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

Urbanismo-AR158-201601

Curso de especialidad en la carrera de Arquitectura de carácter teórico-práctico dirigido a los estudiantes de noveno ciclo que busca desarrollar la competencia general Manejo de la Información y la competencia específica Investigación.La asignatura constituye la primera del área de Urbanismo y tiene como tema principal la ciudad su estructura y morfología vista como fenómeno dinámico y complejo. Dota a los estudiantes de la capacidad de observar la realidad urbana con sensibilidad permitiéndoles analizar científicamente su desarrollo de forma integral. Curso teórico-práctico del séptimo ciclo contribuye a formarles en el manejo de información para la comprensión de la realidad y la realización de investigaciones urbanasLas ciudades cada vez más complejas en su funcionamiento e interacciones en su propio contexto; regional e internacional requieren de la comprensión por parte de los futuros profesionistas de sus funciones y jerarquías para tomar decisiones urbanas con visión humanística de inclusión y equidad conociendo sus implicancias en la competitividad de las ciudades y el manejo sostenible de los recursos disponibles

Seminario de Urbanismo - AR221 - 202100

Descripción: En este Seminario te formarás en la investigación, comprensión, visión critica y reflexión sobre las teorías y problemas de la ciudad en sus diferentes aspectos, confrontando diversos puntos de vista al respecto; elementos que te servirán tanto en la conceptualización de proyectos, a escala urbana y arquitectónica como en el entendimiento de la relación ciudad- arquitectura. Propósito: El curso tiene el propósito de desarrollar en el futuro arquitecto a partir de las bases teóricas, prácticas y herramientas necesarias para las intervenciones urbanas; una postura reflexiva en torno al ecosistema urbano como marco de actuación en relación al Bien Común y la comunidad promoviendo la investigación y los juicios de valor. Busca desarrollar la competencia general Ciudadanía a nivel 3. Tiene como requisito el curso de Gestión Urbana (AR251)

Seminario de Urbanismo - AR221 - 202101

Descripción: En el curso de Seminario de Urbanismo el alumno desarrolla su capacidad para investigar las diferentes teorías urbanísticas, las características económicas, sociales y políticas que son vinculantes para una intervención de una determinada problemática urbana. El estudiante construye una base teórica en base a los conocimientos que adquiere estudiando diferentes conceptos y teorías urbanas, así como analizando casos referenciales donde se aplican dichos conocimientos. De esta manera, el curso desarrolla una postura crítica afinando los criterios de diseño del alumno y cultivando el conocimiento de la cultura arquitectónica y urbana. Propósito: El curso tiene como propósito desarrollar en el futuro arquitecto una base teórica-práctica proporcionándoles conocimientos y herramientas necesarias para entender y analizar las intervenciones urbanas de diferentes escalas generando una postura reflexiva en torno a la disciplina arquitectónica y urbana. Por ello, se involucra al alumno con el conocimiento de las diferentes posturas teóricas a través de los años y como han influenciado en los proyectos urbanos y arquitectónicos, así como el impacto social de los mismos, vinculando el conocimiento teórico con el estudio de propuestas urbanas. 1El en el curso se contribuye al desarrollo de la competencia general Ciudadanía a nivel 3 y Cultura Arquitectónica (que corresponde a los criterios NAAB : PC4) a nivel 3. Tiene como requisito el curso de Gestión Urbana (AR303)

Seminario de Urbanismo - AR221 - 202102

Descripción: En el curso de Seminario de Urbanismo el alumno desarrolla su capacidad para investigar las diferentes teorías urbanísticas, las características económicas, sociales y políticas que son vinculantes para una intervención de una determinada problemática urbana. El estudiante construye una base teórica en base a los conocimientos que adquiere estudiando diferentes conceptos y teorías urbanas, así como analizando casos referenciales donde se aplican dichos conocimientos. De esta manera, el curso desarrolla una postura crítica afinando los criterios de diseño del alumno y cultivando el conocimiento de la cultura arquitectónica y urbana. Propósito: El curso tiene como propósito desarrollar en el futuro arquitecto una base teórica-práctica proporcionándoles conocimientos y herramientas necesarias para entender y analizar las intervenciones urbanas de diferentes escalas generando una postura reflexiva en torno a la disciplina arquitectónica y urbana. Por ello, se involucra al alumno con el conocimiento de las diferentes posturas teóricas a través de los años y como han influenciado en los proyectos urbanos y arquitectónicos, así como el impacto social de los mismos, vinculando el conocimiento 1teórico con el estudio de propuestas urbanas. El en el curso se contribuye al desarrollo de la competencia general Ciudadanía a nivel 3 y Cultura Arquitectónica (que corresponde a los criterios NAAB : PC4) a nivel 3. Tiene como requisito el curso de Gestión Urbana (AR303)

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used