Relationships Between Oral-Mucosal Pressure Ulcers, Mechanical Conditions, and Individual Susceptibility in Intubated Patients Under Intensive Care: A PCR-Based Observational Study

2021 ◽  
pp. 109980042199807
Author(s):  
Soo Hyun Kim ◽  
Hee Sam Nah ◽  
Jin Bom Kim ◽  
Chul Hoon Kim ◽  
Myoung Soo Kim
Keyword(s):  
Intensive Care ◽  
Relative Abundance ◽  
Albumin Level ◽  
Preventive Strategy ◽  
Mechanical Pressure ◽  
Exact Test ◽  
Individual Susceptibility ◽  
Restraint Use ◽  
Frequent Monitoring ◽  
Mucosal Pressure

Purpose: This study was performed to determine the relationship between oral-mucosal pressure ulcer (PU) stage and mechanical conditions and individual susceptibility in intubated patients. Methods: We collected 80 patient-days data from an intensive care unit of a 700-bed hospital in Korea. We analyzed oral-mucosal PUs, medical records, amount of saliva, and oral mucosal swabs. Bacterial abundance was enumerated by real-time polymerase chain reaction. The χ2 or Fisher’s exact test, t-test or Mann-Whitney U test, and Spearman’s rho correlation analysis were performed. Results: The incidence of overall oral-mucosal PUs was 31.3%, and in the maxillary and mandibular sites were 16.3% and 26.3%, respectively. There were significant correlations between the maxillary site PU stage and restraint use (r = .43, p < .001), albumin level (r = −.22, p = .046), and relative abundance of P. aeruginosa (r = .45, p < .001) and S. aureus (r = −.24, p = .033). In the mandibular sites, there were significant correlations between PU stage and restraint use (r = .30, p = .008), level of consciousness (r = .31, p = .005), and relative abundance of P. aeruginosa (r = .25, p = .028) and S. pneumoniae (r = .22, p = .046). Conclusions: Frequent monitoring and repositioning the mechanical pressure on the oral-mucosa could be an effective preventive strategy against the development and advancement of oral-mucosal PUs. Additionally, monitoring the oral microorganisms can prevent advanced stage oral-mucosal PUs in intubated patients.

scholarly journals Continuous Blood Purification on Influenza-associated Neurological Disease in Children: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Jingwen Ni ◽  
Kenan Fang ◽  
Zhe Zhao ◽  
Zhiyuan Wang ◽  
Qian Huang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Neurological Disease ◽  
Retrospective Cohort ◽  
Neurological Complications ◽  
Inflammatory Factors ◽  
Continuous Variables ◽  
Exact Test ◽  
Significant Difference

Abstract Background: Due to lack of proven therapies，we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children.Methods: A single-center, retrospective, cohort study was conducted in Luoyang, Henan province China from January 2018 to January 2020. The children with Influenza-associated neurological disease (<18 years old) were enrolled into this study. The children with CBP indications and the parents’ consent received CBP, and the others were treated with maximal intensive care due to failure of parents consent. The outcomes were compared between CBP group and non-CBP group.Categorical variables were presented as percentage and compared by Chi-square test or Fisher’s exact test. Continuous variables were expressed as median (interquartile ranges) and compared with non-parametric independent sample test. Statistical analyses were finished by SPSS (version 26.0) and p < 0.05 (2 tailed) was considered statistically significant.Results: 30 influenza children with Influenza-associated neurological disease were enrolled in this study. 18 received CBP and other 12 were treated with maximal intensive care. There were no differences between CBP and non-CBP children in age, sex, body weight, type of influenza virus, neurological complications, Glasgow score, PIM-2 score and PCIS at admission (p > 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In CBP group, the level of IL-6 decreased significantly at 3-day of admission (p = 0.003), the level of CRP and PCT also decreased, but there was no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on level of CRP, PCT and IL-6 between at admission and 3-day of admission (p > 0.05). The 28-day mortality in the CBP group was significantly lower compared to non-CBP group (11.11% vs 50%, p = 0.034).Conclusions: CBP could Reduce inflammatory factors and may reduce 28-day mortality and improve neurologic function of influenza children.Trial registration: http://www.chictr.org.cn/index.aspx (ChiCTR2000031754).

