Antioxidant Activity And Polyphenol Composition Of Sesame Paste And Grape Molasses Blends

Tez (Yüksek Lisans) -- İstanbul Teknik Üniversitesi, Fen Bilimleri Enstitüsü, 2014Thesis (M.Sc.) -- İstanbul Technical University, Instıtute of Science and Technology, 2014Uzun yıllardır tahin ve pekmez karışımları gerek lezzeti gerekse besinsel değerleri gereği geleneksel Türk kahvaltılarının vazgeçilmezlerindendir.  Hem tahin hem pekmez tüketiciler tarafından tipik özellikleriyle bilinmektedir. Örnek olarak, pekmezin enerji ya da aktioksidan kaynağı olarak tanınması gösterilebilir.  Fakat, gıdaların beraber tüketiminde içeriklerindeki bileşenlerin etkileşimleri sonucunda meydana gelen veya gelebilecek olanlar değişimlerden tüketicilerin pek haberi yoktur.  Literatür çalışmaları incelendiğinde, gıdaların yapısında bulunan birçok bileşenin birbiriyle etkileşime girebildiği görülmektedir. Protein, yağ veya fenolik maddelerin etkileşimleri üzerine örnekler bulmak mümkündür.  Tahin-pekmez karışımları göz önünde bulundurulduğunda; öncelikle pekmezin fenolik maddece zenginken, tahinin yüksek protein içeriğine sahip bir ürün olduğu göz önünde bulundurulmalıdır. İki ürün karışım olarak tüketildiğinde ise bu iki bileşenin birbirleriyle etkileşimleri gıda matrisinde birçok değişime sebebiyet verebilir.  Çalışmalar gösteriyor ki bu tarz etkileşimler gıdaların yapısal, fonksiyonel ve besinsel değerlerinde değişiklikler ile sonuçlanabilir.  Aynı zamanda, antioksidan kapasitesi, fenolik ve flavonoid miktarlarının da bu etkileşimler ile değişiklik gösterebileceği gözlemlenmiştir. Tez çalışmasının amacı, tahin ve pekmezin birlikte tüketilmesinin toplam fenolik, flavonoid ve antioksidan kapasitelerinde meydana getirebileceği değişiklikleri incelemek olmuştur.  Bu amaçla, tahin, pekmez ve farklı yüzdelere sahip üç karışıma (%50-50, %70-30 ve %30-70) için in vitro gastrointestinal sindirim sisteminin simülasyonu öncesi ve sonrasında analizler yapılmıştır.  Ayrıca, ürün özelliklerinin daha iyi anlaşılmasını sağlamak amacıyla tahin, pekmez ve karışım numuneleri nem, protein ve lipid içeriği tayininin yanısıra reolojik analizlere de tabii tutulmuşlardır. Ürün karakterizasyonu için yapılan analizler sonucunda nem oranı tahin için %3.9 iken bu oran pekmezde %82.5 olarak bulunmuştur. Karışımların nem yüzdeleri ise matematiksel olarak tahmin edildiği gibi iki ürünün yüzdelerinin aralığında değerler olarak bulunmuştur.. Bunun yanısıra numunelerin protein içerikleri Kjeldahl metotu ile ölçülmüştür. Protein miktarı pekmez için %0.09 olarak bulunurken tahin için %28.5 olarak hesaplanmıştır.  Yağ oranı tahin için %55.3 olarak bulunmuştur, pekmezde ise yağ eser miktardadır. Reolojik ölçümler 21°C’de yapılmıştır. Histerezis döngüsü kayma gerilmesi aralığı 0.01 s-1’de 200 s-1 kadar (120 saniye içerisinde), 200 s-1’de 1 dakika ve 200 s-1’den 0.01s-1’e yine 120 saniyede indirilerek elde edilmiştir.  Veriler sisteme kaydedildikten sonra, n ve K değerleri tüm numuneler için ölçülmüştür. Numunelerin Newtonsu olmayan davranışlarını saptamak adına Power law modeli kullanılmıştır.  Reolojik ölçümler sonucunda pekmez Newtonsu davranış kaydetmiştir. Kayma gerilmesi, kayma hızı ile lineer bir ilişki göstermiştir. Fakat, tahinin viskozitesinin sabit kayma hızında azaldığı gözlemlenmiştir ve davranışı tiksotropik olarak tanımlanmıştır. Karışımların n değerleri (0.7-0.8) kaymayla incelen davranışlarını göstermiştir. Fenolik maddelerin yarıya yakını küçük bağırsakta emilmektedir ve analiz sonuçlarına göre de gastrointestinal sindirimden sonra, diyalize olmuş ürünlerin fenolik/flavonoid madde içeriklerine bakıldığında bir düşüş gözlemlemek mümkündür.  Bunun yanısıra ekstrakte edilmiş numunelere gastrointestinal sindirim prosedürü uygulanmadan once yapılan analizlerde görülmüştür ki en yüksek fenolik ve flavonoid içerikleri pekmeze aitken en düşük değerleri tahin göstermiştir. Karışımlar ise iki ürünün verdiği sonuçların arasında değerlere sahip bulunmuştur. Toplam fenolik analizi dikkate alındığında karışımların iki ürünün matematiksel oranıyla hesaplanmış beklenen değerlere yakın sonuçlar verdiği gözlemlenirken benzer sonuçlara flavonoid analizi sonucunda ulaşılamamıştır.  