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Huang C, Luo P, Zhu X, Li N, Ouyang K, Lu Q, Han Z. Causal effect of obesity and adiposity distribution on the risk of pressure ulcers and potential mediation by type 2 diabetes mellitus: insights from multivariable mendelian randomization and mediation analysis. Arch Dermatol Res 2024; 316:550. [PMID: 39162722 DOI: 10.1007/s00403-024-03299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/10/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Previous observational studies have identified a link between obesity, adiposity distribution, type 1 Diabetes Mellitus (T1DM), type 2 Diabetes Mellitus (T2DM), and the risk of pressure ulcers (PUs). However, the definitive causality between obesity and PUs, and potential DM mediators remains unclear. Univariable, multivariable, and mediation Mendelian randomization (MR) analyses were conducted to explore the mediating role of T1DM or T2DM in the association between obesity, adiposity distribution, and PUs. Instrumental variables for obesity and adiposity distribution, including Body Mass Index (BMI), waist circumference, hip circumference, trunk fat mass, whole body fat mass, trunk fat percentage, and body fat percentage, were selected from two genome-wide association studies (GWAS). In univariable MR analysis, BMI, hip circumference, and obesity were associated with PUs using inverse variance weighted (IVW) regression. These findings were further corroborated by the replication cohorts and meta-analysis (BMI: OR = 1.537, 95% CI = 1.294-1.824, p < 0.001; Hip circumference: OR = 1.369, 95% CI = 1.147-1.635, p < 0.001; Obesity: OR = 1.235, 95% CI = 1.067-1.431, p = 0.005), respectively. Even after adjusting for confounding factors such as T1DM and T2DM, BMI and hip circumference remained statistically significant in multivariable MR analyses. T2DM may mediate the pathogenesis of BMI-related (OR = 1.106, 95% CI = 1.054-1.160, p = 0.037) and obesity-related PUs (OR = 1.053, 95% CI = 1.034-1.973, p = 0.004). These findings provide insights for the prevention and treatment of PUs, particularly in patients with obesity or DM.
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Affiliation(s)
- Can Huang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Pei Luo
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, Shaanxi, China
| | - Xiangbin Zhu
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Na Li
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China
| | - Kunfu Ouyang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
| | - Qiang Lu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, Shaanxi, China.
| | - Zhen Han
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
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Al-Dorzi HM, Arabi YM. Quality Indicators in Adult Critical Care Medicine. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:75-84. [PMID: 38725886 PMCID: PMC11077517 DOI: 10.36401/jqsh-23-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 05/12/2024]
Abstract
Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.
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Affiliation(s)
- Hasan M. Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
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Han L, Guo J, Zhang H, Lv L, Dong J, Zhang T, Yan F, Ma Y. Validity and reliability of the Waterlow scale for assessing pressure injury risk in critical adult patients: A multi-centre cohort study. J Clin Nurs 2024; 33:1875-1883. [PMID: 38205587 DOI: 10.1111/jocn.16987] [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: 07/26/2023] [Revised: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
AIM To evaluate the predictive validity and reliability of the Waterlow scale in critically adult hospitalised patients. DESIGN A multi-centre cohort study. METHODS This study was conducted in 72 intensive care units (ICUs) in 38 tertiary hospitals in Gansu Province, China. All adults admitted to the ICU for greater than or equal to 24 h without pressure injury (PI) on admission were screened by the Waterlow scale on admission, during ICU stay and ICU discharge from April 2021 to February 2023. Receiver operating characteristic (ROC) curves were used to determine a potential cut-off value for critical adult hospitalised patients. Cut-off values were then determined using Youden's index, and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated based on these cut-off values. Test-retest reliability was used to evaluate inter-rater reliability. RESULTS A total of 5874 critical patients on admission were included, and 5125 of them were assessed regularly. The area under curve (AUC) was 0.623 (95% CI, 0.574-0.690), with a cut-off score of 19 showing the best balance among sensitivity of 62.7%, specificity of 57.4%, positive predictive value of 2.07% and negative predictive value of 99.08%. The test-retest reliability between the first assessment and the regular assessment was 0.447. CONCLUSIONS The Waterlow scale shows insufficient predictive validity and reliability in discriminating critical adults at risk of PI development. To further modify the items of the Waterlow scale, exploring specific risk factors for PI in the ICU and clarifying their impact degree was necessary. Risk predictive models or better tools are inevitable in the future. PATIENT OR PUBLIC CONTRIBUTION Patients or family members supported nurses with PI risk assessment, skin examination and other activities during the inquiry.
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Affiliation(s)
- Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, China
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, China
| | - Jiali Guo
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, China
| | - Lin Lv
- Wound and Ostomy Care Center, Gansu Provincial Hospital, Lanzhou City, China
- The First Clinical Medical College, Lanzhou University, Lanzhou City, China
| | - Jianhui Dong
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Tong Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Fanghong Yan
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, China
- The First Clinical Medical College, Lanzhou University, Lanzhou City, China
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Wenzel F, Whitaker IY. Relationship between nutritional goals and pressure injuries in critical care patients receiving enteral nutrition. J Wound Care 2024; 33:271-277. [PMID: 38573900 DOI: 10.12968/jowc.2024.33.4.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To examine the relationship between pressure injury (PI) development and achievement of nutritional goals (protein and caloric), as well as consider the clinical conditions, hospitalisation factors, and risk assessment for PI development in patients who are critically ill and receiving enteral nutrition (EN) in the intensive care unit (ICU). METHOD An observational cohort study was conducted in the ICU of the University Hospital in São Paulo, Brazil. Inclusion criteria were as follows: age ≥18 years; length of ICU stay ≥24 hours; without PI at ICU admission; and receiving EN exclusively during ICU stay. The development of PI was considered the dependent variable. The Chi-squared test was applied to compare categorical variables, and the Mann-Whitney U test was used to compare continuous variables between groups of patients with and without a PI. The analysis of the achievement of nutritional goals was performed using Fisher's exact test. A significance level of 5% (p-value<0.05) and a confidence interval (CI) of 95% was adopted in all statistical tests. RESULTS A total of 181 patients met the inclusion criteria, of whom 102 (56.4%) were male and 79 (43.6%) were female. Mean age was 55.1 years, and mean length of ICU stay was 17.5 days. PI development was associated with not achieving nutritional goals. There was a higher percentage (65.3%) of patients without a PI when both protein and caloric goals were achieved. In contrast, 45.6% of patients developed a PI when the goals were not achieved. The mean days for sedation, vasoactive drugs and mechanical ventilation were all significantly higher in patients who developed a PI (p<0.001). CONCLUSION There was a significant association between patients developing a PI and deficits in caloric and protein intake. Patients who did not develop PIs had a greater calorie and protein intake compared with those who developed a PI.
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Affiliation(s)
- Fernanda Wenzel
- Hospital e Maternidade Escola Mario de Moraes Altenfelder Silva, São Paulo, SP, Brazil
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Flæten ØØ, Stafseth SK, Vinje H, Johansen E, Sunde K, Wøien H, Beeckman D, Petosic A. Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project. Intensive Crit Care Nurs 2024; 81:103587. [PMID: 38029679 DOI: 10.1016/j.iccn.2023.103587] [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: 08/28/2023] [Revised: 10/18/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To determine the 12-month cumulative incidence, characteristics, and associated factors of pressure injuries acquired in Intensive Care Units. SETTING Four intensive care units in a Norwegian University Hospital. RESEARCH METHODOLOGY A prospective observational cohort study using data from daily skin inspections during a quality improvement project. We used descriptive statistics and logistic regression. Variables associated with the development of intensive care unit-acquired pressure injuries are presented with odds ratios (OR), and 95% confidence intervals. RESULTS The 12-month cumulative incidence of patients (N = 594) developing intensive care unit-acquired pressure injuries was 29 % (172/594) for all categories and 16 % (95/594) when excluding category I pressure injuries (no skin loss). Cumulative incidence for patients acquiring medical device-related pressure injuries was 15 % (91/594) and 11 % (64/594) for category II or worse. Compression stockings (n = 51) and nasogastric tubes (n = 22) were the most frequent documented medical devices related to pressure injuries. Development of pressure injuries category II or worse was significantly associated with vasoactive drug infusions (OR 11.84, 95 % CI [1.59; 88.13]) and longer intensive care unit length of stay (OR 1.06, 95 % CI [1.04; 1.08]). CONCLUSION The 12-month cumulative incidence of intensive care unit-acquired pressure injuries was relatively high when category I pressure injuries were included, but comparable to other studies when category I was excluded. Some medical device-related pressure injuries were surprisingly frequent, and these may be prevented. However, associated factors of developing pressure injuries were present and deemed non-modifiable. IMPLICATIONS FOR CLINICAL PRACTICE Awareness about pressure injury prevention is needed in the intensive care unit considering high incidences. Nurses can detect category I pressure injuries early, which may be reversed. Our findings show several factors that clinicians can control to reduce the risk of pressure injuries in the intensive care unit.
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Affiliation(s)
- Øystein Øygarden Flæten
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Lovisenberg Diaconal University College, Oslo, Norway.
| | - Siv K Stafseth
- Lovisenberg Diaconal University College, Oslo, Norway; Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Hilde Vinje
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Edda Johansen
- University of South-Eastern Norway, Faculty of Health and Social Sciences, Borre, Norway; General Intensive Care, Vestre Viken Hospital Trust, Drammen, Norway
| | - Kjetil Sunde
- Department of Anesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hilde Wøien
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Dimitri Beeckman
- Ghent University, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent, Belgium; Örebro University, Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro, Sweden; Odense University, Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark
| | - Antonija Petosic
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway
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Riley BH, Pittman J, Otts JAA, Mulekar MS. Key stakeholders' perspectives: A gap analysis of hospital-acquired pressure injuries. J Nurs Scholarsh 2024; 56:291-313. [PMID: 37984994 DOI: 10.1111/jnu.12940] [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: 03/30/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Hospital-acquired pressure injuries (HAPIs) are a global high-stakes patient safety issue. Key stakeholder perspectives regarding their role and experiences with pressure injuries is critical as part of the solution to minimizing HAPI occurrence and attain sustainability. DESIGN A qualitative, descriptive approach provided multiple perspectives of key stakeholders to support the complexity of HAPI care. The qualitative data are a part of a mixed method convergent research study examining pressure injury prevention and management practices. METHODS Nursing system theory, mixed method convergent design, and participatory action research methodologies were chosen to address both the gap analysis development and results, achieve collaborative comprehensiveness, and enable key stakeholder involvement throughout this HAPI prevention and management initiative. Participants were recruited and enrolled from a large Level I trauma hospital and the key stakeholders. Demographic information were collected prior to the individual interview. Focused interviews were conducted virtually using zoom technology. Qualitative data were analyzed using NVivo software and thematic analysis was confirmed across the co-investigators for congruence and applicability to the research questions. RESULTS Qualitative interviews with 26 key stakeholders provided data to support and integrate a link with gap analysis results on the complex health issue of HAPIs. Specific barrier and recommendation themes identified interventions that could be prioritized. The 52 barrier and 52 recommendation themes/sub-theme(s) respectively were organized by Donabedian (structure, process, and outcome) with structure elements the majority. The top three structure barrier themes involved equipment and standards for use, staff prevention education, and specialized health professionals. The top three structure recommendation themes involved specialized health professionals, equipment and standards for use, and an educational plan for those at risk or with HAPIs. CONCLUSION The article provides findings from the qualitative portion of a mixed method study related to HAPIs. The qualitative findings associated with the gap analysis quantitative results, achieved the goal of the participatory action research key stakeholders' input into HAPI care and can be replicated internationally. CLINICAL RELEVANCE The benefit of key stakeholder's involvement in solving a clinical problem is sustainability. A quantitative approach and integrating qualitative stakeholders' perspectives provide an in-depth solution that will advance nursing capacity toward health care delivery and HAPI nursing science and policy development on a global level.
