An overview of co-morbidities and the development of pressure ulcers among older adults

Biomonitoring of toxic metal exposure in New Jersey adults in 2015-2018

This study explores the potential of a convenience sample-based probing approach as a cost-effective alternative for state-level biomonitoring surveillance, addressing the logistical and practical challenges when applying comprehensive probability-based population studies at a state-level. The New Jersey Department of Health (NJDOH) conducted a large-scale biomonitoring study using 2988 blood samples and 1007 urine samples collected from clinical laboratories and blood banks statewide from 2015 to 2018 to characterize toxic metal exposure patterns and trends. The resulting data were analyzed to identify contributing factors and compared to concurrent U.S. population levels from the National Health and Nutrition Examination Survey (NHANES). The study also examined spatial factors such as proximity to environmental sources and residential classification (urban, suburban, and rural) on exposure levels. Results showed that New Jersey adults had higher prevalence levels of mercury in blood (8.1%; ≥5 μg/L) and arsenic in urine (4.1%; ≥100 μg/L) than US adults (5.98% and 2.87%, respectively). Metal levels varied by sex and age, with lower levels observed in younger populations (20-39 years). Proximity to Superfund sites and residential classification were generally not significant factors in explaining measured metal concentrations. This first-of-its-kind study of toxic metal levels in New Jersey adults demonstrates the effectiveness of the convenience sample-based approach in rapidly establishing statewide baseline data. The results highlight the need for ongoing biomonitoring of the New Jersey population and provide valuable baseline information for future research. These findings offer crucial insights for healthcare providers and policymakers in addressing environmental contaminant exposures and developing targeted public health interventions.

Skin Ulcer Development and Deterioration of Social Engagement among Nursing Home Residents

OBJECTIVES

Skin ulcers are a critical indicator of quality of care in nursing homes that influence residents' physical, psychological, and social health. The objective of this study is to understand the influence of developing skin ulcers on deterioration in social engagement in nursing home residents.

DESIGN

Observational retrospective cohort study with 1-year follow-up.

SETTING AND PARTICIPANTS

Nursing home residents aged ≥50 years were followed quarterly (2008/2009-2009/2010), the latest years in which the Minimum Data Set 2.0 measured social engagement.

METHODS

Cumulative incidence ratios (CIRs) and 95% CIs quantified the association between skin ulcer development and deterioration in residents' social engagement levels.

RESULTS

About 1.25% first developed new skin ulcers at the annual follow-up assessment; 1.22% developed skin ulcers at a quarterly assessment that persisted at the annual assessment, and 4.53% developed skin ulcers at a quarterly assessment that were resolved by annual assessment. Compared with residents who remained ulcer-free, those with new skin ulcer at annual assessment and persistent skin ulcers were at increased risk of experiencing a reduction in social engagement (CIR, 1.26; 95% CI, 1.11-1.44; CIR, 1.32; 95% CI, 1.16-1.50, respectively). Those with resolved skin ulcers were also at increased risk of social engagement deterioration (CIR, 1.12; 95% CI, 1.04-1.21) than those who remained ulcer-free.

CONCLUSION AND IMPLICATIONS

Residents who develop skin ulcers are at a higher risk of deteriorating social engagement. Nursing home staff should strive not only to prevent and treat skin ulcers, but also to support social engagement for those with skin ulcers.

A novel skin temperature estimation system for predicting pressure injury occurrence based on continuous body sensor data: A pilot study

BACKGROUND

Pressure injury prevention is important in older patients with immobility. This requires an accurate and efficient prediction of the development of pressure injuries. We aimed to develop a method for estimating skin temperature changes due to ischemia and inflammation using temperature sensors placed under bedsheets to provide an objective, non-invasive, and non-constrained risk assessment tool.

METHODS

This study consisted of a thermal skin simulation study and a descriptive correlation study in healthy participants. A thermal skin simulation study was conducted using a model reproducing the body surface (underwear, diaper, or wet diaper conditions) and bed environment. In a descriptive-correlational study, the participants lay supine on a mattress with a temperature sensor attached to their sacral skin.

FINDINGS

The thermal skin simulation study showed that temperature changes in the skin can be estimated under the sheets by inputting time-shifted temperature data into machine learning (R2 = 0.9967 for underwear, 0.9950 for diapers, and 0.9869 for wet diapers). It was also demonstrated that the absolute skin temperature of a healthy individual (N = 17) could be estimated with the best accuracy by inputting time-shifted data into an extra-tree regressor (R2 = 0.8145).