Karışımlarda ise beklenenden daha düşük flavonoid analizlenebilmiştir. Bu durumu kateşinin ortamdaki amino asitler ile kuvvetli bağ yapma eğilimi ile ilişkilendirmek mümkündür.  Spektrofotometrik tahliller arasında ilişki kurabilmek için korrelasyon hesaplaması yapılmıştır. Bu hesapların sonucu göstermiştir ki en yüksek korrelasyon toplam fenolik analizi ile DPPH ve ABTS metotları arasında bulunurken (R2 sırasıyla 0.989, 0.987); toplam flavonoid analizi ile en yüksek korrelasyonu ABTS metotu göstermiştir (R2 0.962). Ayrıca, ekstrakte edilmiş pekmezin flavonoid madde içeriği en yüksekken, diyalize olmuş pekmezinki diğer ürünlerden çok da yüksek değildir. Bu da karışımların tüketiminde flavonoid emiliminin yalnız pekmez tüketimindekinden daha etkili olabileceğini göstermiştir. Öte yandan, toplam antioksidan kapasiteleri %70 ve %30 tahin içerikli karışımlarda beklenenin altında çıkarken, %50’lik karışımlarda beklenenin üzerinde çıkmıştır. Beklenenin altında çıkan değerleri fenolik bileşenlerin proteinlere bağlanmasının polifenolleri maskelemesi ile ilişkilendirmek mümkündür.  Toplam fenolik içeriği gibi, diyalize olmuş karışımların toplam antioksidan kapasiteleri in vitro gastrointestinal sindirim sistemi simülasyonundan sonra iki ürüne gore daha az bir düşüş göstermiştir.  Ek olarak, toplam antioksidan kapasitesi ölçme metotlarının sonuçlarının birbirlerinden farklı olduğunu söylemek mümkündür. Örneğin, ABTS sonuçlarına gore diyalize olmuş karışımların antioksidan kapasitelerinin tahin ve pekmezden daha yüksek olduğu gözlemlenmiştir.  Bu da göstermektedir ki ekstrakte olmuş karışımlarda proteinlerin fenolikleri maskeleme eğilimi ön plana çıkarken bu ürünler gastrointestinal sistemde tam tersi bir etkileşim içindedirler. HPLC sonuçları ile pekmezdeki baskın fenolik maddeler gallik asit, kateşin, sinnamik asit ve epikateşin olarak saptanırken, ttahinde sesamin olarak gözlemlenmiştir. Ayrıca saptanan bu fenolik maddelerin gastrointestinal sindirim sonrasında miktarlarında genellikle bir azalma meydana geldiği gözlemlenmiştir. Bu sonuçlar önceki analizlerle çoğunlukla tutarlılık göstermiştir.For long years, sesame paste and grape molasses blends are consumed in traditional breakfasts in Turkey due to their nutritional values and taste. Two products are known with their individual characteristics, i.e. grape molasses is considered as an energy or antioxidant source. However, changing characteristics during consumption of foods together is desregarded by consumers although the interactions in food constituents result in significant alterations in food matrix. In the literature, there exist examples to interactions between a variety of food constituents such as proteins, lipids, phenolic compounds and so on.  Grape molasses is rich in phenolic compounds whereas sesame paste has high protein content. Hence, interactions between phenolic compounds and proteins should be paid attention in terms of different characteristics. The studies show that that kind of interactions may result in changes in structural, functional and nutritional properties, and digestibility of proteins. Also these interactions may lead to changes in antioxidant capacity, total phenolic and/or flavonoids content of polyphenols, in addition to bioavailability. The aim was to gain a better understanding about the changes in total phenolic, flavonoids and antioxidant capacity when sesame paste and grape molasses consumed together compared to individual consumptions. For that purpose, sesame paste, grape molasses and three blends with different percentages (50-50%, 70-30% and 30-70%) of both were analyzed before and after in vitro digestion procedure. Furthermore, to gain a better understanding to product characteristics, determination of moisture, protein and lipids as well as rheological analysis were performed. While sesame paste has 3.9 % moisture, that of grape molasses was found as 82.5 %, and also the blends have moisture contents between the two products. Protein contents of all samples were devised by Kjeldahl method. Grape molasses was found to have protein content of 0.09% whereas protein content of sesame paste was calculated as 28.5 %. Lipid content of sesame paste was found as 55.3% while that