Healthcare workers' perceptions and acceptance of an electronic reminder system for hand hygiene.

BACKGROUND: Healthcare-associated infections (HCAIs) have a large negative impact on morbidity, mortality, and quality of life. Approximately 9% of all patients hospitalized in Sweden suffer from HCAI. Hand hygiene plays a key role and is considered the single most important measure to reduce HCAI. The hospital organization works actively to reduce HCAI. Implementing electronic systems to remind and/or notify healthcare workers raises awareness of and adherence to hand hygiene. However, there is a paucity of studies addressing individuals' perceptions of having such a system and how the organization works. AIM: To investigate healthcare workers' perceptions of infection prevention in the healthcare organization and perceptions and acceptance of an electronic reminder system that encourages good hand hygiene. METHODS: Qualitative descriptive design with data collected in eight focus group interviews including assistant nurses, nurses, and physicians (N = 38). Content analysis was applied and data were related to the Theory of Planned Behaviour. FINDINGS: Healthcare workers perceive lack of feedback from the hospital organization and are positive towards an electronic reminder system to increase adherence to hand hygiene. The electronic reminder system should not register data at an individual level since it could be used as an instrument for control by the management that could be stressful for staff. CONCLUSION: In general, there is positive acceptance of the electronic reminder system, and the respondents perceived it as having the ability to change behaviour. However, the concept has to be further developed to protect the individual's integrity and needs to be used with feedback on a group level.

Efficient scavenging of Ph3P and Ph3P=O with high-loading merrifield resin.

[see reaction]. A simple, highly effective method for removing triphenylphosphine and/or triphenylphosphine oxide from reaction mixtures is described. Commercially available high-loading chloromethylated polystyrene 1, modified in situ with NaI, acts as a scavenger resin. Several coupling reactions catalyzed by Pd(0) or Ni(0) which require the removal of triphenylphosphine are tested.

Renal disease potentiates the injury caused by SWL.

PURPOSE: The present study tested the hypothesis that renal disease potentiates the structural/functional changes induced by a clinical dose of shockwaves. MATERIALS AND METHODS: Experimental pyelonephritis was induced in 6- to 8-week-old pigs before treatment with 2,000 shocks at 24 kV. These pigs were divided into two groups according to whether they were infected with a highly virulent (Group 1) or less virulent (Group 2) inoculation of E. coli. All animals were imaged by MR prior to SWL as a means of documenting the extent of pyelonephritis and immediately after SWL to examine the lesion produced by the shockwaves. The glomerular filtration rate (GFR), renal plasma flow (RPF) and para-aminohippurate (PAH) extraction were determined bilaterally on day 30 (Group 1) or day 80 (Group 2). RESULTS: In group 2, urine flow and sodium excretion were reduced by 50% from baseline in the shocked kidneys at both 1 and 4 hours post-SWL. A sustained reduction in RPF through 4 hours post-SWL was noted in the shocked kidneys in Group 1, but RPF was significantly reduced only at the 1-hour determination in Group 2. Large, consistent reductions in GFR were evident at 1 and 4 hours post-SWL in shocked and unshocked kidneys of Group 2 and in the shocked kidneys of Group 1. No significant changes were noted in PAH extraction. CONCLUSION: Acute pyelonephritis exaggerated the effect of a clinical dose of shockwaves on renal hemodynamics. This effect suggests that renal disease may be risk factor for SWL-induced injury.

Relationship between kidney size, renal injury, and renal impairment induced by shock wave lithotripsy.

The relationship between kidney size and impaired renal function induced by shock-wave lithotripsy (SWL) was examined in 6- and 10-wk-old anesthetized pigs. Each pig received 2000 shock waves, 24 kV, or sham SWL to the lower pole calyx of one kidney. Bilateral GFR, renal plasma flow (RPF), and para-aminohippurate extraction was measured 1 h before and 1 and 4 h after SWL. The kidneys were then removed for morphometric analysis. Mean kidney weights were 66.1+/-2.7 g (n = 9) and 103.1+/-3.3 g (n = 8) in the SWL groups, and 60.1+/-2.6 g (n = 9) and 82.3+/-4.0 g (n = 9) in the sham-SWL groups. SWL-induced lesions occupied a significantly greater volume of the small kidneys (6.1+/-1.7 vol % versus 1.5+/-0.2 vol% in the large kidneys). RPF was significantly reduced by SWL in small and large kidneys, but to a significantly greater extent in small kidneys. RPF was also significantly reduced in the contralateral kidneys of both groups, but only at 1 h after SWL. SWL significantly reduced GFR to similar degrees in both kidneys of both groups, regardless of kidney size. Para-aminohippurate extraction was likewise reduced to similar degrees in both groups, but this effect was evident only in the SWL-treated kidneys, and only in the pole to which the shock waves had been applied. The injury induced by SWL affected a larger fraction of small kidneys than large ones, and the renal vasoconstriction induced by SWL was greatest in small kidneys.

