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Munoz N, Litchford M. Nutritional Aspects of Wound Care. Clin Geriatr Med 2024; 40:481-500. [PMID: 38960539 DOI: 10.1016/j.cger.2023.12.005] [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: 07/05/2024]
Abstract
Malnutrition is a collective term that includes both undernutrition and malnutrition. Malnutrition presents with and without inflammation, is reported in underweight, normal weight, and overweight individuals, and is associated with undesirable alterations in body composition, and diminished functional status. Older adults commonly experience dwindling nutritional status as evidenced by insidious weight loss, insufficient dietary intake, loss of muscle mass, quality, and strength, declining functional status, and other physical and emotional decline indicators. Sustained pressure, acute trauma, malnutrition, and inflammatory-driven chronic conditions increase the risk for skin integrity issues.
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Affiliation(s)
- Nancy Munoz
- Chief Nutrition and Food Service, VA Southern Nevada Healthcare System, Las Vegas, NV, USA.
| | - Mary Litchford
- Case Software, 5601 Forest Manor Drive, Greensboro, NC 27410, USA
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Jia YJ, Yu HR, Hu FH, Tang W, Zhang WQ, Ge MW, Shen LT, Du W, Cai B, Xu H, Xia XP, Chen HL. Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis. J Tissue Viability 2024; 33:405-411. [PMID: 38886143 DOI: 10.1016/j.jtv.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The association between underweight and pressure injuries (PIs) has been established in several studies. However, there is a lack of well-designed research investigating the connection between overweight and obesity with these injuries. OBJECTIVE This meta-analysis aims to investigate the dose-response relationship between body mass index (BMI) and the risk of PIs in adult hospitalized patients. METHODS PubMed, Web of Science, and MEDLINE Databases were searched from inception to May 2024. Observational articles with at least three BMI categories were included in the study. BMI was defined as underweight, normal weight, overweight, and morbid obesity for the meta-analysis. The non-linear relationship between BMI and the risk of PIs in hospitalized adults was investigated using restricted cubic spline models. Fractional polynomial modeling was used. RESULTS Eleven articles reporting at least 3 categories of BMI met the inclusion criteria, including 31,389 participants. Compared to patients with normal weight, those with underweight, obesity, and morbid obesity exhibited an increased risk of PIs, with odds ratios of 1.70 (95%CI:1.50-1.91), 1.12 (95%CI:1.02-1.24), 1.70 (95%CI:1.13-2.55), respectively. A J-shaped dose-response model was established for the relationship between PI risk and BMI (Pnon-linearity < 0.001, Plinearity = 0.745). CONCLUSION The J-shaped dose-response pattern revealed that underweight, obesity and morbid obesity heightened the risk of PIs in hospitalized adults. Lower and higher BMI values may signify an increased risk for PIs, particularly among the elderly with lower BMI, providing valuable guidance for medical staff.
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Affiliation(s)
- Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Rong Yu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Bo Cai
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Xiao-Peng Xia
- Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China.
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Morrow MM, Hughes LC, Collins DM, Vos-Draper TL. Clinical Remote Monitoring of Individuals With Spinal Cord Injury at Risk for Pressure Injury Recurrence Using mHealth: Protocol for a Pilot, Pragmatic, Hybrid Implementation Trial. JMIR Res Protoc 2024; 13:e51849. [PMID: 38598267 PMCID: PMC11043927 DOI: 10.2196/51849] [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: 08/31/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Pressure injuries are one of the most challenging secondary conditions for individuals with spinal cord injuries and related disorders (SCI/D) owing to inherent, lifelong risk factors that include a lack of sensory and motor function below the level of injury and reliance on a wheelchair for daily mobility, resulting in prolonged periods of sitting. Although many factors contribute to the development of pressure injuries, the pressure between the skin and a surface is always a factor and the development of injury is dependent on the magnitude and duration of the pressure. Clinically, broad recommendations for relieving pressure are used because we know very little about the unique day-to-day life patterns of the individual wheelchair user. Typically, it is after the occurrence of a pressure injury that the therapist will check equipment fit and the effectiveness of pressure offloading and ask about other surfaces they sit on in their home and community. This time-lapsed, largely self-reported data are fraught with recall bias and inaccuracies that the therapist incorporates into a plan of care. OBJECTIVE This study's objective is to pilot-test the implementation and clinical effectiveness of a telehealth model of care combined with our mobile health (mHealth) Assisted Weight-Shift device for remote monitoring of factors related to maintaining skin health and wheelchair setup. Our overall hypothesis is that this study will result in an effective implementation plan, and the enhanced connected model of care using remote monitoring of pressure management will result in pilot-level, improved clinical outcomes for adults with spinal cord injury at high risk for pressure injury recurrence. METHODS For all aims, we will use a mixed methods design using an exploratory, sequential approach to include the strengths of both qualitative and quantitative data. For aims 1 and 2, we will iteratively collect qualitative data from therapists, patients with SCI/D, and other stakeholders. For aim 3, we will perform a hybrid effectiveness-implementation randomized controlled trial to pilot-test the intervention. The projected results include an iteratively developed and tested implementation plan that meets moderate to high levels of acceptability, feasibility, and appropriateness. Additionally, the pilot trial results are expected to show positive trends in relevant clinical outcomes related to reduced pressure injury incidence, recurrence, and improved healing when compared with the standard of care. RESULTS Currently, 6 participants have been recruited for our aim-1 qualitative study. CONCLUSIONS This study will expand upon our previous study to move the Assisted Weight-Shift system into routine clinical care, which was a strong desire of adults with SCI/D for improved individualized care plans to prevent pressure injuries. The results of this study will guide the next steps in a full, hybrid effectiveness-implementation trial with the goal of improving care to prevent pressure injuries. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51849.
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Affiliation(s)
- Melissa M Morrow
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Lynne C Hughes
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Diane M Collins
- Department of Physical Therapy & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Tamara L Vos-Draper
- College of Pharmacy, Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, United States
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Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2024; 2:CD003216. [PMID: 38345088 PMCID: PMC10860148 DOI: 10.1002/14651858.cd003216.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance behaviours. The prevention and treatment of pressure ulcers involves strategies to optimize hydration, circulation, and nutrition. Adequate nutrient intake can reduce the risk factor of malnutrition and promote wound healing in existing pressure ulcers. However, it is unclear which nutrients help prevent and treat pressure ulcers. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of nutritional interventions (special diets, supplements) for preventing and treating pressure ulcers in people with or without existing pressure ulcers compared to standard diet or other nutritional interventions. SEARCH METHODS We used extensive Cochrane search methods. The latest search was in May 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with or without existing pressure ulcers, that compared nutritional interventions aimed at preventing or treating pressure ulcers with standard diet or other types of nutritional interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome for prevention studies was the proportion of participants who developed new (incident) pressure ulcers. For treatment studies, our primary outcomes were time to complete pressure ulcer healing, number of people with healed pressure ulcers, size and depth of pressure ulcers, and rate of pressure ulcer healing. Secondary outcomes were side effects, costs, health-related quality of life and acceptability. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 33 RCTs with 7920 participants. Data for meta-analysis were available from 6993 participants. Pressure ulcer prevention Eleven studies (with 12 arms) compared six types of nutritional interventions for the prevention of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may result in little to no difference in the proportion of participants developing a pressure ulcer (energy, protein and micronutrient supplements 248 per 1000, standard diet 269 per 1000; RR 0.92, 95% CI 0.71 to 1.19; 3 studies, 1634 participants; low-certainty evidence). Compared to standard diet, protein supplements may result in little to no difference in pressure ulcer incidence (protein 21 per 1000, standard diet 28 per 1000; RR 0.75, 95% CI 0.49 to 1.14; 4 studies, 4264 participants; low-certainty evidence). The evidence is very uncertain about the gastrointestinal side effects of these supplements (protein 109 per 1000, standard diet 155 per 1000; RR 0.70, 95% CI 0.06 to 7.96; 2 studies, 140 participants, very low-certainty evidence). The evidence is very uncertain about the effects of protein, arginine, zinc and antioxidants; L-carnitine, L-leucine, calcium, magnesium and vitamin D; EPA, GLA and antioxidants; disease-specific supplements on pressure ulcer incidence when compared to standard diet (1 study each; very low-certainty evidence for all comparisons). Pressure ulcer treatment Twenty-four studies (with 27 arms) compared 10 types of nutritional interventions or supplements for treatment of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may slightly increase the number of healed pressure ulcers (energy, protein and micronutrients 366 per 1000, standard diet 253 per 1000; RR 1.45, 95% CI 1.14 to 1.85; 3 studies, 577 participants, low-certainty evidence). The evidence is very uncertain about the effect of these supplements on gastrointestinal side effects. Compared to standard diet, the evidence is very uncertain about the effect of protein, arginine, zinc and antioxidant supplements on pressure ulcer healing (pressure ulcer area: mean difference (MD) 2 cm² smaller, 95% CI 4.54 smaller to 0.53 larger; 2 studies, 71 participants, very low-certainty evidence). The evidence on side effects of these supplements is very uncertain. Compared to standard diet, supplements with arginine and micronutrients may not increase the number of healed pressure ulcers, but the evidence suggests a slight reduction in pressure ulcer area (MD 15.8% lower, 95% CI 25.11 lower to 6.48 lower; 2 studies, 231 participants, low-certainty evidence). The evidence is very uncertain about changes in pressure ulcer scores, acceptability, and side effects of these supplements. Compared to placebo, collagen supplements probably improve the mean change in pressure ulcer area (MD 1.81 cm² smaller, 95% CI 3.36 smaller to 0.26 smaller; 1 study, 74 participants, moderate-certainty evidence). The evidence is very uncertain about the effect of these supplements on side effects. The evidence is very uncertain about the effects of vitamin C, different doses of arginine; EPA, GLA (special dietary fatty acids) and antioxidants; protein; a specialized amino acid mixture; ornithine alpha-ketoglutarate and zinc supplements on pressure ulcer healing (1 or 2 studies each; very low-certainty evidence). AUTHORS' CONCLUSIONS The benefits of nutritional interventions with various compositions for pressure ulcer prevention and treatment are uncertain. There may be little or no difference compared to standard nutrition or placebo. Nutritional supplements may not increase gastrointestinal side effects, but the evidence is very uncertain. Larger studies with similar nutrient compositions would reduce these uncertainties. No study investigated the effects of special diets (e.g. protein-enriched diet, vegetarian diet) on pressure ulcer incidence and healing.