of grape molasses was in trace amounts. Moreover, lipid contents of blends decrease with increasing grape molasses content. For rheological characterization, viscometric measurements were conducted at 21 °C. The hysteresis loop was obtained by registering shear stress from 0.01 to 200 s-1 in 120 s, held at 200s-1 for 1 min between the two ramps and down in 120 s. After recording, n and K values for all samples were defined. Power law model was used to describe the non-Newtonian behavior of samples. Grape molasses showed Newtonian behaviour since linear relationship was found between shear stress and shear rate in the experiments. On the other hand, for sesame paste, at constant shear rate, viscosity decreased by 1% in 1 minutes, helping us to understand the reological behaviour of sesame paste as thixotropic. For blends, the values of flow behavior index, n, varied between 0.7 and 0.8 indicating shear-thinning behavior. The degree of pseudoplasticity decreases by increasing n value.  Additionally, in analyzed samples prior to gastrointestinal digestion, grape molasses showed higher contents of total phenolics, total flavonoids and antioxidant activity compared to sesame paste and three blends of 50-50%, 70-30% and 30-70%.  Blends had total phenolic contents close to proportional values with respect to two individual foods. However, their total flavonoid contents were found lower than proportional values probably resulted from the interactions between sesame proteins and catechin in the matrix. Antioxidant capacities of blends were between the two products and the results of the assays were similar for initial samples. Correlation between spectrophotometric assays were calculated in order to relate the results with each other. Highest correlation was found between total phenolic content analysis with DPPH and ABTS assays (R2 is equal to 0.989, 0.987, respectively) while that of total flavonoid content analysis was with ABTS assay (R2 is equal to 0.962). After stomach and pancreatin bile salt digestion, a significant decrease was observed in all dialyzed (IN) samples, half of the phenolic compounds were absorbed in small intestines.  In dialyzed blends, total phenolic contents were close to each other and a little lower than both products. Hence, total phenolic content of sesame paste seems to be absorbed easier than all others, since total phenolic content of dialyzed sesame paste is higher compared to others although it has low phenolic content at the begining. Furthermore, total flavonoid content of blends extracts were less than proportional values that may be caused by strongly binding characteristics of catechin to amino acids. By the way, catechinconcentration may decrease in blends when being together with amino acids in the environment. Also, it is conducted that flavonoids can be absorbed more easily in blends than in grape molasses individually since even if grape molasses has highest total flavonoid content before pancreatic ingestion it has a total flavonoid content a little higher than that of blends. Trolox equivalent antioxidant capacities (TAEC) of the two blends containing sesame paste 70% and 30%, respectively are lower than proportional values while half and half blend has shown higher TAEC value. The blends showed lower TAEC values rather than proportional values since binding of phenolic compounds to protein sites or molecules directly may lead to masking of polyphenol contents on the proteins. As well as total phenolic contents of dialyzed blends decreased less than the two products after in vitro digestion.Outcomes from assays were quite different. To illustrate, in ABTS assay, dialyzed blends have higher antioxidant activities rather than sesame paste or grape molasses although the masking effect of proteins could be detected easily in this assay as mentioned before. Hence, it can be deducted that after pancreatic ingestion, masking effect decreases and presumably changed adversely. HPLC results were generally consistent with previous experiments. Dominant phenolic compounds in grape molasses were found as gallic acid, catechin, cinnamic acid and epicatechin; whereas that of sesame paste was sesamin.Yüksek LisansM.Sc

