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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↗

PubMed2002

Spectrum of antimicrobial activity and user acceptability of the hand disinfectant agent Sterillium Gel.

The antimicrobial efficacy of alcohol-based hand gels has been shown to be significantly less than liquid hand rubs probably because of a lower concentration of alcohol. Sterillium Gel is the first hand gel with 85% ethanol. Its antimicrobial efficacy and user acceptability was studied. Bactericidal activity was tested according to prEN 12054 against Staphylococcus aureus, Enterococcus hirae, Pseudomonas aeruginosa and Escherichia coli (suspension test) and EN 1500 (15 volunteers; four replicates), fungicidal activity according to EN 1275 against Candida albicans and spores of Aspergillus niger (suspension test) and tuberculocidal activity against Mycobacterium terrae using the DGHM suspension test. Virucidal activity was determined in suspension tests based on reduction of infectivity with and without interfering substances (10% fetal calf serum; 0.3% erythrocytes and 0.3% bovine serum albumin). Ninety-six healthcare workers in hospitals in France and the UK used the gel for four weeks and assessed it by filling out a questionnaire. The gel was bactericidal (a reduction factor of > 10(5)-fold), tuberculocidal (reduction factor > 10(5)) and fungicidal (reduction factor > 10(4)) in 30 s. Irrespective of interfering substances the gel inactivated orthopoxvirus and herpes simplex virus type 1 and 2 in 15 s, adenovirus in 2 min, poliovirus in 3 min and papovavirus in 15 min by a factor of > 10(4)-fold. Rotavirus and human immunodeficiency virus were inactivated in 30 s (without interfering substances). Under practical use conditions it was as effective in 30 s as the reference alcohol in 60 s. Most users described the tackiness, aggregation, skin feeling after use and smell as positive or acceptable. A total of 65.6% assessed the new gel to be better than a comparator irrespective of its type (gel or liquid). Overall Sterillium Gel had a unique spectrum of antimicrobial activity. It is probably the first alcohol-based hand gel to pass EN 1500 in 30 s. Due to the excellent acceptance by healthcare workers it may significantly improve compliance for hand hygiene and thereby help to reduce the incidence of nosocomial infection.

Attitude of Health Personnel↗

PubMed1999

Acceptable regret in medical decision making.

When faced with medical decisions involving uncertain outcomes, the principles of decision theory hold that we should select the option with the highest expected utility to maximize health over time. Whether a decision proves right or wrong can be learned only in retrospect, when it may become apparent that another course of action would have been preferable. This realization may bring a sense of loss, or regret. When anticipated regret is compelling, a decision maker may choose to violate expected utility theory to avoid regret. We formulate a concept of acceptable regret in medical decision making that explicitly introduces the patient's attitude toward loss of health due to a mistaken decision into decision making. In most cases, minimizing expected regret results in the same decision as maximizing expected utility. However, when acceptable regret is taken into consideration, the threshold probability below which we can comfortably withhold treatment is a function only of the net benefit of the treatment, and the threshold probability above which we can comfortably administer the treatment depends only on the magnitude of the risks associated with the therapy. By considering acceptable regret, we develop new conceptual relations that can help decide whether treatment should be withheld or administered, especially when the diagnosis is uncertain. This may be particularly beneficial in deciding what constitutes futile medical care.

Brain Ischemia↗

PubMed2026

Acceptability and Feasibility of an Educational Intervention to Improve Researcher-Participant Interactions in a Neonatal Intensive Care Unit Clinical Trial: Research Team Feedback on the BRIEF Intervention.

OBJECTIVE: Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communication-oriented recruitment training among pediatric clinical research teams. Our objective was to evaluate the feasibility and acceptability of Better Research Interactions for Every Family (BRIEF), a multipart educational intervention to improve relationship-based conversations about clinical trial enrollment with families in the neonatal setting. STUDY DESIGN: We piloted BRIEF in partnership with a neonatal clinical research team. Research team members completed surveys following the BRIEF intervention's online module and the BRIEF group training session. They completed self-assessments after consent discussions before and after the BRIEF intervention, in which they rated their achievement of recruitment skills taught in BRIEF. Research team members also completed a final study interview to provide feedback on the intervention components, training content, and use of skills in practice. RESULTS: All nine research team members completed all components of BRIEF. Survey responses showed moderate to low satisfaction with previous recruitment training before BRIEF and high satisfaction with the BRIEF training. Self-assessments showed significant increases in reported partnership with bedside nursing (p = 0.02) and confirmation of family names (p = 0.05) after BRIEF training. Interviews provided further evidence of overall satisfaction with the BRIEF training, its content, and the skills learned, as well as opportunities for improvement, particularly in supporting challenging conversations. CONCLUSION: This pilot study demonstrated the feasibility and acceptability of the BRIEF intervention, as well as opportunities for improvement in future training. KEY POINTS: · It was feasible to implement the BRIEF researcher training in a single-site NICU trial.. · BRIEF training was acceptable to research team members.. · BRIEF training shows potential to improve relationship-based research communication..