Eliciting critical care nurses’ beliefs regarding physical restraint use

2018 ◽  
Vol 26 (5) ◽  
pp. 1458-1472 ◽  
Author(s):  
Gemma Via-Clavero ◽  
Marta Sanjuán-Naváis ◽  
Marta Romero-García ◽  
Laura de la Cueva-Ariza ◽  
Gemma Martínez-Estalella ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Theory Of Planned Behaviour ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Control Beliefs ◽  
Physical Restraints ◽  
Planned Behaviour ◽  
Restraint Use ◽  
And Control

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice. Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. Research design: A belief elicitation study was conducted. Participants and research context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Findings: Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Discussion: Safety arguments based on the surrounding work environment were discussed. Conclusion: Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

scholarly journals The challenges of using physical restraint in intensive care units in Iran: A qualitative study

2020 ◽  
pp. 175114371989278
Author(s):  
Zahra Salehi ◽  
Soodabeh Joolaee ◽  
Fatemeh Hajibabaee ◽  
Tahereh Najafi Ghezeljeh
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Standard Equipment ◽  
Restraint Use ◽  
Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

Factors behind ethical dilemmas regarding physical restraint for critical care nurses

2019 ◽  
Vol 27 (2) ◽  
pp. 598-608 ◽  
Author(s):  
Zahra Salehi ◽  
Tahereh Najafi Ghezeljeh ◽  
Fatemeh Hajibabaee ◽  
Soodabeh Joolaee
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Content Analysis ◽  
Intensive Care ◽  
Ethical Dilemmas ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Legal Problems ◽  
Restraint Use ◽  
Conventional Content Analysis

Background: Physical restraint is among the commonly used methods for ensuring patient safety in intensive care units. However, nurses usually experience ethical dilemmas over using physical restraint because they need to weigh patient autonomy against patient safety. Aim: The aim of this study was to explore factors behind ethical dilemmas for critical care nurses over using physical restraint for patients. Design: This is a qualitative study using conventional content analysis approach, as suggested by Graneheim and Lundman, to analyze the data. Methods: Seventeen critical care nurses were purposefully recruited from the four intensive care units in Tehran, Iran. Data were collected through in-depth semi-structured interviews and were concurrently analyzed through conventional content analysis as suggested by Graneheim and Lundman. Ethical consideration: This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran with the code: IR.IUMS.REC.1397.795. Before interviews, participants were provided with explanations about the aim of the study, the confidentiality of the data, their freedom to participate, and the right to withdraw the study, and their free access to the study findings. Finally, their consents were obtained, and interviews were started. Results: Factors behind ethical dilemmas for critical care nurses over using physical restraint were categorized into three main categories, namely the outcomes of using physical restraint, the outcomes of not using physical restraint, and emotional distress for nurses. The outcomes of using physical restraint were categorized into the three subcategories of ensuring patient safety, physical damage to patients, and mental damage to the patient. The outcomes of not using physical restraint fell into two subcategories, namely the risks associated with not using physical restraint and legal problems for nurses. Finally, the two subcategories of the emotional distress for nurses main category were nurses’ negative feelings about restraint use and uncertainty over the decision on physical restraint use. Conclusion: Decision-making for restraint use is often associated with ethical dilemmas, because nurses need to weight the outcomes of its use against the outcomes of not using it and also consider patient safety and autonomy. Health authorities are recommended to develop clear evidence-based guidelines for restraint use and develop and implement educational and counseling programs for nurses on the principles of ethical nursing practice, patient rights, physical restraint guidelines and protocols, and management of emotional, ethical, and legal problems associated with physical restraint use.

scholarly journals Spatial and temporal analysis of Phytophthora megakarya epidemic in newly established cacao plantations

Plant Disease ◽  
2020 ◽  
Author(s):  
MINETTE MIREILLE DJEUMEKOP NDOUNGUE ◽  
Marie-Ange Ngo Bieng ◽  
Fabienne Ribeyre ◽  
François Bonnot ◽  
Christian Cilas ◽  
...  
Keyword(s):  
Disease Onset ◽  
Temporal Analysis ◽  
Fisher Exact Test ◽  
Preventive Strategy ◽  
Disease Dynamics ◽  
Exact Test ◽  
Distribution Maps ◽  
Infection Dynamics ◽  
Black Pod ◽  
Phytophthora Megakarya

