Bacterial contamination of complex gastrointestinal endoscopes

The worldwide surge of duodenoscope-associated outbreaks since the new millennium show that current reprocessing practices do not guarantee adequately decontaminated endoscopes. To prevent future outbreaks, identification of risk factors contributing to outbreaks and endoscope contamination is essential. The discussion of this thesis is divided into three themes. First, it describes the background of reprocessing of duodenoscopes and linear echoendoscopes (DLE), the multiple parties that are involved, and potential pathways leading to an outbreak. Secondly, it gains insight in the true size of the underlying problem of DLE contamination by showing the enduring high prevalence of DLE contamination with digestive tract bacteria in Dutch hospitals. In the third part of this thesis we show the results of a study of a cleaning test as a potential marker to check for residue to lower the contamination rate

Bacterial contamination of complex gastrointestinal endoscopes

The worldwide surge of duodenoscope-associated outbreaks since the new millennium show that current reprocessing practices do not guarantee adequately decontaminated endoscopes. To prevent future outbreaks, identification of risk factors contributing to outbreaks and endoscope contamination is essential. The discussion of this thesis is divided into three themes. First, it describes the background of reprocessing of duodenoscopes and linear echoendoscopes (DLE), the multiple parties that are involved, and potential pathways leading to an outbreak. Secondly, it gains insight in the true size of the underlying problem of DLE contamination by showing the enduring high prevalence of DLE contamination with digestive tract bacteria in Dutch hospitals. In the third part of this thesis we show the results of a study of a cleaning test as a potential marker to check for residue to lower the contamination rate

Consumer responses to creative advertising:a literature review

Purpose This chapter provides an overview of the state of knowledge about creative media advertising; choosing a novel medium that implicitly communicates the message. It explains what creative media advertising is and how it differs from other unconventional marketing communication formats. It addresses the theoretical mechanisms that explain how creative media affects consumers. Its final purpose is to review all the empirical findings about creative media advertising effects. Methodology/approach This chapter presents a systematic literature review of all the empirical research about creative media advertising that explicitly compares its effectiveness with traditional media advertising. The 11 reviewed articles with 16 experiments appeared between 2005 and 2015. Findings Overall creative media advertising generated positive evaluative outcomes (e.g., brand attitude) and behavior (e.g., word of mouth and sales). These effects were often mediated by a feeling of surprise and an increase in positive thoughts. It remains unclear whether creative media are perceived as persuasion attempts. Mixed findings exist for cognitive outcomes. Creative media advertising seems beneficial for creating strong brand associations, but brand memory might suffer from the technique if solving the link between the medium and the message takes away mental resources for the brand elements in the advertisement. Originality/value By reviewing all the literature about creative media advertising, the authors make recommendations for future research and for using creative media in practice. They emphasize potential boundary conditions and ideal circumstances of using creative media advertising

High prevalence rate of digestive tract bacteria in duodenoscopes: A nationwide study

Objective Increasing numbers of outbreaks caused by contaminated duodenoscopes used for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures have been reported, some with fatal outcomes. We conducted a nationwide cross-sectional study to determine the prevalence of bacterial contamination of reprocessed duodenoscopes in The Netherlands. Design All 73 Dutch ERCP centres were invited to sample ≥2 duodenoscopes using centrally distributed kits according to uniform sampling methods, explained by video instructions. Depending on duodenoscope type, four to six sites were sampled and centrally cultured. Contamination was defined as (1) any microorganism with ≥20 colony forming units (CFU)/20 mL (AM20) and (2) presence of microorganisms with gastrointestinal or oral origin, independent of CFU count (MGO). Results Sixty-seven out of 73 centres (92%) sampled 745 sites of 155 duodenoscopes. Ten different duodenoscope types from three distinct manufacturers were sampled including 69 (46%) Olympus TJF-Q180V, 43 (29%) Olympus TJF-160VR, 11 (7%) Pentax ED34-i10T, 8 (5%) Pentax ED-3490TK and 5 (3%) Fujifilm ED-530XT8. Thirty-three (22%) duodenoscopes from 26 (39%) centres were contaminated (AM20). On 23 (15%) duodenoscopes MGO were detected, including Enterobacter cloacae, Escherichia coli, Klebsiella pneumonia and yeasts. For both definitions, contamination was not duodenoscope type dependent (p values: 0.20 and higher). Conclusion In 39% of all Dutch ERCP centres, at least one AM20-contaminated patient-ready duodenoscope was identified. Fifteen per cent of the duodenoscopes harboured MGO, indicating residual organic material of previous patients, that is, failing of disinfection. These results suggest that the present reprocessing and process control procedures are not adequate and safe