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Padula WV, Crawford SA, Kennerly SM, Yap TL. Estimating the value of repositioning timing to streamline pressure injury prevention efforts in nursing homes: A cost-effectiveness analysis of the 'TEAM-UP' clinical trial. Int Wound J 2024; 21:e14452. [PMID: 37909183 PMCID: PMC10895199 DOI: 10.1111/iwj.14452] [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: 07/21/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023] Open
Abstract
Pressure injury (PrI) prevention guidelines recommend 2-h repositioning intervals in healthcare settings, requiring significant nursing time investment. We analysed the cost-effectiveness of PrI prevention protocols with 2-, 3- and 4-h repositioning intervals in US nursing homes according to 'Turn Everyone and Move for Ulcer Prevention' (TEAM-UP) randomized controlled trial findings. Markov modelling compared 2-, 3- and 4-h repositioning intervals, controlling for other practice guidelines, to prevent PrIs in nursing home residents from a US health sector perspective over one year using TEAM-UP trial data for model structure, sampling and parameterization. Costs, captured in 2020 US dollars, and quality-adjusted life years (QALYs) were used to derive an incremental cost-effectiveness ratio and net monetary benefit (NMB) at $50 000/QALY-$150 000/QALY cost-effectiveness thresholds. Sensitivity analyses tested model uncertainty. Repositioning intervals between 3 and 4 h were cost-effective based on reduced costs at slightly lower QALYs than 2 h at a $50 000/QALY threshold, and the NMB of 4-h repositioning was also more efficient than at 3 h ($9610). Repositioning labour cost and prevention routines were among the most sensitive parameters. Sensitivity analyses demonstrated that 3- and 4-h intervals were cost-effective in over 65% of simulations at any cost-effectiveness threshold. Repositioning intervals of 3 to 4 h have potential to reduce nursing time costs without significant decrements in clinical benefits to nursing home residents. Clinical guidelines for PrI prevention should be updated to reflect TEAM-UP clinical and economic findings. Facilities can use cost-savings recuperated from nursing time to deploy to other patient safety priorities without seriously jeopardizing PrI safety.
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Affiliation(s)
- William V. Padula
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Acute & Chronic Care, School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Samuel A. Crawford
- Department of Pharmaceutical & Health Economics, School of PharmacyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Leonard D. Schaeffer Center for Health Policy & EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Susan M. Kennerly
- College of NursingEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Tracey L. Yap
- School of NursingDuke UniversityDurhamNorth CarolinaUSA
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ALFadhalah T, Lari M, Al Salem G, Ali S, Al Kharji H, Elamir H. Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study. BMC Health Serv Res 2024; 24:173. [PMID: 38326902 PMCID: PMC10851550 DOI: 10.1186/s12913-024-10615-x] [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: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals. METHODS A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis. RESULTS The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied. CONCLUSIONS The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.
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Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Marjan Lari
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Shaimaa Ali
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al Kharji
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
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Chuang YC, Miao T, Cheng F, Wang Y, Chien CW, Tao P, Kang L. Exploration of pressure injury risk in adult inpatients: An integrated Braden scale and rough set approach. Intensive Crit Care Nurs 2024; 80:103567. [PMID: 37924783 DOI: 10.1016/j.iccn.2023.103567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE This study aimed to develop an interpretive model with decision rules to assess the risk level of pressure injuries in adult inpatients and identify the critical risk factors associated with these injuries. METHODS The rough set approach was used to identify the critical risk factors associated with pressure injuries and demonstrate their behavioral patterns. The study focused on adult inpatients aged 18 or above who remained in bed for at least 24 hours after admission. The data was extracted from a nursing electronic medical record system of a hospital in Zhejiang Province, China, from 27 October 2019 to 1 November 2020. RESULTS The critical risk factors associated with pressure injuries in adult inpatients were identified as "Sensory perception," "Nutrition," and "Friction and shear." A prediction model with 89 decision rules was established and demonstrated reliable predictive capabilities. Nursing staff should focus more on high-risk and severe-risk rules (Rules 11 to 18) to reduce the likelihood of potential high-risk pressure injuries. CONCLUSIONS The prediction model established by the rough set approach can be used to identify the critical risk factors of pressure injuries and has good explanatory ability, which can complement and improve the predictive accuracy of the Braden Scale. The decision-making rules can help nurses improve work efficiency. IMPLICATIONS FOR CLINICAL PRACTICE Explanatory analysis can explain most inpatients' potential risk patterns and corresponding critical risk factors. Data-driven research models and results can help nurses understand patients' potential risks better. Additionally, these insights can be valuable in nursing education, aiding new nurses in comprehending and addressing the potential risks patients face.
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Affiliation(s)
- Yen-Ching Chuang
- Institute of Public Health & Emergency Management, Taizhou University, Taizhou 318000, Zhejiang, China; Business College, Taizhou University, Taizhou 318000, Zhejiang, China; Key Laboratory of Evidence-based Radiology of Taizhou, Linhai 317000, Zhejiang, China.
| | - Tao Miao
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China.
| | - Fengmin Cheng
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China.
| | - Yanjiao Wang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen 361008, Fujian, China.
| | - Ching-Wen Chien
- Institute for Hospital Management, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, Guangdong, China.
| | - Ping Tao
- Department of Medical Affairs & Planning, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
| | - Linlin Kang
- Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China.
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Azizoğlu F, Terzi B. Research topics on pressure injury prevention and measurement tools from 1997 to 2023: A bibliometric analysis using VOSviewer. Intensive Crit Care Nurs 2024; 80:103557. [PMID: 37804817 DOI: 10.1016/j.iccn.2023.103557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To identify and visualize studies on pressure injuries in intensive care units, prevention of pressure injuries and measurement tools, and reveal the global trends in this field. RESEARCH METHODOLOGY/DESIGN Descriptive and bibliometric analysis method study. SETTING Data were obtained from the "Web of Science Core Collection" database on July 12th, 2023. For bibliometric data, the Web of Science database was searched with the keywords "intensive care unit," "pressure injury," "prevention," "risk assessment tools," and critical care." Performance analysis, scientific mapping, and bibliometric analyses were completed using the VOSviewer (1.6.15) software program for a total of 326 publications. MAIN OUTCOME MEASURES Publication, cluster, link and network map on pressure injury, prevention and risk measurement tools. RESULTS As a result of the analysis, the most used keywords were "pressure injury," "pressure ulcer," "critical care," "pressure ulcers," "intensive care unit," and "pressure injuries." The journal with the highest number of publications (n = 55) was "Journal of Wound Ostomy Continence Nursing", the highest number of articles (n = 47) was published in 2022, the most active institution was "Queensland University of Technology Qut" (20 articles), the country that published the most was the United States of America (171 articles), the institution that provided the most funding was the "National Institutes of Health NIH USA" (20 articles), and Cox J. was the author who published the most articles. CONCLUSION This study highlights popular fields of research in pressure injury prevention and risk measurement tools aimed at improving quality of care in intensive care units. IMPLICATIONS FOR CLINICAL PRACTICE The bibliometric analysis method used in the study can lead nurses to conduct research to prevent pressure injuries in critical care patients and develop risk measurement tools to overcome deficiencies such as prevention tools and objective risk measurement tools in this field.
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Affiliation(s)
- Fatma Azizoğlu
- Haliç University, Faculty of Health Sciences, 5.Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No: 14/12 34060, Eyüpsultan/İstanbul, Turkey
| | - Banu Terzi
- Akdeniz University, Faculty of Nursing, Fundamentals of Nursing Department, Akdeniz Üniversitesi Dumlupınar Bulvarı, Akdeniz Üniversitesi Yerleşkesi Konyaaltı, 07070 Antalya, Turkey.
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Koc F, Eren MG, Sert H. Comparing the Efficacy of Zinc Oxide Versus Barrier Creams for Pressure Injury Prevention: A Retrospective Cross-sectional Study. Adv Skin Wound Care 2023; 36:1-6. [PMID: 37983583 DOI: 10.1097/asw.0000000000000064] [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 compare the efficacy of zinc oxide versus barrier creams for the maintenance of skin integrity in intensive care patients with a risk of pressure injury (PI). METHODS This was a retrospective and cross-sectional study. The authors included data from 95 patients treated in the neurology and respiratory ICUs of a training and research hospital between January and June 2022. Patients in the neurology ICU were treated with zinc oxide cream (group 1, n = 48), and patients in the respiratory ICU received classic barrier cream (group 2, n = 47). Sociodemographic characteristics and PI data (Braden Scale score, Pressure Ulcer Healing Assessment Scale [PUSH] score, and PI stage) were obtained from each patient's file. RESULTS The mean PUSH score of the patients who received zinc oxide cream was 3.83 ± 4.39 at discharge versus 6.79 ± 4.40 for the group who received barrier cream. When PUSH scores and PI stages during hospitalization and discharge were compared, the authors found a statistically significant between-group difference in mean discharge scores (P < .05). CONCLUSIONS Within the limitations of this retrospective study based on patient records, zinc oxide creams had more positive effects on the prevention of PIs than barrier creams.
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Affiliation(s)
- Ferhat Koc
- In the Internal Medicine Nursing Department, Institute of Health Science, Sakarya University, Turkey, Ferhat Koc, MSc, RN, is Clinical Nurse; Merve Gulbahar Eren, MSc, RN, is Resident Assistant; and Havva Sert, PhD, RN, is Associate Professor. The authors have disclosed no financial relationships related to this article. Submitted November 21, 2022; accepted in revised form January 20, 2023
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12
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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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Huang C, Lee S, Chiu W, Chen C, Chen J, Wang H. Determinants of the success in flap reconstruction-Outcome analysis of 120 flaps in 484 procedures for pressure injury. Int Wound J 2023; 20:3105-3115. [PMID: 37157923 PMCID: PMC10502293 DOI: 10.1111/iwj.14185] [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: 01/10/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/10/2023] Open
Abstract
Pressure injury (PI) mainly occurs in bedridden older adults or those with physical limitations. Here, we aimed to determine the appropriate timing to conduct flap reconstruction in patients with PIs and identify factors affecting surgical outcomes. We retrospectively reviewed the data of all patients who received debridement or flap reconstruction surgery for PIs in our hospital from January 2016 to December 2021. The extracted data included patient demographics, surgical records, blood test results, vital signs, and flap outcomes. In total, 484 surgical procedures (364 debridements and 120 flaps) were performed on 216 patients. Serum albumin level of ≥2.5 g/dL remarkably increased the likelihood of complete wound healing (odds ratio [OR] = 4.12, P = .032) and reduced the risk of postoperative complications (OR = 0.26, P = .040). In contrast, advanced age (OR = 1.04, P = .045) and serum creatinine level ≥2 mg/dL (OR = 5.07, P = .016) increased the risk of postoperative complications. Thus, patients with a favourable nutrition status have a higher likelihood of achieving complete wound healing. By contrast, patients who are older and have serum creatinine ≥2 mg/dL and serum albumin <2.5 g/dL tend to develop more postoperative complications. Overall, thorough correction for patient inflammation, infection, anaemia, and malnutrition status can provide optimal flap surgery outcomes.
