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Dehghani M, Pourmontaseri H. Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review. Int Wound J 2024; 21:e14788. [PMID: 38420873 PMCID: PMC10902764 DOI: 10.1111/iwj.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.
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Affiliation(s)
- Mohammadreza Dehghani
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
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John AM, Nayak U KR, Lobo G, Thaleppaddy M. Assessment of pressure injury knowledge using PZ-PUKT questionnaire among Indian nurses and the evaluation of impact of an educational intervention on the knowledge scores: A quasi-experimental study. J Tissue Viability 2024:S0965-206X(24)00006-8. [PMID: 38360495 DOI: 10.1016/j.jtv.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/23/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
AIM To determine the knowledge of pressure injury among Indian nurses using PZ-PUKT questionnaire and to evaluate the effect of an educational intervention on knowledge scores. MATERIALS AND METHODS A Quasi-experimental study design was used to test the Pressure injury knowledge of 273 nurses in a tertiary care teaching hospital. The Pieper Zulkowski Pressure Ulcer Knowledge Test questionnaire was given as a pre-test prior to education session and re-administered after the activity was completed. RESULTS The mean score of the pre-test was 48.58 ± 6.75 (C·I 47.8-49.4) and post-test 54.14 ± 7.69 (C·I 53.3-55.1), which showed a statistically significant improvement. In the pre-test, nurses had highest score in the prevention subset while wound subset had the greatest improvement in the post-test. Female participants had a better understanding about Pressure injuries when compared to males. Also, the Assistant Nursing Superintendents and ward in Charge nurses had better knowledge as compared with other nurses. CONCLUSIONS The knowledge of pressure injury among nurses is limited. Knowledge deficits should be identified and targeted educational interventions should be administered to all the nurses irrespective of their educational level and work experience. Wound certification courses should be instituted so that it gives the nurses a better opportunity to learn about pressure injuries at a certified level. All nurses should undergo periodic training in this ever-evolving field so as to provide the best care to their patients.
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Affiliation(s)
- Anne Mary John
- Department of Physical Medicine and Rehabilitation, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, India.
| | - Keerthan Ranga Nayak U
- Department of Orthopaedics, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, India.
| | - Gracy Lobo
- Faculty of Nursing, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, India.
| | - Megha Thaleppaddy
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, India.
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Cardona S, Hernández C, Bohórquez-Tarazona MP, Rubiano AM, Parra DMS. Scalp wound management: a narrative review from a neurosurgical perspective. J Wound Care 2024; 33:127-135. [PMID: 38329834 DOI: 10.12968/jowc.2024.33.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
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Affiliation(s)
| | | | | | - Andrés M Rubiano
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Valle Salud IPS Clinic Network, Colombia
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - Diana Marcela Sánchez Parra
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Fellow, Global Neurosurgery and Trauma, University of Cambridge, UK
- Fundación Meditech, Cali, Colombia
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Gheri CF, Scalfi L, Biffi B, Pancani S, Madiai S, Di Vincenzo O, Ghaderi M, Celoni R, Dalladonna M, Draghi F, Maccanti D, Macchi C, Romoli AM, Cecchi F, Hakiki B, Luisi MLE. Relationship between Nutritional Risk, Clinical and Demographic Characteristics, and Pressure Ulcers in Patients with Severe Acquired Brain Injuries Attending a Rehabilitative Program. Nutrients 2023; 15:3336. [PMID: 37571274 PMCID: PMC10421108 DOI: 10.3390/nu15153336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Preliminary evidence in the literature suggests a high prevalence of malnutrition (undernutrition) in patients with severe acquired brain injuries (sABI), with an expected negative impact on clinical outcomes and pressure ulcers (PUs) in particular. In a retrospective cohort study on patients discharged from intensive care units (ICU) and admitted to an intensive rehabilitation unit (IRU), the risk of malnutrition was systematically assessed, in addition to standard clinical procedures (including PUs evaluation), using two different tools: the Malnutrition Universal Screening Tool (MUST) and the Controlling Nutritional Status (CONUT) tool. Eighty-eight patients were included in the analysis. A high proportion (79.5%) of patients with sABI suffered from PUs, being older and more frequently men, with a longer ICU stay between the event and admission to IRU, and a greater MUST score. At discharge, when compared to patients whose PUs had healed, those with persisting PUs were more often men and had the worst cognitive performance at admission. As for nutritional risk, the baseline CONUT score was identified as an independent negative predictor of PUs at discharge by the logistic regression model. In conclusion, the assessment of nutritional risk using simple standard tools may be useful in the clinical evaluation of sABI patients with PUs.
