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Decubitus Ulcers [keywords]
- Heel Response to External Pressure: Is it the Same in Healthy Community-Dwelling Adults and in Hip Surgery Patients? [JOURNAL ARTICLE]
- J Wound Ostomy Continence Nurs 2014 Aug 28.
The purpose of the study was to determine whether the interface pressure created when the heel is in contact with the bed surface reduced healthy adults' heel oxygen delivery (transcutaneous oxygen [TcO2]) and raised heel skin temperature. We also determined whether there was a hyperemic response to pressure relief on 3 consecutive days, and compared data from healthy adults to that from hip surgery patients.A 1-group, prospective, repeated-measures design guided data collection and analysis.Eighteen subjects were age (±5 years) and gender-matched with a previous study on hip surgery patients. The mean age of study participants was 57.3 ± 15.75 (mean ± SD) years and half were men (n = 9).Oxygen and temperature sensors were placed on the plantar surface of each foot, close to the heels. Measures were taken when the heels were (1) suspended above the bed surface (preload), (2) on the bed surface for 15 minutes (loading), and (3) again suspended above the bed surface for 15 minutes (unloading). Repeated measures analysis of variance was used to analyze the data.When compared with preload, both loading and unloading on all 3 days resulted in a statistically significant bilateral reduction in heel TcO2 (P < .001) and a bilateral increase in heel skin temperature (P = .001). There was a significant bilateral heel hyperemic response (during the first 3 minutes of immediate heel unloading) on all 3 days. There were significant changes in heel TcO2 (P = .008) and heel skin temperature (P < .001) in both legs when pressure was relieved. The hyperemic response was not apparent in the operative leg in our prior hip surgery group. When comparing one of the legs of the healthy adults with the operative leg of the prior hip surgery patients, heel TcO2 in both groups decreased (P < .001) while heel skin temperature increased during both loading and unloading in all 3 days (P < .001).Heel TcO2 fell while heel skin temperature increased with both the application and removal of external pressure in healthy adults. The fall in TcO2 and the rise in heel skin temperature were also apparent in the operative leg of the hip surgery group. The brief period of hyperemia, measured by abrupt changes in heel TcO2 and heel skin temperature, was present only in healthy subjects. This raises the question of whether heel pressure ulcer development is related to a blunted hyperemic response in subjects with hip surgery. Further studies are needed that explore the effects of varying the duration of pressure on the hyperemic response as a strategy to understand heel pressure ulcer prevention. Since heel TcO2 fell in both groups after a brief pressure application of 15 minutes, nurses should keep heels off-load at all times to ensure adequate heel skin oxygenation.
- The Impact of Pressure Ulcers on Individuals Living with a Spinal Cord Injury. [JOURNAL ARTICLE]
- Arch Phys Med Rehabil 2014 Aug 25.
To describe the impact of pressure ulcers on the ability to participate in daily and community activities, healthcare utilization, and overall quality of life in individuals living with spinal cord injury (SCI).Cross-sectional study SETTING: Canada-wide survey PARTICIPANTS: A total of 1137 participants with traumatic SCI and greater than one year post-injury living in the community were recruited of which 381 (33.5%, 95% CI = 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 (RHSCIR CFQ-V2.0).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 one or two pressure ulcers were more dissatisfied with their ability to participate in their main activity than those without pressure ulcers (p = 0.0077). Pressure ulcers were also associated with a significantly higher number of consultations with family doctors, nurses, occupational therapists, and wound care nurse/specialist (p < 0.05).Pressure ulcers 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 healthcare professionals.
- Cochrane reviews. [JOURNAL ARTICLE]
- Nurs Manag (Harrow) 2014 Aug 28; 21(5):17.
Evidently Cochrane is a website designed to make Cochrane evidence readily accessible through weekly blogs and articles containing new or updated reviews on various health-related topics. There are blogs and articles for front line staff, patients and carers as well as commissioners, policy makers and researchers focusing on, for example, warfarin loading doses, pressure-ulcer risk assessment, diagnostic test accuracy reviews, and challenges for research and current problems. There are also blogs about using social media, for sharing evidence with a vast audience and in a variety of ways. To find out more go to evidentlycochrane.net.
- Nitrate and nitrite in the diet: How to assess their benefit and risk for human health. [JOURNAL ARTICLE]
- Mol Nutr Food Res 2014 Aug 27.
