WorldWideScience

Sample records for heel pressure ulcers

  1. Are pressure redistribution surfaces or heel protection devices effective for preventing heel pressure ulcers?

    Science.gov (United States)

    Junkin, Joan; Gray, Mikel

    2009-01-01

    Heel pressure ulcers are recognized as second in prevalence only to pressure ulcer (PU) on the heel among hospitalized patients, and recent studies suggest their incidence may be higher than even sacral ulcers. We systematically reviewed the literature to identify and evaluate whether pressure redistribution surfaces or heel protection devices are effective for the prevention of heel ulcers. We searched CINAHL and MEDLINE databases, using the keywords "pressure ulcer" and "heel," which we also searched the Cochrane Library, using the key terms "pressure ulcer," "heel," and "support surface." We hand searched the ancestry of pertinent research reports and review articles in order to identify additional studies. Inclusion criteria were (1) any study that compared one or more pressure redistribution surfaces or heel protection devices designed specifically to prevent heel PU and (2) any study comparing 2 or more pressure redistribution surfaces designed to prevent PU that specifically reported differences in the incidence of heel PU. Exclusion criteria were (1) studies that did not measure heel PU incidence as an outcome, (2) studies without an English language abstract, and (3) studies that reported overall PU incidence but did not analyze heel PU incidence separately. Clinical evidence concerning the efficacy of pressure redistribution surfaces or heel protection devices is sparse. Existing evidence suggests that pressure redistribution surfaces vary in their ability to prevent heel pressure ulcers, but there is insufficient evidence to determine which surfaces are optimal for this purpose. A single study suggests that a wedge-shaped viscoelastic foam cushion is superior to standard foam pillows for preventing heel PU, but further research is needed before a definitive conclusion concerning this issue can be reached. There is insufficient evidence to determine whether heel protection devices are more effective than a standard hospital foam pillow for the prevention

  2. Effectiveness of two cushions in the prevention of heel pressure ulcers.

    Science.gov (United States)

    Heyneman, Alexander; Vanderwee, Katrien; Grypdonck, Mieke; Defloor, Tom

    2009-01-01

    The aim of the study was to determine the effectiveness of two cushions in the prevention of heel pressure ulcers in a geriatric population. Heel pressure ulcers are a major problem in nursing practice. Several measures for the prevention of heel pressure ulcers are discussed in the literature, but the effectiveness of the different types of cushions in the prevention of heel pressure ulcers is poorly studied. In this comparative study, two different cushions to prevent heel pressure ulcers were investigated: a wedge-shaped, bedwide, viscoelastic foam cushion and an ordinary pillow. All patients were lying on a viscoelastic foam mattress and were repositioned every 4 hours. One hundred sixty-two patients over 75 years of age. The incidence of heel pressure ulcers grades 2-4 was 1.9% in the wedge-shaped cushion group and was 10.2% in the pillow group. The patients in the wedge-shaped cushion group developed significantly fewer heel pressure ulcers (p = 0.03). Patients with a wedge-shaped cushion under the lower legs had an 85% less chance in developing a heel pressure ulcer (p = 0.02). The median time to develop a heel pressure ulcer was 4.0 days (IQR = 3.0-5.0) in the wedge-shaped cushion group and 3.5 days (IQR = 1.0-5.8) in the pillow group (p = 0.61). The probability to remain pressure ulcer-free at the heels was significantly higher in the wedge-shaped cushion group (p = 0.008). The study provides evidence that a wedge-shaped, bedwide, viscoelastic foam cushion decreases the risk of developing a heel pressure ulcer compared with the use of a pillow.

  3. Designing and Constructing Blood Flow Monitoring System to Predict Pressure Ulcers on Heel

    OpenAIRE

    Akbari H.; Younessi Heravi M. A.

    2014-01-01

    Background: A pressure ulcer is a complication related to the need for the care and treatment of primarily disabled and elderly people. With the decrease of the blood flow caused by the pressure loaded, ulcers are formed and the tissue will be wasted with the passage of time. Objective: The aim of this study was to construct blood flow monitoring system on the heel tissue which was under external pressure in order to evaluate the tissue treatment in the ulcer. Methods: To measure the blood fl...

  4. Designing and Constructing Blood Flow Monitoring System to Predict Pressure Ulcers on Heel

    Directory of Open Access Journals (Sweden)

    Akbari H.

    2014-06-01

    Full Text Available Background: A pressure ulcer is a complication related to the need for the care and treatment of primarily disabled and elderly people. With the decrease of the blood flow caused by the pressure loaded, ulcers are formed and the tissue will be wasted with the passage of time. Objective: The aim of this study was to construct blood flow monitoring system on the heel tissue which was under external pressure in order to evaluate the tissue treatment in the ulcer. Methods: To measure the blood flow changes, three infrared optical transmitters were used at the distances of 5, 10, and 15 mm to the receiver. Blood flow changes in heels were assessed in pressures 0, 30, and 60 mmHg. The time features were extracted for analysis from the recorded signal by MATLAB software. Changes of the time features under different pressures were evaluated at the three distances by ANOVA in SPSS software. The level of significance was considered at 0.05. Results: In this study, 15 subjects, including both male and female, with the mean age of 54±7 participated. The results showed that the signal amplitude, power and absolute signal decreased significantly when pressure on the tissue increased in different layers (p<0.05. Heart rate only decreased significantly in pressures more than 30 mmHg (p=0.02. In pressures more than 30 mmHg, in addition to a decrease in the time features, the pattern of blood flow signal changed and it wasn’t the same as noload signal. Conclusion: By detecting the time features, we can reach an early diagnosis to prognosticate the degeneration of the tissue under pressure and it can be recommended as a method to predict bedsores in the heel.

  5. Nurses' use of water-filled gloves in preventing heel pressure ulcer in the University College Hospital, Ibadan, Nigeria.

    Science.gov (United States)

    Adejumo, Prisca Olabisi; Ingwu, Justin Agorye

    2010-12-01

    This cross-sectional descriptive survey examined use (knowledge, perception and practices) of water-filled gloves (WFGs) by nurses in the prevention of heel pressure ulcer (PU) in the University College Hospital (UCH), Ibadan, Nigeria. Participants were 250 purposively selected nurses working in the Neurosciences and Surgical units. Quantitative data were generated through the administration of a semi-structured questionnaire, whereas the qualitative data were collected through in-depth interview. Hypotheses were tested using chi-square analysis at a significance level of 0.05, whereas the manual content analysis was used to analyse the qualitative data. Results showed that a significant number of nurses at UCH, Ibadan, were knowledgeable about WFGs and actually used them in their clinical practice. Years of experience in clinical practice was found to be significantly related to knowledge and use of WFGs in heel PU (X(2) = 41·677; DF = 5; P = 0·001). Nurses with adequate knowledge of risk factors in the development of PU used WFGs more than those who were not aware (X(2) = 44·907; DF = 3; P = 0·009). Nurses' perception about WFGs was also significantly related to its use (X(2) = 4·527; DF = 1; P = 0·033). Although knowledge level and perception of WFGs and its use by nurses was fairly adequate, continuous education for practicing nurses should be encouraged in resource-limited settings. © 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  6. Morphological study on the pressure ulcer-like dermal lesions formed in the rat heel skin after transection of the sciatic nerves.

    Science.gov (United States)

    Haba, Daijiro; Minami, Chie; Miyagawa, Miki; Arakawa, Takamitsu; Miki, Akinori

    2017-01-01

    Due to transection of bilateral sciatic nerves, pressure ulcer-like dermal lesion occurred in the hairy skin covering of the heel skin in almost all rats. In the present study, chronological changes of the rat heel skin after the transection were morphologically and immunohistochemically examined. In the heel skin, redness and swelling began by 3days after the operation, and open wound formed by 17days. At the redness and swelling stage, edema extensively occurred in the dermis. At the thickening stage, the epidermis at the pressed site became transiently thicker, and at the whitening stage, rapidly thinner. At these stages, the epidermis in the skin surrounding the pressed site became gradually thicker. At the yellow scar stage, the skin was covered only by necrotic tissues and horny layer. These layers were scratched during walking and turning, and the yellow scar stage became the open wound stage. Inflammatory reaction began at the thickening stage, and at the yellow scar and open wound stages, necrosis, infiltration of inflammatory cells and dilation of small blood vessels were observed. These morphological features are quite similar to those in the human pressure ulcer. These findings suggest that these dermal injuries could compare the human pressure ulcer for medical treatment and depressurization in future study. Copyright © 2016 Elsevier GmbH. All rights reserved.

  7. Spectroscopic detection of the blanch response at the heel of the foot: a possible diagnostic for stage I pressure ulcers

    Science.gov (United States)

    Kohlenberg, Elicia M.; Zanca, Jeanne; Brienza, David M.; Levasseur, Michelle A.; Sowa, Michael G.

    2005-09-01

    Pressure ulcers (sores) can occur when there is constant pressure being applied to tissue for extended periods of time. Immobile people are particularly prone to this problem. Ideally, pressure damage is detected at an early stage, pressure relief is applied and the pressure ulcer is averted. One of the hallmarks of pressure damaged skin is an obliterated blanch response due to compromised microcirculation near the surface of the skin. Visible reflectance spectroscopy can noninvasively probe the blood circulation of the upper layers of skin by measuring the electronic transitions arising from hemoglobin, the primary oxygen carrying protein in blood. A spectroscopic test was developed on a mixed population of 30 subjects to determine if the blanch response could be detected in healthy skin with high sensitivity and specificity regardless of the pigmentation of the skin. Our results suggest that a spectroscopic based blanch response test can accurately detect the blanching of healthy tissue and has the potential to be developed into a screening test for early stage I pressure ulcers.

  8. Pressure ulcers

    National Research Council Canada - National Science Library

    Reddy, Madhuri

    2011-01-01

    Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents...

  9. Sitting: pressure ulcer development.

    Science.gov (United States)

    Collins, F

    Seating is a major factor in pressure ulcer development, but it is frequently overlooked in the literature on pressure area management. Pressure ulcers are largely preventable and nurses are integral to the promotion of good practice. The author examines how implementing careful patient assessment, correct positioning and providing optimum seating equipment can help to reduce the risk of pressure ulcer development.

  10. Management of Chronic Pressure Ulcers

    Science.gov (United States)

    2009-01-01

    Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by

  11. Pressure Ulcers Surveillance Report

    Directory of Open Access Journals (Sweden)

    Zehra Esin Gencer

    2015-04-01

    Full Text Available Objective: Pressure ulcer is a chronic wound. It reduces the quality of life of the elderly and individuals with restricted range of motion. It prolongs hospital stay and increases the risk of complications. The cost is quite high. Preventive actions for the prevention of pressure ulcers should be developed. Planning protocols and standards of care are among the main targets. Material and Method: Research was conducted in one-year period between 2012 May and 2013 May on patients who were followed up in Akdeniz University Hospital clinics and intensive care unit with pressure ulcers. The research population consisted of 569 patients. Patient data were recorded in SPSS 16 for Windows program. Statistical analyzes were performed with retrospective methods. The demographic characteristics of patients with pressure ulcers were analyzed as frequency and descriptive statistics. Prevalence and incidence of one year were calculated. Results: Of the patients, 58% were males, 42% were females. Of the patients, 36% were in the age range of 61-80 years, and their average length of stay was 42,9 days. Of the patients, 70% were at stage 2 and 3. In 15% of patients pressure ulcers occurred on the first day of hospitalization. Pressure ulcers were developed between days 2 and 10 in 59% of the patients. Prevalence rate was 2.5%, the incidence was 1.9%, the prevalence rate was 5.9% in the intensive care unit. Conclusion: It is easier to prevent pressure ulcers than treating.

  12. The effects of increasing heel height on forefoot peak pressure.

    Science.gov (United States)

    Mandato, M G; Nester, E

    1999-02-01

    The purpose of this study was to determine the effect of increasing heel height on peak forefoot pressure. Thirty-five women were examined while wearing sneakers and shoes with 2-inch and 3-inch heels. An in-shoe pressure-measurement system was used to document the magnitude and location of plantar peak pressures. Pressure under the forefoot was found to increase significantly with increasing heel height. As the heel height increased, the peak pressure shifted toward the first metatarsal and the hallux. The reproducibility of data obtained with the in-shoe pressure-measurement system was tested in five subjects; the data were found to be reproducible to within approximately 3% of measured pressures.

  13. Plantar Pressure Variation during Jogging with Different Heel Height

    Directory of Open Access Journals (Sweden)

    Y. D. Gu

    2013-01-01

    Full Text Available This paper presents the key testing and analysis results of an investigation on the effect of heel height on the plantar pressure over different foot areas in jogging. It is important in improving the understanding of jogging with high heels and damage/injury prevention. It can also potentially guide the development of suitable/adaptive exercise schemes in between daily activities with high heels. In this work, plantar pressure data were collected from 10 habituated healthy female subjects (aged 21–25 years at their natural jogging speed with three different conditions: flat heeled shoes (0.8 cm, low heeled shoes (4.0 cm, and high heeled shoes (6.6 cm. Data analysis showed significantly differences in plantar pressure distribution associated with the heel heights with increased pressure in the first metatarsal region and decreased pressure in the lateral metatarsal and midfoot sections. However, there is no significant alteration of plantar pressure in the central area of the forefoot with jogging gait.

  14. Novel Surgical Treatment for Refractory Heel Ulcers in Werner’s Syndrome

    Directory of Open Access Journals (Sweden)

    Keisuke Oe

    2013-01-01

    Full Text Available Patients with Werner’s syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.

  15. Effect of revised high-heeled shoes on foot pressure and static balance during standing.

    Science.gov (United States)

    Bae, Young-Hyeon; Ko, Mansoo; Park, Young-Soul; Lee, Suk-Min

    2015-04-01

    [Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance.

  16. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.

    Science.gov (United States)

    Ledoux, William R; Shofer, Jane B; Cowley, Matthew S; Ahroni, Jessie H; Cohen, Victoria; Boyko, Edward J

    2013-01-01

    We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression. During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Location must be considered when assessing the relationship between PPP and plantar ulceration. © 2013.

  17. A new pressure ulcer conceptual framework

    NARCIS (Netherlands)

    Coleman, S.; Nixon, J.; Keen, J.; Wilson, L.; McGinnis, E.; Dealey, C.; Stubbs, N.; Farrin, A.; Dowding, D.; Schols, J.M.; Cuddigan, J.; Berlowitz, D.; Jude, E.; Vowden, P.; Schoonhoven, L.; Bader, D.L.; Gefen, A.; Oomens, C.W.; Nelson, E.A.

    2014-01-01

    AIM: This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. BACKGROUND: Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR

  18. Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease

    DEFF Research Database (Denmark)

    Holstein, P; Lassen, N A

    1980-01-01

    The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel ...

  19. Wound cleansing for pressure ulcers.

    Science.gov (United States)

    Moore, Zena E H; Cowman, Seamus

    2013-03-28

    Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the elderly, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care. This systematic review seeks to answer the following question: what is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers? For this third update, we searched the Cochrane Wounds Group Specialised Register (searched 3 January 2013); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to November Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 31, 2012); Ovid EMBASE (2010 to 2012 Week 52); and EBSCO CINAHL (2010 to 21 December 2012). Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing. Two review authors extracted data independently and resolved disagreements through discussion. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, risk ratio (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, mean difference (MD), plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. Two review authors independently assessed each included study using the Cochrane Collaboration tool for assessing risk of bias. One additional eligible study was identified from the updated searches, one study was added to the table of excluded studies. A total of three studies (169 participants) met the inclusion criteria for the

  20. Regional plantar foot pressure distributions on high-heeled shoes-shank curve effects

    Science.gov (United States)

    Cong, Yan; Lee, Winson; Zhang, Ming

    2011-12-01

    Forefoot pain is common in high-heeled shoe wearers due to the high pressure caused by the center of body mass moving forward and the increased arch height with heel elevation. Sufficient arch support could reduce the high pressure over forefoot. However, too much arch support could lead to abnormal foot alignment and pain over midfoot. Little information is reported on the relationship among plantar arch height, shank curve design and plantar pressure. This study aimed at quantifying the plantar arch height changes at different heel heights and investigating the effect of shank curve on plantar pressure distribution. The plantar arch height increased to (7.6±1.3)mm at heel height of 75 mm. The Chinese standard suggests the depth of last should be 8.5mm for heel height of 75 mm. When a shank curve with higher depth of last (11 mm) was used, the peak pressure over forefoot further decreased in midstance phase, which might ease the forefoot problems, while the peak pressure over midfoot increased but not exceeded the discomfort pressure thresholds. To achieve a more ideal pressure distribution in high-heeled shoes, a higher than expected depth of last would be suggested that would not cause discomfort over midfoot.

  1. Pressure ulcers in critically ill patients - Preventable by non-sedation? A substudy of the NONSEDA-trial

    DEFF Research Database (Denmark)

    Nedergaard, Helene K.; Haberlandt, Trine; Toft, Palle

    2017-01-01

    Objective: Pressure ulcers still pose a significant clinical challenge to critically ill patients. This study is a substudy of the multicenter NONSEDA-trial, where critically ill patients were randomised to sedation or non-sedation during mechanical ventilation. The objective of this substudy...... was to assess if non-sedation affected the occurrence of pressure ulcers. Design: Retrospective assessment of data from a single NONSEDA-trial site. Setting: Mixed intensive care unit. Outcome measures: The occurrence of pressure ulcers, described by grade and location. Results: 205 patients were included....... Patients with pressure ulcers in the two groups were comparable with regards to baseline data. There were 44 ulcers in 32 patients in the sedated group and 31 ulcers in 25 patients in the non-sedated group (p = 0.08). 64% of the ulcers in sedated patients were located on sacrum and heels, whereas 68...

  2. Pressure ulcer risk in hip fracture patients

    NARCIS (Netherlands)

    Houwing, R. H.; Rozendaal, M; Wouters-Wesseling, W; Buskens, E.; Keller, P; Haalboom, JRE

    Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU

  3. The Changes of COP and Foot Pressure after One Hour's Walking Wearing High-heeled and Flat Shoes.

    Science.gov (United States)

    Ko, Dong Yeol; Lee, Han Suk

    2013-10-01

    [Purpose] This study aimed to determine the most appropriate height for shoe heels by measuring the displacement of the COP (center of pressure) and changes in the distribution of foot pressure after walking in flat (0.5 cm), middle-heeled (4 cm), and high-heeled (9 cm) shoes for 1 hour. [Methods] A single-subject design was used, with 15 healthy women wearing shoes with heels of each height in a random order. The foot pressure and displacement of COP before and after walking in an ordinary environment for 1 hour were measured using an FDM-S (zebris Medical GmbH, Germany). [Results] The distribution of foot pressure did not change significantly after walking in middle-heeled (4 cm) shoes but did change significantly after walking in either flat (0.5 cm) or high-heeled (9 cm) shoes. Similarly, the COP was not significantly displaced after walking in middle-heeled (4 cm) shoes but was significantly displaced after walking in either flat (0.5 cm) or high-heeled (9 cm) shoes. [Conclusion] Both flat and high-heeled shoes had adverse effects on the body. Middle-heeled (4 cm) shoes are preferable to both flat (0.5 cm) and high-heeled (9 cm) shoes for the health and comfort of the feet.

  4. Management of chronic pressure ulcers: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series.PRESSURE ULCER PREVENTION: an evidence based analysisThe cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS: an evidence-based analysis The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions?Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency

  5. The Changes of COP and Foot Pressure after One Hour's Walking Wearing High-heeled and Flat Shoes

    OpenAIRE

    Ko, Dong Yeol; Lee, Han Suk

    2013-01-01

    [Purpose] This study aimed to determine the most appropriate height for shoe heels by measuring the displacement of the COP (center of pressure) and changes in the distribution of foot pressure after walking in flat (0.5 cm), middle-heeled (4 cm), and high-heeled (9 cm) shoes for 1 hour. [Methods] A single-subject design was used, with 15 healthy women wearing shoes with heels of each height in a random order. The foot pressure and displacement of COP before and after walking in an ordinary e...

  6. [Prevalence of pressure ulcers in the the Balearic Islands].

    Science.gov (United States)

    Tomàs-Vidal, Antonia M; Hernández-Yeste, María Soledad; García-Raya, M Dolores; Marín-Fernández, Reyes; Cardona-Roselló, Josefina

    2011-01-01

    The absence of reliable information regarding Pressure Ulcers in the Balearic Islands has led to the development of this study. The main objective was to acquire knowledge of the prevalence in hospitals, nursing homes and patients who have received domiciliary care in the public and semi-private services. It is a descriptive, cross-sectional and observational prevalence study. Data of the whole population (2,454 patients) was collected in hospitals and nursing homes. A stratified systematic randomized sampling was carried out in domiciliary care (342 patients). The information was gathered by specially trained nurses, through direct observation, checking of individual health records and interviews. Data was collected and processed through a computing system with PDA support. A total of 43.8% of the patients were at risk. The crude prevalence was 12.7% and in patients at risk, 28.3%. The prevalence was higher within the group of people aged more than seventy. Injuries in the sacrum and heels exceeded 60%. Except for medium and long-stay hospitals, more than 70% of the patients with pressure ulcers had developed some ulcer in the centre where they were being cared for. It can be concluded that in the Balearic Islands, pressure ulcers are a significant health problem. The quality of healthcare can be potentially improved at every care level. The difference in the methodology used in prevalence studies of prevalence suggests that there is a need to work towards a more standardised information system and to reach a consensus with all the Spanish regions. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  7. Medical device-related pressure ulcers

    OpenAIRE

    Black JM; Kalowes P

    2016-01-01

    Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of ox...

  8. The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper.

    Science.gov (United States)

    Posthauer, Mary Ellen; Banks, Merrilyn; Dorner, Becky; Schols, Jos M G A

    2015-04-01

    Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management.

  9. Influence of in-shoe heel lifts on plantar pressure and center of pressure in the medial-lateral direction during walking.

    Science.gov (United States)

    Zhang, Xianyi; Li, Bo

    2014-04-01

    The aim of this study was to investigate how the height and material of in-shoe heel lifts affect plantar pressure and center of pressure (COP) trajectory in the medial-lateral direction during walking. Seventeen healthy young male adults were asked to walk along an 8m walkway while wearing a high-cut flat shoe and 5 different heel lifts. Peak pressure (PP), pressure-time integral (PTI) and contact area (CA) were measured by Pedar insole system for three foot regions: forefoot, midfoot and heel. Range and velocity of medial-lateral (ML) COP during forefoot contact phase (FFCP) and foot flat phase (FFP) were collected using Footscan pressure plate. Forefoot pressure and ML-COP parameters increased as the heel was elevated. Statistically significant attenuation of heel peak plantar pressure was provided by all heel lifts except for the hard lift. Post hoc tests suggest that material had a greater influence on the range and velocity of ML-COP during FFCP than heel height, while during FFP, heel height seemed to affect these parameters more. The findings from this study suggest that thick heel lifts should be used with caution, and that a heel lift made of materials with good support and elastic properties might be more appropriate to improve footwear comfort and medial-lateral motion control. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Massage therapy for preventing pressure ulcers.

    Science.gov (United States)

    Zhang, Qinhong; Sun, Zhongren; Yue, Jinhuan

    2015-06-17

    Pressure ulcers affect approximately 10% of patients in hospitals and the elderly are at highest risk. Several studies have suggested that massage therapy may help to prevent the development of pressure ulcers, but these results are inconsistent. To assess the evidence for the effects of massage compared with placebo, standard care or other interventions for prevention of pressure ulcers in at-risk populations.The review sought to answer the following questions:Does massage reduce the incidence of pressure ulcers of any grade?Is massage safe in the short- and long-term? If not, what are the adverse events associated with massage? We searched the Cochrane Wounds Group Specialised Register (8 January 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 1), Ovid MEDLINE (1946 to 8 January 2015), Ovid MEDLINE (In-Process Other Non-Indexed Citations 8 January 2015), Ovid EMBASE (1974 to 8 January 2015), and EBSCO CINAHL (1982 to 8 January 2015). We did not apply date or language restrictions. We planned to include all randomised controlled trials (RCTs) and quasi-randomised controlled trials (Q-RCTs) that evaluated the effects of massage therapy for the prevention of pressure ulcers. Our primary outcome was the proportion of people developing a new pressure ulcer of any grade. Two review authors independently carried out trial selection. Disagreements were resolved by discussion. No studies (RCTs or Q-RCTs) met the inclusion criteria. Therefore, neither a meta-analysis nor a narrative description of studies was possible. There are currently no studies eligible for inclusion in this review. It is, therefore, unclear whether massage therapy can prevent pressure ulcers.

  11. Monitoring pressure ulcers in nursing homes.

    Science.gov (United States)

    Madsen, W; Leonard, M

    1997-12-01

    Clinical indicators may be used to monitor the quality of care delivery. Unfortunately, they are often viewed by nursing staff as unnecessary paper work. This study used Waterlow's Pressure Sore Risk Assessment Tool as the basis of a clinical indicator to monitor pressure ulcers within a nursing home. It was found that by closely monitoring the skin status of residents, preventative actions could be implemented, thereby minimizing the risk of pressure ulcer development. The advantage of utilizing such a tool is that it is seen to be clinically relevant for nursing staff while providing a bank of data for quality management.

  12. [Infected pressure ulcers: evaluation and management].

    Science.gov (United States)

    Iori, Ido; Pizzini, Attilia Maria; Arioli, Dimitriy; Favali, Davide; Leone, Maria Cristina

    2009-09-01

    Pressure ulcers in elderly individuals can cause significant morbidity and mortality and are a major economic burden to the health care system. Prevention should be the ultimate objective of pressure ulcer care, and it requires an understanding of the pathophysiology leading to pressure ulcers and the means of reducing both intrinsic and extrinsic risk factors. Clinical examination often underestimates the degree of deep-tissue involvement, and its findings are inadequate for the detection of associated osteomyelitis. Microbiological data, if obtained from deep-tissue biopsy, are useful for directing antimicrobial therapy, but they are insufficient as the sole criterion for the diagnosis of infection. Imaging studies, such as computed tomography and magnetic resonance imaging, are useful, but bone biopsy and histopathological evaluation remain the "gold standard" for the detection of osteomyelitis. The goals of treatment of pressure ulcers should be resolution of infection and promotion of wound healing. A combination of surgical debridement and medical interventions may be required. Systemic antimicrobial therapy should be used for patients with serious pressure ulcers infections, including those with spreading cellulitis, bacteremia or osteomyelitis.

  13. Medical device-related pressure ulcers

    Directory of Open Access Journals (Sweden)

    Black JM

    2016-08-01

    Full Text Available Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in patients of all ages. These pressure ulcers appear in the shape of the device and are most often found from the use of oxygen delivery devices. A hospital program designed to reduce the number of pressure ulcers from medical devices was successful. The program involved the development of a team that focused on skin, the results were then published for the staff to track their performance, and it was found that using foam dressings helped reduce the pressure from the device. The incidence of ulcers from medical devices has remained at zero at this hospital since this program was implemented. Keywords: pressure ulcer, medical device related

  14. Pressure ulcers in spinal cord injury patients in Gombe, Nigeria ...

    African Journals Online (AJOL)

    Pressure ulcers in spinal cord injury patients in Gombe, Nigeria. ... PROMOTING ACCESS TO AFRICAN RESEARCH. AFRICAN ... Key Words: Spinal cord injury, neurological impairment, pressure ulcer, prevention, pressure relieving devices

  15. A new pressure ulcer conceptual framework.

    Science.gov (United States)

    Coleman, Susanne; Nixon, Jane; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Farrin, Amanda; Dowding, Dawn; Schols, Jos M G A; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Schoonhoven, Lisette; Bader, Dan L; Gefen, Amit; Oomens, Cees W J; Nelson, E Andrea

    2014-10-01

    This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework. Discussion Paper. The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010-2011) and an international expert group meeting (conducted December 2011). A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally. By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research. © 2014 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  16. Experimental Investigation of the Unsteady Pressure Field in Decelerated Swirling Flow with 74° Sharp Heel Elbow

    Science.gov (United States)

    Moş, D. C.; Muntean, S.; Bosioc, A. I.; Tănasă, C.; Susan-Resiga, R.

    2017-04-01

    The unsteady pressure at the wall of the conical diffuser without and with a 74° heel elbow is examined. The self-induced instability is experimentally investigated on the swirl generator test rig. As a result, the asynchronous (rotating) pressure pulsation associated with the vortex rope and it second harmonic are discriminated. The discriminated Fourier spectra with plunging and rotating components of the unsteady pressure signals are analyzed for several geometrical configurations in order to identify the frequency associated to the heel elbow. It is shown that a plunging component of 8 Hz corresponds to a 74° heel elbow in the Fourier spectra.

  17. Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking.

    Science.gov (United States)

    Yung-Hui, Lee; Wei-Hsien, Hong

    2005-05-01

    Studying the impact of high-heeled shoes on kinetic changes and perceived discomfort provides a basis to advance the design and minimize the adverse effects on the human musculoskeletal system. Previous studies demonstrated the effects of inserts on kinetics and perceived comfort in flat or running shoes. No study attempted to investigate the effectiveness of inserts in high heel shoes. The purpose of this study was to determine whether increasing heel height and the use of shoe inserts change foot pressure distribution, impact force, and perceived comfort during walking. Ten healthy females volunteered for the study. The heel heights were 1.0cm (flat), 5.1cm (low), and 7.6cm (high). The heel height effects were examined across five shoe-insert conditions of shoe only; heel cup, arch support, metatarsal pad, and total contact insert (TCI). The results indicated that increasing heel height increases impact force (pshoes effectively reduced the heel pressure and impact force (pcomfort (pcomfort when compared to the non-insert condition.

  18. Pressure ulcers - what to ask your doctor

    Science.gov (United States)

    ... pressure ulcers or to help them heal? When lying in bed: What positions are best when lying down? What types of padding or cushioning should ... the first to achieve this important distinction for online health information and services. Learn more about A. ...

  19. Pressure ulcers presentations and management at Kenyatta ...

    African Journals Online (AJOL)

    Objective: To determine the presentation and management of patients with pressure ulcers. Design: A prospective study. Setting: The Kenyatta National Hospital (KNH) and National Spinal Injury Hospital (NSIH). Subjects: One hundred and thirteen patients were evaluated. Ninety six patients from KNH and seventeen from ...

  20. Infected pressure ulcers in elderly individuals.

    Science.gov (United States)

    Livesley, Nigel J; Chow, Anthony W

    2002-12-01

    Pressure ulcers in elderly individuals can cause significant morbidity and mortality and are a major economic burden to the health care system. Prevention should be the ultimate objective of pressure ulcer care, and it requires an understanding of the pathophysiology leading to pressure ulcers and the means of reducing both intrinsic and extrinsic risk factors. Clinical manifestations are protean, and early recognition requires a low threshold of suspicion. Clinical examination often underestimates the degree of deep-tissue involvement, and its findings are inadequate for the detection of associated osteomyelitis. Microbiological data, if obtained from deep-tissue biopsy, are useful for directing antimicrobial therapy, but they are insufficient as the sole criterion for the diagnosis of infection. Imaging studies, such as computed tomography and magnetic resonance imaging, are useful, but bone biopsy and histopathological evaluation remain the "gold standard" for the detection of osteomyelitis. The goals of treatment of pressure ulcers should be resolution of infection, promotion of wound healing, and establishment of effective infection control.

  1. Topical phenytoin for treating pressure ulcers.

    Science.gov (United States)

    Hao, Xiang Yong; Li, Hong Ling; Su, He; Cai, Hui; Guo, Tian Kang; Liu, Ruifeng; Jiang, Lei; Shen, Yan Fei

    2017-02-22

    Pressure ulcers are common in clinical practice and pose a significant health problem worldwide. Apart from causing suffering to patients, they also result in longer hospital stays and increase the cost of health care. A variety of methods are used for treating pressure ulcers, including pressure relief, patient repositioning, biophysical strategies, nutritional supplementation, debridement, topical negative pressure, and local treatments including dressings, ointments and creams such as bacitracin, silver sulphadiazine, neomycin, and phenytoin. Phenytoin is a drug more commonly used in the treatment of epilepsy, but may play an important role in accelerating ulcer healing. To assess the effects of topical phenytoin on the rate of healing of pressure ulcers of any grade, in any care setting. In September 2016, we searched the following electronic databases to identify relevant randomized clinical trials: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library); Ovid MEDLINE; Ovid Embase; and EBSCO CINAHL Plus. We handsearched conference proceedings from the European Pressure Ulcer Advisory Panel, European Wound Management Association and the Tissue Viability Society for all available years. We searched the references of the retrieved trials to identify further relevant trials. We also searched clinical trials registries to identify ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. We included all randomized controlled trials (RCTs) addressing the effects (both benefits and harms) of topical phenytoin on the healing of pressure ulcers of any grade compared with placebo or alternative treatments or no therapy, irrespective of blinding, language, and publication status. Two review authors independently selected studies, extracted information on participants, interventions, methods and results and assessed risk of bias using

  2. Pressure ulcers: understanding the challenges of promoting quality

    OpenAIRE

    Ousey, Karen

    2010-01-01

    Pressure ulcers affect quality of life and general wellbeing, and create significant difficulties for patients, their carers and families. Pressure ulcers are associated with morbidity and mortality, and prove costly for healthcare providers. This article identifies the Government’s quality agenda and the importance of maintaining, developing and delivering quality care for the prevention of pressure ulceration.

  3. Dynamic sitting to prevent pressure ulcers in spinal cord injured

    NARCIS (Netherlands)

    Reenalda, Jasper

    2009-01-01

    At present, clinical interventions and research efforts are not fully successful in defining the risk of pressure ulcer development and as such in eventually preventing pressure ulcers. As a result, the prevalence and incidence values of pressure ulcers remain unacceptably high. It is common sense

  4. Predictors of barefoot plantar pressure during walking in patients with diabetes, peripheral neuropathy and a history of ulceration.

    Directory of Open Access Journals (Sweden)

    Ruth Barn

    Full Text Available Elevated dynamic plantar foot pressures significantly increase the risk of foot ulceration in diabetes mellitus. The aim was to determine which factors predict plantar pressures in a population of diabetic patients who are at high-risk of foot ulceration.Patients with diabetes, peripheral neuropathy and a history of ulceration were eligible for inclusion in this cross sectional study. Demographic data, foot structure and function, and disease-related factors were recorded and used as potential predictor variables in the analyses. Barefoot peak pressures during walking were calculated for the heel, midfoot, forefoot, lesser toes, and hallux regions. Potential predictors were investigated using multivariate linear regression analyses. 167 participants with mean age of 63 years contributed 329 feet to the analyses.The regression models were able to predict between 6% (heel and 41% (midfoot of the variation in peak plantar pressures. The largest contributing factor in the heel model was glycosylated haemoglobin concentration, in the midfoot Charcot deformity, in the forefoot prominent metatarsal heads, in the lesser toes hammer toe deformity and in the hallux previous ulceration. Variables with local effects (e.g. foot deformity were stronger predictors of plantar pressure than global features (e.g. body mass, age, gender, or diabetes duration.The presence of local deformity was the largest contributing factor to barefoot dynamic plantar pressure in high-risk diabetic patients and should therefore be adequately managed to reduce plantar pressure and ulcer risk. However, a significant amount of variance is unexplained by the models, which advocates the quantitative measurement of plantar pressures in the clinical risk assessment of the patient.

  5. Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up

    Science.gov (United States)

    Fernando, Malindu E.; Crowther, Robert G.; Lazzarini, Peter A.; Yogakanthi, Saiumaeswar; Sangla, Kunwarjit S.; Buttner, Petra; Jones, Rhondda; Golledge, Jonathan

    2017-01-01

    Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls). Methods Standardised protocols were used to measure mean peak plantar pressure and pressure-time integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size. Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (pfoot (p = 0.04, d = 0.64) compared to controls throughout follow-up. A reduction in pressure-time integral at multiple plantar sites over time was detected in all participants (pdiabetes patients with chronic foot ulcers than controls at several plantar sites throughout prolonged follow-up. Long term offloading is needed in diabetes patients with diabetes-related foot ulcers to facilitate ulcer healing. PMID:28859075

  6. Pressure ulcer assessment instruments: a critical appraisal.

    Science.gov (United States)

    Woodbury, M G; Houghton, P E; Campbell, K E; Keast, D H

    1999-05-01

    Numerous evaluation tools have been developed to document various aspects of wound status or appearance of pressure ulcers. These include the Pressure Sore Status Tool (PSST), Pressure Ulcer Scale for Healing (PUSH Tool), Sussman Wound Healing Tool (SWHT), Sessing scale, and the Wound Healing Scale (WHS). A critical appraisal of the literature was undertaken to examine the purpose and methods for the development of each instrument, the extent to which the instruments have been validated to date, the practicality of their use, and the work that remains to be done to establish their suitability for clinical and/or research purposes. All of these instruments have been developed to describe and evaluate change in pressure ulcer status over time with the exception of the WHS, which was developed as an alternative to reverse staging. More of the validation parameters have been addressed for the PSST and the Sessing scale than for the PUSH Tool, the SWHT, and the WHS. All of the instruments can be completed within approximately 5 minutes except the PSST, which requires 10 to 15 minutes to complete. For all instruments, experience with wounds and training in the use of the instrument are required to improve reliability. For each of the measurement instruments, suggestions are made that would complete necessary validation procedures and thus prepare the instruments for clinical and/or research purposes.

  7. Anabolic steroids for treating pressure ulcers.

    Science.gov (United States)

    Naing, Cho; Whittaker, Maxine A

    2017-06-20

    Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers. Anabolic steroids are considered because of their ability to stimulate protein synthesis and build muscle mass. Comprehensive evidence is required to facilitate decision making, regarding the benefits and harms of using anabolic steroids. To assess the effects of anabolic steroids for treating pressure ulcers. In March 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Published or unpublished randomised controlled trials (RCTs) comparing the effects of anabolic steroids with alternative treatments or different types of anabolic steroids in the treatment of pressure ulcers. Two review authors independently carried out study selection, data extraction and risk of bias assessment. The review contains only one trial with a total of 212 participants, all with spinal cord injury and open pressure ulcers classed as stage III and IV. The participants were

  8. Foam dressings for treating pressure ulcers.

    Science.gov (United States)

    Walker, Rachel M; Gillespie, Brigid M; Thalib, Lukman; Higgins, Niall S; Whitty, Jennifer A

    2017-10-12

    Pressure ulcers, also known as pressure injuries and bed sores, are localised areas of injury to the skin or underlying tissues, or both. Dressings made from a variety of materials, including foam, are used to treat pressure ulcers. An evidence-based overview of dressings for pressure ulcers is needed to enable informed decision-making on dressing use. This review is part of a suite of Cochrane Reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type. To assess the clinical and cost effectiveness of foam wound dressings for healing pressure ulcers in people with an existing pressure ulcer in any care setting. In February 2017 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase; EBSCO CINAHL Plus and the NHS Economic Evaluation Database (NHS EED). We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. Published or unpublished randomised controlled trials (RCTs) and cluster-RCTs, that compared the clinical and cost effectiveness of foam wound dressings for healing pressure ulcers (Category/Stage II or above). Two review authors independently performed study selection, risk of bias and data extraction. A third reviewer resolved discrepancies between the review authors. We included nine trials with a total of 483 participants, all of whom were adults (59 years or older) with an existing pressure ulcer Category/Stage II or above. All trials had two arms, which compared foam dressings with other dressings for treating pressure ulcers.The certainty of evidence ranged from low to very low due

  9. Healing of elderly patients with diabetic foot ulcers, venous stasis ulcers, and pressure ulcers.

    Science.gov (United States)

    Brem, Harold; Tomic-Canic, Marjana; Tarnovskaya, Alina; Ehrlich, H Paul; Baskin-Bey, Edwina; Gill, Kiran; Carasa, Miriam; Weinberger, Sarah; Entero, Hyacinth; Vladeck, Bruce

    2003-01-01

    Although elderly patients have physiologic impairments in wound healing, their wounds should be expected to heal with the same frequency of closure as those in younger populations, albeit at a slower rate. However, compared to the general population, the elderly population has a higher incidence of chronic wounds: diabetic foot ulcers, pressure ulcers, and venous stasis ulcers. Experimental and clinical data indicate physiologically impaired healing is characterized by decreased angiogenesis and synthesis of critical growth factors. Further, compared to younger populations, the elderly have a higher rate of mortality associated with specific morbidities, such as sepsis and acute respiratory distress. As these morbidities may develop directly from the wound, early intervention is mandated. In this report, 40 consecutive elderly patients (65-102 years old) with chronic wounds were analyzed. All patients were provided the same treatment protocol and healing was defined as 100% epithelization and no drainage. Despite the wounds presenting in a nonhealing and/or infected state, 73% of these chronic wounds in elderly patients healed. This suggests that elderly patients with diabetic foot ulcers, pressure ulcers, and venous stasis ulcers close their wounds at a similar frequency as younger patients. Therefore, early intervention and comprehensive treatment that includes safe topical therapies, in addition to growth factors and cellular therapy used for chronic wounds, ensure these patients will be spared the morbidities of pain, amputation, osteomyelitis, and even death. We hypothesize that if all elderly patients with chronic wounds are provided early treatment, morbidities (e.g., amputation, sepsis, pain) and associated costs will decrease.

  10. [Microbiology of pressure and vascular ulcer infections].

    Science.gov (United States)

    Ortiz Balbuena, Jorge; García Madero, Rodrigo; Segovia Gómez, Teresa; Cantero Caballero, Miriea; Sánchez Romero, Isabel; Ramos Martínez, Antonio

    2015-01-01

    Pressure ulcer (PU) infection is a significant clinical problem in many elderly patients. To determine the microbiology of PU and vascular ulcer (VU) infections by conducting a cross-sectional study of outpatients treated in a chronic wounds unit over an 18 month period. Sixty six patients with PU infection and 159 patients with an infected VU were identified. The PUs were located below the knee in 36 patients (52%). Patients with pressure ulcers had a higher proportion of institutionalization, cognitive impairment, inability to walk, and sphincter incontinence. There was a greater number of infections caused by Enterobacteriaceae (52%, P=.002) and fewer S. aureus infections (24%, P<.001) in patients with a PU compared to those with those with a VU. Forty-one percent of S. aureus strains isolated in all the patients were resistant to methicillin (MRSA). The proportion of Enterobacteriaceae infections was similar in patients with infection of pelvic girdle PU and in those located below the knee. PU patients suffer a higher rate of infection by enterobacteria. The most common pathogen in UV infections is S. aureus. The proportion of MRSA infection in patients with chronic wounds is high. The microbiology of the infection in the pelvic girdle PU is similar to those located below the knee. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  11. Repositioning for pressure ulcer prevention in adults.

    Science.gov (United States)

    Gillespie, Brigid M; Chaboyer, Wendy P; McInnes, Elizabeth; Kent, Bridie; Whitty, Jennifer A; Thalib, Lukman

    2014-04-03

    A pressure ulcer (PU), also referred to as a 'pressure injury', 'pressure sore', or 'bedsore' is defined as an area of localised tissue damage that is caused by unrelieved pressure, friction or shearing forces on any part of the body. PUs commonly occur in patients who are elderly and less mobile, and carry significant human and economic impacts. Immobility and physical inactivity are considered to be major risk factors for PU development and the manual repositioning of patients in hospital or long-term care is a common pressure ulcer prevention strategy. The objectives of this review were to:1) assess the effects of repositioning on the prevention of PUs in adults, regardless of risk or in-patient setting;2) ascertain the most effective repositioning schedules for preventing PUs in adults; and3) ascertain the incremental resource consequences and costs associated with implementing different repositioning regimens compared with alternate schedules or standard practice. We searched the following electronic databases to identify reports of the relevant randomised controlled trials: the Cochrane Wounds Group Specialised Register (searched 06 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 8); Ovid MEDLINE (1948 to August, Week 4, 2013); Ovid EMBASE (1974 to 2013, Week 35); EBESCO CINAHL (1982 to 30 August 2013); and the reference sections of studies that were included in the review. Randomised controlled trials (RCTs), published or unpublished, that assessed the effects of any repositioning schedule or different patient positions and measured PU incidence in adults in any setting. Two review authors independently performed study selection, risk of bias assessment and data extraction. We included three RCTs and one economic study representing a total of 502 randomised participants from acute and long-term care settings. Two trials compared the 30º and 90º tilt positions using similar repositioning frequencies (there was a

  12. Clinical use of interface pressure to predict pressure ulcer development: A systematic review

    NARCIS (Netherlands)

    Reenalda, Jasper; Jannink, M.J.A.; Nederhand, Marcus Johannes; IJzerman, Maarten Joost

    2009-01-01

    Pressure ulcers are a large problem in subjects who use a wheelchair for their mobility. These ulcers originate beneath the bony prominences of the pelvis and progress outward as a consequence of prolonged pressure. Interface pressure is used clinically to predict and prevent pressure ulcers.

  13. Pressure ulcer prevention is everyone's business: the PUPS project.

    Science.gov (United States)

    Blenman, Juliet; Marks-Maran, Di

    2017-03-23

    Prevention of pressure ulcers is one of the greatest healthcare challenges in terms of reducing patient harm. The literature shows that although numerous reports and policy documents have been published, pressure ulcer prevention remains an ongoing challenge. A number of innovations have been published offering practising nurses and managers ideas for raising awareness of skin care and preventing pressure ulcers. The majority of these have focused on patients in hospital settings with very little in the literature related to care-home and community initiatives. This article reports on an innovative approach to education for pressure ulcer prevention through collaboration between patients, carers and health and social care professionals.

  14. A sore spot in pediatrics: risk factors for pressure ulcers.

    Science.gov (United States)

    Samaniego, Irma A

    2003-01-01

    A retrospective, exploratory study was conducted as part of a performance improvement project examining pressure ulcer development in children. In 1 year, 69 children visited the hospital's wound clinic: 50 children had pressure ulcers, and 19 children had skin breakdown secondary to delayed operative wound healing. This article reviews findings from the 50 children with pressure ulcers. The primary diagnosis was myelodysplasia. Risk factors identified included (a) paralysis, (b) insensate areas, (c) high activity, and (d) immobility. The majority of the pressure ulcers occurred in the lower extremities, primarily the feet. As children get older or neurological condition deteriorates, sacral ulcers are seen particularly among wheelchair users. Pressure ulcers occur predominantly in the child's home environment.

  15. Pressure ulcers presentations and management at Kenyatta ...

    African Journals Online (AJOL)

    Most of the ulcers were located along bony prominence points of the pelvic girdle and the proximal femur. Most of the ulcers in this study were treated conservatively, with only a few ulcers subjected to surgical interventions. For the ulcers treated with surgical interventions the early outcome was good, however studies need ...

  16. Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis.

    Science.gov (United States)

    Worsley, Peter R; Smith, Glenn; Schoonhoven, Lisette; Bader, Dan L

    2016-07-01

    The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. Demographic and pressure ulcer related data were collected from patients at risk of developing a pressure ulcer, collated by a single observer using a standardized tool. Comparisons were made within and between patient groups (no PU, CAPU and HAPU). CAPU and HAPU patient groups were significantly (P < 0·001) older, had extended lengths of hospital stay and were less likely to be provided quickly with a pressure relieving support surface than those with no PU. HAPU patients had a longer length of stay and a higher proportion of heel PUs compared to CAPU.

  17. Establishing Baseline Data for Pressure Ulcers in a Rwandan ...

    African Journals Online (AJOL)

    The objective of this study was to establish baseline data and compare prevalence, incidence, and severity of pressure ulcers in this ICU before and after educational classes. Methods. Educational classes on pressure ulcer assessment and classification were held for all ICU nurses. After train- ing, data collection was ...

  18. PRESSURE ULCERS AND THEIR IMPACT ON QUALITY OF LIFE

    OpenAIRE

    Gordana Repić; Sunčica Ivanović

    2014-01-01

    Pressure ulcers are one of most dominant problems that occur in patients with mobility limitations. Such wounds can produce pain and deteriorate the underlying condition. Sometimes, they can be even vitally threatening, and their treatment can impose financial burden for both patient’s family and society. Pressure ulcers are the consequence of a prolonged pressure on the skin above bone prominiscences, and its location depends on patient's position (lying, sitting). The impact of pressure ulc...

  19. Nurses' attitudes towards pressure ulcer prevention in Turkey.

    Science.gov (United States)

    Aslan, Arzu; Yavuz van Giersbergen, Meryem

    2016-02-01

    Pressure ulcers remain a major problem in healthcare system. Pressure ulcer incidence is widely accepted as an indicator for the quality of care. Positive attitudes towards pressure ulcer prevention have positive impacts on preventive care. The aim of this study was to identify nurses' attitude towards pressure ulcer prevention. The study design was descriptive. The study was carried out in a university hospital in Izmir, Turkey. The study population consisted of 660 nurses who work in medical and surgical clinics and intensive care units. The study sample consisted of 426 nurses who agreed to participate. Attitude towards Pressure Ulcer Prevention Instrument was used in order to evaluate nurses' attitudes. Written permissions for ethical considerations and Attitude towards Pressure Ulcer Prevention Instrument permission were obtained. Data were collected between June and July 2014. The statistics program SPSS 18 packaged software was used in the analyses of data. The average age of the nurses who took part in the study was 31.86 ± 7.09 years and the average work experience was 8.88 ± 7.41 years; 36.9% (n: 157) were working in intensive care units. The nurses' average score on the Attitude towards Pressure Ulcer Prevention Instrument was 43.74 ± 4.29 (84.12%). It was seen that the attitudes of the nurses towards the prevention of pressure ulcers was positive. To read guidelines and training time about pressure ulcer prevention affect positively attitudes towards the prevention of pressure ulcers. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  20. The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units.

    Science.gov (United States)

    Li, Dan

    2016-08-01

    To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. A retrospective, comparative, descriptive, correlational study. A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete

  1. Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus.

    Science.gov (United States)

    Hsi, Wei-Li

    2016-03-01

    After initial heel contact, the rearfoot everts and causes medial deviation of the center of pressure (CoP). Although rearfoot angle in single-limb stance has been associated with forefoot varus (FV) ≥ 8°, medial CoP deviation has not. After 12 participants with FV 0 kPa as when it had the most medial CoP, the medial deviations of the CoP of the array, the most medial CoP of the row, and its relative position in the row (CoP%), were compared between neutral and FV groups. The medial deviations of the most medial CoP of the row (1.1 ± 0.6 vs. 1.6 ± 0.3 mm, p = 0.049) and CoP% (2.9 ± 1.4 vs. 4.2 ± 1.1%, p = 0.023) were significantly different between neutral and FV groups, whereas that of the CoP of the array (1.1 ± 0.6 vs. 1.4 ± 0.6 mm, p = 0.36) was not. The most medial CoP of the row and CoP% detected increased medial CoP deviation in FV ≥ 8°, and may be applied to other clinical conditions where rearfoot angle and CoP of the array after initial heel contact cannot detect significant differences. Copyright © 2015. Published by Elsevier B.V.

  2. [Morphological investigations of deep sole ulcers in cattle. Part 2: Toe ulcers, white line disease in the heel and changes due to inappropriate weight bearing and deficient claw care].

    Science.gov (United States)

    Gehringer, Susanne; Müller, Matthias; Maierl, Johann

    2017-04-19

    To demonstrate the morphology of pathological changes to the inner structures of the claw in cases of toe ulcers, white line disease in the heel and changes due to inappropriate weight bearing and deficient claw care. Hind limbs of 55 cows displaying external signs of complicated sole ulcers were examined externally and internally. To examine the samples internally, a sagittal section was performed. Furthermore, the material was examined after bone maceration and histologically. A total of 43 claws of 112 digits with 120 deep sole ulcers displayed a toe ulcer and in 18 claws white line disease was diagnosed. In animals with toe ulcers, necrosis of the pedal bone was found in severely altered claws. In cows with white line disease, osteolysis in the abaxial region of the margo solearis and arthritis in the distal interphalangeal joint were the most common pathological findings. Claws with deficient claw care displayed severe pathological changes to the pedal bone. Sole ulcers may rapidly cause serious and irreversible changes to the structures encased within the hoof capsule and consequently have an impact on animal welfare. Therefore, prophylaxis and functional claw care are essential measures to avoid pathological conditions in claws and to improve animal welfare.

  3. Effectiveness of a honey dressing for healing pressure ulcers.

    Science.gov (United States)

    Yapucu Güneş, Ulkü; Eşer, Ismet

    2007-01-01

    To compare the effect of a honey dressing vs an ethoxy-diaminoacridine plus nitrofurazone dressing in patients with pressure ulcers. This 5-week randomized clinical trial evaluated the effect of a honey dressing on pressure ulcer healing. Thirty-six patients with a total of 68 stage II or III pressure ulcers referred from a university hospital in Izmir were enrolled in the study. Twenty-six subjects completed the trial. Ulcers were measured with acetate tracings and Pressure Ulcer Scale for Healing (PUSH) evaluations. Fifteen patients with 25 pressure ulcers were treated with honey dressings, and 11 patients with 25 pressure ulcers were treated with ethoxy-diaminoacridine plus nitrofurazone dressings. Wound healing was assessed weekly using the PUSH tool, version 3.0. The primary outcome measure was the change in PUSH tool scores in each group at 5 weeks. The two groups were statistically similar with regard to baseline and wound characteristics. After 5 weeks of treatment, patients who were treated by honey dressing had significantly better PUSH tool scores than subjects treated with the ethoxy-diaminoacridine plus nitrofurazone dressing (6.55 +/- 2.14 vs 12.62 +/- 2.15, P honey dressing was approximately 4 times the rate of healing in the comparison group. The use of a honey dressing is effective and practical.

  4. PRESSURE ULCERS AND THEIR IMPACT ON QUALITY OF LIFE

    Directory of Open Access Journals (Sweden)

    Gordana Repić

    2014-12-01

    Full Text Available Pressure ulcers are one of most dominant problems that occur in patients with mobility limitations. Such wounds can produce pain and deteriorate the underlying condition. Sometimes, they can be even vitally threatening, and their treatment can impose financial burden for both patient’s family and society. Pressure ulcers are the consequence of a prolonged pressure on the skin above bone prominiscences, and its location depends on patient's position (lying, sitting. The impact of pressure ulcers on the quality of life is significant, considering their influence on physical, psycological, emotional, spiritual, social and financial dimension of life. Health care professionals involved in pressure ulcers treatment and care at all levels have to recognize the impact of this problem on patient’s quality of life. The impact is significant, long-term and it depents on patient's individual characteristics. Therefore, treatment and care should be tailor-made for each patient.

  5. Pressure ulcer prevention in homecare: do Dutch homecare agencies have an evidence-based pressure ulcer protocol?

    Science.gov (United States)

    Chaves, Lidice M; Grypdonck, Mieke H F; Defloor, Tom

    2006-01-01

    The purpose of this study was to gain insight into the availability and quality of protocols for pressure ulcer prevention in homecare agencies in the Netherlands. A descriptive study was completed. Forty-one homecare agencies in the Netherlands that provide nursing care were queried. Three instruments were used to collect data: (1) a structured questionnaire containing 46 closed and open-ended questions, (2) a checklist used by experts to analyze the protocols for conformity to guidelines, and (3) a tool used to generate a numerical score for each protocol based on the experts' reviews. A questionnaire was mailed to all homecare agencies in the Netherlands that provided nursing care. The quality of each protocol was judged and scored by 3 pressure ulcer prevention experts. The scores were analyzed using descriptive statistics. A pressure ulcer protocol was available in 78% of the agencies. Seventy-five percent had at least 1 wound care nurse who spent an average of 10 hours per week on pressure ulcer prevention. In 20% of the agencies, no introduction or instruction was given to the nurses when the protocol was implemented. In 25% of the agencies, nurses did not participate in the revision of the protocol. At the end of 2003, only 13% of the agencies had executed 1 or more revisions of their protocol since 2002, when the last Dutch pressure ulcer guideline was introduced. The 26 pressure ulcer prevention protocols had a mean score of 47 points out of a maximum of 100 points (range 9 to 82; SD, 18). Although the use of protocols is considered an important adjunct in the prevention of pressure ulcers, 22% of the participating agencies did not have a pressure ulcer prevention protocol and 25% did not have wound care nurses, indicating a need for further promotion of standardized pressure ulcer prevention strategies. In addition, the available protocols were frequently of low quality or outdated, reflecting a need for increased attention to current and accurate tools

  6. Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey.

    Science.gov (United States)

    Lachenbruch, Charlie; Ribble, David; Emmons, Kirsten; VanGilder, Catherine

    2016-01-01

    To measure the prevalence of incontinence in the 2013-2014 International Pressure Ulcer Prevalence (IPUP) surveys and determine the relative risk of developing a facility-acquired pressure ulcers (FAPUs) by stage and by Braden Scale score groupings. The IPUP survey is an observational, cross-sectional cohort database designed to determine the frequency and severity of pressure ulcers in various populations. The survey includes acute care (91.4%), long-term acute care (1.7%), rehabilitation patients (1.7%) and long-term care residents (5.2%). Geographic distribution included 182,832 patients in the United States, 22,282 patients in Canada, and the rest of the world, primarily in Europe and the Middle East. We analyzed data from the 2013 and 2014 IPUP surveys to better understand the relationship between incontinence and the frequency and severity of FAPUs. The IPUP survey is an annual voluntary survey of patients who are hospitalized or who reside in long-term care facilities. Data were collected over a 24-hour period within each participating facility. Data collection included limited demographics, presence and stage of pressure ulcers, and pressure ulcer risk assessment score (Braden Scale for Pressure Sore Risk, Braden Q, Norton, Waterlow, and others). In addition, data were collected on pertinent pressure ulcer risk factors including the number of linen layers, use of a pressure redistributing surface, adherence to repositioning schedule, and whether moisture management was provided in the last 24 hours. We aggregated data by urinary, urinary catheter, fecal, fecal management system, double (urinary and fecal), and ostomy incontinence category. If patients were managed by indwelling urinary catheter or fecal management systems, they were considered incontinent in this analysis. In order to analyze ulcers likely to be affected by incontinence, we defined a subset of ulcers as Relevant Pressure Ulcers, which are ulcers that are facility-acquired, non

  7. Evaluation of skin perfusion pressure to assess refractory foot ulcers.

    Science.gov (United States)

    Kawai, M; Mihara, S; Takahagi, S; Iwamoto, K; Hiragun, T; Hide, M

    2017-05-02

    The number of patients with foot gangrene caused by critical ischaemia and severe infection is increasing significantly in developed countries. The measurement of perilesional skin blood flow by skin perfusion pressure (SPP) is useful to select the appropriate treatment of gangrenous lesions, in that it is not affected by calcifications of blood vessels. However, the prognosis of a foot ulcer may also be affected by the level of blood sugar and infections. This study aimed to validate the use of SPP in cases of foot gangrene and ulcers in patients with and without diabetes mellitus (DM) and infection. Clinical symptoms, ankle-brachial pressure index (ABPI) and SPP were assessed to evaluate the condition of each foot ulcer. Every foot ulcer was treated as independent, even if a participant had multiple ulcers. All ulcers for which we measured SPP were subject to the analysis. All ulcers were purely ischaemic in nature and were exclusively located on the foot or toes. Data were collected from 117 foot ulcers on 91 toes and feet from 65 patients. Almost all SPP values in healed cases were > 27 mmHg. There were three patients whose ulcers failed to heal by conservative treatments were complicated with severe infection. However, no effect of DM on the relationship between SPP values and prognosis was observed. Logistic regression analysis of all ulcers except for the 5 cases complicated with infection revealed that those with 30 mmHg or lower SPP values are likely to heal by conservative treatment with 23% or lower probability, whereas any ulcer with more than 50 mmHg SPP value and without severe infection may heal without the need for further operations with 80% or higher probability. The combination of SPP and careful evaluation of infection may be a good parameter to decide the appropriate treatment for ischaemic skin ulcers, regardless of the complication of DM.

  8. Patient risk factors for pressure ulcer development: Systematic review

    NARCIS (Netherlands)

    Coleman, S.; Gorecki, C.; Nelson, E.A.; Closs, S.J.; Defloor, T.; Halfens, R.; Farrin, A.; Brown, J.; Schoonhoven, L.; Nixon, J.

    2013-01-01

    OBJECTIVE: To identify risk factors independently predictive of pressure ulcer development in adult patient populations? DESIGN: A systematic review of primary research was undertaken, based upon methods recommended for effectiveness questions but adapted to identify observational risk factor

  9. Pressure ulcer prevention and treatment: use of prophylactic dressings

    OpenAIRE

    Reid K; Ayello EA; Alavi A

    2016-01-01

    Kathleen Reid,1 Elizabeth A Ayello,2 Afsaneh Alavi,3 1Department of Nursing Practice and Education, Bridgepoint Active Healthcare, Toronto, Canada; 2School of Nursing, Excelsior College, Albany, NY, USA; 3Department of Medicine, University of Toronto, Toronto, Canada Abstract: The management of pressure ulcers is challenging for health care providers across disciplines. Pressure ulcers have significant impact on emotional and physical wellbeing, quality of life, and health care cost...

