51
|
Ness SJ, Hickling DF, Bell JJ, Collins PF. The pressures of obesity: The relationship between obesity, malnutrition and pressure injuries in hospital inpatients. Clin Nutr 2018; 37:1569-1574. [DOI: 10.1016/j.clnu.2017.08.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
|
52
|
Dukes SF, Maupin GM, Thomas ME, Mortimer DL. Pressure Injury Development in Patients Treated by Critical Care Air Transport Teams: A Case-Control Study. Crit Care Nurse 2018; 38:30-36. [PMID: 29606673 DOI: 10.4037/ccn2018993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The US Air Force transports critically ill patients from all over the world, with transport times commonly ranging from 6 to 11 hours. Few outcome measures have been tracked for these patients. Traditional methods to prevent pressure injuries in civilian hospitals are often not feasible in the military transport environment. OBJECTIVES The incidence rate and risk factors are described of en route-related pressure injuries for patients overseen by the Critical Care Air Transport Team. METHODS This retrospective, case-control, medical records review investigated risk factors for pressure injury in patients who developed a pressure injury after their transport flight compared with those with no documented pressure injuries. RESULTS The pressure injury rate was 4.9%. Between 2008 and 2012, 141 patients in whom pressure injuries developed and who had received care by the team were matched with 141 patients cared for by the team but did not have pressure injury. According to regression analysis, body mass index and 2 or more Critical Care Air Transport Team transports per patient were associated with pressure injury development. CONCLUSION Although the pressure injury rate of 4.9% in this cohort of patients is consistent with that reported by civilian critical care units, the rate must be interpreted with caution, because civilian study data frequently represent the entire intensive care unit length of stay. Targeted interventions for patients with increased body mass index and 2 or more critical care air transports per patient may help decrease the development of pressure injury in these patients.
Collapse
Affiliation(s)
- Susan F Dukes
- Col Susan F. Dukes, USAF, NC, is the Commandant and Assistant Dean for Student Affairs at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and former Division Chief, En Route Care Research Division, US Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Ohio. .,Genny M. Maupin is the Deputy Chief, Commander's Action Group, Air Force Research Laboratory, Ohio. .,Lt Col Marilyn E. Thomas, USAF, NC, is the 27th Special Operations Medical Operations Squadron Commander and the 27th Special Operations Medical Group Chief Nurse, Cannon Air Force Base New Mexico, and former Air Force Aeromedical Evacuation flight nurse and critical care air transport team nurse. .,Darcy L. Mortimer is a nurse researcher with the En Route Care Division, Department of Aeromedical Research, USAF School of Aerospace Medicine, and a former Air Force aeromedical evacuation flight nurse and critical care air transport team nurse.
| | - Genny M Maupin
- Col Susan F. Dukes, USAF, NC, is the Commandant and Assistant Dean for Student Affairs at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and former Division Chief, En Route Care Research Division, US Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Ohio.,Genny M. Maupin is the Deputy Chief, Commander's Action Group, Air Force Research Laboratory, Ohio.,Lt Col Marilyn E. Thomas, USAF, NC, is the 27th Special Operations Medical Operations Squadron Commander and the 27th Special Operations Medical Group Chief Nurse, Cannon Air Force Base New Mexico, and former Air Force Aeromedical Evacuation flight nurse and critical care air transport team nurse.,Darcy L. Mortimer is a nurse researcher with the En Route Care Division, Department of Aeromedical Research, USAF School of Aerospace Medicine, and a former Air Force aeromedical evacuation flight nurse and critical care air transport team nurse
| | - Marilyn E Thomas
