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

Lawmaking through translation: 'translating' crimes and punishments

WOS: 000379257900009This article examines the role translation played in the encounter between legal systems through the examination of the Ottoman Penal Code (1858), which was drafted using the French Penal Code (1810) as the source. The results obtained through the comparative textual analysis of the codes in Ottoman Turkish and French are discussed with respect to the historical/legal circumstances pertinent to the Ottoman modernization/westernization in the Tanzimat (Reorganization) Period. Adherence to the source text norms observed in the translation of the articles on 'crimes against the state and their punishment' is argued to reflect the role the Ottoman Code was expected to play in the modernization of the Ottoman Empire. Adherence to the target culture/system norms observed in the translation of the articles on 'crimes against individuals and their punishment' is argued to reflect the ongoing power of the then-existing Islamic Ottoman penal law system. It is also claimed that the Ottoman Code belonged to the 'translated law' system in the Ottoman-Turkish 'legal polysystem'. Re-thinking the original-translation binary opposition in the context of the Ottoman Code, it is suggested that the Ottoman Code was a translation which was not produced to be presented/perceived as a translation but so as to entertain the status of an original code in the target system where the translated code was the law itself and had legal binding power. Thus the Ottoman Code functioned both as original and as translation and no power relationship existed between the Ottoman Code and the French Code in terms of their statuses in their respective systems/for their respective audience. Consequent to the observed dynamics of the case in question, in the study lawmaking through translation has been suggested as an alternative term to 'legal translation' to explain the specific relationship between making a law and translation where the latter is used as an instrument for the former

Pneumothorax following ultrasound-guided jugular vein puncture for central venous access in interventional radiology: 4 years of experience

PURPOSE: The purpose of our study was to review the rate of pneumothorax following central venous access, using real-time ultrasound guidance. MATERIALS AND METHODS: Data related to ultrasound-guided venous puncture, for central venous access, performed between July 1, 2004 and June 30, 2008 was retrospectively and prospectively collected. Access route, needle gauge, catheter type, and diagnosis of pneumothorax on the intraprocedure spot radiographs and or the postprocedure chest radiographs, were recorded. RESULTS: A total of 1262 ultrasound-guided jugular venous puncture for central venous access were performed on a total of 1066 patients between July 1, 2004 and June 30, 2008. Access vessels included 983 right internal jugular veins, 275 left internal jugular veins, and 4 right external jugular veins. No pneumothorax (0%) was identified. CONCLUSION: Due to an extremely low rate of pneumothorax following ultrasound-guided central venous access, 0% in our study and other published studies, we suggest that routine postprocedure chest radiograph to exclude pneumothorax may be dispensed unless it is suspected by the operator or if the patient becomes symptomatic

Bilateral choroidal metastasis from carcinoma ex pleomorphic adenoma of the parotid gland

The histological, clinical and angiographic findings are reported of a 34-year-old man with bilateral visual loss who had left parotidectomy with subsequent radiotherapy due to carcinoma ex pleomorphic adenoma of the parotid gland 1 year before, Funduscopy disclosed choroical masses with surrounding serous retinal detachment in both posterior poles. At the time of ocular diagnosis, lung, pleura and pharynx metastases had recently been revealed. Because of the extent of disease and its poor prognosis, no treatment was offered. Although parotid gland carcinoma usually spreads via lymphatics, choroical involvement may rarely occur due to haematogenous dissemination