  10. Pressure ulcers: Current understanding and newer modalities of treatment

    Science.gov (United States)

    Bhattacharya, Surajit; Mishra, R. K.

    2015-01-01

    This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient's quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described. PMID:25991879

  11. Pressure ulcers: Current understanding and newer modalities of treatment

    Directory of Open Access Journals (Sweden)

    Surajit Bhattacharya

    2015-01-01

    Full Text Available This article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient′s quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

  12. Diabetic foot disease: impact of ulcer location on ulcer healing

    DEFF Research Database (Denmark)

    Pickwell, KM; Siersma, Volkert Dirk; Kars, M

    2013-01-01

    Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.......Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing....

  13. Pressure ulcer prevention and treatment: use of prophylactic dressings

    Directory of Open Access Journals (Sweden)

    Reid K

    2016-10-01

    Full Text Available Kathleen Reid,1 Elizabeth A Ayello,2 Afsaneh Alavi,3 1Department of Nursing Practice and Education, Bridgepoint Active Healthcare, Toronto, Canada; 2School of Nursing, Excelsior College, Albany, NY, USA; 3Department of Medicine, University of Toronto, Toronto, Canada Abstract: The management of pressure ulcers is challenging for health care providers across disciplines. Pressure ulcers have significant impact on emotional and physical wellbeing, quality of life, and health care costs. The use of wound dressings could be an important and cost-effective strategy in preventing pressure ulcers. The main types of dressings that are examined for this purpose in the literature are foam, hydrocolloid, and films. Some small studies have shown a preventative role for sacral dressings with low-shear backings, though they raise concerns about over-hydration of the skin. Further research demonstrates the application of barrier films over bony prominences to have a prophylactic effect; however, adhesive dressings can also contribute to shearing forces on the skin. There is a vast body of research that examines the use of dressings to prevent pressure ulcers; however, there is limited high-level evidence, such as randomized control trials. A 2013 Cochrane review indicated that there is a paucity of high-level evidence to support the prophylactic use of dressings to prevent pressure ulcers; this paper will examine the emerging literature and consider its relevance to pressure ulcer prevention protocols. Keywords: quality of life, hydrocolloid dressing, topical agent

  14. Do pressure ulcer risk assessment scales improve clinical practice?

    Directory of Open Access Journals (Sweden)

    Jan Kottner

    2010-07-01

    Full Text Available Jan Kottner1, Katrin Balzer21Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany; 2Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, GermanyAbstract: Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.Keywords: Braden pressure ulcer, prevention, risk assessment, nursing assessment, predictive value, clinical effectiveness, review

  15. Preventing Pressure Ulcers: A Multisite Randomized Controlled Trial in Nursing Homes.

    Science.gov (United States)

    Bergstrom, Nancy; Horn, Susan D; Rapp, Mary; Stern, Anita; Barrett, Ryan; Watkiss, Michael; Krahn, Murray

    2014-01-01

    Pressure at the interface between bony prominences and support surfaces, sufficient to occlude or reduce blood flow, is thought to cause pressure ulcers (PrUs). Pressure ulcers are prevented by providing support surfaces that redistribute pressure and by turning residents to reduce length of exposure. We aim to determine optimal frequency of repositioning in long-term care (LTC) facilities of residents at risk for PrUs who are cared for on high-density foam mattresses. We recruited residents from 20 United States and 7 Canadian LTC facilities. Participants were randomly allocated to 1 of 3 turning schedules (2-, 3-, or 4-hour intervals). The study continued for 3 weeks with weekly risk and skin assessment completed by assessors blinded to group allocation. The primary outcome measure was PrU on the coccyx or sacrum, greater trochanter, or heels. Participants were mostly female (731/942, 77.6%) and white (758/942, 80.5%), and had a mean age of 85.1 (standard deviation [SD] ± 7.66) years. The most common comorbidities were cardiovascular disease (713/942, 75.7%) and dementia (672/942, 71.3%). Nineteen of 942 (2.02%) participants developed one superficial Stage 1 (n = 1) or Stage 2 (n = 19) ulcer; no full-thickness ulcers developed. Overall, there was no significant difference in PrU incidence (P = 0.68) between groups (2-hour, 8/321 [2.49%] ulcers/group; 3-hour, 2/326 [0.61%]; 4-hour, 9/295 [3.05%]. Pressure ulcers among high-risk (6/325, 1.85%) versus moderate-risk (13/617, 2.11%) participants were not significantly different (P = 0.79), nor was there a difference between moderate-risk (P = 0.68) or high-risk allocation groups (P = 0.90). Results support turning moderate- and high-risk residents at intervals of 2, 3, or 4 hours when they are cared for on high-density foam replacement mattresses. Turning at 3-hour and at 4-hour intervals is no worse than the current practice of turning every 2 hours. Less frequent turning might increase sleep, improve quality of

  16. Nutritional interventions for preventing and treating pressure ulcers.

    Science.gov (United States)

    Langer, G; Schloemer, G; Knerr, A; Kuss, O; Behrens, J

    2003-01-01

    Pressure ulcers affect 10% of people in hospitals and older people are at highest risk. The correlation between nutritional intake and the development of pressure ulcers is suggested by several studies, but the results are inconsistent. To evaluate the effectiveness of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers. The Cochrane Wounds Group Specialised Trials Register and the Cochrane Central register of Controlled Trials were searched in September 2002. An additional search of PubMed and Cinahl and hand search of conference proceedings and journals was performed, bibliographies of relevant articles were examined and experts in the field as well as manufacturers were contacted in order to find additional literature that may be relevant. Randomised controlled trials evaluating the effectiveness of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers by measuring the incidence of new ulcers, ulcer healing or changes in pressure ulcer severity. There were no restrictions on patients, setting, date, publication status or language. Abstracts were independently inspected and full articles were obtained of potentially relevant studies. In case of disagreement advice was sought from a third person (AK). Data extraction and assessment of quality were undertaken by the three reviewers independently. Only 8 randomised controlled trials out of 16 potentially relevant articles were included. However, most of the 8 trials included are small and of poor methodological quality. Four studies compared a combination of nutritional supplements, consisting of a minimum of energy and protein in different dosages, for the prevention of pressure ulcers. The largest study found that nutritional supplements reduced the number of new pressure ulcers (Bourdel-M 2000). The three smaller studies lacked power. Four studies evaluated the effects of nutritional supplements for the treatment of existing pressure ulcers: one trial

  17. [Innovation in pressure ulcer care: application of electrotherapy].

    Science.gov (United States)

    Navarro Susana Postigo; Puerta Francisco Rivera

    2013-02-01

    Nowadays, pressure ulcers are a mayor health problem with serious consequences for the patient, directly influence by the increase of morbid-mortality and the detriment of the quality of life. Today we know that the best care for pressure ulcers is the prevention and every effort must be oriented in this direction, specially when it is estimated that almost the 95% of the pressure ulcers are preventable and a 60% of the occasions are initiated and developed in hospital. The study's objective is to promote healing of ulcers with a joint technical nursing care and the application of electric current by physiotherapist. This is a descriptive research design and intervention. The sample is composed grade IV ulcer patients who are admitted to the high level of nursing care unit in Complejo Asistencial Benito Menni (Ciempozuelos-Madrid). These patients have different associated pathologies and the study shows the process from the beginning of the ulcer until the end of treatment. The most relevant results show that the application of electric currents favors nursing techniques, promoting a better and faster cleaning, vascularization and subsequent the healing of ulcers.

  18. Heel Pain

    Science.gov (United States)

    ... improperly fitted or excessively worn shoes, or obesity. Plantar Fasciitis: Both heel pain and heel spurs are frequently associated with plantar fasciitis, an inflammation of the band of fibrous connective ...

  19. Pressure relieving interventions for preventing and treating diabetic foot ulcers.

    Science.gov (United States)

    Spencer, S

    2000-01-01

    Foot ulceration is thought to affect 15% of all people with diabetes at some time during their life. To assess the effectiveness of pressure relieving interventions in the prevention and treatment of diabetic foot ulcers. Searches of 19 databases, hand searching of journals, bibliographies and identification of unpublished work by written communication with recognised experts in the diabetic foot. Randomised controlled trials evaluating pressure relieving interventions either in the prevention or the treatment of diabetic foot ulcers. There was no restriction on articles/trials based on language or publication status. Data extraction and assessment of study quality was undertaken by two reviewers independently. Each trial was analysed separately, no pooling of results was possible due to the difference in patients, comparisons and outcomes. Prevention 4 RCTs of pressure relieving interventions were identified. Interventions for the prevention of diabetic foot ulcers indicated that in-shoe orthotics are of benefit. The relative merits of different in-shoe orthotics are unclear; cushioning and pressure redistribution appear of equal benefit. Other pressure relieving interventions such as running shoes have not been adequately evaluated and removable casts (Scotchcast or Hope) or foam inlays do not appear to have been evaluated at all in randomised controlled studies. Treatment 1 RCT of total contact casting indicated that it was effective in the treatment of diabetic ulcers although the evidence was limited. Prevention There is limited evidence of the effectiveness of orthotic interventions over removal of callus. There is some evidence evaluating the relative effectiveness of two types orthotic devices. There is very limited evidence of the effectiveness of therapeutic shoes. Treatment There is very limited evidence of the effectiveness of total contact casts in the treatment of diabetic foot ulcers. Overall there is a need to measure the effectiveness of the range

  20. Monitoring pressure ulcer healing in persons with disabilities.

    Science.gov (United States)

    Mullins, Maria; Thomason, Susan S; Legro, Maria

    2005-01-01

    Pressure ulcers are a high-risk, high-volume, and high-cost problem for persons with disabilities. This article describes four tools published in the literature and reports the validity, reliability, strengths, and limitations of each. These tools include the Pressure Ulcer Scale for Healing (PUSH), the Pressure Sore Status Tool (PSST), the Sussman Wound Healing Tool (SWHT), and the Sessing Scale. Rehabilitation nurses should use a consistent framework with accurate quantification to assess, document, and monitor changes in pressure ulcers over time. Such a measurement tool must prove valid for the disabled population in which the tool is used. This will enable healthcare providers to communicate more effectively and evaluate the therapeutic plan of care.

  1. Exploring factors associated with pressure ulcers: a data mining approach.

    Science.gov (United States)

    Raju, Dheeraj; Su, Xiaogang; Patrician, Patricia A; Loan, Lori A; McCarthy, Mary S

    2015-01-01

    Pressure ulcers are associated with a nearly three-fold increase in in-hospital mortality. It is essential to investigate how other factors besides the Braden scale could enhance the prediction of pressure ulcers. Data mining modeling techniques can be beneficial to conduct this type of analysis. Data mining techniques have been applied extensively in health care, but are not widely used in nursing research. To remedy this methodological gap, this paper will review, explain, and compare several data mining models to examine patient level factors associated with pressure ulcers based on a four year study from military hospitals in the United States. The variables included in the analysis are easily accessible demographic information and medical measurements. Logistic regression, decision trees, random forests, and multivariate adaptive regression splines were compared based on their performance and interpretability. The random forests model had the highest accuracy (C-statistic) with the following variables, in order of importance, ranked highest in predicting pressure ulcers: days in the hospital, serum albumin, age, blood urea nitrogen, and total Braden score. Data mining, particularly, random forests are useful in predictive modeling. It is important for hospitals and health care systems to use their own data over time for pressure ulcer risk prediction, to develop risk models based upon more than the total Braden score, and specific to their patient population. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Pressure Relief Behaviors and Weight Shifting Activities to Prevent Pressure Ulcers in Persons with SCI

    Science.gov (United States)

    2016-10-01

    15. SUBJECT TERMS Pressure ulcer; spinal cord injury, wheelchair seating 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF...8 Inventions , patent applications, and/or licenses...relationship between activities that redistribute weight on the buttocks and the occurrence of pressure ulcers. 2. Keywords Wheelchair , wheelchair

  3. Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs.

    Science.gov (United States)

    Defloor, Tom; Schoonhoven, Lisette

    2004-11-01

    Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested. The purpose of this paper is to examine the inter-rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs. Survey was among pressure ulcer experts. Fifty-six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter-rater reliability was calculated. The multirater-Kappa for the entire group of experts was 0.80 (P < 0.001). Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers). The inter-rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear. The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer

  4. [Nursing diagnoses for patients at risk of developing pressure ulcer].

    Science.gov (United States)

    de Araújo, Thiago Moura; de Araújo, Márcio Flávio Moura; Caetano, Joselany Áfio; Galvão, Marli Teresinha Gimenez; Damasceno, Marta Maria Coelho

    2011-01-01

    This cross-sectional study aimed to identify nursing diagnoses in critical patients at risk of developing pressure ulcer. It was carried out at an Intensive Care Unit in Fortaleza-CE, Brazil, using an intentional sample of thirteen subjects at risk of pressure ulcer, evaluated according to the Waterlow scale. In total, 45 nursing diagnoses were evidenced, seventeen of which were clinically significant for the development of pressure ulcer. The frequency levels for nine of these nursing diagnoses were ≥ 80%, mainly: Impaired skin integrity (100%), Impaired walking (87%), Impaired swallowing (80%), Impaired bed mobility (80%) and Impaired gas exchange (80%). The knowledge of those nursing diagnoses is important in detecting the effects and clinical basis of skin lesions.

  5. Development of the nursing diagnosis risk for pressure ulcer

    Directory of Open Access Journals (Sweden)

    Cássia Teixeira dos Santos

    Full Text Available OBJECTIVE: The study objective was to develop the definition and compile the risk factors for a new Nursing Diagnosis entitled "Risk for pressure ulcer". The process was guided using the research question, "What are the risk factors for development of a PU and what is its definition?" METHOD: An integrative literature review was conducted of articles published in Portuguese, English or Spanish from 2002 to 2012 and indexed on the Lilacs/SCIELO, MEDLINE/PubMed Central and Web of Science databases. The final sample comprised 21 articles that provided answers to the research question. These articles were analyzed and summarized in charts. RESULTS: A definition was constructed and 19 risk factors were selected for the new nursing diagnosis, "Risk for pressure ulcer". CONCLUSIONS: Identification and definition of the components of the new nursing diagnosis should aid nurses to prevent pressure ulcer events.

  6. Documentation and record-keeping in pressure ulcer management.

    Science.gov (United States)

    Chamanga, Edwin; Ward, Renee

    2015-05-06

    National and international guidelines recommend the use of clinical assessments and interventions to prevent pressure-related skin damage. This includes the categorisation of pressure ulcers as avoidable or unavoidable, which is challenging in clinical practice, mainly because of poor documentation and record-keeping for care delivered. Documentation and record-keeping are influenced by the individual's employing organisation, maintenance procedures for documentation and record-keeping, and local auditing processes. A transfer sticker to enable patient assessment and promote pressure ulcer documentation was designed and implemented. The transfer sticker captures the date, time and location of a pressure ulcer preventive risk assessment and the plan of care to be implemented. The increased clarity of record of care achieved by using the transfer sticker has enabled the number of avoidable hospital-acquired pressure ulcers resulting from poor documentation on admission or ward transfers to be reduced. The transfer sticker helps staff identify patients at risk and allows interventions to be implemented in a timely manner.

  7. Costh-effectiveness of a pressure ulcer quality collaborative

    NARCIS (Netherlands)

    P. Makai (Peter); M.A. Koopmanschap (Marc); R.A. Bal (Roland); A.P. Nieboer (Anna)

    2010-01-01

    textabstractABSTRACT. BACKGROUND: A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of

  8. Chitosan Gel to Treat Pressure Ulcers: A Clinical Pilot Study

    Directory of Open Access Journals (Sweden)

    Virginia Campani

    2018-01-01

    Full Text Available Chitosan is biopolymer with promising properties in wound healing. Chronic wounds represent a significant burden to both the patient and the medical system. Among chronic wounds, pressure ulcers are one of the most common types of complex wound. The efficacy and the tolerability of chitosan gel formulation, prepared into the hospital pharmacy, in the treatment of pressure ulcers of moderate severity were evaluated. The endpoint of this phase II study was the reduction of the area of the lesion by at least 20% after four weeks of treatment. Thus, 20 adult volunteers with pressure ulcers within predetermined parameters were involved in a 30 days study. Dressing change was performed twice a week at outpatient clinic upon chronic wounds management. In the 90% of patients involved in the study, the treatment was effective, with a reduction of the area of the lesion and wound healing progress. The study demonstrated the efficacy of the gel formulation for treatment of pressure ulcers, also providing a strong reduction of patient management costs.

  9. Nutritional intervention in pressure ulcer guidelines: an inventory.

    NARCIS (Netherlands)

    Schols, J.M.G.A.; Jager van der Ende, M.A. de

    2004-01-01

    Nutritional data from the literature and the high prevalence of malnutrition in patients at risk of pressure ulcers (PUs) or with established PU mandate structural nutritional actions in these patients. Guidelines can help to improve nutritional alertness in professionals and promote structural

  10. Pressure Ulcer or Decubitus : clinical and etiological aspects

    NARCIS (Netherlands)

    Houwing, R.H.

    2007-01-01

    Pressure ulcers (PU), also called bedsores or decubitus, present a significant problem in healthcare. This thesis addresses some aspects of the aetiology of PU. The possible benefit of interventions with nutrional supplementation and the use of a risk assessment tool are evaluated. The role of

  11. A Secondary Analysis of Longitudinal Prevalence Data to Determine the Use of Pressure Ulcer Preventive Measures in Dutch Nursing Homes, 2005-2014.

    Science.gov (United States)

    van Leen, Martin Wf; Schols, Joseph Mga; Hovius, Steven Er; Halfens, Ruud Jg

    2017-09-01

    Pressure ulcers (PUs) are an important and distressing problem in Dutch nursing homes. A secondary analysis of longitudinal data from the Dutch National Prevalence Measurement of Care Problems (LPZ) - an annual, multicenter, point-prevalence survey - was conducted for the years 2005-2014 to determine the use of specific recommended PU preventive measures from the European Pressure Ulcer Advisory Panel 1998, the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel 2009, and the 2002 and 2011 Dutch PU guidelines. Preventive care was investigated among nursing home residents at risk for PUs and included skin care (moisturization); nutritional and hydration status assessment and optimization; and pressure redistribution involving mattresses, cushions, and heel pressure-relieving strategies and devices. Following abstraction from the study database, data for 3 at-risk groups were distinguished: 1) residents with a Braden score of 17, 18, or 19; 2) residents with a Braden score below 17; and 3) residents with a PU. Data were aggregated at the institutional level. Differences were tested with multiple regression analyses. The mean number of residents over the study period was 5435, the mean age was 82.8 years, and the mean Braden score was 15.3. None of the recommended preventive measures from the guidelines consulted was applied 100% of the time: preventive skin care measures were used in 25.1% to 63.8% of cases and dehydration and/or malnutrition were identified and managed in 27.8% to 65.6% of patients. Pressure redistribution with special types of mattresses was used in 85.2% of patients, cushions in (wheel)chairs were used in 64.8% of patients, and heels were offloaded in 57.8% of patients. The results regarding repositioning for the 3 groups, respectively, showed a maximum use of 9.7%, 30.3%, and 65.6%; the higher the PU risk, the more preventive measures were used. Although the results show a decrease in the percent of category 2 through

  12. Validation of two case definitions to identify pressure ulcers using hospital administrative data

    Science.gov (United States)

    Ho, Chester; Jiang, Jason; Eastwood, Cathy A; Wong, Holly; Weaver, Brittany; Quan, Hude

    2017-01-01

    Objective Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes. Setting A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011. Participants There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer. Results Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay. Conclusion DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and

  13. Pressure ulcer dressings in critical patients: a cost analysis

    Directory of Open Access Journals (Sweden)

    Dinara Raquel Araújo Silva

    Full Text Available Abstract OBJECTIVE To assess the direct cost of dressings in pressure ulcer treatment. METHOD This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. RESULTS The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002, with a mean of USD 11.9 (±7.4. The most common topical treatments used were essential fatty acids and papain. CONCLUSION Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management.

  14. Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs.

    NARCIS (Netherlands)

    Defloor, T.; Schoonhoven, L.

    2004-01-01

    BACKGROUND: Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer

  15. Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.

    Science.gov (United States)

    Schindler, Christine A; Mikhailov, Theresa A; Kuhn, Evelyn M; Christopher, Jean; Conway, Pat; Ridling, Debra; Scott, Annette M; Simpson, Vickie S

    2011-01-01

    The reported incidence of pressure ulcers in critically ill infants and children is 18% to 27%. Patients at risk for pressure ulcers and nursing interventions to prevent the development of the ulcers have not been established. To determine the incidence of pressure ulcers in critically ill children, to compare the characteristics of patients in whom pressure ulcers do and do not develop, and to identify prevention strategies associated with less frequent development of pressure ulcers. Characteristics of 5346 patients in pediatric intensive care units in whom pressure ulcers did and did not develop were compared. Multiple logistic regression was used to determine which prevention strategies were associated with less frequent development of pressure ulcers. The overall incidence of pressure ulcers was 10.2%. Patients at greatest risk were those who were more than 2 years old; who were in the intensive care unit 4 days or longer; or who required mechanical ventilation, noninvasive ventilation, or extracorporeal membrane oxygenation. Strategies associated with less frequent development of pressure ulcers included use of specialty beds, egg crates, foam overlays, gel pads, dry-weave diapers, urinary catheters, disposable under-pads, body lotion, nutrition consultations, change in body position every 2 to 4 hours, blanket rolls, foam wedges, pillows, and draw sheets. The overall incidence of pressure ulcers among critically ill infants and children is greater than 10%. Nursing interventions play an important role in the prevention of pressure ulcers.

  16. Ulcers

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Ulcers KidsHealth / For Teens / Ulcers What's in this article? ... is that the real story? What Is an Ulcer? An ulcer is a sore, which means it's ...

  17. Pressure distribution between the deep digital flexor tendon and the navicular bone, and the effect of raising the heels in vitro.

    Science.gov (United States)

    Weaver, M P; Shaw, D J; Munaiwa, G; Fitzpatrick, D P; Bellenger, C R

    2009-01-01

    The objectives of this study were to topographically map pressure distribution across the palmar surface of the navicular bone in response to forces applied by the deep digital flexor tendon (DDFT), and evaluate the effect of raising the heels in vitro . A rig was constructed to hold an equine cadaver limb and apply controlled pressure to the navicular bone from the DDFT. Pressure-sensitive paper was used to quantify and map the resultant pressure. Changes in response to heel wedges (5 degrees and 10 degrees ) were recorded. The areas subject to maximum pressure from the DDFT were: the central ridge, the paired symmetrical areas adjacent to the ridge and the distal edge of the palmar bone surface. These regions correspond to the known sites of navicular pathology. Heel wedges redistributed the pressure exerted on the palmar surface of the navicular bone, with measurements varying depending on fetlock angle and wedge angle. These in vitro results support the hypothesis that inappropriate forces exerted via the DDFT on the bone cause navicular disease. However, they throw doubt on the practice of shoeing such horses with heel wedges as the redistribution of pressure may increase the force exerted on regions predisposed to disease.

  18. Design and Evaluation of a Pressure and Temperature Monitoring System for Pressure Ulcer Prevention

    Directory of Open Access Journals (Sweden)

    Farve Daneshvar Fard

    2014-08-01

    Full Text Available Introduction Pressure ulcers are tissue damages resulting from blood flow restriction, which occurs when the tissue is exposed to high pressure for a long period of time. These painful sores are common in patients and elderly, who spend extended periods of time in bed or wheelchair. In this study, a continuous pressure and temperature monitoring system was developed for pressure ulcer prevention. Materials and Methods The monitoring system consists of 64 pressure and 64 temperature sensors on a 40×50 cm2 sheet. Pressure and temperature data and the corresponding maps were displayed on a computer in real-time. Risk assessment could be performed by monitoring and recording absolute pressure and temperature values, as well as deviations over time. Furthermore, a posture detection procedure was proposed for sitting posture identification. Information about the patient’s movement history may help caregivers make informed decisions about the patient’s repositioning and ulcer prevention strategies. Results Steady temporal behaviour of the designed system and repeatability of the measurements were evaluated using several particular tests. The results illustrated that the system could be utilized for continuous monitoring of interface pressure and temperature for pressure ulcer prevention. Furthermore, the proposed method for detecting sitting posture was verified using a statistical analysis. Conclusion A continuous time pressure and temperature monitoring system was presented in this study. This system may be suited for pressure ulcer prevention given its feasibility for simultaneous monitoring of pressure and temperature and alarming options. Furthermore, a method for detecting different sitting postures was proposed and verified. Pressure ulcers in wheelchair-bound patients may be prevented using this sitting posture detection method.

  19. Colgajo sural reverso neurotizado en el tratamiento de úlcera postraumática del talón Neurotization in reverse sural flap in treatment of postraumatic heel ulcer

    Directory of Open Access Journals (Sweden)

    J. Gordillo Hernández

    2012-12-01

    Full Text Available En la reconstrucción de la región plantar se debe de cumplir el objetivo de proporcionar una sensibilidad protectora para las zonas de presión del talón y de las epífisis dístales del primer y del quinto metatarsianos. La reconstrucción dependerá del defecto y de las estructuras a restituir, pudiendo emplear colgajos locales, a distancia o microquirúrgicos. El colgajo sural reverso es muy eficaz para cubrir la zona del talón, con vascularización constante, fácil diseño, disección y poca morbilidad del sitio donante. Inicialmente fue considerado neurocutáneo, debido a la inclusión del nervio sural en su pedículo; sin embargo, éste no consta con las características de un colgajo sensitivo. Presentamos el caso de una mujer de 23 años de edad con ulceración crónica del talón izquierdo secundaria a traumatismo y tratada con colgajo sural reverso con exteriorización de pedículo para realizar retardos intermitentes; a los 22 días se realizó sección del pedículo y coaptación de la porción proximal del nervio sural al nervio peroneo medio, obteniendo una cubierta cutánea definitiva, sin recurrencia de la ulceración, con adecuada sensibilidad protectora y con discriminación táctil de dos puntos a los 6 meses.The main goal in the plantar area reconstruction is to restore the protective sensation in the zones of pressure of the heel and distal epiphysis of the first and fifth metatarsals. The reconstruction is in dependence of the defect and of the structures to be replaced that can be treated with local, distant or microvascular free flaps. The reverse sural flap is very efficient for the heel coverage, with constant vascularity, easy tailoring, dissection, and low morbidity of the donor site. Initially the flap was term neurofasciocutaneos due to sural nerve inclusion in the pedicle; never the less, it does not fulfill the characteristics of a sensitive flap. We present the case of a 23 year old female patient with

  20. Esprit HR mattress cover in pressure ulcer prevention.

    Science.gov (United States)

    Khoulowa, J

    Modern mattresses provide soft dense foam, which permits the redistribution of pressure on the patient over a wider area - away from bony prominences where pressure ulcers usually occur. The material used in producing multistretch covers for the new mattresses had a tendency to delaminate as a result of a combination of heat, moisture and inappropriate cleansing techniques causing the water barriers to fall. In partnership with York Health NHS Trust and the material manufacturer, STM Healthcare produced a mattress cover (Esprit HR) which was able to withstand higher pressure from heat and moisture and greatly extended the life expectancy of the Esprit HR mattress.

  1. Wound and skin team. Impact on pressure ulcer prevalence in chronic care.

    Science.gov (United States)

    McNaughton, V; Brazil, K

    1995-02-01

    1. Decreasing the prevalence of pressure ulcers in a chronic care hospital presents a challenge to care providers. 2. The promotion of staff nurses as educational resources has a positive effect on their participation in a wound and skin care team. 3. When basic prevention practices are not in place, risk factors are less useful indicators to predict the development of pressure ulcers. 4. Educating nurses about pressure ulcer etiology, prevention strategies, and treatments has a positive impact on reducing the number of patients who develop pressure ulcers and the number of pressure ulcers that develop on patients in a chronic care hospital.

  2. A prospective study of the pressure ulcer scale for healing (PUSH).

    Science.gov (United States)

    Gardner, Sue E; Frantz, Rita A; Bergquist, Sandra; Shin, Chingwei D

    2005-01-01

    Although the recently developed Pressure Ulcer Scale for Healing (PUSH) was created to monitor healing over time, prospective evidence of its validity in measuring healing is lacking. The purpose of this study was to assess the validity of PUSH (version 3.0) when used to assess pressure ulcers in clinical practice. The authors chose a prospective research design using a convenience sample of nursing home residents with pressure ulcers. The patients' pressure ulcers were assessed each week with the PUSH and the Pressure Sore Status Tool. Surface area measurements derived from wound tracings were also obtained. Weekly assessments continued until the ulcer healed, the resident died, the resident transferred from the nursing home, or 6 months of assessments were complete. Thirty-two pressure ulcers comprised the study sample. Twenty-one (66%) healed during the 6-month study period and 11 (34%) did not heal. The PUSH scores decreased significantly over time among the healed ulcers but did not among the unhealed ulcers. Similarly, PUSH scores were significantly lower among the healed compared with the unhealed ulcers. Finally, total scores on PUSH were highly correlated with both the Pressure Sore Status Tool and surface area measurements. The PUSH provides a valid measure of pressure ulcer healing over time and accurately differentiates a healing from a nonhealing ulcer. It is a clinically practical, evidence-based tool for tracking changes in pressure ulcer status when applied at weekly intervals.

  3. Nurse Assistant Communication Strategies About Pressure Ulcers in Nursing Homes.

    Science.gov (United States)

    Alexander, Gregory L

    2015-07-01

    There is growing recognition of benefits of sophisticated information technology (IT) in nursing homes (NHs). In this research, we explore strategies nursing assistants (NAs) use to communicate pressure ulcer prevention practices in NHs with variable IT sophistication measures. Primary qualitative data were collected during focus groups with NAs in 16 NHs located across Missouri. NAs (n = 213) participated in 31 focus groups. Three major themes referencing communication strategies for pressure ulcer prevention were identified, including Passing on Information, Keeping Track of Needs and Information Access. NAs use a variety of strategies to prioritize care, and strategies are different based on IT sophistication level. NA work is an important part of patient care. However, little information about their work is included in communication, leaving patient records incomplete. NAs' communication is becoming increasingly important in the care of the millions of chronically ill elders in NHs. © The Author(s) 2014.

  4. Data mining techniques for assisting the diagnosis of pressure ulcer development in surgical patients.

    Science.gov (United States)

    Su, Chao-Ton; Wang, Pa-Chun; Chen, Yan-Cheng; Chen, Li-Fei

    2012-08-01

    Pressure ulcer is a serious problem during patient care processes. The high risk factors in the development of pressure ulcer remain unclear during long surgery. Moreover, past preventive policies are hard to implement in a busy operation room. The objective of this study is to use data mining techniques to construct the prediction model for pressure ulcers. Four data mining techniques, namely, Mahalanobis Taguchi System (MTS), Support Vector Machines (SVMs), decision tree (DT), and logistic regression (LR), are used to select the important attributes from the data to predict the incidence of pressure ulcers. Measurements of sensitivity, specificity, F(1), and g-means were used to compare the performance of four classifiers on the pressure ulcer data set. The results show that data mining techniques obtain good results in predicting the incidence of pressure ulcer. We can conclude that data mining techniques can help identify the important factors and provide a feasible model to predict pressure ulcer development.

  5. Assessment of sacrococcygeal pressure ulcers using diffuse correlation spectroscopy

    Science.gov (United States)

    Diaz, David; Lafontant, Alec; Neidrauer, Michael; Weingarten, Michael S.; DiMaria-Ghalili, Rose Ann; Fried, Guy W.; Rece, Julianne; Lewin, Peter A.; Zubkov, Leonid

    2016-03-01

    Microcirculation is essential for proper supply of oxygen and nutritive substances to the biological tissue and the removal of waste products of metabolism. The determination of microcirculatory blood flow (mBF) is therefore of substantial interest to clinicians for assessing tissue health; particularly in pressure ulceration and suspected deep tissue injury. The goal of this pilot clinical study was to assess deep-tissue pressure ulceration by non-invasively measuring mBF using Diffuse Correlation Spectroscopy (DCS). DCS provides information about the flow of red blood cells in the capillary network by measuring the temporal autocorrelation function of scattering light intensity. A novel optical probe was developed in order to obtain measurements under the load of the subject's body as pressure is applied (ischemia) and then released (reperfusion) on sacrococcygeal tissue in a hospital bed. Prior to loading measurements, baseline readings of the sacral region were obtained by measuring the subjects in a side-lying position. DCS measurements from the sacral region of twenty healthy volunteers have been compared to those of two patients who initially had similar non-blanchable redness. The temporal autocorrelation function of scattering light intensity of the patient whose redness later disappeared was similar to that of the average healthy subject. The second patient, whose redness developed into an advanced pressure ulcer two weeks later, had a substantial decrease in blood flow while under the loading position compared to healthy subjects. Preliminary results suggest the developed system may potentially predict whether non-blanchable redness will manifest itself as advanced ulceration or dissipate over time.

  6. The effects of massage as a method to prevent pressure ulcers. A review of the literature.

    Science.gov (United States)

    Duimel-Peeters, Inge G P; Halfens, Ruud J G; Berger, Martijn P F; Snoeckx, Luc H E H

    2005-04-01

    General information about the effects of massage to prevent pressure ulcers is limited. A literature search was conducted to provide more detailed knowledge about the effects of massage in general and in preventing the development of pressure ulcers in particular. Using the keywords massage, rubbing, prevention of pressure ulcers/pressure ulcers, and paying particular attention to referenced articles yielded a summary of different manual massage techniques and indications/contraindications of this intervention for both healthy tissues and tissues in patients at risk for developing pressure ulcers. A careful review of this information; the clinical, physical, and pathophysiological aspects of pressure ulcers, including extrinsic and intrinsic factor; and the time-pressure relationship suggests that one type of massage may be beneficial for persons who are at risk for developing pressure ulcers. Specifically, effleurage applied with moderate pressure is the most preferred massage in the treatment of pressure ulcers, although based on currently existing studies, it cannot be proven statistically that massage is an adequate preventive method for pressure ulcers. Although many guidelines advised against use of massage in people at risk for pressure ulcers, current evidence suggests that research to increase knowledge about the mechanism behind the effects of massage as part of an individualized prevention and treatment plan should be conducted.

  7. Evaluation of four non-invasive methods for examination and characterization of pressure ulcers

    DEFF Research Database (Denmark)

    Andersen, E.S.; Karlsmark, T.

    2008-01-01

    , we here report on usability of four non-invasive techniques for evaluation of pressure ulcers. Methods: Fifteen pressure ulcers in stage 0-IV were examined using four different non-invasive techniques [redness index, skin temperature, skin elasticity (i.e. retraction time), and ultrasound scanning......Background: Pressure ulcers are globally of major concern and there is need for research in the pathogenesis for early intervention. Early studies have suggested existence of a hypo-echogenic subepidermal layer at the location of pressure ulcers, visualized by ultrasound scans. As a continuation......]. Measurements were made at the ulcer, 5 cm from the ulcer, and at a reference skin location without ulcers. Results: The redness index was, in all cases, higher at the ulcers than at the reference skin. Temperature measurements were rather scattered. Ultrasound scans showed a hypo-echogenic subepidermal layer...

  8. Description of the National Pressure Ulcer Long-Term Care Study.

    Science.gov (United States)

    Horn, Susan D; Bender, Stacy A; Bergstrom, Nancy; Cook, Abby S; Ferguson, Maree L; Rimmasch, Holly L; Sharkey, Siobhan S; Smout, Randall J; Taler, George A; Voss, Anne C

    2002-11-01

    To describe and provide baseline data from The National Pressure Ulcer Long-Term Care Study (NPULS). Retrospective cohort study of detailed resident characteristics, treatments, and outcomes using convenience sampling. One hundred nine long-term care facilities throughout the United States. Two thousand four hundred twenty adult residents aged 18 and older, with a length of stay of 14 days or longer and who were at risk of developing a pressure ulcer, as defined by a Braden Scale for Predicting Pressure Sore Risk More than 500 characteristics were obtained for each resident over a 12-week period. This paper describes the NPULS database with respect to the resident (sex, age, diagnoses, severity of illness scores, Braden Scale score, activities of daily living, cognitive ability, mobility, bowel or bladder incontinence, laboratory values, nutritional assessment, and pressure ulcer assessment documentation), treatment (nutritional interventions, pressure relieving devices, incontinence interventions, protective devices, turning schedules, and pressure ulcer treatments), and outcome variables (pressure ulcer development and healing, pressure ulcer and systemic infection, changes in nutritional status, and discharge disposition) associated with pressure ulcers. Descriptive statistics and bivariate associations were used for preliminary analyses of resident, treatment, and outcome characteristics. The average age +/- standard deviation was 79.7 +/- 14.2; 70% of the residents were female. Fifty-three percent of residents (n = 1,293) were at risk of developing a pressure ulcer but never developed one during the study (Group 1), 19% developed a new pressure ulcer during the study (n = 457) (Group 2), 22% had an existing pressure ulcer (n = 534) (Group 3), and 6% had an existing pressure ulcer and developed a new ulcer during the study (n = 136) (Group 4). Residents who developed a new pressure ulcer (Group 2) were more likely to be female, older, cognitively impaired, and

  9. Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies.

    Science.gov (United States)

    Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan

    2014-01-01

    Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290-0.811, pdiabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.

  10. Registers of pressure ulcers in an international context

    Directory of Open Access Journals (Sweden)

    Andrea Pokorná

    2016-05-01

    Full Text Available Aim: The aim of the following review was to search for existing registers of pressure ulcer (PU incidence operating and collecting data on national level. Design: Type of study - review. Methods: Articles focusing on the subject of national PU registers were searched for by means of a systematic trawl through various databases using relevant terms. The search was limited to articles in English issued between 2010 and 2015 in the electronic databases SCOPUS and Nursing OVID. Articles focused on local datasets or registry as a part of local electronic health records were not included as well as studies which do not describe the dataset or the usability of data collection. Results: In total, six papers were found fulfilling the established criteria. Conclusion: According to information available from the literature review, it was recognised that only one register of PUs currently exists at the national level - the Registry of Ulcer Treatment (RUT in Sweden. It can be assumed that registers exist in other countries, but that the information is not available on electronic databases. After a detailed inspection of the articles, it appears the information derived from the studies could provide a useful picture of the data that should be collected, and at what time during the treatment period (initial and final assessment of the patients and local symptomatology of the wound/pressure ulcer it should be collected.

  11. Negative pressure wound therapy for treating leg ulcers.

    Science.gov (United States)

    Dumville, Jo C; Land, Lucy; Evans, Debra; Peinemann, Frank

    2015-07-14

    Leg ulcers are open skin wounds that occur between the ankle and the knee that can last weeks, months or even years and are a consequence of arterial or venous valvular insufficiency. Negative pressure wound therapy (NPWT) is a technology that is currently used widely in wound care and is promoted for use on wounds. NPWT involves the application of a wound dressing to the wound, to which a machine is attached. The machine applies a carefully controlled negative pressure (or vacuum), which sucks any wound and tissue fluid away from the treated area into a canister. To assess the effects of negative pressure wound therapy (NPWT) for treating leg ulcers in any care setting. For this review, in May 2015 we searched the following databases: the Cochrane Wounds Group Specialised Register (searched 21 May 2015); the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2015, Issue 4); Ovid MEDLINE (1946 to 20 May 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 20 May 2015); Ovid EMBASE (1974 to 20 May 2015); EBSCO CINAHL (1982 to 21 May 2015). There were no restrictions based on language or date of publication. Published or unpublished randomized controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT in the treatment of leg ulcers. Two review authors independently performed study selection, risk of bias assessment and data extraction. We included one study, with 60 randomized participants, in the review. The study population had a range of ulcer types that were venous arteriolosclerotic and venous/arterial in origin. Study participants had recalcitrant ulcers that had not healed after treatment over a six-month period. Participants allocated to NPWT received continuous negative pressure until they achieved 100% granulation (wound preparation stage). A punch skin-graft transplantation was conducted and the wound then exposed to further NPWT for four days followed by standard care

  12. Preventing Ischial Pressure Ulcers: I. Review of Neuromuscular Electrical Stimulation

    Directory of Open Access Journals (Sweden)

    Hilton M. Kaplan

    2011-01-01

    Full Text Available Objective: Pressure ulcers (PUs are common and debilitating wounds that arise when immobilized patients cannot shift their weight. Treatment is expensive and recurrence rates are high. Pathophysiological mechanisms include reduced bulk and perfusion of chronically atrophic muscles as well as prolonged occlusion of blood flow to soft tissues from lack of voluntary postural shifting of body weight. This has suggested that PUs might be prevented by reanimating the paralyzed muscles using neuromuscular electrical stimulation (NMES. A review of the published literature over the past 2 decades is detailed.

  13. Pressure ulcer dressings in critical patients: a cost analysis.

    Science.gov (United States)

    Silva, Dinara Raquel Araújo; Bezerra, Sandra Marina Gonçalves; Costa, Jéssica Pereira; Luz, Maria Helena Barros Araújo; Lopes, Vanessa Caminha Aguiar; Nogueira, Lidya Tolstenko

    2017-06-12

    To assess the direct cost of dressings in pressure ulcer treatment. This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL) were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002), with a mean of USD 11.9 (±7.4). The most common topical treatments used were essential fatty acids and papain. Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management. Avaliar o custo direto com curativos no tratamento de lesões por pressão. Estudo observacional descritivo, realizado em Unidade de Terapia Intensiva do nordeste do Brasil, de novembro a dezembro de 2015. Foi aplicada a Pressure Ulcer Scale for Healing e formulário para caracterização e avaliação de custos. Os valores da moeda brasileira (R$) foram convertidos para a moeda norte-americana (US$) à taxa de US$0,26/R$. Foram realizadas análises univariadas e bivariadas. Compuseram a amostra 15 pacientes com lesões, no mínimo, estágio 2. Houve redução significativa dos custos com materiais de curativos entre as avaliações inicial e final (p=0,002), com média de US$11,9 (±7,4). As terapias tópicas mais frequentes foram ácidos graxos essenciais e papaína. Verificou-se redução de custos proporcional aos estágios das lesões. Enfatiza-se o papel do enfermeiro na elaboração de planos de cuidados baseados em evidências para melhor gerenciamento do cuidado. Evaluar el costo directo de curativos para el tratamiento de lesiones por

  14. Mobile health platform for pressure ulcer monitoring with electronic health record integration.

    Science.gov (United States)

    Rodrigues, Joel J P C; Pedro, Luís M C C; Vardasca, Tomé; de la Torre-Díez, Isabel; Martins, Henrique M G

    2013-12-01

    Pressure ulcers frequently occur in patients with limited mobility, for example, people with advanced age and patients wearing casts or prostheses. Mobile information communication technologies can help implement ulcer care protocols and the monitoring of patients with high risk, thus preventing or improving these conditions. This article presents a mobile pressure ulcer monitoring platform (mULCER), which helps control a patient's ulcer status during all stages of treatment. Beside its stand-alone version, it can be integrated with electronic health record systems as mULCER synchronizes ulcer data with any electronic health record system using HL7 standards. It serves as a tool to integrate nursing care among hospital departments and institutions. mULCER was experimented with in different mobile devices such as LG Optimus One P500, Samsung Galaxy Tab, HTC Magic, Samsung Galaxy S, and Samsung Galaxy i5700, taking into account the user's experience of different screen sizes and processing characteristics.

  15. Traditional classroom education versus computer-based learning: how nurses learn about pressure ulcers.

    Science.gov (United States)

    Esche, Carol Ann; Warren, Joan I; Woods, Anne B; Jesada, Elizabeth C; Iliuta, Ruth

    2015-01-01

    The goal of the Nurse Professional Development specialist is to utilize the most effective educational strategies when educating staff nurses about pressure ulcer prevention. More information is needed about the effect of computer-based learning and traditional classroom learning on pressure ulcer education for the staff nurse. This study compares computer-based learning and traditional classroom learning on immediate and long-term knowledge while evaluating the impact of education on pressure ulcer risk assessment, staging, and documentation.

  16. Racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission.

    Science.gov (United States)

    Bliss, Donna Z; Gurvich, Olga; Savik, Kay; Eberly, Lynn E; Harms, Susan; Mueller, Christine; Garrard, Judith; Cunanan, Kristen; Wiltzen, Kjerstie

    2017-09-01

    Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers. To assess racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Multi-levels predictors, at the individual resident, nursing home, and community/Census tract level, were examined in three large data sets. Minimum Data Set records of older individuals admitted to one of 439 nursing homes of a national, for-profit chain over three years with a stages 2-4 pressure ulcer (n=10,861) were searched to the 90-day assessment for the first record showing pressure ulcer healing. Predictors of pressure ulcer healing were analyzed for White admissions first using logistic regression. The Peters-Belson method was used to assess racial or ethnic disparities among minority group admissions. A significantly smaller proportion of Black nursing home admissions had their pressure ulcer heal than expected had they been part of the White group. There were no disparities in pressure ulcer healing disadvantaging other minority groups. Significant predictors of a nonhealing of pressure ulcer were greater deficits in activities of daily living and pressure ulcer severity. Reducing disparities in pressure ulcer healing is needed for Blacks admitted to nursing homes. Knowledge of disparities in pressure ulcer healing can direct interventions aiming to achieve equity in healthcare for a growing number of minority nursing home admissions. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Prevalence of pressure ulcers in three university teaching hospitals in Ireland.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2012-02-03

    AIM: Pressure ulceration is a significant, but preventable, cause of morbidity and resource utilisation in hospital populations. Data on pressure ulcer prevalence in Ireland are limited. This study aims to determine (i) the point-prevalence of pressure ulcers in three teaching hospitals in Ireland and (ii) risk factors for their development. METHODS: Eight teams of one doctor and one nurse visited 672 adult patients over a 2-day period in three teaching hospitals. Each patient was examined and pressure ulcers graded with the European Pressure Ulcer Advisory Panel system. Mental test score, Barthel index, type of support surface, length of stay, documentation of risk assessment and serum albumin were recorded. RESULTS: Point-prevalence of pressure ulceration was 18.5%. Seventy-seven percent of pressure ulcers were hospital-acquired, 49% grade 1, 37% grade 2, 11% grade 3 and 3% grade 4. Reduced mobility, urinary incontinence, cognitive impairment, low serum albumin and length of stay were significantly associated with pressure ulcers. Multivariate logistic regression analysis found reduced mobility (odds ratio 8.84; 95% CI 5.04-15.48, p<0.0001) and length of stay (odds ratio 1.02; 95% CI 1.01-1.02, p<0.0001) to be predictive of the presence of pressure ulcers. Age, gender and risk assessment documentation were not associated with pressure ulcers. Sixty-five percent of patients with pressure ulcers were positioned on appropriate support surfaces. DISCUSSION: Point-prevalence of pressure ulceration was 18.5%, similar to international data. Regular audit of prevalence, prevention and management strategies may raise awareness, influence resource allocation and ultimately improve patient care.

  18. Incidence, prevention and treatment of pressure ulcers in intensive care patients: a longitudinal study.

    Science.gov (United States)

    Shahin, Eman S M; Dassen, Theo; Halfens, Ruud J G

    2009-04-01

    Pressure ulcers are common in acute and long-term care. However, critically ill patients usually have multiple risk factors for pressure ulcers. The study was conducted to assess pressure ulcer incidence in intensive care patients, the factors related to pressure ulcer incidence and the course of pressure ulcers after the admission to an intensive care unit. A longitudinal design. This study was carried out in cardiological and surgical intensive care of a general hospital and in a nephrological intensive care of a university hospital. All patients admitted to intensive care wards during the period from April until October 2006 were invited to take a part in the study. One hundred and twenty-one patients were involved in the study. The inclusion criteria were adult intensive care patients, males and females, all diagnosis were included. The exclusion criterion was patients whose age less than 18 years. Each patient was assessed twice; first, upon admission and second upon discharge or death, or after 2 weeks if the patient was still in intensive care. The assessed data included pressure ulcer preventive measures, risk factors using Braden score, pressure ulcer characteristics and treatment. Additionally, incontinence supplies (urine/bowel) if used and the severity of illness using Acute Physiology and Chronic Health Evaluation (APACHE II score) were assessd. This study revealed a total incidence of 3.3% (4.5% in nephrological patients and 2.9% in surgical patients). Sixteen patients with a total of 21 pressure ulcers were admitted to the intensive care units. During the patients' stay at the intensive care units six pressure ulcers developed newly and five pressure ulcers healed. The mean of the APACHE II score of patients with new pressure ulcers (16.6) were higher than in patients without new pressure ulcers (11.5). Pressure ulcer incidence is low in this study compared to other studies. Pressure ulcers can be healed in intensive care patients. Using some

  19. Are there racial-ethnic disparities in time to pressure ulcer development and pressure ulcer treatment in older adults after nursing home admission?

    Science.gov (United States)

    Bliss, Donna Z; Gurvich, Olga; Savik, Kay; Eberly, Lynn E; Harms, Susan; Mueller, Christine; Wyman, Jean F; Garrard, Judith; Virnig, Beth

    2015-06-01

    The objective of this study was to assess whether there are racial and ethnic disparities in the time to development of a pressure ulcer and number of pressure ulcer treatments in individuals aged 65 and older after nursing home admission. Multi-level predictors of time to a pressure ulcer from three national surveys were analyzed using Cox proportional hazards regression for White Non-Hispanic residents. Using the Peters-Belson method to assess for disparities, estimates from the regression models were applied to American Indians/Alaskan Natives, Asians/Pacific Islanders, Blacks, and Hispanics separately resulting in estimates of expected outcomes as if they were White Non-Hispanic, and were then compared with their observed outcomes. More Blacks developed pressure ulcers sooner than expected. No disparities in time to a pressure ulcer disadvantaging other racial/ethnic groups were found. There were no disparities in pressure ulcer treatment for any group. Reducing disparities in pressure ulcer development offers a strategy to improve the quality of nursing home care. © The Author(s) 2014.

  20. Impact of pressure ulcers on individuals living with a spinal cord injury.

    Science.gov (United States)

    Lala, Deena; Dumont, Frédéric S; Leblond, Jean; Houghton, Pamela E; Noreau, Luc

    2014-12-01

    To describe the impact of pressure ulcers on the ability to participate in daily and community activities, health care utilization, and overall quality of life in individuals living with spinal cord injury (SCI). Cross-sectional study. Nationwide survey. Participants (N=1137) with traumatic SCI who were >1 year postinjury and living in the community were recruited. Of these, 381 (33.5%, 95% confidence interval, 30.8%-36.3%) had a pressure ulcer over the last 12 months. Not applicable. Measures developed for the Rick Hansen Spinal Cord Injury Registry Community Follow-up Survey Version 2.0. Of the 381 individuals with pressure ulcers, 65.3% reported that their pressure ulcer reduced their activity to some extent or more. Pressure ulcers reduced the ability of individuals with SCI to participate in 19 of 26 community and daily activities. Individuals with 1 or 2 pressure ulcers were more dissatisfied with their ability to participate in their main activity than those without pressure ulcers (P=.0077). Pressure ulcers were also associated with a significantly higher number of consultations with family doctors, nurses, occupational therapists, and wound care nurses/specialists (Pulcers have a significant impact on the daily life of individuals with SCI. Our findings highlight the importance of implementing pressure ulcer prevention and management programs for this high-risk population and require the attention of all SCI-related health care professionals. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  1. Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study.

    Science.gov (United States)

    de Almeida Medeiros, Ana Beatriz; da Conceição Dias Fernandes, Maria Isabel; de Sá Tinôco, Jéssica Dantas; Cossi, Marcelly Santos; de Oliveira Lopes, Marcos Venicios; de Carvalho Lira, Ana Luisa Brandão

    2017-12-06

    To evaluate the predictive power of risk factors for pressure ulcers in adult intensive care patients. A retrospective case-control study was performed utilising a heterogeneous sample group allocated into a case group with pressure ulcers (n=90) and a control group without pressure ulcers (n=90). The analysis explored the predictive power of risk factors for pressure ulcers using a hierarchical logistic regression model. The risk factors that predicted pressure ulcers were friction (OR=5.97), previous history of pressure ulcers (OR=5.43), prolonged intensive care unit stay (OR=3.92), dehydration (OR=3.18), elevated skin temperature by 1-2°C (OR=3.12) and treatment of other comorbidities (OR=2.79). Adult intensive care patients have an increased risk of developing a pressure ulcer. These risk factors are regarded as strong predictors for pressure ulceration. This study advances nursing knowledge in that it investigates additional risk factors for the development of pressure ulcers and it identifies a set of factors that best predict their occurrence, which may contribute to the nurses' diagnostic reasoning in the intensive care unit. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Predicting pressure ulcers: cases missed using a new clinical prediction rule.

    Science.gov (United States)

    Schoonhoven, Lisette; Grobbee, Diederick E; Bousema, Mente T; Buskens, Erik

    2005-01-01

    The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule and comparing them with patients who were correctly classified as 'not at risk'. Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified. Between January 1999 and June 2000 a prospective cohort study was conducted in two large hospitals in the Netherlands. Patients admitted to neurology, internal, surgical, and elder care wards for more than 5 days were included (n = 1229), and were examined weekly. Information on potential prognostic determinants for pressure ulcers mentioned in the literature was recorded. Outcome was defined as occurrence of a pressure ulcer grade 2 or worse during hospital admission. Patients who developed pressure ulcers experienced more problems with 'friction and shear' and underwent surgery more often and longer. Also, they were more often admitted because of malignant conditions. We found no specific characteristics that clearly distinguished patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule from patients who were correctly classified as 'not at risk'. It appears difficult to improve further on the prediction of pressure ulcers using available clinical information.

  3. Prediction of pressure ulcer development in hospitalized patients: a tool for risk assessment

    Science.gov (United States)

    Schoonhoven, L; Grobbee, D E; Donders, A R T; Algra, A; Grypdonck, M H; Bousema, M T; Schrijvers, A J P; Buskens, E

    2006-01-01

    Objectives To identify independent predictors for development of pressure ulcers in hospitalized patients and to develop a simple prediction rule for pressure ulcer development. Design The Prevention and Pressure Ulcer Risk Score Evaluation (prePURSE) study is a prospective cohort study in which patients are followed up once a week until pressure ulcer occurrence, discharge from hospital, or length of stay over 12 weeks. Data were collected between January 1999 and June 2000. Setting Two large hospitals in the Netherlands. Participants Adult patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days were eligible. A consecutive sample of 1536 patients was visited, 1431 (93%) of whom agreed to participate. Complete follow up data were available for 1229 (80%) patients. Main outcome measures Occurrence of a pressure ulcer grade 2 or worse during admission to hospital. Results Independent predictors of pressure ulcers were age, weight at admission, abnormal appearance of the skin, friction and shear, and planned surgery in coming week. The area under the curve of the final prediction rule was 0.70 after bootstrapping. At a cut off score of 20, 42% of the patient weeks were identified as at risk for pressure ulcer development, thus correctly identifying 70% of the patient weeks in which a pressure ulcer occurred. Conclusion A simple clinical prediction rule based on five patient characteristics may help to identify patients at increased risk for pressure ulcer development and in need of preventive measures. PMID:16456213

  4. Candesartan restores pressure-induced vasodilation and prevents skin pressure ulcer formation in diabetic mice.

    Science.gov (United States)

    Danigo, Aurore; Nasser, Mohamad; Bessaguet, Flavien; Javellaud, James; Oudart, Nicole; Achard, Jean-Michel; Demiot, Claire

    2015-02-18

    Angiotensin II type 1 receptor (AT1R) blockers have beneficial effects on neurovascular complications in diabetes and in organ's protection against ischemic episodes. The present study examines whether the AT1R blocker candesartan (1) has a beneficial effect on diabetes-induced alteration of pressure-induced vasodilation (PIV, a cutaneous physiological neurovascular mechanism which could delay the occurrence of tissue ischemia), and (2) could be protective against skin pressure ulcer formation. Male Swiss mice aged 5-6 weeks were randomly assigned to four experimental groups. In two groups, diabetes was induced by a single intraperitoneal injection of streptozotocin (STZ, 200 mg.kg(-1)). After 6 weeks, control and STZ mice received either no treatment or candesartan (1 mg/kg-daily in drinking water) during 2 weeks. At the end of treatment (8 weeks of diabetes duration), C-fiber mediated nociception threshold, endothelium-dependent vasodilation and PIV were assessed. Pressure ulcers (PUs) were then induced by pinching the dorsal skin between two magnetic plates for three hours. Skin ulcer area development was assessed during three days, and histological examination of the depth of the skin lesion was performed at day three. After 8 weeks of diabetes, the skin neurovascular functions (C-fiber nociception, endothelium-dependent vasodilation and PIV) were markedly altered in STZ-treated mice, but were fully restored by treatment with candesartan. Whereas in diabetes mice exposure of the skin to pressure induced wide and deep necrotic lesions, treatment with candersartan restored their ability to resist to pressure-induced ulceration as efficiently as the control mice. Candesartan decreases the vulnerability to pressure-induced ulceration and restores skin neurovascular functions in mice with STZ-induced established diabetes.

  5. Cost-effectiveness of nutritional intervention on healing of pressure ulcers.

    Science.gov (United States)

    Hisashige, Akinori; Ohura, Takehiko

    2012-12-01

    Pressure ulcers not only affect quality of life among the elderly, but also bring a large economic burden. There is limited evidence available for the effectiveness of nutritional interventions for treatment of pressure ulcers. In Japan, recently, a 60-patient randomized controlled trial of nutritional intervention on pressure ulcers demonstrated improvement in healing of pressure ulcers, compared with conventional management. To evaluate value for money of nutritional intervention on healing of pressure ulcers, cost-effective analysis was carried out using these trial results. The analysis was carried out from a societal perspective. As effectiveness measures, pressure ulcer days (PUDs) and quality-adjusted life years (QALYs) were estimated. Prevalence of pressure ulcers was estimated by the Kaplan-Meier method. Utility score for pressure ulcers is derived from a cross-sectional survey among health professionals related to pressure ulcers. Costs (e.g., nutritional interventions and management of pressure ulcers) were estimated from trial data during observation and follow-up. Stochastic and qualitative sensitivity analyses were performed to examine the robustness of results. For observation (12 weeks) and follow-up (12-week observation plus 4-week follow-up), nutritional intervention reduced PUDs by 9.6 and 16.2 per person, and gained 0.226 × 10(-2) QALYs and 0.382 × 10(-2) QALYs per person, respectively. In addition, costs were reduced by $542 and $881 per person, respectively. This means nutritional intervention is dominant (cost savings and greater effectiveness). The sensitivity analyses showed the robustness of these results. Economic evaluation of nutritional intervention on healing pressure ulcers from a small randomized controlled trial showed that this intervention is cost saving with health improvement. Further studies are required to determine whether this is a cost-effective intervention for widespread use. Copyright © 2012 Elsevier Ltd and

  6. Measuring static seated pressure distributions and risk for skin pressure ulceration in ice sledge hockey players.

    Science.gov (United States)

    Darrah, Shaun D; Dicianno, Brad E; Berthold, Justin; McCoy, Andrew; Haas, Matthew; Cooper, Rory A

    2016-01-01

    To determine whether sledge hockey players with physical disability have higher average seated pressures compared to non-disabled controls. Fifteen age-matched controls without physical disability and 15 experimental participants with physical disability were studied using a pressure mapping device to determine risk for skin pressure ulceration and the impact of cushioning and knee angle positioning on seated pressure distributions. Regardless of participant group, cushioning, or knee angle, average seated pressures exceeded clinically acceptable seated pressures. Controls had significantly higher average seated pressures than the disability group when knees were flexed, both with the cushion (p = 0.013) and without (p = 0.015). Knee extension showed significantly lower average pressures in controls, both with the cushion (p hockey players utilize positioning with larger knee flexion angles. Implications for Rehabilitation Ice sledge hockey is a fast growing adaptive sport. Adaptive sports have been associated with several positive improvements in overall health and quality of life, though may be putting players at risk for skin ulceration. Measured static seated pressure in sledges greatly exceeds current clinically accepted clinical guidelines. With modern improvements in wheelchair pressure relief/cushioning there are potential methods for improvement of elevated seated pressure in ice hockey sledges.

  7. Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation.

