Sustained Compliance Research Articles

The Effectiveness of Mosquito Larva Monitoring Calendar on Knowledge, Dengue Fever Risk Behavior, and Mosquito Larva Density Rates in Malang, Indonesia

Background The neglected efforts of mosquito larvae observers (typically health cadres and known as Jumantik) require innovative solutions, one of which is the self-monitoring approach with the mosquito larva monitoring calendar (MLMC). This study aimed to test the effectiveness of MLMC in enhancing knowledge, reducing dengue fever (DF) risk behavior, and lowering larva densities. Methods A 4-month quasi-experiment was designed to evaluate the use of MLMC. The experimental group implemented MLMC, while the control group implemented the government’s basic program. Both groups were allocated randomly. Baseline and follow-up surveys in experimental and control groups were conducted, each comprising a village and housing estate. As the data was not normally distributed, the Wilcoxon signed-rank test was used to assess within-group changes, while the Student’s t-test or Mann–Whitney U test was used to compare two groups. Spearman’s test examined the relationship between MLMC utility and knowledge. Results Compared to control groups, there were improvements in DF risk behaviors for experimental, such as hanging clothes (p=0.008 vs p=0.130), closing the trash (p=0.027 vs p=0.004), and using mosquito nets (p< 0.001 vs p<0.001). In the follow-up survey, the MLMC received positive feedback, correlating with increased knowledge (r=0.240, p=0.006). There was no decrease in the existence of the larval stage in either the experimental or control groups (p=1.00 vs p=0.446). The control group showed reduced positive larva (p<0.001), possibly due to higher education and history of DF although not significant. Conclusion MLMC can reducereduce DF risk behavior, increase knowledge, and decrease mosquito larval density, contingent upon sustained compliance, assisted by Jumantik.

An Impact assessment of Post-Approval Regulatory and Quality Compliance at a UK – Only Pharmaceutical Manufacturer

Purpose: To assess the regulatory compliance of operational processes at a British pharmaceutical manufacturing company (Company X). Provide remediation strategies for any compliance gaps identified to align operations with regulatory approvals. Ultimately, to assure Qualified Persons that finished pharmaceutical products released for sale are compliant with regulatory approvals and manufactured to current quality standards. Materials and methods: A gap analysis between regulatory-approved CTD sections and operational documentation is conducted for a single marketed product at Company X. Inclusion of CTD sections for review is determined according to those likely to contain Established Conditions (EC) as specified in the International Council for Harmonisation (ICH) of Technical Requirements for Pharmaceuticals for Human Use Q12 guideline. A three-tiered review process is used to identify Established Conditions and describe compliance. Tier 3 (Student) identifies Established Conditions by comparing like-for-like (compliant), equivocal (further assessment required) and opposing (non-compliant) terminology in the CTD sections compared to operational documentation. Tier 2 (Subject Matter Experts (SMEs)) reviews and approves Tier 1 outputs. Equivocal terminology is assessed as either compliant or non-compliant. Non-compliant conditions are assessed as regulatory gaps if they deviate from the CTD or quality gaps if they are compliant with the CTD but deviate from Good Manufacturing Practices (GMP). A risk assessment is conducted using a risk priority numbering (RPN) tool and remediation proposals are made. Tier 1 (Governance) reviews and confirms Tier 2 compliance gap outputs and ratifies a final adjudication and remediation strategy. Results and discussion: Data outputs for this study could only be generated at Tier 3 and Tier 2 levels due to time constraints. A total of 62 compliance-related Established Conditions (EC) were identified with 37 representing compliance gaps. 49% (30 conditions) related to regulatory compliance gaps, 40% (25 conditions) were compliant and 11% (7 conditions) were quality compliance gaps. Six categories of regulatory compliance gaps were identified with the most commonly observed being the unavailability of regulatory-approved CTD sections for review. Three categories of quality compliance gaps were identified with the most commonly observed being the misalignment of operational and validating documentation. Conclusions: Company X is presently in a state of non-compliance. The unavailability of regulatory-approved documentation emerges as the most common compliance issue suggesting insufficiencies in regulatory document control may currently exist. A root cause analysis coupled with a corrective and preventative action plan may be beneficial to support sustained compliance. Further work is required to remediate identified compliance gaps to bring operations into regulatory compliance.