LONG-TERM RESULTS OF EXTREMITY SOFT TISSUE SARCOMAS LIMB-SPARING SURGERY AND RADIOTHERAPY

Objective: To assess the prognostic factors and results of limb sparing surgery and postoperative radiotherapy (PORT) in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. Methods: Between 1980-2007, 114 extremity-located STS treated with PORT were analyzed retrospectively. Tumors were mostly localized in the lower extremities (71,9%). The median radiotherapy (RT) dose was 60.9 Gy. Chemotherapy was administered to 37.7% of the patients. Tumor sizes were between 3-26 cm (median 7 cm). The three most frequent histological types included undifferentiated pleomorphic sarcoma (26.3%), liposarcoma (25.4%), and synovial sarcoma (13.2%). The median follow-up for all patients was 60 months, and 81 months for survivors. Results: The 5- and 10-year local control (LC) rates were 77% and 70.4%, respectively; actuarial survival rates for 5 and 10 years were 71.8% and 69.1%, respectively. Increasing the dose above 60 Gy for all patients and the patients with positive margins demonstrated a clear benefit on 5-year LC (p =0.03 and p=0.04, respectively). Based on multivariate analysis, the addition of chemotherapy and RT dose were independent prognostic factors for LC. A recurrent presentation significantly affects the disease-free survival. Conclusions: PORT for STS of the extremities provides good long-term disease control with acceptable toxicity in a multidisciplinary approach

Effect of intraabdominal administration of Allium sativum (garlic) oil on postoperative peritoneal adhesione

WOS: 000337863200008PubMed: 24793933Objective(s): Peritoneal adhesion is a serious problem that develops after most abdominopelvic surgeries. Allium sativum (garlic) has been used for centuries as both a nutrient and a traditional medicine. The anti-inflammatory, antibacterial, fibrinolytic, and wound-healing properties of garlic are well-recognized. We evaluated the effect of garlic on formation of postoperative adhesions in rats. Study design: Thirty Wistar-Albino female rats weighing 200-250 g were randomly divided into three groups (10 rats/group). Group 1 rats received 5 ml/kg garlic oil intraperitoneally and no surgery was performed. The ceca of Group 2 rats (controls) were scraped, to trigger adhesion formation, and no treatment was given. In Group 3 rats, 5 ml/kg garlic oil was added to the peritoneal cavity immediately after the cecum was scraped. All animals were sacrificed 10 d after surgery and adhesions graded in terms of severity and histopathologic characteristics. Results: All animals tolerated the operations well. No adhesions were evident upon laparotomy of Group 1 animals. In Group 2 three rats had an adhesion grade 2 and seven rats had an adhesion of grade 3, whereas in Group 3 no adhesions were found in four rats, five rats had an adhesion grade of 1. Only one rat had a grade 2 adhesion. Macroscopic adhesions and mean adhesion scores of Group 3 were significantly lower than Group 2(p < 0.001). Histopathologic evaluation of the specimens also revealed a statistically significant differences in inflammation, fibrosis, and neovascularization scores between Group 2 and 3 (p = 0.001, p = 0.001, and p = 0.011, respectively). Inflammation, fibrosis and vascularization scores in Group 3 were found significantly lower than Group 2. Conclusion: The anti-inflammatory, antibacterial, fibrinolytic, antithrombotic, and wound-healing effects of garlic likely prevent formation of peritoneal adhesions in a rat model, and garlic may be effective and cheap when used to prevent such adhesions in humans. (C) 2014 Elsevier Ireland Ltd. All rights reserved

More than an Uterotonic Agent: Oxytocin Prevents Peritoneal Adhesion

WOS: 000374312100011Prevention of postoperative adhesions (PPA) has become an important issue. The aim is to investigate the effect of Oxytocin (OT) on PPAs. A total of thirty female Wistar-albino rats were randomly divided into three groups (10 rats/group). The cecal peritone of Group I rats (controls) were scraped, to trigger adhesion formation, and no treatment were given. After cecal scrubbing, 1 mL saline solution was applied to each rat in Group II (i.p. saline treated group) and 80 IU/kg of OT (Pituisan (R), Ege Vet, Turkey) to Group III (i.p. OT treated group) intraperitoneally. All animals were sacrificed 10 days after surgery and adhesions graded in terms of severity and histopathologic characteristics. The median scores for the extent, severity, and degree of adhesions in Group I and Group II were statistically significant and considerably higher than those scores for Group III (P<0.001). The inflammation, neovascularization, and fibrosis scores for Group III were statistically significant and considerably lower than those scores for Groups I and II (P<0.001, P<0.001 and P=0.002 respectively). OT, significantly prevented adhesion formation improving wound healing possibly by suppressing adhesion formation with anti-inflammatory and antioxidant properties. OT may be useful in the prevention of PPA in humans