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PubMedDate not supplied

The effectiveness of alcohol based hand rubs and compliance with hand hygiene.

Pittet et al.'s (2000) study observed that an increase in compliance with hand hygiene, especially alcohol based hand rubs, was related to a decrease in the rate of nosocomial infections. The results of this study can be used in a group utilization project of providing information on efficacy and compliance issues related to hand hygiene. All HCWs, but most importantly nurses, can recommend hand hygiene programs on specific units to ensure client health and reduce unwanted health care cost. Feasibility issues would include teaching correct hand hygiene technique and compliance for new hospital employees and costs of educational materials. Considerations would be the length of program, location, and implementation strategies. Future research might focus on the use of a smaller sample size, where more control can be obtained, and the use of different hand hygiene techniques in the prevention of nosocomial infections.

Comment↗
PubMedDate not supplied

[The biochemical characteristics of the sensorimotor cortex in right-handed, left-handed and ambidextrous rats].

The activity of acetylcholinesterase (AChE), 5'-nucleotidase (NT), adenylate cyclase (AC) in P2 fraction of sensory-motor cortex was studied in right-handed, left-handed and ambidexters rats on the 2-nd and 45-th day after revealing preferable forepaw at taking feedstuff out of horizontal tube (1 case, 10 presentations). By bilateral (averaging right and left hemispheres) values of AChE, NT and AC ambidexters differ from animals with absolute motor preference and right-handed rats differ from left-handed ones (2-nd day). In 1.5 month differences between ambidexter and animals with preferable extremity are revealed by NT and AC activity. Chemical brain asymmetry is revealed for ambidexters (AChE, 45-th day), right-handed rats (NT, 45-th day) and left-handed animals (AC, 2-nd day). Functional importance of biochemical characteristics studied is discussed.

5'-Nucleotidase↗
PubMed2003

Independent digit movements and precision grip patterns in 1-5-month-old human infants: hand-babbling, including vacuous then self-directed hand and digit movements, precedes targeted reaching.

Previous work has described human reflexive grasp patterns in early infancy and visually guided reaching and grasping in late infancy. There has been no examination of hand movements in the intervening period. This was the purpose of the present study. We video recorded the spontaneous hand and digit movements made by alert infants over their first 5 months of age. Over this period, spontaneous hand and digit movements developed from fists to almost continuous, vacuous movements and then to self-directed grasping movements. Amongst the many hand and digit movements observed, four grasping patterns emerged during this period: fists, pre-precision grips associated with numerous digit postures, precision grips including the pincer grasp, and self-directed grasps. The finding that a wide range of independent digit movements and grasp patterns are displayed spontaneously by infants within their first 5 months of age is discussed in relation to the development of the motor system, including the suggestion that direct connections of the pyramidal tract are functional relatively early in infancy. It is also suggested that hand babbling, consisting of first vacuous and then self-directed movements, is preparatory to targeted reaching.

Aging↗
PubMed2002

The unoperated hand: the role of passive forces in hand function after tetraplegia.

Passive forces play a large role in hand function after tetraplegia. Most individuals with tetraplegia choose not to undergo surgical reconstruction of hand function and, therefore, depend on the passive properties of their musculoskeletal system to perform functional tasks. Knowledge of the levels of force needed to perform many of these tasks is lacking. Understanding the mechanics of producing passive force is important for designing adaptive tools and other devices for tetraplegic individuals. Knowledge of the passive properties of the upper extremity is important in forming treatment strategies. The passive forces produced for change to the tenodesis grasp are small but useful to the individual. Since these forces arise from basic anatomy and muscle function, they are important even after surgical restoration of hand function. Compensatory strategies for the unoperated hand probably play a role in the operated hand. The approach to surgical restoration of grasp must consider how passive forces contribute to functional outcome.

Adaptation, Physiological↗
PubMed2002

Intracortical excitability in the hand motor representation in hand dystonia and blepharospasm.