Reducing Surgical Site Infections in Neurosurgery During the Intra-operative Phase: An Audit of National Institute for Health and Care Excellence (NICE) Guideline Adherence at a Major Trauma Centre.

Surgical site infections (SSIs) pose significant risks to patient safety and healthcare systems globally despite preventive measures. This study audits compliance with the National Institute for Health and Care Excellence (NICE) guidelines for SSI prevention during the intra-operative phase in the Neurosurgery Department at Salford Royal National Health Service (NHS) Foundation Trust. Conducted in two audit cycles from October 2022 to October 2023, the study assessed adherence to 19 key parameters aimed at minimising SSIs. Significant improvements were observed in various areas, including antibiotic prophylaxis information (from 44% to 90%) and bodywash compliance (from 14% to 80%). Compliance with skin preparation protocols also showed marked progress, with antiseptic application time improving from 12% to 80%. However, areas such as double gloving (increased from 36% to 44%) and the use of antimicrobial sutures (from 2% to 30%) indicate opportunities for further enhancement. The findings underscore the effectiveness of targeted interventions and the importance of continuous education and evaluation of surgical practices to reduce SSIs, ultimately improving patient outcomes and alleviating financial burdens on the NHS. Future audits are recommended to ensure sustained compliance and quality of care in Neurosurgery.

An Intelligent Human–Machine Interface Architecture for Long-Term Remote Robot Handling in Fusion Reactor Environments

This paper addresses the intricate challenge posed by remote handling (RH) operations in facilities with operational lifespans surpassing 30 years. The extended RH task horizon necessitates a forward-looking strategy to accommodate the continuous evolution of RH equipment. Confronted with diverse and evolving hardware interfaces, a critical requirement emerges for a flexible and adaptive software architecture based on changing situations and past experiences. The paper explores the inherent challenges associated with sustaining and upgrading RH equipment within an extended operational context. In response to this challenge, a groundbreaking, flexible, and maintainable human–machine interface (HMI) architecture named MAMIC is designed, guaranteeing seamless integration with a diverse range of RH equipment developed over the years. Embracing a modular and extensible design, the MAMIC architecture facilitates the effortless incorporation of new equipment without compromising system integrity. Moreover, by adopting this approach, nuclear facilities can proactively steer the evolution of RH equipment, guaranteeing sustained performance and compliance throughout the extended operational lifecycle. The proposed adaptive architecture provides a scalable and future-proof solution, addressing the dynamic landscape of remote handling technology for decades.

Early detection of phlebitis among hematology-oncology patients: a best practice implementation project.

Peripherally-inserted venous catheters (PIVC) are essential for cancer patients to receive treatment. Phlebitis is a major complication of PIVC. Currently, nurses' assessment of phlebitis mainly involves visual inspection. However, the latest literature suggests palpation for tenderness to promote the early detection of phlebitis. This project evaluated the effectiveness of a bundle approach to increase nurses' compliance with PIVC site assessment to promote early detection of phlebitis (grade 2 and above). The JBI Evidence Implementation Framework was used to conduct this project in a 28-bed hematology-oncology ward in a Singapore hospital. The bundle approach used in this project consisted of a training presentation, medical mannequin, and phlebitis scale card. The rate of nurses' compliance with best practice for PIVC site assessment was measured at 1 month and 6 months post-implementation. The incidence of phlebitis was monitored up until 12 months post-implementation. Baseline data indicated that only 18.75% (3 out of 16) nurses palpated for tenderness when assessing for phlebitis. Data at 1 month and 6 months post-implementation reported sustained high compliance rates of 85.71% (24 out of 28) and 89.29% (25 out of 28), respectively. Late detection of phlebitis was reduced by 66% (from three cases to one case) at 6 months post-implementation, and no patients required invasive interventions. The bundle approach used in this project facilitated early detection of phlebitis following the inclusion of palpation into nurses' assessment for phlebitis. http://links.lww.com/IJEBH/A204.

