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Kowal S, Vendrov M, Vaz D, Mir ZM, Hanna NM, Zevin B. The Safety and Efficacy of Concurrent Laparoscopic Cholecystectomy during Minimally Invasive Roux-en-Y Gastric Bypass: A Systematic Review. Obes Surg 2024; 34:2650-2655. [PMID: 38767785 DOI: 10.1007/s11695-024-07270-w] [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: 01/22/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
We conducted a systematic review to examine perioperative outcomes for adults undergoing minimally invasive Roux-en-Y gastric bypass (RYGB) with and without concurrent cholecystectomy (CCE). We reviewed the literature using OVID MEDLINE(R), Embase, Cochrane CENTRAL, Web of Science, and medRxiv and identified studies published between 1946 and May 2023. We identified a total of 2402 studies with 11 included in the final analysis (combined 149,356 patients). Studies suggested increased operative time associated with RYGB-CCE, with mixed results regarding length of stay and rates of bile duct injury. Presently available data is not robust enough to conclude whether minimally invasive RYGB with CCE harms or benefits patients compared to RYGB alone.
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Affiliation(s)
- Sloane Kowal
- School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Mitchell Vendrov
- Department of Medicine, Queen's University, Kingston, Ontario 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - David Vaz
- School of Medicine, Queen's University, 80 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Zuhaib M Mir
- Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia Room 8-848, 1278 Tower Road, Halifax, NS, B3H 2Y9, Canada
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, Ontario 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, Ontario 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
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Jia YJ, Yu HR, Hu FH, Tang W, Zhang WQ, Ge MW, Shen LT, Du W, Cai B, Xu H, Xia XP, Chen HL. Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis. J Tissue Viability 2024:S0965-206X(24)00081-0. [PMID: 38886143 DOI: 10.1016/j.jtv.2024.06.006] [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: 01/31/2024] [Revised: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The association between underweight and pressure injuries (PIs) has been established in several studies. However, there is a lack of well-designed research investigating the connection between overweight and obesity with these injuries. OBJECTIVE This meta-analysis aims to investigate the dose-response relationship between body mass index (BMI) and the risk of PIs in adult hospitalized patients. METHODS PubMed, Web of Science, and MEDLINE Databases were searched from inception to May 2024. Observational articles with at least three BMI categories were included in the study. BMI was defined as underweight, normal weight, overweight, and morbid obesity for the meta-analysis. The non-linear relationship between BMI and the risk of PIs in hospitalized adults was investigated using restricted cubic spline models. Fractional polynomial modeling was used. RESULTS Eleven articles reporting at least 3 categories of BMI met the inclusion criteria, including 31,389 participants. Compared to patients with normal weight, those with underweight, obesity, and morbid obesity exhibited an increased risk of PIs, with odds ratios of 1.70 (95%CI:1.50-1.91), 1.12 (95%CI:1.02-1.24), 1.70 (95%CI:1.13-2.55), respectively. A J-shaped dose-response model was established for the relationship between PI risk and BMI (Pnon-linearity < 0.001, Plinearity = 0.745). CONCLUSION The J-shaped dose-response pattern revealed that underweight, obesity and morbid obesity heightened the risk of PIs in hospitalized adults. Lower and higher BMI values may signify an increased risk for PIs, particularly among the elderly with lower BMI, providing valuable guidance for medical staff.
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Affiliation(s)
- Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Rong Yu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Bo Cai
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Xiao-Peng Xia
- Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China.
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Mwala NN, Borkent JW, van der Meij BS, de van der Schueren MAE. Challenges in identifying malnutrition in obesity; An overview of the state of the art and directions for future research. Nutr Res Rev 2024:1-10. [PMID: 38576127 DOI: 10.1017/s095442242400012x] [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: 04/06/2024]
Abstract
(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.
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Affiliation(s)
- Natasha Nalucha Mwala
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Jos W Borkent
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Barbara S van der Meij
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, Australia
| | - Marian A E de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
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Marshall V, Qiu Y, Jones A, Weller CD, Team V. Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review. J Adv Nurs 2024; 80:1262-1282. [PMID: 37788102 DOI: 10.1111/jan.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
AIM(S) To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury. DESIGN Exploratory. METHODS Scoping review. DATA SOURCES Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021). RESULTS Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3). CONCLUSION Quality of evidence was low for the interventional studies and best practice recommendations. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations. IMPACT STATEMENT This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment. REPORTING METHOD We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people. PROTOCOL REGISTRATION Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).
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Affiliation(s)
- Victoria Marshall
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Yunjing Qiu
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Victoria Team
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Monash Partners Academic Health Science Centre, Clayton, Victoria, Australia
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Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2024; 2:CD003216. [PMID: 38345088 PMCID: PMC10860148 DOI: 10.1002/14651858.cd003216.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance behaviours. The prevention and treatment of pressure ulcers involves strategies to optimize hydration, circulation, and nutrition. Adequate nutrient intake can reduce the risk factor of malnutrition and promote wound healing in existing pressure ulcers. However, it is unclear which nutrients help prevent and treat pressure ulcers. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of nutritional interventions (special diets, supplements) for preventing and treating pressure ulcers in people with or without existing pressure ulcers compared to standard diet or other nutritional interventions. SEARCH METHODS We used extensive Cochrane search methods. The latest search was in May 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with or without existing pressure ulcers, that compared nutritional interventions aimed at preventing or treating pressure ulcers with standard diet or other types of nutritional interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome for prevention studies was the proportion of participants who developed new (incident) pressure ulcers. For treatment studies, our primary outcomes were time to complete pressure ulcer healing, number of people with healed pressure ulcers, size and depth of pressure ulcers, and rate of pressure ulcer healing. Secondary outcomes were side effects, costs, health-related quality of life and acceptability. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 33 RCTs with 7920 participants. Data for meta-analysis were available from 6993 participants. Pressure ulcer prevention Eleven studies (with 12 arms) compared six types of nutritional interventions for the prevention of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may result in little to no difference in the proportion of participants developing a pressure ulcer (energy, protein and micronutrient supplements 248 per 1000, standard diet 269 per 1000; RR 0.92, 95% CI 0.71 to 1.19; 3 studies, 1634 participants; low-certainty evidence). Compared to standard diet, protein supplements may result in little to no difference in pressure ulcer incidence (protein 21 per 1000, standard diet 28 per 1000; RR 0.75, 95% CI 0.49 to 1.14; 4 studies, 4264 participants; low-certainty evidence). The evidence is very uncertain about the gastrointestinal side effects of these supplements (protein 109 per 1000, standard diet 155 per 1000; RR 0.70, 95% CI 0.06 to 7.96; 2 studies, 140 participants, very low-certainty evidence). The evidence is very uncertain about the effects of protein, arginine, zinc and antioxidants; L-carnitine, L-leucine, calcium, magnesium and vitamin D; EPA, GLA and antioxidants; disease-specific supplements on pressure ulcer incidence when compared to standard diet (1 study each; very low-certainty evidence for all comparisons). Pressure ulcer treatment Twenty-four studies (with 27 arms) compared 10 types of nutritional interventions or supplements for treatment of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may slightly increase the number of healed pressure ulcers (energy, protein and micronutrients 366 per 1000, standard diet 253 per 1000; RR 1.45, 95% CI 1.14 to 1.85; 3 studies, 577 participants, low-certainty evidence). The evidence is very uncertain about the effect of these supplements on gastrointestinal side effects. Compared to standard diet, the evidence is very uncertain about the effect of protein, arginine, zinc and antioxidant supplements on pressure ulcer healing (pressure ulcer area: mean difference (MD) 2 cm² smaller, 95% CI 4.54 smaller to 0.53 larger; 2 studies, 71 participants, very low-certainty evidence). The evidence on side effects of these supplements is very uncertain. Compared to standard diet, supplements with arginine and micronutrients may not increase the number of healed pressure ulcers, but the evidence suggests a slight reduction in pressure ulcer area (MD 15.8% lower, 95% CI 25.11 lower to 6.48 lower; 2 studies, 231 participants, low-certainty evidence). The evidence is very uncertain about changes in pressure ulcer scores, acceptability, and side effects of these supplements. Compared to placebo, collagen supplements probably improve the mean change in pressure ulcer area (MD 1.81 cm² smaller, 95% CI 3.36 smaller to 0.26 smaller; 1 study, 74 participants, moderate-certainty evidence). The evidence is very uncertain about the effect of these supplements on side effects. The evidence is very uncertain about the effects of vitamin C, different doses of arginine; EPA, GLA (special dietary fatty acids) and antioxidants; protein; a specialized amino acid mixture; ornithine alpha-ketoglutarate and zinc supplements on pressure ulcer healing (1 or 2 studies each; very low-certainty evidence). AUTHORS' CONCLUSIONS The benefits of nutritional interventions with various compositions for pressure ulcer prevention and treatment are uncertain. There may be little or no difference compared to standard nutrition or placebo. Nutritional supplements may not increase gastrointestinal side effects, but the evidence is very uncertain. Larger studies with similar nutrient compositions would reduce these uncertainties. No study investigated the effects of special diets (e.g. protein-enriched diet, vegetarian diet) on pressure ulcer incidence and healing.
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Affiliation(s)
- Gero Langer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Astrid Fink
- Department of Health, District administration Groß-Gerau, Groß-Gerau, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University Graz, Graz, Austria
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Brown T, Edwards A, Pashley A, Lehn B, Vasani S, Hodge R, Bauer J. Nutritional status and post-operative complications in patients undergoing surgery for advanced pharyngeal or laryngeal cancer. Eur Arch Otorhinolaryngol 2023; 280:5531-5538. [PMID: 37535080 PMCID: PMC10620302 DOI: 10.1007/s00405-023-08139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer. METHODS Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications. RESULTS Pre-operative malnutrition incidence was 40%. Malnourished patients had higher incidences of any type of complication (57% vs 44%, p = 0.013) and pressure injury (86% vs 14%, p = 0.011) compared to well-nourished patients. Well-nourished patients had a clinically important shorter median length of stay compared to malnourished patients (17.5 vs 20 days). CONCLUSION Early identification and management of malnutrition is essential to minimize risk of post-operative complications and reduce length of stay and should be considered a key component of prehabilitation programs.
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Affiliation(s)
- Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia.
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
| | - Anna Edwards
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
- Department of Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, Toowoomba Hospital, Darling Downs Health, Toowoomba, QLD, Australia
| | - Alice Pashley
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Belinda Lehn
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sarju Vasani
- Department of Ear Nose Throat, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Robert Hodge
- Department of Ear Nose Throat, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
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Knight G, Mushambi M. Anesthetic challenges of pregnant obesity women. Best Pract Res Clin Obstet Gynaecol 2023; 91:102405. [PMID: 37688846 DOI: 10.1016/j.bpobgyn.2023.102405] [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: 04/28/2023] [Revised: 05/24/2023] [Accepted: 08/06/2023] [Indexed: 09/11/2023]
Abstract
Obesity causes significant morbidity and increases the mortality risk for both mother and fetus. With an increasing projected prevalence, it is vital that the obstetric anesthetist is equipped with the knowledge and tools to manage these women. A multi-disciplinary team approach and early planning is required. Neuraxial analgesia for labor helps to negate the need for general anesthesia, which is associated with increased risk in this subset of women. Catheter techniques for neuraxial anesthesia allow for titration, manipulation, and prolongation of the anesthetic block to reduce the risk of conversion to general anesthesia.
