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PubMed2005

Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: comparison of use of 2 dispenser systems.

BACKGROUND: Adherence to hand hygiene standards is poor. Approaches and systems to improve hand hygiene practices warrant testing. OBJECTIVE: To compare the frequency of use of manually operated and touch-free dispensers of sanitizer for hand hygiene. METHODS: Manual and touch-free dispensers of alcohol sanitizer were placed in the emergency department and an intensive care unit of a large pediatric hospital for two 2-month periods for each type of dispenser. Counting devices installed in each dispenser and direct observations were used to determine actual frequency of and indications for hand hygiene. RESULTS: The touch-free dispensers were used significantly more often than were the manual dispensers. The means for the number of episodes of hand hygiene per hour were 4.42 for the touch-free dispensers and 3.33 for the manual dispensers (P=.04); the means for the number of episodes per patient per hour were 2.22 and 1.79, respectively (P=.004); and the means for the number of uses of the dispenser per day were 41.2 and 25.6, respectively (P=.02). However, the overall compliance rate was 38.4% (2136 episodes of hand hygiene per 5568 indications for hand hygiene). CONCLUSIONS: The type of dispensing system influenced hand hygiene behavior. Nevertheless, overall hand hygiene compliance remained low. In order for interventions to have a major effect on hand hygiene, multiple factors must be considered.

Education, Continuing↗

PubMed2005

Hand dermatitis: a problem commonly affecting nurses.

Hand dermatitis is regarded as one of the most often observed dermatological disorders among nurses. The factors that increase the risk of developing hand dermatitis are as follows: frequent washing hands, using disinfectants, wet-work conditions, exposure to medical substances, detergents and wearing rubber gloves. Most cases of occupational hand dermatitis is due to chronic exposure to irritants that cause the inflammation on the nonallergic pathway. Recurring contact to irritants disturbes the natural skin barrier and causes inflammation. There are reports showing the presence of skin barrier alterations among nurses working in operating room units. The most common contact allergens in the hospital environment include rubber, latex, medicaments and antiseptic products. In our study the incidence of self-reported hand dermatitis in hospital staff was very high. About 70% of respondents declared the presence of symptoms of hand eczema within the last 12 months and about 46% of the studied group had skin lesions at the moment of self-examination. Almost 75% of employees with hand dermatitis had observed the worsening of skin problems in relation to work and 79% reported improvement of skin changes during the leisure time. We also noted that a personal or family history of atopy increases the risk of developing hand dermatitis in nurses. We would also like to emphasize the psychological consequencies that affect nurses with hand dermatitis. According to our data 48% of hospital employees with hand eczema declare psychological distress caused by their skin lesions.

Adult↗

PubMed1991

The interaction of hand vibration with oculomanual coordination in pursuit tracking.

The effects of high frequency hand vibration (150 Hz) on simultaneous ocular and manual tracking performances were investigated in trained human subjects. First, a zero-order pursuit tracking task was performed with and without direct visual control of the hand. Second, eye tracking of an imaginary target linked to the hand was also performed. The results show that hand vibration significantly alters eye and hand tracking performances when the hand is out of sight. However, when the hand is placed in the visual field, tracking performances are less affected by vibration. Visual cues on limb segments may compensate to some extent for the vibration-induced alteration of proprioceptive information otherwise used to control movements. Eye movements are altered during vibration while the subject is tracking or fixating an imaginary target attached to the hand. These findings explicitly show that hand vibration can perturb oculo-manual coordination control. The present results imply that vibration-induced activity of somesthetic mechanoreceptors is likely to contribute to oculomanual coordination alteration and tracking decrement in vibratory environments. Furthermore, direct visual control of the hand and/or arm may be of particular interest in manipulation tasks executed under vibration.

Adult↗

PubMed1993

Hand dysfunction in patients on chronic hemodialysis.