INTERPRETATION

A combination of interface pressure and temperature sensors can be used to estimate skin temperature changes. These findings contribute to the development of a skin temperature measurement method that can capture temperature changes over time in clinical settings.

Perforator-Based Propeller Flap Application in Pressure Ulcer Reconstruction: A Comparative Analysis With Advancement Flaps

BACKGROUND

Pressure ulcers are a prevalent and debilitating condition, often necessitating surgical reconstruction. Various flap techniques, such as Advancement Flaps (AF) and Perforator-based Propeller Flaps (PBPF), are commonly used for pressure sore reconstruction. While both techniques have proven effective, there is limited research comparing their outcomes in different clinical scenarios. In recent years, PBPF has demonstrated favorable outcomes in various reconstruction fields. However, there remains a need to establish the optimal technique for specific clinical conditions and patient populations. Therefore, this study aims to compare the outcomes of PBPF and AF in patients undergoing pressure ulcer reconstruction.

METHODS

A retrospective analysis was performed on patients who underwent pressure sore reconstruction utilizing either AF or PBPF techniques between January 2020 and December 2023. Data on demographics, pressure ulcer details, operative time, hospital stay, recurrence rate, and complications were collected and analyzed.

RESULTS

In this study of 56 patients, 30 underwent AF, and 26 underwent PBPF. Demographic and clinical characteristics showed no significant differences. Clinical and surgical outcomes indicated no significant differences in defect size (p = 0.517), hospitalization period (p = 0.786), follow-up duration (p = 0.746), number of preoperative debridements (p = 0.781), time to recurrence (p = 0.224), or postoperative complications (p = 0.757). However, PBPF resulted in a smaller flap size (93.7 ± 29.5 cm2 for AF vs. 70.5 ± 19.7 cm2 for PBPF, p < 0.001), a longer operation time compared to AF (94.6 ± 39.1 min for AF vs. 161.0 ± 38.9 min for PBPF, p < 0.001), and lower recurrence rate in long-term follow-up (p = 0.036).

CONCLUSIONS

PBPF may have the drawback of prolonged surgical time due to the complexity of the surgical procedure. However, when applied appropriately, it can be a meaningful surgical approach for reducing the recurrence rate of pressure ulcers.

Clinical Presentation and Integrated Management of Pressure Injuries in the Emergency Hospital Setting: A Plastic Surgeon's Perspective

Background: Pressure injuries are localized areas of tissue damage or necrosis that occur when pressure is applied to the skin for prolonged periods, often over bony prominences, often the sacrum, heels, ischial tuberosities, and greater trochanters. The pathophysiology is complex, involving a combination of mechanical forces, ischemia, and tissue hypoxia. Methods: We conducted a 2-year retrospective study aiming to assess the clinical characteristics, risk factors, and management of pressure injuries in patients admitted to an emergency hospital who underwent a plastic surgery examination. Results: This study included 176 patients with clinically diagnosed pressure ulcers, with findings showing 28.52% of cases as stage III and 35.57% as stage IV. Common sites included the sacrum (40.94%), ischium (15.1%), and heel (14.43%). The median patient age was 76 years, with 47.15% between 60 and 80 years and 36.93% ≥ 80 years, often presenting with comorbidities increasing the risk of pressure injuries, such as cardiovascular disease (71.59%), diabetes (18.18%) and obesity (9.66%). Important risk factors included neurological diseases (46.02%), spinal cord injuries (14.7%), and nutritional deficiencies, as indicated by anemia (10.43g/dL; 95% CI [10.04; 10.82]), low serum albumin (2.56 g/dL; 95% CI [2.43; 2.69]) and proteins (5.54 g/dL; 95% CI [5.34; 5.73]). Mortality was significant, at 36.93%, with 23.3% occurring within the first 7 days of hospitalization due to the patients' critical condition. Decision-making for surgical intervention considered the patient's general status, comorbidities, and ulcer severity. Surgical treatment consisted of seriate debridement, negative pressure vacuum therapy, and/or coverage using skin grafting, local advancement, or rotation flaps. Conclusions: The key question for a plastic surgeon to consider is how pressure ulcers should be managed. Various debridement and covering techniques should be tailored to the wound's characteristics, considering patient comorbidities and general health condition.

