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Gilmore JP, Dainton M, McEvoy NL. Caring for Transgender patients in the ICU: Current insights for equitable care. Intensive Crit Care Nurs 2024; 82:103657. [PMID: 38422561 DOI: 10.1016/j.iccn.2024.103657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- John P Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | | | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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2
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McEvoy NL, Tume LN. Undertaking peer review for academic journals: The implications for critical care nursing. Nurs Crit Care 2024; 29:451-454. [PMID: 37846200 DOI: 10.1111/nicc.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Affiliation(s)
- N L McEvoy
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - L N Tume
- Edge Hill University, Ormskirk, UK
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O'Dowd AT, McEvoy NL, Read C, O'Keeffe D, Curley GF. Twelve tips for developing and implementing an effective critical care simulation programme. Med Teach 2024:1-6. [PMID: 38588719 DOI: 10.1080/0142159x.2024.2331055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
Simulation training in healthcare settings has become a valuable training tool. It provides an ideal formative assessment for interdisciplinary teaching. It provides a high fidelity and highly immersive environment where healthcare staff and students can practice developing their skills in a safe and controlled manner. Simulation training allows staff to practice skills that better prepare them for clinical emergencies, therefore possibly optimising clinical care. While the benefits of simulation education are well understood, establishing a programme for use by critical care staff is complex. Complexities include the highly specialised scenarios that are not typically encountered in non-critical care areas, as well as the need for advanced monitoring equipment, ventilation equipment etc. These 12 tips are intended to assist healthcare educators in navigating the complexities in the establishment of a critical care simulation programme, providing advice on selecting target audiences, learning outcomes, creating a critical care simulation environment and recommendations on evaluation and development of the programme.
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Affiliation(s)
- Aidan T O'Dowd
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Dara O'Keeffe
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
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McEvoy NL, Patton D, Curley GF, Moore Z. Pressure ulcer risk assessment in the ICU. Is it time for a more objective measure? Intensive Crit Care Nurs 2024; 83:103681. [PMID: 38518456 DOI: 10.1016/j.iccn.2024.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The Braden scale, one of the most widely used risk assessment tools is often criticized when used in the Intensive Care Unit. Most patients in the Intensive Care Unit are at risk of pressure ulcer development meaning that the Braden score will usually indicate high risk for these patients. This study set out to determine the correlation between Sub-Epidermal Moisture measurements and Braden scores among Intensive Care Unit patients. METHODS This study employed an observational research design. Braden score was assessed on all study days (1-5), in addition to visual skin assessment and Sub-Epidermal Moisture measurements at the sacrum and heels. Sub-Epidermal Moisture measurements were categorised as low (<0.5), borderline abnormal (≥0.5), and high (≥0.8). Correlation was assessed between Sub-Epidermal Moisture levels and Braden scores. RESULTS A total of 53 participants were recruited. The median (interquartile range) baseline Braden score was 9 (9-10) and 81 % (n = 43) of participants were at very high/high risk of pressure ulcer development. Braden scores remained relatively constant over time with little fluctuation in scores. 19 % (n = 10) of patients had normal (<0.5) Sub-Epidermal Moisture delta measurements on enrolment, and all developed abnormal measurements by day 2. There were no significant correlations between Braden scores and Sub-Epidermal Moisture measurements. CONCLUSION Although this was not its original intention, a missing link with the Braden scale is that it does not provide information on how patients are responding to the adverse effects of pressure and shear forces. Furthermore, in patients who are critically unwell, most patients are classified as being "at risk" of pressure ulcer development. Therefore, an objective measure of how patients are responding to pressure and shear forces at different anatomical areas is needed. IMPLICATIONS TO CLINICAL PRACTICE Sub-Epidermal Moisture measurements can offer more information, not only on identifying those who are at risk, but also how those patients are tolerating this risk at different anatomical sites.
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Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Declan Patton
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences
| | - Zena Moore
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium; Lida Institute, Shanghai, China; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
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Gilmore JP, Dainton M, McEvoy NL. Ethical considerations for the nursing care of Transgender patients in the Intensive Care Unit. Nurs Crit Care 2024. [PMID: 38380778 DOI: 10.1111/nicc.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
There is more discussion than ever surrounding the health and care needs of Transgender communities. However, there is limited research on the care of Transgender patients in the Intensive Care Unit which can contribute to knowledge gaps, inconsistencies and uncertainties surrounding health care practices. This article is not intended to address all of the specific needs of Transgender patients in ICU, but to explore the ethical considerations for caring for a Transgender woman in the ICU. In doing so, this article will explore some specific considerations around gender affirming care, challenging discrimination, physiological changes, and systems change to enhance care.
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Affiliation(s)
- John P Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marissa Dainton
- School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, UK
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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McEvoy NL, Curley MAQ. Do ICU dashboards influence quality of care? Nurs Crit Care 2023. [PMID: 38063408 DOI: 10.1111/nicc.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical care, Education and Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Martha A Q Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
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McEvoy NL, Friel O, Clarke J, Browne E, Geoghegan P, Budri A, Avsar P, Connolly S, Patton D, Curley GF, Moore Z. Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study. Nurs Crit Care 2023; 28:1115-1123. [PMID: 36221908 PMCID: PMC9875092 DOI: 10.1111/nicc.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). AIM This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. STUDY DESIGN This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. RESULTS In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). CONCLUSION The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. RELEVANCE TO CLINICAL PRACTICE The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.
