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Chang WP, Jen HJ, Chang YP. Hematologic and Serum Biochemical Values Associated With Different Stages of Hospital-Acquired Pressure Injuries in Patients: A Retrospective Study. J Wound Ostomy Continence Nurs 2024; 51:117-124. [PMID: 38527320 DOI: 10.1097/won.0000000000001058] [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: 03/27/2024]
Abstract
PURPOSE The primary purpose of this study was to determine whether hematologic and serum biochemical values used as indicators of nutritional status, anemia, and/or infection were associated with the risk of hospital-acquired pressure injuries (PIs) and stage of PIs in patients. DESIGN A retrospective review of medical records. SUBJECTS AND SETTING Data were collected from medical records including official PI records and PI incident reports of inpatients at a teaching hospital in Taiwan between January 2019 and October 2020. METHODS We collected demographic variables of the inpatients and their hematologic and serum biochemical values within 1 day of PI occurrence (including the day of PI occurrence), 6 to 7 days before PI occurrence, and 13 to 14 days before PI occurrence. RESULTS Among the 309 inpatients with official PI records, 105 (34.0%) had Stage 1 PIs, 131 (42.4%) had Stage 2 or 3 PIs, and 73 (23.6%) had unstageable or suspected deep tissue injuries. After controlling for the type of department where PIs occurred and length of hospital stay up to the day of PI occurrence, we found significant differences in levels of hemoglobin (odds ratio [OR] = 0.47, P = .009) within 1 day of PI occurrence and in albumin (OR = 0.30, P = .001) 13 to 14 days before PI occurrence. CONCLUSIONS Study findings suggest that lower hemoglobin levels on the day of PI occurrence and lower albumin levels 2 weeks before PI occurrence resulted in a significantly higher risk of developing unstageable or suspected deep tissue injuries than of developing Stage 1 PIs.
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Affiliation(s)
- Wen-Pei Chang
- Wen-Pei Chang, PhD, RN, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, and Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Hsiu-Ju Jen, MSN, RN, Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Yu-Pei Chang, MSN, RN, Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiu-Ju Jen
- Wen-Pei Chang, PhD, RN, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, and Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Hsiu-Ju Jen, MSN, RN, Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Yu-Pei Chang, MSN, RN, Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Pei Chang
- Wen-Pei Chang, PhD, RN, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, and Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Hsiu-Ju Jen, MSN, RN, Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Yu-Pei Chang, MSN, RN, Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Liu S, Huang X, Fu N, Li C, Su Z, Ostadabbas S. Simultaneously-Collected Multimodal Lying Pose Dataset: Enabling In-Bed Human Pose Monitoring. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2023; 45:1106-1118. [PMID: 35239476 DOI: 10.1109/tpami.2022.3155712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Computer vision field has achieved great success in interpreting semantic meanings from images, yet its algorithms can be brittle for tasks with adverse vision conditions and the ones suffering from data/label pair limitation. Among these tasks is in-bed human pose monitoring with significant value in many healthcare applications. In-bed pose monitoring in natural settings involves pose estimation in complete darkness or full occlusion. The lack of publicly available in-bed pose datasets hinders the applicability of many successful human pose estimation algorithms for this task. In this paper, we introduce our Simultaneously-collected multimodal Lying Pose (SLP) dataset, which includes in-bed pose images from 109 participants captured using multiple imaging modalities including RGB, long wave infrared (LWIR), depth, and pressure map. We also present a physical hyper parameter tuning strategy for ground truth pose label generation under adverse vision conditions. The SLP design is compatible with the mainstream human pose datasets; therefore, the state-of-the-art 2D pose estimation models can be trained effectively with the SLP data with promising performance as high as 95% at PCKh@0.5 on a single modality. The pose estimation performance of these models can be further improved by including additional modalities through the proposed collaborative scheme.
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Tang W, Zha ML, Zhang WQ, Hu SQ, Chen HL. APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis. Wound Repair Regen 2022; 30:498-508. [PMID: 35589532 DOI: 10.1111/wrr.13021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 02/02/2023]
Abstract
The present study was designed to determine the association between Acute Physiology and Chronic Health Evaluation (APACHE) scale and elevated pressure injure (PI) risk in intensive care units (ICU) and also evaluate the predictive value of APACHE score in PI patients. Comprehensive strategies were used to search studies from PubMed, Web of Science, and Ovid Embase electronic databases for observational studies that provided data about APACHE scores related to PI in ICU. Eligible studies were selected based on inclusion and exclusion criteria. The pooled SMD with 95% confidence intervals were calculated. A summary ROC curve was plotted to calculate area under curve (AUC) for APACHE-II (15-20). Twenty-one studies involving 11,102 patients who met selection criteria were included. The 11.0% of patients (1229/11102) in ICU developed PIs. Overall, the PI group had a higher score compared with the non-PI group in the APACHE II (22.1 ± 8.0 vs. 14.5 ± 7.4, mean ± SD). The APACHE-III of PI patients was significantly more than that in the non-PI group (79.9 ± 25.6 vs. 59.9 ± 30.4, mean ± SD). The pooled SMD was 0.82 (95% CI: 0.58-1.06, I2 = 91.7%, p-value < 0.001). The subgroup analysis revealed that the risk of PIs did not vary with the type of APACHE score (II, III, IV) and the type of study design (case-control, cross-sectional, cohort, longitudinal study). Proportion of males (I2 = 91.68%, p value = 0.090), publish year (I2 = 91.96%, p value = 0.187) and mean age of patients (I2 = 91.96%, p value = 0.937) were not the sources of heterogeneity. APACHE-II (15-20) achieves the best predictive performance in PI, and the prediction accuracy was balanced with equal sensitivity and specificity (Sen: 0.72, 0.62-0.80; Spec: 1.72, 1.25-2.38). In conclusion, higher APACHE scores are frequently accompanied by a higher incidence of PI among critical-care patients. APACHE-II scores (15-20) satisfactorily predicted PI, and strategies to prevent PI should be aggressively implemented.