Influence of photobiomodulation and radiofrequency on the healing of pressure lesions in mice

The objective of this study was to ascertain the impact of photobiomodulation and radiofrequency on the healing of pressure injuries in mice. A total of 70 animals were randomly assigned to seven experimental groups. A pressure injury was induced in the dorsal region of the mice by the application of two magnets. The photobiomodulation treatment was administered at a dosage of 3.6 J per session. In the radiofrequency group, the treatment time was four minutes and the power was 22 watts. The analyses included the lesion area, infrared thermography, and the collection of material for cytokine, histological, and histochemical analyses following euthanasia. In the macroscopic analyses, the 660 nm photobiomodulation group demonstrated superior outcomes in comparison to the control group. With regard to the microscopic analyses, the greatest difference between the groups was observed when TNF-α was evaluated in the photobiomodulation group. It can be observed that the groups irradiated by electrophysical means (i.e., a combination of radiofrequency with PBM 830 nm-660 nm) exhibited a positive influence on the repair process, with the greatest impact observed in the group irradiated by a combination of radiofrequency and 660 nm photobiomodulation.

Phage Therapy Against Antibiotic-Resistant and Multidrug-Resistant Infections Involving Nonhealing Wounds and Prosthetic Joint Infections Associated With Biofilms: A Mini-Review

Chronic wounds and prosthetic joint infections are difficult to treat and are associated with a high burden of disease and economic cost. The rise of antibiotic resistance and the understanding of biofilm formation has inflamed an already challenging situation. Bacteriophage therapy has been used throughout the last century to treat bacterial infections. However, in the last 10 years, there has been a resurgence in phage therapy as a novel innovative treatment for nonhealing wounds. This mini systemic review assesses relevant clinical studies, case series and trials over 5 years associated with safety, treatment and success rates of phage therapy concerning nonhealing and prosthetic joint infections. A search of PubMed, Web of Science, Cochrane and Clinical Trials.gov databases resulted in 3151 studies, 27 met the criteria, and a total of 152 bacterial infections were treated from 130 individuals. Most common pathogen isolated in wounds was P. aeruginosa, and S. aureus was mostly associated with prosthetic joint infections. Treatment modalities differed across studies, adverse effects were limited, and success rate was deemed to be 91%.

Evaluating the Knowledge of Home Caregivers on Pressure Ulcer Signs and Prevention in Elderly Patients in Al Ahsa

Background Pressure ulcers are significant health issues affecting elderly patients, leading to severe complications, prolonged hospital stays, and high healthcare costs. Preventive care by home caregivers plays a crucial role in mitigating the development of pressure ulcers. Objective This study aims to assess home caregivers' knowledge of pressure ulcer prevention and investigate the factors associated with knowledge levels in elderly patients in Al Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted involving 231 home caregivers of elderly patients registered in Home Health Care, Al-Ahsa Health Cluster. Data were collected using an online questionnaire assessing demographic information and knowledge of pressure ulcer prevention, adapted from the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0. Data analysis was performed using SPSS version 29.0 (IBM Corp., Armonk, USA), with a Chi-square test used for bivariate analysis of categorical outcomes. Results The majority of caregivers were female (64.5%), aged between 35 and 50 years (47.6%), and primarily family members (83.5%). Most caregivers had been providing care for 5 years or less (79.7%), with 67.5% never having received training in pressure ulcer prevention. Knowledge levels were generally sufficient, with 87.0% of caregivers showing adequate knowledge of pressure ulcer prevention. Significant associations were found between knowledge levels and caregiving duration (p=0.006) as well as training in pressure ulcer prevention (p=0.001). However, other demographic factors, such as age and gender, were not significantly associated with knowledge levels. Conclusion The study found that most home caregivers possess sufficient knowledge of pressure ulcer prevention, although training and caregiving duration significantly influence knowledge levels. These findings underscore the need for comprehensive training programs to improve caregivers' knowledge and practice, thereby enhancing the quality of care for elderly patients and reducing the incidence of pressure ulcers.

Care Home Safety Incidents and Safeguarding Reports Relating to Hospital to Care Home Transitions: A Retrospective Content Analysis

OBJECTIVE

The purpose of this study was to further the understanding of reported patient safety events at the interface between hospital and care home including what active failings and latent conditions were present and how reporting helped learning.

METHODS

Two care home organizations, one in the North East and one in the South West of England, participated in the study. Reports relating to a transition and where a patient safety event had occurred were sought during the COVID-19 (SARS-CoV-2) virus prepandemic and intrapandemic periods. All reports were screened for eligibility and analyzed using content analysis.

RESULTS

Seventeen South West England care homes and 15 North East England care homes sent 114 safety incident reports and after screening 91 were eligible for review. A hospital discharge transition (n = 78, 86%) was most common. Pressure damage (n = 29, 32%), medication errors (n = 26, 29%) and premature discharge (n = 21, 23%) contributed to 84% of the total reporting. Many 'active failings' (n = 340) were identified with fewer latent conditions (failings) (n = 14, 15%) being reported. No examples of individual learning were identified. Organization and systems learning were identified in 12 reports (n = 12, 13%).

