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Appiah EO, Appiah S, Oti-Boadi E, Boadu BA, Kontoh S, Adams RI, Appiah C, Sarpong C. Attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. PLoS One 2023; 18:e0290970. [PMID: 37682963 PMCID: PMC10490930 DOI: 10.1371/journal.pone.0290970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Pressure ulcers (PUs), which affect millions of people worldwide, are among the five most prevalent hospitalized cases causing adverse impairment. Nevertheless, pressure ulcers are largely preventable, and their management depends on their severity. The authors, therefore, explored the attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. METHODS An exploratory descriptive qualitative approach was employed for this study to help researchers explore the attitude and practices toward PU (Pressure Ulcer). Purposive sampling approach was employed, and data was analyzed using thematic content analysis. The sample size for this study was 30 which was obtained based on saturation. Participants were engaged in face-to-face interviews which were transcribed verbatim. FINDINGS Two themes and eight subthemes were generated from the analysis of this study. The two themes were preventive practices and attitude towards PU. The study identified that there were no specific protocols illustrated on the wards for managing pressure ulcers. Nevertheless, the study participants were keen on preventing pressure ulcers and hence engaged in practices such as early patients' ambulation, early identification of PU signs, removing creases and crumps from patient beds, nutritional management for PU prevention, and dressing of PU wounds. CONCLUSION Practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence, the nurses recommended the need for accepted guidelines on pressure ulcer management to be illustrated in the various orthopedic wards in the country.
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Affiliation(s)
- Evans Osei Appiah
- School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
- Purdue University, West Lafayette, IN, United States of America
| | - Stella Appiah
- Head of Nursing Department, School of Nursing and Midwifery, Valley View University, Accra, Ghana
| | - Ezekiel Oti-Boadi
- School of Nursing, Heritage Christian College, Valley View University, Accra, Ghana
| | | | - Samuel Kontoh
- Department of Mental Health, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | | | - Cyndi Appiah
- Ghana Christian University College, Amrahia, Ghana
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Farahbakhsh F, Rezaei Aliabadi H, Baigi V, Ghodsi Z, Dashtkoohi M, Pour-Rashidi A, Harrop JS, Rahimi-Movaghar V. Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data. Chin J Traumatol 2023:S1008-1275(23)00024-X. [PMID: 37062622 PMCID: PMC10388246 DOI: 10.1016/j.cjtee.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
PURPOSE To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs) METHODS: Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) centers from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI). RESULTS Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR 3.06, 95% CI 1.55-6.03, p = 0.001), and number of days in the ICU (OR 1.06, 95% CI 1.04-1.09, p < 0.001) maintained significance. CONCLUSIONS These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.
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Affiliation(s)
- Farzin Farahbakhsh
- Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vali Baigi
- Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Dashtkoohi
- Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pour-Rashidi
- Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, USA
| | - Vafa Rahimi-Movaghar
- Sina and Trauma Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Universal Scientific Education and Research Network (USERN), Tehran, Iran; Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; Spine Program, University of Toronto, Toronto, Canada.
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Teng M, Bensmail D, Hanachi M, Haddad R, Hugeron C, Lansaman T, Levy J. Nutritional status in patients with advanced‐stage multiple sclerosis. Eur J Neurol 2022; 29:1730-1740. [DOI: 10.1111/ene.15286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Maëlys Teng
- Service de Médecine Physique et de Réadaptation – APHP Hôpital Rothschild Paris France
| | - Djamel Bensmail
- Service de Médecine Physique et de Réadaptation – APHP Hôpital Raymond Poincaré Garches France
- INSERM U1179 Handicap Neuromusculaire – Université de Versailles St Quentin Montigny‐le‐Bretonneux France
- Fondation Garches, Hôpital Raymond Poincaré Garches France