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Affiliation(s)
- Georgia Knight
- University Hospitals of Leicester, Infirmary Square, Leicester 0300 3031573, UK.
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Shi G, Jiang L, Liu P, Xu X, Wu Q, Zhang P. Using a Decision Tree Approach to Analyze Key Factors Influencing Intraoperative-Acquired Pressure Injury. Adv Skin Wound Care 2023; 36:591-597. [PMID: 37530572 DOI: 10.1097/asw.0000000000000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To determine the key factors influencing intraoperative-acquired pressure injury (IAPI). METHODS Researchers assessed 413 surgical patients in a Shanghai tertiary hospital using an information collection form and an IAPI occurrence record form. Analysis took place using the classification and regression tree algorithm and multiple logistic regression. RESULTS A total of 43 surgical patients (10.4%) had IAPI, including 32 stage 1 cases (74.4%), and 11 stage 2 cases (25.6%). The multiple logistic regression analysis indicated that operation duration, surgical position, preoperative hypertension, and preoperative Braden Scale risk score were independently associated with IAPI development. The decision tree showed that preoperative Braden Scale score, surgical position, operation grade, operation duration, age, prealbumin level, and body mass index were important factors and that preoperative Braden Scale score was the most critical decision variable. The cross-validation method was used to indicate a model accuracy of 91.8%. CONCLUSIONS The decision tree effectively identified key factors for IAPI, complementing the logistic regression analysis and providing a scientific basis for the further development of structural risk assessment, prevention, and treatment strategies for IAPI.
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Affiliation(s)
- Guirong Shi
- At Xinhua Hospital, affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China, Guirong Shi, MSN, RN, is Specialty Nurse; Liping Jiang, PhD, RN, is Director of the Nursing Department; and Ping Liu, MSN, RN, is Associate Director of the Nursing Department. Xin Xu, RN, is Graduate Student, School of Nursing, Wenzhou Medical University, Zhejiang. Also at Xinhua Hospital, Qunfang Wu, BS, RN, is Nursing Supervisor of the Spine Center; and Peipei Zhang, BS, RN, is Nursing Supervisor of the Operating Room. Acknowledgment: The authors thank the postanesthesia care unit nurses and OR nurses for their assistance with the data collection for this study. This research was funded by the Science and Technology Foundation Project of Shanghai Jiao Tong University School of Medicine (Jyh2204, Shanghai Nursing Association fund project 2020MS-B02). The authors have disclosed no other financial relationships related to this article. Submitted September 14, 2022; accepted in revised form October 21, 2022
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9
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Byard RW. Manifestations and etiology of cutaneous findings in cases of morbid obesity. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00721-3. [PMID: 37889417 DOI: 10.1007/s12024-023-00721-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
Morbid obesity is associated with a wide range of metabolic, infective, and organic disorders related to adipose tissue overload. While careful documentation of internal autopsy findings is usual, skin manifestations may be overlooked. Skin manifestations are quite diverse and include striae distensae, skin tags, plantar hyperkeratosis, acanthosis nigricans, the sequelae of hyperandrogenism, lymphedema, panniculus morbidus, chronic venous insufficiency, stasis dermatitis, leg ulceration, intertrigo, cellulitis, pressure ulcers and 'buried penis'. Obesity has also been associated with hidradenitis suppurativa, psoriasis, atopic dermatitis, melanoma, systemic lupus erythematosus, lichen planus and acne vulgaris. Evaluating these findings at the time of autopsy may give a more complete assessment of a particular case and may also identify conditions that may have contributed to, or caused, death.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and the School of Biomedicine, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Frome Road, Adelaide, SA, 5000, Australia.
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10
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Heywood-Everett S, Henderson R, Webb C, Bland AR. Psychosocial factors impacting community-based pressure ulcer prevention: A systematic review. Int J Nurs Stud 2023; 146:104561. [PMID: 37542960 DOI: 10.1016/j.ijnurstu.2023.104561] [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: 11/07/2022] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Pressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership. OBJECTIVE To synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour. DESIGN Mixed methods systematic review and narrative synthesis. METHOD Systematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model. RESULTS Thirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport. CONCLUSIONS Several psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.
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Affiliation(s)
- Suzanne Heywood-Everett
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK.
| | - Rebecca Henderson
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Claire Webb
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Amy R Bland
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
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Irving SY, Berry KG, Morgan S, Seiple SM, Nagle ML, Stetzer M, Tabatabaei N, Murphy S, Srinivasan V, Mascarenhas M. Nutrition association with skin integrity and pressure injury in critically ill pediatric patients. Nutr Clin Pract 2023; 38 Suppl 2:S125-S138. [PMID: 37721464 DOI: 10.1002/ncp.11063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of providing nutrition therapy. METHODS We conducted a narrative literature review with three main thematic concepts to drive our literature search: the association of nutrition therapy with (1) skin integrity; (2) injury, wounds, and wound healing; and (3) differences of skin color. Using pertinent search and subject terms, PubMed, CINAHL, EMBASE, and SCOPUS databases were searched, yielding 316 articles. After removal of duplicates, articles were reviewed based on inclusion and exclusion criteria defined by the authors; only eight articles met the defined criteria to inform this review. RESULTS Large and important gaps exist in the current literature regarding an association between nutrition therapy, skin injury, and wound healing. Little to no attention was found for associations with skin color. The resulting narrative review addresses these topics and subtopics with additional references included that are independent of the original search strategy. CONCLUSIONS A dearth of evidence exists describing associations between nutrition and disruption of skin integrity in pediatric critical illness. Children with dark skin are at increased risk, as manifestation and identification of disruption to skin integrity may not be recognized. Research is needed to describe these associations and the impact of nutrition on skin integrity, including differences of skin color.
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Affiliation(s)
- Sharon Y Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Nursing and Clinical Care Services, Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katarina G Berry
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sherry Morgan
- Holman Biotech Commons, Robert Wood Johnson Pavilion, Philadelphia, Pennsylvania, USA
| | - Stephanie M Seiple
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Monica L Nagle
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Stetzer
- Wound Ostomy and Vascular Access Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeka Tabatabaei
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sara Murphy
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vijay Srinivasan
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maria Mascarenhas
- Department of Clinical Nutrition, Division of Gastroenterology and Nutrition, Philadelphia, Pennsylvania, USA
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12
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Chen F, Wang X, Pan Y, Ni B, Wu J. The paradox of obesity in pressure ulcers of critically ill patients. Int Wound J 2023; 20:2753-2763. [PMID: 36932685 PMCID: PMC10410346 DOI: 10.1111/iwj.14152] [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] [Received: 12/24/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
The relationship between body mass index and pressure ulcers in critically ill patients is controversial. We aimed to investigate the association between body mass index and pressure ulcers by analysing data from the Medical Information Mart for Intensive Care IV (version 2.0) database. Eligible data (21 835 cases) were extracted from the database (2008-2019). The association between body mass index and pressure ulcers in critically ill patients was investigated by adjusting multivariate trend analysis, restricted cubic spline analysis, and segmented linear models. Subgroup analyses and sensitivity analyses were used to ensure the stability of the results. Trend analysis and restricted cubic spline analysis showed an approximate U-shaped correlation between body mass index and the occurrence of pressure ulcers in critically ill patients, with the risk of pressure ulcers decreasing rapidly with increasing body mass index (8.6% decrease per unit) after adjusting for relevant factors; the trend reached its minimum at a body mass index of 27.5 kg/m2, followed by a slow increase in the risk of pressure ulcers with increasing body mass index (1.4% increase per unit). Among the subgroups, the highest overall risk of pressure ulcers and the risk of severe pressure ulcers were significantly higher in the underweight group than in the other subgroups, and the risk associated with the overweight group was the lowest. There is a U-shaped association between body mass index and pressure ulcers in critically ill patients, and being underweight and obese both increase the risk of pressure ulcers. The risk is highest among underweight patients and lowest among overweight patients (but not patients of normal weight), necessitating targeted prevention strategies for critically ill patients with different body mass indexes.
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Affiliation(s)
- Fujin Chen
- Department of Critical Care MedicineWenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical UniversityWenzhouZhejiang325099China
| | - Xiaobo Wang
- Department of Critical Care MedicineWenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical UniversityWenzhouZhejiang325099China
| | - Yujie Pan
- Department of Critical Care MedicineWenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical UniversityWenzhouZhejiang325099China
| | - Bukao Ni
- Department of Critical Care MedicineWenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical UniversityWenzhouZhejiang325099China
| | - Jianhua Wu
- Department of Critical Care MedicineWenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical UniversityWenzhouZhejiang325099China
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13
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Semerci R, Umaç EH, Yılmaz D, Karadağ A. Analysis of the prevalence and risk factors of pressure injuries in the hospitalized pediatric population: A retrospective study. J Tissue Viability 2023; 32:333-338. [PMID: 37130768 DOI: 10.1016/j.jtv.2023.04.004] [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: 10/16/2022] [Revised: 03/11/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Pressure injury (PI) is an essential indicator of the quality of nursing care and affects hospitalized newborns and children. However, studies on the prevalence of PI and associated risk factors in children are limited. AIMS This study aimed to analyze the prevalence of PI and risk factors affecting the development of PI in the hospitalized pediatric population. METHODS This was a descriptive, retrospective study. Data were obtained via electronic medical records of 6350 pediatric patients admitted to a university hospital between January 2019 and April 2022. Ethics committee approval was obtained. Patient medical records and data associated with PI and medical treatment were collected through the 'Information Form,' 'Braden Scale,' 'Braden Q Scale,' 'Pressure Ulcer Staging Form,' and 'Pediatric Nutrition Risk Score (PNRS).' Data were analyzed using descriptive statistics, correlation analysis, Mann-Whitney U test, Kruskal Wallis test, and Multilinear Regression analysis. RESULTS More patients (66.2%) were males, and 49.2% of the children were 0-12 months old. 2368 out of 6350 pediatric patients were treated in the PICU. It was determined that a total of 143 PI occurred in 59 patients from PICU. The PI prevalence was 2.25% for all patients and 6.04% for PICU patients. Twenty-one percent of the patients had medical device-related PI (MDRPIs), 35.7% of PI occurred in the occiput, 13.3% in the coccyx/sacrum, and 67.1% of PI was Deep Tissue Injury. In the multiple regression model, children's albumin level, hemoglobin level, PNRS scores, Body Mass Index, and length of hospital stay significantly affected BRADEN scores. They were explained 30.3% of their scores of Braden. CONCLUSION Despite the limitations of the retrospective study, the prevalence of PI in the pediatric population in this study was lower than that reported in previous studies, but the prevalence of MDRPIs was higher. Based on the study results, it is recommended to implement preventive interventions for MDRPIs and plan prospective studies.