- Col Susan F. Dukes, USAF, NC, is the Commandant and Assistant Dean for Student Affairs at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and former Division Chief, En Route Care Research Division, US Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Ohio.,Genny M. Maupin is the Deputy Chief, Commander's Action Group, Air Force Research Laboratory, Ohio.,Lt Col Marilyn E. Thomas, USAF, NC, is the 27th Special Operations Medical Operations Squadron Commander and the 27th Special Operations Medical Group Chief Nurse, Cannon Air Force Base New Mexico, and former Air Force Aeromedical Evacuation flight nurse and critical care air transport team nurse.,Darcy L. Mortimer is a nurse researcher with the En Route Care Division, Department of Aeromedical Research, USAF School of Aerospace Medicine, and a former Air Force aeromedical evacuation flight nurse and critical care air transport team nurse
| | - Darcy L Mortimer
- Col Susan F. Dukes, USAF, NC, is the Commandant and Assistant Dean for Student Affairs at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and former Division Chief, En Route Care Research Division, US Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Ohio.,Genny M. Maupin is the Deputy Chief, Commander's Action Group, Air Force Research Laboratory, Ohio.,Lt Col Marilyn E. Thomas, USAF, NC, is the 27th Special Operations Medical Operations Squadron Commander and the 27th Special Operations Medical Group Chief Nurse, Cannon Air Force Base New Mexico, and former Air Force Aeromedical Evacuation flight nurse and critical care air transport team nurse.,Darcy L. Mortimer is a nurse researcher with the En Route Care Division, Department of Aeromedical Research, USAF School of Aerospace Medicine, and a former Air Force aeromedical evacuation flight nurse and critical care air transport team nurse
| |
Collapse
|
53
|
Nguyen-Tu MS, Nivoit P, Oréa V, Lemoine S, Acquaviva C, Pagnon-Minot A, Fromy B, Sethi JK, Sigaudo-Roussel D. Inflammation-linked adaptations in dermal microvascular reactivity accompany the development of obesity and type 2 diabetes. Int J Obes (Lond) 2018; 43:556-566. [PMID: 30006585 PMCID: PMC6223541 DOI: 10.1038/s41366-018-0148-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/26/2018] [Accepted: 06/08/2018] [Indexed: 01/04/2023]
Abstract
Background/Objectives The increased prevalence of obesity has prompted great strides in our understanding of specific adipose depots and their involvement in cardio-metabolic health. However, the impact of obesity on dermal white adipose tissue (dWAT) and dermal microvascular functionality remains unclear. This study aimed to investigate the temporal changes that occur in dWAT and dermal microvascular functionality during the development of diet-induced obesity and type 2 diabetes in mice. Methods Metabolic phenotyping of a murine model of hypercaloric diet (HCD)-induced obesity and type 2 diabetes was performed at three time points that reflected three distinct stages of disease development; 2 weeks of HCD-overweight-metabolically healthy, 4 weeks of HCD-obese-prediabetic and 12 weeks of HCD-obese-type 2 diabetic mice. Expansion of dWAT was characterized histologically, and changes in dermal microvascular reactivity were assessed in response to pressure and the vasodilators SNP and Ach. Results HCD resulted in a progressive expansion of dWAT and increased expression of pro-inflammatory markers (IL1β and COX-2). Impairments in pressure-induced (PIV) and Ach-induced (endothelium-dependent) vasodilation occurred early, in overweight-metabolically healthy mice. Residual vasodilatory responses were NOS-independent but sensitive to COX inhibition. These changes were associated with reductions in NO and adiponectin bioavailability, and rescued by exogenous adiponectin or hyperinsulinemia. Obese-prediabetic mice continued to exhibit impaired Ach-dependent vasodilation but PIV appeared normalized. This normalization coincided with elevated endogenous adiponectin and insulin levels, and was sensitive to NOS, COX and PI3K, inhibition. In obese-type 2 diabetic mice, both Ach-stimulated and pressure-induced vasodilatory responses were increased through enhanced COX-2-dependent prostaglandin response. Conclusions We demonstrate that the development of obesity, metabolic dysfunction and type 2 diabetes, in HCD-fed mice, is accompanied by increased dermal adiposity and associated metaflammation in dWAT. Importantly, these temporal changes are also linked to disease stage-specific dermal microvascular reactivity, which may reflect adaptive mechanisms driven by metaflammation.
