Archive for September, 2012

Since my last post two things have happened.

Firstly, I am feeling lots better, so quarantine is being lifted and the plan to go to IPS 2012 is still on – Happy Times!

Secondly, my further readings and discussions surrounding the use of the Cochran Q test proved it was unsuitable for what I wanted to do. This is most definitely not good….  All is not lost, and I can still go forward with Study 3, but can only confidently investigate my first Hypothesis regarding Inherent and Elective Trigger activities – what I cannot plan to do is look into the effect of these triggers over time. In other words, how variable people’s Hand Hygiene behaviour is when reacting to these triggers when measured at different opportunities – do the same people always react to the same Inherent Triggers the same way?  Try as we might we cannot find a statistical analysis model that will allow for binary data using a within-subjects design over some element of ‘longitudinal’ measurement.

Off to Liverpool…!
If only my number puzzles were still this simple….


So, what I am really hoping will happen now is that I can head to IPS 2012, and find inspiration amongst all the promising talk and poster presenters; who knows what kind of study designers may be Liverpool-bound, just desperate for a new study-puzzle to pour over….?

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Currently I am practicing good Infection Control and am in quarantine – which has thrown a spanner in the works with regard to my active research at UHCW, but on the positive has given me time to work on planning my next phase of work.

Following the emerging themes produced from Study 1 and 2 (including interviews with Healthcare Professionals) the design for Study 3 has had to change.  It is no longer feasible to carry out the Inherent/Elective categorisation task as originally planned, as there is too much ‘noise’ around the concepts of Hand Hygiene triggers such as “Patient Contact” and “Contaminated Items”.  Therefore, instead of using existing audit data for a retrospective analysis, the new design involves an in-situ observational study collecting fresh Hand Hygiene data relating to specific activities deemed “Inherent” or “Elective” by current Healthcare Professionals.

From a conceptual point of view, this seems simple.  Indeed, when discussing the idea with others the idea – to see whether people perform Hand Hygiene more at certain points than others, and then whether this behaviour is stable – seems both clear and interesting; however when delving slightly deeper, the actual quantitative analysis required to investigate this theory appears much more complex.  Issues such as the use of binary (dichotomous) data, and a within-subjects design, makes the study actually quite abnormal.   However, after much design/re-design and discussions with some great sources of help, I think we may be getting close to a solution.  Today I thus have to just confirm that  the McNemar and Cochran Q are potentially solutions, and then I can firm up the design…

Whilst statistics are difficult in such cases, as has been said to me recently, the good part is once you have found the correct design, the actual carrying out is relatively simple. I cannot say how much I am looking forward to that part…!  The redesign of Study 3 has really shown how hard it can be to decide what is possible in research – having to compromise what you find interesting with what is possible to quantify or work into a design.  Patience, logic and the understanding that future work is always an option.  Lessons learnt…!

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Research Website Flyer

From the sickbed…………Research Flyer!

Fingers crossed I’ll be back to normal life next week….

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This week was planned to be quite eclectic, with data analysis, interviews with NHS staff and my PhD Annual Review – what I didn’t anticipate, however, was experiencing the NHS as a Patient, rather than a researcher…!


So, I am now writing this from an “out of the office” state, having had to cancel the back half of the weeks activities.  However, all the advice is that “a stitch in time….” and all that, so I am trying to be the patient Patient.  Fortunately today I have been able to seek distraction in an excellent Twitter feed from the Nursing and Midwifery summit at UHCW (#nursingmidwiferysummit) – and I’ve been up to a spot of Interview transcription; both of these activities make me feel closer to the field I am loving researching in, and help make up for the disappointment of missing events this week.

The upside of being ill, to be positive, is that it once again confirms my belief in, and thanks for, our NHS.  I was seen very quickly and a wonderful Nurse was both professional and reassuring.  Service with a smile indeed.


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Happy days


Enough said……


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A rather “off topic” post now, but one which has links to my work by the very nature that it is about a theme which is so linked in with my progress as to be impossible to disregard.  Last week it was Migraine Awareness Week, and as those who follow my Twitter account will now know, I suffer from Migraines.

I use the word “suffer” quite deliberately, as whilst I may also “get” headaches,  to me a Migraine is quite different, and is both debilitating and an event to be endured – quite often rendering me immobile and somewhat useless to the world around.  Hence I do tend to get rather annoyed at images such as the two below, used to illustrate articles on “Migraine”, where the model looks to me mildly irritated at best….


I think I am much more of the “may-not-now-move-for-an-indefinite-time” pose (below),

usually with my hand trying to push my brain back into my skull via an eye socket.

Yes, it is fun times indeed…  I have only been experiencing Migraines for about 6 years, having developed a Classical type (with aura) in 2006, quite suddenly and dramatically with a Hemiplegic Migraine phase, and now have quite a complex case history which features peaks and troughs of recovery/relapse, and rather a lot of treatment regimes.

Thus I wanted to add a post today to raise the awareness of the fact that Migraine is “not just a headache” – until this is clear in the minds of all then both treatment and understanding will be patchy at best, poor at worst.  I spoke with someone earlier this week at HPA2012 about this very topic, and we agreed it was worth trying to highlight this distinction as often as possible…so here we go….

I have been very lucky, being surrounded by very supportive family, co-workers, peers and two very good doctors who have worked hard to try to develop new treatment plans.  I know this is not always the case, and thus acknowledge that I am fortunate.  

The Migraine Trust explain the phases of a Migraine “event” well here – especially good to note that there is a Recovery “phase”; this is often one of the hardest things for me to deal with, because once the acute pain is gone I feel infinitely better, yet still like I have been hit by a truck, and this can last for a number of days. I find this hugely frustrating, because it is only time that can help restore full fitness, and when deadlines and other pressures are looming, this is the one resource we all could do with more of….

As I continue with my research into Hand Hygiene I will also be working, then, in the background on looking into ways to deal with sudden, unexpected, unexplained and unwelcome interruptions – and I am always interested in looking at new potential solutions. But most importantly, we need to make sure people understand that a Migraine is not just a headache – not even a “bad” headache…!

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The past two days saw me taking my research off to a wider audience via the Health Protection Agency annual conference which was held at the Warwick Arts Centre, located at my own University; very handy for me logistics wise…!

I had a great time, engaging in great discussions via Twitter – taking a guess at using #HPA2012 as a hashtag, as there was no official one being flagged up to start…I’m quite new to Twitter, so not sure if this is standard….but we got there in the end, and I made some wonderful contacts leading to very engaging face-to-face chats. A perfect blend of Social Media and Conference opportunity.

My Poster – The Potential Role of Technology to Improve Hand Hygiene Auditing and prevent Hospital Acquired Gastrointestinal Infections – can be seen here – and is a rather whirlwind tour of my PhD research from start to (almost) finish, with an angle focus on Clostridium Difficile (C.difficile), as the particular stream I was engaging with for this conference was Gastrointestinal Infection – however the PhD itself is not necessarily only focussing on the link between Hand Hygiene and C.difficile as a justification for the importance of the former.

Great interest was shown in all aspects of the work, with different people honing in on different aspects – some on the actual technology examples themselves, others on the topic of auditing as a whole, and many being particularly interested in the concept of “splitting” the “5 Moments” into different behavioural categories; Inherent and Elective.  This latter topic, the focus of my future work, is also featuring more heavily on my next poster, now ready for the Infection Prevention Society (IPS) conference at the beginning of October – and I am looking forward immensely to gathering more views and thoughts during those few days. And before then, it’s back to data collection and analysis…!

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