Sustained Culture of Safety After Select Agent Exposure

Abstract Introduction/Objective In January of 2021 our laboratory experienced the occupational exposure of 3 technologists to the select agent Burkholderia pseudomallei due to improper recognition and manipulation outside a biosafety cabinet. Subsequently, an interactive computer module was created to train technologists on timely recognition, followed by a “fake” patient test to evaluate comprehension. In that initial period, 100% compliance and successful recognition was demonstrated. To evaluate sustained compliance and recognition, another wave of evaluation was performed Jan- Dec 2022. Methods/Case Report During the study period several new staff members were hired and demonstrated compliance with completing the computer module. Clinical isolates suspicious for a select agent were reported to the Medical Director on rounds daily and reviewed for potential exposure, which was defined as manipulation of the suspicious isolate outside of the biosafety cabinet. Additional challenge “fake” patients were circulated. Results (if a Case Study enter NA) During the study period, 16 isolates were deemed suspicious for select agents based on macroscopic and microscopic morphology and biochemical reactions. Of these, 0 resulted in laboratory exposures. Of the challenge isolates, 1 resulted in a near-miss potential for exposure due to the lack of recognition of macroscopic characteristics. Conclusion The use of an interactive computer module focused around timely recognition and safe handling of potential select agents resulted in sustained laboratory safety and avoidance of potential occupational exposures.

DELIVERING SUSTAINABLE CHANGE OF POSTOPERATIVE CARE DOCUMENTATION PRACTICES IN SPINAL SURGERY THROUGH QUALITY IMPROVEMENT FRAMEWORKS

AbstractINTRODUCTIONIn the NHS the structure of a “regular healthcare team” is no longer the case. The NHS is facing a workforce crisis where cross-covering of ward-based health professionals is at an all-time high, this includes nurses, doctors, therapists, pharmacists and clerks. Comprehensive post-operative care documentation is essential to maintain patient safety, reduce information clarification requests, delays in rehabilitation, treatment, and investigations. The value of complete surgical registry data is emerging, and in the UK this has recently become mandated, but the completeness of post-operative care documentation is not held to the same importance, and at present there is no published standard. This project summarises a 4-stage approach, including 6 audit cycles, >400 reviewed operation notes, over a 5 year period.OBJECTIVETo deliver a sustainable change in post operative care documentation practices through quality improvement frameworks.METHODSStage 1: Characterise the problem and increase engagement through: SMART aims, process mapping, hybrid action-effect and driver diagram and stakeholder analysis. Multi disciplinary stakeholders were involved in achieving a consensus of evidence-based auditable criteria. Stage 2: Baseline audit to assess current practice. Stage 3: Intervention planning by stakeholders. Stage 4: Longitudinal monitoring through run charts and iterative refinement.RESULTSStage 1: Process mapping identified numerous downstream effects of the absence of critical information from operation notes, and the action-effect diagram highlighted the multiple unnecessary mitigating actions performed by ward staff. An MDT consensus was achieved on 15 essential criteria for complete documentation, including important negative fields. Interest-influence matrix identified stakeholder groups with high influence but low interest who needed engagement to deliver change. Stage 2: Baseline audit demonstrated unexpectedly poor documentation: >75% compliance in 4 criteria, and <50% compliance in 10 criteria, which elevated the interest of key stakeholders. Stage 3: A post-operative care template based on the 15 criteria was embedded within the existing IT software. It allowed use of existing operative templates, with a non-overwriting suffix requiring only two mouse clicks. Stage 4: Re-audit at 3 and 12 months showed improved and sustained compliance. At 24 months compliance had declined. Questionnaire of template usage identified problems of criteria response options, and lack of awareness of template by newly appointed staff. Template update improved compliance over the next 6 months (>75% compliance in 11 criteria). Finally, a further reaudit conducted 12 months after the template update (5 years post baseline audit) showed a sustained improvement in compliance (>75% compliance in 13 criteria).CONCLUSIONSSimple innovation through quality improvement frameworks has changed documentation practices by 1) achieving a consensus from stakeholders, 2) a “shock and awe” moment to highlight existing poor documentation and increase engagement 3) implementing change which fit easily into existing systems, 4) respecting autonomy rather than enforcing change and 5) longitudinal monitoring using run charts and an iterative process to ensure the template remains fit for purpose. This model has now successfully been translated to other subspecialities within the orthopaedic department.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Abstract LB143: Improving treatment outcomes: a digital solution for remote patient monitoring of stomatitis for patients receiving Dato-DXd