Studying spatial and temporal plant disease dynamics helps to understand pathogen dispersal processes and improve disease control recommendations. In this study, three cacao plots devoid of primary inoculum of Phytophthora megakarya (causal agent of cacao black pod rot disease) upon establishment in 2006 were monitored for presence of disease on a weekly basis from 2009 to 2016. Ripley’s K(r) function, join count statistics and Fisher Exact test were used to analyse spatial and temporal disease dynamics. Disease distribution maps showed aggregated disease patterns in all plots although for the years of disease onset, exogenous primary infections were mostly randomly distributed. The K(r) function confirmed these results indicating that inoculum generally disperses only over short distances. Moreover, significant positive spatial autocorrelations showed that diseased trees were often clustered up to a distance of 3-9 m. Temporal disease progression was low, meaning that endogenous inoculum failed to establish itself which is partly explained by rigorous phytosanitation and partly by unfavourable microclimatic conditions for disease development. Since P. megakarya had difficulty establishing itself in the plots, proximity to already infected cacao plantations drove infection dynamics. Thus, isolation of newly established cacao plantations from infected ones and rigorous phytosanitation as a preventive strategy appears to be an effective approach to control black pod for newly established cacao plantations.

scholarly journals Nurses’ Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Tilahun Kassew ◽  
Ambaye Dejen Tilahun ◽  
Bikis Liyew
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Influencing Factors ◽  
Physical Restraint ◽  
Cross Sectional ◽  
Restraint Use ◽  
Academic Qualification ◽  
Level Of Knowledge ◽  
Knowledge And Attitude ◽  
Nurses Knowledge

Background. Physical restraint is a common practice in the intensive care units which often result in frequent skin laceration at restraint site, limb edema, restricted circulation, and worsening of agitation that may even end in death. Despite the sensitivity of the problem, however, it is felt that there are nurses’ evidence-based practice gaps in Ethiopia. To emphasize the importance of this subject, relevant evidence is required to develop protocols and to raise evidence-based practices of health professionals. So, this study aimed to assess the knowledge, attitude, and influencing factors of nurses regarding physical restraint use in the intensive care units in northwest Ethiopia. Methods. An institution-based cross-sectional study was maintained from March to September 2019 at Amhara regional state referral hospitals, northwest Ethiopia. A total of 260 nurses in the intensive care units were invited to take part in the study by a convenience sampling technique. The Level of Knowledge, Attitudes, and Practices of Staff regarding Physical Restraints Questionnaire was used to assess the nurses’ knowledge and attitude. Linear regression analysis was employed to examine the influencing factors of knowledge and attitude. Adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used to report the result of association with a p value < 0.05 statistical significance level. Result. The mean scores of nurses’ knowledge and attitude regarding physical restraint use among critically ill patients were 7.81 ± 1.89 and 33.75 ± 6.50, respectively. These mean scores are above the scale midpoint nearer to the higher ranges which imply a moderate level of knowledge and a good attitude regarding physical restraint. Lower academic qualification and short (<2 years) work experience were associated with lower-level of knowledge, and reading about restraint from any source and taken training regarding restraints were factors associated with a higher knowledge. Diploma and bachelor’s in academic qualification were significantly associated with a negative attitude regarding restraint. Besides, there was a more positive attitude among nurses with a higher level of knowledge and who received training regarding physical restraint use. Conclusion. The nurses working in the intensive care unit had a moderate level of knowledge and a good attitude regarding physical restraint use. So, developing and providing educational and in-service training to the nurses regarding physical restraint are necessary to strengthen the quality of care for critically ill patients.