    Science.gov (United States)

    Delparte, Jude J; Scovil, Carol Y; Flett, Heather M; Higgins, Johanne; Laramée, Marie-Thérèse; Burns, Anthony S

    2015-11-01

    To assess the psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer (PU) risk assessment during inpatient rehabilitation. Prospective cohort. Tertiary rehabilitation centers. Individuals (N=759) participating in inpatient spinal cord injury rehabilitation between January 3, 2012, and April 23, 2014. Not applicable. Admission SCIPUS scores and the corresponding risk stratification, PU incidence, intraclass correlation coefficient (ICC) for interrater reliability, sensitivity, specificity, and likelihood ratios (LRs). Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC). Mean SCIPUS scores were higher for individuals who developed PUs than for those who did not (mean SCIPUS score, 9.8±2.5 vs 8.5±2.6). Interrater reliability was excellent for SCIPUS composite scores (ICC=.91) and very good for risk stratification (ICC=.86). Using the existing cutoff value of ≥6 for "high risk" category, sensitivity and specificity were estimated to be .97 and .12, respectively, with an LR of 1.1. A cutoff value of ≥8 yielded a better balance between sensitivity and specificity (.85 and .38, respectively). The AUC equaled .64 with an LR of 1.4. Results were similar when the analysis was confined to PUs of stage II or greater. The psychometric properties of the SCIPUS do not currently support its routine use as a measure of PU risk in individuals with spinal cord injury undergoing inpatient rehabilitation. LRs of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification

    Directory of Open Access Journals (Sweden)

    Sofia Palagi

    2015-10-01

    Full Text Available AbstractOBJECTIVETo describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC.METHODCase report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument.RESULTSA reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor.CONCLUSIONThere was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.

  9. Sanguis draconis (Daemonorops draco): a case report of treating a chronic pressure ulcer with tunneling.

    Science.gov (United States)

    Ji, Shu; Zhang, Guizhen; Hua, Yafang; Jin, Xueqin

    2015-01-01

    Pressure ulcers are a frequently encountered difficulty in clinical nursing care. In cases of pressure ulcers, continued pressure on soft tissue leads to pathological processes in affected tissues that include ischemia and hypoxia, nutritional and metabolic disorders, and degeneration and necrosis. Pressure ulcers are a common clinical complication. In February 2013, our department admitted a patient with Parkinson's disease who suffered from a chronic pressure ulcer with tunneling. This patient was given an integrative therapy treatment protocol that consisted of external applications of a phytomedicine called sanguis draconis, combined with a series of conventional treatments, including local oxygen therapy, custom-built vacuum aspiration, and anti-infection therapies. The patient's integrative treatment program resulted in complete amelioration of the pressure ulceration. The following sections describe the nursing experiences associated with this case study.

  10. Risks and risk-analysis for the development of pressure ulcers in surgical patients

    NARCIS (Netherlands)

    Keller, Bastiaan Paul Johan Aart

    2006-01-01

    With prevalence figures of 13% for university hospitals and 23% for general hospitals, pressure ulcers are a major health care issue in The Netherlands. Pressure ulcers in surgical patients are frequently encountered, as is illustrated by reported incidence rates up to 66%. The number of patients at

  11. Implementation of a new policy results in a decrease of pressure ulcer frequency.

    NARCIS (Netherlands)

    Laat, E.H. de; Schoonhoven, L.; Pickkers, P.; Verbeek, A.L.M.; Achterberg, T. van

    2006-01-01

    OBJECTIVE: To determine the effects of a new policy on the efficiency of pressure ulcer care. DESIGN: Series of 1-day pressure ulcer surveys before and after the implementation. SETTING: A 900-bed University Medical Centre in The Netherlands. PARTICIPANTS: On the days of the surveys, 657 patients

  12. Pressure ulcers: diagnostics and interventions aimed at wound-related complaints: a review of the literature.

    NARCIS (Netherlands)

    Laat, H.E.W. de; Scholte op Reimer, W.J.; Achterberg, T. van

    2005-01-01

    AIMS AND OBJECTIVES: To describe the current scientific evidence in the field of diagnostics and treatment of pain, malodour and exudate from pressure ulcers and to give recommendations for practice, based on these findings. BACKGROUND: Patients with pressure ulcers are confronted with symptoms of

  13. Prevention Practice Differences Among Persons With Spinal Cord Injuries Who Rarely Versus Frequently Sustain Pressure Ulcers

    Science.gov (United States)

    Jones, Michael L.; Marini, Irmo; Slate, John R.

    2005-01-01

    Pressure ulcers are common among people with spinal cord injury (SCI) and not only are costly to treat but also affect the quality of life of those affected by them. Despite a plethora of literature on prevention, there are few wellness studies focusing on the practices of people who do not develop pressure ulcers. This preliminary study sought to…

  14. Pressure Ulcers in Adults: Prediction and Prevention. Clinical Practice Guideline Number 3.

    Science.gov (United States)

    Agency for Health Care Policy and Research (DHHS/PHS), Rockville, MD.

    This package includes a clinical practice guideline, quick reference guide for clinicians, and patient's guide to predicting and preventing pressure ulcers in adults. The clinical practice guideline includes the following: overview of the incidence and prevalence of pressure ulcers; clinical practice guideline (introduction, risk assessment tools…

  15. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation.

    NARCIS (Netherlands)

    Schuurman, J.P.; Schoonhoven, L.J.; Keller, B.P.; Ramshorst, B. van

    2009-01-01

    AIM AND OBJECTIVE: The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation. BACKGROUND: Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of

  16. Cervical collar-related pressure ulcers in trauma patients in intensive care unit

    NARCIS (Netherlands)

    Ham, H.W.; Schoonhoven, L.; Galer, A.A.; Shortridge-Baggett, L.L.

    2014-01-01

    INTRODUCTION: The application of a cervical collar (C-collar) in trauma patients can be life-saving. Previous studies, however, describe development of pressure ulcers related to C-collars. OBJECTIVE: To retrospectively compare collar-related pressure ulcers (CRPUs) occurring in trauma patients

  17. Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients.

    Science.gov (United States)

    Kim, Junglyun; Ahn, Hyochol; Lyon, Debra E; Stechmiller, Joyce

    2016-01-08

    Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers.

  18. 76 FR 74789 - Scientific Information Request on Pressure Ulcer Treatment Medical Devices

    Science.gov (United States)

    2011-12-01

    ... Ulcer Treatment Medical Devices AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION... (AHRQ) is seeking scientific information submissions from manufacturers of pressure ulcer treatment medical devices, such as (but not limited to): Ultrasonic wound care systems, negative pressure therapy...

  19. The Australian medical sheepskin prevents pressure ulcers: a combined multilevel analysis of three RCTs.

    NARCIS (Netherlands)

    Mistiaen, P.; Jolley, D.; McGowan, S.; Hickey, M.; Spreeuwenberg, P.; Francke, A.

    2010-01-01

    Introduction: Pressure ulcers can to a large extent be prevented by implementing best practice care. For many of the devices to help in the prevention of pressure ulcers there is lack of evidence-based knowledge about their effectiveness. In this study we performed an individual patient data

  20. Pressure ulcers: knowledge and attitude of nurses and nursing assistants in Belgian nursing homes.

    NARCIS (Netherlands)

    Demarre, L.; Vanderwee, K.; Defloor, T.; Verhaeghe, S.; Schoonhoven, L.; Beeckman, D.

    2012-01-01

    AIMS: To gain insight into the knowledge and attitudes of nurses and nursing assistants and to study the correlation between knowledge, attitudes and the compliance with the pressure ulcer prevention guidelines provided to residents at risk of pressure ulcers in nursing homes. BACKGROUND: There is a

  1. Building a Biopsychosocial Conceptual Framework to Explore Pressure Ulcer Pain for Hospitalized Patients

    Directory of Open Access Journals (Sweden)

    Junglyun Kim

    2016-01-01

    Full Text Available Although pressure ulcers are a prevalent condition, pain associated with pressure ulcers is not fully understood. Indeed, previous studies do not shed light on the association between pressure ulcer stages and the experience of pain. Especially, pain characteristics of suspected deep tissue injury, which is a new category that was recently added by the National Pressure Ulcer Advisory Panel, are yet unknown. This is concerning because the incidence of pressure ulcers in hospitalized patients has increased exponentially over the last two decades, and health care providers are struggling to ensure providing adequate care. Thus, in order to facilitate the development of effective interventions, this paper presents a conceptual framework to explore pressure ulcer pain in hospitalized patients. The concepts were derived from a biopsychosocial model of pain, and the relationships among each concept were identified through a literature review. Major propositions are presented based on the proposed conceptual framework, which integrates previous research on pressure ulcer pain, to ultimately improve understanding of pain in hospitalized patients with pressure ulcers.

  2. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients.

    Science.gov (United States)

    Cox, Jill; Rasmussen, Louisa

    2014-12-01

    Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients' burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes. ©2014 American Association of Critical-Care Nurses.

  3. Hybrid equation/agent-based model of ischemia-induced hyperemia and pressure ulcer formation predicts greater propensity to ulcerate in subjects with spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Alexey Solovyev

    Full Text Available Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI. People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation.

  4. Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings.

    Science.gov (United States)

    Sebba Tosta de Souza, Diba Maria; Veiga, Daniela Francescato; Santos, Ivan Dunshee de Abranches Oliveira; Abla, Luiz Eduardo Felipe; Juliano, Yara; Ferreira, Lydia Masako

    2015-01-01

    The purpose of this study was to measure and compare health-related quality of life in elderly patients with pressure ulcers in different health care settings (home care acute care facility, and long-term care facility [LTCF]). Cross-sectional comparative study. One hundred ten elderly patients with (n = 36) and without (n = 74) pressure ulcers living in LTCFs, hospitals, or at home. The research setting included 1 tertiary and 2 community-based hospitals, 10 LTCFs, and 18 community health centers in Brazil. The Mini-Mental State Examination, Braden Scale for Predicting Pressure Sore Risk, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to assess cognitive status, pressure ulcer risk, and health-related quality of life, respectively. Compared with those without pressure ulcers, elderly patients with pressure ulcers reported significantly lower (worse) SF-36 scores on physical functioning (P ulcers scored significantly higher (better) SF-36 scores on mental health (P = .046) and vitality (P = .009). Hospitalized patients without pressure ulcers had lower SF-36 scores on bodily pain (P = .007) and general health (P = .026) than those living in LTCFs or at home. Patients without pressure ulcers in LTCFs had significantly lower Mini-Mental State Examination scores (lower cognitive status) than those living in other settings (P = .001). Elderly patients with pressure ulcers who were hospitalized and living at home or in LTCFs reported low scores on physical functioning and role physical, and LTCF residents also reported low scores on social functioning and role emotional. This shows the need for an environment that includes health care professionals prepared to implement strategies for pressure ulcer prevention.

  5. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives.

    Science.gov (United States)

    Spilsbury, Karen; Nelson, Andrea; Cullum, Nicky; Iglesias, Cynthia; Nixon, Jane; Mason, Su

    2007-03-01

    This paper reports a study exploring patients' perceptions and experiences of the impact of a pressure ulcer and its treatment on their health and quality of life. Pressure ulcers are a significant health problem, and their prevention and management in primary and secondary care is high on the clinical and policy agenda. However, patients' perspectives and experiences of the impact of pressure ulcers on health and quality of life is not understood. Qualitative semi-structured interviews were carried out from 2002 to 2004 with a purposive sample of 23 hospital inpatients (five men, 18 women: aged 33-92 years) with a pressure ulcer (graded 2-5) at various anatomical sites and with varied reasons for hospital admission. Data were analysed thematically. The majority of participants (91%; n = 21) indicated that the pressure ulcer and its treatment affected their lives emotionally, mentally, physically and socially. They presented their perspectives on the causes of their pressure ulcer and descriptions of pain (experienced by 91%), appearance, smell and fluid leakage. Patients described amounts and quality of care they received, including levels of comfort of dressings and pressure relieving equipment and the timing of interventions. They were largely dependent on others to treat, manage and care for their ulcer, but indicated that the pain, discomfort and distress of pressure ulcers was not acknowledged by nursing staff. The pressure ulcers could be pivotal in preventing full recovery, were perceived to increase hospital stays and resulted in ongoing treatments. Healthcare professionals can learn from these patients' experiences about the management of dressings, providing information (in particular about realistic time expectations for healing), providing preventative interventions and understanding the importance of comfort and positioning for patients. The study highlights the complexities of evaluating the impact of pressure ulceration.

  6. Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intensive care unit: a quality improvement project.

    Science.gov (United States)

    Kelleher, Alyson Dare; Moorer, Amanda; Makic, MaryBeth Flynn

    2012-01-01

    We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters.

  7. SURGICAL RECONSTRUCTION IN PRESSURE ULCERS- A RETROSPECTIVE STUDY OF THE WORKHORSE FLAP OPTIONS

    Directory of Open Access Journals (Sweden)

    Sheeja Rajan T. M

    2016-11-01

    Full Text Available BACKGROUND Pressure ulcers can significantly contribute to morbidity and mortality by chronic infections. Radical debridement of all devitalised and infected tissues followed by a reconstructive algorithm for soft tissue padding over bony prominences to prevent recurrent breakdown are the mainstay of surgical management of pressure ulcers. Choice of the soft tissue flap for reconstruction is influenced by the dimensions of ulcers, local tissue availability and surgeon’s preferences. MATERIALS AND METHODS This retrospective study includes 140 patients with spinal injuries having pressure ulcers of NPUAP grade III and IV treated surgically over a period of four years. The demographics of pressure ulcers, the workhorse flap options as well as the outcome were analysed. RESULTS The pressure ulcers were seen predominantly in males (93.6% of 40-49 years’ age group (42.8%. Ischial pressure ulcers (n=104 constituted 74.2% followed by sacral pressure ulcers (n=24 that is 17.1% and trochanteric pressure ulcers (n=12 in 8.6%. Debridement and direct closure of wound were possible only in 10 cases. Majority (92.8% of patients needed additional tissues for wound coverage. Our workhorse fasciocutaneous flaps were rotation flaps from the gluteal region or posterior thigh with medial or lateral based designs (34.2%. Local muscle tissue was used in 64 cases (46% either as gluteal, tensor fascia lata and biceps femoris myocutaneous flaps or gluteus maximus, hamstring or gracilis muscle fillers in myoplasty. CONCLUSIONS Rotation flap along with myoplasty were our workhorse flap options in majority of the pressure ulcers. But, our future perspective is to spare muscle and use more fasciocutaneous perforator flaps for reconstruction according to evidence-based clinical practice.

  8. 77 FR 72865 - Announcement of Requirements and Registration for “Mobilizing Data for Pressure Ulcer Prevention...

    Science.gov (United States)

    2012-12-06

    ... HUMAN SERVICES Announcement of Requirements and Registration for ``Mobilizing Data for Pressure Ulcer..., increased risk for serious infection, and increased health care utilization. The National Pressure Ulcer Advisory Panel (NPUAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer...

  9. Pressure ulcers: diagnostics and interventions aimed at wound-related complaints: a review of the literature.

    Science.gov (United States)

    de Laat, Erik H E W; Scholte op Reimer, Wilma J; van Achterberg, Theo

    2005-04-01

    To describe the current scientific evidence in the field of diagnostics and treatment of pain, malodour and exudate from pressure ulcers and to give recommendations for practice, based on these findings. Patients with pressure ulcers are confronted with symptoms of chronic wounds and impaired wound healing. Assessment and treatment of these symptoms have received very little attention. Systematic literature review. Medline, CINAHL, and Cochrane, were searched for studies on pain, malodour and exudate in patients with pressure ulcers. The McGill Pain Questionnaire, the Visual Analogue Scale and the Faces Rating Scale are useful instruments to assess pressure ulcer related pain. Strong evidence was found to support a positive effect of (dia)morphine. Some evidence was found to support a positive effect of benzydamine gel and Eutectic Mixture of Local Anaesthetic-cream. Wound malodour is subjectively assessed. In a laboratory study, it is proved that activated charcoal is capable of absorbing gas molecules causing malodour. At present, no studies are available on the odour-absorbing capacity of activated charcoal dressings in pressure ulcer patients. Exudate is a symptom of impaired wound healing. The Pressure Sore Status Tool is a valid and reliable instrument for assessing the wound healing process. There is a possible indication that hydrocolloid positively influences healing time because the absorption of exudates is more effective. Little sound research has been performed on wound-related complaints in patients with pressure ulcers. Nevertheless several recommendations could be made on the present state of the art. Regarding pressure ulcer related pain, this review supports the intervention of local pain relieve in patients with pressure ulcers. Regarding pressure ulcer related odour and exudates, this study identifies the gaps in evidence and research.

  10. Preventing in-facility pressure ulcers as a patient safety strategy: a systematic review.

    Science.gov (United States)

    Sullivan, Nancy; Schoelles, Karen M

    2013-03-05

    Complications from hospital-acquired pressure ulcers cause 60,000 deaths and significant morbidity annually in the United States. The objective of this systematic review is to review evidence regarding multicomponent strategies for preventing pressure ulcers and to examine the importance of contextual aspects of programs that aim to reduce facility-acquired pressure ulcers. CINAHL, the Cochrane Library, EMBASE, MEDLINE, and PreMEDLINE were searched for articles published from 2000 to 2012. Studies (any design) that implemented multicomponent initiatives to prevent pressure ulcers in adults in U.S. acute and long-term care settings and that reported pressure ulcer rates at least 6 months after implementation were selected. Two reviewers extracted study data and rated quality of evidence. Findings from 26 implementation studies (moderate strength of evidence) suggested that the integration of several core components improved processes of care and reduced pressure ulcer rates. Key components included the simplification and standardization of pressure ulcer-specific interventions and documentation, involvement of multidisciplinary teams and leadership, use of designated skin champions, ongoing staff education, and sustained audit and feedback.

  11. Older adults' knowledge of pressure ulcer prevention: a prospective quasi-experimental study.

    Science.gov (United States)

    Hartigan, Irene; Murphy, Siobhan; Hickey, Mary

    2012-09-01

    To test an evidence base patient education leaflet to evaluate older adults' knowledge of pressure ulcers and prevention strategies. The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional's verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. A quasi-experimental uncontrolled pre-test, post-test study of participants' knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult's knowledge was measured pre- and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. The results indicate that an education leaflet enhanced patients' knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration. © 2011 Blackwell Publishing Ltd.

  12. The role of habit in recurrent pressure ulcers following spinal cord injury.

    Science.gov (United States)

    Fogelberg, Donald J; Powell, Janet M; Clark, Florence A

    2016-11-01

    Despite the existence of numerous prevention strategies, pressure ulcers remain highly prevalent in those with spinal cord injury (SCI). The concept of habit, broadly defined, may help understand the persistence of this problem and offer strategies for its mitigation by occupational therapy. The aim of this paper is to describe the relationship between habits established prior to sustaining an SCI and post-injury habits that impacted on pressure ulcer risk. Secondary analysis of qualitative data collected during an ethnographic study of community-dwelling adults with SCI. Participants' habits appeared to substantially affect their risk of developing pressure ulcers. Habits established before incurring the SCI either facilitated or hindered the acquisition of new habits intended to prevent pressure ulcers. An understanding of the individual's pre-existing habits may be important when designing a rehabilitation programme intended to minimize risk of pressure ulcer development following SCI. Habit-change strategies could be used to supplement education in pressure ulcer prevention techniques. Occupational therapists have a longstanding interest in habit. A more comprehensive understanding of this concept may provide important insights into the persistence and management of pressure ulcers following SCI.

  13. [Differentiation between moisture lesions and pressure ulcers using photographs in a critical area].

    Science.gov (United States)

    Valls-Matarín, Josefa; Del Cotillo-Fuente, Mercedes; Pujol-Vila, María; Ribal-Prior, Rosa; Sandalinas-Mulero, Inmaculada

    2016-01-01

    To identify difficulties for nurses in differentiating between moisture lesions and pressure ulcers, proper classification of pressure ulcers to assess the adequate classification of the Grupo Nacional para el Estudio y Asesoramiento de Úlceras por Presión y Heridas Crónicas (GNEAUPP) and the degree of agreement in the correct assessment by type and category of injury. Cross-sectional study in a critical area during 2014. All nurses who agreed to participate were included. They performed a questionnaire with 14 photographs validated by experts of moisture lesions or pressure ulcers in the sacral area and buttocks, with 6 possible answers: Pressure ulcer category I, II, III, IV, moisture lesions and unknown. Demographics and knowledge of the classification system of the pressure ulcers were collected according to GNEAUPP. It involved 98% of the population (n=56); 98.2% knew the classification system of the GNEAUPP; 35.2% of moisture lesions were considered as pressure ulcers, most of them as a category II (18.9%). The 14.8% of the pressure ulcers photographs were identified as moisture lesions and 16.1% were classified in another category. The agreement between nurses earned a global Kappa index of .38 (95% CI: .29-.57). There are difficulties differentiating between pressure ulcers and moisture lesions, especially within initial categories. Nurses have the perception they know the pressure ulcers classification, but they do not classify them correctly. The degree of concordance in the diagnosis of skin lesions was low. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  14. Pressure ulcer incidence in Dutch and German nursing homes: design of a prospective multicenter cohort study

    Directory of Open Access Journals (Sweden)

    Lohrmann Christa

    2011-04-01

    Full Text Available Abstract Background Pressure ulcers are a common and serious health care problem in all health care settings. Results from annual national pressure ulcer prevalence surveys in the Netherlands and Germany reveal large differences in prevalence rates between both countries over the past ten years, especially in nursing homes. When examining differences in prevalence and incidence rates, it is important to take into account all factors associated with the development of pressure ulcers. Numerous studies have identified patient related factors, as well as nursing related interventions as risk factors for the development of pressure ulcers. Next to these more process oriented factors, also structural factors such as staffing levels and staff quality play a role in the development of pressure ulcers. This study has been designed to investigate the incidence of pressure ulcers in nursing homes in the Netherlands and Germany and to identify patient related factors, nursing related factors and structural factors associated with pressure ulcer development. The present article describes the protocol for this study. Methods/design A prospective multicenter study is designed in which a cohort of newly admitted nursing home residents in 10 Dutch and 11 German nursing homes will be followed for a period of 12 weeks. Data will be collected by research assistants using questionnaires on four different levels: resident, staff, ward, and nursing home. Discussion The results of the study will provide information on the incidence of pressure ulcers in Dutch and German nursing homes. Furthermore, information will be gathered on the influence of patient related factors, nursing related factors and structural factors on the incidence of pressure ulcers. The present article describes the study design and addresses the study's strengths and weaknesses.

  15. Factors associated with pressure ulcers in patients in a surgical intensive care unit.

    Science.gov (United States)

    Slowikowski, Gerri C; Funk, Marjorie

    2010-01-01

    We sought to describe the occurrence of pressure ulcers in patients managed in a surgical intensive care unit (ICU) and report preliminary work toward development of a pressure ulcer risk assessment tool for use in this population that incorporates comorbidities and other factors not addressed in previous instruments. Three hundred sixty-nine patients managed in the surgical ICU at Yale-New Haven Hospital comprised the sample. Demographic and clinical data, including Braden Scale scores, were collected in this prospective, 2-phase study. The principal investigator (G.C.S.) performed skin assessments on all patients. We used chi-square analysis and t tests to determine variables to include in a stepwise logistic regression analysis to determine factors independently associated with the development of pressure ulcers. We collected data, using a form we developed that contained demographic and clinical factors found in previous research and in our clinical practice to be associated with pressure ulcers. Eighty-eight out of 369 patients (23.9%) experienced a hospital-acquired pressure ulcer. Braden Scale scores ranged from 6 to 21, with a mean score of 11.9 ± 2.2. A lower Braden Scale score, the presence of diabetes mellitus, and patient age 70 years or older independently predicted the development of a pressure ulcer. These factors have been incorporated into the preliminary Surgical ICU Pressure Ulcer Risk Assessment scale. Findings from this study suggest that, in addition to a low Braden Scale score, age >70 years and a diagnosis of diabetes may represent clinically relevant pressure ulcer risk factors in the surgical intensive care population and that patients with these factors may benefit from more aggressive preventive care. In addition, the Surgical ICU Pressure Ulcer Risk Assessment scale requires additional psychometric testing before its use can be recommended for the research or practice settings.

  16. Patient perceptions of the role of nutrition for pressure ulcer prevention in hospital: an interpretive study.

    Science.gov (United States)

    Roberts, Shelley; Desbrow, Ben; Chaboyer, Wendy

    2014-01-01

    The aims of this study were to explore (a) patients' perceptions of the role of nutrition in pressure ulcer prevention; and (b) patients' experiences with dieticians in the hospital setting. Interpretive qualitative study. The sample comprised 13 females and 7 males. Their mean age was 61.3 ± 12.6 years (mean ± SD), and their average hospital length of stay was 7.4 ± 13.0 days. The research setting was a public health hospital in Australia. In this interpretive study, adult medical patients at risk of pressure ulcers due to restricted mobility participated in a 20 to 30 minute interview using a semi-structured interview guide. Interview questions were grouped into 2 domains; perceptions on the role of nutrition for pressure ulcer prevention; and experiences with dieticians. Recorded interviews were transcribed and analyzed using content analysis. Within the first domain, 'patient knowledge of nutrition in pressure ulcer prevention,' there were varying patient understandings of the role of nutrition for prevention of pressure ulcers. This is reflected in 5 themes: (1) recognizing the role of diet in pressure ulcer prevention; (2) promoting skin health with good nutrition; (3) understanding the relationship between nutrition and health; (4) lacking insight into the role of nutrition in pressure ulcer prevention; and (5) acknowledging other risk factors for pressure ulcers. Within the second domain, patients described their experiences with and perceptions on dieticians. Two themes emerged, which expressed differing opinions around the role and reputation of dieticians; they were receptive of dietician input; and displaying ambivalence towards dieticians' advice. Hospital patients at risk for pressure ulcer development have variable knowledge of the preventive role of nutrition. Patients had differing perceptions of the importance and value of information provided by dieticians.

  17. Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks.

    Science.gov (United States)

    Kaewprag, Pacharmon; Newton, Cheryl; Vermillion, Brenda; Hyun, Sookyung; Huang, Kun; Machiraju, Raghu

    2017-07-05

    We develop predictive models enabling clinicians to better understand and explore patient clinical data along with risk factors for pressure ulcers in intensive care unit patients from electronic health record data. Identifying accurate risk factors of pressure ulcers is essential to determining appropriate prevention strategies; in this work we examine medication, diagnosis, and traditional Braden pressure ulcer assessment scale measurements as patient features. In order to predict pressure ulcer incidence and better understand the structure of related risk factors, we construct Bayesian networks from patient features. Bayesian network nodes (features) and edges (conditional dependencies) are simplified with statistical network techniques. Upon reviewing a network visualization of our model, our clinician collaborators were able to identify strong relationships between risk factors widely recognized as associated with pressure ulcers. We present a three-stage framework for predictive analysis of patient clinical data: 1) Developing electronic health record feature extraction functions with assistance of clinicians, 2) simplifying features, and 3) building Bayesian network predictive models. We evaluate all combinations of Bayesian network models from different search algorithms, scoring functions, prior structure initializations, and sets of features. From the EHRs of 7,717 ICU patients, we construct Bayesian network predictive models from 86 medication, diagnosis, and Braden scale features. Our model not only identifies known and suspected high PU risk factors, but also substantially increases sensitivity of the prediction - nearly three times higher comparing to logistical regression models - without sacrificing the overall accuracy. We visualize a representative model with which our clinician collaborators identify strong relationships between risk factors widely recognized as associated with pressure ulcers. Given the strong adverse effect of pressure ulcers

  18. Evaluation of healing of pressure ulcers through thermography: a preliminary study

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    Maria Emília Abreu Chaves

    Full Text Available Introduction Thermography is a surface thermal radiation measurement technique whose application has been expanding in the healthcare field. The unhealed wound is a serious public health problem because it intervenes in the quality of life of patients and may cause emotional and psychological losses. The wound temperature can provide quantitative data that allow for the healing process to be monitored. The aim of this study was to verify whether thermography can be used as a method to evaluate the healing of pressure ulcers. Methods Eight participants with sacral pressure ulcers were recruited and randomly divided into two groups: A (control and B (experimental. Both groups received standard treatment for a period of four weeks, which consisted of a daily cleaning of the pressure ulcers with physiological saline (sodium chloride 0.9% followed by an alginate hydrogel dressing. The group B received light-emitting diode (LED phototherapy in addition to standard treatment, three times a week, yielding a total of 12 sessions. Photographs and thermograms of each pressure ulcer were obtained in all sessions in both groups. Results Pressure ulcers treated with LED phototherapy were healed. The pressure ulcer area of group B decreased over the 12 treatment sessions, whereas the pressure ulcer area of group A increased. The ulcer temperature of group B was higher than that of group A during the treatment (temperature difference up to 7.6%. Discussion The present study suggests a relationship between the temperature and area of pressure ulcers and proposes thermography as an adjunctive method for the evaluation of healing processes.

  19. Spinal Cord Injury and Pressure Ulcer Prevention: Using Functional Activity in Pressure Relief

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    May Stinson

    2013-01-01

    Full Text Available Background. People with spinal cord injury (SCI are at increased risk of pressure ulcers due to prolonged periods of sitting. Concordance with pressure relieving movements is poor amongst this population, and one potential alternative to improve this would be to integrate pressure relieving movements into everyday functional activities. Objectives. To investigate both the current pressure relieving behaviours of SCI individuals during computer use and the application of an ergonomically adapted computer-based activity to reduce interface pressure. Design. Observational and repeated measures design. Setting. Regional Spinal Cord Injury Unit. Participants. Fourteen subjects diagnosed with SCI (12 male, 2 female. Intervention.Comparing normal sitting to seated movements and induced forward reaching positions. Main Outcome Measures. Interface pressure measurements: dispersion index (DI, peak pressure index (PPI, and total contact area (CA. The angle of trunk tilt was also measured. Results. The majority of movements yielded less than 25% reduction in interface pressure compared to normal sitting. Reaching forward by 150% of arm length during an adapted computer activity significantly reduced DI (P<0.05, angle of trunk tilt (p<0.05, and PPI for both ischial tuberosity regions (P<0.001 compared to normal sitting. Conclusion. Reaching forward significantly redistributed pressure at the seating interface, as evidenced by the change in interface pressures compared to upright sitting.

  20. The management of pelvic pressure ulcers by myocutaneous flaps ...

    African Journals Online (AJOL)

    The sex ratio was 5 men for 4 women 10 sacral ulcers were treated by gluteus maximus myocutaneous flaps, 10 trochanteric and 4 ischiatic ulcers were covered by tensor fascia lata myocutaneous flaps. The cure rate was 100%. The main complications were: infection (63.5%), serous fluid discharge (21.05%), and flap ...

  1. [Impact of interventions in the pressure ulcer rate].

    Science.gov (United States)

    Araya Farías, I; Febré, N

    To evaluate the impact of a risk management program for prevention of pressure ulcers (PUs) in an adult Intensive Care Unit (ICU). A quantitative, prospective study performed with a «before and after» evaluation, and designed in three stages: 1) PU incidence study; 2) Intervention by implementing a risk management program, and 3) Assessment of the impact. Adherence to the preventive measures showed a significant increase (11.7%) between the first month of the program and the final month (58.5%) of the assessment. Initial PU rate was 20.9, with a decrease in the rate to 14.0 per 1000 bed occupancy days (P<.05) after the risk management program. The data show that the risk management program, using prevention measures, was effective in reducing the rate of PU in the period under study by more than 33%. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Costs of topical treatment of pressure ulcer patients

    Directory of Open Access Journals (Sweden)

    Cynthia Carolina Duarte Andrade

    2016-04-01

    Full Text Available Abstract OBJECTIVE To evaluate the costs of a topical treatment of pressure ulcer (PU patients in a hospital unit for treatment of chronic patients in 2014. METHOD This is an activity-based costing study. This method encompasses the identification, measurement and pricing of physical and human resources consumed for dressings. RESULTS Procedure costs varied between BRL 16.41 and BRL 260.18. For PUs of the same category, of near areas and with the same type of barrier/adjuvant, the cost varied between 3.5% and 614.6%. For most dressings, the cost increased proportionally to the increase of the area and to the development of PU category. The primary barrier accounted for a high percentage of costs among all items required to the application of dressings (human and material resources. Dressings applied in sacral PUs had longer application times. CONCLUSION This study allowed us to understand the costs involved in the treatment of PUs, and it may support decision-makers and other cost-effectiveness studies.

  3. Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality.

    Science.gov (United States)

    Díez-Manglano, J; Fernández-Jiménez, C; Lambán-Aranda, M P; Landa-Santesteban, M C; Isasi de Isasmendi-Pérez, S; Moreno-García, P; Bejarano-Tello, E; Barranco-Usón, J; Munilla-López, E; Del Corral-Beamonte, E

    2016-12-01

    To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation

    NARCIS (Netherlands)

    Verschueren, J. H. M.; Post, M. W. M.; de Groot, S.; van der Woude, L. H. V.; van Asbeck, F. W. A.; Rol, M.

    Study design: Multicenter prospective cohort study. Objectives: To determine the occurrence and predictors for pressure ulcers in patients with spinal cord injury (SCI) during primary in-patient rehabilitation. Setting: Eight Dutch rehabilitation centres with specialized SCI units. Methods: The

  5. Effects of long-term wearing of high-heeled shoes on the control of the body's center of mass motion in relation to the center of pressure during walking.

    Science.gov (United States)

    Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei

    2014-04-01

    High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. This study investigated the effects of habitual wearing of high-heeled shoes on the body's center of mass (COM) motion relative to the center of pressure (COP) during gait. Fifteen female experienced wearers and 15 matched controls walked with high-heeled shoes (7.3cm) while kinematic and ground reaction force data were measured and used to calculate temporal-distance parameters, joint moments, COM-COP inclination angles (IA) and the rate of IA changes (RCIA). Compared with inexperienced wearers, experienced subjects showed significantly reduced frontal IA with increased ankle pronator moments during single-limb support (pshoes, providing a basis for future design of strategies to minimize the risk of falling during high-heeled gait. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. Using statistical process control for monitoring the prevalence of hospital-acquired pressure ulcers.

    Science.gov (United States)

    Kottner, Jan; Halfens, Ruud

    2010-05-01

    Institutionally acquired pressure ulcers are used as outcome indicators to assess the quality of pressure ulcer prevention programs. Determining whether quality improvement projects that aim to decrease the proportions of institutionally acquired pressure ulcers lead to real changes in clinical practice depends on the measurement method and statistical analysis used. To examine whether nosocomial pressure ulcer prevalence rates in hospitals in the Netherlands changed, a secondary data analysis using different statistical approaches was conducted of annual (1998-2008) nationwide nursing-sensitive health problem prevalence studies in the Netherlands. Institutions that participated regularly in all survey years were identified. Risk-adjusted nosocomial pressure ulcers prevalence rates, grade 2 to 4 (European Pressure Ulcer Advisory Panel system) were calculated per year and hospital. Descriptive statistics, chi-square trend tests, and P charts based on statistical process control (SPC) were applied and compared. Six of the 905 healthcare institutions participated in every survey year and 11,444 patients in these six hospitals were identified as being at risk for pressure ulcers. Prevalence rates per year ranged from 0.05 to 0.22. Chi-square trend tests revealed statistically significant downward trends in four hospitals but based on SPC methods, prevalence rates of five hospitals varied by chance only. Results of chi-square trend tests and SPC methods were not comparable, making it impossible to decide which approach is more appropriate. P charts provide more valuable information than single P values and are more helpful for monitoring institutional performance. Empirical evidence about the decrease of nosocomial pressure ulcer prevalence rates in the Netherlands is contradictory and limited.

  7. Effectiveness of Enteral Nutritional Therapy in the Healing Process of Pressure Ulcers: A Systematic Review

    OpenAIRE

    Gisely Blanc; Marineli Joaquim Meier; Janislei Giseli Dorociaki Stocco; Hellen Roehrs; Karla Crozeta; Dulce Aparecida Barbosa

    2015-01-01

    OBJECTIVE To evaluate the effectiveness of enteral nutritional therapy (ENT) in the healing process of pressure ulcers (PU) in adults and the elderly. METHOD A systematic review whose studies were identified through the databases of Cochrane, MEDLINE/PubMed, SciELO, LILACS, EMBASE, CINAHL, Web of Science, and manual searches. It included randomized clinical trials (RCTs) without delimiting the period or language of publication, which addressed adults and elderly patients with pressure ulcers ...

  8. Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.

    Science.gov (United States)

    Soban, Lynn M; Kim, Linda; Yuan, Anita H; Miltner, Rebecca S

    2017-09-01

    To describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. Comprehensive pressure ulcer programmes include nursing interventions such as use of a risk assessment tool and organisational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programmes. Data were collected by an e-mail survey to all chief nursing officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarise survey responses and evaluate relationships between some variables. Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalised within individual hospitals. Organisational strategies to support implementation of pressure ulcer preventive programmes are often not optimally operationalised to achieve consistent, sustainable performance. The results of the present study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  9. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility

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    Lenche Neloska

    2016-08-01

    Full Text Available BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU. MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014. We recorded: demographic data, body mass index (BMI, Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099. Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001. This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.

  10. Using the Care Dependency Scale for identifying patients at risk for pressure ulcer.

    Science.gov (United States)

    Dijkstra, Ate; Kazimier, Hetty; Halfens, Ruud J G

    2015-11-01

    The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. Cross-sectional design. The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited. © 2015 John Wiley & Sons Ltd.

  11. Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.

    Science.gov (United States)

    Ma, Chenjuan; Park, Shin Hye

    2015-11-01

    To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention. © 2015 Sigma Theta Tau International.

  12. Establishing a comprehensive networkwide pressure ulcer identification process.

    Science.gov (United States)

    Vose, Courtney; Murphy, Robert X; Burmeister, David B; Buckenmyer, Charlotte; Davidson, Carolyn L; Meltsch, Tami J; Holko, Ginger; Karoly, Elizabeth; Porter, Bernadette Glenn

    2011-03-01

    Pressure ulcers (PUs) are a critical concern, endangering patients and requiring significant resources for treatment in Stage II/IV. The Centers for Medicare & Medicaid Services (CMS) denies reimbursement in cases where a more complex diagnosis-related group (DRG) is assigned as a result of hospital-acquired conditions such as a PU that could have been reasonably prevented. An interdisciplinary PU present-on-admission (POA) team developed an algorithm to support the early identification of PUs for units participating in the process. This approach standardized work, resulting in consistent (1) skin assessment, (2) physician notification, (3) reporting of findings in the patient safety reporting system, and (4) communication to receiving units. Computer-entry tools were developed and completed for six months by the patient care services unit-based process improvement councils; these councils made possible immediate "loop closure" for either positive feedback or needed reeducation with the nursing staff. The total number of PUs recognized and reported after implementation of the process improvement initiative--from April 1, 2008, to March 31, 2009--increased to 1,103--an increase of 36.3% in PU reporting when compared with the same period the year before. This initiative has yielded 100% effectiveness in identifying Stage III/IV PUs POA and in preventing hospital-acquired Stage III/IV PUs. The success of the project has helped to ensure high-quality patient care and protection of precious fiscal resources. The data suggest that the identification of all PUs that are present at time of admission is clinically feasible.

  13. Pressure ulcer education improves interrater reliability, identification, and classification skills by emergency nurses and physicians

    NARCIS (Netherlands)

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J.; Veugelers, Rebekka; Leenen, Luke P H

    Introduction: Pressure ulcers (PUs) are a serious health complication that develop as a result of pressure alone or pressure in combination with shearing forces. Although PUs are typically associated with older adults and chronic illness, acutely injured trauma patients may have a particular risk

  14. Pressure ulcer education improves interrater reliability, identification, and classification skills by emergency nurses and physicians

    NARCIS (Netherlands)

    Ham, W.H.; Schoonhoven, L.; Schuurmans, M.J.; Veugelers, R.; Leenen, L.P.

    2015-01-01

    INTRODUCTION: Pressure ulcers (PUs) are a serious health complication that develop as a result of pressure alone or pressure in combination with shearing forces. Although PUs are typically associated with older adults and chronic illness, acutely injured trauma patients may have a particular risk

  15. The Efficiency of Medial Plantar Skin Flap for Reconstructing Heel after Excision of Heel Melanoma

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    Hosseinali Abdolrazaghi

    2016-07-01

    Full Text Available Abstract Background: This essay reports a case about tissue defect of heel due to melanoma excision. Patient history: The patient was a man 60 years old with a heel ulcer that had reported malignant melanoma in biopsy. Then the ulcer was done under wide local excision. Materials and Methods: We should use flap for tissue defect coverage that tendon and heel bone are exposed from it. It seems using skin graft is not useful, because skin graft in persistent contact with shoes will get chronic ulcer. Among different flaps (sural flap or medial plantar flap, we decided to use medial plantar flap. The advantage of this flap is its sensority and low volume. Conclusion: Conclusion with due attention the results, The meial planter flap, as an efficient method, is adviced to teconstruct heed specially after excision of melanoma.

  16. Accuracy of ultrasound, thermography and subepidermal moisture in predicting pressure ulcers: a systematic review.

    Science.gov (United States)

    Oliveira, A L; Moore, Z; O Connor, T; Patton, D

    2017-05-02

    Our aims were to: establish the clinical significance of ultrasound, thermography, photography and subepidermal moisture (SEM) measurement; determine the accuracy of ultrasound, thermography, photography and SEM measurement in detecting skin/tissue damage; determine the relative accuracy of one of these assessment methods over another; make recommendations for practice pertaining to assessment of early skin/tissue damage. The following databases, Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, Elsevier version, EBSCO CINAHL, ClinicalTrials.gov , WHO International Clinical Trials Registry (ICTR) and The EU Clinical Trials Register were searched for terms including; thermography, ultrasound, subepidermal moisture, photograph and pressure ulcer. We identified four SEM, one thermography and five ultrasound studies for inclusion in this review. Data analysis indicated that photography was not a method which allowed for the early prediction of PU presence. SEM values increased with increasing tissue damage, with the sacrum and the heels being the most common anatomical locations for the development of erythema and stage I PUs. Thermography identified temperature changes in tissues and skin that may give an indication of early PU development; however the data were not sufficiently robust. Ultrasound detected pockets of fluid/oedema at different levels of the skin that were comparable with tissue damage. Thus, SEM and ultrasound were the best methods for allowing a more accurate assessment of early skin/tissue damage. Using the EBL Critical Appraisal Tool the overall validities of the studies varied between 33.3-55.6%, meaning that there is potential for bias within all the included studies. All of the studies were situated at level IV, V and VII of the evidence pyramid. Although the methodological quality of the studies warrants consideration, these studies showed the potential that SEM and

  17. Staging and defining characteristics of pressure ulcers using photographs by staff nurses in acute care settings.

    Science.gov (United States)

    Jesada, Elizabeth C; Warren, Joan I; Goodman, Dorothy; Iliuta, Ruth W; Thurkauf, Gail; McLaughlin, Maureen K; Johnson, Joyce E; Strassner, Larry

    2013-01-01

    The aim of this study was to determine if a digital photograph obtained by a staff nurse in the acute care setting could be used to determine staging and wound characteristics of a pressure ulcer when viewed by a panel of wound experts as compared to a bedside assessment by a wound expert. One hundred digital photographs of pressure ulcers were obtained from 69 patients on general and critical care medical-surgical nursing units from 2 Magnet-designated hospitals belonging to a large Mid-Atlantic health care system. Four certified wound ostomy nurses (CWONs), 2 at each hospital site, identified patients with a pressure ulcer for bedside assessment and digital photography. This multisite nonexperimental study compared bedside assessment of wound characteristics and staging of 100 pressure ulcers by the hospital CWON to assessment of the same wound by an expert panel of 3 CWONs via digital photography. This study examined 13 wound characteristics and a total score on the Bates-Jensen Wound Assessment Tool (BWAT) as well as the staging of a pressure ulcer using the National Pressure Ulcer Advisory Panel definitions. A nonprobability sampling plan used a convenience sample of 69 adult inpatients at the 2 hospitals to obtain photographs of 100 pressure ulcers. : The BWAT, formerly the Pressure Sore Status Tool, was used by the bedside and expert panelists to assess the pressure ulcer characteristics. This tool assesses 13 wound characteristics from best to worst, using a modified Likert scale. Studies examining reliability and validity of the BWAT support it as an effective instrument. Interrater reliability among the hospital CWONs using bedside assessment and panelist CWONs using digital photography assessment for the BWAT 13 characteristics ranged from slight to fair agreement for skin color surrounding wound (κ range = 0.12-0.21, P ≤ .02) to fair to moderate agreement for necrotic tissue type (κ range = 0.37-0.60, P = .000). Only slight agreement for total BWAT

  18. The effect of nitric oxide releasing cream on healing pressure ulcers

    Science.gov (United States)

    Saidkhani, Vahid; Asadizaker, Marziyeh; Khodayar, Mohammad Javad; Latifi, Sayed Mahmoud

    2016-01-01

    Background: Pressure ulcer is one of the main concerns of nurses in medical centers around the world, which, if untreated, causes irreparable problems for patients. In recent years, nitric oxide (NO) has been proposed as an effective method for wound healing. This study was conducted to determine the effect of nitric oxide on pressure ulcer healing. Materials and Methods: In this clinical trial, 58 patients with pressure ulcer at hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences were homogenized and later divided randomly into two groups of treatment (nitric oxide cream; n = 29) and control (placebo cream; n = 29). In this research, the data collection tool was the Pressure Ulcer Scale for Healing (PUSH). At the outset of the study (before using the cream), the patients' ulcers were examined weekly in terms of size, amount of exudates, and tissue type using the PUSH tool for 3 weeks. By integrating these three factors, wound healing was determined. Data were analyzed using SPSS. Results: Although no significant difference was found in terms of the mean of score size, the amount of exudates, and the tissue type between the two groups, the mean of total score (healing) between the two groups was statistically significant (P = 0.04). Conclusions: Nitric oxide cream seems to accelerate wound healing. Therefore, considering its easy availability and cost-effectiveness, it can be used for treating pressure ulcers in the future. PMID:27186212

  19. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

    Directory of Open Access Journals (Sweden)

    Ulla Hellstrand Tang

    2015-06-01

    Full Text Available Objective: Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods: Patients diagnosed with type 1 (n=27 or type 2 (n=47 diabetes (mean age 60.0±15.0 years were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results: Neuropathy was present in 28 (38%, and 39 (53% had callosities in the heel region. Low forefoot arch was present in 57 (77%. Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions: This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU. Hallux valgus

  20. Does improvised waterbed reduce the incidence of pressure ulcers in patients with spinal injury?

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    Jude-Kennedy C Emejulu

    2015-01-01

    Full Text Available Background: Pressure ulcers are lesions caused by unrelieved pressure over bony prominences, resulting in damage to underlying tissues. The etiology is multifactorial including prolonged immobility. They usually complicate spinal cord injuries with long periods of bed confinement. The use of bed replacements markedly reduces the incidence of pressure ulcers, but the unaffordability of these replacements in low-income countries has necessitated the need to explore cheaper alternatives. Aim and Objective: The aim of this study was to ascertain whether the use of our cheap and locally improvised waterbeds would reduce the incidence of pressure ulcers in patients on prolonged bed confinement due to spinal injury. Methodology: Over a 16-month period, 51 patients (age range 1-80 years with spinal injuries were managed conservatively in our service using improvised waterbeds in 21 (41.2%, while using the regular hospital bed/foam in 30 (58.8%. Biodata, the time interval between injury and presentation to the hospital, nature of the injury, use of improvised waterbed and development of pressure ulcer, were collected, collated, and analyzed. Statistical significance was calculated with the Chi-square test. Results: Most were males (98%, in the age range of 21-30 years (25.5%, and due to fall from heights (35.3%. Of 21 patients who were managed on improvised waterbeds, 6 (28.6% had pressure ulcers, and of the 30 who did not use the waterbed, 17 (56.7% developed ulcers. The c2 = 3.9381, while P = 0.0472. This difference was statistically significant. Conclusion: The improvised waterbed, which is much cheaper than the standard waterbed, was observed to have significantly reduced the incidence of pressure ulcers among our patients. Nonetheless, further studies would still be needed to confirm this observation.

  1. Effectiveness of an e-learning tool for education on pressure ulcer evaluation.

    Science.gov (United States)

    Morente, Laura; Morales-Asencio, José M; Veredas, Francisco J

    2014-07-01

    To evaluate the effectiveness of information and communication technologies in the undergraduate students' pressure ulcer training as a learning tool, compared with traditional teaching methods. Pressure ulcers constitute one of the great challenges faced by nursing professionals. Currently, pressure ulcer training is based on traditional on-campus teaching, involving lecture-style classes with frequent use of photographs of the wounds. This traditional training has some important weaknesses that can put the efficacy of the training at risk. A randomised controlled trial was developed including undergraduate nursing students. The intervention group used an adaptive self-learning e-learning tool developed by the research team (ePULab) for pressure ulcer assessment and treatment. The control group received a traditional on-campus class on the same topic. Pretest and post-test questionnaires were designed to assess the students' ability in pressure ulcer diagnosis and treatment. The educational intervention based on the use of the ePULab tool produced significantly better learning acquisition results than those obtained by traditional lecture-style classes: the total score improved in the control group from 8·23 (SD 1·23)-11·6 (SD 2·52) after the lecture, whereas in the intervention group, the knowledge score changed from 8·27 (SD 1·39)-15·83 (SD 2·52) (p = 0·01) with the use of ePULab. The results show a higher effectiveness of the devised e-learning approach for education on management of pressure ulcers. Our results reveal the suitability of the ePULab e-learning tool as an effective instrument for training on assessment of and treatment for pressure ulcers and its potential impact on clinical decision-making. © 2013 John Wiley & Sons Ltd.

  2. Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals.

    Science.gov (United States)

    Hoviattalab, Khadijeh; Hashemizadeh, Haydeh; D'Cruz, Gibson; Halfens, Ruud J G; Dassen, Theo

    2015-06-01

    The study aimed to establish the range and extent of preventive interventions undertaken by nurses for patients who are at high risk of developing or currently have a pressure ulcer. Since 2000, the German National Expert Standard for the prevention of pressure ulcers has provided evidence-based recommendations, but limited studies have been published on its adherence in hospitals. There are also limited observational studies that investigated whether patients who are at risk of or have pressure ulcers are provided with appropriate preventative measures. A nonparticipant observational descriptive design was used. A sample of 32 adult patients who were at high risk of developing or currently had a pressure ulcer were observed during all shifts in medical and surgical wards in two general hospitals in Germany. A range of preventive interventions that were in line with the German National Expert Standard was observed. The most frequent preventive measures were 'cleaning the patients' skin' and 'minimizing exposure to moisture' that were undertaken in more than 90% of all patients. The least frequent measures were 'patient and relative education', 'assessment and recording of nutritional status'. This study demonstrates that the pressure ulcers preventive interventions as set out in the German National Expert Standard were not fully implemented. The study highlights the need for further studies on the barriers that impede the undertaking of the interventions that may prevent the development or deterioration of pressure ulcers and the delivery of evidence-based preventative care. This study provides an insight into the extent of pressure ulcers preventive practices used by nurses. The results may serve as a basis for developing an effective strategy to improve nursing practice in this area and the promotion of evidence-based practice. However, our results refer to two general hospitals and for a broader population, further studies with larger data samples are needed.

  3. [Trends in the prevalence of pressure ulcers in an acute care tertiary hospital (2006-2013)].

    Science.gov (United States)

    Alonso-Lorente, C; Barrasa-Villar, J I; Aibar-Remón, C

    2015-01-01

    To analyse the trends in pressure ulcer prevalence from 2006 to 2013. To determine the main risk factors associated with pressure ulcers. A descriptive study analysing the prevalence in a series of pressure ulcers collected in the study on the prevalence of nosocomial infections in Spain from 2006 to 2013 in the Clinical University Hospital of Zaragoza. The mean prevalence among the 5,354 patients included over the period of study was 4.5% (95% CI=3.9-5.0%). No significant difference in its trend or distribution of pressure ulcers was observed over the several years of the study. Prevalence increased up to 5.0% (95% CI=4.4-5.6%) when short-stay patients (less than 24 hours) and those admitted into low risk units (Paediatrics, Psychiatry and Obstetrics) were removed from the study, but there was still no significant differences in its yearly trend or distribution (p>0.05). Age, length of stay, presence of coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were risk factors associated with pressure ulcer prevalence in the logistic regression. Age, length of stay, coma, in-dwelling urethral catheters, malnutrition, infection, and admission unit were independent risk markers for patients with pressure ulcers. No particular trend of pressure ulcer prevalence could be determined to demonstrate any effects from the different strategies of improvement implemented during the period of study, although this fact could be due to the limitations of data used in the study. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  4. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    Science.gov (United States)

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  5. Evaluation of the bacterial diversity of Pressure ulcers using bTEFAP pyrosequencing

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    Wolcott Randall D

    2010-09-01

    Full Text Available Abstract Background Decubitus ulcers, also known as bedsores or pressure ulcers, affect millions of hospitalized patients each year. The microflora of chronic wounds such as ulcers most commonly exist in the biofilm phenotype and have been known to significantly impair normal healing trajectories. Methods Bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP, a universal bacterial identification method, was used to identify bacterial populations in 49 decubitus ulcers. Diversity estimators were utilized and wound community compositions analyzed in relation to metadata such as Age, race, gender, and comorbidities. Results Decubitus ulcers are shown to be polymicrobial in nature with no single bacterium exclusively colonizing the wounds. The microbial community among such ulcers is highly variable. While there are between 3 and 10 primary populations in each wound there can be hundreds of different species present many of which are in trace amounts. There is no clearly significant differences in the microbial ecology of decubitus ulcer in relation to metadata except when considering diabetes. The microbial populations and composition in the decubitus ulcers of diabetics may be significantly different from the communities in non-diabetics. Conclusions Based upon the continued elucidation of chronic wound bioburdens as polymicrobial infections, it is recommended that, in addition to traditional biofilm-based wound care strategies, an antimicrobial/antibiofilm treatment program can be tailored to each patient's respective wound microflora.

  6. Bursitis of the heel

    Science.gov (United States)

    ... heel is swelling of the fluid-filled sac (bursa) at the back of the heel bone. ... A bursa acts as a cushion and lubricant between tendons or muscles sliding over bone. There are bursas around ...

  7. The Nursing Diagnosis of risk for pressure ulcer: content validation.

    Science.gov (United States)

    Santos, Cássia Teixeira Dos; Almeida, Miriam de Abreu; Lucena, Amália de Fátima

    2016-06-14

    to validate the content of the new nursing diagnosis, termed risk for pressure ulcer. the content validation with a sample made up of 24 nurses who were specialists in skin care from six different hospitals in the South and Southeast of Brazil. Data collection took place electronically, through an instrument constructed using the SurveyMonkey program, containing a title, definition, and 19 risk factors for the nursing diagnosis. The data were analyzed using Fehring's method and descriptive statistics. The project was approved by a Research Ethics Committee. title, definition and seven risk factors were validated as "very important": physical immobilization, pressure, surface friction, shearing forces, skin moisture, alteration in sensation and malnutrition. Among the other risk factors, 11 were validated as "important": dehydration, obesity, anemia, decrease in serum albumin level, prematurity, aging, smoking, edema, impaired circulation, and decrease in oxygenation and in tissue perfusion. The risk factor of hyperthermia was discarded. the content validation of these components of the nursing diagnosis corroborated the importance of the same, being able to facilitate the nurse's clinical reasoning and guiding clinical practice in the preventive care for pressure ulcers. validar o conteúdo do novo diagnóstico de enfermagem, denominado risco de úlcera por pressão. trata-se de uma validação de conteúdo, com amostra composta por 24 enfermeiros especialistas no cuidado à pele, procedentes de seis diferentes hospitais do Sul e Sudeste brasileiro. A coleta de dados ocorreu por meio eletrônico, em instrumento construído pelo programa SurveyMonkey, que continha título, definição e 19 fatores de risco para o diagnóstico de enfermagem. Os dados foram analisados pelo método de Fehring e pela estatística descritiva. O projeto foi aprovado em Comitê de Ética em Pesquisa. título, definição e sete fatores de risco foram validados como "muito importante

  8. Costs of topical treatment of pressure ulcer patients.

    Science.gov (United States)

    Andrade, Cynthia Carolina Duarte; Almeida, Cláudia Fernanda Dos Santos Calixto de; Pereira, Walkíria Euzébio; Alemão, Márcia Mascarenhas; Brandão, Cristina Mariano Ruas; Borges, Eline Lima

    2016-04-01

    To evaluate the costs of a topical treatment of pressure ulcer (PU) patients in a hospital unit for treatment of chronic patients in 2014. This is an activity-based costing study. This method encompasses the identification, measurement and pricing of physical and human resources consumed for dressings. Procedure costs varied between BRL 16.41 and BRL 260.18. For PUs of the same category, of near areas and with the same type of barrier/adjuvant, the cost varied between 3.5% and 614.6%. For most dressings, the cost increased proportionally to the increase of the area and to the development of PU category. The primary barrier accounted for a high percentage of costs among all items required to the application of dressings (human and material resources). Dressings applied in sacral PUs had longer application times. This study allowed us to understand the costs involved in the treatment of PUs, and it may support decision-makers and other cost-effectiveness studies. Realizar uma avaliação do custo do tratamento tópico de pacientes com úlceras por pressão (UP), em uma unidade hospitalar de atendimento a pacientes crônicos no ano de 2014. Trata-se de um estudo de custos baseado no Sistema de custeio Baseado em Atividades. Este método contempla a identificação, mensuração e precificação dos recursos físicos e humanos consumidos para a realização de curativos. Os custos dos procedimentos variaram de R$16,41 a R$260,18. Para UP de mesma categoria, de áreas aproximadas e mesmo tipo de cobertura/adjuvante, a variação entre os custos foi de 3,5% a 614,6%. Para a maioria dos curativos, o custo aumentou proporcionalmente ao aumento da área e à progressão da categoria das UP. A cobertura primária representou elevado percentual nos custos entre todos os itens necessários para realizar os curativos (recursos humanos e materiais). Os curativos realizados nas UP sacrais foram os que apresentaram maiores tempos para execução. Este estudo permitiu conhecer os

  9. Pressure ulcer healing: what is it? What influences it? How is it measured?

    Science.gov (United States)

    Xakellis, G C; Frantz, R A

    1997-09-01

    Defining healing requires a set of measurements that quantify the physical factors that change during healing. Such a list of measures gives a de facto definition of what constitutes pressure ulcer healing and what influences it. This paper attempts to answer a more specific question: Which measurements are strong candidates for inclusion in a tool for monitoring pressure ulcer healing? Three sets of clinical measurements are analyzed--the assessment proposed by the Agency for Health Care Policy and Research Guideline Development Panel for the Treatment of Pressure Ulcers; the recommendations of the Wound Healing Society; and the Pressure Sore Status Tool. The validity of the 11 clinical measures common across these assessment methods is examined using empiric evidence from studies of wound healing.

  10. Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury: Biomarkers of Muscle Composition and Resilience

    Science.gov (United States)

    2016-10-01

    Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury : Biomarkers of Muscle Composition and Resilience 5a. CONTRACT NUMBER 5b...with acute spinal cord injury at risk of pressure ulcers. This project will investigate potential linkages between skeletal muscle tissue...AWARD NUMBER: W81XWH-14-1-0618 TITLE: Development of a Personalized Model for Pressure Ulcer Prevention Acutely Following Spinal Cord Injury

  11. Photographic assessment of the appearance of chronic pressure and leg ulcers.

    Science.gov (United States)

    Houghton, P E; Kincaid, C B; Campbell, K E; Woodbury, M G; Keast, D H

    2000-04-01

    The purpose of this paper was to examine the validity and reliability of using photographs of wounds to accurately assess wound status. The results of assessing wound appearance using wound photographs was compared to results obtained from a bedside assessment using the Pressure Sore Status Tool (PSST). The photographic wound assessment tool (PWAT) used in this comparison represents a modified version of the PSST and includes the six domains that can be determined from wound photographs. The PWAT was used on photographs of both chronic pressure ulcers (n = 56) and leg ulcers due to vascular insufficiency (n = 81). The photographic tool has excellent intrarater (ICC = 0.96) and interrater (ICC = 0.73) reliability and good concurrent validity (r = 0.70) compared with a full bedside assessment PSST. The PWAT has also shown to be sensitive to change in wound appearance of healing ulcers, but not nonhealing ulcers. These results would suggest that in the event that a full bedside assessment is not possible, wound photographs may be used to accurately assess wound appearance of both chronic pressure ulcers located on the trunk and vascular ulcers of the lower extremity. Establishing a valid and reliable assessment of wound healing using photographic images is of great relevance to the advancing fields of computer image analysis and telemedicine.