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Affiliation(s)
- Natalie L. McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Oisin Friel
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Emmet Browne
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | | | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
| | - Gerard F. Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Beaumont HospitalDublinIreland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Health Sciences, Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Lida InstituteShanghaiChina
- Cardiff UniversityCardiffWalesUK
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McEvoy NL, Latour JM. From impact factors to Altmetrics: What numbers are important in publishing your paper? Nurs Crit Care 2023; 28 Suppl 1:4-6. [PMID: 37259632 DOI: 10.1111/nicc.12925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
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Shanahan R, Avsar P, Watson C, Moore Z, Patton D, McEvoy NL, Curley G, O'Connor T. The impact of brain tissue oxygenation monitoring on the Glasgow Outcome Scale/Glasgow Outcome Scale Extended in patients with moderate to severe traumatic brain injury: A systematic review. Nurs Crit Care 2023. [PMID: 37735107 DOI: 10.1111/nicc.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Traumatic brain injuries (TBIs) are one of the leading causes of death or long-term disability around the world. As a result of improvements in supportive care, patients are surviving more severe insults with more pronounced dependency on their families, hospitals, and long-term care facilities. The introduction of brain tissue oxygenation (PbtO2) monitoring aims to recognize episodes of reduced cerebral perfusion with and without associated increased intracranial pressure (ICP). AIM The aim of this review is to determine the impact of PbtO2 on the Glasgow Outcome Scale/Glasgow Outcome Scale Extended (GOS/GOSE) in patients with moderate to severe TBI. DESIGN Systematic review with narrative and meta-analysis. All original research in which adult patients undergoing PbtO2 were compared with a control group of traditional ICP/cerebral perfusion pressure (CPP) monitoring. Both randomized controlled trials and observational studies were included in this review. METHODS Databases were searched in September 2022. The primary outcome of the review was the impact of PbtO2 monitoring on GOS/GOSE, while secondary outcomes were mortality and length of stay (LOS) in the intensive care unit (ICU). RESULTS Seven studies with a combined number of 770 patients were included in the review. These patients were adults ≥16 years of age. Only two of the studies included found a statistically significant association between PbtO2 monitoring and improved long-term neurological outcomes in patients with TBI (p = .01, p < .01). A meta-analysis of the secondary outcomes identified an associated reduction of mortality in favour of the group treated with PbtO2 monitoring (p < .0001). Results from studies examining LOS in ICU have demonstrated an associated increase of LOS in ICU in patients treated with PbtO2-guided therapy. CONCLUSION From the studies included in this review, only two found a statistically significant association between PbtO2 monitoring and long-term outcomes. It is unclear whether PbtO2 goal-directed therapy has a positive impact on the long-term neurological functions and mortality of patients suffering from TBI. A multicentre randomized controlled trial may provide further evidence, but not necessarily conclusive. RELEVANCE TO CLINICAL PRACTICE Further research is warranted to determine the efficacy of the introduction of this new monitoring system to guide local policy change.
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Affiliation(s)
- Ruth Shanahan
- Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chanel Watson
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing & Midwifery, Griffith University, Mount Gravatt, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, UK
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Lida Institute, Shanghai, China
- Cardiff University, Cardiff, UK
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing & Midwifery, Griffith University, Mount Gravatt, Queensland, Australia
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Ger Curley
- Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing & Midwifery, Griffith University, Mount Gravatt, Queensland, Australia
- Lida Institute, Shanghai, China
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
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Chan MS, Avsar P, McEvoy NL, Patton D, O'Connor T, Nugent L, Moore Z. The role of proinflammatory cytokines in the detection of early pressure ulcer development: a systematic review. J Wound Care 2023; 32:83-91. [PMID: 36735521 DOI: 10.12968/jowc.2023.32.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pressure ulcers (PUs) commonly occur over bony prominences and are notoriously difficult to treat. Proinflammatory cytokines are substances that initiate the inflammatory process preceding PU development. The aim of this review was to assess whether the increased presence of proinflammatory cytokines could potentially be used as an early detection system for PU development. METHOD A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in August 2020. Data were extracted and a narrative synthesis was undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. The systematic review included original research studies, prospective design, and human studies written in English. Retrospective studies, animal studies, conference papers, opinion papers and qualitative methodology were excluded. No restrictions on the date of publication and study setting were applied. RESULTS The six studies included were conducted between 2015 and 2019, 50% (n=3) used an experimental study design. The mean sample size was 15 participants (standard deviation=1.72). A total of seven proinflammatory cytokines were analysed. Statistically significant differences were found among inflammatory mediators. Overall results showed that the concentration of interleukin (IL)-1α significantly increased in each study. The EBL score varied between 77-88%. In total, 100% (n=6) of the studies scored ≥75%, reflecting validity. CONCLUSION It is not yet certain that monitoring proinflammatory cytokines represents a noninvasive method that could potentially direct preventative measures to those who are identified as at high risk for developing PUs. IL-1α potentially may be elevated for other health conditions, not just PUs. Future studies are therefore recommended.
