Microorganisms cultured from laryngoscope blades in an academic hospital following implementation of a new decontamination technique

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesiology Johannesburg, 2015Background Laryngoscopy is a commonly performed invasive procedure in hospitals, especially in theatre. Lack of formal guidelines and variation of utilised decontamination techniques have resulted in a breach of ensuring patient safety in hospitals. Multiple international and local studies have found microorganism contamination of laryngoscope blades. Aim The aim of this study was to describe the effectiveness of a newly implemented decontamination protocol for reusable laryngoscope blades at Helen Joseph Hospital. Method A prospective, contextual, comparative, descriptive study design was used. A single area on the size 4 blades in the two emergency theatres was swabbed in an aseptic manner. After transport to the laboratory, the samples were inoculated onto petri film and blood agar plates. Following 48 hours of aerobic incubation, plates were examined for colonies with subsequent enumeration and identification of microorganisms. The samples were collected over a two month period. Results Five control samples were collected, all of which had no microorganism growth. Of the 73 samples collected, four samples were misplaced by the laboratory with no results recovered. Positive quantitative counts were reported on eight (11.6%) samples, with only two (2.9%) samples having positive microorganism growth and identification and 67 (97.1%) samples reporting no microorganism growth. The two microorganisms isolated were Chryseobacterium indologenes and Streptococcus salivarius. This showed the effectiveness of the new decontamination technique, with a p-value < 0.0001. Conclusion The reduction in positive microorganism contamination by high-level disinfection with Cidex®OPA will improve patient safety and decrease the potential risk of cross infection. Formal decontamination protocols using a high-level disinfectant should be implemented at all hospitals.MT201

The experience of letting go : a phenomenological study

The purpose of this study was to discover and describe the structure and essence of the phenomenon of letting go. The meaning of the experience had to be revealed, explored and understood. The emphasis in contemporary psychology is on separation, a word often used synonymously with letting go, and, while a plethora of studies have been conducted in the area of separation, with separation-individuation the prevailing paradigm for developmental psychology, the meaning and experience of letting go has remained unexplored. The phenomenon of letting go was approached from a developmental perspective. Literature in the field regarding separation, separation-individuation and the related aspects of holding, attachment, transitional space and autonomy was reviewed. With the focus on an existential-phenomenological understanding of the lived meaning of the experience, a dialogue between the available psychological facts and the world of experience regarding letting go arises. The phenomenon was explored in a qualitative manner employing the phenomenological research method articulated by Amedeo Giorgi. The qualitative research interview, proposed by Kvale, was the method used to collect the data where, five participants were asked to describe a significant letting-go experience. The general psychological structure revealed that the experience of letting go cannot be contained in stasis. The experience is also relative to the contextual environment in which it occurs. Letting go is a transitional process of spiral mobility, as the past is returned to (and repeated), to meet with the challenge of change. In fear of entering the unknown, the familiar is held on to and as a façade evolves which conceals the truth, there is a deceptive belief regarding personal stability. In the push and pull experience of the polarised conflict, a struggle ensues, where unexpected outbursts can occur. Gradual awareness of the inevitability of change and the emerging negativity regarding the self gives rise to the threat of fragmentation, and there is a submission to the omnipotence of time and space. In an attempt to gain control, decisions are made, as the self partakes in the creative process. Successful resolution of the conflict gives rise to a sense of empowerment. While memories fill the gap of the past and new meaning is created regarding the future, a sense of continuity arises that is held on to. To let go is to relinquish control, to submit to, and partake in the process of creation. The vacillation and oscillation between positive and negative forces is the rhythmic process of life. Letting go is characteristic of human development, which though cyclic, is not only phase-related but unpredictable and an integral part of life. The dialectic of holding on and letting go is the dialectic of life and death. The implications of letting go are diverse in relation to microcosmic or macrocosmic change, whether personal, social, political or universal. The findings revealed can contribute to the fields of developmental psychology, social psychology, transpersonal psychology, psychotherapy, bereavement, forgiveness and other related fields. Letting go is the experience of the self in the process of change.Thesis (PhD (Psychotherapy))--University of Pretoria, 2005.Psychologyunrestricte

A comparison of the warming capabilities of two Baragwanath rewarming appliances with the Hotline fluid warming device