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Affiliation(s)
- Gero Langer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Astrid Fink
- Department of Health, District administration Groß-Gerau, Groß-Gerau, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University Graz, Graz, Austria
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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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Han L, Wei Y, Pei J, Zhang H, Lv L, Tao H, Yang Q, Su Q, Ma Y. Nomogram model on estimating the risk of pressure injuries for hospitalized patients in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103566. [PMID: 37913713 DOI: 10.1016/j.iccn.2023.103566] [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: 07/17/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES This study aimed to build and validate a nomogram model to estimate the risk of pressure injuries in intensive care unit patients. DESIGN Multicenter prospective cohort study. SETTING 33 tertiary hospitals in the Gansu Province, China. MEASUREMENTS AND MAIN RESULTS This study included 6420 patients between April 2021 to October 2022 from an information platform of pressure injury risk management called the "Long Hu Hui." Univariate and multivariate logistic regression analyses identified pressure injury risk factors to be included in the nomogram. The resulting nomogram was tested for calibration discrimination, and clinical usefulness. Of the included patients, 77 developed pressure injuries, representing an incidence rate of 1.2 %. Analysis of binary logistic regression revealed that the estimation nomogram included weight loss greater than 5 kg in the last three months, pneumotomy cannula, thoracic catheter, isoproterenol, norepinephrine, abnormal skin color, ruptured erythema, stroke, increased body temperature and nonspecific patients (specific patients include paralysis, unconsciousness, dementia, forced body position). The area under the receiver operating characteristic curve for the training cohort was 0.806 (95 % CI 0.755-0.857), and the AUC of the text cohort was 0.737 (95 % CI 0.574-0.901). The model has excellent calibration in both the training cohort (H-L test: χ2 = 6.34, P = 0.61) and the text cohort (H-L test: χ2 = 4.50, P = 0.81). Furthermore, the decision curve analysis revealed the preferred net benefit and the threshold probability in the estimation nomogram. CONCLUSIONS The nomogram model accurately estimated the risk of pressure injuries among intensive care patients, it should be used to inform risk assessment and facilitate early intervention strategies in future practice. IMPLICATIONS FOR CLINICAL PRACTICE The nomogram allows intensive care providers to dynamically assess the patient's risk of pressure injuries and to implement more targeted interventions accordingly.
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Affiliation(s)
- Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Juhong Pei
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province 730000, China
| | - Lin Lv
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Hongxia Tao
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qiuxia Yang
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China
| | - Qian Su
- First Clinical School of Medicine, Lanzhou University, Lanzhou City, Gansu Province 730000, China; Patient Service Center, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province 730000, China.
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Chuang YC, Miao T, Cheng F, Wang Y, Chien CW, Tao P, Kang L. Exploration of pressure injury risk in adult inpatients: An integrated Braden scale and rough set approach. Intensive Crit Care Nurs 2024; 80:103567. [PMID: 37924783 DOI: 10.1016/j.iccn.2023.103567] [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: 04/02/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to develop an interpretive model with decision rules to assess the risk level of pressure injuries in adult inpatients and identify the critical risk factors associated with these injuries. METHODS The rough set approach was used to identify the critical risk factors associated with pressure injuries and demonstrate their behavioral patterns. The study focused on adult inpatients aged 18 or above who remained in bed for at least 24 hours after admission. The data was extracted from a nursing electronic medical record system of a hospital in Zhejiang Province, China, from 27 October 2019 to 1 November 2020. RESULTS The critical risk factors associated with pressure injuries in adult inpatients were identified as "Sensory perception," "Nutrition," and "Friction and shear." A prediction model with 89 decision rules was established and demonstrated reliable predictive capabilities. Nursing staff should focus more on high-risk and severe-risk rules (Rules 11 to 18) to reduce the likelihood of potential high-risk pressure injuries. CONCLUSIONS The prediction model established by the rough set approach can be used to identify the critical risk factors of pressure injuries and has good explanatory ability, which can complement and improve the predictive accuracy of the Braden Scale. The decision-making rules can help nurses improve work efficiency. IMPLICATIONS FOR CLINICAL PRACTICE Explanatory analysis can explain most inpatients' potential risk patterns and corresponding critical risk factors. Data-driven research models and results can help nurses understand patients' potential risks better. Additionally, these insights can be valuable in nursing education, aiding new nurses in comprehending and addressing the potential risks patients face.
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Affiliation(s)
- Yen-Ching Chuang
- Institute of Public Health & Emergency Management, Taizhou University, Taizhou 318000, Zhejiang, China; Business College, Taizhou University, Taizhou 318000, Zhejiang, China; Key Laboratory of Evidence-based Radiology of Taizhou, Linhai 317000, Zhejiang, China.
| | - Tao Miao
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China.
| | - Fengmin Cheng
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China.
| | - Yanjiao Wang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361008, Fujian, China.
| | - Ching-Wen Chien
- Institute for Hospital Management, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, Guangdong, China.
| | - Ping Tao
- Department of Medical Affairs & Planning, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
| | - Linlin Kang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China.
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Zhang YB, Tang QL, Wang SY, Zhao YH, Wu TR, Wang JX. Evidence mapping of clinical practice guidelines on nutritional management for pressure injuries and their quality. Nutr Rev 2023:nuad146. [PMID: 38156738 DOI: 10.1093/nutrit/nuad146] [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] [Indexed: 01/03/2024] Open
Abstract
CONTEXT The safety and efficacy of nutritional management for pressure injuries (PIs) have been the subjects of ongoing interest. Some evidence demonstrated that nutrition is essential for skin and tissue viability, supporting tissue repair for healing the pressure injury. OBJECTIVE This investigation aimed to systematically review clinical practice guidelines (CPGs) for the nutritional management of PIs and furnish an evidence map to assess research trends and CPG gaps. METHODS The PubMed, Embase, and guidelines databases, and society websites were searched for CPGs for the nutritional management of PIs. The basic recommendations for the nutritional management of PIs, method quality, and reporting CPGs quality were identified and imported into Excel. Four researchers independently elucidated each CPG's quality via the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. All bubble charts were generated using Excel software. RESULTS This review included 12 CPGs with a combined 23 recommendations. The nutrition screening and assessment were summarized on the basis of the PI recommendations for 6 major items, 12 items on nutrition management, and 3 on PI education. The assessed CPGs had mixed quality, and the highest score ± standard deviation based on the clarity of presentation was 83.46 ± 7.62, whereas the lowest mean score based on AGREE II applicability was 53.31 ± 16.90. Field 1 (basic information) in the RIGHT checklist had the greatest reporting rate (68.06%), whereas field 5 (review and quality assurance) had the lowest CPGs quality (41.67%). CONCLUSION This investigation furnishes an evidence map and provides new perspectives on the CPGs for the nutritional management of PIs. However, the CPGs included still need improvement, especially in the applicability and editorial independence domains.