Ethical dilemmas in perinatology: Perinatolojide etik ikilemler

The development of science and technology and in parallel with this, advancements in new applications in health area, confront nurses with ethical problems. It is considerably important that nurses decide based on the ethical problems and ethical principles they face and the effective professional care. Perinatology nursing   are the area, in which the ethical dilemmas are most experienced.  Due  to the fact that  nurses  do not mostly  have   freedom of choice  and the environmental factors,  they are obliged to make a choice  between professional obligation and ethical responsibility  Approach  in obstetric care has to be conducted by considering   the health of  both mother  and baby.  Although the legal regulations, policies, and cooperation with women organizations concerning women enhance quality of care, they influence nursing applications. While the nurses working in the area of perinatology realize the consultancy, educator, and care roles in their every sorts of intervention and decisions in presenting health service, it is highly important for them to behave in the framework of ethical principles. Due to the fact that nurses are the closest health profession members to the patient, have the changing roles and responsibilities in their working areas, and sometimes make decisions and applications on the name of patients, they face to the ethical problems and experience confliction. Therefore, nurses need guidance and support about solution of ethical problems. In this study; ethical dilemmas the nurses working on the perinatology area face and how to be acted in the face of these dilemmas were discussed.  ​Extended English summary is in the end of Full Text PDF (TURKISH) file. Özet Bilim ve teknolojinin gelişmesi, buna paralel olarak sağlık alanında yeni uygulamalarda ilerlemeler hemşireleri etik sorunlarla karşı karşıya bırakmaktadır. Hemşirelerin, karşılaştıkları etik sorunlara etik ilkelere dayanarak karar vermesi ve etkili profesyonel bakım oldukça önemlidir. Perinatoloji hemşireliği etik ikilemlerin en çok yaşandığı alandır. Hemşirelerin çoğu kez seçme hakkının olmaması ve çevresel faktörler nedeniyle kendilerini mesleki yükümlülük ve ahlaki sorumluluk arasında ikilemde bulmalarına neden olmaktadır. Obstetrik bakımda yaklaşım hem annenin hem de bebeğin yararı düşünülerek yapılmalıdır. Kadınları ilgilendiren yasal düzenlemeler, politikalar, kadın kuruluşlarıyla işbirliği yapılması bakım kalitesini artırmakla birlikte hemşirelik uygulamalarını etkilemektedir. Perinatoloji alanında çalışan hemşireler sağlık hizmeti sunmadaki her türlü müdahale ve kararlarında, aynı zamanda danışmanlık, eğitici ve bakım rollerini gerçekleştirirken etik ilkeler çerçevesinde davranış göstermeleri oldukça önemlidir. Hemşireler hastaya en yakın sağlık meslek üyeleri olmaları, çalışma alanlarında değişen rol ve sorumlulukları, kimi zaman hastalar adına karar verme ve uygulamalarda bulunmalarından dolayı etik sorunlarla karşı karşıya kalmakta ve çatışma yaşamaktadır. Bu nedenle etik sorunların çözümü konusunda hemşirelerin rehberliğe ve desteğe gereksinimleri vardır. Bu derlemede perinatoloji alanında çalışan hemşirelerin karşılaştıkları etik ikilemeler ve bu ikilemler karşısında nasıl hareket edilmesi gerektiği amacıyla gerçekleştirilmiştir

Comparison of body mass index level by triage level in the emergency department

INTRODUCTION: Obesity is a high cause of death in both non-communicable and communicable diseases such as COVID-19. The aim of this study is to increase the awareness of emergency department (ED) managers and employees about this problem by showing obesity rates according to triage level in patients admitted to the ED.MATERIAL AND METHODS: BMI levels and complaints of 1246 patients admitted to the ED according to the 3-level triage were re-evaluated with the 5-level ESI (Emergency Severity Index) triage for this study.RESULTS: The mean BMI of 1246 patients was found to be 27.25 ± 5.88 (overweight). 26% of the ED patients were found to be obese and 37.7% of them were overweight. While the mean BMI score of the 6–11 age group was found to be class 1 obesity, the other pediatric and adult age groups were found to be overweight. The highest mean BMI according to both the 3-stage triage system and the 5-stage ESI triage system was found in triage 1 patients (28.8011 ± 7.98; 28.18 ± 6.78, respectively). Obese patients mostly applied to the ED with orthopedic problems and trauma (26.5%). Also, of the patients with class 3 severe obesity, 50% presented with trauma.CONCLUSIONS: The higher the BMI, the higher the triage severity level. BMI levels should be evaluated in the field of triage together with vital signs, especially in trauma patients, and obesity should be considered in ED and hospital management

2,5-Dihexyl-3,6-diphenyl­pyrrolo­[3,4-c]pyrrole-1,4(2H,5H)-dione

The asymmetric unit of the title compound, C30H36N2O2, contains one half-mol­ecule, the other half being generated by a crystallographic inversion centre. The crystal structure is devoid of any classical hydrogen bonds however, non-classical C—H⋯O inter­actions link the mol­ecules into chains propagating in [001] and a C—H⋯π inter­action leads to the formation of a two-dimensional network in (011)

