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Padula WV, Armstrong DG, Pronovost PJ, Saria S. Predicting pressure injury risk in hospitalised patients using machine learning with electronic health records: a US multilevel cohort study. BMJ Open 2024; 14:e082540. [PMID: 38594078 PMCID: PMC11146395 DOI: 10.1136/bmjopen-2023-082540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE To predict the risk of hospital-acquired pressure injury using machine learning compared with standard care. DESIGN We obtained electronic health records (EHRs) to structure a multilevel cohort of hospitalised patients at risk for pressure injury and then calibrate a machine learning model to predict future pressure injury risk. Optimisation methods combined with multilevel logistic regression were used to develop a predictive algorithm of patient-specific shifts in risk over time. Machine learning methods were tested, including random forests, to identify predictive features for the algorithm. We reported the results of the regression approach as well as the area under the receiver operating characteristics (ROC) curve for predictive models. SETTING Hospitalised inpatients. PARTICIPANTS EHRs of 35 001 hospitalisations over 5 years across 2 academic hospitals. MAIN OUTCOME MEASURE Longitudinal shifts in pressure injury risk. RESULTS The predictive algorithm with features generated by machine learning achieved significantly improved prediction of pressure injury risk (p<0.001) with an area under the ROC curve of 0.72; whereas standard care only achieved an area under the ROC curve of 0.52. At a specificity of 0.50, the predictive algorithm achieved a sensitivity of 0.75. CONCLUSIONS These data could help hospitals conserve resources within a critical period of patient vulnerability of hospital-acquired pressure injury which is not reimbursed by US Medicare; thus, conserving between 30 000 and 90 000 labour-hours per year in an average 500-bed hospital. Hospitals can use this predictive algorithm to initiate a quality improvement programme for pressure injury prevention and further customise the algorithm to patient-specific variation by facility.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical & Health Economics, University of Southern California Mann School of Pharmacy & Pharmaceutical Sciences, Los Angeles, CA, USA
- Stage Analytics, Suwanee, GA, USA
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - David G Armstrong
- The Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
- Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA
| | - Peter J Pronovost
- University Hospitals of Cleveland, Shaker Heights, Ohio, USA
- Anesthesiology and Critical Care Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Suchi Saria
- Department of Computer Science, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Kim SJ, Medina M, Hotz K, Kim J, Chang J. Vulnerability to Decubitus Ulcers and Their Association With Healthcare Utilization: Evidence From Nationwide Inpatient Sample Dataset From 2016 to 2020 in US Hospitals. J Patient Saf 2024; 20:164-170. [PMID: 38126801 DOI: 10.1097/pts.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The aim of the study is to identify vulnerable populations at risk of developing decubitus ulcers and their resultant increase in healthcare utilization to promote the use of early prevention methods. METHODS The National Inpatient Sample of the United States was used to identify hospitalized patients across the country who had a length of stay of 5 or more days (N = 9,757,245, weighted N = 48,786,216) from 2016 to 2020. We examined the characteristics of the entire inpatient sample based on the presence of decubitus ulcers, temporal trends, risk of decubitus ulcer development, and its association with healthcare utilization, measured by discounted hospital charges and length of stay. The multivariate survey logistic regression model was used to identify predictors for decubitus ulcer occurrence, and the survey linear regression model was used to measure how decubitus ulcers are associated with healthcare utilization. RESULTS Among 48,786,216 nationwide inpatients, 3.9% had decubitus ulcers. The percentage of inpatients with decubitus ulcers who subsequently experienced increased healthcare utilization rose with time. The survey logistic regression results indicate that patients who were Black, older, male, or those reliant on Medicare/Medicaid had a statistically significant increased risk of decubitus ulcers. The survey linear regression results demonstrate that inpatients with decubitus ulcers were associated with increased hospital charges and longer lengths of stay. CONCLUSIONS Patients with government insurance, those of minority races and ethnicities, and those treated in the Northeast and West may be more vulnerable to pressure ulcers and subsequent increased healthcare utilization. Implementation of early prevention methods in these populations is necessary to minimize the risk of developing decubitus ulcers, even if upfront costs may be increased. For example, larger hospitals were found to have a lower risk of decubitus ulcer development but an increased cost of preventative care. Hence, it is imperative to explore and use universal, targeted preventative methods to improve patient safety.
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Affiliation(s)
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso
| | - Kaci Hotz
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station
| | - Juliy Kim
- Department of Biological Sciences, Texas Woman's University, Denton, Texas
| | - Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station
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3
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Gu S, Lee EW, Zhang W, Simpson RL, Hertzberg VS, Ho JC. Evaluating Natural Language Processing Packages for Predicting Hospital-Acquired Pressure Injuries From Clinical Notes. Comput Inform Nurs 2024; 42:184-192. [PMID: 37607706 PMCID: PMC10884344 DOI: 10.1097/cin.0000000000001053] [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] [Indexed: 08/24/2023]
Abstract
Incidence of hospital-acquired pressure injury, a key indicator of nursing quality, is directly proportional to adverse outcomes, increased hospital stays, and economic burdens on patients, caregivers, and society. Thus, predicting hospital-acquired pressure injury is important. Prediction models use structured data more often than unstructured notes, although the latter often contain useful patient information. We hypothesize that unstructured notes, such as nursing notes, can predict hospital-acquired pressure injury. We evaluate the impact of using various natural language processing packages to identify salient patient information from unstructured text. We use named entity recognition to identify keywords, which comprise the feature space of our classifier for hospital-acquired pressure injury prediction. We compare scispaCy and Stanza, two different named entity recognition models, using unstructured notes in Medical Information Mart for Intensive Care III, a publicly available ICU data set. To assess the impact of vocabulary size reduction, we compare the use of all clinical notes with only nursing notes. Our results suggest that named entity recognition extraction using nursing notes can yield accurate models. Moreover, the extracted keywords play a significant role in the prediction of hospital-acquired pressure injury.
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Affiliation(s)
- Siyi Gu
- Author Affiliations: Department of Computer Science, Center for Data Science (Ms Gu, Mr Lee, and Dr Ho), and Nell Hodgson Woodruff School of Nursing (Drs Zhang, Simpson, and Hertzberg), Emory University, Atlanta, GA
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Wei X, Xu X, Chen Y. A nomogram to predict the risk of surgery-related pressure ulcers in patients undergoing cardiovascular surgery. J Int Med Res 2024; 52:3000605241233149. [PMID: 38422046 PMCID: PMC10906061 DOI: 10.1177/03000605241233149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE In this study, we aimed to establish a new nomogram score to predict the occurrence of surgery-related pressure ulcers (SRPU) in patients undergoing cardiovascular surgery. METHODS We conducted a retrospective study among patients who underwent cardiovascular surgery between February 2016 and November 2020. RESULTS We established a prediction model based on a logistic regression model and tested the calibration and discrimination. We included 1163 patients who had undergone cardiovascular surgery. We formulated the logistic regression model, with Logit(P) = -11.745 + 0.024 preoperative hemoglobin value + 0.118 serum sodium value - 0.014 prealbumin value - 0.213 intraoperative mean temperature - 0.058 minimum mean arterial pressure + 0.646 preoperative blood potassium value + 0.264 smoking frequency + 0.760 hypertension history + 0.536 age ≥70 years. In this model ,"+" indicates that the factor is positively related to the occurrence risk of SRPU and "-" indicates that the factor is negatively associated with SRPU risk. The predictive model and nomogram had good accuracy in estimating the risk of SRPU, with a C-index of 0.755 (95% confidence interval: 0.719-0.792). CONCLUSIONS The present model can be used to effectively screen patients with a high risk of SRPU to devise targeted nursing intervention strategies and ultimately reduce the incidence rate of SRPU.
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Affiliation(s)
| | | | - Yuan Chen
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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5
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Hibbert PD, Molloy CJ, Cameron ID, Gray LC, Reed RL, Wiles LK, Westbrook J, Arnolda G, Bilton R, Ash R, Georgiou A, Kitson A, Hughes CF, Gordon SJ, Mitchell RJ, Rapport F, Estabrooks C, Alexander GL, Vincent C, Edwards A, Carson-Stevens A, Wagner C, McCormack B, Braithwaite J. The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study). BMC Med 2024; 22:22. [PMID: 38254113 PMCID: PMC10804560 DOI: 10.1186/s12916-023-03224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. METHODS Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. RESULTS Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. CONCLUSIONS This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia.