Color TV: total variation methods for restoration of vector-valued images.

We propose a new definition of the total variation (TV) norm for vector-valued functions that can be applied to restore color and other vector-valued images. The new TV norm has the desirable properties of 1) not penalizing discontinuities (edges) in the image, 2) being rotationally invariant in the image space, and 3) reducing to the usual TV norm in the scalar case. Some numerical experiments on denoising simple color images in red-green-blue (RGB) color space are presented.

Quantitation of shock wave lithotripsy-induced lesion in small and large pig kidneys.

BACKGROUND: Shock wave lithotripsy (SWL) is known to cause injury to the kidney. However, it is not known how lesion size varies as the parameters of SWL treatment (number of shocks, kilovoltage, kidney size) are changed. This hypothesis could not be tested because there was no method available to quantitate accurately the SWL-induced renal lesion. METHODS: A dosage of 2,000 shocks at 24 kV delivered by an unmodified Dornier HM3 lithotripter was applied to the lower pole calyx of the right kidney of small and large pig kidneys. A new method was developed to embed a whole pig kidney for serially sectioning, recording, and digitization. Automated computer color recognition made it possible to discriminate regions of hemorrhage from undamaged tissue and allowed quantitation of the lesion in single sections and in the entire kidney. RESULTS: The new protocol resulted in an accurate identification of sites of hemorrhage and calculations of the volume fraction of injured renal tissue. Lesion size induced in small kidneys was significantly larger than that induced in the larger kidneys (7.6 +/- 1.2% and 1.6 +/- 0.7%, respectively). CONCLUSIONS: Computer segmentation of serially sectioned SWL-treated kidneys has determined that kidney size is a risk factor for enhanced renal injury.

Branching patterns of the renal artery of the pig.

BACKGROUND: The pig kidney is similar in structure and function to the human kideny, thus making it a useful model in understanding the human kidney in health and disease. However, little is known about the branching pattern of the pig renal artery as compared with the human and other animals. METHODS: The right and left kidneys from 11 juvenile pigs were injected with either Mercox compound to form a vascular cast or contrast media to obtain a renal arteriogram. Branching patterns of the renal artery were then examined to the level of the interlobar arteries. RESULTS: Examination of all 22 kidneys showed the main stem renal artery branching into two predictable patterns, designated I and II. The renal artery in pattern I (17 of 22 kidneys) divides into upper and lower polar arteries that then form anterior and posterior segmental arteries. Pattern I has two variations. Pattern II (5 of 22 kidneys) has a variable blood flow to the upper pole. Not only do anterior and posterior segmental arteries pass to the upper pole, but additional vessels arising from the lower polar artery also supply the upper pole. CONCLUSIONS: The most common branching pattern of the main stem renal artery is pattern I, which divides the blood flow of the entire kidney into two distinct regions. Pattern II is less frequently seen and shows more variability in number and location of branches.

Market research surveys in the marketing of consumer products.

To achieve commercial success, any skin care product having given functional properties will on the consumer market also depend on a high degree of attraction, comfort and effective marketing. To accomplish this, consumer surveys are necessary in the various stages of product development and the marketing process. A brief description of the latter is given and of the various types of related surveys. To illustrate certain product tests, examples are given of the relaunch of HTH in the nordic markets.

Collective dose to the Swedish population from intraoral radiography.

