Impact of an educational intervention upon the hand hygiene compliance of children.

BACKGROUND: Hand hygiene compliance is the single most effective way to reduce healthcare-associated infections. Children are notoriously vulnerable to infection as well as acting as conduits to transmission. Based on these observations, the authors formulated the hypothesis that behavioural change which improved children's hand hygiene compliance would decrease the spread of infectious diseases. AIM: To create an educational intervention to induce long-term behavioural change culminating in increased hand hygiene compliance of children, and thus a decrease in the rate of infections. METHODS: Focus groups conducted during interactive teaching sessions identified what children felt would help them to increase their hand hygiene compliance. This informed the design of an educational device that was subsequently trialled to measure its effectiveness in increasing hand hygiene compliance. Initial developmental stages were conducted in two schools in the East Midlands with study participants aged 5-8 years; the device was subsequently used in a healthcare setting to assess deployment flexibility. FINDINGS: Focus groups indicated that children enjoyed interactive learning, developed knowledge about cross-transmission of infections, and became motivated to encourage others to improve hand hygiene compliance. Microbiological swabbing verified the presence of pathogens on children's hands and environmental surfaces that could serve as reservoirs of infection, and questionnaires indicated an increase in handwashing following the intervention. CONCLUSION: Educational interventions have the potential to increase hand hygiene and reduce the transmission of infections.

Twenty-four-hour observational study of hospital hand hygiene compliance.

This observational study measured healthcare workers' (HCWs'), patients' and visitors' hand hygiene compliance over a 24h period in two hospital wards using the 'five moments of hand hygiene' observation tool. Hand hygiene is considered to be the most effective measure in reducing healthcare-associated infections but studies have reported suboptimal levels of compliance. Most studies have used random observational time-periods for data collection and this has been criticised. We monitored a total of 823 hand hygiene opportunities (HCWs, N=659; patients and visitors, N=164). Among HCWs, compliance was 47% for doctors, 75% for nurses, 78% for allied health professionals, and 59% for ancillary and other staff (P<0.001). There was no difference in compliance between patients and visitors (56% vs 57%, P=0.87). Hand hygiene compliance varied depending on which of the five moments of hygiene HCWs had undertaken (P<0.001), with compliance before an aseptic task being 100% (3/3); after body fluid exposure 93% (86/93); after patient contact 80% (114/142); before patient contact 68% (196/290); and after contact with surroundings 50% (65/129). Lower levels of compliance were found for HCWs working during the early shift (P<0.001). For patients and visitors there was no evidence of an association between moments of hygiene and compliance. Levels of compliance were higher compared with previous reported estimates. Medical staff had the lowest level of compliance and this continues to be a concern which warrants specific future interventions.

Hand hygiene compliance in healthcare workers.

The 'clean-your-hands' campaign has now been introduced into hospitals in England but it was initially piloted in six acute trusts. The campaign was multi-modal and aimed to improve hand hygiene compliance. This review reports the findings from one of the trusts involved in the pilot. The campaign consisted of a toolkit that included placing alcohol hand rub beside patients, along with posters and supporting marketing materials. A guide to implementation and a strategy aimed at increasing patient information and empowerment was also initiated. In order to assess the success of the campaign, audits of hand hygiene in healthcare workers were conducted over a six-month period. Additionally, data were obtained from staff surveys, patient surveys, usage levels of alcohol hand rub and interviews with the on-site lead. The local campaign indicated that a multi-modal campaign induced a marked increase in hand hygiene compliance (from 32% to 63%), with 74% of staff reporting increased compliance throughout the campaign. Usage of alcohol hand rub increased by 184%. The majority of patients indicated that the public should be actively involved in helping healthcare staff to improve their hand hygiene.

Paediatric nurses' attitudes to massage and aromatherapy massage.

