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Zhang L, Hu SN, Yan XM, Zhang Y, Wei S, Han YF. Latent Profile Analysis of Pressure Injury Knowledge Levels Among Nursing Staff in Tertiary General Hospitals. Br J Hosp Med (Lond) 2024; 85:1-16. [PMID: 39347677 DOI: 10.12968/hmed.2024.0226] [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: 10/01/2024]
Abstract
Aims/Background The prevalence of pressure injuries (PIs) is a widely used clinical indicator of patient safety and quality of care. Nurses' understanding of pressure injury (PI) can significantly impact the treatment outcomes for patients. This study, based on latent profile analysis (LPA), reveals the characteristics associated with PI knowledge levels among clinical nurses in district and county tertiary medical institutions. We aim to help nursing managers formulate training plans accurately so that clinical nurses can provide high-level skin care services for patients. Method In June 2023, 1482 nurse staff from 4 tertiary general hospitals at the district and county level in Chengdu were chosen as research subjects using the convenience sampling method. Responses to the general information questionnaire, the Chinese Version of Pressure Ulcer Knowledge Assessment Tool (C-PUKAT), and the Chinese Version of Attitude towards Pressure ulcer Prevention (C-APuP) were used to compare the population's characteristics based on LPA. Results Three latent profiles of nurses' PI knowledge were identified: weak foundation type (46.3%), strengthening foundation type (42.7%), and special improvement type (11.0%). Subjects' departments, administrative positions, highest degrees and PI prevention attitude scores, as well as whether they have participated in the training, all differed significantly between latent profile groups (p < 0.05). Conclusion The PI knowledge level of nursing staff at the district and county tertiary general hospitals requires urgent improvement. Nursing managers should prioritize the management level and quality of PI training among clinical nursing staff. Precise training programs can be developed based on different categories of nursing staff to enhance their PI knowledge, thereby effectively improving the quality of healthcare for inpatients.
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Affiliation(s)
- Li Zhang
- Department of Nursing, PengZhou People's Hospital, Chengdu, Sichuan, China
| | - Shu-Nan Hu
- Department of Nursing, PengZhou People's Hospital, Chengdu, Sichuan, China
| | - Xu-Mei Yan
- Department of Nursing, PengZhou People's Hospital, Chengdu, Sichuan, China
| | - Yan Zhang
- Department of Nursing, PengZhou People's Hospital, Chengdu, Sichuan, China
| | - Shen Wei
- Department of Gynecology, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Ye-Fen Han
- School of Nursing, Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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2
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Ottaviani S, Rondanina E, Arnone F, Brucato V, Campigli R, Bona MD, Tagliafico L, Ottaviani E, Nencioni A, Monacelli F. Multidimensional-Based Prediction of Pressure Ulcers Development and Severity in Hospitalized Frail Oldest Old: A Retrospective Study. Clin Interv Aging 2024; 19:1509-1517. [PMID: 39253399 PMCID: PMC11381216 DOI: 10.2147/cia.s440943] [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: 01/12/2024] [Accepted: 06/27/2024] [Indexed: 09/11/2024] Open
Abstract
Purpose In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale. Patients and methods The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale. Results Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant. Conclusion Assessing the subject's nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients' frailty, skin frailty, and PU development in very old hospitalized patients.
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Affiliation(s)
- Silvia Ottaviani
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eleonora Rondanina
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | | | - Luca Tagliafico
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ennio Ottaviani
- Department of Mathematics (DIMA), University of Genoa, Genoa, 16132, Italy
| | - Alessio Nencioni
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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El Genedy‐Kalyoncu M, Kottner J. The uptake of the international pressure ulcer/injury prevention and treatment guidelines: An updated systematic citation analysis. Int Wound J 2024; 21:e70036. [PMID: 39254059 PMCID: PMC11386271 DOI: 10.1111/iwj.70036] [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: 07/11/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024] Open
Abstract
The European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance collaboratively developed three editions of the International Clinical Practice Guidelines for preventing and treating pressure ulcers/injuries in 2009, 2014, and 2019. Dissemination and uptake of these guidelines are important to improve care. The aim of this work was to provide an updated and expanded citation analysis of the three published guidelines. Referencing formats, citation counts, and global distribution of citations of the 2009, 2014, and 2019 guidelines were searched in the citation database Scopus from 2009 to 2023. Duplicates were removed manually. The search identified 330 referencing formats with 2887 citations from 2009 to 2023 for the three guideline editions. Citations displayed geographical diversity, with citation peaks observed approximately 4 years after each edition's release and ongoing citations to the present. The International Clinical Practice Guidelines for preventing and treating pressure ulcers/injuries updated since 2009 were cited more than 2800 times in the scientific literature exceeding the thresholds of highly cited papers in the field of clinical medicine. This indicates successful dissemination worldwide.
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Affiliation(s)
| | - Jan Kottner
- Institute of Clinical Nursing ScienceCharité—Universitätsmedizin BerlinBerlinGermany
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Zhang N, Li Y, Li X, Li F, Jin Z, Li T, Ma J. Incidence of medical device-related pressure injuries: a meta-analysis. Eur J Med Res 2024; 29:425. [PMID: 39155379 PMCID: PMC11331740 DOI: 10.1186/s40001-024-01986-2] [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: 04/05/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Medical device-related pressure injures (MDRPIs) are common in critically ill patients and associated with negative clinical outcomes and elevated healthcare expenses. We aim to estimate worldwide incidence of MDRPI and explore associated factors through systemic review and meta-analysis. METHODS The PubMed, Web of Science, Cochrane Library, and Ovid EMBASE databases were systematically queried to identify relevant studies published from Jan 1, 2010 up until June 30, 2024. Studies were included if they provided data on the incidence or prevalence of MDRPI. Random-effect models were utilized to calculate the overall or domain-specific aggregated estimates of MDRPI. A meta-regression analysis was additionally performed to investigate the heterogeneity among studies. RESULTS We included 28 observational studies on 117,624 patients in the meta-analysis. The overall incidence of MDRPI was 19.3% (95% confidence interval (CI) 13.5-25.2%). The incidence of MDRPI in Europe, North America, Asia, South America, and Oceania was 17.3% (95% CI 12.7-21.9%), 3.6% (95% CI 0.0-8.5%), 21.9% (95% CI 14.3-29.6%), 48.3% (95% CI 20.8-75.7%), and 13.0% (95% CI 5.0-21.1%), respectively (p < 0.01). Multivariate meta-regressions revealed South America and special inpatient (critically ill patient, etc.) were independently associated with higher MDRPI incidence. CONCLUSIONS Nearly, 20% of the patients in ICU suffered from MDRPI. The incidence of MDRPI in underdeveloped regions is particularly concerning, highlighting the importance of focusing on measures to prevent it, in order to reduce the medical burden and enhance the quality of life for affected patients.
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Affiliation(s)
- Ning Zhang
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Yanan Li
- Department of General Surgery, Western Medical Branch of PLA General Hospital, Beijing, 100144, China
| | - Xiaogang Li
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Fangfang Li
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China
| | - Zhaofeng Jin
- Department of General Surgery, Huatan Hospital of Hechuan, Chongqing, 401520, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China.
| | - Jinfu Ma
- Department of ICU, The 305 Hospital of PLA, Jia13 Wenjin St, Beijing, 100017, China.
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Lin H, Chen H, Wang J, Ma X. Nomogram for intraoperatively acquired pressure injuries in children undergoing cardiac surgery with cardiopulmonary bypass: a retrospective study. BMC Pediatr 2024; 24:510. [PMID: 39118018 PMCID: PMC11308568 DOI: 10.1186/s12887-024-04989-4] [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: 02/26/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND We aimed to develop and validate a nomogram for predicting the risk of intraoperatively acquired pressure injuries (IAPIs) in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). METHODS This study retrospectively included 208 children aged 21 days to 8 years who underwent cardiac surgery with CPB in a tertiary hospital in China between January 2020 and October 2023. All patients' data were collected from the hospital's medical record system and randomly divided into the training (n = 146) and validation (n = 62) cohorts by a ratio of 7:3. Logistic regression analysis was conducted in the training cohort to identify independent risk factors and establish the nomogram. Finally, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA) were performed in both cohorts to validate the predictive ability of the nomogram. RESULTS 43 (14.7%) children developed IAPIs. Multivariate analysis showed that low Braden Q scores, use of steroids, skin abnormalities, and low intraoperative SpO2 were independent risk factors for IAPIs. A nomogram integrating the 4 factors was established. The areas under the curve (AUCs) of the nomogram were 0.836 and 0.903 in the training and validation cohorts, respectively. Furthermore, calibration curves and DCA demonstrated good calibration and clinical applicability of the nomogram. CONCLUSION We constructed a reliable nomogram based on specific risk factors for children undergoing cardiac surgery with CPB, which could be used as an effective and convenient tool for prevention of IAPIs.
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Affiliation(s)
- He Lin
- Department of Operating Room, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Haiyan Chen
- Department of Operating Room, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jiehui Wang
- Department of Operating Room, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiangai Ma
- Department of Operating Room, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Mahmoodpoor A, Chalkias A, Izadi M, Gohari-Moghadam K, Rahimi-Bashar F, Karadağ A, Khosh-Fetrat M, Vahedian-Azimi A. Association of norepinephrine with pressure ulcer development in critically ill patients with COVID-19-related acute respiratory distress syndrome: A dose-response analysis. Intensive Crit Care Nurs 2024:103796. [PMID: 39117534 DOI: 10.1016/j.iccn.2024.103796] [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: 05/04/2024] [Revised: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To investigate the correlation between varying doses of norepinephrine (NE) and the incidence of pressure injuries (PIs) in COVID-19 patients in intensive care units (ICUs). DESIGN A retrospective multicenter study was conducted on 1,078 COVID-19 patients admitted to ICUs with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. The research spanned from March 2020 to April 2021 across five university-affiliated hospitals in Iran. Univariate and multivariate binary logistic regression analyses, along with linear and non-linear dose-response assessments, were utilized to evaluate the relationship between NE dosages and the probability of PI development. FINDINGS The multivariate analysis revealed a significant association between higher doses of NE administered over 24 h (OR: 1.832, 95 % CI: 1.218-2.754, P=0.004) and cumulative doses (OR: 1.408, 95 % CI: 1.204-1.975, P=0.048) with the occurrence of PIs. Moreover, patients receiving high NE doses had a nearly fourfold increased risk of developing PIs, regardless of PIs stage, compared to those on low or moderate doses (>15 µg/min vs. ≤ 15 µg/min; OR: 4.401, 95 % CI: 3.339-5.801, P=0.001). Although the linear dose-response analysis did not show a significant correlation between NE doses (µg/min) and PI development (P>0.05), the non-linear analysis indicated that NE doses ≤ 9 µg/min were associated with a reduced risk of PI development. CONCLUSION Maintaining NE infusion within the range of 1-9 µg/min appears to be most effective in reducing the likelihood of PIs in ICU patients with COVID-19. Lower NE doses (≤9 µg/min) were associated with a lower risk of PI development, suggesting that factors beyond NE dosage or the use of other vasopressors may play a crucial role in PI formation in this patient cohort. IMPLICATIONS FOR CLINICAL PRACTICE Rather than suggesting a specific threshold, clinicians should consider further studies to determine the optimal dose that balances microvascular perfusion and patient outcomes. It is crucial to comprehensively evaluate additional factors and selectively use vasopressors. Individualized care, including regular monitoring and personalized treatment plans, is essential for achieving the best outcomes in this patient population.