Humans↗

PubMed2006

[Acceptance and practicability of a guideline for rehabilitation in coronary artery disease].

BACKGROUND: Developed within the German Pension Insurance scheme's Guidelines programme, the Guideline for Rehabilitation in Coronary Artery Disease has been publicly available since January 2005. Pension Insurance routine data on the therapeutic benefits and services provided (based on the Classification of Therapeutic Procedures, KTL) were analyzed to assess the extent to which rehabilitation facilities had complied with Guideline requirements already in 2004. In January 2005, the results were disseminated together with the Guideline to the rehabilitation facilities which had participated in Pension Insurance rehabilitation of patients with coronary artery disease in 2004. In an accompanying survey information was requested concerning acceptability and applicability of the Guideline, of the presentation of KTL data, as well as reasons for non-adherence to Guideline requirements. METHODS: In February 2005 a written, anonymous survey was conducted among 72 clinical directors of rehabilitation facilities. The survey instrument contained three standardized questionnaires covering the aspects cited above. The response rate was 73.6 % (n = 53). Descriptive analyses were performed. RESULTS: Views of the Guideline: The Guideline fulfils most of the seven quality attributes surveyed (completely fulfilled: 11.3-32.7 %, basically fulfilled: 49.1-64.2 %). Volume, structure and clarity of the guideline are judged to be "very good" by 62.3 %, 50.9 % and 36.5 % of the respondents. The KTL-procedure codes forming part of the Guideline to be used to assess guideline adherence, were considered appropriate by 88.5 % to 98 %. Consent to Guideline requirements varies between 80.8 and 34.6 %. Views of the audit feedback based on KTL-data: Depending on the various data table types, 37.7 % to 20.0 % of the respondents stated that the tables should remain unchanged in future evaluations. 28.0 % to 39.0 % consider the tables to be very useful for quality management. Reasons for non-adherence to Guideline recommendations: according to the clinicians, the most important reason for deviation from Guideline requirements is incomplete or incorrect coding of therapeutic procedures. DISCUSSION: The Guideline for Rehabilitation in Coronary Artery Disease basically fulfils the formal, methodological and content-related quality criteria considered to be most relevant by the clinical directors. As expected, the greatest need for discussion is focussed on the actual Guideline requirements. Form and content of the KTL-feedback are well accepted, and the feedback itself is considered relevant for everyday practice. The main reason given for non-adherence to guideline requirements (i. e., inaccurate coding) should not be overstated as the KTL-analyses was based on data from 2004, when the guideline had not yet been published. CONCLUSION: The Guideline for Rehabilitation in Coronary Artery Disease is acceptable and practicable, and it is moreover tied in with external quality assurance activities in place (i. e., the quality assurance programme of the statutory Pension Insurance scheme). The audit feedback given in this framework provides rehabilitation facilities participating in the programme not only with comparative analyses but also with input for their internal quality management actions. Future activities within the external quality assurance programme should inter alia focus on more targeted implementation activities and repeated KTL-based appraisals.

Attitude of Health Personnel↗

PubMed2006

[Acceptance of a psychometric routine diagnostics and quality monitoring system among psychotherapists in inpatient psychosomatic rehabilitation].

OBJECTIVE: Psychotherapists are considered to be sceptical of empirical measures of quality assurance. It is generally recognised that the success of these measures mainly depends on how they are accepted by the people involved. METHODS: The acceptance of a quality monitoring system among psychotherapists was investigated with a standardised assessment instrument. RESULTS: Practical relevance and practicability of the system were judged positively on the following dimensions: "support of clinical diagnostics", "examination of the outcome", "reflecting on the therapeutic process", "documentation", "integration in the therapeutic process", "pressure to succeed and control" and "work loading". The factors "professional experience", "profession" and "sex" had just a small influence on the degree of acceptance of the quality monitoring system. CONCLUSIONS: Psychotherapists consider a practically relevant and economical quality monitoring system as useful.