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Affiliation(s)
| | | | - Dilek Yılmaz
- Koç University Hospital, 34010, İstanbul, Turkey.
| | - Ayişe Karadağ
- Koç University, School of Nursing, 34010, İstanbul, Turkey.
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14
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Baykara ZG, Karadag A, Bulut H, Duluklu B, Karabulut H, Aktas D, Celik SS, Guler S, Ay A, Gul S, Ozturk D, Irmak B, Aydogan S, Cebeci F, Karakaya D, Avsar P. Pressure Injury Prevalence and Risk Factors: A National Multicenter Analytical Study. J Wound Ostomy Continence Nurs 2023; 50:289-295. [PMID: 37467407 DOI: 10.1097/won.0000000000000995] [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: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to determine the point prevalence (PP) of general pressure injuries (PIs), hospital-acquired PIs, PI-related risk factors, and PI preventive interventions performed by nurses. DESIGN Descriptive, multicenter, prospective, analytical study. SUBJECTS AND SETTING The sample comprised 5088 patients cared for in 13 hospitals in 12 geographic regions of Turkey. Data were collected between November 5, 2018, and July 17, 2019. METHODS The study was carried out in 2 stages. First, nurses who collected data were trained in the diagnosis of PI, risk assessment, staging, and prevalence studies, and informed about the purpose and methods of the study, including data collection. Second, nurses and researchers who had received training related to data collection for this study conducted a PP study for PIs in their inpatient clinics using the ASSIST II method. The PI Prevalence Study Tool and the Braden Scale for Predicting Pressure Sore Risk were also used during data collection. RESULTS The PP of general PIs was 9.5%; the prevalence of PIs with hospitalization in intensive care units was 43.2%; medical device-related pressure injuries prevalence was 10.7%. We found that 65.1% of the PIs were acquired after hospital admission. CONCLUSIONS Similarities exist between PI prevalence in Turkey and reported PI prevalence rates worldwide. However, the prevalence of nosocomial PIs related to intensive care units and the prevalence of all nosocomial injuries were higher than rates previously reported. Based on results, there is a need to develop strategies to reduce the prevalence of nosocomial PIs.
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Affiliation(s)
- Zehra Gocmen Baykara
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Ayise Karadag
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Hulya Bulut
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Burcu Duluklu
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Hatice Karabulut
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Dilek Aktas
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Sevilay Senol Celik
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Sevil Guler
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Ali Ay
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Senay Gul
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Deniz Ozturk
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Burcin Irmak
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Sinan Aydogan
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Fatma Cebeci
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Derya Karakaya
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
| | - Pinar Avsar
- Zehra Gocmen Baykara, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ayise Karadag, PhD, Fundamentals of Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Hulya Bulut, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Burcu Duluklu, PhD, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey. At the time the research was published, the author was a Post-Doctoral Researcher, General Nursing Department, School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Hatice Karabulut, PhD, Department of Nursing, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
- Dilek Aktas, PhD, Surgical Nursing Department, School of Nursing, Yildirim Beyazit University, Ankara, Turkey
- Sevilay Senol Celik, PhD, Surgical Nursing Department, School of Nursing, Koc University, Istanbul, Turkey
- Sevil Guler, PhD, Surgical Nursing Department, Faculty of Nursing, Gazi University, Ankara, Turkey
- Ali Ay, PhD, Department of Nursing, Faculty of Health Sciences, Bingöl University, Bingöl, Turkey
- Senay Gul, PhD, Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Deniz Ozturk, PhD, Wound Ostomy Incontinence Nurses Society, Ankara, Turkey
- Burcin Irmak, PhD, Department of Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
- Sinan Aydogan, PhD, Department of Nursing, Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Fatma Cebeci, MSc, PhD candidate, Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
- Derya Karakaya, MSc, WOC Nurse, Pursaklar State Hospital, Ankara, Turkey
- Pinar Avsar, PhD, School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Skin Wounds and Trauma Research Centre, Dublin, Ireland
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15
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Ciríaco GV, Menezes-Júnior LAAD, Oliveira WWD, Talvani A, Turbino Ribeiro SML. Pressure ulcer incidence in critically ill patients: Role of body mass index, nutrition therapy, and other non-nutritional factors. Clin Nutr ESPEN 2023; 55:285-291. [PMID: 37202058 DOI: 10.1016/j.clnesp.2023.03.024] [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: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To assess the clinical and nutritional risk factors related to the occurrence of pressure ulcers (PUs) in patients admitted to an Intensive Care Unit (ICU). METHODS This is a cohort retrospective study, carried out by analyzing the medical records of patients admitted to the ICU of a hospital, containing information on sociodemographic, clinical, dietary, and anthropometric data, presence of mechanical ventilation, sedation, and use of noradrenaline. To verify the clinical and nutritional risk factors, multivariate Poisson's regression with robust variance was used to estimate the relative risk (RR) according to the explanatory variables. RESULTS A total of 130 patients were evaluated from January 1 to December 31, 2019. The incidence of PUs in the study population was 29.2%. In univariate analysis, male sex, suspended or enteral diet, use of mechanical ventilation, and sedatives had a significant association with the PUs (p < 0.05). However, when adjusted for potential confounders, only suspended diet remained associated with the PUs. Furthermore, in an analysis stratified by hospitalization time, it was observed that for each 1 kg/m2 increase in body mass index, there is a 10% increased risk of PUs occurrence (RR: 1.10; 95%CI: 1.01-1.23). CONCLUSION Patients with suspended diet, diabetics, with longer-time hospitalization, and overweight have a higher risk of presenting pressure ulcers.
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Affiliation(s)
| | - Luiz Antônio Alves de Menezes-Júnior
- Pós-doctorate Researcher in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto. Ouro Preto, Minas Gerais, Brazil.
| | - Wandeir Wagner de Oliveira
- Department of Family Medicine, Mental Health and Public Health, School of Medicine, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
| | - André Talvani
- Associate Professor in the Post-graduate Program in Health and Nutrition, Nutrition School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil.
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16
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Elliott A, Gibson S, Bauer J, Cardamis A, Davidson Z. Exploring Overnutrition, Overweight, and Obesity in the Hospital Setting-A Point Prevalence Study. Nutrients 2023; 15:nu15102315. [PMID: 37242200 DOI: 10.3390/nu15102315] [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: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Malnutrition is an international healthcare concern associated with poor patient outcomes, increased length of stay, and healthcare costs. Although malnutrition includes both under and overnutrition, there is a large body of evidence that describes the impacts of undernutrition with limited data on overnutrition in hospitalized patients. Obesity itself is a modifiable risk factor associated with hospital-associated complications. However, there is limited reporting of the prevalence of obesity in hospitals. This one-day cross-sectional study (n = 513) captures the prevalence of both under and overnutrition in a hospitalized population and explores dietetic care provided compared to the Nutrition Care Process Model for hospitalized patients who have obesity. The main findings were: (1) the largest proportion of patients were in the overweight and obese classifications (57.3%, n = 294/513); 5.3% of these patients had severe obesity (class III); (2) patients who were overweight and obese had lower malnutrition risk profiles as well as the prevalence of malnutrition; (3) 24.1% of patients who had obesity (n = 34/141) were receiving dietetic intervention; (4) 70.6% (n = 24/34) did not have a nutrition diagnosis that followed the Nutrition Care Process Model. Study results provide valuable clinical insight into the prevalence of overnutrition and opportunities to improve nutrition care for this vulnerable patient group.
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Affiliation(s)
- Andrea Elliott
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
- Nutrition and Dietetics Department, Eastern Health, Box Hill, VIC 3128, Australia
| | - Simone Gibson
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| | - Judy Bauer
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
| | - Anna Cardamis
- Nutrition and Dietetics Department, Eastern Health, Box Hill, VIC 3128, Australia
| | - Zoe Davidson
- Department Dietetics, Nutrition and Food Monash University, Notting Hill, VIC 3168, Australia
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17
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Banks MD, Webster J, Bauer J, Dwyer K, Pelecanos A, MacDermott P, Nevin A, Coleman K, Campbell J, Hickling D, Byrnes A, Capra S. Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study. J Wound Care 2023; 32:292-300. [PMID: 37094924 DOI: 10.12968/jowc.2023.32.5.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To investigate the effectiveness of an intensive nutrition intervention or use of wound healing supplements compared with standard nutritional care in pressure ulcer (PU) healing in hospitalised patients. METHOD Adult patients with a Stage II or greater PU and predicted length of stay (LOS) of at least seven days were eligible for inclusion in this pragmatic, multicentre, randomised controlled trial (RCT). Patients with a PU were randomised to receive either: standard nutritional care (n=46); intensive nutritional care delivered by a dietitian (n=42); or standard care plus provision of a wound healing nutritional formula (n=43). Relevant nutritional and PU parameters were collected at baseline and then weekly or until discharge. RESULTS Of the 546 patients screened, 131 were included in the study. Participant mean age was 66.1±16.9 years, 75 (57.2%) were male and 50 (38.5%) were malnourished at recruitment. Median length of stay was 14 (IQR: 7-25) days and 62 (46.7%) had ≥2 PUs at the time of recruitment. Median change from baseline to day 14 in PU area was -0.75cm2 (IQR: -2.9_-0.03) and mean overall change in Pressure Ulcer Scale for Healing (PUSH) score was -2.9 (SD 3.2). Being in the nutrition intervention group was not a predictor of change in PUSH score, when adjusted for PU stage or location on recruitment (p=0.28); it was not a predictor of PU area at day 14, when adjusted for PU stage or area on recruitment (p=0.89) or PU stage and PUSH score on recruitment (p=0.91), nor a predictor of time to heal. CONCLUSION This study failed to confirm a significant positive impact on PU healing of use of an intensive nutrition intervention or wound healing supplements in hospitalised patients. Further research that focuses on practical mechanisms to meet protein and energy requirements is needed to guide practice.
