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Morrow MM, Hughes LC, Collins DM, Vos-Draper TL. Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial. JMIR Res Protoc 2024; 13:e51849. [PMID: 38598267 PMCID: PMC11043927 DOI: 10.2196/51849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. OBJECTIVE This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. METHODS For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. RESULTS Currently, 6 participants have been recruited for our aim-1 qualitative study. CONCLUSIONS This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51849.
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Affiliation(s)
- Melissa M Morrow
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Lynne C Hughes
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Diane M Collins
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Tamara L Vos-Draper
- College of Pharmacy, Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, United States
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Shiff J, Schwartz K, Hausman B, Seshadri DR, Bogie KM. Development and use of a porcine model with clinically relevant chronic infected wounds. J Tissue Viability 2023; 32:527-535. [PMID: 37716845 DOI: 10.1016/j.jtv.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/18/2023]
Abstract
Chronic ischemic wounds affect millions of people causing significant pain and disability. They can be considered to be stalled in the inflammatory stage and cannot heal without additional measures. A valid animal model is necessary to evaluate the efficacy of topical wound healing therapies and wearable technologies. A porcine model, although higher in cost, maintenance, and space requirements, is superior to the commonly used rodent or rabbit model for wound healing. Previous studies have shown that pig wounds have greater similarity to human wounds in responses to a variety of treatments, including wound dressings and antibiotics. The current study created a porcine model of large chronic wounds to assess a wearable electroceutical technology, with monitoring of healing variables and infection. Electroceutical therapy is the only adjunctive treatment recommended for chronic wound therapy. A porcine model of large chronic wounds of clinically realistic size was created and utilized to evaluate a wearable electroceutical biotechnology. Multivariate non-invasive assessment was used to monitor wound progression over multiple timepoints. Outcomes suggest that a wearable electrostimulation bandage, has the potential to offer therapeutic benefit in human wounds. The tested wearable device provides the same proven effectiveness of traditional electroceutical therapy while mitigating commonly cited barriers, including substantial time requirements, and availability and complexity of currently available equipment, preventing its implementation in routine wound care. The model is also appropriate for evaluation of other wearables or topical therapeutics.
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Affiliation(s)
- Josie Shiff
- Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA
| | - Katie Schwartz
- Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA
| | - Bryan Hausman
- Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA
| | - Dhruv R Seshadri
- Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA; Case Western Reserve University, Cleveland, OH, USA
| | - Kath M Bogie
- Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC), Cleveland, OH, USA; Case Western Reserve University, Cleveland, OH, USA.
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Incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries in Bangladesh. Spinal Cord 2022; 60:348-353. [PMID: 34987177 DOI: 10.1038/s41393-021-00732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/08/2022]
Abstract
DESIGN Cohort study embedded in a clinical trial. SETTING Community, Bangladesh. OBJECTIVES To determine the incidence, severity and time course of pressure injuries over the first two years following discharge from hospital in people with spinal cord injuries (SCI) in Bangladesh. METHODS Participants (n = 186) were contacted by telephone 39 times and assessed face-to-face 4 to 6 times over the two years following discharge. At each point of contact the presence and severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). Survival analyses were conducted to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariable prediction models. RESULTS Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury in the first two years after discharge (incidence rate 0.27 per person-year, 95% CI 0.22 to 0.34). Most pressure injuries were on the sacrum (23%). Pressure injuries took a median (IQR) of 40 (29 to 57) days to heal. The median (IQR) peak PUSH score was 11.0/17 (8.0 to 13.5). The multivariable prediction models had poor predictive properties (maximum c-statistic 0.75). CONCLUSION Pressure injuries impose a large health burden on people with SCI in Bangladesh. However, they are difficult to predict, treat and prevent. Further research is needed to identify who is at most risk and to find solutions for the treatment and prevention of pressure injuries in Bangladesh and other low-middle income countries.
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Gourlan M, Pellechia A, Robineau S, Foulon B, Gault D, Lefort M, Goossens D, Mathieu S, Laffont I, Dupeyron A, Ninot G, Gelis A. "What pressure ulcers mean to me?" Representations of pressure ulcer in persons with spinal cord injury: A qualitative study. J Tissue Viability 2020; 29:324-330. [PMID: 32830010 DOI: 10.1016/j.jtv.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Explore the perceptions and beliefs related to pressure ulcers (PU), their prevention and treatment strategies, in order to discuss potential learning objectives for PU-related therapeutic education in persons with spinal cord injury (SCI). DESIGN Qualitative study, using grounded theory for the analysis of data collected via a questionnaire. SETTING Nine SCI referral centers, inpatient care. PARTICIPANTS 131 persons with SCI were included. 76% were male, and 65% presented with paraplegia. The median age was 48 years (33.5; 58) and median time since injury was 11 years (3; 24.5). 70% had experience with PU. INTERVENTIONS None. MAIN OUTCOME MEASURES Data collection via an open-ended questionnaire on the representation of PU, its prevention and life experience of having a PU. RESULTS Six categories were identified: (1) identifying what might become problematic, (2) daily preventive actions, (3) detecting the early signs, (4) managing the early signs, (5) need for care, (6) experience with PU and being bedridden. Pressure ulcers have dramatic consequences on psychosocial health. Prevention and treatment require self-management skills, such as self-risk assessment abilities, self-detection skills and problem-solving strategies, to optimise daily PU prevention in persons with SCI. CONCLUSION PU prevention tackled by persons with SCI bears some specificities that the physician must take into account in the construction of a self-management program in this high-risk population.
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Affiliation(s)
- Mathieu Gourlan
- Laboratoire Epsylon EA 4556, Université de Montpellier, University, Rue Henri Serre, Montpellier, France
| | - Alessandra Pellechia
- Unité Transversale D'éducation Du Patient (UTEP), CHU Montpellier, Hôpital La Colombière, 39 Avenue Charles Flahault, 34295, Montpellier, Cedex 5, France
| | - Sandrine Robineau
- Pôle de Médecine Physique et de Réadaptation Saint Helier, 54 Rue Saint Helier, Rennes, France
| | - Bernard Foulon
- Association des Paralysés de France, 1620 Rue de Saint Priest, 34090, Montpellier, France
| | - Dominique Gault
- Centre de Rééducation Clemenceau, 45 Boulevard Clemenceau, 67000, Strasbourg, France
| | - Marc Lefort
- Département de Médecine Physique et de Réadaptation, CHU Saint Jacques, 85 Rue Saint-Jacques, 44093, Nantes, France
| | - David Goossens
- Centre de Rééducation de La Tour de Gassies, 33520, Bruges, France
| | - Sarah Mathieu
- Centre de Rééducation Fonctionnelle de Kerpape, Ploemeur, 92 Rue de L'Anse Du Stole, 56270, France
| | - Isabelle Laffont
- Département de Médecine Physique et de Réadaptation, CHU Lapeyronie, 371 Avenue Du Doyen Gaston GIRAUD, Montpellier, France
| | - Arnaud Dupeyron
- Département de Médecine Physique et de Réadaptation, CHU Caremeau, 4 Rue Du Pr Debré, Nîmes, France
| | - Gregory Ninot
- Laboratoire Epsylon EA 4556, Université de Montpellier, University, Rue Henri Serre, Montpellier, France
| | - Anthony Gelis
- Laboratoire Epsylon EA 4556, Université de Montpellier, University, Rue Henri Serre, Montpellier, France; Département de Médecine Physique et de Réadaptation, CHU Lapeyronie, 371 Avenue Du Doyen Gaston GIRAUD, Montpellier, France; Centre Mutualiste Neurologique PROPARA, 263 Rue Du Caducée, Montpellier, France.