Attitude of Health Personnel↗

PubMed1994

[Acceptance of electronic data processing supported documentation of ultrasound findings in routine clinical practice. A survey].

We carried out a survey to determine the acceptance of the ultrasound documentation software, CUBUS, in clinical practice. Since August 1, 1988, CUBUS, versions V1.01 to V2.02 has been employed in clinical routine. By October 1991 10,850 reports had been stored in version 2.02. The software is installed on a personal computer (Siemens PCD-2, 40MB, 640 KB RAM) to which a laserprinter is connected. The work of operating the system is shared between the nursing and medical staff. In order to investigate the acceptance of the printed reports produced with this system, we carried out a poll among the physicians working at the hospital. Among the 86 physicians who receive 95% of the US reports, 58% (n = 50) responded. On the basis of the categories good, satisfactory, adequate and poor, we requested an assessment of layout, presentation, comprehension, completeness and overall impression. The overall impression was assessed as good or satisfactory in 34% and 42%, respectively. In the case of the individual criteria (see above), the categories good and satisfactory scored 62% and 34%, 58% and 32%, 68% and 18% and 72% and 24%, respectively. The terminology used was accepted by 84%. Addition of, for example, image documentation, and endosonography, will expand the advantages of the input of findings and further improve the good overall impression made by the report printout in our survey, so that the relatively long input time requirement accounting for some 30% of the total examination time, is accordingly justified.

Attitude of Health Personnel↗

PubMed1998

[Acceptance of digital image distribution in a "filmless hospital"].

PURPOSE: Since October 1996 a hospital-wide digital image distribution has been added to the PACS of the central radiology department in the Barmherzigen Brüder hospital in Regensburg. In this way an almost film-less procedure has been realized in the hospital. An extensive questioning of the non-radiology physicians is intended to determine the strengths and weakness of the digital image distribution and the general acceptance of the system. MATERIALS AND METHODS: The installed system consists of the PACS of the radiology department and 50 image distribution work stations in all outpatient departments, wards, and operating theaters. RESULTS: 78.8% of the non-radiology physicians of the main departments participated in the study. The acceptance by the participants was highly positive; 90% of them experienced a facilitation of the routine work. CONCLUSIONS: The digital image distribution is also accepted by non-radiology physicians and makes a major contribution to the improvement of procedures in clinical routine.

Attitude of Health Personnel↗

PubMed2005

Comparison of efficiency and bias of free energies computed by exponential averaging, the Bennett acceptance ratio, and thermodynamic integration.

Recent work has demonstrated the Bennett acceptance ratio method is the best asymptotically unbiased method for determining the equilibrium free energy between two end states given work distributions collected from either equilibrium and nonequilibrium data. However, it is still not clear what the practical advantage of this acceptance ratio method is over other common methods in atomistic simulations. In this study, we first review theoretical estimates of the bias and variance of exponential averaging (EXP), thermodynamic integration (TI), and the Bennett acceptance ratio (BAR). In the process, we present a new simple scheme for computing the variance and bias of many estimators, and demonstrate the connections between BAR and the weighted histogram analysis method. Next, a series of analytically solvable toy problems is examined to shed more light on the relative performance in terms of the bias and efficiency of these three methods. Interestingly, it is impossible to conclusively identify a "best" method for calculating the free energy, as each of the three methods performs more efficiently than the others in at least one situation examined in these toy problems. Finally, sample problems of the insertion/deletion of both a Lennard-Jones particle and a much larger molecule in TIP3P water are examined by these three methods. In all tests of atomistic systems, free energies obtained with BAR have significantly lower bias and smaller variance than when using EXP or TI, especially when the overlap in phase space between end states is small. For example, BAR can extract as much information from multiple fast, far-from-equilibrium simulations as from fewer simulations near equilibrium, which EXP cannot. Although TI and sometimes even EXP can be somewhat more efficient in idealized toy problems, in the realistic atomistic situations tested in this paper, BAR is significantly more efficient than all other methods.

Bias↗

PubMed2004

Effect of fat replacement by inulin or lupin-kernel fibre on sausage patty acceptability, post-meal perceptions of satiety and food intake in men.

