Participant perceptions and experiences of a novel community-based respiratory longitudinal sampling method in Liverpool, UK: A mixed methods feasibility study.

Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was utilised. A quantitative questionnaire was completed after every sampling timepoint to report levels of discomfort and pain, as well as time taken to collect samples. Participants were also invited to discuss their experiences in a qualitative structured exit interview. We received questionnaires from 36 families. Most adults and children >5y experienced no pain (94% and 70%) and little discomfort (73% and 47% no discomfort) regardless of sample type, whereas children ≤5y experienced variable levels of pain and discomfort (48% no pain but 14% hurts even more, whole lot or worst; 38% no discomfort but 33% moderate, severe, or extreme discomfort). The time taken for saliva and hand sampling decreased over the study. We conducted interviews with 24 families. Families found the sampling method straightforward, and adults and children >5y preferred nasal sampling using a synthetic absorptive matrix over nasopharyngeal swabs. It remained challenging for families to fit sampling into their busy schedules. Adequate fridge/freezer space and regular sample pick-ups were found to be important factors for feasibility. Messaging apps proved extremely effective for engaging with participants. Our findings provide key information to inform the design of future studies, specifically that self-sampling at home using minimally invasive procedures is feasible in a family context.

Shhh I'm growing: noise in the NICU.

Attempting to mitigate operational and structural noise is important in improving the outcomes of high-risk preterm infants. It was anticipated that a culture change in nursing behaviors to include "Quiet Time" would result in reducing the noise levels towards the National Recommended Safe Sound Level. This culture change alone was inadequate to meet NRL. Both operational and structural changes were also required in order to provide a safer neurophysiological environment for the rest and growth of the neonate.

Informed consent for vascular intervention: completing one audit loop.

AIM: To reaudit documentation of the process of informed consent in patients undergoing vascular surgical and vascular radiological procedures. METHOD: A retrospective audit of randomly selected elective vascular radiological and surgical admissions from October 2005-2006 was undertaken to assess the impact of a previous audit on the documentation of the consent process carried out in 2005. Outpatient clinic letters, handwritten entries in the patients' admission notes, and consent forms were scrutinised and data collated on which doctors took consent, when consent was obtained, what details of the consent process were documented, and whether additional information was made available to patients. RESULTS: 99 sets of notes were reviewed (surgical n=50, radiological n=49). For patients undergoing vascular surgery, the consent form was signed by a consultant in 16 (32%) cases compared to 2 (4%) in the previous audit (p=0.013: Chi-squared). Significantly more vascular radiological consent forms were signed by a consultant (43) compared with surgical consent forms (16) (p<0.001; Chi-squared). Documentation that the risks of surgery had been discussed with the patient was present in 31 (62%) surgical notes and in 20 cases such discussions were documented in letters from clinics. For radiological consent documentation, 34 (69.4%) patient notes recorded discussions regarding procedural risk. Twenty-two (44.9%) of the vascular radiological patients had such risks documented in their outpatient notes by a vascular surgeon compared with 1 (2%) (p <0.001; Chi-squared) in the previous audit. Additional written information was given to 7(14%) of the vascular surgical patients which was similar to the previous audit. No additional information was given to patients who underwent vascular radiological procedures. CONCLUSIONS: Significant improvements have been made since the previous audit with more surgical consultants signing the consent forms and increased documentation of the nature of radiological procedures and risks discussed in outpatient clinics. From the current audit, provision of additional written information (patient information sheets) was an area identified for future improvement.