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Affiliation(s)
- Ching‐Ya Huang
- School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan
| | - Sheng‐Lian Lee
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Wen‐Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Public Health, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan
- Evidence‐Based Medicine Center, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Jin‐Hua Chen
- Biostatistics Center, College of ManagementTaipei Medical UniversityTaipeiTaiwan
- Graduate Institute of Data Science, College of ManagementTaipei Medical UniversityTaipeiTaiwan
| | - Hsian‐Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
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Luther SL, Thomason SS, Sabharwal S, Finch DK, McCart J, Toyinbo P, Bouayad L, Lapcevic W, Hahm B, Hauser RG, Matheny ME, Powell-Cope G. Machine learning to develop a predictive model of pressure injury in persons with spinal cord injury. Spinal Cord 2023; 61:513-520. [PMID: 37598263 DOI: 10.1038/s41393-023-00924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
STUDY DESIGN A 5-year longitudinal, retrospective, cohort study. OBJECTIVES Develop a prediction model based on electronic health record (EHR) data to identify veterans with spinal cord injury/diseases (SCI/D) at highest risk for new pressure injuries (PIs). SETTING Structured (coded) and text EHR data, for veterans with SCI/D treated in a VHA SCI/D Center between October 1, 2008, and September 30, 2013. METHODS A total of 4709 veterans were available for analysis after randomly selecting 175 to act as a validation (gold standard) sample. Machine learning models were created using ten-fold cross validation and three techniques: (1) two-step logistic regression; (2) regression model employing adaptive LASSO; (3) and gradient boosting. Models based on each method were compared using area under the receiver-operating curve (AUC) analysis. RESULTS The AUC value for the gradient boosting model was 0.62 (95% CI = 0.54-0.70), for the logistic regression model it was 0.67 (95% CI = 0.59-0.75), and for the adaptive LASSO model it was 0.72 (95% CI = 0.65-80). Based on these results, the adaptive LASSO model was chosen for interpretation. The strongest predictors of new PI cases were having fewer total days in the hospital in the year before the annual exam, higher vs. lower weight and most severe vs. less severe grade of injury based on the American Spinal Cord Injury Association (ASIA) Impairment Scale. CONCLUSIONS While the analyses resulted in a potentially useful predictive model, clinical implications were limited because modifiable risk factors were absent in the models.
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Affiliation(s)
- Stephen L Luther
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | | | - Sunil Sabharwal
- VA Boston Health Care System, Spinal Cord Injury Service, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Dezon K Finch
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - James McCart
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Peter Toyinbo
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Lina Bouayad
- College of Business, Florida International University, Miami, FL, USA
| | - William Lapcevic
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Bridget Hahm
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | | | - Michael E Matheny
- Geriatrics Research Education and Clinical Care, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Research & Development Service, Tennessee Valley Healthcare System, Nashville, TN College of Nursing, Nashville, TN, USA
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Lewis CP, Schenkenfelder R, Davies CC, Monroe M, Acton D, Phillips T. Developing the Baptist Health Injury Risk Assessment Phase 1: Exploring Risk Factors. J Nurs Adm 2023; 53:438-444. [PMID: 37585494 DOI: 10.1097/nna.0000000000001313] [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: 08/18/2023]
Abstract
OBJECTIVES The aim of this study was to explore risk factors for developing hospital-acquired pressure injuries (HAPIs) among critically ill adult inpatients. BACKGROUND Hospital-acquired pressure injuries remain a priority quality focus for Magnet ® organizations. Recent studies cite medical devices as a primary cause, yet published risk assessments lack inclusion of those threats. METHODS Nurses at a 434-bed, 4-time Magnet ® -designated hospital led a retrospective study acros 9 American Nurses Credentialing Center-designated facilities. Using a chart review tool, data were collected within 48 hours of a confirmed HAPI. RESULTS Of 207 HAPIs reported, 54% (n = 113) involved deep tissue pressure injuries and 50.2% (n = 104) involved 19 medical devices. Individuals with a HAPI also used 1 or more of 7 distinct types of mobility-limiting medical equipment. CONCLUSIONS Study findings support the development of a critical care risk assessment with inclusion of a medical device and mobility-limiting medical equipment as risk factors. A secondary study is underway for specificity and sensitivity testing of this assessment.
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Affiliation(s)
- C Preston Lewis
- Author Affiliations: Executive Director of Orthopedics/Urology Services & Magnet Recognition Program (Dr Lewis), WOC Clinical Nurse (Schenkenfelder), and Research Consultant (Drs Davies and Monroe), Baptist Health Lexington; WOC Clinical Nurse (Acton), Baptist Health Louisville; and Research Nurse (Dr Phillips), Baptist Health Paducah, Paducah, Kentucky
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Özdemir ED, Uslu Y, Karabacak U, Eren D, Isabetli S. Pressure injuries in the operating room: who are at risk? J Wound Care 2023; 32:cxxviii-cxxxvi. [PMID: 37405971 DOI: 10.12968/jowc.2023.32.sup7a.cxxviii] [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: 07/07/2023]
Abstract
OBJECTIVE Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs. METHOD This study used a cohort design. The data were collected at Acıbadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data. RESULTS Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001). CONCLUSION Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.
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Affiliation(s)
- Ezgi Dilan Özdemir
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Yasemin Uslu
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Ukke Karabacak
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Dilek Eren
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
| | - Serpil Isabetli
- Acıbadem Maslak Hospital, Department of Nursing, Buyukdere Street, Istanbul, Turkey
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17
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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DeMellow JM, Dhillon H, Bhattacharyya M, Pacitto D, Kozik TM. Hospital-Acquired Pressure Injuries in Adults With Prone Positioning Using Manual Method Versus Specialty Bed: A Retrospective Comparison Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:197-202. [PMID: 37146109 DOI: 10.1097/won.0000000000000976] [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: 05/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the incidence of hospital-acquired pressure injuries (HAPIs) in patients with acute respiratory distress syndrome (ARDS) and placed in a prone position manually or using a specialty bed designed to facilitate prone positioning. A secondary aim was to compare mortality rates between these groups. DESIGN Retrospective review of electronic medical records. SUBJECTS AND SETTING The sample comprised 160 patients with ARDS managed by prone positioning. Their mean age was 61.08 years (SD = 12.73); 58% (n = 96) were male. The study setting was a 355-bed community hospital in the Western United States (Stockton, California). Data were collected from July 2019 to January 2021. METHODS Data from electronic medical records were retrospectively searched for the development of pressure injuries, mortality, hospital length of stay, oxygenation status when placed in a prone position, and the presence of a COVID-19 infection. RESULTS A majority of patients with ARDS were manually placed in a prone position (n = 106; 64.2%), and 54 of these patients (50.1%) were placed using a specialty care bed. Slightly more than half (n = 81; 50.1%) developed HAPIs. Chi-square analyses showed no association with the incidence of HAPIs using manual prone positioning versus the specialty bed (P = .9567). Analysis found no difference in HAPI occurrences between those with COVID-19 and patients without a coronavirus infection (P = .8462). Deep-tissue pressure injuries were the most common type of pressure injury. More patients (n = 85; 80.19%) who were manually placed in a prone position died compared to 58.18% of patients (n = 32) positioned using the specialty bed (P = .003). CONCLUSIONS No differences in HAPI rates were found when placing patients manually in a prone position versus positioning using a specialty bed designed for this purpose.
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Affiliation(s)
- Jacqueline M DeMellow
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Harbir Dhillon
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Mouchumi Bhattacharyya
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Daniel Pacitto
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
| | - Teri M Kozik
- Jacqueline M. DeMellow, PhD, RN, CCNS, CPHQ, Dignity Health St Joseph's Medical Center, Stockton, California
- Harbir Dhillon, MD, Dignity Health St Joseph's Medical Center, Stockton, California
- Mouchumi Bhattacharyya, PhD, University of the Pacific, Stockton, California
- Daniel Pacitto, DO, Touro University, Vallejo, California
- Teri M. Kozik, PhD, CNS, CCRN-K, Dignity Health St Joseph's Medical Center, Stockton, California
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Bolgeo T, Maconi A, Gardalini M, Gatti D, Di Matteo R, Lapidari M, Longhitano Y, Savioli G, Piccioni A, Zanza C. The Role of Cold Atmospheric Plasma in Wound Healing Processes in Critically Ill Patients. J Pers Med 2023; 13:jpm13050736. [PMID: 37240907 DOI: 10.3390/jpm13050736] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Critically ill patients are at risk of skin wounds, which reduce their quality of life, complicate their pharmacological regimens, and prolong their hospital stays in intensive care units (ICUs), while also increasing overall mortality and morbidity rates. Cold atmospheric plasma (CAP) has been proposed as a viable option for many biological and medical applications, given its capacity to reduce wound bacterial contamination and promote wound healing. The aim of this narrative review is to describe how CAP works and its operating mechanisms, as well as reporting its possible applications in critical care settings. The success of CAP in the treatment of wounds, in particular, bedsores or pressure sores, presents an innovative path in the prevention of nosocomial infections and an opportunity of reducing the negative implications of these diseases for the NHS. This narrative review of the literature was conducted following the 'Scale for the Assessment of Narrative Review Articles' (SANRA) methodology. Previous literature highlights three biological effects of plasma: inactivation of a wide range of microorganisms, including those that are multi-drug-resistant; increased cell proliferation and angiogenesis with a shorter period of plasma treatment; and apoptosis stimulation with a longer and more intensive treatment. CAP is effective in many areas of the medical field, with no significant adverse effects on healthy cells. However, its use can produce potentially serious side effects and should, therefore, be used under expert supervision and in appropriate doses.
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Affiliation(s)
- Tatiana Bolgeo
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Maconi
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Menada Gardalini
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Denise Gatti
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Roberta Di Matteo
- Department of Integrated Research and Innovation Activities, AON SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Marco Lapidari
- Department of Vascular Surgery, St. Antonio and Biagio and Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Gabriele Savioli
- Department of Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Christian Zanza
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
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Huang C, Chang C, Lee S, Chen C, Chen J, Wang H, Chiu W. The change of clinical features and surgical outcomes in patients with pressure injury during the COVID-19 pandemic. Int Wound J 2023; 20:971-980. [PMID: 36054743 PMCID: PMC9539383 DOI: 10.1111/iwj.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/19/2023] Open
Abstract
This retrospective study aims to explore whether the COVID-19 pandemic altered patient conditions and surgery outcomes by studying 213 pressure injury (PI) patients who underwent surgery during 2016 to 2019 (pre-COVID) and 2020 to 2021 (COVID) in Taiwan. We extracted patient demographics, surgical and blood test records, preoperative vital signs, and flap surgery outcomes. In total, 464 surgeries were performed, including 308 pre-COVID and 156 COVID. During the COVID period, there were more patients presenting with dementia, and it had significantly more patients with >12 000 white blood cells/μL (24.03% vs 15.59%, P = 0.029), higher C-reactive protein levels (7.13 ± 6.36 vs 5.58 ± 5.09 mg/dL, P = 0.014), pulse rates (86.67 ± 14.76 vs 81.26 ± 13.66 beats/min, P < 0.001), and respiratory rates (17.87 ± 1.98 vs 17.31 ± 2.39 breaths/min, P = 0.009) but lower haemoglobin levels (9.75 ± 2.02 vs 10.43 ± 1.67 mg/dL, P < 0.001) preoperatively. There were no between-group differences in flap surgery outcomes but had fewer flap surgeries during COVID-19. Thus, PI patient condition was generally poor during the COVID-19 pandemic because of reduced access to medical treatment; this problem may be resolved through holistic care during a future pandemic or pandemic-like situation.
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Affiliation(s)
- Ching‐Ya Huang
- School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan
| | - Chiung‐Wen Chang
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Sheng‐Lian Lee
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Public Health, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan
- Evidence‐Based Medicine Center, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Jin‐Hua Chen
- Biostatistics Center, College of ManagementTaipei Medical UniversityTaipeiTaiwan
- Graduate Institute of Data Science, College of ManagementTaipei Medical UniversityTaipeiTaiwan
| | - Hsian‐Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Wen‐Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan
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Collier M, Jones S, Glendewar G. Pressure ulcer prevention, patient positioning and protective equipment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:108-116. [PMID: 36763473 DOI: 10.12968/bjon.2023.32.3.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Pressure ulcer (PU) prevention is a high priority for health professionals in all settings. While PU incidence is expected to rise given the ageing population in the UK and Europe, PUs can occur in people of any age. It is therefore imperative that all practitioners know about the causes and consequences of PUs and be aware of up-to-date guidance on the prevention and management in patients who have developed a PU or who are at risk of developing a PU. Health professionals should also be aware of preventive equipment highlighted in national and local guidance, prevention strategies and protocols. This article discusses these issues and the Devon (Cardinal Health) prevention and repositioning product range.
