Surveying pediatric caregivers’ readiness for dyad isolation in the hospital during COVID-19

The onset of any emerging outbreak is stressful for everyone. Singapore was one of many countries affected early by COVID-19. In response, many precautionary measures were quickly initiated, including the isolation of suspected COVID-19 pediatric cases, and their caregivers were isolated together with their hospitalized children as a result. Caregivers play an important role in facilitating their child’s health in the hospital. Rooming in with their children during hospitalization promotes the benefits of parental presence and reduces separation effects. However, sudden admission with strict movement restrictions poses stress to these caregivers too. This study ran a 3-part paper-based survey to understand the stresses and concerns which caregivers faced when suddenly entering dyad isolation. The survey polled caregivers’ general perception of the situation, and also used questions adapted from the SARS Fear Scale and the Hospital Anxiety & Depression Scale (HADS). Caregivers in the COVID-19 isolation units did not expect their child to be isolated and were not prepared for dyad isolation with their children. They were found to be more dejected and were concerned that they themselves might have possibly infected their family and friends. Caregivers of children suspected of COVID-19 should be pre-empted to prepare for the possibility of isolation. This may include bringing in toys and personal entertainment to reduce boredom, as well as other essential needs. Patient mental wellness programs may consider extending their services to these caregivers too. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Patient, staff empowerment and hand hygiene bundle improved and sustained hand hygiene in hospital wards

AIM: We piloted a hand hygiene (HH) project in a ward, focusing on World Health Organization moments 1 and 4. Our aim was to design highly reliable interventions to achieve &gt;90% compliance.METHODS: Baseline HH compliance was 57 and 67% for moments 1, 4, respectively, in 2015. After the pilot ward showed sustained improvement, we launched the 'HH bundle' throughout the hospital. This included: (i) appointment of HH champions; (ii) verbal/visual bedside reminders; (iii) patient empowerment; (iv) hand moisturisers; (v) tagging near-empty handrub (HR) bottles. Other hospital-wide initiatives included: (vi) Smartphone application for auditing; (vii) 'Speak up for Patient Safety' Campaign in 2017 for staff empowerment; (viii) making HH a key performance indicator.RESULTS: Overall HH compliance increased from a baseline median of 79.6-92.6% in end-2019. Moments 1 and 4 improved from 71 to 92.7% and from 77.6 to 93.2%, respectively. Combined HR and hand wash consumption increased from a baseline median of 82.6 ml/patient day (PD) to 109.2 mL/PD. Health-care-associated rotavirus infections decreased from a baseline median of 4.5 per 10 000 PDs to 1.5 per 10 000 PDs over time.CONCLUSIONS: The 'HH Bundle' of appointing HH champions, active reminders and feedback, patient education and empowerment, availability of hand moisturisers, tagging near-empty hand rub bottles together with hospital-wide initiatives including financial incentives and the 'Speak Up for Patient Safety' campaign successfully improved the overall HH compliance to &gt;90%. These interventions were highly reliable, sustained over 4 years and also reduced health-care-associated rotavirus infection rates.</p

Effect of fertility health awareness strategies on fertility knowledge and childbearing in young married couples (FertStart): study protocol for an effectiveness-implementation hybrid type I multicentre three-arm parallel group open-label randomised clinical trial

Introduction Birth rates have been declining in many advanced societies including Singapore. We designed two interventions with vastly different resource requirements, which include fertility education, personalised fertility information and a behavioural change component targeting modifiable psychological constructs to modify fertility awareness and childbearing intentions. We aim to evaluate the effect of these two interventions on knowledge, attitudes and practice around childbearing compared with a control group among young married couples in Singapore and understand the implementation factors in the setting of an effectiveness-implementation hybrid type 1 three-arm randomised trial. Methods and analysis We will randomise 1200 young married couples to no intervention (control), Fertility Health Screening group (FHS) or Fertility Awareness Tools (FAT) in a 7:5:5 ratio. Couples in FHS will undergo an anti-Mullerian hormone test and semen analysis, a doctor’s consultation to explain the results and standardised reproductive counselling by a trained nurse. Couples in FAT will watch a standardised video, complete an adapted fertility status awareness (FertiSTAT) tool and receive an educational brochure. The attitudes, fertility knowledge and efforts to achieve pregnancy of all couples will be assessed at baseline and 6 months post-randomisation. Birth statistics will be tracked using administrative records at 2 and 3 years. The primary outcome is the change in the woman’s self-reported intended age at first birth between baseline and 6 months post-randomisation. In addition, implementation outcomes and cost-effectiveness of the two interventions will be assessed

