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Resumo Enquadramento: Estudos indicam que as interrupções contribuem para erros clínicos e falhas em procedimentos. Objetivo: Analisar as interrupções vivenciadas pelos enfermeiros durante a preparação e administração de medicamentos de alto risco. Metodologia: Foi realizado um estudo transversal numa unidade de cuidados intensivos e numa unidade de internamento. As interrupções vivenciadas pelos enfermeiros durante o processo de medicação foram observadas com a ajuda de duas checklists. A amostra foi selecionada por conveniência em abril e maio de 2019. Os dados quantitativos foram analisados através de estatística descritiva no programa IBM SPSS Statistics, versão 24.0, enquanto os dados qualitativos foram tratados por meio da análise de conteúdo. Resultados: Observaram-se 137 interrupções em 193 processos de medicação. A maioria das interrupções foi iniciada por outros membros da equipa de cuidados de saúde por meio de conversas. Estas interrupções foram maioritariamente prejudiciais e ocorreram durante a fase de preparação. A estratégia multitarefa foi utilizada para as gerir. Conclusão: As interrupções ocorridas durante o processo de medicação eram maioritariamente associadas com comunicações profissionais e sociais. A sua relevância diferiu consoante a fase do processo.

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Abstract Background: Interruptions have been reported to contribute to clinical errors and procedural failures. Objective: To analyze the interruptions experienced by nurses during the preparation and administration of high-risk medications. Methodology: A cross-sectional study was conducted in an intensive care and inpatient unit. The interruptions experienced by nurses during the medication process were observed through two checklists. The sample was selected by convenience in April-May 2019. Descriptive statistics was used to analyze quantitative data in IBM SPSS Statistics software, version 24.0, while content analysis was used to analyze qualitative data. Results: In 193 medication processes, there were 137 interruptions. Other members of the healthcare team initiated most interruptions through conversations. These interruptions were mostly negative and occurred during the preparation phase. The multitasking strategy was used to manage them. Conclusion: Interruptions during the medication process were primarily associated with professional and social communications. The impact of these interruptions varied depending on the phase of the process.

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Resumen Marco contextual: Se ha reportado la participación de distracciones en errores clínicos y fallos de procedimiento. Objetivo: Analizar las distracciones del personal de enfermería durante la preparación y administración de fármacos de alto riesgo. Metodología: Estudio transversal desarrollado en una unidad de cuidados intensivos y una unidad de hospitalización. Se observaron distracciones del personal de enfermería durante el proceso de medicación a través de dos listas de control. La muestra fue seleccionada por conveniencia (abril-mayo 2019). Los datos cuantitativos se analizaron mediante estadística descriptiva (IBM SPSS Statistics, versión 24.0). Los datos cualitativos se analizaron mediante análisis de contenido. Resultados: Hubo 137 distracciones en 193 procesos de medicación. La mayoría de las distracciones fueron iniciadas por otros miembros del equipo sanitario a través de conversaciones. La mayoría se produjeron en la fase de preparación y fueron negativas y se gestionaron mediante la estrategia multitarea. Conclusión: Las distracciones durante el proceso de medicación se referían principalmente a las comunicaciones profesionales y sociales. La importancia de esas distracciones variaba en función de la fase del proceso.

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Severe infections caused by multidrug-resistant bacteria have underscored the urgent need for innovative treatment approaches. Novel antimicrobials like cefiderocol have emerged as effective options, but their use in children remains largely unexplored. In this brief report, we describe a severe case of sepsis in a child with an oncohematological disease, caused by a highly drug-resistant strain of Klebsiella pneumoniae. The addition of cefiderocol to other therapies resulted in a successful outcome. Additionally, we provide a literature review of previously published cases involving children treated with this new antibiotic. In our patient, cefiderocol was both safe and effective in combating the multidrug-resistant pathogen. However, further research is needed to better define the indications and safety profile of this novel antibiotic.

