Decubitus Ulcers [keywords]
- A Randomized, Controlled Trial to Assess the Effect of Topical Insulin Versus Normal Saline in Pressure Ulcer Healing. [JOURNAL ARTICLE]
- Ostomy Wound Manage 2016 Jun; 62(6):16-23.
Insulin has been used in wound healing to increase wound collagen, granulation tissue, wound tensile strength, and local production of insulin-like growth factors by fibroblasts. Saline is a widely used irrigating and wound dressing solution. Patients admitted to an acute care facility who had a Grade 2 or Grade 3 pressure ulcer were recruited to participate in a randomized, controlled trial to compare the effect of normal saline-impregnated gauze and insulin dressing in pressure ulcer healing. Persons with immunodeficiency, diabetes mellitus, pregnancy, osteomyelitis, and peripheral vascular illness were not eligible for the study. Study participants were randomized to receive either normal saline dressing gauze or insulin dressing twice daily for 7 days. At baseline, patient demographic data and ulcer history were recorded. Baseline and follow-up ulcer assessments (days 4 and day 7) included ulcer measurement (length and width) and completion of the Pressure Ulcer Scale for Healing (PUSH version 3.0) tool. Patients in the control group received dressings of sterile gauze soaked with normal saline; patients in the intervention group received topical insulin (1 U/cm2 wound area). The insulin was sprayed over the wound surface with an insulin syringe, allowed to dry for 15 minutes, and then covered with sterile gauze. To ascertain the safety of study participants, blood glucose levels were measured with a glucometer 10 minutes before and 1 hour after the topical insulin application in the intervention group. Treatment efficacy was deter- mined by assessing the reduction in wound area and PUSH scores at follow-up. Statistical analysis was performed; data are expressed as mean ± SD and percentage for continuous and categorical variables respectively. The differences in PUSH score and ulcer sizes between the 2 groups were analyzed using independent t-test, and within-group differences were analyzed using ANOVA with repeated measures; Greenhouse-Geisser correction was applied for the 3 consecutive measurements (day 1, day 4 and day 7). Fifty (50) patients (40 men, 10 women), ages 42.46 ± 15.47 years, with 50 ulcers, 25 in each treatment group, were enrolled. At baseline, demographic variables and wound characteristics were comparable between the 2 groups. By day 7, mean wound area had decreased from 11.79 ± 8.97 cm2 (day 1) to 11.43 ± 9.06 cm2 in the saline group (P = 0.566) and from 9.61 ± 6.39 cm2 (day 1) to 6.24 ± 4.33 cm2 (P less than 0.01) in the insulin group. Mean PUSH scores decreased from 10.52 ± 2.37 at baseline to 10.36 ± 2.40 on day 7 in the saline group (P = 0.475), and from 10.28 ± 1.10 to 8.52 ± 1.58 on day 7 (P less than 0.01) in the insulin group. No significant decrease in blood glucose level before and after insulin application (P greater than 0.05) was observed. Treatment with topical insulin was found be safe and effective in reducing pressure ulcer size as compared to normal saline-soaked gauze. Future studies utilizing larger sample sizes, longer follow-up times, and different types of chronic wounds and control treatments are warranted.
- Patients with HIV/Aids and ulcer risk: nursing care demands. [JOURNAL ARTICLE]
- Rev Bras Enferm 2016 Jun; 69(3):574-581.
to analyze the demand for nursing care and the risk of pressure ulcers (PU) of patients with HIV/Aids.quantitative survey, carried out from December 2012 to March 2013 in a public hospital of Teresina, state of Piauí, Brazil.the sample of 31 patients was predominantly male, mean age 36.6 years, average care demand 49.4%, most showing some risk of developing PU. The variables correlated with PU risk were care demand and clinical outcome (death). Those associated with care demand were age and clinical outcome (death).the results showed that patients require moderate nursing care needs and most of them present risk of developing PU.
- Pressure ulcers in critically ill patients: incidence and associated factors. [JOURNAL ARTICLE]
- Rev Bras Enferm 2016 Jun; 69(3):460-467.
to identify the incidence and describe the associated factors for pressure ulcers in critically ill patients.this was a prospective cohort study with 77 patients, using a clinical, metabolic assessment and the associated factors for pressure ulcer, applying the risk scales (Braden and Waterlow) and assigning ulcers to categories.an incidence of 22% (95% CI 12.6 - 31.5), with 17 patients with 32 pressure ulcers in the sacral region (47%), and of Class I (72%). The length of stay was greater than ten days (71%), most admissions were surgical (53%) or for congestive heart failure (24%), and were high risk on the Braden Scale (59%).the study highlights the high incidence of pressure ulcers, clinical and metabolic characteristics and associated factors, as well as the outcome of death, requiring, therefore, preventive measures.