Collapse
Affiliation(s)
- Marie-Sophie Nguyen-Tu
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | - Pierre Nivoit
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | - Valérie Oréa
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | | | - Cécile Acquaviva
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,Centre de Biologie et Pathologie Est, University Hospital, Hospices Civils de Lyon, 69677, Bron, France
| | | | - Bérengère Fromy
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France.,University of Lyon 1, 69367, Lyon Cedex 07, France
| | - Jaswinder K Sethi
- Faculty of Medicine, University of Southampton, Institute of Developmental Sciences Building, Southampton General Hospital, Southampton, SO16 6YD, UK. .,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK. .,Institute for Life Sciences, Life Sciences Building 85, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Dominique Sigaudo-Roussel
- LBTI, UMR CNRS 5305, 69367, Lyon Cedex 07, France. .,University of Lyon 1, 69367, Lyon Cedex 07, France.
| |
Collapse
|
54
|
Smigelski-Theiss R, Gampong M, Kurasaki J. Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity. AACN Adv Crit Care 2018; 28:254-262. [PMID: 28847860 DOI: 10.4037/aacnacc2017446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Obesity is a complex medical condition that has psychosocial and physiological implications for those suffering from the disease. Factors contributing to obesity such as depression, childhood experiences, and the physical environment should be recognized and addressed. Weight bias and stigmatization by health care providers and bedside clinicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity or adiposity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases. The authors describe psychosocial and environmental factors that contribute to obesity, discuss health care providers' weight biases, and highlight implications for acute care of patients suffering from obesity.
Collapse
Affiliation(s)
- Rachel Smigelski-Theiss
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| | - Malisa Gampong
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| | - Jill Kurasaki
- Rachel Smigelski-Theiss is Clinical Nurse Specialist, Queen's Medical Center, 1301 Punchbowl Street, Honolulu, HI 96813 . Malisa Gampong is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii. Jill Kurasaki is Nurse Manager, Queen's Medical Center, Honolulu, Hawaii
| |
Collapse
|
55
|
Oh TK, Lee J, Lee YJ, Hwang JW, Do SH, Jeon YT, Song IA. Association between Modified Body Mass Index and 30-Day and 1-Year Mortality after Intensive Care Unit Admission: A Retrospective Cohort Study. J Clin Med 2018; 7:jcm7040081. [PMID: 29652842 PMCID: PMC5920455 DOI: 10.3390/jcm7040081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 12/26/2022] Open
Abstract
Because conventional body mass index (cBMI) does not reflect fluid accumulation, modified BMI (mBMI, serum albumin multiplied by cBMI) is a more accurate measure of malnutrition status. This study aimed to determine whether mortality after intensive care unit (ICU) admission was associated with cBMI, mBMI, and/or serum albumin levels. The medical records of patients who were admitted to a tertiary hospital ICU between 1 January 2012 and 31 July 2016 were retrospectively reviewed. In total, 6169 ICU-admitted patients were included in the analyses. Multivariate Cox regression analyses revealed that low cBMI, mBMI and albumin level were significantly associated with 30-day and 1-year mortality after ICU admission (hazard ratio < 1.0, p < 0.05). The adjusted area under the curve (AUC) of mBMI for 1-year mortality was significantly higher than that of cBMI (p < 0.001), but not significantly different from that of albumin level (p = 0.098). Low values of mBMI, cBMI and albumin were independently associated with 30-day and 1-year mortality after ICU admission. Combining cBMI and albumin (mBMI) did not increase the validity of the AUC of albumin for 1-year mortality after ICU admission. Our study showed that serum albumin alone, rather than mBMI (combining cBMI), is recommended in predicting mortality among ICU patients.