In 1984 the Swedish National Institute of Radiation Protection (SSI) undertook an investigation (KAST) of 400 randomly selected dental offices to check the extent to which the new rules and recommendations concerning radiation protection (SSI 1978, 1980) were applied. Data for calculation of the energy imparted per bitewing examination of an adult were available. The information obtained was utilized for estimating the collective dose in Sweden from intraoral radiography. The mean value of the energy imparted from an ordinary bitewing examination was 0.48 mJ. The quotient between the sum of all imparted energy during 1984, 5,519 J, and the number of inhabitants in that year was 0.66 mJ. This corresponds to 1.5 ordinary bitewing examinations per individual in Sweden. The collective effective dose equivalent is 79 manSv after transformation from the total energy imparted. The average energy imparted from the annual natural irradiation in Sweden is 100 mJ, with variations between 35 and 350 mJ, giving totally to the population 830,000 J. The dose contribution from intraoral radiography is thus considered of minor importance when taking into account the variations of the natural irradiation as well as the benefit of the diagnostic gain in dentistry and the enhancement of public dental health.

Effect of protein intake on renal function and structure in partially nephrectomized rats.

To examine the effect of high protein intake on renal function and structure in rats with 5/6 nephrectomy chronic renal failure, we pairfed rats with chronic renal failure and sham-operated control rats diets of 14 or 37% protein content for up to 6 months. High protein intake accelerated mortality in rats with chronic renal failure and resulted in a more rapid rate of decrease in renal function as established by plotting the reciprocal of plasma creatinine versus time. High protein intake also increased urine protein excretion in experimental and control rats. High protein intake was associated with increased tubular dilatation and interstitial inflammation, both of which were striking features in rats with chronic renal failure. Glomerular sclerosis was prominent in rats with chronic renal failure. These rats had smaller glomerular tuft dimensions than control rats irrespective of their protein intake. We conclude that high protein intake accelerates the course of chronic renal failure in rats. The pathologic process involves glomerular sclerosis; however, interstitial inflammation and renal tubular changes leading to cyst formation also appear to influence the process adversely.

Application of scanning electron microscopy to kidney development and nephron maturation.

The present study uses scanning electron microscopy to review mammalian kidney development using the dog model. Canine mesonephros and metanephros are examined, focusing on the structure of the nephron from each and the maturation of the different cell types found in the metanephric nephron. The mesonephros possesses numerous nephrons each with a glomerulus, proximal, distal, and collecting tubule which empty into the mesonephric (Wolffian) duct. The mesonephros does not have cortical and medullary regions. The metanephric nephron not only possesses a glomerulus and the same tubular segments as described for the mesonephric nephron (proximal, distal, and collecting tubules), but also has tubular segments that are found in the medulla, namely the loop of Henle and thick ascending limb. Mammalian metanephric glomerulogenesis and tubulogenesis follows an orderly centrifugal pattern (from inner to outer cortex). The glomerular visceral epithelium initially has a columnar shape which is modified into a cuboidal sheet possessing numerous slender foot processes. The endothelium begins as a double layer with minimal fenestrae. With maturation, a single cell layer is formed possessing many large fenestrae. The maturation of the proximal tubule is documented by changes in the apical microvilli, and the foldings of the lateral and basal cell surfaces. Initially, the collecting tubule is lined by a primordial cell which differentiates into both the principal and intercalated cells.

Patient exposures and radiation risks in Swedish diagnostic radiology.

Results are reported of measurements around 1974 on a thousand patient at 13 Swedish hospitals, and additionally at several photofluorographic and dental installations. Energy imparted as well as doses to the thyroid, breast, lung, bone marrow, ovary and testis have been calculated for many types of examination. Collective doses have been calculated and risk estimates made. The energy imparted corresponds to an annual mean body dose to the Swedish population of about 1 mGy (100 mrad), and the genetically significant dose was about the same as the 1955 total of 0.4 mGy; in both cases the uncertainty of the estimate is about +/- 50%. The possibility of dose reduction by a factor of 2 or more using available techniques is demonstrated. The risk of future serious injury is estimated to 0.0002 cases per joule of energy imparted to the patient.

A comparative study of predictive criteria in the predisposition of homicidal adolescents.

The authors evaluated the criteria that are cited in the literature as predictive of homicidal predisposition. They applied three categories of criteria--clinical, developmental, and environmental factors--to a study group of 10 adolescents who had committed homicide, 10 who had threatened or attempted homicide, and 10 hospitalized controls. Their findings did not support the presence of a well-crystallized predisposition for homicidal behavior in this population, but they did show that the adolescents who committed homicide were psychotic-regressive and those who threatened or attempted homicide were organic-impulsive. The study strongly suggests the importance of environmental factors in reinforcing homicidal behavior.