The '5 Moments for Hand Hygiene': casting a critical eye on the implications for practice.

The '5 Moments' approach is a time-space framework that delineates when hand hygiene should be performed and provides a resource for educators and auditors. It has become the dominant paradigm for organisations, practice, policy, and research in relation to hand hygiene. It is a concept that adopts the 'precautionary principle' that if the relative risk of a specific care task is unknown, a safe system must be to treat them on an equal level.

Long-term health care costs following COVID-19: implications for pandemic preparedness.

Objectives: To estimate excess health care costs in the 12 months following COVID-19 diagnosis.

Study Design: Retrospective cohort study using Blue Cross Blue Shield of Rhode Island claims incurred from January 1, 2019, to March 31, 2022, among commercial and Medicare Advantage members.

Methods: Difference-in-differences analyses were used to compare changes in health care spend between the 12 months before (baseline period) and the 12 months after (post period) COVID-19 diagnosis for COVID-19 cases and contemporaneous matched controls without COVID-19.

Emotional intelligence: Its place in infection prevention and control.

Background: The Infection Prevention Societies Competency Framework is a detailed tool that recognises the multi factorial work of Infection Prevention and Control Teams. This work often takes place in complex, chaotic and busy environments where non-compliance with policies, procedures and guidelines is endemic. As reductions in Healthcare Associated Infection became a health service priority the tone of Infection Prevention and Control (IPC) became increasingly uncompromising and punitive.

On the interdependence of ketone body oxidation, glycogen content, glycolysis and energy metabolism in the heart.

In heart, glucose and glycolysis are important for anaplerosis and potentially therefore for d-β-hydroxybutyrate (βHB) oxidation. As a glucose store, glycogen may also furnish anaplerosis. We determined the effects of glycogen content on βHB oxidation and glycolytic rates, and their downstream effects on energetics, in the isolated rat heart.

Footwear characteristics and foot problems in community dwelling people with stroke: a cross-sectional observational study.

Purpose: To explore footwear characteristics and foot problems in community dwelling people with stroke as most research to date focused on the general elderly population.

Methods: Thirty people with mild to moderate stroke (nine men, mean age 68, mean time since onset 67 months) attended a single session to assess footwear and foot problems using established podiatry foot (wear) and ankle assessments.

Results: Most participants wore slippers indoors ( = 17, 57%) and walking shoes outdoors ( = 11, 37%).

Copy rats: Learning by observation during a foraging task by rats.

In two experiments, rats observed expert foragers in a laboratory foraging task. In both experiments, 12 towers with a food cup on top of each tower were placed in a circle. Six towers, marked with black and white stripes, had cups baited with cheese, and were located in randomly selected positions on successive trials.

Potential role for pyruvate kinase M2 in the regulation of murine cardiac glycolytic flux during in vivo chronic hypoxia.

Carbohydrate metabolism in heart failure shares similarities to that following hypoxic exposure, and is thought to maintain energy homoeostasis in the face of reduced O2 availability. As part of these in vivo adaptations during sustained hypoxia, the heart up-regulates and maintains a high glycolytic flux, but the underlying mechanism is still elusive. We followed the cardiac glycolytic responses to a chronic hypoxic (CH) intervention using [5-3H]-glucose labelling in combination with detailed and extensive enzymatic and metabolomic approaches to provide evidence of the underlying mechanism that allows heart survivability.

The use of military planning techniques to manage outbreaks of novel infections in acute inpatient settings: development of an 'infection control estimate' (ICE).

Outbreaks of infection create unique challenges to healthcare leaders and members of infection control teams who lead efforts to manage, control and resolve outbreaks. This is especially true during outbreaks of novel pathogens which may require atypical control methods reflecting the unknowns inherent in such situations. Healthcare providers within the UK have adopted various structures and models of infection prevention and control (IPC) service reflecting the individual needs of different organisations.

Recognition and management of sepsis: the nurse's role.

Caring for a patient with suspected sepsis is a challenging nursing role. Early recognition and appropriate management of a patient with sepsis saves lives. Nurses play a fundamental role in detecting changes in physiological observations that could indicate the onset of sepsis.

The trouble with footwear following stroke: a qualitative study of the views and experience of people with stroke.

Foot problems and suboptimal footwear are risk factors for falls among the elderly. Footwear choice may, therefore, be important for people with balance impairment following stroke, but little is known about their experience. This study explored foot problems experienced following stroke, factors influencing footwear choices and views of footwear in use.

Organ donation: reducing the risk of health care-associated infection.

Health care-associated infection is a real and relative risk within the realm of organ donation. Despite detailed guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on the microbiological safety of human organs, tissues and cells used in transplantation, the topic has received limited exposure in the literature. This paper will give a context to the Safety of Blood, Tissues and Organs guidance, outline the key recommendations for mandatory/recommended screening and provide a summary of infections that may be present at the time of donation that require careful risk assessment.

Domesticated dogs (Canis familiaris) tend to follow repeated deceptive human cues even when food is visible.

There is abundant evidence that domestic dogs (Canis familiaris) readily follow pointing and other cues given by humans. But there has been much less research into the question of whether dogs can learn to discriminate between different humans giving repeated honest or dishonest cues as to food location, by ignoring the information imparted by the deceiver. Prior research has demonstrated that even after repeated exposures to deceptive cues with respect to food location, dogs failed to learn to ignore those cues completely.

Increasing cardiac pyruvate dehydrogenase flux during chronic hypoxia improves acute hypoxic tolerance.