Collapse
Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Jaebong Lee
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea.
| |
Collapse
|
56
|
Abstract
Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63).
Collapse
Affiliation(s)
- Lori A Dambaugh
- Lori A. Dambaugh is an assistant professor of nursing and clinical nurse specialist track coordinator, Wegmans School of Nursing, St John Fisher College, Rochester, New York.Margaret M. Ecklund is an advance practice nurse working as a clinical nurse specialist with the wound, ostomy, and skin care team for Legacy Health, Portland Oregon
| | - Margaret M Ecklund
- Lori A. Dambaugh is an assistant professor of nursing and clinical nurse specialist track coordinator, Wegmans School of Nursing, St John Fisher College, Rochester, New York.Margaret M. Ecklund is an advance practice nurse working as a clinical nurse specialist with the wound, ostomy, and skin care team for Legacy Health, Portland Oregon.
| |
Collapse
|
57
|
Identification of Risk Factors for the Development of Pressure Ulcers Despite Standard Screening Methodology and Prophylaxis in Trauma Patients. Adv Skin Wound Care 2018; 29:329-34. [PMID: 27300364 DOI: 10.1097/01.asw.0000484064.86180.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To present information about a study of risk factors for development of pressure ulcers (PrUs) in trauma patients. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Describe the previous PrU research, scope of the problem, and methodology of the study.2. Explain the results of the study identifying PrU risk factors for trauma patients. ABSTRACT OBJECTIVE Pressure ulceration prevention has been emphasized over the past several years in inpatient hospital settings with subsequent decreases in the development of pressure ulcers (PrUs). However, there remains a subset of trauma and burn patients that develop PrUs despite standard screening methodology and prophylaxis. This study determines the conditions that predict development of pressure ulcers (PrUs) despite conventional prophylaxis and screening. METHODS Demographic and PrU data were collected over a 5-year period from June 2008 to May 2013. Patients diagnosed with PrUs upon arrival in the trauma bay were excluded from analysis. An ordinal logistic regression of PrU stage was used to estimate odds ratios (ORs) and associated 95% confidence intervals (CIs) for the association between characteristics of interest and odds of a PrU. A backward selection process was used to select the most parsimonious model. RESULTS During the study period, 14,616 trauma patients were admitted and had available data. A total of 124 patients (0.85%) that met inclusion criteria went on to develop PrUs during their hospital course. Factors associated with the development of PrUs included spine Abbreviated Injury Scale (AIS) >3 (OR, 5.72; CI, 3.63-9.01), mechanical ventilation (OR, 1.95; CI, 1.23-3.10) and age 40 to 64 (OR, 2.09; CI, 1.24-3.52) and age ≥ 65 (OR, 4.48; CI, 2.52-7.95). Interestingly, head injury AIS >3 was protective from the development of PrUs (OR, 0.56; CI, 0.32-0.96). Hypotension and shock defined as systolic BP <90 mm Hg and base deficit less than -6 were not associated with the development of PrUs. In addition, body mass index was not associated with PrU development. CONCLUSIONS Spinal injuries, older than age 40, and mechanical ventilation predict the development of PrUs for a subset of patients, despite conventional prophylaxis and screening. Advanced prevention methods, such as low-air-loss mattresses for these patient subgroups should be considered immediately upon identification of these risk factors during the hospital course.