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Affiliation(s)
- Mark Collier
- Nurse Consultant and Associate Lecturer-Tissue Viability, University of Lincolnshire; Chair of the Leg Ulcer Forum (England and Wales); and European Wound Management Association Council Member
| | - Sarah Jones
- (case study 1 and 2 author), Paediatric Tissue Viability Clinical Nurse Specialist, Sheffield Children's NHS Foundation Trust, Sheffield
| | - Gilly Glendewar
- (case study 3 and 4 author), Clinical Nurse Specialist Tissue Viability, Queen's Nurse, Family Nursing & Home Care, Le Bas Centre, St Helier
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Bone MA, Gillespie BM, Latimer S, Walker RM, Thalib L. Variations in sacral oedema levels over continuous 60-degree head of bed elevation positioning in healthy adults: An observational study. J Tissue Viability 2023; 32:158-162. [PMID: 36369143 DOI: 10.1016/j.jtv.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Subepidermal moisture (SEM) scanning is a novel technology that measures changes in localised oedema. Accumulation of subepidermal oedema is associated with early tissue damage that may lead to a pressure injury. AIM The primary study objective was to observe the variations in sacral subepidermal oedema levels over a continuous period of 60-degree head of bed elevation positioning. METHODS Healthy adult participants were recruited in this prospective observational study. Participants were positioned at 60-degree head of bed elevation for 120 min and sacral SEM measurements were collected at baseline and in 20 min increments. RESULTS A total of 20 participants with a mean age of 39.3 years (SD = 14.7) were recruited. The mean SEM delta value increased 6.3% from 0.46 SEM delta at baseline to 0.49 SEM delta after 120 min, however these differences are not statistically significant (p = .21). There were also no significant findings between SEM delta variations and demographic factors. CONCLUSION In a sample of healthy individuals, 120 min of continuous loading with a 60-degree head of bed elevation did not lead to a significant change in sacral subepidermal oedema levels. Further research on the response of healthy adult tissue under external forces associated with different angles of head of bed positioning may further contribute to our understanding pressure injury prevention.
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Affiliation(s)
- Madeline A Bone
- NHMRC Wiser Wounds Centre in Research Excellence, Griffith University, Gold Coast, Australia.
| | - Brigid M Gillespie
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast, Australia
| | - Sharon Latimer
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Rachel M Walker
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; The Princess Alexandra Hospital, Brisbane, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
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Asiri S, Alqahtani N. Factors Associated with Intensive Care Units' Nurses Frequency of Performing Pressure Injury Prevention: A Cross-sectional Study. Appl Nurs Res 2022; 68:151640. [PMID: 36473718 DOI: 10.1016/j.apnr.2022.151640] [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: 05/14/2022] [Revised: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
AIM To explore factors associated with frequency of performing pressure injury prevention measures among a sample of intensive care units' nurses. BACKGROUND Pressure injuries may be unavoidable in specific circumstances; however, most pressure injuries may be considered preventable. Nursing actions at the point of care play a significant role in shaping pressure injury prevention. METHODS A cross-sectional, descriptive correlational design was used. Using convenience sampling method, 162 intensive care units' nurses were recruited from three hospitals in Riyadh, Saudi Arabia. The participants completed a survey that included Nurses' Practice of Pressure Ulcer Prevention Questionnaire, Pressure Ulcer Knowledge Assessment Tool, Attitude toward Pressure Ulcer Prevention, Pressure Ulcer Prevention Barriers instrument, and Intention to Use Pressure Injury Preventive Measures instrument. Data were analyzed using descriptive and inferential statistics. RESULTS Nurses lack of knowledge about pressure injury preventions. However, they possessed positive attitudes toward pressure injury preventions. Nurses faced some barriers to prevent pressure injuries. Most nurses agreed that there was social pressure to prevent pressure injury. They had an intention to use preventive measures to prevent pressure injury. Nurses performed pressure injury prevention frequently. The bivariate and multivariate analyses showed only barriers to prevent pressure injury were negatively associated with frequency of performing pressure injury prevention. CONCLUSIONS Several factors that may influence ICU nurses' behavior to perform PIPs have been identified. The participants reflected positive attitude, positive social pressure, and intention to perform PIPs. Nevertheless, they need to improve their knowledge of PIPs and reduce the barriers prevented them from performing PIPs.
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Affiliation(s)
- Saeed Asiri
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Naji Alqahtani
- Nursing Administration and Education Department, College of Nursing, King Saud University, Riyadh 11451, Saudi Arabia.
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24
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Konya C, Takeuchi Y, Nakagami G, Kitamura A, Morita K, Ishizawa M, Abe Y, Higuchi H, Mizuki T, Motegi SI, Shoju S, Shimada K, Tanaka K, Kawakami S, Sanada H. Nationwide time-series surveys of pressure ulcer prevalence in Japan. J Wound Care 2022; 31:S40-S47. [PMID: 36475842 DOI: 10.12968/jowc.2022.31.sup12.s40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Japanese Society of Pressure Ulcers (JSPU) has two purposes: first, to improve knowledge and skills among health professionals related to preventing and managing pressure ulcers (PUs); and second, to represent those in the field managing PUs, including with government and health authorities. Since 2006, JSPU has conducted fact-finding surveys about every four years to identify PU prevalence in Japan (2006, 2010, 2013 and 2016). Based on the prevalence identified by these surveys, an attempt was made to validate the achievements of JSPU's activities. METHOD Information from one-day surveys of hospitals, long-term care health facilities, long-term care welfare facilities, and home visit nursing care stations was analysed. We used generalised estimating equations to estimate the proportions of PUs and their 95% confidence intervals (CIs) for each survey. RESULTS A total of 662,419 patients in 2631 facilities participated in the surveys. The estimated proportions for all facilities (95% CI) in chronological order, from the first to the fourth survey, were: 2.67% (2.52-2.83); 2.61% (2.43-2.80); 1.99% (1.83-2.17); and 1.79% (1.65-1.94), respectively. In all facility types, the proportion of PUs was lower in the fourth survey than the first survey. CONCLUSION The proportion of PUs showed a decreasing trend and was low according to global standards, demonstrating the efficacy of JSPU's activities.
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Affiliation(s)
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- Japanese Society of Pressure Ulcers, Tokyo, Japan
| | - Chizuko Konya
- School of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Nursing Administration and Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koujiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Ishizawa
- Faculty of Nursing, School of Medicine, Nara Medical University, Nara, Japan
| | - Yoshiro Abe
- Department of Plastic and Reconstructive Surgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirobumi Higuchi
- Department of Plastic and Reconstructive Surgery, Iwate Prefectural Chubu Hospital, Iwate, Japan
| | - Takeo Mizuki
- Department of Nursing, Hakodate Municipal Hospital, Hokkaido, Japan
| | | | - Sawako Shoju
- Department of Nursing, Morinomiya Hospital, Osaka, Japan
| | - Kenichi Shimada
- Department of Plastic and Reconstructive Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Hiromi Sanada
- School of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Healing Time of Skin Ulcers in Homecare Residents in the Province of Reggio Emilia, Northern Italy. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121989. [PMID: 36556354 PMCID: PMC9785422 DOI: 10.3390/life12121989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
The growing phenomenon of skin ulcers represents an important health problem; therefore, we conducted a pilot study to evaluate the ulcer healing time among adult subjects followed by the Home Nursing Service of the AUSL-IRCCS of Reggio Emilia, Northern Italy, and diagnosed with at least one skin ulcer during the period of January-August 2020. We recruited 138 subjects (45.5% men) with a mean age of 86.1 years. The subjects presented with 232 ulcers, of which 76.7% were pressure ulcers (60.1% were stage II), 18.1% were vascular ulcers, and 4.7% were diabetic foot ulcers. Ulcer management required only one weekly access for the majority of subjects, with a recovery frequency of 53.6% at the end of the observation period. The median ulcer healing time was 3.6 months and was shorter in women (2.6 months) than men (5.1 months), with an increasing trend according to the number of ulcers and the severity of pressure ulcers for vascular and diabetic foot ulcers. In conclusion, this is the first study carried out in an Italian population describing the distribution and characteristics of homecare residents with skin ulcers and highlighting the factors influencing the healing time and as consequence the duration of nursing care.
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26
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Rubulotta F, Brett S, Boulanger C, Blackwood B, Deschepper M, Labeau SO, Blot S. Prevalence of skin pressure injury in critical care patients in the UK: results of a single-day point prevalence evaluation in adult critically ill patients. BMJ Open 2022; 12:e057010. [PMID: 36418122 PMCID: PMC9685232 DOI: 10.1136/bmjopen-2021-057010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Hospital-acquired pressure injuries (PIs) are a source of morbidity and mortality, and many are potentially preventable. DESIGN This study prospectively evaluated the prevalence and the associated factors of PIs in adult critical care patients admitted to intensive care units (ICU) in the UK. SETTING This service evaluation was part of a larger, international, single-day point prevalence study of PIs in adult ICU patients. Training was provided to healthcare givers using an electronic platform to ensure standardised recognition and staging of PIs across all sites. PARTICIPANTS The characteristics of the ICUs were recorded before the survey; deidentified patient data were collected using a case report form and uploaded onto a secure online platform. PRIMARY AND SECONDARY OUTCOME MEASURES Factors associated with ICU-acquired PIs in the UK were analysed descriptively and using mixed multiple logistic regression analysis. RESULTS Data from 1312 adult patients admitted to 94 UK ICUs were collected. The proportion of individuals with at least one PI was 16% (211 out of 1312 patients), of whom 8.8% (n=115/1312) acquired one or more PIs in the ICU and 7.3% (n=96/1312) prior to ICU admission. The total number of PIs was 311, of which 148 (47.6%) were acquired in the ICU. The location of majority of these PIs was the sacral area, followed by the heels. Braden score and prior length of ICU stay were associated with PI development. CONCLUSIONS The prevalence and the stage of severity of PIs were generally low in adult critically ill patients admitted to participating UK ICUs during the study period. However, PIs are a problem in an important minority of patients. Lower Braden score and longer length of ICU stay were associated with the development of injuries; most ICUs assess risk using tools which do not account for this. TRIAL REGISTRATION NUMBER NCT03270345.
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Affiliation(s)
- Francesca Rubulotta
- Intensive Care Medicine, McGill University, Montreal, Quebec, Canada
- Montreal General Hospital, Montreal, Quebec, Canada
- Anaesthetics and Intensive Care, Imperial College London, London, UK
| | - Stephen Brett
- Anaesthetics and Intensive Care, Imperial College London, London, UK
| | | | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | | | - Stijn Blot
- Ghent University Hospital, Ghent, Belgium
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Botterman L, De Cock I, Blot SI, Labeau SO. A knowledge test on pressure injury in adult intensive care patients: Development, validation, and item analysis. J Tissue Viability 2022; 31:718-725. [PMID: 36085122 DOI: 10.1016/j.jtv.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Pressure injuries are a major problem in critically ill patients, but both students' and intensive care nurses' knowledge about these injuries leaves room for improvement. As no knowledge test is currently available that focuses on pressure injuries in adult intensive care patients, we aimed to develop such tool, establish the content validity, and perform item analysis using Classical test theory. METHODS Test development followed established multiple-choice question-writing guidelines. Content validation used a Delphi procedure including eight international experts. Item analysis (question difficulty and discrimination power, and quality of the distractors) was based on the test results of a convenience sample who completed the test online, based on ready knowledge. RESULTS Four Delphi validation rounds resulted in a 24-item multiple-choice test within seven categories: Epidemiology, Aetiology, Prevention, Classification, Risk factors and risk assessment, Wound care, and Skin care. The content validity index was 0.96. The median score of 12 students and 38 qualified nurses was 12.5/24 (interquartile range 11-14.25; range 4-17; 52%). Least correct answers were in the categories Classification and Wound care. Item analysis revealed several knowledge gaps and misconceptions. CONCLUSIONS The test has excellent content validity. The sample's overall score was low. Item analysis identified various training needs. Future users are recommended to further validate the test and establish its reliability, and to tailor it to their individual context and evaluation requirements.