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Affiliation(s)
- Wen Tang
- School of Medicine, Nantong University, Nantong, China
| | - Man-Li Zha
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, China
| | | | - Shi-Qi Hu
- School of Medicine, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China
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Woźniak A, Smółka I, Dusińska A, Misiąg W, Chabowski M. Pressure Ulcer Incidence and Blood Lactate Levels in Intensive Care Unit Patients. J Inflamm Res 2022. [DOI: 10.2147/jir.s352402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Gedamu H, Abate T, Ayalew E, Tegenaw A, Birhanu M, Tafere Y. Level of nurses' knowledge on pressure ulcer prevention: A systematic review and meta-analysis study in Ethiopia. Heliyon 2021; 7:e07648. [PMID: 34381901 PMCID: PMC8334377 DOI: 10.1016/j.heliyon.2021.e07648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/30/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Pressure ulcers (PU) are injuries to the skin and underlying tissue because of prolonged pressure. It affects millions of people in the world. One of the major nursing roles is to prevent patients from developing PU. Inadequate knowledge of nurses' toward PU can have a significant effect on preventive care strategies. Therefore, the aim of this meta-analysis study was to assess the overall level of nurses' knowledge about the prevention of pressure ulcers. METHODS A systemic review of primary research was undertaken and nurses' knowledge on pressure ulcer prevention was evaluated. All original cross-sectional studies conducted only in Ethiopia in the English language were included in this meta-analysis. After extraction, the data analysis was done using STATA version 11 statistical software. Based on heterogeneity between the studies, the data were analyzed using a random effects model. RESULTS In this systematic review and meta-analysis, all the studies on nurses' knowledge on the prevention of PU were reviewed based on the PRISMA statement. The overall knowledge of nurses' on pressure ulcer prevention was 46.24 % (95 % CI: 26.63-65.85). CONCLUSION The overall knowledge of nurses' on pressure ulcer prevention was low in this meta-analysis study. Sustainable training about the prevention of PU is very important for all nurses.
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Affiliation(s)
- Haileyesus Gedamu
- Adult Health Nursing Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Teshager Abate
- Adult Health Nursing Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Emiru Ayalew
- Adult Health Nursing Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebu Tegenaw
- Adult Health Nursing Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Minyichil Birhanu
- Pediatric and Child Health Nursing Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yilkal Tafere
- Public Health Department, Debremarkos University, Debremarkos, Ethiopia
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BAYKAN H. Evaluation of pressure ulcer development and follow-up in Covid-19 patients followed in pandemic intensive care units. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.883135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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McEvoy N, Avsar P, Patton D, Curley G, Kearney CJ, Moore Z. The economic impact of pressure ulcers among patients in intensive care units. A systematic review. J Tissue Viability 2020; 30:168-177. [PMID: 33402275 DOI: 10.1016/j.jtv.2020.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/19/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The incidence and prevalence of pressure ulcers in critically ill patients in intensive care units (ICUs) remain high, despite the wealth of knowledge on appropriate prevention strategies currently available. METHODS The primary objective of this systematic review was to examine the economic impact of pressure ulcers (PU) among adult intensive care patients. A systematic review was undertaken, and the following databases were searched; Medline, Embase, CINAHL, and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used to formulate the review. Quality appraisal was undertaken using the Consensus on Health Economic Criteria (CHEC)-list. Data were extracted using a pre-designed extraction tool, and a narrative analysis was undertaken. RESULTS Seven studies met the inclusion criteria. Five reported costs associated with the prevention of pressure ulcers and three explored costs of treatment strategies. Four main PU prevention cost items were identified: support surfaces, dressing materials, staff costs, and costs associated with mobilisation. Seven main PU treatment cost items were reported: dressing materials, support surfaces, drugs, surgery, lab tests, imaging, additional stays and nursing care. The overall validities of the studies varied between 37 and 79%, meaning that there is potential for bias within all the included studies. CONCLUSION There was a significant difference in the cost of PU prevention and treatment strategies between studies. This is problematic as it becomes difficult to accurately evaluate costs from the existing literature, thereby inhibiting the usefulness of the data to inform practice. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies.
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Affiliation(s)
- Natalie McEvoy
- School of Nursing & Midwifery, Royal College of Surgeons, Ireland.
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons, Ireland; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons, Ireland
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons, Ireland; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons, Ireland
| | - Gerard Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons, Ireland; Consultant Anaesthetist/Intensivist, Beaumont Hospital, Dublin 9, Ireland
| | - Cathal J Kearney
- Advanced Materials and Bioengineering Research (AMBER) Centre, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, Ireland; Kearney Lab, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons, Ireland; Tissue Engineering Research Group (TERG), Department of Anatomy, Royal College of Surgeons, Ireland
| | - Zena Moore
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, United Kingdom
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Shiferaw WS, Aynalem YA, Akalu TY. Prevalence of pressure ulcers among hospitalized adult patients in Ethiopia: a systematic review and meta-analysis. BMC DERMATOLOGY 2020; 20:15. [PMID: 33160351 PMCID: PMC7649003 DOI: 10.1186/s12895-020-00112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/30/2020] [Indexed: 12/02/2022]
Abstract
Background Globally, PUs are recognized as one of the five most frequent causes of harm to clients. With millions affected globally, the national pooled prevalence of pressure ulcers in Ethiopia remains unknown. Hence, this review and meta-analysis aimed to determine the prevalence of pressure ulcers among hospitalized clients in Ethiopia. Methods Studies were retrieved through search engines in PubMed, Scopus, WHO Afro Library, Google Scholar, Africa Journals Online, and Web of Science. Heterogeneity between-studies were checked using the I2 test. A funnel plot and Egger’s regression test was used to assess the presence of publication bias. The random-effect model was fitted to estimate summary effects and 95% confidence intervals (CIs) across studies. The analyses were performed using STATA™ Version 14 software. Results The pooled prevalence of pressure ulcer in Ethiopia was assessed using seven studies involving a total of 1881 participants. The pooled prevalence of pressure ulcers in Ethiopia was 11.7% (95% CI: 7.28, 16.13). The subgroup analysis showed that the estimated magnitude of pressure ulcers was 15.89% (95% CI: 13.32, 18.46); among studies, their sample size was greater than or equal to 250. Conclusion The current review reported that the pooled prevalence of pressure ulcers in Ethiopia was relatively high. Hence, policymaker and healthcare providers should give attention to reduce the magnitude of pressure ulcers. Furthermore, further a meta-analysis study could be conducted to identify individual and health care service-related factors related to the occurrence of pressure ulcers.
