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Jones T, Luth EA, Cleland CM, Brody AA. Race and Ethnicity Are Related to Undesirable Home Health Care Outcomes in Seriously Ill Older Adults. J Am Med Dir Assoc 2024; 25:104983. [PMID: 38604244 PMCID: PMC11139601 DOI: 10.1016/j.jamda.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Medicare Home Health Care (HHC) services are integral to the care of homebound seriously ill older adults requiring ongoing specialized medical care. Although disparities in health outcomes are well documented in inpatient and primary care, disparities experienced by historically marginalized racial and ethnic groups underrepresented in HHC are understudied. This study aimed to examine the relationship between individual characteristics and differences in HHC health outcomes for seriously ill older adults. DESIGN Secondary data analysis, repeated measure. SETTING AND PARTICIPANTS Seriously ill older adults who received HHC in 2016 in the HHC Outcome and Assessment Information Set (OASIS). METHODS Start of care and discharge data from the 2016 HCC OASIS were used to examine the relationship between individual characteristics and differences in HHC health outcomes identified by the Centers for Medicare and Medicaid Services as key indicators of quality in HHC, including dyspnea, pain frequency, cognitive functioning, and presence of unhealed pressure ulcer stage II or higher. A generalized ordered logit model with partial proportional odds was used for the ordinal categorical outcomes and a logistic regression was used for the binary dependent variable. RESULTS Findings indicated that of 227,402 seriously ill individuals with an HHC episode in 2016, those from underrepresented racial and ethnic groups had between 14% and 57% higher odds of worse health outcomes compared with non-Hispanic white patients with the exception of pain frequency. CONCLUSIONS AND IMPLICATIONS For people living with serious illness, there are significant differences in Medicare HHC health outcomes when comparing underrepresented racial or ethnic beneficiaries with white counterparts. More research is needed to understand how health care processes such as referral patterns or time to care initiation, and structural factors such as HHC agency quality and neighborhood social deprivation are related to health differences observed in the population.
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Affiliation(s)
- Tessa Jones
- Division of General Internal Medicine and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Elizabeth A Luth
- Institute for Health, Health Care Policy, and Aging Research, Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, Rutgers, NJ, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Abraham A Brody
- HIGN, New York University Rory Meyers College of Nursing, and Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, NY, USA
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Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2024; 2:CD003216. [PMID: 38345088 PMCID: PMC10860148 DOI: 10.1002/14651858.cd003216.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance behaviours. The prevention and treatment of pressure ulcers involves strategies to optimize hydration, circulation, and nutrition. Adequate nutrient intake can reduce the risk factor of malnutrition and promote wound healing in existing pressure ulcers. However, it is unclear which nutrients help prevent and treat pressure ulcers. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of nutritional interventions (special diets, supplements) for preventing and treating pressure ulcers in people with or without existing pressure ulcers compared to standard diet or other nutritional interventions. SEARCH METHODS We used extensive Cochrane search methods. The latest search was in May 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with or without existing pressure ulcers, that compared nutritional interventions aimed at preventing or treating pressure ulcers with standard diet or other types of nutritional interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome for prevention studies was the proportion of participants who developed new (incident) pressure ulcers. For treatment studies, our primary outcomes were time to complete pressure ulcer healing, number of people with healed pressure ulcers, size and depth of pressure ulcers, and rate of pressure ulcer healing. Secondary outcomes were side effects, costs, health-related quality of life and acceptability. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 33 RCTs with 7920 participants. Data for meta-analysis were available from 6993 participants. Pressure ulcer prevention Eleven studies (with 12 arms) compared six types of nutritional interventions for the prevention of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may result in little to no difference in the proportion of participants developing a pressure ulcer (energy, protein and micronutrient supplements 248 per 1000, standard diet 269 per 1000; RR 0.92, 95% CI 0.71 to 1.19; 3 studies, 1634 participants; low-certainty evidence). Compared to standard diet, protein supplements may result in little to no difference in pressure ulcer incidence (protein 21 per 1000, standard diet 28 per 1000; RR 0.75, 95% CI 0.49 to 1.14; 4 studies, 4264 participants; low-certainty evidence). The evidence is very uncertain about the gastrointestinal side effects of these supplements (protein 109 per 1000, standard diet 155 per 1000; RR 0.70, 95% CI 0.06 to 7.96; 2 studies, 140 participants, very low-certainty evidence). The evidence is very uncertain about the effects of protein, arginine, zinc and antioxidants; L-carnitine, L-leucine, calcium, magnesium and vitamin D; EPA, GLA and antioxidants; disease-specific supplements on pressure ulcer incidence when compared to standard diet (1 study each; very low-certainty evidence for all comparisons). Pressure ulcer treatment Twenty-four studies (with 27 arms) compared 10 types of nutritional interventions or supplements for treatment of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may slightly increase the number of healed pressure ulcers (energy, protein and micronutrients 366 per 1000, standard diet 253 per 1000; RR 1.45, 95% CI 1.14 to 1.85; 3 studies, 577 participants, low-certainty evidence). The evidence is very uncertain about the effect of these supplements on gastrointestinal side effects. Compared to standard diet, the evidence is very uncertain about the effect of protein, arginine, zinc and antioxidant supplements on pressure ulcer healing (pressure ulcer area: mean difference (MD) 2 cm² smaller, 95% CI 4.54 smaller to 0.53 larger; 2 studies, 71 participants, very low-certainty evidence). The evidence on side effects of these supplements is very uncertain. Compared to standard diet, supplements with arginine and micronutrients may not increase the number of healed pressure ulcers, but the evidence suggests a slight reduction in pressure ulcer area (MD 15.8% lower, 95% CI 25.11 lower to 6.48 lower; 2 studies, 231 participants, low-certainty evidence). The evidence is very uncertain about changes in pressure ulcer scores, acceptability, and side effects of these supplements. Compared to placebo, collagen supplements probably improve the mean change in pressure ulcer area (MD 1.81 cm² smaller, 95% CI 3.36 smaller to 0.26 smaller; 1 study, 74 participants, moderate-certainty evidence). The evidence is very uncertain about the effect of these supplements on side effects. The evidence is very uncertain about the effects of vitamin C, different doses of arginine; EPA, GLA (special dietary fatty acids) and antioxidants; protein; a specialized amino acid mixture; ornithine alpha-ketoglutarate and zinc supplements on pressure ulcer healing (1 or 2 studies each; very low-certainty evidence). AUTHORS' CONCLUSIONS The benefits of nutritional interventions with various compositions for pressure ulcer prevention and treatment are uncertain. There may be little or no difference compared to standard nutrition or placebo. Nutritional supplements may not increase gastrointestinal side effects, but the evidence is very uncertain. Larger studies with similar nutrient compositions would reduce these uncertainties. No study investigated the effects of special diets (e.g. protein-enriched diet, vegetarian diet) on pressure ulcer incidence and healing.
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Affiliation(s)
- Gero Langer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Astrid Fink
- Department of Health, District administration Groß-Gerau, Groß-Gerau, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University Graz, Graz, Austria
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Durak A, Binay Safer V, Catikkas NM. The relationship between pressure injuries and ultrasonographically measured rectus femoris muscle thickness. J Tissue Viability 2024; 33:60-66. [PMID: 38103986 DOI: 10.1016/j.jtv.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/13/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Ayfer Durak
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Division of Geriatrics, Sancaktepe, 34785, Istanbul, Turkey.
| | - Vildan Binay Safer
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine / Department of Physical Medicine and Rehabilitation, Sancaktepe, 34785, Istanbul, Turkey
| | - Nezahat Muge Catikkas
- University of Health Sciences Istanbul, Hamidiye Faculty of Medicine, Sancaktepe Prof. Dr. Ilhan Varank Training and Research Hospital, Department of Internal Medicine, Division of Geriatrics, Sancaktepe, 34785, Istanbul, Turkey
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Yin C, Mpofu E, Brock K, Li X, Zhan R. Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors. J Gerontol Nurs 2024; 50:32-41. [PMID: 38290099 DOI: 10.3928/00989134-20240110-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals. METHOD We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle. RESULTS Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers. CONCLUSION Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].
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Hançer Tok H, Uzun LN. Pressure ulcer prevention: family caregiver training effectiveness. BMJ Support Palliat Care 2024:spcare-2023-004711. [PMID: 38253489 DOI: 10.1136/spcare-2023-004711] [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: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To determine the effectiveness of pressure ulcer prevention training for the relatives of palliative care inpatients. METHODS This study had a pretest-post-test design with parallel groups and a randomised control group, and it was conducted with 70 (experimental n=35, control n=35) patient relatives. A personal information form and Pressure Ulcer Knowledge Test were used as data collection tools. Parametric tests were performed for statistical analysis. RESULTS The pressure ulcer prevention training given to the relatives of palliative care patients in the experimental group was significantly effective in increasing their level of knowledge about these ulcers (p<0.05). However, the routine ward discharge training given to the relatives of palliative care patients in the control group was not significantly effective in increasing their level of knowledge about them (p>0.05). CONCLUSIONS Specialised training regarding pressure ulcers should be given to the relatives of patients receiving palliative care. It is important that the educational materials used in this trainings appeal to all sensory organs in order to improve the educational outcomes. TRIAL REGISTRATION NUMBER NCT05979402.