  12. Development and psychometric characteristics of the SCI-QOL Pressure Ulcers scale and short form.

    Science.gov (United States)

    Kisala, Pamela A; Tulsky, David S; Choi, Seung W; Kirshblum, Steven C

    2015-05-01

    To develop a self-reported measure of the subjective impact of pressure ulcers on health-related quality of life (HRQOL) in individuals with spinal cord injury (SCI) as part of the SCI quality of life (SCI-QOL) measurement system. Grounded-theory based qualitative item development methods, large-scale item calibration testing, confirmatory factor analysis (CFA), and item response theory-based psychometric analysis. Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. Adults with traumatic SCI. SCI-QOL Pressure Ulcers scale. 189 individuals with traumatic SCI who experienced a pressure ulcer within the past 7 days completed 30 items related to pressure ulcers. CFA confirmed a unidimensional pool of items. IRT analyses were conducted. A constrained Graded Response Model with a constant slope parameter was used to estimate item thresholds for the 12 retained items. The 12-item SCI-QOL Pressure Ulcers scale is unique in that it is specifically targeted to individuals with spinal cord injury and at every stage of development has included input from individuals with SCI. Furthermore, use of CFA and IRT methods provide flexibility and precision of measurement. The scale may be administered in its entirety or as a 7-item "short form" and is available for both research and clinical practice.

  13. Reliability and validity of DESIGN, a tool that classifies pressure ulcer severity and monitors healing.

    Science.gov (United States)

    Sanada, H; Moriguchi, T; Miyachi, Y; Ohura, T; Nakajo, T; Tokunaga, K; Fukui, M; Sugama, J; Kitagawa, A

    2004-01-01

    This study reviews the validity and reliability of DESIGN, a tool for classifying pressure ulcer severity and monitoring progression towards healing. Only the tool's healing progression component was evaluated. Inter-rater reliability was evaluated by calculating the agreement rate of scores, based on eight photos of pressure ulcers and six actual ulcers, made by a panel of seven nurses. Validity was assessed, using the same eight photos, by comparing DESIGN scores with those made using the validated Pressure Sore Status Tool (PSST). The DESIGN inter-rater reliability results showed a high correlation of r = 0.98 for the photos and r = 0.91 for the real-life patients with pressure ulcers, respectively, for all seven raters based on total scores. For validity, a correlation greater than 0.91 was found between the DESIGN and PSST scores. Based on our results, DESIGN was found to have both high inter-rater reliability and high validity among the seven nurses who quantitatively evaluated the wound-healing progress of the pressure ulcers in this study.

  14. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review.

    Science.gov (United States)

    Artico, Marco; Dante, Angelo; D'Angelo, Daniela; Lamarca, Luciano; Mastroianni, Chiara; Petitti, Tommasangelo; Piredda, Michela; De Marinis, Maria Grazia

    2017-10-01

    Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers' prevalence, incidence and associated factors are largely insufficient. To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients' and caregivers' characteristics associated with their occurrence. Retrospective chart review. Patients ( n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index ( p 70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. The notable pressure ulcers' incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses' clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers' characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient's needs.

  15. Use of a pressure plate to analyse the toe-heel load redistribution underneath a normal shoe and a shoe with a wide toe in sound warmblood horses at the walk and trot.

    Science.gov (United States)

    Oomen, A M; Oosterlinck, M; Pille, F; Sonneveld, D C; Gasthuys, F; Back, W

    2012-10-01

    The objective of this study was to use a pressure plate to quantify the toe-heel load redistribution in the forelimbs of sound warmblood horses with normal shoes and shoes with a wide toe and narrow branches, used empirically in the treatment of superficial digital flexor tendon or suspensory ligament injuries. In a crossover-design study, six horses, randomly shod with normal shoes and shoes with a wide toe, were led over a dynamically calibrated pressure plate to record data from both forelimbs. There were no significant differences between both shoes in the toe-heel index of stance time, peak vertical force and vertical impulse. For the adapted shoe, the peak vertical pressure was slightly lower and was exerted slightly earlier in the stance phase, albeit not significantly. However, the significantly larger toe contact area of the adapted shoe resulted in a significantly lower total vertical pressure in the toe region. Hence, the pressure plate adequately visualised the individual loading of the toe and heel region, and clearly demonstrated the altered pressure distribution underneath the shoe with a wide toe. Although further research on a deformable surface is needed to confirm this hypothesis, the pressure redistribution from the toe to the heels could promote sinking of the heels in arena footing, thereby mimicking the biomechanical effects of a toe wedge and providing a rationale for its application in the treatment of SDFT or SL injuries. The pressure measuring equipment used in this study can offer to the clinician a diagnostic tool for the evaluation of the load distribution underneath the equine hoof and for the fine-tuning of corrective shoeing. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

    Directory of Open Access Journals (Sweden)

    Olfat A. Fawzy

    2014-01-01

    Full Text Available Background Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. Subjects and Methods A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS, for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan. The studied patients were grouped into: (1 diabetic control group (DC, which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤ 2; (2 diabetic neuropathy group (DN, which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3 diabetic ulcer group (DU, which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. Results PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP, rearfoot peak plantar pressure (RFPPP, forefoot/rearfoot ratio (F/R, forefoot peak pressure gradient (FFPPG rearfoot peak pressure gradient (RFPPG, and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG ( P 0.05. FFPPP, F/R ratio, FFPPG, and FFPPG/RFPPG correlated significantly with the severity of neuropathy according to MNDS ( P < 0.05. These same variables as well as MNDS were also significantly higher in patients with foot deformity compared to those without deformity ( P < 0.05. Using the receiver operating

  17. A Descriptive, Cross-sectional Survey of Turkish Nurses' Knowledge of Pressure Ulcer Risk, Prevention, and Staging.

    Science.gov (United States)

    Gul, Asiye; Andsoy, Isil Isik; Ozkaya, Birgul; Zeydan, Ayten

    2017-06-01

    Nurses' knowledge of pressure ulcer (PU) prevention and management is an important first step in the provision of optimal care. To evaluate PU prevention/risk, staging, and wound description knowledge, a descriptive, cross-sectional survey was conducted among nurses working in an acute care Turkish hospital. The survey instrument was a modified and translated version of the Pieper Pressure Ulcer Knowledge Test (PUKT), and its validity and reliability were established. Nurses completed a Personal Characteristics Form, including sociodemographic information and exposure to educational presentations and information about and experience with PUs, followed by the 49-item modified PUKT which includes 33 prevention/risk items, 9 staging items, and 7 wound description items. All items are true/false questions with an I don't know option (scoring: minimum 0, maximum 49). Correct answers received 1 point and incorrect/unknown answers received 0 points. The paper-pencil questionnaires were distributed by 2 researchers to all nurses in the participating hospital and completed by those willing to be included. Responses were analyzed using descriptive statistics. Pearson's correlation test was used to examine the relationship between quantitative variables, and mean scores were compared using the Mann-Whitney U and Kruskal-Wallis tests. Among the 308 participating nurses (mean age 29.5 ± 8.1 [range 19-56] years) most were women (257, 83.4%) with 7.3 ± 7.8 (range 1-36) years of experience. The mean knowledge score for the entire sample was 29.7 ± 6.7 (range 8-42). The overall percentage of correct answers was 60.6% to 61.8% for PU prevention/risk assessment, 60% for wound description, and 56.6% for PU staging. Knowledge scores were significantly (P <.05) higher for participants who attended at least 1 lecture/conference/course on PUs in the last year, read articles/books about PUs, cared for patients with PUs, or believed their patients were at risk for PU development. Most

  18. Evaluation of a formal care worker educational intervention on pressure ulceration in the community.

    Science.gov (United States)

    Cross, Carol; Hindley, Jenny; Carey, Nicola

    2017-09-01

    To develop and evaluate an educational intervention for formal care workers on pressure ulceration in the community. Pressure ulcers are a major burden to health care and with an ageing population likely to increase. Formal care workers are ideally placed to identify high risk but lack standardised educational provision. An insider approach to action research in one provider organisation, November 2014-May 2015. Number and categorisation of pressure ulcers, within three community nursing teams before and four months after intervention was delivered to a purposive sample (n = 250) of formal care workers, were assessed and the taught element evaluated using a questionnaire and verbal feedback. Total number of pressure ulcers reduced from 28-20, category II, 19-11, III unchanged at 6 and IV from 2-0 following the educational intervention. Key risk factors included impaired mobility (71%), urinary incontinence (61%) and previous pressure damage (25%), and 71% had formal care worker input. The intervention was highly rated 4·95/5 by 215 (86%) formal care workers in the evaluation questionnaire. Formal care workers receive little, if any, education on pressure ulceration. An educational intervention can have a positive effect within community care, with the potential to reduce direct costs of care. However, a standardised approach to education is required; an urgent review of the education provision to formal care workers, in the UK and around the world, is therefore essential if the potential that formal care workers offer is to be realised. Formal care workers are ideally placed to help identify and alert healthcare professionals about patients at high risk of developing pressure ulcers. If this potential is to be realised, a standardised approach to education is required. © 2016 John Wiley & Sons Ltd.

  19. Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration.

    Science.gov (United States)

    Fernando, Malindu E; Crowther, Robert G; Lazzarini, Peter A; Sangla, Kunwarjit S; Wearing, Scott; Buttner, Petra; Golledge, Jonathan

    2016-09-15

    Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm's correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen's d values (standardised mean difference) were reported for all significant outcomes. The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p control groups (p diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

  20. Risk management for pressure ulcers: when the family shows up with a camera.

    Science.gov (United States)

    Levine, Jeffrey M; Savino, Fay; Peterson, Marilyn; Wolf, Carolyn Reinach

    2008-06-01

    Pressure ulcers, although sometimes unavoidable, are frequently viewed as a failure of the health care system. Private civil lawsuits alleging malpractice or negligence related to pressure ulcers are becoming increasingly common. Because of their graphic nature, a photograph of a wound may add value to a plaintiff's case whether or not a negligent act has truly occurred. When the family shows up with a camera, caregivers should be "on notice" that a lawsuit may occur. This applies not only to nursing homes, but to any setting in which pressure ulcers occur including hospital, rehabilitation facility, home care, or hospice. When the threat of litigation arises, we recommend steps that include reestablishing trust with the family, reassessing the patient, reevaluating the care plan, documenting problem behaviors, and incorporating Quality Improvement principles.

  1. Identifying and classifying quality-of-life tools for assessing pressure ulcers after spinal cord injury.

    Science.gov (United States)

    Hitzig, Sander L; Balioussis, Christina; Nussbaum, Ethne; McGillivray, Colleen F; Catharine Craven, B; Noreau, Luc

    2013-11-01

    Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed. To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI. Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model. Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version. Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI.

  2. Identifying and classifying quality-of-life tools for assessing pressure ulcers after spinal cord injury

    Science.gov (United States)

    Hitzig, Sander L.; Balioussis, Christina; Nussbaum, Ethne; McGillivray, Colleen F.; Catharine Craven, B.; Noreau, Luc

    2013-01-01

    Context Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed. Objective To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI. Methods Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model. Results Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version. Conclusion Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI. PMID:24090238

  3. Real-Time Smart Textile-Based System to Monitor Pressure Offloading of Diabetic Foot Ulcers.

    Science.gov (United States)

    Raviglione, Andrea; Reif, Roberto; Macagno, Maurizio; Vigano, Davide; Schram, Justin; Armstrong, David

    2017-09-01

    The lifetime risk of developing a diabetic foot ulcer (DFU) is at least 25%. A DFU carries a 50% risk for infection and at least 20% of those receive some form of amputation. The most significant parameter that prevents or delays ulcer healing is high plantar pressure. To improve the patient's healing process, the DFU's plantar pressure should remain cumulatively low. Therefore, a tool that continuously measures the DFU loading, and provides real-time feedback can improve the healing outcome. We report the development of a system capable of continuously measuring the pressure, which could have applications to monitor DFU. The system contains a textile pressure sensor attached to a stretchable band, hardware that collects data and transmits them via Bluetooth to a phone, an app that gathers the data and stores them in the cloud, and a web dashboard that displays the data to the clinician. The sensor was characterized in vitro using the system, and the web-dashboard was developed and tested on simulated patient data. We demonstrate the feasibility of developing the system and characterize the pressure response of the device. As a result, we demonstrate a viable method for monitoring DFU off-loading in real time. The presented study demonstrates the feasibility to develop a simple, modular wearable system that opens up new possibilities for diabetic foot ulcer care by providing a way of monitoring the pressure under the ulcer in real time.

  4. Clinical evaluation of a new pressure ulcer risk assessment instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T).

    Science.gov (United States)

    Coleman, Susanne; Smith, Isabelle L; McGinnis, Elizabeth; Keen, Justin; Muir, Delia; Wilson, Lyn; Stubbs, Nikki; Dealey, Carol; Brown, Sarah; Nelson, E Andrea; Nixon, Jane

    2018-02-01

    To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter-rater and test-retest reliability, convergent validity and data completeness. Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056). Observational field test. For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from four secondary care and four community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE-T assessments were undertaken. Follow-up retest was undertaken by the expert nurse. Field notes of PURPOSE-T use were collected. Data were collected October 2012-January 2013. The clinical evaluation demonstrated "very good" (kappa) inter-rater and test-retest agreement for PURPOSE-T assessment decision overall. The percentage agreement for "problem/no problem" was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs. The PURPOSE-T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE-T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes. © 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  5. The psychometric performance of generic preference-based measures for patients with pressure ulcers.

    Science.gov (United States)

    Palfreyman, Simon; Mulhern, Brendan

    2015-08-01

    Pressure ulcers are wounds that result from reduced mobility, and can have a significant impact on morbidity, mortality and quality of life. As pressure ulcers are a consequence of a wide range of conditions and interventions, it is unclear whether the best means of capturing the quality of life impacts is via generic or condition specific Patient Reported Outcome Measures (PROMs). The aim of this study was to investigate the psychometric performance of the generic EQ-5D and SF-6D amongst patients identified as having or being at risk of developing pressure ulceration. A survey of patients who were using pressure relieving mattresses and other equipment was undertaken within inpatient and community settings using a handheld tablet and postal survey. Data on EQ-5D-3L, SF-12 (used to calculate SF-6D), an EQ-5D dignity bolt-on question, demographic and wound specific questions were collected. Convergent validity was assessed using Spearman's correlations, and agreement using Bland-Altman plots. Known group validity was assessed by examining whether the instruments discriminated between different pressure ulcer severity groups. Multivariate linear regression was used to examine the impact of a range of pressure ulcer related variables. The total number of participants was 307, including 273 from the acute setting (52% response rate) and 41 from the community (32%). SF-6D and EQ-5D were moderately correlated (0.61), suggesting that both instruments were capturing similar quality of life impacts. Both measures were able to significantly discriminate between groups based on the ulcer grade. Presence of a pressure ulcer and number of comorbidities were significant explanatory variables of EQ-5D and SF-6D score. The results suggest that generic PROMs can effectively capture the impact of pressure ulcers on quality of life, although there are significant challenges in collecting data from this group of patients related to poor clinical condition and mental capacity. The most

  6. Preventing Ischial Pressure Ulcers: III. Clinical Pilot Study of Chronic Neuromuscular Electrical Stimulation

    Directory of Open Access Journals (Sweden)

    Hilton M. Kaplan

    2011-01-01

    Full Text Available Objective: BIONs™ (BIOnic Neurons are injectable, wireless microstimulators that make chronic BION Active Seating (BAS possible for pressure ulcer prevention (PUP. Neuromuscular electrical stimulation (NMES produces skeletal motion and activates trophic factors, counteracting three major etiological mechanisms leading to pressure ulcers (PUs: immobility, soft-tissue atrophy, and ischemia. Companion papers I and II reviewed prior experience with NMES for PUP, and analyzed the biomechanical considerations, respectively. This paper presents a treatment strategy derived from this analysis, and the clinical results of the first three cases.

  7. A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery.

    Science.gov (United States)

    Feuchtinger, Johanna; de Bie, Rob; Dassen, Theo; Halfens, Ruud

    2006-02-01

    In this experimental study, a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure-reducing devices on the operating room (OR)-table should reduce the patients' interface pressure and thus the hazard of skin breakdown. A randomized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table (test OR-table) compared with the standard OR-table (a water-filled warming mattress, no pressure-reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17.6%) than patients on the standard OR-table without the foam overlay (11.1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. The combination of a 4-cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.

  8. Translation, modification and validation of the Chinese version of a knowledge assessment instrument regarding pressure ulcer prevention

    Directory of Open Access Journals (Sweden)

    Ming Liu

    2016-03-01

    Conclusions: This study represents the first trial to translate and modify an existing instrument that measures the knowledge of pressure ulcers in a Chinese Mainland sample. The instrument demonstrated acceptable psychometric properties and could be applied in cross-cultural nursing practices, including nursing education, research and practice, to evaluate knowledge about pressure ulcer prevention.

  9. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study

    NARCIS (Netherlands)

    Ham, W.H.; Schoonhoven, L.; Schuurmans, M.J.; Leenen, L.P.

    2016-01-01

    OBJECTIVES: To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain

  10. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks : An observational study

    NARCIS (Netherlands)

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke P H

    OBJECTIVES: To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain

  11. Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury.

    Science.gov (United States)

    Cogan, Alison M; Blanchard, Jeanine; Garber, Susan L; Vigen, Cheryl Lp; Carlson, Mike; Clark, Florence A

    2017-07-01

    To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.

  12. The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study.

    NARCIS (Netherlands)

    Schoonhoven, L.; Bousema, M.T.; Buskens, E.

    2007-01-01

    BACKGROUND: Pressure ulcers frequently occur in hospitalised patients. The prevalence of pressure ulcers grade 2 or worse varies from 3% to 12% in hospitalised patients. Incidence figures are not frequently reported. While incidence and prevalence are both measures of disease frequency, they provide

  13. Potential efficiency of antioxidants to prevent pressure ulcers. A neglected hypothesis.

    Science.gov (United States)

    Bonne, Claude

    2016-06-01

    Pressure ulcers are necrotic lesions mainly due to capillary hypoperfusion. It is well known that hypoxia and also subsequent oxygenation at reperfusion provoke the formation of reactive oxygen species (ROS) responsible for cell death. The hypothesis of their participation in the pathogenesis of pressure ulcers has already been tested; several antioxidants have the capacity to inhibit skin necrosis in animal models but their efficiency in preventing bedsores has never been demonstrated in patients. The failure of clinical trials to show the protective activity of some antioxidants does not rule out the involvement of ROS in ischemic ulcers and the potential efficacy of other antioxidants in preventing their formation remains possible. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Longitudinal Outcomes of Home Care in Korea to Manage Pressure Ulcers.

    Science.gov (United States)

    Lee, Eunhee

    2017-06-01

    Home care provides preventive, support, and treatment services to economically vulnerable community populations. In this study, we examined the outcomes of a home care program for pressure ulcers (PrUs) in an economically vulnerable group. The 184 participants were admitted with PrUs and received services from a home care agency in South Korea during a study window of 5 years. The changes in PrU staging over time were analyzed in relation to the agency's home care data and the participants' health data. At enrollment, approximately 60% had a single ulcer; 40% had two or more. Most patients' ulcers were at stages 3 or 4, and most patients were bedridden. The maximum odds of reduced ulcer size from one measurement point to the next was estimated at 14.3% for ulcers in stages 1 and 2, 33.4% of those in stage 3, and 25.5% of those in stage 4; more than 10% of ulcers healed completely within a year. PrUs were a serious problem in this community-dwelling economically vulnerable group, and home care played a critical role in providing health care to this population. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. Surgical reconstruction of pressure ulcer defects: a single- or two-stage procedure?

    LENUS (Irish Health Repository)

    Laing, Tereze A

    2012-02-01

    BACKGROUND: The surgical management of pressure ulcers traditionally involved staged procedures, with initial debridement of necrotic or infected material followed by reconstruction at a later date when the wound was deemed viable and free of gross infection. However, over the past decade, it has been suggested that a single-stage procedure, combining initial debridement and definitive reconstruction, may provide advantages over staged surgery. We present our experience with the staged approach and review the current evidence for both methods. SUBJECTS AND SETTINGS: : We reviewed medical records of all patients referred to our service for pressure ulcer management between October 2001 and October 2007. The National Rehabilitation Hospital is the national center in Ireland for primary rehabilitation of adults and children suffering from spinal and brain injury, serving patients locally and from around the country. METHODS: All subjects who were managed surgically underwent a 2-stage procedure, with initial debridement and subsequent reconstruction. The main outcome measures were length of hospital stay, postoperative morbidity and mortality, and time to complete ulcer healing. RESULTS: Forty-one of 108 patients with 58 pressure ulcers were managed surgically. All patients underwent initial surgical debridement and 20 patients underwent subsequent pressure ulcer reconstruction. Postreconstructive complications occurred in 5 patients (20%). The mean time to complete ulcer healing was 17.4 weeks. Partial flap necrosis occurred in 3 patients, but there were no episodes of flap failure. CONCLUSIONS: We achieved favorable results with a 2-stage reconstruction technique and suggest that the paucity of evidence related to single-stage procedures does not support a change in surgical management.

  16. Novel Pressure-Sensing Smart Insole System Used for the Prevention of Pressure Ulceration in the Insensate Foot

    Directory of Open Access Journals (Sweden)

    Allyson R. Alfonso, BS, BA

    2017-12-01

    Full Text Available Summary:. Wounds of the foot challenge reconstructive surgeons to manage multiple factors: sensibility, stability, and durability. In this article, we focus on the insensate foot, which poses challenges to wound prevention with its propensity to develop pressure ulceration. The authors present the innovative use of a pressure-sensing smart insole system (SurroSense Rx, Orpyx Medical Technologies Inc., Calgary, Canada in the management of the insensate foot in a patient following foot reconstruction. The pressure-sensing smart insole system provided unique feedback to both patient and provider in ways that contributed to the prevention of pressure ulcer recurrence, as well as highlight the importance of prescribed footwear in both the affected and unaffected foot. Wearable real-time monitoring and feedback faces the challenge of patient adherence. Future studies are indicated to examine the specific behaviors that are associated with favorable outcomes and long-term behavior changes.

  17. Topical olive oil is not inferior to hyperoxygenated fatty aids to prevent pressure ulcers in high-risk immobilised patients in home care. Results of a multicentre randomised triple-blind controlled non-inferiority trial.

    Directory of Open Access Journals (Sweden)

    Inmaculada Lupiañez-Perez

    Full Text Available Pressure ulcers represent a major current health problem and produce an important economic impact on the healthcare system. Most of studies to prevent pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids and to date, no studies have specifically examined the use of olive oil-based substances.Main objective: To assess the effectiveness of the use of olive oil, comparing it with hyperoxygenated fatty acids, for immobilised home-care patients at risk of suffering pressure ulcers. Design: Non-inferiority, triple-blind, parallel, multicentre, randomised clinical trial. Scope: Population attending Primary Healthcare Centres in Andalusia (Spain. Sample: 831 immobilised patients at risk of suffering pressure ulcers.The follow-up period was 16 weeks. Groups were similar after randomization. In the per protocol analysis, none of the body areas evaluated presented risk differences for pressure ulcers incidence that exceeded the 10% delta value established. Sacrum: Olive Oil 8 (2.55% vs HOFA 8 (3.08%, ARR 0.53 (-2.2 to 3.26 Right heel: Olive Oil 4 (1.27% vs HOFA 5 (1.92%, ARR0.65 (-1.43 to 2.73. Left heel: Olive Oil 3 (0.96% vs HOFA 3 (1.15%, ARR0.2 (-1.49 to 1.88. Right trochanter: Olive Oil 0 (0% vs HOFA 4 (1.54%, ARR1.54 (0.04 to 3.03. Left trochanter: Olive Oil 1 (0.32% vs HOFA 1 (0.38%, ARR0.07 (-0.91 to 1.04. In the intention to treat analysis the lower limit of the established confidence interval was never exceeded.The results obtained confirmed that the use of topical extra-virgin olive oil to prevent PU in the home environment, for immobilised patients at high risk, is not inferior to the use of HOFA. Further studies are needed to investigate the mechanism by which olive oil achieves this outcome.Clinicaltrials.gov NCT01595347.

  18. Topical olive oil is not inferior to hyperoxygenated fatty aids to prevent pressure ulcers in high-risk immobilised patients in home care. Results of a multicentre randomised triple-blind controlled non-inferiority trial.

    Science.gov (United States)

    Lupiañez-Perez, Inmaculada; Uttumchandani, Shakira Kaknani; Morilla-Herrera, Juan Carlos; Martin-Santos, Francisco Javier; Fernandez-Gallego, Magdalena Cuevas; Navarro-Moya, Francisco Javier; Lupiañez-Perez, Yolanda; Contreras-Fernandez, Eugenio; Morales-Asencio, Jose Miguel

    2015-01-01

    Pressure ulcers represent a major current health problem and produce an important economic impact on the healthcare system. Most of studies to prevent pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids and to date, no studies have specifically examined the use of olive oil-based substances. Main objective: To assess the effectiveness of the use of olive oil, comparing it with hyperoxygenated fatty acids, for immobilised home-care patients at risk of suffering pressure ulcers. Design: Non-inferiority, triple-blind, parallel, multicentre, randomised clinical trial. Scope: Population attending Primary Healthcare Centres in Andalusia (Spain). Sample: 831 immobilised patients at risk of suffering pressure ulcers. The follow-up period was 16 weeks. Groups were similar after randomization. In the per protocol analysis, none of the body areas evaluated presented risk differences for pressure ulcers incidence that exceeded the 10% delta value established. Sacrum: Olive Oil 8 (2.55%) vs HOFA 8 (3.08%), ARR 0.53 (-2.2 to 3.26) Right heel: Olive Oil 4 (1.27%) vs HOFA 5 (1.92)%, ARR0.65 (-1.43 to 2.73). Left heel: Olive Oil 3 (0.96%) vs HOFA 3 (1.15%), ARR0.2 (-1.49 to 1.88). Right trochanter: Olive Oil 0 (0%) vs HOFA 4 (1.54%), ARR1.54 (0.04 to 3.03). Left trochanter: Olive Oil 1 (0.32%) vs HOFA 1 (0.38%), ARR0.07 (-0.91 to 1.04). In the intention to treat analysis the lower limit of the established confidence interval was never exceeded. The results obtained confirmed that the use of topical extra-virgin olive oil to prevent PU in the home environment, for immobilised patients at high risk, is not inferior to the use of HOFA. Further studies are needed to investigate the mechanism by which olive oil achieves this outcome. Clinicaltrials.gov NCT01595347.

  19. Impact of pressure ulcers on quality of life in older patients: a systematic review.

    NARCIS (Netherlands)

    Gorecki, C.; Brown, J.M.; Nelson, E.A.; Briggs, M.; Schoonhoven, L.J.; Dealey, C.; Defloor, T.; Nixon, J.

    2009-01-01

    OBJECTIVES: To identify the impact of pressure ulcers (PUs) and PU interventions on health-related quality of life (HRQL). DESIGN: Systematic review and metasynthesis of primary research reporting the impact of PU and PU interventions on HRQL according to direct patient reports. Quality assessment

  20. Predicting pressure ulcers: cases missed using a new clinical prediction rule.

    NARCIS (Netherlands)

    Schoonhoven, L.; Grobbee, D.E.; Bousema, M.T.; Buskens, E.

    2005-01-01

    AIM: The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule and comparing them with patients who were correctly classified as 'not at risk'. BACKGROUND: Patients admitted to hospital are at risk of

  1. Pressure Ulcers in Trauma Patients with Preventive Spinal Immobilization : Incidence, characteristics and risk factors

    NARCIS (Netherlands)

    Ham, H.W.

    2016-01-01

    Introduction To protect the (possibly) injured spine, trauma patients are immobilized on a backboard, with an extrication collar, lateral headblocks, and straps. Although pressure ulcers are typically associated with older adults and chronic illness, of all patients in a hospital environment,

  2. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review.

    Science.gov (United States)

    Lima Serrano, M; González Méndez, M I; Carrasco Cebollero, F M; Lima Rodríguez, J S

    Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. Pressure ulcers in nursing homes: does negligence litigation exceed available evidence?

    Science.gov (United States)

    Meehan, Marge; Hill, W Michael

    2002-03-01

    Nursing homes today face an increasing amount of oversight as they comply with regulations from federal, state, and local governments and agencies. The trend of judicial oversight, particularly in cases involving pressure ulcers, presents a unique set of challenges to the nursing home industry. The standards of care that are increasingly applied to establish the incidence of negligence in relevant cases are dependent on an under-researched area of the clinical phenomenon of skin breakdown within a frail elderly population. As the nursing home population continues to grow and resources are further strained, finding ways to best utilize resources becomes imperative. Consideration must be given to the growing body of evidence indicating that some patients are incapable of mounting a "normal" response to the physical forces responsible for the damage observed with pressure ulcers. Pressure ulcers have evolved to the status of being a synonym for neglect and/or abuse. Clinicians must focus on establishing a realistic and far more nuanced body of knowledge regarding pressure ulcers among the frail elderly.

  4. Randomized clinical trial of ascorbic acid in the treatment of pressure ulcers

    NARCIS (Netherlands)

    ter Riet, G.; Kessels, A. G.; Knipschild, P. G.

    1995-01-01

    The objective of this study was to assess the effects of ascorbic acid supplementation, 500 mg twice daily in the treatment of pressure ulcers as an adjunct to standardized treatment. The design consisted of a multicenter blinded randomized trial. The control group received 10 mg of ascorbic acid

  5. Pressure ulcers from spinal immobilization in trauma patients: A systematic review

    NARCIS (Netherlands)

    Ham, W.; Schoonhoven, L.; Schuurmans, M.J.; Leenen, L.P.H.

    2014-01-01

    BACKGROUND: To protect the (possibly) injured spine, trauma patients are immobilized on backboard or vacuum mattress, with a cervical collar, lateral headblocks, and straps. Several studies identified pressure ulcer (PU) development from these devices. The aim of this literature study was to gain

  6. A Retrospective study of Pressure ulcers in critically ill patients in a ...

    African Journals Online (AJOL)

    Background: Critically ill patients are at increased risk of developing pressure ulcers because of the presence of confounding factors such as reduced mobility, poor nutrition, reduced tissue perfusion, neurologic deficits, faecal or urinary incontinence. This study determined the prevalence and risk factors for the development ...

  7. An exploration of nursing documentation of pressure ulcer care in an acute setting in Ireland.

    LENUS (Irish Health Repository)

    O Brien, J A Jordan

    2012-02-01

    OBJECTIVE: To explore the nature and quality of documented care planning for pressure ulcers in a large teaching hospital in the Republic of Ireland. METHOD: A mixed method design was used; this encompassed a descriptive survey that retrospectively evaluated nursing records (n=85) in two wards (orthopaedic and care of the older adult) and a focus group (n=13) that explored nurses\\' perspectives of the factors influencing concordance and the quality of nursing documentation. Only records of at-risk patients (Waterlow score of >10) were included. RESULTS: It was identified that 47% (n=40) were assessed as at high or very high risk of developing a pressure ulcer. Fifty-two patients (61%) had a weekly risk assessment, but 25% (n=21) had only one follow-up assessment. Only 45% (n=38) of charts had some evidence of documented care planning, and of those 53% (n=20) had no evidence of implementation of the care plan and 66% (n=25) had no evidence of outcome evaluation. Only 48% (n=41) of this at-risk population was nutritionally assessed. Of patients admitted with and without a pressure ulcer, there was no record of regular positioning in 70% (n=59) and 60% (n=51) respectively. CONCLUSION: Documentation on pressure ulcer care is not standardised and requires development. Conflict of interest: None.

  8. SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population

    Science.gov (United States)

    2016-03-01

    extraction tool, which included demographics as well as physical, medical, and psycho- social variables documented in the literature to be associ- ated...good_nutrition=1 Athletic participation Minutes per day/days per week Spasticity Yes/no; medicated Contractures Yes/no; mild, moderate, severe Cognitive ...psychiatric Mental status: anxiety, bipolar, depression, personality Conditions Disorder, dementia, schizophrenia /delusional, brain damage Pressure ulcer

  9. Effectiveness of Enteral Nutritional Therapy in the Healing Process of Pressure Ulcers: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Gisely Blanc

    2015-02-01

    Full Text Available OBJECTIVE To evaluate the effectiveness of enteral nutritional therapy (ENT in the healing process of pressure ulcers (PU in adults and the elderly. METHOD A systematic review whose studies were identified through the databases of Cochrane, MEDLINE/PubMed, SciELO, LILACS, EMBASE, CINAHL, Web of Science, and manual searches. It included randomized clinical trials (RCTs without delimiting the period or language of publication, which addressed adults and elderly patients with pressure ulcers in a comparative treatment of enteral nutritional therapy and placebo or between enteral nutritional therapy with different compositions and dosages. RESULTS We included ten studies that considered different interventions. It resulted in more pressure ulcers healed in the groups that received the intervention. The included studies were heterogeneous with regard to patients, the type of intervention, the sample and the follow-up period, all of which made meta-analysis impossible. CONCLUSION Although the enteral nutritional therapy demonstrates a promotion of pressure ulcer healing, sufficient evidence to confirm the hypothesis was not found.

  10. Prevalence of pressure ulcers among the elderly living in long-stay institutions in São Paulo

    Directory of Open Access Journals (Sweden)

    Julieta Maria Ferreira Chacon

    Full Text Available CONTEXT AND OBJECTIVE: The prevalence of pressure ulcers varies according to geographic region and population group, such as the institutionalized elderly. The aim of this study was to identify the prevalence of pressure ulcers among elderly people living in long-stay institutions. DESIGN AND SETTING: Cross-sectional study in six long-stay institutions for the elderly in São Paulo, Brazil. METHODS: Demographic and clinical data were collected in six long-stay institutions on two visits to each institution between May and August 2007, during which all elderly patients with pressure ulcers were evaluated. The Braden scale was used to identify the risk of developing pressure ulcers and the National Pressure Ulcer Advisory Panel (NPUAP stages for classifying the pressure ulcers. Statistical analysis was performed using the chi-square test, Student's t-test and Fisher's exact test. RESULTS: There was no significant difference in the results between visits. The population was 181 elderly people in May and 184 in August: 23 had pressure ulcers in May (prevalence of 12.7% and 17 in August (prevalence of 9.2%. The mean age at the two times was 84 years, and the average length of stay was 32 months. Pressure ulcers were found mainly in the sacral region (mean, 71.5%, and most commonly in stage II (mean, 41%. CONCLUSION: The prevalence of pressure ulcers was 10.95%. These data provide background information that may aid in developing protocols for applying best practices for prevention and treatment of pressure ulcers, consequently reducing the prevalence.

  11. The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study.

    Science.gov (United States)

    Schoonhoven, Lisette; Bousema, Mente T; Buskens, Erik

    2007-08-01

    Pressure ulcers frequently occur in hospitalised patients. The prevalence of pressure ulcers grade 2 or worse varies from 3% to 12% in hospitalised patients. Incidence figures are not frequently reported. While incidence and prevalence are both measures of disease frequency, they provide different perspectives on pressure ulcers. To describe the incidence rate and prevalence of pressure ulcers in hospitalised patients. Prospective inception cohort study. Two large hospitals, one general (530-beds) and one teaching (1042-beds), in The Netherlands. A non-selected, though not strictly random, sample of 1536 patients was eligible for inclusion in the study. One thousand four hundred and thirty one patients (93.2%) consented to participate. Eventually, 1229 patients (80%) had a complete follow-up. The sample consisted of patients admitted to the surgical, internal, neurological and geriatric wards for more than 5 days between January 1999 and June 2000. Follow-up once a week until pressure ulcer occurrence, discharge or length of stay over 12 weeks. Occurrence of a pressure ulcer grade 2 or worse during admission to hospital, according to the classification of the European Pressure Ulcer Advisory Panel. One hundred and thirty four patients developed 172 pressure ulcers during follow-up. The overall weekly incidence rate was 0.06 per week (95% confidence interval 0.05-0.07 per week). Highest rates were observed for surgical patients and lowest for geriatric and neurologic patients (0.08 and 0.02, respectively). The week specific prevalence varied between 12.8% and 20.3%. Among patients hospitalised for more than 5 days overall one may expect 6% per week to develop pressure ulcers. It would appear that any preventive measures can only be effective if taken timely. Accordingly, preventive measures should be considered early, because pressure ulcers were observed already within the first week of admission.

  12. [Apache III score: a prognostic factor in pressure ulcer development in an intensive care unit].

    Science.gov (United States)

    Almirall Solsona, D; Leiva Rus, A; Gabasa Puig, I

    2009-01-01

    OBJECTIVE. To analyze total APACHE III score association to pressure ulcers development in patients hospitalized in an intensive care unit (ICU). Prospective cohort study conducted in an intensive care unit of the Hospital General de VIC. All the patients hospitalized between January 2001 to December 2001 were enrolled. Age, gender, length of stay, total Norton and APACHE III score and pressure sore development were collected. Pressure sore incidence was 12.5% of the patients. The factors were significantly associated with the appearance of pressure sores in those patients with a length of stay in the intensive care unit, total Norton and severity of the disease measured by the APACHE III score. Patients having the greatest risk of pressure ulcers development were those whose Norton score was less than or equal to 14, and an APACHE III score higher than or equal to 50 (Odds Ratio: 37.9, 95% CI 11.16-128.47) The severity of the diseases measured with the APACHE III scale showed a relationship with the appearance of in-hospital pressure ulcers. The joint use of the APACHE III and Norton scale could be a good strategy to detect patients with very high risk of suffering pressure sores.

  13. Managing pressures ulcers in a resource constrained situation: A holistic approach

    Directory of Open Access Journals (Sweden)

    Abhijit Dam

    2011-01-01

    Full Text Available Managing pressure ulcers remain a challenge and call for a multidisciplinary team approach to care. Even more daunting is the management of such patients in remote locations and in resource constrained situations. The management of pressure sores in a patient with progressive muscular atrophy has been discussed using resources that were locally available, accessible, and affordable. Community participation was encouraged. A holistic approach to care was adopted.

  14. Factors associated with the incidence of pressure ulcer during hospital stay.

    Science.gov (United States)

    Matozinhos, Fernanda Penido; Velasquez-Melendez, Gustavo; Tiensoli, Sabrina Daros; Moreira, Alexandra Dias; Gomes, Flávia Sampaio Latini

    2017-05-25

    Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers. Estimar a taxa de incidência de úlcera por pressão e verificar fatores associados a essa ocorrência em uma coorte de pacientes hospitalizados. Trata-se de estudo de coorte no qual o desfecho foi a ocorrência da úlcera por pressão. A estimativa do efeito das variáveis para a proporção de incidência acumulada do desfecho foi realizada utilizando o modelo de riscos proporcionais de Cox. A seleção das variáveis ocorreu por meio do teste de hipóteses Logrank. A amostra foi composta de 442 adultos, com 25 casos incidentes de úlcera por pressão. Pacientes com altos escores na escala de Braden apresentaram maior risco de incidência de úlcera por pressão quando comparados com aqueles classificados na categoria de baixo escore. Os resultados reforçam a importância do uso da Escala de Braden para auxiliar na identificação dos pacientes com maior probabilidade de desenvolver úlcera por pressão.

  15. Developing a pressure ulcer risk factor minimum data set and risk assessment framework

    Science.gov (United States)

    Coleman, Susanne; Nelson, E Andrea; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Muir, Delia; Farrin, Amanda; Dowding, Dawn; Schols, Jos MGA; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Bader, Dan L; Gefen, Amit; Oomens, Cees WJ; Schoonhoven, Lisette; Nixon, Jane

    2014-01-01

    Aim To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework. Background A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study. Design Consensus study. Method A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010–December 2011. Findings The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways. Conclusion The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework. PMID:24845398

  16. Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers.

    Science.gov (United States)

    Bosch, Marije; Halfens, Ruud J G; van der Weijden, Trudy; Wensing, Michel; Akkermans, Reinier; Grol, Richard

    2011-03-01

    Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ≤ 18) and preventive quality management at ward level. No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. β 0.32; p organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way. Copyright ©2010 Sigma Theta Tau International.

  17. The use of a specialised amino acid mixture for pressure ulcers: a placebo-controlled trial.

    Science.gov (United States)

    Wong, A; Chew, A; Wang, C M; Ong, L; Zhang, S H; Young, S

    2014-05-01

    To compare pressure ulcer healing rates in patients supplemented with a specialised amino acid mixture containing (beta)-hydroxy (beta)-methylbutyrate (HMB), arginine and glutamine, and standard oral nutritional supplements versus patients supplemented with oral nutritional supplements and a placebo mixture. Twenty-three inpatients with stage II, III or IV pressure ulcers in an acute care hospital were randomised to recieve (A) a HMB, arginine and glutamine mixture twice daily alongside oral nutritional supplements (n=11) or (B) standard nutritional care alongside oral nutritional supplements (n=12) for 2 weeks. Pressure ulcers were measured weekly for area, depth and Pressure Ulcer Scale for Healing (PUSH) scores. The proportion of viable tissue was determined based on area of wound tracing. Weekly laboratory tests were performed to measure C-reactive protein and pre-albumin levels. This trial is registered at http://ClinicalTrials.gov under NCT01090076. There was no difference between anthropometrical measurements, biochemical parameters and nutritional intake pre- and post- study. Wound area did not decrease significantly in the short term for both groups. The proportion of viable tissues increased within 2 weeks on HMB, arginine and glutamine supplementation (p=0.02). PUSH scores showed significant improvement within 1 week of supplementation for the experimental group (p=0.013). The use of specialised amino acid does not appear to reduce wound size and PUSH scores but may improve tissue viability after 2 weeks. Further confirmation on a larger scale is required to determine the benefits of supplementing additional HMB, arginine and glutamine in patients with pressure ulcers.

  18. Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

    DEFF Research Database (Denmark)

    Knudsen, M.A.; Biering-Sørensen, Fin

    2008-01-01

    , which more or less persisted for 38 years, despite several attempts of surgical and conservative treatment. At this time, the ulcer was finally excised and the wound closed successfully. Two and a half years later, however, the ulcer recurred. Biopsies showed squamous cell carcinoma and computed...... tomography, and magnetic resonance imaging scans revealed a soft tissue process over the sacral and coccygeal bones and massive destruction of these bony structures. The patient died 11 months later, despite surgical and radiation treatment. CONCLUSION: The present case is unusual because, in spite...... of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies...

  19. Strategies to support prevention, identification and management of pressure ulcers in the community.

    Science.gov (United States)

    Payne, Drew

    2016-06-01

    Pressure ulcers are classified as serious incidents, cause pain and distress, and are a source of infection. Unlike patients in hospital, those in the community spend only a small amount of time with healthcare practitioners, so strategies are required to ensure they remain protected against pressure damage when community nurses are not with them. A risk assessment should be carried out to outline a patient's risks and used to develop a strategy for that person. Patients have different risks so prevention strategies need to be tailored individually. Strategies, which cover issues such as pressure-relieving equipment, mattress type, mobility aids and nutrition, should be monitored to ensure they continue to meet patients' needs, as their health, carers and other matters may change. Patients and their carers may need education on ulcers, including on myths, as it is essential they are involved.

  20. A pilot randomised controlled trial of negative pressure wound therapy to treat grade III/IV pressure ulcers [ISRCTN69032034

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    Ashby Rebecca L

    2012-07-01

    Full Text Available Abstract Background Negative pressure wound therapy (NPWT is widely promoted as a treatment for full thickness wounds; however, there is a lack of high-quality research evidence regarding its clinical and cost effectiveness. A trial of NPWT for the treatment of grade III/IV pressure ulcers would be worthwhile but premature without assessing whether such a trial is feasible. The aim of this pilot randomised controlled trial was to assess the feasibility of conducting a future full trial of NPWT for the treatment of grade III and IV pressure ulcers and to pilot all aspects of the trial. Methods This was a two-centre (acute and community, pilot randomised controlled trial. Eligible participants were randomised to receive either NPWT or standard care (SC (spun hydrocolloid, alginate or foam dressings. Outcome measures were time to healing of the reference pressure ulcer, recruitment rates, frequency of treatment visits, resources used and duration of follow-up. Results Three hundred and twelve patients were screened for eligibility into this trial over a 12-month recruitment period and 12/312 participants (3.8% were randomised: 6 to NPWT and 6 to SC. Only one reference pressure ulcer healed (NPWT group during follow-up (time to healing 79 days. The mean number of treatment visits per week was 3.1 (NPWT and 5.7 (SC; 6/6 NPWT and 1/6 SC participants withdrew from their allocated trial treatment. The mean duration of follow-up was 3.8 (NPWT and 5.0 (SC months. Conclusions This pilot trial yielded vital information for the planning of a future full study including projected recruitment rate, required duration of follow-up and extent of research nurse support required. Data were also used to inform the cost-effectiveness and value of information analyses, which were conducted alongside the pilot trial. Trial registration Current Controlled Trials ISRCTN69032034.

  1. Impact of interferential current on recovery of pressure ulcers grade 1 and 2

    Science.gov (United States)

    Shahrokhi, Akram; Ghorbani, Azam; Aminianfar, Atefeh

    2014-01-01

    Background: Pressure ulcers’ treatment imposes a considerable cost on health system and patients. Electrical stimulation has already been introduced as an effective method for promoting wound healing. This study was conducted to determine the impact of interferential current (IF) on healing of pressure ulcers (grade1 and 2). Materials and Methods: In this clinical trial, 23 patients (12 as cases and 11 as controls) were recruited. The study group was treated with IF daily for 10 days. IF current was applied via isoplanar current with a sweep frequency of 30–99 Hz and with tolerable intensity for 15–20 min. Before intervention, condition of the wounds was assessed and recorded. Routine characteristics of the ulcers in both groups were recorded before intervention (first day) and on the fifth and tenth days after intervention. SPSS (ver. 13) with paired t-test and Fisher's exact test was also used to analyze the data. A P-value of 0.05 was considered significant. Results: According to one-sample Kolmogorov–Smirnov test, demographic characteristics, features of ulcer, as well as the intensity of pain were not significantly different between the study and control groups. All patients in the control and study groups were complaining of pain (7.25 ± 1.21 in the intervention group vs. 6.35 ± 1.28 in the control group). Ulcer size decreased significantly in the study group (P = 0.012) with a significant reduction in pain intensity (P = 0.000), amount of discharge (P = 0.008), and level of edema (P = 0.000), compared to controls. Conclusion: As a first study in this field, the results showed that the use of IF current can accelerate pressure ulcer healing and reduce its size. As IF current can be considered as a deeper form of Transcutaneous Electrical Nerve Stimulation (TENS), it seems to be a safe method with no side effects. PMID:25949259

  2. What is different for people with MS who have pressure ulcers: A reflective study of the impact upon people's quality of life?

    Science.gov (United States)

    McGinnis, Elizabeth; Andrea Nelson, E; Gorecki, Claudia; Nixon, Jane

    2015-08-01

    Multiple Sclerosis (MS) is a progressive, degenerative disease of the central nervous system. People with advanced disease who have compromised mobility, activity, sensory and/or cognitive abilities are at risk of pressure ulcers. Having a pressure ulcer has a substantial impact on a person's quality of life; a generic pressure ulcer Health Related Quality of Life (HRQL) framework has been used in this study. To explore the views and opinions of patients with MS who have a pressure ulcer using a thematic framework and compare these to the general pressure ulcer population. Data for six MS patients was obtained through secondary analysis of transcripts from semi-structured interviews conducted during two studies which were part of a programme of HRQL Research. Patients with MS reported that their pressure ulcer affected their lives physically, psychologically and socially. All were confined to bed (as part of their pressure ulcer treatment) and therefore unable to participate in activities. Difficulties with movement and activity were partially attributed to the MS. Patients with MS did not report feeling ill with their pressure ulcer and expressed positive emotions and optimism. Pain or discomfort was a feature of the pressure ulcer for most patients. Pressure ulcers have a major impact on QOL for all patients. Problems with mobility and activity associated with the pressure ulcer were confounded by the MS. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  3. Mapping the nursing care with the NIC for patients in risk for pressure ulcer

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    Ana Gabriela Silva Pereira

    2014-06-01

    Full Text Available Objective:To identify the nursing care prescribed for patients in risk for pressure ulcer (PU and to compare those with the Nursing Interventions Classification (NIC interventions. Method: Cross mapping study conducted in a university hospital. The sample was composed of 219 adult patients hospitalized in clinical and surgical units. The inclusion criteria were: score ≤ 13 in the Braden Scale and one of the nursing diagnoses, Self-Care deficit syndrome, Impaired physical mobility, Impaired tissue integrity, Impaired skin integrity, Risk for impaired skin integrity. The data were collected retrospectively in a nursing prescription system and statistically analyzed by crossed mapping. Result: It was identified 32 different nursing cares to prevent PU, mapped in 17 different NIC interventions, within them: Skin surveillance, Pressure ulcer prevention and Positioning. Conclusion: The cross mapping showed similarities between the prescribed nursing care and the NIC interventions.

  4. [Mapping the nursing care with the NIC for patients in risk for pressure ulcer].

    Science.gov (United States)

    Pereira, Ana Gabriela Silva; Santos, Cássia Teixeira Dos; Menegon, Dóris Baratz; Mello, Bruna Schroeder; Azambuja, Fernanda; Lucena, Amália de Fátima

    2014-06-01

    To identify the nursing care prescribed for patients in risk for pressure ulcer (PU) and to compare those with the Nursing Interventions Classification (NIC) interventions. Cross mapping study conducted in a university hospital. The sample was composed of 219 adult patients hospitalized in clinical and surgical units. The inclusion criteria were: score ≤ 13 in the Braden Scale and one of the nursing diagnoses, Self-Care deficit syndrome, Impaired physical mobility, Impaired tissue integrity, Impaired skin integrity, Risk for impaired skin integrity. The data were collected retrospectively in a nursing prescription system and statistically analyzed by crossed mapping. It was identified 32 different nursing cares to prevent PU, mapped in 17 different NIC interventions, within them: Skin surveillance, Pressure ulcer prevention and Positioning. The cross mapping showed similarities between the prescribed nursing care and the NIC interventions.

  5. Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends

    Science.gov (United States)

    Kruger, Erwin A.; Pires, Marilyn; Ngann, Yvette; Sterling, Michelle; Rubayi, Salah

    2013-01-01

    Pressure ulcers in spinal cord injury represent a challenging problem for patients, their caregivers, and their physicians. They often lead to recurrent hospitalizations, multiple surgeries, and potentially devastating complications. They present a significant cost to the healthcare system, they require a multidisciplinary team approach to manage well, and outcomes directly depend on patients' education, prevention, and compliance with conservative and surgical protocols. With so many factors involved in the successful treatment of pressure ulcers, an update on their comprehensive management in spinal cord injury is warranted. Current concepts of local wound care, surgical options, as well as future trends from the latest wound healing research are reviewed to aid medical professionals in treating patients with this difficult problem. PMID:24090179

  6. Manualization of Occupational Therapy Interventions: Illustrations from the Pressure Ulcer Prevention Research Program

    Science.gov (United States)

    Blanche, Erna Imperatore; Fogelberg, Donald; Diaz, Jesus; Carlson, Mike; Clark, Florence

    2011-01-01

    The manualization of a complex occupational therapy intervention is a crucial step in ensuring treatment fidelity for both clinical application and research purposes. Towards this latter end, intervention manuals are essential for assuring trustworthiness and replicability of randomized controlled trials (RCT’s) that aim to provide evidence of the effectiveness of occupational therapy. In this paper, literature on the process of intervention manualization is reviewed. The prescribed steps are then illustrated through our experience in implementing the University of Southern California/Rancho Los Amigos National Rehabilitation Center’s collaborative Pressure Ulcer Prevention Project (PUPP). In this research program, qualitative research provided the initial foundation for manualization of a multifaceted occupational therapy intervention designed to reduce incidence of medically serious pressure ulcers in people with SCI. PMID:22214116

  7. [Crosscultural adaptation of the pressure ulcer scale for healing to the portuguese language].

    Science.gov (United States)

    Santos, Vera Lúcia Conceição de Gouveia; Azevedo, Maria Augusta Junqueira; Silva, Thais Salimbeni da; Carvalho, Vilma Maria Justo; Carvalho, Viviane Fernandes de

    2005-01-01

    This study aimed to carry out a crosscultural adaptation of the Pressure Ulcer Scale for Healing (PUSH) to the Portuguese language through the translation of the instrument into Portuguese (by bilingual specialists and a specialist committee) and the validation of inter-rater reliability (comparison between nurses' and stomal therapists' observations) and convergent validity (correlation between pressure ulcers - PU - stages and type of tissue factor and total scale score). Besides the Kappa index, we also used Fisher's and Spearman's Tests. The Kappa indices (0.90 to 1.00) obtained for the comparison between all nurses and stomal therapists' observations for all sub-scales and for the total score and the presence of a positive and statistically significant correlation (p<0.001) between PU stages and total score for nurses and stomal therapists confirmed both scales' measuring properties, thus pointing towards the future use of the PUSH adapted version in the Portuguese culture.

  8. Health Behavior Theory for Pressure Ulcer Prevention: Root-Cause Analysis Project in Critical Care Nursing.

    Science.gov (United States)

    Choi, Kristen R; Ragnoni, Jennifer A; Bickmann, Jonathan D; Saarinen, Hannah A; Gosselin, Ann K

    2016-01-01

    The purpose of this project was to use a behavioral theory to examine pressure ulcer prevention by nurses in a critical care setting. A root-cause analysis approach was used, including an integrative literature review, operationalization of behavioral constructs into a survey, and root-cause analysis application in a cardiovascular intensive care unit. This article highlights an innovative approach to quality improvement in critical care.

  9. Nutritional status among patients with hip fracture in relation to pressure ulcers.

    Science.gov (United States)

    Hommel, Ami; Bjorkelund, Karin B; Thorngren, Karl-Göran; Ulander, Kerstin

    2007-10-01

    Patients with a hip fracture often have a poor nutritional status that is associated with increased risk of complications, morbidity and mortality. The aim of this study was to investigate the effects of an improved care intervention in relation to nutritional status and pressure ulcers. An intervention of best practices for patients with hip fracture was introduced, using the available resources effectively and efficiently with a not too complicated or expensive intervention. A quasi-experimental study of 478 patients consecutively included between April 1, 2003 and March 31, 2004. A new evidence-based clinical pathway was introduced on October 1, 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. The total number of patients with a hospital-acquired pressure ulcer was in the intervention group, 19 patients, and in the control group, 39 patients (p = 0.007). No patient younger than 65 years developed a pressure ulcer. There were no statistical significant differences between the groups with respect to blood biochemical variables at inclusion. Patients in the control group had higher arm muscle circumference (AMC) (p = 0.05), calf circumference (CC) (p = 0.038) and body mass index (BMI) (p = 0.043) values. Abnormal anthropometrical tests of BMI, triceps skin fold (TSF) nutritional status. Results in this study indicate the value of the new clinical pathway, as number of patients who have developed pressure ulcers during their stay in hospital has been reduced by 50%.

  10. An Unusual Cause of Infective Endocarditis: Proteus mirabilis Bacteremia from an Infected Pressure Ulcer

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    Chun-Hao Liu

    2015-12-01

    Full Text Available Proteus species is a common cause of urinary tract and wound infections in humans. We herein present the case of a 71-year-old male who had fever, a new-onset heart murmur, bacteremia, and a vegetation over his native aortic valve in echocardiography. This rare case demonstrated that infective endocarditis could be caused by Proteus mirabilis from an infected pressure ulcer.

  11. Detecting early stage pressure ulcer on dark skin using multispectral imager

    Science.gov (United States)

    Yi, Dingrong; Kong, Linghua; Sprigle, Stephen; Wang, Fengtao; Wang, Chao; Liu, Fuhan; Adibi, Ali; Tummala, Rao

    2010-02-01

    We are developing a handheld multispectral imaging device to non-invasively inspect stage I pressure ulcers in dark pigmented skins without the need of touching the patient's skin. This paper reports some preliminary test results of using a proof-of-concept prototype. It also talks about the innovation's impact to traditional multispectral imaging technologies and the fields that will potentially benefit from it.

  12. Investigating staff knowledge of safeguarding and pressure ulcers in care homes.

    Science.gov (United States)

    Ousey, K; Kaye, V; McCormick, K; Stephenson, J

    2016-01-01

    To investigate whether nursing/care home staff regard pressure ulceration as a safeguarding issue; and to explore reporting mechanisms for pressure ulcers (PUs) in nursing/care homes. Within one clinical commissioning group, 65 staff members from 50 homes completed a questionnaire assessing their experiences of avoidable and unavoidable PUs, grading systems, and systems in place for referral to safeguarding teams. Understanding of safeguarding was assessed in depth by interviews with 11 staff members. Staff observed an average of 2.72 PUs in their workplaces over the previous 12 months, judging 45.6% to be avoidable. Only a minority of respondents reported knowledge of a grading system (mostly the EPUAP/NPUAP system). Most respondents would refer PUs to the safeguarding team: the existence of a grading system, or guidance, appeared to increase that likelihood. Safeguarding was considered a priority in most homes; interviewees were familiar with the term safeguarding, but some confusion over its meaning was apparent. Quality of written documentation and verbal communication received before residents returned from hospital was highlighted. However, respondents expressed concern over lack of information regarding skin integrity. Most staff had received education regarding ulcer prevention or wound management during training, but none reported post-registration training or formal education programmes; reliance was placed on advice of district nurses or tissue viability specialists. Staff within nursing/care homes understand the fundamentals of managing skin integrity and the importance of reporting skin damage; however, national education programmes are needed to develop knowledge and skills to promote patient health-related quality of life, and to reduce the health-care costs of pressure damage. Further research to investigate understanding, knowledge and skills of nursing/care home staff concerning pressure ulcer development and safeguarding will become increasingly

  13. Prevention of pressure ulcers in the intensive care unit: a randomized trial of 2 viscoelastic foam support surfaces.

    Science.gov (United States)

    Ozyurek, Pakize; Yavuz, Meryem

    2015-01-01

    The aim of this study is to compare whether differences exist between 2 viscoelastic foam support surfaces in the development of new pressure ulcers. There is evidence to support the use of viscoelastic foam over standard hospital foam to reduce pressure. A comparative effectiveness study was done to compare 2 viscoelastic foam support surfaces. A randomized controlled trial was carried out. The study was performed in 2 intensive care units between October 1, 2008, and January 4, 2010. Patients (n = 105) admitted to intensive care unit were randomly assigned to viscoelastic foam 1 (n = 53) or viscoelastic foam 2 support surface (n = 52). In total, 42.8% of all patients developed a new pressure ulcer of stage 1 or worse. By stages, pressure ulcer incidence was 28.6%, 13.3%, and 1.0% for stages 1, 2, and 3, respectively. There was no significant difference in pressure ulcer incidence between the viscoelastic foam 1 and 2 groups (X2 = 0.07, df = 1, P > .05). No difference was found between 2 different viscoelastic foam surfaces in the prevention of pressure ulcers in patients treated in intensive care. Pressure ulcer incidence in critically ill patients remains high. Nurses must compare current products for effectiveness and develop innovative systems, processes, or devices to deliver best practices.

  14. Ethical issues and challenges in pressure ulcer research - the research nurses' perspective.

    Science.gov (United States)

    Choo, Jimmy; Blundell, Sally; McGinnis, Elizabeth

    2012-11-01

    This paper explores the issues faced by research nurses in pressure ulcer research through reflection on our own practice and subsequently addresses these issues through critical appraisal of the existing literature. A critical reflection framework which provided an opportunity for group reflection and reflexivity was adopted to guide our reflection. Focus questions were formulated based on our reflections and used to inform our literature review. Keywords used in the literature review search included 'research nurse', ethical principles, ethical issues and reflection. A formal tool was used to appraise normative ethics articles. Reflection on our practice in pressure ulcer research identified four main issues: informed consent, confidentiality, methodological uncertainties and more generally the ethical dilemma of the conflict between our accountability and responsibility to the patients and obligations to the research studies. The notion of 'power relations' was found to permeate our practice as research nurses at all level. Six normative ethics papers were retrieved and critically appraised to aid our personal and professional learning and development in the conduct of ethical practice as research nurses in pressure ulcer research through the theory of practice which other research nurses and/or nurse researchers used in other disciplines. Four main ethical challenges and the issue of power relation were highlighted. Our reflection and the appraisal of the literature provided us the necessary knowledge and skills to better navigate these ethical challenges in the future. Copyright © 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  15. Cervical collar-related pressure ulcers in trauma patients in intensive care unit.

    Science.gov (United States)

    Ham, H W Wietske; Schoonhoven, L Lisette; Galer, A Anju; Shortridge-Baggett, L Lillie M

    2014-01-01

    The application of a cervical collar (C-collar) in trauma patients can be life-saving. Previous studies, however, describe development of pressure ulcers related to C-collars. To retrospectively compare collar-related pressure ulcers (CRPUs) occurring in trauma patients admitted to the intensive care unit wearing a C-collar before and after implementation of preventive interventions and to identify risk factors for CRPU development. Retrospective chart review of 88 trauma patients admitted to the intensive care unit before (2006) and after (2008) implementation of preventive interventions; early C-collar removal (<24 hours) and an occipital foam ring. Data were collected in the first 14 days of admission on pressure ulcer incidence, risk factors, and preventive interventions. The incidence of CRPUs was 1.1%. Although risk factors were present in the sample, it was impossible to identify significant risk factors for CRPU development and explore the effect of preventive interventions. The incidence of CRPUs in this study was low. CRPUs, however, should never be accepted as an inevitable complication of cervical immobilization. To identify trauma patients at risk and to apply effective preventive interventions for CRPU development, further research is needed.

