The impact of automated hand hygiene monitoring with and without complementary improvement strategies on performance rates.

OBJECTIVE: To determine how engagement of the hospital and/or vendor with performance improvement strategies combined with an automated hand hygiene monitoring system (AHHMS) influence hand hygiene (HH) performance rates. DESIGN: Prospective, before-and-after, controlled observational study. SETTING: The study was conducted in 58 adult and pediatric inpatient units located in 10 hospitals. METHODS: HH performance rates were estimated using an AHHMS. Rates were expressed as the number of soap and alcohol-based hand rub portions dispensed divided by the number of room entries and exits. Each hospital self-assigned to one of the following intervention groups: AHHMS alone (control group), AHHMS plus clinician-based vendor support (vendor-only group), AHHMS plus hospital-led unit-based initiatives (hospital-only group), or AHHMS plus clinician-based vendor support and hospital-led unit-based initiatives (vendor-plus-hospital group). Each hospital unit produced 1­2 months of baseline HH performance data immediately after AHHMS installation before implementing initiatives. RESULTS: Hospital units in the vendor-plus-hospital group had a statistically significant increase of at least 46% in HH performance compared with units in the other 3 groups (P ≤ .006). Units in the hospital only group achieved a 1.3% increase in HH performance compared with units that had AHHMS alone (P = .950). Units with AHHMS plus other initiatives each had a larger change in HH performance rates over their baseline than those in the AHHMS-alone group (P < 0.001). CONCLUSIONS: AHHMS combined with clinician-based vendor support and hospital-led unit-based initiatives resulted in the greatest improvements in HH performance. These results illustrate the value of a collaborative partnership between the hospital and the AHHMS vendor.

Who goes in and out of patient rooms? An observational study of room entries and exits in the acute care setting.

The objective of this study is to determine what percentage of patient room entries and exits (opportunities) are attributed to health care personnel (HCP) and non-HCP. A total of 14,876 opportunities were observed by clinicians in 29 units of 16 hospitals. HCP accounted for 83.6%; 95% confidence interval, 81.3%-87.6%. This finding provides hospitals an initial baseline for HCP room traffic when implementing community-based automated hand hygiene monitoring and compliance improvement efforts.

Technological developments for small-scale downstream processing of cell therapies.

Despite considerable regulatory and clinical hurdles, the development and use of cell-based therapies are gaining momentum. As more of these therapies move toward commercial approval and larger-scale distribution, associated manufacturing and processing technologies are being advanced. Modern technologies directed at downstream processing seek to distribute such therapies from the manufacturing site to the patient more efficiently and reliably. Novel small-scale downstream solutions boost the transformation of cell therapies from abstraction to reality.

Standardized cryopreservation of human primary cells.

Cryopreservation is the use of low temperatures to preserve structurally intact living cells. The cells that survive the thermodynamic journey from the 37 °C incubator to the -196 °C liquid nitrogen storage tank are free from the influences of time. Thus, cryopreservation is a critical component of cell culture and cell manufacturing protocols. Successful cryopreservation of human cells requires that the cells be derived from patient samples that are collected in a standardized manner, and carefully handled from blood draw through cell isolation. Furthermore, proper equipment must be in place to ensure consistency, reproducibility, and sterility. In addition, the correct choice and amount of cryoprotectant agent must be added at the correct temperature, and a controlled rate of freezing (most commonly 1 °C/min) must be applied prior to a standardized method of cryogenic storage. This appendix describes how human primary cells can be frozen for long-term storage and thawed for growth in a tissue culture vessel.

Standardized cryopreservation of pluripotent stem cells.

The successful exploitation of human cells for research, translational, therapeutic, and commercial purposes requires that effective and simple cryopreservation methods be applied for storage in local and master cell banks. Of all the cell types utilized in modern research, human embryonic stem cells and their more recent relatives, induced pluripotent stem cells, are two of the most sensitive to cryopreservation. It is frequently observed that the lack of quality control and proper processing techniques yield poor recovery of pluripotent stem cells. The procedures in this unit have been optimized for handling some of the most recalcitrant stem cell lines, and provide a method for controlled-rate freezing, using minimal equipment that affords levels of cell viability comparable to expensive controlled-rate freezers. The protocol also eliminates the requirement for isopropanol, avoiding the hazards, on-going cost, and inconsistencies associated with its use and disposal. It provides a clinically relevant, inexpensive, reliable, and user-friendly method that successfully prepares cells for long-term cold storage and ensures maximum levels of cell viability post thaw.