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Affiliation(s)
- Hümeyra Hançer Tok
- Nursing, Ministry of Health Bolu İzzet Baysal Mental Health and Diseases Hospital, Bolu, Turkey
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Malek Hosseini A, Rostam Khani M, Abdi S, Abdi S, Sharifi N. Comparison of aloe vera gel dressing with conventional dressing on pressure ulcer pain reduction: a clinical trial. BMC Res Notes 2024; 17:25. [PMID: 38229162 DOI: 10.1186/s13104-023-06682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Aloe Vera has a strong analgesic and anti-inflammatory effect, and its use effectively controls pain. This study aimed to determine the effect of Aloe Vera gel versus saline on pain relief of pressure ulcers. METHODS This study is a double-blind, randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran from May 2020 to April 2022. Using the available sampling method, 95 patients with pressure ulcers were assessed for eligibility, 64 patients were selected, 33 patients were placed in the experimental and 34 patients in control. For the experimental group, the ulcers were first cleaned with normal saline to remove the slough and then the already prepared Aloe Vera gel was evenly applied. For control groups, the ulcers were first washed with normal saline to remove off the slough and then covered with a sterile cotton gage, and the wound was tightly bandaged with a cotton roll to keep the "daily dressing" in place. A visual pain scale was used to assess the patient's pain level. Data analysis was done using SPSS 17. Descriptive statistics, ANOVA, and greenhouse tests were used. The significance level was 0.05. RESULTS The results showed that the average pain score in both groups had a downward trend; that is, both dressings effectively reduced pressure ulcer pain (P < 0.001). The greenhouse test results showed that the difference between the two groups was significant (P < 0.001). CONCLUSION The results showed the effect of Aloe Vera gel in reducing pressure ulcer pain. Dressing with Aloe Vera gel is preferable to reducing pain during dressing changes in patients with pressure ulcers. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20180715040478N2, 2021-08-17.
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Affiliation(s)
- Azam Malek Hosseini
- Department of Nursing, Khomein University of Medical Sciences, Khomein, Iran
| | | | - Sina Abdi
- Department of Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Siavash Abdi
- Department of Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Nader Sharifi
- Department of Public Health, Khomein University of Medical Sciences, Khomein, Iran.
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Sugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud 2023; 148:104605. [PMID: 37801939 DOI: 10.1016/j.ijnurstu.2023.104605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN Systematic review and meta-analysis. SETTING(S) Nursing homes, aged care, or long-term care facilities. PARTICIPANTS Older people, 60 years and older. METHODS Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER PROSPERO CRD42022328367. TWEETABLE ABSTRACT Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
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Pei J, Guo X, Tao H, Wei Y, Zhang H, Ma Y, Han L. Machine learning-based prediction models for pressure injury: A systematic review and meta-analysis. Int Wound J 2023; 20:4328-4339. [PMID: 37340520 PMCID: PMC10681397 DOI: 10.1111/iwj.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023] Open
Abstract
Despite the fact that machine learning (ML) algorithms to construct predictive models for pressure injury development are widely reported, the performance of the model remains unknown. The goal of the review was to systematically appraise the performance of ML models in predicting pressure injury. PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Grey literature and other databases were systematically searched. Original journal papers were included which met the inclusion criteria. The methodological quality was assessed independently by two reviewers using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed with Metadisc software, with the area under the receiver operating characteristic curve, sensitivity and specificity as effect measures. Chi-squared and I2 tests were used to assess the heterogeneity. A total of 18 studies were included for the narrative review, and 14 of them were eligible for meta-analysis. The models achieved excellent pooled AUC of 0.94, sensitivity of 0.79 (95% CI [0.78-0.80]) and specificity of 0.87 (95% CI [0.88-0.87]). Meta-regressions did not provide evidence that model performance varied by data or model types. The present findings indicate that ML models show an outstanding performance in predicting pressure injury. However, good-quality studies should be conducted to verify our results and confirm the clinical value of ML in pressure injury development.
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Affiliation(s)
- Juhong Pei
- The First Clinical Medical College, School of NursingLanzhou UniversityLanzhouChina
| | | | - Hongxia Tao
- The First Clinical Medical College, School of NursingLanzhou UniversityLanzhouChina
| | - Yuting Wei
- School of NursingLanzhou UniversityLanzhouChina
| | - Hongyan Zhang
- Department of NursingGansu Provincial HospitalLanzhouChina
| | - Yuxia Ma
- School of NursingLanzhou UniversityLanzhouChina
| | - Lin Han
- The First Clinical Medical College, School of NursingLanzhou UniversityLanzhouChina
- Department of NursingGansu Provincial HospitalLanzhouChina
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Wang L, Gao M, Wang X, Gu M, Qi Q. Effects of bundle-care interventions on pressure ulcers in patients with stroke: A meta-analysis. Int Wound J 2023; 21:e14432. [PMID: 37853846 PMCID: PMC10828713 DOI: 10.1111/iwj.14432] [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: 09/06/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
We conducted a meta-analysis to assess the effects of bundle-care interventions on pressure ulcers in patients with stroke to provide a basis for clinical work. Randomised controlled trials on the effects of bundle-care interventions in patients with stroke were identified using computerised searches of the PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP and Wanfang databases, from the time of inception of each database to July 2023, supplemented by manual literature searches. Two researchers independently retrieved and screened the articles, extracted the data and evaluated the quality of the included studies. After reaching consensus, meta-analysis was performed using RevMan 5.4. Twenty-four papers were included, involving 3330 patients of whom 1679 were in the intervention group and 1651 were in the control group. The results showed that, compared with standard care, bundle-care interventions significantly reduced the incidence of pressure ulcers (3.28% vs. 14.84%, odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.14-0.26, p < 0.001), and aspiration (5.60% vs. 18.84%, OR: 0.25, 95% CI: 0.17-0.39, p < 0.001), and improved patient satisfaction with nursing care (96.59% vs. 84.43%, OR. 5.45, 95% CI: 3.76-7.90, p < 0.001). Current evidence suggests that care bundles are significantly better than conventional nursing measures in preventing pressure ulcers and aspiration, and improving patient satisfaction with nursing care in patients with stroke, and are worthy of clinical promotion and application.
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Affiliation(s)
- Li‐Ping Wang
- Department of NeurologyJinan City People's HospitalJinanChina
| | - Ming‐Ming Gao
- Department of Cadre HealthcareJinan City People's HospitalJinanChina
| | - Xiu‐Qin Wang
- Department of NeurologyJinan City People's HospitalJinanChina
| | - Min‐Min Gu
- Department of NeurologyJinan City People's HospitalJinanChina
| | - Qin‐De Qi
- Department of NeurologyJinan City People's HospitalJinanChina
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Appiah EO, Appiah S, Oti-Boadi E, Boadu BA, Kontoh S, Adams RI, Appiah C, Sarpong C. Attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. PLoS One 2023; 18:e0290970. [PMID: 37682963 PMCID: PMC10490930 DOI: 10.1371/journal.pone.0290970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Pressure ulcers (PUs), which affect millions of people worldwide, are among the five most prevalent hospitalized cases causing adverse impairment. Nevertheless, pressure ulcers are largely preventable, and their management depends on their severity. The authors, therefore, explored the attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. METHODS An exploratory descriptive qualitative approach was employed for this study to help researchers explore the attitude and practices toward PU (Pressure Ulcer). Purposive sampling approach was employed, and data was analyzed using thematic content analysis. The sample size for this study was 30 which was obtained based on saturation. Participants were engaged in face-to-face interviews which were transcribed verbatim. FINDINGS Two themes and eight subthemes were generated from the analysis of this study. The two themes were preventive practices and attitude towards PU. The study identified that there were no specific protocols illustrated on the wards for managing pressure ulcers. Nevertheless, the study participants were keen on preventing pressure ulcers and hence engaged in practices such as early patients' ambulation, early identification of PU signs, removing creases and crumps from patient beds, nutritional management for PU prevention, and dressing of PU wounds. CONCLUSION Practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence, the nurses recommended the need for accepted guidelines on pressure ulcer management to be illustrated in the various orthopedic wards in the country.
