An interactive feedback system for increasing hand antisepsis adherence in stationary intensive care

BACKGROUND

Pathogens causing infections are in many cases transmitted via the hands of personnel. Thus, hand antisepsis has strong epidemiological evidence of infection prevention. Depending on various factors, hand antisepsis adherence ranges between 9.1% and 85.2%.

AIM

To evaluate a new transponder system that reminded medical staff to use an alcohol-based hand rub based on indication by giving real-time feedback, to detect hand antisepsis adherence.

METHODS

The monitoring system consisted of three components: a portable transponder detecting alcohol-based hand rub and able to give feedback; a beacon recognizing entries to and exits from the patient's surroundings; and a sensor placed at the hand-rub dispensers to count the number of hand rubs. With these components, the system provided feedback when hand antisepsis was not conducted although it was necessary according to moments 1, 4, and 5 of hand antisepsis. Adherence was measured in two use-cases with five phases, starting with the baseline measurement followed by intervention periods and phases without intervention to test the sustainability of the feedback.

FINDINGS

Using the monitoring system, hand antisepsis adherence was increased by up to 104.5% in comparison to the baseline measurement. When the intervention ceased, however, hand antisepsis adherence decreased to less than or equal to the baseline measurement.

CONCLUSION

A short-term intervention alone is not sufficient to lead to a long-term change in hand antisepsis adherence. Rather, permanent feedback and/or the integration in a multi-modal intervention strategy are necessary.

Soja in der veganen Ernährung – Lifestyleprodukte mit Gefahrenpotenzial für Birkenpollenallergiker?

Bei 10 % aller Birkenpollenallergiker wurden allergische Reaktionen auf die Sojabohne nachgewiesen. Typischerweise manifestieren diese sich in Form eines milden oralen Allergiesyndroms. Wir stellen 4 Patienten (1 Mann, 3 Frauen, 50 – 72 Jahre) mit primärer Birkenpollenallergie aus unserer Allergieabteilung vor, bei denen sich jedoch nach Verzehr von Sojamilch/-drink schwere allergische Reaktionen bis hin zur Anaphylaxie entwickelten. Diese Patienten litten unter einer Rhinoconjunctivitis allergica im Frühjahr und zusätzlichen pollenassoziierten Nahrungsmittelallergien. Haut-Pricktestungen auf Sojaprodukte waren positiv. Bei 3 von 4 Patienten war die Sojaallergie lediglich durch spezifische IgE-Antikörper auf das birkenpollenhomologe PR-10-Protein Gly m 4 nachweisbar, jedoch nicht auf den Sojagesamtextrakt (< 0,35 KU/l). Bei einer Patientin, die Sojaprodukte bisher immer vertragen hatte, wurde die Sojaallergie erst durch orale Provokationstestung nachgewiesen. Es handelt sich bei allen Patienten um eine sekundäre birkenpollenassoziierte Sojaanaphylaxie nach Einnahme großer Mengen an geringgradig verarbeiteten Sojaprodukten (Sojadrink). Diese stellt für Birkenpollenallergiker mit IgE-vermittelten Allergien sowohl auf das Birkenpollenallergen Bet v 1 als auch auf das homologe Gly m 4 in der Sojabohne aufgrund einer Kreuzreaktion ein Risiko dar.

Isolierte Ziegen- und Schafsmilchallergie

Ein 23-jähriger Patient erlitt mehrere anaphylaktische Reaktionen nach dem Verzehr von Schafsmilch- und Ziegenmilchkäse bei gleichzeitiger Toleranz von Kuhmilchprodukten. Die Pricktestung und die serologische Diagnostik zeigten eine Sensibilisierung gegen Ziegen- und Schafsmilch. Eine orale Provokation mit Kuhmilch sowie Rohmilch wurde vertragen. Wir diagnostizierten eine isolierte Ziegenmilch- und Schafsmilchallergie und empfahlen eine konsequente Meidung von Ziegenmilch- und Schafsmilchprodukten.

Effects of a structured educational intervention on knowledge and emergency management in patients at risk for anaphylaxis

BACKGROUND

Structured educational programmes for patients at risk for anaphylaxis have not yet been established. Patients and caregivers often lack adequate skills in managing the disease.