We sought to determine the activity of inhibiting and facilitating cortical circuits in areas surrounding a hand muscle motor representation in focal dystonia and in controls. In 15 patients with hand dystonia, 16 patients with blepharospasm, and age-matched controls, we applied suprathreshold transcranial magnetic stimuli with a figure-eight coil over the optimal representation of the relaxed abductor digiti minimi muscle of the dominant hand. Additional conditioning stimuli were given through a second figure-eight coil that was held either above the test coil or 2 cm or 4 cm apart in the anterior, posterior, lateral, or medial direction. We measured intracortical excitability in each of the nine positions of the conditioning coil. Intracortical inhibition was reduced in both patient groups at all conditioning coil positions. With both coils centered, the intracortical facilitation did not differ between patients and controls. After shifting the conditioning coil, the intracortical facilitation tended to be less diminished in patients than in controls, this difference between patients and controls was significant for the anterior, posterior, and medial 4-cm conditioning coil shift. Our results demonstrate decreased intracortical inhibition in the cortical hand muscle representation not only in patients with hand dystonia, but also in patients with blepharospasm. In addition, our findings in both patient groups show a trend toward a relatively increased intracortical facilitation in surrounding motor areas.

Adult↗
PubMed2006

Progressive suppression of intracortical inhibition during graded isometric contraction of a hand muscle is not influenced by hand preference.

GABAergic intracortical inhibition (ICI) in human motor cortex (M1) assists fractionated activation of muscles, and it has been suggested that hemispheric differences in ICI may contribute to hand preference. Previous studies of this issue have all been conducted at rest, with conflicting results. Testing during voluntary activation may reveal functionally relevant differences. In normal subjects, we assessed (1) operation of ICI circuits during selective activation of an intrinsic hand muscle at different forces, and (2) whether this differs between right and left hemispheres. Surface EMG was recorded bilaterally from abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles in eleven right-handed subjects. A circular coil applied paired transcranial magnetic stimulation (TMS) with posteriorly directed current in the brain. Conditioning intensity was 0.8 x active threshold and interstimulus interval was 3 ms. TMS was applied to right or left M1 while subjects were at rest or performing isometric thumb abduction at different forces (0.5, 1, 2, 3, 5 and 10 N) with the contralateral hand. Conditioning TMS was less effective at suppressing the muscle evoked potential in APB during 2-10 N thumb abduction (P < 0.0001) versus rest, but not with lower target forces (0.5, 1 N). Conditioning TMS was less effective for FDI and ADM only during 10 N thumb abduction. We conclude that differential modulation of ICI in M1 during selective muscle activation is a function of target isometric force level. At low forces (<5% MVC), ICI is not modulated for the corticospinal neurons controlling the active or inactive muscles. There is a progressive reduction of ICI effects on corticospinal neurons at higher forces, which is largely restricted to corticospinal neurons controlling the muscle targeted for activation over the range of forces tested (up to approximately 25% MVC). The pattern of ICI modulation with selective voluntary muscle contraction was similar in left and right hemispheres during this relatively simple static task. If hemispheric differences in operation of M1 ICI circuits contribute to hand preference, a more challenging finger movement protocol may be needed to demonstrate this asymmetry.

Adult↗
PubMed1997

Hand-arm symptoms related to impact and nonimpact hand-held power tools.

Hand and arm symptoms among workers using impact and non-impact hand-held power tools were investigated in a cross-sectional study and a 5-year follow-up study. The study population consisted of concrete workers (n = 103), truck assemblers (n = 234), electricians (n = 101), platers (n = 140) and lumberjacks (n = 102). Of the original 680 subjects, we followed up 312 after 5 years. A questionnaire concerning ongoing hand and arm symptoms, daily exposure to hand-held power tools, type of tool used, and individual factors was administered. More workers using low-frequency impact tools than workers using non-impact tools reported symptoms in the elbows and shoulders. Elbow symptoms were accentuated in the cross-sectional study, while shoulder symptoms were accentuated in the follow-up study. Wrist symptoms were reported by more of those working with high-frequency impact tools than of those using only non-impact tools when the analyses were controlled for age, years in the occupation and smoking habits. A possible explanation of the results found in this study is that low-frequency impact vibration is transmitted to the upper arm, and thus the elbow and shoulder are at risk, while high-frequency impact vibration is attenuated in the hand and wrist and may predominantly cause symptoms there.