We studied hand function by clinical examination (sensory, motor, coordination, activities of daily living), hand roentgenograms, and nerve conduction studies in 26 patients, aged 62 +/- 11 (SD) years and dialyzed by hemodialysis for 7 +/- 6 years. Multiple sensory deficits were found in 98% of the hands. Motor function and coordination were abnormal in two-thirds of the hands. Roentgenograms were abnormal in 88% of the hands. Metabolic bone disease, joint disease and extraosseous calcifications were detected often. Nerve conduction studies disclosed polyneuropathy and carpal tunnel syndrome, alone or combined, in 90% of the hands. Clinical examination was sensitive, but not specific in detecting neuropathy, and could not distinguish accurately between polyneuropathy and carpal tunnel syndrome. Organic causes of progressive severe hand dysfunction included carpal tunnel syndrome and, in diabetics only, hand gangrene. Disuse led also to hand dysfunction, even in the absence of anatomic hand disease.

Activities of Daily Living↗

PubMed1993

[The hand in hematologic diseases].

Radiography of the hand often reflects the picture of generalized diseases, affecting both the muscolo-skeletal system and the others. Some of the most common hematologic disorders may be detected in roentgenograms of the hand, especially in the anemias, but also in plasma cell dyscrasias and proliferative malignant diseases (i.e., lymphomas and leukemias). On the basis of their experience, the authors have reviewed and discussed the radiographic "pattern" of the hand in several hematologic conditions (i.e., anemias; thalassemias; sickle-cell disease; lymphomas; multiple myeloma; etc.), and their pathogenesis. Radiographies of both the hands, in antero-posterior view, were performed using Kodak-Min R film; xeroradiography was performed--in the same projection--using Rank Xerox plate, developed always in "positive mode" in 125 Rank Xerox System, conditioned with contrast "D", for emphasizing osseous details. Recently, digital radiography--employing PCR system--has substituted xeroradiography, because of its well-known properties and diagnostic advantages: in this manner, changes in bone and soft tissue are demonstrated on the same image, with augmentation of diagnostic information, with reduced dose to patient. In our series, hand is always involved (100% of cases) in thalassemias: lesions are characterized by diffuse osteopenia (washed out melted appearance), with widening of bone marrow space, diaphyseal convex aspect of the long bones, thinning of the cortex, and cyst-like changes (rain drops). Lesions disappear completely after the hypertransfusion regimen (HTR). Following chelation therapy, lesions of the wrist and hand are similar to those described in rickets and/or scurvy. Sometimes, the hand is characteristically affected in sickle-cell disease--particularly in the so called hand-foot syndrome--as "cone-deformity". In multiple myeloma incidence of hand involvement is 2.9%: lesions reflect general abnormalities observed in other skeletal sites, and they consist in multiple well-circumscribed lytic lesions. In amyloidosis, poorly defined radiolucent areas may be discovered. In non-Hodgkin lymphoma, incidence of hand involvement is less frequent, approximately 0.2%: the radiographic pattern is aspecific (mottled lytic lesions), sometimes simulating multiple myeloma and/or leukemias. In hemophilia, swelling of soft tissues, around the interphalangeal joint, related to intra-articular and/or per-articular hematoma, is observed. The other conditions reflect general radiographic features of anemias, which are of three main types: 1. the over active marrow (i.e., polycythemia); 2. the infarction of bone (i.e., sickle-cell disease); 3. non-specific findings, resulting from chronic illness (delays of maturation; dwarfism; osteopenia; tendency to infection).

Adolescent↗

PubMed1993

Examination gloves as barriers to hand contamination in clinical practice.

