Out-of-sight killers–the ongoing problem with hospital gas lines

There is a continuing risk associated with the delivery of piped nitrous oxide into hospitals. While standards and design focus are often directed at the equipment used by clinicians, attention also needs to be directed at developing safety mechanisms throughout an entire gas delivery process to prevent ongoing tragedies associated with gas-delivery errors

Evaluation of Free i-Applications for Tertiary Level Gross Anatomy Education

BackgroundThe use of electronic resources in education, including i-applications used on portable handheld devices, is increasing.  Apple® handheld devices are popular, with free applications the most prevalent download form. Many gross anatomy i-applications are available, however no information on the quality of free anatomy products is available. Rating such products could therefore guide product recommendations.  AimTo evaluate the quality and range of free iPod® applications that are applicable for tertiary level gross anatomy education. MethodsA search of the iTunes® Application Store with keywords anatomy, free, medical, functional, clinical, gross, and human was performed, with inclusion based on free applications containing human gross anatomy usable for tertiary education purposes. Application specification was noted; each was trialled independently and rated for usability, specification, academic level, and quality (image and programme).ResultsSixty-three applications were identified and eleven met inclusion criteria. Two provided gross anatomy of the entire body, nine examined specific regions or systems.  Five were judged introductory in academic level, five intermediate, and one advanced. One application was rated low quality, and four excellent. None were considered difficult to use (six easy, five medium).  Application size ranged between 1.2MB and 229MB (mean 27MB).ConclusionsThere are few free i-applications for learning gross anatomy and most concentrate on individual body systems, with the academic level and usability of all products well rated.  Results suggest some free I-applications could be suitable adjuncts for gross anatomy education at both an undergraduate and graduate level

Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging : a proposed method for the lumbar spine with anatomical cross-reference

Background: There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers. Method: In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described. Results: Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI. Conclusions: We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality

Bacterial Contamination of Unused, Disposable Non-sterile Gloves on a Hospital Orthopaedic Ward

BackgroundNon-sterile disposable gloves are used on large hospital wards, however their potential role as a vehicle for pathogen transmission has not been explored in this setting. AimsThis study investigates glove use on a hospital orthopaedic ward to examine whether pathogen contamination occurs prior to contact with patients.Method  Glove samples were aseptically removed from boxes on a hospital orthopaedic ward on opening and days 3, 6 and 9 thereafter. Following elution of bacteria and viable counts, glove isolates were identified by standard techniques and 16s rDNA sequencing. Methicillin resistance of staphylococci was determined by disc diffusion,Epsilon tests and PCR. Gloves were inoculated to determine two isolate survival rates.ResultsTotal bacterial counts ranged from 0 to 9.6 x 103 cfu/glove. Environmental bacteria, particularly Bacillus species, were present on 31/38 (81.6%) of samples. Half (19/38) the samples were contaminated with skin commensals; coagulase negative staphylococci were predominant. Enterococcus faecalis, Klebsiella pneumoniae, Pseudomonas sp. or methicillin susceptible Staphylococcus aureus were recovered from 5/38 (13.2%) of samples. Significantly more skin commensals and pathogens were recovered from samples from days 3, 6, 9 than box-opening samples. Staphylococcus epidermidis and Klebsiella pneumoniae inoculated onto gloves remained viable for several days but counts decreased. ConclusionHealth-care workers introduced skin commensals and pathogenic bacteria into glove boxes indicating that unused, non-sterile gloves are potential pathogen transmission vehicles in hospitals. Findings highlight adherence to hand-washing guidelines, common glove retrieval practice, and glove-box design as targets for decreasing bacteria transmission via gloves on hospital wards