Arm Injuries↗
PubMed2005

Surgical hand disinfection with a propanol-based hand rub: equivalence of shorter application times.

The aim of this study was to determine the efficacy of a propanol-based hand rub at application times shorter than 3 min. The bacterial pre-value was obtained from the finger tips (prEN 12791). Subjects treated their hands with the reference procedure (n-propanol, 60%) for 3 min or the product (crossover design). Sterillium was applied for 3, 2, 1.5 and 1 min. Four other preparations were tested for 1 min. Post-values (immediate effect) were taken from one hand, and the other hand was gloved for 3h. After the gloves were removed, the second post-value was taken (sustained effect). Sterillium was more effective than the reference procedure at 3, 2 and 1.5 min (immediate and sustained effect). The immediate effect after 1 min was significantly lower [mean log(10) reduction factor (RF): 1.91+/-0.90 vs. 2.52+/-0.95; P=0.001], whereas the sustained effect was not (mean RF: 1.81+/-1.06 vs. 2.05+/-1.14; P=0.204). All other preparations failed the efficacy requirement at 1 min for both the immediate and sustained effect. Using 2 x 3 mL Sterillium for a total of 1.5 min for surgical hand disinfection was at least as effective as the 3-min reference disinfection.

1-Propanol↗
PubMedDate not supplied

The exploded hand syndrome: logical evaluation and comprehensive treatment of the severely crushed hand.

Severe compressive trauma to the hand presents with multiple soft-tissue and osseous manifestations that often appear unrelated, leading to underrecognition and potential undertreatment of the complex injuries. Approaching the crushed hand with a logical and systematic diagnostic plan allows surgeons to recognize the location and severity of the injury portfolio and direct comprehensive treatment. Both for emphasis and for the purpose of describing the hydraulic mechanism of tissue failure, the term exploded hand syndrome is proposed. The exploded hand connotes the compendium of clinical findings that include skin failure at the webspaces or glabrous border, atypical (usually longitudinal) fracture patterns of the tubular bones, and axial carpal dissociations. These are accompanied by extensive compromise of the interosseous musculature that is extruded or may exhibit evolving compartment syndrome. Understanding the trauma mechanism and patterns of injury in the exploded hand will maximize awareness and guide surgical reconstruction and rehabilitation.

Bone Nails↗
PubMed1997

Hand function following Silastic arthroplasty of the metacarpophalangeal joints in the rheumatoid hand.

Twenty-one consecutive rheumatoid patients (23 hands, 92 joints) who underwent Silastic metacarpophalangeal joint arthroplasty between 1989 and 1993 had the 33-task Baltimore quantitative upper extremity function test prior to surgery and then repeated at intervals from 6 weeks to 1 year for all 23 hands and 3 to 4 years for 14 of the hands. In addition all hands had goniometer measurement of active range of finger joint motion and ulnar drift at each assessment. The average preoperative score was 71 improving rapidly to 89 at 6 weeks, to 91 at 1 year and 92 at 3 to 4 years. Most improvement occurred in functions requiring pinch span or hook grip and could be attributed largely to correction of ulnar drift and the change of metacarpophalangeal arc of motion. These results confirm that the Silastic metacarpophalangeal joint arthroplasty significantly improves hand function and that the improvement is maintained over a 3- to 4-year period.

Adult↗
PubMed1986

Functional evaluation of the hand and foot after one-stage toe-to-hand transfer.

Twenty toe-to-hand transfers in 17 patients with an average follow-up of 54 months have been reviewed to quantify hand function and donor morbidity. Eleven toe-to-thumb and nine toe-to-finger procedures were performed. Surgical and follow-up data were available for all patients. Twelve patients (14 procedures) were reviewed in detail, with particular attention given to foot and hand function. Total active motion after toe-to-thumb transfer was 48 degrees and 106 degrees after toe-to-finger transfer. Two-point discrimination was less than or equal to 15 mm in 13 digits (65%). Grip and pinch power were related to the number of digits present on the reconstructed hand and to the presence or absence of functioning thenar muscles. Eleven of 12 patients can walk and run normally (mean of 5 years after surgery). Six (50%) cannot wear thongs or heavy boots, but all can wear normal shoes. The transferred great toe decreased in volume by an average of 10% over the years since the operation. Transferred toes became useful digits in the hand, and foot morbidity was minor and not progressive.