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Affiliation(s)
- Laurien Botterman
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
| | - Irene De Cock
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
| | - Stijn I Blot
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
| | - Sonia O Labeau
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
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28
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Coyer F, Chaboyer W, Lin F, Doubrovsky A, Barakat-Johnson M, Brown W, Lakshmanan R, Leslie G, Jones SL, Pearse I, Martin K, McInnes E, Powell M, Mitchell ML, Sosnowski K, Tallot M, Thompson A, Thompson L, Labeau S, Blot S. Pressure injury prevalence in Australian intensive care units: A secondary analysis. Aust Crit Care 2022; 35:701-708. [PMID: 34848121 DOI: 10.1016/j.aucc.2021.10.009] [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] [Received: 06/20/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pressure injuries (PIs) are an enduring problem for patients in the intensive care unit (ICU) because of their vulnerability and numerous risk factors. METHOD This study reports Australian data as a subset of data from an international 1-day point prevalence study of ICU-acquired PI in adult patients. Patients aged 18 years or older and admitted to the ICU on the study day were included. The outcome measure was the identification of a PI by direct visual skin assessment on the study day. Data collected included demographic data and clinical risk factors, PI location and stage, and PI prevention strategies used. Descriptive statistics were used to describe PI characteristics, and odds ratios (ORs) were used to identify factors associated with the development of a PI. RESULTS Data were collected from 288 patients from 16 Australian ICUs. ICU-acquired PI prevalence was 9.7%, with 40 PIs identified on 28 patients. Most PIs were of stage 1 and stage 2 (26/40, 65.0%). Half of the ICU-acquired PIs were found on the head and face. The odds of developing an ICU-acquired PI increased significantly with renal replacement therapy (OR: 4.25, 95% confidence interval [CI]: 1.49-12.11), impaired mobility (OR: 3.13, 95% CI: 1.08-9.12), fastest respiratory rate (OR: 1.05 [per breath per minute], 95% CI: 1.00-1.10), longer stay in the ICU (OR: 1.04 [per day], 95% CI: 1.01-1.06), and mechanical ventilation on admission (OR: 0.36, CI: 0.14-0.91). CONCLUSION This study found that Australian ICU-acquired PI prevalence was 9.7% and these PIs were associated with many risk factors. Targeted PI prevention strategies should be incorporated into routine prevention approaches to reduce the burden of PIs in the Australian adult ICU patient population.
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Affiliation(s)
- Fiona Coyer
- Joint Appointment School of Nursing, Queensland University of Technology and Intensive Care Services, Royal Brisbane and Women's Hospital, Australia; Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK.
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Australia; Sunshine Coast Health Institute, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District, Australia; Hospital-Acquired Complication Operational Coordinator for Pressure Injury, Sydney Local Health District, Australia; Faculty of Medicine and Health, University of Sydney, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Australia.
| | - Wendy Brown
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital Health Service, Queensland, Australia.
| | - Ramanathan Lakshmanan
- Fairfield Hospital, Australia; Liverpool Hospital, Australia; UNSW, Australia; WSU, Australia.
| | - Gavin Leslie
- Curtin Nursing School, Curtin University, Perth, Western Australia, Australia; School of Nursing & Midwifery, University South Australia, Adelaide, South Australia, Australia.
| | - Sarah L Jones
- Intensive Care Unit, St George Hospital, NSW, Australia.
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Queensland, Australia.
| | - Kerrie Martin
- Intensive Care Unit, The Tweed Hospital, NSW, Australia; Intensive Care NSW, Agency for Clinical Innovation, NSW Health, Australia.
| | - Elizabeth McInnes
- St Vincent's Hospital Melbourne, Australia; Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia.
| | - Madeleine Powell
- University of New South Wales, School of Population Health, New South Wales, Australia.
| | - Marion L Mitchell
- Menzies Health Institute Queensland, Griffith University, Australia; Princess Alexandra Hospital, Brisbane, Australia.
| | | | - Mandy Tallot
- Intensive Care Unit, Gold Coast University Hospital, Queensland Australia.
| | - Amy Thompson
- Nepean Blue Mountains Local Health District, NSW, Australia.
| | - Lorraine Thompson
- Practice Development, Sunshine Coast University Hospital, Australia.
| | - Sonia Labeau
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Ghent, Belgium.
| | - Stijn Blot
- Dept. of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium; Burns Trauma and Critical Care Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
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Garcіa-Fernandez FP, Soldevilla-Agreda JJ, Rodriguez-Palma M, Parra-Anguita L, Pancorbo-Hidalgo PL. Algorithm for the differential diagnosis between dependence-related skin injuries and severe life-threatening skin injuries. J Tissue Viability 2022; 31:575-578. [PMID: 36175255 DOI: 10.1016/j.jtv.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
AIM To develop a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). METHOD A nominal group technique was used. Six experts with extensive knowledge of these types of injuries were selected for the group. All were nurses with a PhD in wound research and had more than 15 years of experience in wound care. The experts were asked only one question: In your opinion, what are the basic and indispensable aspects to differentiate a dependence-related skin injury (DR-SI) from a severe life-threatening skin injury (SLT-SI)? RESULTS The experts identified three basic elements to differentiate DL-SI and SLT-SI (clinical situation, provision of care, and clinical characteristics of the lesions). A diagnostic algorithm was developed to differentiate the two types of skin lesions using the three basic elements identified, a literature review, and what was published in the two articles that define DR-SI and STL-SI. CONCLUSION We developed a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). The algorithm also facilitates the identification of the subtypes of these injuries, depending on its location and characteristics.
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Affiliation(s)
- Francisco P Garcіa-Fernandez
- Faculty of Health Sciences, University of Jaen, Spain. Executive Member of Spanish Pressure Ulcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
| | | | - Manuel Rodriguez-Palma
- Nursing Home "Josee Matia Calvo" of CadizUlcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
| | - Laura Parra-Anguita
- Faculty of Health Sciences, University of Jaen, Spain. Executive Member of Spanish Pressure Ulcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
| | - Pedro L Pancorbo-Hidalgo
- Faculty of Health Sciences, University of Jaen, Spain. Executive Member of Spanish Pressure Ulcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
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Li J, Zhu C, Liu Y, Li Z, Sun X, Bai Y, Song B, Jin J, Liu Y, Wen X, Cheng S, Wu X. Critical care nurses' knowledge, attitudes, and practices of pressure injury prevention in China: A multicentric cross-sectional survey. Int Wound J 2022; 20:381-390. [PMID: 35906851 PMCID: PMC9885482 DOI: 10.1111/iwj.13886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Pressure injury is a serious and preventable problem in intensive care units. Translating guidelines into clinical practice can reduce the incidence of pressure injury. Identifying clinical status, barriers and facilitators contribute to guideline implementation. To identify the knowledge, attitudes, and practices of pressure injury prevention in Chinese critical care nurses. Secondary data were extracted from a multicentric clinical trial. Knowledge and attitudes toward pressure injury prevention were assessed by a fourteen-item questionnaire. The observed practices were recorded using a case report form. The report complies with the STROBE statement. A total of 950 critical care nurses in 15 hospitals from six provinces of China were investigated. A total of 53.1% of nurses received a median score of 6 points or less. Knowledge regarding the repositioning procedure, risk assessment, and heel pressure injury prevention was insufficient. Over 99% of nurses strongly or somewhat agreed that pressure injury prevention was very important and that they were willing to take measures to prevent pressure injury. A total of 27 781 patient days of pressure injury prevention practice were recorded. Repositioning was the most commonly used prevention measure, followed by support surfaces and prophylactic dressings. A combination of repositioning, support surface, and prophylactic dressing was lacking. Chinese critical nurses showed a low level of knowledge and a positive attitude toward pressure injury prevention. Practices of pressure injury prevention were unsatisfactory. There is a clear gap between the guidelines and clinical practices. The barrier (low-level knowledge) and facilitator (positive attitude) were identified in this study. According to these findings, strategies need to be developed to promote guideline implementation.
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Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Ying Liu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Zhaoyu Li
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Xiangyu Sun
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yunfeng Bai
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Baoyun Song
- Department of NursingHenan Provincial People's HospitalZhengzhouChina
| | - Jingfen Jin
- Department of NursingZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Yilan Liu
- Department of NursingWuhan Union HospitalWuhanChina
| | - Xianxiu Wen
- Department of NursingSichuan Academy of Medical Sciences and Sichuan People's HospitalChengduChina
| | - Shouzhen Cheng
- Department of NursingSun Yat‐sen University First Affiliated HospitalGuangzhouChina
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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31
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Lovegrove J, Fulbrook P, Miles SJ. Use of a Sacral Foam Dressing to Prevent Pressure Injury in At-Risk Subacute Hospitalized Older Adults: A Pilot Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2022; 49:322-330. [PMID: 35809008 DOI: 10.1097/won.0000000000000894] [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: 11/25/2022]
Abstract
PURPOSE The purpose of this pilot study was to inform a future trial aimed at comparing the effectiveness of a prophylactic sacral dressing plus standard care to standard care only to reduce sacral pressure injuries (PIs) in at-risk older adults admitted to a subacute hospital setting. DESIGN A pilot study with a pragmatic, open-label, randomized controlled trial design. SAMPLE AND SETTING One hundred thirty participants were randomized (intervention n = 66, 50.8%; control n = 64, 49.2%). Protocol violations occurred in 48 participants (intervention n = 33, 68.8%; control n = 15, 31.3%). The study setting was a subacute hospital inpatient care unit located in Queensland, Australia. METHODS Participants were randomly allocated 1:1 to the intervention (prophylactic dressing plus standard care) or control group (standard care). Standard care included regular PI risk and skin assessments, and selection and implementation of preventive interventions (eg, support surfaces and increased repositioning) from a PI prevention care plan. The sacral dressing was applied for intervention participants immediately following recruitment. Ward and research staff collected data and assessed skin integrity daily; participants were followed up until onset of a PI or up to 28 days without PI occurrence. In addition, retrospective chart reviews were undertaken to verify PI occurrences. Patient comfort and dressing utility were also evaluated. RESULTS Two (3.0%) participants in the intervention group and 1 (1.6%) in the control group developed a sacral PI. The difference was not statistically significant. Only 1 PI was recorded prospectively, while 2 PIs were identified via retrospective chart review. Participants rated dressing comfort highly, particularly during the first 2 weeks, and nurses rated utility highly. Based on the intention-to-treat results, a sample size of 1799 per arm would be required in a definitive trial. CONCLUSIONS A definitive trial is feasible and warranted. However, the large sample size required in a definitive trial indicates the need for multiple sites.
