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

Hall technique survival for restoring decayed primary molars - A systematic review and single-arm meta-analysis

O objetivo desta revisão sistemática e meta-análise foi avaliar a taxa de sobrevida das coroas metálicas pré-formadas utilizando a Hall Technique para restaurar molares deciduos cariados e investigar fatores que pudessem influenciar na sobrevida do tratamento (registro no PROSPERO: CRD42021204415, preprint do protocolo - DOI: 10.31219/osf.io/fxvz7). Uma busca sistemática nas seguintes bases de dados (Medline/PubMed, Embase, Scopus, Web of Science, LIVIVIVO e ProQuest) foi realizada para estudos que atendessem aos critérios de inclusão: Ensaios Clínicos Randomizados (ECRs) e Estudos de Intervenções Não-Randomizados (EINRs) (coortes prospectivas/retrospectivas e estudos não randomizados) até Novembro de 2022; crianças com molares decíduos cariados restaurados usando a Hall Technique; e relatando a sobrevida para pelo menos 1 mês de pós-tratamento. A meta-análise de braço único avaliou a proporção cumulativa (95% CI) das taxas de sobrevivência de HT usando o software RStudio. O risco de viés foi avaliado utilizando as ferramentas Cochrane RoB 2 para ECRs e ROBINS-I para EINRs, e a certeza da evidência avaliada utilizando a abordagem GRADE. A pesquisa identificou inicialmente 1278 referências, sendo que 22 publicações (11 ECRs e 11 EINRs) preencheram os critérios de inclusão e foram submetidas a análise quantitativa. Os períodos de acompanhamento variaram de 1 a 89 meses. Houve uma taxa de sobrevivência de mais de 90% para 19 dos 22 estudos, e todos relataram taxa de sobrevida acima de 76%, independente do tempo avaliado. As meta-análises mostraram taxas médias de sobrevivência de: para ECRs 95% (IC 95%: 92-97) com baixa heterogeneidade (I2: 0%, p=0,53), e EINRs: 97% (IC 95%: 94-98) com heterogeneidade moderada (I2: 34%, p= 0,14). O risco geral de viés para ECRs (55%) variou de baixo a preocupante, enquanto a maioria dos EINRs (64%) eram de qualidade moderada a baixa. A certeza de evidência foi considerada baixa para ECRs e moderada para EINRs. A Hall Technique apresenta alta taxa de sobrevida global, portanto pode ser considerado tratamento alinhado a Mínima Intervenção adequado para restaurar molares decíduos. A maioria dos estudos mostrou risco de viés moderado a alto, e certeza de evidência de moderada a baixa.We aimed to evaluate the survival rate of preformed metal crowns using the Hall Technique to restore carious primary molars and investigated factors that might influence survival. It was registered in PROSPERO database (CRD42021204415), and the protocol preprint was published (DOI: 10.31219/osf.io/fxvz7). A systematic search (Medline/PubMed, Embase, Scopus, Web of Science, LIVIVO and ProQuest) was carried out for studies meeting the inclusion criteria: Randomized Clinical Trials (RCTs) and Non-Randomized Studies of Interventions (NRSIs) (prospective/retrospective cohorts and non-randomized studies) until November 2022; children with decayed primary molars restored using the Hall Technique; and reporting survival for at least 1-month post-treatment. A single-arm meta-analysis assessed the cumulative proportion (95% CI) of HT survival rates using the RStudio Team software. Risk of bias was assessed using the Cochrane RoB 2 tools for RCTs and ROBINS-I for NRSIs, and certainty of evidence assessed using the GRADE approach. The search initially identified 1278 references, and 22 publications (11 RCTs and 11 NRSIs) met the inclusion criteria and underwent quantitative analysis. The follow-up periods ranged from 1 to 89 months. There was a survival rate of over 90% for 19 out of 22 studies (follow-up of 1 to 89 months), and all studies reported a survival rate of over 76%. The meta-analyses showed mean survival rates for RCTs 95% (95% CI: 92-97) with low heterogeneity (I2: 0%, p=0.53), and NRSIs: 97% (95%CI: 94-98) with moderate heterogeneity (I2: 34%, p= 0.14). The overall risk of bias for RCTs (55%) ranged from low to concerning, while the majority of NRSIs (64%) were of moderate to low quality. The certainty of evidence was considered low for randomized studies and moderate for non-randomized studies of intervention. Preformed metal crowns according to the Hall Technique present an overall high survival rate, hence can be considered a Minimum Intervention treatment suitable for restoring primary molars. Most studies showed moderate to high risk of bias and moderate to low certainty of evidence

Do the clinical practice guidelines for pediatric dentistry meet the quality standards? A meta-research and quality appraisal protocol using AGREE II and AGREE REX tools.