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Faculty of Medicine and Health, University of Sydney, Kolling Institute, Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, QLD, 4102, Australia
| | - Richard L Reed
- Discipline of General Practice, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Rebecca Bilton
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Ruby Ash
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Clifford F Hughes
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Susan J Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | | | - Charles Vincent
- Department of Experimental Psychology, Radcliffe Observatory, University of Oxford, Woodstock Road, Oxford, OX2 6GG, England, UK
| | - Adrian Edwards
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, 8Th Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, 8Th Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK
| | - Cordula Wagner
- Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513 CR, The Netherlands
- Amsterdam University Medical Center/VU University, Van Der Boechorststraat 7, 1081 HV, Amsterdam, The Netherlands
| | - Brendan McCormack
- The Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, City Road, Sydney, NSW, 2006, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
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6
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Zhou Y, Liu L, Rong R, Guo L, Pei Y, Lu X. Constructing nursing quality indicators for intraoperative acquired pressure injury in cancer patients based on guidelines. Int J Qual Health Care 2024; 36:mzae001. [PMID: 38183267 DOI: 10.1093/intqhc/mzae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
Cancer patients have a high incidence of intraoperative acquired pressure injury (IAPI). Constructing IAPI quality indicators can reduce the incidence of pressure injury, but there are a lack of these indicators targeting cancer patients. Based on this, this study develops a system of quality indicators for IAPI. Thirty-four potential indicators were included based on the literature review. The 26 experts were asked to rate the importance and feasibility of each indicator using three rounds of email survey. The authoritative coefficient ranged from 0.92 to 0.94. After three rounds of Delphi expert consultation, nine nursing quality indicators were identified for IAPI in cancer patients. The mean importance or feasibility ratings ranged from 4.77 to 5.81 on a six-point scale, with variation coefficients ranging from 0.07 to 0.26. The percentage of full score for potential indicators ranged from 23.10% to 80.80%. Over three rounds, the Kendall's W coefficients ranged from 0.157 to 0.354 (P < .01). The absolute and relative importance and feasibility of the nine indicators were identified as potentially valid measures of nursing quality indicators for IAPI in cancer patients. This instrument is the first set of IAPI quality indicators developed specifically for cancer patients, and it should be useful for evaluating and improving the quality of IAPI in this population.
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Affiliation(s)
- Yu Zhou
- Nursing department, Chengdu Fifth People's Hospital, No. 33 Mashi Road,Wenjiang District, Chengdu 611130, China
| | - Lu Liu
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
| | - Rong Rong
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
| | - Li Guo
- Department of Development Management, Peking University Third Hospital, No. 49 Huayuan North Road, Beijing 100191, China
| | - Yuquan Pei
- Operating Room, Beijing Cancer Hospital, No. 52 Fucheng Road, Haidian District, Beijing 100048, China
| | - Xiuying Lu
- Operating Room, Operating Room, Sichuan Cancer Hospital, No. 55, Section 4, Renmin South Road, Chengdu 610041, China
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Kim M, Kim TH, Kim D, Lee D, Kim D, Heo J, Kang S, Ha T, Kim J, Moon DH, Heo Y, Kim WJ, Lee SJ, Kim Y, Park SW, Han SS, Choi HS. In-Advance Prediction of Pressure Ulcers via Deep-Learning-Based Robust Missing Value Imputation on Real-Time Intensive Care Variables. J Clin Med 2023; 13:36. [PMID: 38202043 PMCID: PMC10780209 DOI: 10.3390/jcm13010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Pressure ulcers (PUs) are a prevalent skin disease affecting patients with impaired mobility and in high-risk groups. These ulcers increase patients' suffering, medical expenses, and burden on medical staff. This study introduces a clinical decision support system and verifies it for predicting real-time PU occurrences within the intensive care unit (ICU) by using MIMIC-IV and in-house ICU data. We develop various machine learning (ML) and deep learning (DL) models for predicting PU occurrences in real time using the MIMIC-IV and validate using the MIMIC-IV and Kangwon National University Hospital (KNUH) dataset. To address the challenge of missing values in time series, we propose a novel recurrent neural network model, GRU-D++. This model outperformed other experimental models by achieving the area under the receiver operating characteristic curve (AUROC) of 0.945 for the on-time prediction and AUROC of 0.912 for 48h in-advance prediction. Furthermore, in the external validation with the KNUH dataset, the fine-tuned GRU-D++ model demonstrated superior performances, achieving an AUROC of 0.898 for on-time prediction and an AUROC of 0.897 for 48h in-advance prediction. The proposed GRU-D++, designed to consider temporal information and missing values, stands out for its predictive accuracy. Our findings suggest that this model can significantly alleviate the workload of medical staff and prevent the worsening of patient conditions by enabling timely interventions for PUs in the ICU.
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Affiliation(s)
- Minkyu Kim
- Department of Research & Development, Ziovision Co., Ltd., Chuncheon 24341, Republic of Korea; (M.K.); (D.K.); (D.L.); (D.K.)
| | - Tae-Hoon Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
| | - Dowon Kim
- Department of Research & Development, Ziovision Co., Ltd., Chuncheon 24341, Republic of Korea; (M.K.); (D.K.); (D.L.); (D.K.)
| | - Donghoon Lee
- Department of Research & Development, Ziovision Co., Ltd., Chuncheon 24341, Republic of Korea; (M.K.); (D.K.); (D.L.); (D.K.)
| | - Dohyun Kim
- Department of Research & Development, Ziovision Co., Ltd., Chuncheon 24341, Republic of Korea; (M.K.); (D.K.); (D.L.); (D.K.)
| | - Jeongwon Heo
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
| | - Seonguk Kang
- Department of Convergence Security, Kangwon National University, Chuncheon 24341, Republic of Korea;
| | - Taejun Ha
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea;
| | - Jinju Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
| | - Da Hye Moon
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
- Department of Pulmonology, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Yeonjeong Heo
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
- Department of Pulmonology, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
| | - Seung-Joon Lee
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
| | - Yoon Kim
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon 24341, Republic of Korea;
| | - Sang Won Park
- Department of Medical Informatics, School of Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea;
- Institute of Medical Science, School of Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Seon-Sook Han
- Department of Internal Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea; (T.-H.K.); (J.H.); (J.K.); (D.H.M.); (Y.H.); (W.J.K.); (S.-J.L.)
| | - Hyun-Soo Choi
- Department of Computer Science and Engineering, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
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Mansell SK, Devani N, Shah A, Schievano S, Main E, Mandal S. Current treatment strategies in managing side effects associated with domiciliary positive airway pressure (PAP) therapy for patients with sleep disordered breathing: A systematic review and meta-analysis. Sleep Med Rev 2023; 72:101850. [PMID: 37812972 DOI: 10.1016/j.smrv.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/25/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Sleep disordered breathing is commonly treated with positive airway pressure therapy. Positive airway pressure therapy is delivered via a tight-fitting mask with common side effects including: leak, ineffective treatment, residual sleep disordered breathing, eye irritation, nasal congestion, pressure ulcers and poor concordance with therapy. This systematic review and meta-analysis aimed to identify the effectiveness of current treatment strategies for managing side effects associated with positive airway pressure therapy. Five databases were searched and 10,809 articles were screened, with 36 articles included in the review. Studies investigated: dressings, nasal spray/douche, chin straps, heated humidification and interfaces. No intervention either improved or detrimentally affected: positive airway pressure concordance, Epworth Sleepiness Score, residual apnoea hypopnea index or interface leak. The review was limited by study heterogeneity, particularly for outcome measures. Additionally, patient demographics were not reported, making it difficult to apply the findings to a broad clinical population. This review highlights the paucity of evidence supporting treatment strategies to manage side effects of positive airway pressure therapy.
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Affiliation(s)
| | | | - Amar Shah
- University College London, UK; Royal Free London NHS Foundation Trust, UK
| | | | | | - Swapna Mandal
- University College London, UK; Royal Free London NHS Foundation Trust, UK
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9
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Cui Y, Zhou X, Sun Z, Yin H. Efficacy of acupuncture therapies on pressure injury: A systematic review and network meta-analysis. Asian J Surg 2023; 46:5224-5226. [PMID: 37537068 DOI: 10.1016/j.asjsur.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Yang Cui
- Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Xinyu Zhou
- Heilongjiang University of Chinese Medicine, Harbin, 150040, China
| | - Zhongren Sun
- Heilongjiang University of Chinese Medicine, Harbin, 150040, China; The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150001, China
| | - Hongna Yin
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150001, China.
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10
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Chen Y, Wang W, Qian Q, Wu B. Comparison of four risk assessment scales in predicting the risk of intraoperative acquired pressure injury in adult surgical patients: a prospective study. J Int Med Res 2023; 51:3000605231207530. [PMID: 37898108 PMCID: PMC10613401 DOI: 10.1177/03000605231207530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVE To develop and compare four predictive models for intraoperative acquired pressure injury (IAPI) in surgical patients. METHODS One hundred patients undergoing various surgeries (hepatobiliary, pancreas, spleen, gastrointestinal, and cardiac surgeries) at Ruijin Hospital from November 2021 to September 2022 were included in this prospective cohort study. Four pressure injury risk assessment scales were used to measure the pressure injury risk: the Braden scale, Munro Pressure Injury Risk Assessment Scale, Scott Triggers tool, and CORN Intraoperative Acquired Pressure Injury Risk Assessment Scale. The patients were divided into the IAPI group and non-IAPI group. RESULTS In total, 37% of patients (37/100) developed class I/stage pressure injury (erythema) after surgery, which resolved within 2 hours after surgery in 86.49% of cases and further progressed to class II/stage or higher pressure injury within 6 days in 15.63% of cases. The application effects of the four commonly used risk assessment tools were compared with the sensitivity, specificity, and area under the receiver operating characteristic curve. The Munro Scale showed the best sensitivity and area under the receiver operating characteristic curve among the four tools for postoperative assessment, but its specificity was only 20.63. CONCLUSIONS More appropriate assessment tools are required for IAPI risk evaluation.