OBJECTIVE: To test the effectiveness of vinyl and latex gloves as barriers to hand contamination with gram-negative organisms and enterococci during routine hospital procedures. DESIGN AND INTERVENTIONS: We studied 137 procedures during which a health care worker's gloved hand contacted a patient's mucous membrane and was thus potentially contaminated with gram-negative rods or enterococci. Quantitative hand cultures were obtained from each health care worker before and after the gloved contact using a modified glove juice method, and the exterior glove surface was also quantitatively cultured after patient contact. Used gloves were then tested for leaks using the American Society for Testing and Materials' watertight test. SETTING: Harborview Medical Center, a 330-bed city-county hospital and level I regional trauma and burn center, is both a teaching facility affiliated with the University of Washington and the major provider of care to indigent and uninsured persons in Seattle-King County, Washington. PATIENTS AND OTHER PARTICIPANTS: Respiratory therapists performing endotracheal tube care on intubated intensive care unit patients, registered nurses performing digital rectal stimulation for bowel training on patients with spinal cord injury in the rehabilitation ward, and dentists performing routine dental examinations and procedures on healthy outpatients in the dental clinic. MAIN OUTCOME MEASURE AND RESULTS: Eighty-six of the 135 gloves cultured had gram-negative rods or enterococci on the external surface after use and were thus sources of potential hand contamination. Microbial contamination of the health care worker's hands occurred in 11 (13%; 95% confidence interval, 6% to 20%) of these 86 events, and was more frequent with vinyl (10 of 42) than latex (one of 44) gloves (P < .01). After use, glove leaks were also more frequent in vinyl gloves (26 of 61) than with latex gloves (six of 70) (P < .001). Even when leaks were present, gloves prevented hand contamination in 77% of instances and quantitative counts of microorganisms contaminating hands were 2 to 4 logs less than counts on external glove surfaces. Health care workers reported awareness of the presence of glove leaks in only seven (22%) of the 32 events in which leaks were subsequently demonstrated. CONCLUSIONS: Under conditions of routine use, gloves effectively function as a protective barrier even when leaks are present. Latex gloves were less frequently associated with leaks and hand contamination. Since hand contamination occurred after 13% of exposures and cannot be readily identified by health care workers, routine hand washing should be done after each patient contact.

Enterococcus↗

PubMedDate not supplied

[Hand injuries due to fireworks explosion].

Two different series of patients with burst injuries of the hand were retrospectively reviewed: one series included 23 men, 15-55 years old, referred to the emergency department for the first-instance assessment of injuries of the right hand (13 patients) and left hand (10 patients). The other series included 44 patients (42 men and 2 women, aged 7-61 years) referred to our department for second-instance examinations: the latter patients had burst injuries involving only the hands in 43 cases and both the hand and the foot in one case. We report the radiologic patterns of traumatic bone injuries (fractures and amputations) and of musculotendinous and cutaneous injuries and discuss their mechanisms and pathogenesis. The two series were compared and the results follow: in both series the right hand was more frequently involved, metacarpal bones were most often fractured and phalanges most often amputated. In the first series, in the right hand the carpal bones were involved in one patient only, the 2nd and 3rd metacarpal bones were most frequently fractured and the 2nd finger was most frequently involved. In the left hand, the carpal bones were never affected, the 1st metacarpal bone was most often amputated and the 5th metacarpal bone most often fractured; the 2nd finger was most frequently involved. In the second series, in the right hand, the 1st metacarpal bone was most frequently fractured and the 2nd metacarpal bone most often amputated; the 2nd finger was most frequently involved. In the left hand, the 4th metacarpal bone was most frequently fractured and the 5th metacarpal bone most often amputated. The severity of the above injuries and the extent of tissue damage depend on several factors, including firecracker speed, shape, size, weight and characteristics. Radiologic exams are very useful for the accurate study of these traumatic injuries, providing indirect information about musculotendinous and cutaneous involvement. Prompted by the relative lack of information on the management of these injuries, we suggest that radiologic exams be quickly performed to help choose the most appropriate surgical approach for best cosmetic and functional results.

Adolescent↗

PubMedDate not supplied

Measuring normal hand dexterity values in normal 3-, 4-, and 5-year-old children and their relationship with grip and pinch strength.

After surgery for trauma or correction of congenital anomaly, hand function is difficult to evaluate in children because there are no reference norms on children 3 to 5 years old. The purpose of this study was to determine whether reproducible normative values for hand dexterity and grip and pinch strength could be obtained in young children using simple tests that could be administered quickly within the attention span of a 3- to 5-year-old. The Functional Dexterity Test (FDT), a pegboard test validated for adults and older children, seemed to meet our requirements for dexterity. The FDT was administered to a convenience sample of normal children in a prekindergarten school who were grouped according to age: 3-year-olds (n = 17), 4-year-olds (n = 24), and 5-year-olds (n = 22). Hand dominance was determined. The task was demonstrated by 1 of the 2 testers. The child was asked to turn the pegs over in the pegboard without using the free hand or balancing the peg against the chest. Both hands were tested. Grip and pinch strengths were measured in both hands in a consistent manner. All the children were tested with the arm at the side and the elbow at 90 degrees. A dynamometer was used for grip strength and a pinch meter was used to measure key (lateral) and tripod pinch strengths. Means and SDs were calculated for each age group, and the dependent values of dexterity, strength, and dominance were correlated. Dexterity and strength scores were significantly different by age group. A good FDT score in the dominant hand was predictive of a good score in the nondominant hand. Grip and pinch strength correlated poorly with functional dexterity. The normative values established in this study for children in the 3- to 5-year-old range can be referenced for disability estimates and establishing goals for children after surgery or hand injury.