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Shiferaw WS, Akalu TY, Mulugeta H, Aynalem YA. The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:334. [PMID: 32471497 PMCID: PMC7260823 DOI: 10.1186/s12891-020-03369-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/25/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pressure ulcers (PU), one of the common challenging public health problems affecting patient with spinal cord injury. PUs occurs over bony areas of the body where pressure and tissue distortion is greatest. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, this review and meta-analysis aimed to estimate the global magnitude of pressure ulcers among patient with spinal cord injury. METHODS PubMed, Scopus, Google Scholar, African Journals Online, PsycINFO, and Web of Science were systematically searched to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. DerSimonian and Laird random-effects model was applied to obtain the pooled effect size. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Egger's regression test statistic. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software. RESULTS A total of 24 studies which comprises of 600,078 participants were included in this study. The global pooled magnitude of pressure ulcers among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18). CONCLUSION This systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policy maker and other concerned body should be design country context- specific preventive strategies to reduce the burden of pressure ulcers in patients with spinal cord injury.
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Affiliation(s)
- Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Science, Institute of Medicine and College of Health Science, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Institute of Medicine and College of Health Science, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
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Lim CAR, Nightingale TE, Elliott S, Krassioukov AV. Lifestyle modifications and pharmacological approaches to improve sexual function and satisfaction in men with spinal cord injury: a narrative review. Spinal Cord 2019; 58:391-401. [PMID: 31857687 DOI: 10.1038/s41393-019-0404-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN A narrative review describing various components of sexual dysfunction in men with spinal cord injury (SCI), as well as addressing potential therapeutic approaches. OBJECTIVES Restoration of sexual function is considered one of the most important health priorities for individuals with SCI. The purpose of this review is to provide information regarding the factors that are less appreciated when considering changes to sexual function in men with SCI. We also propose therapeutic approaches, with a focus on lifestyle modifications, which have been shown to improve sexual function. METHODS A literature search was performed and limited evidence for therapeutic approaches in individuals with SCI was supplemented by consistent findings from the able-bodied population. RESULTS We evaluated the less addressed factors known to contribute to sexual dysfunction in men with SCI, including hormonal influences (i.e., testosterone deficiency, thyroid hormone, and cortisol), psychological factors (i.e., pain, fatigue, depression, and body image), and secondary SCI complications (i.e., urinary tract infection, pressure sores, and autonomic dysreflexia). To address these factors beyond standard medical treatments for sexual dysfunction, options include physical activity/exercise, diet, and specific medications for symptom relief (i.e., testosterone replacement therapy and selective serotonin reuptake inhibitors for depression). CONCLUSIONS Physical activity's potential application, efficacy across multiple aspects of sexuality, and the lack of side effects, suggests that long-term exercise is a viable solution to directly or indirectly improve sexual function in males with SCI. Diet and supplemental medications may further promote body composition changes, which more broadly affect sexuality.
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Affiliation(s)
- Chloe A R Lim
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Stacy Elliott
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,BC Centre for Sexual Medicine, Vancouver Coastal Health, Vancouver, BC, Canada.,Departments of Psychiatry and Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada. .,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Olney CM, Vos-Draper T, Egginton J, Ferguson J, Goldish G, Eddy B, Hansen AH, Carroll K, Morrow M. Development of a comprehensive mobile assessment of pressure (CMAP) system for pressure injury prevention for veterans with spinal cord injury. J Spinal Cord Med 2019; 42:685-694. [PMID: 30702395 PMCID: PMC6830274 DOI: 10.1080/10790268.2019.1570437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: This paper reports the iterative redesign, feasibility and usability of the Comprehensive Mobile Assessment of Pressure (CMAP) system's mobile app used by Veterans with SCI.Design: This three-year, multi-staged study used a mixed-methods approach.Setting: Minneapolis VA Health Care System, Minneapolis, Minnesota.Participants: Veterans with spinal cord injury (N = 18).Interventions: Veterans with spinal cord injury engaged in iterative focus groups and personal interviews, sharing their needs and desires for the CMAP app redesign. App developers used these data for the redesign. The redesigned CMAP app was tested for six-weeks in users' homes.Outcome Measures: Quantitative (surveys) and qualitative (interviews) methods measured feasibility for self-management of seating pressure. Qualitative data were audio recorded, transcribed, anonymized, and coded. Survey data were analyzed using summary statistics.Results: After the CMAP system's redesign, the in-home use interview found: (1) any tool that can assist in prevention and monitoring of skin ulcers is important; (2) the desired key features are present in the app; (3) the main barrier to CMAP use was inconsistent functionality; (4) when functioning as expected, the live pressure map was the central feature, with reminders to weight shift also of high importance. The survey found: power wheelchair users tended to score closer than manual wheelchair users to the positive response end ranges on two separate surveys.Conclusions: Overall both the power and manual wheelchair users reported that they wanted to use the system, felt confident using the system, and that the functions of the system were well integrated.
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Affiliation(s)
- Christine M. Olney
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Correspondence to: Christine M. Olney, PhD RN, Minneapolis VAHCS, 1 Veterans Drive, Minneapolis, MN 55417.
| | - Tamara Vos-Draper
- Center for Allied Health Professions, Program in Occupational Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jason Egginton
- Kern Center for the Science of Health Care Delivery, Health Sciences Research, Rochester, Minnesota, USA
| | - John Ferguson
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Gary Goldish
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Byron Eddy
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Andrew H. Hansen
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA,Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katherine Carroll
- College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Melissa Morrow
- Kern Center for the Science of Health Care Delivery, Health Sciences Research, Rochester, Minnesota, USA
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Campeau-Vallerand C, Michaud F, Routhier F, Archambault PS, Létourneau D, Gélinas-Bronsard D, Auger C. Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation. JMIR Rehabil Assist Technol 2019; 6:e13560. [PMID: 31674918 PMCID: PMC6856862 DOI: 10.2196/13560] [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: 01/30/2019] [Revised: 06/14/2019] [Accepted: 09/02/2019] [Indexed: 01/26/2023] Open
Abstract
Background In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up. Objective This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians. Methods On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts. Results A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up. Conclusions On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.
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Affiliation(s)
- Charles Campeau-Vallerand
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - François Michaud
- Interdisciplinary Institute for Technological Innovation, Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Routhier
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Philippe S Archambault
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Dominic Létourneau
- Interdisciplinary Institute for Technological Innovation, Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dominique Gélinas-Bronsard
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
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Jackson D, Hutchinson M, Neville S, Padula WV, Usher K, Gardner S, Betteridge R, Durrant L. Characteristics of people with pressure ulcers using one year's routinely collected data in a defined diverse community. J Wound Care 2019; 28:576-584. [PMID: 31513500 DOI: 10.12968/jowc.2019.28.9.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if meaningful patient characteristics pertaining to pressure ulcers (PU) can be derived from routinely collected community health data. METHODS A retrospective cohort analysis of records was carried out. To provide a detailed dataset on PU for the community of interest, demographic, general medical and PU data were extracted from mandatory incident reports and audit of electronic and paper medical records. This study is reported in accordance with the RECORD Guidelines from the Equator Network. Adult patients were enrolled from a district nursing service in the target region (n=1085) during 2015. The target region was based on a geographical region bounded by a single postcode district (target region) consisting of 62,000 people of whom approximately 50,000 were adults, 3000 of whom were aged >75 years. RESULTS The total number of recorded PUs was n=137 in 103 individuals. Data from mandatory incident reports was obtainable for nearly all variables. Electronic and paper medical records were less reliable due to missing data. CONCLUSION Detailed characteristics of community-dwelling PU patients can be derived from routinely collected data, and provides various forms and levels of information which could feed into different projects. The use of mandatory reporting fields increases the level of reporting and reduces missing data. Data enriched with information from electronic and paper records could inform the addition of variables to mandatory forms to improve characterisation of community dwellers with PUs.
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Affiliation(s)
- Debra Jackson
- 1 Faculty of Health, University of Technology, Sydney (UTS), Australia.,2 Oxford Health NHS Foundation Trust, UK
| | | | | | - William V Padula
- 1 Faculty of Health, University of Technology, Sydney (UTS), Australia.,5 University of Southern California, US
| | - Kim Usher
- 6 University of New England, Australia
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Gambachidze D, Lefèvre C, Chartier-Kastler E, Perrouin Verbe MA, Kerdraon J, Egon G, Even A, Denys P, Castel-Lacanal E, Gamé X, Ruffion A, Hascoet J, Peyronnet B, Chaussard H, Verde KL, Karsenty G, Phé V. Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French-speaking Neuro-urology Study Group and the Neuro-urology committee of the French Association of Urology. Neurourol Urodyn 2019; 38:1713-1720. [PMID: 31141236 DOI: 10.1002/nau.24047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. MATERIALS AND METHODS Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. RESULTS In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. CONCLUSIONS Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.
