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Charon C, Wuillemin PH, Havreng-Théry C, Belmin J. One Month Prediction of Pressure Ulcers in Nursing Home Residents with Bayesian Networks. J Am Med Dir Assoc 2024; 25:104945. [PMID: 38431264 DOI: 10.1016/j.jamda.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Pressure ulcers (PUs) are a common and avoidable condition among residents of nursing homes, and their consequences are severe. Reliable and simple identification of high-risk residents is a major challenge for prevention. Available tools like the Braden and Norton scale have imperfect predictive performance. The objective is to predict the occurrence of PUs in nursing home residents from electronic health record (EHR) data. DESIGN Longitudinal retrospective nested case-control study. SETTING AND PARTICIPANTS EHR database of French nursing homes from 2013 to 2022. METHODS Residents who suffered from PUs were cases and those who did not were controls. For cases, we analyzed the data available in their EHR 1 month before the occurrence of the first PU. For controls, we used available data 1 month before an index date adjusted on the delays of PU onset. We conducted a Bayesian network (BN) analysis, an explainable machine learning method, using 136 input variables of potential medical interest determined with experts. To validate the model, we used scores, features selection, and explainability tools such as Shapley values. RESULTS Among 58,368 residents analyzed, 29% suffered from PUs during their stay. The obtained BN model predicts the occurrence of a PU at a 1-month horizon with a sensitivity of 0.94 (±0.01), a precision of 0.32 (±0.01) and an area under the curve of 0.69 (±0.02). It selects 3 variables: length of stay, delay since last hospitalization, and dependence for transfer. This BN model is suitable and simpler than models provided by other machine learning methods. CONCLUSIONS AND IMPLICATIONS One-month prediction for incident PU is possible in nursing home residents from their EHR data. The study paves the way for the development of a predictive tool fueled by routinely collected data that do not require additional work from health care professionals, thereby opening a new preventive strategy for PUs.
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Affiliation(s)
- Clara Charon
- LIP6 (UMR 7606), Sorbonne Université, Paris, France; Teranga Software, Paris, France
| | | | | | - Joël Belmin
- LIMICS (UMR 1142), Sorbonne Université, Paris, France; AP-HP, Hôpital Charles-Foix, Ivry-sur-Seine, France.
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2
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Chen Y, Wang W, Qian Q, Wu B. Comparison of four risk assessment scales in predicting the risk of intraoperative acquired pressure injury in adult surgical patients: a prospective study. J Int Med Res 2023; 51:3000605231207530. [PMID: 37898108 PMCID: PMC10613401 DOI: 10.1177/03000605231207530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVE To develop and compare four predictive models for intraoperative acquired pressure injury (IAPI) in surgical patients. METHODS One hundred patients undergoing various surgeries (hepatobiliary, pancreas, spleen, gastrointestinal, and cardiac surgeries) at Ruijin Hospital from November 2021 to September 2022 were included in this prospective cohort study. Four pressure injury risk assessment scales were used to measure the pressure injury risk: the Braden scale, Munro Pressure Injury Risk Assessment Scale, Scott Triggers tool, and CORN Intraoperative Acquired Pressure Injury Risk Assessment Scale. The patients were divided into the IAPI group and non-IAPI group. RESULTS In total, 37% of patients (37/100) developed class I/stage pressure injury (erythema) after surgery, which resolved within 2 hours after surgery in 86.49% of cases and further progressed to class II/stage or higher pressure injury within 6 days in 15.63% of cases. The application effects of the four commonly used risk assessment tools were compared with the sensitivity, specificity, and area under the receiver operating characteristic curve. The Munro Scale showed the best sensitivity and area under the receiver operating characteristic curve among the four tools for postoperative assessment, but its specificity was only 20.63. CONCLUSIONS More appropriate assessment tools are required for IAPI risk evaluation.
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Affiliation(s)
- Yuan Chen
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - QianJian Qian
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - BeiWen Wu
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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3
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Veiga TP, Rêgo AS, Montenegro WS, Ferreira PR, Rocha DS, Felipe IMA, Santos-de-Araújo AD, Mendes RG, Tavarez RRDJ, Bassi-Dibai D. Braden scale has low reliability in different patients under care in intensive care unit. Rev Assoc Med Bras (1992) 2022; 68:1221-1227. [PMID: 36134772 PMCID: PMC9575023 DOI: 10.1590/1806-9282.20220249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations. METHODS This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications. RESULTS For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75. CONCLUSIONS Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.