| | - Mouna Hanachi
- Unité de Nutrition Clinique ‐ APHP Hôpital Paul Brousse Paris France Université Paris‐Saclay
| | - Rebecca Haddad
- Sorbonne Université GRC 001 GREEN Groupe de recherche en Neuro‐Urologie, APHP
- Service de Médecine Physique et de Réadaptation – APHP Hôpital Rothschild Paris France
| | - Caroline Hugeron
- Service de Médecine Physique et de Réadaptation – APHP Hôpital Raymond Poincaré Garches France
| | - Thibaud Lansaman
- Service de Médecine Physique et de Réadaptation – APHP Hôpital Raymond Poincaré Garches France
| | - Jonathan Levy
- Service de Médecine Physique et de Réadaptation – APHP Hôpital Raymond Poincaré Garches France
- INSERM U1179 Handicap Neuromusculaire – Université de Versailles St Quentin Montigny‐le‐Bretonneux France
- Fondation Garches, Hôpital Raymond Poincaré Garches France
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Farkas GJ, Sneij A, Gater DR. Dietetics After Spinal Cord Injury: Current Evidence and Future Perspectives. Top Spinal Cord Inj Rehabil 2021; 27:100-108. [PMID: 33814888 DOI: 10.46292/sci20-00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Following spinal cord injury (SCI), individuals are at high risk for obesity and several chronic cardiometabolic disorders due to a deterioration in body composition, hypometabolic rate, and endometabolic dysregulation. Countermeasures to the consequences of an SCI include adopting a healthy diet that provides adequate nutrition to maintain good body habitus and cardiometabolic health. A proper diet for individuals with SCI should distribute carbohydrates, protein, and fat to optimize a lower energy intake requirement and should stress foods with low caloric yet high nutrient density. The purpose of this article is to present available evidence on how nutritional status after SCI should advance future research to further develop SCI-specific guidelines for total energy intake, as it relates to percent carbohydrates, protein, fat, and all vitamins and minerals, that take into consideration the adaptations after SCI.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.,The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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Incidence of Pressure Injury in Individuals With Spinal Cord Injury: A Systematic Review and Meta-analysis. J Wound Ostomy Continence Nurs 2021; 47:215-223. [PMID: 32384524 DOI: 10.1097/won.0000000000000633] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE The purpose of this systematic review and quantitative analysis of pooled data was to assess the global incidence of pressure injury (PI), across time frames and countries, in individuals with spinal cord injury (SCI). DESIGN Systematic review and meta-analysis. SEARCH STRATEGY PubMed, Web of Science, and EMBASE databases were systematically searched for studies published from database inception to January 2019, with only English language studies that reported the incidence of PIs in individuals with SCI were included. Study quality was assessed by a 14-item standardized checklist. We calculated the incidence of PIs as the number of new PIs in individuals with SCI and the total number of individuals with SCI during the study period. Findings are presented as incidence rate with 95% confidence intervals (CIs). RESULTS The search yielded 1652 studies; after studies were reviewed for inclusion criteria, 29 studies representing N = 82,722 patients were retained for data extraction. The global incidence of PIs was 0.23 (95% CI, 0.20-0.26). Data for regional distribution by country showed a pooled incidence of 0.43 (95% CI, 0.28-0.57) in individuals with SCI in South American countries, 0.36 (95% CI, 0.16-0.56) in African countries, 0.25 (95% CI, 0.14-0.37) in European countries, 0.23 (95% CI, 0.19-0.27) in North American countries, and 0.16 (95% CI, 0.06-0.25) in Asian countries. The incidence was 0.22 (95% CI, 0.19-0.26) in developing countries versus 0.27 (95% CI, 0.17-0.37) in developed countries. From 2000 to 2009, the incidence of PIs in individuals with SCI was 0.28 (95% CI, 0.09-0.47). The incidence rate of PIs before 2000 and after 2009 was 0.23. The hospital- and community-acquired PI incidence was 0.22 (95% CI, 0.19-0.26) and 0.26 (95% CI, 0.20-0.32), respectively. CONCLUSIONS Study findings indicate that more than 1 in 5 individuals with SCI will develop a PI. Individuals with SCI are at high risk of developing PI, especially in community settings or low- and middle-income developing countries. The findings highlight the importance of further investigation of risk factors and prevention and management strategies for PIs in individuals with SCI.