Circulating cell-free DNA (cfDNA) levels and fragmentation pattern can distinguish nonmuscle invasive (NMI) from muscle-invasive (MI) and metastatic (met) bladder cancer (BC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4523-4523
Author(s):  
Jaleh Fallah ◽  
Shinjini Ganguly ◽  
Hong Li ◽  
Wei (Auston) Wei ◽  
Aysegul Balyimez ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Relative Abundance ◽  
Dna Analysis ◽  
Fragment Size ◽  
Low Cost ◽  
Low Molecular Weight ◽  
Fragmentation Pattern ◽  
Exact Test ◽  
Significant Difference ◽  
Muscle Invasive

4523 Background: Occult MI and met BC may be under-staged. Circulating cfDNA may be a dynamic, low-cost and minimally invasive biomarker. We evaluated correlations between total circulating cfDNA and presence of MIBC and met BC. We hypothesized that the relative abundance of circulating low molecular weight cfDNA would correlate with BC stage. Methods: Peripheral blood from pts with BC was collected in Streck BCT tubes and processed to obtain cf nucleic acid extracts. Total cfDNA quantity (ng/ml) was assessed by fluorimetry. cfDNA fragment size was measured by Bioanalyzer DNA analysis. Wilcoxon rank sum test and Fisher’s Exact test were used to compare cfDNA quantity and fragmentation pattern among pts with NMIBC, MIBC, met BC. Results: Blood was obtained from 58 pts with BC (20% women, 34% never smokers, median age 71 (29-89). There was no significant difference in cfDNA between MIBC and met BC, however, it was significantly lower in pts with NMIBC vs MIBC and met BC (table). The concentration of low molecular weight fragments (LMW-frags) (100 - 400) base pairs and the ratio of LMW-Frag to cfDNA were significantly different between pts with NMIBC and pts with MIBC or met BC (table). Using median values as the cutoff, there was a significantly higher proportion of pts with cfDNA > 7 ng/ml and LMW-frags > 1.6 ng/mL, in MIBC & met BC vs NMIBC (p < 0.001). The % of pts with LMW-frags to cfDNA > 30%, was significantly different among NMIBC, MIBC and met BC groups: 16%, 53%, 78%, respectively (p < 0.001). Conclusions: This exploratory study suggests that cfDNA levels may correlate with BC stage. Measuring the relative abundance of LMW-frags with the expected size of cf DNA can enhance the specificity of cfDNA analysis for distinction between MIBC and met BC. Further studies are needed to confirm findings and define the optimal cut-points for optimal BC staging. [Table: see text]

scholarly journals Predictors of physical restraint use in Canadian intensive care units

Critical Care ◽  
2014 ◽  
Vol 18 (2) ◽  
pp. R46 ◽  
Author(s):  
Elena Luk ◽  
Barbara Sneyers ◽  
Louise Rose ◽  
Marc M Perreault ◽  
David R Williamson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Restraint Use

scholarly journals Burnout and depressive symptoms in intensive care nurses: relationship analysis

2018 ◽  
Vol 71 (1) ◽  
pp. 135-141 ◽  
Author(s):  
Eduardo Motta de Vasconcelos ◽  
Milva Maria Figueiredo De Martino ◽  
Salomão Patrício de Souza França
Keyword(s):  
Intensive Care ◽  
Depressive Symptoms ◽  
Beck Depression Inventory ◽  
Maslach Burnout Inventory ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Exact Test ◽  
Intensive Care Nurses ◽  
Relationship Analysis ◽  
Quantitative Descriptive

ABSTRACT Objective: To analyze the existence of a relationship between burnout and depressive symptoms among intensive care unit nursing staff. Method: A quantitative, descriptive, cross-sectional study with 91 intensive care nurses. Data collection used a sociodemographic questionnaire, the Maslach Burnout Inventory - Human Services Survey, and the Beck Depression Inventory - I. The Pearson test verified the correlation between the burnout dimension score and the total score from the Beck Depression Inventory. Fisher's exact test was used to analyze whether there is an association between the diseases. Results: Burnout was presented by 14.29% of the nurses and 10.98% had symptoms of depression. The higher the level of emotional exhaustion and depersonalization, and the lower professional accomplishment, the greater the depressive symptoms. The association was significant between burnout and depressive symptoms. Conclusion: Nurses with burnout have a greater possibility of triggering depressive symptoms.

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