Prevention of hospital infections

Bachelor i sykepleie, 2012Problemstilling: Bacheloroppgaven i sykepleie tar for seg temaer innen sykepleie som forebygger smitte i somatisk sykehus. Ut i fra temaet velger vi å skrive om sykehusinfeksjoner og velger denne problemstillingen: Hvordan kan sykepleier forbygge sykehusinfeksjoner? Oppgavens hensikt er økt kunnskap om sykepleierens rolle i forebygging av sykehusinfeksjoner. Konsekvens av manglende hygiene ved kateterinnleggelse kan påføre pasienten lidelsen urinveisinfeksjon. Med oppgaven ønsker vi å få fram hvordan sykepleiere i praksis skal handle ut i fra lover, retningslinjer og fagkunnskaper for å forebygge denne lidelsen. Avgrensing og presisering av problemstillingen: Oppgaven tar for seg sykepleiers forebyggende rolle i arbeidet med å redusere antall sykehusinfeksjoner, en rolle der sykepleiers moral har betydning. Sykepleieren bør ikke påføre pasienten mer lidelse enn hva han/hun allerede har. Hun får en tydeligere moralsk rolle når hun handler kunnskapsbasert og faglig forsvarlig, i tråd med gjeldende lover og retningslinjer for å fremme helse, forebygge sykdom og lindre lidelse. Sykepleieren har en forebyggende rolle overfor friske mennesker, personer med risiko for helsesvikt og mennesker som utsettes for komplikasjoner. Det forebyggende begrepet kan igjen deles inn i primær-, sekundær- og tertiærforebyggende tiltak. Relevant for denne oppgaven er det tertiærforebyggende tiltaket som skal hindre at nye helseproblemer som at komplikasjoner oppstår ved undersøkelser eller behandling (Kristoffersen, Nortvedt & Skaug, 2005). Fordypning i temaet sykehusinfeksjoner har gjort oss oppmerksomme på at det brukes flere synonyme begreper av det samme ordet. Synonyme ord som nosokomiale infeksjoner, helsetjeneste ervervede infeksjoner og helsetjeneste assosierte infeksjoner. I oppgaven velger vi å bruke begrepet sykehusinfeksjoner, et begrep som faller naturlig når man snakker om infeksjoner ervervet på sykehus. Sykehus infeksjoner [sic] kan defineres som «en infeksjon som oppstår under eller etter og som følge av et opphold på sykehus eller annen helseinstitusjon» (Stordalen, 2009: 55). Sykehusinfeksjoner erverves vanligvis etter 2-3 døgn på somatisk sykehus, og opptil 30 døgn etter utskrivelse fra sykehus. Sykehusinfeksjoner påfører pasienter infeksjoner og ved dette ekstra lidelse. Infeksjonene skyldes ofte slurv, dårlig personlig hygiene eller dårlig generell hygiene blant helsepersonell (Stordalen, 2009). De vanligste sykehusinfeksjonene er urinveisinfeksjoner, nedre luftveisinfeksjoner, postoperative sårinfeksjoner og septikemi (Børøsund, 2010). De tre førstnevnte infeksjonene er de hyppigste og har omtrent lik forekomst (Nasjonalt folkehelseinstitutt, 2011b). Årsaksfaktorene til sykehusinfeksjoner kan være mange og sammensatte. Årsaksfaktorer er blant annet økt instrumentering, effektivisering, rasjonalisering og dårlig hygiene (Stordalen, 2009). Vi velger å avgrense oppgaven til urinveisinfeksjon og hygienens betydning. Dette da vi har bakgrunnskunnskap om at infeksjonsforsvaret i underlivet er ømfintlig overfor mikroorganismer (Bjålie, Haug, Sand & Sjåstad, 2006). Oppgaven begrenses videre til selve kateterinnleggelsen da vi ser det som viktig at sykepleier utfører god hygiene i kontakt med pasientens underliv. Vi har valgt å bruke Florence Nightingale og Joyce Travelbee som sykepleieteoretikere for å få frem sykepleierollen. Vi har valgt Florence Nightingale da hun var en pionèr innenfor sykepleie som tidlig satte fokus på hygienens betydning i forebygging av smitte. Joyce Travelbee valgte vi fordi hun er en sykepleieteoretiker fra nyere år som fokuserer på en profesjonell sykepleie som forebygger sykdom og lidelse. Sykepleieren skal ifølge De basale smittevernrutinene (Nasjonalt Folkehelseinstitutt, 2009) møte pasienter med de samme hygieniske prinsippene ved å følge infeksjonskontrollprogram som finnes i avdelingen. Vi velger derfor ikke å begrense oppgaven til en spesiell avdeling på sykehuset. Den praktiske handlingen i drøftingen tar for seg kateterinnleggelse på voksne kvinner da det er dette vi har mest erfaringer med. I oppgaven benevnes sykepleier som hun/henne