- Low Cost Inkjet Printed Smart Bandage for Wireless Monitoring of Chronic Wounds. [Journal Article]
- Sci Rep 2016.:28949.
Chronic wounds affect millions of patients around the world and their treatment is challenging as the early signs indicating their development are subtle. In addition, a type of chronic wound, known as pressure ulcer, develops in patients with limited mobility. Infection and frequent bleeding are indicators of chronic wound development. In this article, we present an unprecedented low cost continuous wireless monitoring system, realized through inkjet printing on a standard bandage, which can send early warnings for the parameters like irregular bleeding, variations in pH levels and external pressure at wound site. In addition to the early warnings, this smart bandage concept can provide long term wound progression data to the health care providers. The smart bandage comprises a disposable part which has the inkjet printed sensors and a reusable part constituting the wireless electronics. This work is an important step towards futuristic wearable sensors for remote health care applications.
- Correspondence. [JOURNAL ARTICLE]
- Nurs Manag (Harrow) 2002 Jan 1; 8(8):39.
To the editor Further to the LPNS lecture given by Sarah Mullally, chief nursing officer for England (Nursing Management July 2001), I would like to inform readers of a pilot audit project that commenced also in July. The aim is to assess the impact of implementation of the RCN Clinical Guidelines on Pressure Ulcer Risk Assessment and Prevention, which are designed to promote continuous quality improvement by providing high quality treatment and care, to reduce pressure ulcer development and, therefore, potentially, length of stay and resource use.
- Patient safety events in hospital care of individuals with epilepsy. [JOURNAL ARTICLE]
- Epilepsia 2016 Jun 28.
(1) To describe patient adverse events (PAEs) experienced by hospitalized individuals with epilepsy and examine the association of an epilepsy diagnosis on risk of specific PAEs; (2) to examine the impact of a PAE on (a) length of stay (LOS), (b) inpatient death, and (c) use of institutional post-acute care.We applied the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) software to the National Inpatient Sample database to identify potential medical and postoperative PAEs among >72 million hospitalizations of adults in the United States from 2000 to 2010. Logistic regression models compared the odds of experiencing each PAE between hospitalizations of persons with epilepsy (PWE) and the general inpatient population. We also examined the impact of experiencing a PAE on LOS, inpatient death, and discharge disposition.Hospitalized PWEs were at increased risk for specific postoperative PAEs: fall with hip fracture (Adjusted Odds Ratio, AOR 1.90, 1.21-2.99), respiratory failure (AOR 2.64, 2.43-2.87), sepsis (AOR 1.41, 1.21-1.63), and preventable postoperative death (AOR 1.25, 1.15-1.36). The odds of perioperative pulmonary embolism/deep vein thrombosis (AOR 1.65, 1.57-1.73), skin pressure ulcer (AOR 1.25, 1.22-1.29), and central venous catheter-related bloodstream infections (AOR 1.24, 1.17-1.32) were also greater among hospitalizations of PWEs. Experiencing a PAE was associated with a prolonged mean length of stay (15 days vs. 5 days, t-test p < 0.001), a 416% increase in the odds of inpatient death (AOR 4.16, 3.95-4.38), and a 282% increase in use of high-level post-acute care (AOR 2.82, 2.72-2.93).Hospitalized adults with epilepsy are vulnerable to specific safety-related adverse events, and these potential patient safety failures substantially impact outcomes and resource use. Efforts to reduce long-term disability and improve the value of care delivered to PWEs may need to consider provider-level interventions to reduce adverse events.
- [FREQUENCY OF PRESSURE ULCERS IN PATIENTS HOSPITALIZED IN THE CORONARY AND INTENSIVE UNIT CARE OF A HIGH SPECIALITY HOSPITAL]. [English Abstract, Journal Article]
- Rev Enferm 2016 Apr; 39(4):46-51.
