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The invasive intra-arterial approach is the gold standard for measuring blood pressure in intensive care units where accuracy is crucial. However, invasive procedures increase the risk of infections and mortality. This evidence-based review aimed to determine whether continuous non-invasive blood pressure (CNIBP) monitoring, using Radial Artery Applanation Tonometry (RAAT) devices, is as accurate as invasive methods. Six papers were included: three prospective cohort studies and three comparative studies. Most studies showed that mean arterial pressure is accurately recorded through RAAT monitoring; however, more research is needed to assess the accuracy of non-invasive readings of systolic and diastolic blood pressures, as data are not always concordant., (© 2023 British Association of Critical Care Nurses.)

Background: Tackling operating theatre waiting lists may focus healthcare organisations' attention on increased productivity while downplaying safety concerns., Aim: To explore safety culture in a perioperative department from operating theatre practitioners' perspective., Method: Cross-sectional pen-and-paper survey among nurses in an operating theatre department in Malta using the Safety, Communication, Operational Reliability and Engagement questionnaire., Findings: The response rate was 71.2% (n = 146). Engagement domains and Organisational Safety Culture domains were perceived to be at an average level, apart from Unit Leadership which was perceived to be low. Burnout domains were perceived to be high or very high. Correlation analysis showed that leaders' recognition of staff feedback and input is associated with improved safety culture perceptions., Conclusion: An organisational win-win situation is achievable, whereby safety culture perceptions are improved, not necessarily by decreasing job demands such as tackling waiting lists, but by recognising operating theatre staff's input and involving them in work-related decisions., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background: The intensive care unit (ICU) brings together high-risk patients and interventions in a complex environment. Based on this consideration, medication administration error is the most common type of error that occurs in ICUs. Literature confirms that human factors (lack of knowledge, poor practices and negative attitudes) of nurses are the main contributors to the occurrence of medication administration errors in ICUs., Aim: To examine and compare the knowledge, attitudes and behaviour scores on medication administration error according to nurses' sociodemographic and professional variables., Study Design: This is a secondary analysis of data from a cross-sectional international study based on a survey. Descriptive statistics were computed for all items of the questionnaire. Non-parametric tests (Kruskal Wallis and Mann Whitney U tests) were used to carry out the comparison between groups., Results: The international sample consisted of 1383 nurses in 12 different countries. Statistically significant changes were seen in knowledge, attitudes and behaviour scores among several subgroups of the international population. Eastern nurses were more likely to show adequate knowledge about medication administration error prevention than Western nurses; concurrently, Western nurses were significantly more likely to show positive attitudes than Eastern nurses. No statistically significant differences in the behaviour scale were found in this study., Conclusions: The findings show a difference between knowledge and attitudes in relation to cultural background., Relevance to Clinical Practice: Decision makers in ICUs should consider cultural background when planning and implementing prevention strategies for medication administration errors. Further research is needed to investigate the effectiveness of educational systems on the decrease of the incidence of medication administration errors in ICU., (© 2023 British Association of Critical Care Nurses.)

In patients with central venous catheters (CVCs) in situ, the development of catheter-related bloodstream infections (CRBSIs) is often linked with increased morbidity and mortality. Sterile gauze or transparent polyurethane dressings are conventionally used as extraluminal barriers; however, antimicrobial chlorhexidine CVC dressings could potentially reduce infection risk. This short evidence-based review examined the literature comparing the effectiveness of chlorhexidine-based CVC dressings against non-chlorhexidine dressings in reducing CRBSI occurrence. Four systematic reviews with meta-analysis were reviewed, all of which reported a statistically significant reduction in CRBSI occurrence on using chlorhexidine-based dressings. Further research is needed to determine the cost-effectiveness of chlorhexidine-based CVC dressings and their effectiveness in reducing CRBSIs in different catheter types and entry sites because infection risk is not uniform., (© 2022 British Association of Critical Care Nurses.)

Microglia are the primary phagocytes in the central nervous system and clear dead cells generated during development or disease. The phagocytic process shapes the microglia phenotype, which affects the local environment. A unique population of microglia resides in the ventricular-subventricular zone (V-SVZ) of neonatal mice, but how they influence the neurogenic niche is not well understood. Here, we demonstrate that phagocytosis contributes to a pro-neurogenic microglial phenotype in the V-SVZ and that these microglia phagocytose apoptotic cells via the engulfment receptor Jedi-1. Deletion of Jedi-1 decreases apoptotic cell clearance, triggering a neuroinflammatory microglia phenotype that resembles dysfunctional microglia in neurodegeneration and aging and that reduces neural precursor proliferation via elevated interleukin-1β signaling; interleukin-1 receptor inhibition rescues precursor proliferation in vivo. Together, these results reveal a critical role for Jedi-1 in connecting microglial phagocytic activity to the maintenance of a pro-neurogenic phenotype in the developing V-SVZ., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

New drugs that precisely target the immune mechanisms critical for cytotoxic T lymphocyte (CTL) and natural killer (NK) cell driven pathologies are desperately needed. In this perspective, we explore the cytolytic protein perforin as a target for therapeutic intervention. Perforin plays an indispensable role in CTL/NK killing and controls a range of immune pathologies, while being encoded by a single copy gene with no redundancy of function. An immunosuppressant targeting this protein would provide the first-ever therapy focused specifically on one of the principal cell death pathways contributing to allotransplant rejection and underpinning multiple autoimmune and postinfectious diseases. No drugs that selectively block perforin-dependent cell death are currently in clinical use, so this perspective will review published novel small molecule inhibitors, concluding with in vivo proof-of-concept experiments performed in mouse models of perforin-mediated immune pathologies that provide a potential pathway toward a clinically useful therapeutic agent.

