Factors Associated with Sugar-Sweetened Beverage Intake Among Young Children - United States, 2021.

Introduction: Because limited data exist about factors related to sugar-sweetened beverage (SSB) intake among younger children, we investigated factors associated with SSB intake among US children aged 1 to 5 years.

Methods: We examined SSB intake (0, 1-3, or ≥4 times/week) by using data from the 2021 National Survey of Children's Health. We performed a multinomial logistic regression to calculate adjusted odds ratios (aORs) for select sociodemographic and household factors associated with moderate (1-3 times/week) and high (≥4 times/week) SSB intake.

Factors Associated with Daily Fruit and Vegetable Intakes among Children Aged 1-5 Years in the United States.

To describe child, caregiver, and household characteristics associated with fruit and vegetable intakes among US children aged 1-5 years, we examined fruit and vegetable intakes (less than daily vs. daily) using data from the 2021 National Survey of Children's Health among children aged 1-5 years. Multiple logistic regression provided adjusted odds ratios for factors associated with (1) daily fruit and (2) daily vegetable intakes.

Disaggregation of Breastfeeding Initiation Rates by Race and Ethnicity - United States, 2020-2021.

Introduction: Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups.

Cognitive Impairment, Physical Impairment, and Psychological Symptoms in Intensive Care Unit Survivors.

Background: Post-intensive care syndrome (PICS) affects 25% to 50% of adults who survive an intensive care unit (ICU) stay. Although the compounding of PICS impairments (cognitive, physical, and psychological) could intensify the syndrome, research on relationships among impairments is limited, particularly in patients with delirium.

Objectives: To examine associations among PICS impairments and examine delirium status and its relationship to PICS impairments at ICU discharge and 1 month later.

OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients.

Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data.

Lack of Association of High Backrest With Sacral Tissue Changes in Adults Receiving Mechanical Ventilation.

Background: Although higher backrest elevation may be a theoretical risk for integrity of sacral tissues, few data support use of high backrest elevation.

Objective: To describe the effect of backrest elevation on the integrity of sacral tissue in critically ill adults receiving mechanical ventilation.

Methods: Patients from 3 critical care units (surgical trauma, medical respiratory, and neuroscience) who were expected to have mechanical ventilation for at least 24 hours were intubated and mechanical ventilation was started.

High-Frequency Ultrasound: Obtaining Optimal Images and the Effect of Image Artifacts on Image Quality.

High-frequency ultrasound (HFUS) images are being researched for use in the prevention, detection, and monitoring of pressure injuries in patients at risk. This seminal longitudinal study in mechanically ventilated adults describes image quality, the incidence of image artifacts, and their effect on image quality in critically ill subjects. Mechanically ventilated subjects from three adult intensive care units were enrolled, and multiple sacral images from each subject were obtained daily.

High-Frequency Ultrasound: Description of Sacral Tissue Characteristics in Healthy Adults.

Objectives: The purpose of this study was to describe selected sacral tissue characteristics in a convenience sample of healthy volunteer subjects.

Design: Descriptive.

Sample And Setting: Fifty healthy volunteers in a clinical learning center in a school of nursing.

High frequency ultrasound sacral images in the critically ill: Tissue characteristics versus visual evaluation.

Purpose: High frequency ultrasound (HFUS) systems may identify tissue injury. We compared HFUS tissue characteristics (dermal thickness and dermal density) with visual image examination.

Methods: Longitudinal study in critically ill mechanically ventilated adults, from three ICUs (Surgical Trauma, Medical Respiratory, Neuroscience) enrolled within 24hours of airway intubation.

Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients.

Objective: To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations.

Design, Setting, Patients: Descriptive, longitudinal study in critically ill mechanically ventilated adults, from Surgical Trauma ICU-STICU; Medical Respiratory ICU-MRICU; Neuroscience ICU-NSICU in a Mid-Atlantic urban university medical centre. Subjects were enroled in the study within 24hours of intubation.

Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation.

Background: Backrest elevations less than 30° are recommended to reduce pressure ulcers, but positions greater than 30° are recommended during mechanical ventilation to reduce risk for ventilator-associated pneumonia. Interface pressure may vary with level of backrest elevation and anatomical location (eg, sacrum, heels).

Objective: To describe backrest elevation and anatomical location and intensity of skin pressure across the body in patients receiving mechanical ventilation.

Stimulation of Critically Ill Patients: Relationship to Sedation.

Objectives: To describe the number and type of stimulation events and the relationship of stimulation to sedation level in patients receiving mechanical ventilation.

