Evaluation of a visual tool co-developed for training hospital staff on the prevention and control of the spread of healthcare associated infections

BACKGROUND

Staff training in infection prevention and control (IPC) across hospital settings has a crucial role in reducing the incidence of healthcare associated infections (HAIs). However the application of dynamic visualisation approaches in this context is under-developed, with very few in-depth evaluation studies of related processes and impacts.

METHODS

A prototype training tablet app for hospital staff, using interactive visuals was developed and evaluated. To demonstrate different pathogen behaviour, dynamic visualisations of norovirus, Clostridium difficile, and MRSA were developed in relation to location, survival and transmission within a virtual hospital ward model using evidence-based microbiological and staff behavioural data. A three-stage evaluation process was designed, involving a mixed sample of UK National Health Service staff (doctors, nurses and domestic staff, n = 150).

RESULTS

Participants reported improved awareness and understanding of the pathogens responsible for HAI, the types of information relevant for different staff cohorts, those aspects of the visualisations which worked well and those which were prone to cause misunderstandings, and suggestions for further development and improvement. The tool appeared to offer staff a new perspective on pathogens, being able to 'see' them contextualised in the virtual ward, making them seem more real.

CONCLUSION

Results showed the benefits of a detailed co-development process and a more contextualised understanding of the potential for visual apps to be used in IPC training.

Visualisation of biomechanical data to assist therapeutic rehabilitation

PURPOSE: The biomechanics community have to date had limited success in communicating complex biomechanical data and analyses outside of their field. The authors have created an innovative prototype software tool to visualise objective dynamic movement data captured from older adults undertaking activities of daily living (ADLs). Evaluation of this tool has shown it to be a successful way of communicating the complexity of older adult mobility data in an accessible manner for non-biomechanical specialists and lay audiences(1,2). METHODS: A software tool was developed, which generates a 3D animated human 'stick figure', on which the biomechanical demands of ADLs are represented visually at the joints as a percentage of each individual's maximum capability using a continuous colour gradient from green at 0%, amber at 50%, through to red at 100% (Figure 1). The tool was evaluated using a qualitative methodology of interviews and focus groups, where older adults and professionals viewed a series of visualisations of dynamic movement data(3). RESULTS AND DISCUSSION: Analysis of focus group discussions facilitated by the visualizations revealed new kinds of dialogues about biomechanical issues. The method of visualising and presenting the data clearly enabled people without training in biomechanics, both professionals and lay older people, to access and interpret the biomechanical information, based on their background, knowledge of a field or their personal experience. Further, the common visual medium enabled the sharing of different insights without recourse to specialist terminology or knowledge. New kinds of dialogues occurred in focus groups between older people and professionals about their experiences, based on real understanding of where the mobility problems were occurring. New dialogues also emerged between professionals from a range of different disciplines, crucial for different aspects of the care, wellbeing or design of the built environment for older people. Neither of these would have been possible using current conventions of presenting biomechanical data. The visualisations also appear to allow a deeper understanding of the issues within professions, both in healthcare and in design. These findings have led to new research with five discrete yet complementary studies covering a range of clinical applications of this method for: i) mobility and exercise advice for the healthy older adult; ii) falls prevention; iii) rehabilitation of total knee replacement; iv) to enhance early mobilisation of acute stroke patients and v) to enhance biomechanical diagnosis and fitting of ankle foot orthoses (AFO) in late stage stroke.

Breast infarction in a patient with chronic renal failure: a case report

A 41-year-old woman who had chronic renal failure required a simple mastectomy for infarction of one breast. On initial presentation her condition was managed as a skin ulcer. Arterial calcification is common in chronic renal failure and its pathogenetic connection with this uncommon event is relevant to the management of "skin ulcers" in general in this population.

Body position, age and mass effect of adiposity on adipose tissue red cell flux in morbid obesity

OBJECTIVE

To measure red cell flux of adipose tissue in morbidly obese patients' pannus in the upright and supine position to determine factors which would render the lower pannus susceptible to ischemic necrosis.

DESIGN

A cohort study of morbidly obese subjects without ischemic necrosis.

SETTING

University teaching hospital.

PATIENTS

Twenty-three consecutive morbidly obese patients referred for gastroplasty.

MEASUREMENTS

Red cell flux, measured as RMS voltage by a laser Doppler velocimeter. An optical fiber with a tip diameter of 250 mu was inserted into the upper and lower pannus and output recorded in the upright and supine positions. Other variables recorded were age, BMI, blood pressure and serum lipids.

RESULTS

Adipose tissue red cell flux demonstrates considerable spatial and temporal heterogeneity from subject to subject and in various locations in the pannus. No differences in red cell flux were detected in response to change in position. However, regression analysis demonstrated that the gradient between the upper and lower abdomen in the supine position was increasingly positive with age and in the upright position it was increasingly positive with increasing weight or BMI.