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Affiliation(s)
- Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Outcomes Research Consortium, Cleveland, OH 44195, USA.
| | - Morteza Izadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Kievan Gohari-Moghadam
- Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Ayişe Karadağ
- Koc University School of Nursing, 34010 Istanbul, Türkiye.
| | - Masoum Khosh-Fetrat
- Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Amir Vahedian-Azimi
- Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Guo D, Ma Y, Zhang N, Zhang Y, Guo S. PTGS2 as target of compound Huangbai liquid in the nursing of pressure ulcer. Medicine (Baltimore) 2024; 103:e39000. [PMID: 39029075 PMCID: PMC11398748 DOI: 10.1097/md.0000000000039000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVE Pressure ulcer refers to ulceration and necrosis caused by local skin and cell tissues being compressed for a long time, continuous ischemia, hypoxia, and malnutrition. However, role of prostaglandin-endoperoxide synthase 2 (PTGS2) in the management of pressure ulcers in with compound Huangbai liquid is still unclear. METHODS Traditional Chinese medicine components and related targets of compound Huangbai liquid were collected through traditional Chinese medicine systems pharmacology (TCMSP) and Batman-traditional Chinese medicine database. Disease-related targets were obtained using the Gene Cards database. The protein-protein interaction (PPI) network was constructed using the Search tool for retrieval of interacting genes (STRING) and analyzed by Cytoscape to obtain the core components. To evaluate the clinical efficacy of the compound Huangbai liquid in the treatment of pressure ulcers, 40 patients with pressure ulcers were selected and divided into an observation group and a control group, with 20 individuals in each group. The observation group received treatment with compound Huangbai liquid. RESULTS Sixty-five components and 480 targets of compound Huangbai liquid were obtained from TCMSP and Batman - traditional Chinese medicine databases. Two hundred seventy-three pressure ulcer-related targets were obtained. Seventy-two potential targets of compound Huangbai pigment in treatment of pressure ulcer were obtained, and 2 unrelated targets were deleted. There were 70 nodes and 1167 edges in PPI network. Gene ontology (GO) function is involved in biological processes such as reactive oxygen species metabolism and cellular response to chemical stress. Cellular components such as platelet α granules lumen and membrane rafts were involved. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment results showed that compound Huangbai liquid in treatment of pressure ulcer. The clinical results indicate that the compound Huangbai liquid has a good therapeutic effect on pressure ulcers. CONCLUSION PTGS2 may be a target for treatment of pressure ulcers with compound Huangbai liquid, providing a new direction for its treatment.
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Affiliation(s)
- Dongmei Guo
- Department of Nursing, Baoding Second Hospital, Baoding City, China
| | - Yanhong Ma
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nan Zhang
- Department E of Cardiology, Baoding Second Hospital, Baoding City, China
| | - Yan Zhang
- Department of Hepatobiliary Surgery, Baoding Second Hospital, Baoding City, China
| | - Suzhi Guo
- Department of ICU, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Fabrizio G, Sivori F, Cavallo I, Truglio M, Toma L, Sperati F, Francalancia M, Obregon F, Pamparau L, Kovacs D, Pimpinelli F, Di Domenico EG. Efficacy of sodium hypochlorite in overcoming antimicrobial resistance and eradicating biofilms in clinical pathogens from pressure ulcers. Front Microbiol 2024; 15:1432883. [PMID: 39050624 PMCID: PMC11266179 DOI: 10.3389/fmicb.2024.1432883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Sodium hypochlorite (NaOCl) is widely recognized for its broad-spectrum antimicrobial efficacy in skin wound care. This study investigates the effectiveness of NaOCl against a range of bacterial and fungal isolates from pressure ulcer (PU) patients. We analyzed 20 bacterial isolates from PU patients, comprising carbapenem-resistant Klebsiella pneumoniae (CRKP), multidrug-resistant Acinetobacter baumannii (MDRAB), methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible Staphylococcus aureus (MSSA), along with 5 Candida albicans isolates. Antibiotic resistance profiles were determined using standard susceptibility testing. Whole-genome sequencing (WGS) was employed to identify antimicrobial resistance genes (ARGs) and disinfectant resistance genes (DRGs). Genetic determinants of biofilm formation were also assessed. The antimicrobial activity of NaOCl was evaluated by determining the minimum inhibitory concentration (MIC) and the minimal biofilm eradication concentration (MBEC) for both planktonic and biofilm-associated cells. CRKP and MDRAB showed resistance to fluoroquinolones and carbapenems, while MRSA exhibited resistance to β-lactams and levofloxacin. MSSA displayed a comparatively lower resistance profile. WGS identified significant numbers of ARGs in CRKP and MDRAB, with fewer DRGs compared to MRSA and MSSA. All isolates possessed genes associated with fimbriae production and adhesion, correlating with pronounced biofilm biomass production. NaOCl demonstrated substantial antimicrobial activity against both planktonic cells and biofilms. The MIC90 for planktonic bacterial cells was 0.125 mg/mL, and the MBEC90 ranged from 0.225 to 0.5 mg/mL. For planktonic C. albicans, the MIC90 was 0.150 mg/mL, and the MBEC90 was 0.250 mg/mL. These results highlight the challenge in treating biofilm-associated infections and underscore the potential of NaOCl as a robust antimicrobial agent against difficult-to-treat biofilm infections at concentrations lower than those typically found in commercial disinfectants.
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Affiliation(s)
- Giorgia Fabrizio
- Department of Biology and Biotechnology "C. Darwin", Sapienza University of Rome, Rome, Italy
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Mauro Truglio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Luigi Toma
- Medical Directorate, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Massimo Francalancia
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Francisco Obregon
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Luisa Pamparau
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Daniela Kovacs
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Enea Gino Di Domenico
- Department of Biology and Biotechnology "C. Darwin", Sapienza University of Rome, Rome, Italy
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9
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Takashima M, Gibson V, Borello E, Galluzzo L, Gill FJ, Kinney S, Newall F, Ullman AJ. Pediatric invasive device utility and harm: a multi-site point prevalence survey. Pediatr Res 2024; 96:148-158. [PMID: 38200324 PMCID: PMC11257939 DOI: 10.1038/s41390-023-03014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND AIMS Invasive devices are widely used in healthcare settings; however, pediatric patients are especially vulnerable to invasive device-associated harm. This study aimed to explore invasive device utility, prevalence, harm, and clinical practice across three Australian pediatric tertiary hospitals. METHODS In 2022-2023, a multi-center, observational, rolling-point-prevalence survey was conducted. Fifty-per-cent of inpatients were systemically sampled by random allocation. Patients with devices were then followed for up to 3-days for device-related complications/failures and management/removal characteristics. RESULTS Of the 285 patients audited, 78.2% had an invasive device (n = 412 devices), with a median of 1 device-per-patient (interquartile range 1-2), with a maximum of 13 devices-per-patient. Over half of devices were vascular access devices (n = 223; 54.1%), followed by gastrointestinal devices (n = 112; 27.2%). The point-prevalence of all device complications on Day 0 was 10.7% (44/412 devices) and period-prevalence throughout the audit period was 27.7% (114/412 devices). The period-prevalence of device failure was 13.4% (55/412 devices). CONCLUSIONS The study highlighted a high prevalence of invasive devices among hospitalized patients. One-in-ten devices failed during the audit period. These findings underscore the need for vigilant monitoring and improved strategies to minimize complications and enhance the safety of invasive devices in pediatric hospital settings. IMPACT A high prevalence of invasive devices among hospitalized patients was reported. Of the 285 patients audited, almost 80% had an invasive device (total 412 devices), with a median of 1 device-per-patient and a maximum of 13 devices-per-patient. The most common devices used in pediatric healthcare are vascular access devices (n = 223; 54.1%), however, 16% (n = 36) of these devices failed, and one-third had complications. The point prevalence of all device complications at day 0 was 10.7% (44 out of 412 devices), with a period prevalence of 27.7% (114 out of 412 devices) throughout the audit period.
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Affiliation(s)
- Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia.
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Eloise Borello
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lily Galluzzo
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
| | - Fenella J Gill
- Perth Children's Hospital, Child and Adolescent Health Service, Perth, WA, Australia
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Sharon Kinney
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Newall
- Nursing Research Department, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Nursing and Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amanda J Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, QLD, Australia
- Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
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10
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Dünya CP, Kara Ö, Yiğitoğlu ET. Is YouTube a Useful Source of Information on Pressure Injuries? A Content, Reliability, and Quality Analysis. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38899823 DOI: 10.1097/asw.0000000000000172] [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: 06/21/2024]
Abstract
OBJECTIVE To evaluate the comprehensiveness, reliability, and quality of YouTube videos related to pressure injuries. METHODS The authors searched YouTube for relevant videos using the keywords "pressure injury", "pressure ulcer", "bedsore", "pressure injury etiology", "pressure injury classification", "pressure injury prevention", "pressure injury risk assessment", and "pressure injury management". Of the 1,023 videos screened, 269 met the inclusion criteria and were included in the study. For each video, the authors recorded the number of views, likes, and comments; the length; and the video upload source. The Comprehensiveness Assessment Tool for Pressure Injuries, the Quality Criteria for Consumer Health Information score, and the Global Quality Score were used to evaluate the comprehensiveness, reliability, and quality of the videos. RESULTS The mean length of the 269 videos was 6.22 ± 4.62 minutes (range, 0.18-19.47 minutes). Only 14.5% of the videos (n = 39) were uploaded by universities or professional organizations. Most videos included information about PI prevention (69.5%), followed by PI management (27.9%). The mean comprehensiveness score was 2.33 ± 1.32 (range, 1-5). Nearly half of the videos (49.1%) were not reliable. However, the quality of 43.9% of the videos was somewhat useful. The Quality Criteria for Consumer Health Information mean scores of universities/professional organizations (P < .001), nonprofit healthcare professionals (P = .015), and independent health information channel videos (P = .026) were higher than the mean score of medical advertising/profit companies channel videos. CONCLUSIONS This study draws attention to the need for more comprehensive, high-quality, and reliable videos about PIs. It is important that videos on YouTube provide comprehensive and reliable information for patients, caregivers, students, or providers seeking information on PI prevention, assessment, and management.
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Affiliation(s)
- Cansu Polat Dünya
- At Istanbul University, Cerrahpaşa Istanbul, Turkey, Cansu Polat Dünya, PhD, RN, is Assistant Professor, Department of Internal Nursing, School of Nursing; Öykü Kara, MScN, is PhD Student and Research Assistant, Department of Surgical Nursing, Florence Nightingale Faculty of Nursing; and Eylem Toğluk Yiğitoğlu, PhD, RN, is Assistant Professor, Department of Nursing Education, School of Nursing
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Chan SC, Patrick Engkasan J. How Effective Is Negative Pressure Wound Therapy for Treating Pressure Ulcers?-A Cochrane Review Summary With Commentary. Am J Phys Med Rehabil 2024; 103:650-651. [PMID: 38529617 DOI: 10.1097/phm.0000000000002493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Soo Chin Chan
- From the Department of Rehabilitation Medicine, Universiti of Malaya, Kuala Lumpur Malaysia
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12
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Dionne A, Mac-Thiong JM, Alsofyani MA, Richard-Denis A. Are early-onset spasms predictive of poor neurological recovery after traumatic spinal cord injury? J Spinal Cord Med 2024; 47:566-572. [PMID: 36622323 PMCID: PMC11218569 DOI: 10.1080/10790268.2022.2150068] [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: 01/10/2023] Open
Abstract
CONTEXT Following spinal cord injury (SCI), early spasms are associated with decreased functional recovery. It has also been hypothesized that early spasticity might sign underlying maladaptive neuroplasticity, which could translate in worse neurological outcomes. OBJECTIVE In this context, this paper aims to evaluate if early-onset spasms are also associated with neurological outcomes after SCI. METHODS A retrospective review of 196 cases from a prospective SCI database was conducted. The presence of early spasms during the acute hospitalization was assessed by a single physiatrist. The characteristics and long-term neurological outcomes of individuals with and without early spasms were first compared. Multivariate regression analyses were then performed to determine the relationship between early spasms and neurological outcomes. RESULTS 30.1% (N = 59) of patients presented early spasms. These patients had several distinguishing characteristics including higher odds of tetraplegia (vs. paraplegia) and more severe injuries. At the bivariate level, patients with early spasms had higher odds of improving at least 1 AIS grade between baseline and follow-up. However, this was not significant at the multivariate level. CONCLUSIONS Early spasms are not significantly associated with poorer neurological outcomes, contrasting with the unwritten consensus that early spasticity translates maladaptive neuroplasticity.