Age Factors↗

PubMed2005

Interaction between eye and hand movements in multiple sclerosis patients with intention tremor.

Deficient eye and hand movements are present in patients with multiple sclerosis. In the present study, eye and hand movements were simultaneously measured during visually guided wrist step-tracking tasks in 16 patients with intention tremor and 15 healthy controls. The coupling between eye and hand movements was analyzed during simultaneous eye-hand tracking, and interactions were studied by comparing the coordinated eye-hand condition with isolated eye- or hand-tracking conditions. Despite movement abnormalities, the onset of eye and hand movements was highly correlated and an invariant coupling between the saccadic completion time and hand peak velocity was found, suggesting that the temporal coupling was very much preserved. The differences between the experimental tracking conditions suggest that, in MS patients with intention tremor, the ocular system influenced the hand movements. Intention tremor amplitude was reduced when there was no preceding saccadic eye movement, whereas conversely, eye movements were not affected by different hand tremor severity.

Adult↗

PubMed1997

Environmental influences in hand preference: an African point of view.

In order to examine further the role of cultural and environmental factors in human manual preference, two surveys were undertaken in students from Ivory Coast and Sudan. In the first study (Abidjan, Ivory Coast) 382 secondary students, ages 12 to 22, answered a 20-item manual preference questionnaire. The observed frequency of left-hand preference was 7.9%, with very low left-hand use among the 18-22 age group (1%) and high among the 12-15 age group (14%). In the second study (Khartoum, Sudan) 759 undergraduates, ages 18 to 33, answered a 25-item questionnaire. The observed frequency of left manual preference was 5%. Subjects were also asked to indicate any pressure to change hand for writing, eating, or other manual activities and, in the second study, any upper limb injury which temporarily rendered the subject unable to use his (her) preferred hand. Report of an upper limb injury in the past was related to mixed (or inconsistent) hand preference. In both studies, the target activity against left-hand use was eating. These results show that cultural and environmental factors could change "natural" hand preference in three ways: (i) by changing the hand used for only one activity (e.g., eating), with no change for other familiar unimanual activities; (ii) by reducing the degree of hand preference; (iii) by changing the overall preferred hand, generally reducing the prevalence of left-handedness. The design of handedness studies should allow these possibilities to be distinguished.

Adolescent↗

PubMed1995

Parental hand preference and manual functional asymmetry in preschool children.

Hand preference and hand skill in 1150 normal children between 3 and 6 years of age and hand preference of their parents were assessed to study the effect of parental hand preference on different dimensions of manual asymmetry in children. Children hand skill was measured with a computerized version of the Peg Moving Task which allowed us to split the overall performance into two components, a "transport time" and a "search time." Paternal and maternal left-handedness was significantly related to child left-handedness. Both components of hand skill asymmetry were reduced with mother's left-handedness. and one component (search time) with father's left-handedness. A significant impact of paternal and preference on child hand skill asymmetry, after controlling for child hand preference, was observed. When this analysis was limited to strong right-handed children, a greater paternal effect on child hand skill emerged. These results show the usefulness of performance tasks in detecting parent-child associations concerning manual functional asymmetry.

Child Development↗

PubMed2005

Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability.