Abstract Instances of stomatitis are very painful and compromise nutrition and oral hygiene as well as induce an increased risk for local and systemic infection. Stomatitis is a well-known toxicity of radiotherapy, chemotherapy and other targeted therapies and is associated with dose interruptions, reductions, and treatment discontinuation. For upcoming Dato DXd phase III trials, the mitigation strategies included patient education delivered at the site and supported by printed material to foster continued adherence to an oral care protocol (OCP). The study team thought to leverage digital technology, namely patient-provisioned smartphones to bring the OCP right “to the patients’ fingertips”, while enabling health care providers at the site to monitor onset or worsening of stomatitis for each patient. The digital solution consists of a patient interface for data acquisition and personalized education/behavioral reinforcement, and a clinician interactive data dashboard to access, in real time, patients’ records of stomatitis-related symptoms and their impact on nutrition and hydration, respectively. For a few days post infusion, the solution surfaces personalized illustrated vignettes to provide the participant with simple recommendations for self-care and probe to contact the clinical site team when symptom(s) reach a given morbidity threshold. The clinical team can visualize data on demand or upon being prompted, to quickly assess trends towards stomatitis worsening and decide on the next course of action. This solution for remote patient monitoring of stomatitis risk is deployed in four studies and is planned for an additional three, reaching approximately a total of 7,000 patients across 49 sites in 16 countries. Early feedback from patients confirmed the engaging design, the low burden daily usage, and the perceived utility of the solution. Patients who had experienced stomatitis previously indicated that such a solution would have given them confidence to engage with their site sooner to receive care. Further structured feedback from clinical study teams and analyses of clinical trial data are planned to inform patients’ sustained compliance using the solution and its effectiveness in mitigating high grade of stomatitis and helping patients to better manage their treatment and outcomes. Citation Format: Rebecca H. Wray, Elisabeth Piault, Lucie Miller-Potucka, Jill A. Bell, Rick Fairhurst, Sabrina S. Khan, Micah J. Maxwell, Neelima Denduluri, Leora Horn. Improving treatment outcomes: a digital solution for remote patient monitoring of stomatitis for patients receiving Dato-DXd [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB143.

Preventing Wrong Tooth Extraction in Primary Care Oral Surgery: LocSSIPs - Key Aspects of Implementation for Achieving and Sustaining Compliance.

The success of Local Safety Standards for Invasive Procedures (LocSSIPs) in preventing wrong tooth extraction and other patient safety incidents is based on sustained staff compliance from the outset, ahead of implementation. This paper (the second of two on the topic of LocSSIPs) aims to equip primary care dental practitioners with key practical solutions to implement LocSSIPs successfully and sustainably, and the leadership knowledge to create a long-term, safe, patient-centred and just service.