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Affiliation(s)
- Dimitri Gambachidze
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
| | - Chloë Lefèvre
- Department of Physical Medicine and Rehabilitation, CHU de Nantes, Nantes, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France.,Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | | | - Jacques Kerdraon
- Department of Physical Medicine and Rehabilitation, Kerpape Hospital, Ploemeur, France
| | - Guy Egon
- Department of Physical Medicine and Rehabilitation, Rehabilitation Centre of L'Arche, Saint Saturnin, France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris-Ouest Medical School, Versailles-Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | | | - Xavier Gamé
- Department of Urology, CHU Rangueil, Toulouse, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France
| | - Juliette Hascoet
- Department of Urology, Lyon Sud Hospital, Lyon University Hospital, Lyon, France
| | | | - Haude Chaussard
- Department of Orthopedic Surgery, Raymond Poincaré Academic Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kévin Lo Verde
- Department of urology, Aix Marseille Université, Marseille, France
| | - Gilles Karsenty
- Department of urology, Aix Marseille Université, Marseille, France
| | - Véronique Phé
- Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Médecine Sorbonne Université, Paris, France
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11
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Management of established pressure ulcer infections in spinal cord injury patients. Med Mal Infect 2019; 49:9-16. [DOI: 10.1016/j.medmal.2018.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/31/2017] [Accepted: 05/29/2018] [Indexed: 12/20/2022]
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12
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Sonenblum SE, Sprigle SH. Buttock tissue response to loading in men with spinal cord injury. PLoS One 2018; 13:e0191868. [PMID: 29415014 PMCID: PMC5802854 DOI: 10.1371/journal.pone.0191868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE/BACKGROUND Despite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group. Efforts to differentiate risk level would benefit from clinical tools that can measure or predict the buttocks response to loading. Therefore, the goal of this study was to identify how tissue compliance and blood flow were impacted by clinically-measurable risk factors in young men with SCI. METHODS Blood flow at the ischial tuberosity was measured using laser Doppler flowmetry while the seated buttock was unloaded, and loaded at lower (40-60 mmHg) and high (>200 mmHg) loads. Tissue compliance of the buttock was measured using the Myotonometer while subject were lifted in a Guldmann Net. RESULTS Across 28 participants, blood flow was significantly reduced at high loads, while no consistent, significant changes were found at lower loads. At 40-60 mmHg, blood flow decreased in participants with a pressure ulcer history and lower BMI, but stayed the same or increased in most other participants. The buttock displaced an average of 9.3 mm (2.7 mm) at 4.2 N, which represented 82% (7%) of maximum displacement. BMI was related to the amount of buttock tissue displacement while smoking status explained some of the variation in the percent of max displacement. CONCLUSION Wide variability in tissue compliance and blood flow responses across a relatively homogeneous population indicate that differences in biomechanical risk may provide an explanation for the spectrum of PrU risk among persons with SCI.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Stephen H. Sprigle
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Industrial Design, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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13
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Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-860. [PMID: 28592405 DOI: 10.1128/cmr.00112-16] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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WALTER GUSTAVOPALMEIRO, SEIDEL WILLIAM, GIUSTINA RENATADELLA, BINS-ELY JORGE, MAURICI ROSEMERI, NARCISO-SCHIAVON JANAÍNALUZ. PROGNOSTIC FACTORS IN PATIENTS WITH PRESSURE SORES IN A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL. ACTA ORTOPEDICA BRASILEIRA 2017; 25:243-247. [PMID: 29375252 PMCID: PMC5782856 DOI: 10.1590/1413-785220172506169042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord injuries often develop pressure sores. The objective of this study was to describe the epidemiological characteristics of pressure sores and evaluate factors associated with recurrence and cure. Methods: In this historical cohort study, clinical and laboratory data were collected from medical records between 1997 and 2016. Results: Sixty individuals with pressure ulcers were included; mean patient age was 38.1±16.5 (37.0) years, 83.3% were men, and 86.8% identified as white. Most patients (85.1%) had paraplegia, amputation, or trauma of the lower limbs with motor sequelae; the remainder (14.9%) were quadriplegic. Most (78.3%) underwent surgery, and the mean follow-up time was 1.8±2.5 years. The lesions were cured in 25 patients; they recurred in 25% of the patients, and recurrence was seen to be associated with the location of the lesions. Patients with recurrent lesions had more medical consultations and a longer treatment time. Individuals whose ulcers had healed had fewer lesions, higher body mass index (BMI), and a higher proportion of these patients underwent surgery. Conclusions: BMI and location and number of lesions are prognostic factors. Level of Evidence IV, Case Series.
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15
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Peko Cohen L, Gefen A. Deep tissue loads in the seated buttocks on an off-loading wheelchair cushion versus air-cell-based and foam cushions: finite element studies. Int Wound J 2017; 14:1327-1334. [PMID: 29024413 DOI: 10.1111/iwj.12807] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 07/23/2017] [Indexed: 11/27/2022] Open
Abstract
For wheelchair users, a common injury is a sitting-acquired pressure ulcer (PU) which typically onsets near the interface between the ischial tuberosity (IT) and the overlying soft tissues. The risk of developing PUs can be reduced considerably if an adequate cushion is placed on the wheelchair in order to protect tissues from PUs by minimising interface mechanical loads between the body and cushion and also, exposure to internal soft tissue loads. In this work, we studied the biomechanical performances of an off-loading (OL) cushion with limited adjustability, in comparison to a standard foam cushion and a fully adjustable air-cell-based (ACB) cushion. These different cushion design approaches were methodologically and quantitatively analysed and compared here using a finite element (FE) modelling framework. We determined the internal mechanical deformations, strains and stresses in soft tissues of the seated buttocks during symmetric sitting, in a specific anatomy of a person with a spinal cord injury that was acquired during sitting in an open, magnetic resonance imaging configuration. Our results have shown that strains and stresses in muscle, fat and skin tissues are orders of magnitude lower for the ACB cushion with respect to the standard foam and OL cushions. The OL cushion design has taken the approach of protecting at-risk sites of the buttocks by transferring local internal tissue loads away from the ITs and towards the greater trochanters, at the price of increasing exposure to internal tissue loads at sites other than the ITs. The ACB cushion design, however, has taken a different approach, that is, immersion and envelopment of the entire buttocks structure, which is useful for minimising the exposure to internal tissue loads throughout the whole buttocks. Quantifying performances of wheelchair cushions using FE modelling provides insights into deep tissue loads, which is essential for informed decision-making in developing sitting solutions for individuals at risk, as well as for patient groups.
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Affiliation(s)
- Lea Peko Cohen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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16
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Yapp JH, Kamil R, Rozi M, Mohtarrudin N, Loqman MY, Ezamin AR, Ahmad SA, Abu Bakar Z. Trends of reactive hyperaemia responses to repetitive loading on skin tissue of rats - Implications for pressure ulcer prevention. J Tissue Viability 2017; 26:196-201. [PMID: 28438463 DOI: 10.1016/j.jtv.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022]
Abstract
Tissue recovery is important in preventing tissue deterioration, which is induced by pressure and may lead to pressure ulcers (PU). Reactive hyperaemia (RH) is an indicator used to identify people at risk of PU. In this study, the effect of different recovery times on RH trend is investigated during repetitive loading. Twenty-one male Sprague-Dawley rats (seven per group), with body weight of 385-485 g, were categorised into three groups and subjected to different recovery times with three repetitive loading cycles. The first, second, and third groups were subjected to short (3 min), moderate (10 min), and prolonged (40 min) recovery, respectively, while fixed loading time and pressure (10 min and 50 mmHg, respectively). Peak hyperaemia was measured in the three cycles to determine trends associated with different recovery times. Three RH trends (increasing, decreasing, and inconsistent) were observed. As the recovery time is increased (3 min vs. 10 min vs. 40 min), the number of samples with increasing RH trend decreases (57% vs. 29% vs. 14%) and the number of samples with inconsistent RH trend increases (29% vs. 57% vs. 72%). All groups consists of one sample with decreasing RH trend (14%). Results confirm that different recovery times affect the RH trend during repetitive loading. The RH trend may be used to determine the sufficient recovery time of an individual to avoid PU development.