CONCLUSIONS

The findings highlight potentially high levels of underreporting. The most common safety incidents reported were pressure damage, medication errors, and premature discharge. Many active failings causing numerous staff actions were identified emphasizing the cost to patients and services. Additionally, latent conditions (failings) were not emphasized; similarly, evidence of learning from safety incidents was not addressed.

Hospital-acquired pressure ulcers among adult ICU patients in tertiary hospitals in Oman: a one-year prevalence study

BACKGROUND

Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman.

METHOD

A retrospective, cross-sectional, nested, case-control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January-31 December 2019) in two tertiary hospitals in Oman.

RESULTS

The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001).

CONCLUSION

HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs.

Impact of the degree of synergy between patient and nurse perceptions on the clinical outcome of pressure injury prevention: a mixed-methods systematic review protocol

INTRODUCTION

Pressure injuries are a common and significant concern in clinical practice, often serving as a vital quality indicator. While (clinical) practice guidelines have been established to offer recommendations for mitigating hospital-acquired pressure injuries, adherence among stakeholders remains inconsistent. The subjective perceptions of stakeholders, such as patients and nurses, may impede adherence to pressure ulcer prevention guidelines, potentially reducing the effectiveness of these interventions. However, there is currently insufficient evidence to comprehensively understand this influence. Therefore, this review aims to offer a broader understanding of how the perspectives of patients and nurses engaged in pressure injury prevention affect the effectiveness of specific interventions for pressure ulcer management.

METHODS AND ANALYSIS

We will conduct a convergent, segregated mixed-methods systematic review and perform a narrative synthesis with a focus on evidence of the effectiveness of pressure injury prevention strategies and patient and nurse perceptions. Our search will encompass several databases, including the 'Centre for Reviews and Dissemination' (CRD) Database, Medline (via Ovid), CINAHL (via Ebsco) and Scopus (via Elsevier). Additionally, we will cross-check reference lists from all included systematic reviews. Two independent reviewers will screen titles, abstracts, and full texts and extract data from the included studies. The quality of methodology of systematic reviews will be assessed using 'A Measurement Tool to Assess Systematic Reviews-2' (AMSTAR 2) and the risk of bias using 'Risk of Bias in Systematic Reviews' (ROBIS). Qualitative studies will undergo critical appraisal using appropriate Joanna Briggs checklists. If it is feasible to pool data from included studies, we will synthesise them accordingly, using meta-analysis for quantitative reviews and meta-aggregation for qualitative studies. The results from both qualitative and quantitative analyses will be compared with derive new recommendations for healthcare practice aimed at enhancing the quality of care.

ETHICS AND DISSEMINATION

Ethical approval is not required due to the nature of this intended review. The results of this review will be disseminated through publications, reports and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42023438792.

The wound healing and hypoglycemic activates of date palm (Phoenix dactylifera) leaf extract and saponins in diabetic and normal rats

INTRODUCTION

Indigenous plants have historically been crucial in treating human diseases across various cultures worldwide. Research continues to uncover new therapeutic uses for indigenous plants, from treating infectious diseases to managing chronic conditions such as diabetes and wound care. This study aimed to examine the effect of palm tree leaves "Phoenix dactylifera L" extract and its topical film formulation on wound healing and blood glucose levels.

METHODS

Palm leaves were collected, authenticated, powdered, and extracted with ethanol by cold maceration. Saponins were isolated. The dried extract was analyzed using reverse-phase high-pressure liquid chromatography to identify the phytochemicals present. Diabetes mellitus was induced by a single intraperitoneal injection of Streptozotocin (40mg/kg). Rats with blood glucose levels ≥ 200 mg/dl were used to determine the reduction in blood glucose with or without the oral extract. Incision and excision wounds were induced in both diabetic and normal rats. Topical films containing extract or saponin and inert films were applied to the wounds every other day, and wound sizes were recorded until the wound was completely healed.

RESULTS

The presence of six flavonoids, Naringin, Rutin, Quercetin, Kaempferol, Apigenin, and Catechin, and five phenolic acids, Syringic acid, p Coumaric acid, Caffeic acid, Ferulic acid, Ellagic acid were detected in the dried extract. A significant reduction in blood sugar in diabetic rats and wound diameter in the treated group compared to the control group in both diabetic and normal rats was observed, confirming the promising role of palm leaf extract on diabetes and wound care. Macroscopic, morphometric, and histological data suggested that the cutaneous wound healing in rats treated with the leaf extract was better and faster than the control or inert groups.

