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Decubitus Ulcers [keywords]
- Pressure ulcer risk assessment and prevention: What difference does a risk scale make? A comparison between Norway and Ireland. [Journal Article]
- J Wound Care 2014 Jul; 23(7):369-78.
Objective:To explore similarities and differences in nurses' views on risk assessment practices and preventive care activities in a context where patients' risk of developing pressure ulcers is assessed using clinical judgment (Norway) and a context where patients' risk of developing pressure ulcers is assessed using a formal structured risk assessment combined with clinical judgement (Ireland). Method: A descriptive, qualitative design was employed across two different care settings with a total of 14 health care workers, nine from Norway and five from Ireland.
Results:Regardless of whether risk assessment was undertaken using clinical judgment or formal structured risk assessment, identified risk factors, at risk patients and appropriate preventive initiatives discussed by participant were similar across care settings. Furthermore, risk assessment did not necessarily result in the planning and implementation of appropriate pressure ulcer prevention initiatives. Thus, in this instance, use of a formal risk assessment tool does not seem to make any difference to the planning, initiation and evaluation of pressure ulcer prevention strategies.
Conclusion:Regardless of the method of risk assessment, patients at risk of developing pressure ulcers are detected, suggesting that the practice of risk assessment should be re-evaluated. Moreover, appropriate preventive interventions were described. However, the missing link between risk assessment and documented care planning is of concern and barriers to appropriate pressure ulcer documentation should be explored further. Declaration of interest: This work is partly funded by a research grant from the Norwegian Nurses Organisation (NNO) (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.
- The effect of a ceramide-containing dressing in preventing pressure ulcers. [Journal Article]
- J Wound Care 2014 Jul; 23(7):347-53.
Objective:To evaluate the effect of a ceramide-containing dressing (Remois Pad®) on preventing pressure ulcers. Method: A total of 32 patients (64 samples) with a Braden Scale score of 16 or less in intensive care units were enrolled to have the dressing applied for an experimental bilateral comparison study. The dressing was randomly applied to the right or left greater trochanter for 7 days. Incidence of nonblanching erythema and the water-holding capacity of the skin were measured on the third day and seventh day after intervention.
Results:On the third day after intervention, nonblanching erythema was not apparent in either the experimental or the control groups. On the seventh day, one (3.3%) and four (13.3%) cases of nonblanching erythema were observed in the experimental group and the control group, respectively; however, the difference was not statistically significant. The water-retaining capacity of the skin on the third and seventh days after the intervention was significantly higher than that of the control group.
Conclusion:The data collected from this study gave no evidence that a ceramide-containing dressing had an effect on preventing pressure ulcers in the greater trochanter area. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
- Ilium pressure ulcer with pathognomonic wound deformity: the "cliff phenomenon" [JOURNAL ARTICLE]
- Int J Dermatol 2014 Jul 11.
- The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents. [JOURNAL ARTICLE]
- Biol Res Nurs 2014 Jul 18.
Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30° supine tilt and 0° supine positions and over the trochanter major in 30° lateral and 90° lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.Interface pressure was significantly higher in the 0° supine and 90° lateral positions than in 30° supine tilt and 30° lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30° supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.The 30° supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.
- Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment. [JOURNAL ARTICLE]
- Am J Nurs 2014 Jul 17.
: How one hospital reduced the incidence of hospital-acquired pressure ulcers to zero.Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India (now known as the Narayana Institute of Cardiac Sciences), is one of the world's largest and busiest cardiac hospitals. In early 2009,NHCH experienced a sharp increase in the number of surgical procedures performed and a corresponding rise in hospital-acquired pressure ulcers. The hospital sought to reduce pressure ulcer prevalence by implementing a portfolio of quality improvement strategies. Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers. By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program's success and sustainability include strong leadership, nurse and physician involvement, an emphasis on personal responsibility, improved documentation and communication, ongoing training and support, and a portfolio of low-tech changes to core workflows and behaviors. Many of these elements are applicable to U.S. acute care environments.
- Psychometric properties of the dutch national prevalence measurement of care problems used to measure quality of pressure ulcer care in indonesian hospitals. [Journal Article]
- Adv Skin Wound Care 2014 Aug; 27(8):363-70.
To evaluate the psychometric properties of the Indonesian version of the Dutch National Prevalence Measurement of Care Problems. The questionnaire consists of 6 parts: patient characteristics (including pressure ulcer [PrU] risk; assessed by the Braden Scale) and care dependency (assessed by the Care Dependency Scale [CDS]), PrU categorization, prevention, treatment, and structural quality indicators at ward and hospital level.A 3-phase design was used, including questionnaire translation and psychometric testing. The questionnaire was translated into Indonesian on March 2012. Content validity was assessed by 18 Indonesian experts on July 2012. The interrater agreement and reliability of the PrU categories, Braden Scale, and CDS were assessed on October 2012 in 4 Indonesian large public general hospitals.Most Indonesian experts (91.8%) rated the Indonesian version of the questionnaire as "good" on clarity of wording. The content validity indices of the questionnaire ranged from 0.50 to 1.00. The PrU categories assessed showed an interrater reliability of κ = 0.92 (95% confidence interval [CI], 0.87-0.97) and an interrater agreement of po = 98.6% (95% CI, 97.5-99.3). The interrater reliability intraclass correlation coefficient (1,1) of the Braden Scale sum score was 0.90 (95% CI, 0.85-0.93). The exact proportion of agreement sum score was 39%. The interrater reliability intraclass correlation coefficient (1,1) of the CDS sum score was 0.88 (95% CI, 0.83-0.92). There was a 45% exact agreement on the CDS sum scores.The questionnaire can be used in Indonesian hospitals to measure the PrU prevalence and quality of PrU care.