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Affiliation(s)
- Yuan Chen
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - QianJian Qian
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - BeiWen Wu
- Department of Nursing, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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11
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Ghaderi M, Chehre H, Fathpour H. Design and Implementation of a Novel Double-Layered Wavy Mattress for the Prevention and Recovery of Pressure Ulcers: A Feasibility Study. J Biomed Phys Eng 2023; 13:489-494. [PMID: 37868947 PMCID: PMC10589688 DOI: 10.31661/jbpe.v0i0.2305-1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
Abstract
Pressure ulcers are a significant concern in patient care, particularly for those with limited mobility and extended hospital stays. Wavy mattresses are shown an effective tool for preventing or promoting the healing of these wounds by preventing pressure localization in different body regions. The current study aimed to present a novel double-layered wavy mattress design for the prevention and recovery of pressure ulcers, addressing some of the limitations of existing mattresses. The novel mattress includes double-layered cells, with the upper and lower layers, filled with water and air, respectively. The temperature of water in the cells can be manually adjusted to meet patients' needs, prevent skin sweating, regulate body temperature, and promote blood flow in areas susceptible to pressure ulcers. Patients who used this novel mattress during their hospitalization experienced a significantly shorter recovery period for bedsores compared to those who used other mattresses, showing that the novel wavy mattress is an effective tool for preventing and recovering from pressure ulcers in long-term hospitalized patients with limited mobility.
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Affiliation(s)
- Mehrdad Ghaderi
- Department of Electrical and Computer, Technical and Engineering Faculty, Mohaghegh Ardabili University, Ardabil, Iran
| | - Hossein Chehre
- Department of Biomedical Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Helia Fathpour
- Department of Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
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12
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Kottner J, Coleman S. The theory and practice of pressure ulcer/injury risk assessment: a critical discussion. J Wound Care 2023; 32:560-569. [PMID: 37682783 DOI: 10.12968/jowc.2023.32.9.560] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Pressure ulcer/injury (PU) risk assessment is widely considered an essential component in clinical practice. It is a complex and broad concept that includes different approaches, such as clinical judgement, using standardised risk assessment instruments, skin assessments, or using devices to measure skin or tissue properties. A distinction between PU risk assessment and early detection is important. PU risk measures the individual's susceptibility to developing a PU under a specific exposure (primary prevention), and early detection includes the assessment of early (sub)clinical signs and symptoms to prevent progression and to support healing (secondary prevention). PU risk is measured using prognostic/risk factors or prognostic models. Every risk estimate is a probability statement containing varying degrees of uncertainty. It therefore follows that every clinical decision based on risk estimates also contains uncertainty. PU risk assessment and prevention is a complex intervention, where delivery contains several interacting components. There is a huge body of evidence indicating that risk assessment and its outcomes, the selection of preventive interventions and PU incidence are not well connected. Methods for prognostic model development and testing in PU risk research must be improved and follow state-of-the-art methodological standards. Despite these challenges, we do have substantial knowledge about PU risk factors that helps us to make better clinical decisions. An important next step in the development of PU risk prediction might be the combination of clinical and other predictors for more individualised care. Any prognostic test or procedure must lead to better prevention at an acceptable cost.
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Affiliation(s)
- Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Berlin, Germany
| | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
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13
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Shimoni Z, Dusseldorp N, Cohen Y, Barnisan I, Froom P. The Norton scale is an important predictor of in-hospital mortality in internal medicine patients. Ir J Med Sci 2023; 192:1947-1952. [PMID: 36520351 DOI: 10.1007/s11845-022-03250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Norton scale, a marker of patient frailty used to predict the risk of pressure ulcers, but the predictive value of the Norton scale for in-hospital mortality after adjustment for a wide range of demographic, and abnormal admission laboratory test results shown in themselves to have a high predictive value for in-hospital mortality is unclear. AIM The study aims to determine the value of the Norton scale and the presence of a urinary catheter in predicting in hospital mortality. METHODS The study population included all acutely admitted adult patients in 2020 through October 2021 to one of three internal medicine departments at the Laniado Hospital, a regional hospital with 400 beds in Israel. The main objective was to (a) identify the variables associated with the Norton Scale and (b) determine whether it predicts in-hospital mortality after adjustment for these variables. RESULTS The Norton scale was associated with an older age, female gender, presence of a urinary catheter, and abnormal laboratory tests. The odds of in-hospital mortality in those with intermediate, high, and very high Norton scale risk groups were 3.10 (2.23-3.56), 6.48 (4.02-10.46), and 12.27 (7.37-20.44), respectively, after adjustment for the remaining predictors. Adding the Norton scale and the presence of a urinary catheter to the prediction logistic regression model that included age, gender, and abnormal laboratory test results increased the c-statistic from 0.870 (0.864-0.876) to 0.908 (0.902-0.913). CONCLUSIONS The Norton scale and presence of a urinary catheter are important predictors of in-hospital mortality in acutely hospitalized adults in internal medicine departments.
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Affiliation(s)
- Zvi Shimoni
- The Adelson School Of Medicine, Ariel University, Ariel, Israel
- Sanz Medical Center, Laniado Hospital, Netanya, 4244916, Israel
| | | | - Yael Cohen
- Nursing Department, Laniado Hospital, Netanya, Israel
| | | | - Paul Froom
- Clinical Utility Department, Sanz Medical Center, Laniado Hospital, Netanya, 4244916, Israel.
- School of Public Health, University of Tel Aviv, Tel Aviv, Israel.
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14
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Vanaki Z, Mohammadi E, Hosseinzadeh K, Ahadinezhad B, Rafiei H. Prevalence of Pressure Injury among Stroke Patients In and Out of Healthcare Settings: A Systematic Review and Meta-Analysis. Home Healthc Now 2023; 41:158-164. [PMID: 37144931 DOI: 10.1097/nhh.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Pressure injury is a recognized problem for patients with stroke. Knowing the prevalence of pressure injury post stroke can guide clinical professionals and researchers to take appropriate actions for patient care and education. The aim of this study was to systematically review the literature regarding prevalence of pressure injury among patients with stroke in the hospital, and in the home with no home healthcare services and nursing homes. Original articles available in Scopus, Web of Science, PubMed, ProQuest, and Google Scholar databases were searched separately by two researchers using the following keywords: stroke, cerebrovascular attack, pressure injury, pressure ulcer, bedsore, decubitus ulcer, and prevalence. The search was performed according to the PRISMA flow diagram from 2000 to 2020. After the initial review, 14 articles conducted between 2008 and 2019 were included in the final analysis. Eight studies were conducted in healthcare settings, and six studies were conducted out of hospitals. The estimated pooled prevalence for pressure injury in all studies was 3.9%. The estimated pooled prevalence for pressure injury in studies conducted in hospitals and in patients' homes with no home healthcare services and nursing homes were 3.06 and 17.25, respectively. The prevalence of pressure injury among stroke patients after hospital discharge was significantly higher than when they were hospitalized. This could indicate that this group of patients do not receive adequate care and attention for pressure injury after hospital discharge. Given the limitations of the available studies, it is recommended that further studies be conducted on pressure injury among stroke patients both at the time of hospitalization and after hospital discharge.
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15
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Chen Z, He L, Liu S, Liu H, Yu J, Li Y. The Grading of Recommendations, assessment, development, and evaluation approach was rarely followed and inconsistently applied in pressure injury prevention guidelines development: A cross-sectional survey. J Tissue Viability 2022; 31:438-443. [PMID: 35760719 DOI: 10.1016/j.jtv.2022.06.005] [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: 04/15/2021] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was developed to assess the certainty (or quality) of evidence and strength of recommendations in guidelines and endorsed internationally as a standard. Some guidelines had been developed to promote pressure injury prevention. AIMS We explored whether and to what extent the development of pressure injury prevention guidelines had followed or been informed by the GRADE approach. If this approach was not used, we examined which other methods were used instead. METHODS A cross-sectional study of pressure injury prevention guidelines was conducted. PubMed, Embase, CINAHL, and Chinese databases as well as guideline repositories and websites of professional bodies were searched for guidelines from 1990 to 2020. The grading systems of the certainty (or quality) of evidence and strength of recommendations of included guidelines were extracted. For the GRADE approach guidelines, compliance was assessed with the GRADE application criteria. RESULTS Twenty guidelines were identified. Among them, four guidelines (20%) indicated the use of the GRADE approach. The compliance rate ranged from 33.3%-94.4%. Other approaches, such as the Scottish Intercollegiate Guidelines Network (SIGN) approach, were also used. CONCLUSION The GRADE approach is rarely followed and inconsistently applied in pressure injury prevention guidelines. Other systems, such as the SIGN approach, are being used despite being outdated or inconsistent. Strategies for further uptake and appropriate application of the GRADE approach among guideline developers are needed in the future.