Adolescent↗
PubMedDate not supplied

Hand function in workers with hand-arm vibration syndrome.

Hand-arm vibration syndrome has been specially addressed in the Scandinavian countries in recent years, but the syndrome is still not sufficiently recognized in many countries. The object of this preliminary study was to describe the nature and character of vibration-induced impairment in the hands of exposed workers. Twenty symptomatic male workers (aged 28 to 65 years) subjected to vibration by hand-held tools were interviewed about subjective symptoms and activities of daily living and were assessed with a battery of objective tests for sensibility, dexterity, grip function, and grip strength. The test results were compared with normative data. The majority of patients complained of cold intolerance, numbness, pain, sensory impairment, and difficulties in handling manual tools and in handwriting. The various objective tests showed considerable variation in indications of pathologic outcome, revealing differences in sensitivity to detect impaired hand function. Semmes-Weinstein monofilament testing for perception of light touch-deep pressure sensation, the small-object shape identification test, and moving two-point discrimination testing for functional sensibility provided the most indications of pathologic outcomes. The authors conclude that vibration-exposed patients present considerable impairment in hand function.

Activities of Daily Living↗
PubMed2002

Hand to hand.

Examination of the hands has the potential to transform the encounter between physician and patient. Taking the hands conveys a sense of warmth and connectedness and is a means to communicate the physician's mindfulness. The hands can focus the examination on the individual patient as a complete human being, and not merely a disease or a collection of symptoms. The hands provide readily accessible information that may not be available through other evaluations, and they offer clues to a patient's physical and mental health. Commonplace observations, such as those revealed in the hands, can unravel medical mysteries and provide profound clinical insights.

Hand↗
PubMed2002

Clinical double-blind trial on the dermal tolerance and user acceptability of six alcohol-based hand disinfectants for hygienic hand disinfection.

Six commercially available alcohol-based hand rubs [AHD 2000, Desderman, Mucasept A, Manorapid (Poly-Alkohol, Spitacid, and Sterillium] were investigated in a clinical double-blind trial involving 10 participants who had no previous experience of using hand rubs (Group 1), and seven who had substantial professional experience of using hand rubs (Group 2; virology laboratory staff). Group 1 was studied for one week with 20 applications on day 1 and then five applications per day for six days. Transepidermal water loss, dermal water content and superficial sebum content of the skin were measured before and after the seven-day application of the products, as well as user acceptability (self-assessment of smell, speed of drying, emolliant effect, skin dryness). Group 2 used each preparation twice for two weeks in a random sequence, and carried out self assessment at the end of each fortnight. Transepidermal water loss (mean baseline: 18.7 g/m(2)h), dermal water content (mean baseline dorsum: 75.6) and superficial sebum content (mean baseline dorsum: 4.8 microg/cm(2)) did not change significantly. In both groups assessments of the smell and the speed of drying did not reveal any significant differences between the six products. Sterillium had the best emollient effect of all products (P<0.05; Wilcoxon test and Mann-Whitney-U test) and was significantly better than Desderman, AHD 2000, and Mucasept A, causing less skin dryness after seven days use in Group 1 (P<0.05; Mann-Whitney-U test). Manorapid caused significantly less dryness than Spitacid, AHD 2000, and Mucasept A in Group 2 after the first use, but no significant difference was observed after the second use. Thus alcohol-based hand rubs that contain emolliants, irrespective of the type of alcohol (n-propanol, iso-propanol or ethanol), are well tolerated and do not dry out or irritate the skin. Personal assessments showed significant differences for the emolliant effect and the extent of dryness. Both factors are very important, as user acceptability has an impact on compliance. Sterillium is the only hand disinfectant containing mecetronium etilsulphate which has been shown to have an emolliant effect. Future research should focus on user acceptability in order to improve compliance.

Adult↗
PubMed1995

Common hand warts in athletes: association with trauma to the hand.

