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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Seaweeds-derived compounds modulating effects on signal transduction pathways: A systematic review

Background Recently, the study of marine natural products has gained interest due to their relevant biological activities. Specially, seaweeds produce bioactive compounds that could act as modulators of cell signaling pathways involved in a plethora of diseases. Thereby, the description of the molecular mechanisms by which seaweeds elicit its biological functions will certainly pave the way to the pharmacological development of drugs. Aim This review describes the molecular mechanisms by which seaweeds act and its possible utilization in the design of new drugs. Methods This review was conducted according to the PRISMA-P guidelines for systematic reviews. Two independent authors searched into four different databases using combinations of keywords. Two more authors selected the articles following the eligibility criteria. Information extraction was conducted by two separated authors and entered into spreadsheets. Methodological quality and risk of bias were determined applying a 12-question Risk of Bias criteria tool. Results and discussion We found 2360 articles (SCOPUS: 998; PubMed: 678; Wiley: 645 and EBSCO: 39) using the established keywords, of which 113 articles fit the inclusion criteria and were included in the review. This work comprises studies in cell lines, and animal models, any clinical trial was excluded. The articles were published from 2005 up to March 31st 2018. The biggest amount of articles was published in 2017. Furthermore, the seaweeds tested in the studies were collected in 15 countries, mainly in Eastern countries. We found that the main modulated signaling pathways by seaweeds-derivate extracts and compounds were: L-Arginine/NO, TNF-α, MAPKs, PI3K/AKT/GSK, mTOR, NF-κB, extrinsic and intrinsic apoptosis, cell cycle, MMPs and Nrf2. Finally, the articles we analyzed showed moderate risk of bias in almost all the parameters evaluated. However, the studies fail to describe the place and characteristics of sample collection, the sample size, and the blindness of the experimental design. Conclusion In this review we identified and summarized relevant information related to seaweed-isolated compounds and extracts having biological activity; their role in different signal pathways to better understand their potential to further development of cures for cancer, diabetes, and inflammation-related diseases

InBase 2.0: Tietokanta ja tutkimustyökalu automaattisesti isäntäproteiinista irti silmukoituville proteiineille

Inteins are autocatalyzing self-splicing proteins that are excised from a host protein giving a free intein and an active protein. Other protein groups related to inteins by their ability to self-splice are also found and their function are at some level studied. These proteins share a domain named as HINT (Hedgehog/Intein). At the moment these groups are named as inteins, bacterial intein-like proteins A, B and C, hedgehog proteins and Vints. The purpose of this work was to build a platform, named as InBase 2.0, where the functions and properties of these self-splicing elements could be studied efficiently. The database that gathers protein sequences having these common properties lies at the basis of InBase 2.0. The database is a relational database linking other important information to the actual sequential data of the proteins. Such information is for example publications, classification of proteins, measured self-splicing activities etc. A set of tools was added to the InBase 2.0 in order to perform sequential analysis and comparison between the sequences. The set of tools performing sequential analysis includes BLAST, InterProScan 5, ClustalW and WebLogo. Several known inteins contain homing endonuclease domain. This domain can copy the intein coding sequence to another location in a genome. However, the copy site needs to have a specific recognition site, which is again specific to the intein. The capability of the tools were studied by constructing a workflow capable to predict such recognition sites. Some recognition sites are known and the constructed workflow utilizing the tools of InBase 2.0 was capable to find these recognition sites with a small deficiency, not been able to predict the length of the site. Classification of the protein sequences containing the HINT domain is not very clear. InBase 2.0 main purpose for now on is to help to provide more specific definitions to the subgroups of the HINT domain containing proteins.Inteinit ovat proteiineja, jotka silmukoituvat automaattisesti irti isäntäproteiinista ilman entsyymejä tai muita katalyyttejä. Silmukoitumisesta seuraa toimiva isäntäproteiini ja vapaa inteini. Tämä automaattinen leikkauttuminen on inteini -proteiinien perusominaisuus ja myös muita samankaltaisilla ominaisuuksilla varustettuja proteiiniryhmiä on löydetty. Kaikissa näissä ryhmissä - inteinit mukaanluettuna - on proteiini -alue (engl. domain) nimeltä HINT, joka vastaa leikkautumisesta. Tällä hetkellä ryhmät ovat inteinit, bakteeriperäiset inteinien kaltaiset proteiinit A, B ja C, sekä Hedgehog ja Vint -ryhmät. Monet näiden ryhmien proteiineista ovat huonosti tutkittuja. Tämän työn tarkoituksena on rakentaa verkkopohjainen työkalu - nimeltään InBase 2.0 - näiden ryhmien ominaisuuksien tutkimiseen sekä tietokanta proteiinisekvenssien tallennukseen. InBase 2.0:n tietokanta on relaatiotietokanta, jossa proteiinisekvensseihin voidaan linkittää niihin liittyvää tietoa. Tallaista tietoa on esimerkiksi sekvenssiin liittyvät julkaisut, sekvenssien luokitukset ja leikkautumisaktiivisuus. InBase 2.0:n työkalupaketti sisältää sekvenssianalyysissä yleisesti käytettyjä ohjelmistoja. Työkalut ovat BLAST, InterProScan 5, ClustalW ja WebLogo. Useat inteinit sisältävät myös proteiini -domainin nimeltä hakeutuva endonukleaasi. Tämä domaini voi kopioida inteiniä koodavan DNA -sekvenssin toisaalle organismin genomissa. Uusi sijainti tulee kuitenkin sisältää lyhyen ko. inteinille spesifisen DNA -sekvenssin, ns. tunnistusalue. Osalta inteineistä tämä tunnistusalue on tunnettu. Tätä tietoa käytettiin hyväksi, kun InBase 2.0:n työkaluista rakennettiin yhteiskäyttökokonaisuus, jolla näitä tunnistusalueita pyritään ennustamaan. Kokonaisuus toimii kyeten selvittämään tunnetut tunnistusalueet, mutta ei sitä kuinka pitkä tämä alue on. Toinen päätehtävä InBase 2.0:lla on se että HINT domainin sisältävien proteiinien luokittelu on hankalaa ja epämääräistä. Tähän ongelmaan pyritään saada selkeämpi määrittely käyttäen hyväksi InBase 2.0 työkaluja

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