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Affiliation(s)
- Evans Osei Appiah
- School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
- Purdue University, West Lafayette, IN, United States of America
| | - Stella Appiah
- Head of Nursing Department, School of Nursing and Midwifery, Valley View University, Accra, Ghana
| | - Ezekiel Oti-Boadi
- School of Nursing, Heritage Christian College, Valley View University, Accra, Ghana
| | | | - Samuel Kontoh
- Department of Mental Health, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | | | - Cyndi Appiah
- Ghana Christian University College, Amrahia, Ghana
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Jia YJ, Hu FH, Zhang WQ, Tang W, Ge MW, Shen WQ, Chen HL. Incidence, prevalence and risk factors of device-related pressure injuries in adult intensive care unit: A meta-analysis of 10,084 patients from 11 countries. Wound Repair Regen 2023; 31:713-722. [PMID: 37587087 DOI: 10.1111/wrr.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/20/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
Device-related pressure injuries (DRPIs) prevail in the intensive care unit (ICU) and have much to do with medical devices and patients' conditions. This meta-analysis aims to systematically assess the incidence, prevalence and risk factors related to DRPIs among adults in ICU. Web of Science, Cochrane Library, MEDLINE, PubMed and CINAHL were searched from inception to March 2023. Observational studies were included, and the Newcastle-Ottawa scale (NOS) was used to assess literature quality. The primary outcomes were the incidence, prevalence and risk factors regarding DRPIs among adults in ICU. The 19 studies conformed to the criteria for inclusion in the review. The estimated pooled incidence of DRPIs was 14.7% (95% CI: 9.7%-19.6%) in 10 studies (4866 participants). The estimated pooled prevalence of DRPIs was 19.0% (95% CI: 13.6%-24.3%) in 9 studies (5218 participants). The most significant risk factor for DRPIs was using mechanical ventilation. The pooled analysis of the four studies showed that DRPIs were more likely to occur in patients who required mechanical ventilation compared with patients who did not use mechanical ventilation (OR: 9.67, 95% CI: 5.03-18.61, p < 0.001) and using vasopressors, age, length of ICU stays, APACHE II score, Braden score, fever, sex, oedema, diabetes and number of medical devices, SOFA score was also related to pressure injuries risk. The incidence and prevalence of DRPIs in adult ICU were high, and the most significant risk factor for DRPIs was using mechanical ventilation. It is imminent to identify patients of increased risk with DRPIs early.
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Affiliation(s)
- Yi-Jie Jia
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Fei-Hong Hu
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wan-Qing Zhang
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wen Tang
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Meng-Wei Ge
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Wang-Qin Shen
- Medical School, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, People's Republic of China
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Parvizi A, Haddadi S, Mollaei A, Ghorbani Vajargah P, Takasi P, Firooz M, Hosseini SJ, Farzan R, Karkhah S. A systematic review of nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers. Int Wound J 2023; 20:2843-2854. [PMID: 36792930 PMCID: PMC10410313 DOI: 10.1111/iwj.14122] [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: 01/24/2023] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of this review study is to investigate the nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers (MDRPUs). An extensive search was conducted in international electronic databases such as PubMed, Web of Science, and Scopus, and Persian databases, such as Iranmedex and the Scientific Information Database from December 1, 2022. During this search, keywords extracted from Medical Subject Headings, such as "Prevention knowledge," "Nurse," "Pressure ulcer," "Equipment and Supplies," and "Intensive Care Units" were used. The quality of the present studies in this review was evaluated based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 1847 nurses participated in this review from five studies, and the majority of them (82.94%) were female. The mean age of the participants was 31.40 (SD = 5.97). The mean score of MDRPUs prevention knowledge in nurses based on PU2014 scale and researcher-made questionnaires were 16.50 (SD = 3.74) out of 31 and 65.49 (SD = 6.33) out of 100, respectively. The knowledge of nurses is influenced by factors such as age, sex, level of education, work experience, technical titles, type of hospital, level of hospital, and type of ward. Various factors had a significant positive relationship with nurses' MDRPUs prevention knowledge, which includes level of education, work experience, previous training on MDRPU, having a wound care certificate, an online search about MDRPU, and attitude and practise towards MDRPU prevention. At the same time, nurses' knowledge about the prevention of MDRPUs had a significant negative relationship with the time interval since last participating in MDRPU training or workshop. Overall, the level of MDRPUs prevention knowledge among nurses was insufficient to moderate. Therefore, it is suggested to provide facilities for nurses to receive the necessary training.
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Affiliation(s)
- Arman Parvizi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Amirabbas Mollaei
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Pooyan Ghorbani Vajargah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Poorya Takasi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
| | - Mahbobeh Firooz
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
| | | | - Ramyar Farzan
- Department of Plastic & Reconstructive Surgery, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyGuilan University of Medical SciencesRashtIran
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Şimşek E, Demir AS, Semerci R, Karadağ A. The incidence and prevalence of medical device-related pressure injuries in pediatric patients: Systematic review and meta-analysis. J Pediatr Nurs 2023; 72:e130-e138. [PMID: 37344345 DOI: 10.1016/j.pedn.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
PROBLEM To determine the pooled incidence and prevalence rate of medical device-related pressure injuries(MDRPIs) using the Braden QD scale, medical devices that frequently cause MDRPIs, and anatomical locations that are vulnerable to them. ELIGIBILITY CRITERIA Using the Braden QD scale, being published in English between 01/01/2018-and 01/03/2023. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations and registered in the International Prospective Register of Systematic Reviews database (No: CRD42021276501). SAMPLE A total of 7 studies with 25,742 pediatric patients were included. RESULTS The pooled prevalence and cumulative incidence of hospital-acquired pressure injuries(HAPIs) were 7.8% (95% CI: 5.2-11.4%) and 3.9% (95% CI: 0.5-24.6%) respectively, and the incidence rate was 8.2/1000 person-days (95% CI: 2.4-14.2/1000 person-days). The pooled prevalence and cumulative incidence of MDRPIs were 7% (95% CI: 5.5-8.8%) and 5% (95% CI: 3.2-7.8%) respectively, and the incidence rate was 6.7/1000 person-days (95% CI, 0.11-13.4/1000 person-days). The most affected anatomical locations were the face (29.1%), ankle/foot (20.1%), and head (15.7%). Medical devices that frequently caused MDRPIs were external monitoring devices (24.5%), respiratory devices (22.8%), and supportive/securing devices (14.9%). CONCLUSIONS According to the current systematic review and meta-analyses, the incidence and prevalence of HAPIs and MDRPIs are moderate to high. IMPLICATIONS The findings suggested that healthcare providers should pay more attention to reducing HAPIs and MDRPIs and future studies should be conducted to understand their characteristics and risk factors.
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Affiliation(s)
- Enes Şimşek
- Koç University, School of Nursing, Department of Child Health and Disease Nursing, Istanbul, Turkey.
| | - Ayşe Sılanur Demir
- Koç University, School of Nursing, Department of Fundamentals of Nursing, Istanbul, Turkey
| | - Remziye Semerci
- Koç University, School of Nursing, Department of Child Health and Disease Nursing, Istanbul, Turkey
| | - Ayişe Karadağ
- Koç University, School of Nursing, Department of Fundamentals of Nursing, Istanbul, Turkey
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Behnammoghadam M, Alimohammadi N, Riazi A, Eghbali-Babadi M, Rezvani M. Incidence of cervical collar-related pressure injury in patients with head and neck trauma: A scoping review study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:252. [PMID: 37727424 PMCID: PMC10506768 DOI: 10.4103/jehp.jehp_41_23] [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: 01/10/2023] [Accepted: 02/21/2023] [Indexed: 09/21/2023]
Abstract
The use of the cervical collar to support the head and neck is inevitable in many patients with head and spinal cord injuries. One of the consequences of using this instrument is the development of pressure injuries. Therefore, in this review study, the incidence of as well as the risk factors for cervical collar-related pressure injury in this group of patients was evaluated. The current study is a scoping review conducted in 2022. Five scientific databases (PubMed, Scopus, Web of Science, ProQuest, and CINAHL), as well as Google Scholar, were searched for relevant studies published from 1990 to 2022 using the following keywords: trauma, spinal cord injury, head injury, head trauma, collar, cervical collar, cervical immobilization, risk factors, incidence, pressure injury, pressure ulcer, and bed sore. The search was performed independently by two researchers. Articles from the initial search were first recorded in special tables, and then, were reviewed and analyzed separately by two researchers. After extraction, information from each article was entered into a special table categorized by year, country, study design, study population, the incidence of cervical collar-related pressure injury, risk factors for cervical collar-related pressure injury, and grades of pressure injury. Of the 10 articles, 6 were retrospective cohort studies, 3 were cross-sectional descriptive studies, and 1 was a case report study. In terms of the study population, one study was conducted on pediatric patients, one was conducted on elderly patients, and eight were conducted on adults with head and neck trauma. In eight articles, the incidence of cervical collar-related pressure injury was reported. The reported incidence varied between 1.1% and 78.4%. In eight articles, risk factors for cervical collar-related pressure injury were reported. The most common risk factors were duration of cervical collar use, hospitalization in intensive care units, low level of consciousness, and longer hospital stay. The current review study showed that a significant percentage of head and neck trauma patients for whom cervical collar is used suffer from different grades of pressure injuries. Hence, healthcare providers should consider this issue when caring for this group of patients and take the necessary preventive measures in this regard. It should be noted that previous studies in this field had significant limitations, and thereby, it is strongly recommended to conduct further studies with a stronger methodology.