  16. Role of multi-layer foam dressings with Safetac in the prevention of pressure ulcers: a review of the clinical and scientific data.

    Science.gov (United States)

    Davies, Phil

    2016-01-01

    controlled trials, to assess the efficacy and cost-effectiveness of using multi-layer foam dressings with Safetac as a component of standard PU prevention strategies. The results of these studies indicate that the application of multi-layer foam dressings containing Safetac can reduce the occurrence of PUs on anatomical locations such as the sacrum and the heel, and underneath medical devices. Scientists have also developed and used laboratory methods to gain a better understanding of how prophylactic dressings work. The results of these studies indicate that the composition of foam dressings containing Safetac (i.e. their multi-layer structure) sets them apart from other dressings due to their ability to mediate the effects of physical forces (i.e. pressure, friction and shear) and control microclimate, all of which contribute to pressure ulceration. The evidence pool clearly indicates that the prophylactic use of multi-layer foam dressings with Safetac as a component of standard prevention measures is beneficial to the clinician, the health-care provider and the patient. It should be noted that the findings outlined in this review may not be transferable to other products as their makeup and components are likely to differ significantly from those of multi-layer foam dressings with Safetac. As the importance of evidence-based practice and the need for cost-effective care continues to grow, clinicians and provider should carefully consider this point when selecting prophylactic dressings for PU prevention.

  17. Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know.

    Science.gov (United States)

    Dana, Ali N; Bauman, William A

    2015-03-01

    Individuals with spinal cord injury (SCI) are at increased risk for the development of pressure ulcers. These chronic wounds are debilitating and contribute to prolonged hospitalization and worse medical outcome. However, the species of bacteria and the role that specific species may play in delaying the healing of chronic pressure ulcers in the SCI population has not been well characterized. This study will review the literature regarding what is known currently about the bacteriology of pressure ulcers in individuals with SCI. An electronic literature search of MEDLINE (1966 to February 2014) was performed. Eleven studies detailing bacterial cultures of pressure ulcers in the SCI population met inclusion criteria and were selected for review. Among these studies, bacterial cultures were often polymicrobial with both aerobic and anaerobic bacteria identified with culture techniques that varied significantly. The most common organisms identified in pressure ulcers were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and Enterococcus faecalis. In general, wounds were poorly characterized with minimal to no physical description and/or location provided. Our present understanding of factors that may alter the microbiome of pressure ulcers in individuals with SCI is quite rudimentary, at best. Well-designed studies are needed to assess appropriate wound culture technique, the impact of bacterial composition on wound healing, development of infection, and the optimum medical and surgical approaches to wound care.

  18. A Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury.

    Directory of Open Access Journals (Sweden)

    Cordelia Ziraldo

    2015-06-01

    Full Text Available People with spinal cord injury (SCI are predisposed to pressure ulcers (PU. PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM of ischemia/reperfusion-induced inflammation and PU (the PUABM was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to "better" vs. "worse" outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU.

  19. A Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury

    Science.gov (United States)

    Ziraldo, Cordelia; Solovyev, Alexey; Allegretti, Ana; Krishnan, Shilpa; Henzel, M. Kristi; Sowa, Gwendolyn A.; Brienza, David; An, Gary; Mi, Qi; Vodovotz, Yoram

    2015-01-01

    People with spinal cord injury (SCI) are predisposed to pressure ulcers (PU). PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM) of ischemia/reperfusion-induced inflammation and PU (the PUABM) was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to “better” vs. “worse” outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs) suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU. PMID:26111346

  20. Prevention of pressure ulcers after pediatric tracheotomy using a Mepilex Ag dressing.

    Science.gov (United States)

    Kuo, Connie Y; Wootten, Christopher T; Tylor, Dale A; Werkhaven, Jay A; Huffman, Kimberly F; Goudy, Steven L

    2013-12-01

    Skin irritation and ulceration beneath the tracheostomy tube or ties secondary to pressure and shearing forces on the skin frequently complicate pediatric tracheotomy in the immediate postoperative period. The aim of this study is to determine the effectiveness of Mepilex Ag dressings in reducing posttracheotomy wound complications. Retrospective study. We identified 134 pediatric tracheotomies performed between June 2005 and June 2011 at a tertiary care academic pediatric hospital. Peristomal skin breakdown was documented at the time of the first tracheostomy tube change. Starting in February 2010, the application of Mepilex Ag, a silver-impregnated foam dressing, underneath the tracheostomy tube and twill ties became standard practice. The rates of wound breakdown before and after the introduction of Mepilex Ag were compared. Age, indication for tracheotomy, comorbidities, and severity of wound breakdown were also compared. Patients undergoing tracheotomies prior to February 2010 had no dressing applied under the tracheotomy at the end of the procedure (n = 93). Beginning in February 2010, Mepilex Ag barrier was applied beneath the tracheostomy and ties in all subjects undergoing tracheotomy (n = 41). In the cohort without Mepilex Ag, 11.8% developed skin breakdown by the time of first tracheostomy tube change. When Mepilex Ag was used to pad the tracheotomy site, no peristomal skin breakdown occurred (P = 0.02). No comorbidities were associated with postoperative ulcer formation in either cohort. The use of Mepilex Ag after pediatric tracheotomy reduces the occurrence of postoperative peristomal pressure ulcers. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  1. A Computational, Tissue-Realistic Model of Pressure Ulcer Formation in Individuals with Spinal Cord Injury.

    Science.gov (United States)

    Ziraldo, Cordelia; Solovyev, Alexey; Allegretti, Ana; Krishnan, Shilpa; Henzel, M Kristi; Sowa, Gwendolyn A; Brienza, David; An, Gary; Mi, Qi; Vodovotz, Yoram

    2015-06-01

    People with spinal cord injury (SCI) are predisposed to pressure ulcers (PU). PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM) of ischemia/reperfusion-induced inflammation and PU (the PUABM) was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to "better" vs. "worse" outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs) suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU.

  2. Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset.

    Science.gov (United States)

    Krause, James S; Broderick, Lynne

    2004-08-01

    To identify risk and protective factors associated with a history of recurrent pressure ulcers among participants with spinal cord injury (SCI). A mail survey was used to identify factors associated with the presence or absence of recurrent pressure ulcers. A large specialty hospital in the southeastern United States. All participants had traumatic SCI, were nonambulatory, 18 years or older, and had been injured at least 5 years. A total of 826 subjects participated, 633 of whom reported a pressure ulcer history that could be classified as to whether they did or did not have a history of recurrent pressure ulcers. Not applicable. History of pressure ulcers was measured by a single item that required participants to classify their history into 1 of 5 options, ranging from never having any pressure ulcers to having almost continuous pressure ulcers, often requiring hospitalization. Those who either never had a pressure ulcer or had them mostly for a short period after SCI onset were classified as nonrecurrent, whereas those who reported at least 1 per year were classified as recurrent. Seventy percent of the participants failed to report recurrent pressure ulcers (never had any or had them only immediately after SCI onset), whereas 13% reported a clear pattern of recurring pressure ulcers of 1 or more per year. Logistic regression analyses suggested several general behaviors were protective for recurrent pressure ulcers, including lifestyle, exercise, and diet. Yet none of the behaviors generally recommended during inpatient rehabilitation specifically to prevent pressure ulcers (eg, skin checks weight shifts) were associated with pressure ulcer history. Only 2 risk behaviors were identified (number of cigarettes smoked, use of medication for sleep), although several proxy variables were related to pressure ulcer history. Pressure ulcer history is a more viable measure of pressure ulcer outcomes than measures taken at a single point in time (current), over a brief

  3. Pressure ulcers, indentation marks and pain from cervical spine immobilization with extrication collars and headblocks: An observational study.

    Science.gov (United States)

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke P H

    2016-09-01

    To describe the occurrence and severity of pressure ulcers, indentation marks and pain from the extrication collar combined with headblocks. Furthermore, the influence of time, injury severity and patient characteristics on the development of pressure ulcers, indentation marks and pain was explored. Observational. Level one trauma centre in the Netherlands. Adult trauma patients admitted to the Emergency Department in an extrication collar combined with headblocks. Between January and December 2013, 342 patients were included. Study outcomes were incidence and severity of pressure ulcers, indentation marks and pain. The following dependent variables were collected: time in the cervical collar and headblocks, Glasgow Coma Scale, Mean Arterial Pressure, haemoglobin, Injury Severity Score, gender, age, and Body Mass Index. 75.4% of the patients developed a category 1 and 2.9% a category 2 pressure ulcer. Indentation marks were observed in 221 (64.6%) patients; 96 (28.1%) had severe indentation marks. Pressure ulcers and indentation marks were observed most frequently at the back, shoulders and chest. 63.2% experienced pain, of which, 38.5% experienced severe pain. Pain was mainly located at the occiput. Female patients experienced significantly more pain (NRS>3) compared to male patients (OR=2.14, 95% CI 1.21-3.80) None of the investigated variables significantly increased the probability of developing PUs or indentation marks. The high incidence of category 1 pressure ulcers and severe indentation marks indicate an increased risk for pressure ulcer development and may well lead to more severe PU lesions. Pain due to the application of the extrication collar and headblocks may lead to undesirable movement (in order to relieve the pressure) or to bias clinical examination of the cervical spine. It is necessary to revise the current practice of cervical spine immobilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Successful Treatment of Unstageable Pressure Ulcer by Using Advanced Wound Dressing

    Directory of Open Access Journals (Sweden)

    Sri Sunarti

    2016-05-01

    Full Text Available This is a case of a 79-year old male, with late stage prostatic cancer, immobilization and having unstageable stage of lumbosacral pressure ulcer. We manage his ulcer locally with an advanced wound dressing. We apply hydrogel as a primary dressing and hydrofiber as secondary dressing. Advanced wound dressings are designed to maintain a moist environment at the site of application, allowing the fluids to remain close to the wound but not spread to unaffected, healthy skin areas. The relevance of the moist wound environment as a factor accelerating the healing process was first observed by Winter in 1962, but only recently has received more serious attention. An effective dressing should protect the wound, absorb exudate, preserve a moist wound base, and remove excess exudate. Design of effective dressings relies on an understanding of the healing process, as well as the specific conditions of a patient and the effect that each material used could have on the wound.

  5. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study

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    Andressa Tomazini Borghardt

    2015-02-01

    Full Text Available AIMS: to evaluate the accuracy of the Braden and Waterlow risk assessment scales in critically ill inpatients.METHOD: this prospective cohort study, with 55 patients in intensive care units, was performed through evaluation of sociodemographic and clinical variables, through the application of the scales (Braden and Waterlow upon admission and every 48 hours; and through the evaluation and classification of the ulcers into categories.RESULTS: the pressure ulcer incidence was 30.9%, with the Braden and Waterlow scales presenting high sensitivity (41% and 71% and low specificity (21% and 47% respectively in the three evaluations. The cut off scores found in the first, second and third evaluations were 12, 12 and 11 in the Braden scale, and 16, 15 and 14 in the Waterlow scale.CONCLUSION: the Braden scale was shown to be a good screening instrument, and the Waterlow scale proved to have better predictive power.

  6. A PRESSURE ULCER AND FALL RATE QUALITY COMPOSITE INDEX FOR ACUTE CARE UNITS: A MEASURE DEVELOPMENT STUDY

    Science.gov (United States)

    Jayawardhana, Ananda; Burman, Mary E.; Dunton, Nancy E.; Staggs, Vincent S.; Bergquist-Beringer, Sandra; Gajewski, Byron J.

    2016-01-01

    Background Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. Objective The study objective was to develop a unit-level inpatient composite nursing care quality performance index – the Pressure Ulcer and Fall Rate Quality Composite Index. Design Two-phase measure development study. Settings 5,144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013. Methods The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. Results The Pressure Ulcer and Fall Rate Quality Composite Index = 100 − PUR − FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of

  7. Pattern of presentation of pressure ulcers in traumatic spinal cord injured patients in University College Hospital, Ibadan.

    Science.gov (United States)

    Iyun, Ayodele O; Malomo, Adefolarin O; Oluwatosin, Odunayo M; Ademola, Samuel Adesina; Shokunbi, Matthew T

    2012-04-01

    The neurosurgery division in University College Hospital (U.C.H.) admits approximately one traumatic spinal cord injured (SCI) patient per week, most of whom stay a minimum of 42 days on admission. A common complication in these patients is the development of pressure ulcers, which contributes to a longer hospital stay and increased hospital expenses. The purpose of this study was to investigate the pattern of presentation of pressure ulcers in patients on admission and to propose policies or protocols to reduce the incidence. It is a prospective study of traumatic SCI patients managed on the neurosurgery ward from January 2003 to June 2004. The data was analysed using descriptive statistics. Sixty-seven patients were studied. The average hospital stay was 73 days. Thirteen (20%) of the patients were admitted with pressure ulcers, 32 (47·7%) developed it after admission. As much as 87·5% of pressure ulcers seen in the course of this study which occurred on admission in U.C.H. was in the first week of admission, 6·25% in the second week and the remaining 6·25% in the third week. Pressure ulcers were distributed as follows; 69% (42) in the sacral region, 18% (11) trochanteric, 5% (3) scalp, 1·5% (1) ankle, 1·5% (1) ischial tuberosity, the remaining 5% in other sites. Preventive measures for pressure ulcers consisted of basic skin care, pressure dispersion using fenestrated foams and alternating weight-bearing sites by regular turning. Pressure ulcers are commonest in the sacral and gluteal regions and tend to occur within the first week of admission in the neurosurgical wards. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  8. National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study

    Science.gov (United States)

    Clark, Michael; Semple, Martin J; Ivins, Nicola; Mahoney, Kirsten; Harding, Keith

    2017-01-01

    Objective The Chief Nurse National Health Service Wales initiated a national survey of acute and community hospital patients in Wales to identify the prevalence of pressure ulcers and incontinence-associated dermatitis. Methods Teams of two nurses working independently assessed the skin of each inpatient who consented to having their skin observed. Results Over 28 September 2015 to 2nd October 2015, 8365 patients were assessed across 66 hospitals with 748 (8.9%) found to have pressure ulcers. Not all patients had their skin inspected with all mental health patients exempt from this part of the audit along with others who did not consent or were too ill. Of the patients with pressure ulcers, 593 (79.3%) had their skin inspected with 158 new pressure ulcers encountered that were not known to ward staff, while 152 pressure ulcers were incorrectly categorised by the ward teams. Incontinence-associated dermatitis was encountered in 360 patients (4.3%), while medical device-related pressure ulcers were rare (n=33). The support surfaces used while patients were in bed were also recorded to provide a baseline against which future changes in equipment procurement could be assessed. The presence of other wounds was also recorded with 2537 (30.3%) of all hospital patients having one or more skin wounds. Conclusions This survey has demonstrated that although complex, it is feasible to undertake national surveys of pressure ulcers, incontinence-associated dermatitis and other wounds providing comprehensive and accurate data to help plan improvements in wound care across Wales. PMID:28827240

  9. Decreasing pressure ulcer risk during hospital procedures: a rapid process improvement workshop.

    Science.gov (United States)

    Haugen, Vicki; Pechacek, Judy; Maher, Travis; Wilde, Joy; Kula, Larry; Powell, Julie

    2011-01-01

    A 300-bed acute care community hospital used a 2-day "Rapid Process Improvement Workshop" to identify factors contributing to facility-acquired pressure ulcers (PU). The Rapid Process Improvement Workshop included key stakeholders from all procedural areas providing inpatient services and used standard components of rapid process improvement: data analysis, process flow charting, factor identification, and action plan development.On day 1, the discovery process revealed increased PU risk related to prolonged immobility when transporting patients for procedures, during imaging studies, and during the perioperative period. On day 2, action plans were developed that included communication of PU risk or presence of an ulcer,measures to shorten procedure times when clinically appropriate, implementation of prevention techniques during procedures, and recommendations for mattress upgrades. In addition, educational programs about PU prevention were developed, schedules for presentations were established, and an online power point presentation was completed and placed in a learning management system module. Finally, our nursing department amended a hospital wide handoff communication tool to include skin status and PU risk level. This tool is used in all patient handoff situations, including nonnursing departments such as radiology. Patients deemed at risk for ulcers were provided "Braden Risk" armbands to enhance interdepartmental awareness.

  10. Interrater agreement, reliability and validity of the Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale.

    Science.gov (United States)

    Kottner, Jan; Kenzler, Martina; Wilborn, Doris

    2014-04-01

    To determine (1) What is the degree of interrater agreement and reliability of Glamorgan scale item and sum scores? and (2) Are Glamorgan scale sum scores valid? Pressure ulcer risk assessment scales are recommended for use in clinical practice. For paediatric patients, 12 instruments are currently described. Empirical evidence about the performance of Glamorgan scale scores in clinical practice is limited. An observational validation study was conducted on a paediatric cardiac unit of a large university hospital in Germany in April and May 2010. Children were assessed simultaneously and independently by varying convenience samples of three nurses per assessment situation. Pressure ulcer risk was measured by the Glamorgan scale and a 100 mm Visual Analogue Scale (VAS). Proportions of agreement (po ), multirater kappa and intraclass correlation coefficients were calculated. Thirty children were rated by 27 nurses. Median children's age was 5·5 years. Agreement among item scores was high, whereas reliability coefficients of item scores were low. Interrater reliability for the Glamorgan scale sum scores was higher than for VAS scores. Correlation between both scales was moderate. High agreement among item scores indicates that nurses are able to make precise judgements. The low interrater reliability of item and sum scores indicates that nurses were unable to differentiate the rated children based on their item and sum scores, thus providing little additional clinical relevant information about pressure ulcer risk in this setting. The Glamorgan scale and the VAS are unable to make clear distinctions in a low-risk setting. Therefore, it is unlikely that the tools in this setting provide additional information for clinical decision making. Both tools are not recommended for daily use. © 2012 Blackwell Publishing Ltd.

  11. Pressure Ulcer Risk and Prevention Practices in Pediatric Patients: A Secondary Analysis of Data from the National Database of Nursing Quality Indicators®.

    Science.gov (United States)

    Razmus, Ivy; Bergquist-Beringer, Sandra

    2017-01-01

    Little is known about pressure ulcer prevention practice among pediatric patients. To describe the frequency of pressure ulcer risk assessment in pediatric patients and pressure ulcer prevention intervention use overall and by hospital unit type, a descriptive secondary analysis was performed of data submitted to the National Database for Nursing Quality Indicators® (NDNQI®) for at least 3 of the 4 quarters in 2012. Relevant data on pressure ulcer risk from 271 hospitals across the United States extracted from the NDNQI database included patient skin and pressure ulcer risk assessment on admission, time since the last pressure ulcer risk assessment, method used to assess pressure ulcer risk, and risk status. Extracted data on pressure ulcer prevention included skin assessment, pressure-redistribution surface use, routine repositioning, nutritional support, and moisture management. These data were organized by unit type and merged with data on hospital characteristics for the analysis. The sample included 39 984 patients ages 1 day to 18 years on 678 pediatric acute care units (general pediatrics, pediatric critical care units, neonatal intensive care units, pediatric step-down units, and pediatric rehabilitation units). Descriptive statistics were used to analyze study data. Most of the pediatric patients (33 644; 89.2%) were assessed for pressure ulcer risk within 24 hours of admission. The Braden Q Scale was frequently used to assess risk on general pediatrics units (75.4%), pediatric step-down units (85.5%), pediatric critical care units (81.3%), and pediatric rehabilitation units (56.1%). In the neonatal intensive care units, another scale or method was used more often (55% to 60%) to assess pressure ulcer risk. Of the 11 203 pediatric patients (39%) determined to be at risk for pressure ulcers, the majority (10 741, 95.8%) received some kind of pressure ulcer prevention intervention during the 24 hours preceding the NDNQI pressure ulcer survey. The frequency

  12. A randomized clinical trial comparing hydrocolloid, phenytoin and simple dressings for the treatment of pressure ulcers [ISRCTN33429693

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    Khedmat Hossein

    2004-12-01

    Full Text Available Abstract Background Pressure sores are important and common complications of spinal cord injury. Many preventive and therapeutic approaches have been tried and new trials are evolving. One relatively recent method is application of a hydrocolloid dressing (HD. In this study we compared the therapeutic effects of HD on pressure ulcer healing with two other topical applications, phenytoin cream (PC and simple dressing (SD. Methods Ninety-one stage I and stage II pressure ulcers of 83 paraplegic male victims of the Iran-Iraq war were randomly allocated to three treatment groups. Mean age and weight of the participants were 36.64 ± 6.04 years and 61.12 ± 5.08 kg, respectively. All the patients were managed in long term care units or in their homes for 8 weeks by a team of general practitioners and nurses, and the ulcer status was recorded as "Complete healing", "Partial healing", "Without improvement" and "Worsening". Results Complete healing of ulcers, regardless of location and stage, was better in the HD group than the PC [23/31(74.19% vs 12/30(40%; difference: 34.19%, 95% CI = 10.85–57.52, (P 0.05]. We performed a second analysis considering only one ulcer per patient (i.e. 83 ulcers in 83 patients. This "per patient" analysis showed that complete ulcer healing in the HD group was better than in the PC [20/28(71.4% vs 11/28 (39.3%; difference: 32.1%, 95% CI = 7.4–56.7, (P Conclusion We deduced that HD is the most effective method investigated for treating stage I and II pressure ulcers in young paraplegic men.

  13. Decoupled pelvis rotation in sitting: a passive motion technique that regulates buttock load associated with pressure ulcer development

    NARCIS (Netherlands)

    van Geffen, P.; Reenalda, Jasper; Veltink, Petrus H.; Koopman, Hubertus F.J.M.

    2009-01-01

    Wheelchair-users who cannot reposition themselves often suffer from pressure ulcers which are places of tissue breakdown in the buttock region under the sacrum and ischial tuberosities. Periodic pressure relief is needed to recover the buttock tissue from continuous deformation and impairment of

  14. Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: a mixed methods evaluation.

    Science.gov (United States)

    Worsley, Peter R; Clarkson, Paul; Bader, Dan L; Schoonhoven, Lisette

    2017-09-01

    To evaluate the barriers and facilitators for allied health professional's participation in pressure ulcer prevention. Mixed method cohort study. Single centre study in an acute university hospital trust. Five physiotherapists and four occupational therapists were recruited from the hospital trust. Therapists had been working in the National Health Service (NHS) for a minimum of one year. Therapist views and experiences were collated using an audio recorded focus group. This recording was analysed using constant comparison analysis. Secondary outcomes included assessment of attitudes and knowledge of pressure ulcer prevention using questionnaires. Key themes surrounding barriers to participation in pressure ulcer prevention included resources (staffing and equipment), education and professional boundaries. Fewer facilitators were described, with new training opportunities and communication being highlighted. Results from the questionnaires showed the therapists had a positive attitude towards pressure ulcer prevention with a median score of 81% (range 50 to 83%). However, there were gaps in knowledge with a median score of 69% (range 50 to 77%). The therapist reported several barriers to pressure ulcer prevention and few facilitators. The primary barriers were resources, equipment and education. Attitudes and knowledge in AHPs were comparable to data previously reported from experienced nursing staff. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  15. Transcutaneous oxygen pressure measurement in diabetic foot ulcers: mean values and cut-point for wound healing.

    Science.gov (United States)

    Yang, Chuan; Weng, Huan; Chen, Lihong; Yang, Haiyun; Luo, Guangming; Mai, Lifang; Jin, Guoshu; Yan, Li

    2013-01-01

    The purpose of this study was to investigate mean values and cut-point of transcutaneous oxygen pressure (TcPO2) measurement in patients with diabetic foot ulcers. Prospective, descriptive study. Sixty-one patients with diabetes mellitus and foot ulcers comprised the sample. The research setting was Sun Yat-sen Memorial Hospital of SunYat-sen University, Guangzhou, China. Participants underwent transcutaneous oxygen (TcPO2) measurement at the dorsum of foot. Patients were classified into 3 groups according to clinical outcomes: (1) ulcers healed with intact skin group, (2) ulcer improved, and (3) ulcer failed to improve. TcPO2 was assessed and cut-points for predicting diabetic foot ulcer healing were calculated. Thirty-six patients healed with intact skin, 8 experienced improvement, and 17 showed no improvement. Mean TcPO2 levels were significantly higher (Pfoot ulcers. In contrast, all patients with TcPO2≥ 40 mmHg achieved wound closure. Measurement of TcPO2 in the supine position revealed a cut-point value of 25 mmHg as the best threshold for predicting diabetic foot ulcer healing; the area under the curve using this cut-point was 0.838 (95% confidence interval = 0.700-0.976). The sensitivity, specificity, positive predictive value, and negative predictive value for TxPO2 were 88.6%, 82.4%, 90.7%, and 72.2%, respectively. TcPO2≥ 40 mmHg was associated with diabetic foot ulcer healing, but a TcPO2≤ 10 mmHg was associated with failure of wound healing. We found that a cut-point of 25 mmHg was most predictive of diabetic foot ulcer healing.

  16. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department.

    Science.gov (United States)

    Ham, H W Wietske; Schoonhoven, L Lisette; Schuurmans, M Marieke J; Leenen, L Luke P H

    2017-01-01

    To explore the influence of risk factors present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury, admitted to the hospital for evaluation and treatment of acute traumatic injuries. Prospective cohort study setting level one trauma center in the Netherlands participants adult trauma patients transported to the Emergency Department on a backboard, with extrication collar and headblocks and admitted to the hospital for treatment or evaluation of their injuries. Between January and December 2013, 254 trauma patients were included. The following dependent variables were collected: Age, Skin color and Body Mass Index, and Time in Emergency Department, Injury Severity Score, Mean Arterial Pressure, hemoglobin level, Glasgow Coma Score, and admission ward after Emergency Department. Pressure ulcer development during admission was associated with a higher age (p 0.00, OR 1.05) and a lower Glasgow Coma Scale score (p 0.00, OR 1.21) and higher Injury Severity Scores (p 0.03, OR 1.05). Extra nutrition decreases the probability of PU development during admission (p 0.04, OR 0.20). Pressure ulcer development within the first 48h of admission was positively associated with a higher age (p 0.01, OR 1.03) and a lower Glasgow Coma Scale score (p 0.01, OR 1.16). The proportion of patients admitted to the Intensive Care Unit and Medium Care Unit was higher in patients with pressure ulcers. The pressure ulcer risk during admission is high in patients with an increased age, lower Glasgow Coma Scale and higher Injury Severity Score in the Emergency Department. Pressure ulcer risk should be assessed in the Emergency Department to apply preventive interventions in time. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Survival rate and pressure ulcer prevalence in patients with and without dementia: a retrospective study.

    Science.gov (United States)

    Jaul, E; Rosenzweig, J P; Meiron, O

    2017-07-02

    This retrospective study aimed to investigate the prevalence of pressure ulcers (PUs) in older patients with advanced dementia versus older patients without dementia but with other comorbidities, such as diabetes, ischaemic heart disease and chronic renal failure. PUs were thought to be more prevalent and to present a higher risk of mortality in patients with dementia. PUs were assessed on admission using the European Pressure Ulcer Advisory Panel (EPUAP) staging system. Patients were classified as either with or without dementia according to Reisberg's functional assessment staging test (FAST). The prevalence of PUs and the survival rates were analysed and compared in both groups. The combined effect of PUs and dementia on survival was assessed using the Cox proportional hazard model. The median survival rate of patients with PUs and dementia was 63 days, significantly lower than in patients with PUs without dementia 117 days. Both groups had similar other comorbidities. These findings underscore the requirement for geriatricians and health professionals to be more vigilant in examining PUs as dementia progresses.

  18. Biochemical association of metabolic profile and microbiome in chronic pressure ulcer wounds.

    Science.gov (United States)

    Ammons, Mary Cloud B; Morrissey, Kathryn; Tripet, Brian P; Van Leuven, James T; Han, Anne; Lazarus, Gerald S; Zenilman, Jonathan M; Stewart, Philip S; James, Garth A; Copié, Valérie

    2015-01-01

    Chronic, non-healing wounds contribute significantly to the suffering of patients with co-morbidities in the clinical population with mild to severely compromised immune systems. Normal wound healing proceeds through a well-described process. However, in chronic wounds this process seems to become dysregulated at the transition between resolution of inflammation and re-epithelialization. Bioburden in the form of colonizing bacteria is a major contributor to the delayed headlining in chronic wounds such as pressure ulcers. However how the microbiome influences the wound metabolic landscape is unknown. Here, we have used a Systems Biology approach to determine the biochemical associations between the taxonomic and metabolomic profiles of wounds colonized by bacteria. Pressure ulcer biopsies were harvested from primary chronic wounds and bisected into top and bottom sections prior to analysis of microbiome by pyrosequencing and analysis of metabolome using 1H nuclear magnetic resonance (NMR) spectroscopy. Bacterial taxonomy revealed that wounds were colonized predominantly by three main phyla, but differed significantly at the genus level. While taxonomic profiles demonstrated significant variability between wounds, metabolic profiles shared significant similarity based on the depth of the wound biopsy. Biochemical association between taxonomy and metabolic landscape indicated significant wound-to-wound similarity in metabolite enrichment sets and metabolic pathway impacts, especially with regard to amino acid metabolism. To our knowledge, this is the first demonstration of a statistically robust correlation between bacterial colonization and metabolic landscape within the chronic wound environment.

  19. Biochemical association of metabolic profile and microbiome in chronic pressure ulcer wounds.

    Directory of Open Access Journals (Sweden)

    Mary Cloud B Ammons

    Full Text Available Chronic, non-healing wounds contribute significantly to the suffering of patients with co-morbidities in the clinical population with mild to severely compromised immune systems. Normal wound healing proceeds through a well-described process. However, in chronic wounds this process seems to become dysregulated at the transition between resolution of inflammation and re-epithelialization. Bioburden in the form of colonizing bacteria is a major contributor to the delayed headlining in chronic wounds such as pressure ulcers. However how the microbiome influences the wound metabolic landscape is unknown. Here, we have used a Systems Biology approach to determine the biochemical associations between the taxonomic and metabolomic profiles of wounds colonized by bacteria. Pressure ulcer biopsies were harvested from primary chronic wounds and bisected into top and bottom sections prior to analysis of microbiome by pyrosequencing and analysis of metabolome using 1H nuclear magnetic resonance (NMR spectroscopy. Bacterial taxonomy revealed that wounds were colonized predominantly by three main phyla, but differed significantly at the genus level. While taxonomic profiles demonstrated significant variability between wounds, metabolic profiles shared significant similarity based on the depth of the wound biopsy. Biochemical association between taxonomy and metabolic landscape indicated significant wound-to-wound similarity in metabolite enrichment sets and metabolic pathway impacts, especially with regard to amino acid metabolism. To our knowledge, this is the first demonstration of a statistically robust correlation between bacterial colonization and metabolic landscape within the chronic wound environment.

  20. [Financial rating optimization in pressure ulcers management: yes, but at what price?].

    Science.gov (United States)

    Crouzet, C; Chaput, B; Grolleau, J-L

    2013-06-01

    The surgical management of pressure ulcers remains very expensive even if preventive measures and improved care pathways allowed to reduce spending in this domain in recent years. Since 2004, the funding of French hospitals by "fee-for-service" and the needs of saving health spending necessarily compels us to interest ourselves in these purely economic considerations and sometimes modify our requirements for hospital stay to optimize a "patient' valorisation group". In the future, this may lead the surgeon to bias the real needs of the patient for the benefit of hospital establishment. Through a medico-economic analysis of our practices conducted in the plastic surgery department of the University hospital of Toulouse, we tried to identify how to optimize the surgical management of pressure ulcers in terms of valorisation of hospital stay. The aim is still to remain critical about the aberrations that this could introduce in the future for our clinical activity. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Evaluation of the dissemination and implementation of a nutritional guideline for pressure ulcer care.

    Science.gov (United States)

    Meijers, J M M; Schols, J M G A; Jackson, P A; Langer, G; Clark, M; Halfens, R J G

    2007-05-01

    In 2004 the European Pressure Ulcer Advisory Panel nutritional working group developed a nutritional guideline for pressure ulcer prevention and treatment. This study investigated the degree to which the guideline was disseminated and implemented in clinical practice. A cross-sectional study was undertaken in health-care organisations in The Netherlands, Germany and the UK. A printed, standardised questionnaire which followed Rogers' model of the innovation-decision process was developed, translated and distributed to 1087 health-care organisations. The response rate was 33% (n = 363). Sixty-one per cent of respondents knew of the guideline. Twenty-five per cent had applied it to their clinical practice and used it for nutritional screening. The main barrier to the provision of nutritional support appeared to be lack of knowledge and skills. One year after its dissemination, more than half of respondents knew of the guideline, with one in four applying it to their practice. The guideline was better disseminated and implemented in The Netherlands and UK than in Germany, where only 4% of participants had used it.

  2. Traditional Japanese Formula Kigikenchuto Accelerates Healing of Pressure-Loading Skin Ulcer in Rats

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    Mari Kimura

    2011-01-01

    Full Text Available We evaluated the effect of kigikenchuto (KKT, a traditional Japanese formula, in a modified rat pressure-loading skin ulcer model. Rats were divided into three groups, KKT extract orally administered (250 or 500 mg/kg/day for 35 days and control. KKT shortened the duration until healing. Immunohistochemically, KKT increased CD-31-positive vessels in early phase and increased α-smooth muscle actin-(α-SMA- positive fibroblastic cells in early phase and decreased them in late phase of wound healing. By Western blotting, KKT showed the potential to decrease inflammatory cytokines (MCP-1, IL-1β, and TNF-α in early phase, decrease vascular endothelial growth factor in early phase and increase it in late phase, and modulate the expression of extracellular protein matrix (α-SMA, TGF-β1, bFGF, collagen III, and collagen I. These results suggested the possibility that KKT accelerates pressure ulcer healing through decreases of inflammatory cytokines, increase of angiogenesis, and induction of extracellular matrix remodeling.

  3. Finding evidences on oncohematological patients (2nd part: Catheter-related infection and pressure ulcers

    Directory of Open Access Journals (Sweden)

    José Manuel Estrada Lorenzo

    2009-03-01

    Full Text Available There is an enormous knowledge base in the field of health which has no application. Its growth is not limited by its discovery but by the lack of its implementation. The necessity of implementing conclusions is evident in evaluating the real repercussion on quality daily cares; as “strategies” and “outcomes”. In talking about oncohematological nursing, some health outcomes would be: the reduction of adverse events such as nosocomial infections and pressure ulcers. Consequently, our objective has been: to find and summarize the evidences about Venous Catheterization and Pressure Ulcers; in order to encourage the spread of knowledge and promote changes in practice.Method: Databases as CINAHL, MEDLINE, Cochrane Library, EMBASE, Pascal Biomed, LILACS, CUIDEN, CUIDEN qualitative y CUIDATGE were revised in Spanish, French and English. No time restrictions were applied.Findings: The main findings and recommendations were synthesised on a poster, next to suggestions for practical changes to implement, evidence levels used, and the clinic problem significance. The suggested changes arose from nursing staff based on evidences found that includes behaviours and attitudes changes, which should facilitate more rapid innovations diffusion.

  4. Evidence-based education and nursing pressure ulcer prevention textbooks: does it match?

    Science.gov (United States)

    Wilborn, Doris; Halfens, Ruud J; Dassen, Theo

    2009-01-01

    The education of nurses has influenced the way of nursing practice for a long time. Nurse educators are required to offer up-to-date educational material, and textbooks are the most frequently used sources of knowledge during a nurse's education. In this study, researchers investigated the extent to which textbooks were evidence based regarding preventing pressure ulcers and knowing what recommendations to make for nursing students and publishers of nursing textbooks. Educators at nursing schools in Germany were contacted by telephone to identify the most often used nursing textbooks. The recommendations of the German Expert Standard of Pressure Ulcer Prevention were compared with the content of the textbooks in a content analysis. Additionally, teachers were asked what additional material they were using to help prepare lectures. Only one of the four analysed textbooks complied with the recommendations of the German Expert Standard. Contents of the other books were incomplete. The authors of some books did not mention any up-to-date scientific evidence. The teachers often used additional material such as the German Expert Standard and research articles to prepare their lectures. German nursing textbooks were classified into research-based and authoritative texts. Because of the fast development and availability of research findings, one recommendation is that new forms of "textbooks" such as CD ROMs should be considered.

  5. Biochemical Association of Metabolic Profile and Microbiome in Chronic Pressure Ulcer Wounds

    Science.gov (United States)

    Ammons, Mary Cloud B.; Morrissey, Kathryn; Tripet, Brian P.; Van Leuven, James T.; Han, Anne; Lazarus, Gerald S.; Zenilman, Jonathan M.; Stewart, Philip S.; James, Garth A.; Copié, Valérie

    2015-01-01

    Chronic, non-healing wounds contribute significantly to the suffering of patients with co-morbidities in the clinical population with mild to severely compromised immune systems. Normal wound healing proceeds through a well-described process. However, in chronic wounds this process seems to become dysregulated at the transition between resolution of inflammation and re-epithelialization. Bioburden in the form of colonizing bacteria is a major contributor to the delayed headlining in chronic wounds such as pressure ulcers. However how the microbiome influences the wound metabolic landscape is unknown. Here, we have used a Systems Biology approach to determine the biochemical associations between the taxonomic and metabolomic profiles of wounds colonized by bacteria. Pressure ulcer biopsies were harvested from primary chronic wounds and bisected into top and bottom sections prior to analysis of microbiome by pyrosequencing and analysis of metabolome using 1H nuclear magnetic resonance (NMR) spectroscopy. Bacterial taxonomy revealed that wounds were colonized predominantly by three main phyla, but differed significantly at the genus level. While taxonomic profiles demonstrated significant variability between wounds, metabolic profiles shared significant similarity based on the depth of the wound biopsy. Biochemical association between taxonomy and metabolic landscape indicated significant wound-to-wound similarity in metabolite enrichment sets and metabolic pathway impacts, especially with regard to amino acid metabolism. To our knowledge, this is the first demonstration of a statistically robust correlation between bacterial colonization and metabolic landscape within the chronic wound environment. PMID:25978400

  6. Care in prevention of pressure ulcers of bedridden patients at home

    Directory of Open Access Journals (Sweden)

    Arlene Laurenti M. Ayala

    2017-01-01

    Full Text Available This study was carried out in the catchment area of a Basic Health Unit in Joinville/SC patients bedridden at home. We aimed to characterize the risk of bedridden for developing pressure ulcers, describing the factors favorable to its emergence, and evaluate adherence to treatment prescribed to prevent this injury. This is a descriptive study. Data collection was carried out through an instrument containing identification data, clinical conditions of patients and the application of the Braden scale. It was evaluated 12 patients bedridden. The average age of the patients evaluated was 80.5 years. Most were white, with low education and dependent on public health services. All patients had some underlying disease, the most frequent the Stroke (CVA. The laid up time was 67 months (± 53. The mobility and sensory perception were completely or limited to 83% and 50% of the evaluated, respectively. 67% of users had very poor nutritional status or inadequate and 92% constantly moist or too moist skin. Low fluid intake was present for all participants. Adherence to prescribed care of the caregivers was partial. At the end of the study it was found that the findings are consistent with the literature data and the studied patients had an elevated risk for developing pressure ulcers, since the factors favorable to the appearance of the lesion showed with high frequencies.

  7. Use of Pressure-Redistributing Support Surfaces among Elderly Hip Fracture Patients across the Continuum of Care: Adherence to Pressure Ulcer Prevention Guidelines

    Science.gov (United States)

    Baumgarten, Mona; Margolis, David; Orwig, Denise; Hawkes, William; Rich, Shayna; Langenberg, Patricia; Shardell, Michelle; Palmer, Mary H.; McArdle, Patrick; Sterling, Robert; Jones, Patricia S.; Magaziner, Jay

    2010-01-01

    Purpose: To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. Design and Methods: Patients (n = 658) aged [greater than or equal] 65 years who had surgery for hip fracture were examined by research…

  8. Heat-washout measurements compared to distal blood pressure and perfusion in orthopaedic patients with foot ulcers

    DEFF Research Database (Denmark)

    Midttun, M; Azad, B B S; Broholm, R

    2015-01-01

    Distal blood pressure and local skin perfusion pressure were compared to measurement of blood flow rate (BFR) measured by the heat-washout method in orthopaedic patients with and without diabetes, all with a foot ulcer in one foot, compared to healthy controls. The correlation was good between heat......-washout and distal blood pressure in patients with diabetes with and without an ulcer (P = 0·024 and 0·059, respectively). The correlation was weak in patients without diabetes with and without an ulcer, most probably due to power problems (P = 0·118 and 0·116, respectively). The correlation in the healthy controls...... the surrounding tissue, and therefore, measurements are easier made in these subjects. BFR in the first toe increased significantly in all patients when the foot was moved from heart level to 50 cm below heart level (P = between 0·03 and 0·05) as previously seen in patients with claudication...

  9. Potential application of in vivo imaging of impaired lymphatic duct to evaluate the severity of pressure ulcer in mouse model

    Science.gov (United States)

    Kasuya, Akira; Sakabe, Jun-Ichi; Tokura, Yoshiki

    2014-02-01

    Ischemia-reperfusion (IR) injury is a cause of pressure ulcer. However, a mechanism underlying the IR injury-induced lymphatic vessel damage remains unclear. We investigated the alterations of structure and function of lymphatic ducts in a mouse cutaneous IR model. And we suggested a new method for evaluating the severity of pressure ulcer. Immunohistochemistry showed that lymphatic ducts were totally vanished by IR injury, while blood vessels were relatively preserved. The production of harmful reactive oxygen species (ROS) was increased in injured tissue. In vitro study showed a high vulnerability of lymphatic endothelial cells to ROS. Then we evaluated the impaired lymphatic drainage using an in vivo imaging system for intradermally injected indocyanine green (ICG). The dysfunction of ICG drainage positively correlated with the severity of subsequent cutaneous changes. Quantification of the lymphatic duct dysfunction by this imaging system could be a useful strategy to estimate the severity of pressure ulcer.

  10. Effect of vacuum spine board immobilization on incidence of pressure ulcers during evacuation of military casualties from theater.

    Science.gov (United States)

    Mok, James M; Jackson, Keith L; Fang, Raymond; Freedman, Brett A

    2013-12-01

    In the summer of 2009, the vacuum spine board (VSB) was designated by the US Air Force as the preferred method of external spinal immobilization during aeromedical transport of patients with suspected unstable thoracolumbar spine fractures. One purported advantage of the VSB is that, by distributing weight over a larger surface area, it decreases the risk of skin pressure ulceration. To examine whether the rate of pressure ulcers has changed since the introduction of the VSB. Retrospective cohorts. Injured US service members undergoing spinal immobilization during evacuation from the Iraq and Afghanistan theaters to Landstuhl, Germany. Presence and stage of pressure ulceration, and deterioration in neurologic status. Records of the initial 60 patients medically evacuated on the VSB to Landstuhl Regional Medical Center were retrospectively analyzed for patient demographics, injury characteristics, and incidence of pressure injury. The incidence of pressure ulcers after the use of VSB was compared with that in a historical control consisting of 30 patients with unstable spinal injuries evacuated before the introduction of the VSB. No sources of external funding were used for this investigation. The combined cohort had a mean age of 28.8 years and mean Injury Severity Score (ISS) of 20.63 and comprised 96% men. Most injury mechanisms were blunt (58%). The rate of neurological injury was 19%. There were no cases of progressive neurological deficit or deformity in either cohort. In the VSB group, using a broad definition of pressure ulcer, incidence was 13 of 60 patients (22%). Using a strict definition, incidence was eight of 60 (13%): five Stage I and three Stage II. In the non-VSB group, incidence of pressure ulcers was three of 30 (10%), using either definition, all Stage II. Difference in incidence between the groups was not statistically significant. Intubated patients had a significantly higher incidence of pressure ulcers. Both the VSB and historic means (non

  11. Advancing a smart air cushion system for preventing pressure ulcers using projection Moiré for large deformation measurements

    Science.gov (United States)

    Cheng, Sheng-Lin; Tsai, Tsung-Heng; Lee, Carina Jean-Tien; Hsu, Yu-Hsiang; Lee, Chih-Kung

    2016-03-01

    A pressure ulcer is one of the most important concerns for wheelchair bound patients with spinal cord injuries. A pressure ulcer is a localized injury near the buttocks that bear ischial tuberosity oppression over a long period of time. Due to elevated compression to blood vessels, the surrounding tissues suffer from a lack of oxygen and nutrition. The ulcers eventually lead to skin damage followed by tissue necrosis. The current medical strategy is to minimize the occurrence of pressure ulcers by regularly helping patients change their posture. However, these methods do not always work effectively or well. As a solution to fundamentally prevent pressure ulcers, a smart air cushion system was developed to detect and control pressure actively. The air cushion works by automatically adjusting a patient's sitting posture to effectively relieve the buttock pressure. To analyze the correlation between the dynamic pressure profiles of an air cell with a patient's weight, a projection Moiré system was adopted to measure the deformation of an air cell and its associated stress distribution. Combining a full-field deformation imaging with air pressure measured within an air cell, the patient's weight and the stress distribution can be simultaneously obtained. By integrating a full-field optical metrology with a time varying pressure sensor output coupled with different active air control algorithms for various designs, we can tailor the ratio of the air cells. Our preliminary data suggests that this newly developed smart air cushion has the potential to selectively reduce localized compression on the tissues at the buttocks. Furthermore, it can take a patient's weight which is an additional benefit so that medical personnel can reference it to prescribe the correct drug dosages.

  12. Pressure ulcers in trauma patients with suspected spine injury: a prospective cohort study with emphasis on device-related pressure ulcers.

    Science.gov (United States)

    Ham, Wietske Hw; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke Ph

    2017-02-01

    Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device-related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device-related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January-December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28·3% (n = 72/254 patients). The incidence of device-related PUs was 20·1% (n = 51), and 13% (n = 33) developed solely device-related PUs. We observed 145 PUs in total of which 60·7% were related to devices (88/145). Device-related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device-related PUs is very high in trauma patients. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  13. Providing informal home care for pressure ulcer patients: how it affects carers' quality of life and burden.

    Science.gov (United States)

    Rodrigues, Alexandre M; Ferreira, Pedro L; Ferré-Grau, Carmen

    2016-10-01

    To evaluate the quality of life of informal caregivers of patients with pressure ulcer; to assess their levels of burden; to analyse the variables influencing both their quality of life and burden. Informal caregivers of pressure ulcer patients, besides coping with the natural dependency of these patients, deal with the specificity of caring these types of wounds. This situation has an impact on not only the quality of life and burden felt by informal caregivers but also on individual and familiar dynamics. Descriptive and correlational study. This study focused on 145 informal caregivers providing home care. Measurement instruments were: SF-36v2 and the Burden Interview Scale. Descriptive analysis of the quantitative variables was carried out according to measures of central tendency, and the qualitative variables were described using absolute and relative frequencies. The relationships or associations between variables were explored through correlational analysis and, whenever the data allowed, multivariate techniques were used. Informal caregivers showed low levels of quality of life and, most of them, significant burden. Quality of life decreased with overload, with the increasing number of pressure ulcer and with less experience of informal caregivers, with lack of financial remuneration, with unemployment, with patient positioning and with the direct care of the wound. The burden increased with the number of pressure ulcer in each patient and with the lack of financial remuneration. These informal caregivers have low quality of life and are overburdened. Both situations are positively and negatively influenced by factors related to the pressure ulcer and to the patients' sociodemographic data. The results of this study allow more effective monitoring by health professionals of levels of burden and quality of life encountered in pressure ulcer informal caregivers, as well as direct interventions to inhibit the factors inducing burden and enhance those that

  14. Development of a conceptual framework of health-related quality of life in pressure ulcers: a patient-focused approach.

    Science.gov (United States)

    Gorecki, Claudia; Lamping, Donna L; Brown, Julia M; Madill, Anna; Firth, Jill; Nixon, Jane

    2010-12-01

    Evaluating outcomes such as health-related quality of life is particularly important and relevant in skin conditions such as pressure ulcers where the condition and associated interventions pose substantial burden to patients. Measures to evaluate such outcomes need to be developed by utilising patient-perspective to ensure that content and conceptualisation is relevant to patients. Our aim was to develop a conceptual framework of health-related quality of life in pressure ulcers, based on patients' views about the impact of pressure ulcers and interventions on health-related quality of life to inform the development of a new patient-reported outcome measure. SETTING, PARTICIPANTS AND METHODS: We developed a working conceptual framework based on a previous review of the literature, then used semi-structured qualitative interviews with 30 adults with pressure ulcers (22-94 years) purposively sampled from hospital, community and rehabilitation care settings in England and Northern Ireland to obtain patients' views, and thematic content analysis and review by a multidisciplinary expert group to develop the final conceptual framework. Our conceptual model includes four health-related quality of life domains (symptoms, physical functioning, psychological well-being, social functioning), divided into 13 sub-domains and defined by specific descriptive components. We have identified health-related quality of life outcomes that are important to people with pressure ulcers and developed a conceptual framework using robust and systematic methods, which provides the basis for the development of a new pressure ulcer-specific measure of health-related quality of life. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Use of customised pressure-guided elastic bandages to improve efficacy of compression bandaging for venous ulcers.

    Science.gov (United States)

    Sermsathanasawadi, Nuttawut; Chatjaturapat, Choedpong; Pianchareonsin, Rattana; Puangpunngam, Nattawut; Wongwanit, Chumpol; Chinsakchai, Khamin; Ruangsetakit, Chanean; Mutirangura, Pramook

    2017-08-01

    Compression bandaging is a major treatment of chronic venous ulcers. Its efficacy depends on the applied pressure, which is dependent on the skill of the individual applying the bandage. To improve the quality of bandaging by reducing the variability in compression bandage interface pressures, we changed elastic bandages into a customised version by marking them with circular ink stamps, applied when the stretch achieves an interface pressure between 35 and 45 mmHg. Repeated applications by 20 residents of the customised bandage and non-marked bandage to one smaller and one larger leg were evaluated by measuring the sub-bandage pressure. The results demonstrated that the target pressure range is more often attained with the customised bandage compared with the non-marked bandage. The customised bandage improved the efficacy of compression bandaging for venous ulcers, with optimal sub-bandage pressure. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  16. Efficacy of arginine-enriched enteral formulas for the healing of pressure ulcers: a systematic review.

    Science.gov (United States)

    Liu, P; Shen, W-Q; Chen, H-L

    2017-06-02

    Arginine improves healing and modulates inflammation and the immune response. This systematic review aimed to assess the effect of arginine-enriched enteral formulas in pressure ulcer (PU) healing. Systematic computerised searches of PubMed, Web of Knowledge, Scopus, ENTRAL and CINAHL databases were performed from their inception to 20 January 2016. Randomised controlled trials (RCTs) were included in this systematic review. We used the Jadad scale as a quality assessment tool. There were seven RCTs with 369 patients included in this systematic review; four RCTs assessed healing by PU area reduction. All of them reported arginine-enriched enteral nutrition led to a significant improved PU healing compared with standard hospital diet in 2-12 weeks follow-up. Among these four RCTs, one enrolled malnourished patients, one enrolled non-malnourished patients, and the other two studies did not restrict the nutritional status of the patients. Using the Pressure Ulcer Scale for Healing (PUSH) four RCTs assessed healing of PU, all reporting arginine-enriched enteral nutrition resulted in a significant PUSH score improvement compared with control at follow-up. Using the Pressure Sore Status Tool (PSST) one RCT assessed healing of PUs, finding patients receiving arginine had the lowest PSST scores compared with controls. An RCT compared healing with two doses of arginine (4.5g versus 9g), but no difference was found between the doses. Evidence showed that arginine-enriched enteral nutrition led to a significant improvement in PU healing. It was effective not only in malnourished patients, but also in non-malnourished patients.

  17. A preliminary study on pressure-plate evaluation of forelimb toe-heel and mediolateral hoof balance on a hard vs. a soft surface in sound ponies at the walk and trot.

    Science.gov (United States)

    Oosterlinck, M; Royaux, E; Back, W; Pille, F

    2014-11-01

    Thus far, pressure-plate analysis has been limited to measurements on a hard surface, whereas equine athletes routinely perform on a deformable substrate. To explore pressure-plate analysis on arena footing. Nonrandomised crossover study using noninvasive techniques. Five sound, unshod ponies were walked and trotted over a pressure plate in 2 different conditions. In the first session, the plate was covered with only a 5 mm rubber mat, and in the second session, with an additional 50 mm layer of sand and synthetic fibres. Limb loading and timing variables (peak vertical force, vertical impulse, peak vertical pressure, hoof contact area and stance phase duration) were obtained. Toe-heel and mediolateral hoof balance of the vertical force were calculated throughout stance (126 Hz). Peak vertical force, vertical impulse, peak vertical pressure and stance phase duration were decreased on the soft substrate, while hoof contact area increased. At impact, there was more even load distribution between the toe and heel region on the soft vs. hard surface. At mid-stance, there was more loading of the toe region on the soft compared with the hard surface. At impact, there was more even load distribution between lateral and medial on the soft vs. hard surface at walk, but not at trot. Comparison of observed vs. expected impulse indicated that the main factor involved in the lower loading on the soft surface is the dampening effect of the soft substrate, although definitive conclusions require concurrent force-plate analysis. The pressure plate permitted quantitative evaluation of hoof balance of the vertical force on a deformable surface at the walk and trot and proved that there is more even load distribution on arena footing. © 2013 EVJ Ltd.

  18. Treatment of Early-Stage Pressure Ulcers by Using Autologous Adipose Tissue Grafts

    Directory of Open Access Journals (Sweden)

    Giovanni Francesco Marangi

    2014-01-01

    Full Text Available Assessing pressure ulcers (PUs in early stages allows patients to receive safer treatment. Up to now, in addition to clinical evaluation, ultrasonography seems to be the most suitable technique to achieve this goal. Several treatments are applied to prevent ulcer progression but none of them is totally effective. Furthermore, the in-depth knowledge of fat regenerative properties has led to a wide use of it. With this study the authors aim at introducing a new approach to cure and prevent the worsening of early-stage PUs by using fat grafts. The authors selected 42 patients who showed clinical and ultrasonographic evidence of early-stage PUs. Values of skin thickness, fascial integrity, and subcutaneous vascularity were recorded both on the PU area and the healthy trochanteric one, used as control region. Fat grafting was performed on all patients. At three months, abnormal ultrasonographic findings, such as reduction of cutaneous and subcutaneous thickness, discontinuous fascia, and decrease in subcutaneous vascularity, all were modified with respect to almost all the corresponding parameters of the control region. Results highlight that the use of fat grafts proved to be an effective treatment for early-stage PUs, especially in the care of neurological and chronic bedridden patients.

  19. Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP: Going beyond the Basics

    Directory of Open Access Journals (Sweden)

    Amparo Cano

    2015-07-01

    Full Text Available A multidisciplinary process improvement program was initiated at the University of Miami Hospital (UMH in 2009 to identify the prevalence of hospital-acquired pressure ulcers (HAPU at the institution and to implement interventions to reduce the incidence of HAPU. This deliberate and thoughtful committee-driven process evaluated care, monitored results, and designed evidence-based strategic initiatives to manage and reduce the rate of HAPU. As a result all inpatient beds were replaced with support surfaces, updated care delivery protocols were created, and monitored, turning schedules were addressed, and a wound, ostomy, and continence (WOC nurse and support staff were hired. These initial interventions resulted in a decrease in the prevalence of HAPU at UMH from 11.7% of stage II to IV ulcers in the second quarter, 2009 to 2.1% the third quarter. The rate remained at or near the 2009 UMH benchmark of 3.1% until the first quarter of 2012 when the rate rose to 4.1%. At that time new skin products were introduced into practice and continuing re-education was provided. The rate of HAPU dropped to 2.76% by the second quarter of 2012 and has remained steadily low at 1%–2% for nine consecutive quarters.

  20. A Modeled Analysis of Telehealth Methods for Treating Pressure Ulcers after Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Mark W. Smith

    2012-01-01

    Full Text Available Home telehealth can improve clinical outcomes for conditions that are common among patients with spinal cord injury (SCI. However, little is known about the costs and potential savings associated with its use. We developed clinical scenarios that describe common situations in treatment or prevention of pressure ulcers. We calculated the cost implications of using telehealth for each scenario and under a range of reasonable assumptions. Data were gathered primarily from US Department of Veterans Affairs (VA administrative records. For each scenario and treatment method, we multiplied probabilities, frequencies, and costs to determine the expected cost over the entire treatment period. We generated low-, medium-, and high-cost estimates based on reasonable ranges of costs and probabilities. Telehealth care was less expensive than standard care when low-cost technology was used but often more expensive when high-cost, interactive devices were installed in the patient’s home. Increased utilization of telehealth technology (particularly among rural veterans with SCI could reduce the incidence of stage III and stage IV ulcers, thereby improving veterans' health and quality of care without increasing costs. Future prospective studies of our present scenarios using patients with various healthcare challenges are recommended.

  1. Successful Intervention for Pressure Ulcer by Nutrition Support Team: A Case Report

    Directory of Open Access Journals (Sweden)

    Shigeki Inui

    2010-07-01

    Full Text Available A 23-year-old woman with heart failure developed pressure ulcer on her sacral area due to a long-term bed rest and impaired hemodynamics. The ulcer improved only slightly after 2 months with povidone-iodine sugar ointment because of severe nausea and anorexia. Then, the nutrition support team (NST started intervention and estimated the patient’s malnutrition from her body weight (30.1 kg, body mass index (BMI (13.9, triceps skinfold thickness (TSF (3.5 mm, arm circumference (AC (17.2 cm and serum albumin (2.6 g/dl. The NST administrated an enteral nutrition formula through a nasogastric tube and tried to provide meals according to the patient’s taste. Although DESIGN score improved to 7 (DESIGN: d2e1s2i1g1n0 = 7 2 months later, severe nausea prevented the patient from taking any food perorally. However, after nasogastric decannulation, her appetite improved and 1 month later her body weight increased to 32.8 kg, her BMI to 15.2, TSF to 7.5 mm, AC to 19.7 cm and serum albumin to 4.1 g/dl, and the wound completely healed.

  2. Pressure Combined with Ischemia/Reperfusion Injury Induces Deep Tissue Injury via Endoplasmic Reticulum Stress in a Rat Pressure Ulcer Model

    Directory of Open Access Journals (Sweden)

    Fei-Fei Cui

    2016-02-01

    Full Text Available Pressure ulcer is a complex and significant health problem in long-term bedridden patients, and there is currently no effective treatment or efficient prevention method. Furthermore, the molecular mechanisms and pathogenesis contributing to the deep injury of pressure ulcers are unclear. The aim of the study was to explore the role of endoplasmic reticulum (ER stress and Akt/GSK3β signaling in pressure ulcers. A model of pressure-induced deep tissue injury in adult Sprague-Dawley rats was established. Rats were treated with 2-h compression and subsequent 0.5-h release for various cycles. After recovery, the tissue in the compressed regions was collected for further analysis. The compressed muscle tissues showed clear cellular degenerative features. First, the expression levels of ER stress proteins GRP78, CHOP, and caspase-12 were generally increased compared to those in the control. Phosphorylated Akt and phosphorylated GSK3β were upregulated in the beginning of muscle compression, and immediately significantly decreased at the initiation of ischemia-reperfusion injury in compressed muscles tissue. These data show that ER stress may be involved in the underlying mechanisms of cell degeneration after pressure ulcers and that the Akt/GSK3β signal pathway may play an important role in deep tissue injury induced by pressure and ischemia/reperfusion.

  3. Assessment of Nurses’ Knowledge, Attitude, and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government Hospitals, Addis Ababa, Ethiopia, 2015

    Directory of Open Access Journals (Sweden)

    Abebe Dilie

    2015-01-01

    Full Text Available Background. Although pressure ulcer development is now generally considered as an indicator for quality of nursing care, questions and concerns about situations in which they are unavoidable remain. Awareness about the significance of the problem, positive attitude towards prevention, and an adequate level of knowledge are cornerstones to effectively prevent pressure ulcers. Objective. To assess nurses’ knowledge, attitudes, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals. Methods and Materials. This is a cross-sectional study by design. A total of 217 eligible nurses participated in the study and data were collected through pretested self-administered questionnaire. Results. When queried, 61.2% of the respondents had adequate knowledge on pressure ulcer prevention practices, while 68.4% had favorable attitudes towards prevention practices. Moreover, 67.3% of participants had good pressure ulcer prevention practices. Conclusion and Recommendation. More than half of the nurses were found to have adequate knowledge about pressure ulcer prevention and their attitude towards it was overall favorable. Expressed pressure ulcer prevention practice was affected by the participant’s level of knowledge, attitude, and barriers of care. To provide effective prevention of pressure ulcer, nurses’ level of knowledge and attitude should be enhanced besides resolving these barriers.