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Affiliation(s)
- Chiara Francesca Gheri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Luca Scalfi
- Human Nutrition and Dietetics, Department of Public Health, Federico II University, 80131 Naples, Italy; (L.S.); (O.D.V.)
- Santa Maria del Pozzo Private Hospital, Somma Vesuviana, 80049 Naples, Italy
| | - Barbara Biffi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Sara Madiai
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Olivia Di Vincenzo
- Human Nutrition and Dietetics, Department of Public Health, Federico II University, 80131 Naples, Italy; (L.S.); (O.D.V.)
| | - Michele Ghaderi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Rebecca Celoni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Mara Dalladonna
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Daniela Maccanti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Anna Maria Romoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 50134 Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
| | - Maria Luisa Eliana Luisi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS Firenze, 50143 Florence, Italy (S.P.); (M.G.); (R.C.); (M.D.); (F.D.); (D.M.); (C.M.); (A.M.R.); (F.C.); (B.H.); (M.L.E.L.)
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Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, Mücke M, Conrad R. Risk factors for pressure ulcers in adult patients: A meta-analysis on sociodemographic factors and the Braden scale. J Clin Nurs 2022; 32:1979-1992. [PMID: 35191111 DOI: 10.1111/jocn.16260] [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: 08/27/2021] [Revised: 01/11/2022] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES Providing the first meta-analysis of risk factors for pressure ulcer development in adult patients. BACKGROUND Pressure ulcers remain a serious health complication for patients and nursing staff. However, there is a lack of statistical evidence for risk factors as previous research did not include any quantitative synthesis. DESIGN Meta-analysis, using PRISMA guidelines. METHODS Studies from PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews and sources were screened and checked against the inclusion criteria. The risk of bias was evaluated using a slightly modified QUIPS tool. Data regarding population, design, statistical analysis and risk factors were extracted. Meta-analysis with comparable studies was conducted for age, sex, and Braden scale. The sub-group analysis was used to account for heterogeneity. RESULTS 28 studies with 570,162 patients were entered in meta-analysis. Older age and a low total Braden scale score increased the risk for pressure ulcers. All subscales excluding 'moisture' reached significance in meta-analysis based only on few studies, however, limiting overall evidence. Male sex achieved mixed results, too. CONCLUSION The first meta-analytic analysis shows evidence for age and Braden scale as risk factors for pressure ulcer development. Limitations regarding study quality and heterogeneity must be considered, highlighting the need for unifying certain conditions in risk factor research. RELEVANCE TO CLINICAL PRACTICE Patients at risk for new pressure ulcers can be identified by their total Braden score and age, whereas the latter is also connected to deeper pressure ulcers. Nurses and health personnel should pay great attention to patients in older age and undergo specific training to utilise and evaluate the Braden scale effectively, if necessary.
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Affiliation(s)
- Man-Long Chung
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Manuel Widdel
- Institute of Product Development and Engineering Design, Technische Hochschule Köln, Cologne, Germany
| | - Julian Kirchhoff
- Institute of Product Development and Engineering Design, Technische Hochschule Köln, Cologne, Germany
| | - Julia Sellin
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, Aachen, Germany
| | - Mohieddine Jelali
- Institute of Product Development and Engineering Design, Technische Hochschule Köln, Cologne, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Martin Mücke
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, Aachen, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Douthit BJ, Walden RL, Cato K, Coviak CP, Cruz C, D'Agostino F, Forbes T, Gao G, Kapetanovic TA, Lee MA, Pruinelli L, Schultz MA, Wieben A, Jeffery AD. Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature. Appl Clin Inform 2022; 13:161-179. [PMID: 35139564 PMCID: PMC8828453 DOI: 10.1055/s-0041-1742218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications. OBJECTIVES This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature. METHODS We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture. RESULTS Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing. CONCLUSION This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.