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Affiliation(s)
- Antoine Dionne
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
| | - Mohammad A. Alsofyani
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, Quebec, Canada
- Department of Surgery, College of Medicine and University Hospital, University of Haìl, Haìl, Kingdom of Saudi Arabia
| | - Andréane Richard-Denis
- Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Center, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, Quebec, Canada
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Paquin C, Rozaire J, Chenu O, Gelis A, Dubuis L, Duprey S. Studying mechanical load at body-seat interface during dynamic activities such as wheelchair propulsion: a scoping review. Disabil Rehabil Assist Technol 2024; 19:1879-1889. [PMID: 37610140 DOI: 10.1080/17483107.2023.2248184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body-seat interface during dynamic activities. OBJECTIVES A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task. MATERIALS AND METHODS The literature search was performed by applying the PRISMA methodology. RESULTS A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse. CONCLUSION Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load.
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Affiliation(s)
- Clémence Paquin
- Univ Lyon, Univ Gustave Eiffel, Lyon, France
- Texisense, Torcy, France
| | | | | | - Anthony Gelis
- Centre Mutualiste Neurologique Propara, Montpellier, France
- EPSYLON laboratory, Montpellier, France
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Osborne Chambers C, Thompson JA. Shedding new light for nurses: Enhancing pressure injury prevention across skin tones with sub-epidermal moisture assessment technology. J Adv Nurs 2024; 80:2801-2812. [PMID: 38243619 DOI: 10.1111/jan.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/30/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
AIM(S) To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology in the detection of early-stage pressure damage in a critical care unit (CCU) and dark skin tone patients and its impact on hospital-acquired pressure injury (HAPI) incidence. DESIGN Quality improvement study employing Kurt Lewin's change model emphasizing planning, implementation, evaluation and sustainable change. METHODS The study evaluated 140 adult patients admitted to the CCU over a 24-week period, from July to December 2022. Retrospective analysis of standard PI care pathways was performed in 90 patients admitted during a 12-week pre-implementation period. Fifty patients were admitted through the subsequent 12-week implementation period. SEM assessments were performed daily at the sacrum and heels and interventions were applied based on SEM assessments; SEM delta ≥0.6 indicating localized oedema or persistent focal oedema. Statistical analyses were performed on anonymized data. RESULTS Pre-implementation HAPI incidence was 8.9% (N = 8/90). All eight patients were African American with varying skin tones. A 100% reduction in HAPI incidence was achieved in the implementation period which included 35 African American patients. The relative risk of HAPI incidence was 1.6 times higher in the pre-implementation group. CONCLUSION Implementing SEM assessment technology enabled equitable PI care for all population types and resulted in a 100% reduction of PIs in our CCU. Objective SEM assessments detected early-stage PIs, regardless of skin tone and enabled providing interventions to specific anatomies developing tissue damage as opposed to universal preventive interventions. IMPLICATIONS PI care pathways relying on visual and tactile skin assessments are inherently biased in providing equitable care for dark skin tone patients. Implementing SEM assessments empowers healthcare practitioners in driving objective clinical interventions, eliminates bias and enables positive PI health outcomes. IMPACT Implementing SEM assessment technology had three main effects: it detected early tissue damage regardless of skin tone (detection effect), enabled anatomy-specific interventions (treatment effect) and prevented PIs across all population types (prevention effect). The authors have adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. What does this paper contribute to the wider global clinical community? Addressing health inequities in pressure injury prevention; Demonstrated effectiveness across patient populations; Resource optimization and enhanced patient safety.
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15
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Özcan F, Örücü Atar M, Köroğlu Ö, Yılmaz B. Assessment of the reliability and usability of ChatGPT in response to spinal cord injury questions. J Spinal Cord Med 2024:1-6. [PMID: 38860862 DOI: 10.1080/10790268.2024.2361551] [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] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE The use of artificial intelligence chatbots to obtain information about patients' diseases is increasing. This study aimed to determine the reliability and usability of ChatGPT for spinal cord injury-related questions. METHODS Three raters simultaneously evaluated a total of 47 questions on a 7-point Likert scale for reliability and usability, based on the three most frequently searched keywords in Google Trends ('general information', 'complications' and 'treatment'). RESULTS Inter-rater Cronbach α scores indicated substantial agreement for both reliability and usability scores (α between 0.558 and 0.839, and α between 0.373 and 0.772, respectively). The highest mean reliability score was for 'complications' (mean 5.38). The lowest average was for the 'general information' section (mean 4.20). The 'treatment' had the highest mean scores for the usability (mean 5.87) and the lowest mean value was recorded in the 'general information' section (mean 4.80). CONCLUSION The answers given by ChatGPT to questions related to spinal cord injury were reliable and useful. Nevertheless, it should be kept in mind that ChatGPT may provide incorrect or incomplete information, especially in the 'general information' section, which may mislead patients and their relatives.
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Affiliation(s)
- Fatma Özcan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Merve Örücü Atar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Özlem Köroğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Bilge Yılmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Farmer MJS, Callahan CD, Hughes AM, Riska KL, Hill NS. Applying Noninvasive Ventilation in Treatment of Acute Exacerbation of COPD Using Evidence-Based Interprofessional Clinical Practice. Chest 2024; 165:1469-1480. [PMID: 38417700 PMCID: PMC11177098 DOI: 10.1016/j.chest.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/06/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024] Open
Abstract
When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to COPD exacerbation in conjunction with guideline-recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse, and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of COPD that incorporates the necessary interprofessional collaboration among physicians, nurses, and respiratory therapists caring for these patients.
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Affiliation(s)
- Mary Jo S Farmer
- Department of Medicine, Pulmonary & Critical Care Division, UMASS Chan Medical School-Baystate, Springfield, MA.
| | | | - Ashley M Hughes
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL; Center for Innovation in Chronic, Complex Healthcare (CINCCH), Edward Hines JR VA Hospital, Hines, IL
| | | | - Nicholas S Hill
- Division of Pulmonary, Critical Care & Sleep Medicine, Tufts University School of Medicine, Boston, MA
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Catikkas NM, Safer VB, Bas S, Gunay DS, Durak A, Utku IK, Safer U. Comparison of muscle and fat parameters measured by ultrasonography and dual-energy x-ray absorptiometry between older palliative care patients with and without type 2 diabetes mellitus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:608-618. [PMID: 38600828 DOI: 10.1002/jcu.23688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/09/2024] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIMS There are limited data on the comparison of body compositions between diabetic and non-diabetic patients. We aimed to compare the muscle mass and fat parameters measured by ultrasonography (USG) and dual-energy x-ray absorptiometry (DXA) between older palliative care patients with and without type 2 diabetes mellitus (DM). METHODS We conducted a prospective, cross-sectional study. We recorded the demographics, comorbidities, blood pressures, microvascular complications, pressure injuries, ambulation and nutritional status, and laboratory parameters. We measured the handgrip strength with a hand dynamometer and anthropometric parameters. We analyzed the subcutaneous fat thickness, muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii muscles by USG and the total and regional muscle mass and fat parameters by DXA. We performed a regression analysis to examine the independently associated factors of DM. RESULTS We included 55 patients (mean age: 79.0 ± 8.0 years, 56.4%: female). 43.6% had type 2 DM. The patients with DM had significantly higher glucose and HbA1c levels and lower RFMT and RFCSA values than the patients without DM (p < 0.01, for all). The RFMT was independently associated with DM after adjusting age, sex, and body mass index (Odds ratio = 0.735, 95% confidence interval = 0.565-0.956, p = 0.022). CONCLUSION Our study demonstrated that the RFMT might be associated with type 2 DM. This was the first study comparing the body compositions measured by USG and DXA between older diabetic and non-diabetic palliative patients with a wide range of laboratory evaluations. Longitudinal, multi-center studies are warranted to understand the underlying mechanisms.
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Affiliation(s)
- Nezahat Muge Catikkas
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Vildan Binay Safer
- Department of Physical Medicine and Rehabilitation, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Suleyman Bas
- Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Deniz Sevindik Gunay
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Ayfer Durak
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Irem Kirac Utku
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
| | - Umut Safer
- Division of Geriatrics, Department of Internal Medicine, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, University of Health Sciences Istanbul, Istanbul, Turkey
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Lyu Y, Cui H, Liu Y, Lin F. Current perception and knowledge of preventing medical device related pressure injury among nursing staff in intensive care units: A national descriptive cross-sectional study. Intensive Crit Care Nurs 2024; 82:103656. [PMID: 38359599 DOI: 10.1016/j.iccn.2024.103656] [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: 10/11/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Sufficient knowledge is crucial for nurses in intensive care unit to prevent medical device related pressure injuries. This study was aimed to explore the Chinese intensive care nurses' perceptions and knowledge of medical device related pressure injury prevention and identify associated factors. METHODS This descriptive cross-sectional study included a convenience sample of 1286 intensive care nurses recruited from professional networks across China. Participants completed the demographic data form and the adapted 23-item Medical device related pressure injury Knowledge Assessment Questionnaire (MKAQ) questionnaire. Multiple linear regression was used to determine the associated factors. RESULTS The medical device related pressure injury knowledge assessment questionnaire scores among intensive care nurses were relatively high, with a correct rate of 78.3 %. Multiple regression analysis revealed that management position (β = 0.131, P < 0.001) was the strongest associated factor of knowledge scores, followed by academic position (β = 0.114, P = 0.009) and received training on medical device related pressure injury (β = 0.112, P < 0.001). Hospital level (β = 0.087, P = 0.004) and sex (β = 0.068, P = 0.016) were also significant associated factors. Collectively, these five variables accounted for 18.2 % of the variance in knowledge scores. CONCLUSION Sufficient knowledge is a prerequisite for safe nursing practice. Although nurses demonstrated relatively high level of knowledge, it is essential for nursing managers to implement specific measures to enhance the knowledge among junior nursing staff, especially in non-tertiary hospitals, to promote medical device related pressure injury prevention in all intensive care settings. IMPLICATIONS FOR CLINICAL PRACTICE This study highlights the importance of sociodemographic and professional characteristics in promoting satisfactory perception and knowledge of preventing medical device related pressure injury among intensive care nurses. It is necessary for nurse managers and leaders to develop strategic interventions, along with targeted training programs and quality improvement plans that correspond to the actual training needs to improve the medical device related pressure injury prevention.