Collapse
|
58
|
Mendonça PK, Loureiro MDR, Frota OP, Souza ASD. PREVENÇÃO DE LESÃO POR PRESSÃO: AÇÕES PRESCRITAS POR ENFERMEIROS DE CENTROS DE TERAPIA INTENSIVA. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018004610017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: descrever as ações de enfermagem prescritas por enfermeiros para a prevenção de lesões por pressão e sua ocorrência em centros de terapia intensiva. Método: estudo transversal, descritivo e analítico, de abordagem quantitativa conduzido em duas instituições hospitalares de ensino de Campo Grande, Brasil. A coleta ocorreu entre março e junho de 2016 com 104 participantes. Os dados foram submetidos à análise estatística. Resultados: foi encontrada associação estatística entre as ações de mudança de decúbito, aplicação de cobertura hidrocoloide em região sacral, realização de higiene externa, troca de fixação do cateter orotraqueal e/ou cateter nasoenteral e inspeção da pele com a ausência de lesões por pressão. A ocorrência de lesões por pressão foi encontrada em 49% dos clientes em ambas as instituições. Conclusão: a elaboração e implementação de protocolos, o acompanhamento dos registros e dos grupos de maior risco são estratégias que direcionam a prescrição de ações preventivas adequadas para lesões por pressão.
Collapse
|
59
|
Altun Uğraş G, Yüksel S, Erer MTI, Kettaş E, Randa S. Are Nurses Willing to Provide Care to Obese Surgical Patients? Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gülay Altun Uğraş
- Department of Surgical Nursing, Health School, Mersin University, Mersin, Turkey
| | - Serpil Yüksel
- Department of Surgical Nursing, Division of Nursing, Faculty of Health Science, Necmettin Erbakan University, Konya, Turkey
| | | | - Elife Kettaş
- Medical Faculty, Mersin University, Mersin, Turkey
| | - Serap Randa
- Medical Faculty, Mersin University, Mersin, Turkey
| |
Collapse
|
60
|
Ho C, Jiang J, Eastwood CA, Wong H, Weaver B, Quan H. Validation of two case definitions to identify pressure ulcers using hospital administrative data. BMJ Open 2017; 7:e016438. [PMID: 28851785 PMCID: PMC5629722 DOI: 10.1136/bmjopen-2017-016438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes. SETTING A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011. PARTICIPANTS There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer. RESULTS Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay. CONCLUSION DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies.
Collapse
Affiliation(s)
- Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jason Jiang
- Analytics, Alberta Health Services, Calgary, Canada
| | - Cathy A Eastwood
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Holly Wong
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Brittany Weaver
- Family Medicine, University of British Columbia Faculty of Medicine, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
61
|
Scientific and Clinical Abstracts From the WOCN® Society's 49th Annual Conference. J Wound Ostomy Continence Nurs 2017. [DOI: 10.1097/won.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
62
|
Bambi S, Mati E, De Felippis C, Lucchini A. Noninvasive ventilation: open issues for nursing research. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:32-39. [PMID: 28327493 PMCID: PMC10548063 DOI: 10.23750/abm.v88i1 -s.6282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/14/2017] [Indexed: 11/23/2022]
Abstract
According to the current literature, Noninvasive Ventilation (NIV) is a well-recognized respiratory support technique for patients affected by Acute Respiratory Failure (ARF). As highlighted by recent meta-analysis, a tight adherence to protocols regarding patients' selection criteria, relative or absolute contraindications, plus highly skilled and experienced operators, can positively affect the NIV performance and mortality rates. Positive outcome from NIV respiratory support is dependent from: patient's clinical condition and education needs; confidence of the staff with NIV technology; choice and management of the most suitable interface available prevention of interface complications; nutritional assessment (artificial feeding if required) and conditioning of medical gas. Despite these issues, the air leakage represents the major threat during NIV support. Indeed, to obtain a positive outcome from this treatment, the 'NIV troubleshooting' management appears to be crucial. Common issues as air leakage, patient-ventilator asynchrony, interface related pressure ulcers, discomfort, and gastric distention should be promptly detected and solved. The analysis of these current issues reveals a lack of evidence based practice, resulting in bed-side clinical interventions based only on the expert consensus or local opinions. To improve this knowledge gap, more efforts are strongly recommended from medical and nursing research communities. Multicenter randomized controlled clinical trials are needed to achieve adequate knowledge to reach the best patient's outcome. Further information to identify new areas of nursing research on NIV, can be achieved from qualitative studies performed on patients and healthcare operators.