The impact of diabetes-related complications on preference-based measures of health-related quality of life in adults with Type I diabetes

Introduction: This study estimates health-related quality of life (HRQoL) or utility decrements associated with type 1 diabetes mellitus (T1DM) using data from a UK research programme on the Dose Adjustment For Normal Eating (DAFNE) education programme. Methods: A wide range of data was collected from 2,341 individuals who undertook a DAFNE course in 2009-12, at baseline and for two subsequent years. We use fixed and random effects linear models to generate utility estimates for T1DM using different instruments: EQ-5D, SF-6D and EQ-VAS. We show models with and without controls for HbA1c and depression, which may be endogenous (if, for example, there is reverse causality in operation). Results: We find strong evidence of an unobserved individual effect, suggesting the superiority of the fixed effects model. Depression shows the greatest decrement across all the models in the preferred fixed effects model. The fixed effects EQ-5D model also finds a significant decrement from retinopathy, BMI and HbA1c(%). Estimating a decrement using the fixed effects model is not possible for some conditions where there are few new cases. In the random effects model diabetic foot disease shows substantial utility decrements, yet these are not significant in the fixed effects models. Conclusion: Utility decrements have been calculated for a wide variety of health states in T1DM which can be used in economic analyses. However, despite the large dataset, the low incidence of several complications leads to uncertainty in calculating the utility weights. Depression and diabetic foot disease result in a substantial loss in HRQoL for patients with T1DM. HbA1c(%) appears to have an independent negative impact upon HRQoL, although concerns remain regarding the potential endogeneity of this variable

Power dependence of supercontinuum noise in uniform and tapered PCFs

An error was made in the calculation of the relative intensity noise (RIN) because of an incorrectly specified value of the photodetector DC transimpedance gain

Spatial location of correlations in a random distributed feedback Raman fiber laser

Nonlinear interactions between different components of multiwavelength radiation are one of the main processes shaping properties of quasi-CW fiber lasers. In random fiber lasers, nonlinear influence may be more complicated, as there are no distinct longitudinal modes in radiation because of the random nature of the feedback. In this Letter, we experimentally characterize internal correlations in the radiation of a multiwavelength random distributed feedback fiber laser. An analysis of Pearson correlation functions allows us to spatially locate the area over the fiber laser length in which correlations are more likely to occur. This, in turn, leads us to the conclusion about the main mechanism of spectral correlations—the relative intensity noise transfer from the pump wave

Numerical instability of the Akhmediev breather and a finite-gap model of it

In this paper we study the numerical instabilities of the NLS Akhmediev breather, the simplest space periodic, one-mode perturbation of the unstable background, limiting our considerations to the simplest case of one unstable mode. In agreement with recent theoretical findings of the authors, in the situation in which the round-off errors are negligible with respect to the perturbations due to the discrete scheme used in the numerical experiments, the split-step Fourier method (SSFM), the numerical output is well-described by a suitable genus 2 finite-gap solution of NLS. This solution can be written in terms of different elementary functions in different time regions and, ultimately, it shows an exact recurrence of rogue waves described, at each appearance, by the Akhmediev breather. We discover a remarkable empirical formula connecting the recurrence time with the number of time steps used in the SSFM and, via our recent theoretical findings, we establish that the SSFM opens up a vertical unstable gap whose length can be computed with high accuracy, and is proportional to the inverse of the square of the number of time steps used in the SSFM. This neat picture essentially changes when the round-off error is sufficiently large. Indeed experiments in standard double precision show serious instabilities in both the periods and phases of the recurrence. In contrast with it, as predicted by the theory, replacing the exact Akhmediev Cauchy datum by its first harmonic approximation, we only slightly modify the numerical output. Let us also remark, that the first rogue wave appearance is completely stable in all experiments and is in perfect agreement with the Akhmediev formula and with the theoretical prediction in terms of the Cauchy data.Comment: 27 pages, 8 figures, Formula (30) at page 11 was corrected, arXiv admin note: text overlap with arXiv:1707.0565