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Affiliation(s)
- Zhonglan Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; West China School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China; Evidence-Based Nursing Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lingxiao He
- Trauma Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shanshan Liu
- Evidence-Based Nursing Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huan Liu
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiajie Yu
- Chinese Evidence-Based Medicine Centre, Cochrane China Center, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Youping Li
- Chinese Evidence-Based Medicine Centre, Cochrane China Center, Sichuan University, Chengdu, 610041, Sichuan, China
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16
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Farahani B, Fadil R, Aboonabi A, Loscheider J, Tavakolian K, Arzanpour S. Applying Machine Learning for Intelligent Assessment of Wheelchair Cushions from Pressure Mapping Images. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3772-3775. [PMID: 36086444 DOI: 10.1109/embc48229.2022.9871905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pressure ulcers are skin and underlying tissue injuries caused by the cells' lack of oxygen and nutrition due to blood flow obstruction from constant pressure on the skin. It is prevalent in people with motion disabilities, such as wheelchair users. For both prevention and healing, wheelchair users should occasionally change their sitting posture, use cushions that evenly distribute the pressure, or relieve pressure from the sensitive areas. Occupational therapists (OTs) often use pressure mapping systems (PMS) to assess their clients and recommend them a cushion. A cushion with more uniform pressure distribution and fewer pressure concentration points is ranked the highest. This paper offers a novel approach to enhance the objectivity of PMS readings and rankings for OTs. Our method relies on image segmentation techniques to generate quantifiable measures for cushions assessment. We implemented a sequential process to generate a score representing a cushion's suitability for an individual, which begins with PMS image segmentation using machine learning, followed by a deep learning algorithm for identifying high-risk pressure points. We introduced a Cushion Index for quantifying and ranking the cushions. Clinical Relevance- By selecting proper cushions for wheelchair users, the risk of developing PUs is reduced.
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17
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Aksoy M, Büyükbayram Z. The prevalence, characteristics, and related factors of pressure injury in medical staff wearing personal protective equipment against COVID-19 in Turkey: A multicenter cross-sectional study. J Tissue Viability 2022; 31:207-212. [PMID: 35397974 PMCID: PMC8979626 DOI: 10.1016/j.jtv.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of device-related pressure injury (DRPI) related to the use of personal protective equipment (PPE) among healthcare professionals during the COVID-19 pandemic and the associated risk factors effective in the development of DRPI. MATERIALS AND METHODS This descriptive, cross-sectional and correlational study was conducted with 1465 healthcare professionals working in healthcare institutions in Eastern Turkey during the COVID-19 pandemic. The study data were collected by means of an online anonymous survey questioning the prevalence, characteristics, and associated factors of DRPI in the first week of April 2021, using the snowball sampling method. Number, percentage, arithmetic mean, Chi-Square, and regression analysis were used for the evaluation of the study data. RESULTS The prevalence of DRPI due to the use of PPE use among healthcare professionals was calculated to be 60.5%. Of the developed DRPIs, 79.5% were stage 1, and the most frequent anatomical locations of DRPI were the bridge of the nose (30.2%), behind the ears (24.6%), and cheeks (20.8%). The logistic regression analysis revealed that male gender, age <35 years, being a physician and nurse, prolonged duration of PPE use (>4 h), working in a high-risk clinic (COVID-19 clinic and COVID-19 intensive care unit), and sweating during the use of PPE were predictive factors for the development of DRPI (p < 0.05). CONCLUSIONS The prevalence of DRPI due to PPE use among healthcare workers was quite high. Gender, age, occupation, long duration of PPE use, working in a high-risk clinic, and sweating during the use of PPE were found to be risk factors in the development of DRPI.
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Affiliation(s)
- Meyreme Aksoy
- Siirt University, Faculty of Health Sciences, Department of Nursing Fundamentals, Siirt, Turkey.
| | - Zeliha Büyükbayram
- Siirt University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Siirt, Turkey
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18
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Abstract
Chronic wounds originate from venous hypertension, arterial insufficiency, or pressure-induced ischemia. Determination of the type and associated causes and contributory conditions is essential for the diagnosis and management of these common conditions.
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19
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OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 21:702-709. [DOI: 10.1093/eurjcn/zvac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
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Stoltenberg S, Kotila J, Heikkilä A, Kvist T, Junttila K. Incidence and risk factors for pressure injuries in adults in specialised medical care: a prospective observational study. J Wound Care 2021; 30:945-953. [PMID: 34747213 DOI: 10.12968/jowc.2021.30.11.945] [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
INTRODUCTION Hospital-acquired pressure injuries are one of the most important indicators of quality patient care. It is important to identify high-risk patients to guide the implementation of appropriate prevention strategies. This can be done by using an assessment tool that covers the main risk factors for pressure injuries. AIM The purpose of the study was to describe the incidence of pressure injuries and the associated risk factors among patients assessed with the Prevent Pressure Injury (PPI) risk assessment tool developed by the Helsinki University Hospital. METHOD The study was conducted by selecting six wards from medical, surgical and neurological units. The target group were the patients being treated in the study units who gave their informed consent. The research data were retrieved from electronic patient records. RESULTS From the target group, 332 patients were eligible to participate in the study. The pressure injury risk was found to increase with longer hospital stays and older age. Surgical patients had an increased risk of pressure injuries compared to other specialty fields. A primary diagnosis of musculoskeletal or connective tissue disease, and secondary diagnoses of hypertension and cerebral haemorrhage, were linked with an increased pressure injury risk. A total of nine pressure injuries occurred in nine patients, with an incidence of 2.5% (stages II-IV). CONCLUSION The observation and recording of pressure injuries in specialised medical care remain insufficient. Longer hospital stays, older age and surgery increase pressure injury risk. Also, patients' primary and secondary diagnoses may increase the pressure injury risk. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Jaana Kotila
- Helsinki University Hospital and University of Helsinki, Finland
| | - Anniina Heikkilä
- Helsinki University Hospital and University of Helsinki, Finland
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21
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A Comparative Study of 2-Hour Interface Pressure in Different Angles of Laterally Inclined, Supine, and Fowler's Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199992. [PMID: 34639293 PMCID: PMC8507824 DOI: 10.3390/ijerph18199992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022]
Abstract
Insufficient research exists for position change intervals to eradicate pressure ulcers. We tried to provide evidence for the position change interval by comparing peak pressure, risk area ratio, and the time to reach 30 mmHg and 60 mmHg, and presented this in detail, according to the angle in the three positions. The study conducted RCTs on a total of 64 healthy adults. For two hours, interface pressure measurements were compared with 30° and 90° tilting at the inclined, 0° and 45° head-of-bed (HOB) elevation at the supine, and 30° and 45° HOB elevation at the Fowler’s position. The peak pressure on 30° tilting remained less than 60 mmHg for 2 h, unlike 90° tilting. To reach 60 mmHg took 78.18 min at 30° tilting, within 30 min at the 30° supine, 30° and 45° at the Fowler’s position, and 39.55 min at 0° supine. The pressure difference according to the angles was only significant at 30° and 90° tilting, with no difference in the other groups. To prevent pressure ulcers, position changes are required every 2 h in the 30° tilting position, every 1.5 to 2 h at 0° supine, and at least every 1.5 h for all the other positions.
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22
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Faucher N, Barateau M, Hentz F, Michel P, Meaume S, Rousseaux C, Marty M, Le Fort M, Nicolas B. Use of multilayer silicone foam dressings as adjuvant therapy to prevent pressure injuries. J Wound Care 2021; 30:712-721. [PMID: 34554838 DOI: 10.12968/jowc.2021.30.9.712] [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
Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public health problem because of their frequency and morbidity. Protection of the skin by multilayer silicone foam dressings may be an adjuvant measure to prevent PIs in high-risk patients. Despite the available clinical data and published recommendations on this measure, caregivers face difficulties in identifying patients who would benefit from this adjuvant measure. The objective of this work was to define the profiles of high-risk patients who would benefit optimally from this measure in combination with basic preventive procedures. This consensual expert opinion was drawn up using two methods: the Nominal Group Technique with eight medical and paramedical experts, and the Delphi process with 16 experts. The bases for this expert consensual opinion were a formal search and analysis of the published literature regarding evidence on the prevention of PIs using multilayer silicone foam dressings. The consensual expert opinion reported here addresses five proposals mostly intended to define patients who would benefit from the use of a multilayer silicone foam dressing (≥4 layers) to prevent PIs (sacrum and heels).
