Multinational prospective cohort study of rates and risk factors for ventilator-associated pneumonia over 24 years in 42 countries of Asia, Africa, Eastern Europe, Latin America, and the Middle East: Findings of the International Nosocomial Infection Control Consortium (INICC)

Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design: Prospective cohort study. Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. Participants: The study included patients admitted to ICUs across 24 years. Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16-1.28; P <.0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07-1.08; P <.0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23-1.31; P <.0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57-15.48; P <.0001)Revisión por pare

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

Effective Second-Language Reading Transition: From Learner-Specific to Generic Instructional Models

This study examines two questions involving students in a transitional bilingual education program learning to read in a second language. The first question deals with the impact of second-language (L2) text structure on comprehension processes, while the second deals with the level of oral language proficiency necessary to comprehend L2 texts. Findings demonstrate that comprehension "errors" begin at the word level and expand to the sentence level (or beyond) in order for the reader to make meaning from the texts. Oral language proficiency proved to be an inadequate measure in determining "correct" comprehension of L2 texts. A generic processor or whole group model of instruction is inadequate in meeting L2 readers' needs because the generic processor perspective assumes that L2 learners come to school with similar linguistic backgrounds, experiences, and cultural perspectives. The focus of transition instruction should be on individual learning needs, assessed in a manner that enables the teacher to determine the cultural, linguistic, and cognitive interplay between the text and the reader. Knowing students and their families, along with their instructional needs, will enable teachers to help L2 learners move towards a generic processor model with more success

Teachers' Perceptions of Integrated Reading-Writing Instruction for Emergent Bilinguals

Integrated Reading-Writing Instruction (IRWI) is an approach for English Language Arts (ELA) instruction that has gained much attention since the adoption of college and career standards. Previous studies have shown that connecting reading and writing during instruction positively affects students' literacy outcomes as related cognitive processes are engaged in the construction of meaning. This qualitative study of five 4th grade elementary ELA classrooms serving diverse students, including emergent bilinguals, explored the transition from the previous form of writing instruction to IRWI, or analytical text-based writing in elementary classrooms when implementing college and career standards. The findings indicated that IRWI introduced several affordances for the five teachers' instruction, such as an explicit connection between reading and writing, and for their emergent bilingual students, overall improvement of reading comprehension and preparation for more college-like writing. Also, participating teachers reported several disadvantages for their emergent bilingual students stemming from how IRWI was implemented in the district. These disadvantages included the absence of creativity and genre variety for writing instruction, writing that was dependent upon English reading comprehension, and difficulties with teaching how to write evidence and elaboration

Critical SFL Praxis Among Teacher Candidates: Using Systemic Functional Linguistics in K-12 Teacher Education

Drawing on examples of how two teacher educators have developed a critical SFL approach to teacher education, this chapter discusses specific principles of critical SFL to guide analysis of texts in the content areas and planning instruction that integrates these principles. It shows how we have prepared elementary and secondary teachers to use CSFL to plan instruction for culturally and linguistically diverse students, especially English language learners. The chapter concludes by providing some reflections on this process and a few guidelines for teacher educators to integrate this approach into teacher education programs

Comparing Secondary English Teachers' Ideal and Actual Writing Practices for Diverse Learners: Constrained Professionalism in Figured Worlds of High-Stakes Testing

There is limited research of observed writing instruction in inclusive, secondary diverse urban contexts. This study contributes to the field by investigating four urban secondary English teachers' perceptions of ideal writing instruction as compared with their actual instruction, which is primarily driven by high-stakes accountability measures. Sociocultural theories guide analyses of video-recorded writing lesson and interview data, with critical literacy theory framing the discussion and implications for teaching writing to diverse learners. Intersecting themes from interviews and observations point to constrained writing instruction and practices. Although the teachers recognized a responsibility to teach responsively to their diverse students' instructional writing needs, they are inhibited and unable to do so primarily because of high-stakes testing mandates that narrow the curriculum and limit teacher autonomy

Modified Guided Reading: Gateway to English as a Second Language and Literacy Learning

Guided reading is an important component of a comprehensive literacy program. Using this approach to reading instruction is beneficial to all students, including English‐language learners (ELLs). While guided reading is generally used in the early elementary grades, this approach is recommended for ELLs of all ages when appropriate methods and materials are used. Teachers can modify guided reading to better meet the literacy and second language (L2) learning needs of ELLs. Building on previous work in the area of guided reading and L2 reading instruction, this article describes guided‐reading modifications for ELLs, integrating reading, writing, listening, and speaking to build the four language skills. A lesson‐planning guide and examples are provided for teachers who are facing the challenge of providing language and literacy instruction to students learning to read in their L2