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Affiliation(s)
- Thalita Pereira Veiga
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil
| | - Adriana Sousa Rêgo
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil
| | | | | | | | | | | | - Renata Gonçalves Mendes
- Universidade Federal de São Carlos, Department of Physical Therapy – São Carlos (SP), Brazil
| | | | - Daniela Bassi-Dibai
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil.,Corresponding author:
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A 10-Year Prevalence Survey and Clinical Features Analysis of Pressure Injury in a Tertiary Hospital in China, 2009-2018. Adv Skin Wound Care 2021; 34:150-156. [PMID: 33587476 DOI: 10.1097/01.asw.0000732740.92841.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe the 10-year prevalence of pressure injury (PI) in a tertiary hospital in China and determine the clinical characteristics of inpatients with PI. METHODS The authors performed a retrospective analysis of PI cases extracted from the electronic health record of a tertiary hospital. The trend of PI prevalence over 10 years was described by estimating the average percent change (EAPC). Comorbidities were described with the Charlson Comorbidity Index (CCI). The clinical characteristics of PI were described using the number of cases and composition ratio. RESULTS The overall prevalence of PI was 0.59% (5,838/986,404). From 2009 to 2018, the rate increased from 0.19% to 1.00% (EAPC = 22.46%). When stage I PIs were excluded, the prevalence of PI ranged from 0.15% to 0.79% (EAPC = 21.90%). The prevalence of hospital-acquired PI was 0.13%. Prevalence increased with age (Ptrend < .001) and was significantly higher in men than women (P < .001). Patients with PI were more widely distributed in the ICU (20.58%), vasculocardiology department (11.73%), gastroenterology department (10.18%), and OR (8.29%). Of patients with PI, 71.3% had a CCI score 4 or higher. CONCLUSIONS The PI prevalence in the study facility increased rapidly over the study period. Pressure injuries among patients in the gastroenterology department and in the community deserve more attention. The CCI may be a good indicator for PI risk assessment.
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Kohta M, Ohura T, Okada K, Nakamura Y, Kumagai E, Kataoka H, Kitagawa T, Kameda Y, Kitte T. Convergent Validity of Three Pressure Injury Risk Assessment Scales: Comparing the PPRA-Home (Pressure Injury Primary Risk Assessment Scale for Home Care) to Two Traditional Scales. J Multidiscip Healthc 2021; 14:207-217. [PMID: 33564237 PMCID: PMC7866919 DOI: 10.2147/jmdh.s294734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home) was developed to predict pressure injury risk in geriatric individuals requiring long-term care in home settings. This study aimed to compare the convergent validity of the PPRA-Home to that of the two other standardized pressure injury prevention scales: the Braden and Ohura-Hotta (OH) scales. Methods A multicenter, cross-sectional study was conducted with 34 home-based geriatric support service providers located in five Japanese districts. The study included 69 participants (30 had a pressure injury and 39 did not) who were at classified at care levels of 1 through 5 under Japan’s long-term care insurance system. Care managers served as assessors for the PPRA-Home, while physicians or certified expert nurses served as assessors for the Braden and OH scales. Convergent validity was investigated by examining correlation coefficients between total scores on the PPRA-Home and the other two scales. Receiver operating curve analysis was used to quantify each scale’s accuracy for the two groups: those with and without a pressure injury. Results The PPRA-Home was found to be negatively correlated with the Braden scale (r=−0.79, p<0.05), and positively correlated with the OH scale (r=0.58, p<0.05). The area under the curve (AUC) for the PPRA-Home, Braden scale, and OH scale were 0.737, 0.814, and 0.794, respectively. A PPRA-Home cutoff score of 4 had a sensitivity of 63.3% and specificity of 81.6%. Conclusion The AUC for the PPRA-Home as scored by care managers was similar to those of the Braden and OH scales as scored by physicians or expert nurses. More research on the PPRA-Home’s content and predictive validity is required.