Complementary therapies have continued to increase in popularity in healthcare and it is widely accepted that they can be incorporated into the nursing role. However, this acceptance does not necessarily mean that the introduction of therapies into the nursing arena has been without confusion and without professional and legal implications. Consequently, this small-scale, qualitative study aimed to explore the perceptions and lived experiences of paediatric nurses of two therapies, namely massage and aromatherapy massage. There is a dearth of literature exploring nurses' perceptions to the incorporation of these therapies, especially in the arena of paediatric nursing where massage and aromatherapy massage are common practice. Semi-structured interviews were undertaken with qualified nurses and revealed the themes of 'benefit', 'family centred care', 'nursing care' and 'being held back'. It was found that at some stage during their professional career each nurse had performed massage and/or aromatherapy massage. All nurses were able to recall certain benefits of the therapies for the children that they had observed and many discussed the importance of involving the family as a way of including them in to the care of their child. However, for the nurses in this study, it was evident that the incorporation of complementary therapies into the nursing role was determined by the context in which they practised. Due to the dominance of the medical model, nurses faced pressures and conflicts in the realities of their nursing work, which meant they were often unable to carry out these therapies.

Thalamic stimulation for primary writing tremor.

We report a patient with primary writing tremor whose tremor was treated with thalamic stimulation. He had undergone trials of multiple oral medications with no benefit for his tremor. An electrode lead was implanted in the thalamic nucleus ventralis intermedius with nearly complete control of his tremor and no postoperative complications. We conclude that nucleus ventralis intermedius thalamic stimulation is safe and effective for primary writing tremor.

Synthesis of anticonvulsive AMPA antagonists: 4-oxo-10-substituted-imidaz.

The overstimulation of excitatory amino acid receptors such as the glutamate AMPA receptor has been implicated in the physiopathogenesis of epilepsy as well as in acute and chronic neurodegenerative disorders. An original series of readily water soluble 4-oxo-10-substituted-imidazo[1,2-a]indeno[1,2-e]pyrazin-2-carboxylic acid derivatives was synthesized. The most potent derivative 6a exhibited nanomolar binding affinity (IC50 = 35nM) and antagonist activity (IC50 = 6nM) at ionotropic AMPA receptor. This compound also demonstrated potent anticonvulsant properties in MES in mice and rats with long durations of action with ED50 values in the 1-3 mg/kg dose range following ip and iv administration.

Bioisosteres of 9-carboxymethyl-4-oxo-imidazo[1,2-a]indeno-[1,2-e]pyrazin-2-carboxylic acid derivatives. Progress towards selective, potent in vivo AMPA antagonists with longer durations of action.

A novel series of 2- and 9-disubstituted heterocyclic-fused 4-oxo-indeno[1,2-e]pyrazin derivatives was synthesized. One of them, the 9-(1H-tetrazol-5-ylmethyl)-4-oxo-5,10-dihydroimidazo[1,2-a]indeno[1,2-e]pyrazin-2-yl phosphonic acid 4i exhibited a strong and a selective binding affinity for the AMPA receptor (IC50 = 13 nM) and demonstrated potent antagonist activity (IC50 = 6nM) at the ionotropic AMPA receptor. This compound also displayed good anticonvulsant properties against electrically-induced convulsions after ip and iv administration with ED50 values between 0.8 and 1 mg/kg. Furthermore, a strong increase in potency was observed when given iv 3 h before test (ED50 = 3.5 instead of 25.6 mg/kg for the corresponding 9-carboxymethyl-2-carboxylic acid analogue). These data confirmed that there is an advantage in replacing the classical carboxy substituents by their bioisosteres such as tetrazole or phosphonic acid groups.

Past caring? The influence of technology.

The increase in technology in 'general' clinical areas as well as specialized units such as intensive care units and theatres influences the delivery of nursing care. This paper reports findings from a longitudinal study exploring the changes in self-est eem of two cohorts of pre-registration nursing students. The study involved the measurement of the global and professional self-esteem, but its main focus was a qualitative grounded theory approach to identify changes in the self-esteem. The findings det ailed here emphasize the importance of practical nursing skills and the use of technology to student nurses. Results showed that students' self-esteem was effected and constructed by practical and technological competence. The emphasis on both of these a ctivities changed through students' 3-year training course in that although initially students derived their professional self-esteem from being practically capable, this was subjugated to a lower place in gaining their professional self-worth by the end of the course. Instead, the use of technology had ahigh status throughout the course and had associations with scientific and medical power.

