Australian Critical Care最新文献

{"title":"Prevalence and risk factors associated within 48-hour unplanned paediatric intensive care unit readmissions: An integrative review","authors":"Martina K. Barnwell RN BNurs, MAP ,&nbsp;Huaqiong Zhou RN, BSc, PhD ,&nbsp;Simon Erickson FRACP FCICM, DipEcho","doi":"10.1016/j.aucc.2024.03.010","DOIUrl":"10.1016/j.aucc.2024.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Unplanned paediatric intensive care unit (PICU) readmission is associated with increased morbidity/mortality, hospital length of stay, and health service cost and is recognised as a key performance indicator of quality-of-care delivery. However, research evidence on unplanned PICU readmission risk factors is limited, and results were inconsistent across studies.</div></div><div><h3>Aim</h3><div>The aim of this experiment was to collate and synthesise unplanned within-48-h PICU readmission prevalence and associated risk factors.</div></div><div><h3>Methods</h3><div>An integrative review was conducted, guided by a five-stage framework. Seven electronic databases were searched (2013–30th June 2023). Studies published in English with full-text accessibility and detailed methodologies were included. The quality of included studies was critically appraised using the Joanna Briggs Institute checklists. Prevalence and risk factors were extracted, synthesised, and presented narratively.</div></div><div><h3>Results</h3><div>Ten studies met eligibility criteria and reported a varied readmission rate from 0.008% to 6.49%. Fifteen types of significant risk factors were extracted. Twelve consistently cited risk factors were age, weight, complex chronic conditions, admission source, unplanned admission, PICU length of stay, positive pressure ventilation, discharge disposition, oxygen requirements, respiratory rate, heart rate, and Glasgow Coma Score at discharge. Of the 12, five predictors were classified as modifiable factors, including discharge disposition, oxygen requirement, abnormal respiratory rate, abnormal heart rate, and decreased Glasgow Coma Score at discharge.</div></div><div><h3>Conclusion</h3><div>This review acknowledges the complexity of confounding factors impacting unplanned PICU readmission and the lack of standardisation examining potential risk factors. The five modifiable factors are suggestive of clinical instability and premature PICU discharge. Patients with modifiable risk factors should have their readiness for discharge re-evaluated. Scaffolding support to manage patients at risk of readmission includes senior bedside nursing allocation, use of PICU outreach services, and 1:2 nurse-to-patient ratios in the ward setting, which are warranted to ensure patient safety.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101055"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses’ perspectives about end-of-life care when family presence is restricted during a pandemic: A qualitative study","authors":"Myung Hui Choi MSN, RN ,&nbsp;Hyun Jung Kim MSN, RN ,&nbsp;Hye Jin Yoo PhD, RN","doi":"10.1016/j.aucc.2024.06.012","DOIUrl":"10.1016/j.aucc.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><div>To prevent the infection from spreading, patients who were dying from COVID-19 were treated in isolation with restricted family access, which differed from existing end-of-life care procedures. This was a significant change that affected the care provided by nurses.</div></div><div><h3>Objectives</h3><div>This study explored nurses' end-of-life care experiences in a limited family visitation setting during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>A descriptive qualitative study was conducted. Data were collected through individual, in-depth, semistructured interviews with ten critical care nurses who provided end-of-life care to patients with COVID-19 in South Korea. The data were analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used to assess the study's rigour.</div></div><div><h3>Findings</h3><div>Three themes were identified: ‘Witnessing patients’ and families' heartbreak over separation’, ‘The gaps between the ideals and realities of end-of-life care’, and ‘Efforts to provide patients with a comfortable final journey’. Nurses realise the importance of their central role in supporting interactions between patients and families during end-of-life care.</div></div><div><h3>Conclusions</h3><div>Family participation, facilitated by nurses’ interest and efforts as mediators connecting patients and families, is essential for achieving high-quality care for inpatients facing end of life. This study is significant as it emphasises that the direction of end-of-life care should be family centric, even in a pandemic situation with limited family participation. To improve interaction between patients and families, creating an environment based on family participation that builds trust and strengthens communication is essential. Additionally, hospital support, such as professional education and counselling, should be provided to strengthen nurses' end-of-life care competency.