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Affiliation(s)
- Masushi Kohta
- Medical Engineering Laboratory, ALCARE Co. Ltd., Tokyo, Japan
| | - Takehiko Ohura
- Pressure Ulcers and Wound Healing Research Center, Sapporo, Japan
| | - Katsuyuki Okada
- Department of Dermatology, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Yoshinori Nakamura
- Department of Medical Home Healthcare Center, Tenri Hospital Shirakawa Branch, Tenri, Japan
| | | | - Hitomi Kataoka
- Department of Nursing, Yamagata University, Yamagata, Japan
| | - Tomomi Kitagawa
- Department of Nursing, Hikone Municipal Hospital, Hikone, Japan
| | - Yuki Kameda
- Wound Care Marketing Division, ALCARE Co Ltd., Tokyo, Japan
| | - Toshihiro Kitte
- Department of Health Care Policy, Shiga Government Office, Otsu, Japan
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Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. J Tissue Viability 2021; 30:108-115. [PMID: 33485786 DOI: 10.1016/j.jtv.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nursing home residents are vulnerable to chronic wounds. However, the prevalence data are scarce. AIM The purpose of this study was to determine the prevalence of pressure ulcers and/or leg ulcers in nursing home residents, and describe the characteristics of the nursing homes, the residents and the wounds, as well as possible associations between these characteristics. METHODS This was a cross-sectional survey of nursing home residents over the age of 65 in 168 facilities in Barcelona. Those presenting category II-IV pressure ulcers and/or leg ulcers were included. The data were collected by observation/examination. Descriptive, bivariate, and multivariate analyses were performed. RESULTS The overall prevalence of pressure ulcers and leg ulcers combined was 4.4% (3.5% were pressure ulcers and 0.9% were leg ulcers). In small nursing homes with less nursing staff, the overall prevalence was greater than in large nursing homes (5.6% vs 3.8% [p = 0.01]). As expected, residents with pressure ulcers had higher pressure ulcer risk, worse dependence and cognitive status, urinary and faecal incontinence, and most were underweight. However, residents with leg ulcers had worse venous and arterial impairment and also were overweight. A multivariate analysis showed that pressure ulcers were statistically significantly associated with faecal incontinence (OR = 0.28, 95% CI = 0.09-0.81) and dyslipidaemia (OR = 0.21, 95% CI = 0.06-0.66), and leg ulcers were statistically significantly associated with venous insufficiency (OR = 4.93, 95% CI = 1.65-15.34). The characteristics of gluteal and ischial pressure ulcers, a high prevalence of infection, and a low reference to biofilm by nurses, in both types of wounds, suggest that these aspects are not adequately taken into account. CONCLUSIONS Pressure ulcers and leg ulcers, mainly pressure ulcers, remain a public health problem in nursing homes. Further studies are required to confirm the associations found in this study.
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Vera-Salmerón E, Rutherford C, Dominguez-Nogueira C, Tudela-Vázquez MP, Costela-Ruiz VJ, Gómez-Pozo B. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR Res Protoc 2019; 8:e13701. [PMID: 31407669 PMCID: PMC6709896 DOI: 10.2196/13701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients' own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment. OBJECTIVE This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers-associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients. METHODS The DSGM runs SIRUPP, which is linked to patients' electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version. RESULTS The project commenced in June 2017 and is expected to conclude in April 2020. CONCLUSIONS This study addresses two main health outcomes-the time needed for wound healing and the mortality associated with pressure ulcers-both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13701.
