Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery

Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. Methods A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. Results Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs

What are mass media interventions made of?:Exploring the active content of interventions designed to increase HIV testing in gay men within a systematic review

Purpose Mass media HIV testing interventions are effective in increasing testing, but there has been no examination of their theory or behaviour change technique (BCT) content. Within a heterogeneous body of studies with weak evaluative designs and differing outcomes, we attempted to gain useful knowledge to shape future interventions. Methods Within a systematic review, following repeated requests to the authors of included studies for intervention materials, the Theory Coding Scheme, the Theoretical Domains Framework (TDF), and Behaviour Change Technique Taxonomy (BCTT) were used to extract data relating to active intervention content. Results Of 19 studies, five reported an explicit theoretical basis to their intervention. TDF analysis highlighted the key domains employed within the majority of interventions: ‘knowledge’, ‘social roles and identities’, and ‘beliefs about consequences’. BCT analysis showed three BCT groupings commonly reported within interventions: ‘Comparison of outcomes’, ‘Natural consequences’, and ‘Shaping knowledge’. Three individual BCTs formed the backbone of most interventions and can be considered ‘standard’ content: ‘Instructions on how to perform behaviour’; ‘Credible source’; and ‘Information about health consequences’. Conclusions This is the first study to examine and detail active intervention content in this field. It suggests future interventions should improve knowledge about testing, and use well‐branded and trusted sources that endorse testing. Future interventions should also provide clear information about the health benefits of testing. Our analysis also suggests that to improve levels of effectiveness characterizing the current field, it may be useful to elicit commitment, and action plans, relating to how to implement testing intentions

Evaluation of a Multiparametric Immunofluorescence Assay for Standardization of Neuromyelitis Optica Serology

Background: Neuromyelitis optica (NMO) is a severely disabling autoimmune disorder of the central nervous system, which predominantly affects the optic nerves and spinal cord. In a majority of cases, NMO is associated with antibodies to aquaporin-4 (AQP4) (termed NMO-IgG). Aims: In this study, we evaluated a new multiparametric indirect immunofluorescence (IIF) assay for NMO serology. Methods: Sera from 20 patients with NMO, 41 patients with multiple sclerosis (MS), 30 healthy subjects, and a commercial anti-AQP4 IgG antibody were tested in a commercial composite immunofluorescence assay ("Neurology Mosaic 17"; Euroimmun, Germany), consisting of five different diagnostic substrates (HEK cells transfected with AQP4, non-transfected HEK cells, primate cerebellum, cerebrum, and optic nerve tissue sections). Results: We identified AQP4 specific and non-specific fluorescence staining patterns and established positivity criteria. Based on these criteria, this kit yielded a high sensitivity (95%) and specificity (100%) for NMO and had a significant positive and negative likelihood ratio (LR+ = ∞, LR- = 0.05). Moreover, a 100% inter- and intra-laboratory reproducibility was found. Conclusions: The biochip mosaic assay tested in this study is a powerful tool for NMO serology, fast to perform, highly sensitive and specific for NMO, reproducible, and suitable for inter-laboratory standardization as required for multi-centre clinical trials

The dynamics and statistics of bivariate chaotic maps in communications modeling

Statistical and dynamical properties of bivariate (two-dimensional) maps are less understood than their univariate counterparts. This paper gives a synthesis of extended results with exemplifications by bivariate logistic maps, the bivariate Arnold cat map and a bivariate Chebyshev map. The use of synchronization from bivariate maps in communication modeling is exemplified by an embryonic chaos shift keying system

Chaos communication synchronization: Combatting noise by distribution transformation

Research in electronic communications has developed chaos-based modelling to enable messages to be carried by chaotic broad-band spreading sequences. When such systems are used it is necessary to simultaneously know the spreading sequence at both the transmitting and receiving stations. This is possible using the idea of synchronization with bivariate maps, providing there is no noise present in the system. When noise is present in the transmission channel, recovery of the spreading sequence may be degraded or impossible. Once noise is added to the spreading sequence, the result may no longer lie within the boundary of the chaotic map. A usual and obvious method of dealing with this problem is to cap iterations lying outside the bounds at their extremes, but the procedure amplifies loss of synchronization. With a minimum of technical details and a computational focus, this paper first develops relevant dynamical and communication theory in the bivariate map context, and then presents a better way of improving synchronization by distribution transformation. The transmission sequence is transformed, using knowledge of the invariant distribution of the spreading sequence, and before noise corrupts the signal in the transmission channel. An ‘inverse’ transformation can then be applied at the receiver station so that the noise has a reduced impact on the recovery of the spreading sequence and hence its synchronization. Statistical simulations illustrating the effectiveness of the approach are presented

Analysis of rewarming curves in Raynaud's phenomenon of various aetiologies

This study investigated whether a modified Cold Provocation Test could distinguish between 86 normal subjects and 31 patients with Raynaud’s phenomenon or 59 with hand arm vibration syndrome (HAVS). Of the HAVS subjects, 56 were seen for medical reports as they were involved in litigation. Their assessments were done in a different location but the same protocol was used. A standardised cold stress was used to reduce the finger temperature to 15°C or less without inducing reflex hyperaemia. This test had acceptable repeatability for subjects without HAVS with an intra-class correlation of 0.7. Baseline temperature, temperature rise in the first 30 seconds and the time taken to rewarm by 5°C were measured. Patients with Raynaud’s phenomenon and HAVS had cooler hands than controls. HAVS patients rewarmed most in the first 30 seconds. Patients with Raynaud’s phenomenon take longer to rewarm by 5°C than controls or those with HAVS (P7.5°C between the temperature of the digit and that of the room is unlikely to occur in patients with Raynaud’s phenomenon or HAVS. A temperature gain of => 2.2°C in the first 30 seconds on rewarming combined with a low baseline temperature strongly suggests HAVS. This modified cold provocation test may differentiate between patients with Raynaud’s phenomenon, HAVS and controls but this observation requires independent verification in subjects not involved in litigation and tested in the same facilit

Meal accompaniments in the UK

SIGLEAvailable from British Library Document Supply Centre- DSC:3981.08(12) / BLDSC - British Library Document Supply CentreGBUnited Kingdo