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Affiliation(s)
- Josephine Lovegrove
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Paul Fulbrook
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Sandra J Miles
- Josephine Lovegrove, RN, BN(Hons), Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Paul Fulbrook, PhD, MSc, RN, BSc(Hons), PGDip Educ, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sandra J. Miles, PhD, RN, RM, MN (Ch&Adol), BN, CCYPN, Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
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Edsberg LE, Cox J, Koloms K, VanGilder-Freese CA. Implementation of Pressure Injury Prevention Strategies in Acute Care: Results From the 2018-2019 International Pressure Injury Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:211-219. [PMID: 35523235 PMCID: PMC9093720 DOI: 10.1097/won.0000000000000878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the implementation of pressure injury (PI) prevention strategies in adult acute care settings in the United States using the data from the 2018/2019 International Pressure Ulcer Prevalence (IPUP) Survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in the 2018 and/or 2019 IPUP Survey. Slightly less than half (49.4%, n = 146,231) were male, 50% (n = 148,997) were female, 0.6% (n = 17,760) were unknown. Their mean age was 64.29 (SD 17.2) years. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the implementation of prevention strategies including repositioning, support surface use, head-of-bed (HOB) elevation, heel elevation, moisture management, minimizing linen layers, and nutritional support. Practices were analyzed for differences between patients without pressure injuries, and patients with Stage 1 and 2 hospital-acquired pressure injury (HAPI), and those with severe HAPIs (Stage 3, Stage 4, unstageable, and deep tissue pressure injury). Acute care unit types included critical or intensive care units, medical-surgical inpatient care units, and step-down units. RESULTS Compliance rates to PI prevention strategies varied among patients at risk for HAPIs (Braden Scale for Pressure Sore Risk score ≤18). Daily skin assessment was performed for 86% of patients with no HAPIs and 96.8% of patients with severe HAPIs. Pressure redistribution was used in 74.6% of all patients and in over 90% of patients with severe HAPIs; however, compliance to routine repositioning was reported at lower levels between 67% and 84%, respectively. Heel elevation was reported for over 60% of the patients with severe HAPIs while 31.9% did not receive heel elevation, though only 6% were reported as not needing elevation. The majority of patients had HOB greater than the 30° at the time of the data collection; compliance with minimizing linen layers (≤3) was reported in 76% or more. Moisture management strategies were reportedly used in more than 71% of all patients and 89% for patients with severe HAPIs. Nutrition support was used for 55% to 82% of the patients and only documented as contraindicated in fewer than 2% of all groups. CONCLUSION Study findings revealed substantial compliance rates to PI prevention strategies. Nevertheless, there is potential for improvement in the implementation of some of the most basic prevention strategies including repositioning, heel elevation, nutritional support, and moisture management.
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Affiliation(s)
- Laura E. Edsberg
- Correspondence: Laura E. Edsberg, PhD, Center for Wound Healing Research, Daemen University, 4380 Main St, Amherst, NY 14226 ()
| | - Jill Cox
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Kimberly Koloms
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
| | - Catherine A. VanGilder-Freese
- Laura E. Edsberg, PhD, Center for Wound Healing Research and Natural & Health Sciences Research Center, Daemen University, Amherst, New York
- Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, and Englewood Health, Englewood, New Jersey
- Kimberly Koloms, MS, Hillrom, Inc., now a Baxter company Batesville, Indiana
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
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Designing devices to communicate effectively with intensive care nurses to prevent pressure injuries: A qualitative study. Intensive Crit Care Nurs 2022; 71:103244. [DOI: 10.1016/j.iccn.2022.103244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
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Lovegrove J, Fulbrook P, Miles SJ, Steele M, Liu XL, Zhang L, Cobos Vargas A. Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool (the COMHON Index). Int J Nurs Sci 2022; 9:169-178. [PMID: 35509692 PMCID: PMC9052269 DOI: 10.1016/j.ijnss.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Josephine Lovegrove
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
- Corresponding author.
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandra J. Miles
- School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
| | - Michael Steele
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
| | - Xian-Liang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane, Australia
| | - Lin Zhang
- Nursing Department, Shanghai Tenth People's Hospital, Shanghai, China
| | - Angel Cobos Vargas
- Critical Care Department, San Cecilio University Hospital, Granada, Spain
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Deschepper M, Labeau SO, Waegeman W, Blot SI. Heterogeneity hampers the identification of general pressure injury risk factors in intensive care populations: A predictive modelling analysis. Intensive Crit Care Nurs 2022; 68:103117. [PMID: 34393009 DOI: 10.1016/j.iccn.2021.103117] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To determine risk factors for pressure injury in distinct intensive care subpopulations according to admission type (Medical; Surgical elective; Surgery emergency; Trauma/Burns). METHODOLOGY/DESIGN Predictive modelling using generalised linear mixed models with backward elimination on prospectively gathered data of 13 044 adult intensive care patients. SETTINGS 1110 intensive care units, 89 countries worldwide. MAIN OUTCOME MEASURES Pressure injury risk factors. RESULTS A generalised linear mixed model including admission type outperformed a model without admission type (p = 0.004). Admission type Trauma/Burns was not withheld in the model and excluded from further analyses. For the other three admission types (Medical, Surgical elective, and Surgical emergency), backward elimination resulted in distinct prediction models with 23, 17, and 16 predictors, respectively, and five common predictors only. The Area Under the Receiver Operating Curve was 0.79 for Medical admissions; and 0.88 for both the Surgical elective and Surgical emergency models. CONCLUSIONS Risk factors for pressure injury differ according to whether intensive care patients have been admitted for medical reasons, or elective or emergency surgery. Prediction models for pressure injury should target distinct subpopulations with differing pressure injury risk profiles. Type of intensive care admission is a simple and easily retrievable parameter to distinguish between such subgroups.
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Affiliation(s)
- Mieke Deschepper
- Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Sonia O Labeau
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Keramiekstraat 80, 9000 Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Willem Waegeman
- Department of Data Analysis and Mathematical Modelling, Ghent University, Coupure Links 653, 9000 Ghent, Belgium.
| | - Stijn I Blot
- School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Keramiekstraat 80, 9000 Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Cox J, Edsberg LE, Koloms K, VanGilder CA. Pressure Injuries in Critical Care Patients in US Hospitals: Results of the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs 2022; 49:21-28. [PMID: 35040812 PMCID: PMC9200225 DOI: 10.1097/won.0000000000000834] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to examine pressure injury (PI) prevalence, PI risk factors, and prevention practices among adult critically ill patients in critical care units in the United States using the International Pressure Ulcer Prevalence™ (IPUP) Survey database from 2018 to 2019. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 41,866 critical care patients drawn from a sample of 296,014 patients in US acute care facilities who participated in the 2018 and/or 2019 IPUP surveys. The mean age among critical care patients was 63.5 years (16.3) and 55% were male. All geographic regions of the United States were represented in this sample, with the greatest percentages from the Southeast (47.5%) and Midwest (17.5%) regions. METHODS Overall critical care PI prevalence and hospital-acquired PI (HAPI) rates were obtained and analyzed using the 2018/2019 IPUP survey database. Critical care PI risk factors included in the database were analyzed using frequency distributions. Prevention practices among critically ill patients were analyzed to evaluate differences in practices between patients with no PIs, superficial PIs (stage 1, stage 2), and severe PIs (stage 3, stage 4, unstageable, deep tissue pressure injury). RESULTS The overall PI prevalence for critical care patients was 14.3% (n = 5995) and the overall HAPI prevalence was 5.85% (n = 2451). In patients with severe HAPIs, the most common risk factors were diabetes mellitus (29.5%), mechanical ventilation (27.6%), and vasopressor agents (18.9%). Significant differences between patients with no PIs as compared to those with superficial or severe HAPIs (P = .000) for all prevention practices were found. CONCLUSIONS Study findings support the gaps elucidated in previous critical care studies on PI development in this population. The 2 most persistent gaps currently challenging critical care practitioners are (1) accurate risk quantification in this population and (2) the potential for unavoidability in PI development among critically ill patients.
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Affiliation(s)
- Jill Cox
- Correspondence: Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, 180 University Ave. Newark, NJ 07102 ()
| | - Laura E. Edsberg
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Kimberly Koloms
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
| | - Catherine A. VanGilder
- JIll Cox, PhD, RN, APN-c, CWOCN, FAAN, WOC Advanced Practice Nurse, Rutgers University School of Nursing, Newark, New Jersey/Englewood Health, River Vale, New Jersey
- Laura E. Edsberg, PhD, Center for Wound Healing Research, and Natural & Health Sciences Research Center, Daemen College, Amherst, New York
- Kimberly Koloms, MS, Hillrom, Inc, Batesville, Indiana
- Catherine A. VanGilder, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC Bristol, Tennessee
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Lovegrove J, Ven S, Miles SJ, Fulbrook P. Comparison of pressure injury risk assessment outcomes using a structured assessment tool versus clinical judgement: A systematic review. J Clin Nurs 2021; 32:1674-1690. [PMID: 34854158 DOI: 10.1111/jocn.16154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whilst performing a pressure injury risk assessment is not in itself preventive, risk status identification is critical to inform the judicious implementation of prevention strategies. Risk assessment is mostly undertaken using a structured tool informed by clinical judgement, though there is a perception that use of clinical judgement alone may be sufficient. OBJECTIVES Within acute hospital settings, to identify differences in outcomes (risk status, preventive interventions) following nursing assessment of pressure injury risk when using a structured assessment tool compared to clinical judgement. DESIGN Systematic review. DATA SOURCES EBSCO CINAHL Complete, EBSCO MEDLINE Complete, Scopus, Web of Science, Ovid EMBASE. METHODS Primary research relevant to the objectives was eligible for inclusion. Databases were searched in February 2021 (limits: date 2010-2020, English language, adults). Two reviewers undertook the review process, with a third as arbitrator. Appraisal was undertaken using Joanna Briggs Institute critical appraisal tools. Included studies are synthesised narratively. Reporting is in accordance with the PRISMA Statement. RESULTS Five moderate to high-quality studies were included. Synthesis was limited by heterogeneity. Several risk assessment tools and methods of clinical judgement were used. Three studies reported pressure injury risk status using both assessment approaches, but in only one did nurses undertake both. Risk status, as identified by each method, varied and was sometimes contradictory. Three studies reported some elements of preventive intervention prescription and/or implementation following risk assessment, but comparison between approaches was limited. CONCLUSIONS Some research suggests that risk status varies across different methods of pressure injury risk assessment, but it is unclear what impact this has on preventive intervention use. Risk status was not well linked to preventive interventions. Research is warranted to examine the influence that each approach to risk assessment alone and combined has on identified risk and preventive intervention prescription and implementation. REGISTRATION A protocol was prospectively registered with PROSPERO (CRD42021224747).
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Affiliation(s)
- Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Saroeun Ven
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Sandra J Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Pressure Injury Prevalence in Acute Care Hospitals With Unit-Specific Analysis: Results From the International Pressure Ulcer Prevalence (IPUP) Survey Database. J Wound Ostomy Continence Nurs 2021; 48:492-503. [PMID: 34781304 DOI: 10.1097/won.0000000000000817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine overall pressure injury (PI) prevalence and hospital-acquired pressure injury (HAPI) prevalence in US acute care hospitals. Additionally, analysis of patient characteristics associated with HAPIs will be presented. DESIGN Observational, cross-sectional cohort study. SUBJECTS AND SETTING An in-depth analysis of data was performed from the International Pressure Ulcer Prevalence™ (IPUP) Survey database for years 2018-2019 that included 296,014 patients. There were 914 participating US acute care facilities in 2018 and 887 in 2019. Overall PI prevalence and HAPI prevalence over time were also examined for 2006-2019 acute care data from 2703 unique facilities (1,179,108 patients). METHODS Overall PI prevalence and HAPI prevalence were analyzed from the 2006-2019 IPUP survey database. Recent data for 2018-2019 PI prevalence are reported separately for medical-surgical, step-down, and critical care unit types. PI stages, anatomic locations, Braden score associated with HAPIs, and body mass index were analyzed. RESULTS Overall PI prevalence and HAPI prevalence data declined between 2006 and 2019; however, the prevalence plateaued in the years 2015-2019. Data from 2018 to 2019 (N = 296,014) showed that 26,562 patients (8.97%) had at least one PI and 7631 (2.58%) had at least one HAPI. Patients cared for in medical-surgical inpatient care units had the lowest overall PI prevalence (7.78%) and HAPI prevalence (1.87%), while critical care patients had the highest overall PI prevalence (14.32%) and HAPI prevalence (5.85%). Critical care patients developed more severe PIs (stage 3,4, unstageable, and deep-tissue pressure injuries [DTPIs]), which were proportionally higher than those in the step-down or medical-surgical units. The sacrum/coccyx anatomic location had the highest overall PI prevalence and HAPI prevalence, except for DTPIs, which most common occurred on the heel. CONCLUSIONS Overall and HAPI prevalence has plateaued 2015-2019. Prevalence of HAPIs, especially in critical care units, remain high. While medical advancements have improved survival rates among critically ill patients, survival may come with unintended consequences, including PI development.