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Affiliation(s)
- Jong-Heng Yapp
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Raja Kamil
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia.
| | - M Rozi
- Cancer Resource and Education Center, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - M Y Loqman
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - A R Ezamin
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
| | - Zuki Abu Bakar
- Department of Veterinary Pre-Clinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia
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17
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Lustig M, Levy A, Kopplin K, Ovadia-Blechman Z, Gefen A. Beware of the toilet: The risk for a deep tissue injury during toilet sitting. J Tissue Viability 2017; 27:23-31. [PMID: 28446371 DOI: 10.1016/j.jtv.2017.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/18/2017] [Accepted: 04/20/2017] [Indexed: 12/01/2022]
Abstract
A pressure injury (PrI) compromises quality of life and can be life-threatening. The fundamental cause of PrIs is sustained deformations in weight-bearing soft tissues, e.g., during prolonged sitting on inadequate surfaces such as a toilet seat. In nursing homes and geriatric facilities, patients need assistance using the restroom, and patients being left on the toilet for tens-of-minutes is a real-world scenario, unfortunately. Nevertheless, there are no published studies regarding sustained tissue loads during toilet sitting and their effects on tissue physiology. Here, the biomechanical and microcirculatory responses of the buttock tissues to toilet sitting were investigated using finite element modeling and cutaneous hemodynamic measurements, to explore the potential etiology of PrIs occurring on the toilet. We found that prolonged sitting on toilet seats involves a potential risk for PrI development, the extent of which is affected by the seat design. Additionally, we found that specialized toilet seat cushions are able to reduce this risk, by lowering instantaneous tissue exposures to internal stresses (by up to 88%) and maintaining reduced interface pressures. Furthermore, hemodynamic variables were altered during the toilet sitting; in particular, tcPO2 was decreased by 49% ± 7% (44 ± 2[mmHg] to 22 ± 4[mmHg]) during sitting. The current study confirms that investing in expensive PrI prevention (PIP) products is likely to be ineffective for an immobilized patient who is left to sit on a bare toilet seat for long times. This argument highlights the need for a holistic-care approach, employing PIP devices that span across the entire environment where bodyweight forces apply to tissues.
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Affiliation(s)
- Maayan Lustig
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Levy
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Kara Kopplin
- Research & Innovation, Permobil Group, Belleville, IL, USA
| | - Zehava Ovadia-Blechman
- Department of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
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18
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Li C, DiPiro ND, Krause J. A latent structural equation model of risk behaviors and pressure ulcer outcomes among people with spinal cord injury. Spinal Cord 2017; 55:553-558. [DOI: 10.1038/sc.2017.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/06/2017] [Indexed: 12/12/2022]
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Richard-Denis A, Thompson C, Mac-Thiong JM. Effectiveness of a multi-layer foam dressing in preventing sacral pressure ulcers for the early acute care of patients with a traumatic spinal cord injury: comparison with the use of a gel mattress. Int Wound J 2017; 14:874-881. [PMID: 28052526 DOI: 10.1111/iwj.12710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 11/26/2022] Open
Abstract
Individuals with spinal cord injury are at risk of sacral pressure ulcers due to, among other reasons, prolonged immobilisation. The effectiveness of a multi-layer foam dressing installed pre-operatively in reducing sacral pressure ulcer occurrence in spinal cord injured patients was compared to that of using a gel mattress, and stratified analyses were performed on patients with complete tetraplegia and paraplegia. Socio-demographic and clinical data were collected from 315 patients admitted in a level-I trauma centre following a spinal cord injury between April 2010 and March 2016. Upon arrival to the emergency room and until surgery, patients were transferred on a foam stretcher pad with a viscoelastic polymer gel mattress (before 1 October 2014) or received a multi-layer foam dressing applied to their sacral-coccygeal area (after 1 October 2014). The occurrence of sacral pressure ulcer during acute hospitalisation was similar irrespective of whether patients received the dressing or the gel mattress. It was found that 82% of patients with complete tetraplegia receiving the preventive dressing developed sacral ulcers as compared to only 36% of patients using the gel mattress. Although multi-layer dressings were suggested to improve skin protection and decrease pressure ulcer occurrence in critically ill patients, such preventive dressings are not superior to gel mattresses in spinal cord injured patients and should be used with precaution, especially in complete tetraplegia.
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Affiliation(s)
- Andréane Richard-Denis
- Research Center, Hôpital du Sacré-Cœur, Montreal, Canada.,Faculty of Medicine, University of Montreal, Montreal, Canada
| | | | - Jean-Marc Mac-Thiong
- Research Center, Hôpital du Sacré-Cœur, Montreal, Canada.,Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Ste-Justine, Montreal, Canada
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20
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Vos-Draper TL, Morrow MMB. Seating-Related Pressure Injury Prevention in Spinal Cord Injury: A Review of Compensatory Technologies to Improve In-Seat Movement Behavior. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016; 4:320-328. [PMID: 28603664 PMCID: PMC5461958 DOI: 10.1007/s40141-016-0140-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A PURPOSE OF REVIEW The purpose of this review was to (1) assess the factors related to the occurrence of pressure injuries in people with a spinal cord injury (SCI), (2) review methods of pressure injury prevention, and (3) examine compensatory technologies developed to promote in-seat movement to reduce the risk of pressure injuries. B RECENT FINDINGS Risk factors for seating-related pressure injuries are well documented, yet, ulceration remains a daily concern for individuals with SCI. While prompts and alarms have been shown to be effective at increasing in-seat movement, the devices thus far were not designed for long-term use. Wheelchair users will benefit from continued development of novel technologies designed to help them self-manage pressure injury prevention. C SUMMARY Optimized feedback about pressure and movement will help wheelchair users with SCI perform more effective movements to relieve pressure, perform movements more frequently and consistently, and maintain effective and frequent movement behaviors over time while feedback is available.
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Affiliation(s)
- Tamara L. Vos-Draper
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Mayo Clinic, Rochester, MN, 55905, USA
- Rehabilitation Medicine Research Center, Mayo Clinic, Mayo Clinic, Rochester, MN, 55905, USA
| | - Melissa M. B. Morrow
- Rehabilitation Medicine Research Center, Mayo Clinic, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN, 55905, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
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Weihs D, Gefen A, Vermolen FJ. Review on experiment-based two- and three-dimensional models for wound healing. Interface Focus 2016; 6:20160038. [PMID: 27708762 DOI: 10.1098/rsfs.2016.0038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Traumatic and chronic wounds are a considerable medical challenge that affects many populations and their treatment is a monetary and time-consuming burden in an ageing society to the medical systems. Because wounds are very common and their treatment is so costly, approaches to reveal the responses of a specific wound type to different medical procedures and treatments could accelerate healing and reduce patient suffering. The effects of treatments can be forecast using mathematical modelling that has the predictive power to quantify the effects of induced changes to the wound-healing process. Wound healing involves a diverse and complex combination of biophysical and biomechanical processes. We review a wide variety of contemporary approaches of mathematical modelling of gap closure and wound-healing-related processes, such as angiogenesis. We provide examples of the understanding and insights that may be garnered using those models, and how those relate to experimental evidence. Mathematical modelling-based simulations can provide an important visualization tool that can be used for illustrational purposes for physicians, patients and researchers.