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Affiliation(s)
- Nathalie Faucher
- Service de Gériatrie Hôpital Bichat Claude Bernard, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | - Martine Barateau
- Consultation Plaies, Service de Gériatrie, CHU, Bordeaux, France.,Société Française de l'Escarre
| | - Franck Hentz
- Direction des soins CHU, Clermont Ferrand, France
| | - Philippe Michel
- Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France.,Société Française de l'Escarre
| | - Sylvie Meaume
- Service Plaie et Cicatrisation, Hôpital Rothschild, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | | | - Marc Marty
- Nukléus, Research department, Paris, France
| | - Marc Le Fort
- Service de MPR neurologique, Hôpital Saint Jacques, CHU Nantes, France
| | - Benoit Nicolas
- Pôle MPR St Hélier, Rennes, France.,Société Française de l'Escarre
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23
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Yap TL, Bergstrom N, Horn SD, Kennerly SM. The State of Pressure Injury Science: Going Beyond Cochrane to Inform Prevention and Guideline Development. Adv Skin Wound Care 2021; 34:385-388. [PMID: 34125729 DOI: 10.1097/01.asw.0000753108.63550.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tracey L Yap
- Tracey L. Yap, PhD, RN, CNE, WCC, FGSA, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina. Nancy Bergstrom, PhD, RN, FAAN, is Trumble Professor of Aging Research (retired), The University of Texas Health Science Center at Houston. Susan D. Horn, PhD, is Adjunct Professor (retired), University of Utah, Salt Lake City. Susan M. Kennerly, PhD, RN, CNE, WCC, FAAN, is Professor, East Carolina University College of Nursing, Greenville, North Carolina
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24
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Meaume S, Rousseaux C, Marty M. Incidence of pressure ulcer in patients using an alternating pressure mattress overlay: the ACTIVE study. J Wound Care 2021; 30:143-149. [PMID: 33573487 DOI: 10.12968/jowc.2021.30.2.143] [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 The primary objective was to determine the clinical benefit of using a specific alternating-pressure mattress overlay (APMO) in the prevention of pressure ulcer (PU) in patients at medium to high risk. METHOD This prospective study was conducted in five rehabilitation centres and three nursing homes. Patients at medium to high risk of PU, but without PU at baseline, and lying between 15 and 20 hours per day on a specific APMO were included. The primary endpoint was the percentage of patients who developed a sacral, spine, heel or trochanteric PU (supine support areas) of at least category II, at day 35. All patients were included in the analysis. RESULTS A total of 89 patients were included; of whom six patients (6.7%) dropped out of the study (average (±standard deviation) follow-up 32±5.4 days). No sacral, spine, heel or trochanteric PU of at least category II was reported (i.e., an incidence of 0% [95% Confidence Interval: 0-4.1%] according to the exact Clopper-Pearson method]. Patients were 'satisfied' or 'very satisfied' with the comfort and stability of the APMO. The caregivers assessed as 'very easy' or 'easy' the implementation, maintenance and use of the APMO (turning over, moving to a sitting position). CONCLUSION In combination with the usual measures to prevent PU, the results of our study showed a low incidence of PU in high-risk patients lying for between 15 and 20 hours a day on an APMO, use of which is therefore recommended in these patients.
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Affiliation(s)
- Sylvie Meaume
- Rothschild Hospital - Geriatric Department and Wound Care Unit, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Marc Marty
- Rothschild Hospital - Geriatric Department and Wound Care Unit, Assistance Publique Hôpitaux de Paris, Paris, France
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25
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Ting JJ, Garnett A. E-Health Decision Support Technologies in the Prevention and Management of Pressure Ulcers: A Systematic Review. Comput Inform Nurs 2021; 39:955-973. [PMID: 34132227 DOI: 10.1097/cin.0000000000000780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pressure ulcers are problematic across clinical settings, negatively impacting patient morbidity and mortality while resulting in substantial costs to the healthcare system. E-health clinical decision support technologies can play a key role in improving pressure ulcer-related outcomes. This systematic review aimed to assess the impact of electronic health decision support interventions on pressure ulcer management and prevention. A systematic search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane. Nineteen articles, published from 2010 to 2020, were included for review. The findings of this review showed promising results regarding the usability and accuracy of electronic health decision support tools to aid in pressure ulcer prevention and management. Evidence indicated improved clinician adherence to pressure ulcer prevention practices and decreased healthcare costs postimplementation of an electronic health decision support intervention. However, the studies included in this review did not consistently show reductions in pressure ulcer prevalence, incidence, or risk. Most of the articles included in the review were limited by small sample sizes drawn from single hospitals or long-term care homes. More high-quality studies are needed to determine the types of electronic health decision support tools that can drive sustainable improvements to patient outcomes.
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Affiliation(s)
- Justine Jeanelle Ting
- Author Affiliation: Arthur Labatt School of Nursing, Western University, London, Ontario, Canada
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26
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Floyd NA, Dominguez-Cancino KA, Butler LG, Rivera-Lozada O, Leyva-Moral JM, Palmieri PA. The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review. Open Nurs J 2021. [DOI: 10.2174/1874434602115010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background:
Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.
Objective:
The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.
Methods:
This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.
Results:
The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.
Conclusion:
Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.
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Wang Y, Chen R, Ding J, Yang L, Chen J, Huang B. Predictive value of pressure ulcer risk for obstructive coronary artery disease. Nurs Open 2021; 8:1848-1855. [PMID: 33675186 PMCID: PMC8186705 DOI: 10.1002/nop2.835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the relationship between pressure ulcers risk and severity of obstructive coronary artery disease (CAD) by invasive coronary angiography. DESIGN Cross-sectional study. METHODS A total of 193 consecutive patients with underlying pressure ulcers risk who underwent invasive coronary angiography were enrolled. Subjects were divided into three groups according to severity of coronary artery stenosis. Pressure ulcers risk score, fall risk score, self-care ability score and cardiovascular risk factors were compared among the three groups. Multivariate regression analysis and receiver operating curve analysis were performed to explore the diagnostic value of Braden score for left main or three-vessel disease. RESULTS Patients with more severe CAD had higher pressure ulcers risk. The percentage of high-pressure ulcers risk was highest in left main or three-vessel disease group, compared with control group and single- or two-vessel disease group. After adjusting for age, body mass index, diabetes, chronic kidney disease and other confounding factors, Braden score was an independent predictor of left main or three-vessel disease. Moreover, higher Braden score had a moderate area under the curve for excluding more severe CAD. In conclusion, among patients planning for coronary angiography, pressure ulcers risk assessment is conducive to predict the severity of obstructive CAD.
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Affiliation(s)
- Yao Wang
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ran Chen
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jie Ding
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lu Yang
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jiaojiao Chen
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Baotao Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Gillespie BM, Latimer S, Walker RM, McInnes E, Moore Z, Eskes AM, Li Z, Schoonhoven L, Boorman RJ, Chaboyer W. The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines. Int J Nurs Stud 2021; 115:103857. [PMID: 33508730 DOI: 10.1016/j.ijnurstu.2020.103857] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are one of the most frequently occurring, yet preventable hospital-acquired adverse events. Given there are many clinical practice guidelines available on the prevention and treatment of pressure injuries, it is useful to understand the quality of these guidelines and the clinical application of their recommendations. OBJECTIVE To critically evaluate the quality and applicability of the recommendations in pressure injury prevention and treatment clinical practice guidelines. DESIGN Systematic review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES We systematically searched the literature published from 2005 to 2020 using MEDLINE, EMBASE, CINAHL, the Cochrane Library, ProQuest and PubMed electronic databases, and nine guideline repositories. REVIEW METHODS We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE Recommendation Excellence (AGREE-REX) tools. Overall % mean scores across AGREE II and AGREE-REX domains were calculated for each guideline. Clinical practice guidelines were then ranked in tertiles based on "high", "moderate" or "low" quality. The review protocol was registered in the International Prospective Register of Systematic Reviews. RESULTS Initial combined database and repository searches yielded 3247 documents. Of these,73 full text documents were reviewed. The final analysis included 12 complete guidelines and 14 related documents. Overall AGREE II scores ranged from 32% to 96% while AGREE-REX scores were generally lower ranging from 10% to 75%. Combined % mean scores across AGREE II and AGREE-REX criteria suggest that four guidelines were ranked as "high" (range 69% to 85%) and are recommended without modification. These included; the 2019 International Guideline, the 2016 Canadian Guideline, the 2014 NICE Guideline, and the 2013 Belgian Guideline. CONCLUSIONS There is disparity in the quality of the included guidelines, however four high quality guidelines are available. These guidelines could ideally be implemented in daily practice and adapted to local policies.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
| | - Sharon Latimer
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Rachel M Walker
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Elizabeth McInnes
- St Vincent's Health Australia, Sydney, NSW, Australia; St Vincent's Hospital, Melbourne, VIC, Australia; Australian Catholic University, Melbourne, VIC, Australia.