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Anthony D, Alosaimi D, Shiferaw WS, Korsah K, Safari R. Prevalence of pressure ulcers in africa: A systematic review and meta-analysis. J Tissue Viability 2020; 30:137-145. [PMID: 33129668 DOI: 10.1016/j.jtv.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/10/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND A recent global review of pressure ulcers contained no studies from Africa. OBJECTIVE To identify the prevalence and incidence of pressure ulcers in Africa. DATA SOURCES Bibliographic databases, African specific databases, grey literature. STUDY ELIGIBILITY CRITERIA Studies with prevalence or incidence data of pressure ulcers from Africa since the year 2000. PARTICIPANTS Any age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings. STUDY APPRAISAL AND SYNTHESIS METHODS Hoy score for bias, Joanna Briggs Institute Critical Appraisal Instrument. METHOD We followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data. RESULTS Nineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%. LIMITATIONS restricted to English, French and Arabic. CONCLUSION Prevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases. IMPLICATIONS OF KEY FINDINGS Further prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the "Checklist for Prevalence Studies" from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed. SYSTEMATIC REVIEW REGISTRATION NUMBER Prospero registration number CRD42020180093.
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Affiliation(s)
- Denis Anthony
- Health and Social Care Research Centre, University of Derby, UK.
| | | | | | - Kwadwo Korsah
- School of Nursing and Midwifery, University of Ghana, Ghana.
| | - Reza Safari
- Health and Social Care Research Centre, University of Derby, UK.
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Pressure ulcers after traumatic spinal injury in East Africa: risk factors, illustrative case, and low-cost protocol for prevention and treatment. Spinal Cord Ser Cases 2020; 6:48. [PMID: 32541848 DOI: 10.1038/s41394-020-0294-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective, case-control study. OBJECTIVES In a traumatic spinal injury (TSI) cohort from Tanzania, we sought to: (1) describe potential risk factors for pressure ulcer development, (2) present an illustrative case, and (3) propose a low-cost outpatient protocol for prevention and treatment. SETTING Tertiary referral hospital. METHODS All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, time to hospital, injury characteristics, operative management, length of hospitalization, and mortality. Pressure ulcer development was the primary outcome. Regressions were used to report potential predictors, and international guidelines were referenced to construct a low-cost outpatient protocol. RESULTS Of 267 patients that met the inclusion criteria, 51 developed a pressure ulcer. Length of stay was greater for patients with pressure ulcers compared with those without (45 vs. 30 days, p < 0.001). Potential predictors for developing pressure ulcers were: increased days from injury to hospital admission (p = 0.036), American Spinal Injury Association Impairment Scale grade A upon admission (p < 0.001), and thoracic spine injury (p = 0.037). The illustrative case described a young male presenting ~2 months after complete thoracic spinal cord injury with a grade IV sacral pressure ulcer that lead to septic shock and death. Considering the dramatic consequences of pressure ulcers in lower- and middle-income countries (LMICs), we proposed a low-cost protocol for prevention and treatment targeting support surfaces, repositioning, skin care, nutrition, follow-up, and dressing. CONCLUSIONS Pressure ulcers after TSI in LMICs can lead to increased hospital stays and major adverse events. High-risk patients were those with delayed presentation, complete neurologic injuries, and thoracic injuries. We recommended aggressive prevention and treatment strategies suitable for resource-constrained settings.
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Shiferaw WS, Akalu TY, Mulugeta H, Aynalem YA. The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:334. [PMID: 32471497 PMCID: PMC7260823 DOI: 10.1186/s12891-020-03369-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/25/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pressure ulcers (PU), one of the common challenging public health problems affecting patient with spinal cord injury. PUs occurs over bony areas of the body where pressure and tissue distortion is greatest. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, this review and meta-analysis aimed to estimate the global magnitude of pressure ulcers among patient with spinal cord injury. METHODS PubMed, Scopus, Google Scholar, African Journals Online, PsycINFO, and Web of Science were systematically searched to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. DerSimonian and Laird random-effects model was applied to obtain the pooled effect size. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Egger's regression test statistic. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software. RESULTS A total of 24 studies which comprises of 600,078 participants were included in this study. The global pooled magnitude of pressure ulcers among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18). CONCLUSION This systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policy maker and other concerned body should be design country context- specific preventive strategies to reduce the burden of pressure ulcers in patients with spinal cord injury.