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Affiliation(s)
- Yang Lyu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Honghong Cui
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Frances Lin
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Caring Futures Institute, Flinders University, Bedford Park, Adelaide, Australia
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Luo L, Wen X, Wang J, Xiao Q, Su L, Zhou M. Analysis of the Current Status of Nurses' Knowledge of Pressure Injuries and Factors Influencing It in Shaanxi Province, China: A Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:1451-1462. [PMID: 38841316 PMCID: PMC11151280 DOI: 10.2147/rmhp.s458522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
Background Pressure injuries are present in all healthcare environments and not only pose a significant health risk to individuals but also impose a heavy economic burden on society and families. Nurses, as the primary caregivers responsible for the prevention and management of pressure injuries, have knowledge that directly determines the incidence of pressure injuries. Aim To understand the current status of nurses' knowledge of pressure injuries in Shaanxi Province and the factors influencing it. Design A cross-sectional survey. Methods In April - May 2022, 16,599 nurses from hospitals at all levels in Shaanxi Province were selected as survey subjects by convenience sampling method. They were surveyed using the general information questionnaire and the Pieper-Zulkowski pressure injury Knowledge Questionnaire through the Questionnaire Star platform. Results 16,599 nurses had a pressure injury knowledge score of (44.32±10.11). Wound description and pressure ulcer staging dimensions were less than 60% correct. Comparison of pressure injury knowledge scores of nursing staff with different genders, hospital levels, titles, education, whether they were specialized nurses in wound stoma when they last attended a lecture on pressure ulcers, when they last read literature or books on pressure ulcers, and whether they ever looked for information about pressure ulcers on the Internet showed that the differences were statistically significant (P < 0.05), which were the influencing factors of the knowledge scores of the nursing staff in Shaanxi Province. Conclusion Clinical nurses' awareness of stress-related injuries still needs to be improved, and nursing administrators can improve the quality of pressure-related injury care by increasing nursing staff's awareness through continuing education, tiered training, and other measures.
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Affiliation(s)
- Liqun Luo
- Department of Nursing, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Xiulin Wen
- Department of Nursing, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jingrong Wang
- Department of Surgical, The Second Affiliated Hospital of the Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Qian Xiao
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Liuju Su
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Min Zhou
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
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Gordon RJFH, Worsley PR, Filingeri D. An evaluation of the effects of localised skin cooling on microvascular, inflammatory, structural, and perceptual responses to sustained mechanical loading of the sacrum: A study protocol. PLoS One 2024; 19:e0303342. [PMID: 38728306 PMCID: PMC11086830 DOI: 10.1371/journal.pone.0303342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
This study protocol aims to investigate how localised cooling influences the skin's microvascular, inflammatory, structural, and perceptual tolerance to sustained mechanical loading at the sacrum, evaluating factors such as morphology, physiology, and perceptual responses. The protocol will be tested on individuals of different age, sex, skin tone and clinical status, using a repeated-measure design with three participants cohorts: i) young healthy (n = 35); ii) older healthy (n = 35); iii) spinal cord injured (SCI, n = 35). Participants will complete three testing sessions during which their sacrum will be mechanically loaded (60 mmHg; 45 min) and unloaded (20 min) with a custom-built thermal probe, causing pressure-induced ischemia and post-occlusive reactive hyperaemia. Testing sessions will differ by the probe's temperature, which will be set to either 38°C (no cooling), 24°C (mild cooling), or 16°C (strong cooling). We will measure skin blood flow (via Laser Doppler Flowmetry; 40 Hz); pro- and anti-inflammatory biomarkers in skin sebum (Sebutape); structural skin properties (Optical Coherence Tomography); and ratings of thermal sensation, comfort, and acceptance (Likert Scales); throughout the loading and unloading phases. Changes in post-occlusive reactive hyperaemia will be considered as the primary outcome and data will be analysed for the independent and interactive effects of stimuli's temperature and of participant group on within- and between-subject mean differences (and 95% Confidence Intervals) in peak hyperaemia, by means of a 2-way mixed model ANOVA (or Friedman). Regression models will also be developed to assess the relationship between absolute cooling temperatures and peak hyperaemia. Secondary outcomes will be within- and between-subject mean changes in biomarkers' expression, skin structural and perceptual responses. This analysis will help identifying physiological and perceptual thresholds for the protective effects of cooling from mechanically induced damage underlying the development of pressure ulcers in individuals varying in age and clinical status.
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Affiliation(s)
- Ralph J. F. H. Gordon
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Peter R. Worsley
- PressureLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
| | - Davide Filingeri
- ThermosenseLab, Skin Sensing Research Group, School of Health Science, University of Southampton, Southampton, United Kingdom
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Zhang J, Shan H, Guo J, Wang X, Wang W. Dysfunctional iron metabolism in pressure injuries is related to aberrant CD163 and Homx-1 signal transduction. Wound Repair Regen 2024; 32:268-278. [PMID: 38148566 DOI: 10.1111/wrr.13145] [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: 02/10/2023] [Revised: 10/18/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
Dysregulation of iron metabolism has been associated with impaired chronic wound healing. However, changes in iron metabolism have yet to be reported in pressure injuries, a type of chronic wound. In this study, we aimed to investigate changes in iron metabolism and associated regulatory mechanisms in pressure injuries. We collected tissue biopsies and data from 20 consenting stage IV-pressure injuries patients and 5 non-pressure injuries patients hospitalised at the Affiliated Hospital of Qingdao University between March 2021 and June 2021. In addition, we measured the iron content by inductively coupled plasma mass spectrometry and Prussian blue staining in deep tissue pressure injury mouse models. An Enzyme-linked immune sorbent assay measured the expression of ferritin, ferroportin-1 and transferrin. Immunofluorescence staining, high-throughput transcriptome sequencing, Western blot and RT-qPCR further analysed the fundamental mechanisms regulating iron metabolism. In this study, we observed numerous inflammatory cells infiltrating the marginal tissues of stage IV pressure injury patients and in deep tissue pressure injury models. The expression levels of pro-inflammatory factors, such as inducible nitric oxide synthase and interleukin-6, were significantly increased (p < 0.05). The iron level was proportional to the degree of progression, with the most significant change appearing on the third day in deep tissue pressure injury models (p < 0.05). Enzyme-linked immune sorbent assay results suggested abnormal gene expression was related to iron metabolism, including a substantial increase in ferritin and a significant decrease in the expression of ferroportin-1 (p < 0.05). In addition, immunofluorescence staining and Western blot showed that the expression of macrophage membrane receptor CD163 was abnormally elevated (p < 0.05). Both high-throughput transcriptome sequencing and qRT-PCR results suggested aberrant expression of the CD163/Homx-1-mediated signalling pathway. Dysfunctional iron metabolism was suggested to be related to the aberrant CD163/Homx-1 signalling pathway in deep tissue pressure injury models.
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Affiliation(s)
- Ju Zhang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Hui Shan
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Jinglin Guo
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Xiaoying Wang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Weiwei Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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22
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Akpolat R, Sisman H, Alptekin D. The frequency of pressure injury in level 3 intensive care units and determination of risk factors: A cross-sectional study. J Tissue Viability 2024; 33:248-253. [PMID: 38493047 DOI: 10.1016/j.jtv.2024.03.009] [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: 04/03/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
AIM This study was carried out to determine the prevalence of pressure injury and risk factors in patients hospitalized in a university hospital's level 3 intensive care unit. DESIGN It is a descriptive, prospective, observational type study. METHOD The sample of the study consisted of 176 patients aged 18 and over who were admitted to the intensive care units of a University Hospital for at least 24 h. Patient Information Form and Braden Risk Assessment Scale, Glasgow Coma Scale were used to collect data. IBM SPSS Statistics 20 program was used to analyze the data. RESULTS Presence of chronic disease in the development of pressure injury (22.7%), high-risk patients according to the Glasgow Coma Scale (21%), high-risk patients according to the Braden Risk Assessment Scale (84.2%), low hemoglobin (31%), low albumin levels (32.4%) and duration of stay in the intensive care unit until the day of evaluation were found to be independent risk factors (p < 0.05). The prevalence of pressure injury was determined to be 32.4%, and the rate of pressure injury due to medical devices was 7.4%. CONCLUSION Pressure injuries are still common in adult intensive care patients. In terms of patient safety, it is important to give more space to care standards and awareness-raising research and training to prevent pressure injuries.
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Affiliation(s)
- Refiye Akpolat
- Cyprus International University, School of Health Sciences, Nursing Department, Nicosia, Cyprus.
| | - Hamide Sisman
- Cukurova University Abdi Sutcu Health Services Vocational School, Sarıcam, Adana, Turkey.
| | - Dudu Alptekin
- Cukurova University Abdi Sutcu Health Services Vocational School, Sarıcam, Adana, Turkey.
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23
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Tatsuta K, Sakata M, Sugiyama K, Kojima T, Akai T, Suzuki K, Torii K, Morita Y, Kikuchi H, Hiramatsu Y, Kurachi K, Takeuchi H. Impact of shear stress on sacral pressure injury from table rotation during laparoscopic colorectal surgery performed in the lithotomy position. Sci Rep 2024; 14:9748. [PMID: 38679609 PMCID: PMC11056377 DOI: 10.1038/s41598-024-60424-9] [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: 07/04/2023] [Accepted: 04/23/2024] [Indexed: 05/01/2024] Open
Abstract
This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy position. We included 37 patients who underwent this procedure between November 2021 and October 2022. The primary outcome was average horizontal shear stress caused by the rotation of the operating table during the operation, and the secondary outcome was interface pressure over time. Sensors were used to measure shear stress and interface pressure in the sacral region. Patients were divided into two groups according to the presence or absence of PI. PI had an incidence of 32.4%, and the primary outcome, average horizontal shear stress, was significantly higher in the PI group than in the no-PI group. The interface pressure increased over time in both groups. At 120 min, the interface pressure was two times higher in the PI group than in the no-PI group (PI group, 221.5 mmHg; no-PI group, 86.0 mmHg; p < 0.01). This study suggested that shear stress resulting from rotation of the operating table in the sacral region by laparoscopic colorectal surgery performed in the lithotomy position is the cause of PI. These results should contribute to the prevention of PI.
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Affiliation(s)
- Kyota Tatsuta
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Mayu Sakata
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Kosuke Sugiyama
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tadahiro Kojima
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Katsunori Suzuki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kakeru Torii
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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24
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [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: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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25
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Sabolinski ML, Archambault T. Real-world data analysis of bilayered living cellular construct and fetal bovine collagen dressing treatment for pressure injuries: a comparative effectiveness study. J Comp Eff Res 2024; 13:e230109. [PMID: 38348818 PMCID: PMC11044950 DOI: 10.57264/cer-2023-0109] [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: 06/27/2023] [Accepted: 01/31/2024] [Indexed: 03/23/2024] Open
Abstract
Aim: To determine the effectiveness of bilayered living cellular construct (BLCC) versus a fetal bovine collagen dressing (FBCD) in pressure injuries (PRIs). Methods: A real-world data study was conducted on 1352 PRIs analyzed digitally. 1046 and 306 PRIs were treated with BLCC and FBCD, respectively. Results: Cox healing for BLCC (n = 1046) was significantly greater (p < 0.0001) at week 4 (13 vs 7%), 8 (29 vs 17%), 12 (42 vs 27%), 24 (64 vs 45%), and 36 (73 vs 56%). The probability of healing increased by 66%, (hazard ratio = 1.66 [95% CI (1.38, 2.00)]; p < 0.0001. Time to healing was 162 days for FBCD and 103 days for BLCC showing a 36% reduction in time to healing with BLCC; (p < 0.0001). Conclusion: BLCC significantly improved healing of PRIs versus FBCD.
