1
|
Wenzel F, Whitaker IY. Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition. J Wound Care 2024; 33:271-277. [PMID: 38573900 DOI: 10.12968/jowc.2024.33.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.
Collapse
Affiliation(s)
- Fernanda Wenzel
- Hospital e Maternidade Escola Mario de Moraes Altenfelder Silva, São Paulo, SP, Brazil
| | | |
Collapse
|
2
|
Eggmann S, Raab AM. The added value of physiotherapists in preventing pressure injuries in intensive care patients. Intensive Crit Care Nurs 2024; 80:103582. [PMID: 37939530 DOI: 10.1016/j.iccn.2023.103582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Anja M Raab
- Academic-Practice-Partnership of the School of Health Professions of Bern University of Applied Sciences and Insel Gruppe, Bern, Switzerland
| |
Collapse
|
3
|
Han L, Wei Y, Pei J, Zhang H, Lv L, Tao H, Yang Q, Su Q, Ma Y. Nomogram model on estimating the risk of pressure injuries for hospitalized patients in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103566. [PMID: 37913713 DOI: 10.1016/j.iccn.2023.103566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES This study aimed to build and validate a nomogram model to estimate the risk of pressure injuries in intensive care unit patients. DESIGN Multicenter prospective cohort study. SETTING 33 tertiary hospitals in the Gansu Province, China. MEASUREMENTS AND MAIN RESULTS This study included 6420 patients between April 2021 to October 2022 from an information platform of pressure injury risk management called the "Long Hu Hui." Univariate and multivariate logistic regression analyses identified pressure injury risk factors to be included in the nomogram. The resulting nomogram was tested for calibration discrimination, and clinical usefulness. Of the included patients, 77 developed pressure injuries, representing an incidence rate of 1.2 %. Analysis of binary logistic regression revealed that the estimation nomogram included weight loss greater than 5 kg in the last three months, pneumotomy cannula, thoracic catheter, isoproterenol, norepinephrine, abnormal skin color, ruptured erythema, stroke, increased body temperature and nonspecific patients (specific patients include paralysis, unconsciousness, dementia, forced body position). The area under the receiver operating characteristic curve for the training cohort was 0.806 (95 % CI 0.755-0.857), and the AUC of the text cohort was 0.737 (95 % CI 0.574-0.901). The model has excellent calibration in both the training cohort (H-L test: χ2 = 6.34, P = 0.61) and the text cohort (H-L test: χ2 = 4.50, P = 0.81). Furthermore, the decision curve analysis revealed the preferred net benefit and the threshold probability in the estimation nomogram. CONCLUSIONS The nomogram model accurately estimated the risk of pressure injuries among intensive care patients, it should be used to inform risk assessment and facilitate early intervention strategies in future practice. IMPLICATIONS FOR CLINICAL PRACTICE The nomogram allows intensive care providers to dynamically assess the patient's risk of pressure injuries and to implement more targeted interventions accordingly.
Collapse
Affiliation(s)
- Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Juhong Pei
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China
| | - Lin Lv
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Hongxia Tao
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qiuxia Yang
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qian Su
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Patient Service Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China.
| |
Collapse
|
4
|
Fidalgo De Faria M, Bontempo De Azevedo L, Faria De Oliveira K, Guimarães Raponi MB, Da Silva Alves Filgueira V, Marques Dos Santos Felix M, Sagrario Gómez Cantarino M, Barbosa MH. Respiratory device-related pressure injuries in hospitalised adults: An integrative review. J Clin Nurs 2023; 32:5923-5937. [PMID: 37038693 DOI: 10.1111/jocn.16717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/19/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To identify the main ventilatory support medical devices related to the occurrence of pressure injuries in hospitalised adults, as well as the most frequent anatomical localisations of these injuries. METHODS The Integrative review was registered at Open Science Framework as per DOI 10.17605/OSF.IO/P3NTZ. Two independent reviewers, in May 2022, searched the databases: PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS and CINAHL; no language or publication year restriction. The review question was: What are the ventilatory support medical devices that cause PIs in hospitalised adults more often? The terms for searching the database were: "adult," "noninvasive ventilation," "artificial respiration." and "pressure injury," and their synonyms. This review followed the PRISMA checklist. RESULTS The final sample was 21 articles. Oxygen nasal catheters caused up to 40.7% of the pressure injuries by ventilatory support devices identified, all in the ears. Noninvasive mechanical ventilation oronasal masks presented an incidence of pressure injuries of 63.3%. The nasal bridge was the site most affected by this mask. The Set of Holders for Insight® endotracheal tubes was the device that caused the most pressure injuries, with an incidence of 75%, affecting lip commissure. Tracheostomy cannula accounted for 18.2% of the pressure injuries related to ventilatory support devices; all lesions were in the neck. CONCLUSION The ventilatory support devices causing pressure injuries and the most affected sites were, respectively, nasal catheters, ears; masks, nasal bridge; endotracheal tubes, lip commissures; tracheostomy cannulas, neck. RELEVANCE FOR CLINICAL PRACTICE Knowing which respiratory devices cause pressure injuries more often in hospitalised adults and which anatomical localisations are more likely to be affected is fundamental for adopting preventive measures and reducing the occurrence of this problem. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution because of the review.