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Affiliation(s)
- Wondimeneh Shibabaw Shiferaw
- Department of Nursing, College of Health Science, Institute of Medicine and College of Health Science, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Institute of Medicine and College of Health Science, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia
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Bacteriology and Antimicrobial Sensitivity of Isolated Bacteria from Pressure Ulcers After Spinal Cord Injury. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.12446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Xue M, Wang D, Zhang Z, Cao Z, Luo Z, Zheng Y, Lu J, Zhao Q, Zhang XD. Demonstrating the Potential of Using Transcutaneous Oxygen and Carbon Dioxide Tensions to Assess the Risk of Pressure Injuries. Int J Biol Sci 2018; 14:1466-1471. [PMID: 30262998 PMCID: PMC6158733 DOI: 10.7150/ijbs.26987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/22/2018] [Indexed: 02/04/2023] Open
Abstract
Pressure injuries have a high incidence in elderly and critically ill patients, and can endanger lives in severe cases. The key to reducing the incidence of pressure injuries is to find an objective, noninvasive, automatic and consistent scientific method for assessing pressure injuries. To serve this need, we conducted a clinical study to investigate the potential of using transcutaneous oxygen tension (TcPO2) and transcutaneous carbon dioxide tension (TcPCO2) for assessing pressure injuries. From the results of the study we found that first, the values of TcPO2 and TcPCO2 are sensitive to the change of pressure imposed on the measured region and to the risk status of a pressure injury when a pressure is imposed. Second, the magnitude of change in TcPO2 and TcPCO2 is higher in patients with a high risk of a pressure injury compared with those who have a low risk. Third, TcPO2 and TcPCO2 are both significantly correlated with the Braden score, the widely used score for assessing the risk of a pressure injury. Therefore, TcPO2 and TcPCO2 have a potential to be an effective and convenient scientific tool for assessing the risk of pressure injuries.
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Affiliation(s)
- Mei Xue
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Dandan Wang
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
| | - Zhaozhi Zhang
- Department of Statistical Science, Duke University, Durham, NC 27708, USA
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Zujin Luo
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Yingying Zheng
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Jingjing Lu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine, Beijing Engineering Research Center of Respiratory and Critical Care Medicine, Engineering Research Center of Diagnosis and Treatment of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing 100043, China
| | - Qi Zhao
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau
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Abstract
OBJECTIVE Identify the prevalence of alcohol consumption and binge drinking at time of spinal cord injury (SCI) onset, compare these rates to data from the general population, and identify changes in alcohol use at an average of 17 months post-injury. DESIGN Cross sectional, mailed self-report assessment. SETTING A specialty hospital in the southeastern United States. PARTICIPANTS Five hundred sixty-six inpatients completed the baseline measure. After eliminating those under age 18, there were 524 participants at baseline. 410 were approached for follow-up, with 201 of those responding. INTERVENTIONS N/A. OUTCOME MEASURES Self-reported assessments were completed during inpatient rehabilitation and at follow-up approximately 17 months later. The two primary outcomes were the number of days consuming 5 or more drinks (binge drinking) and the number of days consuming any alcoholic beverages within the 30 days prior to the assessment. Comparison data were taken from the Behavioral Risk Factor Surveillance System. RESULTS At SCI onset, the prevalence of alcohol use, particularly binge drinking, was substantially higher than the general population (SCI = 44.9%; general population = 13%). Drinking rates decreased by 17 months post-injury. CONCLUSION Alcohol use and binge drinking are elevated over the general population at the time of injury. Drinking patterns reflect a decrease following injury but remain slightly elevated, signifying a need for interventions to minimize long-term health consequences.
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Affiliation(s)
- Janice F. Davis
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Yue Cao
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James S. Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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Predictors of pressure ulcer incidence following traumatic spinal cord injury: a secondary analysis of a prospective longitudinal study. Spinal Cord 2017; 56:28-34. [PMID: 28895575 DOI: 10.1038/sc.2017.96] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Secondary analysis of data from a prospective cohort study. OBJECTIVES The objective of this study was to identify the medical and demographic factors associated with the development of pressure ulcers during acute-care hospitalization and inpatient rehabilitation following acute spinal cord injury. SETTING The study was carried out at acute hospitalization, inpatient rehabilitation and outpatient rehabilitation sites at a university medical center in the United States. METHODS Adults with acute traumatic spinal cord injury (n=104) were recruited within 24-72 h of admission to the hospital. Pressure ulcer incidence was recorded. RESULTS Thirty-nine participants out of 104 (37.5%) developed at least one pressure ulcer during acute-care hospitalization and inpatient rehabilitation. Univariate logistic regression analyses revealed significant association of pressure ulcer incidence for those with pneumonia and mechanical ventilation (P=0.01) and higher injury severity (ASIA A) (P=0.01). Multiple logistic regression showed that the odds of formation of a first pressure ulcer in participants with ASIA A was 4.5 times greater than that for participants with ASIA B, CI (1-20.65), P=0.05, and 4.6 times greater than that for participants with ASIA C, CI (1.3-16.63), P=0.01. CONCLUSION Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure ulcers. Pneumonia was noted to be associated with the formation of pressure ulcers.
