18 research outputs found
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Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat
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Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
The original version of this article unfortunately contained a mistake
Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study
Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat
Association of postoperative infection and oncological outcome after breast cancer surgery
Background: Surgical-site infection (SSI) is a well known complication after breast cancer surgery and has been reported to be associated with cancer recurrence. The aim of this study was to investigate the association between SSI and breast cancer recurrence, adjusting for several known confounders. The secondary aim was to assess a possible association between any postoperative infection and breast cancer recurrence. Method: This retrospective cohort study included all patients who underwent breast cancer surgery from January 2009 to December 2010 in the Uppsala region of Sweden. Data collected included patient, treatment and tumour characteristics, infection rates and outcome. Association between postoperative infection and oncological outcome was examined using Kaplan-Meier curves and Cox regression analysis. Results: Some 492 patients (439 with invasive breast cancer) with a median follow-up of 8.4 years were included. Mean(s.d.) age was 62(13) years. Sixty-two (14.1 per cent) of those with invasive breast cancer had an SSI and 43 (9.8 per cent) had another postoperative infection. Some 26 patients had local recurrence; 55 had systemic recurrence. Systemic recurrence was significantly increased after SSI with simple analysis (log rank test, P = 0.035) but this was not observed on adjusted analysis. However, tumour size and lymph node status remained significant predictors for breast cancer recurrence on multiple regression. Other postoperative infections were not associated with recurrence. Conclusion: Neither SSI nor other postoperative infections were associated with worse oncological outcome in this study. Rather, other factors that relate to both SSI and recurrence may be responsible for the association seen in previous studies
Inflammatory Pseudotumor of the Liver Presented in a Patient with Cholelithiasis
An inflammatory pseudotumor of the liver is a rare tumor-like lesion
consisting of an inflammatory infiltrate that often can mimic a
malignant liver neoplasm. The cause of an inflammatory pseudotumor of
the liver is unknown, but it has been reported to be associated with
different comorbid conditions most likely inflammatory or infectious in
origin. We present an 83-year-old female who presented with a
symptomatic gallstones disease and an incidental finding of inflammatory
pseudotumor mimicking intrahepatic cholangiocarcinoma in preoperative
liver imaging. Differentiating a pseudotumor from hepatic
space-occupying neoplasms is crucial since it is one of the most
important tumor-mimicking lesions. The imaging findings of this rare
tumor can pose diagnostic difficulties because of the amount of fibrosis
and cellular infiltration. If malignancy has been excluded, patients can
be treated conservatively with steroids and non-steroidal
anti-inflammatory drugs. However, complete surgical resection has been
the modality of treatment for most of the cases with an indeterminate
diagnosis
Pseudomyxoma Peritonei: Presentation of Two Cases and Challenging Issues in the Literature
Pseudomyxoma peritonei (PMP) is a rather uncommon syndrome in oncology
with a unique biological behavior and an estimated incidence of one to
two cases per million per year. Clinically, it usually presents with a
variety of unspecific signs and symptoms including abdominal pain and
distention, ascites, or even bowel obstruction. Despite its intimidating
clinical manifestation, PMP is characterized by satisfactory survival
rates when treated with cytoreduction and hyperthermic intraperitoneal
chemotherapy (HIPEC).
We present two interesting cases of PMP deriving from the appendix with
a rather atypical presentation, which was successfully treated with
cytoreduction and HIPEC. In addition, we intend to raise clinical
suspicion on the diagnosis of PMP and comment on several challenging
issues concerning the origin and classification of PMP
Serous Microcystic Cystadenocarcinoma of the Pancreas with Synchronous Liver Metastases: Clinical Characteristics and Management
Serous cystadenocarcinoma of the pancreas is a rare but well-established
entity. The origin and evolution of this disorder remain unclear, but
even metastatic cases have an excellent prognosis. These tumors are very
similar to benign serous cystic neoplasms (SCNs) of the pancreas, except
that they tend to be larger, are locally invasive, and present distant
metastasis. The most frequent local invasion is adjacent vessels,
spleen, stomach, and duodenum. The most common site of distant
metastasis is the liver. Diagnosis via imaging as well as pathology
examination may be misguided due to atypical characteristics of the
tumor. In fact, in some, the diagnosis of malignancy was established
only after metastases were detected. We present a 60-year-old female
patient with malignant serous microcystic cystadenocarcinoma of the
pancreas and liver metastasis that was initially misdiagnosed as a
metastatic renal cell carcinoma. The patient underwent tumor resection
and liver metastasectomy and she is currently doing well after three
years of follow-up, with no tumor recurrence or new metastatic liver
nodules based on imaging findings
Low-grade Appendiceal Mucinous Neoplasm Presenting as Adnexal Mass: A Case Report
An appendiceal mucocele is a dilatation of the appendix and it is the
result of benign or malignant diseases, which cause the obstruction of
the appendix and the consequent accumulation of mucus secretion. The
preoperative diagnosis is difficult due to non-specific clinical
manifestations of the disease. We present a case of an 83-year-old
female patient with a history of breast cancer that was referred to our
hospital for an evaluation of a right adnexal mass discovered during her
yearly follow-up. The patient underwent an exploratory laparotomy with a
provisional diagnosis of a right adnexal mass. A perioperative,
appendiceal mucocele was diagnosed. She underwent a formal appendectomy
and histopathology of the specimen revealed a low-grade mucinous
neoplasm. Appendiceal mucinous neoplasms represent a rare form of
pathology among all appendectomy specimens. A preoperative diagnosis is
difficult due to the lack of specific symptoms and it is often
misdiagnosed as an adnexal mass. The perforation of the appendix and
subsequent extravasation of its contents into the abdominal cavity may
lead to pseudomyxoma peritonei, which has a very poor prognosis if not
treated properly
Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy : A cross-sectional study
Background: The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). Methods: This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. Results: There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. Conclusions: These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.De två första författarna delar förstaförfattarskapet.</p