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101091"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits","authors":"Lee-anne S. Chapple PhD, APD ,&nbsp;Anneleen Neuts MD ,&nbsp;Stephanie N. O'Connor MNSc, RN ,&nbsp;Patricia Williams BN, RN ,&nbsp;Sally Hurford PG Dip Clinical Research, RN ,&nbsp;Paul J. Young PhD, MBChB ,&nbsp;Naomi E. Hammond PhD, RN ,&nbsp;Serena Knowles PhD, RN ,&nbsp;Marianne J. Chapman PhD, BMBS ,&nbsp;Sandra Peake PhD, BMBS ,&nbsp;the TARGET Investigators, The George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group","doi":"10.1016/j.aucc.2024.07.079","DOIUrl":"10.1016/j.aucc.2024.07.079","url":null,"abstract":"<div><h3>Background</h3><div>The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes.</div></div><div><h3>Aim</h3><div>We aimed to quantify practice change following TARGET.</div></div><div><h3>Methods</h3><div>Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann–Whitney test.</div></div><div><h3>Results</h3><div>The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018–2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and &lt;1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively.</div></div><div><h3>Conclusion</h3><div>In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101098"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Glasgow Coma Scale and Full Outline of UnResponsiveness score to assess the level of consciousness in patients admitted to intensive care units and emergency departments: A quantitative systematic review","authors":"Frida Krag Brun CCRN, MSc ,&nbsp;Vilde Holte Fagertun CCRN, MSc ,&nbsp;Marie Hamilton Larsen RN, PhD ,&nbsp;Marianne Trygg Solberg CCRN, PhD","doi":"10.1016/j.aucc.2024.03.012","DOIUrl":"10.1016/j.aucc.2024.03.012","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to investigate the reliability and validity of the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) score used by nurses and physicians to assess the level of consciousness in patients admitted to intensive care units (ICUs) and emergency departments (EDs).</div></div><div><h3>Review method used</h3><div>This systematic review was guided by the Cochrane Handbook for Systematic Reviews of Interventions and followed the reporting standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement.</div></div><div><h3>Data sources</h3><div>A systematic search was conducted using the following databases: CINAHL, MEDLINE, and EMBASE.</div></div><div><h3>Review methods</h3><div>All authors performed the study selection process, data collection, and assessment of quality. The following psychometric properties were addressed: inter-rater reliability, internal consistency, and construct validity.</div></div><div><h3>Results</h3><div>Six articles were included. The GCS and the FOUR scores demonstrated excellent reliability and very strong validity when used by nurses and physicians to assess the level of consciousness in patients admitted to the ICU and ED. The FOUR score demonstrated slightly higher overall reliability and validity than the GCS.</div></div><div><h3>Conclusion</h3><div>This systematic review indicates that the FOUR score is especially suitable for assessing the level of consciousness in patients admitted to the ICU and ED. The FOUR score demonstrated higher reliability and validity than the GCS, making it a promising alternative assessment scale, despite the GCS’s longstanding use in clinical practice.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101057"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing characteristics and outcomes of in-hospital cardiac arrest during the early and late COVID-19 pandemic at an academic institution in Saudi Arabia","authors":"Abdullah Bakhsh MBBS ,&nbsp;Saleh Binmahfooz MBBS ,&nbsp;Ibtihal Balubaid MBBS ,&nbsp;Hind Aljedani MBBS ,&nbsp;Mohsin Khared MBBS ,&nbsp;Abdulrahman Alghamdi MBBS ,&nbsp;Saleh Alabdulwahab MBBS ,&nbsp;Mohannad Alzahrani MBBS ,&nbsp;Aziza Abushosha MBBS ,&nbsp;Layan Alharbi MBBS ,&nbsp;Reem Baarma MBBS ,&nbsp;Elmoiz Babekir MBBS","doi":"10.1016/j.aucc.2024.06.005","DOIUrl":"10.1016/j.aucc.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic has introduced major changes in the resuscitation practices of cardiac arrest victims.</div></div><div><h3>Aim</h3><div>We aimed to compare the characteristics and outcomes of patients who sustained in-hospital cardiac arrest (IHCA) during the early COVID-19 pandemic period (2020) with those during the late COVID-19 pandemic period (2021).</div></div><div><h3>Methods</h3><div>This was a retrospective review of adult patients sustaining IHCA at a single academic centre. We compared characteristics and outcomes of IHCA for 5 months in 2020 with those experiencing IHCA for 5 months in 2021.</div></div><div><h3>Results</h3><div>Patients sustaining IHCA during the early COVID-19 pandemic period had higher rates of delayed epinephrine administration of more than 5 min (13.4% vs. 1.9%; p &lt; 0.01), more frequent delays in the initiation of chest compressions (55.6% vs. 17.9%; p &lt; 0.01), and were intubated less often (23.0% vs. 59.3%; p &lt; 0.01). In terms of outcomes, both return of spontaneous circulation (35.8% vs. 51.2%; p &lt; 0.01) and survival to hospital discharge rates (13.9% vs. 30.2%; p &lt; 0.01) were lower during the early COVID-19 pandemic period.</div></div><div><h3>Conclusions</h3><div>The early COVID-19 pandemic period was associated with delays in epinephrine administration and chest compression initiation for IHCA. Moreover, both return of spontaneous circulation and survival to hospital discharge were lower during the early COVID-19 pandemic period.