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Affiliation(s)
- Merrilyn D Banks
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Joan Webster
- Centre for Clinical Nursing, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Judy Bauer
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
| | - Kathleen Dwyer
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Anita Pelecanos
- Metro North Hospital and Health Service Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Paula MacDermott
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Amy Nevin
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Kerrie Coleman
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Jill Campbell
- Skin Integrity Services, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Donna Hickling
- Department of Nutrition & Dietetics, The Prince Charles Hospital, Chermside, Australia
| | - Angela Byrnes
- Department of Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Herston, Australia
| | - Sandra Capra
- School of Human Movement & Nutrition Sciences, The University of Queensland, St Lucia, Australia
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18
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Aldughayfiq B, Ashfaq F, Jhanjhi NZ, Humayun M. YOLO-Based Deep Learning Model for Pressure Ulcer Detection and Classification. Healthcare (Basel) 2023; 11:healthcare11091222. [PMID: 37174764 PMCID: PMC10178524 DOI: 10.3390/healthcare11091222] [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: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Pressure ulcers are significant healthcare concerns affecting millions of people worldwide, particularly those with limited mobility. Early detection and classification of pressure ulcers are crucial in preventing their progression and reducing associated morbidity and mortality. In this work, we present a novel approach that uses YOLOv5, an advanced and robust object detection model, to detect and classify pressure ulcers into four stages and non-pressure ulcers. We also utilize data augmentation techniques to expand our dataset and strengthen the resilience of our model. Our approach shows promising results, achieving an overall mean average precision of 76.9% and class-specific mAP50 values ranging from 66% to 99.5%. Compared to previous studies that primarily utilize CNN-based algorithms, our approach provides a more efficient and accurate solution for the detection and classification of pressure ulcers. The successful implementation of our approach has the potential to improve the early detection and treatment of pressure ulcers, resulting in better patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Bader Aldughayfiq
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Farzeen Ashfaq
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - N Z Jhanjhi
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
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19
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Putri IL, Tungga AAA, Pramanasari R, Wungu CDK. Characteristics of Patients with Pressure Injuries in a COVID-19 Referral Hospital. Adv Skin Wound Care 2023; 36:1-6. [PMID: 36940381 DOI: 10.1097/01.asw.0000919956.83713.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
OBJECTIVE This retrospective study aimed to describe the characteristics of patients treated at a COVID-19 referral hospital from March 2020 to June 2021 who experienced pressure injuries (PIs) either before or after admission. METHODS The researchers collected and analyzed data on patients' demographic characteristics, symptoms, comorbidities, location and severity of PI, laboratory values, oxygen therapy, length of stay, and vasopressor use. RESULTS During the study period, 1,070 patients were hospitalized for COVID-19 with varying degrees of severity, and 12 patients were diagnosed with PI. Eight (66.7%) of the patients with PI were men. The median age was 60 (range, 51-71) years, and half of the patients had obesity. Eleven of the patients with PI (91.4%) had at least one comorbid condition. The sacrum and gluteus were the two most commonly affected sites. Those with stage 3 PI had a substantially greater median d-dimer value (7,900 ng/mL) than patients with stage 2 PI (1,100 ng/mL). The average length of stay was 22 (range, 9.8-40.3) days. CONCLUSIONS Health professionals should be aware of an increase in d-dimer in patients with COVID-19 and PI. Even though PIs in these patients might not result in mortality, an increase in morbidity can be avoided with the right care.
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Affiliation(s)
- Indri Lakhsmi Putri
- Indri Lakhsmi Putri, MD, PhD, is Plastic Surgeon, Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, East Java, Indonesia, and Craniofacial Consultant, Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University. Also at Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Aldrich Alexander Afeli Tungga, MD, is Surgical Intern, and Rachmaniar Pramanasari, MD, is Plastic Surgeon. In the Faculty of Medicine at Airlangga University, Citrawati Dyah Kencono Wungu, MD, PhD, is Medical Staff, Department of Physiology and Medical Biochemistry
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20
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Marsall M, Engelmann G, Teufel M, Bäuerle A. Exploring the Applicability of General Dietary Recommendations for People Affected by Obesity. Nutrients 2023; 15:nu15071604. [PMID: 37049445 PMCID: PMC10097167 DOI: 10.3390/nu15071604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Obesity has emerged as a major public health challenge with increasing prevalence globally. The General Dietary Behavior Inventory (GDBI) was developed based on official dietary recommendations. However, little is known about whether general dietary recommendations also apply to people affected by obesity and whether the GDBI can be used appropriately. (2) A cross-sectional study was conducted. A total of 458 people meeting the inclusion criteria participated in the study. The assessment consisted of the GDBI and behavioral, dietary, and health-related variables. We used descriptive analysis to examine the item characteristics of the GDBI and inferential statistics to investigate the associations between the GDBI score and behavioral, dietary, and health-related outcomes. (3) Several items of the GDBI were concerned by ceiling effects. A higher GDBI score (indicating a higher adherence to dietary recommendations) was related to higher age, higher nutrition knowledge, more restrained eating behavior, lower impulsivity, and higher body mass index. There were no associations between the GDBI score and reported physical and mental health or quality of life. (4) The GDBI showed inconsistent relationships with the study outcomes. General dietary recommendations do not appear to be applicable to people with obesity. Hence, there is an urgent need for specific recommendations and subsequent assessments of behavioral adherence for people affected by obesity.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany
- Correspondence:
| | - Gerrit Engelmann
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, 45147 Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
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21
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Sving EBM, Gunningberg LAC, Bååth CB, Björn CUS. Using pressure mapping intraoperatively to prevent pressure ulcers-A quasi-experimental study. Health Sci Rep 2023; 6:e1112. [PMID: 36817631 PMCID: PMC9930190 DOI: 10.1002/hsr2.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
Background and Aim Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. Methods A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. Results The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Conclusion Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.
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Affiliation(s)
- Eva B. M. Sving
- Centre for Research & DevelopmentUppsala University/Region GävleborgUppsalaSweden,Department of Public Health and Caring Sciences, Caring SciencesUppsala UniversityUppsalaSweden
| | - Lena A. C. Gunningberg
- Department of Public Health and Caring Sciences, Caring SciencesUppsala UniversityUppsalaSweden
| | - Carina B. Bååth
- Department of Health Sciences, Faculty of Health, Science and TechnologyKarlstad UniversityKarlstadSweden,Faculty of Health, Welfare and OrganisationØstfold University CollegeFredrikstadNorway
| | - Catrine U. S. Björn
- Centre for Research & DevelopmentUppsala University/Region GävleborgUppsalaSweden,Department of Public Health and Caring Sciences, Caring SciencesUppsala UniversityUppsalaSweden
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22
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Wild H, Baek Y, Shah S, Gasevic D, Owen A. The socioecological correlates of meal skipping in community-dwelling older adults: a systematic review. Nutr Rev 2023; 81:168-179. [PMID: 35913413 DOI: 10.1093/nutrit/nuac050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT Meal skipping may contribute to nutrient deficiency across the lifespan. Multiple socioecological factors have been identified as correlates of meal skipping in adolescents and adults, but evidence in older adults is limited. OBJECTIVE To determine the socioecological correlates of meal skipping in community-dwelling older adults. DATA SOURCE Embase, PsycINFO, CINAHL, and MEDLINE electronic databases were systematically searched from inception to March 2021. DATA EXTRACTION A total of 473 original research studies on socioecological factors and meal skipping among community-dwelling adults aged ≥65 years were identified. Title, abstract, and full-text review was performed by 2 reviewers independently, and a third reviewer resolved disagreements. A total of 23 studies met our inclusion criteria. Data were extracted by 1 reviewer from these studies and independently verified by another. The Newcastle-Ottawa Scale was used to assess methodological quality. DATA ANALYSIS The frequency of meal skipping in included studies ranged between 2.1% and 61%. This review identified 5 domains of socioecological correlates associated with meal skipping in older adults: sociodemographic, behavioral, biomedical, psychological, and social. CONCLUSION Understanding the factors associated with meal skipping in older adults can inform the development of targeted interventions to improve nutrition and health. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021249338.
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Affiliation(s)
- Holly Wild
- are with the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yeji Baek
- are with the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shivangi Shah
- are with the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Danijela Gasevic
- are with the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,with the Centre for Global Health, The Usher Institute, University of Edinburgh, UK
| | - Alice Owen
- are with the School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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23
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Weng P, Chang W. Extrinsic factors of pressure injuries in patients during surgery: A frequency matched retrospective study. Int Wound J 2022. [DOI: 10.1111/iwj.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Pei‐Wei Weng
- Department of Orthopaedics, Shuang Ho Hospital Taipei Medical University New Taipei City Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine Taipei Medical University Taipei Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering Taipei Medical University Taipei Taiwan
| | - Wen‐Pei Chang
- Department of Nursing, Shuang Ho Hospital Taipei Medical University New Taipei Taiwan
- School of Nursing, College of Nursing Taipei Medical University Taipei Taiwan
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24
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Sengul T, Gul A. Pressure injury in the perioperative period during COVID-19 pandemic: Incidence and patient-related risk factors in a hospital in Turkey. J Tissue Viability 2022; 31:714-717. [PMID: 36096956 PMCID: PMC9446680 DOI: 10.1016/j.jtv.2022.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/13/2022] [Accepted: 08/31/2022] [Indexed: 10/25/2022]
Affiliation(s)
- Tuba Sengul
- Koç University, School of Nursing, Davutpasa Street No:4, 34010 Topkapi, Istanbul, Turkey.
| | - Asiye Gul
- T.C. Istanbul Kültür University, Faculty of Health Science, Nursing Department, Turkey.
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25
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Fisher E, Luscombe G, Schmidt D, Brown L, Duncanson K. Using an interactive nutrition technology platform to predict malnutrition risk. J Hum Nutr Diet 2022; 36:912-919. [PMID: 36083834 DOI: 10.1111/jhn.13088] [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: 05/05/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
AIMS The Nutrition Dashboard is an interactive nutrition technology platform that displays food provision and intake data used to categorise the nutrition risk of hospitalised individuals. This study aimed to investigate the Nutrition Dashboard's ability to identify malnutrition compared to a validated malnutrition screening tool. METHODS A retrospective observational study at a 99-bed hospital was conducted using medical record and food intake data presented via the Nutrition Dashboard. Inter-Rater Reliability of food intake estimation between hospital catering staff and a dietitian reported good agreement across 912 food items (κ = 0.69, 95% CI 0.65-0.72, p < 0.001). Default nutritional adequacy thresholds of 4500kJ and 50g protein were applied for Nutrition Dashboard categorisation of supply and intake. Generalised estimating equation regression models explored the association between the Nutrition Dashboard risk categories and the Malnutrition Screening Tool, with and without controlling for patient demographic characteristics. RESULTS Analyses from 216 individuals (1783 hospital-stay days) found those in the highest risk Nutrition Dashboard Category were 1.93 times more likely to have a Malnutrition Screening Tool score indicating risk compared to the lowest Nutrition Dashboard Category (unadjusted odds ratio 1.93, 95% CI, 1.17-3.19, p<0.01). When patient weight was added to the model, lower weight became the only significant predictor of MST≥2 (p<0.01) CONCLUSIONS: This study indicates a role for nutrition intake technology in malnutrition screening. Further adaptions that address the complexities of applying this technology could improve the use of the Nutrition Dashboard to support identification of malnutrition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erin Fisher
- Armidale Rural Referral Hospital, Hunter New England Local Health District and University of Newcastle Department of Rural Health
| | - Georgina Luscombe
- University of Sydney School of Rural Health, 1502 Forest Road PO Box 1191, Orange, NSW, Australia, 2800
| | - David Schmidt
- NSW Health Education Training Institute, 1 Reserve Road, St Leonards, NSW, Australia, 2065
| | - Leanne Brown
- University of Newcastle, Department of Rural Health and Hunter Medical Research Institiute Tamworth Education Centre, 114 - 148 Johnston Street, Tamworth, NSW, Australia, 2340
| | - Kerith Duncanson
- NSW Health Education Training Institute and University of Newcastle, 1 Reserve Road, St Leonards, NSW, Australia, 2065
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26
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Turmell M, Cooley A, Yap TL, Alderden J, Sabol VK, Lin JRA, Kennerly SM. Improving Pressure Injury Prevention by Using Wearable Sensors to Cue Critical Care Patient Repositioning. Am J Crit Care 2022; 31:295-305. [PMID: 35773199 DOI: 10.4037/ajcc2022701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Repositioning patients at regular intervals is the standard of care for pressure injury prevention, yet compliance with routine repositioning schedules can be hard to achieve in busy critical care environments. Cueing technology may help improve repositioning compliance. OBJECTIVE To determine whether using wearable patient sensors to cue nurses about patients' repositioning needs could improve compliance with an every-2-hour repositioning protocol. METHODS A sequential pretest-posttest study design was used in a 12-bed medical intensive care unit. The study occurred in 2 phases. In phase 1, eligible patients wore a triaxial accelerometer-based sensor; nurses were blinded to the data. In phase 2, the sensor technology provided staff with visual cues about patients' positions and repositioning needs. The primary measure was repositioning protocol compliance, which was compared between phase 1 and phase 2 with weighted t tests. Unit staff members were surveyed before the start of phase 1 and at the end of phase 2. RESULTS In phase 1, 25 patients met the inclusion criteria. Phase 2 began 1 day after phase 1 and included 29 patients. In phase 1, repositioning compliance was 55%, and the mean repositioning interval was 3.8 hours. In phase 2, repositioning protocol compliance increased to 89%, and the mean repositioning interval was 2.3 hours. Nursing staff survey results showed improved teamwork in phase 2. CONCLUSION Visual cueing about patients' mobility needs is associated with increased compliance with the facility repositioning protocol.
