A two-arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients

Purpose This study tested the effectiveness of a pressure ulcer (PU) prevention bundle in reducing the incidence of PUs in critically ill patients in two Saudi intensive care units (ICUs). Design A two-arm cluster randomized experimental control trial. Methods Participants in the intervention group received the PU prevention bundle, while the control group received standard skin care as per the local ICU policies. Data collected included demographic variables (age, diagnosis, comorbidities, admission trajectory, length of stay) and clinical variables (Braden Scale score, severity of organ function score, mechanical ventilation, PU presence, and staging). All patients were followed every two days from admission through to discharge, death, or up to a maximum of 28 days. Data were analyzed with descriptive correlation statistics, Kaplan-Meier survival analysis, and Poisson regression. Findings The total number of participants recruited was 140: 70 control participants (with a total of 728 days of observation) and 70 intervention participants (784 days of observation). PU cumulative incidence was significantly lower in the intervention group (7.14%) compared to the control group (32.86%). Poisson regression revealed the likelihood of PU development was 70% lower in the intervention group. The intervention group had significantly less Stage I (p = 002) and Stage II PU development (p = 026). Conclusions Significant improvements were observed in PU-related outcomes with the implementation of the PU prevention bundle in the ICU; PU incidence, severity, and total number of PUs per patient were reduced. Clinical Relevance Utilizing a bundle approach and standardized nursing language through skin assessment and translation of the knowledge to practice has the potential to impact positively on the quality of care and patient outcome.

Residents’ experiences of privacy and comfort in multi-storey apartment dwellings in subtropical Brisbane

Dwellings in multi-storey apartment buildings (MSAB) are predicted to increase dramatically as a proportion of housing stock in subtropical cities over coming decades. The problem of designing comfortable and healthy high-density residential environments and minimising energy consumption must be addressed urgently in subtropical cities globally. This paper explores private residents’ experiences of privacy and comfort and their perceptions of how well their apartment dwelling modulated the external environment in subtropical conditions through analysis of 636 survey responses and 24 interviews with residents of MSAB in inner urban neighbourhoods of Brisbane, Australia. The findings show that the availability of natural ventilation and outdoor private living spaces play important roles in resident perceptions of liveability in the subtropics where the climate is conducive to year round “outdoor living”. Residents valued choice with regard to climate control methods in their apartments. They overwhelmingly preferred natural ventilation to manage thermal comfort, and turned to the air-conditioner for limited periods, particularly when external conditions were too noisy. These findings provide a unique evidence base for reducing the environmental impact of MSAB and increasing the acceptability of apartment living, through incorporating residential attributes positioned around climate-responsive architecture.

Capnography monitoring during procedural sedation and analgesia: A systematic review protocol

Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inadequate oxygenation/ventilation is the most common reason for injury associated with PSA, reducing episodes of hypoxaemia would indicate that using capnography would be safer than relying on standard monitoring alone. Methods/design The primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO2] less than 90 %). A secondary objective of this review is to determine whether changes in the clinical management of sedated patients are the mediating factor for any observed impact of capnography monitoring on the rate of hypoxaemia. The potential adverse effect of capnography monitoring that will be examined in this review is the rate of inadequate sedation. Electronic databases will be searched for parallel, crossover and cluster randomised controlled trials comparing the use of capnography with standard monitoring alone during PSA that is administered in the hospital setting. Studies that included patients who received general or regional anaesthesia will be excluded from the review. Non-randomised studies will be excluded. Screening, study selection and data extraction will be performed by two reviewers. The Cochrane risk of bias tool will be used to assign a judgment about the degree of risk. Meta-analyses will be performed if suitable. Discussion This review will synthesise the evidence on an important potential clinical benefit of capnography monitoring during PSA within hospital settings. Systematic review registration: PROSPERO CRD42015023740

Comparison of the Cosmed K4 b2 and the Deltatrac II™ metabolic cart in measuring resting energy expenditure in adults