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101082"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How is work-family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis.","authors":"Qianqian Yang, Linlin Yang, Chunling Yang, Xia Wu, Zhen Xu, Xiaobing Wang","doi":"10.1016/j.aucc.2024.03.008","DOIUrl":"10.1016/j.aucc.2024.03.008","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work-family conflict and nurse-assessed patient safety among intensive care unit nurses.</p><p><strong>Background: </strong>Most intensive care unit nurses experience work-family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work-family conflict on patient safety, few have investigated whether work-family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>This study included 209 intensive care unit nurses from five general hospitals. The Work-Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses' perception of overall patient safety were used to gather data. Associations between work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis.</p><p><strong>Results: </strong>Work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (p < 0.01). Work-family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = -0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = -0.0464, upper limit [UL] = -0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = -0.0118; SE = 0.0063; 95% CI: LL = -0.0251, UL = -0.0006), the independent mediating role of negative affectivity (effect = -0.0055; SE = 0.0039; 95% CI: LL = -0.0153, UL = -0.0001), and the chain-mediating role of rumination and negative affectivity (effect = -0.0078; SE = 0.0031; 95% CI: LL = -0.0152, UL = -0.0027).</p><p><strong>Conclusion: </strong>Our findings indicated that work-family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work-family conflict would be beneficial for intensive care unit nurses' emotional stability and patient safety.</p>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":" ","pages":"101053"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating a home with a critically ill child: A qualitative study exploring the experiences of parents of children admitted to paediatric critical care following treatment in neonatal care","authors":"Sarah E. Seaton PhD ,&nbsp;Joseph C. Manning RN, PhD ,&nbsp;Gillian Colville MPhil, PhD ,&nbsp;Nicola Mackintosh PhD","doi":"10.1016/j.aucc.2024.07.082","DOIUrl":"10.1016/j.aucc.2024.07.082","url":null,"abstract":"<div><h3>Background</h3><div>Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings.</div></div><div><h3>Objective</h3><div>The overall aim of this study was to understand parents' experiences as they navigate the transition between admissions to the NNU and the PICU. This paper reports on one of the themes (creating a home) identified inductively from the dataset.</div></div><div><h3>Methods</h3><div>We used a qualitative research design using semistructured interviews with parents who had a child (or children) who had been admitted to neonatal care after birth and then subsequently were also admitted to a PICU. We recruited a national purposive sample of parents with experiences of having a child treated in an NNU before being admitted to the PICU. We undertook the interviews and transcribed them before taking a reflexive thematic analysis approach.</div></div><div><h3>Results</h3><div>A total of 15 mothers and three fathers, of 17 children, were interviewed between January and March 2022. ‘We identified ‘creating a home’ as a key inductive theme with three subthemes: (i) developing parental roles; (ii) creating a physical home; and (iii) creating core memories.</div></div><div><h3>Conclusions</h3><div>There is a growing cohort of children living with chronic health conditions. In this work, we have explored how their parents establish a home whilst often spending significant periods within the public arena of intensive care. Families across settings need support from healthcare professionals to help them develop their role as parents, build a home, and to create memories together.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101101"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-led dysphagia screening in the intensive care unit – An implementation study","authors":"Anne Højager Nielsen CCRN, MCN, PhD ,&nbsp;Robert Winding MD ,&nbsp;Bettina Hvas Busk ,&nbsp;Lillian Noe ,&nbsp;Birthe Husted CCRN, MHH ,&nbsp;Gitte Juhl Kristensen CCRN ,&nbsp;Helle Svenningsen CCRN, MCN, PhD ,&nbsp;Therese Ovesen MD, DMSc","doi":"10.1016/j.aucc.2024.07.081","DOIUrl":"10.1016/j.aucc.2024.07.081","url":null,"abstract":"<div><h3>Background</h3><div>Postextubation is common in the intensive care unit, and bedside screening by nurses is important to detect the condition and avoid aspiration to the airways.</div></div><div><h3>Objective</h3><div>The objective of this study was to assess the implementation of nurse-led, systematic dysphagia screening in the intensive care unit and to identify barriers and facilitators for dysphagia screening.</div></div><div><h3>Methods</h3><div>Design: pragmatic implementation study. Based on a programme theory, key behaviours were identified using the Behaviour Change Wheel framework. Implementation activities included education, e-learning, bedside peer support, feedback, and cues in the environment. Data sources included chart reviews, participant logs, implementation log and focus-group interviews.