Forty-nine members of a university track team and 80 members of the crew team were surveyed about warts on their hands. They were also questioned about the nature and extent of their exercise, the types of equipment they used, and whether they wore protective gloves. Common hand warts were significantly more prevalent in members of the crew team than in members of the track team (25% v 10%; p < .05). Although both groups lifted weights regularly, the crew team members were less likely to use protective gloves; they sustained additional trauma to their hands from almost daily exercise on rowing machines and river practice. College health providers should question patients with hand warts about types of athletic activity and should suggest that they protect their hands by wearing weight-lifter's gloves.

Adult↗
PubMed2005

Local cold acclimation of the hand impairs thermal responses of the finger without improving hand neuromuscular function.

AIM: To investigate the effects of cold acclimation on the thermal response and neuromuscular function of the hand. METHODS: Ten healthy subjects [three female, seven male, age (mean +/- SD): 27.9 +/- 7.9 years] immersed their right hand in 8 degrees C water for 30 min, 5 days a week for 3 weeks. On the first and the last day, neuromuscular function of the first dorsal interosseus (FDI) muscle was tested. RESULTS: There was no significant change in maximal voluntary contraction strength or evoked contractile characteristics of the FDI after cold acclimation. Minimum finger temperature decreased significantly from 10.6 +/- 1.2 to 9.3 +/- 0.8 degrees C after 3 weeks (P < 0.01), with most of the decrease occurring after a single exposure. Mean finger temperature dropped significantly from 14.2 +/- 1.9 to 11.7 +/- 1.4 degrees C following cold acclimation (P < 0.05), with 90% of this adaptation occurring after 5 days. Onset time of cold-induced vasodilatation increased from 446 +/- 171 to 736 +/- 384 s (P < 0.05) and the amplitude decreased from 5.3 +/- 3.2 to 2.5 +/- 2.1 degrees C (P < 0.05). This was significantly different from the control group, who immersed their right hand on the first and last days only. CONCLUSION: These data suggest that cold acclimation does not enhance hand temperature or function but may put the hands at a greater risk of cold injury when exposed to the cold.

Acclimatization↗
PubMed1980

Ratio between the amplitude of sensory evoked potentials at the wrist in both hands of left-handed subjects.

Maximum sensory conduction velocity, duration and amplitude of the sensory evoked potentials at the wrist on stimulating digits 1, 2, 3 and 5, were determined bilaterally in 21 left-handed subjects with an age range from 6 to 47 years. The amplitude of the sensory evoked potential at the wrist was larger in the right hand. This asymmetry is the reverse of the one previously observed in right-handed infants and adults. It could be physiological and suggests a difference in density of sensory innervation between the two hands. Asymmetry of sensory innervation can be helpful in the study of hand dominance.

Adolescent↗
PubMedDate not supplied

Strength measurements of the intrinsic hand muscles: a review of the development and evaluation of the Rotterdam intrinsic hand myometer.

Numerous neurological diseases are accompanied by atrophy of the intrinsic muscles of the hand. Muscle strength testing of these muscles is frequently used for clinical decision making. Traditionally, these strength measurements have focused on manual muscle testing (MMT) or on grip and pinch strength dynamometry. We have developed a hand-held dynamometer, the Rotterdam Intrinsic Hand Myometer (RIHM), to measure this intrinsic muscle strength. The RIHM was designed such that it can measure a wide range of muscle groups, such as the abduction and adduction strength of the little finger and index finger, the opposition, palmar abduction (anteposition) and opposition strength of the thumb, and intrinsic muscles of the fingers combined in the intrinsic plus position. We found that the reliability of RIHM measurements in nerve injury patients was comparable to grip and pinch strength measurements and is appropriate to study the functional recovery of the intrinsic muscles of the hand in isolation. We have applied the RIHM in a recent study on the long-term outcome of muscle strength in patients with ulnar and median nerve injuries and found that while recovery of grip and pinch strength was relatively good, recovery of the ulnar nerve innervated muscles measured with the RIHM was poor. This poor recovery could not be detected with manual muscle strength testing or with grip and pinch dynamometry. We conclude that the RIHM provides an accurate clinical assessment of the muscle strength of the intrinsic hand muscles that adds valuable information to MMT and grip and pinch dynamometry.

Equipment Design↗