Incidence and risk factors of pressure injuries in critically ill patients with COVID-19.

OBJECTIVE: to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs. METHOD: a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI. RESULTS: PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001). CONCLUSION: PI incidence in critically ill patients with COVID-19 was high.

Pressure injury prevention in adult critically ill patients: best practice implementation project.

OBJECTIVE: This study assessed compliance with the best practices for pressure injury prevention among ICU patients at a tertiary hospital in São Paulo, Brazil. INTRODUCTION: Intensive care patients are at high risk of developing a pressure injury; preventing this requires a best practice protocol. METHOD: This best practice implementation project was conducted in a Brazilian tertiary hospital in three phases following the JBI Model of Evidence-based Healthcare. Ten criteria derived from the best available evidence were audited and monitored before and after best practice implementation. RESULTS: The baseline and follow-up audits evaluated 28 patients at each step. A total of 448 h of care were analyzed using a monitoring camera and medical records. Compliance with all 10 audited criteria increased, with a 50% reduction in the prevalence of pressure injuries in intensive care. Of the 223 employees, 71% claimed to have some knowledge of pressure injury prevention, and 66% reported adequate adherence to prevention protocols. CONCLUSION: The audit and feedback strategy improved compliance with the criteria. Future audits are needed to promote the sustainability of evidence-based practice.

Incidence and risk factors of pressure injuries in critically ill patients with COVID-19 / Incidencia y factores de riesgo de lesiones por presión en pacientes críticos con COVID-19 / Incidência e fatores de risco de lesão por pressão em pacientes críticos com COVID-19

ABSTRACT Objective: to analyze pressure injury (PI) incidence and risk factors in patients with COVID-19 admitted to an Intensive Care Unit and characterize the identified PIs. Method: a retrospective cohort study, consisting of 668 patients, carried out between March 2020 and February 2021. Clinical/demographic and PI variables were collected from medical records and electronic database. Data were analyzed using descriptive and inferential statistics. Logistic regression was performed to analyze risk factors for PI. Results: PI incidence was 30.2% (n=202), with the majority located in the sacral region (52.9%) and in stage 1 (39%). Risk factors were age (p<0.001), Diabetes Mellitus (p=0.005), length of stay (p<0.001), immunosuppression (p=0.034), nutritional risk (p=0.015) and mechanical ventilation (p<0.001). Conclusion: PI incidence in critically ill patients with COVID-19 was high.

RESUMEN Objetivo: analizar la incidencia y factores de riesgo de lesiones por presión (LP) en pacientes con COVID-19 ingresados en Unidad de Cuidados Intensivos y caracterizar las LP identificadas. Método: estudio de cohorte retrospectivo, compuesto por 668 pacientes, realizado entre marzo de 2020 y febrero de 2021. Las variables clínico/demográficas y de LP se recogieron de historias clínicas y bases de datos electrónicas. Los datos fueron analizados mediante estadística descriptiva e inferencial. Se realizó una regresión logística para analizar los factores de riesgo de LP. Resultados: la incidencia de LP fue del 30,2% (n=202), localizándose la mayoría en la región sacra (52,9%) y en estadio 1 (39%). Los factores de riesgo fueron edad (p<0,001), Diabetes Mellitus (p=0,005), tiempo de estancia hospitalaria (p<0,001), inmunosupresión (p=0,034), riesgo nutricional (p=0,015) y ventilación mecánica (p<0,001). Conclusión: la incidencia de LP en pacientes críticos con COVID-19 fue alta.

RESUMO Objetivo: analisar a incidência e os fatores de risco de lesão por pressão (LP) em pacientes com COVID-19 internados em Unidade de Terapia Intensiva e caracterizar as LP identificadas. Método: estudo de coorte retrospectivo, constituído por 668 pacientes, realizado entre março de 2020 e fevereiro de 2021. Variáveis clínicas/demográficas e das LP foram coletadas dos prontuários e banco de dados eletrônico. Os dados foram analisados por meio de estatística descritiva e inferencial. A regressão logística foi realizada para análise dos fatores de risco para LP. Resultados: a incidência de LP foi de 30,2% (n=202), sendo a maioria localizada na região sacral (52,9%) e em estágio 1 (39%). Os fatores de risco foram idade (p<0,001), Diabetes Mellitus (p=0,005), tempo de internação (p<0,001), imunossupressão (p=0,034), risco nutricional (p=0,015) e ventilação mecânica (p<0,001). Conclusão: a incidência de LP em pacientes críticos com COVID-19 foi alta.

Scape Room Como Estratégia de Sensibilização e Educação Sobre Prevenção de Lesão Por Pressão / Scape Room as a Sensitization and Education Strategy About Pressure Injury Prevention / La Sala de Escape Como Estrategia de Sensibilización y Educación Sobre la Prevención de Lesiones Por Presión

Objetivo:Relatar a experiência da utilização de sala de escape como estratégia educacional e de sensibilização para prevenção de lesão por pressão no contexto hospitalar. Métodos: Trata-se de um relato de experiência decorrente de atividade desenvolvida em novembro de 2021, com profissionais da equipe multiprofissional de um hospital filantrópico de grande porte localizado na região metropolitana de São Paulo (SP), Brasil. Resultados: Realizou-se o jogo como estratégia educacional associado a outras iniciativas sobre a temática, durante a campanha anual de prevenção de lesão por pressão. Participaram da atividade 82 profissionais, entre eles, enfermeiros, técnicos em enfermagem, nutricionistas e fisioterapeutas. O total de 57 participantes (69,5%) conseguiram desvendar os enigmas propostos e sair da sala de escape no tempo determinado. A avaliação de reação demonstrou alto nível de satisfação com a atividade, além de inúmeros elogios sobre a metodologia escolhida, bem como a criatividade com que o tema foi abordado e desenvolvido. Conclusão: A utilização de uma metodologia baseada na interação dos participantes, como as salas de escape, associada a outras atividades educativas parece ser interessante para promover a aprendizagem e a sensibilização na temática prevenção de lesão por pressão.