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Affiliation(s)
| | - Yared Asmare Aynalem
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tadesse Yirga Akalu
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Homauni A, Zargar Balaye Jame S, Hazrati E, Markazi-Moghaddam N. Intensive Care Unit Risk Assessment: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1422-1431. [PMID: 33083318 PMCID: PMC7554395 DOI: 10.18502/ijph.v49i8.3865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: It is of paramount importance to reduce the probability of clinical risks to improve the quality of health care services, make the relationship between service providers and patients more effective, enhance patient satisfaction, and decrease the rate of complaints regarding medical errors in hospitals. This study aimed at detecting potential and unacceptable risks occurring in the hospital ICUs. Methods: In this systematic review, all studies examining the risk assessment of ICUs in hospitals using Failure Mode and Effect Analysis method were reviewed. Google scholar, PubMed, Scopus, SID, Magiran and Web of Science databases were searched to find relevant articles published from 1980 to 2019. Results: The most frequent failures detected in the reviewed articles consisted of high risk of infection inwards for medical and nursing operations, high infection rates inwards for medical devices’ operation within the unit, and early discharge. Moreover, the processes through which potential high-risk Failures were examined in these studies were injection or prescription process, suction process, the process of inserting or removing endotracheal tubes, the process of transferring patients from the operation room to the unit or vice versa, pressure ulcers, and processes related to the medical devices’ operation. Conclusion: There are many possible reasons for failure occurring throughout these processes, and the failure modes occurring in these processes are more probable to cause serious damages to patients, have high repeatability with low probability of failure detection as the failures cannot be discovered by the personnel.
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Affiliation(s)
- Abbas Homauni
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- Department of Anesthesiology, AJA University of Medical Sciences, Tehran, Iran
| | - Nader Markazi-Moghaddam
- Department of Health Management and Economics, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Varaei S, Shirbeygi L, Farahani L, Eslami Hasan Abadi Z, Shamsizadeh M. Comparison the Effects of Massage with Olive Oil and Sweet Almonds Oil on Prevention of Pressure Ulcer in Hospitalized Patients in ICU. ACTA ACUST UNITED AC 2019. [DOI: 10.30699/ajnmc.27.5.353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Deng X, Yu T, Hu A. Predicting the Risk for Hospital-Acquired Pressure Ulcers in Critical Care Patients. Crit Care Nurse 2018; 37:e1-e11. [PMID: 28765361 DOI: 10.4037/ccn2017548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Assessments of risk for pressure ulcers in critical care patients may not include important predictors. OBJECTIVE To construct risk-prediction models of hospital-acquired pressure ulcers in intensive care patients and compare the models' predictive validities with validity of the Braden Scale. METHODS Data were collected retrospectively on patients admitted to intensive care from October 2011 through October 2013. Logistic regression and decision trees were used to construct the risk-prediction models. Predictive validity was measured by using sensitivity, specificity, positive and negative predictive values, and area under the curve. RESULTS With logistic regression analysis, 6 factors were significant independent predictors. With the decision tree, 4 types of high-risk populations were identified. Predictive validity of Braden Scale scores was lower than the validities of the logistic regression and the decision tree models. CONCLUSION Risk for hospital-acquired pressure ulcers is overpredicted with the Braden Scale, with low specificity and low positive predictive value.
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Affiliation(s)
- Xiaohong Deng
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University.,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University
| | - Ting Yu
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University.,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University
| | - Ailing Hu
- Xiaohong Deng is a nurse and enterostomal therapist, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. .,Ting Yu is the head nurse, Emergency Department, Third Affiliated Hospital of Sun Yat-sen University. .,Ailing Hu is the deputy director and professor of nursing, Department of Nursing, Third Affiliated Hospital of Sun Yat-sen University.
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Global incidence and prevalence of pressure injuries in public hospitals: A systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.wndm.2018.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Predictors of Pressure Injuries in a Critical Care Unit in Lebanon: Prevalence, Characteristics, and Associated Factors. J Wound Ostomy Continence Nurs 2018. [PMID: 29521923 DOI: 10.1097/won.0000000000000415] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify factors associated with pressure injury in a medical-surgical intensive care unit (MSICU). DESIGN Retrospective review of medical records. SUBJECTS AND SETTING We reviewed the medical records of 145 patients who developed a new pressure injury in the MSICU of a 420-bed university medical center in Lebanon. METHODS Medical records of all patients cared for in the MSICU from December 2014 to June 2017 were reviewed by a research assistant using a standardized form. We extracted potential risk factors for pressure injury including sex, age, weight upon admission, weight at discharge, length of MSICU stay, episodes of hypotension, administration of inotropes/vasopressors, admitting diagnosis, comorbid conditions, and cumulative scores on the Braden Scale for Pressure Sore Risk. The outcome variable was development of any new pressure injury during their stay in our intensive care unit. RESULTS Forty-nine patents (33.7%) developed a new pressure injury. Bivariate analysis found statistically significant associations between pressure injury occurrences and administration of vasopressors (odds ratio [OR] = 0.42; 95% confidence interval = 0.29-0.87; P = .02), the administration of dopamine (OR = 0.20; 95% confidence interval = 0.04-0.94; P = .04), and hospital-acquired pressure injury. Among the continuous variables, analysis revealed significant relationships between weight at discharge (t = 2.31, P = .02), MSICU length of stay (t = 5.30; P = .000), cumulative Braden Scale score (t = 3.06; P = .002), hypotension (t =-2.74; P = .007), and development a new pressure injury. Multivariate analysis indicated that length of stay (β= -.110; P = .002), administration of vasopressors (β=-.266; P = .029), and total hours of hypotension (β=-.53; P = .041) were significant predictors of pressure injury. CONCLUSIONS Vasopressor use, hypotension, and length of stay were associated with an increased likelihood of pressure injury in adults managed in an MSICU. None of these factors is specifically evaluated during completion of the Braden Scale for Pressure Sore Risk. Based on these findings we recommend development of a pressure injury scale specific to critically ill adults.