The importance of sustained compliance with physical distancing during COVID-19 vaccination rollout

BackgroundIncreasing vaccination coverage against SARS-CoV-2 enabled relaxation of lockdowns in many countries in Europe. As the vaccination rollouts progressed, the public health authorities were seeking recommendations on the continuation of physical distancing measures during ongoing vaccination rollouts. Compliance with these measures was declining while more transmissible virus variants have emerged.MethodsWe used a SARS-CoV-2 transmission model to investigate the feedback between compliance, infection incidence, and vaccination coverage. We quantified our findings in terms of cumulative number of new hospitalisations three and six months after the start of vaccination.ResultsOur results suggest that the combination of fast waning compliance in non-vaccinated individuals, low compliance in vaccinated individuals, low vaccine efficacy against infection and more transmissible virus variants may result in a higher cumulative number of new hospitalisations than in a situation without vaccination. These adverse effects can be alleviated by deploying behavioural interventions that should preferably target both vaccinated and non-vaccinated individuals. The choice of the most appropriate intervention depends on vaccination rate and vaccine efficacy against infection.ConclusionsSupplementary behavioural interventions aiming to boost compliance to physical distancing measures can improve the outcome of vaccination programmes, until vaccination coverage is sufficiently high. For optimal results, these interventions should be selected based on the vaccine efficacy against infection and expected vaccination rate. While we considered the dynamics of SARS-CoV-2, the qualitative effects of the interplay between infectious disease spread and behavior on the outcomes of a vaccination programme can be used as guidance in a future similar pandemic.

Progress: Responsiveness Validation of an Electronic Patient Reported Outcome (ePRO) in Adults with Sickle Cell Disease (NCT05407805)

Background: Vaso-occlusive painful crises (VOC) are a hallmark of sickle cell disease (SCD). Historically, efficacy of drugs intended to reduce frequency of VOCs has been evaluated solely on the frequency of VOC that require a medical intervention, such as a visit to the emergency department, an infusion center and/or hospitalization. Several studies (PiSCES, ELIPSIS) have now demonstrated that the majority of painful events are managed in the home setting.1,2 Therefore, accepted measures to evaluate disease burden do not represent the totality of the patient VOC experience. There is a need to improve and expand on existing clinical trial endpoints to capture the totality of the VOC experience. Moreover, participation in clinical trials for patients with SCD faces numerous barriers, such as transportation difficulties, burden to patient's family/work time and recently, concerns about Covid-19 exposure. We aim to quantify daily pain episodes and provide additional evidence supporting validation of responsiveness in a therapeutic setting for a novel SCD electronic patient reported outcomes (ePRO), that may be utilized in a decentralized or traditional study setting. To successfully assess this tool, it is essential that participants comply with the completion of this daily diary. Methods: PROGRESS (NCT05407805) is a prospective study characterizing VOCs in 2 cohorts of patients with HbS/S or S/B0 Thal ≥18 years of age. Group 1, "control" consists of up to 100 patients not on disease modifiers, and group 2," Hydroxyurea" (HU) includes 50 patients on a stable dose of HU. On Day 1, patients have a blood draw for biomarker evaluation and receive training for their SCD diary on an ePRO device. Patient's participation is approximately 7 months. The blood draw and the training on the SCD ePRO device may be performed remotely by a phlebotomist in the patients' home, or at a site. The SCD ePRO diary consists of up to 6 questions and is completed in the evening to reflect the past 24 hours. Strategies to assure the diary is completed include simplification of questions and responses, device alarms, allowance to complete until noon the following day, morning calls to patients if a diary has not been completed the night before and remuneration for the completion of the diary each day. A small bonus payment is provided when 6 or more diaries are completed over a 7-day period, with the bonus increasing during the final 3 months of the study. Results: To date, two sites have screened 15 individuals and enrolled 10 participants. Participants are generally able to complete the diary in approximately 1-2 minutes and the daily diary completion compliance is ~95% over an average of 75 days (range: 9 to 146 days). Discussion: Classical methods for measuring the rate of VOCs, based solely on utilization of medical resources, vastly underestimate the pain burden in SCD; therefore, developing new validated endpoints that measure the totality of pain episodes, including home VOCs is a priority. Demonstration of sustained compliance and responsiveness of a daily diary may provide additional confidence in the use of this tool as an endpoint in broader therapeutic settings.