Okul Öncesi Dönemdeki Çocukların Okuldaki Oyun Olanaklarının İncelenmesi

DergiPark: 426421tredBu çalışma ile, okul öncesidönemdeki çocuklara sunulan oyun olanaklarının okul öncesi öğretmen görüşlerinegöre incelenmesi amaçlanmıştır. Araştırmanın evrenini Türkiye’de Millî EğitimBakanlığı’na bağlı özel ve resmi anaokullarında görev yapan okul öncesiöğretmenleri oluşturmaktadır. Araştırma verileri araştırmacılar tarafındanhazırlanan Okul Öncesi Öğretmenlerin Gözünden Türkiye Oyun Profili AraştırmasıAnket Formu kullanılarak elde edilmiştir. Anket formunda, okul öncesiöğretmenlerinin cinsiyet, yaş, eğitim düzeyi, mesleki deneyim süresi, çalıştığıkurumun bulunduğu coğrafi bölge, çalıştığı yaş grubu ve sınıf mevcudubilgilerine ilişkin yedi, okul öncesi dönemdeki çocuklara sunulan oyunolanaklarına ilişkin öğretmen görüşlerinin belirlenmesine ilişkin on (çocuklarınen sevdiği aktiviteler, serbest oyuna ayrılan süre, oyun sırasında öğretmeninrolü, açık oyun alanları imkânları, risk faktörleri, oyun sırasında gerçekleşenkazalar ve ailelerin çocukların okuldaki oyunları üzerine görüşleri gibi) soruyer almaktadır. Sorulardan elde edilen cevaplar yüzde ve frekansla ortayakoyulmuş ayrıca açık uçlu sorulardan elde edilen cevaplarla öğretmenleringörüşlerine yer verilmişti

Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): a multi-center study

Background: Diabetes education in Turkey is provided by diabetes nurse educators in almost all healthcare organizations. However, the education is not standardized in terms of learning content, duration, and methods. This multi-center study was performed to assess the self-care behaviors and glycemic control following education provided to the patients with type 2 diabetes mellitus by diabetes nurse educators. Methods: This was a descriptive and cross-sectional study and included 1535 patients admitted to 28 public hospitals for the treatment of type 2 diabetes mellitus. The education was assessed by using a Patient Identification Form and Self-care Scale. Results: The proportion of individuals who received diabetes education within the last year was 78.5%, with 46.7% of them having received it once. Of the patients, 84.8% reported that they received diabetes education individually. It was found that the proportion of individuals who received education about oral antidiabetics (78.5%) and glucose testing at home (78.5%) was higher than the proportion of individuals who received education about exercise (58.8%) and foot care (61.6%). The status of diabetes education, education intervals, and the correlation of the education method with self-care and glycemic control was evaluated. Self-care and glycemic control levels were better among the patients who received diabetes education thrice or more and in patients who received education both individually and in a group (p < 0.05). Conclusions: Approximately three-quarters of individuals with type 2 diabetes mellitus received education by diabetes nurse educators in Turkey. Diabetes education is positively correlated with self-care and glycemic control levels among patients with type 2 diabetes mellitus. Efforts for generalization and standardized education for all diabetes patients are necessary. © 2022, The Author(s)

Nuclear anomalies in the buccal cells of calcite factory workers

The micronucleus (MN) assay on exfoliated buccal cells is a useful and minimally invasive method for monitoring genetic damage in humans. To determine the genotoxic effects of calcite dust that forms during processing, MN assay was carried out in exfoliated buccal cells of 50 (25 smokers and 25 non-smokers) calcite factory workers and 50 (25 smokers and 25 non-smokers) age- and sex-matched control subjects. Frequencies of nuclear abnormalities (NA) other than micronuclei, such as binucleates, karyorrhexis, karyolysis and ‘broken eggs', were also evaluated. Micronuclei and the other aforementioned anomalies were analysed by two way analysis of covariance. The linear correlations between the types of micronucleus and nuclear abnormalities were determined by Spearman's Rho. There was a positive correlation between micronuclei and other types of nuclear abnormalities in accordance with the Spearman's Rho test. Results showed statistically significant difference between calcite fabric workers and control groups. MN and NA frequencies in calcite fabric workers were significantly higher than those in control groups (p < 0.05). The results of this study indicate that calcite fabric workers are under risk of significant cytogenetic damage

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study

PURPOSEThe clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions.METHODSThis retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson’s chi-squared test, the Fisher–Freeman–Halton test, and Fisher’s exact test were used for the statistical analyses.RESULTSThe overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes.CONCLUSIONADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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