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Decubitus Ulcers [keywords]
- Device-related atypical pressure ulcer after cardiac surgery. [Journal Article]
- J Wound Care 2014 Aug; 23(8):383-7.
Medical devices must be closely monitored to prevent harm to patients. Pressure ulcers secondary to medical devices present a significant health burden in terms of length of stay in hospital and cost. Intensivists, anaesthetists and other professionals involved in managing critically ill patients following cardiac surgery need to be aware that pressure ulcers may develop in atypical sites and present at a later stage of the hospital stay. This case report highlights the important issue of device-related pressure ulcers in the cardiac surgical intensive care setting, particularly when the clinical status of the patient may preclude routine assessment and prophylaxis. An algorithm for preventing such pressure ulcers is suggested.No competing interests declared.
- Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. [JOURNAL ARTICLE]
- J Adv Nurs 2014 Aug 19.
To identify predictive factors associated with the development of pressure ulcers in patients at risk who receive standardized preventive care.Numerous studies have examined factors that predict risk for pressure ulcer development. Only a few studies identified risk factors associated with pressure ulcer development in hospitalized patients receiving standardized preventive care.Secondary analyses of data collected in a multicentre randomized controlled trial.The sample consisted of 610 consecutive patients at risk for pressure ulcer development (Braden Score <17) receiving standardized preventive care measures. Patient demographic information, data on skin and risk assessment, medical history and diagnosis were collected during 26 months (December 2007-January 2010). Predictive factors were identified using multivariate statistics.Pressure ulcers in category II-IV were significantly associated with non-blanchable erythema, urogenital disorders and higher body temperature. Predictive factors significantly associated with superficial pressure ulcers were admission to an internal medicine ward, incontinence-associated dermatitis, non-blanchable erythema and a lower Braden score. Superficial sacral pressure ulcers were significantly associated with incontinence-associated dermatitis.Despite the standardized preventive measures they received, hospitalized patients with non-blanchable erythema, urogenital disorders and a higher body temperature were at increased risk for developing pressure ulcers.Improved identification of at-risk patients can be achieved by taking into account specific predictive factors. Even if preventive measures are in place, continuous assessment and tailoring of interventions is necessary in all patients at risk. Daily skin observation can be used to continuously monitor the effectiveness of the intervention.
- Compression therapy: scientific background and practical applications. [JOURNAL ARTICLE]
- J Dtsch Dermatol Ges 2014 Aug 18.
Compression bandaging is the most prevalent form of treatment for venous leg ulcers. Successful treatment requires knowledge of the appropriate materials and the ability to employ them following current guidelines. This study investigates German health-care providers for their knowledge of bandage materials and their practical ability in applying short-stretch compression bandages.Within the framework of nationwide practical education on compression therapy, the participants' knowledge was quantified by asking standardized questions. Furthermore, their practical ability was evaluated by having them apply compression bandages within a pressure range of 50-60 mmHg. Another criterion was the pressure drop after a four-time dorsiflexion.Overall, 891 providers (3.3 % physicians, 5.5 % medical assistants, 90.7 % nursing staff) participated. Within the practical test only few (just under 10%) applied the bandages with the intended pressure; 77.0 % applied them below and 13.7 % above the target pressure. After a four-time dorsiflexion there was an average pressure drop of 6.7 mmHg. Surveying the participant's skills revealed that only 11.9 % knew about padding beneath compression bandages, 15.0 % knew of multi-component systems, and 14.8 % were familiar with ulcer stocking systems.Clearly, compression material and its application are unfamiliar to most practice employees. Without question there are deficits in the provision of compression therapy.
- The pieper-zulkowski pressure ulcer knowledge test. [Journal Article]
- Adv Skin Wound Care 2014 Sep; 27(9):413-20.
To describe the development and initial testing of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT).Cross-sectional, instrument testing.Hospital association pressure ulcer educational program conference.Pressure ulcer research and guidelines from the last 5 years were examined for test item content. The initial PZ-PUKT had 115 items; response options were "true," "false," and "don't know." Registered nurses (N = 108) were randomly divided into 2 groups to take either the 60 prevention/risk and staging items or the 55 wound description items. Analyses of these responses resulted in 72 items, which were administered in total to a second cohort of 98 nurses for reliability.Cronbach's α was .80 for the 72-item PZ-PUKT. Cronbach's α values for the subscales were as follows: staging, .67; wound description, .64; and prevention/risk, .56. The mean correct scores were as follows: total, 80%; prevention, 77%; staging, 86%; and wound description, 77%. Nurses with wound care certification scored significantly higher on the PZ-PUKT than did nurses with other clinical certifications or with nurses who lacked certification.The PZ-PUKT has updated content about pressure ulcer prevention/risk, staging, and wound description. Reliability values are highest for the total test. Further use of the instrument in diverse settings will add to reliability testing and may provide direction for determination of a passing cutoff score.
- Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know. [JOURNAL ARTICLE]
- J Spinal Cord Med 2014 Aug 17.
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.
- Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions. [REVIEW]
- Sleep Med Rev 2014 Jul 18.
The symptom intensity and mortality of human diseases, conditions, and syndromes exhibit diurnal or 24 h patterning, e.g., skin: atopic dermatitis, urticaria, psoriasis, and palmar hyperhidrosis; gastrointestinal: esophageal reflux, peptic ulcer (including perforation and hemorrhage), cyclic vomiting syndrome, biliary colic, hepatic variceal hemorrhage, and proctalgia fugax; infection: susceptibility, fever, and mortality; neural: frontal, parietal, temporal, and occipital lobe seizures, Parkinson's and Alzheimer's disease, hereditary progressive dystonia, and pain (cancer, post-surgical, diabetic neuropathic and foot ulcer, tooth caries, burning mouth and temporomandibular syndromes, fibromyalgia, sciatica, intervertebral vacuum phenomenon, multiple sclerosis muscle spasm, and migraine, tension, cluster, hypnic, and paroxysmal hemicranial headache); renal: colic and nocturnal enuresis and polyuria; ocular: bulbar conjunctival redness, keratoconjunctivitis sicca, intraocular pressure and anterior ischemic optic neuropathy, and recurrent corneal erosion syndrome; psychiatric/behavioral: major and seasonal affective depressive disorders, bipolar disorder, parasuicide and suicide, dementia-associated agitation, and addictive alcohol, tobacco, and heroin cravings and withdrawal phenomena; plus autoimmune and musculoskeletal: rheumatoid arthritis, osteoarthritis, axial spondylarthritis, gout, Sjögren's syndrome, and systemic lupus erythematosus. Knowledge of these and other 24 h patterns of human pathophysiology informs research of their underlying circadian and other endogenous mechanisms, external temporal triggers, and more effective patient care entailing clinical chronopreventive and chronotherapeutic strategies.
- Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument. [JOURNAL ARTICLE]
- Int Wound J 2014 Aug 14.
The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.
- Using an alternating pressure mattress to offload heels in ICU. [Journal Article]
- Br J Nurs 2014 Aug.:S44-9.
The heel continues to be one of the most common sites of pressure damage. This article reviews the anatomy and physiology of the heel and explores significant risk factors, including those found in the critically ill patient. Interventions to prevent heel pressure ulceration by offloading the heel are explored. An evaluation of the Nimbus 4 alternating pressure mattress was undertaken within an intensive care unit (ICU) to consider the efficacy of its unique Wound Valve Technology, which is designed to help prevent heel pressure ulceration. During the evaluation period none of the patients using the Nimbus 4 developed a pressure ulcer. Staff observed that the Wound Valves provided effective pressure redistribution and, although the cells frequently needed to be adjusted, patient safety was maintained throughout. The Wound Valves were most effective on patients who were less prone to voluntary movement.
- Pressure ulcer grading and appropriate equipment selection. [Journal Article]
- Br J Nurs 2014 Aug.:S4-S13.
This article explores the process and rationale for designing a poster to support community nurses in selecting appropriate pressure-relieving equipment based on accurate risk assessment and correct pressure ulcer grading. The project was prompted by the requirement to update community nurses' knowledge and ensure pressure-relieving equipment selection was evidence-based and not reliant on personal preference. The 2012 NHS Midlands and East 'Stop the pressure' campaign provided community nurses with a framework for pressure ulcer prevention and management. The attention to support surfaces highlighted the need for appropriate equipment. However the tissue viability team found that the introduction of this pathway alone did not help with the practical issues of appropriate equipment selection. The poster was designed with consideration as to how adults learn, and by looking to the Plan, Do, Study, Act (PDSA) cycle. This provided the framework for enabling new ideas and changes to practice to be tested on a small scale before full implementation.
- Use of a coverlet system for the management of skin microclimate. [Journal Article]
- Br J Nurs 2014 Aug.:S28-35.
Pressure and shear are the two key extrinsic factors that cause pressure ulcer damage. However, if the resilience of the skin and soft tissue deteriorates, the individual's susceptibility to such pressure damage will increase. The risk is greater if the microclimate at the interface between the skin and the support surface is impaired. This will occur when the skin temperature is elevated and there is excess moisture on the skin surface. Microclimate management therefore plays an important role in pressure ulcer prevention. This article describes how use of a new coverlet system (Skin IQ Microclimate Manager, ArjoHuntleigh) can avoid the accumulation of heat and moisture at the patient/support-surface interface.