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Affiliation(s)
- Mohammad Behnammoghadam
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Riazi
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Eghbali-Babadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, Neurosciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Baek S, Park JH. Negative Pressure Wound Therapy (NPWT) after Hybrid Reconstruction of Occipital Pressure Sore Using Local Flap and Skin Graft. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1342. [PMID: 37512153 PMCID: PMC10386472 DOI: 10.3390/medicina59071342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
Background and objectives: Pressure sores are a common medical burden among patients, particularly those who are bedridden or frail. Surgical management of occipital pressure sores poses unique challenges due to limited elasticity and the spherical shape of the scalp. This study aims to evaluate the efficacy and safety of a novel reconstruction method utilizing a local transpositional flap and split-thickness skin graft with negative pressure wound therapy (NPWT) for occipital pressure sore treatment. Material and methods: A retrospective analysis was performed on patients with occipital pressure sores who underwent hybrid reconstructions using a local flap and split-thickness skin graft in conjunction with NPWT. Surgical outcomes, including flap survival rate, graft take percentage, and complications, were assessed. A comparative analysis was performed between the NPWT group and the conventional dressing group. Results: The NPWT group (n = 24) demonstrated a significantly higher mean graft take percentage at postoperative day 14 compared with the conventional dressing group (n = 22) (98.2% vs. 81.2%, p < 0.05). No significant difference in flap survival rate was observed between the two groups. Conclusions: As the aging population continues to grow, occipital pressure sores have gained significant attention as a crucial medical condition. The innovative surgical method incorporating NPWT offers an efficient and safe treatment option for patients with occipital pressure sores, potentially establishing itself as the future gold standard for managing this condition.
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Affiliation(s)
- Seungchul Baek
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
| | - Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Republic of Korea
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Dolanová D, Búřilová P, Krupová L, Benešová K, Jarkovský J, Saibertová S, Pokorná A. Mortality related to pressure ulcers in Czech Republic - Analyses of national health registries. J Tissue Viability 2023:S0965-206X(23)00059-1. [PMID: 37198049 DOI: 10.1016/j.jtv.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/28/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Pressure ulcers/pressure injuries (PUs/PIs) relate to decreasing quality of life, prolonged hospitalisation, the increased economic cost of care, and increased mortality. That's why this study focused on one of the mentioned factors - mortality. OBJECTIVES The study analyses national data in the Czech Republic to map the mortality phenomenon comprehensively based on data from national health registries. METHOD The retrospective, nationwide cross-sectional data analysis of data collected by the National Health Information System (NHIS) has been provided in the period 2010-2019 with a special focus on 2019. Hospitalisations with PUs/PIs were identified by reporting L89.0-L89.9 diagnosis as a primary or secondary hospitalisation diagnosis. We also included all the patients who died in the given year with an L89 diagnosis reported in 365 days prior the death. RESULTS In 2019, 52.1% of patients with reported PUs/PIs were hospitalised, and 40.8% were treated on an outpatient basis. The most common underlying cause of death mortality diagnosis (43.7%) in these patients was the diseases of the circulatory system. Patients who die in a healthcare facility while hospitalised with an L89 diagnosis generally have a higher category of PUs/PIs than persons who die outside a healthcare facility. CONCLUSION The proportion of patients dying in a health facility is directly proportional to the increasing PUs/PIs category. In 2019, 57% of patients with PUs/PIs died in a healthcare facility, and 19% died in the community. In 24% of patients who died in the healthcare facility, PUs/PIs were reported 365 days before the death.
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Affiliation(s)
- Dana Dolanová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic
| | - Petra Búřilová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic; Department of Public Health, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic
| | - Lenka Krupová
- Department of Dermatology, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava, 708 00, Czech Republic
| | - Klára Benešová
- Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic
| | - Jiří Jarkovský
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic
| | - Simona Saibertová
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic
| | - Andrea Pokorná
- Department of Health Sciences, Masaryk University, Faculty of Medicine, Kamenice 3, Brno, 625 00, Czech Republic; Institute of Health Information and Statistics, Palackého náměstí 4, Prague, 128 01, Czech Republic.
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Development of a Wound Assessment Tool for Use in Adults at End of Life: A Modified Delphi Study. Adv Skin Wound Care 2023; 36:142-150. [PMID: 36812079 DOI: 10.1097/01.asw.0000911992.83362.eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Some patients at end of life (EOL) develop wounds known as Kennedy terminal ulcers, terminal ulcers, and Skin Changes At Life's End. However, there is ambiguity around the defining wound characteristics of these conditions and a lack of validated clinical assessment tools available to identify them. OBJECTIVE To gain consensus on the definition and characteristics of EOL wounds and establish the face and content validity of a wound assessment tool for use in adults at EOL. METHODS Using a reactive online Delphi technique, international wound experts reviewed the 20 items in the tool. Over two iterative rounds, experts assessed item clarity, relevance, and importance using a four-point content validity index. The content validity index scores were calculated for each item, with a level of 0.78 or higher signifying panel consensus. RESULTS Round 1 included 16 panelists (100.0%). The agreement for item relevance and importance ranged from 0.54% to 0.94%, and item clarity scored between 0.25% and 0.94%. Following round 1, four items were removed, and seven others reworded. Other suggestions included changing the tool name and including Kennedy terminal ulcer, terminal ulcer, and Skin Changes At Life's End in the EOL wound definition. In round 2, the now 13 panel members agreed with the final 16 items included and suggested minor wording changes. CONCLUSIONS This tool could provide clinicians with an initially validated tool to accurately assess EOL wounds and gather much needed empirical prevalence data. Further research is needed to underpin accurate assessment and the development of evidence-based management strategies.
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Köberich S, Jansen H, Schink M. Der Unsicherheit begegnen – Dekubitusprophylaxe am Lebensende. ZEITSCHRIFT FÜR PALLIATIVMEDIZIN 2023. [DOI: 10.1055/a-1984-2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Closure of pressure injury and mortality in internal medicine wards. Eur Geriatr Med 2023; 14:373-380. [PMID: 36780106 DOI: 10.1007/s41999-023-00757-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/01/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE The prevalence of pressure injury (PI) in hospitalized patients ranges from 5 to 15%, and is significantly greater in critical care and palliative care units. Prevalence of PI is considered an indicator of health care quality and is associated with increased morbidity and mortality. The study aims to determine the features of PI and its association with mortality among hospitalized patients in the inpatient service of a university hospital. METHODS The present study comprised 89 patients hospitalized on the internal medicine inpatient service who had PI at the time of hospitalization and or who developed PI during hospitalization. Patients were categorized based on the state of PI closure (complete/incomplete). Mortality rates for 1 month, 3 months, 6 months, and 1 year were computed. RESULTS The median age was 74. (IQR: 62-82). Forty-eight patients were female, and 15.7% of hospitalized patients had PI. A third of patients died during their index hospitalization. Patients with completely closed PI had decreased one-month, three-month, six-month, and one-year mortality rates. Complete closure of PI influenced all four mortality rates independently of other parameters, as determined by Cox regression analysis of the factors impacting mortality. CONCLUSION As life expectancy rises, the frequency of PI increases, resulting in a rise in health care expenses. To reduce these expenses, prevention, early identification, and treatment of PI are essential. The primary finding of the study is that complete closure of PI in hospitalized patients reduces the risk of death.
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Aysal BK, Nisanci M. Single-session repair of multiple pressure ulcers in non-ambulatory patients. J Wound Care 2023; 32:109-115. [PMID: 36735526 DOI: 10.12968/jowc.2023.32.2.109] [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: 02/04/2023]
Abstract
OBJECTIVE Pressure ulcers (PUs) are highly prevalent and challenging wounds. In this study, patients with either tetraplegia or paraplegia, all of whom had multiple grade 4 PUs and who underwent single-session surgical treatment were included. In order to increase the mobility of the musculocutaneous flap, the gluteus maximus muscle, which cannot be used by immobile patients, was detached and inserted into the flap. METHOD This was a retrospective case series and all PUs were reconstructed within the same surgical session. RESULTS A total of nine patients participated in the study, all of whom were male. Mean age was 33 years (range: 20-42 years). Mean follow-up period was 14.3 months (range: 9-24 months). All patients had a successful single-session repair of all PUs. Total or partial flap losses were not observed. Mean and total number of reconstructed PUs were 2.55 and 23, respectively. The mean area of reconstructed open wounds per patient was 174.6cm2 and the mean operation duration was 253 minutes. The level of blood loss was acceptable as the decrease in haemoglobin levels was not more than 2g/dl for each patient. CONCLUSION Multiple PUs can be repaired in one session using gluteus maximus musculocutaneous flaps in immobile patients. Based on the fact that the gluteus maximus is an essential muscle for ambulation, our approach can only be used in the treatment of patients with irreversible paraplegia or tetraplegia. When all prerequsities are met, the amount of blood loss and operation duration are acceptable, and returning the patient to a wound-free state can be achieved more quickly compared to multi-session repairs. Air-fluidised beds are vital tools for accomplishing single session repairs of multiple PUs. The data shows that the approach is safe and can be used in patients with multiple PUs.
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Affiliation(s)
- Bilge Kagan Aysal
- Mugla Sitki Kocman University, Department of Plastic, Reconstructive and Aesthetic Surgery, Mugla, Turkey
| | - Mustafa Nisanci
- Mugla Sitki Kocman University, Department of Plastic, Reconstructive and Aesthetic Surgery, Mugla, Turkey
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Prevention and management of hospital-acquired pressure injury among patients with lung disease in a hospital: a best practice implementation project. JBI Evid Implement 2022; 20:301-312. [PMID: 36378109 DOI: 10.1097/xeb.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients. INTRODUCTION Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay. METHODS Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence. RESULTS Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%. CONCLUSION The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.
