Staphylococcus aureus on Computer Mice and Keyboards in Intensive Care Units of the Universitas Academic Hospital; Bloemfontein; and ICU staff's Knowledge of its Hazards and Cleaning Practices

Nosocomial infections result in severe health and financial difficulties for patients and healthcare facilities. The objective of the study was to determine the presence of Staphylococcus aureus on computer mice and keyboards in the intensive care units (ICUs) of Universitas Academic Hospital; Bloemfontein; and ICU staff's knowledge regarding cleaning of computer mice and keyboards and their potential hazard as reservoirs for pathogens. Swab specimens from computer mice and keyboards (14 each) were investigated for S. aureus. Swabbing was repeated six months later. Standard microbiology laboratory methods were used to culture and identify organisms. An anonymous questionnaire completed by the ICU staff determined their awareness of computer mice and keyboards as potential sources of nosocomial infections. In addition to various environmental microorganisms and normal human flora; S. aureus was initially isolated from one computer mouse; and from two keyboards and five mice six months later. The questionnaire response rate was 85.6. Seventy-one percent of respondents stated that they regarded keyboards and mice as an important source of nosocomial infections. Nevertheless; 62of doctors and 40.3of nurses indicated that they never washed their hands before or after using the computer. Ninety-seven percent of respondents were not aware of an official cleaning policy for computer equipment. In order to prevent nosocomial infections resulting from microbial transmission between equipment; staff and patients; proper cleaning policies should be implemented

A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder.

Recent studies have shown that cognitive therapy is an effective treatment for panic disorder. However, little is known about how cognitive therapy compares with other psychological and pharmacological treatments. To investigate this question 64 panic disorder patients were initially assigned to cognitive therapy, applied relaxation, imipramine (mean 233 mg/day), or a 3-month wait followed by allocation to treatment. During treatment patients had up to 12 sessions in the first 3 months and up to three booster sessions in the next 3 months. Imipramine was gradually withdrawn after 6 months. Each treatment included self-exposure homework assignments. Cognitive therapy and applied relaxation sessions lasted one hour. Imipramine sessions lasted 25 minutes. Assessments were before treatment/wait and at 3, 6, and 15 months. Comparisons with waiting-list showed all three treatments were effective. Comparisons between treatments showed that at 3 months cognitive therapy was superior to both applied relaxation and imipramine on most measures. At 6 months cognitive therapy did not differ from imipramine and both were superior to applied relaxation on several measures. Between 6 and 15 months a number of imipramine patients relapsed. At 15 months cognitive therapy was again superior to both applied relaxation and imipramine but on fewer measures than at 3 months. Cognitive measures taken at the end of treatment were significant predictors of outcome at follow-up.

Selective processing of eating-, shape-, and weight-related words in persons with bulimia nervosa.

The Stroop color-naming task was used to investigate selective information processing in people with bulimia nervosa. Three cards were used: a target card consisting of words related to eating, weight, and shape; a control word card; and the standard conflicting-color card. Thirty-six patients with bulimia nervosa were compared with a group of age-matched female controls. It was found that the amount of disruption caused to color naming by the target card was significantly greater in the bulimia nervosa group than in the female control group, whereas that caused by the color card was similar in the two groups. The Stroop color-naming task may be a useful objective measure of one aspect of the cognitive disturbance of patients with bulimia nervosa.

Evaluation of a brief psychological treatment for emotional disorders in primary care.

A randomized trial in general practice compared: (i) a brief psychological treatment (problem-solving) given by a psychiatrist; (ii) any treatment of the GP's choice, whether psychological or pharmacological. The patients had recent onset emotional disorders of poor prognosis. Patients in the problem-solving group showed significantly greater reductions in symptoms. Problem-solving as given by a psychiatrist was feasible in primary care and acceptable to patients. Problem-solving is now being evaluated as given by general practitioners trained in the method.

The relationship between cardiovascular responses in the laboratory and in the field.

