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Decubitus Ulcers [keywords]
- Ethical issues and accountability in pressure ulcer prevention. [Journal Article]
- Nurs Stand 2014 Oct 22; 29(8):56-63.
Pressure ulcers represent a considerable cost, both in terms of healthcare spending and quality of life. They are increasingly viewed in terms of patient harm. For clinicians involved in pressure ulcer prevention, ethical issues surrounding accountability may arise from both policy and practice perspectives. It may be useful for clinicians to refer to ethical theories and principles to create frameworks when addressing ethical dilemmas. However, such theories and principles have been criticised for their simplicity and over-generalisation. Alternative theories, for example, virtue ethics and experiential learning, can provide more comprehensive guidance and promote a pluralistic approach to tackling ethical dilemmas.
- Development of intelligent model for personalized guidance on wheelchair tilt and recline usage for people with spinal cord injury: Methodology and preliminary report. [JOURNAL ARTICLE]
- J Rehabil Res Dev 2014; 51(5):775-788.
Wheelchair tilt and recline functions are two of the most desirable features for relieving seating pressure to decrease the risk of pressure ulcers. The effective guidance on wheelchair tilt and recline usage is therefore critical to pressure ulcer prevention. The aim of this study was to demonstrate the feasibility of using machine learning techniques to construct an intelligent model to provide personalized guidance to individuals with spinal cord injury (SCI). The motivation stems from the clinical evidence that the requirements of individuals vary greatly and that no universal guidance on tilt and recline usage could possibly satisfy all individuals with SCI. We explored all aspects involved in constructing the intelligent model and proposed approaches tailored to suit the characteristics of this preliminary study, such as the way of modeling research participants, using machine learning techniques to construct the intelligent model, and evaluating the performance of the intelligent model. We further improved the intelligent model's prediction accuracy by developing a two-phase feature selection algorithm to identify important attributes. Experimental results demonstrated that our approaches held the promise: they could effectively construct the intelligent model, evaluate its performance, and refine the participant model so that the intelligent model's prediction accuracy was significantly improved.
- Nurse Assistant Communication Strategies About Pressure Ulcers in Nursing Homes. [JOURNAL ARTICLE]
- West J Nurs Res 2014 Oct 20.
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.
- [Current decubitus prevention and treatment algorhytm]. [English Abstract, Journal Article]
- Acta Med Croatica 2014 Oct.:109-16.
Decubitus ulcer treatment options, as well as the etiology, classification and prevention guidelines are presented. The importance of a multidisciplinary approach along with prevention and education is emphasized. The National Pressure Ulcer Advisory Panel guidelines ensure contemporary decubitus ulcer treatment all over the world, while adoption of the basic algorithm is a precondition of good medical practice and nursing care. Upgrading the patient quality of life and complete healing of decubitus ulcer is definitely achievable by strict application of these recommendations.
- An innovative solid oral nutritional supplement to fight weight loss and anorexia: opened, randomised controlled trial of efficacy in institutionalised, malnourished older adults. [JOURNAL ARTICLE]
- Age Ageing 2014 Oct 16.
to evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults >70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis(®), Solidages, France).an open, multicentre, randomised controlled trial.seven nursing homes.one hundred and seventy-five malnourished older adults, aged 86 ± 8 years.all participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0-w6).five visits (w-4, w0, w6, w10 and w18). Main outcome: percentage of weight gain from w0 to w6 (body mass in kg). Secondary outcomes: appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea.average weight increased in Intervention group (n = 88) compared with Control group (n = 87) without cookies supplementation (+1.6 versus -0.7%, P = 0.038). Weight gain persisted 1 month (+3.0 versus -0.2%, P = 0.025) and 3 months after the end of cookies consumption (+3.9 versus -0.9%, P = 0.003), with diarrhea reduction (P = 0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P = 0.024), appetite increase (P = 0.009) and pressure ulcers reduction (P = 0.031).the trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations.
- [Orthopaedic footwear against foot ulcers in diabetes]. [English Abstract, Journal Article]
- Ned Tijdschr Geneeskd 2014; 158(0):A7497.
- In people with diabetes mellitus, foot ulcers are a major problem because they increase the risk of a foot infection and amputation and reduce quality of life.- After a foot ulcer has healed, the risk of recurrence is high. - Orthopaedic shoes and orthotics are often prescribed to high risk patients and aim to reduce the mechanical pressure on the plantar surface of the foot. - Orthopaedic footwear that is modified to reduce pressure is not much more effective in preventing foot ulcer recurrence than orthopaedic footwear that did not undergo such modification, unless the shoes are worn as recommended. In that case, the risk of ulcer recurrence is reduced by 46%. - In patients with a history of ulceration, compliance in wearing orthopaedic shoes at home is low, while these patients walk more inside the house than outside the house.- Foot pressure measurements should be part of the prescription and evaluation of orthopaedic footwear for patients at high risk for foot ulceration.
- Epidemiological and genome-wide association study of gastritis or gastric ulcer in korean populations. [Journal Article]
- Genomics Inform 2014 Sep; 12(3):127-33.
Gastritis is a major disease that has the potential to grow as gastric cancer. Gastric cancer is a very common cancer, and it is related to a very high mortality rate in Korea. This disease is known to have various reasons, including infection with Helicobacter pylori, dietary habits, tobacco, and alcohol. The incidence rate of gastritis has reported to differ between age, population, and gender. However, unlike other factors, there has been no analysis based on gender. So, we examined the high risk factors of gastritis in each gender in the Korean population by focusing on sex. We performed an analysis of 120 clinical characteristics and genome-wide association studies (GWAS) using 349,184 single-nucleotide polymorphisms from the results of Anseong and Ansan cohort study in the Korea Association Resource (KARE) project. As the result, we could not prove a strong relation with these factors and gastritis or gastric ulcer in the GWAS. However, we confirmed several already-known risk factors and also found some differences of clinical characteristics in each gender using logistic regression. As a result of the logistic regression, a relation with hyperlipidemia, coronary artery disease, myocardial infarction, hyperlipidemia therapy, hypotensive or antihypotensive drug, diastolic blood pressure, and gastritis was seen in males; the results of this study suggest that vascular disease has a potential association with gastritis in males.