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Affiliation(s)
- Eugenio Vera-Salmerón
- Distrito Sanitario Granada-Metropolitano (Servicio Andaluz de Salud), Armilla, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,Unidades Asistenciales Churriana de la Vega y Peligros, Granada, Spain
| | - Claudia Rutherford
- Beckett Senior Research Fellow Quality of Life Office, University of Sydney, Sydney, Australia
| | | | - María Pilar Tudela-Vázquez
- Distrito Sanitario Granada-Metropolitano (Servicio Andaluz de Salud), Armilla, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Victor J Costela-Ruiz
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Basilio Gómez-Pozo
- Distrito Sanitario Granada-Metropolitano (Servicio Andaluz de Salud), Armilla, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,Unidad Interniveles de Prevención Promoción y Vigilancia de la Salud, Granada, Spain
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8
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Gould LJ, Bohn G, Bryant R, Paine T, Couch K, Cowan L, McFarland F, Simman R. Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage. Wound Repair Regen 2019; 27:497-508. [DOI: 10.1111/wrr.12730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lisa J. Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
| | | | - Ruth Bryant
- Abbott Northwestern Hospital Minneapolis Minnesota
| | - Tim Paine
- Department of RehabilitationLitchfield Hills Orthopedic Torrington Connecticut
| | - Kara Couch
- Wound Healing and Limb Preservation CenterGeorge Washington University Hospital Washington District of Columbia
| | - Linda Cowan
- Center of Innovation on Disability and Rehabilitation ResearchVirginia Health Care Richmond Virginia
| | | | - Richard Simman
- Jobst Vascular InstituteUniversity of Toledo College of Medicine Toledo Ohio
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9
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Zimmermann BM, Koné I, Rost M, Leu A, Wangmo T, Elger BS. Factors associated with post-acute discharge location after hospital stay: a cross-sectional study from a Swiss hospital. BMC Health Serv Res 2019; 19:289. [PMID: 31068169 PMCID: PMC6505070 DOI: 10.1186/s12913-019-4101-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2012, Switzerland introduced the diagnosis-related group hospital payment system. Fearing that vulnerable patients may be discharged early, Acute and Transitional Care (ATC) was introduced to address the nursing care of patients who no longer needed an acute hospital stay. ATC is more costly for patients when compared to other discharge options like rehabilitation while providing less rehabilitative services. This study investigates factors associated with the place of discharge for patients in need of care. METHODS Data was collected from 660 medical records of inpatients 50 years and older of the municipal hospital Triemli in Zurich, Switzerland. We used stepwise logistic regression to identify factors associated with their discharge into ATC or rehabilitation. RESULTS Older patients with higher Delirium Observation Scale (DOS), lack of supplementary health insurance, resuscitation order and a lower social network were more likely to be discharged into ATC than rehabilitation. CONCLUSIONS The association of supplementary health insurance and social network with discharge into ATC or rehabilitation is problematic because patients that are already vulnerable from a financial and social perspective are potentially discharged into a more costly and less rehabilitative post-acute care facility.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Agnes Leu
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Careum Research, Department Health Sciences, Kalaidos University of Applied Sciences, Pestalozzistrasse 3, 8032, Zürich, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Sari SP, Everink IH, Sari EA, Afriandi I, Amir Y, Lohrmann C, Halfens RJ, Schols JM. The prevalence of pressure ulcers in community-dwelling older adults: A study in an Indonesian city. Int Wound J 2019; 16:534-541. [PMID: 30768769 PMCID: PMC6850703 DOI: 10.1111/iwj.13081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
The objectives of this study were to investigate the prevalence and the characteristics of pressure ulcers (PU) in community‐dwelling older adults in Indonesia, including specific characteristics of the PU patients and their use of formal and informal care. A cross‐sectional design was used for the study, with 325 participants aged 60 years or older, randomly chosen from the general community. The overall PU prevalence and the PU prevalence excluding category 1 were 10.8% (95% confidence interval [CI], 5.8‐15.8) and 5.2% (95% CI 0.2‐10.2), respectively. Category 1 PUs were mostly (34.3%) located on knees and toes, while category 2 and higher PUs were mostly (70.4%) located on the shoulder, sacrum, and hip. The main factors that contributed strongly to PUs among older adults in the community were the degree of physical activity, problems with sensory perception, and having a history of stroke. None of the participants with a PU received wound care or information about PUs from formal caregivers and only 11.4% received wound care from family caregivers. This study shows that pressure ulcers in community‐dwelling older adults in Indonesia are a relevant and largely unaddressed problem. Developing an intervention program to manage the PU problem in the community is recommended.
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Affiliation(s)
- Sheizi P Sari
- Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia.,Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Irma H Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Eka A Sari
- Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia
| | - Irvan Afriandi
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Christa Lohrmann
- Department of Nursing Science, Medical University of Graz, Graz, Austria
| | - Ruud J Halfens
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos M Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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11
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Bueno de Camargo WH, Pereira RDC, Tanita MT, Heko L, Grion IC, Festti J, Mezzaroba AL, Carvalho Grion CM. The Effect of Support Surfaces on the Incidence of Pressure Injuries in Critically Ill Patients: A Randomized Clinical Trial. Crit Care Res Pract 2018; 2018:3712067. [PMID: 30662770 PMCID: PMC6312579 DOI: 10.1155/2018/3712067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/15/2018] [Accepted: 12/02/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To analyze whether a viscoelastic mattress support surface can reduce the incidence of stage 2 pressure injuries compared to a standard hospital mattress with pyramidal overlay in critically ill patients. METHOD A randomized clinical trial with intention-to-treat analysis was carried out recruiting patients with Braden scale ≤14 on intensive care unit admission from April 2016 to April 2017. Patients were allocated into two groups: intervention group (viscoelastic mattress) and control group (standard mattress with pyramidal overlay). The level of significance adopted was 5%. RESULTS A total of 62 patients were included in the study. There was a predominance of males (53%) and the mean age was 67.9 (SD 18.8) years. There were no differences in clinical or severity characteristics between the patients in the control group and the intervention group. Pressure injuries occurred in 35 patients, with a median time of 7 days (ITQ 4-10) from admission. The frequency of pressure injuries was higher in the control group (80.6%) compared to the intervention group (32.2%; p < 0.001). CONCLUSIONS Viscoelastic support surfaces reduced the incidence of pressure injuries in moderate or higher risk critically ill patients when compared to pyramidal support surfaces.