  4. Prevalencia de las úlceras por presión en una residencia asistida de mayores Prevalence of pressure ulcers in an assisted residence for the elderly

    Directory of Open Access Journals (Sweden)

    J.M. Díaz Pizarro

    2007-09-01

    Full Text Available Se recogieron datos de 282 residentes distribuidos en las diferentes áreas asistenciales de una residencia asistida de mayores, con el objetivo de analizar la prevalencia de lesiones por presión y sus características, así como el estado funcional y psíquico de los usuarios para poder realizar un estudio descriptivo de su situación actual. Se observó una prevalencia del 13,47% de UPP con una mayor presencia en talones y una media de edad de 82,93 años. Además, se analizaron factores que aumentan el riesgo de aparición de UPP, con especial atención a la presencia de incontinencia, uso de suplementos nutricionales y a las medidas de prevención como cambios posturales y colchones antiescaras.We made a survey and collected data from 283 people distributed in the different welfare areas of an assisted residence for the elderly in order to analyse the prevalence of pressure ulcers as well as their functional and psychic conditions of the users to develop a descriptive report of their current situations. A prevalence percentage of 13,47 was found, the sores in their heels being the most spread ones and within people at the average age of 82,93. Besides, there were analyzed factors that increase the risk of PUs appearance with special attention to the presence of incontinence, use of nutritional supplements and the prevention measures as position changes and no injure mattresses.

  5. Nursing Intervention Classifications (NIC) validated for patients at risk of pressure ulcers.

    Science.gov (United States)

    Bavaresco, Taline; Lucena, Amália de Fátima

    2012-01-01

    to validate the Nursing Intervention Classifications (NIC) for the diagnosis 'Risk of Impaired Skin Integrity' in patients at risk of pressure ulcers (PU). the sample comprised 16 expert nurses. The data was collected with an instrument about the interventions and their definitions were scored on a Likert scale by the experts. The data was analyzed statistically, using the calculation of weighted averages (WA). The study was approved by the Research Ethics Committee (56/2010). nine interventions were validated as 'priority' (WA ≥0.80), among them Prevention of PU (MP=0.92); 22 as 'suggested' (WA >0.50 and <0.80) and 20 were discarded (WA ≤0.50). the prevention of PU results from the implementation of specific interventions related to the risk factors for development of the lesion, with implications for nursing practice, teaching and research.

  6. [Venous ulcer].

    Science.gov (United States)

    Böhler, Kornelia

    2016-06-01

    Venous disorders causing a permanent increase in venous pressure are by far the most frequent reason for ulcers of the lower extremity. With a prevalence of 1 % in the general population rising to 4 % in the elderly over 80 and its chronic character, 1 % of healthcare budgets of the western world are spent on treatment of venous ulcers. A thorough investigation of the underlying venous disorder is the prerequisite for a differenciated therapy. This should comprise elimination of venous reflux as well as local wound management. Chronic ulcers can successfully be treated by shave therapy and split skin grafting. Compression therapy is a basic measure not only in venous ulcer treatment but also in prevention of ulcer recurrence. Differential diagnosis which have to be considered are arterial ulcers, vasculitis and neoplasms.

  7. Getting evidence-based pressure ulcer prevention into practice: a process evaluation of a multifaceted intervention in a hospital setting.

    Science.gov (United States)

    Sving, Eva; Fredriksson, Lennart; Gunningberg, Lena; Mamhidir, Anna-Greta

    2017-10-01

    To describe registered nurses', assistant nurses' and first-line managers' experiences and perceptions of a multifaceted hospital setting intervention focused on implementing evidence-based pressure ulcer prevention. Pressure ulcer prevention is deficient. Different models exist to support implementation of evidence-based care. Little is known about implementation processes. A descriptive qualitative approach. Five focus-group nurse interviews and five individual first-line manager interviews were conducted at five Swedish hospital units. Qualitative content analysis was used. The findings support that the intervention and the implementation process changed the understanding and way of working with pressure ulcer prevention: from treating to preventing. This became possible as 'Changed understanding enables changed actions - through one's own performance and reflection on pressure ulcer prevention'. Having a common outlook on pressure ulcer prevention, easy access to pressure-reducing equipment, and external and internal facilitator support were described as important factors for changed practices. Bedside support, feedback and discussions on current results increased the awareness of needed improvements. The multifaceted intervention approach and the participants' positive attitudes seemed to be crucial for changing understanding and working more preventatively. The strategies used and the skills of the facilitators need to be tailored to the problems surrounding the context. Feedback discussions among the staff regarding the results of the care provided also appear to be vital. It is crucial that dedicated facilitators are involved to promote the implementation process. A preventative mindset should be strived for. Creating an implementation plan with an outcome and a process evaluation should be emphasised. It is important to give the staff regular feedback on the quality of care and on those occasions allocate time for discussion and reflection. © 2016 John

  8. Treatment of pressure ulcers with noncontact normothermic wound therapy: healing and warming effects.

    Science.gov (United States)

    Whitney, J D; Salvadalena, G; Higa, L; Mich, M

    2001-09-01

    This study compared healing rates in stage III and IV pressure ulcers treated with noncontact normothermic wound therapy or moist dressings. Periwound temperature changes with noncontact normothermic wound therapy were evaluated. This 8-week, prospective, randomized clinical trial evaluated linear rate of healing of the wound edge and periwound temperature changes during the 1-hour warming treatment and for 15 minutes after warming. Forty subjects referred from primary care providers, home care providers, acute care facilities, and long-term care facilities were enrolled in the study. Twenty-nine subjects completed the trial (14 received standard care, and 15 received noncontact normothermic wound therapy). Ulcers were measured with acetate tracings, digital and Polaroid photography, and Pressure Sore Status Tool evaluations. The linear rate of healing was determined with use of computerized planimetry. Periwound temperatures were recorded with use of a Cole Parmer thermometer YSI 400 series. Subjects were evaluated weekly. Subjects randomly assigned to noncontact normothermic wound therapy received 3 treatments daily, during which the dressing was warmed to 38 degrees C for 1 hour. Subjects in the standard care group were treated with dressings that were moisture retentive and provided absorption as needed. The two groups were statistically similar with regard to baseline and wound characteristics. The linear rate of healing was significantly faster in the group treated with noncontact normothermic wound therapy (Mann-Whitney U test = 47, P =.01). On average, periwound temperatures increased 2.4 degrees C at the end of warming (1 hour), a significant increase above baseline values (P =.001). The healing rate was significantly increased with noncontact normothermic wound therapy treatment. Periwound temperature increased significantly after 1 hour of warming, achieving levels approximating normothermia. Healing effects associated with noncontact normothermic wound

  9. Patient and organisational variables associated with pressure ulcer prevalence in hospital settings: a multilevel analysis.

    Science.gov (United States)

    Bredesen, Ida Marie; Bjøro, Karen; Gunningberg, Lena; Hofoss, Dag

    2015-08-27

    To investigate the association of ward-level differences in the odds of hospital-acquired pressure ulcers (HAPUs) with selected ward organisational variables and patient risk factors. Multilevel approach to data from 2 cross-sectional studies. 4 hospitals in Norway were studied. 1056 patients at 84 somatic wards. HAPU. Significant variance in the odds of HAPUs was found across wards. A regression model using only organisational variables left a significant variance in the odds of HAPUs across wards but patient variables eliminated the across-ward variance. In the model including organisational and patient variables, significant ward-level HAPU variables were ward type (rehabilitation vs surgery/internal medicine: OR 0.17 (95% CI 0.04 to 0.66)), use of preventive measures (yes vs no: OR 2.02 (95% CI 1.12 to 3.64)) and ward patient safety culture (OR 0.97 (95% CI 0.96 to 0.99)). Significant patient-level predictors were age >70 vs variables entered the explanatory model, indicates that the HAPU problem may be reduced by ward-level organisation of care improvements, that is, by improving the patient safety culture and implementation of preventive measures. Some wards may prevent pressure ulcers better than other wards. The fact that ward-level variation was eliminated when patient-level HAPU variables were included in the model indicates that even wards with the best HAPU prevention will be challenged by an influx of high-risk patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Quality of life and self-esteem in patients with paraplegia and pressure ulcers: a controlled cross-sectional study.

    Science.gov (United States)

    Lourenco, L; Blanes, L; Salomé, G M; Ferreira, L M

    2014-06-01

    To evaluate health-related quality of life (HRQoL) and self-esteem in patients with traumatic spinal cord injury (SCI) and pressure ulcers. This study was a controlled cross-sectional study. HRQoL was assessed using the generic Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire and the Rosenberg Self-Esteem/UNIFESP-EPM Scale. A total of 120 patients with traumatic SCI were included in the sample, of which 60 had pressure ulcers and were assigned to the study group, and 60 had no pressure ulcers and were assigned to the control group. Statistical analysis was performed using the chi-square test, Fisher's exact test, and Student's t-test. Of the 60 patients in the study group, 83.3% were men and the mean age was 38.17 years (SD = 9.08 years). When compared with controls, patients in the study group reported significantly lower scores (worse health status) on all SF-36 subscales (p less than or equal to 0.0013) except for general health (p=0.109). The RSE/UNIFESP-EMP scale total score indicated that patients with pressure ulcers had significantly lower self-esteem than controls (pulcers had an adverse impact on the HRQoL and self-esteem of patients with SCI. There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

  11. Pressure ulcer development in trauma patients with suspected spinal injury; the influence of risk factors present in the Emergency Department

    NARCIS (Netherlands)

    Ham, H. W (Wietske); Schoonhoven, Lisette; Schuurmans, M. (Marieke) J; Leenen, L. (Luke) P H

    2017-01-01

    Objectives To explore the influence of risk factors present at Emergency Department admission on pressure ulcer development in trauma patients with suspected spinal injury, admitted to the hospital for evaluation and treatment of acute traumatic injuries. Design Prospective cohort study setting

  12. Predictive validity and reliability of the Braden scale for risk assessment of pressure ulcers in an intensive care unit.

    Science.gov (United States)

    Lima-Serrano, M; González-Méndez, M I; Martín-Castaño, C; Alonso-Araujo, I; Lima-Rodríguez, J S

    2017-02-15

    Contribution to validation of the Braden scale in patients admitted to the ICU, based on an analysis of its reliability and predictive validity. An analytical, observational, longitudinal prospective study was carried out. Intensive Care Unit, Hospital Virgen del Rocío, Seville (Spain). Patients aged 18years or older and admitted for over 24hours to the ICU were included. Patients with pressure ulcers upon admission were excluded. A total of 335 patients were enrolled in two study periods of one month each. None. The presence of gradei-iv pressure ulcers was regarded as the main or dependent variable. Three categories were considered (demographic, clinical and prognostic) for the remaining variables. The incidence of patients who developed pressure ulcers was 8.1%. The proportion of gradei andii pressure ulcer was 40.6% and 59.4% respectively, highlighting the sacrum as the most frequently affected location. Cronbach's alpha coefficient in the assessments considered indicated good to moderate reliability. In the three evaluations made, a cutoff point of 12 was presented as optimal in the assessment of the first and second days of admission. In relation to the assessment of the day with minimum score, the optimal cutoff point was 10. The Braden scale shows insufficient predictive validity and poor precision for cutoff points of both 18 and 16, which are those accepted in the different clinical scenarios. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective.

    NARCIS (Netherlands)

    Mistiaen, P.; Ament, A.; Francke, A.L.; Achterberg, W.; Halfens, R.; Huizinga, J.; Post, H.

    2010-01-01

    BACKGROUND: Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of

  14. Biomechanics Analysis of Pressure Ulcer Using Damaged Interface Model between Bone and Muscle in the Human Buttock

    Science.gov (United States)

    Slamet, Samuel Susanto; Takano, Naoki; Tanabe, Yoshiyuki; Hatano, Asako; Nagasao, Tomohisa

    This paper aims at building up a computational procedure to study the bio-mechanism of pressure ulcer using the finite element method. Pressure ulcer is a disease that occurs in the human body after 2 hours of continuous external force. In the very early stage of pressure ulcer, it is found that the tissues inside the body are damaged, even though skin surface looks normal. This study assumes that tension and/or shear strain will cause damage to loose fibril tissue between the bone and muscle and that propagation of damaged area will lead to fatal stage. Analysis was performed using the finite element method by modeling the damaged fibril tissue as a cutout. By varying the loading directions and watching both tensile and shear strains, the risk of fibril tissue damage and propagation of the damaged area is discussed, which may give new insight for the careful nursing for patients, particularly after surgical treatment. It was found that the pressure ulcer could reoccur for a surgical flap treatment. The bone cut and surgical flap surgery is not perfect to prevent the bone-muscle interfacial damage.

  15. Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

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    Kamal Kataria

    2012-05-01

    Full Text Available Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature.

  16. Inter rater reliability of Pressure Ulcer Scale for Healing (PUSH in patients with chronic leg ulcers Confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH en pacientes con úlceras crónicas en la pierna Confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH, em pacientes com úlceras crônicas de perna

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Conceição de Gouveia Santos

    2007-06-01

    Full Text Available This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH, in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00 obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (pEl objetivo del estúdio fue probar la confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH, en su versión adaptada al portugués, en pacientes con úlceras crónicas en la pierna. Para el análisis de concordancia se utilizó el Indice Kappa. Posterior a la aprobación del Comité de Ética, 41 pacientes con úlcera fueron examinados, siendo que 49% de las úlceras se localizaron a la derecha y 36% eran de etiología venosa. Los indices Kappa obtenidos (0,97 a 1,00, con un nivel significativo de pTestar a confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH, em sua versão adaptada para o português, em pacientes com úlceras crônicas de perna foi o objetivo deste estudo. Para a análise de concordância, utilizou-se o índice Kappa. Após aprovação pelo Comitê de Ética, pacientes com úlceras (41 úlceras foram examinados, sendo que 49% das úlceras localizavam-se à direita e 36% eram de etiologia venosa. Os índices Kappa obtidos (0,97 a 1,00, com significância estatística (p<0,001, ratificaram a confiabilidade interobservadores, ao ser obtida concordância de muito boa a total entre as observações de enfermeiros clínicos e especialistas em estomaterapia (padrão-ouro, para todas as subescalas do PUSH, como para o escore total. Esses resultados

  17. A Clinical Nurse Specialist-Led Interprofessional Quality Improvement Project to Reduce Hospital-Acquired Pressure Ulcers.

    Science.gov (United States)

    Fabbruzzo-Cota, Christina; Frecea, Monica; Kozell, Kathryn; Pere, Katalin; Thompson, Tamara; Tjan Thomas, Julie; Wong, Angela

    2016-01-01

    The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. Hospital-acquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families. This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization. An 80% decrease in HAPUs has been achieved since the implementation of best practices by the Best Practice Guideline Pressure Ulcer working group. The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication. This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.

  18. Nutrition care-related practices and factors affecting nutritional intakes in hospital patients at risk of pressure ulcers.

    Science.gov (United States)

    Roberts, S; Chaboyer, W; Desbrow, B

    2015-08-01

    Malnutrition is common in hospitals and is a risk factor for pressure ulcers. Nutrition care practices relating to the identification and treatment of malnutrition have not been assessed in patients at risk of pressure ulcers. The present study describes nutrition care practices and factors affecting nutritional intakes in this patient group. The study was conducted in four wards at two hospitals in Queensland, Australia. Adult patients at risk of pressure ulcers as a result of restricted mobility were observed for 24 h to determine their daily oral intake and practices such as nutrition screening, documentation and intervention. Independent samples t-tests and chi-squared tests were used to analyse dietary intake and nutrition care-related data. Predictors of receiving a dietitian referral were identified using logistic regression analyses. Two hundred and forty-one patients participated in the present study. The observed nutritional screening rate was 59% (142 patients). Weight and height were documented in 71% and 34% of cases. Sixty-nine patients (29%) received a dietitian referral. Predictors of receiving a dietitian referral included lower body mass index and longer length of stay. On average, patients consumed 73% and 72% of the energy and protein provided, respectively. Between 22% and 38% of patients consumed Nutrition care practices including malnutrition risk screening and documentation of nutritional parameters appear to be inadequate in patients at risk of pressure ulcers. A significant proportion of these patients eat inadequately at main meals, further increasing their risk of malnutrition and pressure ulcers. © 2014 The British Dietetic Association Ltd.

  19. Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: A randomized double-blind controlled trial.

    Science.gov (United States)

    Taly, Arun B; Sivaraman Nair, Krishan P; Murali, Thyloth; John, Archana

    2004-10-01

    To study the efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with spinal cord disorders. Randomized controlled trial. Neurologic rehabilitation ward of a referral center in India. Thirty-five subjects with spinal cord injury, with 64 pressure ulcers (stage 2, n=55; stage 3, n=8; stage 4, n=1), were randomized into treatment and control groups. One subject refused consent. Mean duration of ulcers in the treatment group was 34.2+/-45.5 days and in the control group, 57.1+/-43.5 days. Treatment group received 14 sessions of multiwavelength light therapy, with 46 probes of different wavelengths from a gallium-aluminum-arsenide laser source, 3 times a week. Energy used was 4.5 J/cm(2). Ulcers in the control group received sham treatment. Healing of the ulcer, defined as the complete closure of the wound with healthy scar tissue, time taken for the ulcer to heal, and stage of the ulcer and Pressure Sore Status Tool score 14 days after last treatment. There was no significant difference in healing between the treatment and control groups. Eighteen ulcers in treatment group and 14 in control group healed completely ( P =.802). Mean time taken by the ulcers to heal was 2.45+/-2.06 weeks in the treatment group and 1.78+/-2.13 weeks in the control group ( P =.330). Time taken for stage 3 and 4 ulcers to reach stage 2 was 2.25+/-0.5 weeks in treatment group and 4.33+/-1.53 weeks in control group ( P =.047). Multiwavelength light therapy from a gallium-aluminum-arsenide laser source did not influence overall healing pressure ulcers. Limited evidence suggested that it improved healing of stage 3 and 4 pressure ulcers.

  20. Evaluation of the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers: a systematic review and documentary analysis.

    Science.gov (United States)

    McGraw, Caroline; Drennan, Vari M

    2015-02-01

    To evaluate the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers. The objective was to identify the extent to which these frameworks take account of the setting where the ulcer originated as being the person's home rather than a hospital setting. Pressure ulcers involving full-thickness skin loss are increasingly being regarded as indicators of nursing patient safety failure, requiring investigation using root cause analysis frameworks. Evidence suggests that root cause analysis frameworks developed in hospital settings ignore the unique dimensions of risk in home healthcare settings. A systematic literature review and documentary analysis of frameworks used to investigate community-acquired grade three and four pressure ulcers by home nursing services in England. No published papers were identified for inclusion in the review. Fifteen patient safety investigative frameworks were collected and analysed. Twelve of the retrieved frameworks were intended for the investigation of community-acquired pressure ulcers; seven of which took account of the setting where the ulcer originated as being the patient's home. This study provides evidence to suggest that many of the root cause analysis frameworks used to investigate community-acquired pressure ulcers in England are unsuitable for this purpose. This study provides researchers and practitioners with evidence of the need to develop appropriate home nursing root cause analysis frameworks to investigate community-acquired pressure ulcers. © 2014 John Wiley & Sons Ltd.

  1. Utility of a three-dimensional wound measurement device in pressure ulcers

    Directory of Open Access Journals (Sweden)

    Goto T

    2017-10-01

    Full Text Available Taichi Goto,1–3 Gojiro Nakagami,1,4 Ayano Nakai,1 Shuhei Noyori,1,5 Sanae Sasaki,6 Chieko Hayashi,6 Tomomitsu Miyagaki,7 Kaname Akamata,7 Hiromi Sanada1,4 1Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, 2Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Bunkyo-ku, 3Japan Society for the Promotion of Science, Chiyoda-ku, Japan; 4Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 5Graduate Program for Social ICT Global Creative Leaders, The University of Tokyo, 6Department of Nursing, 7Department of Dermatology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan Introduction: Depth assessment is important for severe pressure ulcers (PUs; however, a device for the metric measurement of wounds, including depth, is lacking in clinical settings. Recent technological advancements have enabled the evaluation of the depth of wounds, and three-dimensional measurements are now available. The aim of this study was to test the utility of a newly developed three-dimensional wound measurement device in the clinical setting.Methods: We recruited three patients, each with a PU, who were being treated by a PU team at a university hospital. We measured the length, width, area, and maximal depth of the ulcers by using the device and with the conventional method. The ulcer volume was measured only with the device. The difference in measurement results of the device before and after debridement was compared in the first patient. The difference in measurement results between the conventional method and the device was compared in the second patient. Correlation coefficients between the conventional method and the device obtained from longitudinal data were calculated in the third patient.Results: The changes in measurements between before and after debridement were easily detected by the device in the first patient. Although the maximal depth was

  2. Chronic Iliac Vein Occlusion and Painful Nonhealing Ulcer Induced by High Venous Pressures from an Arteriovenous Malformation

    Directory of Open Access Journals (Sweden)

    Daniel P. Link

    2011-01-01

    Full Text Available Chronic femoral vein compression (May-Thurner Syndrome is a known rare cause of deep venous thrombosis. Subsequent angiogenesis and the development of arteriovenous malformation (AVM in the setting of chronic venous thrombosis is by itself a rare and poorly understood phenomenon. We report a case in which elevated venous pressures resulting from such compression appear to have resulted in the development of a pelvic arteriovenous malformation, which was further complicated by chronic, nonhealing painful lower extremity ulcers, and the development of extensive subcutaneous venous collaterals. Following successful embolization of the pelvic AVM and ablation of veins under the ulcers with laser and sclerotherapy, the patient's ulcers healed and she became pain-free.

  3. Analysis of Gene Expression in Experimental Pressure Ulcers in the Rat with Special Reference to Inflammatory Cytokines.

    Directory of Open Access Journals (Sweden)

    Tomoyuki Kurose

    Full Text Available Pressure ulcers have been investigated in a few animal models, but the molecular mechanisms of pressure ulcers are not well understood. We hypothesized that pressure results in up-regulation of inflammatory cytokines and those cytokines contribute to the formation of pressure ulcers. We measured genome-wide changes in transcript levels after compression, and focused especially on inflammatory cytokines. The abdominal wall of rats was compressed at 100 mmHg for 4 hours by two magnets. Specimens were obtained 12 hours, 1, or 3 days after compression, and analyzed by light microscopy, microarray, Real-Time PCR, and ELISA. The skin and subcutaneous tissue in the compressed area were markedly thickened. The microarray showed that numerous genes were up-regulated after the compression. Up-regulated genes were involved in apoptosis, inflammation, oxidative stress, proteolysis, hypoxia, and so on. Real-Time PCR showed the up-regulation of granulocyte-macrophage colony stimulating factor (GM-CSF, interferon γ (IFN-γ, interleukin 1β (IL-1β, interleukin 1 receptor antagonist gene (IL1Ra, interleukin 6 (IL-6, interleukin 10 (IL-10, matrix metalloproteinase 3 (MMP-3, tissue inhibitor of metalloproteinase 1 (TIMP-1, and tumor necrosis factor α (TNF-α at 12 hours, IFN-γ, IL-6, IL-10, MMP-3, and TIMP-1 at 1 day, and IFN-γ, IL-6, and MMP-3 at 3 days. Some genes from subcutaneous tissue were up-regulated temporarily, and others were kept at high levels of expression. ELISA data showed that the concentrations of IL-1β and IL-6 proteins were most notably increased following compression. Prolonged up-regulation of IL-1β, and IL-6 might enhance local inflammation, and continuous local inflammation may contribute to the pressure ulcer formation. In addition, GM-CSF, IFN-γ, MMP-3, and TIMP-1 were not reported previously in the wound healing process, and those genes may have a role in development of the pressure ulcers. Expression data from Real-Time PCR were

  4. What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors.

    Science.gov (United States)

    Gorecki, C; Nixon, J; Madill, A; Firth, J; Brown, J M

    2012-02-01

    With the recognition of health-related quality of life (HRQL) as an important and relevant outcome in pressure ulceration, it is important to gain better understanding of the complex relationship among the various factors that affect it. A problem with existing literature in this area is that the impact of having a pressure ulcer on HRQL is combined conceptually with contributory factors which may influence outcome. This study identified contributory factors affecting pressure ulcer-related HRQL and explored interrelationships between factors based on views of adults with pressure ulcers. We obtained patient-reported qualitative data through semi-structured interviews with 30 patients with pressure ulcers recruited from hospital and community settings around England and Northern Ireland. Patients described how pressure ulcers affected their lives by recounting specific relevant events. Events (patient-reported issues) were sorted into categories and data framework analysed to produce a taxonomy of contributory factors. Inter-rater reliability established the extent of agreement between two independent raters. We identified 16 contributory factors, into two theme taxonomy: experience-of-care and individual-patient factors, defined by descriptive components. Our taxonomy is a comprehensive theoretical model of factors that contribute to pressure ulcer-related HRQL. We have also identified further research priorities to inform clinical practice. Copyright © 2011 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  5. Heel pain--operative results.

    Science.gov (United States)

    Baxter, D E; Thigpen, C M

    1984-01-01

    In 6 years through 1982, the authors performed 34 operative cases in 26 patients with recalcitrant heel pain. The operative procedure involves an isolated neurolysis of the mixed nerve supplying the abductor digiti quinti muscle as it passes beneath the abductor hallucis muscle and beneath the medial ridge of the calcaneus. The deep fascia of the abductor hallucis muscle is released routinely, and an impinging heel spur or tight plantar fascia is partially removed or released if it is causing entrapment of the nerve. The biomechanical pathogenesis of heel pain in relation to pes planus and pes cavus predisposing to an entrapment neuropathy is described, and the anatomy of the heel in relation to the nerve distribution is clarified and well illustrated. Of the 34 operated heels, 32 had good results and two had poor results. Heel pain can cause total disability in the working population and may jeopardize one's employment or professional athletic career. The authors believe operative treatment has a place in the care of recalcitrant heel pain and that an entrapment neuropathy is an etiological factor in heel pain.

  6. [A jogger with painful heels].

    Science.gov (United States)

    Van Gool, Arthur R; Pepels, Wout R J

    2012-01-01

    A 54-year-old man had chronic pain of his left heel region, which was initially diagnosed as 'tendinopathy'. An X-ray of the ankle joint showed a Haglund deformity. After successful surgery, he developed pain on his right heel, where again a Haglund deformity was diagnosed.

  7. Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking.

    Science.gov (United States)

    Hong, Wei-Hsien; Lee, Yung-Hui; Chen, Hsieh-Ching; Pei, Yu-Cheng; Wu, Ching-Yi

    2005-12-01

    The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF). Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done. The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait. These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.

  8. Process evaluation of a cluster-randomised trial testing a pressure ulcer prevention care bundle: a mixed-methods study.

    Science.gov (United States)

    Roberts, Shelley; McInnes, Elizabeth; Bucknall, Tracey; Wallis, Marianne; Banks, Merrilyn; Chaboyer, Wendy

    2017-02-13

    As pressure ulcers contribute to significant patient burden and increased health care costs, their prevention is a clinical priority. Our team developed and tested a complex intervention, a pressure ulcer prevention care bundle promoting patient participation in care, in a cluster-randomised trial. The UK Medical Research Council recommends process evaluation of complex interventions to provide insight into why they work or fail and how they might be improved. This study aimed to evaluate processes underpinning implementation of the intervention and explore end-users' perceptions of it, in order to give a deeper understanding of its effects. A pre-specified, mixed-methods process evaluation was conducted as an adjunct to the main trial, guided by a framework for process evaluation of cluster-randomised trials. Data was collected across eight Australian hospitals but mainly focused on the four intervention hospitals. Quantitative and qualitative data were collected across the evaluation domains: recruitment, reach, intervention delivery and response to intervention, at both cluster and individual patient level. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. In the context of the main trial, which found a 42% reduction in risk of pressure ulcer with the intervention that was not significant after adjusting for clustering and covariates, this process evaluation provides important insights. Recruitment and reach among clusters and individuals was high, indicating that patients, nurses and hospitals are willing to engage with a pressure ulcer prevention care bundle. Of 799 intervention patients in the trial, 96.7% received the intervention, which took under 10 min to deliver. Patients and nurses accepted the care bundle, recognising benefits to it and describing how it enabled participation in pressure ulcer prevention (PUP) care. This process evaluation found no major failures

  9. Psychometric Testing of INTEGRARE, an Instrument for the Assesment of Pressure Ulcer Risk in Inpatients.

    Science.gov (United States)

    Porcel-Gálvez, Ana María; Romero-Castillo, Rocío; Fernández-García, Elena; Barrientos-Trigo, Sergio

    2017-08-21

    The aim of this study is to evaluate the psychometric properties of INTEGRARE, an instrument based on Nursing Outcome Classification. A multicenter, cross-sectional, methodological design was used. The study included 3,835 patients. Internal consistency α = 0.86. Confirmatory factor analysis demonstrated the unidimensionality of the scale, indicating a good model fit (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028). INTEGRARE is a valid and reliable instrument with high sensitivity, specificity, and diagnostic accuracy in measuring pressure ulcer (PU) risk in inpatients. This instrument allows us to know the effectiveness of nursing interventions, providing evidence for the validation of the diagnosis Risk for pressure ulcer (00249) as well as on health outcomes, due to the fact that PUs are nursing-sensitive outcomes. Evaluar las propiedades psicométricas de INTEGRARE, un instrumento basado en la Clasificación de Resultados de Enfermería. MÉTODO: Se optó por un diseño transversal multicéntrico. El estudio incluyó a 3,835 pacientes. Consistencia interna α = 0.86. El análisis factorial confirmatorio demostró la unidimensionalidad de la escala, indicando un buen ajuste del modelo (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028). INTEGRARE es un instrumento válido y fiable con alta sensibilidad, especificidad y precisión diagnóstica en la medición de riesgo de úlcera por presión (UPP) en pacientes hospitalizados. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: Este instrumento nos permite conocer la efectividad de las intervenciones enfermeras, aportando evidencia para la validación del diagnóstico Riesgo de úlcera por presión (00249), así como sobre los resultados de salud, debido a que las UPP son resultados sensibles a la práctica enfermera. © 2017 NANDA International, Inc.

  10. Healthy Skin Wins: A Glowing Pressure Ulcer Prevention Program That Can Guide Evidence-Based Practice.

    Science.gov (United States)

    Martin, Donna; Albensi, Lisa; Van Haute, Stephanie; Froese, Maria; Montgomery, Mary; Lam, Mavis; Gierys, Kendra; Lajeunesse, Rob; Guse, Lorna; Basova, Nataliya

    2017-07-29

    In 2013, an observational survey was conducted among 242 in-patients in a community hospital with a pressure ulcer (PU) prevalence of 34.3%. An evidence-based pressure ulcer prevention program (PUPP) was then implemented including a staff awareness campaign entitled "Healthy Skin Wins" with an online tutorial about PU prevention. To determine the effectiveness of the PUPP in reducing the prevalence of PUs, to determine the effectiveness of the online tutorial in increasing hospital staff's knowledge level about PU prevention, and to explore frontline staff's perspectives of the PUPP. This was a mixed methods study. A repeat observational survey discerned if the PUPP reduced PU prevalence. A pre-test post-test design was used to determine whether hospital staff's knowledge of PU prevention was enhanced by the online tutorial. Qualitative interviews were conducted with nurses, allied health professionals, and health care aides to explore staff's perspectives of the PUPP. A comparison of initial and repeat observational surveys (n = 239) identified a statistically significant reduction in the prevalence of PU to 7.53% (p tutorial enhanced staff knowledge level with a statistically significantly higher mean post-test score (n = 80). Thirty-five frontline staff shared their perspectives of the PUPP with "it's definitely a combination of everything" and "there's a disconnect between what's needed and what's available" as the main themes. Incorporating evidence-based PU prevention into clinical practice greatly reduced the prevalence of PUs among hospital in-patients. Due to the small sample size for the pre-test post-test component, the effectiveness of the online tutorial in improving the knowledge level of PU prevention among hospital staff requires further research. Evidence-based PU prevention strategies are facilitated by using a multidisciplinary approach. Educational tools about PU prevention must target all members of the healthcare team including healthcare

  11. Pressure ulcers from spinal immobilization in trauma patients: a systematic review.

    Science.gov (United States)

    Ham, Wietske; Schoonhoven, Lisette; Schuurmans, Marieke J; Leenen, Luke P H

    2014-04-01

    To protect the (possibly) injured spine, trauma patients are immobilized on backboard or vacuum mattress, with a cervical collar, lateral headblocks, and straps. Several studies identified pressure ulcer (PU) development from these devices. The aim of this literature study was to gain insight into the occurrence and development of PUs, the risk factors, and the possible interventions to prevent PUs related to spinal immobilization with devices in adult trauma patients. We systematically searched PubMed (MEDLINE), EMBASE, Cochrane, and CINAHL for the period 1970 to September 2011. Studies were included if participants were healthy volunteers under spinal immobilization or trauma patients under spinal immobilization until spine injuries were diagnosed or excluded. Outcomes of primary interest included occurrence, severity, and risk for PU development as well as prevention of PU development related to spinal immobilization devices. The results of included studies show an incidence of collar-related PUs ranging from 6.8% to 38%. Described locations are the occiput, chin, shoulders, and back. The severity of these PUs varies between Stages 1 and 3, and one study describes PUs requiring surgical debridement, indicating a Stage 4 PU. Described risk factors for PU development are high pressure and pain from immobilizing devices, the length of time in/on a device, intensive care unit admission, high Injury Severity Scores (ISSs), mechanical ventilation, and intracranial pressure monitoring. Preventive interventions for collar-related PUs include early replacement of the extrication collar and regular skin assessment, collar refit, and position change. The results from this systematic review show that immobilization with devices increases the risk for PU development. This risk is demonstrated in nine experimental studies with healthy volunteers and in four clinical studies. Systematic review, level III.

  12. Factors associated with pressure ulcer risk in spinal cord injury rehabilitation.

    Science.gov (United States)

    DeJong, Gerben; Hsieh, Ching-Hui J; Brown, Patrick; Smout, Randall J; Horn, Susan D; Ballard, Pamela; Bouchard, Tara

    2014-11-01

    The aim of this study was to identify patient and clinical factors most strongly associated with a spinal cord injury patient's risk for developing a pressure ulcer (PU) during rehabilitation. This is a prospective observational cohort study conducted at an urban rehabilitation hospital-based specialized spinal cord injury center. The main outcome measure was the onset of a stage 2 or higher PU. Study patients (N = 159) with new (n = 66) and patients with earlier (n = 99) spinal injuries had identical rates at which they acquired a new PU (stage ≥2) in rehabilitation--13.1%. The patients who came to rehabilitation with a PU or myocutaneous flap exhibited a higher rate of developing yet another PU while in rehabilitation (30.2%) than those who came to rehabilitation without an existing PU or flap (6.9%). Logistic regression analysis identified two variables that best predicted a patient's risk at admission for developing a PU during rehabilitation (c = 0.77)--entering rehabilitation with a PU and admission Functional Independence Measure transfers score of less than 3.5. The greatest risk of developing a new PU in rehabilitation is being admitted with an existing PU followed by admission Functional Independence Measure transfers score of less than 3.5. Using these two variables, one can develop a patient PU risk algorithm at admission that can alert clinicians for the need to enhance vigilance, skin monitoring, and early patient education.

  13. Pressure Ulcers Among Newly Admitted Nursing Home Residents: Measuring the Impact of Transferring From Hospital.

    Science.gov (United States)

    Doupe, Malcolm B; Day, Suzanne; McGregor, Margaret J; John, Philip St; Chateau, Dan; Puchniak, Joe; Dik, Natalia; Sarkar, Joykrishna

    2016-06-01

    Pressure ulcers (PUs) are reported more often among newly admitted nursing home (NH) residents who transfer from hospital versus community. We examine for whom this increased risk is greatest, further defining hospitalized patients most in need of better PU preventive care. Retrospective observational cohort study. All NH residents (N=5617) newly admitted between April 1, 2008 and March 31, 2012 in Winnipeg, MB, Canada. RAI-MDS 2.0 data were linked to administrative health care use files capturing each person's NH admission date, their presence of a PU at this time, whether they transferred into NH from hospital or community, and their PU susceptibility (eg, amount of help needed to maneuver in bed or to transfer from one surface to another, frequency of incontinence, presence of diabetes, amount of food consistently left uneaten). Log-binomial regression with interaction terms was used to analyze data. 67.6% of our cohort transferred into a NH directly from hospital; 9.2% of these residents were reported to have a stage 1+ PU on NH admission versus 2.6% of those who transferred from community. From regression models, transferring from hospital versus community was associated with increased PU risk equally across various subgroups of less and more susceptible residents. Transferring from hospital versus community places both more and less susceptible newly admitted NH residents at increased PU risk. Using evidence-based preventive care practices is thus needed for all subgroups of hospital patients before NH use, to help reduce PU risk.

  14. Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups.

    Science.gov (United States)

    Yap, Tracey L; Kennerly, Susan; Corazzini, Kirsten; Porter, Kristie; Toles, Mark; Anderson, Ruth A

    2014-07-25

    The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI) model guided staff interviews about their perceptions of the intervention's characteristics, outcomes, and sustainability. This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members). One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. The a priori codes (observability, trialability, compatibility, relative advantage and complexity) described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled "brainstormed ideas", focusing on strategies for improving the innovation. Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs.

  15. Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups

    Directory of Open Access Journals (Sweden)

    Tracey L. Yap

    2014-07-01

    Full Text Available The purpose of the manuscript is to describe long-term care (LTC staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI model guided staff interviews about their perceptions of the intervention’s characteristics, outcomes, and sustainability. Methods: This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members. One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. Results: The a priori codes (observability, trialability, compatibility, relative advantage and complexity described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled “brainstormed ideas”, focusing on strategies for improving the innovation. Implications: Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs.

  16. Analysis of the Pressure Distribution Qualities of a Silicone Border Foam Dressing.

    Science.gov (United States)

    Miller, Stephannie K; Sharma, Neal; Aberegg, Lauren C; Blasiole, Kimberly N; Fulton, Judith A

    2015-01-01

    To determine whether application of a silicone foam dressing is associated with decreased interface pressures when applied to the heel. Prospective, within-subjects design. The study was conducted in a community-based hospital using a convenience sample of 50 healthy volunteers with a mean age of 39.6 years and mean body mass index of 26.6; 70% were female. Application of the silicone border foam dressing was randomized between the left and right heels. Participants were asked to lie down in the supine position on a viscoelastic foam mattress. Interface pressure measurements were captured using a pressure mapping system; measurements were taken once with the dressing applied to the heel (intervention map) and once without (control map). Data were captured after a 4-minute time period allowing stabilization. Analysis was based on mean interface pressure; data points were collected for both heels in each of the 2 frames, yielding 4 observations per subject. Application of the dressing was associated with a significant decrease in average pressure measurements as compared to the heel with no dressing applied (P foam dressing is associated with significant reduction in interface pressure and may be considered as part of a pressure ulcer prevention program.

  17. Neuroprotective effect of erythropoietin against pressure ulcer in a mouse model of small fiber neuropathy.

    Directory of Open Access Journals (Sweden)

    Aurore Danigo

    Full Text Available An increased risk of skin pressure ulcers (PUs is common in patients with sensory neuropathies, including those caused by diabetes mellitus. Recombinant human erythropoietin (rhEPO has been shown to protect the skin against PUs developed in animal models of long-term diabetes. The aim of this work was to determine whether rhEPO could prevent PU formation in a mouse model of drug-induced SFN. Functional SFN was induced by systemic injection of resiniferatoxin (RTX, 50 µg/kg, i.p.. RhEPO (3000 UI/kg, i.p. was given the day before RTX injection and then every other day. Seven days after RTX administration, PUs were induced by applying two magnetic plates on the dorsal skin. RTX-treated mice expressed thermal and mechanical hypoalgesia and showed calcitonin gene-related peptide (CGRP and substance P (SP depletion without nerve degeneration or vascular dysfunction. RTX mice developed significantly larger stage 2 PUs than Vehicle mice. RhEPO prevented thermal and mechanical hypoalgesia and neuropeptide depletion in small nerve fibers. RhEPO increased hematocrit and altered endothelium-dependent vasodilatation without any effect on PU formation in Vehicle mice. The characteristics of PUs in RTX mice treated with rhEPO and Vehicle mice were found similar. In conclusion, RTX appeared to increased PU development through depletion of CGRP and SP in small nerve fibers, whereas systemic rhEPO treatment had beneficial effect on peptidergic nerve fibers and restored skin protective capacities against ischemic pressure. Our findings support the evaluation of rhEPO and/or its non-hematopoietic analogs in preventing to prevent PUs in patients with SFN.

  18. Quantitative skin assessment using spatial frequency domain imaging (SFDI) in patients with or at high risk for pressure ulcers.

    Science.gov (United States)

    Yafi, Amr; Muakkassa, Fuad K; Pasupneti, Tejasvi; Fulton, Judy; Cuccia, David J; Mazhar, Amaan; Blasiole, Kimberly N; Mostow, Eliot N

    2017-11-01

    Pressure ulcers (PU) are a significant problem facing the health system in the United States. Here, we present preliminary case studies demonstrating feasibility of Spatial Frequency Domain Imaging (SFDI) to assess skin status in high-risk populations and pre-existing wounds. SFDI is a wide-field non-contact optical imaging technology that uses structured light to obtain tissue optical properties and of tissue constituents. This study aims to determine the fit of SFDI for PU care and determine the next steps. Patients at risk for pressure ulcers were imaged using a near-infrared SFDI system. SFDI-derived images of tissue function (tissue hemoglobin, tissue oxygen saturation) and structure (tissue scattering) were then compared to each other as well as a blinded dermatologist's clinical impressions. Four case series were chosen to demonstrate the imaging capability of this technology. The first scenario demonstrates normal skin of three patients without skin breakdown with spatially uniform measures of tissue oxygen saturation, scattering, and blood volume. The second scenario demonstrates a stage II PU; the third case shows non-blanchable erythema of an unstageable PU; a fourth scenario is a clinically indistinguishable skin rash versus early stages of a PU. In all these cases, we observe spatial changes in tissue constituents (decrease in tissue oxygen saturation, increased blood pooling, decreased scattering). We have presented the first use of SFDI for pressure ulcer imaging and staging. This preliminary study demonstrates the feasibility of this optical technology to assess tissue oxygen saturation and blood volume status in a quantitative manner. With the proposed improvements in modeling and hardware, SFDI has potential to provide a means for pressure ulcer risk stratification, healing and staging. Lasers Surg. Med. 49:827-834, 2017 © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  19. Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice: Overlaying a Care Bundle Approach With a Model for Research Implementation.

    Science.gov (United States)

    Tayyib, Nahla; Coyer, Fiona

    This article reports on the development and implementation process used to integrate a care bundle approach (a pressure ulcer [PU] prevention bundle to improve patients' skin integrity in intensive care) and the Ottawa Model of Research Use (OMRU). The PU prevention care bundle demonstrated significant reduction in PU incidence, with the OMRU model providing a consolidated framework for the implementation of bundled evidence in an effective and consistent manner into daily clinical nursing practice.

  20. Olive oil-induced reduction of oxidative damage and inflammation promotes wound healing of pressure ulcers in mice.

    Science.gov (United States)

    Donato-Trancoso, Aline; Monte-Alto-Costa, Andréa; Romana-Souza, Bruna

    2016-07-01

    The overproduction of reactive oxygen species (ROS) and exacerbated inflammatory response are the main events that impair healing of pressure ulcers. Therefore, olive oil may be a good alternative to improve the healing of these chronic lesions due to its anti-inflammatory and antioxidant properties. This study investigated the effect of olive oil administration on wound healing of pressure ulcers in mice. Male Swiss mice were daily treated with olive oil or water until euthanasia. One day after the beginning of treatment, two cycles of ischemia-reperfusion by external application of two magnetic plates were performed in skin to induced pressure ulcer formation. The olive oil administration accelerated ROS and nitric oxide (NO) synthesis and reduced oxidative damage in proteins and lipids when compared to water group. The inflammatory cell infiltration, gene tumor necrosis factor-α (TNF-α) expression and protein neutrophil elastase expression were reduced by olive oil administration when compared to water group. The re-epithelialization and blood vessel number were higher in the olive oil group than in the water group. The olive oil administration accelerated protein expression of TNF-α, active transforming growth factor-β1 and vascular endothelial growth factor-A when compared to water group. The collagen deposition, myofibroblastic differentiation and wound contraction were accelerated by olive oil administration when compared to water group. Olive oil administration improves cutaneous wound healing of pressure ulcers in mice through the acceleration of the ROS and NO synthesis, which reduces oxidative damage and inflammation and promotes dermal reconstruction and wound closure. Copyright © 2016 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

  1. The Relationship Among Evidence-Based Practice and Client Dyspnea, Pain, Falls, and Pressure Ulcer Outcomes in the Community Setting

    OpenAIRE

    Doran, Diane; Lefebre, Nancy; O'Brien-Pallas, Linda; Estabrook, Carole A; White, Peggy; Carryer, Jennifer; Sun, Winnie; Qian, Gan; Bai, Yu Qing; Li, Mingyang

    2014-01-01

    Background There are gaps in knowledge about the extent to which home care nurses’ practice is based on best evidence and whether evidence-based practice impacts patient outcomes. Aim The purpose of this study was to investigate the relationship between evidence-based practice and client pain, dyspnea, falls, and pressure ulcer outcomes in the home care setting. Evidence-based practice was defined as nursing interventions based on best practice guidelines. Methods The Nursing Role Effectivene...

  2. Clinical use of cold atmospheric pressure argon plasma in chronic leg ulcers: A pilot study.

    Science.gov (United States)

    Ulrich, C; Kluschke, F; Patzelt, A; Vandersee, S; Czaika, V A; Richter, H; Bob, A; Hutten, J von; Painsi, C; Hüge, R; Kramer, A; Assadian, O; Lademann, J; Lange-Asschenfeldt, B

    2015-05-01

    In the age of multiresistant microbes and the increasing lack of efficient antibiotics, conventional antiseptics play a critical role in the prevention and therapy of wound infections. Recent studies have demonstrated the antiseptic effects of cold atmospheric pressure plasma (APP). In this pilot, study we investigate the overall suitability of one of the first APP sources for wound treatment focusing on its potential antimicrobial effects. The wound closure rate and the bacterial colonisation of the wounds were investigated. Patients suffering from chronic leg ulcers were treated in a clinical controlled monocentric trial with either APP or octenidine (OCT). In patients who presented with more than one ulceration in different locations, one was treated with APP and the other one with OCT. Each group was treated three times a week over a period of two weeks. The antimicrobial efficacy was evaluated immediately after and following two weeks of treatment. Wounds treated with OCT showed a significantly higher microbial reduction (64%) compared to wounds treated with APP (47%) immediately after the treatment. Over two weeks of antiseptic treatment the bacterial density was reduced within the OCT group (-35%) compared to a slight increase in bacterial density in the APP-treated group (+12%). Clinically, there were no signs of delayed wound healing observed in either group and both treatments were well tolerated. The immediate antimicrobial effects of the APP prototype source were almost comparable to OCT without any signs of cytotoxicity. This pilot study is limited by current configurations of the plasma source, where the narrow plasma beam made it difficult to cover larger wound surface areas and in order to avoid untreated areas of the wound bed, smaller wounds were assigned to the APP-treatment group. This limits the significance of AAP-related effects on the wound healing dynamics, as smaller wounds tend to heal faster than larger wounds. However, clinical wound

  3. Ongoing nursing training influence on the completion of electronic pressure ulcer records.

    Science.gov (United States)

    López, María; Jiménez, José María; Peña, Isabel; Cao, María José; Simarro, María; Castro, María José

    2017-05-01

    Pressure ulcer (PU) care in nursing at the Hospital Clínico Universitario de Valladolid (HCUV) in Spain includes basic care and its registration through the electronic GACELA Care tool. To assess and evaluate the nursing intervention in PU evolution, a training programme was carried out to unify criteria on PU assessment, treatment, evaluation and monitoring. To assess the influence of training on the completion of PU records in the GACELA Care application, and identify the level of satisfaction of the nurses after its use. A quasi-experimental prospective study consisting of a specific training programme assessed pre- and post-training was carried out on the records of PU documentation at the HCUV. The PU records included in the study were collected using the electronic nursing healthcare management computer tool GACELA Care and belonged to patients admitted for >48h, excluding venous, arterial and stage I PUs. The pre-training sample consisted of 65 records collected between 1 April and 30 June 2014, and there were 57 post-training records, completed from 1 January to 31 March 2015. The training programme consisted of thirty-minute theoretical and practice training sessions. The study variables were ulcer type, location, stage, length and diameter, perilesional skin, cure type, products used and cure frequency, in addition to the number of actions taken in the records in correlation to the days of hospitalisation. To identify the nurses' opinions, a satisfaction survey about the management platform of ongoing Castilla y León training was administered. The variations from the pre- to the post-training PU-sample completion rates were the following: from 23% to 40% for PU diameter, from 11% to 38% for PU length and from 57% to 79% for perilesional skin condition records. There was also a significant increase in the number of form updates after the training activity. The nurses' level of satisfaction with the training activity showed a positive outcome, with an

  4. Adding an arch support to a heel lift improves stability and comfort during gait.

    Science.gov (United States)

    Zhang, Xianyi; Li, Bo; Hu, Kun; Wan, Qiufeng; Ding, Yuhao; Vanwanseele, Benedicte

    2017-10-01

    Heel lifts have been widely used as a conservative treatment for some musculoskeletal problems and complaints. However, the heel rise caused by heel lifts may also affect the plantar pressure distribution and stability during walking. This study aimed to test whether adding an arch support to a heel lift would improve its stability and comfort through comparing the center of pressure (COP) during walking and subjective ratings between heel lifts with and without an arch support. Fifteen healthy male participants were asked to walk along an 8m walkway while wearing high-cut footwear with the control heel lifts and the heel lifts with an arch support. A Footscan pressure plate was used to measure the COP during walking. Subjective ratings including medial-lateral control, dynamic foot/shoe fitting and overall comfort were assessed for each participant. The results showed that compared to the control condition, the COP trajectory was medially shifted during stance phase of gait in the arch support condition. The maximum displacements and velocity of medial-lateral COP in the forefoot contact phase were smaller in the arch support condition than in the control condition. Adding an arch support to a heel lift also significantly improved the subjective ratings in terms of the medial-lateral control, dynamic foot/shoe fitting and overall comfort. The findings of this study suggest that adding an arch support to a heel lift could improve its stability and comfort during walking. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Biomechanical evaluation of heel elevation on load transfer — experimental measurement and finite element analysis

    Science.gov (United States)

    Luximon, Yan; Luximon, Ameersing; Yu, Jia; Zhang, Ming

    2012-02-01

    In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.

  6. The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program.

    Science.gov (United States)

    Scovil, Carol Y; Flett, Heather M; McMillan, Lan T; Delparte, Jude J; Leber, Diane J; Brown, Jacquie; Burns, Anthony S

    2014-09-01

    To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Quality improvement. SCI Rehabilitation Center. Inpatients admitted January 2012 to July 2013. Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges. Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation). Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.

  7. Developing a Model of Care for Healing Pressure Ulcers With Electrical Stimulation Therapy for Persons With Spinal Cord Injury

    Science.gov (United States)

    Lala, D.; Houghton, P.E.; Kras-Dupuis, A.

    2016-01-01

    Background: Electrical stimulation therapy (EST) has been shown to be an effective therapy for managing pressure ulcers in individuals with spinal cord injury (SCI). However, there is a lack of uptake of this therapy, and it is often not considered as a first-line treatment, particularly in the community. Objective: To develop a pressure ulcer model of care that is adapted to the local context by understanding the perceived barriers and facilitators to implementing EST, and to describe key initial phases of the implementation process. Method: Guided by the Knowledge-to-Action (KTA) and National Implementation Research Network (NIRN) frameworks, a community-based participatory research (CBPR) approach was used to complete key initial implementation processes including (a) defining the practice, (b) identifying the barriers and facilitators to EST implementation and organizing them into implementation drivers, and (c) developing a model of care that is adapted to the local environment. Results: A model of care for healing pressure ulcers with EST was developed for the local environment while taking into account key implementation barriers including lack of interdisciplinary collaboration and communication amongst providers between and across settings, inadequate training and education, and lack of resources, such as funding, time, and staff. Conclusions: Using established implementation science frameworks with structured planning and engaging local stakeholders are important exploratory steps to achieve a successful sustainable best practice implementation project.

  8. Encoding and verification of a computer-interpretable guideline: a case study of pressure-ulcer management.

    Science.gov (United States)

    Kim, Hyun-Young; Park, Hyeoun-Ae; Cho, InSook; Kim, JeongAh; Lee, JaeHoon

    This study examined ways to improve the accuracy of translating clinical practice guidelines (CPGs) into a computer-interpretable guideline (CIG) for pressure-ulcer management using the Shareable Active Guideline Environment (SAGE) guideline model, and aimed to verify the accuracy of the obtained CIG. The study was conducted using the following procedures: selecting CPGs, extracting rules from the selected CPGs, developing a CIG using the SAGE guideline model, and verifying the obtained CIG with test cases using an execution engine. The CIG for pressure-ulcer management was developed based on 38 rules and three algorithms at the semiformal representation level using MS Excel and MS Visio. The CIG was encoded by two Activity Graphs consisting of 115 instances representing algorithms and rules as knowledge elements in the SAGE guideline model. Two errors were found and corrected. Results of the study demonstrated that a CIG representing knowledge on pressure-ulcer management can be effectively developed using commonly available programs and the SAGE guideline model, and that the obtained CIG can be verified with a locally developed execution engine. The CIG developed in the study could contribute to health information management once it is implemented successfully in a clinical decision support system.

  9. Pattern of outsole shoe heel wear in infantry recruits.

    Science.gov (United States)

    Finestone, Aharon S; Petrov, Kaloyan; Agar, Gabriel; Honig, Assaf; Tamir, Eran; Milgrom, Charles

    2012-10-25

    Excessive shoe heel abrasion is of concern to patients, parents and shoe manufacturers, but little scientific information is available. The purpose of this study was to describe the phenomenon in a group of infantry recruits performing similar physical activity, and search for biomechanical factors that might be related. Seventy-six subjects (median age 19) enrolled. Pre-training parameters measured included height, weight, tibial length, foot arch height and foot progression angle. Digital plantar pressure maps were taken to calculate arch indexes. Shoe heel abrasion was assessed manually after 14 weeks of training with different-sized clock transparencies and a calliper. Outsole abrasion was posterolateral, averaging 12 degrees on each shoe. The average heel volume that was eroded was almost 5 cm3. The angle of maximum wear was related to right foot progression angle (r = 0.27, p = 0.02). Recruits with lateral ankle sprains had higher angles of maximal abrasion (17° versus 10°, p = 0.26) and recruits with lateral heel abrasion had more lateral ankle sprains (14% versus 3%, p = 0.12). While shoe heel wear affects many people, very little has been done to measure it. In this study in healthy subjects, we found the main abrasion to be posterolateral. This seems to be related to foot progression angle. It was not related to hindfoot valgus/varus or other factors related to subtalar joint motion. These findings do not warrant modification of subtalar joint motion in order to limit shoe heel abrasion.

  10. Approaches that use software to support the prevention of pressure ulcer: A systematic review.

    Science.gov (United States)

    Marchione, F G; Araújo, L M Q; Araújo, L V

    2015-10-01

    The incidence and costs for pressure ulcer (PU) treatment remain high even though preventive methods are applied. Approaches that use software to support the prevention of PU are presented in the literature to make it more effective. Identify the state of art of the approaches that use software to support the prevention of PUs. A systematic literature review was performed to analyze approaches that use software to support the prevention of PU. ACM, IEEE, PubMed, Scopus, CINAHL and Embase databases have been searched with a predetermined search string to identify primary studies. We selected the ones that met the established inclusion criteria. Thirty-six articles met the inclusion criteria. To support prevention, most approaches monitor the patient to provide information about exposure to pressure, temperature level, humidity level and estimated body position in bed providing risk factor intensity charts and intensity maps. The main method to perform patient's monitoring is using sensors installed on the mattress, but recently, alternative methods have been proposed such as electronic sensors and tactile sensory coils. Part of the approaches performs automated management of the risk factors using ventilation tubes and mattresses with porous cells to decrease body's temperature and movable cells to automatically redistribute the pressure over the body. Matters as cost of the approach, patient comfort and hygiene of the monitoring equipment is only briefly discussed in the selected articles. No experiments have been conducted to evidence the approached may reduce PU incidence. Currently, approaches that use software to support the prevention of PU provide relevant information to health professionals such as risk factor intensity charts and intensity maps. Some of them can even automatically manage risk factors in a limited way. Yet, the approaches are based on risk factor monitoring methods that require patient's contact with the monitoring equipment. Therefore, some

  11. Pressure ulcer prevalence and prevention practices: a cross-sectional comparative survey in Norway and Ireland.

    Science.gov (United States)

    Moore, Z; Johansen, E; Etten, M van; Strapp, H; Solbakken, T; Smith, B Eskerud; Faulstich, J

    2015-08-01

    This study explored whether the risk assessment method, structured versus clinical judgment, influences pressure ulcer (PU) prevalence or prevention strategies. A cross section survey design was employed with use of a pre-designed data collection instrument. Following ethical approval and consent, data was gathered from two acute care settings, one in Norway (clinical judgment) and one in Ireland (structured risk assessment using the Maelor Score). Data were obtained from 180 patients, 59 in Norway and 121 in Ireland. Of the patients 48% were male and 49% were female, gender was not recorded for 3%. The most common age bracket was 70-99 years of age, 46% of the study population. PU prevalence was 54% in the Norwegian site with the majority of PUs (69%) being category 1, and 12% in the Irish site with the majority (50%) being category 2. Only 8% of patients in the Norwegian site were risk assessed on admission compared with 85% in the Irish site. No dynamic mattresses and four pressure redistribution cushions were in use in the Norwegian site, whereas, in the Irish site, 27 dynamic mattresses and 11 pressure redistribution cushions were used, the majority (44%) for high-risk individuals. Of those at risk of PU development, 15% in the Norwegian site and 56% in the Irish site had a documented repositioning care plan when in bed, and 0% in the Norwegian site and 13% in the Irish site for when seated on a chair. There were inconsistencies in approach to PU risk assessment and prevention across the two clinical settings. However, prevalence rates differed, mainly relating to category 1 PU damage. Even though formal risk assessment is well established in the Irish site, this is not necessarily followed up with appropriated PU prevention. Thus, the method of risk assessment does not seem to influence subsequent care planning, questioning the role of formal risk assessment; however, despite this, risk assessment does put a focus on an important clinical problem. In the

  12. Incidence of Pressure Ulcers During Home and Institutional Care Among Long-Term Care Insurance Beneficiaries With Dementia Using the Korean Elderly Cohort.

    Science.gov (United States)

    Kim, Juyeong; Choi, Young; Shin, Jaeyong; Jang, Suk-Yong; Cho, Kyeong Hee; Nam, Jin Young; Park, Eun-Cheol

    2017-07-01

    To assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI). Data from LTCI beneficiaries (benefit level 1 or 2) with dementia, aged 60 and older (n = 7841), in the Korean Elderly Cohort data set from 2008 to 2013 were used. Type of long-term care service was categorized into home or institutional care using the LTCI Claims Database. The National Health Insurance Claims Database was used to identify the incidence of pressure ulcers as the outcome variable in a survival analysis using the time-dependent Cox proportional hazard model. Of the 7841 participants, 98 (1.2%) exhibited pressure ulcers. Compared with beneficiaries receiving home care, those receiving institutional care had a higher adjusted hazard ratio for pressure ulcers (hazard ratio 6.48, 95% confidence interval 3.48-10.86). These associations were particularly strong among beneficiaries without pressure ulcers during the mandatory assessment for benefit eligibility and who were partially ambulatory. Beneficiaries receiving institutional care were more likely to have pressure ulcers than were those receiving home care. The government must monitor the quality of institutional long-term care services and encourage service providers to improve such care. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Nursing care missed in patients at risk of or having pressure ulcers.