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Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge. Spinal Cord 2016; 55:208-212. [PMID: 27527239 DOI: 10.1038/sc.2016.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/10/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective follow-up study. OBJECTIVES To increase the knowledge regarding clinical and functional outcomes after traumatic spinal cord injuries (TSCI) in a resource-constrained setting. A special focus was placed on secondary complications such as pressure ulcers. SETTING The national referral hospital in Gaborone, Botswana. METHODS The study included all patients admitted with an acute TSCI during a 2-year period (n=39). Data collection was conducted at the time of discharge, and clinical characteristics, length of stay and pressure ulcers were analysed using descriptive and inferential statistics. RESULTS Completeness of injury and presence of pressure ulcers were the factors found to significantly prolong hospitalization, which was 5 months (median). One patient died before discharge and one was discharged to rehabilitation in South Africa; all other patients were living with close or distant family members after discharge. Patients were supplied with electrical or manual active wheelchairs. Self-catheterization or suprapubic catheters were the main methods for bladder management, and ano-rectal stimulation to manage the bowel. Pressure ulcers, urinary tract infections and pain were the most frequent complications during in-patient care. CONCLUSIONS Rehabilitation of patients with TSCI in Botswana has been going through big changes, and new rehabilitation objectives, such as techniques used for the management of bladder and bowel dysfunctions and the provision of technical aids, have been implemented, which likely can contribute to an overall improvement in the outcomes. However, basic care at the general wards is still lagging behind, causing high rates of pressure ulcers that significantly extend hospitalization periods.
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Emejulu JKC, Nwadi UV, Obiegbu HO. Does Improvised Waterbed Reduce the Incidence of Pressure Ulcers in Patients with Spinal Injury? Niger J Surg 2015; 21:119-23. [PMID: 26425065 PMCID: PMC4566317 DOI: 10.4103/1117-6806.162571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Pressure ulcers are lesions caused by unrelieved pressure over bony prominences, resulting in damage to underlying tissues. The etiology is multifactorial including prolonged immobility. They usually complicate spinal cord injuries with long periods of bed confinement. The use of bed replacements markedly reduces the incidence of pressure ulcers, but the unaffordability of these replacements in low-income countries has necessitated the need to explore cheaper alternatives. Aim and Objective: The aim of this study was to ascertain whether the use of our cheap and locally improvised waterbeds would reduce the incidence of pressure ulcers in patients on prolonged bed confinement due to spinal injury. Methodology: Over a 16-month period, 51 patients (age range 1-80 years) with spinal injuries were managed conservatively in our service using improvised waterbeds in 21 (41.2%), while using the regular hospital bed/foam in 30 (58.8%). Biodata, the time interval between injury and presentation to the hospital, nature of the injury, use of improvised waterbed and development of pressure ulcer, were collected, collated, and analyzed. Statistical significance was calculated with the Chi-square test. Results: Most were males (98%), in the age range of 21–30 years (25.5%), and due to fall from heights (35.3%). Of 21 patients who were managed on improvised waterbeds, 6 (28.6%) had pressure ulcers, and of the 30 who did not use the waterbed, 17 (56.7%) developed ulcers. The χ2 = 3.9381, while P = 0.0472. This difference was statistically significant. Conclusion: The improvised waterbed, which is much cheaper than the standard waterbed, was observed to have significantly reduced the incidence of pressure ulcers among our patients. Nonetheless, further studies would still be needed to confirm this observation.