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Affiliation(s)
- Michelle Turmell
- Michelle Turmell is an educator in the medical intensive care unit, Henry Ford Medical Center, Detroit, Michigan
| | - Annemari Cooley
- Annemari Cooley is senior director of clinical development, Smith & Nephew, Fort Worth, Texas
| | - Tracey L Yap
- Tracey L. Yap is an associate professor, Duke University School of Nursing, Durham, North Carolina
| | - Jenny Alderden
- Jenny Alderden is an associate professor, Boise State University School of Nursing, Boise, Idaho
| | - Valerie K Sabol
- Valerie K. Sabol is a professor and division chair, Healthcare in Adult Populations, Duke University School of Nursing
| | | | - Susan M Kennerly
- Susan M. Kennerly is a professor, East Carolina University College of Nursing, Greenville, North Carolina
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27
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Healthcare Service Interventions to Improve the Healthcare Outcomes of Hospitalised Patients with Extreme Obesity: Protocol for an Evidence and Gap Map. Methods Protoc 2022; 5:mps5030048. [PMID: 35736549 PMCID: PMC9228870 DOI: 10.3390/mps5030048] [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: 04/12/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Hospitalised patients with extreme obesity have poorer healthcare outcomes compared to normal weight patients. How hospital services are coordinated and delivered to meet the care needs of patients with extreme obesity is not well understood. The aim of the proposed evidence gap map (EGM) is to identify and assess the available evidence on healthcare interventions to improve healthcare outcomes for hospitalised patients with extreme obesity. This research will use standardised evidence gap map methods to undertake a five-stage process to develop an intervention–outcome framework; identify the current evidence; critically appraise the quality of the evidence, extract, code, and summarise the data in relation to the EGM objectives; and create a visualisation map to present findings. This EGM will provide a means of determining the nature and quality of health service initiatives available, identify the components of the services delivered and the outcome measures used for evaluation, and will identify areas where there is a lack of research that validates the funding of new research studies.
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28
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Argenti G, Ishikawa G, Fadel CB, Gomes RZ. Singular Predictors of Hospital-Acquired Pressure Injuries Under Intensive Care: A Retrospective Cohort Study in a Medium-Complexity Hospital. Clin Nurs Res 2022; 31:639-647. [PMID: 34663120 DOI: 10.1177/10547738211051567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A retrospective cohort study of hospital-acquired pressure injuries (HAPI) reported an incidence rate of 34.3% based on 582 medical records of adult patients admitted to the intensive care unit (ICU) of a medium-complexity public hospital in 2017 and 2018. Sixty percent of the patients used respirators, 49.3% presented hypotension, and 48.1% used norepinephrine. The main individual predictors of HAPI in the ICU were "days of norepinephrine" with an odds ratio (OR) of 1.625 (95% CI: 1.473-1.792) and concordance statistic (AUC) of 0.818 (95% CI: 0.779-0.857), "days of mechanical ventilation" with an OR of 1.521 (1.416-1.634) and AUC of 0.879 (0.849-0.909), "ICU stay (days)" with an OR of 1.279 (1.218-1.342) and AUC of 0.846 (0.812-0.881), and "Braden's sensory perception" with an OR of 0.345 (95% CI: 0.278-0.429) and AUC of 0.760 (0.722-0.799). The duration of mechanical ventilation, norepinephrine administration, and ICU length of stay presented significant discriminative capacity for HAPI prediction.
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Affiliation(s)
- Graziela Argenti
- Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, Brazil
| | - Gerson Ishikawa
- Universidade Tecnologica Federal do Parana (UTFPR), Ponta Grossa, Parana, Brazil
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29
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Amini M, Mansouri F, Vafaee K, Janbakhsh A, Mahdavikian S, Moradi Y, Fallahi M. Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study. Int Wound J 2022; 19:2039-2054. [PMID: 35322547 PMCID: PMC9111574 DOI: 10.1111/iwj.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.
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Affiliation(s)
- Mahin Amini
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Vafaee
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Mahdavikian
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences Sciences, Kermanshah, Iran
| | - Yasaman Moradi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Fallahi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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30
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Munoz N, Litchford M, Cox J, Nelson JL, Nie AM, Delmore B. Malnutrition and Pressure Injury Risk in Vulnerable Populations: Application of the 2019 International Clinical Practice Guideline. Adv Skin Wound Care 2022; 35:156-165. [PMID: 35188483 DOI: 10.1097/01.asw.0000816332.60024.05] [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: 11/26/2022]
Abstract
ABSTRACT Nutrition plays a vital role in promoting skin integrity and supporting tissue repair in the presence of chronic wounds such as pressure injuries (PIs). Individuals who are malnourished are at greater risk of polymorbid conditions, adverse clinical outcomes, longer hospital lengths of stay, PI development, and mortality, and incur increased healthcare costs compared with patients who are adequately nourished. In addition, some patient populations tend to be more vulnerable to PI formation, such as neonates, patients with obesity, older adults, and individuals who are critically ill. Accordingly, this article aims to review the latest nutrition care recommendations for the prevention and treatment of PIs, including those recommendations tailored to special populations. A secondary objective is to translate nutrition recommendations into actionable steps for the healthcare professional to implement as part of a patient plan of care.Implementing an evidence-based plan of care built around individualized nutrition interventions is an essential step supporting skin integrity for these populations. The 2019 Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (CPG) affirms that meeting nutrient requirements is essential for growth, development, maintenance, and repair of body tissues. Many macronutrients and micronutrients work synergistically to heal PIs. Registered dietitian nutritionists play an important role in helping patients identify the most nutrient dense foods, protein supplements, and oral nutrition supplements to meet their unique requirements.
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Affiliation(s)
- Nancy Munoz
- Nancy Munoz, DCN, MHA, RDN, LD, FAND, is Lecturer, University of Massachusetts Amherst. Mary Litchford, PhD, RDN, LDN, is President, CASE Software & Books, Greensboro, North Carolina. Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, is Clinical Associate Professor, Rutgers University School of Nursing, and Advanced Practice Nurse-WOCN, Englewood Health, Englewood, New Jersey. Jeffrey L. Nelson, PhD, is Associate Research Fellow, Abbott Nutrition, Columbus, Ohio. Ann Marie Nie, PhDc, RN, MSN, CNP, FNP-BC, CWOCN, is Wound, Ostomy Nurse Practitioner, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota. Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC-NYU, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, NYU Langone Health, New York, New York. Submitted June 22, 2021; accepted in revised form August 10, 2021
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31
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Workum JD, van Olffen A, Vaes PJ, van Gestel A, Vos P, Ramnarain D. The association between obesity and pressure ulcer development in critically ill patients: A prospective cohort study. Obes Res Clin Pract 2022; 16:56-62. [PMID: 35148964 DOI: 10.1016/j.orcp.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/07/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pressure ulcers (PUs) are one of the leading potentially preventable adverse events in the hospital. Critically ill patients are at risk for the development of PUs. The primary aim of the study was to investigate the relation of PUs and obesity in critically ill ICU patients. METHODS A single center prospective cohort study was conducted on adult patients with obesity (defined as a body mass index BMI ≥ 30 kg/m2) and patients without obesity (BMI 18-25 kg/m2) admitted to the intensive care unit between May 2013 and July 2017 with an ICU length of stay of at least 3 days without pre-existing PUs at admission. RESULTS 851 of 1205 patients (70.6%) had a normal BMI and 354 (29.4%) had a BMI ≥ 30 kg/m2 and were considered obese. Overall, 157 patients (13.0%) developed PUs; 112/851 (13.2%) of patients without obesity and 45/354 (12.7%) of patients with obesity (p = 0.907). There was no difference in the severity (p = 0.609) and PU location (p = 0.261). Mean days to PU development was 11.1; 11.7 days for patients without obesity and 9.5 days for patients with obesity (p = 0.270). Mean days to PU recovery was 13.2, which was 14.1 days for patients without obesity and 10.8 days for patients with obesity (p = 0.215). A multivariate logistic regression model showed no significant correlation between the occurrence of PUs in the ICU and obesity (OR 0.875 with 95% CI 0.528-1.448, p = 0.594). Subgroup analysis showed that patients with morbid obesity (BMI ≥ 40 kg/m2) developed PUs earlier during ICU admission when compared to patients without obesity (p = 0.004). CONCLUSION Our study demonstrates that obesity is not an independent risk factor for the development of PUs in the ICU. However, patients with morbid obesity might develop PUs earlier compared to patients without obesity.
