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Sugathapala RDUP, Latimer S, Gillespie BM, Balasuriya A, Chaboyer W. Prevalence and incidence of pressure injuries among nursing home residents with darker skin tones: A prospective cohort study. J Nurs Scholarsh 2024. [PMID: 39129213 DOI: 10.1111/jnu.13012] [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: 05/15/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024]
Abstract
AIM To measure the prevalence and incidence of nursing home-acquired pressure injuries in older adults residing in Sri Lankan nursing homes. BACKGROUND Pressure injury prevalence and incidence are indicators of safety and quality of care. A significant portion of the global population has a skin color dominated by the presence of melanin. Yet, the number of nursing home residents with darker skin tones who develop pressure injuries in nursing homes is relatively unknown. DESIGN Prospective multisite cohort study conducted in nine nursing homes in Sri Lanka. The sample comprised 210 residents aged ≥60 years old. METHODS Semi structured observations and chart audits were used to gather data from July to October 2023. Head-to-toe visual skin assessment to check for nursing home- acquired pressure injuries, Braden pressure injury risk scale and Fitzpatrick skin tone assessments were conducted on all recruited residents at baseline. All recruited residents were followed-up weekly for 12 weeks until detection of a new pressure injury, death, discharge, or transfer. RESULTS Pressure injury point prevalence at baseline was 8.1% (17/210). Cumulative incidence was 17.1% (36/210). Incidence density was 15.8 per 1000 resident weeks. Most nursing home-acquired pressure injuries were located on the ankle at baseline (29.4%; 5/17) and in the follow-up period (27.8%; 10/36). Stage I pressure injuries were most common: 58.8% (10/17) and 44.4% (16/36) at baseline and during follow-up respectively. CONCLUSIONS About one in six nursing home residents developed a new pressure injury over the 12-week follow-up period. Despite staff and resource constraints, there remains a need to focus on the prevention of pressure injuries in Sri Lankan nursing homes. CLINICAL RELEVANCE Studies on the burden of pressure injuries among darker skin tone nursing home residents are lacking and the current evidence available are predominantly from Western countries. The findings of this study highlight the need of targeted preventive measures for nursing home residents with darker skin tones.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
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Kottner J, Amin R, Tomova‐Simitchieva T, Hillmann K, Blume‐Peytavi U. Effects of a mattress cover with special airflow technology on the structure and function of the sacral and heel skin during loading: A two-arm exploratory crossover trial. Int Wound J 2024; 21:e14957. [PMID: 38994923 PMCID: PMC11240536 DOI: 10.1111/iwj.14957] [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: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/13/2024] Open
Abstract
Prolonged mechanical loading of the skin and underlying soft tissue cause pressure ulceration. The use of special support surfaces are key interventions in pressure ulcer prevention. They modify the degree and duration of soft tissue deformation and have an impact on the skin microclimate. The objective of this randomized cross-over trial was to compare skin responses and comfort after lying for 2.5 h supine on a support surface with and without a coverlet that was intended to assist with heat and moisture removal at the patient/surface interface. In addition, physiological saline solution was administered to simulate an incontinence episode on the mattress next to the participants' skin surface. In total, 12 volunteers (mean age 69 years) with diabetes mellitus participated. After loading, skin surface temperature, stratum corneum hydration and skin surface pH increased, whereas erythema and structural stiffness decreased at the sacral area. At the heel skin area, temperature, erythema, and stratum corneum hydration increased. These results indicate occlusion and soft tissue deformation which was aggravated by the saline solution. The differences in skin response showed only minor differences between the support surface with or without the coverlet.
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Affiliation(s)
- Jan Kottner
- Institute for Clinical Nursing ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ruhul Amin
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- BCSIR Laboratories DhakaBangladesh Council of Scientific and Industrial ResearchDhakaBangladesh
| | - Tsenka Tomova‐Simitchieva
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
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Wynn MO, Goldstone L, Gupta R, Allport J, Fraser RDJ. Improving pressure injury risk assessment using real-world data from skilled nursing facilities: A cohort study. Int Wound J 2024; 21:e70000. [PMID: 38994867 PMCID: PMC11240528 DOI: 10.1111/iwj.70000] [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: 04/23/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024] Open
Abstract
This study aimed to improve the predictive accuracy of the Braden assessment for pressure injury risk in skilled nursing facilities (SNFs) by incorporating real-world data and training a survival model. A comprehensive analysis of 126 384 SNF stays and 62 253 in-house pressure injuries was conducted using a large calibrated wound database. This study employed a time-varying Cox Proportional Hazards model, focusing on variations in Braden scores, demographic data and the history of pressure injuries. Feature selection was executed through a forward-backward process to identify significant predictive factors. The study found that sensory and moisture Braden subscores were minimally contributive and were consequently discarded. The most significant predictors of increased pressure injury risk were identified as a recent (within 21 days) decrease in Braden score, low subscores in nutrition, friction and activity, and a history of pressure injuries. The model demonstrated a 10.4% increase in predictive accuracy compared with traditional Braden scores, indicating a significant improvement. The study suggests that disaggregating Braden scores and incorporating detailed wound histories and demographic data can substantially enhance the accuracy of pressure injury risk assessments in SNFs. This approach aligns with the evolving trend towards more personalized and detailed patient care. These findings propose a new direction in pressure injury risk assessment, potentially leading to more effective and individualized care strategies in SNFs. The study highlights the value of large-scale data in wound care, suggesting its potential to enhance quantitative approaches for pressure injury risk assessment and supporting more accurate, data-driven clinical decision-making.