- [Logistic regression analysis on risk factors of cerebral hemorrhage complicated with stress ulcer]. [English Abstract, Journal Article]
- Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2014 Oct; 26(10):730-3.
To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU).The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender, age, amount of bleeding, the bleeding site (basal ganglia, thalamus, brainstem, brain lobe, ventricle, subarachnoid, and cerebellum), disturbance of consciousness, acute physiology and chronic health evaluation II (APACHEII) score, systolic blood pressure (SBP), history of hypertension, and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve) was plotted to analyze the independent risk factors and evaluate their power of test.1 185 patients with cerebral hemorrhage were enrolled in the study, 293 cases occurred SU, accounting for 24.7%, and 892 cases without SU, which accounted for 75.3%. As shown by univariate analysis, risk factors for cerebral hemorrhage complicated with SU included age, amount of bleeding, the bleeding site, disturbance of consciousness, APACHEII score, SBP. As to the site of bleeding, brain, thalamus, brainstem hemorrhage complicated with SU were higher proportion, 45.3% (43/95), 39.1% (63/161), 36.9% (48/130), which were significantly higher than those of the lobes of the brain [26.2% (33/126)], cerebellum [18.8% (15/80)], basal ganglia [16.1% (78/485)], arachnoid the inferior vena cava [12.0% (13/108)]. Multivariate logistic regression analysis showed that amount of bleeding [odds ratio (OR)=3.305, P=0.001, 95% confidence interval (95%CI) 2.213-48.634], the bleeding site (OR=1.762, P=0.008, 95%CI 0.123-2.743), SBP (OR=1.223, P=0.034, 95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC) of amount of bleeding and SBP were 0.846 and 0.597, suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value.Cerebral hemorrhage patients with large amount of bleeding, the bleeding site in the ventricle, thalamus or brainstem, high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.
- A novel model of human skin pressure ulcers in mice. [Journal Article]
- PLoS One 2014; 9(10):e109003.
Pressure ulcers are a prevalent health problem in today's society. The shortage of suitable animal models limits our understanding and our ability to develop new therapies. This study aims to report on the development of a novel and reproducible human skin pressure ulcer model in mice.Male non-obese, diabetic, severe combined immunodeficiency mice (n = 22) were engrafted with human skin. A full-thickness skin graft was placed onto 4×3 cm wounds created on the dorsal skin of the mice. Two groups with permanent grafts were studied after 60 days. The control group (n = 6) was focused on the process of engraftment. Evaluations were conducted with photographic assessment, histological analysis and fluorescence in situ hybridization (FISH) techniques. The pressure ulcer group (n = 12) was created using a compression device. A pressure of 150 mmHg for 8 h, with a total of three cycles of compression-release was exerted. Evaluations were conducted with photographic assessment and histological analysis.Skin grafts in the control group took successfully, as shown by visual assessment, FISH techniques and histological analysis. Pressure ulcers in the second group showed full-thickness skin loss with damage and necrosis of all the epidermal and dermal layers (ulcer stage III) in all cases. Complete repair occurred after 40 days.An inexpensive, reproducible human skin pressure ulcer model has been developed. This novel model will facilitate the development of new clinically relevant therapeutic strategies that can be tested directly on human skin.
- Maggots as a wound debridement agent for chronic venous leg ulcers under graduated compression bandages: a randomised controlled trial. [JOURNAL ARTICLE]
- Phlebology 2014 Oct 8.
Slough in chronic venous leg ulcers may be associated with delayed healing. The purpose of this study was to assess larval debridement in chronic venous leg ulcers and to assess subsequent effect on healing.All patients with chronic leg ulcers presenting to the leg ulcer service were evaluated for the study. Exclusion criteria were: ankle brachial pressure indices <0.85 or >1.25, no venous reflux on duplex and <20% of ulcer surface covered with slough. Participants were randomly allocated to either 4-layer compression bandaging alone or 4-layer compression bandaging + larvae. Surface areas of ulcer and slough were assessed on day 4; 4-layer compression bandaging was then continued and ulcer size was measured every 2 weeks for up to 12 weeks.A total of 601 patients with chronic leg ulcers were screened between November 2008 and July 2012. Of these, 20 were randomised to 4-layer compression bandaging and 20 to 4-layer compression bandaging + larvae. Median (range) ulcer size was 10.8 (3-21.3) cm(2) and 8.1 (4.3-13.5) cm(2) in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Mann-Whitney U test, P = 0.184). On day 4, median reduction in slough area was 3.7 cm(2) in the 4-layer compression bandaging group (P < 0.05) and 4.2 cm(2) (P < 0.001) in the 4-layer compression bandaging + larvae group. Median percentage area reduction of slough was 50% in the 4-layer compression bandaging group and 84% in the 4-layer compression bandaging + larvae group (Mann-Whitney U test, P < 0.05). The 12-week healing rate was 73% and 68% in the 4-layer compression bandaging and 4-layer compression bandaging + larvae groups, respectively (Kaplan-Meier analysis, P = 0.664).Larval debridement therapy improves wound debridement in chronic venous leg ulcers treated with multilayer compression bandages. However, no subsequent improvement in ulcer healing was demonstrated.