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

Outcomes of gender-sensitivity educational interventions for healthcare providers: A systematic review

Background: Although gender plays an important role in health, most healthcare providers lack knowledge in providing gender-sensitive care. Offering gender-sensitivity training for healthcare providers can help to address gender-based health inequalities. Method: A mixed-methods systematic review of gender-sensitivity training programmes or interventions for healthcare providers was undertaken to assess their outcomes and to document areas for future research. Comprehensive searches of seven international databases were conducted for peer-reviewed literature published between 1998 and 2018. Eligible studies included at least one outcome related to gender-sensitivity training for healthcare providers. Results: Twenty-nine studies met the inclusion criteria. Fourteen studies focused on gender-sensitivity in reducing gender bias towards men and women, and 15 studies focused on addressing the needs of lesbian, gay, bisexual and transgender (LGBT) patients. Thirty-seven percent of studies showed a significant improvement in gender-related knowledge, attitudes or practice after the training. Multiple training methods were used to teach gender-sensitive care. Common content of the training included learning sex/gender terminology, understanding gender issues and inequalities in health, stigma and discrimination and communication skills. The duration and frequency of interventions ranged considerably. Sex differences in training outcomes also occurred among the learners. Conclusion: Review findings highlight that although gender-sensitivity training for healthcare providers is increasing, there is insufficient evidence to determine its effectiveness. Additional, more rigorously designed studies are needed to assess the long-term implications on learner behaviours and practices, especially across a wide variety of healthcare providers.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded through a Canadian Institutes of Health Research and Social Sciences and Humanities Research Council (CIHR-SSHRC) partnership grant and also the Kimmel Family Fund

Disclosure and workplace accommodations for people with autism: a systematic review

This is an Accepted Manuscript of an article published by Taylor & Francis in Disability and Rehabilitation July 7th 2019, available online: http://www.tandfonline.com/10.1080/09638288.2019.1635658Purpose: The objective of this systematic review was to describe the prevalence and processes of disability disclosure for persons with autism spectrum disorder. Methods: Systematic searches of seven international databases revealed 26 studies meeting our inclusion criteria. We analyzed these studies with respect to participant demographics, methodology, results and quality of the evidence. Results: Among the 26 studies, 7006 participants (aged 13-75, mean 28.1 years) were represented across seven countries. Our findings showed that rates of disclosure and receiving workplace accommodations varied considerably. Benefits of disclosing in the workplace included greater acceptance and inclusion, receiving accommodations, and increasing awareness about autism. Limitations of disclosing to employers involved experiencing stigma and discrimination. Factors affecting decisions to disclose included age at diagnosis, social demands of the job, and workplace policies. Types of accommodations that were received or desired included adjustments to the job interview process, schedules (i.e., flexibility, working from home), job content or working conditions, environment (i.e., lighting, quiet space); support with communication and social skills; and disability awareness training for their workplace colleagues. Conclusions: Our findings highlight that disclosing a condition of autism in the workplace and requesting accommodations is complex. More research is needed to explore processes of disclosing and accommodation and how these processes vary by autism sub-type, gender, and industry type. Implications for rehabilitation Clinicians and vocational Counselors should support people with autism to advocate for their needs in the workplace, including the potential benefits of disclosing their conditions so they can access accommodations that allow them to keep healthy and productive in workplace.Clinicians should recognize that people with autism spectrum disorder may have different workplace accommodation needs than those with other types of disabilities, in particular support with social and communication skills.Clinicians should aid people with autism to access resources and supports that are available to them to access workplace accommodations.This research was funded by a CIHR-SSHRC partnership grant and the Kimmel Family Fund

A methodology for the sampling and identification of microplastics in bird nests

Plastic pollution has significantly impacted terrestrial ecosystems and using bird nests to monitor microplastics in the environment is economical, uses green reagents, is relatively easy to sample, and is non-invasive. The plastics can generally be fragmented in the nests, giving rise to mesoplastics and later to microplastics. Microplastics (MPs) in nests can cause adverse effects on the chicks that ingest them by mistaking them for their food. In addition, chemical compounds such as pesticides, hydrocarbons, heavy metals, and flame retardants, among many others, can be adhered to the MPs. Therefore, applying green methodologies to determine microplastics in bird nests is of importance since it is an environmentally friendly manual technique due to the fact that no reagents or chemical substances are used during the nest-breaking procedures and MPs separation, and allows to perform other analyses. The methodology was applied to nests of Great-tailed grackle (Quiscalus mexicanus) from an urban area. The results of MPs in the nests of this study presented an average of 250.3 ± 221.3 items/nest. The mean (± SE) of MPs per kilogram of a nest was 2,535.3 ± 2,175.9 items/kg. The most abundant MPs were the synthetic fibers composed of polyethylene and polypropylene. The proposed step-by-step methodology does not use reagents, so it is considered a sustainable analytical method (Green chemistry)

Mapping of Brain Activity by Automated Volume Analysis of Immediate Early Genes

Summary Understanding how neural information is processed in physiological and pathological states would benefit from precise detection, localization, and quantification of the activity of all neurons across the entire brain, which has not, to date, been achieved in the mammalian brain. We introduce a pipeline for high-speed acquisition of brain activity at cellular resolution through profiling immediate early gene expression using immunostaining and light-sheet fluorescence imaging, followed by automated mapping and analysis of activity by an open-source software program we term ClearMap. We validate the pipeline first by analysis of brain regions activated in response to haloperidol. Next, we report new cortical regions downstream of whisker-evoked sensory processing during active exploration. Last, we combine activity mapping with axon tracing to uncover new brain regions differentially activated during parenting behavior. This pipeline is widely applicable to different experimental paradigms, including animal species for which transgenic activity reporters are not readily available