A Pharmacy Quality and Internal Audit Program Promoting Continuous Survey Readiness with Medication Management Standards.

Showcasing compliance with Joint Commission Medication Management (MM) standards during accreditation visits is important, but it is equally vital to maintain a state of continuous survey readiness. This article describes a Pharmacy Quality and Internal Audit Program to promote continuous survey readiness and sustained compliance with MM standards. A comprehensive MM audit was developed to assess for compliance in all inpatient, ambulatory, and procedural areas that use medications, with each area undergoing the internal auditing process at least twice per calendar year. The audit is performed by an MM subject matter expert from the Department of Pharmacy and incorporates electronic chart review, clinical staff interviews, and observations of area-specific medication practices. Notable findings and recommendations are communicated to area-specific leadership. Institutionwide scorecards are compiled to track performance with MM standards, identify opportunities, and determine future focus areas to improve and sustain compliance. Results revealed consistent compliance (≥ 90%) with a majority of MM standards. These included hazardous medication management, controlled substances compliance, look-alike/sound-alike drugs, medication storage/security, and labeling of medication syringes. Several areas of opportunity were identified: awareness of high-alert medications and risk-reduction safety strategies, compliance with pill cutter standards, and therapeutic duplication of "as needed" medication orders. Subsequent implementation of corrective actions and mitigation strategies resulted in improved compliance rates from < 50% to ≥ 90% for awareness of high-alert medications and risk-reduction strategies, from < 60% to ≥ 80% for compliance with pill cutter standards, and from < 90% to ≥ 90% for therapeutic duplication of "as needed" orders. Establishment of a Pharmacy Quality and Internal Audit Program allowed for performance tracking, identification of compliance deficiencies, implementation of focused corrective actions, and promotion of continuous survey readiness with MM standards.

A Single-Centre Retrospective Study on the Impact of Reducing Surgical Prophylaxis from 48 Hours to 24 Hours in Cardiothoracic Surgery

Introduction: In November 2016, surgical antibiotic prophylaxis (SAP) guidelines for cardiothoracic surgeries at the authors’ centre were updated. SAP was reduced from 48 to 24 hours, and dual cover with vancomycin and cefazolin instead of vancomycin monotherapy was recommended for patients colonised with methicillin-resistant Staphylococcus aureus. This study was conducted to review compliance to the updated guidelines, and compare the incidence of surgical site infections (SSI). Methods: A list of patients undergoing sternotomy in National Heart Centre, Singapore, from March 2016 to February 2019 was extracted from the hospital’s electronic database; every fourth patient was included in the analysis. The patients were divided into three groups: Group 1 (before guideline revision, March–October 2016), Group 2 (post-guideline implementation, July 2017–May 2018), and Group 3 (July 2018–February 2019). Compliance to guidelines, incidence, and epidemiology of SSIs within 90 days of surgery were evaluated. Results: 509 patients (Group 1: 149; Group 2: 184; Group 3: 176) were included. There was appropriate selection and timely administration of SAP across all three groups. Post-guideline implementation, the proportion of patients on SAP for &gt;24 hours decreased from 149 (100%) in Group 1 to 55 (29.9%), and 67 (38.1%) in Group 2 and 3, respectively (p &lt;0.001). Despite the reduction in SAP duration, SSI rates remained stable: 4.7%, 3.3%, and 5.1% in Group 1, 2, and 3, respectively (p=0.662). Conclusion: Guideline implementation significantly reduced SAP duration in the authors’ cardiothoracic surgeries, with no increase in SSIs. Continual feedback to ensure sustained compliance may be necessary.

A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.

There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events. This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured. Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI95 : -8% to 1%, p=.11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 : -6% to 5%, p=.75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 : -3% to 11%, p=.29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 : 23% to 51%, p < .001). Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.

