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

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

Tourism, female entrepreneurs and gender: Crafting economic realities in rural Greece

This thesis utilises feminist economics theory to investigate gender and tourism development by exploring the economic relations associated with the services that maintain human life. Often, tourism development programs with a gender focus attempt to promote women’s involvement with tourism by encouraging them to produce handicrafts for tourism retail. However, female tourism entrepreneurs face unique challenges such as seasonality and 14-hour days which affect how they negotiate the activities needed to reproduce human life on a daily basis, and inter-generationally, which include household duties. These activities, referred to in political economy literature collectively as ‘social reproduction’, are used here as a lens through which to examine the relationship between entrepreneurship and gender roles and relations within tourism development. This relationship is investigated using participant observation and interviews held with tourism handicraft entrepreneurs in Greece from June to December 2012 and thus in the context of a macro-scale economic crisis. Thematic analysis shows that the type of tourism development affects entrepreneurship bringing to the fore the importance of time in gender role negotiations as collective entrepreneurs re-distribute time amongst themselves rather than intra-generationally, thus prompting for less gender role negotiation than individual entrepreneurs. Indeed tourism-induced time scarcity adds value to social reproductive activities, whilst women use ‘domestic inaction’ as a negotiation tool to achieve an equal distribution of economic activities. The identification of a liminal gender re-negotiation period at the end and beginning of the season that prompts seasonal gender role negotiations adds an interesting dimension to the perceived impacts of seasonality. In addition, the economic crisis is prompting women to ‘recruit’ their husbands into handicraft tourism entrepreneurship as a solution to male unemployment, the gender implications for which are discussed. Future research could benefit from investigating men’s and children’s roles in tourism entrepreneurship and how these act upon negotiations of gender roles. Finally, this study raises methodological questions regarding the knowledge constructed in participant observation that includes a pedagogical element

Tourism, female entrepreneurs and gender: Crafting economic realities in rural Greece

This thesis utilises feminist economics theory to investigate gender and tourism development by exploring the economic relations associated with the services that maintain human life. Often, tourism development programs with a gender focus attempt to promote women’s involvement with tourism by encouraging them to produce handicrafts for tourism retail. However, female tourism entrepreneurs face unique challenges such as seasonality and 14-hour days which affect how they negotiate the activities needed to reproduce human life on a daily basis, and inter-generationally, which include household duties. These activities, referred to in political economy literature collectively as ‘social reproduction’, are used here as a lens through which to examine the relationship between entrepreneurship and gender roles and relations within tourism development. This relationship is investigated using participant observation and interviews held with tourism handicraft entrepreneurs in Greece from June to December 2012 and thus in the context of a macro-scale economic crisis. Thematic analysis shows that the type of tourism development affects entrepreneurship bringing to the fore the importance of time in gender role negotiations as collective entrepreneurs re-distribute time amongst themselves rather than intra-generationally, thus prompting for less gender role negotiation than individual entrepreneurs. Indeed tourism-induced time scarcity adds value to social reproductive activities, whilst women use ‘domestic inaction’ as a negotiation tool to achieve an equal distribution of economic activities. The identification of a liminal gender re-negotiation period at the end and beginning of the season that prompts seasonal gender role negotiations adds an interesting dimension to the perceived impacts of seasonality. In addition, the economic crisis is prompting women to ‘recruit’ their husbands into handicraft tourism entrepreneurship as a solution to male unemployment, the gender implications for which are discussed. Future research could benefit from investigating men’s and children’s roles in tourism entrepreneurship and how these act upon negotiations of gender roles. Finally, this study raises methodological questions regarding the knowledge constructed in participant observation that includes a pedagogical element

Desarrollo de zonas rurales y pequeñas ciudades a través del turismo creativo: el proyecto CREATOUR