Cytotoxic T lymphocytes (CTLs) and natural killer cells kill virus-infected and tumor cells through the polarized release of perforin and granzymes. Perforin is a pore-forming toxin that creates a lesion in the plasma membrane of the target cell through which granzymes enter the cytosol and initiate apoptosis. Endosomal sorting complexes required for transport (ESCRT) proteins are involved in the repair of small membrane wounds. We found that ESCRT proteins were precisely recruited in target cells to sites of CTL engagement immediately after perforin release. Inhibition of ESCRT machinery in cancer-derived cells enhanced their susceptibility to CTL-mediated killing. Thus, repair of perforin pores by ESCRT machinery limits granzyme entry into the cytosol, potentially enabling target cells to resist cytolytic attack.

Objective: The aim of the study was to explore the degree of agreement of intensive care unit nurses working on a set of medication error preventive strategies and to examine possible predictors of nurses' knowledge, attitude and behavior., Materials and Methods: Observational, international, and cross-sectional study. Iran, Malta, Spain, Pakistan, Nepal, Qatar, Ecuador, Australia, Finland, Italy, Egypt, and Jordan were the countries included in this survey. To collect data, the Knowledge, Attitude and Behavior in Medication Errors questionnaire was used. A descriptive statistical analysis was performed for the socio-demographic characteristics of the sample and three multiple logistic regressions were performed., Results: The international sample consists of 1383 nurses, of whom 478 (34.6%) were men and 900 (65.1%) were women and their mean age was 35.61 years with a range of 19-61. Descriptive statistics conducted on the international sample show a medium to high degree of agreement among participants concerning some preventive strategies of medication error. In addition, the results of the present study show a strong relationship between positive nurses' attitudes and correct behaviors and/or adequate knowledge, as well as between adequate knowledge and correct behaviors (p< 0.01)., Conclusions: Further studies are needed to explore the issue of medication error concerning nurses' cultural backgrounds, as well as to assess similarities and disparities among international nurses.

Background: Femoral fractures are associated with high mortality and morbidity, including pain. Skin traction may be used pre-operatively as an adjunct to analgesia to decrease pain., Objective: To evaluate the effects on pain of the use of pre-operative skin traction in adults with a fracture of the proximal femur., Research Question: Is the use of pre-operative skin traction effective in reducing pain in adults with proximal femoral fractures?, Method: A systematic review was conducted based on a search of PubMed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews. The keywords 'preoperative', 'skin traction', 'hip fractures' and 'pain' were used. Randomised controlled trials published in English between April 2011 and November 2020 were included and appraised using the Cochrane Risk of Bias tool., Results: Five articles met the inclusion criteria; all were randomised controlled trials. The results confirm those of earlier reviews: skin traction does not significantly decrease pain and analgesia use. The quality of the evidence available is weak., Conclusion: There is no strong evidence for the routine pre-operative use of skin traction in adults with a hip fracture. As the quality of the evidence is weak, further high-quality research on this topic is warranted., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Chimeric antigen receptor (CAR)-T-cell therapy is a promising approach for the treatment of childhood cancers, particularly high-risk tumors that fail to respond to standard therapies. CAR-T cells have been highly successful in treating some types of hematological malignancies. However, CAR-T cells targeting solid cancers have had limited success so far for multiple reasons, including their poor long-term persistence and proliferation. Evidence is emerging to show that maintaining CAR-T cells in an early, less-differentiated state in vitro results in superior persistence, proliferation, and antitumor effects in vivo. Children are ideal candidates for receiving less-differentiated CAR-T cells, because their peripheral T-cell pool primarily comprises naïve cells that could readily be harvested in large numbers to generate early-phenotype CAR-T cells. Although several studies have reported different approaches to successfully generate early CAR-T cells, there are only a few clinical trials testing these in adult patients. No trials are currently testing early CAR-T cells in children. Here, we summarize the different strategies used to maintain CAR-T cells in an early phenotypic stage and present evidence suggesting that this approach may be particularly relevant to treating childhood cancers., Competing Interests: Disclosures DSZ received consultant fees from Amgen, Bayer, and DayOne. PJN received research funding from BMS, Roche Genentech, Compugen, and Allergan. PKD declares research funding from Myeloid Therapeutics, Prescient Therapeutics, and Juno Therapeutics. All other authors have declared no conflicts of interest., (Copyright © 2021 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.)