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Affiliation(s)
- Jessica D Workum
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
| | - Annechien van Olffen
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Pieter J Vaes
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Anca van Gestel
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Piet Vos
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands; Department of Intensive Care, Saxenburg Medisch Centrum Hardenberg, The Netherlands
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32
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Zhang H, Ma Y, Wang Q, Zhang X, Han L. Incidence and prevalence of pressure injuries in children patients: A systematic review and meta-analysis. J Tissue Viability 2022; 31:142-151. [PMID: 34312030 DOI: 10.1016/j.jtv.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pressure injuries presently has been a serious healthcare problem all over the world. Children were recognized as the high-risk population of pressure injuries in the latest prevention and treatment of pressure injuries clinical practice guideline. However, the estimates of incidence, and prevalence of pressure injuries in hospitalized children patients vary considerable in relevant published studies. OBJECTIVE To systematically quantify the incidence and prevalence of pressure injuries (PIs) in hospitalized children and the most affected PIs sites. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases searches of the Cochrane Library, Pubmed, Web of Science, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP), and hand-search through references were conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using Hoy's tool. The I2 statistic and random-effects model were used to assess the heterogeneity. Meta-regression analysis and subgroup analysis were conducted to examine between-study heterogeneity. RESULTS A total of 6, 672 articles were screened, and 30 studies with 251, 501 participants were ultimately included in this review. The pooled incidence of PIs for 3, 205 children was 13.5% (95% CI: 10.5-16.5); and the pooled prevalence of PIs for 4, 639 children was 12.2% (95% CI: 8.0-16.3). The most affected body sites were occiput, ears, and nose. Meta-regression and subgroup analysis showed that the inpatient ward, and region were the sources of heterogeneity. CONCLUSIONS The incidence and prevalence of PIs was significantly higher than the adults. Our discoveries recommended that healthcare givers ought to pay more consideration to diminish the happens of PIs. Additionally, more research may be needed to improve our understanding of the characteristics of PIs among children and to identify PIs risk factors to prevent and treat it in children effectively.
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Affiliation(s)
- Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China.
| | - Qing Wang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China.
| | - Xiujuan Zhang
- Department of Respiratory, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China.
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33
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Factors Predicting Pressure Injury Incidence in Older Adults Following Elective Total Hip Arthroplasty: A Longitudinal Study. Adv Skin Wound Care 2022; 35:48-55. [PMID: 34935722 DOI: 10.1097/01.asw.0000801540.04621.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the factors associated with pressure injury (PI) development in older adult patients who underwent elective total hip arthroplasty (THA). METHODS A nonexperimental longitudinal prospective study was conducted with a sample of 40 patients undergoing elective THA. Patients were evaluated for PI at hospital admission, 24 hours postsurgery, at discharge, and 1 month after surgery. RESULTS The incidence of PIs (category 1 or category 2) in this study was 7.9% 24 hours after surgery and 24.3% at discharge. The most common PI location was the sacrum/coccyx or the ischial tuberosity. This study found significant relationships between PIs and female sex (odds ratio [OR], 8.75), body fat mass percentage (OR, 1.15), and the motor score from a Functional Independence Measure scale (OR, 0.89). Finally, the following variables were also associated with PIs (P < .1): skeletal muscle mass (OR, 0.82), lower limb with osteoarthritis weight (OR, 0.61), lower limb without osteoarthritis weight (OR, 0.62), and geriatric depression scale (OR, 1.12). CONCLUSIONS This work identifies those patients at higher risk of PI, enabling targeted prevention and treatment in the population of patients undergoing elective THA. The findings of this study are in line with extant literature and suggest that women with a higher percentage of body fat and less mobility had a higher risk of PI.
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Hu B, Zhao Y, Yang J, Zeng Z, Wu Y, Gui C, Gong J, Gao Y, Yang Y, Luo C, Wang Y, Jiang Q, Guo W, Lu P, Yuan F, Li X, Dai X. Frequency of and risk factors for intensive care unit-acquired sacrum pressure injuries in critically ill patients: A multicenter cross-sectional study in China. Health Sci Rep 2021; 4:e390. [PMID: 34722934 PMCID: PMC8532509 DOI: 10.1002/hsr2.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022] Open
Abstract
RATIONALE AIMS AND OBJECTIVES Hospital-acquired pressure injuries (HAPI) prolong hospital stays and are an important health problem worldwide. The aim of this study was to assess the frequency of and risk factors for intensive care unit (ICU)-acquired pressure injuries (IAPI) on the sacrum in critically ill patients in China. METHODS We performed a multicenter, cross-sectional survey of IAPI on the sacrum in 23 adult ICUs in 19 hospitals in China. Data for 421 critically ill patients were collected on December 13, 2019, and January 13, 2020, including patient characteristics, physiological, and clinical information. Logistic regression was used to analyze the risk factors for IAPI on the sacrum in the ICU. RESULTS Forty-one patients presented sacrum pressure injuries in the ICU, with a frequency of 9.74%. Risk factors that significantly increased the risk of IAPI on the sacrum were lower body mass index (BMI, odds ratio [OR] = 1.115, confidence interval [CI]: 1.011-1.229, P = .029), chronic obstructive pulmonary disease (COPD, OR = 3.183, CI: 1.261-8.037, P = .014), multiple organ dysfunction syndrome (MODS, OR = 2.670, CI: 1.031-6.903, P = .043), and a lower Braden risk score (OR = 1.409, CI: 1.197-1.659, P < .001). CONCLUSION Lower BMI, COPD, MODS, and lower Braden risk score are independent risk factors for sacrum IAPI in China.
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Affiliation(s)
- Binqin Hu
- Department of Critical Care MedicineAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
| | - Yang Zhao
- Department of Critical Care MedicineThe Fourth People's Hospital of ChenzhouChenzhouChina
| | - Jijun Yang
- Department of Critical Care MedicineCentral Hospital of LoudiLoudiChina
| | - Zhenhua Zeng
- Department of Critical Care MedicineNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Yanhong Wu
- Department of Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Chunmei Gui
- Department of Critical Care MedicineThe First People's Hospital of ChangdeChangshaChina
| | - Jiang Gong
- Department of Intensive Care MedicineThe Third People's Hospital of LonggangShenzhenChina
| | - Yi Gao
- Department of Critical Care MedicineXiangya Boai Rehabilitation Hospital, Central South UniversityChangshaChina
| | - Yong Yang
- Department of Critical Care MedicineChangsha Central Hospital, University of South ChinaChangshaChina
| | - Cuizhu Luo
- Department of Critical Care MedicineJiangXi Pingxiang People's HospitalPingxiangChina
| | - Yu Wang
- Department of Critical Care MedicineThe Third People's Hospital of YongzhouYongzhouChina
| | - Qingjuan Jiang
- Department of Critical Care Medicinethe First Affiliated Hospital, Hunan College of Traditional Chinese MedicineZhuzhouChina
| | - Wenlong Guo
- Department of Critical Care MedicineThe First People's Hospital of YueyangYueyangChina
| | - Pan Lu
- Department of Critical Care MedicineThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityShenzhenChina
| | - Fen Yuan
- Department of Critical Care MedicineThe Second People's Hospital of ShenzhenShenzhenChina
| | - Xiaofang Li
- Department of OstomyAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
| | - Xingui Dai
- Department of Critical Care MedicineAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
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Kwak C, Ko Y. Influencing factors of pressure injury healing in an acute care setting: A retrospective cohort study. J Tissue Viability 2021; 31:152-157. [PMID: 34758923 DOI: 10.1016/j.jtv.2021.11.001] [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: 11/10/2020] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
AIM This study aimed to investigate the factors that influence healing during acute care hospitalization by examining the differences in pressure injury (PI) status between admission and discharge. MATERIAL AND METHODS A total of 371 patients who met the study's inclusion criteria were divided into two groups (aggravated or improved) based on the PI status observed at admission and discharge. We used bivariate analyses to compare demographics and clinical factors associated with wound severity and aggravation/improvement of wound condition. Using multiple logistic regression, we identified and examined independent predictors for significant association with aggravation/improvement of the wound status. RESULTS The prevalence rate of PI at acute hospital admission was 12.5%. By the time of discharge, only 5.4% of PI patients had improved PI, whereas 12.6% had aggravated PI. The significant aggravating factors of PI during acute care hospitalization were the patient's consciousness level, use of foley catheter, creatinine level, and Braden Scale scores (p < .05). Residential place prior to admission were found to be associated with the healing. CONCLUSIONS Nurses providing prophylactic management require close attention to patients who are admitted from long-term facilities to prevent aggravation of PI during acute care hospitalization.
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Affiliation(s)
- Chanyeong Kwak
- School of Nursing, Hallym University, Hallymdaehak-gil, Chuncheon, Gangwon-do, 24252, South Korea.
| | - Young Ko
- College of Nursing, Gachon University, 191 Hambakmoeiro, Yeonsu-Gu, Incheon, 21936, Republic of Korea.
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Tervo-Heikkinen TA, Heikkilä A, Koivunen M, Kortteisto TR, Peltokoski J, Salmela S, Sankelo M, Ylitörmänen TS, Junttila K. Pressure injury prevalence and incidence in acute inpatient care and related risk factors: A cross-sectional national study. Int Wound J 2021; 19:919-931. [PMID: 34605185 PMCID: PMC9013578 DOI: 10.1111/iwj.13692] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 02/02/2023] Open
Abstract
The aim of this national cross‐sectional study was to explore the prevalence of pressure injuries and incidence of hospital‐acquired pressure injuries, and the relating factors in somatic‐specialised inpatient care in Finland. The study was conducted in 16 (out of 21) Finnish health care organisations offering specialised health care services. Data were collected in 2018 and 2019 from adult patients (N = 5902) in inpatient, emergency follow‐up, and rehabilitation units. Pressure injury prevalence (all stages/categories) was 12.7%, and the incidence of hospital‐acquired pressure injuries was 10%. Of the participants, 2.6% had at least one pressure injury at admission. The risk of hospital‐acquired pressure injuries was increased for medical patients with a higher age, the inability to move independently, mode of arrival, being underweight, and the absence of a skin assessment or pressure injury risk assessment at admission. For surgical patients, the risk was associated with the inability to move independently, mode of arrival, and lack of skin assessment at admission, while being overweight protected the patients. Overall, medical patients were in greater risk of hospital‐acquired pressure injuries than the surgical patients. An assessment of the pressure injury risk and skin status should be carried out more systematically in Finnish acute care hospitals.
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Affiliation(s)
| | - Anniina Heikkilä
- Group Administration, Nursing, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marita Koivunen
- Research and Development Unit, Satakunta Hospital District, Pori, Finland.,University of Turku, Turku, Finland
| | | | - Jaana Peltokoski
- Administration Services, Central Finland Health Care District, Jyväskylä, Finland
| | - Susanne Salmela
- Unit of Research and Development, Vaasa Central Hospital, Vaasa, Finland
| | - Merja Sankelo
- University of Turku, Turku, Finland.,Department of Nursing Administration, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Tuija Sinikka Ylitörmänen
- Health and Welfare, Strategic support services, Development and operations, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Kristiina Junttila
- University of Turku, Turku, Finland.,Nursing Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Neaves B, Bell JJ, McCray S. Impact of room service on nutritional intake, plate and production waste, meal quality and patient satisfaction and meal costs: A single site pre-post evaluation. Nutr Diet 2021; 79:187-196. [PMID: 34609060 DOI: 10.1111/1747-0080.12705] [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: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
AIM Room service is a patient-focused foodservice model gaining interest in Australian hospitals following demonstrated patient and organisational benefits. This study aimed to compare nutritional intake, waste, patient satisfaction, meal costs and meal quality between a bought-in, thaw-retherm foodservice model and a cook-fresh, on-demand room service model at a large tertiary public hospital. METHODS A retrospective analysis of quality assurance data compared thaw-retherm to room service. Nutritional intake and plate waste were measured using a visual intake analysis tool; production waste was measured using weighted analysis methodology; patient satisfaction was measured using a validated patient satisfaction survey; meal quality was assessed using a validated meal quality audit tool, and meal costs were obtained from hospital finance reports. Independent sample t-tests or nonparametric equivalent (Mann-Whitney U-test) for continuous variables and Pearson's Chi-square for categorical data were applied for comparative purposes. RESULTS Average energy and protein intake, as well as percentage requirements met, improved between thaw-retherm and room service (4320 kJ/day vs 7265 kJ/day; 42.4 g/day vs 82.5 g/day; and 46% vs 80.7%; 49.9% vs 98.4%; all P < .001. Reductions in plate waste (40% vs 15%) and production waste (15% vs 5.6%, P < .001) were observed and food costs decreased by 9% with room service. Meal quality audit results improved, and patient satisfaction increased with % respondents satisfied increasing from 75.0% to 89.8% (χ2 9.985[2]; P = .007) for room service. CONCLUSIONS This research demonstrates significant improvements in patient and organisational outcomes with room service compared to a thaw-retherm model in a large public hospital.