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Raepsaet C, Serraes B, Verhaeghe S, Beeckman D. Integrating Sensor Technology in Disposable Body-Worn Absorbent Products: A Qualitative Study to Define User Profile, (Technical) Criteria, Conditions, and Potential Benefits. J Wound Ostomy Continence Nurs 2021; 48:560-567. [PMID: 34781313 DOI: 10.1097/won.0000000000000812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to define the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. DESIGN Qualitative study using a framework method. SUBJECT AND SETTING The sample included residents with incontinence, nurses, and decision-makers in a selection of Flemish nursing homes (Belgium). METHODS Semistructured interviews were performed between June and August 2020. The interviews with nurses included open-ended questions focusing on the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. The interviews with decision-makers were supplemented with questions about purchase cost and other economic criteria (such as reimbursement). Interviews with residents included questions about wearing comfort. Interviews were tape-recorded and transcribed verbatim. Data were analyzed using a framework method. RESULTS The user profile was defined as (1) residents with cognitive impairment and (2) residents who are bedridden or are severely limited in mobility. The following (technical) criteria emerged from the analyses: a small, thin, and oval/circular sensor, an adaptable or in front attachment of the sensor on the absorbent product, a real-time indication of the absorbent product's saturation, leakage detection, liquid stool detection, the automatic recording of incontinence-related data, a durable sensor easy to disinfect, and receiving notifications on a wearable device. Conditions included a stable connection between the wearable device and the sensor, accurate measurements, user-friendly system, comprehensible training, affordability, and data protection. Potential benefits included workload reduction, increased comfort for residents and staff, more person-centered care, increased quality of care, less skin damage and economic (eg, less costs due to less excessive absorbent product changes), and/or environmental (e.g. less waste) gains. CONCLUSION Study findings identified the user profile, (technical) criteria, conditions, and potential benefits of the integration of sensor technology in disposable body-worn incontinence materials. Respondents reported problems with changing routines and skepticism about the sensor's accuracy. Based on findings from this study, we recommend involving representatives of all relevant stakeholders in the design of sensor technology to ensure users' needs and increase the use of sensor technology. Comprehensive education is recommended to inform nurses, residents, and their family members on the importance and benefits of the technology and to aid overcoming barriers to use (skepticism, resistance to new technologies, and changing care routines). Study findings also indicate that the sensor technology cannot replace the existing voiding programs; rather it should be an addition to routine continence care.
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Affiliation(s)
- Charlotte Raepsaet
- Charlotte Raepsaet, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Brecht Serraes, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Sofie Verhaeghe, Professor, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing, VIVES University College, West Flanders, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Dimitri Beeckman, Professor Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark
| | - Brecht Serraes
- Charlotte Raepsaet, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Brecht Serraes, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Sofie Verhaeghe, Professor, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing, VIVES University College, West Flanders, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Dimitri Beeckman, Professor Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark
| | - Sofie Verhaeghe
- Charlotte Raepsaet, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Brecht Serraes, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Sofie Verhaeghe, Professor, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing, VIVES University College, West Flanders, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Dimitri Beeckman, Professor Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark
| | - Dimitri Beeckman
- Charlotte Raepsaet, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Brecht Serraes, Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Sofie Verhaeghe, Professor, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Nursing, VIVES University College, West Flanders, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Dimitri Beeckman, Professor Skin Integrity Research Group, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden; Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Odense, Denmark
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García-Fernández FP, Soldevilla-Agreda JJ, Rodriguez-Palma M, Pancorbo-Hidalgo PL. Skin injuries associated with severe life-threatening situations: A new conceptual framework. J Nurs Scholarsh 2021; 54:72-80. [PMID: 34741398 DOI: 10.1111/jnu.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. DESIGN A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. METHODS Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight-phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. FINDINGS Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life-threatening situations (SI-SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI-MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI-ESVs). SI-MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI-ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). CONCLUSIONS We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI-SLTSs, distinguishing between SI-MODSs and SI-ESVs. CLINICAL RELEVANCE This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi-organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence-related skin lesions.
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Coyer F, Barakat-Johnson M, Campbell J, Palmer J, Parke RL, Hammond NE, Knowles S, Doubrovsky A. Device-related pressure injuries in adult intensive care unit patients: An Australian and New Zealand point prevalence study. Aust Crit Care 2021; 34:561-568. [PMID: 33622521 DOI: 10.1016/j.aucc.2020.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/01/2020] [Accepted: 12/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Device-related pressure injuries (DRPIs) are an ongoing iatrogenic problem evident in intensive care unit (ICU) settings. Critically ill patients are at high risk of developing pressure injuries caused by devices. OBJECTIVE The aim of the study was to determine the prevalence of DRPI in critically ill patients in intensive care and the location, stage, and attributable device of DRPI and describe the products and processes of care used to prevent these injuries. METHODS This was a prospective, multicentre, cross-sectional point prevalence study of patients aged more than 16 years in Australian and New Zealand ICUs. The study was part of the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program coordinated by The George Institute for Global Health. MAIN OUTCOME MEASURE Identification of DRPI on the study day was the main outcome measure. RESULTS Of the 624 patients included from 44 participating ICUs, 27 were found to have 35 identified DRPIs, giving a point prevalence DRPI rate of 4.3% (27/624). Study patients had a mean age of 59 years, and 60.3% were men. Patients with DRPI compared with patients without DRPI were significantly heavier (median: 92 kg versus 80 kg, respectively, p = 0.027), were less likely to survive the ICU (63.0% versus 85.9%, respectively, p = 0.015), had higher Acute Physiology and Chronic Health Evaluation II scores at admission to the ICU (median: 20 versus 16, respectively, p = 0.001), received mechanical ventilation more often (88.9% versus 43.5%, respectively, p < 0.001), and were more frequently diagnosed with respiratory conditions (37.0% versus 18.6%, respectively, p = 0.022). Processes of care activities were surveyed in 42 ICUs. Most DRPIs were attributed to endotracheal tubes and other respiratory devices. Forty-two ICUs reported processes of care to prevent DRPI, and just more than half of the participating sites (54.8%, 23/44) reported a dedicated ICU-based protocol for prevention of DRPI. CONCLUSION DRPIs pose a burden on patients in the ICU. Our study showed a DRPI prevalence comparable with other studies. Prevention strategies targeting DRPI should be included in ICU-specific pressure injury prevention guidelines or protocols.
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Affiliation(s)
- Fiona Coyer
- Joint Appointment Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK; Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4029, Australia.
| | - Michelle Barakat-Johnson
- Skin Integrity Lead, Sydney Local Health District, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, Australia; Adjunct Associate Professor, School of Nursing, Queensland University of Technology, Australia.
| | - Jill Campbell
- Conjoint Senior Research Fellow, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Australia.
| | - Jennifer Palmer
- Intensive Care Services, Intensive Care Services, Royal Brisbane and Women's Hospital, Australia; Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4029, Australia.
| | - Rachael L Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, 2 Park Road, Grafton, 1023, Auckland, New Zealand; School of Nursing, University of Auckland, Faculty of Medical and Health Sciences, Grafton, Auckland, 1023, New Zealand; Australian and New Zealand Intensive Care Research Centre, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Naomi E Hammond
- Critical Care Program, The George Institute for Global Health, Sydney, Australia; Intensive Care Clinical Research Manager, Malcom Fisher Department of Intensive Care, Royal North Shore Hospital, Australia; Sydney Senior Lecturer, Faculty of Medicine, UNSW, Sydney, Australia.
| | - Serena Knowles
- The George Institute for Global Health, Sydney, Australia.
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Australia.
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Brennan MR, Grahn E, Oropallo A, Probst N, Reynolds D, Rivera J. A HAPI Opinion Commentary. Adv Skin Wound Care 2021; 34:569-571. [PMID: 34669658 DOI: 10.1097/01.asw.0000792936.94123.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary R Brennan
- At the North Shore University Hospital, Manhasset, New York, Mary R. Brennan, MBA, RN, CWON, is Clinical Development Educator; Elizabeth Grahn, MSN, NP-C, CWOCN, is Senior Manager, Wound and Ostomy Services. Alisha Oropallo, MD, FACS, FAWPCA, is Director, Comprehensive Wound Healing Center, Lake Success, New York. Nicole Probst, MS, RN, AGNP-C, CWOCN, is Manager, Patient Care, Huntington Hospital, Huntington, New York. Deborah Reynolds, BA, RN, CWOCN, is Clinical Professional Development Educator, Phelps Memorial Hospital, Sleepy Hollow, NY. Julie Rivera, MSN, RN, NPD-BC, CWOCN, is Clinical Professional Development Educator, Lenox Hill Hospital, New York City, NY
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Liu PJ, Caspi E, Cheng CW. Complaints Matter: Seriousness of Elder Mistreatment Citations in Nursing Homes Nationwide. J Appl Gerontol 2021; 41:908-917. [PMID: 34486438 DOI: 10.1177/07334648211043063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mistreatment of nursing home residents is prevalent and leads to harmful consequences. The Centers for Medicare & Medicaid Services's (CMS) mission to protect residents' right to be free from mistreatment is implemented partially through state survey agencies' (SSAs) issuance of deficiency citations. The goal of this study was to compare SSA standard surveys and SSA complaint investigations with regard to the seriousness (scope and severity) of the mistreatment citations issued. A cumulative link mixed model was built to estimate the differences between standard surveys and complaint investigations in the seriousness of four core and two secondary mistreatment citations nationwide from 2014 to 2017. In all of the six mistreatment deficiency citations, complaint investigations were more likely to be determined as more serious compared with standard surveys. The findings reinforce the importance of strengthening nursing homes' and CMS/SSA response to consumers' concerns and grievances before they escalate into more harmful mistreatment.
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Affiliation(s)
- Pi-Ju Liu
- Purdue University, West Lafayette, IN, USA
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Padula WV, Lee KKH, Pronovost PJ. Using Economic Evaluation to Illustrate Value of Care for Improving Patient Safety and Quality: Choosing the Right Method. J Patient Saf 2021; 17:e568-e574. [PMID: 28786836 DOI: 10.1097/pts.0000000000000410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT To scale and sustain successful quality improvement (QI) interventions, it is recommended for health system leaders to calculate the economic and financial sustainability of the intervention. Many methods of economic evaluation exist, and the type of method depends on the audience: providers, researchers, and hospital executives. This is a primer to introduce cost-effectiveness analysis, budget impact analysis, and return on investment calculation as 3 distinct methods for each stakeholder needing a measurement of the value of QI at the health system level. Using cases for the QI of hospital-acquired condition rates (e.g., pressure injuries), this primer proceeds stepwise through each method beginning from the same starting point of constructing a model so that the repetition of steps is minimized and thereby capturing the attention of all intended audiences.
