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Introduction Evidence shows that improving hand-hygiene practices reduces the frequency of health-care-associated infections in hospitals. (1,2) Studies have examined the association between hand-hygiene and health-care-associated infections: some were conducted over [...], Objective To determine changes in hand-hygiene compliance after the introduction of direct observation of hand-hygiene practice for doctors and nurses, and evaluate the relationship between the changes and the incidence of health-care -associated infections. Methods We conducted an internal audit survey in a tertiary-care hospital in Finland from 2013 to 2018. Infection -control link nurses observed hand-hygiene practices based on the World Health Organization's strategy for hand hygiene. We calculated hand-hygiene compliance as the number of observations where necessary hand-hygiene was practised divided by the total number of observations where hand hygiene was needed. We determined the incidence of health-care -associated infections using a semi-automated electronic incidence surveillance programme. We calculated the Pearson correlation coefficient (r) to evaluate the relationship between the incidence of health-care-associated infections and compliance with hand hygiene. Findings The link nurses made 52 115 hand-hygiene observations between 2013 and 2018. Annual hand-hygiene compliance increased significantly from 76.4% (2762/3617) in 2013 to 88.5% (9034/10 211) in 2018 (P < 0.0001). Over the same time, the number of health-care-associated infections decreased from 2012 to 1831, and their incidence per 1000 patient-days fell from 14.0 to 11.7 (P < 0.0001). We found a weak but statistically significant negative correlation between the monthly incidence of health-care-associated infections and hand-hygiene compliance (r = -0.48; P < 0.001). Conclusion The compliance of doctors and nurses with hand-hygiene practices improved with direct observation and feedback, and this change was associated with a decrease in the incidence of health-care-associated infections. Further studies are needed to evaluate the contribution of hand hygiene to reducing health-care-associated infections. Objectif Identifier les changements dans l'application des mesures d'hygiene des mains apres l'introduction d'un systeme d'observation directe des pratiques en la matiere chez les medecins et infirmiers. Evaluer le rapport entre ces changements et le nombre d'infections liees aux soins de sante. Methodes Nous avons effectue un audit interne au sein d'un hopital de soins tertiaires en Finlande entre 2013 et 2018. Les infirmieres chargees du controle des infections ont juge les pratiques d'hygiene en se basant sur la strategie d'hygiene des mains de l'Organisation mondiale de la Sante. Nous avons defini dans quelle mesure le personnel respectait les consignes d'hygiene des mains en divisant le nombre de cas ou le niveau d'hygiene requis etait respecte par le nombre total de cas ou l'hygiene des mains etait necessaire. Nous avons egalement determine le nombre d'infections liees aux soins de sante a l'aide d'un programme de surveillance electronique semi-automatique. Enfin, nous avons calcule le coefficient de correlation de Pearson (r) afin d'evaluer le rapport entre le nombre d'infections liees aux soins de sante et le respect de l'hygiene des mains. Resultats Les infirmieres ont observe 52 115 cas d'hygiene des mains entre 2013 et 2018. La moyenne annuelle du respect des mesures a considerablement augmente, passant de 76,4% (2762/3617) en 2013 a 88,5% (9034/10 211) en 2018 (P < 0,0001). Durant la meme periode, le nombre d'infections liees aux soins de sante a diminue, passant de 2012 a 1831, et leur frequence sur 1000 jours-patients a chute, de 14,0 a 11,7 (P < 0,0001). Nous avons detecte une correlation negative faible mais statistiquement significative entre le taux d'incidence mensuel d'infections liees aux soins de sante et le respect de l'hygiene des mains (r = -0,48; P < 0,001). Conclusion Les observations directes et retours ont encourage les medecins et infirmiers a mieux respecter les consignes d'hygiene des mains. Ce changement a entraine une baisse du nombre d'infections liees aux soins de sante. D'autres etudes sont cependant necessaires pour evaluer l'impact de l'hygiene des mains sur la diminution des infections liees aux soins de sante. Objetivo Determinar los cambios del cumplimiento de la higiene de las manos tras las observaciones directas en las practicas de higiene de las manos que realizan los medicos y las enfermeras, ademas de evaluar la relacion entre los cambios y la incidencia de las infecciones relacionadas con la atencion medica. Metodos Se realizo una encuesta de auditoria interna en un hospital de atencion terciaria en Finlandia de 2013 a 2018. Las enfermeras de control de infecciones observaron las practicas de higiene de las manos segun la estrategia de la Organizacion Mundial de la Salud para la higiene de las manos. Se estimo que el cumplimiento de la higiene de las manos equivalia a dividir el numero de las observaciones en las que era necesario practicar la higiene de las manos por el numero total de observaciones en las que se requeria la higiene de las manos. Se determino la incidencia de las infecciones relacionadas con la atencion medica mediante un programa semiautomatizado y electronico de vigilancia de la incidencia. Se calculo la correlacion de Pearson (r) para evaluar la relacion entre la incidencia de las infecciones relacionadas con la atencion medica y el cumplimiento de la higiene de las manos. Resultados Las enfermeras realizaron 52 115 observaciones de higiene de las manos entre 2013 y 2018. El cumplimiento anual de la higiene de las manos aumento significativamente del 76,4 % (2762/3617) en 2013 al 88,5 % (9034/10 211) en 2018 (P < 0,0001). Durante el mismo tiempo, el numero de infecciones relacionadas con la atencion medica disminuyo de 2012 a 1831, y su incidencia por cada 1000 dias de pacientes se redujo de 14,0 a 11,7 (P < 0,0001). Se encontro una correlacion negativa debil pero estadisticamente significativa entre la incidencia mensual de las infecciones relacionadas con la atencion medica y el cumplimiento de la higiene de las manos (r = -0,48; P < 0,001). Conclusion El cumplimiento de las practicas de higiene de las manos que realizan los medicos y las enfermeras mejoro con la observacion directa y la retroalimentacion, lo que se asocio a una disminucion de la incidencia de las infecciones relacionadas con la atencion medica. Se requieren mas estudios para evaluar la contribucion de la higiene de las manos a la reduccion de las infecciones relacionadas con la atencion medica. [phrase omitted]