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Affiliation(s)
| | | | | | | | - Robert D. J. Fraser
- Swift Medical IncTorontoOntarioCanada
- Arthur Labatt Family School of NursingWestern UniversityLondonOntarioCanada
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Roddis J, Dyson J, Woodhouse M, Devrell A, Oakley K, Cowdell F. Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study. BMJ Open 2024; 14:e080398. [PMID: 38503413 PMCID: PMC10953097 DOI: 10.1136/bmjopen-2023-080398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers. DESIGN Theoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis. SETTING The study was conducted in one geographical region in the UK, spanning several community National Health Service Trusts. PARTICIPANTS Community-dwelling older patients at risk of pressure ulcer development (n=10) and their lay carers (n=10). RESULTS Six themes and subthemes were identified: (1) knowledge and beliefs about consequences (nature, source, timing and taboo); (2) social and professional role and influences (who does what, conflicting advice and disagreements); (3) motivation and priorities (competing self-care needs and carer physical ability); (4) memory; (5) emotion (carer exhaustion and isolation, carergiver role conflict and patient feelings) and (6) environment (human resource shortage and equipment). CONCLUSIONS There is minimal research in pressure ulcer prevention in community-dwelling older people. This study has robustly applied the theoretical domains framework to understanding barriers and facilitators to pressure ulcer prevention behaviours. Our findings will support co-design of strategies to promote preventative behaviours and are likely to be transferable to comparable healthcare systems nationally and internationally.
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Affiliation(s)
- Jennifer Roddis
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Judith Dyson
- C-SCHaRR, School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Marjolein Woodhouse
- School of Health and Care Professions, University of Portsmouth, Portsmouth, UK
| | - Anne Devrell
- Patient and Public Involvement representative, Birmingham, UK
| | | | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
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Torsy T, Tency I, Beeckman D, De Vylder F. Effectiveness of glutamine and arginine in wound healing of pressure ulcers: A systematic review protocol. J Tissue Viability 2024:S0965-206X(24)00026-3. [PMID: 38448329 DOI: 10.1016/j.jtv.2024.03.001] [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: 01/30/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Various nutrients play a physiological role in the healing process of pressure ulcers (PUs). Nutritional interventions include the administration of enteral nutritional supplements and formulas containing arginine, glutamine, and micronutrients. The aim of this systematic review is to evaluate the effectiveness of enteral nutritional supplements and formulas containing arginine and glutamine on wound-related outcomes. These include (1) time to healing, (2) changes in wound size, (3) local wound infection, (4) PU recurrence, and (5) PU-related pain. MATERIALS AND METHODS This protocol was developed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A search will be conducted in the Cochrane Library, EMBASE, PubMed (MEDLINE), CINAHL (EBSCOhost interface) and Web of Science. In addition, a manual search will be conducted to identify relevant records. Except for systematic reviews, no restrictions will be placed on the study design, the population studied or the setting. Studies that do not address PUs, in vitro studies and studies that do not report wound-related outcomes will be excluded. Study selection, risk of bias assessment and data extraction will be performed independently by three researchers. Depending on the extent of heterogeneity of interventions, follow-up time and populations, results will be summarised either by meta-analysis or narrative synthesis. CONCLUSIONS This is the first systematic review to identify, evaluate and summarise the current evidence for enteral arginine and glutamine supplementation on wound-related outcomes in PUs. The review will provide a solid basis for deriving valid and clinically relevant conclusions in this area.
