Thirty to sixty per cent of older patients experience functional decline after hospitalisation, associated with an increase in dependence, readmission, nursing home placement and mortality. First step in prevention is the identification of patients at risk. The objective of this study is to develop and validate a prediction model to assess the risk of functional decline in older hospitalised patients.
Introduction: Few data described practicalities of using mechanical insufflation-exsufflation (MI-E) for invasively ventilated ICU patients and evidence for benefit of their use is lacking.Aim and objective: To identify barriers and facilitators to use MI-E devices in invasively ventilated ICU patients, and to explore reasons for their use in various patient indications.Methods: Four focus group discussions; 3 national (Netherlands) and 1 with international representation, each with a purposeful interprofessional sample of a maximum 10 participants with experience in using MI-E in invasively ventilated ICU patients. We developed a semi-structured interview guide informed by the Theoretical Domain Framework. An observer was present in each session. Sessions were audio recorded and transcribed verbatim. Data were analysed using content analysis.Results: Barriers for MI-E use were lack of evidence and lack of expertise in MI-E, as well as lack of device availability within the ICU. Facilitators were experience with MI-E and perceived clinical improvement in patients with MI-E use. Common reasons to start using MI-E were difficult weaning, recurrent atelectasis and pneumonia. Main contraindications were, bullous emphysema, ARDS, high PEEP, hemodynamic instability, recent pneumothorax. There was substantial variability on used technical settings of MI-E in invasively ventilated patients.Conclusions: Key barriers and facilitators to MI-E were lack of evidence, available expertise and perceived clinical improvement. Variability on technical settings likely reflect lack of evidence. Future studies should focus on settings, safety and feasibility of MI-E in invasively ventilated patients before studies on effect can be conducted.
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Purpose In this systematic literature review, the effects of the application of a checklist during in hospital resuscitation of trauma patients on adherence to the ATLS guidelines, trauma team performance, and patient-related outcomes were integrated. Methods A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Metaanalyses checklist. The search was performed in Pubmed, Embase, CINAHL, and Cochrane inception till January 2019. Randomized controlled- or controlled before-and-after study design were included. All other forms of observational study designs, reviews, case series or case reports, animal studies, and simulation studies were excluded. The Effective Public Health Practice Project Quality Assessment Tool was applied to assess the methodological quality of the included studies. Results Three of the 625 identified articles were included, which all used a before-and-after study design. Two studies showed that Advanced Trauma Life Support (ATLS)-related tasks are significantly more frequently performed when a checklist was applied during resuscitation. [14 of 30 tasks (p < 0.05), respectively, 18 of 19 tasks (p < 0.05)]. One study showed that time to task completion (− 9 s, 95% CI = − 13.8 to − 4.8 s) and workflow improved, which was analyzed as model fitness (0.90 vs 0.96; p < 0.001); conformance frequency (26.1% vs 77.6%; p < 0.001); and frequency of unique workflow traces (31.7% vs 19.1%; p = 0.005). One study showed that the incidence of pneumonia was higher in the group where a checklist was applied [adjusted odds ratio (aOR) 1.69, 95% Confidence Interval (CI 1.03–2.80)]. No difference was found for nine other assessed complications or missed injuries. Reduced mortality rates were found in the most severely injured patient group (Injury Severity score > 25, aOR 0.51, 95% CI 0.30–0.89). Conclusions The application of a checklist may improve ATLS adherence and workflow during trauma resuscitation. Current literature is insufficient to truly define the effect of the application of a checklist during trauma resuscitation on patientrelated outcomes, although one study showed promising results as an improved chance of survival for the most severely injured patients was found.
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Chemical preservation is an important process that prevents foods, personal care products, woods and household products, such as paints and coatings, from undesirable change or decomposition by microbial growth. To date, many different chemical preservatives are commercially available, but they are also associated with health threats and severe negative environmental impact. The demand for novel, safe, and green chemical preservatives is growing, and this process is further accelerated by the European Green Deal. It is expected that by the year of 2050 (or even as soon as 2035), all preservatives that do not meet the ‘safe-by-design’ and ‘biodegradability’ criteria are banned from production and use. To meet these European goals, there is a large need for the development of green, circular, and bio-degradable antimicrobial compounds that can serve as alternatives for the currently available biocidals/ preservatives. Anthocyanins, derived from fruits and flowers, meet these sustainability goals. Furthermore, preliminary research at the Hanze University of Applied Science has confirmed the antimicrobial efficacy of rose and tulip anthocyanin extracts against an array of microbial species. Therefore, these molecules have the potential to serve as novel, sustainable chemical preservatives. In the current project we develop a strategy consisting of fractionation and state-of-the-art characterization methods of individual anthocyanins and subsequent in vitro screening to identify anthocyanin-molecules with potent antimicrobial efficacy for application in paints, coatings and other products. To our knowledge this is the first attempt that combines in-depth chemical characterization of individual anthocyanins in relation to their antimicrobial efficacy. Once developed, this strategy will allow us to single out anthocyanin molecules with antimicrobial properties and give us insight in structure-activity relations of individual anthocyanins. Our approach is the first step towards the development of anthocyanin molecules as novel, circular and biodegradable non-toxic plant-based preservatives.