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OBJECTIVE: To systematically assess the prevalence and risk factors for subsyndromal delirium (SSD) in the intensive care unit. DESIGN: A systematic reviewand meta-analysis. METHODOLOGY: This systematic review and meta-analysis was conducted in eight databases, including PubMed, Web of Science, Ovid,Scopus, China Knowledge Resource Integrated Database, Wanfang Database,Weipu Database and Chinese Biomedical Database. All original observational studies of subsyndromal delirium in the ICU were included, with languages limited to English and Chinese. The methodological quality was assessed by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality recommendation checklist. Meta-analysis was performed using Stata software (version 18.0). RESULT: A total of 27 studies involving 7,286 participants were included in this review. The pooled prevalence of SSD was 32.4 % (95 %CI: 27.1 %-37.7 %).Fourteen studies reported 34 independent risk factors, and the following ten factors were significantly associated with SSD: older age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, lower Mini-mental Status Examination (MMSE) score, pain, mechanical ventilation, hypoproteinemia, blood transfusion, longer ICU stay, infection, and physical restraint. CONCLUSION: We conducted a systematic review and meta-analysis to evaluate the prevalence of SSD in the ICU and identified 10 risk factors associated with SSD. However, the studies have significant heterogeneity, future research should be conducted in multicenter with large samples to strengthen the current evidence. IMPLICATIONS FOR CLINICAL PRACTICE: Subsyndromal delirium is a frequently occurring adverse event in the ICU, so it is recommended that clinicians and nurses incorporate the assessment of SSD into their daily routine. In this study, we also identified ten risk factors associated with SSD, and some of which could be modified or intervened. These findings provide a basis for ICU medical staff to identify patients at high risk of SSD and then implement individualized interventions to reduce the prevalence of SSD.

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INTRODUCTION: Compromised neonatal intensive care unit neonates are at risk of acquiring late-onset infections (late-onset sepsis [LOS]). Neonates born with congenital anomalies (CAs) could have an additional LOS risk. METHODS: Utilising the population-based Australian and New Zealand Neonatal Network data from 2007 to 2017, bacterial LOS rates were determined in very preterm (VPT, <32 week), moderately preterm (MPT, 32-36 weeks), and term (FT, 37-41 weeks) neonates with or without CA. Stratified by major surgery, the association between CA and bacterial LOS was evaluated. RESULTS: Of 102,808 neonates, 37.7%, 32.8%, and 29.6% were born VPT, MPT, and FT, respectively. Among these, 3.4% VPT, 7.5% MPT, and 16.2% FT neonates had CA. VPT neonates had the highest LOS rate (11.1%), compared to MPT (1.8%) and FT (1.8%) neonates. LOS rates were higher in CA neonates than those without (8.2% versus 5.1% adjusted relative risk [aRR] 1.67, 95% confidence interval [CI]: 1.45-1.92). Neonates with surgery had a higher LOS rate (14.2%) than neonates without surgery (4.4%, p < 0.001). Among the neonates without surgery, CA neonates had consistently higher LOS rates than those without CA (VPT 14.3% vs. 9.6% [aRR 1.32, 95% CI: 1.11-1.57]; MPT 4% vs. 0.9% [aRR 4.45, 95% CI: 3.23-6.14]; and FT 2% vs. 0.7% [aRR 2.87, 95% CI: 1.97-4.18]). For the neonates with surgery, CAs were not associated with additional LOS risks. CONCLUSION: Overall, we reported higher rates of LOS in neonates with CA compared to those without CA. Regardless of gestation, CA was associated with an increased LOS risk among non-surgical neonates. Optimisation of infection prevention strategies for CA neonates should be explored. Future studies are needed to evaluate if the infection risk is caused by CA or associated complications.

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INTRODUCTION: A statutory system of medical examiners (ME) was introduced in England and Wales in September 2024. The next of kin will be given the opportunity to speak to the ME and all medical certificates of cause of death (MCCDs) will require an ME countersignature. In children, there is already established guidance for a comprehensive child death review (CDR) that encompasses best operational practice with statutory requirements that must be followed. OBJECTIVE AND DESIGN: A national survey of all paediatric intensive care units (PICUs) in England to evaluate the processes where both systems have been adopted. RESULTS: 21 of 23 (91%) PICUs responded. 75% of the surveyed PICUs have ME services established. Of these, 60% reported that the ME reviewed all deaths, including those reported to the coroner. Out-of-hours ME provision was available in only 33% of the surveyed PICUs and no review of medical notes occurred in 27% of cases. 60% of the respondents agreed ME scrutiny improved the quality of the MCCD. 40% of the respondents believed that ME review might cause delay in cultural or religious rites and the offer of organ donation. CONCLUSION: A national ME service has potential to improve the quality of national mortality data and give voice to bereaved families' concerns. However, in relation to children's deaths, it needs to interface with existing statutory expectations that have similar objectives. We recommend that prospective audit be conducted to ensure both CDR and ME systems are coordinated to each other's mutual benefit.