- The Use of PriMatrix, a Fetal Bovine Acellular Dermal Matrix, in Healing Chronic Diabetic Foot Ulcers: A Prospective Multicenter Study. [Journal Article]
- Adv Skin Wound Care 2014 Aug; 27(8):356-62.
The objective of this multicenter study was to prospectively evaluate the healing outcomes of chronic diabetic foot ulcers (DFUs) treated with PriMatrix (TEI Biosciences, Boston, Massachusetts), a fetal bovine acellular dermal matrix.Inclusion criteria required the subjects to have a chronic DFU that ranged in area from 1 to 20 cm and failed to heal more than 30% during a 2-week screening period when treated with moist wound therapy. For qualifying subjects, PriMatrix was secured into a clean, sharply debrided wound; dressings were applied to maintain a moist wound environment, and the DFU was pressure off-loaded. Wound area measurements were taken weekly for up to 12 weeks, and PriMatrix was reapplied at the discretion of the treating physician.A total of 55 subjects were enrolled at 9 US centers with 46 subjects progressing to study completion. Ulcers had been in existence for an average of 286 days, and initial mean ulcer area was 4.34 cm. Of the subjects completing the study, 76% healed by 12 weeks with a mean time to healing of 53.1 ± 21.9 days. The mean number of applications for these healed wounds was 2.0 ± 1.4, with 59.1% healing with a single application of PriMatrix and 22.9% healing with 2 applications. For subjects not healed by 12 weeks, the average wound area reduction was 71.4%.The results of this multicenter prospective study demonstrate that the use of PriMatrix integrated with standard-of-care therapy is a successful treatment regimen to heal DFUs.
- The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program. [JOURNAL ARTICLE]
- J Spinal Cord Med 2014 Jul 16.
Objectives To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Design Quality improvement. Setting SCI Rehabilitation Center. Participants Inpatients admitted January 2012 to July 2013. Interventions 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. Outcome Measures Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Results 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). Conclusion 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.
- Who needs surgery for pediatric myelomeningocele? A retrospective study and literature review. [JOURNAL ARTICLE]
- J Spinal Cord Med 2014 Jul 16.
Introduction Children with myelomeningocele (MMC) are usually subjected to multiple surgeries. However, the number and type of surgeries are not the same in every patient with MMC over time. This report summarizes the surgical interventions in a cohort of several ages. Materials and methods Data on all of the patients with MMC, aged from 1 year and 10 months to 21 years and 11 months, were retrospectively reviewed at the Dona Estefânia Hospital in Lisbon, Portugal. Data were collected by chart review and individual interviews. The factors analyzed were demographics, ambulatory status, neurological level of involvement, shunt status, Arnold-Chiari malformation type II, surgical history, and occurrence of fracture. The surgical interventions were categorized as neurosurgical, orthopedic, urinary, ulcer repair and others. Results A total of 84 alive were eligible and enrolled. The average age was 14 years and six months. A total of 59 patients received shunts (all but one ventriculoperitoneal). In the study group, the 84 patients required 663 surgeries. Neurosurgical interventions were the most frequent surgical procedure and predominated during the first 2 years of life. Surgical interventions related to shunts were the most common neurosurgical interventions. Orthopedic surgeries were more frequent in the age group 6-12 years. Urological surgeries were done mainly after 6 years of age. Surgical repair of pressure ulcers was more common after 12 years of age. Conclusions Our study brings to light the complexity of this condition, with multiple surgeries among patients with MMC.
- [Cross-sectional lesions : Still an interdisciplinary challenge.] [JOURNAL ARTICLE]
- Orthopade 2014 Jul 6.
Spinal cord injuries with symptoms of paraplegia remain incurable even 5000 years after the first description. However, the treatment of the residual paralysis and sensory deficits at the level of or below the spinal injury has made great progress.This study involved a selective literature review with an emphasis on historical development, epidemiology, classification, acute and secondary rehabilitation after spinal cord injury with specific aspects of hand surgery in tetraplegia, decubitus treatment and urological specialist care, taking the experiences in a specialized center for spinal cord injuries into account.Modern comprehensive management started in the 1940s led by Sir Ludwig Guttmann. Early operative decompression and stabilization of spinal injuries is safe and can reduce secondary damage to the spinal cord but definitive evidence is lacking. Operative approaches provide advantages for the patient compared to conservative therapy, e.g. being able to be immediately transferred to a specialized center. Epidemiologically, the proportion of women and the average age has increased during the past decades, as well as the percentage of patients with tetraplegia. Common sequelae of spinal cord injuries include disorders of the digestive and urogenital system, autonomic regulation, chronic pain as well as swallowing and breathing restrictions. Frequent complications, such as thrombosis and pulmonary embolism, heterotopic ossification, decubitus ulcers, contractures, neuropathic pain and spasticity can impede rehabilitation. The general objective of rehabilitation and life-long care of patients with spinal cord injuries is to achieve the greatest possible autonomy, mobility, integration, employability and quality of life. A partial recovery of arm and grip function by surgical muscle or nerve transposition, joint stabilization and tenodesis can reliably support these goals in approximately 70 % of patients with tetraplegia.Spinal cord injuries require holistic interdisciplinary therapy from the beginning and regular life-long comprehensive and specific orthopedic examinations are also required to maintain the best possible level of independence.