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Affiliation(s)
- Jude-Kennedy C Emejulu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Uchenna V Nwadi
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Henry O Obiegbu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Pressure ulcers in people with spinal cord injury in developing nations. Spinal Cord 2014; 53:7-13. [PMID: 25366536 DOI: 10.1038/sc.2014.179] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 09/22/2014] [Accepted: 09/28/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Literature review. OBJECTIVES To explore the prevalence or incidence, risk factors, and costs of pressure ulcers among individuals with spinal cord injury (SCI), specifically in the context of the developing world. To highlight important targets for intervention and research for pressure ulcer management the world over. SETTING World Bank 'low-income' and 'middle-income' countries with a gross national income per capita <$12 746. METHODS PubMed search. RESULTS SCI-associated pressure ulcers are very prevalent in developing nations; however, reported prevalence and incidence numbers are highly variable. Risk factors for pressure ulcers are similar in developed and developing countries however many of the risk factors are more prevalent in developing nations. CONCLUSION SCI-associated pressure ulcers are common but can be prevented in the developing world. Key targets for interventions include acute care, nurse-to-patient ratios, support surfaces and education.
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Alja'afreh M, Mosleh SM. Pressure ulcers in Jordan: a snapshot survey of a tertiary public hospital. ACTA ACUST UNITED AC 2014; 22:S10, S12, S14-6. [PMID: 24225505 DOI: 10.12968/bjon.2013.22.sup20.s10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients are at risk of developing pressure ulcers while they are hospitalised. These risks need to be managed effectively to avoid harm and to minimise costs. OBJECTIVE This study was aimed at determining the prevalence and incidence of pressure ulcers at selected acute clinical settings in central Jordan. DESIGN A cross-sectional survey design. METHOD An inpatient snapshot survey was conducted over 4 weeks in the two medical wards in a tertiary public hospital. RESULTS 190 participants were surveyed, 30 cases were identified, 53% were male, and 75% were aged 60 years or older. Prevalence was 24%, approximately half of the cases were grade 2 and 23% were grade 3 and 4. Pressure ulcers were mainly found on the sacrum (43%), followed by the heel (24%). Over 4 weeks, 29 new pressure ulcer cases were identified; 55% were male, and 90% were aged 60 years or older. Pressure ulcers were mainly-in 38% of cases-identified with cerebral vascular accident patients. CONCLUSION The results of the snapshot survey confirmed that there is a problem with maintaining patients' safety in terms of patients acquiring pressure ulcers in hospital. The number of pressure ulcers indicate less-than-optimal management of patient safety, which requires a more detailed investigation.
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Affiliation(s)
- Mahmoud Alja'afreh
- Head of Department of Fundamental and Adult Nursing, at Faculty of Nursing Mutah University, Karak, Jordan
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Dugaret E, Videau MN, Faure I, Gabinski C, Bourdel-Marchasson I, Salles N. Prevalence and incidence rates of pressure ulcers in an Emergency Department. Int Wound J 2012; 11:386-91. [PMID: 23043304 DOI: 10.1111/j.1742-481x.2012.01103.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Older patients represent an increasing population in emergency department (ED) with underlying diseases and longer ED length of stay, which are potential risk factors of pressure ulcers (PUs). The aim of the study was to determine the prevalence and incidence rates of PUs in an Emergency Department and to analyse variables related to PUs occurrence. The study was carried out in the Emergency Department of Bordeaux (France), and included 602 patients from 1 to 15 June 2010. All the potential body sites of pressure were examined at admission and discharge for all the patients by trained nurses. Comorbidity score, list of treatment, length of stay (hours), PUs (including stage I) and C-reactive protein (CRP) level were systematically recorded. A total of 47 (7·8%) patients had prevalent PUs at admission and 74 (12·3%) at discharge. The cumulative incidence was 4·9% and the incidence density was 5·4 per 1000 patients per hour. In multivariate analysis, higher comorbidities (OR 1·3; P = 0·014) and CRP levels (OR 1·005; P = 0·017) were both independent risk factors for developing PU. In conclusion, these data show that even a very short stay to the ED is sufficient to induce PUs especially stage I.
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Affiliation(s)
- Elodie Dugaret
- CHU Bordeaux, Pôle de Gérontologie Clinique, Pessac, FrancePôle de Médecine et Urgences, Bordeaux, France
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TeslimOnigbinde A, Ogunsanya GI, Oniyangi SO. Pressure ulcer incidence among high-risk inpatients in Nigeria. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjon.2012.21.sup12.s4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ayodele TeslimOnigbinde
- Medical Rehabilitation Department, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Gbolade Isaac Ogunsanya
- Medical Rehabilitation Department, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Shuaib Olanrewaju Oniyangi
- Department of Human Kinetics and Health Education, Faculty of Education, University of Ilorin, Ilorin, Nigeria
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