Clinical Practice Guidelines (CPGs) are recommendations for the health care providers and a method to close the know-do gap, transferring the knowledge from the academic research to the clinician. The proposal of this systematic review is to assess the quality of published guidelines regarding Pediatric Dentistry topics using AGREE II instrument and AGREE REX tool. This study is registered on Open Science Framework (OSF). Two examiners will independently search for literature based on the PICO question and will perform a screening of the literature according to inclusion and exclusion criteria, as well as data collection and extraction. The search will be performed in different electronic databases including Medline (PubMed), Embase, Scopus, LIVIVO, Caribbean Health Sciences Literature (Lilacs), Scientific societies, and International association websites (American Academy of Pediatric Dentistry - AAPD, European Academy of Pediatric Dentistry - EAPD, Guidelines International Network (GIN), National Institute for Health and Care Excellence – NICE, TRIP - Turning Research Into Practice database and Scottish Dental Clinical Effectiveness Programme - SDCEP), and grey literature (ProQuest) to identify any topic regarding Pediatric Dentistry guidelines. The search strategy for this systematic review will be defined through the PICO question: “Do the clinical practice guidelines and recommendations on pediatric dentistry meet the quality standards based on the AGREE II instrument and AGREE REX tool?”. We will include evidence-based and consensus-based guidelines that address any topic related to Pediatric Dentistry, and that report on the evidence level supporting each recommendation. We will exclude any outdated documents (when they have the updated version), topics irrelevant to Pediatric Dentistry, and duplicate publications. Inter-rater reliability (Intraclass correlation coefficient) will be calculated to ensure the level of agreement among researchers. For the assessment of eligible guidelines and recommendations, the AGREE II instrument and AGREE REX tool will be used in the complete form. Lastly, descriptive statistics and linear regression models will be conducted

Do the clinical practice guidelines for paediatric dentistry meet the quality standards? A meta-research and quality appraisal using AGREE II tool

Clinical Practice Guidelines (CPGs) are recommendations for health care providers and a method to close the know-do gap, transferring the knowledge from academic research to the clinician. The proposal of this meta-research is to assess the quality of published clinical practice guidelines in Pediatric Dentistry using AGREE II instrument

Preformed metal crowns placed by Hall technique for restoring primary molars have an optimal survival? - a Systematic Review and Meta-analysis protocol

Background: Unsuccessful restorative treatment of carious lesions in deciduous molars remains a priority for clinicians to resolve when caring for children's dentition. However, regardless of the material or technique used, standard restorative treatments continue to fail and present low survival rates. In an effort to solve these problems, a non-invasive technique known as the Hall Technique was developed with reduced adverse effects and is being studied over the last years, presenting great success in comparison with other restorative techniques. Thus, this systematic review and meta-analysis aim to address the question concerning the survival of preformed metal crowns using the Hall Technique for restoring deciduous molars. Methods: Electronic databases and other sources, such as gray literature will be searched. Randomized controlled trials (RCTs), and Non-Randomized studies of interventions (NRSI) will be included that assess the use of preformed metal crowns using the Hall Technique on primary molars. The outcome will be the cumulative survival rate of preformed metal crowns applied according to the Hall Technique. Two independent reviewers will perform screening, study selection, data extraction, risk of bias, and certainty of evidence assessment. Any discrepancies in opinion will be resolved by a third reviewer who is considered to be an expert in the field. Assessment of the risk of bias of included studies will be evaluated by RoB 2 and ROBINS-I tools. The certainty of evidence will be determined using the GRADE tool. Methodological heterogeneity across studies will be evaluated to determine the best model for the meta-analysis. Discussion: To the best of our knowledge, no systematic review has addressed this gap directly. Findings obtained from the review will be valuable in the decision-making process regarding the use of Hall Technique preformed metal crowns for restoration of decayed primary molars

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

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