Collapse
Affiliation(s)
- Stefano Bambi
- University of Florence; Emergency &Trauma Intensive Care Unit, Careggi Teaching Hospital, Florence, Italy.
| | | | | | | |
Collapse
|
63
|
Mizuno J, Takahashi T. Evaluation of external pressure to the sacral region in the lithotomy position using the noninvasive pressure distribution measurement system. Ther Clin Risk Manag 2017; 13:207-213. [PMID: 28255240 PMCID: PMC5322810 DOI: 10.2147/tcrm.s122489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pressure ulcers (PUs) in the sacral region can be a complication of surgical procedures performed in the lithotomy position. Previous reports have noted a difference between men and women in PU development related to the supine position, and body weight and body mass index (BMI) have been also described as known risk factors in supine position-related PU development. The BIG-MAT® system is a noninvasive pressure distribution measurement device used to measure external pressure (EP). We used this system to investigate the relationship between EP to the sacral region in the lithotomy position and selected physical characteristics. METHODS We recruited 21 young, healthy volunteers (11 men and 10 women, aged 21.4±0.5 years). Using the BIG-MAT system, we measured four types of EP to the sacral region: box pressure, peak box pressure, contact pressure, and peak contact pressure. We analyzed the relationships between these dynamic parameters and physical characteristics of the participants. RESULTS There were no differences between men and women in the four types of EP, and no significant differences related to the participants' height, weight, or BMI. CONCLUSION An individual's height, weight, and BMI may not contribute to the risk of inducing lithotomy position-related PUs in the sacral region. The noninvasive pressure distribution measurement system BIG-MAT for patients in the lithotomy position during surgery could become a significant device when estimating EP at the sacral region.
Collapse
Affiliation(s)
- Ju Mizuno
- Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Bunkyo-ku, Tokyo
| | - Toru Takahashi
- Faculty of Health and Welfare Science, Okayama Prefectural University, Soja-shi, Okayama, Japan
| |
Collapse
|
64
|
Al-Kuraishy HM, Al-Gareeb AI. Effects of Rosuvastatin Alone or in Combination with Omega-3 Fatty Acid on Adiponectin Levels and Cardiometabolic Profile. J Basic Clin Pharm 2017; 8:8-14. [PMID: 28104968 PMCID: PMC5201066 DOI: 10.4103/0976-0105.195080] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adiponectin is an important adipocyte-related protein that has been postulated to participate in prevention of the development of metabolic syndrome. The relationship between adiponectin serum levels and risk of coronary artery disease (CAD) has been widely investigated and remains controversial. The aim of the present study was to evaluate the effects of rosuvastatin and/or omega-3 fatty acid on adiponectin serum levels in patients with insulin resistance (IR) and CAD. PATIENTS AND METHODS This study involved 87 patients with CADs and IR of different etiology, the patients were divided into three groups; 24 patients on treatment with rosuvastatin, 22 patients on treatment with omega-3 fatty acid, 23 patients on treatment with omega-3 fatty acid and rosuvastatin, 18 patients were not previously or currently treated with either rosuvastatin or omega-3 fatty acid, those regarded as control patients. Anthropometric measures, adiponectin serum levels, and other biochemical parameters were assessed in each treated group. RESULTS Rosuvastatin therapy leads to a significant elevation in adiponectin serum levels from 4.1 ± 0.99 ng/mL to 6.76 ± 1.03 ng/mL compared to control P < 0.01. Omega-3 fatty acid therapy leads to a significant elevation in adiponectin serum levels from 4.1 ± 0.99 ng/mL to 6.11 ± 1.29 ng/mL compared to control P < 0.01. Rosuvastatin plus omega-3 fatty acid therapy lead to a significant elevation in adiponectin serum levels from 4.1 ± 0.99 ng/mL to 7.99 ± 1.76 ng/mL compared to control P < 0.01. CONCLUSIONS Rosuvastatin and/or omega-3 fatty acid lead to significant cardiometabolic protection through an increment in adiponectin serum levels.