Methods: A 4-hour direct observation was conducted in 103 patients receiving mechanical ventilation. Stimulation events and sedation level before and after the stimulation were documented.

Validity and sensitivity of 6 pain scales in critically ill, intubated adults.

Background: Self-report is the best indicator of pain; however, pain is more difficult to assess in noncommunicative patients who may be receiving mechanical ventilation or sedated and unable to report pain.

Objectives: To evaluate the validity and sensitivity of 6 pain scales (Adult Nonverbal Pain Scale; Behavior Pain Scale [BPS]; Comfort Scale; FACES; Face, Legs, Activity, Cry, and Consolability scale; Pain Assessment Behavioral Scale with Numeric Rating Scale [NRP]) to identify the best measure of pain in noncommunicative patients.

Methods: Fifty communicative and 100 noncommunicative patients receiving mechanical ventilation were observed before and during routine physical examination and endotracheal tube suctioning.

Effect of alertness level and backrest elevation on skin interface pressure.

Introduction: Critically ill patients may experience reduced mobility and sensation related to various pharmacologic therapies and treatments, making this patient population especially susceptible to pressure ulcers. An alert patient may be better able to reposition in response to discomfort, therefore preventing the development of pressure ulcers. However, little is known about the effect of an individual's alertness level on skin interface pressures.

Effects of position and operator on high-frequency ultrasound scan quality.

Objectives: High-frequency ultrasound may evaluate those at risk for pressure ulcers. Images may be obtained by clinicians with limited training. The prone position is recommended for obtaining sacral scans but may not be feasible in the critically ill.

Use of high frequency ultrasound to detect changes in skin integrity: An image evaluation validation procedure.

Objectives: High frequency ultrasound (HFUS) scanning may be used for prevention, detection and monitoring of pressure ulcers in patients at risk and is amenable for portable, bedside use by a variety of clinicians. Limited data are available about the criteria to determine an ideal image or measures of tissue changes representative of tissue injury. We developed and evaluated criteria for overall image quality and measures of tissue integrity.

Preintubation application of oral chlorhexidine does not provide additional benefit in prevention of early-onset ventilator-associated pneumonia.

Background: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

The effect of oral care on intracranial pressure in critically ill adults.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP.

Biobehavioral examination of fatigue across populations: report from a P30 Center of Excellence.

Objectives: This article reports the cross-studies analysis of projects from the P30 Center of Excellence for Biobehavioral Approaches to Symptom Management. Although the projects investigated diverse populations, a consistent theoretical and empirical approach guided each project.

Methods: Common data elements included the following measures of psychobehavioral variables: the PROMIS Short-Form Fatigue Scale, the Center of Epidemiologic Studies Depression Scale, and the Perceived Stress Scale.

Predictors of agitation in critically ill adults.

Background: Agitation in critically ill adults is a frequent complication of hospitalization and results in multiple adverse outcomes. Potential causes of agitation are numerous; however, data on factors predictive of agitation are limited.

Objectives: To identify predictors of agitation by examining demographic and clinical characteristics of critically ill patients.

Agitation onset, frequency, and associated temporal factors in critically ill adults.

Background: Agitation is a frequent complication in critically ill adults, can result in life-threatening events for patients or care providers, and extends the hospital length of stay, thereby increasing hospital costs.

Objectives: To describe the incidence, onset, and temporal factors related to agitation in critically ill adults.

Methods: Data were collected for the first 5 days of stay of all adult patients consecutively admitted to a medical respiratory intensive care unit and a surgical trauma intensive care unit during a 2-month period.

Patient ventilator asynchrony in critically ill adults: frequency and types.

Background: Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay).

Methods: Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90 min per subject and blinded waveform analysis was performed.

Subglottic secretion volume and viscosity: effect of systemic volume and oral hydration.

Objectives: Removal of secretions from the subglottic space, which is the larynx cavity below the glottis that contains the vocal cords, reduces the risk for ventilator associated pneumonia. Relationships between factors associated with subglottic secretion volume and viscosity have not been investigated. Subglottic secretions may have a possible link with systemic volume status and oral cavity hydration.

Utility of high-frequency ultrasound: moving beyond the surface to detect changes in skin integrity.

Ultrasound imaging is a versatile modality frequently used in clinical medicine, most likely due to its low cost, low risk to patients, and the ability to provide images in real time. Ultrasound used typically in clinical settings has frequencies between 2 and 12 MHz. Lower frequencies produce greater resolution but are limited in depth penetration; higher frequencies produce greater resolution, but depth of penetration is limited.