Hand Hygiene Auditing: Is It a Roadway to Improve Adherence to Hand Hygiene Among Hospital Personnel?

BackgroundOver the years, there has been an increase in hospital-acquired infections (HAIs) among patients in India. One of the main reasons is a lack of compliance with infection control guidelines, such as hand hygiene. So the present study was conducted to determine the compliance of hand hygiene among healthcare workers in a private tertiary care teaching hospital in South India.Materials and methodsThe prospective observational study was carried out between April 2017 and March 2020. Nineteen areas were directly observed for hand hygiene (HH) compliance. At each location, HH audit was conducted for one hour per day for five days per month. HH complete adherence rate (HHCAR) and HH partial adherence rate (HHPAR) were analyzed.ResultsNine hundred and twenty observation periods were completed during the entire study period. Overall, hand hygiene complete adherence rate was 29.9% (11,981/39,998); partial adherence rate was 45.3% (18,131/39,998) and the non-adherence rate was 24.7% (9886/39,998). A better adherence rate was seen among nurses (44.7%), followed by other staff (33.7%) and doctors (33.04%). Moment-specific adherence rates show almost equal adherence rates of 50.7%, 50.75%, and 50.1%, respectively, for moments 2, 3, and 4, and comparatively low for moments 1 and 5 (48.4% and 47.6%, respectively).ConclusionDespite adequate hand hygiene facilities, compliance remains low. Hand hygiene is a bundle care approach that needs to consider factors including healthcare staff, clinical, institutional, environmental, and behavioral changes. Multimodal interventions and multidisciplinary commitment are mandatory for sustained compliance.

The Evolution of Vigilance and Its Atrophy Preceding the COVID-19 Global Pandemic.

IntroductionRecent infectious outbreaks preceding the COVID-19 crisis resulted in the evolution of vigilance for preparedness against the next pandemic. This vigilance was maintained to varying degrees in different jurisdictions.ObjectiveTo evaluate the evolution of vigilance following previous epidemics and pandemics and the subsequent atrophy of vigilance prior to the COVID-19 global pandemic.MethodsWe evaluated documentation discussing US, Canada, and South Korea from March 2002 to October 2021. Our policy search strategy was rooted in academic literature, government documents and media reports.ResultsIn the US, there were examples of atrophy of vigilance; however, there was clear understanding of pandemic readiness actions that were simply not executed amongst political chaos. In Canada, political mishaps were less evident at the time the pandemic unfolded. Nevertheless, atrophy was evident with erosion in preparedness programs following SARS. South Korea appeared least subjected to atrophy of vigilance. The more recent MERS outbreak prompted evolution of sustained vigilance and compliance with basic public health measures such as mask wearing.RecommendationsPolicy options need to be explored and instituted that increase protection of preparedness programs through institutional safeguards and accountability measure.

Ergonomic assessment of office worker postures using 3D automated joint angle assessment

Sedentary activity and static postures are associated with work-related musculoskeletal disorders (WMSDs) and worker discomfort. Ergonomic evaluation for office workers is commonly performed by experts using tools such as the Rapid Upper Limb Assessment (RULA), but there is limited evidence suggesting sustained compliance with expert’s recommendations. Assessing postural shifts across a day and identifying poor postures would benefit from automation by means of real-time, continuous feedback. Automated postural assessment methods exist; however, they are usually based on ideal conditions that may restrict users’ postures, clothing, and hair styles, or may require unobstructed views of the participants. Using a Microsoft Kinect camera and open-source computer vision algorithms, we propose an automated ergonomic assessment algorithm to monitor office worker postures, the 3D Automated Joint Angle Assessment, 3D-AJA. The validity of the 3D-AJA was tested by comparing algorithm-calculated joint angles to the angles obtained from manual goniometry and the Kinect Software Development Kit (SDK) for 20 participants in an office space. The results of the assessment show that the 3D-AJA has mean absolute errors ranging from 5.6° ± 5.1° to 8.5° ± 8.1° for shoulder flexion, shoulder abduction, and elbow flexion relative to joint angle measurements from goniometry. Additionally, the 3D-AJA showed relatively good performance on the classification of RULA score A using a Random Forest model (micro averages F1-score = 0.759, G-mean = 0.811), even at high levels of occlusion on the subjects’ lower limbs. The results of the study provide a basis for the development of a full-body ergonomic assessment for office workers, which can support personalized behavior change and help office workers to adjust their postures, thus reducing their risks of WMSDs.