Nitrate is a natural constituent of the human diet and an approved food additive. It can be partially converted to nitrogen monoxide, which induces vasodilation and thereby decreases blood pressure. This effect is associated with a reduced risk regarding cardiovascular disease, myocardial infarction and stroke. Moreover, dietary nitrate has been associated with beneficial effects in patients with gastric ulcer, renal failure or metabolic syndrome. Recent studies indicate that such beneficial health effects due to dietary nitrate may be achievable at intake levels resulting from the daily consumption of nitrate-rich vegetables. N-nitroso compounds are endogenously formed in humans. However, their relevance for human health has not been adequately explored up to now. Nitrate and nitrite are per se not carcinogenic, but under conditions that result in endogenous nitrosation it cannot be excluded that ingested nitrate and nitrite may lead to an increased cancer risk probably be carcinogenic to humans. In this review the known beneficial and detrimental health effects related to dietary nitrate/nitrite intake are described and the identified gaps in knowledge as well as the research needs required to perform a reliable benefit/risk assessment in terms of long-term human health consequences due to dietary nitrate/nitrite intake are presented. This article is protected by copyright. All rights reserved.
- Behaviour of the plasma concentration of gelatinases and their tissue inhibitors in subjects with venous leg ulcers. [JOURNAL ARTICLE]
- Clin Hemorheol Microcirc 2014 Aug 26.
Venous leg ulcers are common in subjects with chronic venous insufficiency. The increased intraluminal pressure causes alteration of the skin microcirculation, leukocyte activation and release of proteolytic enzymes leading to ulceration. An impaired expression and activity of matrix metalloproteases (MMPs) and their tissue inhibitors (TIMPs) might influence extracellular matrix degradation and deposition in chronic venous ulcers with the failure of the healing process. Our aim was to evaluate plasma concentration of gelatinases (MMP-2 and MMP-9) and their inhibitors (TIMP-1 and TIMP-2) in subjects with venous leg ulcers before and after the compression therapy. We enrolled 36 subjects (12 men and 24 women, mean age 67.38 ± 12.7 yrs) with non-infected venous leg ulcers (CEAP C6), which underwent a color Duplex scan examination of the veins and arteries of the inferior limbs and were treated with a multi-layer bandaging system. The ulcer healing was obtained in 23 subjects only (9 men and 14 women). We evaluated, on fasting venous blood, the plasma levels of MMP-2, MMP-9, TIMP-1 and TIMP-2 using ELISA kit, before and after the treatment. We observed a significant increase in plasma concentration of gelatinases and their inhibitors and in MMP-2/TIMP-2 ratio in subjects with leg ulcers in comparison with normal controls. In subjects with healed ulcers we found a decrease in MMP-9 and TIMP-1 levels and in MMP-2/TIMP-2 ratio compared to the baseline values, although higher levels of all the examined parameters in comparison with normal controls. In conclusion, plasma MMPs profile is impaired in subjects with venous leg ulcers and it improves after the healing, persisting anyway altered in respect to healthy controls.
- The effect of a transforming care initiative on patient outcomes in acute surgical units: a time series study. [JOURNAL ARTICLE]
- J Adv Nurs 2014 Aug 27.
To examine the relationship between the implementation of a transforming care initiative and two patient outcomes, inpatient falls and hospital acquired pressure ulcers.Patients continue to experience harm in hospitals from adverse events such as inpatient falls and hospital acquired pressure ulcers. These and other patient safety concerns led to transforming care initiatives.This cohort study used historical controls and a time series design. The setting was two surgical units of an acute care hospital; 7125 patients discharged from these units between July 2008-December 2010 were included. Those patients discharged during the initial 3 months of implementation were excluded. Several interventions were adopted as part of the transforming care initiative such as bedside handover and bedside whiteboards. Coded administrative data were accessed to identify patients who had experienced a fall or acquired a pressure ulcer during their hospital stay. Statistical process control was used to identify changes in outcomes over time.The findings demonstrated variation in the proportion of patients experiencing a fall in both units and for the proportion of patients acquiring a pressure ulcer in one unit, following implementation.These results demonstrate that implementing a transforming care initiative may have some influence on the quality and safety of patient care as measured by patient falls and pressure ulcers but findings varied. Further research is required to gain an understanding of the inconsistency of the impact of these initiatives across all clinical contexts.