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Affiliation(s)
| | | | - Marcos T. Tanita
- Post-graduate Student, Universidade Estadual de Londrina, Londrina, Brazil
| | - Lidiane Heko
- Registered Nurse, Associação Evangélica Beneficente de Londrina, Londrina, Brazil
| | | | - Josiane Festti
- Professor, Department of Internal Medicine, Universidade Estadual de Londrina, Londrina, Brazil
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Anrys C, Van Tiggelen H, Verhaeghe S, Van Hecke A, Beeckman D. Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium. Int Wound J 2018; 16:325-333. [PMID: 30412652 DOI: 10.1111/iwj.13032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/31/2023] Open
Abstract
The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.
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Affiliation(s)
- Charlotte Anrys
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Hanne Van Tiggelen
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Ann Van Hecke
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
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13
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Courvoisier DS, Righi L, Béné N, Rae AC, Chopard P. Variation in pressure ulcer prevalence and prevention in nursing homes: A multicenter study. Appl Nurs Res 2018; 42:45-50. [DOI: 10.1016/j.apnr.2018.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/30/2018] [Accepted: 06/03/2018] [Indexed: 11/25/2022]
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14
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Bennett SL, Goubran R, Knoefel F. Long term monitoring of a pressure ulcer risk patient using thermal images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1461-1464. [PMID: 29060154 DOI: 10.1109/embc.2017.8037110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients in an immobile state are susceptible to pressure ulcers, which are localized injuries to the skin and/or underlying tissues due to prolonged pressure. This paper builds upon a body of work examining in-hospital older adult patients at-risk of developing pedal pressure ulcers by examining thermal images of one patient, who was reporting pain in her right foot, over 112 days of a hospital stay. Thermal images of the patient's left and right heels and malleoli were subjected to image processing to remove noise and enhance contrast, region selection and feature extraction to observe changes in temperature over time. Mean intensity within each ROI was extracted, and the difference in temperature between the left and right heels was calculated over time. The resulting temperature pattern was consistent with the physical phenomenon related to ulcer development, intervention and recovery; the right heel was similar in temperature when starting the study and at the end of the study, but was drastically warmer when experiencing erythema and drastically colder when experiencing ischaemia. These results suggest that consistent thermal imaging, in conjunction with image processing may be able to detect the formation of pressure ulcers faster than can be visually observed. Early detection of pressure ulcers is critical in the prevention of pressure ulcers, and is of great importance to any hospital or nursing home.