Collapse
Affiliation(s)
- Maíla Fidalgo De Faria
- Stricto Sensu Postgraduate Program in Health Care, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | - Karoline Faria De Oliveira
- Scientific Teaching Department of Nursing in the Hospital Care of the Institute of Health Sciences, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | - Viviane Da Silva Alves Filgueira
- Stricto Sensu Postgraduate Program in Health Care, Nurse in Neurology Unit and the Infectious Parasitic Diseases Unit of the Clinic Hospital of the Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | - Maria Helena Barbosa
- School of Nursing and Stricto Sensu Postgraduate Program in Health Care, Federal University of Triângulo Mineiro, Uberaba, Brazil
| |
Collapse
|
5
|
Lin F, Dawson D. Pressure injury: Reflecting on previous publications in Intensive and Critical Care Nursing and a call for papers. Intensive Crit Care Nurs 2023; 75:103379. [PMID: 36566142 DOI: 10.1016/j.iccn.2022.103379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Frances Lin
- University of the Sunshine Coast, Queensland, Sippy Downs 4556, Queensland, Australia.
| | - Deborah Dawson
- Ventilator Unit, Royal Hospital for Neuro-disability West Hill, London SW15 3SW, United Kingdom.
| |
Collapse
|
6
|
Pressure Injury Management in Critically Ill Patients with COVID-19 in a Makeshift Hospital in Indonesia: A Report of Two Cases. Adv Skin Wound Care 2022; 35:1-6. [PMID: 36409193 DOI: 10.1097/01.asw.0000891076.19171.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT Patients who are critically ill with COVID-19 need ventilation support in the ICU. However, ICU patients are at higher risk of developing a pressure injury (PI). Unfortunately, PI prevention is not optimally implemented in Indonesia, especially in the makeshift hospitals created during the COVID-19 pandemic. Here, the authors report two cases of critically ill patients with COVID-19 who developed large sacral PIs during hospitalization in a makeshift hospital in Indonesia. The first patient developed a stage 3, 7 × 7-cm sacral PI on the 14th day of hospitalization. The second patient developed a stage 4, 12 × 8-cm sacral PI on the 16th day of hospitalization. Both patients had elevated d-dimer levels and used a noninvasive ventilator for 1 week. The wounds were treated with surgical debridement, silver hydrogel dressing, and hydrocolloid dressing and complemented with static air mattress overlay. The authors recommend that in situations where there is a shortage of healthcare workers, the government should provide pressure-redistribution devices and silicone foam dressings for all critically ill patients to prevent PI development and lighten the workload of healthcare workers.