This research focuses on the CREATOUR project which investigates how organizations, tourists and communities in small cities and rural areas in Portugal interact and forge new alliances. CREATOUR is a three-year research and application project, involving five research centres, that started in 2016 and is creating a network of creative tourism offers in Portugal. Participants are 40 pilot projects, which are entrepreneurs or organizations who are incentivized to offer innovative creative tourism products within rural areas and small cities. Data that supports this article is based on articles written about the project by CREATOUR researchers and researchers’ participant observation accounts. This paper aims to: 1) provide an overview of this innovative research and application project, 2) present examples of creative tourism offers developed within the project and 3) to examine two development frameworks in wich creative tourism offers are placed in, in a non-urban context. The insights that this article presents, can be useful in practical and theoretical terms when other countries attempt to create similar creative tourism networks.Esta pesquisa centra-se no projeto CREATOUR, que investiga como é que organizações, turistas e comunidades, em cidades pequenas e zonas rurais, em Portugal, interagem e forjam novas alianças. O CREATOUR é um projeto de investigação e aplicação de três anos, envolvendo cinco centros de investigação, que começou em 2016 e está a criar uma rede de ofertas de turismo criativo em Portugal. Tem 40 projetos piloto participantes, empreendedores ou organizações, que são incentivados a oferecer produtos turísticos inovadores e criativos dentro de áreas rurais e cidades pequenas. Os dados que suportam este artigo são baseados em artigos escritos sobre o projeto, por investigadores do CREATOUR, com base em entrevistas realizadas e considerações da observação participante. Este artigo tem como objetivos: 1) dar uma visão geral deste projeto inovador de investigação e aplicação, 2) apresentar exemplos de ofertas de turismo criativo desenvolvidas no âmbito do projeto e 3) examinar dois enquadramentos de desenvolvimento em que as ofertas de turismo criativo são colocadas, num contexto não urbano. As perspetivas selecionadas que este artigo apresenta, podem ser úteis em termos práticos e teóricos quando outros países tentarem criar as suas próprias redes de turismo criativo.Este proyecto de investigación se centra en CREATOUR, que investiga cómo las organizaciones, los turistas y las comunidades en las ciudades pequeñas y zonas rurales en Portugal, interactuar y forjar nuevas alianzas. El CREATOUR es una investigación y aplicación del proyecto de tres años, con la participación de cinco centros de investigación, que se inició en 2016 y está creando una red de ofertas de turismo creativo en Portugal. Tiene 40 proyectos piloto participantes, emprendedores u organizaciones, que son incentivados a ofrecer productos turísticos innovadores y creativos dentro de áreas rurales y ciudades pequeñas. Los datos que apoyan este artículo se basan en artículos escritos sobre el proyecto, por investigadores del CREATOUR, con base en entrevistas realizadas y consideraciones de la observación participante. Este artículo tiene como objetivos: 1) dar una visión general de este proyecto innovador de investigación y aplicación, 2) presentar ejemplos de ofertas de turismo creativo desarrolladas en el marco del proyecto y 3) examinar dos marcos de desarrollo en que las ofertas de turismo creativo son en un contexto no urbano. Las perspectivas seleccionadas que este artículo presenta, pueden ser útiles en términos prácticos y teóricos cuando otros países intentan crear sus propias redes de turismo creativo

Creative Tourism: A Humanistic Paradigm in Practice

A humanistic paradigm framework is used to examine leading practices in contemporary creative tourism, with a particular focus on the rural and small city context. These experiences are drawn from a research-and-application project, CREATOUR, which catalyzed a network of 40 creative tourism initiatives in Portugal. Focusing on eight initiatives, it examines the ways in which creative tourism strategies and practices embody and advance a humanistic paradigm. We find that creative tourism promotes human flourishing, engages the other in a journey of mutual discovery, honors the dignity of each stakeholder, and contributes to the common good in intriguing ways

Who are the language tourists? A factor‐cluster analysis based on language‐related attitudes, beliefs, and travel outcomes