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Affiliation(s)
- Daphne Weihs
- Faculty of Biomedical Engineering , Technion-Israel Institute of Technology , Haifa 3200003 , Israel
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering , Tel Aviv University , Tel Aviv 6997801 , Israel
| | - Fred J Vermolen
- Department of Applied Mathematics , Delft University of Technology , Delft , The Netherlands
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22
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Asymmetry in traction forces produced by migrating preadipocytes is bounded to 33%. Med Eng Phys 2016; 38:834-8. [DOI: 10.1016/j.medengphy.2016.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 11/22/2022]
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Cullum N, Buckley H, Dumville J, Hall J, Lamb K, Madden M, Morley R, O’Meara S, Goncalves PS, Soares M, Stubbs N. Wounds research for patient benefit: a 5-year programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04130] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Nicky Cullum
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Hannah Buckley
- Department of Health Sciences, University of York, York, UK
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Jill Hall
- Department of Health Sciences, University of York, York, UK
| | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Mary Madden
- Department of Health Sciences, University of York, York, UK
| | - Richard Morley
- Department of Health Sciences, University of York, York, UK
| | - Susan O’Meara
- Department of Health Sciences, University of York, York, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
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Norman G, Dumville JC, Moore ZEH, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev 2016; 4:CD011586. [PMID: 27040598 PMCID: PMC6486293 DOI: 10.1002/14651858.cd011586.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. A range of treatments with antimicrobial properties, including impregnated dressings, are widely used in the treatment of pressure ulcers. A clear and current overview is required to facilitate decision making regarding use of antiseptic or antibiotic therapies in the treatment of pressure ulcers. This review is one of a suite of Cochrane reviews investigating the use of antiseptics and antibiotics in different types of wounds. It also forms part of a suite of reviews investigating the use of different types of dressings and topical treatments in the treatment of pressure ulcers. OBJECTIVES To assess the effects of systemic and topical antibiotics, and topical antiseptics on the healing of infected and uninfected pressure ulcers being treated in any clinical setting. SEARCH METHODS In October 2015 we searched: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid EMBASE, and EBSCO CINAHL Plus. We also searched three clinical trials registries and the references of included studies and relevant systematic reviews. There were no restrictions based on language or date of publication or study setting. SELECTION CRITERIA Randomised controlled trials which enrolled adults with pressure ulcers of stage II or above were included in the review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included 12 trials (576 participants); 11 had two arms and one had three arms. All assessed topical agents, none looked at systemic antibiotics. The included trials assessed the following antimicrobial agents: povidone iodine, cadexomer iodine, gentian violet, lysozyme, silver dressings, honey, pine resin, polyhexanide, silver sulfadiazine, and nitrofurazone with ethoxy-diaminoacridine. Comparators included a range of other dressings and ointments without antimicrobial properties and alternative antimicrobials. Each comparison had only one trial, participant numbers were low and follow-up times short. The evidence varied from moderate to very low quality.Six trials reported the primary outcome of wound healing. All except one compared an antiseptic with a non-antimicrobial comparator. There was some moderate and low quality evidence that fewer ulcers may heal in the short term when treated with povidone iodine compared with non-antimicrobial alternatives (protease-modulating dressings (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.98) and hydrogel (RR 0.64, 95% CI 0.43 to 0.97)); and no clear difference between povidone iodine and a third non-antimicrobial treatment (hydrocolloid) (low quality evidence). Pine resin salve may heal more pressure ulcers than hydrocolloid (RR 2.83, 95% CI 1.14 to 7.05) (low quality evidence). There is no clear difference between cadexomer iodine and standard care, and between honey a combined antiseptic and antibiotic treatment (very low quality evidence).Six trials reported adverse events (primary safety outcome). Four reported no adverse events; there was very low quality evidence from one showing no clear evidence of a difference between cadexomer iodine and standard care; in one trial it was not clear whether data were appropriately reported.There was limited reporting of secondary outcomes. The five trials that reported change in wound size as a continuous outcome did not report any clear evidence favouring any particular antiseptic/anti-microbial treatments. For bacterial resistance, one trial found some evidence of more MRSA eradication in participants with ulcer treated with a polyhexanide dressing compared with a polyhexanide swab (RR 1.48, 95% CI 1.02 to 2.13); patients in the dressing group also reported less pain (MD -2.03, 95% CI -2.66 to -1.40). There was no clear evidence of a difference between interventions in infection resolution in three other comparisons. Evidence for secondary outcomes varied from moderate to very low quality; where no GRADE assessment was possible we identified substantial limitations which an assessment would have taken into account. AUTHORS' CONCLUSIONS The relative effects of systemic and topical antimicrobial treatments on pressure ulcers are not clear. Where differences in wound healing were found, these sometimes favoured the comparator treatment without antimicrobial properties. The trials are small, clinically heterogenous, generally of short duration, and at high or unclear risk of bias. The quality of the evidence ranges from moderate to very low; evidence on all comparisons was subject to some limitations.
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Affiliation(s)
- Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Zena EH Moore
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
| | - Judith Tanner
- University of NottinghamSchool of Health SciencesQueens Medical CentreNottinghamUKNG7 2HA
| | - Janice Christie
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Saori Goto
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
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Tadiparthi S, Hartley A, Alzweri L, Mecci M, Siddiqui H. Improving outcomes following reconstruction of pressure sores in spinal injury patients: A multidisciplinary approach. J Plast Reconstr Aesthet Surg 2016; 69:994-1002. [PMID: 27117674 DOI: 10.1016/j.bjps.2016.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 02/02/2016] [Accepted: 02/28/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Pressure sore treatment in spinal injury patients is challenging. A multidisciplinary approach with joint management by the plastic surgery and spinal injury teams was initiated at our institution in 2005 to improve patient care and surgical outcomes following reconstruction. This study assessed the surgical outcomes following reconstruction using the team approach and to compare inpatient stay and readmissions for complications before and after the multidisciplinary protocol was introduced. METHODS A retrospective review of consecutive patients in the multidisciplinary pressure sore clinic was performed. Data were collected on patient demographics, reconstructive techniques, surgical outcomes and readmission for any complications. RESULTS In total, 45 patients with 60 pressure sores (grade 3 or 4) were reviewed in the joint clinic between 2005 and 2011. The majority of patients were paraplegic (78%), while the remaining 22% were tetraplegic. Ischial sores were the most common (45%) followed by trochanteric (23%) and sacral (20%) sores. Multiple sores were noted in 44% of patients. Flap reconstruction was required in 32 patients (71%); after a mean follow-up time of 33 months (range 25-72 months), there were three (9%) major complications (two recurrences of pressure sores and one sinus) and seven (22%) minor complications. After introduction of patient care pathways through the multidisciplinary approach, the rate of readmission for complications decreased from 14% to 5.5% and inpatient stay upon readmission reduced from 65 to 45 days. CONCLUSIONS Implementation of a multidisciplinary approach was key to optimising surgical outcomes, achieving a low recurrence rate (6%) and reducing readmissions.
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Affiliation(s)
- S Tadiparthi
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - A Hartley
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - L Alzweri
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - M Mecci
- The Golden Jubilee North East Regional Spinal Injuries Centre, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - H Siddiqui
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
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Sonenblum SE, Sprigle SH, Martin JS. Everyday sitting behavior of full-time wheelchair users. ACTA ACUST UNITED AC 2016; 53:585-598. [DOI: 10.1682/jrrd.2015.07.0130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/02/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Sharon E. Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
| | - Stephen H. Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
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Surgical Treatment of Pressure Ulcers with a Fibrin Sealant in Patients with Spinal Cord Injury: A Cost-Consequence Analysis. Adv Skin Wound Care 2015; 28:503-7. [PMID: 26479693 DOI: 10.1097/01.asw.0000471875.06135.a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A comparative study was performed to evaluate the effectiveness and costs of a fibrin sealant (Tissucol Duo [known as Tisseel in the United States], Baxter International, Deerfield, Illinois) to improve postoperative outcomes in patients with spinal cord injury undergoing surgical treatment for pressure ulcers (PrUs). METHODS Between January and June 2011, 27 patients underwent surgical treatment for PrUs with the direct application of Tissucol Duo sprayed before closure. The costs and outcomes obtained in this cohort were compared with those obtained in a previous retrospective study where 71 patients underwent conventional surgery. RESULTS Lower rates of hematoma-seroma were observed in the study group (3.7% vs 33.8%; P < .05). Drain removal occurred earlier (10 vs 15 days; P < .05), and the average drain volume was also lower (155 vs 360 mL; P < .05) for this group. The mean length of hospital stay was significantly lower in the study group and was the main contributing factor to the overall costs. CONCLUSIONS The application of Tissucol Duo during surgical treatment of PrUs in patients with spinal cord injury has been shown to be effective in reducing postoperative complications and in shortening the duration of the hospital stay with a consequent savings in costs.
