Exploring Pressures, Tissue Reperfusion and Body Positioning: A Pilot Evaluation

Objective: To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature; and interface pressure (IP) and tissue reperfusion (TR). Also to assess the relationship in critically ill patients between: sequential organ failure assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, and IP and TR. Setting: 27-bed intensive care unit (ICU) of an Australia tertiary hospital. Participants: 23 low- and high-acuity ICU patients and 9 healthy adult volunteers. Methods: IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), and peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. Results Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings substantively differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling additionally for age and BMI. The controlling variable of age was also significant (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were revealed; however, temperature was revealed to be substantively related to TR (p=0.091). Conclusions: While not being powered to detect significant effects, this pilot analysis has nonetheless determined several associations of importance, with substantive differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteer

A Study on Copyright Protection of Mobile Applications in Small and Micro Computer Enterprises

As more and more small and micro software developers begin to participate in the development process and gradually become the intermediate force of Internet innovation, people are enjoying their life in scientific and technological progress. As a special kind of software, mobile application has the characteristics of lightweight and simple development, which enhances the difficulty of protecting rights and interests of its copyright owners, especially the small and micro software copyright owners. This paper will explore the particularity of its right protection and its solution, and dig out ways to further motivate social innovation

Exploring body morphology, skin microcirculation and microclimate in patients with critical illness

This doctoral research explored the association between body morphology, skin microcirculation, and skin microclimate on skin integrity in patients with a critical illness. As a result of the burden of illness, patients can experience a range of complications, including impaired skin integrity, with subsequent pressure injury development. This research found that participants with an overweight and obese body mass index and participants with an inverted triangle body shape were at a greater risk of pressure injury development. This innovative research considered risk factors for skin vulnerability from a new and person-centred perspective and it has provided direction for future research

Exploring body morphology, sacral skin microclimate and pressure injury development and risk among patients admitted to an intensive care unit: A prospective, observational study

Objective: To determine the association between body morphology, sacral skin microclimate and their impact on the development and risk of pressure injuries among patients in an intensive care unit. Methodology: A prospective observational exploratory study was conducted over 30 weeks. Repeat study observations occurred multiple times a week for 28 days or until discharge. Participant inclusion criteria were ≥ 18 years of age, expected intensive care length of stay > 24 h and intact skin over the sacrum region. Setting: The study was conducted in a 36-bed intensive care unit of a major metropolitan public hospital in Queensland, Australia. Outcome measures: Pressure injuries were staged and independently verified according to the international pressure injury classification system. Pressure injury risk was determined by the Braden scale score and subepidermal oedema, using a subepidermal moisture scanner at the sacrum. Results: Of the 93 participants recruited, an inverted triangle body shape (p =.049), a BMI > 25 kg/m2 (p =.008), a standard foam mattress type (p =.017) and increased length of stay (p <.001) were associated with an increased pressure injury risk according to subepidermal oedema. Participants with increased sacral skin temperature (p <.001), mechanical ventilation (p <.001), vasoactive drugs administered (p =.003), increased sequential organ failure assessment score (p =.047), neurovascular diagnosis (p =.031) and increased length of stay (p =.027) were associated with increased pressure injury risk according to the Braden scale score. Conclusion: Body morphology and skin microclimate are associated with pressure injury risk during critical illness. Implications for Clinical Practice: Subepidermal oedema was associated with a patient's shape, body mass index and mattress type, factors that directly influence the pressure loading and the skin, whereas the Braden scale was associated with sacral temperature and clinical measures of critical illness. Consideration of body morphology and skin microclimate in pressure injury risk assessment could lead to more specific prevention strategies targeting high risk patients.</p

Exploration into the factors influencing evidence uptake of delirium management in intensive care. A qualitative descriptive study

Introduction: Delirium remains a commonly under recognised or misdiagnosed patient complication of admission to the ICU. Objectives: To explore clinicians’ perceptions of factors that affect the delivery of evidence-based practice for the assessment and management of delirium in adult ICU patients.Methods: This study, conducted in the 27-bed ICU of a major metropolitan quaternary public hospital in Queensland, Australia, used a qualitative descriptive design with purposive sampling and semi-structured in-depth one on one interviews. Clinicians, both medical professionals and registered nurses, employed in the study setting with greater than 12-months ICU experience were recruited. Interviews were audio recorded and transcribed verbatim. Transcripts were cross-checked by participants for veracity. Data were analysed using Braun and Clark’s six phases for thematic analysis. Results: Fifteen clinicians participated; 10 registered nurses and 5 medical staff specialists. Thematic analysis revealed the main barriers affecting delirium best-practice were: 1) the physical environment, including iatrogenic high noise levels and lighting, 2) cocktail of treatments, with continuance of frequent observations, reliance on multiple pharmacological agents and use of restraints, and 3) accessing evidence-based practice, including a lack of awareness of current guidelines and.using previous experience to guide practice. 4) A reactionary approach to treat rather than prevent. Enablers of best-practice approaches were shown in the themes of 1) family engagement, connecting with the family, 2) leadership, including support by peers and peer leaders, 3) exemplary practice, highlighted by going the extra mile and patient focussed care. Conclusions: This study highlights the existence of facilitators and barriers to the adoption of evidence -based practice approaches. Further research is required to develop site-specific evidence adoption strategies to address the iatrogenic complication of delirium. <br/

Exploring body morphology and skin microcirculation in patients with critical illness

Patients in the intensive care unit are at a high risk for developing pressure injuries. Critical illness is multifaceted and not all patients are at equal risk for impaired skin integrity. Body morphology and skin microcirculatory response may reduce the skin’s tolerance level to pressure