Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene.

BACKGROUND: Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands. AIM: To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH. METHODS: A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013. FINDINGS: Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak. CONCLUSION: A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.

Effects of essential oils, yeast culture and malate on rumen fermentation, blood metabolites, growth performance and nutrient digestibility of Baluchi lambs fed high-concentrate diets.

The experiment was conducted to evaluate the effects of dietary supplementation with a mixture of essential oils (MEO), yeast culture (YC) and malate on performance, nutrient digestion, rumen fermentation and blood metabolites of lambs fed high-concentrate growing diets. For this purpose, twenty Baluchi lambs (17.3 ± 0.5 kg body weight and 3 months old) were randomly assigned to four dietary treatments in a completely randomized design with five lambs per treatment. The treatment groups were as follows: (i) control: basal diet without any additive, (ii) basal diet plus 400 mg/day MEO (thymol, carvacrol, eugenol, limonene and cinnamaldehyde), (iii) basal diet with 4 g/day YC and (iv) basal diet plus 4 g/day malate. No differences between the dietary treatments were observed in dry matter intake, average daily gain or feed conversion ratio (p > 0.05). Compared with control and malate treatment, lambs fed MEO and YC had an improved crude protein digestibility (p < 0.05). Yeast culture significantly increased (p > 0.05) cell wall digestibility compared to the other treatments. No differences were observed between treatments with respect to nitrogen balance or ruminal pH and ammonia concentrations (p > 0.05). No differences were observed between treatments with respect to ruminal total volatile fatty acid concentration and molar proportions of acetate, butyrate and valerate. Molar proportion of propionate was higher (p < 0.05) for YC and malate compared to control and MEO. Plasma glucose concentration was higher (p < 0.05) in lambs fed YC and malate than in lambs fed the control or the MEO diet. Blood concentration of triglycerides significantly decreased when feeding the MEO and YC diets (p < 0.05). It was concluded that YC may be more useful as a feed additive for manipulation of rumen fermentation in lambs fed with high-concentrate diets than MEO and malate, because YC enhanced crude protein and cell wall digestibility, ruminal molar proportion of propionate and plasma glucose concentration.

The failure of negative pressure rewarming (Thermostat) to accelerate recovery from mild hypothermia in postoperative surgical patients.

UNLABELLED: The Thermostat device (Aquarius Medical Corp., Phoenix, AZ) is used in a new technique to accelerate recovery from hypothermia by mechanically distending blood vessels in the hand, thereby increasing transfer of exogenous heat to the body core. We evaluated the use of the Thermostat device in patients with mild postoperative hypothermia (< 36 degrees C). We studied adult patients undergoing elective surgery, general anesthesia, and neuromuscular blockade. Patients with an initial postoperative tympanic membrane temperature < 36 degrees C were randomized into two groups: 1) Thermostat, which consisted of a hypothermia warming mitt/seal and thermal exchange chamber for 60 min, and 2) conventional treatment, which consisted of warm blankets and/or radiant heat. Of the 191 patients enrolled, 60 (31%) developed hypothermia and were randomized to receive the Thermostat (n = 30) or conventional methods (n = 30). Fourteen patients in the Thermostat group and 17 patients in the conventional group rewarmed to 36 degrees C before discharge from the recovery room (P is not significant). There were no differences in vital signs, rewarming time, time to discharge from the recovery room, or postoperative temperature between groups. We conclude that patients with mild postoperative hypothermia rewarmed in a similar fashion, regardless of whether the Thermostat or conventional methods were used. IMPLICATIONS: We found that a commercially available negative pressure rewarming device (Thermostat; Aquarius Medical Corp., Phoenix, AZ) was not effective in accelerating rewarming in postoperative hypothermic surgical patients after general anesthesia.