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Affiliation(s)
- Ya-Bin Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qi-Lan Tang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shui-Yu Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yu-Hua Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Tian-Rui Wu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jun-Xia Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Alito A, Portaro S, Leonardi G, Ventimiglia C, Bonanno F, Fenga D, Sconza C, Tisano A. Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes. Diagnostics (Basel) 2023; 13:3213. [PMID: 37892035 PMCID: PMC10605717 DOI: 10.3390/diagnostics13203213] [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: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery. METHODS A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System. RESULTS Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition. CONCLUSION The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98125 Messina, Italy
| | - Simona Portaro
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Giulia Leonardi
- Physical Rehabilitation Medicine Department, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Carlotta Ventimiglia
- Department of Adult and Developmental Human Pathology, University of Messina, 98125 Messina, Italy;
| | - Francesco Bonanno
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. “G. Martino”, 98125 Messina, Italy
| | - Cristiano Sconza
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Adriana Tisano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (A.T.); (F.B.)
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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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11
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Vijayakanth T, Shankar S, Finkelstein-Zuta G, Rencus-Lazar S, Gilead S, Gazit E. Perspectives on recent advancements in energy harvesting, sensing and bio-medical applications of piezoelectric gels. Chem Soc Rev 2023; 52:6191-6220. [PMID: 37585216 PMCID: PMC10464879 DOI: 10.1039/d3cs00202k] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 08/17/2023]
Abstract
The development of next-generation bioelectronics, as well as the powering of consumer and medical devices, require power sources that are soft, flexible, extensible, and even biocompatible. Traditional energy storage devices (typically, batteries and supercapacitors) are rigid, unrecyclable, offer short-lifetime, contain hazardous chemicals and possess poor biocompatibility, hindering their utilization in wearable electronics. Therefore, there is a genuine unmet need for a new generation of innovative energy-harvesting materials that are soft, flexible, bio-compatible, and bio-degradable. Piezoelectric gels or PiezoGels are a smart crystalline form of gels with polar ordered structures that belongs to the broader family of piezoelectric material, which generate electricity in response to mechanical stress or deformation. Given that PiezoGels are structurally similar to hydrogels, they offer several advantages including intrinsic chirality, crystallinity, degree of ordered structures, mechanical flexibility, biocompatibility, and biodegradability, emphasizing their potential applications ranging from power generation to bio-medical applications. Herein, we describe recent examples of new functional PiezoGel materials employed for energy harvesting, sensing, and wound dressing applications. First, this review focuses on the principles of piezoelectric generators (PEGs) and the advantages of using hydrogels as PiezoGels in energy and biomedical applications. Next, we provide a detailed discussion on the preparation, functionalization, and fabrication of PiezoGel-PEGs (P-PEGs) for the applications of energy harvesting, sensing and wound healing/dressing. Finally, this review concludes with a discussion of the current challenges and future directions of P-PEGs.
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Affiliation(s)
- Thangavel Vijayakanth
- Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv-6997801, Israel
| | - Sudha Shankar
- Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv-6997801, Israel
- Blavatnik Center for Drug Discovery, Tel Aviv University, Tel Aviv-6997801, Israel
| | - Gal Finkelstein-Zuta
- Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv-6997801, Israel
- Department of Materials Science and Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv-6997801, Israel.
| | - Sigal Rencus-Lazar
- Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv-6997801, Israel
| | - Sharon Gilead
- Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv-6997801, Israel
- Blavatnik Center for Drug Discovery, Tel Aviv University, Tel Aviv-6997801, Israel
| | - Ehud Gazit
- Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv-6997801, Israel
- Department of Materials Science and Engineering, Iby and Aladar Fleischman Faculty of Engineering, Tel Aviv University, Tel Aviv-6997801, Israel.
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12
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Annie Nancy G, Ramakrishnan K, Senthil Nathan J. Prediction of internal changes in the sacral region on immobility using bio-mechanical and bio-thermal modelling. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-222485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pressure injury usually develop in the bony prominence of immobile bedridden subjects. Predicting pressure injuries based on the subjects’ physiological information will reduce the burden of the caretakers in adjusting the frequency of repositioning such subjects. Visual assessment, diagnostic, and prognostic approaches only provide pressure injury information after onset. Therefore, the objective of this unique modeling technique is to predict the internal alterations that take place in human tissues before the onset of pressure injuries. In this approach the bio-mechanical and bio-thermal properties was integrated to predict the internal changes of skin, fat, and muscle layers when subjects were self-loaded continuously for one hour in the sacrum region. A change in temperature of all the layers, as well as the distribution of Von-Mises stress in these layers, was observed. The inflammation caused by the changes in the temperature and the stress was measured from the simulation model. Ultrasound measurements was also taken for the same subjects in the supine position in the sacral region, before and after one hour by applying a self-load. An identical change in the thickness of the above-mentioned layers due to thermal expansion was noticed. Hence this computational model is hypothesized to give identical thermal expansion in comparison with the ultrasound measurements. There was an agreement between the thermal expansion using the simulation technique and the ultrasound technique which was assessed through Bland-Altman analysis, with a 96% confidence interval.
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Affiliation(s)
- G. Annie Nancy
- Department of Electrical and Electronics Engineering, Loyola-ICAM college of Engineering and Technology, Chennai, Tamil Nadu, India
| | - Kalpana Ramakrishnan
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
| | - J. Senthil Nathan
- D. M (Neuro), Consultant Neurologist, Fortis Malar Hospital, Chennai, Tamil Nadu, India
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Zhang ZL, Hu XX, Yang HL, Wang D. Development and Validation of a Risk Nomogram Model for Predicting Community-Acquired Pressure Injury Among the Older Adults in China: A Case-Control Study. Clin Interv Aging 2022; 17:1471-1482. [PMID: 36212512 PMCID: PMC9533784 DOI: 10.2147/cia.s380994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/24/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose A predictive model of community-acquired pressure injury (CAPI) was established and validated to allow the early identification of the risk of pressure injuries by family caregivers and community workers. Patients and Methods The participants were hospitalized patients 65 years and older from two branches of a tertiary hospital in China, one for model training set and the other for validation set. This study was a case-control study based on hospital electronic medical records. According to the presence of pressure injury at admission, patients were divided into a case group and a control group. In the model training set, LASSO regression was used to select the best predictors, and then logistic regression was used to construct a nomogram. The performance of the model was evaluated by drawing the receiver operating characteristic curve (ROC) and calculating the area under the curve (AUC), calibration analysis, and decision curve analysis. The model used a 10-fold crossover for internal and external validation. Results The study included a total of 20,235 subjects, including 11,567 in the training set and 8668 in the validation set. The prevalence of CAPI in the training and validation sets was 2.5% and 1.8%, respectively. A nomogram was constructed including eight variables: age ≥ 80, malnutrition status, cerebrovascular accidents, hypoproteinemia, respiratory failure, malignant tumor, paraplegia/hemiplegia, and dementia. The AUC of the prediction model in the original model, internal validation, and external validation were 0.868 (95% CI: 0.847, 0.890), mean 0.867, and 0.840 (95% CI: 0.807,03.873), respectively. The nomogram showed acceptable calibration and clinical benefit. Conclusion We constructed a nomogram to predict CAPI from the perspective of comorbidity that is suitable for use by non-specialists. This nomogram will help family caregivers and community workers with the early identification of PI risks.
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Affiliation(s)
- Zhi Li Zhang
- Department of Surgery, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan, People’s Republic of China
| | - Xiao Xue Hu
- Department of Endocrinology, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan, People’s Republic of China
| | - Hong Li Yang
- Department of Public Health, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan, People’s Republic of China,Correspondence: Hong Li Yang, Department of Public Health, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan, People’s Republic of China, Tel +86 13407171884, Fax +86 27-68894769, Email
| | - Du Wang
- Department of Orthopedic, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan, People’s Republic of China,Du Wang, Department of Orthopedic, Tongren Hospital of Wuhan University and Wuhan Third Hospital, Wuhan, People’s Republic of China, Tel +86 15308657075, Fax +86 27-88850381, Email
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Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial. J Clin Med 2022; 11:jcm11195683. [PMID: 36233551 PMCID: PMC9570985 DOI: 10.3390/jcm11195683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before−after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.
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15
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Manley S, Mitchell A. The impact of nutrition on pressure ulcer healing. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S26-S30. [PMID: 35736848 DOI: 10.12968/bjon.2022.31.12.s26] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pressure ulcers are debilitating and often painful problem, particularly in people who are elderly, immobile and/or obese. It is estimated that more than 100 000 new pressure ulcers develop each year. These wounds are caused by friction and shear and are particularly prevalent in older people, where malnutrition can be a factor in their development. Nutrition plays a key role in pressure ulcer care because wounds need both macronutrients and micronutrients to heal. It is essential that nurses understand the role of nutrition in pressure ulcer management.
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Affiliation(s)
- Sarah Manley
- Staff Nurse, Royal Berkshire NHS Foundation Trust, Reading
| | - Aby Mitchell
- Senior Lecturer, Adult Nursing, Professional Lead for Simulation and Immersive Technologies, University of West London, London
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Johnson VF, Raphael K. Prevention of Pressure Injury in Patients Hospitalized with Heart Failure. Crit Care Nurs Clin North Am 2022; 34:181-189. [PMID: 35660232 DOI: 10.1016/j.cnc.2022.02.010] [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: 11/03/2022]
Abstract
Hospital-acquired pressure injuries are problematic within organizations. The Centers for Medicare and Medicaid Services counts hospital-acquired pressure injuries as a patient safety event and encourages hospitals to reduce or eliminate them in part by reducing payments to the hospital. Individuals who are admitted to hospitals with acute heart failure are usually elderly with comorbidities that increase their risk of developing a pressure injury. Therefore, evidence-based protocols should be made, implemented, and analyzed by an interprofessional team to combat the development of pressure injuries to maintain the best quality of life for patients hospitalized with heart failure.
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Affiliation(s)
| | - Krystal Raphael
- Wound and Ostomy Care, Diabetes Management, East Jefferson General Hospital, Metairie, LA, USA
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17
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Najjar YW, Saleh MY, Hassan ZM. Medical device related pressure ulcers in Jordan: Prevalence study among critically ill patients. Health Sci Rep 2022; 5:e620. [PMID: 35539444 PMCID: PMC9069546 DOI: 10.1002/hsr2.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background Medical device‐related pressure ulcers are increasingly common in critical care units. These ulcers can be complicated due to the necessity of the device for diagnosis or treatment. Purpose To determine the prevalence of and risk for medical device‐related pressure ulcers in critical care units in Jordan in addition to identifying the preventive measures for those ulcers as well as identifying the most frequently used medical devices that cause ulcers and to assess the relationships between prevention measures and developing ulcers. Methods A cross‐sectional survey was used to assess ulcers among 318 patients who were elder than 18 years old. Data collection was based on an outline published by the European Pressure Ulcer Advisory Panel, Braden Scale, and an author‐developed specific checklist. Results The prevalence rate of medical device‐related pressure ulcers was 38.1%. Most affected sites were sacrum and heel, and most affected were those with old age, being admitted to public hospitals, and with a prolonged hospital stay. About half of the patients (46.3%) had severe risk. Only 17% of the patients who were at risk got adequate preventive measures. Face masks, endotracheal tubes, pulse oximetry probes, and intravenous catheters were associated with almost half of the ulcers. Conclusion Medical device‐related pressure ulcers are threats to patient safety and quality of nursing care in hospitals, which require determining appropriate preventive measures. Key messages: Medical device‐related pressure ulcers are common among patients in critical care units, which raise the need to evaluate the prevalence of such type of ulcers in those patients. Three hundred and eighteen patients were investigated for the prevalence of medical device‐related pressure ulcers through a cross‐sectional survey. Patients in critical care units in Jordan had a high prevalence rate for medical device‐related pressure ulcers, which require the need to apply appropriate preventive measures.
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Affiliation(s)
- Yahya W. Najjar
- Zarqa University College Al‐Balqa Applied University Zarqa Jordan
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18
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Ding L, Hu X, Wei L, Sun M, Sun G, Jiang G, Li H. Risk factors for hospital-acquired and community-acquired pressure injuries: a multicentre mixed case-control study. BMJ Open 2022; 12:e057624. [PMID: 35437253 PMCID: PMC9016407 DOI: 10.1136/bmjopen-2021-057624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To separately examine and comprehensively compare the risk factors for hospital-acquired (HAPIs) and community-acquired pressure injuries (CAPIs). DESIGN A mixed case-control study. SETTING Four medical centres in China. PARTICIPANTS Inclusion criteria included patients who were (1) aged ≥18 years on admission; (2) admitted between January 2014 and December 2018, and (3) diagnosed with HAPIs (cases) or with no HAPIs (controls) during hospitalisation in the HAPIs study, and confirmed with CAPIs (cases) or with no PIs (controls) on admission in the CAPIs study. The exclusion criteria were as follows: (1) admitted for childbirth, psychiatric reasons or rehabilitation; (2) admitted for observation; (3) transferred from another hospital and (4) confirmed to have suffered PIs from previous hospitalisations in the CAPIs study. In total, 320 cases and 1657 controls were included in the HAPIs study, and 1763 cases and 1786 controls were included in the CAPIs study. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome variable was the occurrence of PIs. RESULTS The existence of PIs or scars from previous PIs on admission, presence of forced posture, use of medical devices and surgery during hospitalisation were found to be independent risk factors for HAPIs, as evidenced by the corresponding OR and 95% CI values of 51.931 (34.241 to 78.763), 2.006 (1.405 to 2.864), 3.226 (1.709 to 6.089) and 2.161 (1.452 to 3.215), respectively. Age, sex, Braden rating and diabetes were found to be independent risk factors for CAPIs, as evidenced by the corresponding OR and 95% CI values of 1.031 (1.026 to 1.036), 0.810 (0.698 to 0.941), 1.235 (1.167 to 1.307) and 2.059 (1.332 to 3.184), respectively. CONCLUSIONS The existence of PIs or scars from previous PIs on admission, presence of forced posture, use of medical devices and surgery during hospitalisation are suggested to be included as independent items for the risk assessment of PIs, together with the Braden scale. The Braden rating plays different roles in the development of CAPIs and HAPIs.
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Affiliation(s)
- Lei Ding
- Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xia Hu
- Department of Human Resources, Qingdao Endocrine and Diabetes Hospital, Qingdao, Shandong, China
- Department of Disease Prevention and Health Care, Qingdao Endocrine and Diabetes Hospital, Qingdao, Shandong, China
| | - Lili Wei
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mojian Sun
- Center for Medical Record Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guixia Sun
- Department of Quality Management and Evaluation, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guangfeng Jiang
- Department of Medical Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huanting Li
- Department of Medical Management, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Huang X, Zan T, Tang J, Zhang D, Zu W, Wang T, Wang L, Nie W. Psychometric properties of the Chinese version of the attitude towards pressure ulcer prevention instrument: A cross‐sectional survey. Int Wound J 2022; 19:2019-2030. [PMID: 35307948 DOI: 10.1111/iwj.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Tao Zan
- Department of Intensive Care Unit Bethune First Hospital of Jilin University Changchun China
| | - Jing Tang
- Department of Intensive Care Unit Bethune First Hospital of Jilin University Changchun China
| | - Dan Zhang
- School of Life and Health Yenching Institute of Technology Langfang China
| | - Wanting Zu
- School of Nursing Jilin University Changchun China
| | - Taiwei Wang
- Department of Intensive Care Unit Bethune First Hospital of Jilin University Changchun China
| | - Lisheng Wang
- School of Nursing Jilin University Changchun China
| | - Wenbo Nie
- School of Nursing Jilin University Changchun China
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Arensberg MB, Brunton C, Richardson B, Bolhack S. The Case for Malnutrition Quality Measures and Nutrition-Focused Quality Improvement Programs (QIPs) in US Skilled Nursing Facilities. Healthcare (Basel) 2022; 10:healthcare10030549. [PMID: 35327026 PMCID: PMC8949306 DOI: 10.3390/healthcare10030549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 01/22/2023] Open
Abstract
As skilled nursing in the United States moves to a value-based model, malnutrition care remains a critical gap area that is associated with multiple poor health outcomes, including hospital readmissions and declines in functional status, psychosocial well-being, and quality of life. Malnutrition is often undiagnosed/untreated, even though it impacts up to half of skilled nursing facility (SNF) residents, and COVID-19 infections/related symptoms have likely further increased this risk. In acute care, malnutrition quality measures have been both developed/tested, and nutrition-focused quality improvement programs (QIPs) have been shown to reduce costs and effectively improve care processes and patient outcomes. Less is known about such quality initiatives in SNF care. This perspective paper reviewed malnutrition-related quality measures and nutrition-focused QIPs in SNFs and nursing home care. It identified that although the Centers for Medicare & Medicaid Services (CMS) has had a nursing home Quality Assurance and Performance Improvement (QAPI) program for 10 years and has had SNF quality measures for nearly 20 years, there are no malnutrition-specific quality measures for SNFs and very few published nutrition-focused QIPs in SNFs. This represents an important care gap that should be addressed to improve resident health outcomes as SNFs more fully move to a value-based care model.
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Affiliation(s)
- Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
- Correspondence:
| | - Cory Brunton
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
| | | | - Scott Bolhack
- The Wound Care Center at Northwest Hospital, Tucson, AZ 85741, USA;
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21
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Haavisto E, Kielo-Viljamaa E, Hjerppe A, Puukka P, Stolt M. Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities. Adv Skin Wound Care 2022; 35:1-10. [PMID: 35188487 DOI: 10.1097/01.asw.0000818576.93870.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland. METHODS A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument. RESULTS According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices. CONCLUSIONS Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.
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Affiliation(s)
- Elina Haavisto
- At the University of Turku, Finland, Elina Haavisto, PhD, RN, is Professor, Department of Nursing Science; Emilia Kielo-Viljamaa, PhD, RN, is Researcher, Department of Nursing Science; Anna Hjerppe, MD, is Chief Physician and Clinical Teacher, Department of Medicine; Pauli Puukka, MSocSci, is Statistician, Department of Nursing Science; and Minna Stolt, PhD, is University Lecturer, Department of Nursing Science. Acknowledgments: The authors thank all the contact persons who participated in this study by assessing the skin condition of all patients at their own long-term care facilities and completing the questionnaires. Study materials and salaries were funded by State Research Funding, Satakunta Hospital District, Finland. The authors have disclosed no other financial relationships related to this article. Submitted February 16, 2021; accepted in revised form April 7, 2021
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22
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Nancy GA, Kalpana R, Nandhini S. A Study on Pressure Ulcer: Influencing Factors and Diagnostic Techniques. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2022; 21:254-263. [PMID: 35188406 DOI: 10.1177/15347346221081603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pressure ulcer (PU) is one of the most common occurrences in bedridden subjects. Despite the standard of care, there is a huge challenge in monitoring immobile subjects in all the bodily pressure points. This increases the chance of onset of PU which in turn increases the expenditure for treating and managing the PU. Hence, we made a study on the biological and physiological factors that are responsible for the formation of PU and also on various techniques used for diagnosis. Thus, we have summarised the efficacy of various advanced diagnostic procedures with their limitations. Though there are advanced imaging techniques, risk assessment tools based on the visual inspection are widely followed in hospitals. Based on our observation, we here have identified three major areas; one being the development of mathematical modeling, the second is towards the development of non-invasive devices and finally to automate cot facility. We have also provided possible suggestions as to solutions that could be useful to researchers and for society. Thus, this review covers the present difficulty faced by bedridden subjects and respective care-takers along with the knowledge gap and a few suggestions as to future scope.
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Affiliation(s)
- G Annie Nancy
- 382205Loyola-ICAM college of Engineering and Technology, Chennai, India
| | - R Kalpana
- 29862Rajalakshmi Engineering College, Thandalam, Chennai, India
| | - S Nandhini
- 29862Rajalakshmi Engineering College, Thandalam, Chennai, India
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23
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Full-Thickness Facial Pressure Injury and Buried Dentition from Prone Positioning in a Patient with COVID-19. Adv Skin Wound Care 2021; 34:1-3. [PMID: 33901104 DOI: 10.1097/01.asw.0000749796.16178.7b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT Prone positioning is recognized for its efficacy in the treatment of acute respiratory distress syndrome related to COVID-19. Here the authors present a case of a facial pressure injury and buried dentition that occurred as a result of prolonged prone positioning in a patient who was COVID-19 positive. The patient was treated with primary closure of the injury and pressure offloading.
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Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury: A Retrospective Cohort Study. J Wound Ostomy Continence Nurs 2021; 47:470-476. [PMID: 32925591 DOI: 10.1097/won.0000000000000691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs. DESIGN Retrospective cohort study. SUBJECTS AND SETTING We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018. METHODS Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs. RESULTS Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs. CONCLUSIONS Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.
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Cuomo R, Giardino FR, Pozzi M, Nisi G, Sisti A, Han J, Nuzzo A, Muratori A, Cigna E, Losco L, Grimaldi L. Management of skin damage of health workers' face: the role of plastic surgery in the time of Pandemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021185. [PMID: 33988151 PMCID: PMC8182579 DOI: 10.23750/abm.v92i2.11006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022]
Abstract
Background and aim: The Sars-Cov-2 virus is characterized by a being highly contagiousness, and this is the reason why massive use of personal protective equipment is required by medical and paramedical staff of the COVID-19 dedicated departments. The aim of this manuscript is to describe and share our experience in the prevention and treatment of the personal protective equipment related pressure sores and other skin alterations in the medical and paramedical staff. Methods: All healthcare workers with PPE-related skin damages were registered at time 0. Age, sex, profession, type of skin damage, diseases and possible drugs were registered. Results: Two strategies were employed: the first strategy was to immediately treat the skin and the second one was to prevent pressure wounds formation both in already affected healthcare workers and the recurrence in healed staff. Three weeks after the two strategies were used, the incidence rate PPE-related skin damage was reduced in a statistically significant way. Conclusions: Proper management helps in reducing the incidence of pressure ulcers related to personal protective devices in Covid-19 Units. Skin prevention and hydration, have been obtained achieved by using products applied at home, autonomously.
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Affiliation(s)
| | - Francesco Ruben Giardino
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Mirco Pozzi
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Giuseppe Nisi
- 1- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
| | - Andrea Sisti
- Visiting Researcher - Department of Plastic Surgery, Cleveland Clinic Ohio, USA.
| | - Jingjian Han
- Jining First People's Hospital - Jining Medical University - Jining city - People's Republic of China.
| | - Angelo Nuzzo
- COVID Department - Intensive Care Unit - University of Siena - Italy.
| | - Alessia Muratori
- COVID Department - Intensive Care Unit - University of Siena - Italy.
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; Pisa, Italy.
| | - Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa; Pisa, Italy.
| | - Luca Grimaldi
- Department of Medicine, Surgery and Neuroscience - Plastic and Reconstructive Surgery Unit - University of Siena - Italy.
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Do Khac A, Jourdan C, Fazilleau S, Palayer C, Laffont I, Dupeyron A, Verdun S, Gelis A. mHealth App for Pressure Ulcer Wound Assessment in Patients With Spinal Cord Injury: Clinical Validation Study. JMIR Mhealth Uhealth 2021; 9:e26443. [PMID: 33620327 PMCID: PMC7943335 DOI: 10.2196/26443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 01/14/2023] Open
Abstract
Background Clinical evaluation of a pressure ulcer is based on quantitative and qualitative evaluation. In clinical practice, acetate tracing is the standard technique used to measure wound surface area; however, it is difficult to use in daily practice (because of material availability, data storage issues, and time needed to calculate the surface area). Planimetry techniques developed with mobile health (mHealth) apps can be used to overcome these difficulties. Objective The goal of this study was to evaluate the metrological properties of a free-access mHealth app, called imitoMeasure, to assess pressure ulcers. Methods This was a noninterventional, validation study. We included patients with spinal cord injury presenting with a pressure ulcer, regardless of its stage or location. We performed wound measurements with a ruler, and we performed acetate tracing using a transparent dressing with a wound measurement grid. Wound evaluation via the mHealth app was conducted twice by the main investigator and also by a coinvestigator to determine validity, intrarater reproducibility, and interrater reproducibility. Bland-Altman plots and intraclass correlation coefficients were used to compute the minimal detectable change percentage. Results Overall, 61 different pressure ulcers were included. The validity, intrarater reproducibility, and interrater reproducibility of the mHealth app vs acetate tracing (considered the method of reference) were good, with intraclass correlation coefficients of 0.97 (95% CI 0.93-0.99), 0.99 (95% CI 0.98-0.99), and 0.98 (95% CI 0.96-0.99), respectively, and minimal detectable change percentages between 17% and 35%. Conclusions The imitoMeasure app had good validity and reproducibility. It could be an alternative to standard wound assessment methods. Further studies on larger and more diverse wounds are needed. Trial Registration ClinicalTrials.gov NCT04402398; http://clinicaltrials.gov/ct2/show/NCT04402398
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Affiliation(s)
- Ariane Do Khac
- Unité de Rééducation Neurologique, Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire, Nîmes, France
| | - Claire Jourdan
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire, Montpellier, France
| | - Sylvain Fazilleau
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire, Montpellier, France
| | - Claire Palayer
- Centre Mutualiste Neurologique Propara, Montpellier, France
| | - Isabelle Laffont
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire, Montpellier, France
| | - Arnaud Dupeyron
- Unité de Rééducation Neurologique, Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire, Nîmes, France
| | - Stéphane Verdun
- Délégation à la Recherche Clinique et à l'Innovation, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
| | - Anthony Gelis
- Centre Mutualiste Neurologique Propara, Montpellier, France
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Young C. Using the 'aSSKINg' model in pressure ulcer prevention and care planning. Nurs Stand 2021; 36:61-66. [PMID: 33491345 DOI: 10.7748/ns.2021.e11674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/09/2022]
Abstract
Pressure ulcers are painful, costly and can negatively affect a patient's quality of life. It has long been recognised that they increase the risk of infection, prolong hospital stays and can result in death. To prevent the occurrence of pressure ulcers, nurses need to understand what a pressure ulcer is and the underlying factors that cause them. Furthermore, it is essential that they recognise why some people are more susceptible to pressure and shear forces than others, so that preventable factors can be addressed. Nursing care to prevent pressure ulcers needs to be planned, implemented and evaluated in a systematic manner following an assessment of the patient and their circumstances. The 'aSSKINg' (assess risk; skin assessment and skin care; surface; keep moving; incontinence and moisture; nutrition and hydration; and giving information or getting help) model ensures all fundamental aspects of pressure ulcer prevention are included in patient care. This article outlines the definitions and causes of pressure ulcers, and explains how nurses can assess, plan, implement and evaluate pressure ulcer preventative care using the aSSKINg model as a guide.
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Affiliation(s)
- Carole Young
- Tissue Viability Team, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
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Everink IHJ, van Haastregt JCM, Manders M, de van der Schueren MAE, Schols JMGA. Malnutrition Prevalence Rates among Dutch Nursing Home Residents: What Has Changed over One Decade? A Comparison of the Years 2009, 2013 and 2018. J Nutr Health Aging 2021; 25:999-1005. [PMID: 34545920 DOI: 10.1007/s12603-021-1668-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To assess changes in prevalence of malnutrition and its associated factors among people living in Dutch nursing homes in 2009, 2013 and 2018. DESIGN Secondary data analysis of the International Prevalence Measurement of Care Quality (LPZ) study. SETTING Dutch nursing homes. PARTICIPANTS Residents living at a psychogeriatric or somatic ward in Dutch nursing homes in 2009, 2013 or 2018. MEASUREMENTS weight and height, unintentional weight loss over the last month and last six months, age, sex, length of stay up to the measurement day, care dependency, and the presence of various diseases (dementia, diabetes mellitus, stroke, diseases of the respiratory system, respiratory diseases and pressure ulcers). RESULTS In total, 14,317 residents were included in this study with a mean age of 82.2, 70.9 female and 66.8% was living on a psychogeriatric ward. Results of this study show relative stability in background characteristics of the nursing home population over the last decade. In the total sample, 16.7% was malnourished and these percentages were 16.6% in 2009, 17.5% in 2013 and 16.3% in 2018. Multiple binary logistic regression analyses revealed having a pressure ulcer, female sex and living on a psychogeriatric department to be positively associated and having diabetes mellitus to be negatively associated with malnutrition throughout the years. These associations were strong and similar across years. CONCLUSION Even though much attention has been paid to prevent malnutrition in Dutch nursing homes over the last decades, results show a relatively stable malnutrition prevalence rate of around 16%. This leads to the question if nursing staff is able to sufficiently recognize residents with (a risk of) malnutrition, and if they are aware of interventions they could perform to decrease this rate.
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Affiliation(s)
- I H J Everink
- Irma Everink, Maastricht University, Maastricht, Nederland,
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Nutrition et cicatrisation. ACTUALITES PHARMACEUTIQUES 2020. [DOI: 10.1016/j.actpha.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shiferaw WS, Aynalem YA, Akalu TY. Prevalence of pressure ulcers among hospitalized adult patients in Ethiopia: a systematic review and meta-analysis. BMC DERMATOLOGY 2020; 20:15. [PMID: 33160351 PMCID: PMC7649003 DOI: 10.1186/s12895-020-00112-z] [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: 02/17/2020] [Accepted: 10/30/2020] [Indexed: 12/02/2022]
Abstract
Background Globally, PUs are recognized as one of the five most frequent causes of harm to clients. With millions affected globally, the national pooled prevalence of pressure ulcers in Ethiopia remains unknown. Hence, this review and meta-analysis aimed to determine the prevalence of pressure ulcers among hospitalized clients in Ethiopia. Methods Studies were retrieved through search engines in PubMed, Scopus, WHO Afro Library, Google Scholar, Africa Journals Online, and Web of Science. Heterogeneity between-studies were checked using the I2 test. A funnel plot and Egger’s regression test was used to assess the presence of publication bias. The random-effect model was fitted to estimate summary effects and 95% confidence intervals (CIs) across studies. The analyses were performed using STATA™ Version 14 software. Results The pooled prevalence of pressure ulcer in Ethiopia was assessed using seven studies involving a total of 1881 participants. The pooled prevalence of pressure ulcers in Ethiopia was 11.7% (95% CI: 7.28, 16.13). The subgroup analysis showed that the estimated magnitude of pressure ulcers was 15.89% (95% CI: 13.32, 18.46); among studies, their sample size was greater than or equal to 250. Conclusion The current review reported that the pooled prevalence of pressure ulcers in Ethiopia was relatively high. Hence, policymaker and healthcare providers should give attention to reduce the magnitude of pressure ulcers. Furthermore, further a meta-analysis study could be conducted to identify individual and health care service-related factors related to the occurrence of pressure ulcers.
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Affiliation(s)
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Citty SW, Bjarnadottir RI, Marlowe BL, Jones S, Lucero RJ, Garvan CW, Kamel AY, Westhoff L, Keenan G. Nutrition Support Therapies on the Medication Administration Record: Impacts on Staff Perception of Nutrition Care. Nutr Clin Pract 2020; 36:629-638. [PMID: 33095472 DOI: 10.1002/ncp.10590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND It has been reported that many hospitals in the United States have fragmented and ineffective ordering, administration, documentation, and evaluation/monitoring of nutrition therapies. This paper reports on a project to investigate if perceived hospital staff awareness and documentation of nutrition support therapies (NSTs) improves by including them as part of the medication administration record (MAR). METHODS Surveys were conducted with nursing staff, physicians, and dietitians before and after adding NSTs to the MAR to evaluate the perceived impact on the outcome of interest. The outcomes of interest include nurses' perception of ease of finding information, awareness of an order, and ability to assess administration and documentation and dietitian, nurse, and physician staff perceptions of impact of intervention on aspects of the nutrition care process. RESULTS After adding NST to the MAR, nursing staff perceived improvement in knowing that their patient had an oral nutritional supplement (ONS) order (P = .01), when and how much product was last administered (P = .01), and documentation of the type of product consumed (P = .01) and volume of product consumed (P = .01). The majority of dietitian and nurses surveyed reported perceived improvement in placing and finding ONS orders, in administration of ONS, in ability to evaluate patient nutrition status, and in ONS intake and a positive impact on clinical practice. CONCLUSION Inclusion of NST in the MAR presents an innovative solution to enhance staff awareness of ordered therapies and perception of improved documentation of nutrition interventions for hospitalized patients.
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Affiliation(s)
- Sandra W Citty
- Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA.,Gainesville Geriatric Research Education and Clinical Center (GRECC), North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Ragnhildur I Bjarnadottir
- Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Belinda Lee Marlowe
- Food and Nutrition Services Department, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Shannon Jones
- Information Technology Department, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Robert J Lucero
- Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Cynthia Wilson Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Amir Y Kamel
- Pharmacy Department, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Lynn Westhoff
- Nursing Services Department, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Gail Keenan
- Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
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Alderden JG, Shibily F, Cowan L. Best Practice in Pressure Injury Prevention Among Critical Care Patients. Crit Care Nurs Clin North Am 2020; 32:489-500. [PMID: 33129409 DOI: 10.1016/j.cnc.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear. Pressure injury prevention in the critical care population necessitates risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions. Best practices in preventive interventions among critical care patients, including skin and tissue assessment, skin care, repositioning, nutrition, support surfaces, and early mobilization, are described. Unique considerations in special populations including older adults and individuals with obesity are also addressed.
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Affiliation(s)
- Jenny G Alderden
- University of Utah College of Nursing, 10 2000 East, Salt Lake City, UT 84112, USA.
| | - Faygah Shibily
- Faculty of Nursing, King Abdulaziz University, P.O.Box 42828, Jeddah 21551, Saudi Arabia
| | - Linda Cowan
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Anthropometric, Biochemical, and Food Consumption Parameters are Associated with Venous Leg Ulcer Area and Duration. Adv Skin Wound Care 2020; 33:476-481. [PMID: 32810060 DOI: 10.1097/01.asw.0000694160.19845.1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the dietary habits and anthropometric and biochemical parameters of patients with active venous leg ulcers and to verify the association of these variables with wound duration and area. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study conducted with 33 participants diagnosed with venous leg ulcers in outpatient care. MAIN OUTCOME MEASURES Socioeconomic data, anthropometric parameters, biochemical parameters, food consumption, and wound characteristics were analyzed by an interprofessional team. MAIN RESULTS Participants were an average of 58 ± 13 years, 57.6% women, 84.8% overweight, and had a median wound duration of 10 months (range, 1-192 months) and an average wound area of 5 cm (range, 0.22-61.1 cm). Diets were typically hypocaloric and hypoproteic, with a low amount of vitamin A and magnesium. Wound duration was negatively associated with polyunsaturated fat intake (P = .032), whereas wound area was significantly associated with lipid intake (P = .002) and C-reactive protein (P = .040). CONCLUSIONS Patients with active venous leg ulcers were overweight (leading to systemic inflammation) and had low consumption of calories, protein, and micronutrients that could support cicatrization. Wound area was associated with a high-fat diet, whereas wound duration was negatively associated with polyunsaturated fat intake.
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Choi BK, Kim MS, Kim SH. Risk prediction models for the development of oral-mucosal pressure injuries in intubated patients in intensive care units: A prospective observational study. J Tissue Viability 2020; 29:252-257. [PMID: 32800513 DOI: 10.1016/j.jtv.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Oral-mucosal pressure injury (PI) is the most commonly encountered medical device-related PIs. This study was performed to identify risk factors and construct a risk prediction model for oral-mucosal PI development in intubated patients in the intensive care unit. METHODS The study design was prospective, observational with medical record review. The inclusion criteria stipulated that 1) participants should be > 18 years of age, 2) there should be ETT use with holding methods including adhesive tape, gauze tying, and commercial devices. Data of 194 patient-days were analysed. The identification and validation of risk model development was performed using SPSS and the SciKit learn platform. RESULTS The risk prediction logistic models were composed of three factors (bite-block/airway, commercial ETT holder, and corticosteroid use) for lower oral-mucosal PI development and four factors (commercial ETT holder, vasopressor use, haematocrit, and serum albumin level) for upper oral-mucosal PI development among 10 significant input variables. The sensitivity and specificity for lower oral-mucosal PI development were 85.2% and 76.0%, respectively, and those for upper oral-mucosal PI development were 60.0% and 89.1%, respectively. Based on the results of the machine learning, the upper oral-mucosal PI development model had an accuracy of 79%, F1 score of 88%, precision of 86%, and recall of 91%. CONCLUSIONS The development of lower oral-mucosal PIs is affected by immobility-related factors and corticosteroid use, and that of upper oral-mucosal PIs by undernutrition-related factors and ETT holder use. The high sensitivities of the two logit models comprise important minimum data for positively predicting oral-mucosal PIs.
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Affiliation(s)
- Byung Kwan Choi
- Department of Neurosurgery, College of Medicine, Pusan National University, Busan, South Korea.
| | - Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Soo Hyun Kim
- The Artificial Kidney Room, Busan Medical Center, Busan, South Korea.
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Osis SL, Diccini S. Incidence and risk factors associated with pressure injury in patients with traumatic brain injury. Int J Nurs Pract 2020; 26:e12821. [PMID: 31994827 PMCID: PMC9285356 DOI: 10.1111/ijn.12821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
AIM To identify the prevalence of pressure injury in patients diagnosed with traumatic brain injury and analyse the risk factors involved during hospitalization. METHODS This was a prospective study evaluating patients who were diagnosed with traumatic brain injury between November 2013 and September 2014. Patient characteristics, clinical and metabolic factors and therapeutic interventions, were evaluated within 30 days of hospital admission. RESULTS Most of the 240 patients included in the study were male, young, and non-Caucasian. The incidence of pressure injury was 18.8%. In terms of severity classification, the incidence of pressure injury was 2.7%, 23.2%, and 42.6% in mild, moderate, and severe traumatic brain injury, respectively. Pressure injury development was more likely in the first 10 days of hospitalization. A moderate or severe traumatic brain injury classification, the use of noradrenaline, and older age were pressure injury risk factors. The presence of pressure injury was associated with mortality within 30 days of hospitalization (P < .001). CONCLUSION The incidence of pressure injury was high in patients diagnosed with traumatic brain injury, especially in those whose injury was classified as severe. Older age, noradrenaline use, and a classification of moderate or severe traumatic brain injury were identified as pressure injury risk factors.
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Affiliation(s)
- Sibila Lilian Osis
- School of NursingState University of Amazonas, Brazilian Association Critical Care NursesManausBrazil
| | - Solange Diccini
- School of NursingFederal University of São PauloSão PauloBrazil
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Bernardi M, Fedullo AL, Bernardi E, Munzi D, Peluso I, Myers J, Lista FR, Sciarra T. Diet in neurogenic bowel management: A viewpoint on spinal cord injury. World J Gastroenterol 2020; 26:2479-2497. [PMID: 32523306 PMCID: PMC7265150 DOI: 10.3748/wjg.v26.i20.2479] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.
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Affiliation(s)
- Marco Bernardi
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome 00185, Italy
- Italian Paralympic Committee, Rome 00191, Italy
- Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
| | - Anna Lucia Fedullo
- Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
| | - Elisabetta Bernardi
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Bari 70121, Italy
| | - Diego Munzi
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
| | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome 00178, Italy
| | - Jonathan Myers
- VA Palo Alto Health Care System and Stanford University, Cardiology Division, Palo Alto, CA 94025, United States
| | | | - Tommaso Sciarra
- Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
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Herberger K, Müller K, Protz K, Zyriax BC, Augustin M, Hagenström K. Nutritional status and quality of nutrition in chronic wound patients. Int Wound J 2020; 17:1246-1254. [PMID: 32378317 PMCID: PMC7949234 DOI: 10.1111/iwj.13378] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022] Open
Abstract
Malnutrition is a negative confounding factor influencing wound healing. The prevalence of malnutrition increases with age, as do chronic wounds. The aim of this prospective study was to analyse the nutritional status of patients with chronic wounds. Data collection of sociodemographic and nutritional parameters was based on an inter‐professionally developed questionnaire as well as the Mini Nutritional Assessment (MNA). A total of 90 patients with chronic wounds of different aetiologies were included. Pain and dental health were found to be significant factors: Patients with malnutrition or the risk of malnutrition had significantly lower tooth and oral health scores (rs = −0.218, P = .039), and higher pain levels at rest (rs = 0.339, P < .001), while dressing (rs = 0.268, P = .014), and upon exercising (rs = 0.303, P = .005). Our data address the impact of nutrition on chronic wounds and confirm the relationship between pain, dental health, and nutritional status. Clinicians should be aware of adequate pain management and dental health care in chronic wound patients. Further studies, particularly on characterisation of preventive and therapeutic measures in the nutrition of chronic wound patients, are of great importance.
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Affiliation(s)
- Katharina Herberger
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Müller
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kerstin Protz
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Preventive Medicine and Nutrition, Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Kristina Hagenström
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Parameters for Nutrition Assessment. Adv Skin Wound Care 2020; 33:232. [DOI: 10.1097/01.asw.0000655500.25651.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Post-stroke Complications and Mortality in Burkinabè Hospitals: Relationships with Deglutition Disorders and Nutritional Status. Dysphagia 2020; 36:85-95. [PMID: 32303906 DOI: 10.1007/s00455-020-10111-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/01/2020] [Indexed: 12/20/2022]
Abstract
Stroke frequently causes deglutition disorders, leading to a decline in nutritional status and complications, and increasing mortality. Sub-Saharan data are scarce. The objectives of this study were to assess complications and mortality among hospitalized patients in Burkina Faso during the first two weeks after stroke, and to investigate associated factors. Patients with stroke were followed prospectively in Ouagadougou and Bobo-Dioulasso hospitals. Deglutition disorders and nutritional parameters were assessed at baseline (D0) and on Days 8 (D8) and 14 (D14). Complications and mortality were recorded up to D14. Factors associated with complications and mortality were investigated using multivariate analysis. Of the 222 patients included, 81.5% developed at least one complication, and mortality was 17.1%. At D0, D8, and D14, the rate of deglutition disorders was 37.4%, 28.4%, and 15.8%, respectively, and that of undernourishment 25.2%, 29.4%, and 31.0%, respectively. In multivariate analysis, only the presence of deglutition disorders was a risk factor for developing at least one complication (OR = 5.47, 95% CI 1.81-16.51). Factors predicting death were the presence of deglutition disorders at D0 (OR = 7.19, 95% CI 3.10-16.66), and at least one seizure during follow-up (OR = 3.69, 95% CI 1.63-8.36). After stroke, the rates of complications, death, and undernourishment were high compared to Western countries. Prevention and management of deglutition disorders, and specific follow-up of patients with seizures could reduce post-stroke mortality.
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Song Y, Wang L, Yu H, Yuan B, Shen H, Du L, Cai J, Chen H. Zinc Therapy Is a Reasonable Choice for Patients With Pressure Injuries: A Systematic Review and Meta‐Analysis. Nutr Clin Pract 2020; 35:1001-1009. [PMID: 32166790 DOI: 10.1002/ncp.10485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Yi‐Ping Song
- School of Medicine Nantong University Nantong Jiangsu PR China
| | - Lei Wang
- Information Department The Third People's Hospital of Nantong Nantong Jiangsu PR China
| | - Hai‐Rong Yu
- Nursing Department Affiliated Hospital of Nantong University Nantong Jiangsu PR China
| | - Bao‐Fang Yuan
- Nursing Department Affiliated Hospital of Nantong University Nantong Jiangsu PR China
| | - Hong‐Wu Shen
- Nursing Department Affiliated Hospital of Nantong University Nantong Jiangsu PR China
| | - Lin Du
- School of Medicine Nantong University Nantong Jiangsu PR China
| | - Ji‐Yu Cai
- School of Medicine Nantong University Nantong Jiangsu PR China
| | - Hong‐Lin Chen
- School of Public Health Nantong University Nantong Jiangsu PR China
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Hewlings S, Kalman D. A Review of Zinc-L-Carnosine and Its Positive Effects on Oral Mucositis, Taste Disorders, and Gastrointestinal Disorders. Nutrients 2020; 12:nu12030665. [PMID: 32121367 PMCID: PMC7146259 DOI: 10.3390/nu12030665] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Zinc-L-carnosine (ZnC), also called polaprezinc known as PepZin GI™, is a chelated compound that contains L-carnosine and zinc. It is a relatively new molecule and has been associated with multiple health benefits. There are several studies that support ZnC’s benefits in restoring the gastric lining, healing other parts of the gastrointestinal (GI) tract, improving taste disorders, improving GI disorders, and enhancing skin and liver. Oral mucositis is a common complication of cytotoxic radiotherapy and/or chemotherapy. It occurs in almost every person with head and neck cancer who receive radiotherapy. It is often overlooked because it is not considered life threatening. However, mucositis often leads to a decreased quality of life and cessation of treatment, ultimately decreasing positive outcomes. Therefore, solutions to address it should be considered. The primary mechanisms of action are thought to be localized and related to ZnC’s anti-inflammatory and antioxidant functions. Therefore, the purpose of this review is to discuss the research related to ZnC and to explore its benefits, especially in the management of conditions related to damaged epithelial cells, such as oral mucositis. Evidence supports the safety and efficacy of ZnC for the maintenance, prevention, and treatment of the mucosal lining and other epithelial tissues. The research supports its use for gastric ulcers (approved in Japan) and conditions of the upper GI and suggests other applications, particularly for oral mucositis.
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Affiliation(s)
- Susan Hewlings
- Central Michigan University, Department of Nutrition and Dietetics Mount Pleasant, MI 48859, USA
- Correspondence:
| | - Douglas Kalman
- College of Healthcare Sciences, Nova Southeastern University, Fort Lauderdale 33314, USA;
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Raveh Y, Livingstone J, Mahan J, Tekin A, Selvaggi G, Bowdon‐Romero M, Nicolau‐Raducu R. Comprehensive Frailty Severity Index for End‐Stage Liver Disease Predicts Early Outcomes After Liver Transplantation. JPEN J Parenter Enteral Nutr 2019; 44:1079-1088. [DOI: 10.1002/jpen.1729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/20/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Yehuda Raveh
- Department of AnesthesiaUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
| | - Joshua Livingstone
- Department of AnesthesiaUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
| | - Jared Mahan
- Department of RadiologyUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
| | - Akin Tekin
- Department of SurgeryMiami Transplant InstituteUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
| | - Gennaro Selvaggi
- Department of SurgeryMiami Transplant InstituteUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
| | - Molly Bowdon‐Romero
- Miami Transplant InstituteUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
| | - Ramona Nicolau‐Raducu
- Department of AnesthesiaUniversity of Miami/Jackson Memorial Hospital Miami Florida USA
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Lauer H, Goertz O, Kolbenschlag J, Hernekamp JF. Gluteal propeller flaps - A reliable reconstructive alternative for elderly patients with pressure ulcers of the sacrum. J Tissue Viability 2019; 28:227-230. [PMID: 31645309 DOI: 10.1016/j.jtv.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Henrik Lauer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Martin Luther Hospital Berlin, Caspar-Theyss Str. 27-31, 14193, Berlin, Germany
| | - Ole Goertz
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Martin Luther Hospital Berlin, Caspar-Theyss Str. 27-31, 14193, Berlin, Germany
| | - Jonas Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, Eberhard Karl University, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Jochen-Frederick Hernekamp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Martin Luther Hospital Berlin, Caspar-Theyss Str. 27-31, 14193, Berlin, Germany.
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Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. J Am Acad Dermatol 2019; 81:893-902. [DOI: 10.1016/j.jaad.2018.12.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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Effectiveness of Arginine Supplementation on Wound Healing in Older Adults in Acute and Chronic Settings: A Systematic Review. Adv Skin Wound Care 2019; 32:457-462. [DOI: 10.1097/01.asw.0000579700.20404.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Pressure injuries are caused by prolonged pressure to an area of the body, which can result in open wounds that descend to the bone. Pressure injuries should not occur in healthcare settings, and yet, they still affect 2.5 million patients in the United States and have an impact on quality of life. Pressure injuries come at a cost of $11 billion in the United States, and 90% of pressure injuries are a secondary condition. In this paper, we survey the literature on preventative techniques to address pressure injures, which we classify into two categories: active prevention strategies and sensor-based risk-factor monitoring. Within each category of techniques, we discuss the literature and assess each class of strategies based on its commercial availability, results of clinical trials when available, the ability for the strategy to save time for healthcare staff, and whether the technique can be tuned to an individual. Based on our findings, the most promising current solutions, supplementary to nursing guidelines, are electrical stimulation, pressure monitoring, and inertial measurement unit monitoring. We also find a need for a clinical software system that can easily integrate with custom sensors, use custom analysis algorithms, and provide visual feedback to the healthcare staff.
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Royall D. Educating registered nurses and healthcare support workers on nutrition and tissue viability. Br J Community Nurs 2019; 24:S29-S31. [PMID: 31264458 DOI: 10.12968/bjcn.2019.24.sup7.s29] [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: 06/09/2023]
Abstract
This article provides an outline of an educational programme designed to inform and guide registered nurses and healthcare support workers on understanding the connection between nutrition and wound healing, with the aim of helping them recognise malnutrition in older community-dwelling adults with wounds. The Agents for Nutrition and Tissue Viability programme was set up 9 years ago, The Agents for Nutrition and Tissue Viability Programme was set up 9 years ago within an acute trust and has since then has been rolled out to a local community trust. Benefits have included greater networking between acute and community trusts and quality improvements for patients.
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Affiliation(s)
- Dawn Royall
- Lead Tissue Viability Nurse, Princess Alexandra Hospital NHS Trust, Harlow, Essex
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Citty SW, Cowan LJ, Wingfield Z, Stechmiller J. Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv Wound Care (New Rochelle) 2019; 8:309-322. [PMID: 31832278 PMCID: PMC6906754 DOI: 10.1089/wound.2018.0925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Significance: It is estimated that up to 50% of hospitalized patients are malnourished. Malnutrition can lead to longer hospital stays, altered immune function, and impaired skin integrity and wound healing. Malnutrition has been found to be a significant factor influencing pressure injury (PI) risk and wound healing. While PI prevention requires multidimensional complex care using a variety of evidence-based strategies, hospitalized patients benefit from interventions that focus on improving oral nutrition to reduce PI risk and enhance wound healing. Unfortunately, malnutrition is often under-recognized and inadequately managed in hospitalized patients and this can lead to higher rates of complications such as PI. Recent Advances: Recent studies suggest that nutritional care has a major impact in PI prevention and management. Strategies, including early identification and management of malnutrition and provision of specially-formulated oral nutritional interventions to at-risk patients, optimization of electronic health record systems to allow for enhanced administration, monitoring, and evaluation of nutritional therapies, and implementation of protocol-based computerized decision support systems, have been reported to improve outcomes. Critical Issues: Unfortunately, there are gaps in the implementation of nutritional care in hospitals. Timely identification and management of malnutrition is needed to advance quality care for hospitalized patients and reduce malnutrition and associated PI. Future Directions: Further research on effective, evidence-based strategies for implementation of all stages of the nutrition care process is needed to reduce pressure injuries and malnutrition in hospitalized patients.
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Affiliation(s)
- Sandra W. Citty
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Linda J. Cowan
- Nursing Service and Research, Tampa VA Center of Innovation for Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Zandra Wingfield
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida
| | - Joyce Stechmiller
- Department of Behavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida
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Delaney CL, Smale MK, Miller MD. Nutritional Considerations for Peripheral Arterial Disease: A Narrative Review. Nutrients 2019; 11:E1219. [PMID: 31146408 PMCID: PMC6627356 DOI: 10.3390/nu11061219] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Those with peripheral arterial disease (PAD) require important considerations with respect to food and nutrition, owing to advanced age, poor diet behaviours and immobility associated with the disease process and co-morbid state. These considerations, coupled with the economic effectiveness of medical nutrition therapy, mandate that dietetic care plays a vital role in the management of PAD. Despite this, optimising dietetic care in PAD remains poorly understood. This narrative review considers the role of medical nutrition therapy in every stage of the PAD process, ranging from the onset and initiation of disease to well established and advanced disease. In each case, the potential benefits of traditional and novel medical nutrition therapy are discussed.
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Affiliation(s)
- Christopher L Delaney
- Department of Vascular Surgery, Flinders Medical Centre and Flinders University, Bedford Park 5042, South Australia, Australia.
| | - Matilda K Smale
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia.
| | - Michelle D Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, South Australia, Australia.
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