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Abstract
OBJECTIVE The aim of this study was to determine whether skin barrier factors were associated with the common complication of pressure ulcers (PrUs) in intensive care unit (ICU) patients. It is unclear whether skin barrier factors influence the development of PrUs. PATIENT POPULATION The sample was composed of 102 ICU patients (54 men, 48 women). The patients ranged in age from 23 to 88 years, with a mean age of 55.7 (SD, 19.1) years. METHODS Demographic variables and the score for the Acute Physiology and Chronic Health Evaluation IV were recorded on admission. The Braden Scale assessment and measurements of the skin barrier factors were performed daily. Standard care for the prevention of PrUs was strictly administered, and PrUs that developed were evaluated according to the recommendations of the US National Pressure Ulcer Advisory Panel 2007 (Note: The authors used the 2007 recommendations at the time of their study.). Data were analyzed using descriptive statistics and logistic regression. RESULTS The mean score for the Braden Scale was 11.2, and the incidence of PrUs was 31.4%. Lower moisture content of the stratum corneum and higher skin surface pH at the lower sacrum and hip were risk factors for PrUs, whereas scapular and heel skin barrier factors were not. CONCLUSION Nursing strategies aimed at preventing PrUs should place added emphasis on the lower sacral and hip regions.
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Zhou Q, Yu T, Liu Y, Shi R, Tian S, Yang C, Gan H, Zhu Y, Liang X, Wang L, Wu Z, Huang J, Hu A. The prevalence and specific characteristics of hospitalised pressure ulcer patients: A multicentre cross-sectional study. J Clin Nurs 2017; 27:694-704. [PMID: 28815825 DOI: 10.1111/jocn.14019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To ascertain the pressure ulcer prevalence in secondary and tertiary general hospitals in different areas of Guangdong Province in China and explore the possible risk factors that are related to pressure ulcers. BACKGROUND Few multicentre studies have been conducted on pressure ulcer prevalence in Chinese hospitals. DESIGN A cross-sectional study design was used. METHODS Data from a total of 25,264 patients were included in the analysis at 25 hospitals in China. The investigators were divided into two groups. The investigators in group 1 examined the patients' skin. When a pressure ulcer was found, a pressure ulcer assessment form was completed. The investigators in group 2 provided guidance to the nurses, who assessed all patients and completed another questionnaire. A multivariate logistic regression analysis was used to analyse the relationship between the possible risk factors and pressure ulcer. RESULTS The overall prevalence rate of pressure ulcers in the 25 hospitals ranged from 0%-3.49%, with a mean of 1.26%. The most common stage of the pressure ulcers was stage II (41.4%); most common anatomical locations were sacrum (39.5%) and the feet (16.4%). Braden score (p < .001), expected length of stay (p < .001), incontinence (p < .001), care group (p = .011), hospital location (p < .001), type of hospitals (p = .004), ages of patients (p < .001) were associations of pressure ulcers from the multivariate logistic regression analysis. CONCLUSIONS The overall prevalence rate of pressure ulcers in Chinese hospitals was lower than that reported in previous investigations. Specific characteristics of pressure ulcer patients were as follows: low Braden score, longer expected length of stay, double incontinence, an ICU and a medical ward, hospital location in the Pearl River Delta, a university hospital and an older patient. RELEVANCE TO CLINICAL PRACTICE The survey could make managers know their prevalence level of pressure ulcers and provide priorities for clinical nurses.
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Affiliation(s)
- Qing Zhou
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ting Yu
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan Liu
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruifen Shi
- Guangdong Nursing Association, Guangzhou, China
| | | | - Chaoxia Yang
- The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Huaxiu Gan
- Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Yanying Zhu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xia Liang
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ling Wang
- Zhongshan People's Hospital, Zhongshan, China
| | - Zhenhua Wu
- Foshan First People 's Hospital, Foshan, China
| | | | - Ailing Hu
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lima Serrano M, González Méndez M, Carrasco Cebollero F, Lima Rodríguez J. Factores de riesgo asociados al desarrollo de úlceras por presión en unidades de cuidados intensivos de adultos: revisión sistemática. Med Intensiva 2017; 41:339-346. [DOI: 10.1016/j.medin.2016.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
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Risk factors for pressure ulcer development in Intensive Care Units: A systematic review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.medine.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Scientific and Clinical Abstracts From the WOCN® Society's 49th Annual Conference. J Wound Ostomy Continence Nurs 2017. [DOI: 10.1097/won.0000000000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Differentiating a Pressure Ulcer from Acute Skin Failure in the Adult Critical Care Patient. Adv Skin Wound Care 2017; 28:514-24; quiz 525-6. [PMID: 26479695 DOI: 10.1097/01.asw.0000471876.11836.dc] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this learning activity is to provide information regarding the differentiation between pressure ulcers and acute skin failure (ASF) in critically ill patients. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Describe the purpose, methodology and impact of this research.2. Differentiate the pathophysiology of pressure ulcers and ASF.3. Identify risk factors and diagnostic criteria for ASF. ABSTRACT To develop a statistical model to predict the development of acute skin failure in patients admitted to the intensive care unit (ICU) and to validate this model.Retrospective case-control, logistic regression modeling552 ICU patientsIntensive care unit patients with and without pressure ulcers (PrUs) were studied and compared on key variables sorted into the following categories: (1) disease status, (2) physical conditions, and (3) conditions of hospitalization.The variables, peripheral arterial disease (odds ratio [OR], 3.8; P = .002), mechanical ventilation greater than 72 hours (OR, 3.0; P < .001), respiratory failure (OR, 3.2; P < .001), liver failure (OR, 2.9; P = .04), and severe sepsis/septic shock (OR, 1.9; P = .02), were found to be statistically significant and independent predictors of acute skin failure in ICU patients. These variables created a predictor model for acute skin failure in the ICU.Lack of objective criteria to define acute skin failure presents a clinical conundrum for practitioners-the acknowledgment that skin failure exists, but no clear-cut diagnostic criteria in which to support its existence as a result of a paucity of empirical evidence. In certain populations, such as the critically ill patient, the phenomenon of acute skin failure may be occurring, and with the current level of evidence, these ulcers may be incorrectly identified as PrUs. Accurately distinguishing risk factors that lead to a PrU from factors that result in a lesion due to acute skin failure is crucial in the quest to provide evidence-based practice to patients.