</div></div><div><h3>Results</h3><div>Participant logs showed 94% of nurses participated in educational sessions, less in e-learning (67%). Chart reviews showed very little use of nurse-led dysphagia screening. Only 19% of extubated patients followed screening protocol. Focus groups showed that nurses accepted the Yale Swallow Protocol as valid that new skills and understandings led to empowerment of nurses and aided decision making. Important barriers were keeping patients nil-per-mouth for intubation, lack of social support from other professionals, and difficulties with documentation. Facilitators were social support from colleagues.</div></div><div><h3>Conclusion</h3><div>Implementation of nurse-led screening in intensive care was possible but challenged by external factors. Attention should be given to alterations of the screening protocol to avoid alteration of the instrument and easy documentation. Implementation of nurse-led dysphagia screening in intensive care may facilitate safe oral intake in patients and identify patients in need of specialised assessment. Implementation should aim to provide nurses with competences in screening patients swallowing function and allow contextualisation without altering the properties of the instrument.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101100"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study","authors":"Josephine Lovegrove RN, PhD ,&nbsp;Paul Fulbrook RN, PhD ,&nbsp;Cui Yuan RN, MN ,&nbsp;Frances Lin RN, PhD ,&nbsp;Xian-Liang Liu RN, MD, PhD","doi":"10.1016/j.aucc.2024.05.015","DOIUrl":"10.1016/j.aucc.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><div>The COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use.</div></div><div><h3>Objectives</h3><div>This study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale.</div></div><div><h3>Methods</h3><div>The study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales.</div></div><div><h3>Results</h3><div>Inter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949–0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values &gt;0.6, whereas two Braden Scale subscales (<em>Mobility</em>, <em>Activity</em>) were below this threshold. Instrument sum scores were strongly correlated (Pearson's <em>r =</em> −0.76 [<em>r</em>^<em>2</em> = 0.58]; <em>p</em> &lt; 0.001), as were three subscale item pairs (mobility <em>r</em>_<em>s</em> <em>=</em> −0.56 [<em>r</em>^<em>2</em> = 0.32]; nutrition <em>r</em>_<em>s</em> <em>=</em> −0.63 [<em>r</em>^<em>2</em> = 0.39]; level of consciousness/sensory perception <em>r</em>_<em>s</em> <em>=</em> −0.67 [<em>r</em>^<em>2</em> = 0.45] <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Both the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101093"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional gap after transfer from the intensive care unit to a general ward – A retrospective quality assurance study","authors":"Anne Wilkens Knudsen RN, RD, PhD ,&nbsp;Simone Møller Hansen RD, BN ,&nbsp;Thordis Thomsen RN, PhD ,&nbsp;Heidi Knudsen RN, BN ,&nbsp;Tina Munk RD, PhD","doi":"10.1016/j.aucc.2024.07.083","DOIUrl":"10.1016/j.aucc.2024.07.083","url":null,"abstract":"<div><h3>Background</h3><div>Adequate nutrition is important for recovery after critical illness. Even so, our knowledge of patients' nutritional intake after intensive care unit (ICU) discharge is scarce.</div></div><div><h3>Objectives</h3><div>We aimed to explore nutritional planning and achieved nutritional intake in ICU patients who transfer from the ICU to general wards.</div></div><div><h3>Methods</h3><div>A retrospective quality assurance study. Inclusion criteria: adult ICU patients transferring to a general ward at Copenhagen University Hospital-Herlev from May to August 2021. Primary outcomes were as follows: having a nutritional plan on the day of ICU transfer. A nutritional plan was defined as follows: (i) individual assessment of energy and protein requirement; (ii) intake, documented as achieved percentage of energy and protein requirements; (iii) prescribed type of nutrition. If using enteral or parenteral nutrition; (iv) the prescribed doses; and (v) the prescribed product. Secondary outcomes were as follows: achieved percentage of energy and protein requirements from day -1 before ICU transfer until day +1 and day +3 after ICU transfer.</div></div><div><h3>Results</h3><div>We included 57 patients; the mean age was 64 years (±11.1); 43 (75%) patients were male; the median ICU stay was 6 days (interquartile range: 3–11). One (2%) patient had a full nutritional plan according to listed criteria. Patients' median percentage of requirements met declined significantly from the day before to the day after ICU discharge (energy: from 94% to 30.5%; p = 0.0051; protein: from 73% to 27.5%; p = 0.0117). The decline in percentage of requirements met remained unchanged from day 1 to 3 after ICU transfer.</div></div><div><h3>Conclusions</h3><div>In conclusion, few patients had a nutritional plan when transferring from the ICU to a general ward. After ICU discharge, percentage of energy and protein requirements met declined significantly and remained insufficient during the first 3 days at the general ward.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101102"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}