Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

Are Tattoos an Indicator of Severity of Non-Suicidal Self-Injury Behavior in Adolescents?

OBJECTIVE: To compare adolescents with non-suicidal self-injury behavior and tattoos [NSSI (T+)] with another group with non-suicidal self-injury behavior without tattoos [NSSI (T-)]. METHODS: Adolescents (n=438) 42.6% males from the community (M=12.3, SD=1.3), completed the Self-Injury Schedule. RESULTS: The lifetime prevalence of tattoos performed with the purpose to feel pain was 1.8%. Compared to the NSSI (T-) group, the NSSI (T+) group was significantly more likely to meet the DSM-5 frequency criteria of 5 self-injury events in 1 year, practice more than one method of self-injury, and topography, more suicidal intentionality, more negative thoughts and affective emotions before, during, and after self-injury and more academic and social dysfunction. CONCLUSION: Adolescents from the community who practice tattooing to feel pain, show a distinct phenotype of NSSI. Health professionals and pediatricians should assess tattooing characteristics such as intention (to feel pain), frequency, and presence of non-suicidal self-injury behavior and suicide intentionality.

A Non-Invasive Medical Device for Parkinson's Patients with Episodes of Freezing of Gait.

A critical symptom of Parkinson's disease (PD) is the occurrence of Freezing of Gait (FOG), an episodic disorder that causes frequent falls and consequential injuries in PD patients. There are various auditory, visual, tactile, and other types of stimulation interventions that can be used to induce PD patients to escape FOG episodes. In this article, we describe a low cost wearable system for non-invasive gait monitoring and external delivery of superficial vibratory stimulation to the lower extremities triggered by FOG episodes. The intended purpose is to reduce the duration of the FOG episode, thus allowing prompt resumption of gait to prevent major injuries. The system, based on an Android mobile application, uses a tri-axial accelerometer device for gait data acquisition. Gathered data is processed via a discrete wavelet transform-based algorithm that precisely detects FOG episodes in real time. Detection activates external vibratory stimulation of the legs to reduce FOG time. The integration of detection and stimulation in one low cost device is the chief novel contribution of this work. We present analyses of sensitivity, specificity and effectiveness of the proposed system to validate its usefulness.

Neoadjuvant combined chemotherapy followed by external whole pelvic irradiation in two cases of primary extranodal non-Hodgkin's lymphoma of the uterine cervix.

BACKGROUND: Primary extranodal lymphomas of the genital tract are rare. CASES: As there is no current consensus in its management, we present two further cases and their treatment with neoadjuvant chemotherapy, followed by radiation therapy. A radical hysterectomy with bilateral pelvic lymphadenectomy was performed after primary treatment in one case. Clinical response was complete in both cases and pathological response was documented in one. CONCLUSIONS: Complete response of these lymphoid neoplasms can be achieved by neoadjuvant chemotherapy followed by external irradiation.