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15
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Griswold LH, Griffin RL, Swain T, Kerby JD. Validity of the Braden Scale in grading pressure ulcers in trauma and burn patients. J Surg Res 2017; 219:151-157. [PMID: 29078875 DOI: 10.1016/j.jss.2017.05.095] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/08/2017] [Accepted: 05/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pressure ulcers are a costly hospital-acquired condition in terms of clinical outcome and expense. The Braden Scale was developed in 1987 as a risk scoring method for pressure ulcers and uses six different risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A score of ≤18 is considered high risk. To date, research on the utility of the Braden Scale has focused on general medicine and nontrauma/burn surgery patients. We hypothesize that the Braden Scale does not accurately discriminate who will get a pressure ulcer among trauma and burn patients. METHODS We collected data from medical records regarding documented Braden scores and presence of pressure ulcers regardless of staging. Patients with ulcers present on admission were excluded from analysis. For each patient, the lowest Braden score documented before the occurrence of the pressure ulcer was determined. A logistic regression was used to estimate odds ratios and associated 95% confidence intervals for the association between pressure ulcer likelihood and lowest Braden Scale measurement. To determine the discriminatory ability of the Braden Scale on pressure ulcer risk, four measures of performance (i.e., sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio) were calculated for four nonmutually exclusive groups: a Braden Scale measurement ≤18, ≤14, ≤12, and ≤9. RESULTS From 2011 through 2014, a total of 2660 patients were admitted to the trauma/burn intensive care unit. Of these patients, 63 (2.3%) subsequently developed a pressure ulcer. A Braden Scale of ≤18 as the threshold for being at-risk of pressure ulcer had a sensitivity of 100% and specificity of 6%, whereas a Braden Scale of ≤9 had a sensitivity of 28.6% and a specificity of 90%. For all Braden Scale measurements, the positive likelihood ratio never reached the value of 10 that suggests high likelihood of an ulcer. CONCLUSIONS The Braden scale has mediocre discriminatory ability among the trauma/burn population. In addition, the low positive likelihood ratio suggests that the Braden scale may not be a useful clinical tool as it may result in unnecessary expenditure of time and personnel resources in preventing pressure ulcer formation.
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Affiliation(s)
- Lauren H Griswold
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell L Griffin
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; The Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas Swain
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey D Kerby
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
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16
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Understanding Interrater Reliability and Validity of Risk Assessment Tools Used to Predict Adverse Clinical Events. CLIN NURSE SPEC 2017; 31:23-29. [PMID: 27906730 DOI: 10.1097/nur.0000000000000260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This article will describe how to assess interrater reliability and validity of risk assessment tools, using easy-to-follow formulas, and to provide calculations that demonstrate principles discussed. DESCRIPTION Clinical nurse specialists should be able to identify risk assessment tools that provide high-quality interrater reliability and the highest validity for predicting true events of importance to clinical settings. Making best practice recommendations for assessment tool use is critical to high-quality patient care and safe practices that impact patient outcomes and nursing resources. Optimal risk assessment tool selection requires knowledge about interrater reliability and tool validity. OUTCOME The clinical nurse specialist will understand the reliability and validity issues associated with risk assessment tools, and be able to evaluate tools using basic calculations. CONCLUSION Risk assessment tools are developed to objectively predict quality and safety events and ultimately reduce the risk of event occurrence through preventive interventions. To ensure high-quality tool use, clinical nurse specialists must critically assess tool properties. The better the tool's ability to predict adverse events, the more likely that event risk is mediated. Interrater reliability and validity assessment is relatively an easy skill to master and will result in better decisions when selecting or making recommendations for risk assessment tool use.
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17
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Luther SL, Thomason SS, Sabharwal S, Finch DK, McCart J, Toyinbo P, Bouayad L, Matheny ME, Gobbel GT, Powell-Cope G. Leveraging Electronic Health Care Record Information to Measure Pressure Ulcer Risk in Veterans With Spinal Cord Injury: A Longitudinal Study Protocol. JMIR Res Protoc 2017; 6:e3. [PMID: 28104580 PMCID: PMC5290296 DOI: 10.2196/resprot.5948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/09/2016] [Accepted: 10/30/2016] [Indexed: 12/05/2022] Open
Abstract
Background Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal cord injury (SCI). The health care team should periodically identify PrU risk, although there is no tool in the literature that has been found to be reliable, valid, and sensitive enough to assess risk in this vulnerable population. Objective The immediate goal is to develop a risk assessment model that validly estimates the probability of developing a PrU. The long-term goal is to assist veterans with SCI and their providers in preventing PrUs through an automated system of risk assessment integrated into the veteran’s electronic health record (EHR). Methods This 5-year longitudinal, retrospective, cohort study targets 12,344 veterans with SCI who were cared for in the Veterans Health Administration (VHA) in fiscal year (FY) 2009 and had no record of a PrU in the prior 12 months. Potential risk factors identified in the literature were reviewed by an expert panel that prioritized factors and determined if these were found in structured data or unstructured form in narrative clinical notes for FY 2009-2013. These data are from the VHA enterprise Corporate Data Warehouse that is derived from the EHR structured (ie, coded in database/table) or narrative (ie, text in clinical notes) data for FY 2009-2013. Results This study is ongoing and final results are expected in 2017. Thus far, the expert panel reviewed the initial list of risk factors extracted from the literature; the panel recommended additions and omissions and provided insights about the format in which the documentation of the risk factors might exist in the EHR. This list was then iteratively refined through review and discussed with individual experts in the field. The cohort for the study was then identified, and all structured, unstructured, and semistructured data were extracted. Annotation schemas were developed, samples of documents were extracted, and annotations are ongoing. Operational definitions of structured data elements have been created and steps to create an analytic dataset are underway. Conclusions To our knowledge, this is the largest cohort employed to identify PrU risk factors in the United States. It also represents the first time natural language processing and statistical text mining will be used to expand the number of variables available for analysis. A major strength of this quantitative study is that all VHA SCI centers were included in the analysis, reducing potential for selection bias and providing increased power for complex statistical analyses. This longitudinal study will eventually result in a risk prediction tool to assess PrU risk that is reliable and valid, and that is sensitive to this vulnerable population.