Moral Decision-Making During COVID-19: Moral Judgements, Moralisation, and Everyday Behaviour.

The COVID-19 pandemic continues to pose significant health, economic, and social challenges. Given that many of these challenges have moral relevance, the present studies investigate whether the COVID-19 pandemic is influencing moral decision-making and whether moralisation of behaviours specific to the crisis predict adherence to government-recommended behaviours. Whilst we find no evidence that utilitarian endorsements have changed during the pandemic at two separate timepoints, individuals have moralised non-compliant behaviours associated with the pandemic such as failing to physically distance themselves from others. Importantly, our findings show that this moralisation predicts sustained individual compliance with government-recommended behaviours.

Rebuilding public trust through the lens of corporate culture: an inevitable necessity to sustain business success in Australia

PurposeThis paper aims to promote corporate culture (CC) of compliance to ensure responsible business by motivating self-felt and self-imposed strategies by corporations in Australia. It argues that the way “legal compliance” is pursued in Australia may develop undesirable features within corporate internal affairs ranging from adverse reactions to resentment rationalising or concealing of misconduct. This study showcases that the integration of corporation and ethical values in the compliance governance is inevitable to sustain productive CC and public trust in businesses.Design/methodology/approachThis research is based on existing primary and secondary legal resources and different reports, including the Royal Commission’s Report 2019 and public submissions. It attempts to establish a claim that a self-felt and self-motivated approach to legal compliance contemplated by commitment and devotion to the company, and its consumers instead of external control can achieve consistent and positive outcomes that benefit both the company and its stakeholders.FindingsWhile the sanction-deterrence based legal directives provide a strong and sophisticated foundation for detecting and punishing inappropriate culture and have traditionally been effective in fostering compliance, the inclusion of ethical values in the regulatory approach and self-led corporate strategies are required to stimulate sustained compliance, accountability and public trust.Practical implicationsThere has been a dearth of intellectual inquiries (to the best of the author’s knowledge) about the role of CC and self-imposed corporate strategies in ensuring legal compliance. This paper will contribute to filling this gap in the legal literature and the wider academic deliberation on the standard and effectiveness of CC.Originality/valueThis research is the author’s original work and has not been submitted elsewhere for publication.

Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder.

In this review, we first present a case of chronic myeloid leukemia with acute psychosis, and then we will discuss the incidence of cancer in patients with psychotic disorders, the manifestations of new-onset psychosis, and the prevalence of preexisting psychosis in cancer patients, coupled with their impact on the treatment, diagnosis, and prognosis of cancer. This was a case that presented with acute psychosis and was found to have an elevated white blood cell count upon admission to an inpatient psychiatric unit. He was diagnosed with chronic myeloid leukemia and successfully managed with imatinib/dasatinib therapy. Psychiatrically, he was stabilized on two long-acting injectable medications to help maintain adherence. We were able to eliminate his active psychotic symptoms and return him to normal functioning in affect and thinking, achieving sustained compliance with treatment. We identified multiple inconsistencies in screening for cancer of all types in these patients, masking of signs and symptoms that would typically clue physicians to the presence of cancers, underreporting of symptoms, and disparate access to healthcare resources in patients with mental disorders when compared to the general population. Treatment of cancer in these patients as compared to the general population has also been shown to be incongruent, which will be elaborated upon. Psychiatric interventions, as well as supportive measures, for treating patients who are facing challenges during active cancer treatment will be discussed.