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Contoured Foam Cushions Cannot Provide Long-term Protection Against Pressure-Ulcers for Individuals with a Spinal Cord Injury. Adv Skin Wound Care 2015; 28:303-16. [DOI: 10.1097/01.asw.0000465300.99194.27] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3D anatomy and deformation of the seated buttocks. J Tissue Viability 2015; 24:51-61. [DOI: 10.1016/j.jtv.2015.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022]
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Norman G, Dumville JC, Moore ZEH, Tanner J, Christie J. Antibiotics and antiseptics for pressure ulcers. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Van Asbeck FWA, Post MWM. Bedside prediction of the progress of pressure ulcer healing in patients with spinal cord injury using the ‘Decu-stick’. Spinal Cord 2015; 53:539-43. [DOI: 10.1038/sc.2015.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/09/2022]
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Groah SL, Schladen M, Pineda CG, Hsieh CHJ. Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review. PM R 2014; 7:613-36. [PMID: 25529614 DOI: 10.1016/j.pmrj.2014.11.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/25/2014] [Accepted: 11/29/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the literature on the effectiveness of bed and wheelchair positioning and repositioning in the prevention of pressure ulcers (PUs) in both the spinal cord injury (SCI) and non-SCI populations. DESIGN Systematic review. METHODS PubMed, CINAHL, PsycINFO, and EMBASE were queried with the subject heading terms "pressure sore," "pressure ulcer," "position or turn in bed, wheelchair," "pressure relief," and "pressure release." All study design types that assessed the effectiveness of bed and wheelchair positioning and pressure relief maneuvers in any patient group and in any setting were sought. Three independent reviewers extracted and summarized details of eligible trials using a standardized method. Two independent reviewers assessed the methodological quality of each trial using the American Academy of Neurology guidelines. When reviewers were not able to reach consensus, a third independent reviewer served as tiebreaker. RESULTS We identified 2820 publications, of which 49 met inclusion criteria. Of these publications, the subject population was 2834 (923 persons with SCI, 717 persons without SCI, and 1194 healthy control subjects). Among studies examining pressure related to position or repositioning in bed or sitting, procedures for measuring skin pressure and metabolism were highly variable by anatomic location, measurement technique, outcome measure, study site, participant characteristics, and description of position/turning for bed and seated interventions. Numerous factors can influence tissue interface pressures, and no prospective studies had been performed to determine a causal relationship between interface pressure and skin breakdown. Several studies suggest that skin response to pressure differs between subjects with and without SCI. Conflicting results and insufficient evidence for optimal bed and seated positioning and turning and pressure relief maneuvers to prevent PUs in both SCI and non-SCI populations were limiting factors. CONCLUSIONS Although there is no clear optimal positioning or turning frequency in bed, the evidence suggests avoiding the 90° lateral position because of high pressures and PU risk over the trochanters. During sitting, pressures are linearly redistributed from the sitting area during recline and tilt; however, reclining carries with it an increased risk of shear forces on this skin. The evidence does not support conclusive guidelines on positioning or repositioning techniques for PU prevention in bed or during sitting. We conclude that PU risk is highly individualized, with the SCI population at a higher risk, which demands flexible PU prevention strategies for bed/seated positioning and pressure relief maneuvers. Education has and will remain our most powerful ally to thwart this pervasive public health problem.
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Affiliation(s)
- Suzanne L Groah
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010; Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, DC(∗).
| | - Manon Schladen
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010; MedStar Health Research Institute, Hyattsville, MD; Washington, DC Veterans Affairs Medical Center, Washington, DC(†)
| | - Cynthia G Pineda
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010; Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, DC; MedStar Montgomery Medical Center, Olney, MD(‡)
| | - Ching-Hui J Hsieh
- MedStar National Rehabilitation Hospital, 102 Irving St., NW, Washington, DC 20010; MedStar Health Research Institute, Hyattsville, MD(§)
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Hall J, Buckley HL, Lamb KA, Stubbs N, Saramago P, Dumville JC, Cullum NA. Point prevalence of complex wounds in a defined United Kingdom population. Wound Repair Regen 2014; 22:694-700. [PMID: 25224463 DOI: 10.1111/wrr.12230] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/05/2014] [Indexed: 11/28/2022]
Abstract
Complex wounds (superficial-, partial-, or full-thickness skin loss wounds healing by secondary intention) are common; however, there is a lack of high-quality, contemporary epidemiological data. This paper presents point prevalence estimates for complex wounds overall as well as for individual types. A multiservice, cross-sectional survey was undertaken across a United Kingdom city (Leeds, population 751,485) during 2 weeks in spring of 2011. The mean age of people with complex wounds was approximately 70 years, standard deviation 19.41. The point prevalence of complex wounds was 1.47 per 1,000 of the population, 95% confidence interval 1.38 to 1.56. While pressure ulcers and leg ulcers were the most frequent, one in five people in the sample population had a less common wound type. Surveys confined to people with specific types of wound would underestimate the overall impact of complex wounds on the population and health care resources.
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Affiliation(s)
- Jill Hall
- Department of Health Sciences, University of York, York, United Kingdom
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Sonenblum SE, Vonk TE, Janssen TW, Sprigle SH. Effects of wheelchair cushions and pressure relief maneuvers on ischial interface pressure and blood flow in people with spinal cord injury. Arch Phys Med Rehabil 2014; 95:1350-7. [PMID: 24480336 DOI: 10.1016/j.apmr.2014.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/10/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the effectiveness and interactions of 2 methods of pressure ulcer prevention, wheelchair cushions and pressure relief maneuvers, on interface pressure (IP) and blood flow of the buttocks. DESIGN Within-subject repeated measures. SETTING Rehabilitation center. PARTICIPANTS Wheelchair users with a spinal cord injury or disorder (N=17). INTERVENTIONS Participants performed 3 forward leans and 2 sideward leans with different degrees of lean while seated on each of 3 different wheelchair cushions. MAIN OUTCOME MEASURES IP measured with a custom sensor and blood flow measured with laser Doppler flowmetry were collected at the ischial tuberosity. RESULTS Pressure relief maneuvers had a significant main effect on the ischial IP (P<.001); all maneuvers except for the small frontward lean resulted in a significant reduction in IP compared with upright sitting. Blood flow significantly varied across postures (P<.001) with flow during upright sitting and small forward leans being significantly lower than during the full and intermediate leans in both the forward and sideward directions. CONCLUSIONS The results of the study highlight the importance of positioning wheelchair users in a manner that facilitates in-seat movement. Regardless of the cushion being used, the pressure relief maneuvers resulted in very large reductions in IPs and significant increases in buttock blood flow. Only the small frontward lean was shown to be ineffective in reducing pressure or increasing blood flow. Because these pressure relief maneuvers involved postural changes that can occur during functional activities, these pressure relief maneuvers can become a part of volitional pressure relief and functional weight shifts. Therefore, clinical instruction should cover both as a means to impart sitting behaviors that may lead to better tissue health.