Collapse
Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, AlMustansiriya University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Pharmacology, Toxicology and Medicine, College of Medicine, AlMustansiriya University, Baghdad, Iraq
| |
Collapse
|
65
|
Blanco-Blanco J, Gea-Sánchez M, Valenzuela-Pascual F, Barallat-Gimeno E, Espart A, Escobar-Bravo MÁ. Are the classic signs of infection in concordance with results from percutaneous aspiration to diagnose infection in pressure injuries? J Adv Nurs 2016; 73:1433-1442. [DOI: 10.1111/jan.13225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joan Blanco-Blanco
- GESEC Research Group, Faculty of Nursing and Physiotherapy; University of Lleida, Health Care Research Group (GRECS); Biomedical Research Institute of Lleida; Spain
| | | | | | | | - Anna Espart
- GESEC Research Group; FIF-UdL; GRECS; IRBLleida; Spain
| | | |
Collapse
|
66
|
Poledníková Ľ, Slamková A. At risk of pressure ulcers - a nursing diagnosis. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2016. [DOI: 10.15452/cejnm.2016.07.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
67
|
|
68
|
Grap MJ, Munro CL, Wetzel PA, Schubert CM, Pepperl A, Burk RS, Lucas V. Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation. Am J Crit Care 2016; 25:e56-63. [PMID: 27134239 DOI: 10.4037/ajcc2016317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Backrest elevations less than 30° are recommended to reduce pressure ulcers, but positions greater than 30° are recommended during mechanical ventilation to reduce risk for ventilator-associated pneumonia. Interface pressure may vary with level of backrest elevation and anatomical location (eg, sacrum, heels). OBJECTIVE To describe backrest elevation and anatomical location and intensity of skin pressure across the body in patients receiving mechanical ventilation. METHODS In a longitudinal study, patients from 3 adult intensive care units in a single institution receiving mechanical ventilation were enrolled within 24 hours of intubation from February 2010 through May 2012. Backrest elevation (by inclinometer) and pressure (by a pressure-mapping system) were measured continuously for 72 hours. Mean tissue interface pressure was determined for 7 anatomical areas: left and right scapula, left and right trochanter, sacrum, and left and right heel. RESULTS Data on 133 patients were analyzed. For each 1° increase in backrest elevation, mean interface pressure decreased 0.09 to 0.42 mm Hg. For each unit increase in body mass index, mean trochanter pressure increased 0.22 to 0.24 mm Hg. Knee angle (lower extremity bent at the knee) and mobility were time-varying covariates in models of the relationship between backrest elevation and tissue interface pressure. CONCLUSIONS Individual factors such as patient movement and body mass index may be important elements related to risk for pressure ulcers and ventilator-associated pneumonia, and a more nuanced approach in which positioning decisions are tailored to optimize outcomes for individual patients appears warranted.
Collapse
Affiliation(s)
- Mary Jo Grap
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio.