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Kandi LA, Rangel IC, Movtchan NV, Van Spronsen NR, Kruger EA. Comprehensive Management of Pressure Injury. Phys Med Rehabil Clin N Am 2022; 33:773-787. [DOI: 10.1016/j.pmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shu Y, Li L, Shu F, Wei Y, Zhang L, Zhou Y. Application of an adjustable medical foot support pillow to prevent foot drop in patients with stroke. Technol Health Care 2022; 31:991-1001. [PMID: 36314179 DOI: 10.3233/thc-220462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND: Foot drop is one of the most common complications after stroke. OBJECTIVE: This study investigates the role of an adjustable medical foot support pillow in preventing foot drop and improving the lower limb function of patients after stroke. METHODS: A total of 88 patients with strokes admitted to our hospital from September 2019 to September 2020 were selected and categorised into the control (n= 44) and intervention groups (n= 44) using a random number table. The control group received routine rehabilitation nursing, while the intervention group adopted a self-made adjustable medical foot support pillow based on routine rehabilitation nursing. After four weeks, the simplified Fugl Meyer Assessment (FMA) and the modified activities of daily living (ADL) scales were used to measure the ankle range of motion of the lower limbs. The lower limb motor function, ADL, and ankle mobility before and after treatment, as well as the incidence of foot ptosis, were compared between the two groups. RESULTS: After the procedure, the intervention group was superior to the control group in the FMA score of the lower extremities, ADL score, and ankle joint mobility in the lower limbs, indicating statistically significant differences (P< 0.05). The incidence rate of foot drop was lower in the intervention group than in the control group, and the difference was statistically significant (P< 0.05). CONCLUSION: The adjustable medical foot support pillow can prevent foot drop in patients after stroke, improve lower limb function, provide a favourable basis for walking training, and improve the ADL of patients.
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Affiliation(s)
- Yan Shu
- Department of Nursing, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
- Department of Nursing, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
| | - Ling Li
- Department of Obstetrics and Gynecology, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
- Department of Nursing, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
| | - Fanglian Shu
- Department of Radiology, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
- Department of Nursing, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
| | - Yanhong Wei
- Department of Nursing, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
| | - Li Zhang
- Department of Nursing, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
| | - You Zhou
- Department of Neurology, International Rehabilitation Center, Suzhou High-Tech Zone People’s Hospital, Suzhou, Jiangsu, China
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Application Value of Management Model Based on “Zero Tolerance” Concept in Pressure Ulcer Management. Emerg Med Int 2022; 2022:6792584. [PMID: 36262118 PMCID: PMC9576404 DOI: 10.1155/2022/6792584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Pressure injuries are the most prevalent health problem worldwide. Improving the quality of hospital pressure injury management is an important indicator to improve the quality of hospital management. Objective To explore the application value of the management model centered on the concept of “zero tolerance” in the management of pressure ulcers (PU). Methods The effects of conventional management mode and management mode centered on the concept of “zero tolerance” on PU patients and nursing staff were retrospectively analyzed. The patients were evaluated by the general comfort questionnaire (GCQ), Generic Quality of Life Inventory 74 (GQOL-74), and pressure ulcer healing scale (PUSH). At the same time, the satisfaction of PU patients and nursing staff with different management modes was investigated. Results When comparing the conditions of patients under different management modes, it was found that the “zero tolerance” management mode can improve the comfort and quality of life of patients during hospitalization. Compared with the conventional management mode, the “zero tolerance” management mode can significantly improve the degree of pressure ulcer healing in patients. In addition, the “zero tolerance” management model can not only improve the satisfaction of patients with management but also improve the satisfaction of nursing staff with management. Conclusion Standardized management of PU patients with the concept of “zero tolerance” as the core can improve the health status and quality of life of patients, promote wound healing, and improve the satisfaction of patients and nurses with the management plan.
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Alkeridy WA, Aljasser A, Alayed KM, Alsaad SM, Alqahtani AS, Lim CA, Alamri SH, Mekkawy DZ, Al-Sofiani M. Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia. J Multidiscip Healthc 2022; 15:1997-2005. [PMID: 36101552 PMCID: PMC9464450 DOI: 10.2147/jmdh.s379782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design Retrospective cross-sectional descriptive study. Setting and Participants A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods Only individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.
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Affiliation(s)
- Walid A Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada.,General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad M Alsaad
- Department of Family & Community medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani S Alqahtani
- Research department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Claire Ann Lim
- Department of Medical Rehabilitation, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan H Alamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Saudi Geriatrics Society, Riyadh, Saudi Arabia
| | - Doaa Zainhom Mekkawy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Sofiani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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Abstract
OBJECTIVE To systematically review recommendations for promoting and maintaining skin integrity in end-of-life care and their level of evidence. DATA SOURCES MEDLINE (PubMed interface), CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and The Cochrane Library were systematically searched using a combination of key terms including end-of-life care, skin care, skin hygiene, and skin cleansing. STUDY SELECTION Articles were included if they (1) described skin care recommendations, including but not limited to the use of skin care products and interventions such as cleansing procedures; and (2) included adult patients who were expected to die within 12 months. There were no restrictions on study design, study setting, or language. Articles with a publication date before 2000 were excluded. DATA EXTRACTION Two data extraction forms were developed. The first included information about the author, publication year, type of evidence, study topic, sample, sample size, setting, limitations of the study, level of evidence, and quality of the study. The second included recommendations for promoting and maintaining skin integrity in patients at the end of life. DATA SYNTHESIS Because of methodological heterogeneity, results were synthesized narratively, and no meta-analysis was performed. CONCLUSIONS The information contained in the recommendations will assist nurses in promoting and maintaining skin integrity in patients at the end of life. More research is needed on end-of-life skin care, with an emphasis on patient-centered, holistic strategies that improve patient well-being and quality of life. In most current research, recommendations are limited to literature reviews and level V evidence. Skin care must balance the promotion and maintenance of skin integrity, wound prevention, and management while promoting patient dignity and quality of life.
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Elbourne S. Pressure ulcers at the end of life. Br J Community Nurs 2022; 27:S5-S6. [PMID: 35671196 DOI: 10.12968/bjcn.2022.27.sup6.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Scott Elbourne
- Clinical Lead, District Nursing, Berkshire Healthcare Foundation Trust
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Zhao J, Sun H, Cao Y, Hu X, Shan E, Li X, Zhou Y. A Cartoon Version of Braden Scale to Assess the Risk of Pressure Injury: Content Validity and Interrater Reliability Study. J Surg Res 2022; 276:394-403. [PMID: 35461011 DOI: 10.1016/j.jss.2022.02.050] [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: 08/05/2021] [Revised: 01/21/2022] [Accepted: 02/13/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The Braden Scale is widely used to assess the risk of pressure injury. However, the vague literal description of the items creates difficulties for bedside nurses and limits its sensitivity. To solve this problem, we developed a cartoon version of the Braden scale (CVBS) to improve the pressure injury risk assessment ability of bedside nurses. METHODS The CVBS was constructed by two nurses, and the final version was determined through a two-round Delphi consultation. The scale's content validity was calculated based on expert ratings. A total of 265 patients were evaluated simultaneously with the CVBS by 119 bedside nurses and 46 wound care specialists; and 114 bedside nurses and the same 46 wound care specialists evaluated 239 patients with the original Braden scale (OBS). The interrater reliability between the two groups was calculated as Kappa value, and then the Kappa values of the two versions were compared. RESULTS The content validity for the draft scale was not good enough. After modification, the indices of all the items in the final CVBS reached 1.00. The Kappa value of the OBS was 0.69 (95% CI 0.61-0.76); for each item, it ranged from 0.60 to 0.80. The interrater reliabilities of the CVBS were higher than those of the OBS, with an overall kappa value of 0.87 (95% CI 0.81-0.92) and a range of 0.77 to 0.93 for each item. The differences between the Kappa values of the CVBS and those of the OBS were all statistically significant. CONCLUSIONS The CVBS had good validity and showed higher interrater reliability than the OBS, indicating that it may improve bedside nurses' ability to assess pressure injury risk.
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Affiliation(s)
- Jing Zhao
- Department of Outpatient Treatment, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Hang Sun
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yinan Cao
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyu Hu
- Department of Outpatient Treatment, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Enfang Shan
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Xianwen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Yufeng Zhou
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China.