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Affiliation(s)
- Mai Shanley Chan
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Linda Nugent
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Lida Institute, Shanghai, China.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,University of Wales, Cardiff, UK.,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Australia
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11
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McEvoy NL. Visual abstracts: The way forward. Nurs Crit Care 2022; 28:9-11. [PMID: 36541012 DOI: 10.1111/nicc.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Natalie L McEvoy
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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12
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McEvoy NL, Tume LN. Creating a conference poster: Out with the old and in with the new, moving from the traditional to the improved modern poster format. Nurs Crit Care 2022; 27:619-622. [PMID: 36017789 DOI: 10.1111/nicc.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Lyvonne N Tume
- School of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK.,Paediatric Intensive care Unit, Alder Hey Children's NHS FT, Liverpool, UK
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13
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Affiliation(s)
- Aglecia Moda Vitoriano Budri
- Lecturer/Programme Director, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Lead Researcher, Skin, Wounds and Trauma (SWaT) Centre, Dublin, Ireland
| | - Natalie L McEvoy
- StAR Lecturer, Department of Critical Care and Anaesthesia, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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14
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Moore Z, McEvoy NL, Avsar P, Byrne S, Vitoriano Budri AM, Nugent L, O'Connor T, Curley G, Patton D. Measuring subepidermal moisture to detect early pressure ulcer development: a systematic review. J Wound Care 2022; 31:634-647. [PMID: 36001704 DOI: 10.12968/jowc.2022.31.8.634] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim was to assess evidence related to the measuring of subepidermal moisture (SEM) to detect early, nonvisible development of pressure ulcers (PUs). METHOD Using systematic review methodology, all quantitative animal and human research studies written in English were considered. In January 2021, PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases were searched. The primary outcome of interest was the validity of SEM measurement to detect early PU development. The secondary outcome was time to PU detection, sensitivity and specificity of SEM measurement, and the impact of SEM measurements on PU prevention. Data analysis was undertaken using RevMan and narrative synthesis. RESULTS A total of 17 articles met the inclusion criteria. In all studies, a consistent abnormal deviation in SEM measurements corresponded with evidence of visual PU development. Time to PU development, explored in four studies, showed earlier detection of PU development using SEM measurement. RevMan analysis identified the mean difference in time to PU development (SEM measurement versus visual skin assessment, VSA) was 4.61 days (95% confidence interval: 3.94-5.28; p=0.0001) in favour of SEM measurements. The sensitivity of SEM measurements was reported in four studies, and scores varied from 48.3% to 100.0%. Specificity was also reported in four studies and scores ranged from 24.4% to 83.0%. The impact of the detection of abnormal SEM measurements on PU prevention was explored by one study. Results showed a 93% decrease in PU rates when staff acted on the results of the SEM readings. CONCLUSION The findings of this review identified that SEM measurement detects PU development earlier than VSA. Furthermore, when staff responded to abnormal SEM measurements, prevention strategies were enhanced, with a subsequent reduction in visible PU development. SEM measurement may therefore be a useful addition to PU prevention strategies. DECLARATION OF INTEREST The School of Nursing & Midwifery, RCSI has a research agreement with Bruin Biometrics. Funding for the study was through an Irish Research Council PhD Enterprise Partnership Scheme with Bruin Biometrics. The authors have no other conflicts of interest.
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Affiliation(s)
- Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Visiting Professor, School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland.,Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Honorary Professor, Lida Institute, Shanghai, China.,Cardiff University, Wales.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Natalie L McEvoy
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Sorcha Byrne
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin
| | - Aglecia Moda Vitoriano Budri
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Linda Nugent
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Honorary Professor, Lida Institute, Shanghai, China.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Gerard Curley
- Department of Anaesthesia and Critical Care, RCSI University of Medicine and Health Sciences, Dublin
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin.,Adjunct Professor, School of Nursing & Midwifery, Griffith University, Queensland, Australia.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
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15
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McEvoy NL, Trapani J, Tume LN. The changing face of scientific conferences: Face to face, online or a hybrid model? Nurs Crit Care 2022. [PMID: 35906718 DOI: 10.1111/nicc.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Josef Trapani
- Department of Nursing, University of Malta, Msida, Malta
| | - Lyvonne N Tume
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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16
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Tume LN, McEvoy NL, Vollam S. Randomized controlled trials in critical care nursing: Essential to move practice forward. Nurs Crit Care 2022; 27:477-479. [PMID: 35546080 DOI: 10.1111/nicc.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lyvonne N Tume
- School of Health and Society, University of Salford, Manchester, UK.,Paediatric Intensive Care Unit, Alder Hey Children's NHS FT, Liverpool, UK
| | | | - Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK
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17
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McEvoy NL, Tume LN, Trapani J. What are publication reporting checklists and why are they so important? Nurs Crit Care 2022; 27:291-293. [PMID: 35526087 DOI: 10.1111/nicc.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical Care, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lyvonne N Tume
- School of Health and Society, University of Salford, Manchester, UK
| | - Josef Trapani
- Department of Nursing, University of Malta, Msida, Malta
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18
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McElvaney OJ, McEvoy NL, Boland F, McElvaney OF, Hogan G, Donnelly K, Friel O, Browne E, Fraughen DD, Murphy MP, Clarke J, Choileáin ON, O'Connor E, McGuinness R, Boylan M, Kelly A, Hayden JC, Collins AM, Cullen A, Hyland D, Carroll TP, Geoghegan P, Laffey JG, Hennessy M, Martin-Loeches I, McElvaney NG, Curley GF. A randomized, double-blind, placebo-controlled trial of intravenous alpha-1 antitrypsin for acute respiratory distress syndrome secondary to COVID-19. Med 2022; 3:233-248.e6. [PMID: 35291694 PMCID: PMC8913266 DOI: 10.1016/j.medj.2022.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022]
Abstract
Background Patients with severe coronavirus disease 2019 (COVID-19) develop a febrile pro-inflammatory cytokinemia with accelerated progression to acute respiratory distress syndrome (ARDS). Here we report the results of a phase 2, multicenter, randomized, double-blind, placebo-controlled trial of intravenous (IV) plasma-purified alpha-1 antitrypsin (AAT) for moderate to severe ARDS secondary to COVID-19 (EudraCT 2020-001391-15). Methods Patients (n = 36) were randomized to receive weekly placebo, weekly AAT (Prolastin, Grifols, S.A.; 120 mg/kg), or AAT once followed by weekly placebo. The primary endpoint was the change in plasma interleukin (IL)-6 concentration at 1 week. In addition to assessing safety and tolerability, changes in plasma levels of IL-1β, IL-8, IL-10, and soluble tumor necrosis factor receptor 1 (sTNFR1) and clinical outcomes were assessed as secondary endpoints. Findings Treatment with IV AAT resulted in decreased inflammation and was safe and well tolerated. The study met its primary endpoint, with decreased circulating IL-6 concentrations at 1 week in the treatment group. This was in contrast to the placebo group, where IL-6 was increased. Similarly, plasma sTNFR1 was substantially decreased in the treatment group while remaining unchanged in patients receiving placebo. IV AAT did not definitively reduce levels of IL-1β, IL-8, and IL-10. No difference in mortality or ventilator-free days was observed between groups, although a trend toward decreased time on ventilator was observed in AAT-treated patients. Conclusions In patients with COVID-19 and moderate to severe ARDS, treatment with IV AAT was safe, feasible, and biochemically efficacious. The data support progression to a phase 3 trial and prompt further investigation of AAT as an anti-inflammatory therapeutic. Funding ECSA-2020-009; Elaine Galwey Research Bursary.