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Affiliation(s)
- Brian J. Douthit
- Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Rachel L. Walden
- Annette and Irwin Eskind Family Biomedical Library, Vanderbilt University, Nashville, Tennessee, United States
| | - Kenrick Cato
- Department of Emergency Medicine, Columbia University School of Nursing, New York, New York, United States
| | - Cynthia P. Coviak
- Professor Emerita of Nursing, Grand Valley State University, Allendale, Michigan, United States
| | - Christopher Cruz
- Global Health Technology and Informatics, Chevron, San Ramon, California, United States
| | - Fabio D'Agostino
- Department of Medicine and Surgery, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Thompson Forbes
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Grace Gao
- Department of Nursing, St Catherine University, Saint Paul, Minnesota, United States
| | - Theresa A. Kapetanovic
- College of Nursing, East Carolina University, Greenville, North California, United States
| | - Mikyoung A. Lee
- College of Nursing, Texas Woman's University, Denton, Texas, United States
| | - Lisiane Pruinelli
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States
| | - Mary A. Schultz
- Department of Nursing, California State University, San Bernardino, California, United States
| | - Ann Wieben
- School of Nursing, University of Wisconsin-Madison, Wisconsin, United States
| | - Alvin D. Jeffery
- School of Nursing, Vanderbilt University; Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, United States,Address for correspondence Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC 461 21st Avenue South, Nashville, TN 37240United States
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Chung ML, Widdel M, Kirchhoff J, Sellin J, Jelali M, Geiser F, Mücke M, Conrad R. Risk Factors for Pressure Injuries in Adult Patients: A Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020761. [PMID: 35055583 PMCID: PMC8776011 DOI: 10.3390/ijerph19020761] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 01/27/2023]
Abstract
Pressure injuries remain a serious health complication for patients and nursing staff. Evidence from the past decade has not been analysed through narrative synthesis yet. PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews/sources were screened. Risk of bias was evaluated using a slightly modified QUIPS tool. Risk factor domains were used to assign (non)statistically independent risk factors. Hence, 67 studies with 679,660 patients were included. In low to moderate risk of bias studies, non-blanchable erythema reliably predicted pressure injury stage 2. Factors influencing mechanical boundary conditions, e.g., higher interface pressure or BMI < 18.5, as well as factors affecting interindividual susceptibility (male sex, older age, anemia, hypoalbuminemia, diabetes, hypotension, low physical activity, existing pressure injuries) and treatment-related aspects, such as length of stay in intensive care units, were identified as possible risk factors for pressure injury development. Health care professionals' evidence-based knowledge of above-mentioned risk factors is vital to ensure optimal prevention and/or treatment. Openly accessible risk factors, e.g., sex, age, BMI, pre-existing diabetes, and non-blanchable erythema, can serve as yellow flags for pressure injury development. Close communication concerning further risk factors, e.g., anemia, hypoalbuminemia, or low physical activity, may optimize prevention and/or treatment. Further high-quality evidence is warranted.
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Affiliation(s)
- Man-Long Chung
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
- Correspondence:
| | - Manuel Widdel
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julian Kirchhoff
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Julia Sellin
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Mohieddine Jelali
- Institute of Product Development and Engineering De sign, Technische Hochschule Köln, 50679 Cologne, Germany; (M.W.); (J.K.); (M.J.)
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
| | - Martin Mücke
- Department of Digitalization and General Practice, University Hospital RWTH Aachen, 52074 Aachen, Germany; (J.S.); (M.M.)
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, 53127 Bonn, Germany; (F.G.); (R.C.)
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Hu B, Zhao Y, Yang J, Zeng Z, Wu Y, Gui C, Gong J, Gao Y, Yang Y, Luo C, Wang Y, Jiang Q, Guo W, Lu P, Yuan F, Li X, Dai X. Frequency of and risk factors for intensive care unit-acquired sacrum pressure injuries in critically ill patients: A multicenter cross-sectional study in China. Health Sci Rep 2021; 4:e390. [PMID: 34722934 PMCID: PMC8532509 DOI: 10.1002/hsr2.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022] Open
Abstract
RATIONALE AIMS AND OBJECTIVES Hospital-acquired pressure injuries (HAPI) prolong hospital stays and are an important health problem worldwide. The aim of this study was to assess the frequency of and risk factors for intensive care unit (ICU)-acquired pressure injuries (IAPI) on the sacrum in critically ill patients in China. METHODS We performed a multicenter, cross-sectional survey of IAPI on the sacrum in 23 adult ICUs in 19 hospitals in China. Data for 421 critically ill patients were collected on December 13, 2019, and January 13, 2020, including patient characteristics, physiological, and clinical information. Logistic regression was used to analyze the risk factors for IAPI on the sacrum in the ICU. RESULTS Forty-one patients presented sacrum pressure injuries in the ICU, with a frequency of 9.74%. Risk factors that significantly increased the risk of IAPI on the sacrum were lower body mass index (BMI, odds ratio [OR] = 1.115, confidence interval [CI]: 1.011-1.229, P = .029), chronic obstructive pulmonary disease (COPD, OR = 3.183, CI: 1.261-8.037, P = .014), multiple organ dysfunction syndrome (MODS, OR = 2.670, CI: 1.031-6.903, P = .043), and a lower Braden risk score (OR = 1.409, CI: 1.197-1.659, P < .001). CONCLUSION Lower BMI, COPD, MODS, and lower Braden risk score are independent risk factors for sacrum IAPI in China.