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Affiliation(s)
- Tim Torsy
- Odisee University College, Faculty of Healthcare, Department of Nursing and Midwifery, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Belgium.
| | - Inge Tency
- Odisee University College, Faculty of Healthcare, Department of Nursing and Midwifery, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Belgium
| | - Dimitri Beeckman
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Belgium; Örebro University, School of Health Sciences, Sweden
| | - Flore De Vylder
- Odisee University College, Faculty of Healthcare, Department of Nursing and Midwifery, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports Sciences, Belgium
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Aljinović J, Barun B, Poljičanin A, Kero D, Matijaca M, Dujmović D, Marinović I. The Odds of One-Year Mortality in Bedridden Geriatric Patients Discharged from Acute Rehabilitation Ward Are Increased Eightfold If the Patients Have Three or More Complications. J Clin Med 2024; 13:537. [PMID: 38256671 PMCID: PMC10816072 DOI: 10.3390/jcm13020537] [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: 01/04/2024] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Low muscle strength, functional score at discharge, and complications during a ten-day rehabilitation hospital stay can affect mortality rates in bedridden geriatric patients. This was a prospective observational study in a cohort of 105 bedridden geriatric patients admitted to the Rehabilitation ward after a major illness or surgery. All participants had a severe dependency on another person (Barthel's Index < 60). The one-year mortality rate in this cohort was 15.2%, with further subdivision according to the number of complications: 61.5% in patients with ≥3 complications during hospitalization, 17.6% in patients with two complications, 9.5% with one complication, and 3% in patients with no complications. The Barthel Index at discharge (OR = 0.95; p = 0.003) and ≥3 medical complications (OR = 8.33; p = 0.005) during rehabilitation ward stay were significant predictors for one-year mortality. The odds of one-year mortality after discharge increased eightfold in patients with ≥3 medical complications. Sarcopenia, age, and sex were not significant predictors of mortality in this cohort. The 10-day acute rehabilitation was too short to achieve progress from severe to moderate independence in 60% of patients. The Barthel Index at discharge and a number of complications affect the mortality rate. These findings provide valuable insights into the complex dynamics of mortality and functional outcomes in bedridden geriatric patients.
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Affiliation(s)
- Jure Aljinović
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (A.P.); (M.M.); (D.D.); (I.M.)
- University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Blaž Barun
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (A.P.); (M.M.); (D.D.); (I.M.)
| | - Ana Poljičanin
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (A.P.); (M.M.); (D.D.); (I.M.)
- University Department of Health Studies, University of Split, 21000 Split, Croatia
| | - Darko Kero
- Study Program of Dental Medicine, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Marija Matijaca
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (A.P.); (M.M.); (D.D.); (I.M.)
| | - Dora Dujmović
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (A.P.); (M.M.); (D.D.); (I.M.)
| | - Ivanka Marinović
- Institute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (A.P.); (M.M.); (D.D.); (I.M.)
- University Department of Health Studies, University of Split, 21000 Split, Croatia
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Badino G, Veronese N, Cella A. Effectiveness of a kinesio-taping-based treatment in stage IV sacral pressure ulcers in older patients: a pilot study. J Wound Care 2024; 33:60-65. [PMID: 38197280 DOI: 10.12968/jowc.2024.33.1.60] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE As reduced tissue vascularity is one of the mechanisms that prevent skin ulcers from healing, treatments that can improve local circulation could accelerate their clinical resolution. Given that kinesio-taping (KT) can improve tissue blood circulation and lymphatic drainage, we aimed to determine whether applying KT close to stage IV pressure ulcers (PUs) could improve their healing. METHOD Older patients with stage IV sacral PUs, and impaired mobility and functional dependency who were consecutively admitted in a six-month period to the Home Care service of Galliera Hospital (Genoa, Italy) were screened for participation in this pilot clinical trial. Patients' PUs were divided into two treatment areas-in the experimental intervention, KT was applied close to a portion of the PU, while the contralateral portion of the same lesion was treated according to the standard protocol ('control'). The surface reduction of both portions was measured every four days, for a total of five examinations (timepoints (T2-T6) after the baseline evaluation (T1). RESULTS A total of 12 patients (male=5, female=7; mean age 78.83±8.94 years) fulfilled the inclusion criteria and were enrolled in the study. At all timepoints (T2-T6), the mean percentage reduction was significantly greater in KT-treated areas than in control areas: T2=20.66% versus 6.17%, respectively; p<0.001; T3=37.33% versus 17.31%, respectively; p<0.001; T4=57.01% versus 30.06%, respectively; p<0.001; T5=69.04% versus 40.55%, respectively; p<0.001; and T6=80.34% versus 51.91%, respectively; p<0.001. Furthermore, from T3 onwards, a significantly higher number of KT-treated areas than control areas had halved in size, the maximum difference being recorded at T5 (10 versus two, respectively; p=0.002). CONCLUSION From the findings of this pilot study, KT would seem to be an effective, rapid, low-cost therapy for advanced sacral PUs in older patients with impaired mobility and functional dependency. Declaration of interest: The authors have no conflicts of interest to declare.
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Affiliation(s)
- Giorgio Badino
- Difficult Wound Healing Unit, Local Health Agency 'ASL3 Genovese', Genoa, Italy
| | - Nicola Veronese
- Department of Internal Medicine, Geriatric Unit, University of Palermo, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Primary Care Department, Local Health Agency 'ASL2 Savonese', Savona, Italy
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