The effect of a 3-year pre-registration training course on students' self-esteem.

Self-esteem is an acquired set of beliefs about the 'self' and is the largest determinant of behaviour. This study was carried out to identify changes in the self-esteem of students in order to assess the major influencing factors during their transition to becoming a nurse and to explore the interpretations and constructions which students ascribed to their experiences during this transition. Data were collected by the use of unstructured interviews. Analysis of data was qualitative, using a grounded theory method. Students' self-esteem became fragmented during the transition to becoming a nurse. The findings indicate a need to implement strategies to increase nurses' self-esteem.

ICE/Caspase-1 inhibitors as novel anti-inflammatory drugs.

In recent years, several strategies that selectively inhibit pro-inflammatory cytokines, have yielded effective protein-based therapies for inflammatory disorders, validating the therapeutic hypothesis that intervention in cytokine signalling can provide clinical benefit. However, these protein-based products must be administered by injection, a constraint associated with inconvenience, adverse effects and expense for patients, caregivers and insurers. Besides interfering with the effects of cytokines such as TNF-alpha or IL-1beta that have already been produced, inhibition of pro-inflammatory cytokine production or signalling with low-molecular weight orally-active drugs would combine the convenience of conventional pharmaceuticals with the focused efficacy of the protein therapies. Reducing IL-1beta and IL-18 production by inhibition of IL-1beta converting enzyme (ICE, caspase-1) is one promising strategy because of the key roles of these cytokines in many inflammatory diseases. Pralnacasan, the first orally available, potent and selective ICE inhibitor to enter clinical trials, is currently under investigation in rheumatoid arthritis.

8-Methylureido-10-amino-10-methyl-imidazo[1,2-a]indeno[1,2-e] pyrazine-4-ones: highly in vivo potent and selective AMPA receptor antagonists.

Water soluble 8-methylureido-10-amino-10-methyl-imidazo[1,2-a]indeno[1,2-e]pyraz ine-4-one 4 represents a novel class of highly potent and selective AMPA receptors antagonists with in vivo activity. The dextrorotatory isomer (+)-4 was found to display the highest affinity with an IC50 of 10 nM. It also exhibited very good anticonvulsant effects after i.p., s.c. and i.v. administration in mice subjected to electrical convulsions (MES) and i.p. in audiogenic seizure-e in DBA/2 mice (ED50's < or = 10 mg/kg).

Should calcaneal fractures be treated surgically? A meta-analysis.

A MEDLINE search from 1980 through 1996 revealed 1845 articles dealing with calcaneal fractures. Six of these articles that compared operative versus nonoperative treatment for displaced calcaneal fractures met the minimum criteria for inclusion in a meta-analysis. A statistical summary of information across the six articles revealed a trend for surgically treated patients to be more likely to return to the same type of work as compared with nonoperatively treated individuals. There also was a trend for nonoperatively treated patients to have a higher risk of experiencing severe foot pain than did operatively treated patients. Unfortunately, none of the other outcomes could be summarized formally across studies using statistical techniques because of variability in reporting across studies. Although the tendency was always for operatively treated patients to have better outcomes (reaching statistical significance in some of the articles), the strength of evidence to recommend operative treatment for displaced intraarticular calcaneal fractures remains weak. A large prospective randomized controlled trial should be able to answer this question.

Indeno[1,2-b]pyrazin-2,3-diones: a new class of antagonists at the glycine site of the NMDA receptor with potent in vivo activity.