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Affiliation(s)
- Bianca Neaves
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Jack J Bell
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia.,School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
| | - Sally McCray
- Department of Dietetics & Foodservices, Mater Health, South Brisbane, Queensland, Australia.,Mater Research Institute, The University of Queensland, South Brisbane, Queensland, Australia
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Jacq G, Valera S, Muller G, Decormeille G, Youssoufa A, Poiroux L, Allaert F, Barrois B, Rigaudier F, Ferreira P, Huard D, Heming N, Aissaoui N, Barbar S, Boissier F, Grimaldi D, Hraiech S, Lascarrou JB, Piton G, Michel P. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The PRESSURE study. Aust Crit Care 2021; 34:411-418. [PMID: 33483180 DOI: 10.1016/j.aucc.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of pressure injuries (PIs) in critically ill patients has been extensively studied, but there is uncertainty regarding the risk factors. The main objective of this study was to describe the prevalence of PIs in critically ill patients. Secondary objectives were to describe PI, use of preventive measures for PI, and factors associated with occurrence of PI in the intensive care unit (ICU). MATERIAL AND METHODS This was a 1-day point-prevalence study performed on a weekday in June 2017 in ICUs in France. On the same day, we noted the presence or absence of PI in all hospitalised patients of the participating ICUs, data on the ICUs, and the characteristics of patients and of PI. RESULTS Eighty-six participating ICUs allowed the inclusion of 1228 patients. The prevalence of PI on the study day was 18.7% (95% confidence interval: 16.6-21.0). PIs acquired in the ICU were observed in 12.5% (95% confidence interval: 10.6-14.3) of critically ill patients on the study day. The most frequent locations of PI were the sacrum (57.4%), heel (35.2%), and face (8.7%). Severe forms of PI accounted for 40.8% of all PIs. Antiulcer mattresses were used in 91.5% of the patients, and active and/or passive mobilisation was performed for all the patients. Multiple logistic regression analysis identified longer length of stay in the ICU, a higher Simplified Acute Physiology Score, higher body weight, motor neurological disorder, high-dose steroids, and absence of oral nutrition on the study day as factors independently associated with occurrence of PI in the ICU. CONCLUSION This large point-prevalence study shows that PIs are found in about one of five critically ill patients despite extensive use of devices for preventing PI. Acquisition of PI in the ICU is strongly related to the patient's severity of illness on admission to the ICU and length of stay in the ICU.
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Association of overweight and obesity with the prevalence and incidence of pressure ulcers: A systematic review and meta-analysis. Clin Nutr 2021; 40:5089-5098. [PMID: 34455268 DOI: 10.1016/j.clnu.2021.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIM Pressure ulcers challenge the health status, complicate medical conditions, and affect quality of life. The aim of this systematic review and meta-analysis was to investigate the role of obesity and body weight status, as potentially modifiable risk factors, in the incidence and prevalence of pressure ulcers. METHODS A systematic search of observational studies was performed to assess documents published between January 1990 and December 2019 in PubMed and Scopus. Finally, 17 articles with total sample size of 2228724 in the prevalence and 218178 in the incidence study were included in the meta-analysis. RESULTS The pooled data analysis showed no significant effect of obesity on odds of pressure ulcers' prevalence (OR 0.91, 95% CI 0.65 to 1.27, P = 0.579, I2 = 84.8%) or incidence (OR 0.97, 95% CI 0.56 to 1.66, P = 0.905, I2 = 89.8%) compared with non-obese individuals. Overweight was associated with significantly lower odds of prevalence of pressure ulcers compared to non-overweight individuals (OR 0.54, 95% CI 0.33 to 0.88, P = 0.014, I2 = 90.2%). The subgroup analyses showed significantly higher odds of prevalence (OR 2.38, 95% CI 1.72 to 3.29, P < 0.001, I2 = 63.4%) and incidence (OR 2.28, 95% CI 1.77 to 2.94, P < 0.001, I2 = 27.9%) of pressure ulcers in the underweight compared to normal weight groups. Pooled data analyses showed significantly lower odds of prevalence (OR 0.6, 95% CI 0.37 to 0.96, P = 0.034, I2 = 82%) and incidence (OR 0.72, 95% CI 0.53 to 0.98, P = 0.039, I2 = 67.1%) of pressure ulcers in the overweight than normal weight individuals. The findings showed no significant differences in the odds of prevalence or incidence of pressure ulcers in the obese and morbidly obese compared to normal weight individuals. CONCLUSION This systematic review and meta-analysis showed no significant effect of obesity or morbid obesity on the odds of pressure ulcers. Additionally, overweight was associated with lower odds of pressure ulcers while underweight significantly increased the odds of pressure injuries.
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Gershon S, Okonkwo H. Evaluating the sensitivity, specificity and clinical utility of algorithms of spatial variation in sub-epidermal moisture (SEM) for the diagnosis of deep and early-stage pressure-induced tissue damage. J Wound Care 2021; 30:41-53. [PMID: 33439080 DOI: 10.12968/jowc.2021.30.1.41] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sub-epidermal moisture (SEM) is a measurable biomarker detecting early pressure damage in order to objectively support current 'gold standard' skin tissue assessments (STA) for the detection of deep and early-stage pressure-induced injuries or ulcers (PI/PUs). OBJECTIVE A multi-site, dual arm, cross sectional, retrospective study was conducted to evaluate the sensitivity, specificity and clinical utility of spatial variation in SEM readings between healthy and damaged skin tissue. METHOD The study enrolled 175 subjects: 125 with confirmed PI/PUs or suspected deep tissue injury (sDTI), and 50 confirmed healthy subjects. Expert principal investigators and PI/PU healthcare practitioners (HCPs) evaluating all subjects were trained in SEM measurements but blinded to clinical interpretation of SEM readings. Sequential and spatial SEM readings of the sacrum and heels, subjects' demographic data, STAs, risk assessment tool scores (RATS), pain assessment and potential confounders were recorded. Independent statistical analyses were performed. RESULTS Mean spatial SEM measures within subjects with healthy tissue and within subjects with damaged tissue were statistically similar. Mean spatial SEM measures within anatomies of subjects with damaged tissue were significantly different (p<0.05). There was no significant difference between spatial readings in healthy subjects. Algorithms computing a range of SEM delta thresholds indicated a sensitivity of 82-87% and a specificity of 51-88% at an SEM delta ≥0.6. Receiver operating characteristic (ROC) curves computed areas under the curve (AUC) of 0.7809-0.9181 (95% CI: 0.7221-0.8817, 0.8397-0.9545, p<0.0001) exceeding clinical judgement. CONCLUSION These SEM data augment clinical decision-making for developing intact skin PI/PUs including sDTIs and Stage I PI/PUs. Informing HCPs of this subclinical, non-visible skin and tissue damage and providing opportunities for alternative PI/PU care pathways is an exciting prospect.
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Affiliation(s)
- Steve Gershon
- Medical Director; Gershon Pain Specialists, 1133 First Colonial Rd, Virginia Beach, VA 23454, US
| | - Henry Okonkwo
- Chief Operations Officer/Chief Clinical Officer; Skilled Wound Care, 12021 Wilshire Blvd #745, Los Angeles, CA 90025, US
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van Vliet IMY, Gomes-Neto AW, de Jong MFC, Bakker SJL, Jager-Wittenaar H, Navis GJ. Malnutrition screening on hospital admission: impact of overweight and obesity on comparative performance of MUST and PG-SGA SF. Eur J Clin Nutr 2021; 75:1398-1406. [PMID: 33589809 PMCID: PMC8416656 DOI: 10.1038/s41430-020-00848-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients. SUBJECTS/METHODS We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m2 vs. BMI ≥ 25 kg/m2. RESULTS Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. CONCLUSIONS More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Antonio W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bell JJ, Geirsdóttir ÓG, Hertz K, Santy-Tomlinson J, Skúladóttir SS, Eleuteri S, Johansen A. Nutritional Care of the Older Patient with Fragility Fracture: Opportunities for Systematised, Interdisciplinary Approaches Across Acute Care, Rehabilitation and Secondary Prevention Settings. PRACTICAL ISSUES IN GERIATRICS 2021. [DOI: 10.1007/978-3-030-48126-1_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractNutritional care of the older patient with fragility fracture is complex. Diagnostic difficulties, multi-morbidities and interdependencies and social complexities all contribute to the wicked problem of malnutrition. Whilst many settings have attempted to address malnutrition through highly specialised care, increasing evidence supports the role of systematised, interdisciplinary approaches across acute care, rehabilitation and secondary prevention settings. Consequently, this chapter is devoted to highlighting why a SIMPLE approach to malnutrition should underpin the nutritional care of the older patient with fragility fracture, regardless of setting or healthcare provider.S Screen for nutrition riskI Interdisciplinary assessmentM Make the diagnosis (es)P Plan with the patientL impLement interventionsE Evaluate ongoing care requirements
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Chen G, Lin L, Yan-Lin Y, Loretta CYF, Han L. The prevalence and incidence of community-acquired pressure injury: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22348. [PMID: 33235056 PMCID: PMC7710219 DOI: 10.1097/md.0000000000022348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pressure injury (PI) is a serious problem in health care settings globally. It leads to tremendous burden both individuals and healthcare systems. Since 2008, hospital-acquired pressure injuries have been a major focus of nursing quality improvement programs within hospitals and are considered never events. However, insufficiency attention has been paid to community-acquired pressure injuries (CAPI) or pressure ulcers that occur at home or in nursing homes. The prevalence or incidence of community-acquired pressure injury has been reported but never been synthesized in a meta-analysis manner. To fill the gaps in the evidence matrix, the aims of this study are to estimate the prevalence of CAPI in the general population and to pool the overall incidence of CAPI in the general population. METHODS PubMed, Web of Science, EMBASE, CINHAL, the Cochrane Library, Chongqing VIP, and China National Knowledge Infrastructure were electronically searched to identify eligible studies updated to May 2020 to collect studies on the prevalence or incidence of community-acquired pressure injuries. Two reviewers independently will screen the literature, extracted data, and assess the risk of bias of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. Meta-analyses of pooled weighted estimates will be calculated using random effect models with 95% CIs reported due to high heterogeneity. RESULTS Of the 5242 studies initially identified, of the 22 studies (total 479,761 participants) 17 reporting prevalence of community-acquired pressure injury and 5 reporting incidence were included. Other results of this study will be published in a peer-reviewed journal. CONCLUSION This study will summarize the pooled estimate prevalence and incidence of community-acquired pressure injuries and the pooled estimate of frequencies of different anatomic sites. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required, because this study is a meta-analysis based on published studies. INPLASY REGISTRATION NUMBER INPLASY202080044.