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Affiliation(s)
- Oliver J McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, Division of Biostatistics and Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oisín F McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Grace Hogan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Daniel D Fraughen
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Mark P Murphy
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer Clarke
- Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | - John C Hayden
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ann M Collins
- RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Ailbhe Cullen
- RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Hyland
- RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Tomás P Carroll
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - John G Laffey
- Department of Anaesthesia, Galway University Hospitals, SAOLTA University Health Group, Galway, Ireland
| | - Martina Hennessy
- Department of Critical Care Medicine, St. James' Hospital, Dublin, Ireland
| | | | - Noel G McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - Gerard F Curley
- Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Dublin, Ireland
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19
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McElvaney OF, Asakura T, Meinig SL, Torres-Castillo JL, Hagan RS, Gabillard-Lefort C, Murphy MP, Thorne LB, Borczuk A, Reeves EP, Zumwalt RE, Mikami Y, Carroll TP, Okuda K, Hogan G, McElvaney OJ, Clarke J, McEvoy NL, Mallon PW, McCarthy C, Curley G, Wolfgang MC, Boucher RC, McElvaney NG. Protease-anti-protease compartmentalization in SARS-CoV-2 ARDS: Therapeutic implications. EBioMedicine 2022; 77:103894. [PMID: 35217407 PMCID: PMC8861575 DOI: 10.1016/j.ebiom.2022.103894] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background Interleukin-6 (IL-6) is elevated in SARS-CoV-2 infection. IL-6 regulates acute-phase proteins, such as alpha-1 antitrypsin (AAT), a key lung anti-protease. We investigated the protease-anti-protease balance in the circulation and pulmonary compartments in SARS-CoV-2 acute respiratory distress syndrome (ARDS) compared to non-SARS-CoV-2 ARDS (nsARDS) and the effects of tocilizumab (IL-6 receptor antagonist) on anti-protease defence in SARS-CoV-2 infection. Methods Levels and activity of AAT and neutrophil elastase (NE) were measured in plasma, airway tissue and tracheal secretions (TA) of people with SARS-CoV-2 ARDS or nsARDS. AAT and IL-6 levels were evaluated in people with moderate SARS-CoV-2 infection who received standard of care +/- tocilizumab. Findings AAT plasma levels doubled in SARS-CoV-2 ARDS. In lung parenchyma AAT levels were increased, as was the percentage of neutrophils involved in NET formation. A protease-anti-protease imbalance was detected in TA with active NE and no active AAT. The airway anti-protease, secretory leukoprotease inhibitor was decreased in SARS-CoV-2-infected lungs and cleaved in TA. In nsARDS, plasma AAT levels were elevated but TA samples had less AAT cleavage, with no detectable active NE in most samples Induction of AAT in ARDS occurred mainly through IL-6. Tocilizumab down-regulated AAT during SARS-CoV-2 infection. Interpretation There is a protease-anti-protease imbalance in the airways of SARS-CoV-2-ARDS patients. This imbalance is a target for anti-protease therapy.
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Affiliation(s)
- Oisin F McElvaney
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Takanori Asakura
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne L Meinig
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jose L Torres-Castillo
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Robert S Hagan
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Claudie Gabillard-Lefort
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark P Murphy
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Leigh B Thorne
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alain Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Emer P Reeves
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ross E Zumwalt
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Yu Mikami
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tomas P Carroll
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; Alpha-1 Foundation, Ireland
| | - Kenichi Okuda
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grace Hogan
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver J McElvaney
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick W Mallon
- Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland; Centre for Experimental Pathogen Host Research (CEPHR), University College Dublin, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Ger Curley
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Matthew C Wolfgang
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Richard C Boucher
- Marsico Lung Institute/Cystic Fibrosis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noel G McElvaney
- Irish Centre for Genetic Lung Disease, RCSI Education and Research Centre, Beaumont Hospital, Dublin 9, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Moore Z, Moore D, McEvoy NL, Avsar P, O'Connor T, Budri A, Curley G, Walsh S, Burke F, Porter‐Armstrong A, Chaboyer W, Rice J, Patton D. Preventing facial pressure injuries among health care staff working in diverse COVID-19 care environments. Int Wound J 2022; 19:1677-1685. [PMID: 35146927 PMCID: PMC9111615 DOI: 10.1111/iwj.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries among frontline health care workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. This was a mixed methods study. First, a pre-posttest observational design was employed to evaluate the impact of the pre-piloted intervention, a care bundle including skin cleansing and hydration, protective material use, facemask selection and skin inspection, developed in line with international best practice guidelines. Data were collected using survey methodology. Frontline COVID-19 staff working in acute, community and ambulance services were invited to participate. Then, judgemental and volunteer sampling was used to select participants to undertake semi-structured interviews to elicit feedback on their perceptions of the care bundle. The sample included 120 acute hospital staff, 60 Ambulance staff, 24 Community Hub staff and 20 COVID-19 testing centre staff. A survey response rate of 61% was realised (n = 135/224). Of the participants, 32% (n = 43) had a facial pressure ulcer (FPI) pre-intervention and 13% (n = 18) developed an FPI while using the care bundle. The odds ratio (OR) was 0.33 (95% CI: 0.18 to 0.61; P = .0004), indicating a 77% reduction in the odds of FPI development with use of the care bundle. Analysis of the qualitative data from 22 interviews identified three key themes, the context for the care bundle, the ease of use of the care bundle and the care bundle as a solution to FPI development. The care bundle reduced the incidence of FPI among the participants and was found to be easy to use. Implementation of skin protection for frontline staff continues to be important given the persistently high incidence of COVID-19 and the ongoing need to wear PPE for protracted durations.