    Science.gov (United States)

    Valles, Jonathan Hermayn Hernández; Monsiváis, María Guadalupe Moreno; Guzmán, Ma Guadalupe Interial; Arreola, Leticia Vázquez

    2016-11-21

    to determine the nursing care missed as perceived by the nursing staff and its relation with the nursing care missed identified in the assessment of patients at risk of or having pressur ulcers. descriptive correlation study. The participants were 161 nurses and 483 patients from a public hospital. The MISSCARE survey was used in combination with a Nursing Care Assessment Form for Patients at Risk of or having pressure ulcers. For the analysis, descriptive and inferential statistics were used. the nursing staff indicated greater omission in skin care (38.5%), position change (31.1%) and the registration of risk factors for the development of pressure ulcers (33.5%). The nursing care missed identified in the assessment related to the use of pressure relief on bony prominences and drainage tubes interfering in the patient's movements (both with 58.6%) and the use of pneumatic mattresses (57.6%). a high percentage of nursing care missed was found according to the staff's perception. Nevertheless, the assessment of the nursing care missed was much higher. No significant relation was found between both. Therefore, it is a priority to reflect on the importance of objective patient assessments. determinar o cuidado de enfermagem omitido percebido pela equipe de enfermagem e sua relação com o cuidado omitido identificado na avaliação de pacientes com risco ou com de úlceras por pressão. estudo descritivo correlacional. Participaram 161 enfermeiras e 483 pacientes de um hospital público. Foram utilizados o levantamento MISSCARE e um Formulário de Avaliação de Cuidados de Enfermagem em Pacientes com Risco ou com úlceras por pressão. Para a análise foi utilizada estatística descritiva e inferencial. a equipe de enfermagem assinalou que há maior omissão no cuidado da pele (38,5%), reposicionamento (31,1%) e no registro de fatores de risco para o aparecimento de úlceras por pressão (33,5%). Os cuidados de enfermagem omitidos identificados na avaliação foram

  14. Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study.

    Science.gov (United States)

    Sauvage, P; Touflet, M; Pradere, C; Portalier, F; Michel, J-M; Charru, P; Passadori, Y; Fevrier, R; Hallet-Lezy, A-M; Beauchêne, F; Scherrer, B

    2017-06-02

    Our aim was to compare Axtair One, an alternating pressure air mattress (APAM), with a viscoelastic foam mattress (VFM) in elderly patients at moderate to high risk of developing pressure ulcers (PUs). A randomised, controlled, superiority, parallel-group, open-label, multicentre study, was conducted, between February 2012 and March 2015, in nine French, medium- and long-term stay facilities. Eligible patients were aged 70 and over, had no PUs on enrolment, were bedridden for at least 15 hours per day, had reduced mobility, an absent or minimal positioning capability, a Braden score 12 and a Karnofsky score <40%. The primary endpoint was the appearance of PUs over a 30-day monitoring period. The primary objective was to demonstrate a 50% reduction in instantaneous risk of PUs in the APAM versus the VFM group. Secondary objectives were to determine if preventive care was less frequent in the APAM group, the instantaneous relative risk of PUs (hazard ratio) was constant over time and the comfort experienced was higher in the APAM group and to verify the uniformity of the preventive benefit of an APAM, regardless of the level of exposure to major risk factors for PUs. We randomised 76 patients (39 in the APAM group and 37 in the VFM group). The groups were comparable on enrolment and throughout the study. The cumulative risk of PUs was estimated at 6.46% [95% confidence interval (CI): 1.64; 23.66] in the APAM group and at 38.91% [95% CI: 24.66; 57.59] in the VFM group, p=0.001 (log-rank test). The adjusted hazard ratio according to the Cox model with four prognostic factors for the appearance of PUs was 7.57 [95% CI: 1.67; 34.38, p=0.009]. Preventive care proved to be equivalent in both groups. The only risk factor significantly associated with an increased risk of PUs was the type of mattress (VFM). The comfort and tolerance perceived by the patients were both high and similar in the two groups. The constancy over time of the preventive benefit of an APAM could not

  15. Reliability of Pressure Ulcer Rates: How Precisely Can We Differentiate Among Hospital Units, and Does the Standard Signal‐Noise Reliability Measure Reflect This Precision?

    Science.gov (United States)

    Cramer, Emily

    2016-01-01

    Abstract Hospital performance reports often include rankings of unit pressure ulcer rates. Differentiating among units on the basis of quality requires reliable measurement. Our objectives were to describe and apply methods for assessing reliability of hospital‐acquired pressure ulcer rates and evaluate a standard signal‐noise reliability measure as an indicator of precision of differentiation among units. Quarterly pressure ulcer data from 8,199 critical care, step‐down, medical, surgical, and medical‐surgical nursing units from 1,299 US hospitals were analyzed. Using beta‐binomial models, we estimated between‐unit variability (signal) and within‐unit variability (noise) in annual unit pressure ulcer rates. Signal‐noise reliability was computed as the ratio of between‐unit variability to the total of between‐ and within‐unit variability. To assess precision of differentiation among units based on ranked pressure ulcer rates, we simulated data to estimate the probabilities of a unit's observed pressure ulcer rate rank in a given sample falling within five and ten percentiles of its true rank, and the probabilities of units with ulcer rates in the highest quartile and highest decile being identified as such. We assessed the signal‐noise measure as an indicator of differentiation precision by computing its correlations with these probabilities. Pressure ulcer rates based on a single year of quarterly or weekly prevalence surveys were too susceptible to noise to allow for precise differentiation among units, and signal‐noise reliability was a poor indicator of precision of differentiation. To ensure precise differentiation on the basis of true differences, alternative methods of assessing reliability should be applied to measures purported to differentiate among providers or units based on quality. © 2016 The Authors. Research in Nursing & Health published by Wiley Periodicals, Inc. PMID:27223598

  16. Identifying Patterns in Implementation of Hospital Pressure Ulcer Prevention Programs: A Multisite Qualitative Study.

    Science.gov (United States)

    Soban, Lynn M; Finley, Erin P; Miltner, Rebecca S

    2016-01-01

    To describe the presence or absence of key components of hospital pressure ulcer (PU) prevention programs in 6 acute care hospitals. Multisite comparative case study. Using purposeful selection based on PU rates (high vs low) and hospital size, 6 hospitals within the Veterans Health Administration health care system were invited to participate. Key informant interviews (n = 48) were conducted in each of the 6 participating hospitals among individuals playing key roles in PU prevention: senior nursing leadership (n = 9), nurse manager (n = 7), wound care specialist (n = 6), frontline RNs (n = 26). Qualitative data were collected during face-to-face, semistructured interviews. Interview protocols were tailored to each interviewee's role with a core set of common questions covering 3 major content areas: (1) practice environment (eg, policies and wound care specialists), (2) current prevention practices (eg, conduct of PU risk assessment and skin inspection), and (3) barriers to PU prevention. We conducted structured coding of 5 key components of PU prevention programs and cross-case analysis to identify patterns in operationalization and implementation of program components across hospitals based on facility size and PU rates (low vs high). All hospitals had implemented all PU prevention program components. Component operationalization varied considerably across hospitals. Wound care specialists were integral to the operationalization of the 4 other program components examined; however, staffing levels and work assignments of wound care specialists varied widely. Patterns emerged among hospitals with low and high PU rates with respect to wound care specialist staffing, data monitoring, and staff education. We found hospital-level variations in PU prevention programs. Wound care specialist staffing may represent a potential point of leverage in achieving other PU program components, particularly performance monitoring and staff education.

  17. The efficacy of negative pressure wound therapy on chemotherapeutic extravasation ulcers: An experimental study

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    Evren Isci

    2014-01-01

    Full Text Available Context: The extravasation of the chemotherapeutic agents is not an unusual phenomenon. Necrosis of the skin and underlying structures has been reported, depending on the cytotoxicity of the extravasating drug. Despite the presence of some antidotes, such wounds tend to enlarge with time and are likely to resist the treatment. Aims: The objective of this study was to investigate the efficacy of negative pressure wound therapy (NPWT on extravasation ulcers. Settings and Design: Animals were separated into two groups; conventional dressing group and NPWT group. Materials and Methods: Extravasation necrosis was established by intradermal doxorubicin injection. Following the debridement of the necrotic areas, one group of animals was treated with the conventional dressing while NPWT was applied to the other group. The wound areas were measured, and then biopsies were taken on the 3 rd , 7 th and 14 th days after the debridement. Statistical Analysis Used: SPSS 11.5 for Windows was used. Two-way ANOVA test was used to compare wound areas between groups. Willcoxon sign test with Bonferroni correction was used to compare histological scores between groups. Chi-square test with Bonferroni correction was used to compare histological scores within the group between the days. Results: There is no significant difference in terms of inflammatory cell count, neovascularisation, granulation tissue formation between the groups. Contrary to these results wound areas at the end of the treatment were smaller in the NPWT group compared with the dressing group. Conclusion: There is the superiority of NPWT over conventional dressing in chemotherapeutic extravasation wounds as well as the wound area is concerned, but it is not proven histologically.

  18. Implementing trials of complex interventions in community settings: The USC – Rancho Los Amigos Pressure Ulcer Prevention Study (PUPS)

    Science.gov (United States)

    Clark, Florence; Pyatak, Elizabeth A.; Carlson, Mike; Blanche, Erna Imperatore; Vigen, Cheryl; Hay, Joel; Mallinson, Trudy; Blanchard, Jeanine; Unger, Jennifer B.; Garber, Susan L.; Diaz, Jesus; Florindez, Lucia I.; Atkins, Michal; Rubayi, Salah; Azen, Stanley Paul

    2014-01-01

    Background Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)–Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to: (a) participant recruitment and retention, (b) intervention delivery and fidelity, (c) randomization and assessment, and (d) potential inadvertent treatment effects. Purpose We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury. Method Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes. Results PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accord

  19. Mouth ulcers

    Science.gov (United States)

    Oral ulcer; Stomatitis - ulcerative; Ulcer - mouth ... Mouth ulcers are caused by many disorders. These include: Canker sores Gingivostomatitis Herpes simplex ( fever blister ) Leukoplakia Oral cancer ...

  20. Inter-rater reliability of pressure ulcer staging: ordinal probit Bayesian hierarchical model that allows for uncertain rater response.

    Science.gov (United States)

    Gajewski, Byron J; Hart, Sara; Bergquist-Beringer, Sandra; Dunton, Nancy

    2007-11-10

    This article describes a method for estimating the inter-rater reliability of pressure ulcer (PU) staging (stages I-IV) from raters in National Database of Nursing Quality Indicators (NDNQI) participating hospitals. The method models ordinal spanning data utilizing an ordinal probit Bayesian hierarchical model (BHM) across several hospitals in which raters monitor patient's PUs. An ulcer that cannot be accurately assessed because the base of the wound cannot be seen is defined as unstageable. Our novel approach allows for an unstageable PU rating to be included in the analysis. We compare the ordinal probit BHM to an approximate random-effects (standard approach in the literature) model that assumes that the raw ordinal data are continuous. Copyright 2007 John Wiley & Sons, Ltd.

  1. The influence of high- and low-heeled shoes on balance in young women.

    Science.gov (United States)

    Mika, Anna; Oleksy, Łukasz; Kielnar, Renata; Świerczek, Marta

    2016-01-01

    To evaluate the influence of two different heel heights on static balance and on limits of stability during functional reach test, with both the eyes open and eyes closed, in young women (age 22-27) who did not wear heeled shoes habitually. Thirtyone young women (age 22-27) performed balance tests on a stabilometric platform without footwear and in shoes with 4 cm and 10 cm heels. The center of pressure (COP) deviations range and velocity in anteroposterior (AP) and mediolateral (ML) directions were assessed. The limits of stability were measured when the subject leaned the body in sagittal plane. The ranges of COP deviations in AP and ML directions were already significantly higher in 4 cm heels in comparison to the barefoot condition. COP deviation velocity significantly raised with increasing heel height as well as when the eyes were closed. A more pronounced increase of COP deviation velocity than COP deviation range when measurement conditions become more difficult may indicate that young women anticipate postural corrections by stimulation of ankle proprioception when heeled shoes are worn. High-heeled shoes may lead to alterations in velocity feedback balance mechanism, which may increase the risk of musculoskeletal injuries. Observed in our study adverse effect of heeled footwear on balance may predispose women to falls and injuries. Permanent use of stiletto high heels should be avoided by women.

  2. High Heels Increase Women's Attractiveness.

    Science.gov (United States)

    Guéguen, Nicolas

    2015-11-01

    Research has found that the appearance of women's apparel helps increase their attractiveness as rated by men and that men care more about physical features in potential opposite-sex mates. However, the effect of sartorial appearance has received little interest from scientists. In a series of studies, the length of women's shoe heels was examined. A woman confederate wearing black shoes with 0, 5, or 9 cm heels asked men for help in various circumstances. In Study 1, she asked men to respond to a short survey on gender equality. In Study 2, the confederate asked men and women to participate in a survey on local food habit consumption. In Study 3, men and women in the street were observed while walking in back of the female confederate who dropped a glove apparently unaware of her loss. It was found that men's helping behavior increased as soon as heel length increased. However, heel length had no effect on women's helping behavior. It was also found that men spontaneously approached women more quickly when they wore high-heeled shoes (Study 4). Change in gait, foot-size judgment, and misattribution of sexiness and sexual intent were used as possible explanations.

  3. Effects of using a high-density foam pad versus a viscoelastic polymer pad on the incidence of pressure ulcer development during spinal surgery.

    Science.gov (United States)

    Wu, Tsokuang; Wang, Shin-Tien; Lin, Pi-Chu; Liu, Chien-Lin; Chao, Yann-Fen C

    2011-10-01

    The purpose of this study was to evaluate the effect of high-density foam (HDF) pads versus viscoelastic polymer (VP) pads in the prevention of pressure ulcer formation during spinal surgery and their cost-effectiveness. Subjects were 30 patients who underwent spinal surgery for more than 3 hr in a prone position. One side of the chest and iliac crest was padded with HDF pads and the other side was padded with VP pads. An Xsensor® pressure measuring sheet was placed between the pad and the patient. Bilateral chest and iliac crest points were observed for the presence of pressure ulcers at 30 min after the operation. Results showed that a pressure ulcer had occurred at 9 of 120 compression points (7.5% of the total), 30 min after the operation. Risk evaluation showed that female gender, weight <50 kg, and body mass index (BMI) <18 kg/m(2) as well as location (the iliac crest) were all risk factors for development of pressure ulcers. The most significant factor was BMI <18 kg/m(2). The average and peak pressures measured at the points padded with the VP pads were significantly lower than those padded with the HDF pads. However, there was no significant difference between the VP and the HDF pads regarding ulcer prevention. Because the cost of a VP pad is 250 times greater than that of an HDF pad of similar size, the VP pad should only be considered for use in high-risk patients.

  4. Predictive validity of weekly monitoring of wound status using DESIGN-R score change for pressure ulcer healing: a multicenter prospective cohort study.

    Science.gov (United States)

    Iizaka, Shinji; Sanada, Hiromi; Matsui, Yuko; Furue, Masutaka; Tachibana, Takao; Nakayama, Takeo; Sugama, Junko; Furuta, Katsunori; Tachi, Masahiro; Tokunaga, Keiko; Miyachi, Yoshiki

    2012-01-01

    There are few studies on predictive validity of methods to monitor the healing process of pressure ulcers. We evaluated whether the change of DESIGN-R (rating) score could predict subsequent healing, and determined the optimal cutoff points. In a multicenter prospective cohort study, patients were followed until wound healing or censoring. Wound severity was evaluated by the DESIGN-R tool every week, and the score change was calculated over 1-4 weeks (n = 411, 286, 224, and 170, respectively). In the multivariate analyses stratified by depth, a one-point improvement in DESIGN-R score over any period was positively associated with healing within the next 30 days independent of initial wound severity (hazard ratios over each 1-4 weeks ranging from 1.16 to 1.33 for superficial ulcers and from 1.21 to 1.27 for deep ulcers; all p change for superficial ulcers and as positive change of ≥two points for deep ulcers. Nonhealing rate was higher for ulcers with DESIGN-R score change below the cutoff points than that aforementioned for both depths. Weekly monitoring by the DESIGN-R tool will be advantageous for evaluating prognosis of pressure ulcers independent of initial wound severity and depth. © 2012 by the Wound Healing Society.

  5. What makes a good head positioner for preventing occipital pressure ulcers.

    Science.gov (United States)

    Katzengold, Rona; Gefen, Amit

    2017-11-27

    Patients who are stationary endure prolonged soft tissue distortions and deformations at contact areas between their body and the support surface, which may lead to the onset of pressure ulcers (PUs) over time. A novel technology for patient positioning employs innovation in materials science, specifically viscoelastic materials with shape memory properties that compose the Z-Flo™ head positioner (Mölnlycke Health Care, Gothenburg, Sweden). Head positioners are generally known to reduce the occurrence of PUs in scalp tissues and the ears, but quantitative assessments of their biomechanical efficacy are missing in the literature. To determine potential differences in mechanical loads formed in the soft tissues of the back of the head while in contact with 2 head positioner types, Z-Flo vs flat medical foam, we developed 2 comparable finite element model configurations, both including the same 3-dimensional adult head. For both model variants, stresses in skin and fat peaked at the occiput. The skin at the back of the resting head is subjected to greater stress values with respect to fat; however, the Z-Flo positioner reduced the exposure of both skin and fat tissues to elevated stresses considerably (by a factor of 3) compared to the medical foam support. We found the Z-Flo device effective in reducing tissue loads at the surface of the head as well as internally in scalp tissues, with a particular strength in reducing internal tissue shear. The Z-Flo device achieves this protective quality through highly effective immersion and envelopment of the back of the head, generated in the process of manual moulding of the device in preparation for use. Additional protection is achieved through the viscoelastic response of the filling material of this positioner, which relaxes promptly and considerably under the weight of the head (by more than 2-fold within approximately 1 s) as opposed to the elastic recoil of the foam that pushes back on scalp tissues. © 2017

  6. Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years.

    Science.gov (United States)

    Jordan, Sumanas W; De la Garza, Mauricio; Lewis, Victor L

    2017-07-01

    Despite newly introduced techniques, reconstruction of ischial pressure ulcers remains a difficult problem with high-reported failure rates. A retrospective chart review was performed on all spinal cord injury patients who underwent ischial pressure ulcer reconstruction by the senior author (V.L.) between 2004 and 2012. The two-stage procedure consisted of debridement and bone biopsy, followed by bursectomy, partial ischiectomy, fascial release, and gluteus maximus and hamstring advancement flaps. Postoperative care included 2-week supine bed rest on an air-fluidized bed, sitting tolerance rehabilitation, and thorough behavioral training. Sixty-five patients (74 flaps) were identified. A 45.9% had a previous attempt at reconstruction. The median follow-up period was 622 days. Overall, 67.6% of flaps were intact at the last follow-up. Superficial and deep dehiscence rates were 16.2 and 28.4%, respectively. Seven out of 35 flaps suffered late recurrence after being well healed for more than 1 year. History of previous reconstruction was found to be associated with increased odds of superficial (OR 6.02, 95% CI 1.55-23.3) and deep dehiscence (OR 12.3, 95% CI 1.99-76.9). The evolution of the senior author's decades of practice has led to the development of a simpler repair, which relies on plane-by-plane release of scarred tissues to improve the mobility of muscle and skin flaps without large tissue movements, even in the setting of apparent extensive tissue loss. This technique is a reliable option, particularly for the primary ischial pressure ulcer. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. A pilot study evaluating protein abundance in pressure ulcer fluid from people with and without spinal cord injury.

    Science.gov (United States)

    Edsberg, Laura E; Wyffels, Jennifer T; Ogrin, Rajna; Craven, B Catharine; Houghton, Pamela

    2015-07-01

    To determine whether the biochemistry of chronic pressure ulcers differs between patients with and without chronic spinal cord injury (SCI) through measurement and comparison of the concentration of wound fluid inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases. Survey. Tertiary spinal cord rehabilitation center and skilled nursing facilities. Twenty-nine subjects with SCI and nine subjects without SCI (>18 years) with at least one chronic pressure ulcer Stage II, III, or IV were enrolled. Total protein and 22 target analyte concentrations including inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases were quantified in the wound fluid and blood serum samples. Blood samples were tested for complete blood count, albumin, hemoglobin A1c, total iron binding capacity, iron, percent (%) saturation, C-reactive protein, and erythrocyte sedimentation rate. Wound fluid concentrations were significantly different between subjects with SCI and subjects without SCI for total protein concentration and nine analytes, MMP-9, S100A12, S100A8, S100A9, FGF2, IL-1b, TIMP-1, TIMP-2, and TGF-b1. Subjects without SCI had higher values for all significantly different analytes measured in wound fluid except FGF2, TGF-b1, and wound fluid total protein. Subject-matched circulating levels of analytes and the standardized local concentration of the same proteins in the wound fluid were weakly or not correlated. The biochemical profile of chronic pressure ulcers is different between SCI and non-SCI populations. These differences should be considered when selecting treatment options. Systemic blood serum properties may not represent the local wound environment.

  8. Surgery for pressure ulcers improves general health and quality of life in patients with spinal cord injury.

    Science.gov (United States)

    Singh, Roop; Singh, Raghubir; Rohilla, Rajesh K; Siwach, Ramchander; Verma, Vineet; Kaur, Kiranpreet

    2010-01-01

    Prospective clinical study. Pressure ulcers interfere with the rehabilitation process in patients with spinal cord injury (SCI) and are a significant deterrent to participation in activities that contribute to independent, productive, and satisfying life. To evaluate the effect of surgery for pressure ulcers on general health and quality of life in patients with SCI. Tertiary care center in northern India. Various types of flap surgery were performed on 30 patients with SCI and 32 pressure ulcers (stages III and IV). Outcome was evaluated using general improvement in health (hemoglobin, serum proteins, and general well-being), patient satisfaction, and global quality of life scores (according to the visual analog scale). At admission, the mean values of global quality of life, hemoglobin, serum albumin, and total serum proteins were 50.15 (range, 30-65), 8.75 g/dL (range, 6-12 g/dL), 3.12 g/dL (range, 2.9-4.3 g/dL), and 5.21 (range, 5-6.2 g/dL), respectively. At 6-month follow up, mean values of global quality of life score, hemoglobin, serum albumin, and total serum proteins were 87.36 (range, 44-96), 10.85 g/dL (range, 8.2-13.5 g/dL), 3.89 g/dL (range, 3.2-4.5 g/dL), and 6.43 g/dL (range, 5.85-6.70 g/dL), respectively. The overall rise in quality of life scores, hemoglobin, serum albumin, and total serum proteins was statistically significant. Most of the patients (76.7%) reported improvement in subjective well-being, and 83.3% were satisfied with the ultimate outcome of the surgery. Results suggest that surgery for stages III and IV pressure ulcers offers the greatest benefit to the patients in terms of improvement in general health (anemia, hypoproteinemia, and general well-being) and quality of life.

  9. Using cognitive pre-testing methods in the development of a new evidenced-based pressure ulcer risk assessment instrument

    Directory of Open Access Journals (Sweden)

    S. Coleman

    2016-11-01

    Full Text Available Abstract Background Variation in development methods of Pressure Ulcer Risk Assessment Instruments has led to inconsistent inclusion of risk factors and concerns about content validity. A new evidenced-based Risk Assessment Instrument, the Pressure Ulcer Risk Primary Or Secondary Evaluation Tool - PURPOSE-T was developed as part of a National Institute for Health Research (NIHR funded Pressure Ulcer Research Programme (PURPOSE: RP-PG-0407-10056. This paper reports the pre-test phase to assess and improve PURPOSE-T acceptability, usability and confirm content validity. Methods A descriptive study incorporating cognitive pre-testing methods and integration of service user views was undertaken over 3 cycles comprising PURPOSE-T training, a focus group and one-to-one think-aloud interviews. Clinical nurses from 2 acute and 2 community NHS Trusts, were grouped according to job role. Focus group participants used 3 vignettes to complete PURPOSE-T assessments and then participated in the focus group. Think-aloud participants were interviewed during their completion of PURPOSE-T. After each pre-test cycle analysis was undertaken and adjustment/improvements made to PURPOSE-T in an iterative process. This incorporated the use of descriptive statistics for data completeness and decision rule compliance and directed content analysis for interview and focus group data. Data were collected April 2012-June 2012. Results Thirty-four nurses participated in 3 pre-test cycles. Data from 3 focus groups, 12 think-aloud interviews incorporating 101 PURPOSE-T assessments led to changes to improve instrument content and design, flow and format, decision support and item-specific wording. Acceptability and usability were demonstrated by improved data completion and appropriate risk pathway allocation. The pre-test also confirmed content validity with clinical nurses. Conclusions The pre-test was an important step in the development of the preliminary PURPOSE-T and the

  10. Povezave med razjedo zaradi pritiska in ohranjanjem integritete kože pacienta v intenzivni zdravstveni obravnavi: literature review: pregled literature: Relations between pressure ulcer and patient skin integrity maintenance in intensive care:

    OpenAIRE

    Emeđi, Dragica; Skela-Savič, Brigita

    2015-01-01

    Introduction: The research aims to demonstrate the multidimensional needs and potential high-risk factors for developing pressure ulcer in adult patients in the intensive care. Methods: The analysis and synthesis of the evidence review from the EMERALD, CINAHL, PubMed, and ProQuest database were employed in the research. The search terms used were: "quality of care", "pressure ulcer", "prevention and treatment of pressure ulcers", "skin integrity critical care patients". The filtering search ...

  11. Experimental study with nursing staff related to the knowledge about pressure ulcers.

    Science.gov (United States)

    Baron, Miriam Viviane; Reuter, Cézane Priscila; Burgos, Miria Suzana; Cavalli, Veniria; Brandenburg, Cristine; Krug, Suzane Beatriz Frantz

    2016-11-21

    to compare the scores of knowledge in teams participating or not participating in educational interventions about pressure ulcers. a quantitative study with experimental design. Data were collected through a validated questionnaire. The study included 71 individuals, including nurses and nursing technicians from three intensive care units, divided into intervention group and control group. Data analysis considered the scores of the groups in the moment before and after intervention. To check the average rate of correct answers, we calculated the mean and standard deviation. We carried out the Mann-Whitney test for analysis of two independent samples, and the Wilcoxon test for related samples. The mean percentage of correct answers, at the baseline was 74.1% (SD = 26.4) in the intervention group and 76.0% (SD = 22.9) in the control group and post time -intervention, was 87.8% (SD = 18.8) in the group receiving educational intervention, considering that in the control group it was 79.1% (SD = 22.2). The group that participated in educational interventions did not reach the proper average of 90% correct answers for the test. educational interventions on staging, evaluation and prevention of pressure ulcers contributed significantly to the increase of correct responses score in the knowledge test of the intervention group and improved their knowledge on the subject. comparar os escores de conhecimento sobre úlcera por pressão das equipes que participaram ou não de intervenções educativas. estudo quantitativo com delineamento experimental. Os dados foram coletados por meio de questionário validado. Participaram deste estudo 71 pessoas, dentre enfermeiros e técnicos de Enfermagem de três unidades de terapia intensiva, divididos em grupo-intervenção e grupo-controle. A análise dos dados considerou os escores dos grupos no momento pré e pós-intervenção. Para verificar o escore médio de acertos, foram calculados a média e o desvio-padrão. Foi realizado o

  12. Peptic ulcer

    Science.gov (United States)

    ... hemorrhage - peptic ulcer; G.I. bleed - peptic ulcer; H. pylori - peptic ulcer; Helicobacter pylori - peptic ulcer ... of the stomach by bacteria called Helicobacter pylori ( H pylori ). Most people with peptic ulcers have these bacteria ...

  13. How I Manage Heel Spur Syndrome.

    Science.gov (United States)

    Seder, Joseph I.

    1987-01-01

    This article discusses plantar fascitis and heel spurs, the two contributing causes of heel spur syndrome. Treatment methods, which include rest, anti-inflammatory medication, shoe padding, and, as a last resort, surgery are described. (Author/MT)

  14. Monitorización de úlceras por presión en una Unidad de cuidados intensivos Monitorization of pressure ulcers in a critical care Unit

    Directory of Open Access Journals (Sweden)

    José A. Esperón Güimil

    2007-09-01

    Full Text Available Introducción: Las úlceras por presión (UPP son un indicador de mala calidad asistencial. Los pacientes ingresados en Unidades de cuidados intensivos presentan gran número de factores de riesgo de padecer UPP, siendo de las Unidades con mayores índices de incidencia. Objetivos: Determinar la prevalencia de UPP y el paciente tipo que desarrolla UPP. Material y métodos: Estudio prospectivo de prevalencia. Variables dependientes: nº de UPP (nº de UPP excluyendo las iatrogénicas; nº de UPPY (nº de UPP iatrogénicas y nº de UPPT (nº de UPP + nº de UPPY. Variables independientes: sexo, edad, diagnóstico, riesgo Nova 4, estadios, índice de severidad, localizaciones, fechas de registro de las UPP, medidas preventivas. Análisis: Paquete estadístico G-Stat 2.0. Descriptivo: media y desviación estándar; frecuencias relativas y absolutas. Inferencial: T-Student, ANOVA, modelo de regresión lineal. Significación estadística de pIntroduction: Pressure ulcers (PU are an indicator of poor assistance quality. Patients in units of intensive care present a considerable number of risk factors of suffering UPP, in fact, these units are among with a higher of incidence of PUs. Objectives: To determine the prevalence of PUs and the type of patient who develops PUs. Material and methods: Prospective study of prevalence. Dependent variables: no. of PUs (no. of PUs, excluding iatrogenic ones; no. of IPUs (no. of iatrogenic PU and no. of TPUs (no. of PUs + no. of IPUs. Independent variables: sex, age, diagnostic, risk Nova 4, stadiums, Index of severity, localizations, dates of registration of the UPP, preventive measures. Analysis: statistical package G-Stat 2.0.Descriptive:mean and standard desviation; relative and absolute frequencies. Inferential: T-Student, ANOVA, linear regression model. Statistical significance: p< 0,05; IC 95%. Results: PUs prevalenc: 12,7%; IPUs prevalence: 6,8%. 142 PUs registered, 45 of them of iatrogenic origin. More

  15. Pressure ulcer prevalence and barriers to treatment after spinal cord injury: comparisons of four groups based on race-ethnicity.

    Science.gov (United States)

    Saladin, Lisa K; Krause, James S

    2009-01-01

    To compare the prevalence of pressure ulcer (PU) and barriers to treatment in the event of PU development as a function of race-ethnicity in persons with spinal cord injury (SCI). Interview data were collected from three rehabilitation hospitals each of which was designated as a model SCI system of care by the United States Department of Education. There were 475 participants with similar portions of each racial-ethnic group (African-American n = 121, American-Indian n = 105, Caucasians n = 127, Hispanics n = 122). The lowest prevalence rates for pressure ulcers were reported by Hispanics followed by Caucasians. Logistic regression revealed racial-ethnic differences in the odds of developing a PU within the past 12 months. Social support and injury severity were also associated with risk of PU while age, gender, years since injury, and education were not. Significant racial-ethnic differences were also observed in 5 of 9 barriers to the treatment of PUs. Results suggest that variability in social support and barriers to treatment may contribute to the racial-ethnic differences in prevalence rates for PU that were observed. Future research in this area could lead to the development of strategies to enhance prevention and treatment targeted at the elimination of any racial-ethnic disparities.

  16. Using a Lean Six Sigma Approach to Yield Sustained Pressure Ulcer Prevention for Complex Critical Care Patients.

    Science.gov (United States)

    Donovan, Elizabeth A; Manta, Christine J; Goldsack, Jennifer C; Collins, Michelle L

    2016-01-01

    Under value-based purchasing, Medicare withholds reimbursements for hospital-acquired pressure ulcer occurrence and rewards hospitals that meet performance standards. With little evidence of a validated prevention process, nurse managers are challenged to find evidence-based interventions. The aim of this study was to reduce the unit-acquired pressure ulcer (UAPU) rate on targeted intensive care and step-down units by 15% using Lean Six Sigma (LSS) methodology. An interdisciplinary team designed a pilot program using LSS methodology to test 4 interventions: standardized documentation, equipment monitoring, patient out-of-bed-to-chair monitoring, and a rounding checklist. During the pilot, the UAPU rate decreased from 4.4% to 2.8%, exceeding the goal of a 15% reduction. The rate remained below the goal through the program control phase at 2.9%, demonstrating a statistically significant reduction after intervention implementation. The program significantly reduced UAPU rates in high-risk populations. LSS methodologies are a sustainable approach to reducing hospital-acquired conditions that should be broadly tested and implemented.

  17. Bacteremia due to Staphylococcus cohnii ssp. urealyticus caused by infected pressure ulcer: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Jonathan Soldera

    Full Text Available CONTEXTCoagulase-negative staphylococci are common colonizers of the human skin and have become increasingly recognized as agents of clinically significant nosocomial infections.CASE REPORTThe case of a 79-year-old male patient with multi-infarct dementia who presented systemic inflammatory response syndrome is reported. This was attributed to bacteremia due to Staphylococcus cohnii ssp. urealyticus, which was grown on blood cultures originating from an infected pressure ulcer. The few cases of Staphylococcus cohnii infection reported in the literature consist of bacteremia relating to catheters, surgical prostheses, acute cholecystitis, brain abscess, endocarditis, pneumonia, urinary tract infection and septic arthritis, generally presenting a multiresistant profile, with nearly 90% resistance to methicillin.CONCLUSIONSThe reported case is, to our knowledge, the first case of true bacteremia due to Staphylococcus cohnii subsp. urealyticus caused by an infected pressure ulcer. It shows that this species may be underdiagnosed and should be considered in the differential diagnosis for community-acquired skin infections.

  18. An Approach to Acquiring, Normalizing, and Managing EHR Data From a Clinical Data Repository for Studying Pressure Ulcer Outcomes.

    Science.gov (United States)

    Padula, William V; Blackshaw, Leon; Brindle, C Tod; Volchenboum, Samuel L

    2016-01-01

    Changes in the methods that individual facilities follow to collect and store data related to hospital-acquired pressure ulcer (HAPU) occurrences are essential for improving patient outcomes and advancing our understanding the science behind this clinically relevant issue. Using an established electronic health record system at a large, urban, tertiary-care academic medical center, we investigated the process required for taking raw data of HAPU outcomes and submitting these data to a normalization process. We extracted data from 1.5 million patient shifts and filtered observations to those with a Braden score and linked tables in the electronic health record, including (1) Braden scale scores, (2) laboratory outcomes data, (3) surgical time, (4) provider orders, (5) medications, and (6) discharge diagnoses. Braden scores are important measures specific to HAPUs since these scores clarify the daily risk of a hospitalized patient for developing a pressure ulcer. The other more common measures that may be associated with HAPU outcomes are important to organize in a single data frame with Braden scores according to each patient. Primary keys were assigned to each table, and the data were processed through 3 normalization steps and 1 denormalization step. These processes created 8 tables that can be stored efficiently in a clinical database of HAPU outcomes. As hospitals focus on organizing data for review of HAPUs and other types of hospital-acquired conditions, the normalization process we describe in this article offers directions for collaboration between providers and informatics teams using a common language and structure.

  19. The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage.

    Science.gov (United States)

    Clarke, Mairead; Moore, Zena; Patton, Declan; O'Connor, Tom; Nugent, Linda

    2017-12-01

    To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests. Education was provided to home support workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. At post-test 1, 55% of the photographs were classified correctly. In post-test 2 this increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-0.44; n=27; p=0.02). The educational intervention has been shown not to have a statistically significantly positive effect on home support workers' ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores concur with the aforementioned qualitative findings, and similarly indicate behaviour associated with individuals experiencing difficulty comprehending new health terms.

  20. Elevated Levels of Protein Disulfide Isomerase and Binding Immunoglobulin Protein Implicated in Spinal Cord Injury Paraplegia Patients with Pressure Ulcers.

    Science.gov (United States)

    Chen, Weiyan; Liu, Jing; Zhao, Liang; Wang, Cuijiang; Li, Zengjun; Liu, Ting

    2016-07-01

    To explore the associations between two endoplasmic reticulum (ER) stress proteins, protein disulfide isomerase (PDI), binding immunoglobulin protein (BIP), and the development and progression of pressure ulcers (PUs) in spinal cord injury (SCI) paraplegia patients. ELISA kits were used to measure the levels of serum PDI and BIP in 67 SCI paraplegia patients with PUs and 61 SCI paraplegia patients without PUs. The associations between PDI and BIP, PU formation, PU staging, and pressure ulcer scale for healing (PUSH) score were analyzed. The patients in the PU group had higher levels of PDI and BIP than those in the non-PU group (both p  0.05). The PUSH scores also decreased at 28 days after debridement for stages II, III, and IV (all p < 0.01). Higher PUSH scores indicated a longer time of debridement accompanied by a longer wound surface healing time (p < 0.05). ER stress proteins may be involved in the process of PU formation and healing; moreover, the levels of PDI and BIP were also associated with the severity of the PUs. Finally, we found that the PUSH scores can be used as a reference to evaluate PU severity and healing.

  1. Diagnosis of heel pad injuries

    DEFF Research Database (Denmark)

    Matteoli, Sara

    , height and gender did influence HPCI, E and EDR, and that there was a significant statistically difference between males and females in E, but not in EDR and HPCI. In order to attempt a verification of the method used above, compression tests and ultrasound investigations on artificial heel pad models...

  2. Heel Pain in Recreational Runners.

    Science.gov (United States)

    Bazzoli, Allan S.; Pollina, Frank S.

    1989-01-01

    Provides physicians with the signs, symptoms, and management of heel/sole pain in recreational runners (usually due to plantar fasciitis, Achilles tendinitis, and calcaneal stress fractures). Remedies involve palliative treatment of symptoms, correction of underlying biomechanical problems, and flexibility exercises. (SM)

  3. Prevalencia de úlceras por presión en una zona básica de salud Prevalence of the pressure ulcers in a Basic Zone of Health

    Directory of Open Access Journals (Sweden)

    Juan de Con Redondo

    2009-06-01

    ás frecuente fue el talón con un 33,33% (10 lesiones, seguida del sacro con un 27,27% (9 lesiones, en la pierna había un 9,09% (3 lesiones y el resto 6,06% (2 lesiones en otras localizaciones. El nivel asistencial origen de las lesiones sitúa un 60,6% (20 lesiones en el domicilio de las personas, un 39,4% (13 lesiones en el hospital y ningún registro en centros sociosanitarios, siendo de mayor severidad (Estadios III y IV las originadas en el hospital. Conclusiones: La implantación y utilización de protocolos de valoración y registro con el soporte de las nuevas tecnologías permite disponer de datos reales y fiables sobre la población de nuestra ZBS, posibilitando un seguimiento temporal de la prevalencia de UPP y otros indicadores epidemiológicos.Introduction: The pressure ulcers (PU represent an important problem of health in all the welfare levels, but a volume of them need continued care from the community. The aim of our study is to know the period of prevalence of the pressure ulcers and its distribution among other characteristics that we find in our Basic Zone of Health. Material and methods: A cut was realized for retrospective period of prevalencia in Piloña's BZH (Asturias for the interval of time from 01/09/2004 to 31/08/2005 both included. The population to study belongs to 01/09/2004 to 31/08/2005 both included. The population to study belongs to 8475 inhabitants, (information of the Municipal poll updated in 2005 of which 4339 were women. There were 2644 persons over 65 years old of which 853 are over 80 years old. It is a dispersed, aged population and in regression with an index of dependence of 0,69. Was considered to be PU's case anyone that with an index of dependence of 0,69. Was considered to be PU's case anyone that should consist in the record of the Clinical History of Primary care, an electronic format OMI - AP 6.0, of our Team of Primary care for the studied period. Results: There were studied 33 PU (32 patients of which 20 (60,60 % women

  4. Bilateral Heel Numbness due to External Compression during Obstetric Epidural Analgesia

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    Vivian P. Kamphuis

    2015-01-01

    Full Text Available We describe the case of a 32-year-old woman who developed bilateral heel numbness after obstetric epidural analgesia. We diagnosed her with bilateral neuropathy of the medial calcaneal nerve, most likely due to longstanding pressure on both heels. Risk factors for the development of this neuropathy were prolonged labour with spinal analgesia and a continuation of analgesia during episiotomy. Padded footrests decrease pressure and can possibly prevent this neuropathy.

  5. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.

    Science.gov (United States)

    Bus, S A; van Deursen, R W; Armstrong, D G; Lewis, J E A; Caravaggi, C F; Cavanagh, P R

    2016-01-01

    Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment. We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006. We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches. Sufficient

  6. Lifestyle risk factors for pressure ulcers in community-based patients with spinal cord injuries in Japan.

    Science.gov (United States)

    Morita, T; Yamada, T; Watanabe, T; Nagahori, E

    2015-06-01

    Case-control study. To identify daily living-related risk factors for pressure ulcer (PU) occurrence in community-living patients with spinal cord injury (SCI). To determine whether seat pressure influences PU occurrence, and how often patients with SCI perform pressure relief activities while living in the community. Kanagawa Rehabilitation Hospital, Kanagawa, Japan. Thirty-one patients admitted to this hospital for PU treatment were included in the case (PU) group. Thirty outpatients who did not have PUs at the time of the study, and had lived without PUs for at least a year, were included in the control (No PU) group. Patients were interviewed about lifestyle-related PU risk factors and a pressure-mapping system was used to measure interface pressure (IP) on their wheelchair seat. The No PU group patients recorded their daily activities and pressure relief maneuvers for 1 week. Eight lifestyle factors and one risk assessment scale significantly differed between groups. Three factors showed significant odds ratios by logistic regression. IP did not significantly differ between groups. The self-counted number of pressure relief maneuvers (median (25th-75th percentile)) performed per hour in the No PU group was 2.5 (0.7-4.3) and including transfer and urination was 3.5 (2.0-5.3). We identified potential PU risk factors related to lifestyle. The scores of one risk assessment scale were also associated with PU risk. Our results did not suggest an IP damage threshold. Patients in the No PU group performed pressure relief maneuvers, including related activities, approximately once every 17 min.

  7. Pattern of outsole shoe heel wear in infantry recruits

    Directory of Open Access Journals (Sweden)

    Finestone Aharon S

    2012-10-01

    Full Text Available Abstract Background Excessive shoe heel abrasion is of concern to patients, parents and shoe manufacturers, but little scientific information is available. The purpose of this study was to describe the phenomenon in a group of infantry recruits performing similar physical activity, and search for biomechanical factors that might be related. Methods Seventy-six subjects (median age 19 enrolled. Pre-training parameters measured included height, weight, tibial length, foot arch height and foot progression angle. Digital plantar pressure maps were taken to calculate arch indexes. Shoe heel abrasion was assessed manually after 14 weeks of training with different-sized clock transparencies and a calliper. Results Outsole abrasion was posterolateral, averaging 12 degrees on each shoe. The average heel volume that was eroded was almost 5 cm3. The angle of maximum wear was related to right foot progression angle (r = 0.27, p = 0.02. Recruits with lateral ankle sprains had higher angles of maximal abrasion (17° versus 10°, p = 0.26 and recruits with lateral heel abrasion had more lateral ankle sprains (14% versus 3%, p = 0.12. Conclusion While shoe heel wear affects many people, very little has been done to measure it. In this study in healthy subjects, we found the main abrasion to be posterolateral. This seems to be related to foot progression angle. It was not related to hindfoot valgus/varus or other factors related to subtalar joint motion. These findings do not warrant modification of subtalar joint motion in order to limit shoe heel abrasion.

  8. Construct Validity of the Braden Scale for Pressure Ulcer Assessment in Acute Care: A Structural Equation Modeling Approach.

    Science.gov (United States)

    Chen, Hong-Lin; Cao, Ying-Juan; Shen, Wang-Qin; Zhu, Bin

    2017-02-01

    The Braden Scale is the most widely used pressure ulcer risk assessment system in the world. To investigate its construct validity using structural equation modeling (SEM), a secondary analysis of retrospective data of patients admitted to an acute care facility was conducted using the records of 2588 patients who were at risk for pressure ulcers and admitted between January 2013 and December 2013. Data were extracted to an Excel sheet and analyzed, including demographic characteristics (ie, patients age, gender, weight, and disease spectrum), as well as total Braden scores and subscale scores. The SEM was set according to modification indices suggestion. The original Braden Scale model was supported by χ2(9) = 22.854, CFI = 0.902, GFI = 0.974, root mean square error of approximation (RMSEA) = 0.092, indicating inadequate model fit. After modification according to software indices, χ2(2) = 2.052, CFI = 0.999, GFI = 0.999, RMSEA = 0.020 indicated an acceptable fit of the model (final model). The factor loadings of 6 subscales were all significant (P perception, .626 for mobility, and .556 for moisture subscale. The nutrition, activity, and friction and shear subscales were corrected to examine their relationships with other Braden Scale subscales (nutrition with activity [φ -0.063], activity with friction/shear [φ 0.136], and nutrition (φ friction/shear [0.159]). The factor loadings ranged from -0.067 to 0.159. These findings suggest the original Braden Scale has inadequate construct validity for acute care patients and that new risk-predicting scales should be designed based on data mining. Second, according to the factor loadings in the SEM, the most important risk factor in the Braden Scale for this patient population is sensory perception, followed by mobility and moisture. This suggests practitioners should pay particular attention to pressure ulcer prevention when patients have limited sensory perception, mobility limitations, and/or when moisture status

  9. TexiCare: an innovative embedded device for pressure ulcer prevention. Preliminary results with a paraplegic volunteer.

    Science.gov (United States)

    Chenu, Olivier; Vuillerme, Nicolas; Bucki, Marek; Diot, Bruno; Cannard, Francis; Payan, Yohan

    2013-08-01

    This paper introduces the recently developed TexiCare device that aims at preventing pressure ulcers for people with spinal cord injury. This embedded device is aimed to be mounted on the user wheelchair. Its sensor is 100% textile and allows the measurement of pressures at the interface between the cushion and the buttocks. It is comfortable, washable and low cost. It is connected to a cigarette-box sized unit that (i) measures the pressures in real time, (ii) estimates the risk for internal over-strains, and (iii) alerts the wheelchair user whenever necessary. The alert method has been defined as a result of a utility/usability/acceptability study conducted with representative end users. It is based on a tactile-visual feedback (via a watch or a smartphone for example): the tactile modality is used to discreetly alarm the person while the visual modality conveys an informative message. In order to evaluate the usability of the TexiCare device, a paraplegic volunteer equipped his wheelchair at home during a six months period. Interestingly, the first results revealed bad habits such as an inadequate posture when watching TV, rare relief maneuvers, and the occurrence of abnormal high pressures. Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  10. Ugh! Ulcers

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Ugh! Ulcers KidsHealth / For Kids / Ugh! Ulcers What's in this ... real story? Let's find out. What Is an Ulcer? An ulcer (say: UL-sur) is a sore, ...

  11. Automated Seat Cushion for Pressure Ulcer Prevention Using Real-Time Mapping, Offloading, and Redistribution of Interface Pressure

    Science.gov (United States)

    2016-10-01

    Mac). The interface also displays pertinent diagnostic information. 4) The communication architecture is established for efficient and error free...Accomplishment #8: Finalized the design of the sensorized anthropomorphic model Specific objectives: 1) Finalize the sensory system to measure pressure and...cylindrical actuators 3) GUI for seat cushion pressure mapping and controlling. 4) Control architecture for closed loop pressure modulation 5) S

  12. Perioperative Use of Bispectral Monitor (BIS) for a Pressure Ulcer patient with Lock-In Syndrome (LIS)

    Science.gov (United States)

    Yoo, Christine; Ayello, Elizabeth A.; Robins, Bryan; Salamanca, Victor R.; Bloom, Marc J.; Linton, Patrick; Brem, Harold; O'Neill, Daniel K.

    2013-01-01

    The bispectral (BIS) monitor uses brain electroencephalographic data to measure depth of sedation and pharmacological response during anesthetic procedures. In this case, the BIS monitor was used for another purpose, to demonstrate postoperatively to the nursing staff that a patient with history of locked-in syndrome (LIS), who underwent pressure ulcer debridement, had periods of wakefulness and apparent sensation, even with his eyes closed. Furthermore, as patients with LIS can feel pain, despite being unable to move, local block or general anesthesia should be provided for sharp surgical debridement and other painful procedures. This use of the BIS has shown that as a general rule, the staff should treat the patient as though he might be awake and sensate even if he does not open his eyes or move his limbs. Our goal was to continuously monitor pain level and communicate these findings to the entire wound team, ie anesthesiologists, surgeons, and nurses. PMID:25252146

  13. Deep tissue injury in development of pressure ulcers: a decrease of inflammasome activation and changes in human skin morphology in response to aging and mechanical load.

    Directory of Open Access Journals (Sweden)

    Olivera Stojadinovic

    Full Text Available Molecular mechanisms leading to pressure ulcer development are scarce in spite of high mortality of patients. Development of pressure ulcers that is initially observed as deep tissue injury is multifactorial. We postulate that biomechanical forces and inflammasome activation, together with ischemia and aging, may play a role in pressure ulcer development. To test this we used a newly-developed bio-mechanical model in which ischemic young and aged human skin was subjected to a constant physiological compressive stress (load of 300 kPa (determined by pressure plate analyses of a person in a reclining position for 0.5-4 hours. Collagen orientation was assessed using polarized light, whereas inflammasome proteins were quantified by immunoblotting. Loaded skin showed marked changes in morphology and NLRP3 inflammasome protein expression. Sub-epidermal separations and altered orientation of collagen fibers were observed in aged skin at earlier time points. Aged skin showed significant decreases in the levels of NLRP3 inflammasome proteins. Loading did not alter NLRP3 inflammasome proteins expression in aged skin, whereas it significantly increased their levels in young skin. We conclude that aging contributes to rapid morphological changes and decrease in inflammasome proteins in response to tissue damage, suggesting that a decline in the innate inflammatory response in elderly skin could contribute to pressure ulcer pathogenesis. Observed morphological changes suggest that tissue damage upon loading may not be entirely preventable. Furthermore, newly developed model described here may be very useful in understanding the mechanisms of deep tissue injury that may lead towards development of pressure ulcers.

  14. The relationship among evidence-based practice and client dyspnea, pain, falls, and pressure ulcer outcomes in the community setting.

    Science.gov (United States)

    Doran, Diane; Lefebre, Nancy; O'Brien-Pallas, Linda; Estabrook, Carole A; White, Peggy; Carryer, Jennifer; Sun, Winnie; Qian, Gan; Bai, Yu Qing Chris; Li, Mingyang

    2014-10-01

    There are gaps in knowledge about the extent to which home care nurses' practice is based on best evidence and whether evidence-based practice impacts patient outcomes. The purpose of this study was to investigate the relationship between evidence-based practice and client pain, dyspnea, falls, and pressure ulcer outcomes in the home care setting. Evidence-based practice was defined as nursing interventions based on best practice guidelines. The Nursing Role Effectiveness model was used to guide the selection of variables for investigation. Data were collected from administrative records on percent of visits made by Registered Nurses (RN), total number of nursing visits, and consistency of visits by principal nurse. Charts audits were used to collect data on nursing interventions and client outcomes. The sample consisted of 338 nurses from 13 home care offices and 939 de-identified client charts. Hierarchical generalized linear regression approaches were constructed to explore which variables explain variation in client outcomes. The study found documentation of nursing interventions based on best practice guidelines was positively associated with improvement in dyspnea, pain, falls, and pressure ulcer outcomes. Percent of visits made by an RN and consistency of visits by a principal nurse were not found to be associated with improved client outcomes, but the total number of nursing visits was. Implementation of best practice is associated with improved client outcomes in the home care setting. Future research needs to explore ways to more effectively foster the documentation of evidence-based practice interventions. © 2014 The Authors Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

  15. Effects of Electrical Stimulation on Risk Factors for Developing Pressure Ulcers in People with a Spinal Cord Injury : A Focused Review of Literature

    NARCIS (Netherlands)

    Smit, Christof A. J.; de Groot, Sonja; Stolwijk-Swuste, Janneke M.; Janssen, Thomas W. J.

    Pressure ulcers (PUs) are a common and serious problem for wheelchair users, such as individuals with a spinal cord injury (SCI), resulting in great discomfort, loss of quality of life, and significant medical care costs. Therefore, it is of utmost importance to prevent PUs. In this literature

  16. A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: A two-armed randomized controlled trial

    NARCIS (Netherlands)

    Beeckman, D.; Clays, E.; Hecke, A. Van; Vanderwee, K.; Schoonhoven, L.; Verhaeghe, S.

    2013-01-01

    BACKGROUND: Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals. OBJECTIVES: To determine

  17. Adaptação transcultural do pressure ulcer scale for healing (PUSH para a língua portuguesa Adaptación transcultural del pressure ulcer scale for healing para el idioma portugués Crosscultural adaptation of the pressure ulcer scale for healing to the portuguese language

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Conceição de Gouveia Santos

    2005-06-01

    Full Text Available O objetivo do estudo foi realizar a adaptação transcultural do Pressure Ulcer Scale for Healing (PUSH para a língua portuguesa, através da tradução do instrumento para a língua portuguesa, feita por especialistas bilingües e comitê de especialistas, e teste das propriedades de medida: confiabilidade interobservadores e validade convergente. Para tais análises foram utilizados o índice Kappa e os Testes de Fisher e Spearman. Após aprovação pelo Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo, 34 úlceras de pressão foram examinadas. Os resultados obtidos para os índices Kappa (0,90 a 1,0 entre as observações dos enfermeiros e estomaterapeutas (padrão-ouro para todas as subescalas e escore total da escala, bem como a existência de correlação positiva e estatisticamente significativa (pLa finalidad de este estudio fue efectuar la adaptación transcultural del Pressure Ulcer for Healing Scale para el portugués, mediante la traducción del instrumento al portugués (por especialistas bilingües; y la validación de la confiabilidad inter-observadores y validad convergente. Para los análisis fueron usados el Índice Kappa y los test de Fisher y Spearman, respectivamente. Después de la aprobación del proyecto por el Comité de Ética de la Escuela de Enfermería de USP, 34 úlceras por presión fueran evaluadas. Los índices de Kappa (0.90 al 1.0 obtenidos entre las observaciones de los enfermeros y estomaterapeutas para todas las subescalas y puntuación total y la presencia de correlaciones estadísticas significativas (pThis study aimed to carry out a crosscultural adaptation of the Pressure Ulcer Scale for Healing (PUSH to the Portuguese language through the translation of the instrument into Portuguese (by bilingual specialists and a specialist committee and the validation of inter-rater reliability (comparison between nurses' and stomal therapists' observations and convergent validity (correlation

  18. A multicenter, randomized, controlled study of the use of nutritional supplements containing collagen peptides to facilitate the healing of pressure ulcers

    Directory of Open Access Journals (Sweden)

    Hideharu Yamanaka, MD, PhD

    2017-06-01

    Full Text Available Since collagen peptide stimulates fibroblast growth in skin, it may accelerate the healing of pressure ulcers. Therefore, the purpose of our study was to verify whether the intake of collagen peptides in the form of a supplement drink facilitates the healing of pressure ulcers. We conducted a multicenter, randomized, controlled trial in patients with pressure ulcers. Patients were randomized into 3 groups at a 1:1:1 ratio; control group (usual care, collagen peptide-containing drink group and arginine-containing drink group. The DESIGN-R tool was used to assess healing of pressure ulcers, and nutritional status was measured for 4 weeks while consuming the usual daily meals. Out of 66 patients randomized, 51 patients were analyzed, since 15 patients were excluded from the final analysis. The total DESIGN-R score in patients who received the collagen peptide-containing drink (n = 18 was significantly lower than that in patients in the control group (n = 16 after 2 weeks as well as at the final value. However, the DESIGN-R score in the arginine-containing drink group (n = 17 did not show difference from the control group. There was no significant difference in nutrition status among the 3 groups through the study. Our results indicated that a supplemental addition of the collagen peptide-containing drink to the usual meal facilitated pressure ulcer healing, since the collagen peptide-containing drink led to more changes in the DESIGN-R scores.

  19. A cost minimisation analysis of olive oil versus hyperoxygenated fatty acid treatment for the prevention of pressure ulcers in primary health care: A randomised controlled trial.

    Science.gov (United States)

    Lupiañez-Pérez, Inmaculada; Morilla-Herrera, Juan Carlos; Kaknani-Uttumchanchandani, Shakira; Lupiañez-Perez, Yolanda; Cuevas-Fernandez-Gallego, Magdalena; Martin-Santos, Francisco; Caro-Bautista, Jorge; Morales-Asencio, Jose Miguel

    2017-09-18

    Pressure ulcers represent a major current health problem and cause an important economic impact on the health care system. Most studies on the prevention of pressure ulcers have been carried out in hospital contexts, with respect to the use of hyperoxygenated fatty acids, and to date no studies have specifically examined the use of olive oil-based treatments. To evaluate the cost of using extra virgin olive oil, rather than hyperoxygenated fatty acids, in the prevention of pressure ulcers among persons with impaired mobility and receiving home care. Cost minimisation analysis of the results obtained from a non-inferiority, triple-blind, parallel, multicentre, randomised clinical trial. Population attending primary health care centres in Andalusia (Spain). 831 immobilised patients at risk of suffering pressure ulcers. These persons were included in the study and randomly assigned as follows: 437 to the olive oil group and 394 to the hyperoxygenated fatty acid group. At the end of the follow-up period, the results obtained by the olive oil group were not inferior to those of the hyperoxygenated fatty acid group, and did not exceed the 10% delta limit. The total treatment cost for 16 weeks was €19,758 with hyperoxygenated fatty acids and €9,566 with olive oil. Overall, the olive oil treatment was €10,192 less costly. It has been concluded the non-inferiority of olive oil makes this product an effective alternative for the prevention of pressure ulcers in patients who are immobilised and in a domestic environment. This treatment enables considerable savings in direct costs. This article is protected by copyright. All rights reserved. © 2017 by the Wound Healing Society.

  20. Assessing complexity of skin blood flow oscillations in response to locally applied heating and pressure in rats: Implications for pressure ulcer risk

    Science.gov (United States)

    Liao, Fuyuan; O'Brien, William D.; Jan, Yih-Kuen

    2013-10-01

    The objective of this study was to investigate the effects of local heating on the complexity of skin blood flow oscillations (BFO) under prolonged surface pressure in rats. Eleven Sprague-Dawley rats were studied: 7 rats underwent surface pressure with local heating (△t=10 °C) and 4 rats underwent pressure without heating. A pressure of 700 mmHg was applied to the right trochanter area of rats for 3 h. Skin blood flow was measured using laser Doppler flowmetry. The loading period was divided into nonoverlapping 30 min epochs. For each epoch, multifractal detrended fluctuation analysis (MDFA) was utilized to compute DFA coefficients and complexity of endothelial related metabolic, neurogenic, and myogenic frequencies of BFO. The results showed that under surface pressure, local heating led to a significant decrease in DFA coefficients of myogenic frequency during the initial epoch of loading period, a sustained decrease in complexity of myogenic frequency, and a significantly higher degree of complexity of metabolic frequency during the later phase of loading period. Surrogate tests showed that the reduction in complexity of myogenic frequency was associated with a loss of nonlinearity whereas increased complexity of metabolic frequency was associated with enhanced nonlinearity. Our results indicate that increased metabolic activity and decreased myogenic response due to local heating manifest themselves not only in magnitudes of metabolic and myogenic frequencies but also in their structural complexity. This study demonstrates the feasibility of using complexity analysis of BFO to monitor the ischemic status of weight-bearing skin and risk of pressure ulcers.

  1. Electrical stimulation therapy for the treatment of pressure ulcers in individuals with spinal cord injury: a systematic review and meta-analysis.

    Science.gov (United States)

    Lala, Deena; Spaulding, Sandi J; Burke, Shauna M; Houghton, Pamela E

    2016-12-01

    To conduct a systematic review and meta-analysis on the effects of electrical stimulation therapy (EST) on healing pressure ulcers in individuals with spinal cord injury (SCI). CINAHL, The Cochrane Library, PubMed, SCOPUS, EMBASE, Nursing & Allied Health and Dissertation & Theses databases were searched for relevant English language articles from the date of inception to 31 January 2014. Separate searches were conducted in Google Scholar and academic journals specialised in wound care. Two reviewers independently assessed study eligibility. Studies were included if EST was used to treat pressure ulcers in individuals with SCI. A total of 599 articles were screened, and 15 studies met the inclusion criteria. A meta-analysis with five studies demonstrated that EST significantly decreased the ulcer size by 1·32%/day [95% confidence interval (CI): 0·58-2·05, P < 0·001] compared to standard wound care (SWC) or sham EST. Another meta-analysis conducted with four studies showed that EST increased the risk of wound healing by 1·55 times compared with standard wound care or sham EST (95% CI: 1·12 to 2·15, P < 0·0001). Because of the wide array of outcome measures across studies, a single meta-analysis could not be conducted. EST appears to be an effective adjunctive therapy to accelerate and increase pressure ulcer closure in individuals with SCI. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  2. Venous Ulcers

    Science.gov (United States)

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  3. Corneal Ulcer

    Science.gov (United States)

    ... Español Eye Health / Eye Health A-Z Corneal Ulcer Sections What Is a Corneal Ulcer? Corneal Ulcer ... Diagnosis Corneal Ulcer Treatment What Is a Corneal Ulcer? Leer en Español: ¿Qué es una Úlcera de ...