Real-time observation of dissipative soliton formation in nonlinear polarization rotation mode-locked fibre lasers

Formation of coherent structures and patterns from unstable uniform state or noise is a fundamental physical phenomenon that occurs in various areas of science ranging from biology to astrophysics. Understanding of the underlying mechanisms of such processes can both improve our general interdisciplinary knowledge about complex nonlinear systems and lead to new practical engineering techniques. Modern optics with its high precision measurements offers excellent test-beds for studying complex nonlinear dynamics, though capturing transient rapid formation of optical solitons is technically challenging. Here we unveil the build-up of dissipative soliton in mode-locked fibre lasers using dispersive Fourier transform to measure spectral dynamics and employing autocorrelation analysis to investigate temporal evolution. Numerical simulations corroborate experimental observations, and indicate an underlying universality in the pulse formation. Statistical analysis identifies correlations and dependencies during the build-up phase. Our study may open up possibilities for real-time observation of various nonlinear structures in photonic systems

Single-shot compressed ultrafast photography at one hundred billion frames per second

The capture of transient scenes at high imaging speed has been long sought by photographers, with early examples being the well known recording in 1878 of a horse in motion and the 1887 photograph of a supersonic bullet. However, not until the late twentieth century were breakthroughs achieved in demonstrating ultrahigh-speed imaging (more than 10^5 frames per second). In particular, the introduction of electronic imaging sensors based on the charge-coupled device (CCD) or complementary metal–oxide–semiconductor (CMOS) technology revolutionized high-speed photography, enabling acquisition rates of up to 10^7 frames per second. Despite these sensors’ widespread impact, further increasing frame rates using CCD or CMOS technology is fundamentally limited by their on-chip storage and electronic readout speed. Here we demonstrate a two-dimensional dynamic imaging technique, compressed ultrafast photography (CUP), which can capture non-repetitive time-evolving events at up to 10^(11) frames per second. Compared with existing ultrafast imaging techniques, CUP has the prominent advantage of measuring an x–y–t (x, y, spatial coordinates; t, time) scene with a single camera snapshot, thereby allowing observation of transient events with temporal resolution as tens of picoseconds. Furthermore, akin to traditional photography, CUP is receive-only, and so does not need the specialized active illumination required by other single-shot ultrafast imagers. As a result, CUP can image a variety of luminescent—such as fluorescent or bioluminescent—objects. Using CUP, we visualize four fundamental physical phenomena with single laser shots only: laser pulse reflection and refraction, photon racing in two media, and faster-than-light propagation of non-information (that is, motion that appears faster than the speed of light but cannot convey information). Given CUP’s capability, we expect it to find widespread applications in both fundamental and applied sciences, including biomedical research

The impact of type 2 diabetes on health related quality of life in Bangladesh: results from a matched study comparing treated cases with non-diabetic controls

Background Little is known about the association between diabetes and health related quality of life (HRQL) in lower-middle income countries. This study aimed to investigate HRQL among individuals with and without diabetes in Bangladesh. Methods The analysis is based on data of a case-control study, including 591 patients with type 2 diabetes (cases) who attended an outpatient unit of a hospital in Dhaka and 591 age -and sex-matched individuals without diabetes (controls). Information about socio-demographic characteristics, health conditions, and HRQL were assessed in a structured interview. HRQL was measured with the EuroQol (EQ) visual analogue scale (VAS) and the EQ five-dimensional (5D) descriptive system. The association between diabetes status and quality of life was examined using multiple linear and logistic regression models. Results Mean EQ-VAS score of patients with diabetes was 11.5 points lower (95 %-CI: −13.5, −9.6) compared to controls without diabetes. Patients with diabetes were more likely to report problems in all EQ-5D dimensions than controls, with the largest effect observed in the dimensions ‘self-care’ (OR = 5.9; 95 %-CI: 2.9, 11.8) and ‘mobility’ (OR = 4.5; 95 %-CI: 3.0, −6.6). In patients with diabetes, male gender, high education, and high-income were associated with higher VAS score and diabetes duration and foot ulcer associated with lower VAS scores. Other diabetes-related complications were not significantly associated with HRQL. Conclusions Our findings suggest that the impact of diabetes on HRQL in the Bangladeshi population is much higher than what is known from western populations and that unlike in western populations comorbidities/complications are not the driving factor for this effect