Efficacy of a heel offloading boot in reducing heel pressure injuries in patients in Australian intensive care units: A single-blinded randomised controlled trial

ObjectivesTo compare time to incidence, extent of incidence and severity of heel pressure injury with a heel off-loading boot (intervention) or pillows (control).Research methodology/designMulti-centre, single-blinded randomised controlled trial of 394 critically ill patients. Patients were randomised to the intervention or control for heel offloading.SettingThree hospital intensive care units; two in greater Sydney, Australia and one in regional New South Wales, Australia.Main outcome measuresTime to intensive care unit-acquired pressure injury in heels of patients without pre-existing heel pressure injury within 28 days from intensive care unit admission. Secondary outcomes: incidence of heel pressure injury within 28 days of intensive care unit admission; severity of intensive care unit-acquired heel pressure injuries; occurrence of plantar contractures (a change in ankle dorsiflexion of 5° or greater) within 28 days of admission.ResultsWithin 28 days of admission, one pressure injury was recorded in the intervention group and 11 in the control group. Hazard of pressure injury incidence within 28 days of admission was significantly lower (p = 0.0239) in heels assigned to the intervention (hazard ratio 0.0896 [95% CI 0.0110, 0.727]). Odds of pressure injury incidence within 28 days of admission were significantly lower (p = 0.0261) in the intervention group (odds ratio 0.0883 [95% CI 0.0104, 0.749]). The pressure injury recorded in the intervention group was superficial (stage 1) whereas those recorded in the control group were more severe (stage 2 to 4).ConclusionThe heel-offloading boot used in this study significantly reduced heel pressure injury occurrence compared with heel offloading using pillows.     

Circulating angiotensin converting enzyme 2 and COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has triggered a widespread outbreak since December 2019. The SARS-CoV-2 infection-related illness has been dubbed the coronavirus disease 2019 (COVID-19) by the World Health Organization. Asymptomatic and subclinical infections, a severe hyper-inflammatory state, and mortality are all examples of clinical signs. After attaching to the angiotensin converting enzyme 2 (ACE2) receptor, the SARS-CoV-2 virus can enter cells through membrane fusion and endocytosis. In addition to enabling viruses to cling to target cells, the connection between the spike protein (S-protein) of SARS-CoV-2 and ACE2 may potentially impair the functionality of ACE2. Blood pressure is controlled by ACE2, which catalyzes the hydrolysis of the active vasoconstrictor octapeptide angiotensin (Ang) II to the heptapeptide Ang-(1-7) and free L-Phe. Additionally, Ang I can be broken down by ACE2 into Ang-(1-9) and metabolized into Ang-(1-7). Numerous studies have demonstrated that circulating ACE2 (cACE2) and Ang-(1-7) have the ability to restore myocardial damage in a variety of cardiovascular diseases and have anti-inflammatory, antioxidant, anti-apoptotic, and anti-cardiomyocyte fibrosis actions. There have been some suggestions for raising ACE2 expression in COVID-19 patients, which might be used as a target for the creation of novel treatment therapies. With regard to this, SARS-CoV-2 is neutralized by soluble recombinant human ACE2 (hrsACE2), which binds the viral S-protein and reduces damage to a variety of organs, including the heart, kidneys, and lungs, by lowering Ang II concentrations and enhancing conversion to Ang-(1-7). This review aims to investigate how the presence of SARS-CoV-2 and cACE2 are related. Additionally, there will be discussion of a number of potential therapeutic approaches to tip the ACE/ACE-2 balance in favor of the ACE-2/Ang-(1-7) axis.     