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Affiliation(s)
- Michael L Sabolinski
- Sabolinski LLC, Managing Member, Department of Medicine, Franklin, MA 02038, USA
| | - Tad Archambault
- Virtu Stat Ltd., Department of Statistics, North Wales, PA 19454, USA
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26
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Van Wicklin SA. Fundamentals of Plastic and Aesthetic Nursing: Postoperative Management of Older Adult Patients Undergoing Plastic Surgical Procedures. Pediatr Phys Ther 2024; 44:99-115. [PMID: 38639967 DOI: 10.1097/psn.0000000000000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
- Sharon Ann Van Wicklin
- Sharon Ann Van Wicklin, PhD, RN, CNOR, CRNFA(E), CPSN-R, PLNC, ISPAN-F, FAORN, FAAN, is Editor in Chief, Plastic and Aesthetic Nursing, and is a Perioperative and Legal Nurse Consultant, Aurora, CO
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27
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Giovannoni L, Longobucco Y, Iovino P, Barbetti C, Becattini S, Bonanni D, Cordelli F, Cosci M, Del Perugia C, Flego R, Giannuzzi D, Guasti B, Iannone SR, Latini R, Macchitella C, Piccardi F, Prisco E, Pucci T, Tricca M, Rasero L. Complementing Braden scale for pressure ulcer risk with clinical and demographic-related factors in a large cohort of hospitalized Italian patients. J Tissue Viability 2024:S0965-206X(24)00030-5. [PMID: 38458956 DOI: 10.1016/j.jtv.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/23/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
AIMS To determine the prevalence, risk, and determinants of pressure ulcer risk in a large cohort of hospitalized patients. DESIGN A prospective cross-sectional study with data collection in January 2023. METHODS Registered nurses collected data from 798 patients admitted to 27 health care units of an Italian hospital. The pressure ulcer risk was assessed using the Braden scale. The presence of comorbidities was collected from clinical reports. Obesity was assessed according to international indicators (Body Mass Index). The receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of different Braden scores for identifying participants with pressure ulcers. RESULTS The prevalence of pressure ulcers was 9.5%, and 57.4% of the sample were at risk of developing pressure ulcers. The area under the ROC curve was 0.88. The best sensitivity and specificity were found for a Braden cutoff score of 15.5 (sensibility = 0.76; specificity = 0.85). The determinants of lower Braden scores were older age (p < 0.001), comorbidities (p < 0.001), wounds of other nature (p = 0.001), urinary incontinence (p < 0.001), fecal incontinence (p < 0.001), and urinary catheterization (p < 0.001). CONCLUSION Several demographic factors and specific clinical indicators have been identified as determinants of the risk of developing pressure ulcers, which are easily ascertainable by healthcare providers; thus, they may routinely complement the Braden Scale in the assessment of pressure ulcer risk in order to reinforce and accelerate clinical judgment.
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Affiliation(s)
- Lorenzo Giovannoni
- Research and Development of Clinical Practice Unit, Careggi University Hospital, Florence, Italy; Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Yari Longobucco
- Research and Development of Clinical Practice Unit, Careggi University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Iovino
- Department of Health Sciences, University of Florence, Florence, Italy.
| | - Chiara Barbetti
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Silvia Becattini
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Daniela Bonanni
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Francesco Cordelli
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Matteo Cosci
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | | | - Rachele Flego
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Domenica Giannuzzi
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Barbara Guasti
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | | | - Riccardo Latini
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | | | - Francesca Piccardi
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Elia Prisco
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Tiziana Pucci
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Manola Tricca
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Laura Rasero
- Research and Development of Clinical Practice Unit, Careggi University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
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28
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Li Y, Huang Z, Yu K, Li Y. Effects of evidence-based nursing in preventing pressure ulcers in intensive care unit patients: A meta-analysis. Int Wound J 2024; 21:e14489. [PMID: 37973556 PMCID: PMC10898412 DOI: 10.1111/iwj.14489] [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: 10/07/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023] Open
Abstract
To systematically analyse the effects of evidence-based nursing (EBN) in preventing the development of pressure ulcers (PUs) in intensive care unit (ICU) patients. We conducted a computerised search of the Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials on the prevention of PUs in ICU patients by EBN, published before the respective databases were established until September 2023. Two investigators independently performed literature screening, data extraction and quality assessment. A meta-analysis was performed using Stata 17.0. Eighteen papers were included, comprising 2593 patients, of whom 1297 and 1296 received EBN and conventional nursing, respectively. The incidence of PUs was 2.70% and 12.04% in the EBN and conventional nursing groups, respectively. Meta-analysis showed a statistically significantly lower incidence of PUs in the EBN group than that in the conventional nursing group (risk ratio = 0.22, 95% confidence interval: 0.16-0.32, p < 0.001). EBN interventions are more effective than conventional nursing in preventing PUs in ICU patients. However, since the literature included in this study was from China, the conclusions require further confirmation via higher-quality studies.
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Affiliation(s)
- Yuanli Li
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Zhifeng Huang
- Department of Trauma OrthopedicsChongqing General HospitalChongqingChina
| | - Keping Yu
- Department of NursingChongqing General HospitalChongqingChina
| | - Ya Li
- Department of Cardiovascular SurgeryChongqing General HospitalChongqingChina
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29
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Sengul T, Erden S, Karadağ A, Yilmaz D, Gokduman T. Overlooked Pain Assessment Records in Patients with Pressure Injuries During the COVID-19 Pandemic: A Retrospective Data Analysis. Adv Skin Wound Care 2024; 37:162-166. [PMID: 38393705 DOI: 10.1097/asw.0000000000000105] [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: 02/25/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare professionals focused on identifying the cause of hemodynamic instability in patients and may have neglected to assess pressure injury (PI)-related pain. Although pain is an early indicator of PI development, there has been no systematic evaluation of PI-related pain in patients. OBJECTIVE To review nurses' records of PI-related pain in patients who developed PIs during the COVID-19 pandemic. METHODS This retrospective, descriptive study included data from 510 patients at one hospital. Collected data included patient demographics (age, sex, diagnosis, and comorbidities), PI classification, and assessment of PI-related pain. Assessment data regarding PI-related pain included the characteristics of the pain, the type of analgesia (pharmacologic/nonpharmacologic) administered before and after PI management (debridement, dressing change, etc), the route of administration, and the frequency of pain assessment before and after analgesia. RESULTS The mean age of the patients (60.4% men) was 28.96 (SD, 5.82) years, and the mean length of hospital stay was 26.15 (SD, 16.1) days. Overall, 43.1% of the patients were treated in the ICU, 68.0% were conscious, and 18.6% tested positive for COVID-19. Deep-tissue injuries occurred in 57.5% of patients, with 48.6% developing stage 2 PI. The sacral region was the most common area for PI development (44.8%). The mean duration of repositioning in patients with PI was 23.03 (SD, 5.4) hours. Only 0.40% of patients (n = 2) were evaluated for pain, and only one patient was assessed for pain before and after analgesia was administered. CONCLUSIONS The findings suggest a lack of comprehensive evaluation and records concerning PI-related pain in patients with COVID-19.
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Affiliation(s)
- Tuba Sengul
- Tuba Sengul, PhD, RN, CWON, is Associate Professor, School of Nursing, Koç University, Istanbul, Turkey. Sevilay Erden, PhD, RN, is Associate Professor, Çukurova University, Adana, Turkey. Ayişe Karadağ, PhD, RN, ET/WOCN, is Dean and Professor, School of Nursing, Koç University. At Koç University Hospital, Dilek Yilmaz, MSc, RN, and Tugba Gokduman, RN, are Wound and Ostomy Care Nurses. Acknowledgments: The authors thank the nurses and institutions who took part in the study. The authors have disclosed no financial relationships related to this article. Submitted February 1, 2023; accepted in revised form April 26, 2023
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30
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Zhang W, Peng Y, Zhuang H, Yu H, Liu Q, Gu Y, Yao J. Application of direct observation of operational skills in nursing skill evaluation of pressure injury: A randomized clinical trial. Int Wound J 2024; 21:e14498. [PMID: 38050456 PMCID: PMC10898409 DOI: 10.1111/iwj.14498] [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: 10/02/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
This was a non-blinded, single-centre, randomized, controlled clinical trial that compared the effectiveness of direct observation of procedural skills (DOPSs)with traditional assessment methods in pressure injury (PI) care skills. The study population included 82 nursing professionals randomly assigned to the study group (n = 41) and the control group (n = 41). Both groups of nurses underwent a 6-month training in PI care skills and were subsequently evaluated. The main outcome variables were the PI skill operation scores and theoretical scores. Secondary outcome variables included satisfaction and critical thinking abilities. Independent sample t-tests and chi-square tests were used to assess differences between the two groups of nurses. The results showed no statistically significant difference in PI skill operation scores between the two groups of nurses (p > 0.05). When comparing the PI theoretical scores, the study group scored higher than the control group, and this difference was statistically significant (p < 0.05). In terms of satisfaction assessment, the study group and the control group showed differences in improving self-directed learning, enhancing communication skills with patients, improving learning outcomes and increasing flexibility in clinical application (p < 0.05). When comparing critical thinking abilities between the two groups of nurses, there was no statistically significant difference at the beginning of the training, but after 3 months following the training, there was a statistically significant difference between the two groups (p < 0.01).The results indicated that the DOPS was effective in improving PI theoretical scores, increasing nurse satisfaction with the training and enhancing critical thinking abilities among nurses.
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Affiliation(s)
- Wei‐ying Zhang
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Youqing Peng
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Hui‐ren Zhuang
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
- Shanghai East Hospital Ji'an HospitalJi'AnChina
| | - Hai‐ping Yu
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Qin Liu
- Department of Nursing, Health School Attached to Shanghai University of Medicine & Health SciencesShanghaiChina
| | - Yingjie Gu
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Jiali Yao
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
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31
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Xu X, Miao M, Shi G, Zhang P, Liu P, Zhao B, Jiang L. Operative Positioning and Intraoperative-Acquired Pressure Injury: A Retrospective Cohort Study. Adv Skin Wound Care 2024; 37:148-154. [PMID: 38393704 DOI: 10.1097/asw.0000000000000108] [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: 02/25/2024]
Abstract
OBJECTIVE To comprehensively assess the association between operative positioning with intraoperative-acquired pressure injury (IAPI) development. METHODS This retrospective cohort study included 455 patients who underwent surgery between October 2020 and January 2021. The authors grouped patients by operative positioning into the prone position and nonprone position groups. They used propensity-score matching at a 1:2 ratio to control for preoperative confounders, applied multiple logistic regression models to analyze the effects between positioning and IAPI, and assessed interactions of positioning and intraoperative factors on IAPI. RESULTS The final enrollment was 92 cases in the prone position group and 181 in the nonprone position group. Multivariable logistic analysis suggested that the prone position had a 2.92 times higher risk of IAPI than the nonprone position (odds ratio, 2.92; 95% CI, 1.13-7.57; P = .026). Subgroup analysis showed a significant multiplicative interaction between positioning and foam dressing on IAPI (P < .05), which was not observed in other intraoperative factors (P > .05). CONCLUSIONS This study provides evidence that prone operative positioning can increase IAPI risk. Patients in the prone position may particularly benefit from using dressings in Chinese populations. Further large-sample longitudinal studies are required to confirm these findings.
