An investigation of contact transmission of methicillin-resistant staphylococcus aureus

Hand hygiene is critical in the healthcare setting and it is believed that methicillin-resistant Staphylococcus aureus (MRSA), for example, is transmitted from patient to patient largely via the hands of health professionals. A study has been carried out at a large teaching hospital to estimate how often the gloves of a healthcare worker are contaminated with MRSA after contact with a colonized patient. The effectiveness of handwashing procedures to decontaminate the health professionals' hands was also investigated, together with how well different healthcare professional groups complied with handwashing procedures. The study showed that about 17% (9–25%) of contacts between a healthcare worker and a MRSA-colonized patient results in transmission of MRSA from a patient to the gloves of a healthcare worker. Different health professional groups have different rates of compliance with infection control procedures. Non-contact staff (cleaners, food services) had the shortest handwashing times. In this study, glove use compliance rates were 75% or above in all healthcare worker groups except doctors whose compliance was only 27%.

Releasing Dragons

As a woman traveling from one of the world’s youngest nations, Australia, my aim was to examine if western ideology had infiltrated life styles of Chinese women since the “opening up” of China in the 1980s. It is through a metaphoric examination of the contents of women’s handbags – traditionally a very secretive environment – that I sought to investigate aspects of a gender-based economic and social basis of China in 1999.

Motorcycle protective clothing : protection from injury or just the weather?

Background Apart from helmets, little is known about the effectiveness of motorcycle protective clothing in reducing injuries in crashes. The study aimed to quantify the association between usage of motorcycle clothing and injury in crashes. Methods and findings Cross-sectional analytic study. Crashed motorcyclists (n = 212, 71% of identified eligible cases) were recruited through hospitals and motorcycle repair services. Data was obtained through structured face-to-face interviews. The main outcome was hospitalization and motorcycle crash-related injury. Poisson regression was used to estimate relative risk (RR) and 95% confidence intervals for injury adjusting for potential confounders. Results Motorcyclists were significantly less likely to be admitted to hospital if they crashed wearing motorcycle jackets (RR = 0.79, 95% CI: 0.69–0.91), pants (RR = 0.49, 95% CI: 0.25–0.94), or gloves (RR = 0.41, 95% CI: 0.26–0.66). When garments included fitted body armour there was a significantly reduced risk of injury to the upper body (RR = 0.77, 95% CI: 0.66–0.89), hands and wrists (RR = 0.55, 95% CI: 0.38–0.81), legs (RR = 0.60, 95% CI: 0.40–0.90), feet and ankles (RR = 0.54, 95% CI: 0.35–0.83). Non-motorcycle boots were also associated with a reduced risk of injury compared to shoes or joggers (RR = 0.46, 95% CI: 0.28–0.75). No association between use of body armour and risk of fracture injuries was detected. A substantial proportion of motorcycle designed gloves (25.7%), jackets (29.7%) and pants (28.1%) were assessed to have failed due to material damage in the crash. Conclusions Motorcycle protective clothing is associated with reduced risk and severity of crash related injury and hospitalization, particularly when fitted with body armour. The proportion of clothing items that failed under crash conditions indicates a need for improved quality control. While mandating usage of protective clothing is not recommended, consideration could be given to providing incentives for usage of protective clothing, such as tax exemptions for safety gear, health insurance premium reductions and rebates.

Cryotherapy for docetaxel-induced hand and nail toxicity: Randomised control trial

Purpose This study investigated the efficacy and safety of cryotherapy, in the form of frozen gel gloves, in relation to docetaxel-induced hand and fingernail toxicities. Patients and methods After piloting with 21 patients, a consecutive series sample of patients (n=53) prescribed docetaxel every three weeks, for a minimum of three cycles, was enrolled in this randomised control trial. Participants acted as their own control, with the frozen gel glove worn on one randomised hand for 15 minutes prior to infusion, for the duration of the infusion, and for 15 minutes of after completion of treatment. Hand and nail toxicities were evaluated by two blinded assessors according to CTCAE.v4 criteria. To assess the potential for cross-infection of multi-use gloves, microbial culture and sensitivity swabs were taken of each glove at every tenth use. Results Of the 53 participants enrolled in the main study, 21 provided evaluable data. There was a 60% withdrawal rate due to patient discomfort with the intervention. The mean incidence and severity of toxicities in all evaluable cycles in control and intervention hands respectively were erythroderma Grade 1 (5%/5%); nail discolouration Grade 1 (81%/67%); nail loss Grade 1 (19%/19%) and nail ridging Grade 1 (57%/57%). No significant differences were determined between hand conditions in terms of time to event, nor in terms of toxicity in gloved and non-gloved hands. Conclusion While cryotherapy in the form of frozen gloves for the cutaneous toxicities associated with docetaxel is safe, its limited efficacy, patient discomfort and some logistical issues preclude its use in our clinical setting.