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Guo Y, Pattavana F, Siangco C, Ngo-Huang A, Fu J, Hui D, Bruera E. Overall Survival among Patients with Cancer and Pressure Injury and Its Association with Braden Scale Score. J Palliat Med 2022; 25:1254-1257. [PMID: 35394852 DOI: 10.1089/jpm.2021.0645] [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: 11/12/2022] Open
Abstract
Background: The overall survival (OS) of hospitalized cancer patients with pressure injury (PI) has not been studied in a large cohort. Objective: To assess risk factors associated with OS of hospitalized cancer patients with PI. Methods: After IRB approval, charts of 445 hospitalized cancer patients with PI were reviewed. Kaplan-Meier method was used to estimate the OS time and log-rank test was used to assess the association between OS and other variables. Results: Stage 1, 2, 3, 4, deep tissue injury, unstageable, and unknown stage were 79 (17.8%), 91 (20.4%), 24 (5.4%), 3 (0.7%), 144 (32.4%), 36 (8.1%), and 68 (15.3%), respectively. The OS rate is 55.3% at one month. OS is significantly associated with Braden Scale (BS) Score. The OS time is significantly shorter in patients with advanced disease. Conclusion: Cancer patients with PI have limited OS, especially those with ≤14 BS and advanced diseases.
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Affiliation(s)
- Ying Guo
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Faith Pattavana
- Wound Ostomy Continence Nursing, Harris Health System, Houston, Texas, USA
| | - Christian Siangco
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - An Ngo-Huang
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack Fu
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Karimianfard N, Jaberi A. The prevalence of using complementary and alternative medicine products among patients with pressure ulcer. BMC Complement Med Ther 2022; 22:91. [PMID: 35346164 PMCID: PMC8958779 DOI: 10.1186/s12906-022-03573-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/22/2022] [Indexed: 12/17/2022] Open
Abstract
Background The use of complementary and alternative medicine (CAM) therapies has increased in recent years throughout the world and in Iran. Nonetheless, there are limited data about the prevalence of their use. This study aimed to assess the prevalence of using CAM therapies among patients with pressure ulcer (PU). Methods This cross-sectional study was conducted in 2019–2020. Participants were 299 patients with PU conveniently selected from wound clinics and healthcare settings in Shiraz, Iran. A demographic questionnaire and the International Questionnaire to Measure Use of CAM were used for data collection. The data were analyzed using the SPSS software (v. 22.0). Results All 299 participants completed the study. Their mean age was 59.56 ± 18.76 years. The most common CAM therapies used for PU management were herbal products (100%), vitamin supplementation therapy (45.2%), spiritual therapies (21.7%), wet cupping therapy (16.4%), leech therapy (9.4%), acupuncture (1.7%), dry cupping therapy (1.3%), and massage therapy (1.3%). The most common herbal product used for PU management was Pistacia atlantica gum either alone or in combination with other herbal products (15.5%). The use of CAM therapies had significant relationship with participants’ age, underlying conditions, and PU stage (P < 0.05) and the most significant predictor of using herbal products for PU was educational level (P < 0.05, OR = 5.098). Conclusions The use of CAM therapies, particularly herbal products, for PU management is high in Iran. Quality public education and close professional supervision are needed for the safe use of these products.
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Mitchell A, Elbourne S. Pressure ulcers at the end of life. Br J Community Nurs 2022; 27:S14-S18. [PMID: 35274986 DOI: 10.12968/bjcn.2022.27.sup3.s14] [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: 11/11/2022]
Abstract
Skin compromise at the end of life (SCALE) is not a new concept. The development of SCALE at the end of life is often deemed unavoidable and a result of multiorgan failure resulting in tissue hypoperfusion, which leads to depletion of oxygen and nutrients for the skin. Pressure ulcers, formed due to pressure, shearing or continuous friction, are also common at the end of life. The goal of care for patients with pressure ulcers at the end of life is usually wound management and good quality of life, rather than wound healing. Nurses must assess all pressure ulcers or SCALE at the end of life holistically and consider treatment and management based on the patient's condition.
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Affiliation(s)
- Aby Mitchell
- Senior Lecturer Adult Nursing, University of West London, Brentford
| | - Scott Elbourne
- Clinical Lead, District Nursing Berkshire Healthcare Foundation Trust
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Raine G. Is it time to re-evaluate the inevitability of ulcers at the end of life? Int J Palliat Nurs 2021; 27:440-448. [PMID: 34846932 DOI: 10.12968/ijpn.2021.27.9.440] [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: 11/11/2022]
Abstract
BACKGROUND The prevention of pressure injuries/ulcers (PI/PUs) in patients at the end of life is achievable, albeit challenging. Objective diagnostic tools, such as sub-epidermal moisture (SEM) scanning, support healthcare practitioners' clinical judgment in preventing PI/PUs. AIM A pragmatic study was conducted to assess the feasibility of preventing PI/PUs using SEM technology as an adjunct to routine care in a 22-bed inpatient hospice. METHODS Daily SEM scanning was introduced to support the device-trained practitioners' clinical judgment in detecting developing, non-visible PI/PUs. Preventive interventions were initiated by clinical judgment informed by Waterlow scores, visible, tactile skin and tissue assessments and scanner readings. RESULTS Prior to the study, the incidence of PI/PUs was 9%. The 6 month study period reported a 4.8% PI/PU incidence, 7/146 consenting patients developed a PI/PU, resulting in a 47% reduction in incidence rates. CONCLUSION Preventing the development of PI/PUs is possible with clinical judgment aided by SEM data.
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Affiliation(s)
- Gillian Raine
- Lead Nurse, Marie Curie Hospice, Newcastle upon Tyne, UK
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Dalgleish L, Campbell J, Finlayson K, Barakat-Johnson M, Beath A, Ingleman J, Parker C, Coyer F. Understanding Skin Failure: A Scoping Review. Adv Skin Wound Care 2021; 34:542-550. [PMID: 34175867 DOI: 10.1097/01.asw.0000755844.87283.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To map the use of the term "skin failure" in the literature over time and enhance understanding of this term as it is used in clinical practice. DATA SOURCES The databases searched for published literature included PubMed, Embase, the Cumulative Index for Nursing and Allied Health Literature, and Google Scholar. The search for unpublished literature encompassed two databases, Open Gray and ProQuest Dissertation and Theses. STUDY SELECTION Search terms included "skin failure," "acute skin failure," "chronic skin failure," and "end stage skin." All qualitative and quantitative research designs, editorial, opinion pieces, and case studies were included, as well as relevant gray literature. DATA EXTRACTION Data collected included author, title, year of publication, journal name, whether the term "skin failure" was mentioned in the publication and/or in conjunction with other skin injury, study design, study setting, study population, sample size, main focus of the publication, what causes skin failure, skin failure definition, primary study aim, and primary outcome. DATA SYNTHESIS Two main themes of skin failure were identified through this scoping review: the etiology of skin failure and the interchangeable use of definitions. CONCLUSIONS Use of the term "skin failure" has increased significantly over the past 30 years. However, there remains a significant lack of empirical evidence related to skin failure across all healthcare settings. The lack of quality research has resulted in multiple lines of thinking on the cause of skin failure, as well as divergent definitions of the concept. These results illustrate substantial gaps in the current literature and an urgent need to develop a globally agreed-upon definition of skin failure, as well as a better understanding of skin failure etiology.
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Affiliation(s)
- Lizanne Dalgleish
- At the School of Nursing, Queensland University of Technology, Brisbane, Australia, Lizanne Dalgleish, PhD, RN, is PhD Candidate; Jill Campbell, PhD, RN, is Senior Research Fellow; Kathleen Finlayson, PhD, RN, is Lecturer; Jessica Ingleman, MSN, RN, is Lecturer; Christina Parker, PhD, RN, is Senior Lecturer; and Fiona Coyer, PhD, RN, is Professor. Michelle Barakat-Johnson, PhD, RN, is Senior Lecturer, University of Sydney, Camperdown. Amy Beath, BSN, RN, is Transitional Nurse Practitioner-Wounds, Murrumbidgee Local Health District, New South Wales. The authors have disclosed no financial relationships related to this article. Submitted June 21, 2020; accepted in revised form December 1, 2020; published online ahead of print June 23, 2021
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Cornish L. Preventing and managing pressure ulcers in patients receiving palliative care. Nurs Older People 2021; 33:34-41. [PMID: 34105318 DOI: 10.7748/nop.2021.e1299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 06/12/2023]
Abstract
Pressure ulcers are more common in patients being cared for in palliative care settings than in the general population. Patients with life-limiting illnesses are living longer than ever before, and many present with multiple co-morbidities. Palliative care involves improving the patient's quality of life by achieving a balance between treatment, comfort and maintaining dignity. The length of time required to heal pressure ulcers in this patient population can prove challenging, requiring significant resources and expertise. However, when the appropriate nursing expertise and resources are available, prevention, improvement and healing of pressure ulcers are achievable.