Primary motor cortex (M1) excitability is modulated by both ipsilateral limb movement and passive observation of movement of the contralateral limb. An interaction of these effects within M1 may account for recent research suggesting improved functional recovery of the impaired arm following stroke by viewing a mirror reflection of movements of the unimpaired arm superimposed over the (unseen) impaired arm. This hypothesis was tested in the present study using single-pulse transcranial magnetic stimulation (TMS) in eight neurologically healthy subjects. Excitability of M1 ipsilateral to a phasic, unilateral hand movement was measured while subjects performed paced (1 Hz), unilateral index finger-thumb opposition movements. Motor evoked potentials (MEPs) were obtained from the inactive first dorsal interosseous (FDI) in each of four viewing conditions: Active (viewing the active hand), Central (viewing a mark positioned between hands), Inactive (viewing the inactive hand) and Mirror (viewing a mirror-reflection of the active hand in a mirror oriented in the mid-sagittal plane) and with both hands at rest (Rest). MEPs were significantly enhanced during ipsilateral hand movement compared with the Rest condition (P<0.05). Largest MEPs were obtained in the Mirror condition, and this was significant compared with both the Inactive and Central viewing conditions (P<0.05). There was no difference between the dominant and non-dominant hand. Excitability of M1 ipsilateral to a unilateral hand movement is facilitated by viewing a mirror reflection of the moving hand. This finding provides neurophysiological evidence supporting the application of mirror therapy in stroke rehabilitation.

Adult↗

PubMed2006

Evaluation of Allen's test in both arms and arteries of left and right-handed people.

The Allen's test as described in 1929 by Edgar V. Allen has been modified, adapted and complemented by other newer modalities but remains a first line standard test to evaluate the arterial supply of the hand. In this study an attempt has been made to add more information regarding the arterial supply of the hand, in left- and right-handed individuals, left and right hands and the ulnar and radial arteries, when doing the Allen's test. A modified Allen's test using an oxygen saturation monitor was used. The sample group consisted of 80 (30 left-handed and 50 right-handed) students. No significant differences between the Allen's test of the left and right hands in the left and right-handed individuals were found. There was a marginal but not significant difference between the two arteries. The ulnar artery took slightly longer to reach baseline values as compared to the radial artery. The results suggest that a positive Allen's test can be found in both left and right-handed people, with regard to the left and right hands and both radial and ulnar arteries may be implicated. This information should be kept in mind when selecting either the radial or ulnar artery for grafting purposes (e.g. coronary angiosurgery) and forearm artery cannulation.

Adult↗

PubMed2003

Laparoscopic cholecystectomy in situs inversus totalis: The importance of being left-handed.

Since laparoscopic cholecystectomy has become the standard procedure for the treatment of gallstone disease, several cases have been reported in patients with situs inversus. These cases require more technically demanding procedures due to the symmetrical disposition of the anatomy. Thus, handedness could influence the performance of these operations. The two of us (L.M.O.) and (J.M.B.), a right-handed and a left-handed surgeon, respectively, placed the instruments in reverse mode from that used in orthotopic patients. The right-handed surgeon felt more impairment when dissecting with his left hand and decided to cross the instruments within the abdomen. The left-handed surgeon was able to alternate the performance of the dissection maneuvers between the right and left hands. Surgical procedures are apparently designed for right-handed surgeons and can be approached by the left-handed in alternative ways. In fact, the accommodation of laparoscopic cholecystectomy to left-handedness has been described in the literature. The rare opportunity to operate in a symmetrical way allows the right-handed surgeon to understand the absence of comfort and ergonomy often experienced by left-handed colleagues.

Aged↗

PubMed1989

Right-hand superiority for throwing but not for intercepting.

In humans, the organization of movements performed by both upper limbs, relies significantly on a left hemisphere "praxis" system that also subsumes speech function. Right hand preference may also be an expression of this left hemisphere dependence, arising from the preferential connections of the right hand to the left hemisphere. Consequently, a manual task that maximizes the spatial complexity of a target (presumably engaging right hemisphere mechanisms), while concurrently minimizing motor-programming demands, was expected to yield a diminished disparity in preference and performance between the hands. Left and right hand accuracy were measured independently for two motor tasks in 48 normal right-handed university students. In the first task, darts were thrown overhand at a stationary target. For the second task, subjects were asked to use the open hand to block (but not catch) projectiles launched at varying trajectories and velocities. ANOVA yielded a significant Hand x Task interaction, in which the left hand did not differ from the right hand in intercepting ability, but was significantly less accurate than the right hand for throwing. A sex difference favouring males was found for both tasks; this difference was not reducible to differences in physique or athleticism.

Adult↗

PubMed2003

A prospective study of a hand-held ultrasound device in abdominal aortic aneurysm evaluation.