Collapse
|
7
|
Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis. Int J Nurs Stud 2022; 129:104222. [PMID: 35344836 DOI: 10.1016/j.ijnurstu.2022.104222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are a frequent complication in intensive care unit (ICU) patients, especially in those with comorbid conditions such as chronic obstructive pulmonary disease (COPD). Yet no epidemiological data on pressure injuries in critically ill COPD patients are available. OBJECTIVE To assess the prevalence of ICU-acquired pressure injuries in critically ill COPD patients and to investigate associations between COPD status, presence of ICU-acquired pressure injury, and mortality. STUDY DESIGN AND METHODS This is a secondary analysis of prospectively collected data from DecubICUs, a multinational one-day point-prevalence study of pressure injuries in adult ICU patients. We generated a propensity score summarizing risk for COPD and ICU-acquired pressure injury. The propensity score was used as matching criterion (1:1-ratio) to assess the proportion of ICU-acquired pressure injury attributable to COPD. The propensity score was then used in regression modeling assessing the association of COPD with risk of ICU-acquired pressure injury, and examining variables associated with mortality (Cox proportional-hazard regression). RESULTS Of the 13,254 patients recruited to DecubICUs, 1663 (12.5%) had documented COPD. ICU-acquired pressure injury prevalence was higher in COPD patients: 22.1% (95% confidence interval [CI] 20.2 to 24.2) vs. 15.3% (95% CI 14.7 to 16.0). COPD was independently associated with developing ICU-acquired pressure injury (odds ratio 1.40, 95% CI 1.23 to 1.61); the proportion attributable to COPD was 6.4% (95% CI 5.2 to 7.6). Compared with non-COPD patients without pressure injury, mortality was no different among patients without COPD but with pressure injury (hazard ratio [HR] 1.07, 95% CI 0.97 to 1.17) or COPD patients without pressure injury (HR 1.13, 95% CI 1.00 to 1.27). Mortality was higher among COPD patients with pressure injury (HR 1.35, 95% CI 1.15 to 1.58). CONCLUSION AND IMPLICATIONS Critically ill COPD patients have a statistically significant higher risk of pressure injury. Moreover, those that develop pressure injury are at higher risk of mortality. As such, pressure injury may serve as a surrogate for poor prognostic status to help clinicians identify patients at high risk of death. Also, delivery of interventions to prevent pressure injury are paramount in critically ill COPD patients. Further studies should determine if early intervention in critically ill COPD patients can modify development of pressure injury and improve prognosis.
Collapse
|
8
|
Yu M, Park KH, Shin J, Lee JH. Predicting the cut-off point for interface pressure in pressure injury according to the standard hospital mattress and polyurethane foam mattress as support surfaces. Int Wound J 2022; 19:1509-1517. [PMID: 35107216 PMCID: PMC9493213 DOI: 10.1111/iwj.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/19/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to investigate the interface pressure (IP) of patients using a standard hospital mattress and polyurethane foam mattress as support surfaces and present cut‐off points for IP in patients who exhibited skin changes. A total of 189 inpatients enrolled from six general wards and three intensive care units at a Korean University Hospital. Skin changes were classified, and peak IP at the sacral and occipital regions was measured using a pressure scanner. Differences in IPs according to mattress type were analysed using independent t‐tests. The receiver operating characteristic curve was constructed to determine the cut‐off point, and the area under the curve with a 95% confidence interval was obtained using the Stata 15.1.program. The IP for a standard hospital mattress was significantly higher than that of a polyurethane foam mattress. The cut‐off points for IP at the sacral region were 52.90 and 30.15 mm Hg for a standard hospital mattress and polyurethane foam mattress, respectively. The cut‐off point for IP at the occipital region was 36.40 mm Hg for a polyurethane foam mattress. Using IP measurements to prevent pressure injuries is important and employ individualised interventions based on the cut‐off points for different support surfaces.
Collapse
Affiliation(s)
- Mi Yu
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Kyung Hee Park
- Department of Nursing Science, The University of Suwon, Hwaseong-si, Republic of Korea
| | - Jiseon Shin
- Department of Nursing, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Hyun Lee
- Department of Nursing, Gyeongsang National University Hospital, Jinju, Republic of Korea
| |
Collapse
|
9
|
Wenzel F, Whitaker IY. Is there a relationship between nutritional goal achievement and pressure injury risk in intensive care unit patients receiving enteral nutrition? Intensive Crit Care Nurs 2021; 62:102926. [PMID: 32859481 DOI: 10.1016/j.iccn.2020.102926] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess pressure injury risk and time until pressure injury development according to the achievement of nutritional goals, i.e. caloric and protein intake within the first 72 hours of the intensive care admission. METHOD Prospective observational cohort study conducted in two units at a public university hospital. The development of pressure injury was considered the dependent variable. Survival curves were prepared with the Kaplan Meier method. Univariate and multivariate Cox regression analysis was used to identify factors associated with the development of pressure injury. RESULTS The study sample included 181 patients, of which 56.4% were male and the average age was 55 years. Neurological pathologies were the most frequent cause of hospitalisation (44.8%). The average length of stay was 17.5 days and mortality 30.4%. With regards to nutritional goals, 105 patients (58.0%) achieved their caloric goal, 130 (71.8%) achieved protein goals, and 98 (54.1%) achieved both. The frequency of pressure injury occurrence was 31.5%. Caloric intake (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.24-4.36) and protein intake (HR 3.21, 95% CI 1.76-5.86), were identified as independently associated with pressure injury development. Higher Braden scores were identified as a protective factor (HR 0.65, 95% CI 0.56-0.77). CONCLUSIONS These results indicate that the time to pressure injury development in the group of patients who did not achieve nutritional goals was shorter compared to those who achieved nutritional goals. Further studies should be conducted to confirm these data and to study the relationships in greater detail.