Indeno¿1,2-bpyrazin-2,3-diones have been identified as a novel series of potent ligands on the glycine site of the NMDA receptor. To improve their in vivo activities, an acetic acid-type side chain was introduced to the 5-position, giving water-soluble compounds when formulated as the sodium salt (>10 mg/mL). Introduction of a chlorine atom in the 8-position led to a dramatic improvement of anticonvulsant activity and this was surprising since this change did not improve binding affinity. A plausible explanation is a reduced recognition by a Na(+),K(+)-ATPase active transport system responsible for the excretion of these compounds from the brain and kidney. This promising new chemical series led to the optically active isomer (-)-10i (RPR 118723), a glycine/NMDA antagonist with nanomolar binding affinity and in vivo activity in animal model of convulsions and electrophysiology at doses in the range of 2-3 mg/kg following iv administration.

4,10-Dihydro-4-oxo-4H-imidazo[1,2-a]indeno[1,2-e]pyrazin-2-carboxylic acid derivatives: highly potent and selective AMPA receptors antagonists with in vivo activity.

A novel series of 2-substituted-4,5-dihydro-4-oxo-4H-imidazo[1,2-a]indeno[1,2-e]pyrazine derivatives was synthesised. One of them, 4e-a highly water soluble compound exhibited a nanomolar affinity and demonstrated competitive antagonist properties at the ionotropic AMPA receptors. This compound also displayed potent anticonvulsant properties against electrically or sound-induced convulsions in mice after systemic administration, thus suggesting adequate brain penetration.

8-Methylureido-4,5-dihydro-4-oxo-10H-imidazo[1,2-a]indeno[1,2-e]pyrazines: highly potent in vivo AMPA antagonists.

A novel series of readily water soluble 8-methylureido-4,5-dihydro-4-oxo-10H-imidazo[1,2-a]indeno[1,2-e]++ +pyrazines were synthesized. The -10-yl acetic acid ((+)-3) and -10-carboxylidene (4) derivatives exhibit potent affinities (IC50=4 and 19 nM, respectively) and antagonist properties (IC50 = 2 and 3 nM, respectively) at the ionotropic AMPA receptor. These compounds also display anticonvulsant properties against both electrically and sound-induced convulsions in mice after ip, sc and iv administration with ED50 values between 0.9 and 11 mg/kg, thus suggesting adequate brain penetration.

Synthesis and potent anticonvulsant activities of 4-oxo-imidazo[1,2-a]inden.

The over-stimulation of excitatory amino acid receptors such as the glutamate AMPA receptor has been suggested to be associated with neurodegenerative disorders. Here we describe an original series of readily water soluble 4-oxo-imidazo[1,2-a] indeno[1,2-e]pyrazin-8- and -9-carboxylic (acetic) acid derivatives. One of these compounds, 4f, exhibited nanomolar binding affinity, potent competitive antagonism at the ionotropic AMPA receptor and a long duration of anticonvulsant activity after administration by parenteral route in vivo.

Ipsilateral thalamic stimulation after thalamotomy for essential tremor. A case report.

We report a patient with severe essential tremor who was treated with thalamic stimulation ipsilateral to a prior thalamotomy. Thalamotomy performed 30 years prior to stimulator implantation provided tremor reduction for one year before the tremor recurred. An electrode lead was implanted in the thalmaic nucleus ventralis intermedius (Vim) with nearly complete control of his tremor with sustained benefit over an 18-month follow-up period. Vim thalamic stimulation is an effective treatment option for recurrent tremor in patients who have undergone ipsilateral thalamotomy.

Spiro-imidazo[1,2-a]indeno[1,2-e]pyrazine-4-one derivatives are mixed AMPA and NMDA glycine-site antagonists active in vivo.

Original spiro-imidazo[1,2-a]indeno[1,2-e]pyrazine-4-one derivatives were synthesised and led to the identification of 3e which showed good affinities for both the AMPA and the NMDA glycine-site receptors, and displayed good anticonvulsant effects after i.p. and i.v. administrations in the electroshock-induced convulsion assay in mice. The corresponding dextrorotatory isomer (+)-3e was notably more potent than the levorotatory isomer (-)-3e in in vitro and in vivo assays.