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OBJECTIVE: Neonatal meningitis significantly contributes to neonatal morbidity and mortality, yet large-scale epidemiological data in developing countries, particularly among very preterm infants (VPIs), remain sparse. This study aimed to describe the epidemiology of meningitis among VPIs in China. DESIGN: Cross-sectional study using the Chinese Neonatal Network database from 2019 to 2021. SETTING: 79 tertiary neonatal intensive care units in China. PATIENTS: Infants with gestational age <32 weeks or birth weight <1500 g. MAIN OUTCOME MEASURES: Incidence, pathogen distribution, antimicrobial use and outcomes of bacterial and fungal meningitis. RESULTS: Of 31 915 VPIs admitted, 122 (0.38%) infants were diagnosed with culture-confirmed meningitis, with 14 (11.5%) being early-onset (≤6 days of age) and 108 (88.5%) being late-onset (>6 days of age). The overall in-hospital mortality was 18.0% (22/122). A total of 127 pathogens were identified, among which 63.8% (81/127) were Gram-negative bacteria, 24.4% (31/127) were Gram-positive bacteria and 11.8% (15/127) were fungi. In terms of empirical therapy (on the day of the first lumbar puncture), the most commonly used antibiotic was meropenem (54.9%, 67/122). For definitive therapy (on the sixth day following the first lumbar puncture, 86 cases with available antibiotic data), meropenem (60.3%, 35/58) and vancomycin (57.1%, 16/28) were the most used antibiotics for Gram-negative and Gram-positive bacterial meningitis, respectively. 44% of infants with Gram-positive bacterial meningitis and 52% with Gram-negative bacterial meningitis received antibiotics for more than 3 weeks. CONCLUSION: 0.38% of VPIs in Chinese neonatal intensive care units were diagnosed with meningitis, experiencing significant mortality and inappropriate antibiotic therapy. Gram-negative bacteria were the predominant pathogens, with fungi emerging as a significant cause.

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INTRODUCTION: Successful organ transplantation in patients with end-stage organ failure improves long-term survival, improves quality of life and reduces costs to the NHS. Despite an increase in the number of deceased organ donors over the last decade, there remains a considerable shortfall of suitable organs available for transplantation. Over half of UK donors are certified dead by neurological criteria following brain stem compression, which leads to severe physiological stress in the donor, combined with a hyperinflammatory state. Brain stem death-related dysfunction is an important reason for poor organ function and hence utilisation. For example, more than 30% of donation after brain stem death cardiac transplant recipients need short-term mechanical cardiac support, reflecting donor heart dysfunction.A small, randomised study previously showed improved outcomes for cardiac transplant recipients if the donor was given simvastatin. SIGNET takes inspiration from that study and hypothesises a potential reduction in damage to the heart and other organs during the period after diagnosis of death and prior to organ retrieval in donors that receive simvastatin. METHODS AND ANALYSIS: SIGNET is a multicentre, single-blind, prospective, group sequential, randomised controlled trial to evaluate the benefits of a single high dose of simvastatin given to potential organ donors diagnosed dead by neurological criteria on outcomes in all organ recipients. The trial will run across a minimum of 89 UK sites with a recruitment target of 2600 donors over 4 years. ETHICS AND DISSEMINATION: SIGNET received a favourable opinion from the London, Queen Square Research Ethics Committee (Ref: 21/LO/0412) and following approval of substantial amendment 1 in January 2023, the current protocol is version 2 (7 December 2022). Substantial amendment 1 clarified consent procedures and added additional sites and prescribers. Findings from the study will be publicly available and disseminated locally and internationally through manuscript publications in peer-reviewed journals and conference presentations at national and international platforms. TRIAL REGISTRATION NUMBER: ISRCTN11440354.