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Musa L, Ore N, Raine G, Smith G. Clinical impact of a sub-epidermal moisture scanner: what is the real-world use? J Wound Care 2021; 30:198-208. [PMID: 33729842 DOI: 10.12968/jowc.2021.30.3.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The presence of sub-epidermal moisture (SEM) over a bony prominence is indicative of incipient pressure ulcer (pressure injury/decubitus/bedsore) (PU). Early identification of patients at increased risk of PU can prompt interventions that reduce the incidence and severity of hospital (or community)-acquired PUs (HAPUs). This study evaluated the clinical utility of a SEM Scanner device in HAPU management. METHOD The study used a pragmatic 'real-world' approach. HAPU data before and during SEM Scanner use were obtained through routine audit. Patients had regular visual and daily SEM Scanner skin assessments over the sacrum and heels. Nursing care otherwise followed standard of care according to the established protocols of individual participating sites. HAPU incidence rates were determined and feedback gathered from health professionals on how the device influenced HAPU-related clinical decision-making. RESULTS There were 15 participating sites: 13 acute care, one palliative care and one community care setting. The sample size was 1478 patients. All sites reported a substantial reduction in mean HAPU incidence: 87.2% in acute care settings; 46.7% in the palliative care setting and 26.7% in the community care setting. A 100% incidence reduction was reported in 10 (66.7%) sites. In the palliative care setting, SEM Scanner results changed HAPU-related clinical decision-making for 40% of patients scanned. The community care site demonstrated a 82% change in clinical decision-making. CONCLUSION In this study, SEM analysis fitted seamlessly into routine skin assessment and enabled early identification of increased risk of tissue damage, with clinically important reductions in the incidence of HAPU across all participating sites.
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Affiliation(s)
- Louisa Musa
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Nicky Ore
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | | | - Glenn Smith
- St. Helens Medical Centre, Isle of Wight, UK
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36
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Samuriwo R. End of life skin care - Research informing theory to traverse between Scylla and Charybdis? Palliat Med 2021; 35:986-987. [PMID: 34092139 DOI: 10.1177/02692163211019192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- Wales Centre for Evidence Based Care, Cardiff University, Cardiff, United Kingdom
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Nayar SK, Li D, Ijaiya B, Lloyd D, Bharathan R. Waterlow score for risk assessment in surgical patients: a systematic review. Ann R Coll Surg Engl 2021; 103:312-317. [PMID: 33851894 DOI: 10.1308/rcsann.2020.7136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The Waterlow score (WS) is used routinely in clinical practice to assess risk of pressure sore development. Recent studies have also suggested its use in preoperative risk stratification. The primary aim of this systematic review was to evaluate the current evidence on the WS in predicting morbidity and mortality in surgical patients. METHODS A systematic review was carried out in accordance with PRISMA and SWiM guidelines. A search strategy was conducted on the MEDLINE and EMBASE databases. Quality was assessed using the Newcastle-Ottawa scale. FINDINGS Overall, 72 papers were identified, of which 7 met inclusion criteria for full text review, and 4 were included for analysis. All studies were cohort in nature and published between 2013 and 2016, encompassing a total of 505 surgical patients. The studies included general, vascular, transplant and orthopaedic surgery. A high WS was demonstrated to have statistically significant association with increased morbidity and mortality as well as need for intensive care unit admission and length of stay. Furthermore, this was a more accurate predictor compared with the P-POSSUM and ASA scoring systems used currently in routine practice. CONCLUSIONS The WS is a promising tool for risk stratification of surgical patients. It is already collected routinely by nursing staff throughout hospitals in the UK and would therefore be easy to implement. However, further large prospective studies are required in order to validate these findings prior to its establishment for this role in everyday surgical practice.
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Affiliation(s)
- S K Nayar
- Whittington Health NHS Trust, London, UK
| | - D Li
- University Hospitals of Leicester NHS Trust, UK
| | - B Ijaiya
- University Hospitals of Leicester NHS Trust, UK
| | - D Lloyd
- University Hospitals of Leicester NHS Trust, UK
| | - R Bharathan
- University Hospitals of Leicester NHS Trust, UK
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Huang C, Ma Y, Wang C, Jiang M, Yuet Foon L, Lv L, Han L. Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis. Nurs Open 2021; 8:2194-2207. [PMID: 33630407 PMCID: PMC8363405 DOI: 10.1002/nop2.792] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
AIM Pressure injuries are common adverse events in clinical practice, affecting the well-being of patients and causing considerable financial burden to healthcare systems. It is therefore essential to use reliable assessment tools to identify pressure injuries for early prevention. The Braden Scale is a widely used tool to assess pressure injury risk, but the literature is currently lacking in determining its accuracy. This study aimed to evaluate the accuracy of the Braden Scale in assessing pressure injury risk. DESIGN Systematic review and meta-analysis. METHODS Articles published between 1973-2020 from periodicals indexed in the PubMed, EMBASE, CINAHL, Web of Science and the Cochrane Library were selected. Two reviewers independently selected the relevant studies for inclusion. Data were analysed by the STATA 15.0 and the RevMan 5.3 software. RESULTS In total, 60 studies involving 49,326 individuals were eligible for this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.78 (95% CI: 0.74 to 0.82), 0.72 (95% CI: 0.66 to 0.78), 2.80 (95% CI: 2.30 to 3.50), 0.30 (95% CI: 0.26 to 0.35), 9.00 (95% CI: 7.00 to 13.00) and 0.82 (95% CI: 0.79 to 0.85), respectively. Subgroup analyses indicated that the AUC was higher for prospective design (0.84, 95% CI: 0.81 to 0.87), mean age <60 years (0.87, 95% CI: 0.84 to 0.90), hospital (0.82, 95% CI: 0.79 to 0.86) and Caucasian population (0.86, 95% CI: 0.82 to 0.88). In addition, 18 was found to be the optimal cut-off value. CONCLUSION The evidence indicated that the Braden Scale had a moderate predictive validity. It was more suitable for mean age <60 years, hospitalized patients and the Caucasian population, and the cut-off value of 18 might be used for the risk assessment of pressure injuries in clinical practice. However, due to the different cut-off values used among included studies, the results had a significant heterogeneity. Future studies should explore the optimal cut-off value in the same clinical environment.
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Affiliation(s)
- Can Huang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Chenxia Wang
- Nursing Department, Gansu Provincial Hospital, Lanzhou, China
| | - Mengyao Jiang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Loretta Yuet Foon
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Lin Lv
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Nursing Department, Gansu Provincial Hospital, Lanzhou, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Nursing Department, Gansu Provincial Hospital, Lanzhou, China
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Artico M, Piredda M, D'Angelo D, Lusignani M, Giannarelli D, Marchetti A, De Chirico C, Mastroianni C, De Marinis MG. Prevalence, incidence and associated factors of pressure injuries in hospices: A multicentre prospective longitudinal study. Int J Nurs Stud 2020; 111:103760. [PMID: 32919359 DOI: 10.1016/j.ijnurstu.2020.103760] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients in palliative care are the population cohort that most frequently develop pressure injuries, severely impacting their quality of life. Data from prospective studies on the prevalence and incidence of pressure injuries in hospices are lacking. AIM To describe the point prevalence and cumulative incidence of pressure injuries in patients admitted to residential hospices, and to analyze their predictive factors over time. DESIGN Multicentre prospective longitudinal observational study. SETTING/PARTICIPANTS Adult patients (n = 992) enrolled in 13 Italian residential hospices, with a minimum sample of 280 for each macro-region (North, center, South/Islands). METHODS Assessments including the Karnofsky Performance Status, Braden, Edmonton Symptom Assessment System Revised scales and pressure injury staging according to National Pressure Ulcer Advisory Panel were conducted at least every four days, from admission to patients' death/discharge. RESULTS The 7,967 observations recorded provided prevalence and incidence rates of 34.1% and 26.5%, respectively. The logistic regression model showed non-cancer disease (OR = 2.39, 95%CI = 1.65-3.47), age >80 (OR = 2.01, 95%CI = 1.49-2.71), Braden score 'at risk' (OR = 1.92, 95%CI = 1.17-3.14), urinary catheter (OR = 1.96, 95%CI = 1.40-2.75), drowsiness (OR = 1.41, 95%CI = 1.02-1.95) and artificial nutrition (OR = 1.47, 95%CI = 1.01-2.14) as the variables associated with pressure injury at admission. The generalized estimating equations models, built on the timeframes for observation groups, revealed male gender (OR = 1.68, 95%CI = 1.01-2.79) and Braden score 'at risk' (OR = 4.45, 95%CI = 1.74-11.34) as predictive factors of a new pressure injury developed up to three weeks before a patient's death, while in the last ten days of life these predictors were replaced by diagnosis of cancer (OR = 1.80, 95%CI = 1.11-2.91), worsening pain (OR = 1.65, 95%CI = 1.10-2.49), drowsiness (OR = 1.79, 95%CI = 1.25-2.57) and dyspnea (OR = 1.48, 95%CI = 1.01-2.18). CONCLUSIONS The high incidence and prevalence of pressure injuries confirm the importance of palliative care nurses continuously focusing on prevention and management strategies. In the last three weeks of a patient's life, the predictive power of the Braden scale for a new pressure injury is not confirmed, throwing doubt on the effectiveness of aimed interventions at modifying risk factors. Along the different disease trajectories, pressure injuries developed during the instability/worsening phases of illness, occurring before hospice admission for non-cancer patients and in the end-of-life phase for cancer patients. Despite continuous provision of appropriate interventions, most of the new pressure injuries were detected during the last ten days of a patient's' life and assessed as 'unavoidable'. These results are crucial to guiding palliative care nursing plans during the different phases of illness, and to predicting care needs, possible management strategies ('wound management' vs. 'wound palliation'), and resource utilization.