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Li D. The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units. J Clin Nurs 2016; 25:2336-47. [PMID: 27302084 DOI: 10.1111/jocn.13363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. BACKGROUND Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. DESIGN A retrospective, comparative, descriptive, correlational study. METHOD A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. RESULT The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. CONCLUSION This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. RELEVANCE TO CLINICAL PRACTICE The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation.
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Affiliation(s)
- Dan Li
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Psychometric properties of the Dutch National Prevalence Measurement of Care Problems used to measure quality of pressure ulcer care in Indonesian hospitals. Adv Skin Wound Care 2016; 27:363-70. [PMID: 25033311 DOI: 10.1097/01.asw.0000452044.58375.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Indonesian version of the Dutch National Prevalence Measurement of Care Problems. The questionnaire consists of 6 parts: patient characteristics (including pressure ulcer [PrU] risk; assessed by the Braden Scale) and care dependency (assessed by the Care Dependency Scale [CDS]), PrU categorization, prevention, treatment, and structural quality indicators at ward and hospital level. DESIGN, PARTICIPANTS, AND SETTING A 3-phase design was used, including questionnaire translation and psychometric testing. The questionnaire was translated into Indonesian on March 2012. Content validity was assessed by 18 Indonesian experts on July 2012. The interrater agreement and reliability of the PrU categories, Braden Scale, and CDS were assessed on October 2012 in 4 Indonesian large public general hospitals. RESULTS Most Indonesian experts (91.8%) rated the Indonesian version of the questionnaire as "good" on clarity of wording. The content validity indices of the questionnaire ranged from 0.50 to 1.00. The PrU categories assessed showed an interrater reliability of κ = 0.92 (95% confidence interval [CI], 0.87-0.97) and an interrater agreement of po = 98.6% (95% CI, 97.5-99.3). The interrater reliability intraclass correlation coefficient (1,1) of the Braden Scale sum score was 0.90 (95% CI, 0.85-0.93). The exact proportion of agreement sum score was 39%. The interrater reliability intraclass correlation coefficient (1,1) of the CDS sum score was 0.88 (95% CI, 0.83-0.92). There was a 45% exact agreement on the CDS sum scores. CONCLUSIONS The questionnaire can be used in Indonesian hospitals to measure the PrU prevalence and quality of PrU care.
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Thomas E, Vinodkumar S, Mathew S, Setia MS. A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis. Indian J Dermatol 2015; 60:566-72. [PMID: 26677269 PMCID: PMC4681194 DOI: 10.4103/0019-5154.169127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross-sectional, have used pooled data, or cox-regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data. Aims and Objectives: The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time. Materials and Methods: We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were: (1) Score on the pressure risk assessment scale; and (2) the proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data. Results: The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high-risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01–12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16–1.86). Conclusion: There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high-risk score for PU on the monitoring scale, and these patients require active interventions.
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Affiliation(s)
- Elizebeth Thomas
- Department of Nursing, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India
| | - Sudhaya Vinodkumar
- Department of Nursing, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India
| | - Silvia Mathew
- Department of Nursing, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India
| | - Maninder Singh Setia
- Consultant Epidemiologist, Dr. L H Hiranandani Hospital, Powai, Mumbai, Maharashtra, India
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Cox J, Roche S. Vasopressors and development of pressure ulcers in adult critical care patients. Am J Crit Care 2015; 24:501-10. [PMID: 26523008 DOI: 10.4037/ajcc2015123] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied. OBJECTIVE To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients. METHODS A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012. RESULTS Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit. CONCLUSION The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.
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Affiliation(s)
- Jill Cox
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
| | - Sharon Roche
- Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center
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Cox J, Rasmussen L. Enteral nutrition in the prevention and treatment of pressure ulcers in adult critical care patients. Crit Care Nurse 2015; 34:15-27; quiz 28. [PMID: 25452406 DOI: 10.4037/ccn2014950] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Prevention and healing of pressure ulcers in critically ill patients can be especially challenging because of the patients' burden of illness and degree of physiological compromise. Providing adequate nutrition may help halt the development or worsening of pressure ulcers. Optimization of nutrition can be considered an essential ingredient in prevention and healing of pressure ulcers. Understanding malnutrition in critical care patients, the effect of nutrition on wound healing, and the application of evidence-based nutritional guidelines are important aspects for patients at high risk for pressure ulcers. Appropriate screenings for nutritional status and risk for pressure ulcers, early collaboration with a registered dietician, and administration of appropriate feeding formulations and micronutrient and macronutrient supplementation to promote wound healing are practical solutions to improve the nutritional status of critical care patients. Use of nutritional management and enteral feeding protocols may provide vital elements to augment nutrition and ultimately result in improved clinical outcomes.
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Affiliation(s)
- Jill Cox
- Jill Cox is an assistant professor of nursing at Rutgers University, Newark, New Jersey. She maintains a clinical practice as an advanced practice and certified wound, ostomy, and continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey.Louisa Rasmussen is the registered dietician for the critical care service at Englewood Hospital and Medical Center.
