Factors Contributing to the Utilization of Adult Mental Health Services in Children and Adolescents Diagnosed with Hyperkinetic Disorder

Objectives. To examine whether age of First diagnosis, gender, psychiatric comorbidity, and treatment modalities (pharmacotherapy or psychotherapy) at Child and Adolescent Mental Health Services (CAMHS) moderate the risk of Adult Mental Health Services (AMHS) utilization in patients diagnosed with hyperkinetic disorder at CAMHS. Methods. Data were derived from the Madrid Psychiatric Cumulative Register Study. The target population comprised 32,183 patients who had 3 or more visits at CAMHS. Kaplan-Meier curves were used to assess survival data. A series of logistic regression analyses were performed to study the role of age of diagnosis, gender, psychiatric comorbidity, and treatment modalities. Results. 7.1% of patients presented with hyperkinetic disorder at CAMHS. Compared to preschool children, children and adolescents first diagnosed with hyperkinetic disorder at CAMHS were more likely to use AMHS. Female gender and comorbidity with affective disorders, schizophrenia, schizotypal and delusional disorders increased the risk of use of AMHS. Pharmacological or combined treatment of hyperkinetic disorder diagnosed at CAMHS was associated with increased risk of use at AMHS. Conclusions. Older age of first diagnosis, female gender, psychiatric comorbidity, and pharmacological treatment at CAMHS are markers of risk for the transition from CAMHS to AMHS in patients with hyperkinetic disorder diagnosed at CAMHS

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

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

MEDIREUMA: protocolo y metodología de un estudio observacional de estados de salud y tratamiento de pacientes con poliartritis en la Comunidad Valenciana

Objetivo: Diseñar y probar un sistema de recogida de datos clínicos para artritis reumatoide, basado en formularios Web que los pacientes rellenan por sí mismos. Material y Método: Proyecto piloto ejecutado en 8 centros de la Comunidad Valenciana Se ha diseñado un sistema de entrada de datos para pacientes con artritis reumatoide, basado en claves unívocas y permisos de acceso jerarquizados. Los pacientes cumplimentan un formulario Web en su domicilio que incluye datos demográficos, diagnósticos, tratamientos actuales y anteriores, y HAQ de 20 preguntas. Al finalizar la sesión pueden imprimir un informe de resumen de los datos introducidos. Resultados: Se ha desarrollado un sistema Web semiautomatizado que permite a los pacientes entrar información clínica de forma directa, con generación automática de claves de acceso. El sistema está programado en PHP y los datos se almacenan en una base de datos online tipo MySQL. Actualmente se dispone de datos clínicos de 65 pacientes, incluidos por 8 reumatólogos de 6 centros. Aproximadamente un 40% de pacientes han rehusado participar debido principalmente a falta de acceso a Internet. Conclusión: La recogida de datos clínicos directamente a partir del paciente es una posibilidad real y que en este estudio ha demostrado ser factible y aceptable por los pacientes. Dado que este modelo no implica sobrecarga asistencial para el médico y permite una monitorización más detallada de la situación del paciente, se propone una generalización y valoración formal en estudios prospectivos a mayor escala

A New Calcium Vectoring Technology: Concentration and Distribution of Ca and Agronomic Efficiency in Pepper Plants

Calcium (Ca) is an important macronutrient for plants, although its low mobility through the phloem makes more difficult the translocation to growing tissues, including fruits. The blossom end rot (BER) physiopathy occurs mainly in fruits and is associated with water stress, and especially with low Ca levels, which has a very negative effect on the production of many crops. Currently, through the vectoring process, it is possible to increase the transport of immobile elements to the fruits. The objective of this study is to evaluate the effect of BRANDT® MANNI-PLEX® Ca, which contains Ca with a vector (polyalcohols), provided by the company BRANDT EUROPE S.L. (Carmona, Spain), on Ca accumulation and the production and quality of pepper fruits, both at harvest and post-harvest stage. Pepper plants were grown in a shaded greenhouse and supplied with BRANDT® MANNI-PLEX® Ca and parameters related to biomass, production, and fruit quality were analyzed. The results showed that the product increased shoot biomass, photosynthesis performance, Ca accumulation and quality of pepper fruits both at harvest and post-harvest, while reducing the incidence of Ca physiopathies by 70%. Therefore, this study proves the BRANDT® MANNI-PLEX® Ca efficacy in a crop with a high incidence of Ca physiopathies, such as pepper

A New Calcium Vectoring Technology: Concentration and Distribution of Ca and Agronomic Efficiency in Pepper Plants

Calcium (Ca) is an important macronutrient for plants, although its low mobility through the phloem makes more difficult the translocation to growing tissues, including fruits. The blossom end rot (BER) physiopathy occurs mainly in fruits and is associated with water stress, and especially with low Ca levels, which has a very negative effect on the production of many crops. Currently, through the vectoring process, it is possible to increase the transport of immobile elements to the fruits. The objective of this study is to evaluate the effect of BRANDT&reg; MANNI-PLEX&reg; Ca, which contains Ca with a vector (polyalcohols), provided by the company BRANDT EUROPE S.L. (Carmona, Spain), on Ca accumulation and the production and quality of pepper fruits, both at harvest and post-harvest stage. Pepper plants were grown in a shaded greenhouse and supplied with BRANDT&reg; MANNI-PLEX&reg; Ca and parameters related to biomass, production, and fruit quality were analyzed. The results showed that the product increased shoot biomass, photosynthesis performance, Ca accumulation and quality of pepper fruits both at harvest and post-harvest, while reducing the incidence of Ca physiopathies by 70%. Therefore, this study proves the BRANDT&reg; MANNI-PLEX&reg; Ca efficacy in a crop with a high incidence of Ca physiopathies, such as pepper