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Affiliation(s)
- Marco Artico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Daniela D'Angelo
- Center for Clinical Excellence and Quality of Care (CNEC), Istituto Superiore di Sanità (ISS), Via Regina Elena, 299, Rome 00161, Italy.
| | - Maura Lusignani
- Associate Professor, Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 35, Milan 20133, Italy.
| | - Diana Giannarelli
- Biostatistical Unit, National Cancer Institute "Regina Elena" - IRCCS, Via Chianesi, 53, Rome 00144, Italy.
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Cosimo De Chirico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Chiara Mastroianni
- Centro ANTEA, Piazza Santa Maria della Pietà, 5 Pad. XXII, Rome 00135, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
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Ge R, Gao G. Anti-antioxidant impacts of circZNF609 silence in HaCaT cells through regulating miR-145. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2020; 48:384-392. [PMID: 31905030 DOI: 10.1080/21691401.2019.1709863] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: CircZNF609 (cZNF609) is previously revealed as an essential mediator in oxidative stress. This paper determined the role of cZNF609 in skin oxidative damage to evaluate its importance in pressure ulcer.Methods: HaCaT cells treated by H2O2 were considered as a cell model of pressure ulcer. The role of cZNF609 in the model was checked by conducting CCK-8 assay, FITC-PI double-staining, ROS detection and Western blot. The downstream gene and signalling of cZNF609 were studied by utilizing qRT-PCR and Western blot.Results: HaCaT cells were remarkably damaged by H2O2, as evidenced by the viability loss, apoptosis and ROS generation. It was coupled with the elevated expression of p53, p16, Bax and the activated forms of caspase-3 and PARP. Meanwhile, cZNF609 was high-expressed in response to H2O2. The oxidative stress driven by H2O2 was alleviated by transfection with cZNF609 specific siRNA. Further, the anti-antioxidant impacts of cZNF609 silence were impeded by miR-145 silence. The inhibition of JNK and p38MAPK pathways induced by cZNF609 silence was impeded by miR-145 silence.Conclusion: The protective function of cZNF609 silence in H2O2-injured HaCaT cells was revealed in vitro. Silence of cZNF609 exhibited its impact possibly through regulating miR-145, and JNK and p38MAPK pathways.
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Affiliation(s)
- Rongli Ge
- Department of Galactophore, Linyi Central Hospital, Linyi, China
| | - Guanglei Gao
- Department of Galactophore, Linyi Central Hospital, Linyi, China
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Samuriwo R, Lovell-Smith C, Anstey S, Job C, Hopkinson J. Nurses' decision-making about cancer patients' end-of-life skin care in Wales: an exploratory mixed-method vignette study protocol. BMJ Open 2020; 10:e034938. [PMID: 32624470 PMCID: PMC7337620 DOI: 10.1136/bmjopen-2019-034938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Patients with cancer are at high risk of developing pressure ulcers at the end of life as a result of their underlying condition or cancer treatment. There are many guidelines which set out best practice with regard to end-of-life skin care. However, the complexity of palliative cancer care often means that it is challenging for nurses to make the appropriate person-centred decisions about end-of-life skin care. This study seeks to explore the perceived importance that nurses place on different factors in their end-of-life skin care for patients with cancer. The utility, face validity and content validity of a prototype decision-making tool for end-of-life skin care will also be evaluated. METHODS AND ANALYSIS A mixed-method design will be used to gather data from primary and secondary care nurses working in different hospitals and local authority areas across Wales. Clinical vignettes will be used to gather qualitative and quantitative data from nurses in individual interviews. Qualitative data will be subject to thematic analysis and quantitative data will be subject to descriptive statistical analysis. Qualitative and quantitative data will then be synthesised, which will enhance the rigour of this study, and pertinently inform the further development of an end-of-life skin care decision-making tool for patients with cancer. ETHICS AND DISSEMINATION Ethical approval to undertake the study has been granted by Cardiff University School of Healthcare Sciences Research Governance and Ethics Screening Committee. Informed consent will be obtained in writing from all the participants in this study. The results of this study will be disseminated through journal articles, as well as presentations at national and international conferences. We will also report our findings to patient and public involvement groups with an interest in improving cancer care, palliative care as well as skin care.
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Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
- Wales Centre for Evidence Based Care, School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | | | - Sally Anstey
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Claire Job
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jane Hopkinson
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
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Team V, Tuck M, Reeves J, Way M, Enticott J, Evans S, Weller CD. Pressure injury data in Australian acute care settings: A comparison of three data sets. Int Wound J 2020; 17:578-586. [PMID: 32027094 PMCID: PMC7948723 DOI: 10.1111/iwj.13320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Hospital-acquired pressure injuries (HAPIs) represent a serious clinical and economic problem. The cost of treating HAPIs in Australian public hospitals was recently reported at AUS$983 million per annum. There are three main sources of data for documenting pressure injury (PI) occurrence in Australian hospitals: incident reporting, medical record coded data, and real-time surveys of pressure injury. PI data reported at hospital level and to external agencies using these three different sources are variable. This reporting issue leads to inaccurate data interpretation and hinders improvement in accuracy of PI identification and PI prevention. This study involved a comparison of the three different data sources in selected Australian hospitals, to improve the accuracy and comparability of data. Findings from this study provide benchmark areas for improvement in PI documenting and reporting. Better understanding the agreement between the three data sets could lead to a more efficient and effective sharing of data sources.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
| | - Michelle Tuck
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Judy Reeves
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Margaret Way
- Safety and QualityBarwon HealthGeelongVictoriaAustralia
| | - Joanne Enticott
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
- Department of General Practice, School of Primary and Allied Health Care, Southern Synergy, Department of PsychiatryMonash UniversityMelbourneVictoriaAustralia
| | - Susan Evans
- Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Palmer K, Hill J, Clegg A. One in 10 hospitalised patients have a pressure injury worldwide. Evid Based Nurs 2020; 24:ebnurs-2020-103276. [PMID: 32398266 DOI: 10.1136/ebnurs-2020-103276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Karen Palmer
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - James Hill
- Evidence Synthesis, University of Central Lancashire, Preston, Lancashire, UK
| | - Andrew Clegg
- Evidence Synthesis, University of Central Lancashire, Preston, Lancashire, UK
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Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud 2020; 105:103546. [DOI: 10.1016/j.ijnurstu.2020.103546] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
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Team V, Bouguettaya A, Richards C, Turnour L, Jones A, Teede H, Weller CD. Patient education materials on pressure injury prevention in hospitals and health services in Victoria, Australia: Availability and content analysis. Int Wound J 2020; 17:370-379. [PMID: 31850664 PMCID: PMC7948898 DOI: 10.1111/iwj.13281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 12/14/2022] Open
Abstract
Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high-quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence-based, consumer-endorsed, uniform materials on all hospital websites to prevent PIs in acute care.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
| | - Ayoub Bouguettaya
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Catelyn Richards
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Louise Turnour
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
| | - Helena Teede
- Monash Partners Academic Health Science Centre, 43‐51 Kanooka Grove ClaytonVictoriaAustralia
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Karimian M, Khalighi E, Salimi E, Borji M, Tarjoman A, Mahmoudi Y. The effect of educational intervention on the knowledge and attitude of intensive care nurses in the prevention of pressure ulcers. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 31:89-95. [PMID: 32039864 DOI: 10.3233/jrs-191038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pressure ulcers can cause disability, which can lead to a default in patients' safety and results in frequent complications for patients. OBJECTIVES This study aimed to determine the effect of educational intervention on nurses' knowledge and attitude in preventing pressure ulcers. METHODS In this study, 67 nurses of ICU wards at Ilam University of Medical Sciences were randomly assigned to the experimental or control group. Data collection tools included the demographic characteristics questionnaire, the Pieper Pressure Ulcer Knowledge test (PUKT) and the Attitude toward Pressure Ulcer tool (APuP). In the experimental group, the nurses were allocated into groups of four-five persons and for each group four face-to-face training sessions and two virtual training sessions by means of educational videos on bed sores were performed. Gathered data were analyzed using SPSS software version 16, and descriptive and analytical tests were performed. RESULTS PUKT questionnaire score in the experimental group improved from 15.68 (3.42) to 29.75 (12.33) (P = 0.000), while in the control group it was 16.40 (3.13) and 17.54 (6.62) before intervention, which was not significant (P > 0.05). Furthermore, the APUP questionnaire score in the experimental group improved from 27.12 (2.13) to 39.37 (3.21) (P = 0.000), while in the control group it was 27.65 (1.71) and 28.37 (5.00) before intervention, which was not significant (P > 0.05). CONCLUSIONS Since educational intervention improved the knowledge and attitude of nurses in preventing pressure ulcers, it is required to conduct appropriate educational interventions to improve their knowledge and attitude.
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Affiliation(s)
- Mohamad Karimian
- Assistant Professor of Vascular Surgery, Ilam University of Medical Sciences, Ilam, Iran
| | - Ebrahim Khalighi
- Department of Anaesthesiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ebrahim Salimi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Milad Borji
- Department of Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asma Tarjoman
- Student Research Committee, Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Yosof Mahmoudi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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