| | - Louisa Rasmussen
- Jill Cox is an assistant professor of nursing at Rutgers University, Newark, New Jersey. She maintains a clinical practice as an advanced practice and certified wound, ostomy, and continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey.Louisa Rasmussen is the registered dietician for the critical care service at Englewood Hospital and Medical Center
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Koskela M, Gäddnäs F, Koivukangas V, Oikarinen A, Laurila J, Kallioinen M, Ala-Kokko TI. Dermal expression of laminin-332 and type IV collagen in humans with severe sepsis. Acta Anaesthesiol Scand 2015; 59:1009-14. [PMID: 26032240 DOI: 10.1111/aas.12539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND An intact basement membrane at the dermal-epidermal junction is essential to the viability of the skin. The effect of sepsis on the basement membrane is unknown. METHODS Skin biopsies were used to study basement membrane structure in severe sepsis (Day 1). Subsequent biopsies were taken on Day 8 and at 3 months in the survivors. Immunohistochemical staining was undertaken using laminin-223 and type IV collagen. Twenty patients with severe sepsis and four control subjects were included in the analysis. RESULTS Intensive care unit mortality was 4/20, and total 30-day mortality was 5/20. Exactly, 7/17 of patients with severe sepsis exhibited weak or absent laminin-332 expression and 11/15 exhibited weak or absent type IV collagen expression compared with 0/4 of control subjects on Day 1 in intact skin. The proportion of sepsis patients with weak or absent laminin-332 expression was 5/11 on Day 8 and fell to 1/7 at 3 months. The proportion of sepsis patients with weak or absent type IV collagen expression was 10/11 on Day 8 and 4/7 at 3 months. CONCLUSION These findings suggest that basement membrane formation may be compromised in patients with severe sepsis.
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Affiliation(s)
- M. Koskela
- Department of Surgery; Oulu University Hospital; Oulu Finland
- Department of Surgery; Kainuu Central Hospital; Kajaani Finland
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
| | - F. Gäddnäs
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
| | - V. Koivukangas
- Department of Surgery; Kainuu Central Hospital; Kajaani Finland
| | - A. Oikarinen
- Department of Dermatology; Oulu University Hospital; Oulu Finland
| | - J. Laurila
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
| | - M. Kallioinen
- Department of Pathology; Oulu University Hospital; Oulu Finland
| | - T. I. Ala-Kokko
- Department of Anesthesiology; Division of Intensive Care Medicine; Oulu University Hospital; University of Oulu; Medical Research Center Oulu; OUH Finland
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Ribeiro S. Iyengar Yoga Therapy Intervention for Ischial Pressure Ulcers in a Patient with Amyotrophic Lateral Sclerosis: A Case Study. J Altern Complement Med 2015. [PMID: 26222670 DOI: 10.1089/acm.2014.0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although some research suggests that the formation of pressure ulcers is rare in patients with amyotrophic lateral sclerosis (ALS), several patients have nonetheless developed this problem. To date, however, no case reports in the literature have described patients with ALS who develop ischial pressure ulcers. Outside of the ALS literature, evidence suggests that ischial pressure ulcers frequently develop in wheelchair users and also in patients treated in various health care settings. CASE DESCRIPTION A patient diagnosed with ALS reported the development of ischial pressure ulcers after consistent immobility for 1 year (32 months after her ALS diagnosis). This patient, who was sitting on the wounds, was treated with ointment and morphine; the latter was ineffective in controlling the pain. Moving the patient from sitting to supine, lateral, or semilateral positions, either on the bed or wheelchair, to separate the ulcers from the surface of the chair or bed was deemed impossible because of exaggeration of other symptoms, including shortness of breath and pain in other parts of the body. A new method of postural alignment was developed to alleviate the pain associated with the pressure ulcer. This method, Iyengar yoga therapy, which uses props to reposition a patient, alleviated pain and healing of two pressure ulcers of the patient after 3 weeks of starting this intervention. CONCLUSION Although the ischial pressure ulcers were successfully treated in a patient with ALS, further study is necessary to investigate the effectiveness of this postural alignment intervention in ALS and other patient populations for the management of ischial pressure ulcers.
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Affiliation(s)
- Subbappa Ribeiro
- B.K.S. Iyengar Yoga Center of the Willamette Valley , Corvallis, OR
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27
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Shahin ESM, Lohrmann C. Prevalence of Fecal and Double Fecal and Urinary Incontinence in Hospitalized Patients. J Wound Ostomy Continence Nurs 2015; 42:89-93. [DOI: 10.1097/won.0000000000000082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prevalence and Associated Factors of Pressure Ulcer among Hospitalized Patients at Felegehiwot Referral Hospital, Bahir Dar, Ethiopia. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/767358] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction. Pressure ulcers, also known as decubitus ulcers (bed sores), are localized skin injuries that remain a major health problem affecting approximately 3 million adults. Objective. The aim of this study was to assess the prevalence and associated factors of pressure ulcer among hospitalized patients in Felegehiwot referral hospital. Methods. This cross-sectional study used systematic sampling on a sample of 422 patients. The data was collected by trained data collectors through pretested checklist. Bivariate analysis was used principally and variables were then entered into multiple logistic regressions model for controlling the possible effect of confounders and the variables which have significant association were identified on the basis of OR with 95% CI and P value. Results. The finding of this study revealed that 71 (16.8%) of them had pressure ulcer. Prolonged length of stay in hospital, slight limit of sensory perception, and friction and shearing forces were significantly associated with the presence of pressure ulcer. Conclusions and Recommendations. The prevalence of pressure ulcer was high among hospitalized patients. Researches of prospective (follow-up) study required investigating the incidence and associated factors of pressure ulcer for hospitalized patients.
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Hoviattalab K, Hashemizadeh H, D'Cruz G, Halfens RJG, Dassen T. Nursing practice in the prevention of pressure ulcers: an observational study of German Hospitals. J Clin Nurs 2014; 24:1513-24. [DOI: 10.1111/jocn.12723] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Gibson D'Cruz
- School of Nursing Sciences; Faculty of Medicine and Health Sciences; University of East Anglia; Norwich UK
| | - Ruud JG Halfens
- Department of Health Services Research; Faculty of Health, Medicine and Life Sciences; Maastricht University; Maastricht Netherlands
| | - Theo Dassen
- Department for Nursing Science; Charité-Unversitätsmedizin Berlin; Berlin Germany
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Nosocomial Pressure Ulcer Risk Factors in a Relatively Young Adult Population. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2014. [DOI: 10.1097/jdn.0000000000000073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Valente PMD, Deva A, Ngo Q, Vickery K. The increased killing of biofilms in vitro by combining topical silver dressings with topical negative pressure in chronic wounds. Int Wound J 2014; 13:130-6. [PMID: 24712658 DOI: 10.1111/iwj.12248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 12/23/2022] Open
Abstract
Chronic wounds remain a significant medical and financial burden in hospitals of today. A major factor in the transition from an acute to a chronic wound is its bacterial bioburden. Developments in molecular techniques have shown that chronic wounds remain colonised by many species of bacteria and that the bacteria within these chronic wounds exist in two forms. Treatments of chronic wounds have maintained a challenging field and significant ongoing research is being conducted. With the development of an in vitro wound model, we applied topical negative pressure (TNP) dressings to a spectrum of common bacterial biofilms found in chronic wounds and studied the synergistic efficacy between the application of TNP and silver-impregnated foam against these biofilms. This synergistic response was seen within the laboratory strains of staphylococcal biofilms over a 3-day treatment period but lost following the 5 days of treatment. However, combining topical pressure dressings and silver foam lead to a synergistic inactivation in Pseudomonas species over both 3-day and 5-day treatments.