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Muerte Encefálica , Simvastatina , Donantes de Tejidos , Humanos , Simvastatina/administración & dosificación , Simvastatina/uso terapéutico , Método Simple Ciego , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como Asunto , Reino Unido , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Trasplante de Órganos

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BACKGROUND: Influenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia. METHODS: This was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality. RESULTS: During the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality. CONCLUSIONS: Influenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

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Mortalidad Hospitalaria , Gripe Humana , Unidades de Cuidados Intensivos , Centros de Atención Terciaria , Humanos , Masculino , Femenino , Arabia Saudita/epidemiología , Anciano , Estudios Retrospectivos , Gripe Humana/mortalidad , Gripe Humana/epidemiología , Gripe Humana/complicaciones , Persona de Mediana Edad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Factores de Riesgo , Adulto , Hospitalización/estadística & datos numéricos , Anciano de 80 o más Años , Coinfección , Modelos Logísticos , Respiración Artificial/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A

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INTRODUCTION: Enteral nutrition (EN) is the recommended nutritional support in most critically ill populations. When given by feeding tube, EN may be administered either continuously or intermittently. It is unclear which approach is superior in reducing gastrointestinal complications-such as diarrhea-and meeting nutritional targets. The main objectives of this systematic review and meta-analysis are to (1) determine whether continuous or intermittent enteral nutrition is associated with higher incidence of adverse gastrointestinal outcomes, including diarrhea, and (2) determine which feeding modality is associated with reaching nutritional goals. METHODS AND ANALYSIS: This systematic review protocol is reported in accordance with guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. We will search MEDLINE, Embase, the Cochrane Library, and the World Health Organization (WHO) International Clinical Trials Registry (ICTRP) search portal for studies comparing continuous EN and intermittent EN in critically ill patients with no date or language restrictions. Studies will be screened, selected, and extracted independently and in duplicate. We will assess the risk-of-bias assessment using the Cochrane Collaboration's Risk of Bias (RoB) 2 tool. The primary outcome will include the incidence of diarrhea; secondary outcomes include other adverse GI outcomes (nausea, vomiting, abdominal pain, and constipation), as well as reaching nutritional goals, and length of ICU and hospital stay and mortality. We will pool data using a random-effects model and assess the certainty of the evidence for each outcome using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. ETHICS AND DISSEMINATION: Ethics approval is not required for this study as no original data will be collected. We will disseminate results through peer-reviewed publication and conference presentations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022330118.

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Enfermedad Crítica , Diarrea , Nutrición Enteral , Humanos , Enfermedad Crítica/terapia , Nutrición Enteral/métodos , Metaanálisis como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto

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Objective: To better understand the experience of parents with neonates with congenital heart diseases (CHD) admitted to a neonatal intensive care unit (NICU) in order to identify challenges faced by parents and discover support strategies helpful in positive coping. Study design: Prospective cohort study of parents of neonates with CHD. Parents completed a questionnaire with open ended questions regarding their experience and feeling during the hospitalization within one week of the child discharge from the NICU. Krippendorff's content analysis was used to examine data. Results: Sixty-four parents participated. Three themes were highlighted - Dialectical parental experiences, Suboptimal Parental Experiences and Positive Parental Experiences - describing the state of being and feelings that these parents face. Through this analysis, we were able to develop clinical considerations and identify coping strategies. Conclusion: The understanding of parental experience and challenges when dealing with their child admitted in the NICU is crucial to identify coping strategies to promote adaptation and enhance the development of positive coping mechanisms.