Collapse
|
10
|
Galetto SGDS, Nascimento ERPD, Hermida PMV, Lazzari DD, Reisdorfer N, Busanello J. Percepção de profissionais de enfermagem sobre lesões por pressão relacionadas a dispositivos médicos. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Conhecer a percepção de profissionais de enfermagem atuantes em unidade de terapia intensiva acerca das lesões por pressão relacionadas a dispositivos médicos. Método Pesquisa qualitativa, descritiva, realizada com 12 profissionais de enfermagem de um hospital público de ensino de Santa Catarina. A coleta de dados se deu por entrevista semiestruturada, e análise pela técnica do discurso do sujeito coletivo com o emprego do software QualiQuantiSoft®. Resultados Emergiram cinco Ideias Centrais: tipos de dispositivos e ocorrência das lesões por pressão relacionadas a dispositivos médicos; (in)visibilidade e (des)valorização destas lesões no cuidado ao paciente crítico; lesões por pressão relacionadas a dispositivos médicos podem ser inevitáveis; perfil do paciente crítico e risco para desenvolver a lesão; e (des)conhecimento profissional sobre o impacto da lesão na vida das pessoas após alta da terapia intensiva. Conclusão e implicações para a prática A percepção da enfermagem acerca das lesões por pressão relacionadas a dispositivos médicos está vinculada aos tipos de dispositivos, a ocorrência das lesões na terapia intensiva, ao cuidado ofertado e ao impacto das lesões na vida das pessoas.
Collapse
|
11
|
Kim CH, Kim MS, Kang MJ, Kim HH, Park NJ, Jung HK. Oral mucosa pressure ulcers in intensive care unit patients: A preliminary observational study of incidence and risk factors. J Tissue Viability 2018; 28:27-34. [PMID: 30551969 DOI: 10.1016/j.jtv.2018.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/03/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE This study examined the incidence of oral mucosa pressure ulcers (PUs) in intensive care unit (ICU) patients and the relationship between biomechanical and physiological variables in onset of PUs. METHODS A prospective observational descriptive study design was used. We recruited patients over 18 years of age with endotracheal tube (ETT) insertion in three ICUs in a tertiary hospital in Korea. We analysed 113 patient-days of data. Patient assessments and medical record reviews were conducted to gather biomechanical and physiological data. Fisher's exact tests and χ2 test and Spearman's rank correlations were used to compare data. RESULTS The highest incidence of oral mucosa PUs occurred in lower oral mucosa (36.3%). There was a significant relationship between lower oral mucosa PU stage and bite-block or airway use (r = .20, p = .036), commercial ETT holder use (r = 0.19, p = .048), sedative use (r = -0.22, p = .022), and plasma protein (r = 0.20, p = .033). Upper oral mucosa PU stage was related to commercial ETT holder use (r = 0.19, p = .044), haemoglobin(r = 0.24, p = .011), haematocrit (r = 0.27, p = .004), and serum albumin (r = -0.24, p = .012). Stage was related to commercial ETT holder use in both sites (r = 0.28, p = .003), haematocrit (r = 0.19, p = .039), and serum albumin (r = -0.23, p = .015). CONCLUSION Oral mucosa PUs developed more frequently and healed more quickly than general skin PUs. Taken together, these data indicate that biomechanical and haematological variables are risk factors associated with PU incidence should be considered in intensive care patients.
Collapse
Affiliation(s)
- Chul-Hoon Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, Dong-A University, Busan, South Korea
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Myung Ja Kang
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Hyun Hee Kim
- Respiratory Intensive Care Unit, Pusan National University Hospital, Busan, South Korea
| | - Nam Jung Park
- Infection Control Team, Pusan National University Hospital, Busan, South Korea
| | - Hyun Kyeong Jung
- Urology Ward, Pusan National University Hospital, Busan, South Korea
| |
Collapse
|
12
|
|
13
|
Llaurado-Serra M, Afonso E. Pressure injuries in intensive care: What is new? Intensive Crit Care Nurs 2018; 45:3-5. [PMID: 29306598 DOI: 10.1016/j.iccn.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- M Llaurado-Serra
- Nursing Department, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - E Afonso
- Neonatal Intensive Care Unit, Rosie Hospital, Cambridge University Hospitals, Cambridge, UK; Dept. of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Belgium
| |
Collapse
|