Cryopreservation and thawing of cells.

Successful cryopreservation of cells requires not only that the cells be handled in a proper fashion for harvesting with equipment in place to ensure consistency, reproducibility, and sterility, but also that a correct choice and amount of cryoprotective agent is added. In general, a controlled freezing rate of 1°C/min is necessary to retain optimal viability of the recovered cells. There are many variations of cell freezing methods in use, including costly electronically regulated control rate freezers, unstandardized, passive isopropyl alcohol freezing containers, and crude rudimentary devices constructed from Styrofoam boxes or paper insulation. However, for the freezing and recovery of cell lines, primary cells, and stem cell cultures, the protocol described in this unit is simple, reproducible, and successful. Not only does it eliminate the need for isopropanol, as well as the costs and hazards associated with its use and disposal, but it provides a uniform method with improved cell viability and recovery.

A role for counselling psychologists within the Neonatal Intensive Care Unit.

Counselling psychology appears to be neglecting the importance and merits of working with the client population associated with the preterm neonate within the Neonatal Intensive Care Unit (NICU). Throughout, the benefits of such a move are highlighted with particular emphasis on how counselling psychologists are uniquely qualified for this role. Specialist knowledge required to provide clients with the greatest therapeutic gains illustrates the pertinent issues, with proposals for clinical practice put forward. NHS Trusts nationwide are encouraged to recruit this ready-made professional into the Department for the psychological health of parents and caregivers engaged in caring for the preterm neonate.

Phase I evaluation of prolonged-infusion gemcitabine with fludarabine for relapsed or refractory acute myelogenous leukemia.

PURPOSE: The purpose of this study was to determine the maximum tolerated duration of infusion of gemcitabine at 10 mg/m(2)/min in combination with fludarabine at 25 mg/m(2) daily for 5 days in the treatment of relapsed or refractory acute myelogenous leukemia. EXPERIMENTAL DESIGN: Eighteen patients with relapsed or refractory acute myelogenous leukemia were enrolled. The median age was 54.5 years (range, 21-80 years). Patients received a 30-min infusion of fludarabine at 25 mg/m(2) daily for 5 days. i.v. gemcitabine was given as a single infusion at 10 mg/m(2)/min with the duration adjusted following a modified continuous reassessment method. RESULTS: After 18 patients, the maximum recommended duration of infusion of gemcitabine in combination with fludarabine was selected as a 15-h infusion given at 10 mg/m(2)/min (9,000 mg/m(2)). Severe stomatitis or esophagitis was the most common nonhematological dose-limiting toxicity. Myelosuppression was universal. Febrile neutropenia was common, and 3 of 18 (17%) patients developed bacteremia. Occasional nausea, vomiting, or diarrhea was also reported. There were three complete responses and two partial responses for an overall response rate of 28%. CONCLUSIONS: Prolonged-infusion gemcitabine at a fixed dose rate of 10 mg/m(2)/min for 15 h with 25 mg/m(2)/day fludarabine for 5 days is a tolerable induction regimen for relapsed or refractory leukemia. Stomatitis, esophagitis, febrile neutropenia, and myelosuppression should be anticipated; however, this regimen may be beneficial in patients with relapsed or refractory leukemia.

Características clínico-evolutivas del carcinoma de vértice pulmonar / Clinical evolutional characteristics of apical lung carcinoma

Se analizaron 1365 historias clínicas de pacientes con cáncer pulmonar, 35 de ellos (2,9%) correspondieron a portadores de tumores de vértice. La totalidad eran fumadores del sexo masculino con una media de edad de 65,7 años. La demora promedio entre primer síntoma y primera consulta fue de 6 meses. Clínicamente el dolor fue el síntoma dominante. En el 17% de los casos las metástasis fueron confirmadas simultáneamente con el diagnóstico. La variedad histológica más frecuente fue el adenocarcinoma (34%). Se irradiaron 27 pacientes, 23 com caráter paliativo y 4 como preoperatoria La cirugía se efectuó en 5. La sobrevida media de 5,1 meses. Se destacan como factores de mal pronóstico la consulta tardía y las dificuldades en el diagnóstico endoscópico e histológico lo cual lleva a tratamientos en etapas de compromiso loco-regional avanzado