Facilitating personal hygiene choices for renal patients with central venous lines: a multi-phase study

This study explored personal hygiene options of renal patients that maintain the integrity of central venous catheter exit site dressings between dialysis sessions. Background: Infection is a major life-limiting risk for patients undergoing haemodialysis via a central venous catheter. Meticulous attention to keeping the exit site dressings clean and dry is an essential defence in preventing local and systemic infections. It is difficult to maintain the integrity of waterresistant dressings in tropical environments. Study Design: A three-phase exploratory study was conducted in a northern Australian Renal Service. Methods: Phase 1 employed a cross-sectional, anonymous, online survey of renal nurses about the acceptability and feasibility of two hygiene options for patients: bathing wipes and a waterproof dressing cover. The survey also canvassed their concerns about the options. Descriptive statistics were used to summarise Likert-scale responses and content analysis was used for responses to open-ended survey questions. Phase 2 used conversational-style interviews with patients about their hygiene preferences, how they endeavoured to keep their dressings dry, and their impressions regarding the proposed options. Phase 3 was a series of case studies of patients trialling the provided options over a six-week period. Participants were progressively recruited to this phase and were provided with the product/s of their choice at each dialysis session; renal nurses also assessed the integrity of the dressings at each dialysis session. Research nurses discussed with the participants their experiences with the options. Results: Phase 1: Nurses (N=37, response rate 58.7%) considered both options acceptable and feasible for patients, noting some practical concerns related to their use. Phase 2: Patients (N=27, 100% participation rate) described hygiene preferences and difficulties they encountered with keeping dressings dry. Only one participant had a bath, as per written advice. All were enthusiastic about trying the proposed options. Phase 3: Patients (N=22) appreciated being able to shower without wetting their exit site dressings. Individuals were inventive in modifying the application and use of the waterproof cover according to their body shape and the central venous catheter exit site location. Although participants liked both options, the waterproof covering was most popular and most frequently used. Intactness of the dressings was 83% during the trial; there were no central venous catheter-associated infections during the study. Conclusion: Self-management and choice were motivating factors for participants. Patients embraced being able to keep their dressings dry and intact during personal hygiene in a tropical environment. Implications for research, policy, and practice: Patients demonstrated their willingness to undertake a more active role in their dressing care, while exercising choice with respect to personal hygiene. Studies that further increase patients’ participation in other aspects of their self-care warrant further investigation. The organisation is pursuing options for the ongoing provision of the products used in this study and how their use can be monitored in clinical practice. What is already known about the topic? • Intact dressings provide an important line of defence against infection in the vulnerable population of patients receiving dialysis via central lines. • Hygiene needs are also an important consideration for quality of life, empowerment, and autonomy. • Patients’ current attempts to meet their own hygiene needs often result in a disruption to the intactness of the dressing site and predispose them to systemic infections. What this paper adds • This study facilitated exploration of two feasible hygiene options in an open and culturally safe manner, from both patients’ and nurses’ perspectives. • The opportunity to perform personal hygiene according to individual preferences resulted in a willingness of participants to undertake a more active role in the care of their dressing. • The identification of two acceptable and feasible personal hygiene options has the potential of removing one of the many lifestyle modifications faced by people who undergo haemodialysis via a central venous catheter

Whole of Life Tariffs in the Shadow of Europe: Penological Foundations and Political Popularity

This article explores the escalating conflict between European judges and domestic politicians over the issue of whole of life tariffs. After the decision of the European Court of Human Rights (ECtHR) in Vinter and Others v. the United Kingdom and the subsequent decision of the Court of Appeal in R v. McLoughlin, there has been a very public tension between the two sides over reviewing prisoner sentences. When bids for release have previously been made by whole life prisoners, most infamously Myra Hindley, the political mood has been defiant. Now Europe has decreed that such prisoners are entitled to an enhanced review of their sentence beyond the possibility of executive release owing to terminal illness, the political stance has further hardened. Instead of enhanced sentence review, the response to Europe has been the announcement of widening the applicability of the tariff to those who kill police or prison officers

A non-linear case-based reasoning approach for retrieval of similar cases and selection of target credits in LEED projects

Leadership in Energy and Environmental Design (LEED) is a widely used international green building certification program developed by the U.S. Green Building Council (USGBC). Although the need for LEED certification has grown significantly, LEED managers still face challenges in target credit selection and green building technology design. They frequently meet new types of projects with different project characteristics and requirements. Therefore, it would be helpful if LEED managers could refer to other similar certified green building cases when planning and designing LEED projects. However, this is not supported in current studies and research. This paper proposes a case-based reasoning (CBR) approach to provide case studies of similar certified green building projects and suggestions on target LEED credits. Currently, linear formation of Local-Global method is commonly used in the retrieval step of CBR. This paper presents a non-linear formation of Local-Global retrieval based on Artificial Neural Network (ANN), which can provide a higher accuracy. LEED for New Construction (LEED-NC) is the focus of this paper, and 1000 LEED-NC v2009 certified cases were collected for the case base. Pairwise comparison was conducted to generate the local distance (attribute similarity) and the target for training the ANN model. The proposed non-linear CBR approach was tested and evaluated using 20 recently certified projects, and the results showed a prediction accuracy of 80.75% on the LEED credit selection. The results were also compared with those calculated by commonly used linear CBR approaches: Multiple Regression Analysis, Correlation Analysis, and the k-NN approach. The accuracy achieved by these methods was between 71.23% and 77.54%, which was lower than the proposed approach