Background. Accidental intraoperative hypothermia is a common and avoidable adverse event of the perioperative period and is associated with detrimental effects on multiple organ systems and postoperative patient outcomes. In a resource-limited environment, prevention of intraoperative hypothermia is often challenging. Resourceful clinicians overcome these challenges through creative devices and frugal innovations. Objective. To investigate the thermal performance of two Baragwanath Rewarming Appliances (BaRA) against that of the Hotline device to describe an optimal setup for these devices. Methods. This was a quasi-experimental laboratory study that measured the thermal performance of two BaRA devices and the Hotline device under a number of scenarios. Independent variables including fluid type, flow rate, warming temperature and warming transit distance were sequentially altered and temperatures measured along the fluid stream. Change in temperature (ΔT) was calculated as the difference between entry and exit temperature for each combination of variables for each warming device. Results. A total of 219 experiments were performed. At a temperature of 43.0°C and a transit distance of 200 cm, the BaRA A configuration either matched or exceeded the ΔT of the Hotline over all fluid type and flowrate combinations. The BaRA B configuration does not provide comparable thermal performance to the Hotline. Measured flowrates were noticeably slower than manufacturer-quoted values for all intravenous (IV) cannulae used. Conclusion. A warm-water bath at 43.0°C with 200 cm of submerged IV tubing provides thermal performance comparable to the Hotline device, with all fluid type and flowrate combinations

Polycystic kidney disease in patients on the renal transplant waiting list: trends in hematocrit and survival

BACKGROUND: The patient characteristics and mortality associated with autosomal dominant polycystic kidney disease (PKD) have not been characterized for a national sample of end stage renal disease (ESRD) patients on the renal transplant waiting list. METHODS: 40,493 patients in the United States Renal Data System who were initiated on ESRD therapy between 1 April 1995 and 29 June 1999 and later enrolled on the renal transplant waiting list were analyzed in an historical cohort study of the relationship between hematocrit at the time of presentation to ESRD and survival (using Cox Regression) in patients with PKD as a cause of ESRD. RESULTS: Hematocrit levels at presentation to ESRD increased significantly over more recent years of the study. Hematocrit rose in parallel in patients with and without PKD, but patients with PKD had consistently higher hemoglobin. PKD was independently associated with higher hematocrit in multiple linear regression analysis (p < 0.0001). In logistic regression, higher hematocrit was independently associated with PKD. In Cox Regression analysis, PKD was associated with statistically significant improved survival both in comparison with diabetic (hazard ratio, 0.64, 95% CI 0.53–0.77, p < 0.001) and non-diabetic (HR 0.68, 95% CI 0.56–0.82, p = 0.001) ESRD patients, adjusted for all other factors. CONCLUSIONS: Hematocrit at presentation to ESRD was significantly higher in patients with PKD compared with patients with other causes of ESRD. The survival advantage of PKD in ESRD persisted even adjusted for differences in hematocrit and in comparison with patients on the renal transplant waiting list

Icodextrin does not impact infectious and culture-negative peritonitis rates in peritoneal dialysis patients: a 2-year multicentre, comparative, prospective cohort study

Background. Icodextrin is a glucose polymer derived by hydrolysis of cornstarch. The different biocompatibility profile of icodextrin-containing peritoneal dialysis (PD) solutions may have a positive influence on peritoneal host defence. Furthermore, cases of sterile peritonitis potentially associated with icodextrin have been reported

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.publishedVersio

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

Background: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings: In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation: The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding: National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic

Cognitive factors predicting checking, procrastination and other maladaptive behaviours: prospective versus Inhibitory Intolerance of Uncertainty

Intolerance of Uncertainty (IU) is a cognitive construct which is strongly linked to psychopathology, particularly anxiety and obsessive-compulsive symptoms. IU has also been proposed to be linked to maladaptive behaviours such as checking and procrastination in uncertain situations. Additionally, two subfactors of IU have recently been identified, Prospective IU (Desire for Predictability) and Inhibitory IU (Uncertainty Paralysis). These factors may differentially predict approach and avoidance behaviours respectively, however research is lacking. This study investigated associations between IU subfactors and self-reported maladaptive behaviours. University students (n=110; 74.3% female) completed self-report measures of behaviours including checking, procrastination, general avoidance and controlling behaviours. We hypothesised that Prospective IU would be associated with checking behaviours while Inhibitory IU would be associated with procrastination. Procrastination was predicted only by Inhibitory IU, however Checking was predicted equally by Inhibitory IU and Prospective IU. The results provide the first evidence of a differentiation between the two IU subfactors in predicting maladaptive behaviours. Uncertainty Paralysis may be an important cognitive factor reflecting tendencies to freeze during uncertainty, which predicts both checking and procrastination. Checking behaviours may be associated with additional unwillingness to leave outcomes to chance. This research provides new information about specific cognitive factors associated with checking and procrastination and other maladaptive behaviours, which could potentially be targeted in interventions