Background and Aims: The objective of the study was to compare data obtained from the Cosmed K4 b2 and the Deltatrac II™ metabolic cart for the purpose of determining the validity of the Cosmed K4 b2 in measuring resting energy expenditure. Methods: Nine adult subjects (four male, five female) were measured. Resting energy expenditure was measured in consecutive sessions using the Cosmed K4 b2, the Deltatrac II™ metabolic cart separately and the Cosmed K4 b2 and Deltatrac II™ metabolic cart simultaneously, performed in random order. Resting energy expenditure (REE) data from both devices were then compared with values obtained from predictive equations. Results: Bland and Altman analysis revealed a mean bias for the four variables, REE, respiratory quotient (RQ), VCO2, VO2 between data obtained from Cosmed K4 b2 and Deltatrac II™ metabolic cart of 268 ± 702 kcal/day, -0.0±0.2, 26.4±118.2 and 51.6±126.5 ml/min, respectively. Corresponding limits of agreement for the same four variables were all large. Also, Bland and Altman analysis revealed a larger mean bias between predicted REE and measured REE using Cosmed K4 b2 data (-194±603 kcal/day) than using Deltatrac™ metabolic cart data (73±197 kcal/day). Conclusions: Variability between the two devices was very high and a degree of measurement error was detected. Data from the Cosmed K4 b2 provided variable results on comparison with predicted values, thus, would seem an invalid device for measuring adults. © 2002 Elsevier Science Ltd. All rights reserved.

A systematic review of capnography for sedation

We included six trials with 2524 participants. Capnography reduced hypoxaemic episodes, relative risk (95% CI) 0.71 (0.56-0.91), but the quality of evidence was poor due to high risks of performance bias and detection bias and substantial statistical heterogeneity. The reduction in hypoxaemic episodes was statistically homogeneous in the subgroup of three trials of 1823 adults sedated for colonoscopy, relative risk (95% CI) 0.59 (0.48-0.73), although the risks of performance and detection biases were high. There was no evidence that capnography affected other outcomes, including assisted ventilation, relative risk (95% CI) 0.58 (0.26-1.27), p = 0.17.

Sustainable building envelope design by considering energy cost and occupant satisfaction

The built environment is a major contributor to the world’s carbon dioxide emissions, with a considerable amount of energy being consumed in buildings due to heating, ventilation and air-conditioning, space illumination, use of electrical appliances, etc., to facilitate various anthropogenic activities. The development of sustainable buildings seeks to ameliorate this situation mainly by reducing energy consumption. Sustainable building design, however, is a complicated process involving a large number of design variables, each with a range of feasible values. There are also multiple, often conflicting, objectives involved such as the life cycle costs and occupant satisfaction. One approach to dealing with this is through the use of optimization models. In this paper, a new multi-objective optimization model is developed for sustainable building design by considering the design objectives of cost and energy consumption minimization and occupant comfort level maximization. In a case study demonstration, it is shown that the model can derive a set of suitable design solutions in terms of life cycle cost, energy consumption and indoor environmental quality so as to help the client and design team gain a better understanding of the design space and trade-off patterns between different design objectives. The model can very useful in the conceptual design stages to determine appropriate operational settings to achieve the optimal building performance in terms of minimizing energy consumption and maximizing occupant comfort level.

Indoor air quality and energy management through real–time sensing in commercial buildings

Rapid growth in the global population requires expansion of building stock, which in turn calls for increased energy demand. This demand varies in time and also between different buildings, yet, conventional methods are only able to provide mean energy levels per zone and are unable to capture this inhomogeneity, which is important to conserve energy. An additional challenge is that some of the attempts to conserve energy, through for example lowering of ventilation rates, have been shown to exacerbate another problem, which is unacceptable indoor air quality (IAQ). The rise of sensing technology over the past decade has shown potential to address both these issues simultaneously by providing high–resolution tempo–spatial data to systematically analyse the energy demand and its consumption as well as the impacts of measures taken to control energy consumption on IAQ. However, challenges remain in the development of affordable services for data analysis, deployment of large–scale real–time sensing network and responding through Building Energy Management Systems. This article presents the fundamental drivers behind the rise of sensing technology for the management of energy and IAQ in urban built environments, highlights major challenges for their large–scale deployment and identifies the research gaps that should be closed by future investigations.