CONCLUSIONS

Our research findings highlight the marked effect of Phoenix dactylifera extract as a supportive or alternative treatment for both hyperglycemia and incision or excision wounds. Further research and clinical trials are warranted to validate these findings and explore the underlying mechanisms of action.

Point prevalence and risk factors for pressure ulcers in hospitalized adult patients: a cross-sectional study

OBJECTIVE

To estimate the point prevalence of and risk factors associated with the development of pressure ulcers at a university hospital in Brazil.

METHODS

This study was conducted on 196 participants using a structured questionnaire, physical examination of the skin, and the Braden scale. The Mann-Whitney U, χ2, or Fisher's exact tests were used to compare the participants and the associations of variables with pressure ulcers. A modified multivariate Poisson regression model was built considering the presence of pressure injuries and the independent variables.

RESULTS

The point prevalence of pressure ulcers was 10.71% and was significantly associated with less than 12 years of schooling (p=0.0213), use of antihypertensive drugs during hospital stay (p=0.0259), diagnosis of systemic hypertension (p=0.0035), and diabetes mellitus. Lower scores on the Braden scale (p=0.0001) were positively associated with the presence of pressure ulcers. Furthermore, cardiovascular disease (p=0.0267) and diaper use (p=0.0001) were associated with the presence of pressure ulcers. Moreover, they were also associated with prolonged hospital stay, advanced age, less than 12 years of schooling, use of antihypertensive drugs, hypertension, diabetes, and lower Braden scale scores.

CONCLUSION

Health professionals should be aware of the risk factors associated with pressure ulcers, evaluate patient skin daily, and offer prevention. Our findings support the need to allocate resources for the prevention and treatment of pressure injuries.

Multidimensional-Based Prediction of Pressure Ulcers Development and Severity in Hospitalized Frail Oldest Old: A Retrospective Study

Purpose

In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale.

Patients and methods

The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale.

Results

Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant.

Conclusion

Assessing the subject's nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients' frailty, skin frailty, and PU development in very old hospitalized patients.

The value of epidemiological data for pressure ulcer/injury management

Pressure ulcers/injuries (PU/Is) are a burden on healthcare systems worldwide. They are costly and have a negative impact on the quality of life of patients. PU/Is cause discomfort, prolong hospital stays and can even lead to death. Data on the incidence and prevalence of PU/Is are used to implement effective, tailored prevention practices. The aim of this paper is to highlight the importance and value of collecting epidemiological data in terms of its practical use in Slovakia. The prevalence of PU/Is was found to be low compared to global data. Shortcomings in the collection of epidemiological data are highlighted; however, the use of those available data in amending national standards, such as the mandatory reporting of PU/Is, is summarised. Several steps and activities related to the prevention and care of PU/Is have been carried out in Slovakia. It is important to know not only the prevalence in terms of field of care, time and provider, but also, more specifically, the risk characteristics and/or presence of PU/I in order to initiate more individualised and tailored patient care.

Causal effect of obesity and adiposity distribution on the risk of pressure ulcers and potential mediation by type 2 diabetes mellitus: insights from multivariable mendelian randomization and mediation analysis

Previous observational studies have identified a link between obesity, adiposity distribution, type 1 Diabetes Mellitus (T1DM), type 2 Diabetes Mellitus (T2DM), and the risk of pressure ulcers (PUs). However, the definitive causality between obesity and PUs, and potential DM mediators remains unclear. Univariable, multivariable, and mediation Mendelian randomization (MR) analyses were conducted to explore the mediating role of T1DM or T2DM in the association between obesity, adiposity distribution, and PUs. Instrumental variables for obesity and adiposity distribution, including Body Mass Index (BMI), waist circumference, hip circumference, trunk fat mass, whole body fat mass, trunk fat percentage, and body fat percentage, were selected from two genome-wide association studies (GWAS). In univariable MR analysis, BMI, hip circumference, and obesity were associated with PUs using inverse variance weighted (IVW) regression. These findings were further corroborated by the replication cohorts and meta-analysis (BMI: OR = 1.537, 95% CI = 1.294-1.824, p < 0.001; Hip circumference: OR = 1.369, 95% CI = 1.147-1.635, p < 0.001; Obesity: OR = 1.235, 95% CI = 1.067-1.431, p = 0.005), respectively. Even after adjusting for confounding factors such as T1DM and T2DM, BMI and hip circumference remained statistically significant in multivariable MR analyses. T2DM may mediate the pathogenesis of BMI-related (OR = 1.106, 95% CI = 1.054-1.160, p = 0.037) and obesity-related PUs (OR = 1.053, 95% CI = 1.034-1.973, p = 0.004). These findings provide insights for the prevention and treatment of PUs, particularly in patients with obesity or DM.