The Pressure Ulcer Scale for Healing (PUSH) represent a serious problem around the world since they have important consequences, personal and economic, this making it a public problem health. The PUSH are a challenge for professionals nursing at all levels of care.Identify the frequency of Pressure Ulcer Scale for Healing in patients hospitalized in coronary and intensive unit care of a high specialty hospital.A descriptive, observational, prospective, and cross-sectional study. The population was composed of 139 patients who were admitted in June and July period of 2015 in the Coronary and Intensive Unit Care.The total of patients valued (139) show a mean age of 50 years old, the 51.8% male, of these the 61.4% developed a skin lesion related to prostration. The 84.17% are not mobilized as recommended, of these the (45.3%) belonged to Neurosurgery, with a range hospital stay from 1 to 36-day. The 79.8% (111 patients) were under sedation drug. Directly related to the emergence of PUSH, obtaining 41% of patients ulcerated lesions the 8.2 average days.The PUSH as problem are present in a Coronary and General Intensive Care Unit frequently (41%) in June and July of 2015. The care and treatment of people with PUSH must be dynamic and interdisciplinary.
- Treating Pressure Ulcers with Clostridial Collagenase Ointment: Results From the US Wound Registry. [JOURNAL ARTICLE]
- Wound Repair Regen 2016 Jun 27.
We assessed the clinical effectiveness of clostridial collagenase ointment as an adjunct to selective debridement compared with selective debridement alone for the management of stage IV pressure ulcers in the hospital outpatient department setting. Outcomes data were derived from retrospective de-identified electronic medical records from 2007-2013 using the United States Wound Registry. A propensity score method was used to adjust for selection bias and to test for treatment effect between pressure ulcers treated with clostridial collagenase ointment plus selective debridement versus selective debridement alone. A total of 337 clostridial collagenase ointment and 336 non-clostridial collagenase ointment stage IV pressure ulcers were identified. The proportion of wounds closed at any time (e.g., at 1 year or 2 years) was 2 times greater for stage IV pressure ulcers treated with clostridial collagenase ointment compared with those not treated with clostridial collagenase ointment. Kaplan-Meier analysis showed that time to wound closure at 1 year was significantly faster for pressure ulcers treated with clostridial collagenase ointment versus pressure ulcers not treated with clostridial collagenase ointment. Among those with 5 or more clostridial collagenase ointment applications or selective debridement treatments, significantly more clostridial collagenase ointment-treated pressure ulcers were closed at 1 or 2 years than non-clostridial collagenase ointment-treated pressure ulcers. Clostridial collagenase ointment as an adjunct to selective debridement improved clinical outcomes and provided faster rates of closure of stage IV pressure ulcers relative to selective debridement alone. This article is protected by copyright. All rights reserved.
- Prophylactic use of dressings for pressure ulcer prevention in the critical care unit. [Journal Article]
- Br J Nurs 2016 Jun 23; 25(12):S6-S12.
Multiple comorbidities and intensive therapy increase the risk of pressure ulcer (PU) development in critical care unit (CCU) patients. Given the high number of risk factors that CCU patients present with, it is important to acknowledge that not all PUs are entirely preventable, and incidence is thought to be between 14% and 42%. The consequences of acquiring a PU in critical care include increased mortality, morbidity and longer length of stay. Implementing prevention strategies as soon as the patient enters the unit can significantly reduce incidence. By adopting a proactive versus reactive mind-set, one CCU abandoned traditional PU risk assessment and implemented a number of intensive interventions, including the use of a prophylactic sacral dressing as an adjunct. As a result, PU incidence fell from 19.9 per 1000 patient population to 0.84 per 1000 patient population in 2014. In addition, 310 PU-free days were achieved.
- Educational campaign to increase knowledge of pressure ulcers. [Journal Article]
- Br J Nurs 2016 Jun 23; 25(12):S30-5.
A pressure ulcer (PU) steering group was set up in Zhongda Hospital in China to develop a campaign to increase knowledge of PUs, to improve management and reduce incidence.Questionnaires were completed by 275 nurses to ascertain their knowledge of PUs. The initial questionnaire indicated that the nurses had insufficient knowledge of PUs. The steering group then ran a campaign focusing on standardising the management of PUs. The measurement of PU knowledge for all nurses was tested after 2 years of training.After 2 years, the nursing staff's knowledge of PUs had improved. Usage of the Braden scale had risen from (60.0±22.9) to (88.0±9.0) and showed a statistically significant difference (p<0.01). Moreover, the rate for patients reported as being at high risk of developing a PU had increased from 0.98% in 2012 to 1.24% in 2013, while the occurrence rate of PUs in the hospital had decreased from 0.09% in 2012 to 0.05% in 2013.The campaign significantly enhanced the knowledge of PUs and improved the ability of nursing staff to evaluate PU risks, resulting in a decrease in the occurrence of PUs.