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Affiliation(s)
- Binqin Hu
- Department of Critical Care MedicineAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
| | - Yang Zhao
- Department of Critical Care MedicineThe Fourth People's Hospital of ChenzhouChenzhouChina
| | - Jijun Yang
- Department of Critical Care MedicineCentral Hospital of LoudiLoudiChina
| | - Zhenhua Zeng
- Department of Critical Care MedicineNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Yanhong Wu
- Department of Critical Care MedicineHunan Provincial People's HospitalChangshaChina
| | - Chunmei Gui
- Department of Critical Care MedicineThe First People's Hospital of ChangdeChangshaChina
| | - Jiang Gong
- Department of Intensive Care MedicineThe Third People's Hospital of LonggangShenzhenChina
| | - Yi Gao
- Department of Critical Care MedicineXiangya Boai Rehabilitation Hospital, Central South UniversityChangshaChina
| | - Yong Yang
- Department of Critical Care MedicineChangsha Central Hospital, University of South ChinaChangshaChina
| | - Cuizhu Luo
- Department of Critical Care MedicineJiangXi Pingxiang People's HospitalPingxiangChina
| | - Yu Wang
- Department of Critical Care MedicineThe Third People's Hospital of YongzhouYongzhouChina
| | - Qingjuan Jiang
- Department of Critical Care Medicinethe First Affiliated Hospital, Hunan College of Traditional Chinese MedicineZhuzhouChina
| | - Wenlong Guo
- Department of Critical Care MedicineThe First People's Hospital of YueyangYueyangChina
| | - Pan Lu
- Department of Critical Care MedicineThe Sixth Affiliated Hospital, Sun Yat‐sen UniversityShenzhenChina
| | - Fen Yuan
- Department of Critical Care MedicineThe Second People's Hospital of ShenzhenShenzhenChina
| | - Xiaofang Li
- Department of OstomyAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
| | - Xingui Dai
- Department of Critical Care MedicineAffiliated to the First People's Hospital of Chenzhou, University of South ChinaChenzhouChina
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Yoon JE, Cho OH. Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit. Clin Nurs Res 2021; 31:648-655. [PMID: 34622689 DOI: 10.1177/10547738211050489] [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: 11/16/2022]
Abstract
Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.
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Affiliation(s)
- Jeong Eun Yoon
- Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ok-Hee Cho
- Kongju National University, Gongju, Republic of Korea
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Kumar S, Theis T, Tschang M, Nagaraj V, Berthiaume F. Reactive Oxygen Species and Pressure Ulcer Formation after Traumatic Injury to Spinal Cord and Brain. Antioxidants (Basel) 2021; 10:antiox10071013. [PMID: 34202655 PMCID: PMC8300734 DOI: 10.3390/antiox10071013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Traumatic injuries to the nervous system, including the brain and spinal cord, lead to neurological dysfunction depending upon the severity of the injury. Due to the loss of motor (immobility) and sensory function (lack of sensation), spinal cord injury (SCI) and brain injury (TBI) patients may be bed-ridden and immobile for a very long-time. These conditions lead to secondary complications such as bladder/bowel dysfunction, the formation of pressure ulcers (PUs), bacterial infections, etc. PUs are chronic wounds that fail to heal or heal very slowly, may require multiple treatment modalities, and pose a risk to develop further complications, such as sepsis and amputation. This review discusses the role of oxidative stress and reactive oxygen species (ROS) in the formation of PUs in patients with TBI and SCI. Decades of research suggest that ROS may be key players in mediating the formation of PUs. ROS levels are increased due to the accumulation of activated macrophages and neutrophils. Excessive ROS production from these cells overwhelms intrinsic antioxidant mechanisms. While short-term and moderate increases in ROS regulate signal transduction of various bioactive molecules; long-term and excessively elevated ROS can cause secondary tissue damage and further debilitating complications. This review discusses the role of ROS in PU development after SCI and TBI. We also review the completed and ongoing clinical trials in the management of PUs after SCI and TBI using different technologies and treatments, including antioxidants.
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Affiliation(s)
- Suneel Kumar
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
- Correspondence: ; Tel.: +1-848-445-6581
| | - Thomas Theis
- Keck Center for Collaborative Neuroscience, Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08554, USA; (T.T.); (V.N.)
| | - Monica Tschang
- School of Art and Sciences, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
| | - Vini Nagaraj
- Keck Center for Collaborative Neuroscience, Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ 08554, USA; (T.T.); (V.N.)
| | - Francois Berthiaume
- Department of Biomedical Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA;
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