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Jacq G, Valera S, Muller G, Decormeille G, Youssoufa A, Poiroux L, Allaert F, Barrois B, Rigaudier F, Ferreira P, Huard D, Heming N, Aissaoui N, Barbar S, Boissier F, Grimaldi D, Hraiech S, Lascarrou JB, Piton G, Michel P. Prevalence of pressure injuries among critically ill patients and factors associated with their occurrence in the intensive care unit: The PRESSURE study. Aust Crit Care 2021; 34:411-418. [PMID: 33483180 DOI: 10.1016/j.aucc.2020.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of pressure injuries (PIs) in critically ill patients has been extensively studied, but there is uncertainty regarding the risk factors. The main objective of this study was to describe the prevalence of PIs in critically ill patients. Secondary objectives were to describe PI, use of preventive measures for PI, and factors associated with occurrence of PI in the intensive care unit (ICU). MATERIAL AND METHODS This was a 1-day point-prevalence study performed on a weekday in June 2017 in ICUs in France. On the same day, we noted the presence or absence of PI in all hospitalised patients of the participating ICUs, data on the ICUs, and the characteristics of patients and of PI. RESULTS Eighty-six participating ICUs allowed the inclusion of 1228 patients. The prevalence of PI on the study day was 18.7% (95% confidence interval: 16.6-21.0). PIs acquired in the ICU were observed in 12.5% (95% confidence interval: 10.6-14.3) of critically ill patients on the study day. The most frequent locations of PI were the sacrum (57.4%), heel (35.2%), and face (8.7%). Severe forms of PI accounted for 40.8% of all PIs. Antiulcer mattresses were used in 91.5% of the patients, and active and/or passive mobilisation was performed for all the patients. Multiple logistic regression analysis identified longer length of stay in the ICU, a higher Simplified Acute Physiology Score, higher body weight, motor neurological disorder, high-dose steroids, and absence of oral nutrition on the study day as factors independently associated with occurrence of PI in the ICU. CONCLUSION This large point-prevalence study shows that PIs are found in about one of five critically ill patients despite extensive use of devices for preventing PI. Acquisition of PI in the ICU is strongly related to the patient's severity of illness on admission to the ICU and length of stay in the ICU.
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Levine JM, Brandeis G, Namagiri S, Spinner R. Wound Care Consultation in Postacute/Long-term Care: Characteristics and Practice Implications. Adv Skin Wound Care 2021; 34:417-421. [PMID: 34260419 DOI: 10.1097/01.asw.0000755932.27249.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the characteristics of residents in postacute (PA)/long-term care (LTC) facilities with wounds and prevalence of wound types other than pressure injuries (PIs). METHODS The authors conducted a retrospective review of all wound care consultations over 1 year at The New Jewish Home, a 514-bed academically affiliated facility in an urban setting. Investigators analyzed residents by age, sex, type of wound, presence of infection, and whether the resident was PA or LTC. Authors designated PIs as facility acquired or present on admission. RESULTS During the study period, 190 wound care consultations were requested; 74.7% of consults were for those in PA care. The average patient age was 76.3 years, and there were 1.7 wounds per resident receiving consultation. Of studied wounds, 53.2% were PIs, 15.8% surgical, 6.8% arterial, 6.3% soft tissue injury, 5.8% venous, 2.6% malignant wounds, and 2.1% diabetic ulcers; however, 11.6% of residents receiving consults had more than one wound type. In this sample, 13.2% of residents had infected wounds, and 76.2% of PIs were present on admission. CONCLUSIONS The wide variety of wounds in this sample reflects the medical complexity of this population. The transformation of LTC into a PA environment has altered the epidemiology of chronic wounds and increased demand for wound care expertise. These results challenge traditional perceptions of wound care centered on PIs. Given its importance, a wound care skill set should be required of all PA/LTC providers.
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Affiliation(s)
- Jeffrey M Levine
- Jeffrey M. Levine, MD, AGSF, CMD, CWS-P, is Associate Clinical Professor, Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York; and Consultant, Advantage Surgical & Wound Care. Gary Brandeis, MD, CMD, is Chief, Geriatrics, Mt Sinai Services, Elmhurst Hospital Center, New York; and Clinical Professor, Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai. At The New Jewish Home in New York, Santhini Namagiri, MD, is Physician; and Ruth Spinner, MD, CMD, is Medical Director. Acknowledgments: The authors thank Orah Burack, Senior Research Associate at The New Jewish Home, who assisted with study design and institutional review board submission; and Shark Bird, MD, Chief Medical Officer of Vohra Wound Physicians, who provided insights into models of wound care. A subset of 27 residents from this database was analyzed and previously published as Levine JM, Menezes R, Namagiri S. Wounds related to malignancy in postacute/LTC: a case series. Adv Skin Wound Care 2020;33:99-102. Parts of this article were presented as an abstract at the AMDA/PALTC Annual Meeting in Atlanta, 2019. The authors have disclosed no financial relationships related to this article. Submitted September 2, 2020; accepted in revised form October 28, 2020
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Hospital-Acquired Pressure Injury Development Among Surgical Critical Care Patients Admitted With Community-Acquired Pressure Injury: A Retrospective Cohort Study. J Wound Ostomy Continence Nurs 2021; 47:470-476. [PMID: 32925591 DOI: 10.1097/won.0000000000000691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Community-acquired pressure injuries (CAPIs) are present among approximately 3% to 8% of patients admitted to acute care hospitals. In the critical care population, little is known about hospital-acquired pressure injury (HAPI) development among patients with CAPIs because most studies exclude patients with CAPIs. The purpose of our study was to determine the incidence of HAPI development and the associated risk factors among surgical critical care patients with CAPIs. DESIGN Retrospective cohort study. SUBJECTS AND SETTING We used electronic health record data from adult critical care patients admitted to the surgical and cardiovascular surgical intensive care units (ICUs) at a level 1 trauma center and academic medical center between 2014 and 2018. METHODS Univariate analysis was used to compare patients with CAPIs who developed a HAPI and those who did not, as well as logistic regression analysis to identify independent risk factors for HAPIs among patients with CAPIs. RESULTS Among 5101 patients admitted to 2 surgical critical care units, 167 (3%) patients were admitted with CAPIs. Hospital-acquired pressure injuries were 4 times more common among patients with CAPIs compared to patients without CAPIs. Among the 167 patients with CAPIs, 47 patients (28%) went on to also develop a HAPI, whereas in the 4934 patients without CAPIs, 352 patients (7%) went on to develop a HAPI. Findings from the multivariate logistic regression analysis (n = 151) showed that decreased serum albumin (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.25-0.85; P = .02) and excessively dry skin (OR = 2.6; 95% CI, 1.1-6.22; P = .03) were independent predictors of HAPI development among patients admitted with CAPIs. CONCLUSIONS Results from our study show that patients with CAPIs are at high risk for developing a HAPI, particularly among patients with decreased serum albumin or excessively dry skin. Patients with excessively dry skin may benefit from the application of skin moisturizers.
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Abstract
Identification of the appropriate pressure injury (PI) risk factors is the first step in successful PI prevention. Measuring PI risk through formalized PI risk assessment is an essential component of any PI prevention program. Major PI risk factors identified in the empirical literature in the critical care population include age, diabetes, hypotension, mobility, prolonged intensive care unit admission, mechanical ventilation and vasopressor administration. Future risk assessment using sophisticated data analytics available in the electronic medical record may result in earlier, targeted PI prevention and will improve our understanding of risk factors that may contribute to unavoidable PIs.
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Abela G. Root cause analysis to identify contributing factors for the development of hospital acquired pressure injuries. J Tissue Viability 2021; 30:339-345. [PMID: 34074581 DOI: 10.1016/j.jtv.2021.04.004] [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: 04/16/2020] [Revised: 04/03/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Many hospital settings are adopting a zero-tolerance policy towards pressure injury (PI) development; this requires good planning and the implementation of care, as the incidence of PIs reflects the quality of care given in a hospital or facility. AIM To identify common contributing factors towards the development of PIs in a geriatric rehabilitation hospital and improve patient safety through the reduction of hospital-acquired PIs. METHOD This was done using root cause analysis (RCA). All patients who developed a Stage 3 or 4 deep tissue injuries or unstageable hospital-acquired PI between December 2017 and April 2018 PIs were investigated using RCA. The RCA was facilitated through the use of a contributing framework developed by the National Pressure Ulcer Advisory Panel which guides investigations of different areas of care. Qualitative and quantitative data was collected from several sources and placed in a timeline to reconstruct the series of events. The investigator then identified if the PI was avoidable or not by comparing the evidence with pre-set criteria. Content analysis was further used to analyse the themes retrieved. RESULTS A variety of root causes were common amongst all the cases. These included both flaws in the system, such as poor equipment and inadequate educational programmes, as well as human factors such as a lack of basic routine care. No skin assessment was being performed (n = 0) apart from the assessment done on admission. Documentation of action planning when it comes to PI prevention was also missing (n = 0). It was identified that 7 patients were mobilized on admission while the others (n = 3) had a delay in mobilisation, due to some fragmentation in care. There was no documentation of patient and relative education on the prevention of PIs (n = 0). All the patients were provided with the right pressure redistributing mattress however, some mattresses were bottoming out. Some causes overlapped, with system defects like lack of protocols, equipment and tools pushing human errors to occur. This created a series of events leading to the adverse event. The identification of these factors helped to provide an understanding of the changes that are needed to reduce future harm and improve patient safety. CONCLUSION Recommendations were proposed to reduce contributing factors to the development of hospital-acquired PIs. These include audits to reinforce adherence to hospital guidelines, streamlining of the documentation system, investment in new equipment and improvements to educational programmes. The recommendations implemented resulted in a decreased incidence rate of HAPIs.
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Worobey LA, Heinemann AW, Anderson KD, Fyffe D, Dyson-Hudson TA, Berner T, Boninger ML. Factors Influencing Incidence of Wheelchair Repairs and Consequences Among Individuals with Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:779-789. [PMID: 33845000 DOI: 10.1016/j.apmr.2021.01.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the frequency and consequences of wheelchair repairs, looking at the relationship to usage, components, out-of-pocket costs, number of days affecting the user, and factors associated with the need for repairs or consequences. DESIGN Survey, cross-sectional. SETTING Nine spinal cord injury (SCI) Model Systems centers. PARTICIPANTS Wheelchair users with SCI (N=533). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Cost and incidence of wheelchair repairs and consequences and wheelchair usage within the past 6 months. RESULTS A total of 310 participants (56%) reported repairs, 127 (42%) of whom experienced at least 1 adverse consequence lasting a median of 5 days (interquartile range [IQR], 2-17.3 days). Repair rates were highest for the seating system, electronics, and tires. Participants were most often stranded at home or forced to use a backup chair. Median out-of-pocket costs were $150 (IQR, $50-$620). Active users, based on type of mobility and terrain, experienced more repairs and consequences than less active users. Repairs were more common among those who were Black (odds ratio [OR], 2.42) or power wheelchair (PWC) users (OR, 1.84), whereas consequences were more common among those who were Black (OR, 2.27), PWC (OR, 2.08) or power assist users (OR, 2.76), and those who had public insurance (OR, 1.70). CONCLUSIONS Wheelchair repairs continue to affect more than 50% of wheelchair users with significant financial and personal cost. High repair rates limited participation inside and outside of the home. Consequences lasted longer than 2 weeks for many and may be minimized by a working backup chair. Disparities exist based on participant and wheelchair factors; repairs and adverse consequences appear to hit those most vulnerable with the least financial resources. Costs may be a barrier to repair completion for some individuals. This ongoing problem of high repair rates and their associated effects requires action such as higher standards, access to quicker service, and better training of users on wheelchair maintenance and repair.
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Affiliation(s)
- Lynn A Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA.
| | | | | | | | | | - Theresa Berner
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare system, Pittsburgh, PA
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