PURPOSE: Effective treatment of abdominal aortic aneurysm (AAA) requires both early detection and timely repair to reduce aneurysm-related mortality. The purpose of this prospective study was to evaluate the utility of a hand-held ultrasonography (US) device in AAA screening in a Veterans Affairs vascular surgical service. METHODS: During a 16-month period, patients with risk factors for AAA were evaluated in a blinded fashion with a hand-held US device performed by physicians. A conventional abdominal duplex US examination was also performed by a certified vascular ultrasonographer. Results of the hand-held US was compared with the conventional duplex US examination. RESULTS: A total of 104 patients were evaluated (97 men, mean age 67 +/- 6.3 years). The mean times for hand-held and conventional duplex US examinations were 5.3 +/- 3.2 minutes and 3.1 +/- 2.4 minutes (not significant), respectively. Using the conventional duplex US as a reference, the sensitivity and specificity of the hand-held device in detecting a AAA were 93% and 97%, respectively. The positive and negative predictive values of the hand-held device were 89% and 98%, respectively. The likelihood ratios of positive and negative tests of the hand-held US device examination were 82 and 0.14, respectively. The diagnostic accuracy of the hand-held US device as compared with the conventional duplex US was 98%. CONCLUSIONS: A hand-held portable US device is effective and accurate in AAA screening with results comparable to the conventional abdominal duplex examination. Moreover, hand-held portable US for AAA screening can be performed expeditiously during physical examination. It should be used as an extension in routine physical examination in vascular patients.

Aged↗

PubMed1998

Comparison of stapled and hand-sewn esophagogastric anastomoses.

BACKGROUND: Esophagogastric anastomotic leaks continue to be a major source of morbidity and mortality after esophagectomy. Leaks usually result from technical errors or occult ischemia of the mobilized gastric fundus. The introduction of stapled esophagogastric anastomoses was initially very promising; leak rates appeared to be reduced. DATA SOURCES: The English language medical literature was searched for publications comparing stapled and hand-sewn esophagogastric anastomoses. We reviewed data from four randomized trials and seven nonrandomized comparative studies to determine if stapling was superior to hand suturing for esophagogastric anastomoses. RESULTS: Pooled data from randomized trials comparing stapled with hand-sewn esophagogastric anastomoses showed no significant difference for leaks (stapled 9%, hand-sewn 8%, P <0.67), but a higher incidence of strictures in stapled anastomoses (stapled 27%, hand-sewn 16%, P < 0.02). In nonrandomized studies, stapled anastomoses had a lower leak rate (stapled 6%, hand-sewn 11%, P < 0.0001), but strictures were more frequent (stapled 31%, hand-sewn 16%, P < 0.0001). A major source of bias in the nonrandomized studies was the comparison of contemporary stapled experience and earlier hand-sewn experience. This bias was not present in three of seven nonrandomized studies that featured prospective data collection. Pooled data from these three studies showed no difference in anastomotic leak rate (stapled 4%, hand-sewn 6%, P < 0.28). CONCLUSIONS: Stapled and hand-sewn esophagogastric anastomotic techniques have equivalent anastomotic leak rates, but strictures are more common in stapled anastomoses. Irrespective of which technique is used, surgical experience and meticulous attention to detail are required to prevent anastomotic complications. Anastomotic technical modifications alone are unlikely to eliminate the problem of leaks, since they do not address the problem of gastric fundal ischemia.

Anastomosis, Surgical↗

PubMed1997

Hand, space and attentional asymmetries in goal-directed manual aiming.

Two experiments were conducted to explore the interaction of the two cerebral hemispheres in motor control, by examining hand, space and attentional asymmetries in goal-directed aiming. In Experiment 1, right-handed subjects moved to targets more quickly with their right hand than their left hand. In addition, each hand was faster when moving in its own hemispace. Although in a control condition, movements were initiated more quickly with the left hand, visual distractors disrupted left hand performance more than right hand performance. For contralateral aiming, ipsilateral distractors caused the greatest interference. In Experiment 2, when targets and distractors were all presented at the midline, a right hand advantage was found for movement time along with a left hand advantage for reaction time, independent of target and distractor location. Our findings are discussed in terms of a right hemisphere role in movement preparation and the allocation of attention in space, and greater left hemisphere involvement in movement execution.

Adolescent↗