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Affiliation(s)
- Sharon E Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA.
| | - Teddie E Vonk
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Thomas W Janssen
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Stephen H Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
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Levy A, Kopplin K, Gefen A. Computer simulations of efficacy of air-cell-based cushions in protecting against reoccurrence of pressure ulcers. ACTA ACUST UNITED AC 2014; 51:1297-319. [DOI: 10.1682/jrrd.2014.02.0048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 07/03/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Ayelet Levy
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
| | | | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
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Levy A, Kopplin K, Gefen A. An air-cell-based cushion for pressure ulcer protection remarkably reduces tissue stresses in the seated buttocks with respect to foams: finite element studies. J Tissue Viability 2013; 23:13-23. [PMID: 24405723 DOI: 10.1016/j.jtv.2013.12.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/12/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
A sitting-acquired pressure ulcer (PU) is a common injury in wheelchair-bound patients. Preventative measures for the post spinal cord injury (SCI) population include prescription of a supportive thick cushion on the wheelchair, in order to better distribute loads between the buttocks and support surface (which are quantifiable using interface pressure measurements), and potentially, to minimize internal soft tissue loads (which are typically unknown). Information about the biomechanical efficacy of commercially-available structured cushion designs such as air-cell-based (ACB) cushions, gel, and honeycomb-like cushions is sparse. Considering the importance of such evaluations to patient safety and quality of life, we studied the biomechanical performances of an ACB cushion in comparison to standard, flat foam cushions with different stiffness properties. Using a set of finite element (FE) model variants, we determined the mechanical stresses in muscle, fat, and skin tissues under the ischial tuberosities during sitting. Tissue stress analyses were conducted in a reference SCI anatomy, incorporating pathoanatomical and pathophysiological changes associated with chronic SCI, including bone shape adaptation, muscle atrophy, and spasms. We found up to 57% greater immersion and 4 orders-of-magnitude lower muscle, fat, and skin tissue stresses for the ACB cushion. We also found the ACB cushion provides better protection against the aforementioned bone shape adaptation, muscle atrophy, and spasms. Hence, theoretically, the use of a suitable ACB cushion should provide longer safe sitting times for SCI patients with respect to standard foam cushions.
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Affiliation(s)
- Ayelet Levy
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Kara Kopplin
- Efficacy Research, Standards and Public Policy, ROHO, Inc., Belleville, IL, USA
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 69978, Israel.
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Levy A, Kopplin K, Gefen A. Simulations of skin and subcutaneous tissue loading in the buttocks while regaining weight-bearing after a push-up in wheelchair users. J Mech Behav Biomed Mater 2013; 28:436-47. [DOI: 10.1016/j.jmbbm.2013.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 11/29/2022]
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Sprigle S, Sonenblum S, Conner-Kerr T. mobilityRERC state of the science conference: individualizing pressure ulcer risk and prevention strategies. Disabil Rehabil Assist Technol 2013; 8:454-61. [DOI: 10.3109/17483107.2013.823574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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López de Heredia L, Hauptfleisch J, Hughes R, Graham A, Meagher TMM. Magnetic resonance imaging of pressure sores in spinal cord injured patients: accuracy in predicting osteomyelitis. Top Spinal Cord Inj Rehabil 2013; 18:146-8. [PMID: 23459682 DOI: 10.1310/sci1802-146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Identify key magnetic resonance imaging (MRI) features that have a significant correlation with osteomyelitis of pressure ulcers in spinal injury patients. DESIGN Retrospective review study. PARTICIPANTS Adult patients admitted to the National Spinal Injuries Centre with spinal cord injury (SCI) and signs of pressure ulceration investigated with MRI. METHODS Analysis of MRI examinations and clinical records collected over a 4-year period. Images were independently assessed by 2 experienced radiologists for osteomyelitis based on assigned predictive indicators including cortical bone erosion, soft tissue edema, deep collections, heterotopic new bone, hip effusion, and abnormal signal change of the marrow. RESULTS Thirty-seven patients underwent 41 MRI scans. The prevalence of osteomyelitis was highly correlated with cortical bone erosion (r = 0.84) and abnormal bone marrow changes on T1-weighted images (r = 0.82).
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Stinson M, Gillan C, Porter-Armstrong A. A Literature Review of Pressure Ulcer Prevention: Weight Shift Activity, Cost of Pressure Care and Role of the Occupational Therapist. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13651610908371] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Pressure ulcers are a major concern for those who spend a prolonged period of time sitting. Weight shifts are one prevention strategy used to reduce the risk of tissue damage. Currently, the prevalence of pressure ulcers is high, suggesting that concordance with preventative methods is poor. Occupational therapy focuses on the use of functional activity to promote health and wellbeing. The aim of this literature review was to evaluate the role of functional activity in reducing seated interface pressure. Method: A comprehensive search of nine electronic databases (AMED, CINAHL, Ovid MEDLINE, SportDiscus, EMBASE, British Nursing Index, Cochrane Library, Google Scholar and OTDBASE) was conducted between January 2000 and October 2011. Findings: From the 24 articles included in the review, there is limited evidence evaluating the role of functional activity and weight shifts in reducing seated interface pressure. Limited evidence suggests poor concordance with weight shifts, with wheelchair users repositioning on average once every 1–2 hours. The cost of pressure ulcer care is considerable, with an average annual cost of £1.7 billion in the United Kingdom. Occupational therapists have a key preventative role. Conclusion: Further research is needed to explore the role of functional activity and to determine the effectiveness of weight shift activity in reducing seated interface pressure.
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Affiliation(s)
- May Stinson
- Lecturer in Occupational Therapy, School of Health Sciences, University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland
| | - Catherine Gillan
- Formerly Research Assistant, School of Health Sciences, University of Ulster, Newtownabbey, Co. Antrim, and currently Occupational Therapist, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Alison Porter-Armstrong
- Senior Lecturer in Rehabilitation Sciences, Health and Rehabilitation Sciences Research Institute, University of Ulster, Newtownabbey, Co. Antrim, Northern Ireland
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Dai R, Sonenblum SE, Sprigle S. A robust wheelchair pressure relief monitoring system. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:6107-10. [PMID: 23367322 DOI: 10.1109/embc.2012.6347387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is essential to prevent pressure ulcers for people with spinal cord injuries (SCI). Pressure ulcer is likely to develop when there is excessive pressure on the body tissue for lengthy durations. Therefore, persons with SCI, who usually spend long time sitting in wheelchairs, are advised to perform regular pressure reliefs in their daily lives. This paper proposes a system for the monitoring of wheelchair users' pressure relief behaviors. The system utilizes piezo resistive sensors beneath a wheelchair cushion to monitor pressure, and employs supervised learning techniques to classify a wheelchair user's pressure relief status. Key features of the system include robustness and not interfering with cushion performance or the daily activities of wheelchair users. The system works well on different types of cushions, and achieves 91% sensitivity and 89% specificity based on tests on different wheelchair users.
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Affiliation(s)
- Rui Dai
- Rehabilitation Engineering and Applied Research Laboratory (REAR Lab), Georgia Institute of Technology, 490 10th St., NW, Atlanta, GA 30318, USA.
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Hauptfleisch J, Meagher TM, Hughes RJ, Singh JP, Graham A, López de Heredia L. Interobserver agreement of magnetic resonance imaging signs of osteomyelitis in pelvic pressure ulcers in patients with spinal cord injury. Arch Phys Med Rehabil 2012; 94:1107-11. [PMID: 23164978 DOI: 10.1016/j.apmr.2012.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 10/30/2012] [Accepted: 11/09/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the interobserver reliability of magnetic resonance imaging (MRI) signs of osteomyelitis in complex chronic pressure ulcers in patients with spinal cord injury (SCI). DESIGN Retrospective review study. SETTING Specialist SCI rehabilitation center. PARTICIPANTS Adult patients with SCI and pressure ulceration investigated with MRI. INTERVENTIONS Analysis of MRI examinations and clinical records collected over a 4-year period. Images were independently assessed by 2 experienced radiologists for osteomyelitis based on assigned predictive indicators including cortical bone erosion, soft tissue edema, deep collections, heterotopic new bone, hip effusion, and abnormal signal change of the marrow. MAIN OUTCOME MEASURES Interobserver agreement for indicative MRI signs of osteomyelitis in complex pressure ulcers. RESULTS Thirty-seven patients underwent 41 MRI scans. Concordance for marrow edema was 71% on both short tau inversion recovery and T1-weighted sequences, and for cortical erosion was 85%. CONCLUSIONS For the assessment of pelvic osteomyelitis related to pressure ulcers, the T1-weighted MRI signal for marrow edema and cortical erosion has strong interobserver agreement.