METHODS

To investigate effects of structured patient education intervention on knowledge, emergency management skills and psychological parameters in patients with previous episodes of anaphylaxis and caregivers of affected children 95 caregivers (11 male, 84 female, mean age 37 years) of affected children and 98 patients (32 male, 66 female, mean age 47.5 years) were randomly assigned to an intervention (IG) or control group (CG) in a multicentre randomized controlled trial. The IG received two 3-h schooling modules of group education; the CG received standard auto-injector training only. Knowledge of anaphylaxis and emergency management competence in a validated training anaphylaxis situation as main outcome measures as well as secondary psychological parameters were assessed at baseline and 3 months after intervention.

RESULTS

In comparison with controls, the intervention led to significant improvement of knowledge from baseline to 3-month follow-up (caregivers: IG 3.2/13.2 improvement/baseline vs CG 0.7/12.6; P < 0.001; patients: IG 3.9/10.8 vs 1.3/12.6; P < 0.001). Moreover, emergency management competence was increased after intervention as compared to controls (caregivers: IG 8.6/11.2 vs CG 1.2/10.8; P < 0.001; patients: 7.1/11.0 vs 1.1/11.1; P < 0.001). Intervention showed significant reduction of caregiver anxiety (-1.9/8.4 vs -0.7/7.5; P < 0.05). There were no significant changes in the depression scores.

CONCLUSION

Structured patient education programmes may be beneficial in the management of anaphylaxis by increasing patients' empowerment to prevent and treat the disease.

Investigating recurrent neural networks for OCT A-scan based tissue analysis

OBJECTIVES

Optical Coherence Tomography (OCT) has been proposed as a high resolution image modality to guide transbronchial biopsies. In this study we address the question, whether individual A-scans obtained in needle direction can contribute to the identification of pulmonary nodules.

METHODS

OCT A-scans from freshly resected human lung tissue specimen were recorded through a customized needle with an embedded optical fiber. Bidirectional Long Short Term Memory networks (BLSTMs) were trained on randomly distributed training and test sets of the acquired A-scans. Patient specific training and different pre-processing steps were evaluated.

RESULTS

Classification rates from 67.5% up to 76% were archived for different training scenarios. Sensitivity and specificity were highest for a patient specific training with 0.87 and 0.85. Low pass filtering decreased the accuracy from 73.2% on a reference distribution to 62.2% for higher cutoff frequencies and to 56% for lower cutoff frequencies.

CONCLUSION

The results indicate that a grey value based classification is feasible and may provide additional information for diagnosis and navigation. Furthermore, the experiments show patient specific signal properties and indicate that the lower and upper parts of the frequency spectrum contribute to the classification.

Pulmonary haptoglobin and CD163 are functional immunoregulatory elements in the human lung

BACKGROUND

The acute-phase protein haptoglobin (Hp) and its receptor CD163 serve as immunomodulators and possess anti-inflammatory besides antioxidant functions.

OBJECTIVES

To further understand the role of the recently described pulmonary Hp (pHp) and its receptor CD163 in case of inflammation and infection, pHp and CD163 were investigated on mRNA and protein level to gain insight into the cellular events taking place upon stimulation with the inflammatory mediators LPS, Pam3, cytokine IL-6 and dexamethasone, and upon infection with respiratory pathogens (Haemophilus influenzae, Streptococcuspneumoniae and Chlamydia pneumoniae) by use of a human ex vivo tissue culture model and cell cultures of A549 and alveolar epithelial cells type II. In addition, pHp and CD163 expression in COPD and sarcoidosis was assessed.

METHODS

We conducted experiments using 942 ex vivo cultured lung samples applying immunohistochemistry, immunocytochemistry, in situ hybridization, immunofluorescence, real-time PCR, RT-PCR, slot and Western immunoblot analyses with tissue lysates and culture supernatants as well as ELISA and cytometric bead array analyses.

RESULTS

This study describes for the first time the expression, regulation and secretion of pHp and its receptor CD163 in the human lung. The release of soluble mediators from A549 cell line and human monocyte-derived macrophages was observed indicating that Hp differentially activates the release of soluble mediators and major chemoattractants.