A multi-stakeholder approach to eHealth development: promoting sustained healthy living among cardiovascular patients

Background: Healthy living is key in the prevention and rehabilitation of cardiovascular disease (CVD). Yet, supporting and maintaining a healthy lifestyle is exceptionally difficult and people differ in their needs regarding optimal support for healthy lifestyle interventions.Objective: The goals of this study were threefold: to uncover stakeholders' needs and preferences, to translate these to core values, and develop eHealth technology based on these core values. Our primary research question is: What type of eHealth application to support healthy living among people with (a high risk of) CVD would provide the greatest benefit for all stakeholders? Methods: User-centered design principles from the CeHRes roadmap for eHealth development were followed to guide the uncovering of important stakeholder values. Data were synthesized from various qualitative studies (i. e., literature studies, interviews, think-aloud sessions, focus groups) and usability tests (i.e., heuristic evaluation, cognitive walkthrough, think aloud study). We also developed an innovative application evaluation tool to perform a competitor analysis on 33 eHealth applications. Finally, to make sure to take into account all end-users needs and preferences in eHealth technology development, we created personas and a customer journey.Results: We uncovered 10 universal values to which eHealth-based initiatives to support healthy living in the context of CVD prevention and rehabilitation should adhere to (e.g., providing social support, stimulating intrinsic motivation, offering continuity of care). These values were translated to 14 desired core attributes and then prototype designs. Interestingly, we found that the primary attribute of good eHealth technology was not a single intervention principle, but rather that the technology should be in the form of a digital platform disseminating various interventions, i.e., a 'one-stop-shop'.Conclusion: Various stakeholders in the field of cardiovascular prevention and rehabilitation may benefit most from utilizing one personalized eHealth platform that integrates a variety of evidence-based interventions, rather than a new tool. Instead of a one-size-fits-all approach, this digital platform should aid the matchmaking between patients and specific interventions based on personal characteristics and preferences.Cardiolog

A multi-stakeholder approach to eHealth development: Promoting sustained healthy living among cardiovascular patients

Background: Healthy living is key in the prevention and rehabilitation of cardiovascular disease (CVD). Yet, supporting and maintaining a healthy lifestyle is exceptionally difficult and people differ in their needs regarding optimal support for healthy lifestyle interventions. Objective: The goals of this study were threefold: to uncover stakeholders’ needs and preferences, to translate these to core values, and develop eHealth technology based on these core values. Our primary research question is: What type of eHealth application to support healthy living among people with (a high risk of) CVD would provide the greatest benefit for all stakeholders? Methods: User-centered design principles from the CeHRes roadmap for eHealth development were followed to guide the uncovering of important stakeholder values. Data were synthesized from various qualitative studies (i.e., literature studies, interviews, think-aloud sessions, focus groups) and usability tests (i.e., heuristic evaluation, cognitive walkthrough, think aloud study). We also developed an innovative application evaluation tool to perform a competitor analysis on 33 eHealth applications. Finally, to make sure to take into account all end-users needs and preferences in eHealth technology development, we created personas and a customer journey. Results: We uncovered 10 universal values to which eHealth-based initiatives to support healthy living in the context of CVD prevention and rehabilitation should adhere to (e.g., providing social support, stimulating intrinsic motivation, offering continuity of care). These values were translated to 14 desired core attributes and then prototype designs. Interestingly, we found that the primary attribute of good eHealth technology was not a single intervention principle, but rather that the technology should be in the form of a digital platform disseminating various interventions, i.e., a ‘one-stop-shop’. Conclusion: Various stakeholders in the field of cardiovascular prevention and rehabilitation may benefit most from utilizing one personalized eHealth platform that integrates a variety of evidence-based interventions, rather than a new tool. Instead of a one-size-fits-all approach, this digital platform should aid the matchmaking between patients and specific interventions based on personal characteristics and preferences

A Systematic Review of Social Presence: Definition, Antecedents, and Implications

Social presence, or the feeling of being there with a “real” person, is a crucial component of interactions that take place in virtual reality. This paper reviews the concept, antecedents, and implications of social presence, with a focus on the literature regarding the predictors of social presence. The article begins by exploring the concept of social presence, distinguishing it from two other dimensions of presence—telepresence and self-presence. After establishing the definition of social presence, the article offers a systematic review of 233 separate findings identified from 152 studies that investigate the factors (i.e., immersive qualities, contextual differences, and individual psychological traits) that predict social presence. Finally, the paper discusses the implications of heightened social presence and when it does and does not enhance one's experience in a virtual environment