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The COVID-19 pandemic underscored the critical importance of intensive care units (ICUs), a field institutionalized by Bjørn Ibsen during the 1952 polio epidemic in Copenhagen. Ibsen's groundbreaking innovations, including positive pressure ventilation and real-time physiological monitoring, laid the foundation for modern intensive care medicine. Trained in Denmark and the United States, Ibsen demonstrated the effectiveness of manual ventilation during the polio outbreak after successfully resuscitating a young patient, Vivi Ebert, which in turn led to the creation of the world's first multidisciplinary ICU at Blegdams Hospital. This article explores the historical context and significance of Ibsen's contributions, tracing the evolution of the physiology of breathing from the early concepts of Vesalius and Hook to the widespread application of ventilation techniques. The establishment of the ICU introduced new ethical dilemmas, highlighting the delicate balance between prolonging life and maintaining patient dignity. Ibsen's legacy extends beyond medical advancements to the compassionate care he championed, a principle that remains a cornerstone of modern intensive care. This ethical complexity is a crucial aspect of the history of intensive care medicine.

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Introduction Prolonged stays in the intensive care unit (ICU) are known to increase the risk of adverse outcomes following severe conditions. This study focuses on the factors affecting ICU length of stay, particularly in Urology and Nephrology patients who require intensive monitoring and specialized care, and their impact on patient outcomes. Methods A descriptive cross-sectional study was conducted with a sample size of 45 patients. Data was collected using a validated closed-ended questionnaire and analyzed with IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results The study found positive associations between prolonged ICU stay and several factors, including elevated total bilirubin levels, deranged creatinine, urea, sodium, and calcium levels, as well as abnormal C-reactive protein levels. Higher bilirubin levels and positive blood and culture results were linked to extended ICU stays. Additionally, the use of contrast CT and MRI was associated with longer ICU durations. Conversely, broad-spectrum antibiotics showed a negative association with ICU stay length, while transfusion of blood products was positively associated with longer stays. Conclusion Understanding these factors can help improve the management of ICU patients and enhance outcomes in future cases.

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Death and dying, while uncommon in day-to-day paediatrics practice, are becoming increasingly common occurrences as children with life-limiting illnesses are living longer. We reflect on our experiences with death and dying in our residency training and whether paediatrics, as a specialty, is uncomfortable with death. Paediatric trainees should be included in honest discussions about disease trajectories and participate in providing end-of-life care. Anticipatory guidance helps personalize care and can prevent unnecessary procedures or suffering that patients may experience. While trainees may not be present at the end-of-life for many patients, managing death and dying are important competencies for future paediatricians. Current paediatricians should reflect on their comfort with death and how this may impact their patient care.

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Objective: To construct an interpretation structure model of adverse experiences of cardiac surgery patients in intensive care unit, so as to provide a reference for optimizing the experience of critical patients step by step. Methods: Literature review, semi-structured interviews, questionnaires and Delphi method were used to summarize and analyze the influencing factors of intensive care experience in cardiac surgery. The explanatory structural model was used to divide the influencing factors into levels and construct the explanatory structural model of adverse experience of cardiac surgery patients in intensive care. Results: A hierarchical structure model containing 34 elements and 15 levels was constructed, which were divided into Surface level, middle level and root level. Conclusion: The intensive care experience of patients in cardiac surgery department is mainly affected by 34 factors. There are direct or indirect correlations between the influencing factors, and different levels have different effects.

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Objectives: This study was performed to identify predictive markers of worse outcomes in patients with severe COVID-19 in an intensive care unit. Methods: Sixty patients with severe COVID-19, hospitalized in the Intensive Care Unit (ICU) between March and July 2021, were stratified into two groups according to the outcome survivors and non-survivors. After admission to the ICU, blood samples were collected directly for biomarker analysis. Routine hematological and biochemical biomarkers, as well as serum levels of cytokines, chemokines, and immunoglobulins, were investigated. Results: Lymphopenia, neutrophilia, and thrombocytopenia were more pronounced in non-surviving patients, while the levels of CRP, AST, creatinine, ferritin, AST, troponin I, urea, magnesium, and potassium were higher in the non-surviving group than the survival group. In addition, serum levels of IL-10, CCL2, CXCL9, and CXCL10 were significantly increased in patients who did not survive. These changes in the biomarkers evaluated were associated with increased mortality in patients with severe COVID-19. Conclusion: The present study confirmed and expanded the validity of laboratory biomarkers as indicators of mortality in severe COVID-19.

