Supporting family carers using interative multimedia.

ACTION (Assisting Carers using Telematic Interventions to meet Older persons' Needs) is a nursing led Pan-European project (1997-2000). Its primary aim is to maintain the autonomy, independence and quality of life of frail older and disabled persons and their family carers by the application of telematic technology. This article describes the development of two multimedia programmes created as part of the ACTION project. Programme 1 'Planning ahead' helps family carers and frail older people to think about and plan for the future. Programme 2 'Break from caring' assists carers and older people to explore the range of respite care options available. Both programmes have been developed using a multimethod, user-centred approach. Preliminary evaluation data have indicated that frail older people and their carers have used the programmes to assist them when making difficult decisions such as selecting a nursing home, or exploring the use of respite care facilities.

Central venous catheter-related bloodstream infections: an analysis of incidence and risk factors in a cohort of 400 patients.

OBJECTIVE: To determine the incidence of central catheter-related bloodstream infection (CR-BSI) and to compare patient and catheter characteristics of those with and without CR-BSI from a clinically suspected subgroup. Secondly, to assess the efficacy of the acridine orange leucocyte cytospin test (AOLC) as a rapid in situ method of detecting central venous catheter (CVC) infection. DESIGN: One-year prospective audit. SETTING: Intensive care unit/high dependency unit (ICU/HDU) and general wards of a tertiary referral hospital. PATIENTS AND PARTICIPANTS: 400 patients with non-tunnelled CVCs. INTERVENTIONS: Daily surveillance, blood culture from peripheral venepuncture, blood sample from the CVC for assessment of the AOLC test and removal of suspected CVCs were carried out on patients clinically suspected of having CR-BSI. MEASUREMENTS AND RESULTS: CR-BSI was diagnosed using well defined criteria. Infection rate was calculated by dividing the number of definitive catheter associated infections by the total number of appropriate catheter in situ days. The AOLC test was performed on all those with suspected CR-BSI. A total of 499 CVCs in 400 patients were assessed, representing 3014 catheter in situ days. Over 80 % of patients were from our ICU/HDU, representing 404 CVCs and 1901 catheter in situ days. A total of 49/499 (9.8%) CVCs in the same number of patients were suspected of being infected subsequently 12/499 (2.4 %) CVCs [95% confidence interval (CI) 1.25 to 4.16] in 12 separate patients were demonstrated to be the direct cause of the patient's BSI. Rates of CR-BSI per 1000 catheter days were 3.98 (95 % CI 2.06 to 6.96) for the whole cohort and 4.20 (95 % CI 1.81 to 8.29) for the ICU/HDU subgroup. In the group suspected of having CR-BSI, CVCs were removed unnecessarily in 55 %, and no patient or catheter variables measured were predictive of the development of CR-BSI. The AOLC test was negative in all 12 catheters subsequently shown to be the definitive cause of BSI. CONCLUSIONS: We have defined the incidence of CR-BSI in a cohort of patients from a tertiary referral hospital, the rates comparing favourably with those reported for similar populations. We were unable to demonstrate significant differences in any patient or catheter variables between those with and without CR-BSI. The AOLC test used alone was unhelpful as a method to diagnose in situ CVC infection in this patient population.

Acanthamoeba keratitis: a sobering case and a promising new treatment.

This case report describing Acanthamoeba keratitis in a 41-year-old male disposable contact lens wearer, adds some sobering and some encouraging information for the future management of this infection. Initial treatment with topical propamidine isethionate (Brolene) and polymyxin B/neomycin/gramicidin (Neosporin) led to an unsatisfactory clinical response. Topical miconazole 1%, prednisolone acetate 0.12% and oral itraconazole were then added to his treatment. This was later discontinued on noticing ipsilateral toxic cataract formation and an unresponsive pupil. The above medications were replaced with topical polyhexamethylene biguanide (PHMB) 0.02%, which we had shown to have superior in-vitro amoebicidal activity when compared to the other antiamoebic agents used in this case. Withdrawal of the multitreatment schedule and commencement of PHMB was associated with resolution of his keratitis, healing of a large epithelial defect and settling of severe conjunctivitis. The identical Acanthamoeba strain was isolated from the patient's contact lens storage case and cornea, possibly implicating the contaminated contact lens case in the aetiology of his keratitis. This is the first Australasian experience using PHMB to treat Acanthamoeba keratitis. It appears to be a promising new treatment for this infection.

Taxonomic position and seasonal variations in marine neritic environment of some gram-negative antibiotic-producing bacteria.

Six marine bacteria which synthesize macromolecular antibiotics were isolated from neritic waters on the French Mediterranean coast, and their frequency recorded over two successive years. They appeared in relatively large numbers during the period August to December, and can be identified as marine pseudomonads; however, the low guaninecytosine ratio of their DNA, lack of catalase and specific self-inhibition are not compatible with the characteristics of the genus Pseudomonas. Two produced violacein, usually synthesized by bacteria belonging to the genus Chromobacterium. Their taxonomic position is discussed.