Researching language tourism (where language learning is a primary or secondary motivation for the trip) is a growing field of interest as the importance of language within tourism experiences is recognized. Conceptually located at the intersection of cultural, youth, academic, and educational tourism, past research has focused on the analysis of tourists who travel to formally learn a language, missing out on an imporrtant number of tourists who travel to learn a language informally. To overcome this gap in research, cluster analysis of a sample of 1014 formal and informal language tourists was undertaken to segment them based on language related attitudes, beliefs, and travel outcomes. Four clusters of language tourists were identified, called the Enthusiasts, the Devoted, the Pragmatists, and the Less-Committed. We propose that two axes are fundamental for characterizing and understanding language tourists, thus contributing to expand theory on language tourism.info:eu-repo/semantics/publishedVersio

Creative tourism microentrepreneurs in Portugal

When researching the role of microentrepreneurship in equitable and sustainable development, the question of how tourism microentrepreneurs forge relationships between place, community, and resources is significant. Two case studies from CREATOUR, a project investigating creative tourism, a novel type of cultural tourism that includes active participation in creative activities and connection to place, bring to light how these relationships are developed and implemented. Findings indicate that creative tourism microentrepreneurs’ activities in two small cities are being shaped by, and shaping, place in multifaceted ways. Creative tourism activities stimulate new perspectives on place, are designed synergistically with the ‘seasonal’ fluctuations of the type of visitors, are embedded in personal networks of collaborators, and actively encourage alternative patterns of tourism consumption

Why is research–practice collaboration so challenging to achieve? A creative tourism experiment

Within tourism research, there has been little attention to research–practice knowledge exchange during the research process nor to practice-based research. This article examines a research-and-application project on creative tourism in which research–practice collaboration is explicitly foregrounded and made central. Through a reflexive process, the challenges this hybrid approach embodies and the pragmatic dilemmas that accompany the complexities of building closer research–practice relations and capturing practice-based knowledge are examined in three strategic areas: developing spaces for ongoing knowledge exchange, enabling practitioners to take on the role of co-researcher, and fostering researchers’ close attention to the application side of the project. In the context of the CREATOUR project, hybrid roles question who can do research, reinforce consideration of the added value of research processes for practitioners, and lead researchers to go beyond traditional research activities, with this ‘disruptive’ context causing tensions, uncertainties, and dynamic co-learning situations. Ongoing interactions over time are necessary to build relations, understanding, and trust, while flexibility and responsiveness are vital to address emerging issues. Training on research–practice collaboration, knowledge transfer, and mentorship techniques for both researchers and practitioners is advised. Challenges in integrating practice-based knowledge directly into research articles suggest a customized communication platform may be a useful ‘bridging’ mechanism between practice-based and academic knowledge systems.摘要:在旅游研究领域, 很少关注研究过程中的研究与实践的知识交流, 也很少关注基于实践的研究。本文研究了一个创意旅游方面的研究应用项目, 该项目明确以研究与实践的合作为中心展开研究。本文通过一个反思的过程从三个方面（发展持续进行知识交流的空间,推动实业界认识承担合作研究人员的视角以及促进研究者密切关注项目的应用面）思考了这种混合方法表现出来的挑战以及伴随建立更紧密的研究实践关系, 获取实践性知识的复杂所提出的实际困难。在创意旅游项目的背景下, 多元混搭角色, 用这种产生紧张、不确定性和动态共同学习状况的“颠覆性”背景, 质问了谁可以做研究, 强化研究过程给从业者带来附加价值的想法, 以及带领研究人员超越传统的研究活动等方面的问题。为了建立关系、理解和信任, 需要不断地进行互动, 同时灵活性和反应能力对于解决新出现的问题至关重要。建议为研究人员和实践者提供研究-实践协作、知识转移和辅导技巧方面的培训。将基于实践的知识直接集成到研究文章中所面临的挑战表明, 定制的交流平台可能是基于实践的知识系统和学术知识系统之间有用的“桥梁”机