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

El norte no se hizo para todos/The United States wasn\u27t made for everyone: Imagined lives, social difference, and discourse in migration

Based on two years of research in Uriangato, Mexico and Chester County, Pennsylvania, this dissertation argues that commonly-occurring discourses---understood as instances of language use---about migration shape migration patterns. In particular, the dissertation details discourse production among working-class migrants and their loved ones, examining this process from the perspective of current, former, and non-migrants. The dissertation also considers how migration develops inside of and influences family life and class mobility. The dissertation demonstrates that discourses generated by migrants and their loved ones typify migration practice by portraying the types of people who do and do not---or who should and should not---migrate. From this starting point, several key claims are made. First, these discourses characterize and enact the shape and function of the forms of social difference, such as gender, that inform who migrates and how. Second, in this, these discourses offer images of personhood---or social personae---that speakers perform in articulating them, thereby modeling possible life trajectories for themselves and others. Third, these discourses thus allow speakers to imagine what life would be like if they migrated; such imagining can encourage, or discourage, migration by making it personally immediate and tangible to speakers, as they try on what life would be like if they migrated. Fourth, this process is evidenced most tangibly in the positions---or role alignments---speakers take to the social personae they articulate, accepting or rejecting personae as models for their own lives. Finally, it is the central claim of the dissertation that sustained patterns of role alignment between speakers and the personae they create---patterns that endure across events of speaking---regiment and are predictive of whether and how speakers migrate, both at the individual and aggregate level. The dissertation explores this claim from multiple speaker perspectives, considering the variety of linguistic tools---from patterns of pronominal reference to direct reported speech---that speakers use to construct personae and their alignments to them, as well as the function of these processes at the level of individual speakers and in the discourse of many speakers taken in concert

El norte no se hizo para todos/The United States wasn\u27t made for everyone: Imagined lives, social difference, and discourse in migration

Based on two years of research in Uriangato, Mexico and Chester County, Pennsylvania, this dissertation argues that commonly-occurring discourses---understood as instances of language use---about migration shape migration patterns. In particular, the dissertation details discourse production among working-class migrants and their loved ones, examining this process from the perspective of current, former, and non-migrants. The dissertation also considers how migration develops inside of and influences family life and class mobility. The dissertation demonstrates that discourses generated by migrants and their loved ones typify migration practice by portraying the types of people who do and do not---or who should and should not---migrate. From this starting point, several key claims are made. First, these discourses characterize and enact the shape and function of the forms of social difference, such as gender, that inform who migrates and how. Second, in this, these discourses offer images of personhood---or social personae---that speakers perform in articulating them, thereby modeling possible life trajectories for themselves and others. Third, these discourses thus allow speakers to imagine what life would be like if they migrated; such imagining can encourage, or discourage, migration by making it personally immediate and tangible to speakers, as they try on what life would be like if they migrated. Fourth, this process is evidenced most tangibly in the positions---or role alignments---speakers take to the social personae they articulate, accepting or rejecting personae as models for their own lives. Finally, it is the central claim of the dissertation that sustained patterns of role alignment between speakers and the personae they create---patterns that endure across events of speaking---regiment and are predictive of whether and how speakers migrate, both at the individual and aggregate level. The dissertation explores this claim from multiple speaker perspectives, considering the variety of linguistic tools---from patterns of pronominal reference to direct reported speech---that speakers use to construct personae and their alignments to them, as well as the function of these processes at the level of individual speakers and in the discourse of many speakers taken in concert

Haciendo de Tripas el Corazón/Plucking Up Courage: Migration, Family Internal Conflict, and Gender in Veronica’s Story

This article considers how migrants conceptualize and negotiate the emotional conflicts that accompany decisions to migrate. Such conflicts are a regular feature of migrants’ experience, informing how they understand the act of and reasons for migrating. The article focuses on the life of one mi-grant: a woman I call “Veronica,” whom I met during research on migration between Uriangato, Guanajuato, Mexico and Chester County, Pennsylvania. I argue that the analysis of discourse offers a particularly illuminating window into how migrants conceptualize and negotiate emotional conflicts. I place this discussion in dialogue with the literature on family internal conflict and gender in migration.Mexico-US migration ; discourse analysis ; emotion ; family internal conflict ; gender

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