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

The Innovators : Kisah Para Peretas, Genius, dan Maniak yang Melahirkan Revolusi Digital

Komputer dan internet tergolong temuan terpenting di zaman kita, namun hanya segelintir orang yang mengetahui siapa pencipta keduanya. Komputer dan internet tidak diciptakan begitu saja di loteng atau garasi oleh seorang penemu yang bisa digadang-gadang di sampul majalah atau dimuliakan sejajar dengan Thomas Alva Edison atau Alexander Graham Bell yang ciptaannya memulai sebuah revolusi baru.Inovasi-inovasi yang tercipta pada era digital justru bukan hasil karya satu "superhero", melainkan hasil dari sebuah kolaborasi. Banyak orang hebat lintas generasi yang terlibat di dalamnya, orang-orang yang luar biasa cerdas, kreatif, dan jenius.The Innovators memaparkan kisah para pionir, peretas, penemu, dan pebisnis: profil, pola pikir, ribuan riset-riset yang dilakukan, hingga latar belakang pemicu kreativitas mereka. Mulai dari Ada Byron, Edisson, Alan Turing, Bill Gates, Steve Jobs, Lary Page, hingga Mark Zuckerberg.xxiv+508hlm.;15,5x23,5c

First steps on the way to a modular concept for the preparation of carbon based catalysts

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Carcinoma Espinocelular cutâneo bem diferenciado: apresentação atípica

O câncer de pele não-melanoma é a neoplasia maligna mais comum no Brasil. Seu subtipo menos frequente, o carcinoma espinocelular (CEC), pode ser agressivo, mas, na maioria das vezes, é completamente curado por medidas terapêuticas locais. Relatamos o caso de uma mulher de 75 anos que apresentava lesão de 2,5 cm em dorso da mão esquerda diagnosticada como CEC bem diferenciado. Foi submetida à ressecção da lesão com margem cirúrgica de 1,5 cm. Após 75 dias da cirurgia, paciente retornou com linfadenomegalia axilar esquerda. Foi realizada biópsia, que conclui tratar-se de CEC bem diferenciado metastático. O tratamento proposto foi linfadenectomia axilar com radioterapia adjuvante. Paciente evoluiu com recidiva axilar ulcerada e dor intensa, sendo realizada ressecção ampliada da lesão. Foi proposto à paciente desarticulação interescapulotorácica e a paciente concordou com a realização do procedimento. Atualmente, encontra-se em controle ambulatorial, sem sinais de recidiva ou metástases à distância. O caso clínico mostra uma evolução atípica de um CEC bem diferenciado, com lesão primária em dorso da mão esquerda e metástase linfonodal axilar precoce, com comprometimento da qualidade de vida. Optamos pela desarticulação interescapulotorácica devido à presença de um tumor localmente avançado, a não funcionalidade do membro, a possibilidade de melhor higienização local e a ausência de metástases em outros sítios

Carcinoma Espinocelular cutâneo bem diferenciado: apresentação atípica doi: http://dx.doi.org/10.5892/ruvrv.2012.102.5258

O câncer de pele não-melanoma é a neoplasia maligna mais comum no Brasil. Seu subtipo menos frequente, o carcinoma espinocelular (CEC), pode ser agressivo, mas, na maioria das vezes, é completamente curado por medidas terapêuticas locais. Relatamos o caso de uma mulher de 75 anos que apresentava lesão de 2,5 cm em dorso da mão esquerda diagnosticada como CEC bem diferenciado. Foi submetida à ressecção da lesão com margem cirúrgica de 1,5 cm. Após 75 dias da cirurgia, paciente retornou com linfadenomegalia axilar esquerda. Foi realizada biópsia, que conclui tratar-se de CEC bem diferenciado metastático. O tratamento proposto foi linfadenectomia axilar com radioterapia adjuvante. Paciente evoluiu com recidiva axilar ulcerada e dor intensa, sendo realizada ressecção ampliada da lesão. Foi proposto à paciente desarticulação interescapulotorácica e a paciente concordou com a realização do procedimento. Atualmente, encontra-se em controle ambulatorial, sem sinais de recidiva ou metástases à distância. O caso clínico mostra uma evolução atípica de um CEC bem diferenciado, com lesão primária em dorso da mão esquerda e metástase linfonodal axilar precoce, com comprometimento da qualidade de vida. Optamos pela desarticulação interescapulotorácica devido à presença de um tumor localmente avançado, a não funcionalidade do membro, a possibilidade de melhor higienização local e a ausência de metástases em outros sítios