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Biomarcadores , COVID-19 , Unidades de Cuidados Intensivos , SARS-CoV-2 , Humanos , COVID-19/mortalidad , COVID-19/sangre , COVID-19/inmunología , Masculino , Biomarcadores/sangre , Femenino , Persona de Mediana Edad , Anciano , Citocinas/sangre , Hospitalización , Índice de Severidad de la Enfermedad , Pronóstico , Adulto , Anciano de 80 o más Años

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BACKGROUND: Direct cardiac surgery often necessitates intensive post-operative care, and the intensive care unit (ICU) activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery. AIM: To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery. METHODS: One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method. The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale. The control group was assessed in accordance with the routine rehabilitation activities, and the postoperative rehabilitation indexes of the patients in both groups were compared (time of tracheal intubation, time of ICU admission, occurrence of complications, and activity scores before ICU transfer). The two groups were compared according to postoperative rehabilitation indicators (time of tracheal intubation, length of ICU stay, and occurrence of complications) and activity scores before ICU transfer. RESULTS: In the observation group, tracheal intubation time lasted for 18.30 ± 3.28 h and ICU admission time was 4.04 ± 0.83 d, which were significantly shorter than the control group (t-values: 2.97 and 2.038, respectively, P < 0.05). The observation group also had a significantly lower number of complications and adverse events compared to the control group (P < 0.05). Before ICU transfer, the observation group (6.7%) had few complications and adverse events than the control group (30.0 %), and this difference was statistically significant (P < 0.05). Additionally, the activity score was significantly higher in the observation (26.89 ± 0.97) compared to the control groups (22.63 ± 1.12 points) (t-value; -17.83, P < 0.05). CONCLUSION: Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.

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Objectives: We aim to investigate the prevalence of respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) among pediatric patients with acute respiratory tract illness (ARTI) in southern China both pre- and post-COVID-19 pandemic, as well as identify associated risk factors for severe infections. Methods: The study conducted a real-time PCR analysis on hospitalized children with ARTI from 2012 to 2023, specifically targeting RSV, hMPV, and other respiratory pathogens. Additionally, demographic data was collected during this analysis. Results: The prevalence of RSV occurs triennially, and likewise, the temporal pattern of hMPV outbreaks mirrors that of RSV. The peak infection rates of RSV and hMPV occurred during and following the implementation of COVID-19 epidemic prevention and control measures. The incidence of RSV infection exhibited bimodal peaks in 2022, while hMPV demonstrated seasonal peaks during the spring, fall, and winter periods post-COVID-19 pandemic. After the COVID-19 outbreak, there has been an upward trend in the proportion of female patients and patients aged one year and older presenting with ARTI, RSV infections, and hMPV infections. Infant (OR = 4.767, 95%CI: [3.888-5.846], p < 0.0001), presence of co-infection (OR = 0.540, 95%CI: [0.404-0.722], p < 0.0001), and existence of comorbidities (OR = 1.582, 95%CI: [1.285-1.949], p < 0.0001) was the risk ratio for the severity of RSV infection. Children infected with hMPV under the age of 1 year (OR = 0.322, 95%CI: [0.180 - 0.575], p < 0.0001), as well as those with comorbidities (OR = 8.809, 95%CI: [4.493 - 17.272], p < 0.0001), have a higher risk of developing severe illness. Conclusion: The changing epidemiological patterns have the potential to lead to widespread severe outbreaks among children, particularly those with underlying medical conditions who may experience more severe symptoms. Conducting surveillance for pneumoviridae viruses in children is an imperative measure to establish a robust foundation for future epidemic prevention and treatment strategies.