Medical and nursing students perceived knowledge, attitudes, and practices concerning human immunodeficiency virus

Objective. To assess medical and nursing students’ knowledge, attitudes, and practices (KAP) regarding human immunodeficiency virus (HIV) in Fiji. Methods. A cross-sectional study of 275 medical and 252 nursing students that participated in a questionnaire survey on HIV KAP. Data was analysed according to their gender, program of study, and academic year. Results. The mean HIV knowledge (HK) and attitude scores were 16.0 and 41.3, respectively. Mean HK score was significantly higher in males compared to females. Significant positive correlations were found between HK and academic year for medical () and nursing () students and between HK and attitude scores (). The majority of students indicated fear in contracting HIV through clinical practice and felt that health care workers have the right to know a patients HIV status for their own safety. The majority would wear gloves to touch a patient if suspected of HIV. Conclusions. The study found a high level of HIV knowledge and positive attitude towards HIV patients. However, respondents also displayed negative attitudes and unacceptable practices probably due to fear. Training institutions need to ensure that students gain accurate knowledge on HIV especially on transmission routes to allay the fear of caring for HIV-infected patients.

Mediastinitis after cardiac surgery

Mediastinitis as a complication after cardiac surgery is rare but disastrous increasing the hospital stay, hospital costs, morbidity and mortality. It occurs in 1-3 % of patients after median sternotomy. The purpose of this study was to find out the risk factors and also to investigate new ways to prevent mediastinitis. First, we assessed operating room air contamination monitoring by comparing the bacteriological technique with continuous particle counting in low level contamination achieved by ultra clean garment options in 66 coronary artery bypass grafting operations. Second, we examined surgical glove perforations and the changes in bacterial flora of surgeons' fingertips in 116 open-heart operations. Third, the effect of gentamicin-collagen sponge on preventing surgical site infections (SSI) was studied in randomized controlled study with 557 participants. Finally, incidence, outcome, and risk factors of mediastinitis were studied in over 10,000 patients. With the alternative garment and textile system (cotton group and clean air suit group), the air counts fell from 25 to 7 colony-forming units/m3 (P<0.01). The contamination of the sternal wound was reduced by 46% and that of the leg wound by >90%. In only 17% operations both gloves were found unpunctured. Frequency of glove perforations and bacteria counts of hands were found to increase with operation time. With local gentamicin prophylaxis slightly less SSIs (4.0 vs. 5.9%) and mediastinitis (1.1 vs. 1.9%) occurred. We identified 120/10713 cases of postoperative mediastinitis (1.1%). During the study period, the patient population grew significantly older, the proportion of women and patients with ASA score >3 increased significantly. In multivariate logistic regression analysis, the only significant predictor for mediastinitis was obesity. Continuous particle monitoring is a good intraoperative method to control the air contamination related to the theatre staff behavior during individual operation. When a glove puncture is detected, both gloves are to be changed. Before donning a new pair of gloves, the renewed disinfection of hands will help to keep their bacterial counts lower even towards the end of long operation. Gentamicin-collagen sponge may have beneficial effects on the prevention of SSI, but further research is needed. Mediastinitis is not diminishing. Larger populations at risk, for example proportions of overweight patients, reinforce the importance of surveillance and pose a challenge in focusing preventive measures.

Randomized, double-blind, placebo-controled clinical trial of sublingual immunotherapy in natural rubber latex allergic patients

Trial registration number: CTRN12611000543987

Avaliação de propriedades de artefatos à base de borracha natural

A combinação de excelentes propriedades mecânicas aliadas à biocompatibilidade torna a borracha natural um material amplamente empregado na fabricação de artefatos voltados à saúde, tais como bicos de chupetas e de mamadeiras, e luvas cirúrgicas e de procedimentos não-cirúrgicos. Esses artefatos são processados a partir de látices de poli(cis-isopreno) extraído de seringueiras. Entretanto, o grande número de insaturações presentes na cadeia polimérica, mesmo após a vulcanização, resulta em uma baixa resistência desse material ao envelhecimento, causado principalmente pela associação de fatores como temperatura, oxigênio, ozônio e radiação. Outro inconveniente associado à aplicação da borracha natural é a presença de proteínas no látex, com potencial alergênico, podendo promover reações fisiológicas em alguns usuários. Por esse motivo artefatos comerciais à base de material sintético também são encontrados no mercado. Esses artefatos também não são isentos dos processos naturais de desgaste e decomposição. Esta Dissertação teve como objetivo realizar um estudo comparativo de propriedades dos produtos comerciais à base de borracha natural e à base de material sintético (bicos de chupeta e de mamadeiras e luvas) de diferentes fabricantes, como adquiridos e após sofrerem envelhecimento acelerado. O estudo foi feito empregando-se as técnicas de espectroscopia na região do infravermelho com transformada de Fourier (FTIR) e termogravimetria (TG). Uma avaliação mecânica com métodos padronizados foi também realizada

Bronchiolitis

INTRODUCTION: Bronchiolitis is the most common lower respiratory tract infection in infants, occurring in a seasonal pattern, with highest incidence in the winter in temperate climates and in the rainy season in warmer countries. Bronchiolitis is a common reason for attendance at and admission to hospital.

METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of prophylactic interventions for bronchiolitis in high-risk children? What are the effects of measures to prevent transmission of bronchiolitis in hospital? What are the effects of treatments for children with bronchiolitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS: We found 59 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bronchodilators (oral, inhaled salbutamol, inhaled adrenaline [epinephrine], hypertonic saline), chest physiotherapy, continuous positive airway pressure, corticosteroids, fluid management, heliox, montelukast, nasal decongestants, nursing interventions (cohort segregation, hand washing, gowns, masks, gloves, and goggles), oxygen, respiratory syncytial virus immunoglobulins, pooled immunoglobulins, or palivizumab (monoclonal antibody), ribavirin, or surfactants.

The Right to a Fair Fight: Sporting Lessons on Consensual Harm

This article critically assesses the criminal law on consensual harm through an examination of the legality of fighting sports. The article begins by considering fighting sports such as bare-fisted prize fighting (dominant in the nineteenth century). It then, in historical chronology, examines the legality of professional boxing with gloves (dominant in the twentieth century). Doctrinally, the article reviews why and how, in a position adopted by the leading common law jurisdictions, fighting sports benefit from an application of the “well-established” category-based exceptions to the usual bodily harm threshold of consent in the criminal law. Centrally, fighting sports and doctrinal law on offenses against the person are juxtaposed against the theoretical boundaries of consent in the criminal law to examine whether and where the limit of the “right to be hurt” might lie. In sum, this article uses fighting sports as a case study to assess whether the criminal law generally can or should accommodate the notion of a fair fight, sporting or otherwise, predicated on the consent of the participants to the point that the individuals involved might be said, pithily, to have extended an open invite to harm.

Segurança alimentar nos refeitórios de uma universidade portuguesa : aplicação da teoria do comportamento planeado

A Organização Mundial de Saúde estima que nos países mais industrializados uma em cada três pessoas sofra, por ano, de uma doença de origem alimentar. De acordo com os dados da Agência Europeia para a Segurança Alimentar foram relatados pelos 27 Estados Membros da União Europeia, no ano 2012, um total de 5.363 surtos de origem alimentar, assistindo-se a uma prevalência do setor da restauração, como o local de maior ocorrência dos surtos de doenças de origem alimentar. Para o mesmo ano, Portugal reportou 7 surtos de origem alimentar, envolvendo 135 pessoas com 42 hospitalizações. Neste contexto, a aplicação de boas práticas de higiene, nomeadamente no setor da restauração, é essencial para proteger o consumidor das doenças de origem alimentar. Neste estudo, pretendeu-se identificar os constructos do modelo da Teoria do Comportamento Planeado (Theory of Planned Behaviour – TPB, segundo a terminologia anglo-saxónica), de Icek Ajzen, que melhor explicam a intenção dos operadores de alimentos em adotarem os comportamentos de higiene, a saber: i) utilização de luvas e touca de proteção de cabelos, e ii) remoção de adornos pessoais, durante a manipulação de alimentos. Para o efeito, foi aplicado um questionário tendo por base a Teoria do Comportamento Planeado, a uma amostra de cento e vinte e três operadores dos vários refeitórios de uma universidade portuguesa, na sua grande maioria do sexo feminino (91,1%) e que manipulam alimentos numa base diária, recorrendo-se primeiramente a uma fase preliminar de estudo qualitativo, ou pré-inquérito, para melhor selecionar os temas essenciais e as principais categorias a considerar na construção deste inquérito. Os inquéritos foram tratados estatisticamente recorrendo-se à estatística descritiva, à análise fatorial e avaliação da consistência interna dos fatores resultantes, seguido da aplicação de regressão linear e metodologia de análise de trajetórias (path modeling) com vista à validação do TPB. Os resultados obtidos apontam para o fato de a Atitude ser o melhor preditor da Intenção em adotar os comportamentos em estudo. Verificou-se também que a motivação de cumprir resulta da pressão exercida pelos superiores hierárquicos ou colegas, influenciando positivamente a intenção, na medida em que as crenças normativas assumiram-se como sendo o segundo preditor que melhor previu a intenção.

Letter - E.C. Schmon to Arthur A. Schmon, 27 March 1920

The letter describes some difficulty Arthur has had with a man named Walter. She also describes her activities for the day. Eleanore Celeste mentions all of the things she is packing to bring to Shelter Bay when she leaves to be with Arthur. Accompanying this letter is a letter to "Aunt Lessie". It appears to be signed "Love from all and more than ever from Pal". This letter discusses his writing and soon sending it to a magazine and boxing gloves he has just purchased.

Photograph - Young Boy holding Dog

A young boy in hat gloves and coat, holding a dog in front of a barn.