The present study examined whether replacing fat with inulin or lupin-kernel fibre influenced palatability, perceptions of satiety, and food intake in thirty-three healthy men (mean age 52 years, BMI 27.4 kg/m(2)), using a within-subject design. On separate occasions, after fasting overnight, the participants consumed a breakfast consisting primarily of either a full-fat sausage patty (FFP) or a reduced-fat patty containing inulin (INP) or lupin-kernel fibre (LKP). Breakfast variants were alike in mass, protein and carbohydrate content; however the INP and LKP breakfasts were 36 and 37 % lower in fat and 15 and 17 % lower in energy density respectively compared with the FFP breakfast. The participants rated their satiety before breakfast then evaluated patty acceptability. Satiety was rated immediately after consuming the breakfast, then over the subsequent 4.5 h whilst fasting. Food consumed until the end of the following day was recorded. All patties were rated above 'neither acceptable or unacceptable', however the INP rated lower for general acceptability (P=0.039) and the LKP lower for flavour (P=0.023) than the FFP. The LKP breakfast rated more satiating than the INP (P=0.010) and FFP (P=0.016) breakfasts. Total fat intake was 18 g lower on the day of the INP (P=0.035) and 26 g lower on the day of the LKP breakfast (P=0.013) than the FFP breakfast day. Energy intake was lower (1521 kJ) only on the day of the INP breakfast (P=0.039). Both inulin and lupin-kernel fibre appear to have potential as fat replacers in meat products and for reducing fat and energy intake in men.

Adult↗

PubMed2005

Effect of cycle time and duty cycle on psychophysically determined acceptable levels in a highly repetitive task.

Psychophysical methodology has been used to develop guidelines for lifting and more recently similar methods have been applied to repetitive upper limb movements. While a range of cycle times are usually used, there is often no control for duty cycle. The purpose of this paper is to present psychophysically determined acceptable torques for a common upper limb task, with both cycle time and duty cycle conditions set by the researcher. Eight female participants, sitting at adjustable workstations, performed a simulated in-line screw running task. A computer-controlled torque motor applied a torque every 3, 6, 12 or 20 s with a duty cycle of 25, 50 or 83%. The participants worked with one set of conditions each day and self-selected the highest torque that they felt was acceptable without developing undue pain and discomfort. Duty cycle was found to significantly affect the amount of torque selected. With duty cycle controlled, cycle time was no longer found to have any significant effect on selected torque. Acceptable torques for 25, 50 and 83% duty cycles were 1.09, 0.9 and 0.73 Nm. Discomfort and stiffness were concentrated on the back of the hand and on the thumb web. These findings suggest that increased perception of discomfort with increased frequency (decreased cycle time) may be related to decreased rest/recovery time for muscles.

Adult↗

PubMed1992

Acceptable workloads for three common mining materials.

A series of psychophysical lifting studies was conducted to establish maximum acceptable weights of lift (MAWL) for three supply items commonly handled in underground coal mines (rock dust bags, ventilation stopping blocks, and crib blocks). Each study utilized 12 subjects, all of whom had considerable experience working in underground coal mines. Effects of lifting in four postures (standing, stooping under a 1.5 m ceiling, stooping under a 1.2 m ceiling, and kneeling) were investigated together with four lifting conditions (combinations of lifting symmetry and lifting height). The frequency of lifting was set at four per min, and the task duration was 15 min. Posture significantly affected the MAWL for the rock dust bag (standing MAWL was 7% greater than restricted postures and kneeling MAWL was 6.4% less than stopped); however, posture interacted with lifting conditions for both of the other materials. Physiological costs were found to be significantly greater in the stooped postures compared with kneeling for all materials. Other contrasts (standing versus restricted postures, stooping under 1.5 m ceiling versus stopping under 1.2 m ceiling) did not exhibit significantly different levels of energy expenditure. Energy expenditure was significantly affected by vertical lifting height; however, the plane of lifting had little influence on metabolic cost. Recommended acceptable workloads for the three materials are 20.0 kg for the rock dust bag, 16.5 kg for the ventilation stopping block, and 14.7 kg for the crib block. These results suggest that miners are often required to lift supplies that are substantially heavier than psychophysically acceptable lifting limits.

Accidents, Occupational↗

PubMed1994

Self-discrepancies and perceived peer acceptance.

We examined developmental changes in the self and the relationship between such changes and perceived peer acceptance in a sample of 414 6- to 11-year-old Australian children (211 boys, 203 girls) who completed a self-discrepancy scale and a perceived peer acceptance scale specifically constructed for this study. Resulting scores suggested that critical periods in developmental changes in the structure of the self occur at about 7 to 8 years and that a relationship exists between the reporting of a comparative large number and a larger size of discrepancies and a perception of lack of peer acceptance.

