A Survey on Parents’ Feelings and QOL of Children with Medical Complexity After Discharge from NICU under the COVID-19 Pandemic

【背景・目的】 　NICU を退院した後も医療的ケアを必要とする児が増加しており、A 病院では2018 年よりNICU 退院後も医療的ケアを要する児の両親の思いと生活の質に関する調査を継続している。また現在、COVID-19 感染拡大による面会制限の中、短時間で退院支援をしており、退院後の両親の状況、制限がある中での退院支援の課題を明確にする必要があると考えた。引き続き、NICU を退院した医療的ケアを要する児の両親の思いと生活の質を明確にすることを目的とし、本研究を実施した。 【方法】 　2021 年9 月から2022 年10 月にNICU を退院した医療的ケアを要する児の両親を対象に、質問紙調査を行なった。調査項目は、①基本属性、②退院後の両親の思い、③育児環境、④生活の質（WHO QOL26）とした。各項目の記述統計を算出後、父と母の群間比較にはχ2 検定、Mann-Whitney のU 検定を用いた。自由記載については類似内容ごとに分類しカテゴリーを抽出した。 【結果】 　19 人（8 組の両親と3 組の母）からアンケートを回収した（回収率67.9％）。WHO QOL26 平均値は父が3.36±0.52、母が3.35±0.59 であった。退院後の思いについては全員がポジティブな気持ちを抱いており、ネガティブな気持ちも抱いた者は78.9% であった。自由記載では、ポジティブな気持ちに、＜子どもといられる喜び＞などが挙げられ、ネガティブな気持ちに、＜自責の念＞＜入院時には想定していなかったケアや手技の難しさ＞などが挙げられた。面会制限による＜愛着形成への不安＞や＜配偶者との思い・育児手技の差異＞も記載されていた。 【考察・結論】 　本研究でのWHO QOL 得点の平均値は、2018 年からの先行研究と比較し、両親ともに低かった。また、全国平均値と比較し、母は身体的領域のQOL が低かった。面会制限のなか、父は面会できないことで役割遂行に戸惑いを感じ、母のみの退院支援となり、両親間に情報格差や育児ケア習得に差が生じたことで母への負担が大きくなったと考えられる。父の育児参加や父性育成促進のため、また、母の負担軽減のためにもタイムリーな面会制限の見直しと、各家族に応じた退院指導を行っていく必要がある。departmental bulletin pape

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

Fungal Decolorization of Microbially Treated Night Soils

A fungal strain LM-12 was selected for the decolorization of microbially treated night soils {filtrate (iv) in Fig.1} and it was identified as Penicillium janthinellum. Strain LM-12 decolorized 50% of the color of the medium with 5.0 g/l glucose and 0.6 g/l ammonium sulfate at 30°C for 24 hr. Over 50% decolorization was not attained in any culture conditions tested, but the increase of the mycelial amount enhanced the decolorization rate. So by using repeated replacement culture, the decolorization period was reduced to 2.0 hr. The amount of nutrient addition could be reduced in further replacement culture

医療的ケアを必要とする児の両親のCOVID-19蔓延下におけるNICU退院後の思いと生活の質に関する調査

【背景・目的】 　NICU を退院した後も医療的ケアを必要とする児が増加しており、A 病院では2018 年よりNICU 退院後も医療的ケアを要する児の両親の思いと生活の質に関する調査を継続している。また現在、COVID-19 感染拡大による面会制限の中、短時間で退院支援をしており、退院後の両親の状況、制限がある中での退院支援の課題を明確にする必要があると考えた。引き続き、NICU を退院した医療的ケアを要する児の両親の思いと生活の質を明確にすることを目的とし、本研究を実施した。 【方法】 　2021 年9 月から2022 年10 月にNICU を退院した医療的ケアを要する児の両親を対象に、質問紙調査を行なった。調査項目は、①基本属性、②退院後の両親の思い、③育児環境、④生活の質（WHO QOL26）とした。各項目の記述統計を算出後、父と母の群間比較にはχ2 検定、Mann-Whitney のU 検定を用いた。自由記載については類似内容ごとに分類しカテゴリーを抽出した。 【結果】 　19 人（8 組の両親と3 組の母）からアンケートを回収した（回収率67.9％）。WHO QOL26 平均値は父が3.36±0.52、母が3.35±0.59 であった。退院後の思いについては全員がポジティブな気持ちを抱いており、ネガティブな気持ちも抱いた者は78.9% であった。自由記載では、ポジティブな気持ちに、＜子どもといられる喜び＞などが挙げられ、ネガティブな気持ちに、＜自責の念＞＜入院時には想定していなかったケアや手技の難しさ＞などが挙げられた。面会制限による＜愛着形成への不安＞や＜配偶者との思い・育児手技の差異＞も記載されていた。 【考察・結論】 　本研究でのWHO QOL 得点の平均値は、2018 年からの先行研究と比較し、両親ともに低かった。また、全国平均値と比較し、母は身体的領域のQOL が低かった。面会制限のなか、父は面会できないことで役割遂行に戸惑いを感じ、母のみの退院支援となり、両親間に情報格差や育児ケア習得に差が生じたことで母への負担が大きくなったと考えられる。父の育児参加や父性育成促進のため、また、母の負担軽減のためにもタイムリーな面会制限の見直しと、各家族に応じた退院指導を行っていく必要がある

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