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

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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Elites and democracy in Ghana : A social network approach

This article presents new theoretical and empirical insights into democratization in Africa, using the typology developed by John Higley and Michael Burton to understand elite interaction in Ghana. Social network analysis (SNA) is used to test the main proposition of the Higley/Burton theory, namely that a ‘liberal democracy is impossible without a consensually united elite’. Empirical evidence is provided from a unique data set that maps the interaction patterns between Members of Parliament elected to the Ghanaian legislature in 2012. The article shows that MPs in Ghana form a dense and strongly interconnected network bridging ethnic and party cleavages, and that MPs from different parties have developed a measure of trust in one another. These findings not only support Higley and Burton's claim that elite integration is conducive to stable democracy, but also point to new directions in African Studies by demonstrating the capacity of actor-centric approaches to explain processes of democratization in countries that lack the classic structural preconditions for consolidation.publishe

Political Parties in Ghana : Agents of Democracy?

Political parties are generally thought of as agents of democracy that fulfil a range of functions, such as policy formulation, interest aggregation and articulation, social integration, and elite recruitment. However, given the weakness of many African parties, are they able to contribute positively to democracy? This article seeks to answer this question by using Ghana – one of Africa's most successful democracies – as a case study. It is found that parties in Ghana are comparatively strong and do indeed mobilise large numbers of voters. They even expose a degree of ideological competition and have successfully adapted their strategies to the local context. On the other hand, they expose serious weaknesses in the field of social integration and interest representation. Against this background it is argued that even in procedurally well-functioning democracies like Ghana, political parties can be instruments of elite competition that contribute to the exclusion of the poor from decision-making

Like father, like son? : Power and influence across two Gnassingbé presidencies in Togo

In personalized authoritarian systems, the death of a leader poses a serious challenge to regime survival. Togo, however, belongs to a small number of countries in which regime collapse has been avoided by the transfer of power to the deceased ruler’s son. But can the son simply pick up where the father left off? Combining a theoretically guided single case study with statistical network analysis, this article argues that hereditary succession involves both changes and continuities. While Gnassingbé Eyadema’s rule rested on repression, patronage, and a bizarre leadership cult, his son Faure Gnassingbé has partly adapted and reformulated these strategies. The quantitative part of the article is based on a novel data set that contains information on the biographical characteristics and interaction patterns of the deputies in the Togolese parliament. Using exponential random graph models (ERGMs), the article shows that people who have held important positions in the past or belong to the president’s ethnic group still play a significant role in the regime elite. The article not only presents detailed insights on a so far under-researched country, but also contributes to the wider literature by showing how mixed-method designs can further our understanding of authoritarian regimes.publishe

Michael Amoah: Reconstructing the nation in Africa : the politics of nationalism in Ghana

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From Conflict to Consensus? : Elite Integration and Democracy in Ghana

The paper takes as its starting point Higley and Burton’s (2006) contention that no liberal democracy has ever evolved without a ‘consensually united elite’ which is structurally integrated and shares some general values. The fact that the evolution of a consensually united elite is a very rare event limits the prospects for the worldwide spread of liberal democracy. Ghana, however, could represent one of these rare cases. This paper looks at if and how an elite consensus on the “rules of the game” has emerged in the country and what the potential threats to this consensus are. It pays special attention to the social composition of elites and their patterns of interaction between elites (horizontal integration) as well as the relationship between elites and the wider population (vertical integration).publishe

Formal party organisation and informal relations in African parties : evidence from Ghana

It is often assumed that political parties in Africa have only weak formal structures and are instead dominated by informal, personalised networks. This paper seeks to challenge this view by presenting a much more nuanced picture of intra-party dynamics. Based on unique survey data from Ghana, it is shown how formal and informal party structures co-exist and interact at the national and constituency level. Because informal relationships are not directly observable and difficult to study, the paper employs a social network approach to map the personal interactions between the Members of the 6th Parliament of Ghana and their respective parties. It is found that the local party organisation plays a strong role in both of the major parties NDC (National Democratic Congress) and NPP (New Patriotic Party). There are, however, also differences between the parties. At the national level, the NDC is strongly centralised and dominated by its national executives. The NPP, in contrast, has an informal power center located in the Ashanti Region. Ethno-regional factions play only a minor role in both parties. By demonstrating that the relative importance of informal relations varies even between parties in the same country, the paper contributes to a better understanding of the variation in party organisation across Africa.publishe