Obtaining correct and reliable data on provider adherence is however no easy task, and several methodological challenges can cross the researcher’s path. Besides the World Health Organisation’s (WHO) ...recommendations for measuring hand hygiene compliance (World Health Organisation, 2009b), utmost few resources are however available that provide specific methodological guidance. A typical example of contradicting recommendations is that the WHO recommends the use of examination gloves for open endotracheal suctioning (World Health Organisation, 2009a) while various institutional protocols instruct to use sterile gloves (Day et al., 2002); (c) recommendations of interest should be checked for being the subject of an ongoing or recent study or quality improvement project. ...the question remains which percentage of adherence is clinically relevant and/or represents appropriate patient care. ...one-time or short-period observation may provide results that are biased by random confounding factors, such as extremely low staffing levels or extremely high patient turn-over on the single observation day. ...it can be recommended to observe over an extended time period or to repeat the observations at intervals.
The interest in research on oral care in intensive care unit (ICU) patients has emerged largely from the 2000s onward after years of being a rather ignored topic in health science. Since, the focus ...has been on its potential contribution to preventing pneumonia by eliminating contaminated oral pathogens that might invade the lower respiratory tract. Accumulating evidence of the effectiveness of oral care with chlorhexidine gluconate (CHG) in preventing ventilator-associated pneumonia (VAP) or postoperative pneumonia 1, 2 has led to adopting CHG oral care as the gold standard for intubated patients. Recently, however, potential adverse effects of CHG on the oral mucosa 3 and reduced bacterial susceptibility 4 have been reported, as well as an even more alarming potential association of CHG oral care with an increased risk of mortality 5–8. Although the latter association results from retrospective studies or meta-analyses, righteous calls for caution and for a thorough re-evaluation of the established gold standard have been launched 9, 10.
...although types of supporting surfaces vary widely among geographic regions, within countries and even among ICUs in the same hospital, the one and same report form needed to allow reporting of ...every type of supporting surface used worldwide. ...not only for supporting surfaces but for all materials we wanted to collect information about, we had to find then write all-encompassing descriptions that every data collector worldwide could recognise and that allowed them to report the corresponding materials used in the own unit appropriately. ...after a process of several weeks of intensive searches and correspondence with local centres, 15 May 2018 was set as the international data collection day.Challenge #3. The recruitment resulting from that approach however covered a restricted part of the globe only. ...our next step consisted of meticulously screening the PubMed database to identify recent publications in the domain of intensive care, then to invite authors from countries where a national representative for the study was still lacking. ...intended study participation from a number of African countries was prevented by difficulties in obtaining ethical clearance (see below).
Summary Background We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ...ventilator-associated pneumonia versus oral care without these antiseptics in adults. Methods Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the I2 test. Findings 14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50–0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55–0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11–1.36; p=0.14). Heterogeneity was moderate ( I2 =29%; p=0.16) for the trials using chlorhexidine and high ( I2 =67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31–0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17–0.98). Interpretation This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients. Funding None.
•We generated covariance matrices for independent fission yields.•We used a generalised least-square approach to create the covariances.•Covariances are consistent with conservation equations and ...evaluations.•Covariances solve the discrepancy found in the yield uncertainties of JEFF-3.1.1.•Fission yield covariances strongly reduce uncertainties in burnup calculations.
Fission yield uncertainties and correlations should be considered in the uncertainty quantification of burnup responses — e.g. isotopic inventory, effective neutron multiplication factor keff. Although nuclear data libraries generally provide independent fission yield uncertainties along with the best estimates, currently they lack complete covariance matrices. In addition, several inconsistencies were detected amongst the current fission yield evaluated uncertainties, which could impact on uncertainty quantification (UQ) studies. As a part of this work, we introduced fission yield correlations to sort out the data inconsistency found in the JEFF-3.1.1 fission yield library. Such correlations are produced using an iterative generalised least square (GLS) updating technique, with conservation equations acting as fitting models. The process revises the fission yield estimates and covariances according to reliable evaluations, when available, or conservation criteria.
We chose to work with the PWR fuel rod model of the REBUS international program to test the new covariances, since experimental uncertainties on several concentrations are available. We propagated the original and updated fission yield covariances using a sampling approach and we quantified the uncertainty of keff and nuclide densities in the chosen burnup problem. The response uncertainty for keff and nuclide densities showed a sharp drop when using the new set of fission yield covariance matrices.
•ICU populations are too varied to identify general pressure injury risk factors.•Risk profile for pressure injury acquisition is strongly related with ICU admission.•Risk factors for pressure injury ...highly vary among ICU subpopulations.
To determine risk factors for pressure injury in distinct intensive care subpopulations according to admission type (Medical; Surgical elective; Surgery emergency; Trauma/Burns).
Predictive modelling using generalised linear mixed models with backward elimination on prospectively gathered data of 13 044 adult intensive care patients.
1110 intensive care units, 89 countries worldwide.
Pressure injury risk factors.
A generalised linear mixed model including admission type outperformed a model without admission type (p = 0.004). Admission type Trauma/Burns was not withheld in the model and excluded from further analyses. For the other three admission types (Medical, Surgical elective, and Surgical emergency), backward elimination resulted in distinct prediction models with 23, 17, and 16 predictors, respectively, and five common predictors only. The Area Under the Receiver Operating Curve was 0.79 for Medical admissions; and 0.88 for both the Surgical elective and Surgical emergency models.
Risk factors for pressure injury differ according to whether intensive care patients have been admitted for medical reasons, or elective or emergency surgery. Prediction models for pressure injury should target distinct subpopulations with differing pressure injury risk profiles. Type of intensive care admission is a simple and easily retrievable parameter to distinguish between such subgroups.
In the timespan of roughly the two past decades and with large regional differences in timing and approaches, nurse educators have thus invested considerable efforts into defining and validating new ...learning outcomes and competencies, and into integrating these in curricula that include a thorough introduction into the principles and application of evidence based nursing, courses on behavioural change theories and reflective skills acquisition, and a plethora of innovative educational tools. In order to assist nurses of all ages and educational backgrounds in narrowing the theory-practice gap, the efforts dedicated by nursing educators need to be supplemented by interventions for quality of care improvement and programs for continuing education initiated and conducted at the hospital- or unit-level. ...translating theory into daily nursing practice is a slow and laborious process in the field of oral care provision as in many other domains of patient care.
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