| | - Cindy L Munro
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Paul A Wetzel
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Christine M Schubert
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Anathea Pepperl
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Ruth S Burk
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
| | - Valentina Lucas
- Mary Jo Grap is an emeritus professor and Ruth S. Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, and Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, College of Nursing, University of South Florida, Tampa, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio
| |
Collapse
|
69
|
Palagi S, Severo IM, Menegon DB, Lucena ADF. Laser therapy in pressure ulcers: evaluation by the Pressure Ulcer Scale for Healing and Nursing Outcomes Classification. Rev Esc Enferm USP 2015; 49:826-33. [DOI: 10.1590/s0080-623420150000500017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AbstractOBJECTIVETo describe the pressure ulcer healing process in critically ill patients treated with conventional dressing therapy plus low-intensity laser therapy evaluated by the Pressure Ulcer Scale for Healing (PUSH) and the result of Wound Healing: Secondary Intention, according to the Nursing Outcomes Classification (NOC).METHODCase report study according to nursing process conducted with an Intensive Care Unit patient. Data were collected with an instrument containing the PUSH and the result of the NOC. In the analysis we used descriptive statistics, considering the scores obtained on the instrument.RESULTSA reduction in the size of lesions of 7cm to 1.5cm of length and 6cm to 1.1cm width, in addition to the increase of epithelial tissue and granulation, decreased secretion and odor.CONCLUSIONThere was improvement in the healing process of the lesion treated with adjuvant therapy and the use of NOC allowed a more detailed and accurate assessment than the PUSH.
Collapse
Affiliation(s)
- Sofia Palagi
- Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | |
Collapse
|
70
|
Kim BS, Pallua N, Bernhagen J, Bucala R. The macrophage migration inhibitory factor protein superfamily in obesity and wound repair. Exp Mol Med 2015; 47:e161. [PMID: 25930990 PMCID: PMC4454997 DOI: 10.1038/emm.2015.26] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/03/2015] [Indexed: 12/15/2022] Open
Abstract
The rising number of obese individuals has become a major burden to the healthcare systems worldwide. Obesity includes not only the increase of adipose tissue mass but importantly also the altered cellular functions that collectively lead to a chronic state of adipose tissue inflammation, insulin resistance and impaired wound healing. Adipose tissue undergoing chronic inflammation shows altered cytokine expression and an accumulation of adipose tissue macrophages (ATM). The macrophage migration inhibitory factor (MIF) superfamily consists of MIF and the recently identified homolog D-dopachrome tautomerase (D-DT or MIF-2). MIF and D-DT, which both bind to the CD74/CD44 receptor complex, are differentially expressed in adipose tissue and have distinct roles in adipogenesis. MIF positively correlates with obesity as well as insulin resistance and contributes to adipose tissue inflammation by modulating ATM functions. D-DT, however, is negatively correlated with obesity and reverses glucose intolerance. In this review, their respective roles in adipose tissue homeostasis, adipose tissue inflammation, insulin resistance and impaired wound healing will be reviewed.
Collapse
Affiliation(s)
- Bong-Sung Kim
- 1] Department of Medicine, Yale University School of Medicine, New Haven, CT, USA [2] Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, Aachen, Germany [3] Department of Plastic and Reconstructive Surgery, Hand Surgery-Burn Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Norbert Pallua
- Department of Plastic and Reconstructive Surgery, Hand Surgery-Burn Center, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jürgen Bernhagen
- Institute of Biochemistry and Molecular Cell Biology, RWTH Aachen University, Aachen, Germany
| | - Richard Bucala
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
71
|
Kwak HR, Kang J. Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission. ACTA ACUST UNITED AC 2015. [DOI: 10.7475/kjan.2015.27.3.347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Hye Ran Kwak
- Dong-A University Medical Center, CCU, Busan, Korea
| | - Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Korea
| |
Collapse
|
72
|
Abstract
The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters.
Collapse
Affiliation(s)
- Stijn Blot
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium and the Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Elsa Afonso is a staff nurse in the neonatal intensive care unit, Chelsea and Westminster NHS Trust, London, United Kingdom. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Elsa Afonso
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium and the Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Elsa Afonso is a staff nurse in the neonatal intensive care unit, Chelsea and Westminster NHS Trust, London, United Kingdom. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| | - Sonia Labeau
- Stijn Blot is a professor in the Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Belgium and the Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia. Elsa Afonso is a staff nurse in the neonatal intensive care unit, Chelsea and Westminster NHS Trust, London, United Kingdom. Sonia Labeau is a lecturer in the Faculty of Education, Health and Social Work, University College Ghent, Belgium
| |
Collapse
|