- A New Way for Antihelixplasty in Prominent Ear Surgery: Modified Postauricular Fascial Flap. [JOURNAL ARTICLE]
- Ann Plast Surg 2014 Aug 25.
Otoplasty procedures aim to reduce the concha-mastoid angle and recreate the antihelical fold. Here, we explained the modified postauricular fascial flap, described as a new way for recreating the antihelical fold, and reported the results of patients on whom this flap was used.The defined technique was used on 24 patients (10 females and 14 males; age, 6-27 years; mean, 16.7 years) between June 2009 and July 2012, a total of 48 procedures in total (bilateral). Follow-up ranged from 1 to 3 years (mean, 1.5 years). At the preoperative and postoperative time points (1 and 12 months after surgery), all patients were measured for upper and middle helix-head distance and were photographed. The records were analyzed statistically using t test and analysis of variance.The procedure resulted in ears that were natural in appearance without any significant visible evidence of surgery. The operations resulted in no complications except 1 patient who developed a small skin ulcer on the left ear because of band pressure. When we compared the preoperative and postoperative upper and middle helix-head distance, there was a high significance statistically.To introduce modified postauricular fascial flap, we used a simple and safe procedure to recreate an antihelical fold. This procedure led to several benefits, including a natural-in-appearance antihelical fold, prevention of suture extrusion and granuloma, as well as minimized risk for recurrence due to neochondrogenesis. This method may be used as a standard procedure for treating prominent ears surgically.
- New pressure ulcer risk tool moves forward with implementation study. [Journal Article]
- OR Manager 2014 Jul; 30(7):20-1.
- Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients. [JOURNAL ARTICLE]
- Int J Nurs Pract 2014 Aug; 20(4):418-423.
The objective of this study was to assess relationship between smoking, some other risk factors and ulcers development in intensive care unit. This prospective cohort study was performed in two university-affiliated hospitals. The sample consisted of adult male patients who were admitted to medical-surgical intensive care units. All eligible patients were grouped according to their cigarette smoking status as smoker and non-smoker. The final sample included 160 smokers and 192 non-smokers. Pressure ulcer occurred in 62 smoker patients and 28 of non-smoker who showed significant difference. Also number of pack-year of cigarettes smoking showed significant association with ulcer development. Ulcer stage was significantly different between the two groups. Besides of smoking, age, length of stay, faecal incontinency, diabetes mellitus, anaemia and trauma were significantly associated with pressure ulcers. Our study showed significant association between smoking and development of pressure ulcers.
- A longitudinal study of foot ulceration and its risk factors in community-based patients with type 2 diabetes: The Fremantle Diabetes Study. [JOURNAL ARTICLE]
- Diabetes Res Clin Pract 2014 Jul 26.
To determine the prevalence and associates of foot ulcer, and the subsequent incidence and predictors of first-ever hospitalisation for this complication, in well-characterised community-based patients with type 2 diabetes.Baseline foot ulceration was ascertained in 1296 patients (mean age 64 years, 48.6% male, median diabetes duration 4.0 years) recruited to the longitudinal Fremantle Diabetes Study between 1993 and 1996. Incident hospitalisation for foot ulceration was monitored through validated data linkage until end-December 2010.At baseline, 16 participants (1.2%) had a foot ulcer which was independently associated with intermittent claudication, peripheral sensory neuropathy (PSN) and diabetes duration (P≤0.01). The incidence of hospitalisation for this complication in those without prior/prevalent foot ulceration was 5.21 per 1000 patient-years. This rate and other published data suggest that 1 in 7-10 foot ulcers require hospitalisation. In a Cox proportional hazards model, intermittent claudication and PSN were significant independent predictors of time to admission with foot ulceration, in addition to retinopathy, cerebrovascular disease, HbA1c, alcohol consumption, renal impairment, peripheral arterial disease and pulse pressure (P≤0.038).These data confirm PSN as an important risk factor for foot ulceration but, in contrast to some other studies, peripheral arterial disease was also a major independent contributor. Associations between hospitalisation for foot ulcer and both retinopathy and raised pulse pressure suggest a role for local microvascular dysfunction, while alcohol may have non-neuropathic toxic effects on skin/subcutaneous structures. The multifactorial nature of foot ulceration complicating type 2 diabetes may have implications for its management.