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Affiliation(s)
- Stephen L Luther
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,College of Public Health, University of South Florida, Tampa, FL, United States
| | - Susan S Thomason
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,Tampa VA Research and Education Foundation, Inc, Tampa, FL, United States
| | - Sunil Sabharwal
- VA Boston Healthcare System, VA New England Healthcare System, Department of Veterans Affairs, West Roxbury, MA, United States
| | - Dezon K Finch
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States
| | - James McCart
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,Muma College of Business, University of South Florida, Tampa, FL, United States
| | - Peter Toyinbo
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States
| | - Lina Bouayad
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States
| | - Michael E Matheny
- Geriatrics Research Education and Clinical Care, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Glenn T Gobbel
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Research and Development Service, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States
| | - Gail Powell-Cope
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,College of Public Health, University of South Florida, Tampa, FL, United States.,College of Nursing, University of South Florida, Tampa, FL, United States
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18
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Full-Thickness and Unstageable Pressure Injuries That Develop in Nursing Home Residents Despite Consistently Good Quality Care. J Wound Ostomy Continence Nurs 2016; 43:464-70. [DOI: 10.1097/won.0000000000000253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Biz C, Buffon L, Marin R, Petrova N. Orthopaedic nursing challenges in poly-traumatised patient management: A critical analysis of an Orthopaedic and Trauma Unit. Int J Orthop Trauma Nurs 2016; 23:60-71. [PMID: 27561247 DOI: 10.1016/j.ijotn.2016.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 02/15/2016] [Accepted: 04/15/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND BACKGROUND Trauma is the most frequent cause of death in people under 40 years old. It is an important problem not only because of the high mortality but also because of the consequential disability that can lead to serious economic consequences. STUDY AIMS This descriptive, comparative study investigates the definitive management of poly-traumatised patients in an Italian Orthopaedic Ward in order to highlight its strengths and weaknesses in comparison with the most recent literature. This has led to the development of a pre-established algorithm for evaluation, preventive care and management of the poly-trauma patient and a flow-chart for improved patient care. RESEARCH METHODS A five-step observational and exploratory approach was employed in this study which critically analysed the nursing management of 60 multiple trauma patients admitted to our Orthopaedic Unit from April 2013 to October 2014. RESULTS The findings highlight the need for adherence to plans of care, which can be approached by a shared management of poly-trauma patients that involves the medical team, the patient and his family/caregiver. DISCUSSION The protocols and guidelines in use in our Orthopaedic and Trauma Unit are in line with European standards, although there is still margin for improvement. The study has led to the development of an algorithm that allows health professionals to have reference values for the care of polytrauma patients. CONCLUSIONS AND RECOMMENDATIONS This study demonstrates the use of theoretical and practical tools for the evaluation and management of poly-traumatised patients during their hospital stay. We recommend the use of both proposed tools: the general algorithm and the flow-chart for the management of the poly-trauma patient, as they allow identification of barriers and facilitators related to the implementation of international guidelines, currently well-defined for Emergency Departments but not yet for Orthopaedic Units.
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Affiliation(s)
- Carlo Biz
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padova, Italy; Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy.
| | - Lisa Buffon
- Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy; Edith Cavell Campus, Bretton Gate, Peterborough, Cambridgeshire PE3 9GZ, United Kingdom
| | - Roberto Marin
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padova, Italy
| | - Natalia Petrova
- Orthopaedic and Traumatology Clinic, Padua Hospital, Padova, Italy
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