Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

No abstract

Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

Introduction Neutrophils have been involved in sepsis-induced organ damage. Neutrophils could be directly activated by TLR binding ligands including LPS. IRAK-1 is one of many intracellular proteins that are activated upon stimulation of TL receptors. This triggers a series of events that results in the migration of NF-κB into the nucleus and the activation NF-κB-dependent genes. Objectives To identify a single nucleotide polymorphism at position 532 (coding SNP) in volunteers and patients with sepsis. To determine whether IRAK-1 SNP532 results in a decrease in neutrophil NF-κB activation in volunteers and patients with sepsis. To evaluate neutrophil gene expression patterns in IRAK-1 SNP532 and wildtype patients with sepsis. Methods Thirty severe sepsis patients and 34 healthy volunteers were enrolled in this study. Peripheral blood was obtained and neutrophils were isolated by plasma-percoll gradients after dextran sedimentation of erythrocytes. Neutrophils from volunteers were resuspended in RPMI and cultured with or without 100 ng/ml LPS for 60 min. The electrophoretic mobility shift assay technique was used to measure the NF-κB activation. Real-time PCR allelic discrimination assays were developed by the assay-by-design service offered by Applied Biosystems (Foster City, CA, USA). Probe and primer combinations were designed at the single nucleotide polymorphism 532. PCR reactions were performed according to the manufacturer's manual using the Applied Biosystems 7500 Real-Time PCR system. Microarray analysis was used to evaluate the neutrophil gene expression in unstimulated neutrophils and after LPS stimulus. Results The median AUC for NF-κB activation was higher in wildtype genotyped neutrophils as compared with IRAK-1 SNP532 genotyped neutrophils (85.2 vs 100.5, P = 0.05) (Fig. 1). In terms of kinetics pattern, we found some differences on nuclear levels of NF-κB in neutrophils from volunteers cultured with LPS. At 30 min after LPS, the culture nuclear translocation of NK-κB was significantly greater in wildtype genotyped neutrophils than in IRAK-1 SNP532 genotyped neutrophils. Even after 60 min, the NF-κB translocation remained high in wildtype genotyped neutrophils, while in IRAK-1 SNP532 genotyped neutrophils the NF-κB translocation was similar to baseline (Fig. 2). In unstimulated neutrophils from septic patients, the NF-κB translocation was significantly lower in IRAK-1 SNP532 genotyped neutrophils than in wildtype genotyped neutrophils (1.20 vs 2.10, P = 0.05) (Fig. 3). Finally, the expression of some inflammatory related genes (IL-8, IL1β, MIP-2, COX-2, and SOD2) was decreased in IRAK-1 SNP532 genotyped neutrophils. Conclusion IRAK-1 SNP532 genotyped neutrophils from volunteers (after LPS ex vivo challenge) and from septic patients are associated with lower NF-κB activation and lower expression of some IRAK1-related genes. These results demonstrate that IRAK1 Introduction Neutrophils play a major role in sepsis-induced organ dysfunction, especially in the lung. HMGB1 has emerged as a late cytokine...