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COVID-19 , Metapneumovirus , Infecciones por Paramyxoviridae , Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Humanos , Metapneumovirus/genética , Metapneumovirus/aislamiento & purificación , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/virología , Lactante , Femenino , Masculino , Preescolar , Infecciones por Paramyxoviridae/epidemiología , Infecciones por Paramyxoviridae/virología , Estudios Retrospectivos , China/epidemiología , Niño , COVID-19/epidemiología , COVID-19/virología , Virus Sincitial Respiratorio Humano/genética , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Prevalencia , Factores de Riesgo , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Adolescente , Estaciones del Año , Recién Nacido , Incidencia , Índice de Severidad de la Enfermedad

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OBJECTIVE: Pressure ulcers (PUs) severely impact health outcomes in neonatal intensive care, with up to 28% prevalence and doubled mortality rates. Due to their only partially developed stratum corneum, neonates are highly susceptible to PUs because of a lack of adequate support surfaces. The occipital region of the head and hip are the main risk areas due to immobility and newborn body proportions. The main goal of the study was to investigate the impact of reduction in local pressure in these body areas by two air mattress designs and different filling states. METHOD: Two innovative air-filled mattress prototypes (prototype 1 and prototype 2), consisting of three different segments (head, trunk and feet regions), were developed to reduce local interface pressures by optimising pressure distribution, and were assessed with three air pressure filling states (0.2kPa, 0.4kPa and 0.6kPa). A baby doll was used to investigate pressure distribution and local pressure impact. It measured 51cm and the weight was modified to be 1.3kg, 2.3kg and 3.3kg, representing premature to term newborn weights, respectively. A specialised foam mattress and an unsupported surface were considered as controls. RESULTS: The interface pressures at the hip region for newborn models could be reduced by up to 41% with mattress prototype 1 and 49% with prototype 2 when filled with 0.2kPa air pressure. It was found that the size and the pressure inside air segments was crucial for interface pressure. CONCLUSION: Our results demonstrated that air mattresses achieved lower interface pressures compared to conventional support surfaces, and that the benefit of the air mattresses depended on their filling status. The importance of using innovative, segmented designs that were tailored to meet the specific needs of highly vulnerable paediatric patients was demonstrated.

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Lechos , Diseño de Equipo , Úlcera por Presión , Úlcera por Presión/prevención & control , Humanos , Recién Nacido , Presión

RESUMEN

BACKGROUND: Among people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda. METHODS: In this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI). RESULTS: We studied 420 participants of whom 204 (48.6%) were aged 20-39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64-0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67-0.87), malnutrition (aRR 0.65, 95% CI 0.43-0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01-1.49) was associated with a higher likelihood of IAC completion. CONCLUSIONS: We found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate.

Asunto(s)

Consejo , Infecciones por VIH , Cumplimiento de la Medicación , Humanos , Femenino , Uganda , Estudios Retrospectivos , Masculino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Adulto , Cumplimiento de la Medicación/estadística & datos numéricos , Consejo/métodos , Consejo/estadística & datos numéricos , Adulto Joven , Carga Viral , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos

RESUMEN

Background: End-of-life (EOL) care is associated with high resource utilization. Recognizing and effectively communicating that EOL is near promotes more patient-centered care, while decreasing futile interventions. We hypothesize that provider assessment of futility during the surgical intensive care unit (SICU) admission would result in higher rates of Do Not Resuscitate (DNR). Methods: We performed a retrospective review of a prospective SICU registry of all deceased patients across a health system, 2018-2022. The registry included a subjective provider assessment of patient's expected survival. We employed multivariable logistic regression to adjust for clinical factors while assessing for association between code status at death and provider's survival assessment with attention to race-based differences. Results: 746 patients-105 (14.1%) traumatically injured and 641 (85.9%) non-traumatically injured-died over 4.5 years in the SICU (mortality rate 5.9%). 26.3% of these deaths were expected by the ICU provider. 40.9% of trauma patients were full code at the time of death, compared with 15.6% of non-traumatically injured patients. Expected death was associated with increased odds of DNR code status for non-traumatically injured patients (OR 1.8, 95% CI 1.03 to 3.18), but not for traumatically injured patients (OR 0.82, 95% CI 0.22 to 3.08). After adjusting for demographic and clinical characteristics, black patients were less likely to be DNR at the time of death (OR 0.49, 95% CI 0.32 to 0.75). Conclusion: 20% of patients who died in our SICU had not declared a DNR status, with injured black patients more likely to remain full code at the time of death. Further evaluation of this cohort to optimize recognition and communication of EOL is needed to avoid unnecessary suffering. Level of evidence: Level III/prognostic and epidemiological.