Future systems of measurement for hand hygiene in healthcare

Hand hygiene is considered a key infection prevention strategy against the challenge of healthcare associated infections, as it prevents cross-transmission of microorganisms which may cause harm. Despite this, compliance amongst healthcare professionals is often poor. Considerable attention has been placed on developing interventions to increase hand hygiene, however known problems with measurement make determining improvement from established baselines difficult. This thesis addresses measurement through three research themes: The importance of meaningful data (Study 1), the potential for technology (Study 2), and the influence of human behaviour (Study 3). These are considered in relation to guidelines developed by the World Health Organisation (WHO) (My 5 Moments for Hand Hygiene). The thesis output provides recommendations for the healthcare setting, technology industry and research community by forming a new conceptual and integrated way of considering the measurement of hand hygiene compliance. A mixed methods approach was applied using a single case study methodology comprising three studies (two qualitative, one quantitative), based at a UK acute National Health Service Trust. Healthcare professionals involved in the current hand hygiene measurement process participated in all three studies (N=47). Methods included structured literature reviews, participant observation, one-to-one and group interviews, nonparticipant observation and analysis of existing case study site data. In Study 1 healthcare professionals identified a lack of clarity regarding feedback, and a lack of synergy between hand hygiene training and measurement. Combined with data accuracy flaws, their view was that the current hand hygiene measurement process produced meaningless data. Study 2 investigated healthcare professional views regarding the potential of technology to measure hand hygiene. It found that whilst current innovations are unable to detect all the WHO 5 Moments, healthcare professionals are interested in their potential to aid measurement and compliance. However they raised concerns about Fit for Purpose, anonymity and resistance, and over-reliance on technology and habituation. Interestingly participants suggested that hand hygiene across all WHO 5 Moments is not equal, expecting higher levels of adherence to Moments 2 and 3 than Moments 1, 4 and 5. Study 3 explored this, investigating the theory of Inherent and Elective hand hygiene behaviour. Inherent can be linked to Moments 2 and 3, through activities likely to stimulate an automatic “disgust” reaction within humans. Hand hygiene was significantly lower when healthcare professionals performed Elective rather than Inherent activities. The research developed Inherent and Elective theory further by proposing it as a lens with which to view the WHO 5 Moments and develop strategies for improved compliance. Understanding that hand hygiene is less likely at Elective activities, linked to Moments 1, 4 and 5 suggests these as key areas of focus for technology development. Acknowledging that hand hygiene may be more instinctive at Moment 2 and 3 may be useful when planning education, leading to reduced healthcare professional apathy towards hand hygiene. Involvement of healthcare professionals in exploring measurement processes and developing technologies for hand hygiene is proposed as key to ensure data produced by future methods of measurement is meaningful, vital to ensure desired behaviour change

Digital crowdsourcing in healthcare environment co-design

Improving user experiences of healthcare environments via their participation has become a central theme in healthcare studies and strategic agendas. The co-design approach is often utilized to take into account opinions from different stakeholders including hospital staff. However, there are a number of competing stimuli and demands on staff at any point in time potentially making it difficult for them to participate in the co-design processes. Digital crowdsourcing may engage staff in participating in the design and appraisal of hospital environments when they have a spare moment by collecting small amounts of relevant data. In order to explore this, we have implemented a digital crowdsourcing co-design prototype. As users’ perceived acceptance of technologies is among the determining factors for a successful digital approach, in this paper, we report on participants’ acceptance of the prototype, aiming to reflect if and to what extend they accept this prototype to aid further development

The Relationships Among Social Capital, HIV Self-Management, and Substance Use in Women.

Women living with HIV (WLHIV) face unique challenges to successfully self-manage HIV including substance use and limited social capital. We conducted a 6-month mixed-methods study to describe how social capital influences HIV self-management and substance use among WLHIV. Participants completed a self-report survey and in-depth interview at baseline, and 3 and 6 months. Descriptive statistics, t-tests, and generalized estimating equations (GEEs) were used to examine quantitative relationships. Qualitative data were analyzed using qualitative description. Current substance users reported lower social capital compared with past substance users (2.63 vs. 2.80; p = .34). Over time, substance use and social capital were associated with HIV self-management (Wald χ2 = 28.43; p < .001). Qualitative data suggest that HIV self-management is influenced by overlapping experiences with social capital, including influential trust, community, and value of self can be complicated by ongoing substance use. Social capital can facilitate improved HIV self-management; however, substance use and trauma can weaken this relationship

Controlled interventions to reduce burnout in physicians a systematic review and meta-analysis

IMPORTANCE Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. OBJECTIVE To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched. STUDY SELECTION Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified. MAIN OUTCOMES AND MEASURES The core outcomewas burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95confidence intervals. RESULTS Twenty independent comparisons from 19 studieswere included in the meta-analysis (n = 1550 physicians; mean SD age, 40.3 9.5 years; 49%male). Interventionswere associated with small significant reductions in burnout (standardized mean difference SMD = ?0.29; 95%CI, ?0.42 to ?0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = ?0.45; 95%CI, ?0.62 to ?0.28) compared with physician-directed interventions (SMD = ?0.18; 95%CI, ?0.32 to ?0.03). Interventions delivered in experienced physicians and in primary care were associated with higher effects compared with interventions delivered in inexperienced physicians and in secondary care, but these differences were not significant. The results were not influenced by the risk of bias ratings. CONCLUSIONS AND RELEVANCE Evidence from this meta-analysis suggests that recent intervention programs for burnout in physicians were associated with small benefits that may be boosted by adoption of organization-directed approaches. This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals