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Affiliation(s)
- Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMonashAustralia,Department of Public HealthFaculty of Medicine and Health Sciences, Ghent UniversityGhentBelgium,Lida InstituteShanghaiChina,University of WalesCardiffUK,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandQueenslandAustralia
| | | | - Natalie L. McEvoy
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Beaumont HospitalDublinIreland
| | - Pinar Avsar
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Lida InstituteShanghaiChina
| | - Aglecia Budri
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Gerard Curley
- Beaumont HospitalDublinIreland,RCSI University of Medicine and Health SciencesDublinIreland
| | - Simone Walsh
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Frank Burke
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | | | - Wendy Chaboyer
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandQueenslandAustralia
| | | | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Faculty of Science, Medicine and HealthUniversity of WollongongAustralia
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21
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McEvoy NL. How to compose a good research tweet: Five steps to ensure your tweet reaches a wider audience. Nurs Crit Care 2021; 26 Suppl 1:6-7. [PMID: 34651387 DOI: 10.1111/nicc.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie L McEvoy
- Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
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22
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McEvoy NL, Clarke JL, Mc Elvaney OJ, Mc Elvaney OF, Boland F, Hyland D, Geoghegan P, Donnelly K, Friel O, Cullen A, Collins AM, Fraughen D, Martin-Loeches I, Hennessy M, Laffey JG, Mc Elvaney NG, Curley GF. A randomised, double-blind, placebo-controlled, pilot trial of intravenous plasma purified alpha-1 antitrypsin for SARS-CoV-2-induced Acute Respiratory Distress Syndrome: a structured summary of a study protocol for a randomised, controlled trial. Trials 2021; 22:288. [PMID: 33874981 PMCID: PMC8054126 DOI: 10.1186/s13063-021-05254-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The primary objective is to demonstrate that, in patients with PCR-confirmed SARS-CoV-2 resulting in Acute Respiratory Distress Syndrome (ARDS), administration of 120mg/kg of body weight of intravenous Prolastin®(plasma-purified alpha-1 antitrypsin) reduces circulating plasma levels of interleukin-6 (IL-6). Secondary objectives are to determine the effects of intravenous Prolastin® on important clinical outcomes including the incidence of adverse events (AEs) and serious adverse events (SAEs). TRIAL DESIGN Phase 2, randomised, double-blind, placebo-controlled, pilot trial. PARTICIPANTS The study will be conducted in Intensive Care Units in hospitals across Ireland. Patients with a laboratory-confirmed diagnosis of SARS-CoV-2-infection, moderate to severe ARDS (meeting Berlin criteria for a diagnosis of ARDS with a PaO2/FiO2 ratio <200 mmHg), >18 years of age and requiring invasive or non-invasive mechanical ventilation. All individuals meeting any of the following exclusion criteria at baseline or during screening will be excluded from study participation: more than 96 hours has elapsed from onset of ARDS; age < 18 years; known to be pregnant or breastfeeding; participation in a clinical trial of an investigational medicinal product (other than antibiotics or antivirals) within 30 days; major trauma in the prior 5 days; presence of any active malignancy (other than nonmelanoma skin cancer) which required treatment within the last year; WHO Class III or IV pulmonary hypertension; pulmonary embolism prior to hospital admission within past 3 months; currently receiving extracorporeal life support (ECLS); chronic kidney disease receiving dialysis; severe chronic liver disease with Child-Pugh score > 12; DNAR (Do Not Attempt Resuscitation) order in place; treatment withdrawal imminent within 24 hours; Prisoners; non-English speaking patients or those who do not adequately understand verbal or written information unless an interpreter is available; IgA deficiency. INTERVENTION AND COMPARATOR Intervention: Either a once weekly intravenous infusion of Prolastin® at 120mg/kg of body weight for 4 weeks or a single dose of Prolastin® at 120mg/kg of body weight intravenously followed by once weekly intravenous infusion of an equal volume of 0.9% sodium chloride for a further 3 weeks. Comparator (placebo): An equal volume of 0.9% sodium chloride intravenously once per week for four weeks. MAIN OUTCOMES The primary effectiveness outcome measure is the change in plasma concentration of IL-6 at 7 days as measured by ELISA. Secondary outcomes include: safety and tolerability of Prolastin® in the respective groups (as defined by the number of SAEs and AEs); PaO2/FiO2 ratio; respiratory compliance; sequential organ failure assessment (SOFA) score; mortality; time on ventilator in days; plasma concentration of alpha-1 antitrypsin (AAT) as measured by nephelometry; plasma concentrations of interleukin-1β (IL-1β), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TNF receptor 1 (sTNFR1, a surrogate marker for TNF-α) as measured by ELISA; development of shock; acute kidney injury; need for renal replacement therapy; clinical relapse, as defined by the need for readmission to the ICU or a marked decline in PaO2/FiO2 or development of shock or mortality following a period of sustained clinical improvement; secondary bacterial pneumonia as defined by the combination of radiographic findings and sputum/airway secretion microscopy and culture. RANDOMISATION Following informed consent/assent patients will be randomised. The randomisation lists will be prepared by the study statistician and given to the unblinded trial personnel. However, the statistician will not be exposed to how the planned treatment will be allocated to the treatment codes. Randomisation will be conducted in a 1:1:1 ratio, stratified by site and age. BLINDING (MASKING) The investigator, treating physician, other members of the site research team and patients will be blinded to treatment allocation. The clinical trial pharmacy personnel and research nurses will be unblinded to facilitate intervention and placebo preparation. The unblinded individuals will keep the treatment information confidential. The infusion bag will be masked at the time of preparation and will be administered via a masked infusion set to maintain blinding. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) A total of 36 patients will be recruited and randomised in a 1:1:1 ratio to each of the trial arms. TRIAL STATUS In March 2020, version 1.0 of the trial protocol was submitted to the local research ethics committee (REC), Health Research Consent Declaration Committee (HRCDC) and the Health Products regulatory Authority (HPRA). REC approval was granted on April 1st 2020, HPRA approval was granted on April 24th 2020 and the HRCDC provided a conditional declaration on April 17th 2020. In July 2020 a substantial amendment (version 2.0) was submitted to the REC, HRCDC and HPRA. Protocol changes in this amendment included: the addition of trial sites; extending the duration of the trial to 12 months from 3 months; removal of inclusion criteria requiring the need for vasopressors; amendment of randomisation schedule to stratify by age only and not BMI and sex; correction of grammatical error in relation to infusion duration; to allow for inclusion of subjects who may have been enrolled in a clinical trial involving either antibiotics or anti-virals in the past 30 days; to allow for inclusion of subjects who may be currently enrolled in a clinical trial involving either antibiotics or anti-virals; to remove the need for exclusion based on alpha-1 antitrypsin phenotype; removal of mandatory isoelectric focusing of plasma to confirm Pi*MM status at screening; removal of need for mandatory echocardiogram at screening; amendment on procedures around plasma analysis to reflect that this will be conducted at the central site laboratory (as trial is multi-site and no longer single site); wording amended to reflect that interim analysis of cytokine levels taken at 7 days may be conducted. HRCDC approved version 2.0 on September 14th 2020, and HPRA approved on October 22nd 2020. REC approved the substantial amendment on November 23rd. In November 2020, version 3.0 of the trial protocol was submitted to the REC and HPRA. The rationale for this amendment was to allow for patients with moderate to severe ARDS from SARS-CoV-2 with non-invasive ventilation. HPRA approved this amendment on December 1st 2020 and the REC approved the amendment on December 8th 2020. Patient recruitment commenced in April 2020 and the last patient will be recruited to the trial in April 2021. The last visit of the last patient is anticipated to occur in April 2021. At time of writing, patient recruitment is now complete, however follow-up patient visits and data collection are ongoing. TRIAL REGISTRATION EudraCT 2020-001391-15 (Registered 31 Mar 2020). FULL PROTOCOL The full protocol (version 3.0 23.11.2020) is attached as an additional file accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
| | | | | | | | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Oisin Friel
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ailbhe Cullen
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ann M Collins
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Moore Z, McEvoy NL, Avsar P, McEvoy L, Curley G, O'Connor T, Budri A, Nugent L, Walsh S, Bourke F, Patton D. Facial pressure injuries and the COVID-19 pandemic: skin protection care to enhance staff safety in an acute hospital setting. J Wound Care 2021; 30:162-170. [PMID: 33729846 DOI: 10.12968/jowc.2021.30.3.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries (PI) among frontline healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. The primary outcome of interest was the incidence of facial PIs. The secondary outcomes of interest were facial pain while wearing PPE and ease of use of the care bundle. METHODS This study used a voluntary survey by questionnaire, supplemented by a qualitative analysis of interviews from a small purposive sample that took place in one large Irish hospital over a two-month period in 2020. The hospital was a city-based public university teaching hospital with 800 inpatient beds. The intervention was a care bundle consisting of skin protection, face mask selection, material use, skin inspection, cleansing and hydration developed in line with international best practice guidelines. All staff working in COVID-19 wards, intensive care units and the emergency department in the hospital were given a kitbag containing the elements of the care bundle plus an information pamphlet. Data were collected via a survey and interviews. RESULTS A total of 114 staff provided feedback on the use of the care bundle. Before using the care bundle 29% (n=33) of the respondents reported developing a facial PI, whereas after using the care bundle only 8% (n=9) of the respondents reported developing a facial PI. The odds ratio (OR) of skin injury development was 4.75 (95% confidence interval (CI): 2.15-10.49; p=0.0001), suggesting that after the care bundle was issued, those who responded to the survey were almost five times less likely to develop a skin injury. Interviews with 14 staff determined that the bundle was easy to use and safe. CONCLUSION Among those who responded to the survey, the use of the bundle was associated with a reduction in the incidence of skin injury from 29% to 8%, and respondents found the bundle easy to use, safe and effective. As with evidence from the international literature, this study has identified that when skincare is prioritised, and a systematic preventative care bundle approach is adopted, there are clear benefits for the individuals involved.
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Affiliation(s)
- Zena Moore
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Lida Institute, Shanghai, China
| | - Natalie L McEvoy
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
- Beaumont Hospital, Dublin
| | - Pinar Avsar
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | | | - Gerard Curley
- Beaumont Hospital, Dublin
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin
| | - Tom O'Connor
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Lida Institute, Shanghai, China
| | - Aglecia Budri
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Linda Nugent
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Simone Walsh
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Frank Bourke
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
| | - Declan Patton
- School of Nursing and Midwifery and Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
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24
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McElvaney OJ, McEvoy NL, McElvaney NG, Curley GF. Reply to Blot et al. and to Inoue et al.. Am J Respir Crit Care Med 2021; 203:141-142. [PMID: 32955924 PMCID: PMC7781117 DOI: 10.1164/rccm.202008-3169le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Oliver J McElvaney
- Royal College of Surgeons in Ireland Dublin, Ireland and.,Beaumont Hospital Dublin, Ireland
| | | | - Noel G McElvaney
- Royal College of Surgeons in Ireland Dublin, Ireland and.,Beaumont Hospital Dublin, Ireland
| | - Gerard F Curley
- Royal College of Surgeons in Ireland Dublin, Ireland and.,Beaumont Hospital Dublin, Ireland
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25
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McElvaney OJ, O'Connor E, McEvoy NL, Fraughan DD, Clarke J, McElvaney OF, Gunaratnam C, O'Rourke J, Curley GF, McElvaney NG. Alpha-1 antitrypsin for cystic fibrosis complicated by severe cytokinemic COVID-19. J Cyst Fibros 2021; 20:31-35. [PMID: 33288475 PMCID: PMC7678455 DOI: 10.1016/j.jcf.2020.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The clinical course of severe COVID-19 in cystic fibrosis (CF) is incompletely understood. We describe the use of alpha-1 antitrypsin (AAT) as a salvage therapy in a critically unwell patient with CF (PWCF) who developed COVID-19 while awaiting lung transplantation. METHODS IV AAT was administered at 120 mg/kg/week for 4 consecutive weeks. Levels of interleukin (IL)-1β, IL-6, IL-8, and soluble TNF receptor 1 (sTNFR1) were assessed at regular intervals in plasma, with IL-1β, IL-6, IL-8 and neutrophil elastase (NE) activity measured in airway secretions. Levels were compared to baseline and historic severe exacerbation measurements. RESULTS Systemic and airway inflammatory markers were increased compared to both prior exacerbation and baseline levels, in particular IL-6, IL-1β and NE activity. Following each AAT dose, rapid decreases in each inflammatory parameter were observed. These were matched by marked clinical and radiographic improvement. CONCLUSIONS The results support further investigation of AAT as a COVID-19 therapeutic, and re-exploration of its use in CF.