Proactive monitoring in process control using predictive trend displays

Process control such as that in the petrochemical industry is inherently difficult for humans to operate and monitor. Console operators need to manage hundreds of interrelated components using sluggish controls in a high-risk environment. They need to keep the process stable while optimizing production, which puts variables near plant operating limits. Any anomaly or upset has to be resolved quickly before the severity of the problem escalates. All these tasks are performed using a control console called the Distributed Control System (DCS). This project was initiated with the goal of exploring viable information visualizations on DCS displays to support proactive monitoring in console operators. While operators may choose to be alerted of and react to problems through the alarms on the DCS, expert operators prefer to stay proactive, and seize the problem before it disrupts the stability of the process. Being proactive requires prediction, a mental process which is not well understood and difficult to perform accurately. A series of literature reviews was conducted to find out more about the concepts related to the psychology of prediction, followed by various engineering elements, particularly in process control, that aid prediction. Currently there are no explicit predictive displays for process control. Four studies were conducted during the span of this project, each filling in knowledge gaps either not found in current literature, or provided empirical proof-of-concept for a viable predictive tool that improved control performance. The first qualitative investigation revealed how expert console operators derive, update and apply their mental models while at work. A second qualitative investigation documented the use of trend information displayed on current DCS consoles with the purpose of facilitating proactive monitoring. A simulator study was conducted which found operator performance benefits from using a trend-based predictive display with multi-variate rate-of-change cues. A second, final experiment featured a high-fidelity schematic display and a single-variate rate-of-change algorithm. Final results showed a viable prototype predictive visualization and algorithm for further industry application.DOCTOR OF PHILOSOPHY (MAE

Prognostic signature of colorectal cancer based on uric acid-related genes

Colorectal cancer (CRC) is one of the deadliest cancers worldwide. Numerous studies have reported a correlation between uric acid (UA) level and CRC risk. Here, we investigated the role and prognostic value of UA-related genes in CRC progression. CRC-associated gene expression and clinical data were retrieved from The Cancer Genome Atlas (TCGA), and UA-related genes were identified by overlapping the TCGA and GeneCards databases. The Gene Ontology annotation, Kyoto Encyclopedia of Genes and Genomes pathway, and Molecular Signatures Database dataset were subjected to gene set enrichment analysis. A prognostic model was constructed using the univariate and multivariate COX regression and least absolute shrinkage and selection operator (LASSO) analyses and validated using the Gene Expression Omnibus cohort. Competing endogenous RNA network, CellMiner, and Human Protein Atlas were used to detect the signature of 13 UA-related genes in the prediction model. The expression of five potential UA-related genes in CRC cell lines was confirmed via qPCR. CIBERSORT was used to evaluate immune cell infiltration in the TCGA-CRC dataset. Thirteen highly prognostic UA-related genes were used to construct a prognostic model of CRC with risk score accuracy and predictive efficacy. Abundance of activated M0 macrophages, monocytes, CD8+ T cells, and natural killer cells positively correlated with the risk score. Five promising UA-related genes showed higher expression levels in CRC than in colonic cell lines. Thus, our model posits a direct relationship between UA-related genes and CRC risk, offering novel insights into diagnosis, prognosis, and treatment