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Affiliation(s)
- Geng Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University
| | | | - Yang Yan-Lin
- Evidence-based Nursing Center, School of Nursing, Lanzhou University
| | | | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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Lovegrove J, Fulbrook P, Miles S. Relationship Between Prescription and Documentation of Pressure Injury Prevention Interventions and Their Implementation: An Exploratory, Descriptive Study. Worldviews Evid Based Nurs 2020; 17:465-475. [PMID: 33222368 DOI: 10.1111/wvn.12473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Formal assessment by nurses of a patient's pressure injury (PI) risk level is often highlighted as being key to PI prevention. However, if no action is taken to address the determined risk (i.e., if appropriate preventative interventions are not implemented), the patient remains vulnerable to PI development, and the assessment process is rendered pointless. AIM To explore the relationship between the prescription (planning) and implementation of PI preventative interventions by nurses following formal risk assessment. METHODS Using an exploratory, descriptive design, the charts and bedside areas of 200 adult patients admitted across four hospital wards were examined. Data collected included PI risk level, documented prescribed preventative interventions, and interventions for which there was evidence of implementation. RESULTS Of the final sample (n = 187), 66.8% of cases were categorized as being "at-risk" or above. As the risk category of patients increased, proportionately more patients in each category were prescribed each intervention. However, in most cases, significantly fewer interventions were actually implemented than were prescribed, except for several interventions that were implemented in more cases than were prescribed. There were 14 cases, including four at-risk and three high-risk patients, in which no preventative interventions were prescribed, while 88.7% of not at-risk patients had (unnecessary) preventative interventions prescribed. DISCUSSION These results indicate that intervention prescription increased relative to assessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. The results indicate a significant mismatch between these two steps of PI prevention. LINKING EVIDENCE TO ACTION These results indicate that intervention prescription increased relative to assessed level of risk; however, the rates of intervention prescription and actual implementation were suboptimal. A significant mismatch between these two steps of PI prevention was evident. Following patient risk assessment, there should be a greater focus on appropriate preventative intervention prescription (planning) with regular review and audit to help ensure that interventions are implemented as prescribed. Improved implementation of preventative interventions should, in turn, help to reduce hospital-acquired pressure injuries.
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Affiliation(s)
- Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia.,Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, QLD, Australia
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Hossein Abbasi N, Aghaamiri M. Relationship Between Health-Promoting Lifestyle and Body Mass Index in Male Nurses Based on Demographic Variables. Am J Mens Health 2020; 14:1557988320966519. [PMID: 33238801 PMCID: PMC7705790 DOI: 10.1177/1557988320966519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/29/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022] Open
Abstract
Behaviors such as an appropriate diet, physical activities, health responsiveness such as attending diagnoses and treatment recommendations, preventing from known health risks such as smoking, allocating time to rest and peace and managing stress are related to health-promoting lifestyles (HPLs). The objective of the current study was to determine the relationship between HPL and body mass index (BMI) of male nurses based on demographic variables. A descriptive correlation survey was conducted among 108 male nurses using the nonprobability sampling technique. Data were gathered through a questionnaire consisting of two parts: demographic characteristics and Pender's health promotion questionnaire. Data were analyzed by presenting measures, mean, standard deviation, independent t-test, Pearson's coefficient correlation, and one-way analysis of variance (ANOVA), using SPSS version 22. The mean score for male nurses' HPL was good (3.13). The highest mean was from spiritual growth (3.48) and the lowest was from physical activity (2.69). Approximately 24.07% participants were overweight and obese. The mean of HPL in normal-weight people was better than that of obese ones. Participants did not pay much attention to their family's health-promoting behaviors. They also were exposed to occupational hazards, including psychological (47.2%), ergonomic (21.7%), physical (20.8%), and biological hazards (10.4%). There was no significant relationship between age (p = .14), educational level (p = .95), marital status (p = .32), job experiences (p = .17), and HPL variables. As health providers, nurses should both provoke patients to attain their health and to strive to maintain and sustain their own health, especially for obesity prevention. From society's perspective, a nurse is one who knows more and acts better; therefore, paying attention to nurses' HPL is a professional and social expectation.
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Affiliation(s)
- Nahid Hossein Abbasi
- Department of Nursing and Midwifery,
Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
| | - Maryam Aghaamiri
- Department of Nursing and Midwifery,
Ahvaz Branch, Islamic Azad University, Ahvaz, Iran
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Bell JJ, Pulle RC, Lee HB, Ferrier R, Crouch A, Whitehouse SL. Diagnosis of overweight or obese malnutrition spells DOOM for hip fracture patients: A prospective audit. Clin Nutr 2020; 40:1905-1910. [PMID: 32994070 DOI: 10.1016/j.clnu.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Crude diagnostic parameters such as BMI limit recognition of malnutrition in overweight and obese patients. This study applied a robust malnutrition diagnostic measure to investigate whether malnutrition impacts clinical outcomes in overweight or obese hip fracture inpatients. METHODS A prospective, consecutive 12-month audit of inpatients admitted to a dedicated hip fracture unit with a BMI of ≥25 for surgical intervention. Univariate and logistic regression analyses were performed to investigate the relationship of demographics (age, gender), comparative measures (type of fracture, Charlson Comorbidity Index (CCI) on admission, time to surgery, type of surgery and anaesthesia, nutrition status) and outcome measures (delirium, time to mobilise post-operatively, length of stay, 12-month mortality). Malnutrition was defined using the International Classification of Diseases, Tenth Revision - Australian Modification protein-energy malnutrition criteria. RESULTS 127 overweight or obese hip fracture patients for surgical intervention were included in analyses. Patients were predominantly older females (median 81.0, range 48-97 years; 66.9%). Malnutrition prevalence was not infrequent (18.3%) despite the median BMI of 28.3 (range 25.0-63.9). Mortality at 12-months (17.3%) was lower than routinely reported across broader hip fracture populations. Logistic regression modelling demonstrated that malnutrition increased the likelihood of 12-month mortality (OR: 4.47, 95% CI 1.27-15.77; p = 0.020), post-operative delirium (OR: 3.64, 95% CI 1.00 to 13.33; p = 0.051), and delayed post-operative mobility (OR: 3.29, 95% CI 1.05 to 10.31; p = 0.041), in overweight or obese hip fracture patients. Length of stay demonstrated poor association with all predictor measures. CONCLUSION Hip fracture patients who are both overweight or obese, and malnourished, have significantly and substantially worse clinical outcomes than their well-nourished, albeit overweight or obese, counterparts. Comprehensive nutrition assessment measures should be applied to all hip fracture inpatients to ensure appropriate clinical nutrition care is appropriately directed.
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Affiliation(s)
- Jack J Bell
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, 4072, Australia.
| | - Ranjeev C Pulle
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Hui Bing Lee
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia
| | - Rebecca Ferrier
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Alisa Crouch
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, 4032, Australia
| | - Sarah L Whitehouse
- Orthopaedic Research Unit, The Prince Charles Hospital and Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Grap MJ, Schubert CM, Munro CL, Wetzel PA, Burk RS, Lucas V, Pepperl A. OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients. AORN J 2020; 109:229-239. [PMID: 30694547 DOI: 10.1002/aorn.12583] [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] [Indexed: 11/05/2022]
Abstract
Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data. The multivariable model containing OR bed time, body mass index, and Braden Scale score produced the best prediction of pressure injury (area under the curve = 0.859). A higher body mass index (P = .09), shorter OR bed time (P = .01), and lower Braden Scale score (P = .05) were associated with a greater chance of pressure injury. These results suggest that use of high frequency ultrasound may identify tissue changes before observable skin changes, leading to earlier pressure injury prevention strategies.
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Lackoff AS, Hickling D, Collins PF, Stevenson KJ, Nowicki TA, Bell JJ. The association of malnutrition with falls and harm from falls in hospital inpatients: Findings from a 5-year observational study. J Clin Nurs 2019; 29:429-436. [PMID: 31715045 DOI: 10.1111/jocn.15098] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 09/01/2019] [Accepted: 10/20/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inpatient falls continue to be a significant clinical issue, and while malnutrition is a known risk factors for falls, few studies have investigated its association with inpatient falls. This study aimed to explore the independent association between malnutrition and fall risk as well as harm from falls in hospital inpatients. METHODS Malnutrition identified in annual malnutrition audits was combined with inpatient fall data captured through the electronic patient incident reporting system in the 12 months following audit days. Audit data were available for 1,849 inpatients across 2011-2015, and covariate associations between age, gender, BMI, malnutrition, falls and harmful falls were analysed. The reporting of this paper is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations (see Appendix S1). RESULTS The prevalence of malnutrition was 32.4% (n = 543), and 171 (9.2%) inpatients experienced a fall with 0.7% (n = 13) categorised as harmful. In bivariate analysis, patients who fell were more likely to be older (median 79.0 vs. 70.0 years; p < .0001) or malnourished (40.9% vs. 31.5%; p = .021). Malnutrition (p < .0001) and having a lower BMI (p = .026) were significant predictors of harmful falls. Regression modelling demonstrated that only increasing age increased the likelihood of having an inpatient fall (OR 1.022 95% CI 1.021-1.046; p < .0001). Malnourished inpatients were almost 8 times more likely to have a harmful fall than those not malnourished (OR 7.94 95% CI 1.457-43.338; p = .017), independent of age and BMI. CONCLUSIONS Malnourished patients are more likely to experience a harmful fall. Assessment of malnutrition should be incorporated into fall risk assessments as a way of highlighting those patients at greater risk and to link to nutritional care pathways.
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Affiliation(s)
- Ariel S Lackoff
- Nutrition and Dietetics, Faculty of Health, School of Exercise and Nutrition Sciences, QUT, Brisbane, Qld, Australia.,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | | | - Peter F Collins
- Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Qld, Australia
| | | | | | - Jack J Bell
- The Prince Charles Hospital, Brisbane, Qld, Australia.,Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Qld, Australia
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Karg P, Ranganathan VK, Churilla M, Brienza D. Sacral skin blood flow response to alternating pressure operating room overlay. J Tissue Viability 2019; 28:75-80. [DOI: 10.1016/j.jtv.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
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