Self-Assembled Fibroblast Growth Factor Nanoparticles as a Therapeutic for Oxidant-Induced Neuronal and Skin Cell Injury

Traumatic brain injury (TBI) and spinal cord injury (SCI) are neurological conditions that result from immediate mechanical injury, as well as delayed injury caused by local inflammation. Furthermore, TBI and SCI often lead to secondary complications, including pressure wounds of the skin, which can heal slowly and are prone to infection. Pressure wounds are localized areas of damaged tissue caused by prolonged pressure on the skin due to immobility and loss of neurological sensation. With the aim to ameliorate these symptoms, we investigated whether fibroblast growth factors 2 (FGF-2) could contribute to recovery. FGF-2 plays a significant role in both neurogenesis and skin wound healing. We developed a recombinant fusion protein containing FGF-2 linked to elastin-like polypeptides (FGF-ELP) that spontaneously self-assembles into nanoparticles at around 33 °C. The nanoparticle's size was ranging between 220 and 250 nm in diameter at 2 μM. We tested this construct for its ability to address neuronal and skin cell injuries. Hydrogen peroxide was used to induce oxidant-mediated injury on cultured neuronal cells to mimic the impact of reactive oxidants released during the inflammatory response in vivo. We found that FGF-ELP nanoparticles protected against hydrogen peroxide-mediated injury and promoted neurite outgrowth. In the skin cell models, cells were depleted from serum to mimic the reduced levels of nutrients and growth factors in chronic skin wounds. FGF-ELP increased the proliferation and migration of human keratinocytes, fibroblasts, and endothelial cells. FGF-ELP is, therefore, a potentially useful agent to provide both neuroprotection and promotion of cellular processes involved in skin wound healing.

Open ankle fractures in the elderly: predisposing factors and the associated mortality

The purpose of this study was to investigate the independent effect of open ankle fractures on postoperative mortality and to identify factors leading to open ankle fractures in the elderly population. This is a retrospective case-control study of 1,045 patients aged 65 years and older, with ankle fractures undergoing surgical fixation between 2010 and 2020 at three medical centers (Levels 1-2). A logistic regression analysis was used to identify risk factors for open fractures. Propensity score matching and survival analysis were used to measure the hazard of mortality attributable to open versus closed ankle fractures. There were 128 (12.2%) patients with open ankle fractures. Patients with open ankle fractures were more likely to be older, to be active smokers (OR = 1.7, p = 0.049), and tended to have a higher number of medical comorbidities including hypertension (OR = 2, p = 0.006) and chronic kidney disease (OR = 2.9, p = 0.005). Open ankle fractures were, independently of comorbid conditions and age, associated with higher risk of mortality (HR = 1.7, p = 0.03).

Development and validation of a risk prediction model for community-acquired pressure injury in a cancer population: A case-control study

BACKGROUND

Patients with cancer are susceptible to pressure injuries, which accelerate deterioration and death. In patients with post-acute cancer, the risk of pressure injury is ignored in home or community settings.

OBJECTIVE

To develop and validate a community-acquired pressure injury risk prediction model for cancer patients.

METHODS

All research data were extracted from the hospital's electronic medical record system. The identification of optimal predictors is based on least absolute shrinkage and selection operator regression analysis combined with clinical judgment. The performance of the model was evaluated by drawing a receiver operating characteristic curve and calculating the area under the curve (AUC), calibration analysis and decision curve analysis. The model was used for internal and external validation, and was presented as a nomogram.

RESULTS

In total, 6257 participants were recruited for this study. Age, malnutrition, chronic respiratory failure, body mass index, and activities of daily living scores were identified as the final predictors. The AUC of the model in the training and validation set was 0.87 (95 % confidence interval [CI], 0.85-0.89), 0.88 (95 % CI, 0.85-0.91), respectively. The model demonstrated acceptable calibration and clinical benefits.

CONCLUSIONS

Comorbidities in patients with cancer are closely related to the etiology of pressure injury, and can be used to predict the risk of pressure injury.

IMPLICATIONS FOR PRACTICE

This study provides a tool to predict the risk of pressure injury for cancer patients. This suggests that improving the respiratory function and nutritional status of cancer patients may reduce the risk of community-acquired pressure injury.