Human Factors and Operating Room Design Challenges

Diffusing innovations from other industries have been suggested as a source to improve safety and quality of surgical patient care. Operating rooms are high-risk areas for preventable patient harm. Many studies focus on teaching, training, and changing staff behaviour as an approach to improvement. Most safety improvements in other high-risk industries, however, first focus on work area design before attempting to change behaviour. Design can purposefully shape behaviour towards more sustainable practices and improve teamwork dynamics and situational awareness. Human factor engineering, concerned with the understanding of interactions among humans and other elements of a system, can help in ‘mistake proofing’ by changing designs to make processes more reliable and effective. The field of design and human factor engineering can assist improving safety in the operating room. The application of these principles will be demonstrated in two case studies: Effects of operating floor marking on the position of surgical devices to promote clean air flow compliance and minimize infection risks, and use of video feedback and computer-assisted systems using video imaging technology to improve sensomotor and non-technical skills

Surveying pediatric caregivers’ readiness for dyad isolation in the hospital during COVID-19

The onset of any emerging outbreak is stressful for everyone. Singapore was one of many countries affected early by COVID-19. In response, many precautionary measures were quickly initiated, including the isolation of suspected COVID-19 pediatric cases, and their caregivers were isolated together with their hospitalized children as a result. Caregivers play an important role in facilitating their child’s health in the hospital. Rooming in with their children during hospitalization promotes the benefits of parental presence and reduces separation effects. However, sudden admission with strict movement restrictions poses stress to these caregivers too. This study ran a 3-part paper-based survey to understand the stresses and concerns which caregivers faced when suddenly entering dyad isolation. The survey polled caregivers’ general perception of the situation, and also used questions adapted from the SARS Fear Scale and the Hospital Anxiety & Depression Scale (HADS). Caregivers in the COVID-19 isolation units did not expect their child to be isolated and were not prepared for dyad isolation with their children. They were found to be more dejected and were concerned that they themselves might have possibly infected their family and friends. Caregivers of children suspected of COVID-19 should be pre-empted to prepare for the possibility of isolation. This may include bringing in toys and personal entertainment to reduce boredom, as well as other essential needs. Patient mental wellness programs may consider extending their services to these caregivers too. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Root Cause Analysis: The HFE Practitioner\u27s Journey From Individual Blame to System Fixes

Panel discussion during the Patient Safety Research and Initiatives Track. Joy Rivera chaired the discussion

Ni₃S₂ Nanosheet Flowers Decorated with CdS Quantum Dots as a Highly Active Electrocatalysis Electrode for Synergistic Water Splitting

A facile and effective strategy for fabricating a three-dimensionally (3D) structured nanocomposite catalyst based on nonprecious metals for water splitting in alkaline electrolyzers is reported in this paper. This nanocomposite catalyst consists of the CdS quantum dots (QDs) decorated Ni₃S₂ nanosheet flowers deposited on the plasma-treated nickel foam (PNF). The NiO formed during the plasma treatment is shown to play an important role for pushing the hydrogen and oxygen evolution reactions (HER and OER) in alkaline media. The enhanced exposure of active sites on the nanopetalages results in superior catalytic performance for promoting HER and OER in alkaline electrolyzers. Specifically, a current density of 10 mA cm^–2 can be achieved for the HER with a 121 mV overpotential when the working electrode based on the 1 mM CdS/Ni₃S₂/PNF catalyst is employed in 1 M KOH. The corresponding Tafel slope is 110 mV/decade. For the OER, the onset potential can be as low as 1.25 V vs reversible hydrogen electrode (RHE) reference electrode, which is substantially lower than the commercial IrO₂ catalyst (∼1.47 V). This nanostructured catalyst has excellent long-term stability, and the linear scan voltammetry (LSV) curves of the HER and OER in 1 M KOH solution show negligible decay after undergoing 10⁴ cycles of cyclic voltammogram. The nanocomposite material developed in this study is an ideal candidate as a catalyst for splitting water in alkaline media with relatively low overpotentials at reasonably high current densities (≥100 mA cm^–2)