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Affiliation(s)
| | - Anand Deva
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Quan Ngo
- Department of Plastic and Reconstructive Surgery, Liverpool Hospital, Sydney, NSW, Australia
| | - Karen Vickery
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
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Aljezawi M, Qadire MA, Tubaishat A. Pressure ulcers in long-term care: a point prevalence study in Jordan. ACTA ACUST UNITED AC 2014; 23:S4, S6, S8, S10-1. [DOI: 10.12968/bjon.2014.23.sup6.s4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ma'en Aljezawi
- Assistant Professor of Gerontological Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Mohammad Al Qadire
- Doctor of Adult Oncology and Palliative Care Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Ahmad Tubaishat
- Assistant Professor of Nursing Informatics at the Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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Clements L, Moore M, Tribble T, Blake J. Reducing Skin Breakdown in Patients Receiving Extracorporeal Membranous Oxygenation. Nurs Clin North Am 2014; 49:61-8. [DOI: 10.1016/j.cnur.2013.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Predictive power of the Braden scale for pressure sore risk in adult critical care patients: a comprehensive review. J Wound Ostomy Continence Nurs 2014; 39:613-21; quiz 622-3. [PMID: 22948495 DOI: 10.1097/won.0b013e31826a4d83] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Critical care is designed for managing the sickest patients within our healthcare system. Multiple factors associated with an increased likelihood of pressure ulcer development have been investigated in the critical care population. Nevertheless, there is a lack of consensus regarding which of these factors poses the greatest risk for pressure ulceration. While the Braden scale for pressure sore risk is the most commonly used tool for measuring pressure ulcer risk in the United States, research focusing on the cumulative Braden Scale score and subscale scores is lacking in the critical care population. This author conducted a literature review on pressure ulcer risk assessment in the critical care population, to include the predictive value of both the total score and the subscale scores. In this review, the subscales sensory perception, mobility, moisture, and friction/shear were found to be associated with an increased likelihood of pressure ulcer development; in contrast, the Activity and Nutrition subscales were not found to predict pressure ulcer development in this population. In order to more precisely quantify risk in the critically ill population, modification of the Braden scale or development of a critical care specific risk assessment tool may be indicated.
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Abstract
OBJECTIVE The objective of this study was to determine critical care physicians' attitudes, beliefs, and knowledge toward pressure ulcer (PrU) prevention and treatment in critical care patients. DESIGN Descriptive, correlational PARTICIPANTS 56 critical care physicians MAIN OUTCOME MEASURES Survey instrument developed to collect demographic information and information regarding attitudes and beliefs about PrUs and PrU knowledge. RESULTS The majority of physicians (69%) reported poor to adequate basic medical education training on PrU prevention and treatment. Sixty percent reported never attending a PrU lecture. Most physicians reported their role to be important to very important in the areas of PrU prevention (71.4%) and treatment (67.9%). Physicians' perceived knowledge regarding PrU prevention and treatment was most frequently reported as adequate (48%) and poor (37%). The mean score on the knowledge test was 18.1 (range, 12-24; SD, 2.26), equating to a percentage score of 75%. No significant relationship was found between physicians' perceived PrU knowledge and actual knowledge score. CONCLUSIONS Prevalence rates of acquired PrUs in critical care adult patients are cited as the highest among hospitalized patients; thus, critical care physicians encounter patients at risk for or with PrUs regularly in clinical practice. Management of a critically ill patient requires a cohesive, multidisciplinary approach, including prevention and/or management of PrUs. The critical care physician, as a vital member of this team, may benefit from PrU education in an effort to heighten awareness of this phenomenon in critical care patients.
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Kim E, Choi M, Lee J, Kim YA. Reusability of EMR Data for Applying Cubbin and Jackson Pressure Ulcer Risk Assessment Scale in Critical Care Patients. Healthc Inform Res 2013; 19:261-70. [PMID: 24523990 PMCID: PMC3920038 DOI: 10.4258/hir.2013.19.4.261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/25/2013] [Accepted: 12/25/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purposes of this study were to examine the predictive validity of the Cubbin and Jackson pressure ulcer risk assessment scale for the development of pressure ulcers in intensive care unit (ICU) patients retrospectively and to evaluate the reusability of Electronic Medical Records (EMR) data. METHODS A retrospective design was used to examine 829 cases admitted to four ICUs in a tertiary care hospital from May 2010 to April 2011. Patients who were without pressure ulcers at admission to ICU, 18 years or older, and had stayed in ICU for 24 hours or longer were included. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) were calculated. RESULTS The reported incidence rate of pressure ulcers among the study subjects was 14.2%. At the cut-off score of 24 of the Cubbin and Jackson scale, the sensitivity, specificity, positive predictive value, negative predictive value, and AUC were 72.0%, 68.8%, 27.7%, 93.7%, and 0.76, respectively. Eight items out 10 of the Cubbin and Jackson scale were readily available in the EMR data. CONCLUSIONS The Cubbin and Jackson scale performed slightly better than the Braden scale to predict pressure ulcer development. Eight items of the Cubbin and Jackson scale except mobility and hygiene can be extracted from the EMR, which initially demonstrated the reusability of EMR data for pressure ulcer risk assessment. If the Cubbin and Jackson scale is a part of the EMR assessment form, it would help nurses perform tasks to effectively prevent pressure ulcers with an EMR alert for high-risk patients.