Aquilegia, Vol. 17 No. 1, January-March 1993: Newsletter of the Colorado Native Plant Society

https://epublications.regis.edu/aquilegia/1066/thumbnail.jp

Three-axis magnetic field detection with a compact, high-bandwidth, single beam zero-field atomic magnetometer

Zero-field optically pumped magnetometers (OPMs) have emerged as an important technology in the realm of biomagnetic research, providing extremely small magnetic field detection capabilities, femtotesla-level, contained in a non-cryogenic compact form factor. Often, compact zero-field OPMs extract single or two-axis magnetic information, typically with a sensing bandwidth of < 100 Hz. The resolution of multiple axes of magnetic field is particularly important for accurate representation of radial components of biomagnetic fields. However, the presence of multi-axis static magnetic fields across the OPM causes measurement errors that degrade signal resolution. 1 Here, we utilise our compact caesium single beam zero-field OPM 2 to address these limitations. We magnetically modulated along both transverse axes of the sensor, at unique frequencies, to extract all axes static-field information. Active feedback can be realised through a lock-in detection scheme at f Mod,x/y for the x- and y-axes, and at 2f Mod,x for the beam axis, z. Operation in this scheme allows for the extraction of three-axis magnetic field information from only a single beam and highlights the importance of active feedback in high-sensitivity biomagnetic applications. The portable sensor also demonstrates a bandwidth with a -3 dB point at ≃ 1600 Hz. The combination of high bandwidth and the capability to extract three-axis magnetic fields opens up exciting prospects for resolving high-frequency biomagnetic signals

Towards Value-Sensitive Learning Analytics Design

To support ethical considerations and system integrity in learning analytics, this paper introduces two cases of applying the Value Sensitive Design methodology to learning analytics design. The first study applied two methods of Value Sensitive Design, namely stakeholder analysis and value analysis, to a conceptual investigation of an existing learning analytics tool. This investigation uncovered a number of values and value tensions, leading to design trade-offs to be considered in future tool refinements. The second study holistically applied Value Sensitive Design to the design of a recommendation system for the Wikipedia WikiProjects. To proactively consider values among stakeholders, we derived a multi-stage design process that included literature analysis, empirical investigations, prototype development, community engagement, iterative testing and refinement, and continuous evaluation. By reporting on these two cases, this paper responds to a need of practical means to support ethical considerations and human values in learning analytics systems. These two cases demonstrate that Value Sensitive Design could be a viable approach for balancing a wide range of human values, which tend to encompass and surpass ethical issues, in learning analytics design.Comment: The 9th International Learning Analytics & Knowledge Conference (LAK19

Prognosis for Improvement During Acute Rehabilitation as Measured by the Western Aphasia Battery

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Prevention of, and response to, sexual harassment at secondary school: a system map

Background: Sexual harassment in secondary school is common but only recently acknowledged as a widespread problem in the United Kingdom. There is limited research on how schools respond to incidents of sexual harassment. The aim of this study was to understand how school systems shape the dynamics of disclosure, reporting and handling of sexual harassment in school (including behaviours, processes, norms), and to identify opportunities for effecting systems change. Methods: We used participatory systems mapping to elicit school stakeholders' perspectives on systems factors and their connections. Researchers built the map based on in-person workshops with students (n = 18) and staff (n = 4) from three schools in Scotland. Survey data (n = 638 students; n = 119 staff) was used to augment participant perspectives. The map was validated via three workshops (two online, one in-person) involving students and staff from seven schools. Results: The final map (causal loop diagram) represents a hypothesised system of 25 causally connected factors and three feedback loops shaping the disclosure, reporting and handling of sexual harassment. We grouped these factors into four interlinked themes: 1] Knowledge and confidence; 2] Trust in reporting system and processes; 3] Communication, confidentiality and safeguarding; and, 4] Prioritisation of sexual harassment. Conclusions and implications: This study highlights the interconnectedness of factors shaping disclosure, reporting and handling of sexual harassment within secondary schools. The map surfaces key challenges for schools and provides a foundation for learning and discussions on where to focus efforts in future

Interventions to prevent obesity in children aged 5 to 11 years old

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. The overall aim of the review is to determine the effectiveness of interventions to prevent obesity in 5 to 11-year-old children. The four objectives are:. to evaluate the effects of interventions that aim to modify dietary intake on changes in zBMI score, BMI and serious adverse events among children; to evaluate the effects of interventions that aim to modify physical activity, sedentary behaviour, sleep, play and/or structured exercise on changes in zBMI score, BMI and serious adverse events among children; to evaluate the combined effects of interventions that aim to modify both dietary intake and physical activity/movement behaviours on changes in zBMI score, BMI and serious adverse events among children; to compare the effects of interventions that aim to modify dietary interventions with those that aim to modify physical activity/movement behaviours on changes in zBMI score, BMI and serious adverse events among children. The secondary objectives are designed to explore if, how, and why the effectiveness of interventions on zBMI/BMI varies depending on the following PROGRESS factors. Place of residence Race/ethnicity/culture/language Occupation Gender/sex Religion Education Socioeconomic status Social capital. The PROGRESS acronym is intended to ensure that there is explicit consideration of health inequity, the unfair difference in disease burden, when conducting research and adapting research evidence to inform the design of new interventions (O'Neill 2014). The PROGRESS acronym describes factors that contribute to health inequity. Recent work on race and religion in the UK suggests that consideration of these factors is critical to the design of new interventions (Rai 2019). We will also collect, from RCTs, information about the costs of interventions so that policymakers can use the review as a source of information from which they may prepare cost-effectiveness analyses