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

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

Evaluation of the transfer parameters in patients who admitted to our hospital with ST elevation myocardial infarction

YÖK Tez No: 319238Akut miyokard infarktüsü (AMİ), ciddi morbidite ve mortalite ile seyreden yaygın bir hastalıktır. Hızlı damar reperfüzyonu ST elevasyonlu miyokard infarktüsü (STEMI) tedavisinin en önemli aşamasıdır ve reperfüzyon ne kadar erken sağlanırsa o kadar çok canlı miyokard dokusunun kurtarıldığı birçok çalışmada gösterilmiştir.Ocak 2010-Mart 2012 tarihleri arasında, ST elevasyonlu miyokard infarktüsü nedeniyle primer perkütan koroner girişim (PKG) uygulanan 200 hasta (160 erkek, 40 kadın) geriye dönük olarak değerlendirildi. Hastaların semptom başlangıcından ilk damar açıcı tedaviye kadar olan transfer parametreleri, klinik özellikleri ve laboratuar değerleri kaydedildi. Hastaların ortalama ağrı süresi (Ağrı-ilk hastane başvuru süresi) 123,1±109,7 dakika, ortalama kapı-balon süresi 52,1±23,7 dakika olarak tespit edildi.Primer PKG, infarktüs ile ilişkili arterde tam reperfüzyon sağlanmasında etkili bir tedavi yöntemidir. Sonuçların başarısı sadece merkezin deneyimi ve donanımına değil, aynı zamanda reperfüzyonun ne kadar kısa sürede sağlandığına da bağlıdır. Çalışmamızda ortalama ağrı-balon süresinin dört saatden fazla olduğu ve hastaların ambulans yerine daha çok kendi imkanları ile acil servislere başvurdukları görüldü. Önemli oranda, ilk hastane başvurusunun, primer anjiyoplasti imkanı olan bir merkeze yapılmadığı tespit edildi. Reperfüzyon tedavi süresini geciktiren olumsuz durumların ortadan kaldırılması amacıyla bölgesel ya da ulusal düzeyde, tanı,transfer ve tedavi programlarının oluşturulması gereklidir.Acute myocardial infarction (AMI) is a common disease that causes severe morbidity and mortality. Assesment of risk stratification at admission is important for deciding whether medical or interventional therapy is better. The most important step of the STEMI treatment is rapid reperfusion of arteries and it is shown in many studies that, sooner you get reperfusion more you get alive myocardial tissue. We retrospectively evaluated 200 patients (160 males, 40 females) who underwent primary PCI for acute ST-elevation myocardial infarction between January 2010- May 2012. Transfer parameters of symptom to reperfusion treatment, clinical characteristics and laboratory values were recorded. The mean duration of pain (Time from symptom onset to hospital arrival) was 123.1 ± 109.7 minutes, mean door-to-balloon time was 52.1 ± 23.7 minutes.Primary PCI is an effective method in achieving complete revascularization of the infarct-related artery. Successful results not only depend on the experience and equipment of the center, but also on how rapidly reperfusion is achieved. In our study were seen that the mean pain-to-balloon time were more than four hours and patients admitted to emergency departments with their own facility rather than an ambulance. Significantly, the first application made to a PCİ hospital.To remove the negative factors that delay reperfusion time, it is necessary to create transfer and therapy program in local district or all over the country

Supply chain management under fuzziness: recent developments and techniques

Supply Chain Management Under Fuzziness presents recently developed fuzzy models and techniques for supply chain management. These include: fuzzy PROMETHEE, fuzzy AHP, fuzzy ANP, fuzzy VIKOR, fuzzy DEMATEL, fuzzy clustering, fuzzy linear programming, and fuzzy inference systems. The book covers both practical applications and new developments concerning these methods. This book offers an excellent resource for researchers and practitioners in supply chain management and logistics, and will provide them with new suggestions and directions for future research. Moreover, it will support graduate students in their university courses, such as specialized courses on supply chains and logistics, as well as related courses in the fields of industrial engineering, engineering management and business administration

A Fuzzy Inference System for Supply Chain Risk Management

Risk management is the identification, assessment, and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events. In the last decade risk management has become a vital part of supply chain management. The risk sources of supply chain are identified in five areas namely: transport/distribution, manufacturing, order cycle, warehousing, and procurement. The aim of the study is to build a supply chain risk measurement system using Fuzzy Inference Systems (FIS)

A Fuzzy Inference System for Supply Chain Risk Management

Risk management is the identification, assessment, and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events. In the last decade risk management has become a vital part of supply chain management. The risk sources of supply chain are identified in five areas namely: transport/distribution, manufacturing, order cycle, warehousing, and procurement. The aim of the study is to build a supply chain risk measurement system using Fuzzy Inference Systems (FIS)

Myocardial performance index in patients with dipper and nondipper hypertension

WOS: 000339169500006PubMed: 24847725Background The aim of this study was to evaluate the relationship between left ventricular (LV) myocardial performance index (MPI) and nondipper pattern in hypertensive patients. Methods Between June 2012 and November 2012, patients admitted to the Cardiology Department of Duzce University Faculty of Medicine and diagnosed previously with essential hypertension were included in the study. Patients were divided into two groups, nondippers and dippers, using ambulatory blood pressure measurement. All patients were evaluated by two-dimensional and Doppler echocardiography. LV MPI was calculated from tissue Doppler imaging parameters. Results There was no significant difference between the two groups in the proportion of each class of antihypertensive medications. Dippers and nondippers had similar age, BMI, lipid profiles, and smoking status. The MPI value was significantly higher in nondippers than in dippers, and was correlated negatively with the rate of systolic and diastolic blood pressure fall at night (P < 0.001). Conclusion Our study showed that MPI is disturbed in patients with nondipper hypertension. MPI may be used in the diagnosis and follow-up of global LV dysfunction in patients with a nondipper pattern, but further prospective studies are needed. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins