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Dupitier EA, Perrier AP, Laforêt P, Pouplin SD. User opinions about connected pressure detection systems to prevent wheelchair-related pressure injuries: An exploratory cross-sectional survey. Assist Technol 2024; 36:275-284. [PMID: 38607290 DOI: 10.1080/10400435.2024.2335944] [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] [Accepted: 07/31/2023] [Indexed: 04/13/2024] Open
Abstract
About 1% of the world's population uses a wheelchair. Wheelchair use is a well-known risk of pressure injury. A connected pressure detection system could help to prevent this complication that is linked to long durations of sitting, provided that user expectations are understood. The aim of this study was to explore the needs of wheelchair users (WU) regarding connected pressure detection systems to prevent pressure injury. A cross-section survey-based study of WU was conducted, using an anonymous electronic questionnaire posted from July 2019 to June 2020. Eighty-eight people responded. The majority were power wheelchair users (72.7%); one third (33.0%) had already sustained a pressure injury; only 17.0% knew of the existence of pressure detection systems, nevertheless 78.4% believed that they could be useful in daily life. The feature that received the highest rating was a pressure warning alarm (4.2/5 points). The majority (71.6%) preferred reminder-alerts to be set according to their habits and not according to medical guidelines. In conclusion, pressure detecting systems were perceived as useful to prevent pressure injuries by both manual and power wheelchair users. Work is needed to inform potential users of the existence of such systems.
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Affiliation(s)
- Elise A Dupitier
- Rehabilitation Research Team in Neuromotor Disability ERPHAN, Paris-Saclay University, Garches, France
- U 1179 National Institute of Health and Medical Research (INSERM), Paris-Saclay University, Versailles, France
- Medical Department, AFM-Téléthon, Evry, France
| | - Antoine P Perrier
- TIMC Lab, Biomeca Team, National Center for Scientific Research (CNRS), Grenoble Alpes University, Grenoble, France
- Orthopedic surgery, Hospital Group Diaconesses - Croix Saint-Simon, Paris, France
| | - Pascal Laforêt
- U 1179 National Institute of Health and Medical Research (INSERM), Paris-Saclay University, Versailles, France
- Neurology Department, Raymond Poincaré University Hospital, Garches, France
- Garches, Nord-Est-lle-de-France Neuromuscular Reference Center, FHU PHENIX, France
| | - Samuel D Pouplin
- Rehabilitation Research Team in Neuromotor Disability ERPHAN, Paris-Saclay University, Garches, France
- U 1179 National Institute of Health and Medical Research (INSERM), Paris-Saclay University, Versailles, France
- New Technologies Plateform, Raymond Poincaré University Hospital, Garches, France
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Kottner J, Amin R, Tomova‐Simitchieva T, Hillmann K, Blume‐Peytavi U. Effects of a mattress cover with special airflow technology on the structure and function of the sacral and heel skin during loading: A two-arm exploratory crossover trial. Int Wound J 2024; 21:e14957. [PMID: 38994923 PMCID: PMC11240536 DOI: 10.1111/iwj.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/14/2024] [Accepted: 06/14/2024] [Indexed: 07/13/2024] Open
Abstract
Prolonged mechanical loading of the skin and underlying soft tissue cause pressure ulceration. The use of special support surfaces are key interventions in pressure ulcer prevention. They modify the degree and duration of soft tissue deformation and have an impact on the skin microclimate. The objective of this randomized cross-over trial was to compare skin responses and comfort after lying for 2.5 h supine on a support surface with and without a coverlet that was intended to assist with heat and moisture removal at the patient/surface interface. In addition, physiological saline solution was administered to simulate an incontinence episode on the mattress next to the participants' skin surface. In total, 12 volunteers (mean age 69 years) with diabetes mellitus participated. After loading, skin surface temperature, stratum corneum hydration and skin surface pH increased, whereas erythema and structural stiffness decreased at the sacral area. At the heel skin area, temperature, erythema, and stratum corneum hydration increased. These results indicate occlusion and soft tissue deformation which was aggravated by the saline solution. The differences in skin response showed only minor differences between the support surface with or without the coverlet.
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Affiliation(s)
- Jan Kottner
- Institute for Clinical Nursing ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ruhul Amin
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- BCSIR Laboratories DhakaBangladesh Council of Scientific and Industrial ResearchDhakaBangladesh
| | - Tsenka Tomova‐Simitchieva
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Kathrin Hillmann
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
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Paquin C, Rozaire J, Chenu O, Gelis A, Dubuis L, Duprey S. Studying mechanical load at body-seat interface during dynamic activities such as wheelchair propulsion: a scoping review. Disabil Rehabil Assist Technol 2024; 19:1879-1889. [PMID: 37610140 DOI: 10.1080/17483107.2023.2248184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 04/20/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body-seat interface during dynamic activities. OBJECTIVES A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task. MATERIALS AND METHODS The literature search was performed by applying the PRISMA methodology. RESULTS A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse. CONCLUSION Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load.
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Affiliation(s)
- Clémence Paquin
- Univ Lyon, Univ Gustave Eiffel, Lyon, France
- Texisense, Torcy, France
| | | | | | - Anthony Gelis
- Centre Mutualiste Neurologique Propara, Montpellier, France
- EPSYLON laboratory, Montpellier, France
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Sonenblum SE, McDonald A, Maurer CL, Bass A, Watson M, Zellner H. Reducing pressure with the goal of improving outcomes: a retrospective chart review of cushion evaluations and recommendations at one seating clinic. Disabil Rehabil Assist Technol 2024; 19:1552-1560. [PMID: 37177785 DOI: 10.1080/17483107.2023.2212012] [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: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To describe the current seating recommendations made by a seating clinic for wheelchair users who presented with a Pressure Injury (PrI) or history of PrI. METHODS Retrospective review of electronic medical records of 133 adults who used a wheelchair as their primary means of mobility who had a cushion evaluation during which interface pressure mapping data was documented. RESULTS Clinicians adjusted 71% of participants' wheelchair cushions, including 49% who received a new cushion, and 37% of participants' wheelchairs. The most common adjustments besides receiving a new cushion were: addition of an underlay, adjusting the inflation of a cushion, and adjustments to the foot or back support of the wheelchair. Forty-five participants only received adjustments (i.e. no new cushion), while 23 participants only received education and feedback rather than equipment modifications. Those 23 participants had significantly lower Peak Pressure Index (PPI) than those who received equipment modifications (mean [95% CI] 76.7 [59.1, 94.3] versus 111.6 [102.1, 121.2] respectively, p = 0.001). The PPI was reduced by an average of 22.5 mmHg from the initial to final seating system amongst those who received modifications ([13.9-31.0], p<.001). CONCLUSIONS The seating clinicians considered interface pressure mapping in their decision-making and effectively reduced interface pressures with their interventions. Cushion replacement is important when someone presents with a PrI. However, adjusting an existing wheelchair cushion and/or seating system provides important additions and alternatives to consider for reducing interface pressure. There is also a role for education about proper use of equipment, weight shifts, and alternate seating surfaces.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, GA Institute of Technology, Atlanta, GA, USA
| | | | | | - Amber Bass
- Division of Physical Therapy, Emory School of Medicine, Atlanta, GA, USA
| | - Marigny Watson
- Division of Physical Therapy, Emory School of Medicine, Atlanta, GA, USA
| | - Haley Zellner
- Division of Physical Therapy, Emory School of Medicine, Atlanta, GA, USA
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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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de Groot S, Kouwijzer I, Valent L, van der Woude L. Handbike configurations and the prevalence of experienced sitting and riding-related problems in recreational handcyclists training for the HandbikeBattle. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38372244 DOI: 10.1080/17483107.2024.2315466] [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: 09/22/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
Implications for rehabilitationA large variety in handbike configurations is seen in recreationally-active handcyclists.Although the majority of the recreationally-active handcyclists seemed to be satisfied with their handbike configurations, 31-50% of them thought that their handbike configuration could be improved.Evidence-based guidelines for handbike fitting should be developed in the future.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Ingrid Kouwijzer
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Linda Valent
- Research & Development, Rehabilitation Center Heliomare, Wijk aan Zee, the Netherlands
| | - Lucas van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, The Netherlands
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Yin C, Mpofu E, Brock K, Li X, Zhan R. Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors. J Gerontol Nurs 2024; 50:32-41. [PMID: 38290099 DOI: 10.3928/00989134-20240110-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals. METHOD We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle. RESULTS Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers. CONCLUSION Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].
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Sonenblum SE, Feng C, Sprigle S. The relationship between in-seat movement and pressure ulcers in wheelchair users with SCI/D. J Spinal Cord Med 2024; 47:91-99. [PMID: 36260494 PMCID: PMC10795617 DOI: 10.1080/10790268.2022.2122340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To identify parameters that are associated with time at pressure, are most related to pressure ulcer outcomes, and that may be used to influence pressure ulcer (PrU) outcomes in future intervention studies. DESIGN Analysis used datasets from cross-sectional and longitudinal observational studies. Wheelchair-usage and in-seat metrics thresholds were optimized to differentiate individuals in PrU or No PrU groups. Logistic regression identified the demographics and in-seat activity metrics that impacted PrU outcomes. SETTING General Community. PARTICIPANTS Fifty individuals with spinal cord injuries and/or disorders (SCI/D) who use a wheelchair as their primary mobility device. 22 subjects were within the first year following injury and 28 had been using a wheelchair for over 2 years. Twenty-one participants reported PrU outcomes. INTERVENTIONS Not applicable. OUTCOME MEASURES Time in chair, pressure relief frequency, weight shift frequency, percentage of seated time that the subject is active (CoP Percent Active), frequency of in-seat movement, unloading event frequency, maximum time between events, and number of transfers. RESULTS Optimal cutoff thresholds for the most significant in-seat movement metrics included: unloading event frequency of 3.1 times per hour (OR 0.353, 95% CI [0.110, 1.137]), maximum time between events of 155.4 min (OR 2.888, 95% CI [0.886, 9.413]), and CoP Percent Active of 2.6% (OR 0.221, 95% CI [0.063, 0.767]). When individuals were more active than these cutoffs, significantly more individuals were in the no pressure ulcer group. In predictive modeling, CoP Percent Active was the in-seat movement metric that significantly predicted PrU outcomes. The model was improved by adding age, occupation, and injury completeness. CONCLUSION Of the 4 significant predictors in the model, only CoP Percent Active was modifiable. Therefore, an opportunity exists to design approaches to modify behavior. However, the results illustrate that the key to preventative movement may be through functional movement as opposed to scheduled, routine pressure reliefs.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Chen Feng
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Stephen Sprigle
- Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, Georgia, USA
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Stevens L, Liu J, Voigt N. Improving the Use of Subscale-Specific Interventions of the Braden Scale Among Nurses. J Contin Educ Nurs 2024; 55:42-48. [PMID: 37921477 DOI: 10.3928/00220124-20231030-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Pressure injuries (PIs) are costly to hospitals and have a negative impact on patient outcomes. Despite the use of validated tools that describe PI risk, such as the Braden Scale, the incidence of PIs remains high. Studies have shown that Braden Scale subscale scores should be considered when planning care; however, there is a discrepancy between understanding the importance of subscale-specific interventions and implementation. The goal of this study was to test the ability of an educational intervention tailored to specific interventions based on the subscales of the Braden Scale to improve knowledge among nurses. METHOD This study was a prospective, quasi-experimental, single-group design where nurses (n = 35) from a neurosurgery stepdown unit in a large teaching hospital completed a preintervention survey (T1), attended an educational presentation, and then completed an immediate postintervention survey (T2) and a 2-month postintervention survey (T3). RESULTS Data analysis compared presurvey scores with postsurvey scores. Nursing comprehension improved from the preintervention survey (T1, M = 5.57) to the postintervention surveys (T2, M = 6.34; T3, M = 6.42) (p = .031). CONCLUSION Nurses showed increased comprehension after the educational intervention from T1 to T3. [J Contin Educ Nurs. 2024;55(1):42-48.].
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Rohn EJ, Hearn JH, Philippus AM, Monden KR. "It's been a double-edged sword": An online qualitative exploration of the impact of COVID-19 on individuals with spinal cord injury in the US with comparisons to previous UK findings. J Spinal Cord Med 2024; 47:51-63. [PMID: 36260026 PMCID: PMC10795552 DOI: 10.1080/10790268.2022.2129164] [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: 10/24/2022] Open
Abstract
OBJECTIVE The impact of COVID-19 lockdowns and social distancing for persons with spinal cord injury (SCI) are poorly understood. This exploratory online qualitative study collected self-reported COVID-19 experiences from persons with SCI in the United States (US). To enrich understanding, these data were compared to similar previously-published data from a sample of SCI participants from the United Kingdom (UK). DESIGN Explorative, online qualitative study. Participants completed an online survey of open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized to generate themes from the US data. These themes were compared to our previously-published thematic analysis of data from the UK. SETTING Community-based sample of persons with SCI in the US. PARTICIPANTS Participants were recruited via SCI-focused research registries and social media outlets serving the SCI community, using convenience sampling (n = 36). Key themes identified in the US data were compared to themes identified in a similar sample from the UK (n = 42) collected at the same time and published previously. RESULTS Analysis resulted in three themes from the US data, each containing positive and negative qualitative reflections. Themes included (1) health and access to care, (2) making sense of the pandemic, and (3) daily life during the pandemic. Each theme captured common facets of life during the pandemic, often shared by those without physical disabilities, but included accounts particularly relevant to persons with disabilities. Comparisons to thematic findings from the UK study revealed similarities (e.g. healthcare access challenges, isolation) and differences (e.g. importance of previous SCI experiences). CONCLUSION We detailed common experiences of COVID-19 pandemic lockdowns and their impact on people with SCI, while contrasting these with sense-making positive reflections and social benefits that appeared to be helpful in managing distress and coping with the pandemic.
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Affiliation(s)
- Edward J. Rohn
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jasmine H. Hearn
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Angela M. Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kimberley R. Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Tzen YT, Sambandam S, Delmore B, Wang J, Chu A, Wukich DK. Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture. Adv Skin Wound Care 2023; 36:642-650. [PMID: 37983577 DOI: 10.1097/asw.0000000000000068] [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: 11/22/2023]
Abstract
OBJECTIVE To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications. METHODS In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications. RESULTS Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation. CONCLUSIONS Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.
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Affiliation(s)
- Yi-Ting Tzen
- Yi-Ting Tzen, PhD, is Assistant Professor, Department of Applied Clinical Research, and Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. Senthil Sambandam, MD, is Assistant Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, and Division of Orthopedic Surgery, Veterans Affairs North Texas Health Care System, Dallas. Barbara Delmore, PhD, RN, CWCN, MAPWCA, FAAN, is Senior Nurse Scientist, Center for Innovations in the Advancement of Care, and Clinical Assistant Professor, Hansjörg Wyss, Department of Plastic Surgery, NYU Langone Health, New York. Jijia Wang, PhD, is Assistant Professor, Department of Applied Clinical Research, University of Texas Southwestern Medical Center. Andy Chu, MS, RD, CDN, CNSC, is Registered Dietitian, Food and Nutrition Services, NYU Langone Health. Dane K. Wukich, MD, is Professor, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center. Conflict of Interest: Dr Wukich serves as consultant with Orthofix Medical Inc, Stryker, and Wright Medical and receives royalties from Arthrex Inc. The authors have disclosed no other financial relationships related to this article. Submitted August 5, 2022; accepted in revised form January 4, 2023
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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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Vos-Draper TL, Morrow MMB, Ferguson JE, Mathiowetz VG. Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study. JMIR Rehabil Assist Technol 2023; 10:e49813. [PMID: 37824188 PMCID: PMC10603555 DOI: 10.2196/49813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. OBJECTIVE We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. METHODS Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. RESULTS Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. CONCLUSIONS Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. TRIAL REGISTRATION ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243.
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Affiliation(s)
- Tamara L Vos-Draper
- Center for Allied Health Professions, Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Melissa M B Morrow
- School of Health Professions, Center for Health Promotion, Performance, and Rehabilitation Research, University of Texas Medical Branch, Galveston, TX, United States
| | - John E Ferguson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Medicine & Rehabilitation, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - Virgil G Mathiowetz
- Center for Allied Health Professions, Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
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14
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Ghaderi M, Chehre H, Fathpour H. Design and Implementation of a Novel Double-Layered Wavy Mattress for the Prevention and Recovery of Pressure Ulcers: A Feasibility Study. J Biomed Phys Eng 2023; 13:489-494. [PMID: 37868947 PMCID: PMC10589688 DOI: 10.31661/jbpe.v0i0.2305-1617] [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: 05/07/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
Abstract
Pressure ulcers are a significant concern in patient care, particularly for those with limited mobility and extended hospital stays. Wavy mattresses are shown an effective tool for preventing or promoting the healing of these wounds by preventing pressure localization in different body regions. The current study aimed to present a novel double-layered wavy mattress design for the prevention and recovery of pressure ulcers, addressing some of the limitations of existing mattresses. The novel mattress includes double-layered cells, with the upper and lower layers, filled with water and air, respectively. The temperature of water in the cells can be manually adjusted to meet patients' needs, prevent skin sweating, regulate body temperature, and promote blood flow in areas susceptible to pressure ulcers. Patients who used this novel mattress during their hospitalization experienced a significantly shorter recovery period for bedsores compared to those who used other mattresses, showing that the novel wavy mattress is an effective tool for preventing and recovering from pressure ulcers in long-term hospitalized patients with limited mobility.
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Affiliation(s)
- Mehrdad Ghaderi
- Department of Electrical and Computer, Technical and Engineering Faculty, Mohaghegh Ardabili University, Ardabil, Iran
| | - Hossein Chehre
- Department of Biomedical Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Helia Fathpour
- Department of Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
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15
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Salgueiro-Oliveira A, Rêgo ADS, Santos-Costa P, Bernardes RA, Filipe L, Sousa LB, Barboza R, Carvalho M, Bouçanova M, Lopes MCFDG, Apóstolo JA, Parreira P. Design of Innovative Clothing for Pressure Injury Prevention: End-User Evaluation in a Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6773. [PMID: 37754632 PMCID: PMC10530919 DOI: 10.3390/ijerph20186773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
The global relevance of pressure injury (PI) prevention technologies arise from their impact on the quality of life of people with limited mobility and the costs associated with treating these preventable injuries. The purpose of this mixed methods study is to evaluate the design of a prototype integrating Smart Health Textiles for PI prevention based on feedback from specialist nurses who care for individuals who are prone to or have PIs. This is a mixed methods study. A structured questionnaire was conducted as part of an evaluation of a prototype garment for the prevention of PIs. This questionnaire was applied during the evaluation of the prototype and afterwards focus group discussions were held with experts. Descriptive statistics techniques were used to analyze the data and thematic and integrated content analysis was conducted through concomitant triangulation. Nineteen nurses took part, aged 30 to 39 years (52.6%) and with 12.31 ± 8.96 years of experience. Participants showed that the prototype required more manipulation and physical effort, which interfered its usefulness, in addition to presenting difficulties with the openings and the material of the closure system, which interfered with the ease of use and learning. Overall satisfaction with the product was moderate, with some areas for improvement found, such as satisfaction, recommendations to colleagues, and pleasantness of use. It is concluded that areas for improvement have been found in all dimensions, including in the design of openings and the choice of materials. These findings supply significant insights for improving clothing to meet the needs of healthcare professionals and patients.
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Affiliation(s)
- Anabela Salgueiro-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Anderson da Silva Rêgo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Rafael A. Bernardes
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Luísa Filipe
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Liliana B. Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Rochelne Barboza
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal (M.C.)
| | - Miguel Carvalho
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal (M.C.)
| | - Maria Bouçanova
- Impetus Portugal-têxteis Sa (IMPETUS), 4740-696 Barcelos, Portugal
| | | | - João A. Apóstolo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
| | - Pedro Parreira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal (R.A.B.); (L.B.S.); (J.A.A.)
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16
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Byrne S, Patton D, Avsar P, Strapp H, Budri A, O'Connor T, Nugent L, Moore Z. Sub epidermal moisture measurement and targeted SSKIN bundle interventions, a winning combination for the treatment of early pressure ulcer development. Int Wound J 2023; 20:1987-1999. [PMID: 36575149 PMCID: PMC10333035 DOI: 10.1111/iwj.14061] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022] Open
Abstract
This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. A quantitative quasi-experimental observational approach was used. A total of 149 at risk acute hospital patients took part, 78 treatment, and 71 control. SEM deltas were recorded daily for a maximum of 5 days using the SEM Scanner (Bruin Biometrics LLC, Los Angeles, California), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted PU prevention interventions occurring in those with an elevated SEM delta scores in the treatment group. Intention to treat analysis was used to guide the final composition of results. SEM PU represents PU development as identified by 2 days of sustained abnormal SEM delta scores, ≥0.5, after day one. The mean number of days completed by participants was just under 4 days, participants had many different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. Results showed that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD: 0.49; 95% CI: 0.59, 0.39; P < .0001), and in the odds of developing a SEM PU (OR: 0.59, 95% CI: 0.24 to 1.00; P = .05). In the treatment group, none of the participants developed a visual PU, whereas, in the control group, 1.41% (n = 1/71) developed a visual PU. Based on all the results, the following is concluded, (1). There was a greater reduction in mean SEM delta scores among those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta scores was statistically significantly lower at the study end for those who received targeted treatments based on abnormal SEM scores. More research is now needed in other and larger at-risk groups to further validate what was found in this study.
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Affiliation(s)
| | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Pinar Avsar
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | | | - Aglecia Budri
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Lida InstituteShanghaiChina
| | - Linda Nugent
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
| | - Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- Lida InstituteShanghaiChina
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- University of WalesCardiffUK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandGriffithQueenslandAustralia
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17
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Sprigle S. Measure It: Proper Wheelchair Fit Is Key to Ensuring Function while Protecting Skin Integrity. Adv Skin Wound Care 2023; 36:404-413. [PMID: 37471445 DOI: 10.1097/asw.0000000000000001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
GENERAL PURPOSE To review the biomechanics of posture, appropriate means to configure a wheelchair to permit proper postural support, and common problems arising from improper wheelchair fit. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Synthesize the concepts influencing proper wheelchair fit.2. Identify the biomechanics of posture as they apply to wheelchair fit.3. Summarize the appropriate assessment guidelines for determining and preparing to adjust wheelchair fit.
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Affiliation(s)
- Stephen Sprigle
- Professor, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, Georgia, USA
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18
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Anderson KK, Maresh S, Ward A, Koller EA, Connor P, Evans M, Kiptanui Z, Raja MM, Thomas S, Wolfe T, Gill CS. The COVID-19 pandemic's impact on all-cause mortality disparities in Medicare: By race, income, chronic health, mental/behavioral health, disability. Gen Hosp Psychiatry 2023; 81:57-67. [PMID: 36805333 PMCID: PMC9886431 DOI: 10.1016/j.genhosppsych.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Medicare-enrolled population is heterogeneous across race, ethnicity, age, dual eligibility, and a breadth of chronic health, mental and behavioral health, and disability-related conditions, which may be differentially impacted by the COVID-19 pandemic. OBJECTIVE To quantify changes in all-cause mortality prior-to and in the first year of the COVID-19 pandemic across Medicare's different sociodemographic and health-condition subpopulations. METHODS This observational, population-based study used stratified bivariate regression to investigate Medicare fee-for-service subpopulation differences in pre-pandemic (i.e., 2019 versus 2016) and pandemic-related (2020 versus 2019) changes in all-cause mortality. RESULTS All-cause mortality in the combined Medicare-Advantage (i.e., managed care) and fee-for-service beneficiary population improved by a relative 1% in the ten years that preceded the COVID-19 pandemic, but then escalated by a relative 15.9% in 2020, the pandemic's first year. However, a closer look at Medicare's fee-for-service subpopulations reveals critical differences. All-cause mortality had actually been worsening prior to the pandemic among most psychiatric and disability-related condition groups, all race and ethnicity groups except White Non-Hispanic, and Medicare-Medicaid dual-eligible (i.e., low-income) beneficiaries. Many of these groups then experienced all-cause mortality spikes in 2020 that were over twice that of the overall Medicare fee-for-service population. Of all 61 chronic health conditions studied, beneficiaries with schizophrenia were the most adversely affected, with all-cause mortality increasing 38.4% between 2019 and 2020. CONCLUSION This analysis reveals subpopulation differences in all-cause mortality trends, both prior to and in year-one of the COVID-19 pandemic, indicating that the events of 2020 exacerbated preexisting health-related inequities.
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Affiliation(s)
- Karyn Kai Anderson
- Centers for Medicare and Medicaid Services, 7500 Security Blv., Baltimore MD 21244, USA.
| | - Sha Maresh
- Centers for Medicare and Medicaid Services, 7500 Security Blv., Baltimore MD 21244, USA
| | - Andrew Ward
- Centers for Medicare and Medicaid Services, 7500 Security Blv., Baltimore MD 21244, USA
| | - Elizabeth A Koller
- Centers for Medicare and Medicaid Services, 7500 Security Blv., Baltimore MD 21244, USA
| | - Philip Connor
- Centers for Medicare and Medicaid Services, 7500 Security Blv., Baltimore MD 21244, USA
| | - Melissa Evans
- Centers for Medicare and Medicaid Services, 7500 Security Blv., Baltimore MD 21244, USA
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19
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Jordan K, Vos-Draper T, Morrow M, Sonenblum S. The usability of two mobile health assistive technologies for wheelchair-related in-seat movement and pressure. J Rehabil Assist Technol Eng 2023; 10:20556683231211808. [PMID: 38028632 PMCID: PMC10648002 DOI: 10.1177/20556683231211808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction This study aimed to understand the degree to which two different mobile health assistive technologies, AW-Shift© and Sensoria® Mat, addressed seven constructs for managing wheelchair-related in-seat movement and pressure. Methods After using each intervention system, participants answered questions regarding the general usability and usefulness of the systems. Results System Usability Survey scores ranged from 5 (Poor) to 97.5 (Excellent), with a median response of 60.0 (Okay) for AW-Shift© and 76.3 (Good) for Sensoria® Mat. Participants reported using AW-Shift© to check areas of high pressure on their cushion, the quality of their weight shifts, and their posture significantly more often than to check the condition of their cushion or to track their movement goals. Participants reported using Sensoria® Mat to check the quality and number of weight shifts, and their posture significantly more often than to check the condition of their cushion. Conclusions The findings of this study highlight that there is no one-size-fits-all solution and that different subpopulations of wheelchair users may have different needs and preferences. Optimizing the design for specific cohorts or constructs can result in an effective product that consistently provides meaningful and accurate information about behavior and performance.
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Affiliation(s)
- Kathleen Jordan
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tamara Vos-Draper
- Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Morrow
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Sharon Sonenblum
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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20
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Ozcan O, Karaali HK. Physiotherapists' knowledge on pressure ulcer prevention. Int Wound J 2022. [DOI: 10.1111/iwj.14049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ozlem Ozcan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences Manisa Celal Bayar University Manisa Turkey
| | - Hayriye Kul Karaali
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences Manisa Celal Bayar University Manisa Turkey
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21
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Ogle L, Hand MW, Swenty C. Pressure injury screening in the emergency department: A concept analysis. Nurs Forum 2022; 57:1508-1512. [PMID: 36214422 DOI: 10.1111/nuf.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023]
Abstract
AIM This concept analysis analyzes pressure injury screening in the emergency department setting using Walker and Avant's approach. BACKGROUND Pressure injury treatment cost in the United States totals over 11 billion dollars annually. Although a pressure injury could develop in the few hours a patient is in the emergency department, there is little guidance on how an emergency department should screen, prevent, and treat patients. DATA SOURCE Five sources resulted from database searches of CINAHL full-text, Health Business FullTEXT, and MEDLINE with Full Text. Key search terms used to narrow the search consist of the following terminology: "pressure injury" OR "pressure ulcer" AND "screening" AND "risk factors" AND "emergency room" OR "emergency department. REVIEW METHODS Walker and Avant's method of concept analysis was used to clarify the concept of pressure injury screening in the emergency department. RESULTS The concept analysis identified two attributes of pressure injury screening in the emergency department: patient length of stay and the cost of pressure injury treatment. Antecedents identified are patient risk factors: age, mobility status, sensory perception, comorbidities, and pre-existing pressure injuries. Positive consequences identified are increased patient comfort, increased staff satisfaction, decreased hospital-acquired pressure injuries, and increased adherence to established treatment protocols. CONCLUSIONS This concept analysis may help to guide evidence-based practice for pressure injury screening in the emergency setting. Perhaps screening in the emergency department, if adopted globally, is the missing element needed to finally see a reduction in pressure injury rates.
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Affiliation(s)
- Laura Ogle
- MedStar Southern Maryland Hospital Center, Chesapeake Beach, Maryland, United States
| | - Mikel W Hand
- Stone Family Center for Health Sciences, University of Southern Indiana, Evansville, Indiana, USA
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22
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Delmore B, Sprigle S, Samim M, Alfonso AR, Lin L, Chiu E. Does Sacrococcygeal Skeletal Morphology and Morphometry Influence Pressure Injury Formation in Adults? Adv Skin Wound Care 2022; 35:586-595. [PMID: 36264750 DOI: 10.1097/01.asw.0000874180.84660.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
GENERAL PURPOSE To present a study that investigated sacrococcygeal skeletal structure as a possible nonmodifiable intrinsic risk factor for pressure injury and identify possible issues caused by its morphology. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Recognize the background information the authors considered when planning and conducting their study of sacrococcygeal skeletal structure as a possible pressure injury risk factor.2. Identify the characteristics of the two groups of study participants.3. Choose the results of the study clinicians may consider when implementing evidence-based practice.
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23
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General Skin Issues in the Adult Rehabilitation Population. Phys Med Rehabil Clin N Am 2022; 33:745-758. [DOI: 10.1016/j.pmr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Mechanical analysis of deep tissue injury during sitting in patients with spinal cord injury via parametric finite element model. Biomech Model Mechanobiol 2022; 21:1573-1584. [PMID: 35931860 DOI: 10.1007/s10237-022-01607-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022]
Abstract
Spinal cord injury patients are prone to develop deep tissue injury because of long-term mechanical load. However, there is a lack of statistical research on the influence of tissue characteristics on the internal mechanical state of soft tissue. This study aimed to investigate the influence of tissue characteristics on the internal mechanical state of buttock in spinal cord injury patients. A three-dimensional reference buttock model was established and a visualization program was generated to modify the parameter values. Through changing the muscle atrophy, body mass index and the radius of curvature of the ischial tuberosity, 96 different model variants were simulated and validated in this study. With body mass index increasing from 16 to 40, the principal shear stress was 10.4 times principal compressive stress, the maximum shear strain and the max cluster volume increased by 1.2 (P < 0.001) and 8.8 times (P < 0.001), respectively. The interaction between BMI and muscle atrophy was significant when BMI was greater than or equal to 22.5 kg/m2. In all BMI stages, when the radius of curvature of the ischial tuberosity was 19 mm, the internal stress of the tissue always occupies the highest value. The results demonstrate that body mass index is the most important factor affecting the risk of buttock deep tissue injury. This study provides insights into investigation of inter-individual factors influencing the soft tissue response and assessment of deep tissue injury risk during sitting.
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25
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Cha YH, Song SY, Park KS, Yoo JI. Relationship between pressure ulcer risk and sarcopenia in patients with hip fractures. J Wound Care 2022; 31:532-536. [PMID: 35678788 DOI: 10.12968/jowc.2022.31.6.532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcer (PU) is a frequent complication of hip fractures. PUs can develop at any time after a hip fracture but most appear within 2-4 days after surgery. The purpose of this study was to investigate the association between hip fractures due to sarcopenia and the risk of PUs in patients with hip fracture. METHOD Between March 2017 and March 2019, patients aged ≥65 years of age with hip fractures were included in this retrospective cohort study. PU risk assessment according to the Braden Scale was performed within the first few hours after arrival at hospital. Skeletal muscle mass index (SMI) and hand grip strength were evaluated for a diagnosis of sarcopenia. RESULTS Of the 289 patients admitted to the study institution, 180 patients were finally enrolled in the study (129 females; 51 males). In male patients, as SMI increased, so too did the Braden Scale score, which was statistically significant (p=0.02). However, there was no statistically significant difference between SMIs and Braden Scale scores in female patients (p=0.304). In male patients, there was no statistically significant difference between hand grip strength and Braden Scale score (p=0.251). However, in female patients, as hand grip strength increased, so too did the Braden Scale score; this was also statistically significant (p=0.041). CONCLUSION In this study, decreased muscle mass and muscle weakness in patients with hip fractures were associated with increased PU risk as measured by Braden Scale scores in both males and females.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Sang-Youn Song
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ki-Soo Park
- Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jun-Ii Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
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26
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Desenvolvimento de aplicativo móvel para avaliar, tratar e prevenir lesão por pressão. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao0329345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Jan YK, Major MJ, Pu F, Sonenblum SE. Editorial: Soft Tissue Biomechanics in Wound Healing and Prevention. Front Bioeng Biotechnol 2022; 10:897860. [PMID: 35449596 PMCID: PMC9017806 DOI: 10.3389/fbioe.2022.897860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- *Correspondence: Yih-Kuen Jan,
| | - Matthew J. Major
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, United States
- Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Fang Pu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Sharon Eve Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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Douthit BJ, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Forbes T, Gao G, Kapetanovic TA, Lee MA, Pruinelli L, Schultz MA, Wieben A, Jeffery AD. Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature. Appl Clin Inform 2022; 13:161-179. [PMID: 35139564 PMCID: PMC8828453 DOI: 10.1055/s-0041-1742218] [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: 01/18/2023] Open
Abstract
BACKGROUND The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications. OBJECTIVES This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature. METHODS We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture. RESULTS Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing. CONCLUSION This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.
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Affiliation(s)
- Brian J. Douthit
- Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Rachel L. Walden
- Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee, United States
| | - Kenrick Cato
- Department of Emergency Medicine, Columbia University School of Nursing, New York, New York, United States
| | - Cynthia P. Coviak
- Professor Emerita of Nursing, Grand Valley State University, Allendale, Michigan, United States
| | - Christopher Cruz
- Global Health Technology and Informatics, Chevron, San Ramon, California, United States
| | - Fabio D'Agostino
- Department of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Thompson Forbes
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Grace Gao
- Department of Nursing, St Catherine University, Saint Paul, Minnesota, United States
| | - Theresa A. Kapetanovic
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Mikyoung A. Lee
- College of Nursing, Texas Woman's University, Denton, Texas, United States
| | - Lisiane Pruinelli
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Mary A. Schultz
- Department of Nursing, California State University, San Bernardino, California, United States
| | - Ann Wieben
- School of Nursing, University of Wisconsin-Madison, Wisconsin, United States
| | - Alvin D. Jeffery
- School of Nursing, Vanderbilt University; Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, United States,Address for correspondence Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC 461 21st Avenue South, Nashville, TN 37240United States
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Stewart TP, Black JM, Alderden J, Yap TL. The Past, Present, and Future of Deep-Tissue (Pressure) Injury. Adv Skin Wound Care 2022; 35:78-80. [PMID: 35050914 DOI: 10.1097/01.asw.0000803592.21401.8f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas P Stewart
- Thomas P. Stewart, PhD, is the founder of the National Pressure Injury Advisory Panel and Senior Associate Clinical Professor, Daemen College, Amherst, New York. Joyce M. Black, PhD, RN, FAAN, is Florence Niedfelt Professor in Nursing, University of Nebraska Medical Center, Omaha. Jenny Alderden, PhD, APRN, CCRN, CCNS, is Associate Professor, Boise State University, Idaho. Tracey L. Yap, PhD, RN, WCC, CNE, FGSA, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina. This article is considered expert opinion and was not subject to peer review
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30
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Abdallah MA, Abdelaziem F, Soliman M. Prevalence of the need for adaptive seating systems among children with cerebral palsy in Egypt. Prosthet Orthot Int 2022; 46:7-11. [PMID: 34840277 DOI: 10.1097/pxr.0000000000000065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND An adaptive seating system is a basic rehabilitation need for children and youth with cerebral palsy (CP) as it supports the structure and function of the musculoskeletal system and can positively affect their activities and participation. Despite the importance of adaptive seating systems, there is limited access to such systems in low-income countries. OBJECTIVES To determine the percentage of children and youth between 4 and 18 years of age with CP in Egypt whose activity level and sitting ability suggest the need for an adaptive seating system. STUDY DESIGN Observational cross-sectional study. METHODS One hundred ninety-three participants were included after fulfilling the criteria of the Surveillance of Cerebral Palsy of Europe. Their level of activity was assessed by a physical therapist using the Gross Motor Function Classification System (GMFCS), and their sitting ability was evaluated using the Level of Sitting Scale (LSS). Participants were considered to require an adaptive seating system if they scored GMFCS level IV or V and LSS level 1-5 concurrently. RESULTS Approximately 44% of the study participants were classified as GMFCS level IV or V and LSS level 1-5, suggesting that they were in need of an adaptive seating system. CONCLUSIONS There is a large percentage of children and youth with CP in Egypt who need an adaptive seating system to be integrated into their rehabilitation.
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Affiliation(s)
- Mohamed Adel Abdallah
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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31
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Xu J, Chen D, Deng X, Pan X, Chen Y, Zhuang X, Sun C. Development and validation of a machine learning algorithm-based risk prediction model of pressure injury in the intensive care unit. Int Wound J 2022; 19:1637-1649. [PMID: 35077000 PMCID: PMC9615270 DOI: 10.1111/iwj.13764] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/03/2023] Open
Abstract
The study aimed to establish a machine learning-based scoring nomogram for early recognition of likely pressure injuries in an intensive care unit (ICU) using large-scale clinical data. A retrospective cohort study design was employed to develop and validate a top-performing clinical feature panel accessibly in the electronic medical records (EMRs), which was in the mode of a quantifiable nomogram. Clinical factors regarding demographics, admission cause, clinical laboratory index, medical history and nursing scales were extracted as risk candidates. The performance improvement was based on the application of the machine learning technique, comprising logistic regression, decision tree and random forest algorithm with five-fold cross-validation (CV) technique. The comprehensive assessment of sensitivity, specificity and the area under the receiver operating characteristic curve (AUROC) was considered in the evaluation of predictive performance. The receiver operating characteristic curves revealed the top performance for the logistic regression model in respect to machine learning improvement, achieving the highest sensitivity and AUC among three types of classifiers. Compared against the 23-point Braden scale routinely recorded online, an incorporated nomogram of logistic regression model and Braden scale achieved the best performance with an AUC of 0.87 ± 0.07 and 0.84 ± 0.05 in training and test cohort, respectively. Our findings suggest that the machine learning technique potentiated the limited predictive validity of routinely recorded clinical data on pressure injury development during ICU hospitalisation. Easily accessible electronic records held the potentials to substitute the traditional Braden score in the prediction of pressure injury in intensive care unit. Preoperative prediction of pressure injury facilitates the exemption from the severe consequences.
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Affiliation(s)
- Jie Xu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Danxiang Chen
- Department of Breast SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiaofang Deng
- Nursing departmentWenzhou Medical UniversityWenzhouChina
| | - Xiaoyun Pan
- Department of Thoracic SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Yu Chen
- Nursing DepartmentThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiaoming Zhuang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Caixia Sun
- Nursing DepartmentThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
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Sefcik JS, McLaurin EJ, Bass EJ, DiMaria-Ghalili RA. Chronic wounds in persons living with dementia: An integrative review. Int J Older People Nurs 2022; 17:e12447. [PMID: 35043568 PMCID: PMC9186127 DOI: 10.1111/opn.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/20/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons living with dementia (PLWD) are at risk for chronic wounds; however, they are rarely included in research. OBJECTIVES To inform practice and research directions, the aim of this integrative review was to identify and synthesise previous knowledge about the characteristics of chronic wounds in PLWD, in terms of chronic wound types, prevalence, setting and interventions. DESIGN A literature search was conducted for publications in English using PubMed, Web of Science and CINAHL. The minimum information required for inclusion was how many PLWD enrolled in the study had wounds. METHODS This integrative review followed the Whittemore and Knafl methodology. Data extraction and synthesis were guided by a directed content analysis, with a coding structure based on an initial review of the literature. RESULTS Thirty-six articles met the inclusion criteria. The majority were missing characteristics of PLWD including severity of dementia and race/ethnicity/nationality, and none mentioned skin tone. Most focused on pressure injuries in the nursing home and acute care setting. Few included information on interventions. Only one discussed challenges of wound care for a PLWD exhibiting aggression. CONCLUSION There is a gap in the literature regarding PLWD and chronic wounds other than pressure injuries that are common in older adults (e.g. diabetic foot ulcers, venous leg ulcers). Research is warranted among those PLWD who live alone and those who receive wound care from family caregivers to understand experiences. Knowledge can inform the development of future novel interventions for wound healing. Future research is needed regarding chronic wounds in those who exhibit behavioural and psychological symptoms of dementia. RELEVANCE TO CLINICAL PRACTICE Nurses that care for chronic wounds in PLWD can contribute their knowledge to include information in guidelines on best care practices and contribute their perspective to research teams for future research.
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Affiliation(s)
- Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elease J McLaurin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Ellen J Bass
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA.,College of Computing & Informatics, Drexel University, Philadelphia, Pennsylvania, USA
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Analysis of epidemiological characteristics and surgical treatment of patients with pressure ulcer. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh200319093p] [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] Open
Abstract
Introduction/Objective A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence. It appears as a result of pressure or the combination of pressure and shear. Pressure ulcers can be identified within a wide variety of patient subpopulations and epidemiological and etiological aspects play a major role in their treatment. Methods A retrospective study of data analysis included 72 patients with pressure ulcers that were hospitalized and surgically treated in our institution over a five-year period. Main data features used in the analysis were sex, age, principal diseases, comorbidities, and biochemical indicators of malnutrition. The patients? data was obtained from the existing patients? records. Additionally, the study analyzed the method of treating pressure ulcers, types of reconstructive methods in surgical treatment, as well as the incidence rate of partial osteotomy. Results A total of 72 patients with pressure ulcers were included in this study, with a mean age of 54.7 ? 16.1 years. Three times more patients injured in traffic accidents were male (75% vs. 25%), while most of the patients with multiple sclerosis were female (85.7%). More than 95% of patients who had pressure ulcers of stage III or IV were treated surgically with a reconstructive method of transposition or rotation myocutaneous flap. Patients with stage IV pressure ulcer were usually treated with partial osteotomy. Conclusion Surgical reconstructive treatment with fasciocutaneous and myocutaneous flaps represents the gold standard for treating patients with pressure ulcers. These procedures provide reconstruction with adequate flap coverage and obliteration of dead space with well-vascularized tissue but with necessity of further implementation of antidecubitus measures.
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Sonenblum SE, Measel M, Sprigle SH, Greenhalgh J, Cathcart JM. An Exploratory Analysis of the Role of Adipose Characteristics in Fulltime Wheelchair Users' Pressure Injury History. Front Bioeng Biotechnol 2021; 9:753897. [PMID: 34912788 PMCID: PMC8666593 DOI: 10.3389/fbioe.2021.753897] [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: 08/05/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The goals of this study were 1) to identify the relationship between adipose (subcutaneous and intramuscular) characteristics and pressure injury (PrI) history in wheelchair users and 2) to identify subject characteristics, including biomechanical risk, that are related to adipose characteristics. Materials and Methods: The buttocks of 43 full-time wheelchair users with and without a history of pelvic PrIs were scanned in a seated posture in a FONAR UPRIGHT® MRI. Intramuscular adipose (the relative difference in intensity between adipose and gluteus maximus) and the subcutaneous adipose characteristics (the relative difference in intensity between subcutaneous adipose under and surrounding the ischium) were compared to PrI history and subject characteristics. Results: Participants with a history of PrIs had different subcutaneous fat (subQF) characteristics than participants without a history of PrIs. Specifically, they had significantly darker adipose under the ischium than surrounding the ischium (subQF effect size = 0.21) than participants without a history of PrIs (subQF effect size = 0.58). On the other hand, only when individuals with complete fat infiltration (n = 7) were excluded did individuals with PrI history have more fat infiltration than those without a PrI history. The presence of spasms (μ intramuscular adipose, 95% CI with spasms 0.642 [0.430, 0.855], without spasms 0.168 [-0.116, 0.452], p = 0.01) and fewer years using a wheelchair were associated with leaner muscle (Pearson Corr = -0.442, p = 0.003). Conclusion: The results of the study suggest the hypothesis that changes in adipose tissue under the ischial tuberosity (presenting as darker SubQF) are associated with increased biomechanical risk for pressure injury. Further investigation of this hypothesis, and the role of intramuscular fat infiltration in PrI development, may help our understanding of PrI etiology. It may also lead to clinically useful diagnostic techniques that can identify changes in adipose and biomechanical risk to inform early preventative interventions.
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Affiliation(s)
- Sharon Eve Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Megan Measel
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Stephen H Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States.,College of Design, Georgia Institute of Technology, Atlanta, GA, United States
| | | | - John McKay Cathcart
- School of Health Sciences, Ulster University, Northern Ireland, Coleraine, United Kingdom
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35
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Santos CTD, Barbosa FM, Almeida TD, Vidor ID, Almeida MDA, Lucena ADF. Clinical evidence of the nursing diagnosis Adult pressure injury. Rev Esc Enferm USP 2021; 55:e20210106. [PMID: 34617953 DOI: 10.1590/1980-220x-reeusp-2021-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify clinical evidence of the nursing diagnosis Adult pressure injury. METHOD Cross-sectional study with 138 adult patients, with community-acquired or hospital-acquired pressure injuries, admitted to clinical, surgical, and intensive care units. Data collected from Electronic health records (EHR) and from the clinical assessment of patients at the bedside, analyzed through descriptive statistics. RESULTS The partial thickness loss of dermis presenting as a shallow open ulcer, intact or open/ruptured blister, consistent with a stage II pressure injury, was the significant defining characteristic. Significant related factors were pressure on bony prominence, friction surface, shear forces, and incontinence. The population at significant risk was that at age extremes (≥60 years). Significant associated conditions were pharmacological agent, physical immobilization, anemia, decreased tissue perfusion, and impaired circulation. CONCLUSION The clinical indicators assessed in the patients showed evidence of the nursing diagnosis Adult pressure Injury, with significant lesions consistent with stage II, resulting from pressure, especially in elderly individuals, and in those on various medications.
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Affiliation(s)
- Cássia Teixeira Dos Santos
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, RS, Brazil
| | | | - Thayná de Almeida
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Isabella Duarte Vidor
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | | | - Amália de Fátima Lucena
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, RS, Brazil
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Xu W, Yu X, Jiang H, Wang Y, Ye Y. A nomogram prediction of pressure injury in critical ill patients: A retrospective cohort study. Int Wound J 2021; 19:826-833. [PMID: 34477312 PMCID: PMC9013588 DOI: 10.1111/iwj.13680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/07/2021] [Accepted: 08/17/2021] [Indexed: 02/03/2023] Open
Abstract
Pressure injury (PI) is still a significant public health problem to be solved. Accurate prediction can lead to timely prophylaxis and therapy. However, the currently used Braden score shows insufficient predictive validity. We aimed to develop a nomogram to predict PI development in critically ill patients. We extracted data from Medical Information Mart for Intensive Care-IV v1.0. Variable selection was based on univariate logistic regression and all-subset regression. The area under the receiver operating characteristic curve (AUC) was used to assess the performance of the nomogram and Braden score. Decision curve analysis (DCA) was performed to identify and compare the clinical usefulness between the nomogram model and Braden score. We have developed a novel and practical nomogram that accurately predicts pressure ulcers. The AUC of the new model was better than that of the Braden score (P < .001). DCA showed that the nomogram model had a better net benefit than the Braden score at any given threshold. This finding needs to be confirmed by external validation as well as multicentre prospective studies.
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Affiliation(s)
- Wen Xu
- Department of Nursing DivisionThe Second Affiliated Hospital of Zhejiang University, School of MedicineHangzhouPeople's Republic of China
| | - Xueshu Yu
- Department of Intensive Care UnitThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople's Republic of China
| | - Hao Jiang
- Department of Intensive Care UnitThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople's Republic of China
| | - Yumin Wang
- Department of Laboratory MedicineThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople's Republic of China
| | - Yincai Ye
- Department of Blood TransfusionThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouPeople's Republic of China
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37
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Jiang M, Ma Y, Guo S, Jin L, Lv L, Han L, An N. Using Machine Learning Technologies in Pressure Injury Management: Systematic Review. JMIR Med Inform 2021; 9:e25704. [PMID: 33688846 PMCID: PMC7991995 DOI: 10.2196/25704] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Pressure injury (PI) is a common and preventable problem, yet it is a challenge for at least two reasons. First, the nurse shortage is a worldwide phenomenon. Second, the majority of nurses have insufficient PI-related knowledge. Machine learning (ML) technologies can contribute to lessening the burden on medical staff by improving the prognosis and diagnostic accuracy of PI. To the best of our knowledge, there is no existing systematic review that evaluates how the current ML technologies are being used in PI management. Objective The objective of this review was to synthesize and evaluate the literature regarding the use of ML technologies in PI management, and identify their strengths and weaknesses, as well as to identify improvement opportunities for future research and practice. Methods We conducted an extensive search on PubMed, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, China National Knowledge Infrastructure (CNKI), the Wanfang database, the VIP database, and the China Biomedical Literature Database (CBM) to identify relevant articles. Searches were performed in June 2020. Two independent investigators conducted study selection, data extraction, and quality appraisal. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Results A total of 32 articles met the inclusion criteria. Twelve of those articles (38%) reported using ML technologies to develop predictive models to identify risk factors, 11 (34%) reported using them in posture detection and recognition, and 9 (28%) reported using them in image analysis for tissue classification and measurement of PI wounds. These articles presented various algorithms and measured outcomes. The overall risk of bias was judged as high. Conclusions There is an array of emerging ML technologies being used in PI management, and their results in the laboratory show great promise. Future research should apply these technologies on a large scale with clinical data to further verify and improve their effectiveness, as well as to improve the methodological quality.
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Affiliation(s)
- Mengyao Jiang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Siyi Guo
- Key Laboratory of Knowledge Engineering with Big Data of the Ministry of Education, School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
| | - Liuqi Jin
- Key Laboratory of Knowledge Engineering with Big Data of the Ministry of Education, School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
| | - Lin Lv
- Wound and Ostomy Center, Outpatient Department, Gansu Provincial Hospital, Lanzhou, China
| | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
| | - Ning An
- Key Laboratory of Knowledge Engineering with Big Data of the Ministry of Education, School of Computer Science and Information Engineering, Hefei University of Technology, Hefei, China
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Role of microRNAs in Pressure Ulcer Immune Response, Pathogenesis, and Treatment. Int J Mol Sci 2020; 22:ijms22010064. [PMID: 33374656 PMCID: PMC7793489 DOI: 10.3390/ijms22010064] [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: 12/07/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.
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