The psychophysiological responses to laboratory stressors are often examined because it is believed that such responses relate to responsiveness in real life situations. This belief has seldom been tested. The changes in heart rate, pulse transit time, and respiration rate produced by a variety of laboratory tasks (active and passive coping and physical exercise) were related to ambulatory measures of heart rate in 32 young men. The field measures were the difference in heart rate between the waking day and when asleep, and estimates of the variability of heart rate during the day, derived from time series analyses. Average changes in heart rate and pulse transit time during specific tasks did not relate consistently to heart rate in the field. However, an active coping index, derived from the ratio of the peak heart rate during an active coping task to the peak during physical exercise related to all the field measures of heart rate responsiveness. This index, which may relate to measures of additional heart rate and heightened sympathetic response to stress, also correlated positively with Trait Anxiety and elevated basal sympathetic arousal, as measured by skin conductance level. Measures of the cardiovascular response to a passive coping task, the cold pressor, and exercise did not relate to heart rate responses in the field. The findings suggest that heightened cardiac responsiveness in real life is exhibited by subjects who show elevated peak responses to active coping stressors specifically.

A simple activity measure for use with ambulatory subjects.

A simple activity measure based on the EMG recorded from the thigh was developed to monitor the physical activity of ambulatory subjects. The performance of this activity measure was assessed during four major physical activities: running, walking, standing, and sitting. Heart rate was also monitored. The results were analysed within individuals using time series analysis. The heart rate and activity series (of consecutive 30-s means) required similar models within individuals, and both measures differentiated among running, walking, and non-movement. The activity measure did not discriminate between postures. This measure covaried closely with heart rate and emerged as a necessary and relatively more significant predictor of heart rate variance than knowledge of the type of physical activity the subjects were undertaking. Posture, however, did add a significant and independent contribution to heart rate variance. This activity measure appears to be a simple, reliable, and valuable method of measurement of physical activity variations in ambulatory subjects.

The relationship between heart rate and mood in real life.

Very little is known about the relationship between stress and cardiovascular responses in everyday settings. The three subjective states of Stress, Arousal and Time Pressure were measured every 30 min during a normal day in 32 healthy male volunteers and related to heart rate, which was measured continuously using standard ambulatory techniques. An index of the subjects physical activity was derived from the muscle activity of the thigh. Heart rate related to emotional state in very few subjects when time-series statistical methods, which take into account the autocorrelated nature of the data, were used. The relationship was further reduced when allowance was made for concurrent physical activity. The minority of subjects who exhibited a significant association between heart rate and mood variations were significantly more anxious, reported more anger, and had higher systolic blood pressures at rest than subjects who did not show a relationship between mood and heart rate.

Prognostic factors in bulimia nervosa.

Factors predictive of outcome were sought from the data from a controlled study of the treatment of bulimia nervosa. Four different indices of outcome were used, and outcome was assessed at four points during a 12-month, treatment-free follow-up period. It was found that the pre-treatment level of self-esteem was a consistent predictor of outcome with those patients having low self-esteem responding least well to treatment. There were no other consistent predictors of outcome.

The behavioural significance of heart rate: the Laceys' hypothesis.

The Laceys' account of the significance of heart rate changes for behaviour is critically evaluated. Two interwoven propositions are discerned in their account: first, the cardiac variations regulate central attentional activities via an afferent feedback mechanism; second, that environmental intake-rejection comprises a basic dimension underlying directional cardiac changes. Examination of pertinent psychophysiological research reveals that the first of these propositions lacks substantive support. The intra-cardiac cycle method has yielded highly equivocal results. Inter-cardiac cycle studies offer only modest correlational support and the two studies which have directly manipulated heart rate found that sensori-motor performance was largely unaffected. Difficulties also surround the other proposition. Consideration of the verbalization, pleasantness-unpleasantness and time estimation studies indicates that the relationship between heart rate and attention is variable and that heart rate is associated with factors other than attentional requirements. While the Laceys have attempted to reconcile such unfavourable evidence, conceptual clarity is frequently sacrificed in the process. It is concluded that the interpretation of cardiac responses must be sought in superordinate variables that account for both heart rate changes that can be related to attention and those that cannot, and that any afferent feedback mechanism, based on heart rate, most likely fulfills functions other than that proposed by the Laceys.