Key Points: The cardiac metabolic reprogramming seen in heart diseases such as myocardial infarction and hypertrophy shares similarities with that seen in chronic hypoxia, but understanding of how the hypoxic heart responds to further hypoxic challenge - hypoxic tolerance - is limited. The pyruvate dehydrogenase complex serves to control irreversible decarboxylation of pyruvate within mitochondria, and is a key regulator of substrate metabolism, potentially regulating hypoxic tolerance. Acute activation of the pyruvate dehydrogenase complex did not improve cardiac function during acute hypoxia; however, simultaneous activation of the pyruvate dehydrogenase complex during chronic hypoxic exposure improved tolerance to subsequent acute hypoxia.

A survey exploring self-reported indoor and outdoor footwear habits, foot problems and fall status in people with stroke and Parkinson's.

Background: Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson's explored people's choice of indoor and outdoor footwear, foot problems and fall history.

Methods: Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson's UK groups and stroke clubs in the wider Southampton area, UK.

Novel ketone diet enhances physical and cognitive performance.

Ketone bodies are the most energy-efficient fuel and yield more ATP per mole of substrate than pyruvate and increase the free energy released from ATP hydrolysis. Elevation of circulating ketones via high-fat, low-carbohydrate diets has been used for the treatment of drug-refractory epilepsy and for neurodegenerative diseases, such as Parkinson's disease. Ketones may also be beneficial for muscle and brain in times of stress, such as endurance exercise.

The von Hippel-Lindau Chuvash mutation in mice alters cardiac substrate and high-energy phosphate metabolism.

Hypoxia-inducible factor (HIF) appears to function as a global master regulator of cellular and systemic responses to hypoxia. HIF pathway manipulation is of therapeutic interest; however, global systemic upregulation of HIF may have as yet unknown effects on multiple processes. We used a mouse model of Chuvash polycythemia (CP), a rare genetic disorder that modestly increases expression of HIF target genes in normoxia, to understand what these effects might be within the heart.

Pattern Cue and Visual Cue Competition in a Foraging Task by Rats.

In 4 experiments, rats searched for food located on top of 4 of 16 towers which were arranged in a 4 × 4 matrix. The location of the baited towers was cued by visual landmark cues (the baited towers were striped, the others white) and by pattern cues (the baited towers were located in a 2 × 2 pattern within the larger 4 × 4 matrix) or simply by pattern cues without visual landmark cues. In 3 of the experiments, visual cues, after being paired with pattern cues, were removed altogether (Experiment 1), put into competition with pattern cues (Experiment 2), or made noninformative (Experiment 3).

On the pivotal role of PPARα in adaptation of the heart to hypoxia and why fat in the diet increases hypoxic injury.

The role of peroxisome proliferator-activated receptor α (PPARα)-mediated metabolic remodeling in cardiac adaptation to hypoxia has yet to be defined. Here, mice were housed in hypoxia for 3 wk before in vivo contractile function was measured using cine MRI. In isolated, perfused hearts, energetics were measured using (31)P magnetic resonance spectroscopy (MRS), and glycolysis and fatty acid oxidation were measured using [(3)H] labeling.

How language choice can affect HCAI prevention.

The financial and human costs of healthcare-associated infections have prompted many local and national policies/guidelines aimed at controlling or preventing infection. However, the language used in the discourse of this are of practice tends to lack objectivity and may make unachievable demands of staff. This article explores how such language can negatively affect staff behaviour and drive poor practice underground.

Increased oxidative metabolism following hypoxia in the type 2 diabetic heart, despite normal hypoxia signalling and metabolic adaptation.

Key Points: Adaptation to hypoxia makes the heart more oxygen efficient, by metabolising more glucose. In contrast, type 2 diabetes makes the heart metabolise more fatty acids. Diabetes increases the chances of the heart being exposed to hypoxia, but whether the diabetic heart can adapt and respond is unknown.

The application of epic3 guidelines: the complexity of practice.

Healthcare-associated infection (HCAI) is a major patient safety concern and is associated with morbidity, mortality and increased healthcare costs. Prevention and control requires a multi-modal approach, but the individual's accountability and rigorous application of standard infection prevention and control behaviours is at its core. The third instalment of the epic3 guidance ( Loveday et al, 2014a ) provided the evidence and advanced the importance of hand-hygiene behaviour, the use of non-sterile gloves and environmental cleanliness.

A discourse analysis of hand hygiene policy in NHS Trusts.

Introduction: Healthcare-associated infection is a major patient safety concern. Hand hygiene is widely thought to be the single most important measure to affect reductions but compliance is problematic. Producing policies that clearly outline the responsibilities of staff is seen as a key way to instil accountability and improve performance.

Effect of isoproterenol on myocardial perfusion, function, energy metabolism and nitric oxide pathway in the rat heart - a longitudinal MR study.

The chronic administration of the β-adrenoreceptor agonist isoproterenol (IsoP) is used in animals to study the mechanisms of cardiac hypertrophy and failure associated with a sustained increase in circulating catecholamines. Time-dependent changes in myocardial blood flow (MBF), morphological and functional parameters were assessed in rats in vivo using multimodal cardiac MRI. Energy metabolism, oxidative stress and the nitric oxide (NO) pathway were evaluated in isolated perfused rat hearts following 7 days of treatment.

Cardiac metabolism in a new rat model of type 2 diabetes using high-fat diet with low dose streptozotocin.

Background: To study the pathogenesis of diabetic cardiomyopathy, reliable animal models of type 2 diabetes are required. Physiologically relevant rodent models are needed, which not only replicate the human pathology but also mimic the disease process. Here we characterised cardiac metabolic abnormalities, and investigated the optimal experimental approach for inducing disease, in a new model of type 2 diabetes.