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

Procesamiento no consciente de imágenes y palabras: un estudio con priming enmascarado y electroencefalografía (EEG)

Muchas de nuestras conductas y decisiones están basadas en procesos no conscientes que lleva a cabo nuestro cerebro luego de percibir estímulos que no alcanzan el umbral de la consciencia. Varios experimentos han demostrado que si se muestran imágenes agradables a una velocidad tal que no se pueden describir verbalmente, aun así la percepción de esa imagen influye en la valoración que hacemos de estímulos posteriores (por ejemplo, si la imagen velozmente presentada es agradable, la valoración de la imagen de una taza será positiva. En cambio, si la imagen velozmente presentada es desagradable, la valoración de la imagen de la misma taza será negativa). Experimentalmente, estos estudios se han llevado a cabo a través de un paradigma denominado “priming subliminal”. En este paradigma, una imagen es mostrada “subliminalmente”, y otra imagen es mostrada en forma normal (no subliminal), para determinar hasta qué punto la imagen subliminal ha tenido efecto sobre la imagen percibida. Estos experimentos usualmente consisten en presentar categorías de estímulos y solicitarle a los participantes que determinen lo más rápido posible si el estímulo pertenece a una u otra categoría (por ejemplo, animal u objeto). La trascendencia de los experimentos es que la imagen subliminal a veces coincide con la característica del objeto a categorizar (imagen subliminal=gato, imagen percibida=perro; ambos categoría animal), y otras veces no (imagen subliminal=gato, imagen percibida=martillo; categorías animal y objeto, respectivamente). Se ha demostrado ampliamente que cuando la imagen subliminal es incongruente con la percibida, los tiempos de reacción son significativamente más lentos que cuando ambas imágenes coinciden (es decir, los participantes tardan más en decidir la categoría a la que pertenece el estímulo percibido cuando no coincide con el estímulo subliminalmente presentado).Adicionalmente, se ha sugerido que el procesamiento en el nivel semántico de esos estímulos subliminales (es decir, catalogarlos inconscientemente) depende de si la presentación del estímulo es una imagen o una palabra. Varios estudios demostraron que los estímulos pictóricos tienen un acceso privilegiado al contenido semántico de nuestro cerebro. Esas investigaciones llevaron a pensar que el efecto subliminal del priming semántico sería más fuerte para los estímulos pictóricos que para los estímulos verbales. Este efecto, se testeó en imágenes y palabras a través de la manipulación de la similitud semántica entre el estímulo subliminal (al que llamaremos “prime”) y el estímulo percibido(al que llamaremos “target”). La similitud semántica puede ser explicada como la fuerza asociativa que existe entre dos conceptos. Por ejemplo, el par gato-león posee una similitud semántica más fuerte que el par gato-canario, pero más débil que el par león-tigre. En nuestra investigación, les pedimosa los participantes que realizaran una tarea de categorización semántica mediante el paradigma de priming subliminal. La tarea se realizó tanto con estímulos pictóricos como verbales bajo tres condiciones de similitud semántica: fuertemente relacionados, débilmente relacionados y no relacionados.Encontramos diferencias significativas solo entre los pares fuertemente relacionados y los pares no relacionados, tanto para los estímulos pictóricos como para los estímulos verbales, con respuestas más rápidas para las imágenes en comparación con las palabras. No obstante, las imágenesno mostraron un efecto subliminal superior a las palabras, tal como la literatura sugería. Por lo tanto,nuestros resultados podrían introducir una nueva hipótesis que dice que aunque el procesamiento semántico de los estímulos pictóricos es más rápido que el procesamiento de los estímulos verbales, esto no implica un efecto subliminal más fuerte a nivel de los procesamientos inconscientes llevados a cabo por nuestro cerebro.Los resultados de esta investigación han sido publicados este año en la revista científica Consciousness and Cognition de la editorial Elesevier:https://www.sciencedirect.com/science/article/abs/pii/S105381001930319

The complete sequence of a human Y chromosome

The human Y chromosome has been notoriously difficult to sequence and assemble because of its complex repeat structure that includes long palindromes, tandem repeats and segmental duplications1-3. As a result, more than half of the Y chromosome is missing from the GRCh38 reference sequence and it remains the last human chromosome to be finished4,5. Here, the Telomere-to-Telomere (T2T) consortium presents the complete 62,460,029-base-pair sequence of a human Y chromosome from the HG002 genome (T2T-Y) that corrects multiple errors in GRCh38-Y and adds over 30 million base pairs of sequence to the reference, showing the complete ampliconic structures of gene families TSPY, DAZ and RBMY; 41 additional protein-coding genes, mostly from the TSPY family; and an alternating pattern of human satellite 1 and 3 blocks in the heterochromatic Yq12 region. We have combined T2T-Y with a previous assembly of the CHM13 genome4 and mapped available population variation, clinical variants and functional genomics data to produce a complete and comprehensive reference sequence for all 24 human chromosomes

The complete sequence of a human Y chromosome.

The human Y chromosome has been notoriously difficult to sequence and assemble because of its complex repeat structure that includes long palindromes, tandem repeats and segmental duplications1-3. As a result, more than half of the Y chromosome is missing from the GRCh38 reference sequence and it remains the last human chromosome to be finished4,5. Here, the Telomere-to-Telomere (T2T) consortium presents the complete 62,460,029-base-pair sequence of a human Y chromosome from the HG002 genome (T2T-Y) that corrects multiple errors in GRCh38-Y and adds over 30 million base pairs of sequence to the reference, showing the complete ampliconic structures of gene families TSPY, DAZ and RBMY; 41 additional protein-coding genes, mostly from the TSPY family; and an alternating pattern of human satellite 1 and 3 blocks in the heterochromatic Yq12 region. We have combined T2T-Y with a previous assembly of the CHM13 genome4 and mapped available population variation, clinical variants and functional genomics data to produce a complete and comprehensive reference sequence for all 24 human chromosomes

Continuous vs intermittent Non-Invasive blood pressure MONitoring in preventing postoperative organ failure (niMON): study protocol for an open-label, multicenter randomized trial

Background: Blood pressure has become one of the most important vital signs to monitor in the perioperative setting. Recently, the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) recommended, with low level of evidence, continuous monitoring of blood pressure during the intraoperative period. Continuous monitoring allows for early detection of hypotension, which may potentially lead to a timely treatment. Whether the ability to detect more hypotension events by continuous noninvasive blood pressure (C-NiBP) monitoring can improve patient outcomes is still unclear. Here, we report the rationale, study design, and statistical analysis plan of the niMON trial, which aims to evaluate the effect of intraoperative C-NiBP compared with intermittent (I-NiBP) monitoring on postoperative myocardial and renal injury. Methods: The niMon trial is an investigator-initiated, multicenter, international, open-label, parallel-group, randomized clinical trial. Eligible patients will be randomized in a 1:1 ratio to receive C-NiBP or I-NiBP as an intraoperative monitoring strategy. The proportion of patients who develop myocardial injury in the first postoperative week is the primary outcome; the secondary outcomes are the proportions of patients who develop postoperative AKI, in-hospital mortality rate, and 30 and 90 postoperative days events. A sample size of 1265 patients will provide a power of 80% to detect a 4% absolute reduction in the rate of the primary outcome. Conclusions: The niMON data will provide evidence to guide the choice of the most appropriate intraoperative blood pressure monitoring strategy. Clinical trial registration: Clinical Trial Registration: NCT05496322, registered on the 5th of August 2023