Risk factors for pressure injuries in individuals with spinal cord injuries who have sarcopenic obesity: A comparison of time-dependent changes in sacral region pressure between individuals with and without sarcopenic obesity

OBJECTIVE

To identify the risk factors for pressure injuries in individuals with spinal cord injuries (SCIs) who have sarcopenic obesity, comparing time-dependent changes in sacral region pressure in individuals with and without sarcopenic obesity.

DESIGN

An experimental time series study.

SETTING

Single-center hospital.

PARTICIPANTS

Twenty-five adult participants with subacute and chronic paraplegia who visited our rehabilitation center, Republic of Korea, between May 2021 and June 2022.

INTERVENTIONS

Whole-body dual-energy X-ray absorptiometry was performed to diagnose sarcopenic obesity. After the participants were placed in the supine position for 1 hour, the average pressure (mmHg), peak pressure (mmHg), and total contact area (cm2) of the sacral region were measured using the pressure-mapping system.

RESULTS

Compared with the non-sarcopenic obesity group, the sarcopenic obesity group showed significant before-and-after differences in peak pressure. Furthermore, the risk factors that were significantly associated with peak pressure in the sarcopenic obesity group were the American Spinal Injury Association Impairment Scale score and the fat mass index.

CONCLUSION

Among participants with SCIs, the risk of pressure injuries is higher in the sarcopenic obesity group than in the non-sarcopenic obesity group. Notably, the risk of pressure injuries increases in participants who have complete injury and an increased fat mass index, indicating the importance of close monitoring and more active management to prevent pressure injuries in this subpopulation.

Characteristics of older adults receiving enteral feeding at a geriatric medical center

BACKGROUND

Malnutrition is a prevalent and hard-to-treat condition in older adults. enteral feeding is common in acute and long-term care. Data regarding the prognosis of patients receiving enteral feeding in geriatric medical settings is lacking. Such data is important for decision-making and preliminary instructions for patients, caregivers, and physicians. This study aimed to evaluate the prognosis and risk factors for mortality among older adults admitted to a geriatric medical center receiving or starting enteral nutrition (EN).

METHODS

A cohort retrospective study, conducted from 2019 to 2021. Patients admitted to our geriatric medical center who received EN were included. Data was collected from electronic medical records including demographic, clinical, and blood tests, duration of enteral feeding, Norton scale, and Short Nutritional Assessment Questionnaire score. Mortality was assessed during and after hospitalization. Data were compared between survivors and non-survivors. Multivariate logistic regressions were performed to identify the variables most significantly associated with in-hospital mortality.

RESULTS

Of 9169 patients admitted, 124 (1.35%) received enteral feeding tubes. More than half of the patients (50.8%) had polypharmacy (over 8 medications), 62% suffered from more than 10 chronic illnesses and the majority of patients (122/124) had a Norton scale under 14. Most of the patients had a nasogastric tube (NGT) (95/124) and 29 had percutaneous endoscopic gastrostomies (PEGs). Ninety patients (72%) died during the trial period with a median follow-up of 12.7 months (0.1-62.9 months) and one-year mortality was 16% (20/124). Associations to mortality were found for marital status, oxygen use, and Red Cell Distribution Width (RDW). Age and poly-morbidity were not associated with mortality.

CONCLUSION

In patients receiving EN at a geriatric medical center mortality was lower than in a general hospital. The prognosis remained grim with high mortality rates and low quality of life. This data should aid decision-making and promote preliminary instructions.

Providing evidence for content validity of the most frequently used hip specific recovery outcome measures in hip fracture studies: an International Classification of Functioning approach

PURPOSE

We established the most commonly used clinician and patient-reported hip fracture outcome measures as of 2022, assessed their content validity using an International Classification of Functioning, Disability and Health (ICF) framework, and operationalized these results to contribute to an updated hip fracture core set.

MATERIALS AND METHODS

A literature search was conducted to identify articles utilizing outcome measures related to hip fracture. A total of five outcome measures were identified, linked to the ICF, and assessed for content validity via bandwidth percent, content density, and content diversity.

RESULTS

Outcome measures were linked to 191 ICF codes, most of which were associated with Activities and Participation. Notably, no outcome measure contained concepts linked to Personal Factors and Environmental Factors were underrepresented across all outcome measures. The modified Harris Hip Score had the highest content diversity (0.67), the Hip Disability and Osteoarthritis Outcome Score had the highest bandwidth of ICF content coverage (2.48), and the Oxford Hip Score had the highest content density (2.92).