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Friesen E, Theodoros D, Russell T. Clinical assessment, design and performance testing of mobile shower commodes for adults with spinal cord injury: an exploratory review. Disabil Rehabil Assist Technol 2012; 8:267-74. [PMID: 22830674 DOI: 10.3109/17483107.2012.704656] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this article is to explore evidence concerning clinical assessment, design and performance testing of mobile shower commodes used by adults with spinal cord injury (SCI). METHOD Searches of electronic databases, conference proceedings and key journals were undertaken with no restriction on language or study design. Keywords included spinal cord injury, lesion, sanichair, sanitary chair, shower chair, bowel chair and commode. RESULTS A total of 20 publications were included in this review. Common approaches to clinical assessments were questionnaires and observational analysis to assess bowel care routines, function and skin integrity. Design features addressed access for bowel care, postural support, transfers, stability, use in wet environments and skin integrity. Objective performance measures addressed requirements for static stability, backward-sloping seat angles, arm supports and seat materials. CONCLUSIONS Evidence reviewed was of low methodological quality and lacking in validated instruments to guide clinical practice. Further high-quality research is needed to identify bathing, showering and personal hygiene tasks affecting mobile shower commodes use and to develop validated clinical assessment tools. Performance testing to published standards is also needed.
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Affiliation(s)
- Emma Friesen
- Telerehabilitation Research Unit, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia.
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Boldt C, Velstra IM, Brach M, Linseisen E, Cieza A. Nurses' intervention goal categories for persons with spinal cord injury based on the International Classification of Functioning, Disability and Health: an international Delphi survey. J Adv Nurs 2012; 69:1109-24. [DOI: 10.1111/j.1365-2648.2012.06100.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2012] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | - Elisabeth Linseisen
- Department of Medical Informatics, Biometry and Epidemiology - IBE; Research Unit for Biopsychosocial Health; Ludwig-Maximilian University; Munich; Germany
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Solis LR, Liggins A, Uwiera RRE, Poppe N, Pehowich E, Seres P, Thompson RB, Mushahwar VK. Distribution of internal pressure around bony prominences: implications to deep tissue injury and effectiveness of intermittent electrical stimulation. Ann Biomed Eng 2012; 40:1740-59. [PMID: 22354272 DOI: 10.1007/s10439-012-0529-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 02/03/2012] [Indexed: 11/27/2022]
Abstract
The overall goal of this project is to develop interventions for the prevention of deep tissue injury (DTI), a form of pressure ulcers that originates in deep tissue around bony prominences. The present study focused on: (1) obtaining detailed measures of the distribution of pressure experienced by tissue around the ischial tuberosities, and (2) investigating the effectiveness of intermittent electrical stimulation (IES), a novel strategy for the prevention of DTI, in alleviating pressure in regions at risk of breakdown due to sustained loading. The experiments were conducted in adult pigs. Five animals had intact spinal cords and healthy muscles and one had a spinal cord injury that led to substantial muscle atrophy at the time of the experiment. A force-controlled servomotor was used to load the region of the buttocks to levels corresponding to 25%, 50% or 75% of each animal's body weight. A pressure transducer embedded in a catheter was advanced into the tissue to measure pressure along a three dimensional grid around the ischial tuberosity of one hind leg. For all levels of external loading in intact animals, average peak internal pressure was 2.01 ± 0.08 times larger than the maximal interfacial pressure measured at the level of the skin. In the animal with spinal cord injury, similar absolute values of internal pressure as that in intact animals were recorded, but the substantial muscle atrophy produced larger maximal interfacial pressures. Average peak internal pressure in this animal was 1.43 ± 0.055 times larger than the maximal interfacial pressure. Peak internal pressure was localized within a ±2 cm region medio-laterally and dorso-ventrally from the bone in intact animals and ±1 cm in the animal with spinal cord injury. IES significantly redistributed internal pressure, shifting the peak values away from the bone in spinally intact and injured animals. These findings provide critical information regarding the relationship between internal and interfacial pressure around the ischial tuberosities during loading levels equivalent to those experienced while sitting. The information could guide future computer models investigating the etiology of DTI, as well as inform the design and prescription of seating cushions for people with reduced mobility. The findings also suggest that IES may be an effective strategy for the prevention of DTI.
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Affiliation(s)
- Leandro R Solis
- Rehabilitation Science Program, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Mittmann N, Chan BC, Craven BC, Isogai PK, Houghton P. Evaluation of the cost-effectiveness of electrical stimulation therapy for pressure ulcers in spinal cord injury. Arch Phys Med Rehabil 2011; 92:866-72. [PMID: 21621661 DOI: 10.1016/j.apmr.2010.12.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/16/2010] [Accepted: 12/31/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective. DESIGN A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can $) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted. SETTING The perspective of this analysis is from a Canadian public health system payer. PARTICIPANTS Model target population was an SCI cohort with grade III/IV PUs. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Incremental cost per PU healed. RESULTS ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of $224 at 1 year. ES plus SWC were thus considered a dominant economic comparator. Probabilistic sensitivity analysis resulted in economic dominance for ES plus SWC in 62%, with another 35% having incremental cost-effectiveness ratios of $50,000 or less per PU healed. The largest driver of the economic model was the percentage of PU healed with ES plus SWC. CONCLUSIONS The addition of ES to SWC improved healing in grade III/IV PU and reduced costs in an SCI population.
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Affiliation(s)
- Nicole Mittmann
- Health Outcomes and PharmacoEconomics Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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The impact of tilting on blood flow and localized tissue loading. J Tissue Viability 2010; 20:3-13. [PMID: 21145240 DOI: 10.1016/j.jtv.2010.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 09/01/2010] [Accepted: 10/05/2010] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY The overall goal of this research was to improve the use of seated tilt to increase function, health and quality of life for people using power wheelchairs. Specifically, the objective of this study was to evaluate the biomechanical responses to seated full body tilt in persons with spinal cord injury (SCI). MATERIALS AND METHODS Laser Doppler Flowmetry and interface pressure measurement were employed to measure changes in blood flow and loading at the ischial tuberosities across different amounts of tilt. Eleven participants with SCI were studied in a laboratory setting. RESULTS Results showed that biomechanical responses to tilt were highly variable. Pressure reduction at the ischial tuberosity was not present at 15°, but did occur with tilts to 30° and greater, and could be explained by the tilt position and upright pressure. Unlike pressure, blood flow increased with all tilts from an upright position, but did not increase when tilting from 15° to 30°. Only 4 of 11 participants had increases in blood flow of ≥10% at 30° tilt, whereas 9 participants did during maximum tilt (i.e., 45°-60°). CONCLUSIONS Based on the results of this study, tilting for pressure reliefs as far as the seating system permits is suggested to maximize the potential for significant blood flow increases and pressure relief. The use of interim small tilts is also supported, as they also provide some benefit.
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James J, Evans JA, Young T, Clark M. Pressure ulcer prevalence across Welsh orthopaedic units and community hospitals: surveys based on the European Pressure Ulcer Advisory Panel minimum data set. Int Wound J 2010; 7:147-52. [PMID: 20602646 DOI: 10.1111/j.1742-481x.2010.00665.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The survey used the European Pressure Ulcer Advisory Panel (EPUAP) methodology for the collection of pressure ulcer prevalence data. The orthopaedic survey was conducted across all National Health Service Trusts in Wales between 2 and 6 July 2007 while the community hospital survey covering 25% of all community hospital beds was conducted between 21 April 2008 and 2 May 2008. Data were gathered upon 1196 patients (581, 48.6% within orthopaedic units with 615 located in community hospitals). Of these patients, 81 (13.9%) and 162 (26.7%) had pressure ulcers in orthopaedic and community hospitals, respectively. Where patients presented with multiple pressure ulcers, the most severe pressure ulcer was recorded. Across both surveys, most pressure ulcers were reported to be either category I or II with 91 category I wounds (33 in orthopaedic units and 58 in community hospitals). Severe (categories III and IV) pressure ulcers affected 78 patients (19 in orthopaedic units and 59 in community hospitals). Adoption of the EPUAP pressure ulcer prevalence methods can help achieve consistent data upon pressure ulcer prevalence in different health care organisations and specialities. The adoption of a consistent data collection capture methodology is a clear prerequisite for the compilation of meaningful pressure ulcer prevalence data sets at a national level.
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Affiliation(s)
- Jane James
- Hywel Dda Health Board, Haverfordwest, Pembrokeshire, UK
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