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Anne M Eskes
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Zhaoyu Li
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Ultrecht University, Ultrecht, The Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom.
| | - Rhonda J Boorman
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
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Lima LS, Aragão NRO, Santos GKDBB, Santos ES, Palmeira CS. Perfil clínico-epidemiológico dos pacientes com lesão por pressão no contexto hospitalar. ESTIMA 2020. [DOI: 10.30886/estima.v18.917_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: descrever o perfil clínico-epidemiológico dos pacientes com lesão por pressão internados em um hospital universitário. Método: estudo descritivo com 122 pacientes com lesão por pressão internados em um hospital universitário, entre janeiro de 2018 e dezembro de 2019. Os dados foram coletados nos prontuários dos pacientes e no banco de dados do Serviço Assistencial de Cuidados com a Pele. Utilizou-se estatística descritiva para análise dos dados. Resultados: as lesões por pressão predominaram entre adultos e idosos, pardos, que estudaram até o ensino fundamental e não possuíam companheiro. Houve semelhança entre os sexos. Os pacientes possuíam, principalmente, doença infecciosa, uma ou mais comorbidades, alteração nutricional, incontinência mista e utilizavam terapia nutricional, mas não apresentavam dermatite associada à incontinência e histórico de tabagismo. A maioria dos pacientes foi classificada como risco alto de lesão por pressão. O estudo totalizou 237 lesões, sendo a maior parte adquirida antes da internação, não classificável, localizada na região sacrococcígea, tratada topicamente com hidrogel com alginato e hidrocoloide, e não cicatrizada no momento da alta hospitalar. Conclusão: o estudo descreveu aspectos importantes da caracterização das lesões por pressão, assim como das pessoas acometidas por esse grave problema de saúde, o que pode otimizar as ações de prevenção e tratamento.
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Lima LS, Aragão NRO, Santos GKDBB, Santos ES, Palmeira CS. Clinical-epidemiological profile of patients with pressure injuries in the hospital context. ESTIMA 2020. [DOI: 10.30886/estima.v18.917_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: describe the clinical-epidemiological profile of patients with pressure injuries admitted to a university hospital. Method: descriptive study with 122 patients with pressure injuries admitted to a university hospital between January 2018 and December 2019. Data were collected from patients’ medical records and from the Serviço Assistencial de Cuidados com a Pele (Skin Care Assistance Service) database. Descriptive statistics were used for data analysis. Results: pressure injuries predominated among adults and the elderly, browns, who studied up to elementary school and had no partner. There was a similarity between the sexes. The patients had, mainly, infectious disease, one or more comorbidities, nutritional alteration, mixed incontinence and used nutritional therapy, but did not present dermatitis associated with incontinence and smoking history. Most patients were classified as high risk of pressure injury. The study totaled 237 lesions, most of which were acquired before admission, not classifiable, located in the sacrococcygeal region, treated topically with hydrogel with alginate and hydrocolloid, and not healed at the time of hospital discharge. Conclusion: the studydescribed important aspects of the characterization of pressure injuries, as well as the people affected by this serious health problem, which can optimize prevention and treatment actions.
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Abstract
There are well-documented physiologic changes that occur in the human body during the aging process, such as decreased body fat, decreased muscle mass, cellular senescence, changes in skin pH, decreased metabolism, decreased immune function, vascular changes, altered tissue perfusion, nutritional status changes, and poor hydration. These changes affect skin integrity and wound healing, and raise the risk of pressure-related skin injury. This article discusses aging as a risk factor for pressure injury (PrI). Topics include evidence for advancing age as a significant PrI risk factor, identifying pathophysiologic changes/mechanisms of aging, and specific PrI preventive interventions to consider in older adults.
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Hoversten KP, Kiemele LJ, Stolp AM, Takahashi PY, Verdoorn BP. Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults. Mayo Clin Proc 2020; 95:2021-2034. [PMID: 32276784 DOI: 10.1016/j.mayocp.2019.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022]
Abstract
Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.
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Affiliation(s)
| | | | - Anne M Stolp
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Department of Medicine, Divisions of Community Internal Medicine and Geriatric Medicine/Gerontology, Mayo Clinic, Rochester, MN
| | - Brandon P Verdoorn
- Department of Medicine, Divisions of Community Internal Medicine and Geriatric Medicine/Gerontology, Mayo Clinic, Rochester, MN.
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Tang J, Zhang S, Chen Q, Li W, Yang J. Risk factors for facial pressure sore of healthcare workers during the outbreak of COVID-19. Int Wound J 2020; 17:2028-2030. [PMID: 32592509 PMCID: PMC7361841 DOI: 10.1111/iwj.13434] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jieying Tang
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Shihong Zhang
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qiang Chen
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Weiwei Li
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jianmin Yang
- Department of Plastic Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Andayani RP, Nurhaeni N, Wanda D. Assessing effectiveness of regular repositioning in preventing pressure ulcers in children. Pediatr Rep 2020; 12:8696. [PMID: 32904962 PMCID: PMC7463136 DOI: 10.4081/pr.2020.8696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
Pressure ulcers have adverse effects on health. Thus, early detection of damage to skin integrity is important for preventing the occurrence of pressure sores. Meanwhile, two-hourly repositioning is a nursing intervention performed to prevent pressure ulcers. This study aimed to evaluate the implementation of regular repositioning for preventing pressure sores. The Braden Q Scale is an instrument that predicts skin breakdown caused by pressure ulcers. The designs used quasi-experiment pretest and posttest nonequivalent control group; 93 participants were selected through a nonprobability sampling technique by consecutive sampling (43 for the intervention group and 50 for the control group). Respondents in the intervention group were repositioned every 2 hours, and the control group received pressure mattress, which is done for 14 days or until the child can go home. The findings suggest that there is a significant difference in the Braden Q scores from before and after repositioning of the intervention group and the control group using pressure mattress (P<0.001). Nurses are expected to be able to detect early damage to skin integrity and to implement regular repositioning by using the Braden Q Scale.
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Affiliation(s)
- Rifka Putri Andayani
- Faculty of Nursing, Universitas Indonesia.,Institute of Health Science Mercubaktijaya Padang, Indonesia
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35
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Horup MB, Soegaard K, Kjølhede T, Fremmelevholm A, Kidholm K. Static overlays for pressure ulcer prevention: a hospital-based health technology assessment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S24-S28. [PMID: 32579463 DOI: 10.12968/bjon.2020.29.12.s24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION At Odense University Hospital (OUH) alternating-air mattresses (AAM) are used in the prevention of pressure ulcers (PU); however, static overlays might be more effective and have lower costs. To investigate the properties and consequences of using static overlays for prevention of PU at OUH, a hospital-based health technology assessment (HTA) was conducted. METHODS Two types of static overlays were tested in an observational study and compared with AAM for patients with a medium-high risk of PU in geriatric and orthopaedic wards at OUH. Incidence of PU was investigated 7 months before (n=720) and 6 months after implementation (n=837). Staff attitudes were examined in a questionnaire survey (n=55) and focus group interviews (n=13). Patients who had tried one of the overlays and the AAM were interviewed (n=12). RESULTS No statistical difference in PU incidence was found before and after the implementation of overlays (2.5% before, 2.7% after, P=0.874, n=1557) and no patients lying on overlays developed PU (n=123). Staff had mixed attitudes, but the majority preferred having overlays as an option for their patients. Interviewed patients preferred overlays due to less noise and improved mobility. CONCLUSION Both types of overlay are effective in PU prevention. However, overlays introduce challenges for staff and clear guidelines for the selection of support surfaces are needed. Overall, it is recommended that static overlays are considered as an alternative to AAM for PU prevention.
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Affiliation(s)
- Mette Boeg Horup
- Project Manager, Centre for Innovative Medical Technology, Odense University Hospital, Denmark
| | - Knaerke Soegaard
- PhD candidate, Nurse, Department of Plastic Surgery, Odense University Hospital, Denmark
| | - Tue Kjølhede
- Project Manager, Centre for Innovative Medical Technology, Odense University Hospital, Denmark
| | - Aase Fremmelevholm
- Pressure Ulcer Specialist Nurse, Department of Plastic Surgery, Odense University Hospital, Denmark
| | - Kristian Kidholm
- Professor, Centre for Innovative Medical Technology, Odense University Hospital, Denmark
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Tchuenkam LW, Titcheu F, Mbonda A, Kamto T, Nwaha AM, Kamla IJ, Tochie JN. The gluteus maximus V-Y advancement flap for reconstruction of extensive soft tissue loss following an advanced sacral pressure ulcer. A case report and mini review. Int J Surg Case Rep 2020; 73:15-21. [PMID: 32623328 PMCID: PMC7334543 DOI: 10.1016/j.ijscr.2020.06.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The occurrence of pressure injuries (PIs) in an inpatient is a serious medical condition that requires a rigorous clinical evaluation. Management of these lesions should be comprehensive, including general measures and local care. Wound care occupies a large part of the treatment. For large skin loss, the treatment requires plastic surgery techniques for reconstruction. Myocutaneous advancement flaps are a good therapeutic option due to the provision of vascularized tissue within the skin defect. To ensure the success of the surgery, a good surgical technique preceeded by careful preparation of the patient in conjunction with the anesthesia team is imperative. CASE PRESENTATION We report the case of a 60-year-old bed ridden man for more than two months following an ischemic stroke with left spastic hemiplegia and loss of sensitivity. He was transferred to our surgical unit for the management of a chronic stage 4 PIs in the sacral area complicated with cellulitis, subcutaneous abscess and severe sepsis. Initial management consisted of resuscitation measures combining fluid therapy, antibiotic therapy, analgesics, blood transfusion, nutritional support, physioteherapy, wound care as well as preventive measures and psychological support. Once the granulation tissues were fully developed, the patient underwent reconstruction surgery with a V-Y myocutaneous advancement flap. The graft was successful with complete wound healing thereafter. CONCLUSION PIs are a multifactorial, complex and disabling pathology that requires multidisciplinary care. Surgeons, anesthetists, nutritionists, physiotherapists, nurses must act in agreement in order to provide optimal treatment. Prevention is the rule.