Objective:To report the experience of using the escape room as an educational and awareness strategy for the prevention of pressure injuries in the hospital context. Methods: This is an experience report about an activity developed in November 2021, with professionals from the multidisciplinary team of a large philanthropic hospital located in the metropolitan region of São Paulo (SP), Brazil. Results: The game was played as an educational strategy associated with other initiatives on the issue, during the annual pressure injury prevention campaign. Eighty-two professionals participated in the activity, including nurses, nursing technicians, nutritionists, and physiotherapists. A total of 57 participants (69.5%) managed to unravel the proposed puzzles and leave the escape room in the proposed time. The reaction evaluation showed a high level of satisfaction with the activity, in addition to numerous compliments on the chosen methodology, as well as the creativity in which the topic was approached and developed. Conclusion: The use of a methodology based on the interaction of the participants, such as escape rooms, associated with other educational activities seems to be interesting to promote learning and awareness about pressure injury prevention.

Objetivo:Reportar la experiencia del uso del escape room como estrategia educativa y de concientización para la prevención de lesiones por presión en el contexto hospitalario. Métodos: Este es un relato de experiencia, resultado de una actividad desarrollada en noviembre de 2021, con profesionales del equipo multidisciplinario de un gran hospital filantrópico, ubicado en la región metropolitana de São Paulo, Brasil. Resultados: El juego se realizó como una estrategia educativa asociada a otras iniciativas en el tema, durante la campaña anual de prevención de lesiones por presión. Participaron de la actividad 82 profesionales, entre enfermeros, técnicos de enfermería, nutricionistas y fisioterapeutas. Un total de 57 participantes (69,5%) consiguieron desentrañar los puzzles propuestos y salir del escape room en el tiempo propuesto. La evaluación de la reacción mostró un alto nivel de satisfacción con la actividad, además de numerosos elogios sobre la metodología elegida, así como la creatividad con la que se abordó y desarrolló el tema. Conclusión: El uso de una metodología basada en la interacción de los participantes, como las salas de escape, asociada a otras actividades educativas, parece interesante para promover el aprendizaje y la sensibilización en el tema de prevención de lesiones por presión.

Clinical and molecular study in congenital muscular dystrophy with partial laminin alpha 2 (LAMA2) deficiency.

Complete laminin alpha2 (LAMA2) deficiency causes approximately half of congenital muscular dystrophy (CMD) cases. Many loss-of-function mutations have been reported in these severe, neonatal-onset patients, but only single missense mutations have been found in milder CMD with partial laminin alpha2 deficiency. Here, we studied nine patients diagnosed with CMD who showed abnormal white-matter signal at brain MRI and partial deficiency of laminin alpha2 on immunofluorescence of muscle biopsy. We screened the entire 9.5 kb laminin alpha2 mRNA from patient muscle biopsy by direct capillary automated sequencing, single strand conformational polymorphism (SSCP), or denaturing high performance liquid chromatography (DHPLC) of overlapping RT-PCR products followed by direct sequencing of heteroduplexes. We identified laminin alpha2 sequence changes in six of nine CMD patients. Each of the gene changes identified, except one, was novel, including three missense changes and two splice-site mutations. The finding of partial laminin alpha2 deficiency by immunostaining is not specific for laminin alpha2 gene mutation carriers, with only two patients (22%) showing clear causative mutations, and an additional three patients (33%) showing possible mutations. The clinical presentation and disease progression was homogeneous in the laminin alpha2-mutation positive and negative CMD patients.

Integrin alpha 7 beta 1 in muscular dystrophy/myopathy of unknown etiology.

To investigate the role of integrin alpha 7 in muscle pathology, we used a "candidate gene" approach in a large cohort of muscular dystrophy/myopathy patients. Antibodies against the intracellular domain of the integrin alpha 7A and alpha 7B were used to stain muscle biopsies from 210 patients with muscular dystrophy/myopathy of unknown etiology. Levels of alpha 7A and alpha 7B integrin were found to be decreased in 35 of 210 patients (approximately 17%). In six of these patients no integrin alpha 7B was detected. Screening for alpha 7B mutation in 30 of 35 patients detected only one integrin alpha 7 missense mutation (the mutation on the second allele was not found) in a patient presenting with a congenital muscular dystrophy-like phenotype. No integrin alpha 7 gene mutations were identified in all of the other patients showing integrin alpha 7 deficiency. In the process of mutation analysis, we identified a novel integrin alpha 7 isoform presenting 72-bp deletion. This isoform results from a partial deletion of exon 21 due to the use of a cryptic splice site generated by a G to A missense mutation at nucleotide position 2644 in integrin alpha 7 cDNA. This spliced isoform is present in about 12% of the chromosomes studied. We conclude that secondary integrin alpha 7 deficiency is rather common in muscular dystrophy/myopathy of unknown etiology, emphasizing the multiple mechanisms that may modulate integrin function and stability.

Inteligibilidade4 da fala em portadores da síndrome de down, relaçöes com praxia motora oral, memória auditiva verbal, idade, sexo e nível intelectual / Speech intelligibility in individuals with Down`s syndrome and its relations to motor oral praxis, verbal auditory memory, age, gender and intellectual level

Foram estudados 45 portadores da síndrome de down, de idades entre 5 e 13 anos, quanto à inteligibilidade de fala. Mais de 70 por cento das emissöes näo repetitivas foram inteligíveis em 16 sujeitos, menos 40 por cento foram inteligíveis em 17, e 12 sujeitos ficaram em situaçäo intermediária