Author(s): James A. Russell [sup.1] Author Affiliations: (1) grid.17091.3e, 0000 0001 2288 9830, Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, , 1081 Burrard Street, Vancouver, [...], Background Vasopressors are administered to critically ill patients with vasodilatory shock not responsive to volume resuscitation, and less often in cardiogenic shock, and hypovolemic shock. Objectives The objectives are to review safety and efficacy of vasopressors, pathophysiology, agents that decrease vasopressor dose, predictive biomarkers, [beta]1-blockers, and directions for research. Methods The quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Vasopressors bind adrenergic: [alpha]1, [alpha]2, [beta]1, [beta]2; vasopressin: AVPR1a, AVPR1B, AVPR2; angiotensin II: AG1, AG2; and dopamine: DA1, DA2 receptors inducing vasoconstriction. Vasopressor choice and dose vary because of patients and physician practice. Adverse effects include excessive vasoconstriction, organ ischemia, hyperglycemia, hyperlactatemia, tachycardia, and tachyarrhythmias. No randomized controlled trials of vasopressors showed a significant difference in 28-day mortality rate. Norepinephrine is the first-choice vasopressor in vasodilatory shock after adequate volume resuscitation. Some strategies that decrease norepinephrine dose (vasopressin, angiotensin II) have not decreased 28-day mortality while corticosteroids have decreased 28-day mortality significantly in some (two large trials) but not all trials. In norepinephrine-refractory patients, vasopressin or epinephrine may be added. A new vasopressor, angiotensin II, may be useful in profoundly hypotensive patients. Dobutamine may be added because vasopressors may decrease ventricular contractility. Dopamine is recommended only in bradycardic patients. There are potent vasopressors with limited evidence (e.g. methylene blue, metaraminol) and novel vasopressors in development (selepressin). Conclusions Norepinephrine is first choice followed by vasopressin or epinephrine. Angiotensin II and dopamine have limited indications. In future, predictive biomarkers may guide vasopressor selection and novel vasopressors may emerge.

Psychiatry, as conventionally practiced, is being influenced by increasing openness to non-Western healing traditions in the context of accumulating research evidence for select complementary and alternative medicine (CAM) modalities and [...]

As diagnosticians, healers, and leaders of provider teams, physicians help relieve suffering and create the conditions for recovery from illness. To optimally carry out their critical roles in the health [...], Context.--In the past decades, physician wellness has diminished in every aspect of professional life. Burnout symptoms in the United States affect 30% to 68% of physicians overall--exceeding the levels of any other professional group. The ramifications of burnout present an underrecognized crisis in the health care system that carries the consequences of personal, professional, institutional, and societal costs. Objective.--To bring to light the elements of current medical practice that contribute to physician professional fulfillment and burnout. Intervention measures, steps toward burnout prevention, and the present limitations thereof are also addressed. Data Sources.--This narrative literature review was performed by using studies in PubMed (National Center for Biotechnology Information) and large online physician surveys, published through December 2015. Because of geographic differences, the review is primarily concentrated on physicians across specialties in the United States. Small studies and those of single disciplines were excluded. Conclusions.--Many physicians learn to tolerate burnout symptoms despite negative personal consequences. Long-term work-related stress, however, may lead to the potential for negative effects on the quality of patient care, and to attrition. Interestingly, the factors that enhance physician fulfillment and those that may precipitate burnout symptoms are distinct. Optimization of physician well-being, therefore, requires tailored approaches in each of these 2 dimensions and is most likely to succeed if it includes approaches that are customized to career phase, physician specialty, and practice setting. Importantly, organization leaders must prioritize this issue and provide sustained support for wellness initiatives, to foster a culture that is conducive to physician well-being. (doi: 858/arpa.2015-0524-RA)

A trip to the dentist can induce anxiety in anyone. The thought of being stuck in a chair while someone pokes and prods in your mouth is disconcerting enough, and [...]

Dental professionals must be confident they are providing safe dental care for every patient at every visit. Recent breaches in dental infection control such as the Hepatitis C transmission at [...]

This article provides an overview of the most prevalent types of skin cancer and pre-cancerous lesions, and shows primary care practitioners how to pick up early presentations of the disease. [...]

Keywords * standards and guidelines * chronic conditions * evidence based practice * National Collaborating Centre for Chronic Conditions * NICE ********** During 2008 Primary Health Care will focus on [...]

Introduction: The literature identifies significant inequalities in the health status of rural and Aboriginal populations, compared with the general population. Providing rural primary care physicians with public health skills could [...]