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Affiliation(s)
- Landry W Tchuenkam
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
| | | | - Aimé Mbonda
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
| | - Trevor Kamto
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
| | - Axel M Nwaha
- Urology Unit, Department of Surgery, Douala Laquintinie Hospital, Cameroon.
| | - Igor J Kamla
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
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Pressure ulcers after traumatic spinal injury in East Africa: risk factors, illustrative case, and low-cost protocol for prevention and treatment. Spinal Cord Ser Cases 2020; 6:48. [PMID: 32541848 DOI: 10.1038/s41394-020-0294-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective, case-control study. OBJECTIVES In a traumatic spinal injury (TSI) cohort from Tanzania, we sought to: (1) describe potential risk factors for pressure ulcer development, (2) present an illustrative case, and (3) propose a low-cost outpatient protocol for prevention and treatment. SETTING Tertiary referral hospital. METHODS All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, time to hospital, injury characteristics, operative management, length of hospitalization, and mortality. Pressure ulcer development was the primary outcome. Regressions were used to report potential predictors, and international guidelines were referenced to construct a low-cost outpatient protocol. RESULTS Of 267 patients that met the inclusion criteria, 51 developed a pressure ulcer. Length of stay was greater for patients with pressure ulcers compared with those without (45 vs. 30 days, p < 0.001). Potential predictors for developing pressure ulcers were: increased days from injury to hospital admission (p = 0.036), American Spinal Injury Association Impairment Scale grade A upon admission (p < 0.001), and thoracic spine injury (p = 0.037). The illustrative case described a young male presenting ~2 months after complete thoracic spinal cord injury with a grade IV sacral pressure ulcer that lead to septic shock and death. Considering the dramatic consequences of pressure ulcers in lower- and middle-income countries (LMICs), we proposed a low-cost protocol for prevention and treatment targeting support surfaces, repositioning, skin care, nutrition, follow-up, and dressing. CONCLUSIONS Pressure ulcers after TSI in LMICs can lead to increased hospital stays and major adverse events. High-risk patients were those with delayed presentation, complete neurologic injuries, and thoracic injuries. We recommended aggressive prevention and treatment strategies suitable for resource-constrained settings.
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39
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Urrutia-Bastardo R, Turin TC. Complex interactions between provider, organisation and patient level characteristics influence the effect of pressure ulcer preventive care interventions. Evid Based Nurs 2020; 24:42. [PMID: 32220876 DOI: 10.1136/ebnurs-2019-103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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KARAKAYA Y, ÖZKAYA H, TUZCULAR E, GÖNENÇ I. Palyatif bakım hastalarında basınç ülserleri ile bakım verenlerin bilgi düzeyleri arasındaki ilişki. FAMILY PRACTICE AND PALLIATIVE CARE 2020. [DOI: 10.22391/fppc.670074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bukowska J, Alarcon Uquillas A, Wu X, Frazier T, Walendzik K, Vanek M, Gaupp D, Bunnell BA, Kosnik P, Mehrara B, Katz AJ, Gawronska-Kozak B, Gimble JM. Safety of Human Adipose Stromal Vascular Fraction Cells Isolated with a Closed System Device in an Immunocompetent Murine Pressure Ulcer Model. Stem Cells Dev 2020; 29:452-461. [PMID: 31992147 DOI: 10.1089/scd.2019.0245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pressure ulcers (PUs) result in part due to ischemia-reperfusion injury to the skin and present frequently in elderly or quadriplegic patients with reduced mobility. Despite the high economic and societal cost of this condition, PU therapy relies primarily on preventive strategies and invasive surgical intervention. A growing body of clinical literature suggests that localized injection of adipose-derived cells can accelerate and enhance the closure of PUs. The current study systematically evaluated the safety of human adipose stromal vascular fraction (SVF) cells isolated using a closed system device when injected into a murine PU injury model. The human SVF cells were characterized by colony-forming unit-fibroblast and differentiation assays before use. Young (2 months) immunocompetent C57BL/6 mice subjected to a magnet-induced ischemia-reperfusion injury were injected subcutaneously with human SVF cells at increasing doses (0.25-2 million cells). The size of the PU was monitored over a 20-day period. Both female and male mice tolerated the concentration-dependent injection of the SVF cells without complications. While male mice trended toward more rapid wound closure rates in response to lower SVF cell concentrations (0.25-0.5 million cells), female mice responded favorably to higher SVF cell concentrations (1-2 million cells); however, outcomes did not reach statistical significance in either sex. Overall, the study demonstrates that human SVF cells prepared with a closed system device designed for use at point of care can be safely administered for PU therapy in an immunocompetent host animal model.
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Affiliation(s)
- Joanna Bukowska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | | | - Xiying Wu
- LaCell LLC, New Orleans, Louisiana.,Obatala Sciences, Inc., New Orleans, Louisiana
| | - Trivia Frazier
- LaCell LLC, New Orleans, Louisiana.,Obatala Sciences, Inc., New Orleans, Louisiana
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | | | - Dina Gaupp
- Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Bruce A Bunnell
- Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Babak Mehrara
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam J Katz
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- LaCell LLC, New Orleans, Louisiana.,Obatala Sciences, Inc., New Orleans, Louisiana.,Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Bukowska J, Alarcon Uquillas A, Wu X, Frazier T, Walendzik K, Vanek M, Gaupp D, Bunnell BA, Kosnik P, Mehrara B, Katz AJ, Gawronska-Kozak B, Gimble JM. Safety and Efficacy of Human Adipose-Derived Stromal/Stem Cell Therapy in an Immunocompetent Murine Pressure Ulcer Model. Stem Cells Dev 2020; 29:440-451. [PMID: 31950878 DOI: 10.1089/scd.2019.0244] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pressure injuries/ulcers are frequent complications in elderly, paraplegic, and quadriplegic patients, which account for considerable cost to the international health care economy and remain refractory to current treatment options. Autologous or allogeneic adult stromal/stem cells represent an alternative therapeutic approach. The current study extends prior findings by exploring the safety and efficacy of human adipose-derived stromal/stem cell (ASC) therapy in an established immunocompetent murine skin pressure ulcer model where dermal fibroblast cells (DFCs) served as a control. Human adipose tissue was processed using a closed system device designed for point-of-care use in the operating room and on file with the Food and Drug Administration. Cell characterization was performed using colony-forming unit-fibroblast, differentiation, and immunophenotypic assays in vitro. Wound healing was assessed over a 20-day period based on photomicrographs, histology, and immunohistochemistry. The isolated human ASCs displayed significantly greater colony formation relative to DFCs while both populations exhibited comparable immunophenotype and differentiation potential. Both fresh and cryopreserved human ASCs significantly accelerated and enhanced wound healing in young (2 month) mice of both sexes relative to DFC controls based on tissue architecture and CD68+ cell infiltration. In contrast, while injection of either fresh or cryopreserved human ASCs was safe in older mice, the fresh ASCs significantly enhanced wound closure relative to the cryopreserved ASCs. Overall, these findings support the safety and efficacy of human ASCs isolated using a closed system device designed for clinical procedures in the future treatment of pressure injuries.
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Affiliation(s)
- Joanna Bukowska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | | | - Xiying Wu
- LaCell LLC, New Orleans, Louisiana
- Obatala Sciences, Inc., New Orleans, Louisiana
| | - Trivia Frazier
- LaCell LLC, New Orleans, Louisiana
- Obatala Sciences, Inc., New Orleans, Louisiana
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Mikaela Vanek
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana
| | - Dina Gaupp
- Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana
| | - Bruce A Bunnell
- Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana
| | | | - Babak Mehrara
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam J Katz
- Department of Plastic and Reconstructive Surgery, Wake Forest University, Winston Salem, North Carolina
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- LaCell LLC, New Orleans, Louisiana
- Obatala Sciences, Inc., New Orleans, Louisiana
- Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana
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Al Mutair A, Ambani Z, Al Obaidan F, Al Salman K, Alhassan H, Al Mutairi A. The effectiveness of pressure ulcer prevention programme: A comparative study. Int Wound J 2020; 17:214-219. [PMID: 31696665 PMCID: PMC7948995 DOI: 10.1111/iwj.13259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/04/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022] Open
Abstract
Hospital-acquired pressure ulcers (HAPUs) affect patients during hospitalisation, putting patients at risk for further complications. HAPU is one of the hospital quality indicators that require quality initiatives or programmes to minimise its occurrence and consequences. The aim of this study was to assess the effectiveness of a developed quality improvement programme in preventing HAPUs. This is a retrospective comparative study, which tracked the outcomes of pressure ulcer prevention programme (PUPP) for 5 years from 2014 to 2018. Data from 50 441 patients were collected from different units in a tertiary hospital in the eastern region of Saudi Arabia. The programme focused on building a wound care team; providing education to hospital staff, patients, and their families; and continuous data monitoring, in addition to follow-up visits after discharge. Implementation of the programme was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The PUPP was effective in reducing the percentage of pressure ulcer cases. The programme can be extended and implemented in other hospitals.
