Manpower

Non

The use of privacy-protected computer vision to measure the quality of healthcare worker hand hygiene

© 2018 The Author(s). Objectives: (i) To demonstrate the feasibility of automated, direct observation and collection of hand hygiene data, (ii) to develop computer visual methods capable of reporting compliance with moment 1 (the performance of hand hygiene before touching a patient) and (iii) to report the diagnostic accuracy of automated, direct observation of moment 1. Design: Observation of simulated hand hygiene encounters between a healthcare worker and a patient. Setting: Computer laboratory in a university. Participants: Healthy volunteers. Main outcome measures: Sensitivity and specificity of automatic detection of the first moment of hand hygiene. Methods: We captured video and depth images using a Kinect camera and developed computer visual methods to automatically detect the use of alcohol-based hand rub (ABHR), rubbing together of hands and subsequent contact of the patient by the healthcare worker using depth imagery. Results: We acquired images from 18 different simulated hand hygiene encounters where the healthcare worker complied with the first moment of hand hygiene, and 8 encounters where they did not. The diagnostic accuracy of determining that ABHR was dispensed and that the patient was touched was excellent (sensitivity 100%, specificity 100%). The diagnostic accuracy of determining that the hands were rubbed together after dispensing ABHR was good (sensitivity 83%, specificity 88%). Conclusions: We have demonstrated that it is possible to automate the direct observation of hand hygiene performance in a simulated clinical setting. We used cheap, widely available consumer technology and depth imagery which potentially increases clinical application and decreases privacy concerns

Scanning the horizon: emerging hospital-wide technologies and their impact on critical care

This commentary represents a selective survey of developments relevant to critical care. Selected themes include advances in point-of-care diagnostic testing, glucose control, novel microbiological diagnostics and infection control measures, and developments in information technology that have implications for intensive care. The latter encompasses an early example of an artificially intelligent clinical decision support mechanism, the introduction of a national health care information technology programme (UK NPfIT) and its implications, and exotic threats to patient safety due to emergent behaviour in complex information systems

Experimental investigation of a timber-concrete floor panel system with a hybrid glass fibre reinforced polymer-timber corrugated core

Hybrid timber-concrete (HTC) floor systems are well-suited for prefabricated construction and so have seen widespread use in modern sustainable buildings. This paper investigates a novel extension to such systems by introducing a corrugated core between tensile timber and compressive concrete layers. This new ‘HTCC’ floor panel system is hypothesised to have an increased weight-specific flexural capacity relative to HTC systems, by reducing the volume of concrete below the panel neutral axis without decreasing flexural capacity. This paper experimentally investigates the flexural performance of the new system, acting in two configurations: with core orientation parallel to the span for maximum longitudinal one-way spanning capacity; and with core orientation transverse to the span for generation of a novel transverse spanning capacity. In total, eight HTCC floor panels were prepared and tested, with the flexural capacities and critical failure modes analysed for each. Effects of different core geometries, shear force transfer methods, and manifested composite action are also closely studied. Longitudinal specimens achieved the best composite action and correspondingly the highest panel performance, with a 73% ultimate moment carrying efficiency and an 85% stiffness efficiency at SLS, compared to an idealised HTC section with full composite action

Longitudinal investigation of prognostic communication: Feasibility and acceptability of studying serial disease reevaluation conversations in children with high-risk cancer

BACKGROUND: Prospective investigation of medical dialogue is considered the gold standard in prognostic communication research. To the authors' knowledge, the achievability of collecting mixed methods data across an evolving illness trajectory for children with cancer is unknown. METHODS: The objective of the current study was to investigate the feasibility and acceptability of recording sequential medical discussions at disease reevaluation time points for children with high‐risk cancer. Mixed methods data (ie, surveys, interviews, checklists, and chart reviews) corresponding to each disease reevaluation conversation also were captured in real‐time for 34 patients across 24 months at an academic pediatric cancer center. RESULTS: All eligible oncology clinicians (65 of 65 clinicians; 100%) and the majority of eligible patient/parent dyads (34 of 41 dyads; 82.9%) enrolled on the study; of 200 disease reevaluation discussions, 185 discussions (92.5%) were recorded, totaling >3300 minutes of recorded medical dialogue. Longitudinal data were captured for 31 of 34 patient/parent dyads (91.2%). The vast majority of study materials were completed, including 138 of 139 nonverbal communication checklists (99.3%), all 49 oncologist surveys (100%), 40 of 49 parent surveys (81.6%), all 34 oncologist interviews (100%), and 24 of 34 parent interviews (70.6%). Only 1 parent reported participation to be a “very” distressing experience, no parents believed that their level of distress warranted speaking with a psychosocial provider, and the majority of parents (18 of 29 parents; 62.1%) described study participation as “somewhat” or “very” useful to them. CONCLUSIONS: The prospective, longitudinal investigation of prognostic communication using a mixed methods approach appears to be feasible and acceptable to clinicians, patients, and families. The study of sensitive content can be accomplished without causing undue participant burden or harm, thereby enabling further advancement of communication research