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Affiliation(s)
- Eunkyung Kim
- Department of Nursing, Yonsei University Health System, Seoul, Korea
| | - Mona Choi
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Juhee Lee
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Young Ah Kim
- Department of Medical Informatics, Yonsei University Health System, Seoul, Korea
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Nassaji M, Askari Z, Ghorbani R. Cigarette smoking and risk of pressure ulcer in adult intensive care unit patients. Int J Nurs Pract 2013; 20:418-23. [PMID: 25157943 DOI: 10.1111/ijn.12141] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess relationship between smoking, some other risk factors and ulcers development in intensive care unit. This prospective cohort study was performed in two university-affiliated hospitals. The sample consisted of adult male patients who were admitted to medical-surgical intensive care units. All eligible patients were grouped according to their cigarette smoking status as smoker and non-smoker. The final sample included 160 smokers and 192 non-smokers. Pressure ulcer occurred in 62 smoker patients and 28 of non-smoker who showed significant difference. Also number of pack-year of cigarettes smoking showed significant association with ulcer development. Ulcer stage was significantly different between the two groups. Besides of smoking, age, length of stay, faecal incontinency, diabetes mellitus, anaemia and trauma were significantly associated with pressure ulcers. Our study showed significant association between smoking and development of pressure ulcers.
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Affiliation(s)
- Mohammad Nassaji
- Department of Infectious Diseases, Fatemieh Hospital, Semnan University of Medical Science, Semnan, Iran
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Meesterberends E, Halfens RJ, Spreeuwenberg MD, Ambergen TA, Lohrmann C, Neyens JC, Schols JM. Do Patients in Dutch Nursing Homes Have More Pressure Ulcers Than Patients in German Nursing Homes? A Prospective Multicenter Cohort Study. J Am Med Dir Assoc 2013; 14:605-10. [DOI: 10.1016/j.jamda.2013.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 11/27/2022]
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Abstract
Pressure ulcers (a type of skin failure) have served as an indicator of care quality. The purpose of this study was to utilize data-mining techniques as a means of identifying risk factors related to different stages of pressure ulcers to demonstrate how this means of analysis might be used as a vehicle to guide improved care quality. Data were obtained from a Web-based incident reporting system at a regional hospital in Taiwan. A total of 4301 cases dating from March 2005 to May 2009 were collected. For data-cleaning purposes, data within 3 SDs were kept for further analysis. Data-mining techniques were applied to identify the predictors, and a logistic regression analysis was used for result comparison purposes. The results revealed that sacral ulcer was the most prevalent, and most ulcers were in stage I, followed by stages II to IV. Five predictors were identified including hemoglobin, weight, sex, height, and use of repositioning sheet. The study concluded that nurses could use data-mining technique to identify predictors to assist in guiding ulcer interventions such as those based on a patient's demographic profile and application of a repositioning sheet to prevent ulcer occurrence to minimize harm.
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Incontinence-associated dermatitis: consensus statements, evidence-based guidelines for prevention and treatment, and current challenges. J Wound Ostomy Continence Nurs 2012; 39:303-15; quiz 316-7. [PMID: 22572899 DOI: 10.1097/won.0b013e3182549118] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2010, an international consensus conference was held to review current evidence regarding the pathology, prevention, and management of incontinence-associated dermatitis (IAD). The results of this literature review were published in a previous issue of this Journal. This article summarizes key consensus statements agreed upon by the panelists, evidence-based guidelines for prevention and management of IAD, and a discussion of the major challenges currently faced by clinicians caring for these patients. The panelists concur that IAD is clinically and pathologically distinct from pressure ulcers and intertriginous dermatitis, and that a consistently applied, structured, or defined skin care program is effective for prevention and management of IAD. They also agreed that differential assessment of IAD versus pressure ulceration versus intertriginous dermatitis remains a major challenge. Panel members also concur that evidence is lacking concerning which products and protocols provide the best outcomes for IAD prevention and treatment in individual patients. Issues related to differential assessment, product labeling and utilization, staff education, and cost of care are the primary focus of this article.
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Abstract
BACKGROUND Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate. Currently, consensus is lacking on the most important risk factors for pressure ulcers in critically ill patients, and no risk assessment scale exclusively for pressure ulcers in these patients is available. OBJECTIVE To determine which risk factors are most predictive of pressure ulcers in adult critical care patients. Risk factors investigated included total score on the Braden Scale, mobility, activity, sensory perception, moisture, friction/shear, nutrition, age, blood pressure, length of stay in the intensive care unit, score on the Acute Physiology and Chronic Health Evaluation II, vasopressor administration, and comorbid conditions. METHODS A retrospective, correlational design was used to examine 347 patients admitted to a medical-surgical intensive care unit from October 2008 through May 2009. RESULTS According to direct logistic regression analyses, age, length of stay, mobility, friction/shear, norepinephrine infusion, and cardiovascular disease explained a major part of the variance in pressure ulcers. CONCLUSION Current risk assessment scales for development of pressure ulcers may not include risk factors common in critically ill adults. Development of a risk assessment model for pressure ulcers in these patients is warranted and could be the foundation for development of a risk assessment tool.
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Affiliation(s)
- Jill Cox
- Jill Cox is an advanced practice nurse and a wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey
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Kaitani T, Tokunaga K, Matsui N, Sanada H. Risk factors related to the development of pressure ulcers in the critical care setting. J Clin Nurs 2010; 19:414-21. [DOI: 10.1111/j.1365-2702.2009.03047.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nagel T, Loerakker S, Oomens C. A theoretical model to study the effects of cellular stiffening on the damage evolution in deep tissue injury. Comput Methods Biomech Biomed Engin 2009; 12:585-97. [DOI: 10.1080/10255840902788603] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ligita T, Jayasekara R. Skin care strategies to prevent pressure ulcer for patients in acute care settings: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2009; 7:1-12. [PMID: 27819995 DOI: 10.11124/01938924-200907161-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Titan Ligita
- 1Health Training Officer, Centre for Health Training, West Kalimantan Province, Indonesia 2Research Fellow, The Joanna Briggs Institute, Adelaide, South Australia
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