  4. Peptic Ulcers

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Peptic Ulcers KidsHealth / For Parents / Peptic Ulcers What's in this ... age — even kids — can develop ulcers. About Peptic Ulcers An ulcer is a sore, which means it's ...

  5. Cost-effectiveness and value of information analysis of nutritional support for preventing pressure ulcers in high-risk patients: implement now, research later.

    Science.gov (United States)

    Tuffaha, Haitham W; Roberts, Shelley; Chaboyer, Wendy; Gordon, Louisa G; Scuffham, Paul A

    2015-04-01

    Pressure ulcers are a major cause of mortality, morbidity, and increased healthcare cost. Nutritional support may reduce the incidence of pressure ulcers in hospitalised patients who are at risk of pressure ulcer and malnutrition. To evaluate the cost-effectiveness of nutritional support in preventing pressure ulcers in high-risk hospitalised patients, and to assess the value of further research to inform the decision to implement this intervention using value of information analysis (VOI). The analysis was from the perspective of Queensland Health, Australia using a decision model with evidence derived from a systematic review and meta-analysis. Resources were valued using 2014 prices and the time horizon of the analysis was one year. Monte Carlo simulation was used to estimate net monetary benefits (NB) and to calculate VOI measures. Compared with standard hospital diet, nutritional support was cost saving at AU$425 per patient, and more effective with an average 0.005 quality-adjusted life years (QALY) gained. At a willingness-to-pay of AU$50,000 per QALY, the incremental NB was AU$675 per patient, with a probability of 87 % that nutritional support is cost-effective. The expected value of perfect information was AU$5 million and the expected value of perfect parameter information was highest for the relative risk of developing a pressure ulcer at AU$2.5 million. For a future trial investigating the relative effectiveness of the interventions, the expected net benefit of research would be maximised at AU$100,000 with 1,200 patients in each arm if nutritional support was perfectly implemented. The opportunity cost of withholding the decision to implement the intervention until the results of the future study are available would be AU$14 million. Nutritional support is cost-effective in preventing pressure ulcers in high-risk hospitalised patients compared with standard diet. Future research to reduce decision uncertainty is worthwhile; however, given the

  6. The Achilles heel of adults and children

    NARCIS (Netherlands)

    Wiegerinck, J.I.

    2014-01-01

    This thesis focuses on the imaging and treatment of the Achilles heel of adults and children. The figurative and literal Achilles heel consists of a number of pathologies: ankle impingement, Achilles tendinopathy, retrocalcaneal bursitis and calcaneal apophysitis. Research as well as diagnosis and

  7. Elective proximal lower limb amputation in spinal cord injury patients with chronic pressure ulcers: improve quality of life, function, and shorten hospital stay. Case report.

    Science.gov (United States)

    Yusmido, Y A; Hisamud-Din, N; Mazlan, M

    2014-10-01

    Pressure ulcers are common among patients with spinal cord injury and can be very challenging to treat. The treatment involves multidisciplinary approach and ranges from simple pressure relieve and wound dressings to a more radical treatment like proximal lower limb amputations, especially in chronic cases with potential detrimental effects to physical and mental health. To report the outcome of three spinal cord injury patients with a history of chronic pressure ulcers who underwent elective proximal lower limb amputations. We reviewed three patients; patient 1 with bilateral hip disarticulation, patient 2 with left hip disarticulation and right transfemoral amputation and patient 3 with bilateral transfemoral amputation. The clinical impact and functional outcome of the patients were reviewed by comparing the length of hospital stay, the short version of the World Health Organization Quality of Life (WHOQOL- BREF) score and the Spinal Cord Independence Measures (SCIM) score before and after amputation. After amputation, all patients have marked reduction in hospital stay (mean reduction of 208 days), improvement in WHOQOL-BREF scores(mean increment of 14.68 scores) and minimal improvement in SCIM scores (mean increment of 3 scores) compared to before amputation. Proximal amputations of the lower limbs are procedures that can be considered as part of the treatment for complicated pressure ulcers. In properly selected patients, it can reduce the number of hospital stay, improve the quality of life and functional outcome.

  8. Stomach ulcer

    Science.gov (United States)

    ... the acid and enzymes by a mucous lining. Ulcers are caused when there is an imbalance between ... protect the lining of the stomach. Symptoms of ulcers may include bleeding. On rare occasions, an ulcer ...

  9. SCI Survey to Determine Pressure Ulcer Vulnerability in the Outpatient Population

    Science.gov (United States)

    2011-10-01

    30 and 30% have been diagnosed with depression . The data set also identified a number of variables that are not easily extracted from the...HX CURR USE COCAINE HEROIN INHALANTS LSD MARIJUANA/HASH MDMA(ECSTASY) PCP Methamphetimines STEROIDS CRACK HALLUCINOGENS AMPHETIMINES OTHER CAD CHF COPD...HX #Pack Yrs CURR USE #Pack/Days COGNITIVE FUNCTION BIPOLAR BRAIN DMG-SURG ANXIETY PTSD/ADJUST DEPRESSION PERSONALITY DO DEMENTIA SCHIZ/DELUS PRESSURE

  10. Does the Acute Care Spinal Cord Injury Setting Predict the Occurrence of Pressure Ulcers at Arrival to Intensive Rehabilitation Centers?

    Science.gov (United States)

    Richard-Denis, Andréane; Thompson, Cynthia; Bourassa-Moreau, Étienne; Parent, Stefan; Mac-Thiong, Jean-Marc

    2016-04-01

    The objective of this study was to evaluate the impact of acute care in specialized spinal cord injury (SCI) trauma centers on the prevalence of pressure ulcers (PU) upon arrival at a functional rehabilitation center after a traumatic SCI. This is a retrospective cohort study among 123 patients with traumatic SCI referred to intensive functional rehabilitation between January 1, 2009, and December 31, 2011. Group 1 (n = 90) was referred from a level 1 specialized SCI trauma center and group 2 (n = 33) was referred from seven trauma centers not specialized in SCI. The total prevalence of patients with PU at admission to functional rehabilitation was 33.3% (26.7% in group 1 and 51.5% in group 2, P = 0.017). There were also more patients with multiple PU in group 2 (24.2% vs. 2.2%, P = 0.0001). A binary logistic regression showed a significant relationship between the occurrence of PU and the type of acute care facility as well as the ASIA (American Spinal Injury Association) Impairment Scale grade. Receiving acute care at the specialized SCI trauma center was associated with a decrease in the number of patients developing one and multiple PU. These results highlight the importance of specialized SCI trauma centers in acute care of patients with traumatic SCI in reducing PU at their admission to functional rehabilitation settings.

  11. Perioperative use of bispectral (BIS) monitor for a pressure ulcer patient with locked-in syndrome (LIS).

    Science.gov (United States)

    Yoo, Christine; Ayello, Elizabeth A; Robins, Bryan; Salamanca, Victor R; Bloom, Marc J; Linton, Patrick; Brem, Harold; O'Neill, Daniel K

    2014-10-01

    The bispectral (BIS) monitor uses brain electroencephalographic data to measure the depth of sedation and pharmacological response during anaesthetic procedures. In this case, the BIS monitor was used for another purpose, to demonstrate postoperatively to the nursing staff that a patient with history of locked-in syndrome (LIS), who underwent pressure ulcer debridement, had periods of wakefulness and apparent sensation, even with his eyes closed. Furthermore, as patients with LIS can feel pain, despite being unable to move, local block or general anaesthesia should be provided for sharp surgical debridement and other painful procedures. This use of the BIS has shown that as a general rule, the staff should treat the patient as though he might be awake and sensate even if he does not open his eyes or move his limbs. The goal of this study was to continuously monitor pain level and communicate these findings to the entire wound team, i.e. anaesthesiologists, surgeons and nurses. © 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  12. Can the use of an early mobility program reduce the incidence of pressure ulcers in a surgical critical care unit?

    Science.gov (United States)

    Dickinson, Sharon; Tschannen, Dana; Shever, Leah L

    2013-01-01

    The Agency for Healthcare Research and Quality has defined pressure ulcers (PUs) an important patient safety indicator (#3). Despite the existence of evidence-based guidelines for PU prevention and treatment from the United States Department of Health and Human Services, the sustained success in reducing the development of PUs is elusive in many acute care hospitals. The specific aim of the study was to determine whether the implementation of an early standardized process for mobility could reduce or eliminate the development of PUs in a surgical intensive care unit. Patient data were collected pre- and postimplementation of the early mobility protocol. The mobility compliance for patients postimplementation was 71.30% (SD = 12.73), with a range of 25% to 100%. A χ² test for independence (with Yates continuity correction) indicated a significant association between unit-acquired PUs and the pre- and postimplementation mobility groups (χ²(1,1051) = 6.86, P = .009). Specifically, patients in the intervention group had significantly more unit-acquired PUs than the control group. No significant differences were identified between the 2 groups. Despite implementation of the early mobility protocol, we did not see an improvement in the PU rate overall or with time as protocol compliance improved.

  13. Prevention of falls, malnutrition and pressure ulcers among older persons - nursing staff's experiences of a structured preventive care process.

    Science.gov (United States)

    Lannering, Christina; Ernsth Bravell, Marie; Johansson, Linda

    2017-05-01

    A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, team-based interventions and evaluation of results. Since development, this structured work process has become web-based and has been implemented in a national quality registry called 'Senior Alert' and used countrywide. The aim of this study was to describe nursing staff's experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and home-based nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team-based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work. © 2016 John Wiley & Sons Ltd.

  14. Hospital-acquired pressure ulcers and risk of hospital mortality in intensive care patients on mechanical ventilation.

    Science.gov (United States)

    Manzano, Francisco; Pérez-Pérez, Ana M; Martínez-Ruiz, Susana; Garrido-Colmenero, Cristina; Roldan, Delphine; Jiménez-Quintana, María Del Mar; Sánchez-Cantalejo, Emilio; Colmenero, Manuel

    2014-08-01

    Pressure ulcers (PUs) are a common and serious complication in critically ill patients. The aim of this study was to evaluate the relationship between the development of a PU and hospital mortality in patients requiring mechanical ventilation (MV) in an intensive care unit (ICU). A prospective cohort study was performed over two years in patients requiring MV for ≥ 24 hours in a medical-surgical ICU. Primary outcome measure was hospital mortality and main independent variable was the development of a PU grade ≥ II. Hazard ratios (HRs) were calculated using a Cox model with time-dependent covariates. Out of 563 patients in the study, 110 (19.5%) developed a PU. Overall hospital mortality was 48.7%. In the adjusted multivariate model, PU onset was a significant independent predictor of mortality (adjusted HR, 1.28; 95% confidence interval, 1.003-1.65; P = 0.047). The model also included the Acute Physiology and Chronic Health Evaluation II score, total Sequential Organ Failure Assessment on day 3, hepatic cirrhosis and medical admission. Within the limitations of a single-centre approach, PU development appears to be associated with an increase in mortality among patients requiring MV for 24 hours or longer. © 2014 John Wiley & Sons, Ltd.

  15. [Oral ulcers].

    Science.gov (United States)

    Bascones-Martínez, Antonio; Figuero-Ruiz, Elena; Esparza-Gómez, Germán Carlos

    2005-10-29

    Ulcers commonly occur in the oral cavity, their main symptom being pain. There are different ways to classify oral ulcers. The most widely accepted form divides them into acute ulcers--sudden onset and short lasting--and chronic ulcers--insidious onset and long lasting. Commonest acute oral ulcers include traumatic ulcer, recurrent aphthous stomatitis, viral and bacterial infections and necrotizing sialometaplasia. On the other hand, oral lichen planus, oral cancer, benign mucous membrane pemphigoid, pemphigus and drug-induced ulcers belong to the group of chronic oral ulcers. It is very important to make a proper differential diagnosis in order to establish the appropriate treatment for each pathology.

  16. Design, application and impact of quality improvement 'theme months' in orthopaedic nursing: a mixed method case study on pressure ulcer prevention.

    Science.gov (United States)

    Unbeck, Maria; Sterner, Eila; Elg, Mattias; Fossum, Bjöörn; Thor, Johan; Pukk Härenstam, Karin

    2013-04-01

    While there is growing awareness of quality problems in healthcare systems, it remains uncertain how best to accomplish and sustain improvement over time. To report on the design and application of quality improvement theme months in orthopaedic nursing, and evaluate the impact on pressure ulcer as an example. Retrospective mixed method case study with time series diagrams. An orthopaedic department at a Swedish university hospital. The interventions were led by nursing teams and focused on one improvement theme at a time in two-month cycles, hence the term 'improvement theme months'. These included defined objectives, easy-to-use follow-up measurement, education, changes to daily routines, "reminder months" and data feedback. The study draws on retrospective record data regarding one of the theme topics, pressure ulcer risk assessment and prevalence, in 2281 orthopaedic admissions during January 2007-October 2010 through point prevalence measurement one-day per month. Data were analysed in time series diagrams and through comparison to annual point prevalence data from mandatory county council-wide measurements prior to, during and after interventions from 2003 to 2010. By using document analysis we reviewed concurrent initiatives at different levels in the healthcare organisation and related them to the improvement theme months and their impact. The 46 monthly point prevalence samples ranged from 28 to 66 admissions. Substantial improvements were found in risk assessment rates for pressure ulcers both in the longitudinal follow-up (ptheme month design and the way it was applied in this case showed potential, contributing to reduced pressure ulcer prevalence, as a way to conduct quality improvement initiatives in nursing. For sustainable improvement, multi component interventions are needed with regular monitoring and reminder efforts. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study.

    Science.gov (United States)

    Fossum, Mariann; Ehnfors, Margareta; Svensson, Elisabeth; Hansen, Linda M; Ehrenberg, Anna

    2013-10-01

    Nursing documentation is essential for facilitating the flow of information to guarantee continuity, quality and safety in care. High-quality nursing documentation is frequently lacking; the implementation of computerized decision support systems is expected to improve clinical practice and nursing documentation. The present study aimed at investigate the effects of a computerized decision support system and an educational program as intervention strategies for improved nursing documentation practice on pressure ulcers and malnutrition in nursing homes. An intervention study with two intervention groups and one control group was used. Fifteen nursing homes in southern Norway were included. A convenience sample of electronic healthcare records from 46 units was included. Inclusion criteria were records with presence of pressure ulcers and/or malnutrition. The residents were assessed before and after an intervention of a computerized decision support system in the electronic healthcare records. Data were collected through a review of 150 records before (2007) and 141 records after the intervention (2009). The nurses in intervention group 1 were offered educational sessions and were trained to use the computerized decision support system, which they used for eight months in 2008 and 2009. The nurses in intervention group 2 were offered the same educational program but did not use the computerized decision support system. The nurses in the control group were not subject to any intervention. The resident records were examined for the completeness and comprehensiveness of the documentation of pressure ulcers and malnutrition with three data collection forms and the data were analyzed with non-parametric statistics. The implementation of the computerized decision support system and the educational program resulted in a more complete and comprehensive documentation of pressure ulcer- and malnutrition-related nursing assessments and nursing interventions. This study

  18. The reproducibility of acquiring three dimensional gait and plantar pressure data using established protocols in participants with and without type 2 diabetes and foot ulcers.

    Science.gov (United States)

    Fernando, Malindu; Crowther, Robert G; Cunningham, Margaret; Lazzarini, Peter A; Sangla, Kunwarjit S; Buttner, Petra; Golledge, Jonathan

    2016-01-01

    Several prospective studies have suggested that gait and plantar pressure abnormalities secondary to diabetic peripheral neuropathy contributes to foot ulceration. There are many different methods by which gait and plantar pressures are assessed and currently there is no agreed standardised approach. This study aimed to describe the methods and reproducibility of three-dimensional gait and plantar pressure assessments in a small subset of participants using pre-existing protocols. Fourteen participants were conveniently sampled prior to a planned longitudinal study; four patients with diabetes and plantar foot ulcers, five patients with diabetes but no foot ulcers and five healthy controls. The repeatability of measuring key biomechanical data was assessed including the identification of 16 key anatomical landmarks, the measurement of seven leg dimensions, the processing of 22 three-dimensional gait parameters and the analysis of four different plantar pressures measures at 20 foot regions. The mean inter-observer differences were within the pre-defined acceptable level (gait analysis. The intra-observer assessment concordance correlation coefficients were > 0.9 for 100 % (7 of 7) of leg dimensions. The coefficients of variations (CVs) were within the pre-defined acceptable level (gait parameters. The CVs were within the pre-defined acceptable level (gait and plantar pressure measurements can be reliably acquired. Nearly all measures contributing to three-dimensional gait parameter assessments were within predefined acceptable limits. Most plantar pressure measurements were also within predefined acceptable limits; however, reproducibility was not as good for assessment of the maximum sensor pressure. To our knowledge, this is the first study to investigate the reproducibility of several biomechanical methods in a heterogeneous cohort.

  19. Patients' Perceptions of a Pressure Ulcer Prevention Care Bundle in Hospital: A Qualitative Descriptive Study to Guide Evidence-Based Practice.

    Science.gov (United States)

    Roberts, Shelley; Wallis, Marianne; McInnes, Elizabeth; Bucknall, Tracey; Banks, Merrilyn; Ball, Lauren; Chaboyer, Wendy

    2017-10-01

    Pressure ulcers place a significant burden on patients and hospitals. Our team developed and tested a pressure ulcer prevention care bundle (PUPCB) in a cluster randomized trial. As part of the process evaluation conducted alongside the trial, we explored patients' perceptions of the intervention. To identify patients' perceptions and experiences of a PUPCB in hospital. This qualitative descriptive study explored the perceptions of a subset of patients who participated in a trial testing the PUPCB across four intervention hospitals. A trained interviewer conducted semistructured interviews, which were digitally recorded, transcribed, and analyzed using thematic analysis. Nineteen patients were interviewed across the four hospitals. Three main themes emerged: (a) importance of personal contact in PUPCB delivery; (b) understanding pressure ulcer prevention (PUP) enhances participation; and (c) individual factors impact patients' engagement in PUP. The extent to which patients adopted the intervention appeared to be influenced by the complexity of education materials, compatibility with patients' existing knowledge and beliefs, and perceived advantage of the intervention; ability for human interaction; and patient-related facilitators and barriers to participating in PUP care. This study found patients accepted a PUPCB that encouraged participation in care, particularly as it involved personal and positive interactions with nurses and provision of information that was easy to understand and resonated with patients. © 2017 Sigma Theta Tau International.

  20. The Achilles’ heel of positivism

    Directory of Open Access Journals (Sweden)

    D.F.M. Strauss

    2003-08-01

    Full Text Available The 20th century encompasses philosophical trends as wide apart as (neo- positivism and postmodernism. The assumed objectivity and neutrality of the former and the radical relativity claimed by the latter both have difficulties in accounting for the nature of universality. Since sense experience is directed towards concrete entities and events, the universal scope of law-statements remains problematic – particularly exemplified in the universal scope of modal terms (what will be designated as modal universality. Not even postmodernism can side-step this fundamental ontic dimension of reality. Insofar as the positivistic ideal of an objective and neutral science still dominates the thought-world of many practising (natural and social scientists, a critique of the Achilles’ heel of positivism may render a service to the ideal of Christian scholarship, since it is argued that such a critique highlights the inevitability of a distinct theoretical view of reality which ultimately emanates from a person’s deepest convictions. The contributions of Popper and Stegmüller are contextualized in the argumentation. Popper realized that rationality needs a more-than-rational foundation and Stegmüller acknowledges that one cannot justify something without a prior trust. The inability of sense experience to account for the functional properties of natural things and their accompanying concepts indeed reveals the Achilles’ heel of positivism. This view is explained with reference to the uniqueness of function concepts employed in the historical development of the concept of matter. In the final part of the article Popper’s idea of falsification is assessed by taking into account the criticism raised by Stegmüller. In the course of the argumentation the relevance for the South African context is mentioned with reference to the idea of neutrality as it is advanced in the current debate about the teaching of religion at school.

  1. Polyurethane film dressings and ceramide 2-containing hydrocolloid dressing reduce the risk of pressure ulcer development in high-risk patients undergoing surgery: a matched case-control study

    Directory of Open Access Journals (Sweden)

    Kohta M

    2015-02-01

    Full Text Available Masushi Kohta,1 Kazumi Sakamoto,2 Tsunao Oh-i31Medical Engineering Laboratory, ALCARE Co, Ltd, Sumida-ku, Tokyo, 2Department of Nursing, 3Department of Dermatology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, JapanBackground: Numerous clinical challenges regarding adhesive dressings have shown that using an adhesive dressing could minimize or prevent superficial skin loss in patients at risk of developing pressure ulcers. However, evidence that polyurethane film dressings and ceramide 2-containing hydrocolloid dressing can reduce the risk of pressure ulcer development in high-risk patients undergoing surgery is limited. Therefore, we assessed the effects of application of these dressings for reducing the risk of pressure ulcer development in these patients and identified other risk factors.Methods: A matched case-control study was conducted involving 254 patients at high risk for pressure ulcer development at one acute care hospital in Japan. No patients in this study had a pressure ulcer at the start of the study. Thirty-one patients developed a pressure ulcer during surgery, and these patients were defined as cases. Controls were randomly matched for sex and age (±4 years, from which 62 patients were selected. Medical records were obtained for preoperative factors, including age, sex, body mass index, diabetes mellitus, albumin, total protein, C-reactive protein, white cell count, red cell count, and hemoglobin, and for intraoperative factors, including dressing application, operation time, body position, and surgery type. The odds ratio (OR and 95% confidence interval (CI were determined to identify risk factors for pressure ulcer development in patients undergoing surgery.Results: By multiple logistic regression analysis, there was a significantly reduced risk of pressure ulcer development for patients who had dressing applications as compared with those without dressing applications (OR 0.063; 95% CI 0.012–0.343; P=0

  2. The Braden Scale cannot be used alone for assessing pressure ulcer risk in surgical patients: a meta-analysis.

    Science.gov (United States)

    He, Wei; Liu, Peng; Chen, Hong-Lin

    2012-02-01

    The validity and reliability of the Braden Scale for pressure ulcer development has been established in a variety of patient care settings, but studies suggest the scale does not capture risk factors in surgical patients. The purpose of this metaanalysis was to assess the predictive validity of the Braden Scale for pressure ulcer development in surgical patients. A literature search using PubMed and Web of Science databases (through July 2011) was conducted to identify all clinical studies on predicting pressure ulcers in surgical patients using the Braden Scale. To be eligible for inclusion, studies had to include sensitivity (true positive rate, TPR) and specificity (true negative rate, TNR) results or include sufficient data to calculate these factors. Study quality was assessed using the 14-item Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument, and two-by-two tables of predictive validity were constructed from each article. Meta-analysis for predictive validity was performed, including calculation of pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), construction of summary receiver operating characteristic (SROC) curves, and overall diagnostic accuracy (Q*). Three studies (N = 609 patients) met the meta-analysis inclusion criteria. The pooled estimates for sensitivity and specificity were 0.42 (95% CI: 0.38 to 0.47) and 0.84 (95% CI: 0. 83 to 0.85), respectively, yielding a combined DOR of 4.40 (95% CI: 2.98 to 6.50). The area under the ROC curve (AUC) was 0.6921 ± 0.0346, and the Q* was 0.6466 ± 0.0274. Significant heterogeneity was noted between the included studies with Q value 34.49 (P = 0.0321), and I2 for pooled sensitivity, pooled specificity, and pooled DOR was 88.7%, 98.6%, and 39.1%, respectively. Although the observed heterogeneity between studies may have affected the results, the low values for overall diagnostic accuracy (Q*) and diagnostic capability (AUC) indicate the Braden Scale has low predictive

  3. Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities caused by Plantar Fasciitis

    Science.gov (United States)

    Alotaibi, Abdullah K.; Petrofsky, Jerrold S.; Daher, Noha S.; Lohman, Everett; Laymon, Michael; Syed, Hasan M.

    2015-01-01

    Background Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material/Methods Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. Conclusions This trial showed that MPC is useful in treating inferior heel symptoms caused by PF. PMID:25791231

  4. Eccrine syringofibroadenoma in a patient with a burn scar ulcer.

    Science.gov (United States)

    Ichikawa, E; Fujisawa, Y; Tateishi, Y; Imakado, S; Otsuka, F

    2000-09-01

    A 72-year-old woman with a burn scar on the calves of both legs developed an ulcer on her right heel, surrounded by multiple verrucous nodules and plaques. She had experienced similar verrucous lesions on both legs in the burn scar areas. Although the clinical diagnosis was Marjolin's ulcer, histologically the ulcer region showed thick fibrous tissue without any atypical epithelial cells. The verrucous lesions were consistent with the diagnosis of eccrine syringofibroadenoma (ESFA). Moreover, an ESFA-like growth pattern was seen in the elevated margin of the ulcer. Our findings suggest that these lesions developed as a result of reactive eccrine duct hyperplasia followed by skin tissue remodelling.

  5. Support pressure distribution for positioning in neutral versus conventional positioning in the prevention of decubitus ulcers: a pilot study in healthy participants.

    Science.gov (United States)

    Pickenbrock, Heidrun; Ludwig, Vera U; Zapf, Antonia

    2017-01-01

    Decubitus ulcers are associated with a burden for the patients and cause enormous costs. One of the reasons for the development of decubitus is prolonged exposure to pressure. The aim of this pilot study was to examine the pressure distribution of healthy individuals either positioned in Positioning in Neutral (LiN) or conventional positioning (CON). Four healthy participants were positioned in a supine, 30° degree side lying and 90° side lying position both in LiN and CON. A thousand pressure sensors in a mattress enabled a visual presentation of low, medium and high pressure on a screen. This presentation was processed by Photoshop in order to count the pixels representing the total support pressure surface and the pressure intensity. LiN showed, on average, a smaller surface with measurable pressure compared to CON (46,293 versus 64,090 pixels). The areas of medium pressure were comparable. Mean areas of low and high pressure were both smaller in LiN as compared to CON (low: 8315 versus 22,790 pixels; high: 3744 versus 7277 pixels). The results of this pilot study indicate that LiN is suitable for pressure sore prophylaxis because LiN showed less support surface and less maximum pressure as compared to CON.

  6. Mini nutritional assessment as a useful method of predicting the development of pressure ulcers in elderly inpatients.

    Science.gov (United States)

    Yatabe, Midori S; Taguchi, Fumie; Ishida, Izumi; Sato, Atsuko; Kameda, Toshio; Ueno, Shuichi; Takano, Kozue; Watanabe, Tsuyoshi; Sanada, Hironobu; Yatabe, Junichi

    2013-10-01

    To determine the usefulness of the Mini Nutritional Assessment (MNA) and plasma amino acid analysis in predicting the formation of pressure ulcers (PUs) in inpatients. Prospective, observational cohort study with a mean observation period of 62.2 ± 86.4 days. Intermediate and acute care wards of a hospital in rural Japan. Inpatients with an average age of 85.0 ± 7.6 (N = 422). Mini Nutritional Assessment, Subjective Global Assessment (SGA), Braden Scale (PU prognostic score), PU formation, and biochemical analysis including plasma amino acid concentrations. PUs developed in 7.1% of participants. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of less than 15 in predicting future PUs. The area under the receiver operating characteristic curve (AUC) of the MNA was superior to that of the Braden Scale. The Braden Scale nutrition subscore had the lowest AUC of the six Braden Scale subscores. Individuals who developed PUs had significantly lower plasma arginine concentrations than those who did not. Mini Nutritional Assessment was able to predict the development of PUs. A MNA score of less than 8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the AUC for arginine was not significantly different from 0.50. The findings from this prospective study support the use of nutritional assessment in inpatients to predict PU risk and target appropriate interventions. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  7. Applying of Decision Tree Analysis to Risk Factors Associated with Pressure Ulcers in Long-Term Care Facilities.

    Science.gov (United States)

    Moon, Mikyung; Lee, Soo-Kyoung

    2017-01-01

    The purpose of this study was to use decision tree analysis to explore the factors associated with pressure ulcers (PUs) among elderly people admitted to Korean long-term care facilities. The data were extracted from the 2014 National Inpatient Sample (NIS)-data of Health Insurance Review and Assessment Service (HIRA). A MapReduce-based program was implemented to join and filter 5 tables of the NIS. The outcome predicted by the decision tree model was the prevalence of PUs as defined by the Korean Standard Classification of Disease-7 (KCD-7; code L89 * ). Using R 3.3.1, a decision tree was generated with the finalized 15,856 cases and 830 variables. The decision tree displayed 15 subgroups with 8 variables showing 0.804 accuracy, 0.820 sensitivity, and 0.787 specificity. The most significant primary predictor of PUs was length of stay less than 0.5 day. Other predictors were the presence of an infectious wound dressing, followed by having diagnoses numbering less than 3.5 and the presence of a simple dressing. Among diagnoses, "injuries to the hip and thigh" was the top predictor ranking 5th overall. Total hospital cost exceeding 2,200,000 Korean won (US $2,000) rounded out the top 7. These results support previous studies that showed length of stay, comorbidity, and total hospital cost were associated with PUs. Moreover, wound dressings were commonly used to treat PUs. They also show that machine learning, such as a decision tree, could effectively predict PUs using big data.

  8. Prevention of pressure ulcers in patients undergoing sub-acute rehabilitation after severe brain injury: an observational study.

    Science.gov (United States)

    Sachs, Marianne Brostrup; Wolffbrandt, Mia Moth; Poulsen, Ingrid

    2018-01-09

    The aim of this study was to uncover efforts made by healthcare professionals to prevent pressure ulcers (PUs) in patients with severe brain injury undergoing treatment at a sub-acute rehabilitation department. PUs is a major burden for patients and also generate considerable healthcare costs. PUs are, nevertheless, prevalent in both secondary and primary care. In this qualitative study, we performed 24-hour observation on four patients undergoing rehabilitation for severe brain injury. An observation guide was developed inspired by the Braden Scale and Spradley's theory and methods. Observations were analysed using content analysis. Patricia Benner's aspects of clinical grasp were employed in the interpretation of the observations. One overarching theme was identified: "Professionalism expressed by preventing intervention, involving the patient, employing clinical grasp and professional pride". Seven subcategories were summed up into the following three categories: Organisation of clinical practice, Professional assessment and Interactions with the patient. The healthcare professionals' actions to prevent PUs consisted of attaining the necessary knowledge about PU care and performing the activities. However, our observations revealed one important additional aspect; a very distinct impression that the healthcare professionals were committed to learning about the patients' former life and actively used this knowledge in their planning and provision of daily patient care. We believe this commitment has a very positive effect on prevention of PUs. Professional knowledge about prevention of PU is a necessary requisite, but is not sufficient to ensure effective treatment. To transfer knowledge into practice, we recommend that patients' rehabilitation days be planned in such a manner that activities, mobilisation and training are conducted throughout the day and evening. We also recommend that professional staff are encouraged to seek information about the former life

  9. Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury: A Pilot Study.

    Science.gov (United States)

    Krishnan, Shilpa; Vodovotz, Yoram; Karg, Patricia E; Constantine, Gregory; Sowa, Gwendolyn A; Constantine, Florica J; Brienza, David M

    2017-09-01

    To identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers (PUs). Retrospective. Acute hospitalization and inpatient rehabilitation unit of a university medical center. Individuals (N=86) with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not. Not applicable. Twenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated. Initial chi-square analysis revealed a significant (P=.02) association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann-Whitney U exact tests suggested an association (P<.05) between the formation of a first PU and a slight increase in plasma concentrations of tumor necrosis factor-alpha (TNF-α), and a decrease in urine concentrations of TNF-α, granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin (IL)-15 after onset of pneumonia. These findings suggest that a relatively small increase in plasma TNF-α, and decreases in urine TNF-α, GM-CSF, and IL-15 from just before to just after the diagnosis of pneumonia could be markers for an increased risk of PUs in individuals with pneumonia after traumatic SCI. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Pressure ulcer is associated with malnutrition as assessed by Nutritional Risk Screening (NRS 2002) in a mixed hospital population.

    Science.gov (United States)

    Alhaug, Johanne; Gay, Caryl L; Henriksen, Christine; Lerdal, Anners

    2017-01-01

    Background and aim: Pressure ulcers (PUs) and malnutrition represent a significant health problem for hospital inpatients. Satisfactory nutritional status is crucial for proper wound healing. Risk of malnutrition can be identified using standardized screening tools, such as the Nutritional Risk Screening (NRS) 2002. Objective: The objective of this study was to examine whether nutritional status based on the NRS 2002 is associated with PU in hospital inpatients. Design: The data for this cross-sectional analysis were based on 10 screening days between September 2012 and May 2014. All adult inpatients admitted to a medical or surgical ward on the screening days were evaluated for eligibility. Nursing students and ward nurses conducted the NRS 2002 initial screening and skin examinations for PU classification (Stages I-IV). A registered clinical dietician conducted all NRS 2002 final screenings. Results: The sample consisted of 651 patients, with mean age 62.9 years. Skin examinations indicated an 8% PU prevalence. Factors associated with PUs included age ≥ 70 years, low body mass index (BMI) and hospitalization in the medical department. Based on the initial screening, 48% were at 'Low risk' for malnutrition and 52% were at 'Possible risk'. After final screening, 34% of the sample was identified as 'At risk' for malnutrition. Patients identified at 'Possible risk' by the initial screening or 'At risk' by the final screening were more likely than patients at 'Low risk' to have a PU (OR = 2.58 and 2.55, respectively). Each of the three initial screening items was significantly associated PU, with 'Is BMINutritional risk using the NRS 2002 is associated with the presence of PU in a mixed hospital population. The final screening had a slightly stronger association with PU compared to the initial screening.

  11. The influence of valgus heel position on foot loading in a child's gait

    Directory of Open Access Journals (Sweden)

    Eliška Martinásková

    2012-12-01

    Full Text Available BACKGROUND: Flat foot is a typical clinical sign in childhood, expressed as valgus positioning of the heel during vertical foot loading. This may lead to medial deviation of the foot axis and cause overloading of some foot areas. OBJECTIVE: To determine the influence of valgus position of the heel (both bilateral and unilateral on foot loading during gait. METHODS: An experimental group consisting of children with bilateral heel valgus deformity (16 children, age 5.3 ± 1.3 years and children with unilateral heel valgus deformity (14 children, age 5.6 ± 1.6 years. The control group comprised of 14 children (age 4.5 ± 1.2 years. For measuring foot loading during gait, the Footscan (RSScan International, Olen, Belgium pressure plate was used. Each subject went through 8 trials of gait measurement. From each trial, 8 foot areas were evaluated. Data processing with mean values for each subject was performed by non-parametric tests (Mann-Whitney and Wilcoxon tests, Spearman correlation in the STATISTICA programme (StatSoft, Inc., Tulsa, USA. RESULTS: Pressure peak and pressure impulse in the first metatarsal was greater for the bilateral valgus group (p CONCLUSION: The results show that valgus positioning of the heel influences foot loading in children during gait. The findings of this study suggest the necessity of a complex solution to the problem of preventing further progression of pathological changes.

  12. Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds.

    Science.gov (United States)

    Choi, Edmond P H; Chin, Weng Yee; Wan, Eric Y F; Lam, Cindy L K

    2016-05-01

    To examine the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing the healing progress in acute and chronic wounds. It is important to establish the responsiveness of instruments used in conducting wound care assessments to ensure that they are able to capture changes in wound healing accurately over time. Prospective longitudinal observational study. The key study instrument was the PUSH tool. Internal responsiveness was assessed using paired t-testing and effect size statistics. External responsiveness was assessed using multiple linear regression. All new patients with at least one eligible acute or chronic wound, enrolled in the Nurse and Allied Health Clinic-Wound Care programme between 1 December 2012 - 31 March 2013 were included for analysis (N = 541). Overall, the PUSH tool was able to detect statistically significant changes in wound healing between baseline and discharge. The effect size statistics were large. The internal responsiveness of the PUSH tool was confirmed in patients with a variety of different wound types including venous ulcers, pressure ulcers, neuropathic ulcers, burns and scalds, skin tears, surgical wounds and traumatic wounds. After controlling for age, gender and wound type, subjects in the 'wound improved but not healed' group had a smaller change in PUSH scores than those in the 'wound healed' group. Subjects in the 'wound static or worsened' group had the smallest change in PUSH scores. The external responsiveness was confirmed. The internal and external responsiveness of the PUSH tool confirmed that it can be used to track the healing progress of both acute and chronic wounds. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  13. [Aphthous ulcers and oral ulcerations].

    Science.gov (United States)

    Vaillant, Loïc; Samimi, Mahtab

    2016-02-01

    Aphthous ulcers are painful ulcerations located on the mucous membrane, generally in the mouth, less often in the genital area. Three clinical forms of aphthous ulcers have been described: minor aphthous ulcers, herpetiform aphthous ulcers and major aphthous ulcers. Many other conditions presenting with oral bullous or vesiculous lesions orulcerations and erosions can be mistaken for aphthous ulcers. Currently, treatment of aphthous ulcers is palliative and symptomatic. Topical treatments (topical anesthetics, topical steroids and sucralfate) are the first line therapy. Recurrent aphthous stomatitis (RAS) is defined by the recurrence of oral aphthous ulcers at least 4 times per year. RAS is often idiopathic but can be associated with gastro-intestinal diseases (i.e. celiac disease, inflammatory bowel diseases), nutritional deficiencies (iron, folates...), immune disorders (HIV infection, neutropenia) and rare syndromes. Behçet's disease is a chronic, inflammatory, disease whose main clinical feature is recurrent bipolar aphthosis. Colchicine associated with topical treatments constitutes a suitable treatment of most RAS. Thalidomide is the most effective treatment of RAS but its use is limited by frequent adverse effects. Oral ulcers can be related to a wide range of conditions that constitute the differential diagnoses of aphthous ulcers. Oral ulcers are classified into three main groups: acute ulcers with abrupt onset and short duration, recurrent ulcers (mainly due to postherpetic erythema multiforme) and chronic ulcers (with slow onset and insidious progression). Acute oral ulcers are due to trauma, bacterial infections (including acute necrotizing ulcerative gingivitis), deep fungal infection, gastro-intestinal (namely inflammatory bowel disease) or systemic diseases. Chronic oral ulcers may be drug-induced, or due to benign or malignant tumors. Every oral solitary chronic ulcer should be biopsied to rule out squamous cell carcinoma. A solitary palatal ulcer

  14. Interference of high-heeled shoes in static balance among young women.

    Science.gov (United States)

    Gerber, Susana Bacelete; Costa, Rafael Vital; Grecco, Luanda André Collange; Pasini, Hugo; Marconi, Nádia Fernanda; Oliveira, Claudia Santos

    2012-10-01

    The aim of the present study was to assess the effect of the use of high-heeled shoes on static balance in young adult women. Fifty-three women between 18 and 30 years of age and accustomed to wearing high-heeled shoes participated in the study. None of the participants had any orthopedic or neurologic alterations. Static balance was assessed using a force plate. Oscillations from the center of pressure in the mediolateral and anteroposterior directions were measured both when barefoot and when wearing high-heeled shoes [7 centimeters (cm) in height and 1cm in diameter] under the conditions of eyes open and eyes closed. Two-way analysis of variance was employed for the statistical analysis, with the level of significance set at 5% (pstatic balance in the healthy young women analyzed, increasing the oscillation of the center of pressure, regardless of visual restriction. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Bone imaging of the heel in Reiter's syndrome. [/sup 99m/Tc-pyrophosphate

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    Khalkhali, I. (Univ. of California, Sacramento); Stadalnik, R.C.; Wiesner, K.B.; Shapiro, R.F.

    1979-01-01

    Classic Reiter's syndrome, which affects young adult males, is characterized by arthritis, conjunctivitis, and nongonococcal urethritis. Other features of probably equal significance include circinate balanitis, shallow ulcerations of the buccal mucosa, and a dermatitis. Reiter's arthritis is usually asymmetrical and tends to involve lower extremity joints. Talalgia, or heel pain, is an often underrated characteristic feature of the arthritis. With an incidence of 50% talalgia can be localized to either the posterior aspect of the heel or to the plantar surface of the heel. Radiographic alterations in these regions are common in patients with recurrent or chronic disease, but are infrequent or minimal in patients with acute Reiter's syndrome. Recent observation of a young male with Reiter's syndrome suggests that bone imaging may help substantiate this clinical feature before radiography reveals calcaneal spurs.

  16. Preventing pressure ulcers

    Science.gov (United States)

    ... a bed or a chair Are overweight or underweight Are not able to control your bowels or ... to drain pus. Your wheelchair does not fit. Alternative Names ... by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also ...

  17. Prospective and randomised evaluation of the protease-modulating effect of oxidised regenerated cellulose/collagen matrix treatment in pressure sore ulcers.

    Science.gov (United States)

    Kloeters, Oliver; Unglaub, Frank; de Laat, Erik; van Abeelen, Marjolijn; Ulrich, Dietmar

    2016-12-01

    In chronic wounds, excess levels and activity of proteases such as elastase and plasmin have been detected. Oxidised regenerated cellulose/collagen matrix (ORC/collagen matrix) has been reported to ameliorate the wound microenvironment by binding and inactivating excess proteases in wound exudates. In this study, the levels and activity of elastase and plasmin in wound exudates of pressure sore ulcers were measured to determine the beneficial effect of ORC/collagen matrix treatment compared with control treatment with a foam dressing. A total of 33 patients with pressure sores were enrolled in the study and were followed up for 12 weeks after treatment. Ten control patients were treated with a foam hydropolymer dressing (TIELLE® , Systagenix), and the remaining 23 patients were treated with ORC/collagen matrix plus the foam dressing (TIELLE® , Systagenix) on top. Wound assessments were carried out over 12 weeks on a weekly basis, with dressing changes twice a week. Ulcers were photographed and wound exudates were collected on admission and at days 5, 14 and then every 14 days to provide a visual record of any changes in appearance of the ulcer and healing rate and for biochemical analysis of the wound. The levels and activity of elastase and plasmin were measured in wound exudates. Statistical analysis was performed using ANOVA and Bonferroni's post hoc test with P-values matrix-treated pressure sore wounds showed a significant faster healing rate, which positively correlated with a decreased activity of elastase and plasmin in wound exudates. No signs of infection or intolerance to the ORC/collagen matrix were observed. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  18. Peptic Ulcer

    Science.gov (United States)

    A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your small ... and goes for several days or weeks Peptic ulcers happen when the acids that help you digest ...

  19. Úlceras por presión en el postoperatorio de intervenciones quirúrgicas de cadera o de rodilla A Pressure ulcers after hip or knee surgery

    Directory of Open Access Journals (Sweden)

    Juana Mª Díaz Martínez

    2009-06-01

    developing pressure ulcers. Some studies found a high incidence of pressure ulcers (PU in patients after surgical orthopaedic interventions. Several factors increasing risk have been proposed, although this is a controversial point. Aims: The aims of this research were: a To obtain epidemiological data about pressure ulcers frequency in patients treated by hip or knee replacement surgery; b To establish if some surgery-related factors are associated with pressure ulcers development; c To assess how appropriate is the pressure ulcers prevention protocol for these patients. Methods: Prospective and longitudinal research carried out in the Unit of Post-anaesthetic Reanimation and two Traumatologia wards in a University Hospital, between January and June in 2008. Inclusion: Adults patients treated by hip replacement, knee replacement or hip fracture surgical repair. Exclusion: Patients with PU previous to surgery. A convenience sample of patients was selected with a sample size estimated in 89 patients. The observation of the patients began in the Unit of Post-anaesthetic Reanimation, immediately after surgery and continued in the wards. The follow-up period was until discharge or 10 days, with re-assess-ment every 48 hours. The main outcome was pressure ulcer development and as independent variables were recorded several surgery-related factors. Pressure ulcer risk was measured by EMINA scale. Results: 91 patients were finally included in the research; a 76.9% of whom were female. Patient´s average age was 72.2 years (±8.4. Almost all the patients were in PU risk, according to EMINA scale (medium risk: 19.8%, high risk: 76.9%. 18 patients (19.8% developed PU in the hospital after surgery. PU grading was: fourteen ulcers (66.6% grade 1; six (28.6% grade 2 and one (4.8% was a non-gradable ulcer (necrotic scar. The average time until PU appearance was 3.72 days (CI95%: 2.73 - 4.71. Preventive measures application was irregular: visco-elastic mattresses (100%; turning out (0

  20. Prevalence of standing plantar pressure distribution variation in north Asian Indian patients with diabetes mellitus: a study to understand ulcer formation.

    Science.gov (United States)

    Periyasamy, R; Anand, S; Ammini, A C

    2013-02-01

    Diabetes Mellitus is a disorder of metabolism. Foot problems are common in diabetes and altered plantar pressures distribution may lead to ulceration in people with Diabetes Mellitus. Therefore the aim of this study was to investigate standing plantar pressure distribution variations in north Asian Indian diabetes mellitus subjects and its association with duration of diabetes. Thirty three subjects with age range from 40 to 75 years are recruited from AIIMS Endocrinology & metabolism lab Delhi, India and divided into three groups: 11 control subjects (non-diabetic), 11 diabetic subjects without neuropathy (DNN) and II diabetic subjects with neuropathy (DN). Neuropathy status was assessed by measuring loss of protective sensation to 10 gm Semen's Weinstein monofilament. Plantar pressure distributions parameter-Power ratio (PR) was measured during barefoot standing using portable PedoPowerGraph and results are analyzed using one way analysis of variance to detect significant difference between the groups. We found significant (p foot and hind foot but no significant (p > 0.05) difference in PR value was found between DNN and CG groups in the foot. As compared to DNN, DN group have maximum PR variations in the fore foot. Plantar pressure distribution parameter-PR was higher with longer duration of diabetes among type 2 diabetes subjects. In this study we conclude that plantar pressure distribution parameter-PR was able to distinguish the DN groups from the CG group in hind and fore foot during standing. Increased forefoot PR value is prevalent in the diabetic neuropathic subjects and may be responsible for the occurrence of foot sole ulcers but additional prospective studies are needed. In the future we will investigate the plantar pressure distribution parameter-PR variations in diabetes with obese and osteoarthritis subject.

  1. Aspectos legales relacionados con las úlceras por presión Legal aspects related to pressure ulcers

    Directory of Open Access Journals (Sweden)

    J. Javier Soldevilla Agreda

    2006-12-01

    hace años" en España. Finalmente la exposición pormenorizada y comentada de los pronunciamientos judiciales de los casos relacionados con estas lesiones de los últimos años, permiten concluir que, a pesar del creciente número de sentencias que hacen mención a las UPP, son simbólicas las que con rotundidad pronuncian como causa de éstas una deficiencia en los cuidados, negligencia o mala praxis y llama la atención las raquíticas condenas e indemnizaciones. Tal vez el mismo e histórico espíritu de devaluación de estas lesiones, presente en ámbitos profesionales y en la sociedad en general, se ha trasladado a la judicatura, especialmente de la mano de peritos y/o forenses, no alcanzando a cifrar la dimensión real del problema (pérdida de salud y calidad de vida y las fatales consecuencias de las UPP (incluida la muerte por esa causa y olvidando que son previsibles casi en la totalidad de las situaciones.Over the past few years, Spain has been experiencing a significant increase in questionable health care practices. During the long process which aims to dismiss pressure ulcer (PU as a banal, especially inevitable process due to being closely related to old age and terminal illness, it is becoming apparent that patients and their families are now reacting, complaining and suing for lack of prevention or inadequate treatment, something that has already been happening for years in other countries with similar cultural and economic characteristics. A revision on the impact and the way the pressure ulcer issue is being legally dealt with in our surrounding countries (United Kingdom, United States, Germany... from the point of view of penal law, civil law or through disciplinary procedures, has made a very noticeable difference in the way professionals, institutions and people behave with regards to this subject. With an entirely instructive purpose, the legal configuration of our country's health care practice is described, as well as the types of liability

  2. A quantitative analysis of microcirculation in sore-prone pressure areas on conventional and pressure relief hospital mattresses using laser Doppler flowmetry and tissue spectrophotometry.

    Science.gov (United States)

    Rothenberger, Jens; Krauss, Sabrina; Held, Manuel; Bender, Dominik; Schaller, Hans-Eberhard; Rahmanian-Schwarz, Afshin; Constantinescu, Mihai Adrian; Jaminet, Patrick

    2014-11-01

    Pressure ulcers are associated with severe impairment for the patients and high economic load. With this study we wanted to gain more insight to the skin perfusion dynamics due to external loading. Furthermore, we evaluated the effect of different types of pressure relief mattresses. A total of 25 healthy volunteers were enrolled in the study. Perfusion dynamics of the sacral and the heel area were assessed using the O2C-device, which combines a laser light, to determine blood flow, and white light to determine the relative amount of hemoglobin. Three mattresses were evaluated compared to a hard surface: a standard hospital foam mattress bed, a visco-elastic foam mattress, and an air-fluidized bed. In the heel area, only the air-fluidized bed was able to maintain the blood circulation (mean blood flow of 13.6 ± 6 versus 3.9 ± 3 AU and mean relative amount of hemoglobin of 44.0 ± 14 versus 32.7 ± 12 AU.) In the sacral area, all used mattresses revealed an improvement of blood circulation compared to the hard surface. The results of this study form a more precise pattern of perfusion changes due to external loading on various pressure relief mattresses. This knowledge may reduce the incidence of pressure ulcers and may be an influencing factor in pressure relief mattress selection. Copyright © 2014 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  3. Cultured allogeneic skin cells are effective in the treatment of chronic diabetic leg and foot ulcers.

    Science.gov (United States)

    Harvima, I T; Virnes, S; Kauppinen, L; Huttunen, M; Kivinen, P; Niskanen, L; Horsmanheimo, M

    1999-05-01

    Diabetic ulcers on the lower extremities present a difficult treatment problem, and some ulcers respond poorly to conventional topical and cast treatment. The purpose of this study was to assess the effect of cultured allogeneic keratinocyte epithelium and fibroblast-gelatin sponge on the healing of chronic, refractory diabetic leg and foot ulcers. Non-diabetic chronic leg ulcers were treated for comparison. This open study comprised 22 patients with type I or type II diabetes and 16 patients with leg or ankle ulcers of different aetiologies. A total of 26 diabetic and 25 non-diabetic ulcers were treated mainly with keratinocyte epithelium and/or fibroblast-gelatin sponge once weekly until complete healing or until no further healing could be observed despite several repeated treatments. The duration of diabetic ulcers was 10.3+/-15.8 (mean+/-SD) months and the size 3.1+/-6.6 cm2. The diabetic ulcers were located in the heel (7), toe (7), sole (5), leg (6) and Achilles (1). The mean duration of non-diabetic ulcers was 6.8+/-6.0 months and the size 10.5+/-11.8 cm2. A total of 12+/-11 skin cell transplantations were performed for the diabetic ulcers. All but 1 diabetic ulcer healed during the study. The time for 50% reduction in ulcer area was 32+/-32 days, but 99+/-110 days were needed for complete ulcer closure. The longer the ulcer had existed the longer was the healing time. Heel ulcers showed significantly slower healing response than leg, sole and toe ulcers. Preliminary results suggest that both keratinocytes and fibroblasts are equally effective in the healing process. The time required for healing of the diabetic ulcers did not differ markedly from that of the non-diabetic ulcers. The results suggest that cultured allogeneic skin cells used once weekly are effective in the treatment of recalcitrant diabetic ulcers.

  4. Investigating the Effects of Knee Flexion during the Eccentric Heel-Drop Exercise

    Directory of Open Access Journals (Sweden)

    Robert A. Weinert-Aplin, Anthony M.J. Bull, Alison H. McGregor

    2015-06-01

    Full Text Available This study aimed to characterise the biomechanics of the widely practiced eccentric heel-drop exercises used in the management of Achilles tendinosis. Specifically, the aim was to quantify changes in lower limb kinematics, muscle lengths and Achilles tendon force, when performing the exercise with a flexed knee instead of an extended knee. A musculoskeletal modelling approach was used to quantify any differences between these versions of the eccentric heel drop exercises used to treat Achilles tendinosis. 19 healthy volunteers provided a group from which optical motion, forceplate and plantar pressure data were recorded while performing both the extended and flexed knee eccentric heel-drop exercises over a wooden step when barefoot or wearing running shoes. This data was used as inputs into a scaled musculoskeletal model of the lower limb. Range of ankle motion was unaffected by knee flexion. However, knee flexion was found to significantly affect lower limb kinematics, inter-segmental loads and triceps muscle lengths. Peak Achilles load was not influenced despite significantly reduced peak ankle plantarflexion moments (p < 0.001. The combination of reduced triceps lengths and greater ankle dorsiflexion, coupled with reduced ankle plantarflexion moments were used to provide a basis for previously unexplained observations regarding the effect of knee flexion on the relative loading of the triceps muscles during the eccentric heel drop exercises. This finding questions the role of the flexed knee heel drop exercise when specifically treating Achilles tendinosis.

  5. Evaluation of five search strategies in retrieving qualitative patient-reported electronic data on the impact of pressure ulcers on quality of life.

    Science.gov (United States)

    Gorecki, Claudia A; Brown, Julia M; Briggs, Michelle; Nixon, Jane

    2010-03-01

    This paper is a report of a study conducted to compare the effectiveness of qualitative methodology search strategies with subject-specific (health-related quality of life) search strategies in the retrieval of qualitative patient-reported data of the impact of pressure ulcers on health-related quality of life. Methods to locate qualitative patient-reported health-related quality of life research data electronically have undergone little replication and validation. A major problem in searching for this type of data is that it is reported in accounts of both primary qualitative research as well as mixed methods research. We combined five search strategies with terms for pressure ulcer and searched seven electronic databases from inception to October 2007. The sensitivity, specificity, precision and accuracy for each search strategy were assessed. A subject-specific (health-related quality of life) search strategy, developed by us, had a high yield (100% sensitivity), but low specificity (quality of life data, whereas, research methodology-based strategies did not identify qualitative data reported in mixed method studies, making subject-based strategies more effective in retrieving qualitative patient-reported health-related quality of life research. An important consideration in the health-related quality of life field is that qualitative data are reported in both qualitative and mixed methodology research and searching for this type data involves trade-offs between yield, sensitivity and specificity. Accurate indexing of subject-specific outcomes and methodology used in electronic databases and publications is also needed.

  6. Predictive validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) in acute care and inpatient rehabilitation in individuals with traumatic spinal cord injury.

    Science.gov (United States)

    Krishnan, Shilpa; Brick, Rachelle S; Karg, Patricia E; Tzen, Yi-Ting; Garber, Susan L; Sowa, Gwendolyn A; Brienza, David M

    2016-04-06

    To evaluate the validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) during acute care and inpatient rehabilitation following spinal cord injury (SCI) by determining critical cutoff points and assessing the ability to predict risk for pressure ulceration (PrU). Retrospective. Sensitivity, specificity, and area under the curve (AUC) for the receiver operating characteristic were determined for the scale's ability to predict PrU 2-3 and 5-7 days after administrating the SCIPUS during acute care, and 5-7 and 14-21 days after administrating the SCIPUS during inpatient rehabilitation. During acute hospitalization, SCIPUS's ability to assess risk for PrUs within 2-3 days was determined at cutoff score of 15 with 100% sensitivity and 75% specificity, AUC = 0.85. The scale was unable to assess PrU risk at 5-7 days, AUC rehabilitation, the scale was unable to assess PrU risk at 5-7 and 14-21 days, AUC rehabilitation. Improved PrU risk assessment following SCI may be possible with modification to the SCIPUS.

  7. Comparison of in-person and digital photograph assessment of stage III and IV pressure ulcers among veterans with spinal cord injuries.

    Science.gov (United States)

    Terris, Darcey D; Woo, Christine; Jarczok, Marc N; Ho, Chester H

    2011-01-01

    Digital photographs are often used in treatment monitoring for home care of less advanced pressure ulcers. We investigated assessment agreement when stage III and IV pressure ulcers in individuals with spinal cord injury were evaluated in person and with the use of digital photographs. Two wound-care nurses assessed 31 wounds among 15 participants. One nurse assessed all wounds in person, while the other used digital photographs. Twenty-four wound description categories were applied in the nurses' assessments. Kappa statistics were calculated to investigate agreement beyond chance (p < or = 0.05). For 10 randomly selected "double-rated wounds," both nurses applied both assessment methods. Fewer categories were evaluated for the double-rated wounds, because some categories were chosen infrequently and agreement could not be measured. Interrater agreement with the two methods was observed for 12 of the 24 categories (50.0%). However, of the 12 categories with agreement beyond chance, agreement was only "slight" (kappa = 0-0.20) or "fair" (kappa = 0.21-0.40) for 6 categories. The highest agreement was found for the presence of undermining (kappa = 0.853, p < 0.001). Interrater agreement was similar to intramethod agreement (41.2% of the categories demonstrated agreement beyond chance) for the nurses' in-person assessment of the double-rated wounds. The moderate agreement observed may be attributed to variation in subjective perception of qualitative wound characteristics.

  8. Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse.

    Science.gov (United States)

    Shepherd, Marilyn Murphy; Wipke-Tevis, Deidre D; Alexander, Gregory L

    2015-01-01

    The purpose of this study was to compare pressure ulcer prevention programs in 2 long-term care (LTC) facilities with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the WOC nurse. Secondary analysis of narrative data obtained from a mixed-methods study. The study setting was 2 LTC facilities in the Midwestern United States. The sample comprised 39 staff from 2 facilities, including 26 from a high-ITS facility and 13 from the low-ITS facility. Respondents included certified nurse assistants, certified medical technicians, restorative medical technicians, social workers, RNs, licensed practical nurses, information technology staff, administrators, and directors. This study is a secondary analysis of interviews regarding communication and education strategies in 2 LTC agencies. This analysis focused on focus group interviews, which included both direct and nondirect care providers. Eight themes (codes) were identified in the analysis. Three themes are presented individually with exemplars of communication and education strategies. The analysis revealed specific differences between the high-ITS and low-ITS facilities in regard to education and communication involving pressure ulcer prevention. These differences have direct implications for WOC nurses consulting in the LTC setting. Findings from this study suggest that effective strategies for staff education and communication regarding PU prevention differ based on the level of ITS within a given facility. Specific strategies for education and communication are suggested for agencies with high ITS and agencies with low ITS.

  9. Eradication of methicillin-resistant Staphylococcus aureus in pressure ulcers comparing a polyhexanide-containing cellulose dressing with polyhexanide swabs in a prospective randomized study.

    Science.gov (United States)

    Wild, Thomas; Bruckner, Maria; Payrich, Martina; Schwarz, Christoph; Eberlein, Thomas; Andriessen, Anneke

    2012-01-01

    The study evaluated eradication of methicillin-resistant Staphylococcus aureus (MRSA) from pressure ulcers comparing swabs containing polyhexanide with a cellulose dressing + polyhexanide. After receiving approval from the ethics committee and informed consent, patients from the centers were recruited. Prospective randomized study. Thirty patients (n = 15/n = 15), not responding to wound disinfection after a washout period of 2 weeks, were included in the intention-to-treat analysis. This study was performed on hospital patients. Patients had pressure ulcers containing MRSA. For the control group, cleansing was performed with polyhexanide swabs (20 minutes), after which a foam dressing was applied. The study group received a polyhexanide-containing cellulose dressing. For bacterial analysis, semiquantitative swab cultures (Robert Koch Institute recommendations) were taken on days 0, 7, and 14 and during 3 consecutive days. The groups were comparable at baseline. At day 7, in the control group, 6 of 15 (40%) MRSA eradication. For the study group, there were 13 of 15 (86.67%) who showed MRSA eradication. At day 14, in the control group, there were 10 of 15 (66.67%) who had MRSA eradication, compared with the study group, where 15 of 15 (100%; P polyhexanide was shown to be successful in both groups, showing superior results for the study group.

  10. The effectiveness of hydrocolloid dressings versus other dressings in the healing of pressure ulcers in adults and older adults: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Franciele Soares Pott

    2014-06-01

    Full Text Available OBJECTIVE: to evaluate the effectiveness of hydrocolloids in the healing of pressure ulcers in adult and older adult patients.METHOD: systematic review with meta-analysis, based on the recommendations of the Cochrane Handbook. The search was undertaken in the databases: Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature (LILACS, Cochrane Database, Cumulative Index to Nursing and Allied Health Literature, Web of Science and the Scientific Electronic Library Online.RESULTS: 646 primary studies were identified, 69 were evaluated and nine were selected, referring to the use of the hydrocolloid dressing in healing; of these, four studies allowed meta-analysis. There was no statistically significant difference between the hydrocolloid group and the foams group (p value=0.84; Odds Ratio 1.06, CI 95% 0.61-1.86. A slight superiority of the polyurethane dressings w