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Affiliation(s)
- Xin Xu
- At the Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China, Xin Xu, MSN, is Clinical Nurse. Miao Miao, MSN, is Graduate, Shanghai Jiaotong University. Also at Xinhua Hospital, Guirong Shi, MSN, is Clinic Nurse; Peipei Zhang, BS, is Nursing Supervisor of the Emergency Operating Room; Ping Liu, MSN, is Associate Director of the Nursing Department RN; Bing Zhao, MSN, is Anesthetist Nurse; and Liping Jiang, PhD, is Professor and Chief Nursing Officer. Acknowledgments: The authors thank Chengnan Guo from the School of Public Health, Fudan University, Shanghai, China, who provided statistical guidance and support for this study. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
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32
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Zhang A, Li L, Li Y, Sun S, Wang M, Tang X. Effects of cluster nursing interventions on the prevention of pressure ulcers in intensive care units patients: A meta-analysis. Int Wound J 2024; 21:e14776. [PMID: 38494661 PMCID: PMC10945037 DOI: 10.1111/iwj.14776] [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: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 03/19/2024] Open
Abstract
A meta-analysis was conducted to comprehensively evaluate the impact of cluster nursing interventions on the prevention of pressure ulcers (PUs) in intensive care unit (ICU) patients. Computer searches were performed in databases including Embase, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure for randomized controlled trials (RCTs) implementing cluster nursing interventions for PUs prevention in ICU patients, with the search period covering the database inception to November 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1463 ICU patients were included. The analysis showed that compared with conventional nursing, cluster nursing interventions significantly reduced the incidence of PUs (odds ratio: 0.24, 95% confidence intervals [CI]: 0.17-0.34, p < 0.001) and also significantly improved the levels of anxiety (standardized mean difference [SMD]: -1.39, 95% CI: -1.57 to 1.22, p < 0.001) and depression (SMD: -1.64, 95% CI: -2.02 to 1.26, p < 0.001) in ICU patients. This study indicates that the application of cluster nursing interventions in ICU patients can effectively reduce the incidence of PUs, as well as improve patients' anxiety and depression levels, thereby enhancing their quality of life, which is worth clinical promotion and application.
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Affiliation(s)
- Ai‐Guo Zhang
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Ling Li
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Yuan‐Li Li
- Department of Critical MedicineChongqing General HospitalChongqingChina
| | - Shun‐Xia Sun
- Department of OrthopaedicsChongqing General HospitalChongqingChina
| | - Min Wang
- Department of Special MedicalChongqing General HospitalChongqingChina
| | - Xiao‐Ling Tang
- Department of Critical MedicineChongqing General HospitalChongqingChina
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Bazaliński D, Sieńczak K, Pytlak K, Przybek-Mita J, Pelczar K, Leppert W, Więch P. Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds. J Clin Med 2024; 13:884. [PMID: 38337579 PMCID: PMC10856309 DOI: 10.3390/jcm13030884] [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: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0-no pain, 10-the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p < 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p < 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.
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Affiliation(s)
- Dariusz Bazaliński
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
| | - Karol Sieńczak
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
- Institute of Medicine, Sanok State University, 38-500 Sanok, Poland
| | - Kamila Pytlak
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Podkarpackie Specialist Oncology Centre, Father B. Markiewicz Specialist Hospital in Brzozów, 36-200 Brzozów, Poland;
| | - Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Klaudia Pelczar
- Independent Public Healthcare Institution, Ministry of Internal Affairs and Administration, 35-959 Rzeszów, Poland;
| | - Wojciech Leppert
- Institute of Medical Sciences, Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland;
- University Clinical Hospital in Poznań, 60-245 Poznań, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland; (D.B.); (K.P.); (J.P.-M.)
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Durmuş Sarıkahya S. Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis. J Tissue Viability 2024:S0965-206X(24)00005-6. [PMID: 38326162 DOI: 10.1016/j.jtv.2024.02.001] [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: 07/30/2023] [Revised: 12/04/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting. OBJECTIVE The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services. METHOD This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale." FINDINGS In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale. CONCLUSION The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.
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Affiliation(s)
- Selma Durmuş Sarıkahya
- Artvin Coruh University, Faculty of Health Sciences, Department of Public Health Nursing, Artvin, Turkey.
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Miller JN, Barnason SA, Rogge KA, Steinkuhler CR. Feasibility, acceptability, and usability of implementing a medical device-related pressure injury algorithm for critically ill patients using non-invasive ventilation. Intensive Crit Care Nurs 2024; 80:103574. [PMID: 37925816 DOI: 10.1016/j.iccn.2023.103574] [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: 06/09/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Describe the feasibility, acceptability, and usability of implementing a nurse-led intervention to prevent medical device-related pressure injury in critical care patients using non-invasive ventilation during hospitalization. STUDY DESIGN A quality improvement project, using a descriptive single-arm study design with convenience sampling. SETTING AND PARTICIPANTS This study was conducted at a Midwestern medical center with 640 beds (two hospital campuses). After an educational session, the nurse-led algorithm for non-invasive ventilation medical device-related pressure injury prevention was implemented in two critical care nursing units (cardiac medical progressive care and neurotrauma intensive care unit). Nursing staff were full or part-time critical care nurses. MAIN OUTCOME MEASURES Feasibility, acceptability, and usability of the non-invasive ventilation medical device-related pressure injury algorithm were measured (bedside rounding and pre/post System Usability Scale). RESULTS Thirty-five nurses (52.2 %) completed a pre-educational survey; 8 (11.2 %) completed a post-survey. The total mean pre-survey score was 70.7 (SD ± 13.6) and the post-survey mean score was 71.3(SD ± 19.6). There was a statistically significant increase in the post-survey mean score {Χ2 (1, N = 43) = 43.5, p <.05}, however, the 0.06 increase was not clinically meaningful. Bedside rounding interviews (n = 22) indicated 82 % (n = 18) of the nurses used the algorithm. The SUS tool mean score was 83.3 (10.73) pre-implementation (n = 21); and 85.63 (8.26) post-implementation (n = 5), indicating clinical usability of the algorithm pre- and post-implementation. CONCLUSION The feasibility, acceptability, and usability of implementing a medical device-related pressure injury algorithm for critically ill patients using non-invasive ventilation were demonstrated during this study. More nursing research is needed to develop scalable interdisciplinary clinical algorithms to reduce medical device-related pressure injuries in patients using non-invasive ventilation. IMPLICATIONS FOR CLINICAL PRACTICE This study focused on the bedside usability of the algorithm in a clinical setting. Implementing this nursing-developed algorithm created an interdisciplinary framework in which nursing assessment may guide clinical care.
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Affiliation(s)
- Jennifer N Miller
- University of Nebraska Medical Center, College of Nursing, Lincoln, NE 68588, United States.
| | - Susan A Barnason
- University of Nebraska Medical Center, College of Nursing, Lincoln, NE 68588, United States
| | - Kaitlin A Rogge
- University of Nebraska Medical Center, College of Nursing, Lincoln, NE 68588, United States
| | - Capri R Steinkuhler
- University of Nebraska Medical Center, College of Nursing, Lincoln, NE 68588, United States
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Forkuo-Minka AO, Kumah A, Asomaning AY. Improving Patient Safety: Learning from Reported Hospital-Acquired Pressure Ulcers. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:15-21. [PMID: 38406657 PMCID: PMC10887484 DOI: 10.36401/jqsh-23-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 02/27/2024]
Abstract
Introduction A hospital-acquired pressure ulcer (HAPU) is a localized lesion or injury to the underlying tissue (wound) while the patient is on admission. It occurs when standardized nursing care is not correctly followed in the presence of friction and shear, leading to skin or underlying tissue breakdown. Unfortunately, inadequate knowledge of nurses to assess and provide standardized care for pressure ulcers or manage HAPUs results in patient harm. We aim to share lessons from a reported HAPU incident and address the knowledge gap in patient safety risk assessment, identification, and wound management at Nyaho Medical Centre (Accra, Ghana). Methods A review of HAPU incidents was conducted using quality improvement tools such as cause-and-effect analyses to identify contributing factors and root causes. Subsequently, plan-do-study-act (PDSA) cycles were used to test interventions to improve pressure ulcer assessments and wound management. A run chart was used to analyze and evaluate the interventions over 12 weeks (Aug-Oct 2021). Results Development of policies and a standard operating procedure for pressure ulcers and wounds improved accuracy in identifying pressure ulcer risks and management of wounds. Eighty-three patients were assessed with the pressure ulcer assessment tool. Complete (100%) adherence to the pressure ulcer and wound policy and standard operating procedure (SOP) was achieved, and the number of HAPUs decreased from five to one during the study period. Conclusion This study demonstrated that the combined use of quality methods and tools can be suitable for improving processes and outcomes for patients at risk for HAPUs.
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Chen N, Wang H, Shao Y, Yang J, Song G. A Comparative Study on Platelet-Rich Plasma From Elderly Individuals and Young Adults to Treat Pressure Ulcers in Mice. J Surg Res 2024; 294:198-210. [PMID: 37913727 DOI: 10.1016/j.jss.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/25/2023] [Accepted: 08/28/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of the present study was to compare the therapeutic effects of activated platelet-rich plasma (PRP) prepared from elderly individuals and young adults to treat pressure ulcers (PUs), and to accumulate a theoretical basis for allogeneic PRP treatment of PUs in elderly patients. MATERIALS AND METHODS Whole blood was extracted from elderly individuals aged >65 y and young adult volunteers for PRP preparation, and platelet concentrations in whole blood and PRP were compared. Growth factors released from activated PRP were assayed using the enzyme-linked immunosorbent assay. C57BL/6 mice were divided into three groups: the control saline, elderly-PRP (Group A), and young adult-PRP (Group B). Ischemia-reperfusion injury-induced PUs were established on the backs of mice. PUs were photographed on days 0, 5, and 10 to assess their sizes. Specimens were collected on day 10 and subjected to hematoxylin and eosin and Masson's staining. Immunohistochemical staining for CD31 was conducted to evaluate vascular formation, and cell invasion was assessed using a Transwell assay. The action of PRP on transforming growth factor-beta (TGF-β)-dependent fibroblast activity and epithelial-mesenchymal transition was analyzed using immunofluorescence and Western blotting in vitro. RESULTS The platelet concentrations in whole blood and PRP of young adults were significantly higher than that in elderly individuals. The two PRP treatment groups had similar platelet enrichment coefficients of PRP. After activation, PRP from young adults produced significantly higher levels of platelet-derived growth factor, TGF-β, and vascular endothelial growth factor than PRP from elderly individuals (P < 0.05). The concentrations of platelet-derived growth factor, TGF-β, and vascular endothelial growth factor were positively correlated with the platelet concentrations in whole blood and PRP. The effects of PRP in regulating the expressions of TGF-β, α-smooth muscle actin, vimentin, and E-cadherin were observed in vivo and in vitro. The two PRP treatment groups exhibited better wound healing than the control group, as evidenced by more re-epithelialization, higher collagen content, skin fibrosis, and more blood vessel formation over time. Group B exhibited better wound healing than Group A (P < 0.05). CONCLUSION PRP exhibits potent wound healing ability in PU therapy, and PRP from young adults is seemingly superior to that from elderly individuals because of a higher concentration of platelets and increased production of growth factors.
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Affiliation(s)
- Ningjie Chen
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Haitao Wang
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Yang Shao
- Department of Burns and Orthopedic Surgery, Jinan Central Hospital, Shandong University, Jinan, Shandong, China
| | - Jincun Yang
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Shandong University, Weihai, Shandong, China
| | - Guodong Song
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Burns and Orthopedic Surgery, Jinan Central Hospital, Shandong University, Jinan, Shandong, China.