CONCLUSIONS

These data suggest that red cell flux is heterogeneously distributed in the abdominal pannus and is not greatly influenced by body position. However, with increasing age and adiposity there is a gradient for decreased red cell flux to the lower portion of the pannus. This may be a factor in rendering this part of the pannus prone to ischemic fat necrosis.

Acinar structure and function in canine pancreatic autografts with duct drainage into the urinary bladder

Autotransplants of pancreas in 8 dogs, with exocrine drainage into the urinary bladder, were stimulated in vivo with cholecystokinin-pancreozymin (CCK-PZ). Transplant biopsies, when compared with 6 normal pancreases, showed normal acinar structure by light and electron microscopy 13-18 months after initial surgery; 2 transplants with sutures unintentionally transecting ducts were fibrosed and had duct obstruction. After in vivo stimulation, the normal-appearing transplants produced a 7-fold increase in urinary amylase, and quantitative electron microscopy showed a 50% reduction in mature zymogen granules; there were no intracellular organelle abnormalities prior or subsequent to stimulation. Fibrosed transplants produced lesser urinary amylase both prior to and after stimulation. In vitro stimulation of grafts with normal structure increased amylase secretion from 1.5-2.1-fold. In vitro dose-response showed a maximum at 10(-9)M cholecystokinin-octopeptide (CCK-OP) in transplant and control. The in vivo stimulation is more responsive and may be useful for clinical monitoring of graft survival. In vivo stimulation occurred after induced urinary tract infection; because no pancreatitis ensued, a regimen of trophic stimulation by CCK-PZ was not contraindicated. The bladder tolerated exocrine drainage with no significant change, and bladder infection did not adversely affect the transplant. The islets appeared normal in the transplants by light and qualitative electron microscopic observation; fasting blood glucose and insulin values were normal during the 12-18-month follow-up. Bladder drainage of segmental grafts of pancreas provides a preparation with intact acinar-islet relationships; the present observations suggest that this may permit longer islet survival in the absence of acinar destruction and subsequent fibrosis.

Oral administration of BCG as an adjuvant to surgical treatment of carcinoma of the bronchus

A controlled clinical trial of the value of bacille Calmette--Guérin (BCG) vaccine given orally to patients with resectable carcinoma of the lung was conducted in 18 centres across Canada. A total of 308 patients were included in the analysis, 155 in the BCG group and 153 in the control group. The two groups were similar at the time of admission to the trial. BCG (120 mg) was given orally at weekly intervals for 1 month, every 2 weeks up to 3 months and then every 3 months until the total duration of therapy was 18 months. Over a 3- to 5-year follow-up period after the operation there was no difference in survival between the two groups, the proportion alive at 2 years being 61% in the BCG group and 58% in the control group. There was also no evidence of differences in the time to the detection of recurrent or metastatic disease or in the distribution of such disease. An analysis of prognostic factors confirmed the poor survival associated with histologically confirmed lymph node involvement. It may be concluded that no favourable effect from the oral administration of BCG was demonstrated.

Effects of cortisone acetate, methylprednisolone and medroxyprogesterone on wound contracture and epithelization in rabbits

Standardized flank wounds were made on 20 rabbits divided into the following five groups: Group 1 served as controls, Group 2 were given cortisone acetate 6.25 mg/kg/day (I.M.), Group 3--methylprednisolone (Solu-Medrol) 1 mg/kg/day, Group 4--medroxyprogesterone (Depo-Provera) 35 mg/kg/day, Group 5--methylprednisolone 1 mg/kg/day and medroxyprogresterone 35 mg/kg/day. Wound contracture and epithelization was measured by planimetry of photographs taken twice weekly; weekly weights were recorded, and the maturation phase of wound healing followed in the control and methylprednisolone groups. All three steroids prolonged the latent phase of wound healing, slowed the rate and decreased the total amount of contracture. Cortisone showed the most inhibition of wound contracture and was the only steroid to inhibit epithelization suggesting it may have a slightly different or more potent mode of action. When the methylprednisolone group was followed for seven weeks on daily injections, the maturation phase of wound healing was inhibited, and this inhibition persisted during the next nine weeks after the drug was withdrawn. Only the control and the medroxyprogesterone group gained weight. Combining medroxyprogesterona and methylprednisolone resulted in the severest weight loss of 20% with a 60% mortality.

Liver preservation by single passage hypothermic "squirt" perfusion

A single passage, hypothermic, intermittent squirt perfusion of the pig's liver is described which has allowed preservation of porcine livers for up to 17 hours. After preservation, orthotopically allografted livers can maintain recipient animals in good health. If this technique can be applied to clinical liver transplantation it should be possible to move livers from one hospital to another in the same way that kidneys are transported. This should increase the availability of donor livers for transplantation and avoid the serious disadvantages of moving the sick recipient just before the operation to the hospital where the donor has died.