, are perhaps worthy of closer consideration.

Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology

This study prospectively analyzed outcomes in 49 consecutive patients undergoing temporary abdominal closure (TAC) between 1993 and 1996 at a single university hospital. There were 37 males and 12 females, mean age was 57 years (range, 25-79 years), mean Acute Physiology and Chronic Health Evaluation score was 27 (+7.8 SD), and mean Simplified Acute Physiology II score was 53.0 (+/-15.4). The reason for TAC was decompression in 22 patients, inability to close the abdomen in 10 patients, to facilitate reexploration for sepsis in 8 patients, and multifactorial in 9 patients. After TAC, there was a significant reduction in intra-abdominal pressure from 24.2+/-9.3 to 14.1+/-5.5 mm Hg and improvement in lung dynamic compliance from 24.1+/-7.9 to 27.6+/-9.4 mL/cm H2O (p < 0.05). Although 10 patients experienced brisk diuresis, there was no significant improvement in renal function; in fact, serum creatinine increased. The median length of stay was 35 days (range, 1-232 days). The mean number of abdominal operations after mesh insertion was 2.6+/-2.4. There were 21 deaths, for a standardized mortality rate of 0.80. Although it achieved significant reductions in abdominal pressures and improved lung dynamic compliance, TAC did not result in improved renal function or patient oxygenation.