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Schott M, Dalmolin C, Golin A, Alves BP, Cassol MC, Brondani JE, Marques AR, Marques CT, Colpo E. Nutritional factors and pressure injury risk in hospitalised patients post-stroke. J Wound Care 2024; 33:S32-S39. [PMID: 38348865 DOI: 10.12968/jowc.2024.33.sup2.s32] [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: 02/15/2024]
Abstract
OBJECTIVE This study aimed to analyse the nutritional factors and pressure injury (PI) risk in hospitalised patients post-stroke. METHOD The research employed a descriptive observational method in which patients ≥18 years of age were followed for six days. Nutritional evaluation was based on anthropometric and dietary factors. The nutritional risk was assessed via anthropometric measurements, Braden nutrition subscale and daily dietary intake. PI risk was evaluated through the Braden Scale. The Wilcoxon test, paired t-test, and Kruskal-Wallis test were applied and corrected with Bonferroni correction or analysis of variance, followed by the post hoc Tukey test. RESULTS During their hospital stays, the participating 59 patients had an increase in sensory perception (p=0.02) and nutrition (p=0.005) scores. It was observed that patients at high risk of PI did not meet daily nutritional recommendations for calories, proteins, carbohydrates, lipids and micronutrients (zinc, selenium and copper) compared with patients at low-to-moderate risk. Weight (p<0.001), body mass index (p<0.001), calf (p=0.01) and arm (p=0.04) circumferences, and subscapular (p=0.003) and triceps (p<0.001) skinfolds decreased during the six days of hospitalisation. CONCLUSION From the findings of this study, it was concluded that nutritional factors, such as unmet recommended daily nutritional requirements of macronutrients and micronutrients, and nutritional status are associated with a higher risk of developing a PI.
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Affiliation(s)
- Mairin Schott
- Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | - Anieli Golin
- Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | | | - Juliana Ebling Brondani
- Graduate Program in Pharmacology, Federal University of Santa Maria, Rio Grande do Sul, Brazil
- Nutritionist, University Hospital of Santa Maria, Rio Grande do Sul, Brazil
| | | | - Clandio Timm Marques
- University of Lisbon, Portugal
- Professor, Franciscan University, Santa Maria, Rio Grande do Sul, Brazil
| | - Elisângela Colpo
- Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
- Professor of the Nutrition and Postgraduate Master's Degree in Health Sciences and Life Sciences, Franciscan University, Santa Maria, Rio Grande do Sul, Brazil
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Zhou J, Mo X, Xiao S, Chang S, Chen W, Wei Z. A Guide to Perforator Flap Selection for Buttock Pressure Sore Reconstruction. Ann Plast Surg 2024; 92:222-229. [PMID: 38198628 PMCID: PMC11441734 DOI: 10.1097/sap.0000000000003753] [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: 01/12/2024]
Abstract
ABSTRACT Perforator flaps have been increasingly used to repair stage IV buttock pressure ulcers. However, no one has proposed an approach for stage IV buttock pressure ulcers repairing based on the subregion of buttock pressure ulcers. This study aims to evaluate the effect of perforator flaps in the repair of stage IV buttock pressure ulcers, and flap selection was based on the location of the pressure ulcers. Over the past 5 years, we evaluated 65 cases of stage IV buttock pressure ulcers repaired using perforator flaps. Flap selection was based on the subregion of each buttock pressure ulcer, following our approach. A total of 87 perforator flaps were used for 65 cases, including 42 superior gluteal artery perforator flaps, 19 fourth lumbar artery perforator flaps, and 26 descending inferior gluteal artery perforator flaps. All patients showed satisfactory reconstruction. The authors' approach can support surgeons in selecting the appropriate flaps to repair stage IV buttock pressure ulcers and achieve excellent reconstructive outcomes. This method makes the selection of flaps for pressure ulcer repair systematic, simple, and highly feasible and thus is worthy of promotion.
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Affiliation(s)
- Jian Zhou
- From the Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University
| | - Xiaojin Mo
- From the Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University
| | | | - Shusen Chang
- From the Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University
| | - Wei Chen
- From the Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University
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Mazzucco L, Balbo V, Zingarelli EM, Desilvestri M, Marchioni M, Perrero L, Pollis F, Varvello I. Treatment of severe pressure ulcers with protein-enriched filtered platelet-rich plasma (PEF PRP): a possible management. Front Bioeng Biotechnol 2024; 11:1279149. [PMID: 38288245 PMCID: PMC10823015 DOI: 10.3389/fbioe.2023.1279149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024] Open
Abstract
Background: Biological dressings with non-transfusion blood components are among the treatments available for pressure ulcers (PUs). Biological dressings contain active concentrated pro-regenerative molecules that can modify and switch off local inflammatory pathways. This re-establishes the physiological homing, which results in healing. In our study, we used a biological component obtained by ultrafiltration of plasma-platelet concentrate: protein-enriched filtered platelet-rich plasma (PEFPRP) with a higher platelet and higher plasma protein concentration. We tested whether treatment with PEFPRP could improve healing in advanced-stage pressure ulcers with a large surface area. All the patients in this study had a surgical indication but were not able to undergo surgery for various reasons. Materials and methods: Ten patients with severe neurological disability and advanced-stage sacral pressure ulcers were treated with allogenic PEFPRP. The mean lesion surface area at T0 was 13.4 cm2 ( ± 9.8 SD). PEFPRP was derived from allogenic plasma-platelet apheresis that had been pre-ultrafiltered with a ProSmart™ filter (Medica, Italy) to obtain a concentration after filtration of the plasma protein (12-16 g/dL) and platelet (1-1.2 x 106 microL). Results and Conclusion: All cases showed a reduction in the surface area of the pressure ulcer and in the Pressure Ulcer Scale for Healing (PUSH) score. The mean reduction values at week 6 were as follows: -52% for surface area and -21% for PUSH. Rapid wound healing is fundamental to avoid infections and improve patients' quality of life. This blood component builds new tissue by creating a new extracellular matrix. This, in turn, promotes rapid restoration of the three-dimensional structure of the tissue necessary for healing deeper wounds. PEFPRP shrinks the PU and improves its morphological features (reducing undermining and boosting granulation tissue). PEFPRP also promotes tissue restoration, obtaining an optimal scar. It is a safe and feasible treatment, and these preliminary results support the use of PEFPRP in the treatment of pressure ulcers. PEFPRP dressings could be integrated in the standard treatment of advanced-stage PU.
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Affiliation(s)
- Laura Mazzucco
- Transfusion Medicine and Regeneration Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Valeria Balbo
- Transfusion Medicine and Regeneration Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Enrico Maria Zingarelli
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Manuela Desilvestri
- Neuro-Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo-Alessandria, Alessandria, Italy
| | - Manuela Marchioni
- Neuro-Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo-Alessandria, Alessandria, Italy
| | - Luca Perrero
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesca Pollis
- Transfusion Medicine and Regeneration Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Ilaria Varvello
- Neuro-Rehabilitation Unit, Rehabilitation Department, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo-Alessandria, Alessandria, Italy
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Heller R, Torri M, Gaab J, Haubruck P, Moghaddam-Alvandi A, Biglari B. Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases. SAGE Open Nurs 2024; 10:23779608241229507. [PMID: 38379575 PMCID: PMC10878226 DOI: 10.1177/23779608241229507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Pressure injuries (PIs) arise from sustained pressure on tissue, leading to reduced blood flow to the affected area. In patients with spinal cord injuries (SCIs), these PIs can significantly diminish their independence and overall quality of life. This research sought to assess the frequency of surgical complications in treatment regimens for large sacral PIs involving the anus. Specifically, the study focused on the incorporation of stoma formation in patients with SCIs. Methods A retrospective review identified 25 SCI patients who had extensive sacral PIs. These patients underwent intestinal stoma formation as a preparatory step before plastic reconstructive surgery to address the wounds between 2015 and 2020. Results Successful wound closure was achieved in all instances. Notably, each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before this intervention. The observed rate of surgical complications aligned with findings from previous analogous studies. Conclusion While often viewed as a treatment of last resort, an intestinal stoma might serve as a valuable strategy, particularly for SCI patients with extensive PIs near the anal region, to promote the healing of such injuries. Tailored decision-making is essential to ensure the best possible patient outcomes.
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Affiliation(s)
- Raban Heller
- Department of Traumatology and Orthopaedics Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
- Institute for Experimental Endocrinology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marco Torri
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jasmin Gaab
- Department of Traumatology and Orthopaedics Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Patrick Haubruck
- Raymond Purves Bone and Joint Research Laboratory, Kolling Institute, Institute of Bone and Joint Research, Faculty of Medicine and Health University of Sydney, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | | | - Bahram Biglari
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
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Cai J, Jiang M, Qi H. Evaluating the Effects of a General Anesthesia and Prone Position Nursing Checklist and Training Course on Posterior Lumbar Surgery: A Randomized Controlled Trial. J Patient Saf 2024; 20:22-27. [PMID: 37921750 DOI: 10.1097/pts.0000000000001178] [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: 11/04/2023]
Abstract
BACKGROUND While general anesthesia in the prone position is one of the most utilized surgical positions, it predisposes to multiple types of complications. Existing studies on this topic are mostly literature reviews or focus on solving one complication, which limits their clinical use. OBJECTIVE The aims of the study were to evaluate the effectiveness of a 22-item general anesthesia and prone position nursing checklist and specific training course at preventing complications related to general anesthesia in the prone position. DESIGN The study used a randomized controlled trial. SETTINGS AND PARTICIPANTS Convenience sampling was used to recruit patients who underwent general anesthesia during posterior lumbar surgery from July 2021 to December 2021 at the Run Run Shaw Hospital, Zhejiang University School of Medicine Hospital. METHODS Patients involved in the study were randomly assigned to the control (standard general anesthesia and prone position care) or experimental group (general anesthesia and prone position nursing checklist combined with specific training course in addition to standard general anesthesia and prone position care). Outcomes were pressure injuries, peripheral nerve injuries, ocular complications, and length of stay (LOS). Patient satisfaction, Numeric Pain Rating Scale (NRS) and the Oswestry Disability Scale were also measured. RESULTS Compared with the control group, pressure injury, brachial plexus injury, and two ocular findings (foreign body sensation and blurry vision) were significantly less common in the intervention group ( P ≤ 0.01). Participants who received standard general anesthesia and prone position care had lower self-reported satisfaction than those managed with the general anesthesia and prone position nursing checklist plus specific training course ( P = 0.002). The checklist-based intervention also significantly reduced LOS ( P = 0.000) and NRS ( P = 0.000). CONCLUSIONS The intervention group had significant fewer general anesthesia in the prone position-related complications, improved satisfaction, reduced LOS, and lower NRS. These findings suggest that a general anesthesia and prone position nursing checklist in addition to a specific training course are beneficial to standardizing prone position nursing care during posterior lumbar surgery.
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Affiliation(s)
- Jianshu Cai
- From the Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Tomas N, Mandume AM. Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study. Nurs Open 2024; 11:e2079. [PMID: 38268250 PMCID: PMC10782216 DOI: 10.1002/nop2.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation. DESIGN A qualitative descriptive phenomenological study. METHODS The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method. RESULTS The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales. CONCLUSION The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.