CONCLUSIONS

The findings indicate a native function of pHp and CD163 as functional pulmonary defense elements due to local expression, regulation and secretion during lung infection and as part of the inflammatory immune response of the respiratory system.

[Billing based on a case-based lump sum for stroke. Did this lead to discharge of patients in a worse clinical condition?]

BACKGROUND

It has been supposed that the introduction of a new inpatient reimbursement system starting in 2004 in Germany using the German diagnosis-related groups (G-DRG) may lead to false incentives with encouragement of premature hospital discharge of patients. Exploring a large database on stroke patients, we addressed the question whether length of stay (LOS) and discharge in more severe condition were associated with the introduction of the G-DRG. We further examined other factors with probable effect on LOS such as variations of patient characteristics and treatment during the observation period.

PATIENTS AND METHODS

All stroke patients treated in 2003-2006 in the German state of Hesse (6,100,000 inhabitants) were assessed with respect to stroke severity, symptoms on admission and discharge, LOS and stroke-related deficits on discharge. We compared LOS and outcome in 2003 (before introduction of the G-DRG) with 2004 when the G-DRG had recently been introduced and with 2006 when the G-DRG was already well established in the clinical routine. The effects of LOS and treatment year on outcome were assessed using a logistic regression model.

RESULTS

During the observation period, we evaluated 37,396 stroke patients. The length of stay was reduced significantly from 12.2 to 10.4 days (p<0.001). Both severity of stroke on admission and outcome on discharge decreased during the observation period. A multivariate analysis revealed a minor but significant association [odds ratio (OR): 1.020 per day of hospital treatment; 95% confidence interval (CI): 1.016-1.024] of LOS on outcome. Treatment in 2006 compared to 2003 led to good outcome with an OR of 1.378 (95% CI: 1.279-1.485). Subgroup analysis limited to patients with severe stroke revealed that LOS was significantly lower in 2006 compared to 2003 also in this patient subgroup; moreover, the proportion of patients discharged with severe outcome was lower in 2006 compared to 2003.

CONCLUSIONS

This study reveals a significant reduction of LOS during the years after introduction of the G-DRG. However, reduction of LOS was not associated with more severe outcome on discharge, possibly due to changes in stroke treatment implemented during the observational period. Our results do not support the conjecture that changes in the reimbursement system were associated with compromised patient care.

Allergenicity of wine containing processing aids: a double-blind, placebo-controlled food challenge

BACKGROUND

The European Union requires allergenic food ingredients to appear on labels in order to protect allergic consumers.

OBJECTIVE

To determine whether traces of egg-, milk-, and fish-derived processing aids used in winemaking might elicit clinical reactions in food-allergic patients.

METHODS

Five German wines were fined with a high dose of egg albumin, lysozyme, milk casein, fish gelatin, or isinglass, and filtered. Fourteen adults with allergy to egg (n = 5), milk (n = 5), or fish (n = 4) were included. Skin prick tests were performed with fining agents, and fined and unfined wines. All patients underwent double-blind placebo-controlled food challenges with fined and unfined wines.

RESULTS

Skin prick tests were positive to hen's egg (n = 5), ovalbumin (n = 5), lysozyme (n = 4), cow's milk (n = 5), casein (n = 4), and cod (n = 3), but not to isinglass or fish gelatin (n = 0). Positive skin prick test results were observed for wines fined with albumin (n = 3), lysozyme (n = 2), casein (n = 1), gelatin (n = 0), and isinglass (n = 3), and for unfined wines (n = 1-2 in each patient group), with no significant differences between groups. Seventy-five percent of skin test-positive patients had specific immunoglobulin E to other allergens present in wine (eg, carbohydrates). The provocation test revealed no reactions to fined or unfined wines.

CONCLUSIONS

Although concentrated fining agents containing ovalbumin, lysozyme, and casein were allergenic in the skin prick test, no patient reacted adversely in the provocation test to fined wine. Wines treated with fining agents at commercial concentrations appear not to present a risk to allergic individuals when filtered,