Identifying current uses of return to work screening tests and their effectiveness of reducing the risk of reinjury in athletic occupations – A systematic review

ObjectiveTo identify the current return-to-work (RTW) screening tests conducted for athletic occupations following injury and their effectiveness of reducing reinjury risk.MethodsA search was made of multiple databases (BioMed Central, CINAHL through ebscohost, EMBASE, Google Scholar, PUBMED, Scopus, SPORTDiscus and Web of Science) from their inception to March 2022, using relevant terms to identify articles meeting predefined inclusion/exclusion criteria. The search, data extraction, risk of bias, and evaluation of the certainty of the findings were completed independently by two authors. To understand the effectiveness of screening tests and their impact in reducing in reinjury rates, results were split into the following three time points: “Short-term” (≤1 year), “Medium-term” (≥2 years) and “Long-term” (≥3 years).ResultsFive studies (n = 507) met the inclusion criteria. There was a very low level of certainty for the effectiveness of screening tools reducing reinjury risk at short-term, medium-term and long-term follow ups. Only one study recorded a large effect in the reducing reinjury risk.ConclusionThe results demonstrated very low level of certainty for the effectiveness of screening tests reducing the risk of reinjury. A gap in our understanding currently exists for the effectiveness of RTW screening tests in tactical athletic occupations following injury and further research investigating is required.     

Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial

ObjectivesThe reduction of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management compared with a fixed flow perfusion (conventional strategy) remains controversial. The purpose of this study was to determine whether a oxygen delivery strategy would reduce the incidence of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery.MethodsWe randomly enrolled 300 patients undergoing cardiopulmonary bypass surgery. Patients were randomly assigned to a oxygen delivery strategy (maintaining a oxygen delivery index value >300 mL/min/m² through pump flow adjustments during cardiopulmonary bypass) or a conventional strategy (a target pump flow was determined on the basis of the body surface area). The primary end point was the development of acute kidney injury. Secondary end points were the red blood cell transfusion rate and number of red blood cell units, intubation time, postoperative length of stay in the intensive care unit and the hospital, predischarge estimated glomerular filtration rate, and hospital mortality.ResultsAcute kidney injury occurred in 20 patients (14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%) receiving the conventional strategy (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P = .002). The secondary end points were not significantly different between strategies. In a prespecified subgroup analysis of patients who had nadir hematocrit less than 23% or body surface area less than 1.40 m², the oxygen delivery strategy seemed to be superior to the conventional strategy and the existence of quantitative interactions was suggested.ConclusionsAn oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury.     

Actualización de las recomendaciones de medidas de prevención y aislamiento frente al SARS-CoV-2 en las unidades de diálisis: un posicionamiento de la Sociedad Española de Nefrología

SARS-CoV-2 pandemic has changed across the last 2 years. The development and approval of SARS-CoV-2 vaccines and the emergence of new variants has opened up a new scenario. On this regard, Spanish Society of Nephrology (S.E.N.) Council considers that an update of the previous recommendations should be performed. In the present statement, and taking into account the current epidemiological situation, are included updated recommendations of protection and isolation for patients on dialysis programs.     

Analysis of landing performance and ankle injury in elite British artistic gymnastics using a modified drop land task: A longitudinal observational study

ObjectivesTo determine whether differences in landing force and asymmetry of landing force exist between gymnasts at the time of data collection versus those that subsequently experienced an ankle injury 12-months later.Study designProspective longitudinal observational design with baseline measures and 12 month follow up.SettingBritish Gymnastics National Training Centre.ParticipantsThirty-two asymptomatic elite level gymnasts from three artistic gymnastic squads (n = 15 senior female, n = 10 junior female and n = 7 senior male).Main outcome measuresA modified drop land task was used to quantify measures of landing performance. Peak Vertical Ground Reaction Force (PVGRF) was used to measure landing force. The level of inter-limb asymmetry of landing force was calculated using the Limb Symmetry index (LSI). Other measures included injury incidence and percentage coefficient of variation (% CV).ResultsThere was no statistical difference for landing force (p = 0.481) and asymmetry of landing force (p = 0.698) when comparing injured and non-injured gymnasts. Most participants (69%) demonstrated inter-limb asymmetry of landing forces.ConclusionsOur findings observed inter-limb asymmetry of landing force in injured gymnasts, although uninjured gymnasts also exhibited asymmetry of landing force. Both magnitude of landing force and inter-limb asymmetries of landing force failed to identify the risk of ankle injury.