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Affiliation(s)
- Abbas Al Mutair
- Research CenterDr Sulaiman Al Habib Medical GroupRiyadhSaudi Arabia
- School of NursingWollongong UniversityAustralia
- College of MedicineAlfaisal UniversityRiyadhSaudi Arabia
| | - Zainab Ambani
- College of NursingKing Saud bin Abdulaziz University for Health SciencesAl AhsaSaudi Arabia
| | | | - Khulud Al Salman
- Nursing DepartmentAl Jaber Hospital for eye, Ear, Nose and Throat, Ministry of HealthSaudi Arabia
| | | | - Alya Al Mutairi
- Faculty of Science, Department of MathematicsTaibah UniversitySaudi Arabia
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Díaz-Caro I, García Gómez-Heras S. Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale. PLoS One 2020; 15:e0227052. [PMID: 31914154 PMCID: PMC6948734 DOI: 10.1371/journal.pone.0227052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Pressure ulcers (PUs) nowadays are a major health problem in society, associated with increased morbidity and increased health care costs. The incidence of HAPU is an indicator of health care quality. Objective To describe the profile of patients with minimal risk on the Norton-MI scale who developed PUs during hospitalization, and to identify the incidence of hospital-acquired pressure ulcers (HAPU). Methods Retrospective cohort study conducted between 2014 and 2017. Study population Patients over 18 years of age classified as "minimum risk" according to Norton-MI, admitted to acute hospital units of the Severo Ochoa University Hospital—Madrid-Spain. Patients were classified as patients with hospital-acquired pressure ulcers (PWHAPU) if they developed one or more new PU during their hospitalization. Variables Sociodemographic variables, hospitalization units, Morton-MI score and characteristics of the risk factors of HAPU were studied. Results The risk of PU was evaluated in 5530 patients, being 1260 patients classified as "minimum risk", with a median of 16 points in the Norton-MI scale. The average age was 76 years old and 52.5% were women. Principal causes of admission: traumatological pathologies (20.8%) and cardiovascular pathologies (20%). 129 HAPU were diagnosed in 112 patients, implying an incidence of HAPU of 8.89% (CI95%: 7.44–10.59). 106 PWHAPU (94.6%) presented up to 6 risk factors. The excess pressure and altered skin sensibility were identified as statistically significant risk factors as predictive factors of HAPU. In terms of severity, 55% of the HAPU were category I and 42.6% were category II, mainly with anatomical sacro-coxygeal location. In 65.2% of the patients the HAPU appeared in the first week of hospitalization. Conclusion In our study the incidence of HAPU in patients classified as minimum risk with Norton-MI scale was 8.89%. This elevated risk suggests for future investigations to develop new validity studies of the Norton-MI scale and to maintain a continuo training of professionals in the knowledge of PU risk assessment scales for their safe application in the patients, since it directs the practice of care in the prevention of PUs. It would be advisable to specially control the risk of PUs in care units, mainly in the first week of their hospital stay to minimize the HAPU incidence.
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Affiliation(s)
- Isabel Díaz-Caro
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Nurse of Hospital University Severo Ochoa, Madrid, Spain
| | - Soledad García Gómez-Heras
- Basic Health Science Department, Health Science Faculty, Rey Juan Carlos University, Madrid, Spain
- * E-mail:
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Examining Social Risk Factors in a Pressure Ulcer Quality Measure for Three Post-Acute Care Settings. Adv Skin Wound Care 2020; 33:156-163. [DOI: 10.1097/01.asw.0000651456.30210.8a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wynn M, Holloway S. A clinimetric analysis of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool: PURPOSE-T. ACTA ACUST UNITED AC 2019; 28:S4-S8. [PMID: 31714836 DOI: 10.12968/bjon.2019.28.20.s4] [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] [Indexed: 11/11/2022]
Abstract
The assessment of patients' risk for developing pressure ulcers is a routine and fundamental nursing process undertaken to prevent avoidable harm to patients in all care settings. Many risk assessment tools are currently used in clinical practice, however no individual tool is recommended by advisory bodies such as the National Institute for Health and Care Excellence or the European Pressure Ulcer Advisory Panel. The evidence base on the value of structured risk assessment tools in reducing the incidence or severity of pressure ulcers is poor. This purpose of this article is to provide a clinimetric analysis of the recently developed Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) and identify areas for future research to improve the utility of structured risk assessment in identifying patients at risk of developing pressure ulcers.
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Affiliation(s)
- Matthew Wynn
- Infection Control and Tissue Viability Nurse, Manchester University NHS Foundation Trust
| | - Samantha Holloway
- Reader, Centre for Medical Education, and Programme Director, Masters in Wound Healing and Tissue Repair, School of Medicine, Cardiff University
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Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol 2019; 81:881-890. [DOI: 10.1016/j.jaad.2018.12.069] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/15/2022]
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Wong AL, Walia GS, Bello R, Aquino CS, Sacks JM. Pressure ulcer prevalence and perceptions on prevention: a hospital-wide survey of health professionals. J Wound Care 2019; 27:S29-S35. [PMID: 29641343 DOI: 10.12968/jowc.2018.27.sup4.s29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hospital-acquired pressure ulcers (HAPUs) remain a problem despite numerous prevention initiatives. To understand why, it is necessary to know health professionals' perceptions regarding the importance of prevention, and the usability of current initiatives. We hypothesised that positive perceptions of existing initiatives would not be correlated with low HAPU prevalence, and that health professionals would perceive the initiatives to have a low usability. METHOD A two-part, online survey was developed and distributed electronically to nurses, in-training physicians and attending physicians, across all inpatient and perioperative departments of an academic hospital. Part one of the survey was the Agency for Healthcare Research and Quality (AHRQ) Staff Attitude Scale on beliefs regarding PU prevention; part two was additional questions on the usability of existing preventative initiatives. The results of the survey were compared with quarterly HAPU prevalence data by hospital unit. RESULTS In total, 839 health professionals completed the survey (579 nurses, 131 residents, 119 attending physicians). The mean score for the AHRQ survey was 42.5 (≥40 denoting positive perceptions). There was a moderate correlation between AHRQ scores and prevalence of HAPUs (r=-0.60, p=0.402). For usability, repositioning was felt to be the most effective intervention (mean: 4.54, standard deviation (SD): 0.64), while educational posters were felt to be the least effective (mean: 3.31, SD: 0.99). Respondents generally rated satisfaction much lower, with no single initiative significantly better than the others (range: 3.21-3.79). Perceived effectiveness and satisfaction were all positively correlated. CONCLUSION High HAPU prevalence, despite position perceptions, suggests that prevention methods are not as effective as thought, or they are not being used as widely as they should. Further research should take advantage of positive attitudes by prospectively investigating the usability of novel interventions.
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Affiliation(s)
- Alison L Wong
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax Infirmary Site, Halifax, NS, Canada, Center for Bioengineering Innovation and Design, Johns Hopkins University, Baltimore, MD, US
| | - Gurjot S Walia
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ricardo Bello
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Carla S Aquino
- Nursing Clinical Quality and Magnet Program, Department of Nursing Administration. Johns Hopkins Hospital, Baltimore, MD, US
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, US
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Abstract
Pressure injuries (previously called pressure ulcers) are a common finding among patients in acute, long-term, or home settings. Numerous pathophysiologic and risk mechanisms factor into the development of pressure injuries. The timely recognition of these injuries is imperative. Many treatments exist for pressure injuries but the focus of patient management should be on preventing injury-related complications.
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Abstract
Severe spinal cord injury (SCI) causing significant morbidity and mortality remains one of the most challenging problems in both human and veterinary medicine. Due to the restricted regeneration potential of the central nervous system (CNS) in mammals, the neurological deficit caused by spinal cord (SC) injury is permanent, and no therapeutic measures are able to completely restore neurological functions either in primates or in non-primate animals with traumatic tetraparesis/tetraplegia or paraparesis/paraplegia. The constant progress in the understanding of pathophysiologic events developing after spinal cord trauma constitute an unremitting inspiration for neuroscientists and health care professionals to test novel medicaments and treatment strategies to cope with this situation. Recent experimental studies and preclinical trials have delivered promising results. The aim of this review is a presentation of generally accepted methods of management of dogs with SCI as well as a report on new therapeutic modalities, and comment on their potential for clinical translation. The research strategy involved a search of PubMed, Medline, and ISI Web of Science from January 2010 to December 2018 using the terms “spinal cord injuryˮ and “management of spinal traumaˮ in the English language literature. References from selected papers were also scanned and evaluated for relevance.
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