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Affiliation(s)
- Nestor Tomas
- Department of General Nursing Science, School of Nursing and Publish Health, Faculty of Health Sciences and Veterinary MedicineUniversity of Namibia (UNAM)RunduNamibia
| | - Annalisa M. Mandume
- Department of General Nursing Science, School of Nursing, Faculty of Health Sciences and Veterinary MedicineUniversity of Namibia (UNAM)RunduNamibia
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Zhao Y, Zhang M, Zhang C, Yan H. Effect of local oxygen therapy combined with vacuum sealing drainage on the healing of stage IV sacrococcygeal pressure ulcers. Int Wound J 2023; 20:4253-4261. [PMID: 37574848 PMCID: PMC10681464 DOI: 10.1111/iwj.14327] [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: 06/12/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
The present study aimed to investigate the effect of local oxygen therapy combined with vacuum sealing drainage (VSD) on the healing of stage IV pressure ulcers sacrococcygeal. In this prospective study, we included a total of 98 patients with stage IV sacrococcygeal pressure ulcers in our hospital between February 2021 and June 2022. The patients enrolled were randomly and equally divided into two groups: the study group (undergoing local oxygen therapy combined with VSD treatment) and the control group (receiving conventional treatment). The wound healing time and hospital stay were compared between the two groups. Additionally, the wound area, tissue type, wound exudation and pain intensity were assessed before treatment, 10, 20, 30 and 40 days after treatment. The incidence of complications was also calculated. The study group demonstrated significantly shorter wound healing time and hospital stays compared to the control group (p < 0.05). Before treatment, there were no significant differences in terms of wound area, tissue type and wound exudation between the two groups (p > 0.05); after 10, 20, 30 and 40 days of treatment, however, evidently smaller wound areas, improved tissue types and reduced wound exudation were observed in the study group compared to the control group (p < 0.05). Furthermore, the study group exhibited increased microvascular count compared to the control group (p < 0.05). Before treatment, there was no significant difference in pain intensity between the two groups (p > 0.05), whereas markedly lower pain intensity was seen in the study group than in the control group after 10, 20, 30 and 40 days of treatment (p < 0.05). The incidence of complications did not significantly differ between the two groups after 40 days of treatment (p > 0.05). Local oxygen therapy combined with VSD was found to effectively accelerate the healing process of stage IV sacrococcygeal pressure ulcers, leading to shorter hospital stays and improved patient prognosis. This combined therapy shows promise for widespread application in clinical practice.
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Affiliation(s)
- Yi Zhao
- Department of Burn and Plastic Surgery, Renmin HospitalHubei University of MedicineShiyanChina
| | - Mi Zhang
- Department of Dermatology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Chuanlin Zhang
- Department of Cardiology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Hongwei Yan
- Department of Burn and Plastic Surgery, Renmin HospitalHubei University of MedicineShiyanChina
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Dimanopoulos TA, Chaboyer W, Plummer K, Mickan S, Ullman AJ, Campbell J, Griffin BR. Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis. J Adv Nurs 2023. [PMID: 38037540 DOI: 10.1111/jan.16002] [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: 10/12/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
AIM This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI. DESIGN A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023. METHODS Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach. RESULTS Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence. CONCLUSION These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings. IMPACT Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.
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Affiliation(s)
- Tanesha A Dimanopoulos
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Karin Plummer
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Sharon Mickan
- Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia
| | - Jill Campbell
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Bronwyn R Griffin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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ALGhabra Y, Hamdi M, Kammasha A, Nashawi FE, Ashreefa R, Yousfan A. Bilateral Tongue Necrosis in a Young Patient as a Complication of Prolonged Oral Endotracheal Intubation: A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231211309. [PMID: 37997645 DOI: 10.1177/01455613231211309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
We present a unique case of complete tongue necrosis caused by a compression of an endotracheal tube (ETT). A 39-year-old female underwent endotracheal intubation secondary to respiratory failure following sudden altered mental status. Tongue swallowing developed and worsened with obvious pallor on examination. Extensive ischemic changes with tongue necrosis developed dramatically due to the compression during her prolonged intubation. This case of tongue necrosis highlights the importance of proper ETT sizing and positioning during prolonged intubation in ICU patients.
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Affiliation(s)
- Yasser ALGhabra
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Hamdi
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
- M.D, Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Ahmad Kammasha
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Faez Ebrahim Nashawi
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Reem Ashreefa
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Abdulmajeed Yousfan
- Department of Otolaryngology-Head and Neck Surgery, Al-Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
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Liu H, Zhang Y, Jiang H, Yao Q, Ren X, Xie C. Outcomes of hospital-acquired pressure injuries and present-on-admission pressure injuries: A propensity score matching analysis. J Tissue Viability 2023; 32:590-595. [PMID: 37563057 DOI: 10.1016/j.jtv.2023.08.001] [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: 06/16/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Pressure injuries (PIs) continue to present significant challenges. In recent years, the number of patients with present-on-admission pressure injury (POA-PI) has increased, but researchers have devoted little attention to it, and little is known about its clinical outcome. AIMS To compare the clinical outcomes of POA-PI and hospital-acquired pressure injury (HAPI) patients. METHODS In this study, hospitalized patients with pressure injuries were divided into two groups based on whether they acquired the injury in the hospital or already present at the time of their admission. The disease prognosis, duration of stay, and healthcare costs of patients with HAPI and POA-PI were evaluated using propensity score matching analysis (PSM), t-tests, and Mann-Whitney U tests. RESULTS The information on 1871 patients was retrieved from the electronic case system retroactively. A total of 305 pairs of patients were effectively matched between the two groups using propensity score matching (HAPI group = 305, POA-PI group = 305). There was no statistically significant difference at characteristics between the two groups (P > 0.05). The percentage of POA-PI group patients who were discharged from the hospital was greater than that of the HAPI group (P < 0.05). Conversely, the percentage of POA-PI group patients who died, ceased receiving treatment, or transferred to the hospital was lower than that of the HAPI group. Patients in the POA-PI group had shorter hospital stays than those in the HAPI group (P < 0.05). Patients in the POA-PI group had lower healthcare costs than those in the HAPI group (P < 0.05). CONCLUSIONS Patients with POA-PI have superior clinical outcomes than patients with HAPI, but make up the overwhelming majority of hospitalized patients. It is imperative that future research focuses on the reduction of POA-PI and HAPI incidence and the identification of therapies that will enhance patient prevention for these conditions.
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Affiliation(s)
- Hanmei Liu
- Affiliated Hospital of Zunyi Medical University, Zunyi, China; Philippine Women's University, Manila, Philippines
| | - Yongmei Zhang
- Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hu Jiang
- The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China.
| | | | - Xu Ren
- Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chaoqun Xie
- The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, China
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Aloweni FBAB, Lim SH, Agus NLB, Ang SY, Goh MM, Yong P, Fook-Chong S, Tucker-Kellogg L, Soh CR. Evaluation of an Evidence-Based Care Bundle for Preventing Hospital-Acquired Pressure Injuries in High-Risk Surgical Patients. AORN J 2023; 118:306-320. [PMID: 37882600 DOI: 10.1002/aorn.14021] [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: 06/17/2021] [Revised: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 10/27/2023]
Abstract
The aim of this study was to evaluate the effectiveness of an evidence-based care bundle to prevent perioperative pressure injuries. In a single facility, using a preintervention and postintervention quasi-experimental design, we compared the pressure injury incidence rate for two patient groups (ie, before and after care bundle implementation). The bundle included a variety of elements, such as educating patients, applying protection, controlling skin moisture, and using pressure-relieving devices according to the patient's risk. Before the intervention, patients received standard care before procedures that did not address risk for pressure injury development. The study involved a total of 944 patients, and the incidence of pressure injury was lower in the postintervention group than in the preintervention group (1.6% versus 4.8%; P < .001). However, the odds ratio was nonsignificant and therefore the clinical relevance of the bundle is unclear. Additional research with a control group and multiple sites is needed.
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Kim M, Shin YS. Risk factors for device-related pressure injuries in general ward inpatients of a tertiary general hospital: A case-control study. J Tissue Viability 2023; 32:601-606. [PMID: 37558560 DOI: 10.1016/j.jtv.2023.07.006] [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: 04/11/2023] [Revised: 07/03/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
AIMS To identify the characteristics of device-related pressure injuries (DRPI) in general ward inpatients, and to confirm the DRPI risk factors by examining differences between a DRPI and non-DRPI group. METHODS This study is a retrospective case-control study. High-risk adult patients for pressure injuries (rated at 16 points or less on the Braden scale) who were admitted to a general ward of a tertiary general hospital in South Korea from January 1 to September 30, 2021 were enrolled in this study. Among them, participants were selected by matching the patients with DRPI (n = 50) to the non-DRPI patient group (n = 100) in a ratio of 1:2. RESULTS As for risk factors, longer hospitalization periods and the presence of oedema increased DRPI risk. In blood tests, higher glucose levels increased the risk by 1.03 times, and lower albumin levels increased the risk by 0.08 times. Furthermore, the risk of developing DRPI was 7.89 times higher when sedatives were administered. CONCLUSIONS Based on the DRPI risk factors identified in this study, patients who have oedema, who have long hospital stays, use sedatives and devices, have a low albumin level, and whose blood glucose is not well controlled should be recognized as having a high risk of developing DRPI. In order to prevent the development of DRPI, it is necessary to recognize risk factors at an early stage, increase actively preventive interventions. The results of this study contribute to recognizing the risk of DRPI in patients and evaluating risk factors for DRPI prevention.
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Affiliation(s)
- Minkyung Kim
- Graduate School, Hanyang University, Samsung Medical Center, 81 Irwon-Ro Gangnam-gu. Seoul, 06351, Republic of Korea.
| | - Yong Soon Shin
- College of Nursing, Hanyang University, Republic of Korea.
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50
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Luo Y, Luo S, Luo L, Ou M, Tang M. Effect of hydrocolloid dressing on pressure ulcer in patients with non-invasive positive pressure ventilation: A meta-analysis. Int Wound J 2023; 21:e14442. [PMID: 37857589 PMCID: PMC10828119 DOI: 10.1111/iwj.14442] [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] [Received: 09/17/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
This study systematically evaluated the effect of hydrocolloid dressings on facial pressure ulcers in patients receiving non-invasive positive pressure ventilation (NIPPV). The Embase, PubMed, Cochrane Library, CNKI, VIP, Chinese Biomedical Literature Database and Wanfang databases were searched for randomised controlled trials on the use of hydrocolloid dressings in patients receiving NIPPV published from the inception of each database to August 2023. The literature was independently screened, data were extracted by two authors based on the inclusion and exclusion criteria, and the quality of the included literature was assessed. The meta-analysis was performed using Stata 17.0. Thirteen studies including 1248 patients were included, with 639 patients in the intervention group and 609 patients in the control group. Meta-analysis showed that the hydrocolloid dressing significantly reduced the incidence of facial pressure ulcers in patients with NIPPV (odds ratio = 0.16, 95% confidence intervals: 0.11-0.24, p < 0.001). Hydrocolloid dressings are effective in reducing the incidence of facial pressure ulcers in patients receiving NIPPV. However, because of the small number of included studies, this conclusion needs to be confirmed with larger samples and high-quality clinical studies.
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Affiliation(s)
- Yu‐Lan Luo
- Department of Critial Care MedicineWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduSichuanChina
| | - Shi‐Feng Luo
- Department of Critial Care MedicineWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduSichuanChina
| | - Lin Luo
- Department of Critial Care MedicineWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduSichuanChina
| | - Min Ou
- Department of Critial Care MedicineWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduSichuanChina
| | - Meng‐Lin Tang
- Department of Cardiovascular SurgeryWest China Hospital, Sichuan University/West China School of Nursing, Sichuan UniversityChengduSichuanChina
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