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Affiliation(s)
- Oliver J McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland,Beaumont Hospital, Dublin, Ireland
| | | | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Jennifer Clarke
- Beaumont Hospital, Dublin, Ireland,Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oisín F McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Gerard F Curley
- Beaumont Hospital, Dublin, Ireland,Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland,Beaumont Hospital, Dublin, Ireland,Corresponding author at: Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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26
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Ward SE, Curley GF, Lavin M, Fogarty H, Karampini E, McEvoy NL, Clarke J, Boylan M, Alalqam R, Worrall AP, Kelly C, de Barra E, Glavey S, Ni Cheallaigh C, Bergin C, Martin-Loeches I, Townsend L, Mallon PW, O'Sullivan JM, O'Donnell JS. Von Willebrand factor propeptide in severe coronavirus disease 2019 (COVID-19): evidence of acute and sustained endothelial cell activation. Br J Haematol 2020; 192:714-719. [PMID: 33326604 DOI: 10.1111/bjh.17273] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022]
Abstract
Endothelial cell (EC) activation plays a key role in the pathogenesis of pulmonary microvascular occlusion, which is a hallmark of severe coronavirus disease 2019 (COVID-19). Consistent with EC activation, increased plasma von Willebrand factor antigen (VWF:Ag) levels have been reported in COVID-19. Importantly however, studies in other microangiopathies have shown that plasma VWF propeptide (VWFpp) is a more sensitive and specific measure of acute EC activation. In the present study, we further investigated the nature of EC activation in severe COVID-19. Markedly increased plasma VWF:Ag [median (interquatile range, IQR) 608·8 (531-830)iu/dl] and pro-coagulant factor VIII (FVIII) levels [median (IQR) 261·9 (170-315) iu/dl] were seen in patients with severe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Sequential testing showed that these elevated VWF-FVIII complex levels remained high for up to 3 weeks. Similarly, plasma VWFpp levels were also markedly elevated [median (IQR) 324·6 (267-524) iu/dl]. Interestingly however, the VWFpp/VWF:Ag ratio was reduced, demonstrating that decreased VWF clearance contributes to the elevated plasma VWF:Ag levels in severe COVID-19. Importantly, plasma VWFpp levels also correlated with clinical severity indices including the Sequential Organ Failure Assessment (SOFA) score, Sepsis-Induced Coagulopathy (SIC) score and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio). Collectively, these findings support the hypothesis that sustained fulminant EC activation is occurring in severe COVID-19, and further suggest that VWFpp may have a role as a biomarker in this setting.
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Affiliation(s)
- Soracha E Ward
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Michelle Lavin
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Helen Fogarty
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Ellie Karampini
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Maria Boylan
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Razi Alalqam
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Amy P Worrall
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Claire Kelly
- Department of Haematology, Beaumont Hospital, Dublin, Ireland
| | - Eoghan de Barra
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.,Department of Tropical Medicine and International Health, RCSI, Dublin, Ireland
| | - Siobhan Glavey
- Department of Haematology, Beaumont Hospital, Dublin, Ireland
| | | | - Colm Bergin
- St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Ignacio Martin-Loeches
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Liam Townsend
- St James's Hospital, Trinity College Dublin, Dublin, Ireland
| | - Patrick W Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland.,St Vincent's University Hospital, Dublin, Ireland
| | - Jamie M O'Sullivan
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - James S O'Donnell
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,National Coagulation Centre, St James's Hospital, Dublin, Ireland.,National Children's Research Centre, Our Lady's Children's Hospital Crumlin, Dublin, Ireland
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27
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McElvaney OJ, Hobbs BD, Qiao D, McElvaney OF, Moll M, McEvoy NL, Clarke J, O'Connor E, Walsh S, Cho MH, Curley GF, McElvaney NG. Corrigendum to 'A linear prognostic score based on the ratio of interleukin-6 to interleukin-10 predicts outcomes in COVID-19'. EBioMedicine 2020; 62:103116. [PMID: 33181463 PMCID: PMC7654328 DOI: 10.1016/j.ebiom.2020.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Oliver J McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland.
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Dandi Qiao
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Oisín F McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland
| | - Matthew Moll
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer Clarke
- Beaumont Hospital, Dublin, Ireland; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Gerard F Curley
- Beaumont Hospital, Dublin, Ireland; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland.