Age Factors↗

PubMed1998

Acceptance of disability and its correlates.

In a sample of 1,266 U.S. adults with disabilities, relationships were examined between acceptance of disability and (a) demographic characteristics (age, gender, race, education, marital status, and income); (b) disability conditions (disability onset, multiple disabilities, and chronic pain); and (c) other psychosocial factors (self-esteem, emotional support, perceived discrimination, and hostility). Self-esteem and emotional support from family and friends played important roles in the participants' adjustment to disability. Furthermore, perceived social discrimination against people with disabilities had a significant impact on acceptance of disability. Disability conditions such as acquired disability, multiple disabilities, and chronic pain were also important variables related to disability acceptance.

Adaptation, Psychological↗

PubMed2004

Demonstration of the effectiveness and acceptability of self-study module use in residency education.

Educators face increasing challenges to promote lifelong learning skills, to include new content areas in an already full curriculum and to maximize limited resources for curriculum implementation. Self-study modules (hereafter modules) offer potential solutions. Three modules on preventive medicine topics were evaluated in Family Medicine residencies. A retrospective pre-/post-test of a resident's ability to meet the module's objectives was used for evaluation. Additionally, residents rated the appropriateness and acceptability of the modules, their preference for 13 methods of learning, and completed a multiple-choice knowledge test. This study demonstrates the effectiveness of modules at multiple levels of evaluation in accordance with a modified version of Kirkpatrick's hierarchy of levels of evaluation. Residents found the modules to be acceptable and useful. Significant gains were seen in residents' abilities to meet objectives. The multiple-choice knowledge test was used to demonstrate mastery of the module materials at an appropriate performance level for future practitioners. Module use was in the top five choices of preferred learning methods. No correlation was seen between residents' preference for learning using modules and educational outcomes. Modules are an effective and acceptable learning method for residents. Even those who prefer other learning methods show improved educational outcomes.

Humans↗

PubMedDate not supplied

Validation and regulatory acceptance of new carcinogenicity tests.

The 3 Rs concept, which was developed by Russell and Burch in 1959, was implemented into the legal framework in the European Union(EU) for the protection of vertebrate animals used for experimental and other scientific purposes, when Directive 86/609/EEC was adopted in 1986. To reduce or replace animal testing for regulatory purposes, nonanimal tests must be independently validated to prove that they can provide information that is relevant and reliable for hazard prediction in vivo. At the end of the 1980s, no scientific concept existed for the formal validation ofin vitro toxicity tests, so a small group of European and American scientists developed a set of principles for experimental validation, which was accepted internationally by the OECD in 1996. A major breakthrough was the acceptance in the EU of the scientifically validated in vitro toxicity test for phototoxic potential in 2000, which was accepted by the OECD at the worldwide level in 2002. Taking the progress in the development and validation of alternative toxicity tests during the past decade into account, the current concepts of developing alternatives to the standard 2-year rodent bioassay for carcinogenicity testing are discussed.

Animal Testing Alternatives↗

PubMedDate not supplied

Speech rate effects upon intelligibility and acceptability of dysarthric speech.

Sentences recorded by four speakers with dysarthria and two control speakers were presented to listeners at three different rates: habitual, a 30% slower rate and a 30% higher rate. Rate changes were made by digitally manipulating the habitual sentences. Thirty young normal adult listeners rated the sentences for intelligibility (per cent correct words) and acceptability (via 9-point equal interval scale ranging from "terrible" through "excellent"). Intelligibility for each speaker remained unchanged across rate changes. Acceptability improved as rates increased for the two more intelligible impaired speakers. For the less intelligible impaired speakers, ratings were better and similar for the habitual and fast speaking rate conditions. Results are discussed in terms of the objective nature of intelligibility ratings vs. the subjective ratings of acceptability.

Aged↗

PubMed2004

Acceptability for French people of physician-assisted suicide.

Our aim was to understand better how people judge the acceptability of physician-assisted suicide (PAS). We found that, for people in France of all ages and for elderly people with life-threatening illnesses, acceptability is an additive combination of the number of requests for PAS, the patient's age, the amount of physical suffering, and the degree of curability of the illness, not only when judging for hypothetical patients, but also for their spouses and for themselves. PAS can be highly acceptable to people even when the patient does not satisfy all the criteria of legislation about PAS.

Adult↗