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28
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McElvaney OJ, Hobbs BD, Qiao D, McElvaney OF, Moll M, McEvoy NL, Clarke J, O'Connor E, Walsh S, Cho MH, Curley GF, McElvaney NG. A linear prognostic score based on the ratio of interleukin-6 to interleukin-10 predicts outcomes in COVID-19. EBioMedicine 2020; 61:103026. [PMID: 33039714 PMCID: PMC7543971 DOI: 10.1016/j.ebiom.2020.103026] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prognostic tools are required to guide clinical decision-making in COVID-19. METHODS We studied the relationship between the ratio of interleukin (IL)-6 to IL-10 and clinical outcome in 80 patients hospitalized for COVID-19, and created a simple 5-point linear score predictor of clinical outcome, the Dublin-Boston score. Clinical outcome was analysed as a three-level ordinal variable ("Improved", "Unchanged", or "Declined"). For both IL-6:IL-10 ratio and IL-6 alone, we associated clinical outcome with a) baseline biomarker levels, b) change in biomarker level from day 0 to day 2, c) change in biomarker from day 0 to day 4, and d) slope of biomarker change throughout the study. The associations between ordinal clinical outcome and each of the different predictors were performed with proportional odds logistic regression. Associations were run both "unadjusted" and adjusted for age and sex. Nested cross-validation was used to identify the model for incorporation into the Dublin-Boston score. FINDINGS The 4-day change in IL-6:IL-10 ratio was chosen to derive the Dublin-Boston score. Each 1 point increase in the score was associated with a 5.6 times increased odds for a more severe outcome (OR 5.62, 95% CI -3.22-9.81, P = 1.2 × 10-9). Both the Dublin-Boston score and the 4-day change in IL-6:IL-10 significantly outperformed IL-6 alone in predicting clinical outcome at day 7. INTERPRETATION The Dublin-Boston score is easily calculated and can be applied to a spectrum of hospitalized COVID-19 patients. More informed prognosis could help determine when to escalate care, institute or remove mechanical ventilation, or drive considerations for therapies. FUNDING Funding was received from the Elaine Galwey Research Fellowship, American Thoracic Society, National Institutes of Health and the Parker B Francis Research Opportunity Award.
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Affiliation(s)
- Oliver J McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland.
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Dandi Qiao
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Oisín F McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland
| | - Matthew Moll
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer Clarke
- Beaumont Hospital, Dublin, Ireland; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Gerard F Curley
- Beaumont Hospital, Dublin, Ireland; Department of Anaesthesia and Critical Care Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G McElvaney
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; Beaumont Hospital, Dublin, Ireland.
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29
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McElvaney OJ, McEvoy NL, McElvaney OF, Carroll TP, Murphy MP, Dunlea DM, Ní Choileáin O, Clarke J, O'Connor E, Hogan G, Ryan D, Sulaiman I, Gunaratnam C, Branagan P, O'Brien ME, Morgan RK, Costello RW, Hurley K, Walsh S, de Barra E, McNally C, McConkey S, Boland F, Galvin S, Kiernan F, O'Rourke J, Dwyer R, Power M, Geoghegan P, Larkin C, O'Leary RA, Freeman J, Gaffney A, Marsh B, Curley GF, McElvaney NG. Characterization of the Inflammatory Response to Severe COVID-19 Illness. Am J Respir Crit Care Med 2020; 202:812-821. [PMID: 32584597 PMCID: PMC7491404 DOI: 10.1164/rccm.202005-1583oc] [Citation(s) in RCA: 403] [Impact Index Per Article: 100.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022] Open
Abstract
Rationale: Coronavirus disease (COVID-19) is a global threat to health. Its inflammatory characteristics are incompletely understood.Objectives: To define the cytokine profile of COVID-19 and to identify evidence of immunometabolic alterations in those with severe illness.Methods: Levels of IL-1β, IL-6, IL-8, IL-10, and sTNFR1 (soluble tumor necrosis factor receptor 1) were assessed in plasma from healthy volunteers, hospitalized but stable patients with COVID-19 (COVIDstable patients), patients with COVID-19 requiring ICU admission (COVIDICU patients), and patients with severe community-acquired pneumonia requiring ICU support (CAPICU patients). Immunometabolic markers were measured in circulating neutrophils from patients with severe COVID-19. The acute phase response of AAT (alpha-1 antitrypsin) to COVID-19 was also evaluated.Measurements and Main Results: IL-1β, IL-6, IL-8, and sTNFR1 were all increased in patients with COVID-19. COVIDICU patients could be clearly differentiated from COVIDstable patients, and demonstrated higher levels of IL-1β, IL-6, and sTNFR1 but lower IL-10 than CAPICU patients. COVID-19 neutrophils displayed altered immunometabolism, with increased cytosolic PKM2 (pyruvate kinase M2), phosphorylated PKM2, HIF-1α (hypoxia-inducible factor-1α), and lactate. The production and sialylation of AAT increased in COVID-19, but this antiinflammatory response was overwhelmed in severe illness, with the IL-6:AAT ratio markedly higher in patients requiring ICU admission (P < 0.0001). In critically unwell patients with COVID-19, increases in IL-6:AAT predicted prolonged ICU stay and mortality, whereas improvement in IL-6:AAT was associated with clinical resolution (P < 0.0001).Conclusions: The COVID-19 cytokinemia is distinct from that of other types of pneumonia, leading to organ failure and ICU need. Neutrophils undergo immunometabolic reprogramming in severe COVID-19 illness. Cytokine ratios may predict outcomes in this population.
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Affiliation(s)
| | | | | | | | | | | | | | - Jennifer Clarke
- Department of Anaesthesia and Critical Care
- Beaumont Hospital, Dublin, Ireland; and
| | | | | | | | | | | | | | | | | | | | | | | | - Eoghan de Barra
- Department of International Health and Tropical Medicine, and
| | | | - Samuel McConkey
- Department of International Health and Tropical Medicine, and
| | - Fiona Boland
- Data Science Centre, Division of Biostatistics and Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | | | | - Brian Marsh
- Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care
- Beaumont Hospital, Dublin, Ireland; and
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Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A, Nugent L, Walsh S, O'Connor T. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency. J Wound Care 2020; 29:312-320. [PMID: 32530776 DOI: 10.12968/jowc.2020.29.6.312] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery. METHOD Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only. RESULTS The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown. CONCLUSION Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.
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Affiliation(s)
- Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Natalie L McEvoy
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Gerard Curley
- Anaesthetics and Critical Care, Royal College of Surgeons in Ireland
| | - Aglecia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Simone Walsh
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland
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