CONCLUSIONS

These results clarify the clinical applicability of outcome measures and guide development of hip fracture outcomes that allow providers to assess the complex role of social, environmental, and personal factors in patient rehabilitation.IMPLICATIONS FOR REHABILITATIONHip fracture is a complex and disabling pathology predominantly affecting older adults and represents a public health problem.There are a variety of outcome measures used to assess a patient's recovery following a hip fracture, each with distinctive objectives and modes of administration.Content validity metrics associated with the Harris Hip Score suggest it would be a suitable outcome measure during early-stage recovery, whereas the modified Harris Hip Score may be more suitable for tracking long-term recovery tracking.Choosing an outcome measure most appropriate for a hip fracture patient is an individualized decision that must consider aspects such as age, activity level, needs, and environmental factors.

Skin health of community-living older people: a scoping review

The population of older people is steadily increasing and the majority live at home. Although the home and community are the largest care settings worldwide, most of the evidence on dermatological care relates to secondary and tertiary care. The overall aims were to map the available evidence regarding the epidemiology and burden of the most frequent skin conditions and regarding effects of screening, risk assessment, diagnosis, prevention and treatment of the most frequent skin conditions in older people living in the community. A scoping review was conducted. MEDLINE, Embase and Epistemonikos were systematically searched for clinical practice guidelines, reviews and primary studies, as well as Grey Matters and EASY for grey literature published between January 2010 and March 2023. Records were screened and data of included studies extracted by two reviewers, independently. Results were summarised descriptively. In total, 97 publications were included. The vast majority described prevalence or incidence estimates. Ranges of age groups varied widely and unclear reporting was frequent. Sun-exposure and age-related skin conditions such as actinic keratoses, xerosis cutis, neoplasms and inflammatory diseases were the most frequent dermatoses identified, although melanoma and/or non-melanoma skin cancer were the skin conditions investigated most frequently. Evidence regarding the burden of skin conditions included self-reported skin symptoms and concerns, mortality, burden on the health system, and impact on quality of life. A minority of articles reported effects of screening, risk assessment, diagnosis, prevention and treatment, mainly regarding skin cancer. A high number of skin conditions and diseases affect older people living at home and in the community but evidence about the burden and effective prevention and treatment strategies is weak. Best practices of how to improve dermatological care in older people remain to be determined and there is a particular need for interventional studies to support and to improve skin health at home.

Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review

BACKGROUND

The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies.

PURPOSE

Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA.

METHODS

This systematic review of the literature used, PRISMA to guide the search.

FINDINGS

The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces.

DISCUSSION

There were gaps in the interventions that have been proven successful in other global settings.

CONCLUSION

In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.

A Diagnostic-Driven Prospective Clinical Study Evaluating the Combination of an Antibiofilm Agent and Negative Pressure Wound Therapy

BACKGROUND

Each year, millions of Americans develop truncal pressure ulcers (PUs) which can persist for months, years, or until the end of life. Despite the negative impact on quality of life and escalating costs associated with PUs, there is sparse evidence supporting validated and efficacious treatment options. As a result, treatment is based on opinion and extrapolation from other wound etiologies. The ideal reconstructive plan maximizes the patient's nutritional status, incorporates the basic tenets of wound bed preparation (debridement, offloading, proper moisture balance, reduction of bacterial burden), and employs diagnostics to guide therapeutic intervention. The use of combination therapies can potentially overcome several of the barriers to wound healing. Negative pressure wound therapy (NPWT), a commonly used modality in the management of PUs, facilitates healing by stimulating the formation of granulation tissue and promoting wound contraction; however, NPWT alone is not always effective. Clinical studies examining microbial bioburden in PUs determined that most ulcers contain bacteria at levels that impede wound healing (>104 CFU/g).

OBJECTIVE

Thus, we hypothesized that adding an anti-microbial agent to decrease both planktonic and biofilm bacteria in the wound would increase the efficacy of NPWT.

METHOD

In this prospective study, twenty patients with recalcitrant PUs that previously failed NPWT were treated with a biofilm-disrupting agent (Blast-X, Next Science, Jacksonville, FL, USA) in combination with NPWT. Fluorescence imaging was used to follow bacterial burden and guide therapy.

RESULTS

In total, 45% of the PUs reduced in size over the course of the four-week study, with a resolution of bacterial fluorescence in the NPWT dressing and wound bed seen in an average of three weeks.

CONCLUSION

The combination of an antibiofilm agent and NPWT reduced bacterial levels and improved wound healing in recalcitrant PUs.

Vulnerability to Decubitus Ulcers and Their Association With Healthcare Utilization: Evidence From Nationwide Inpatient Sample Dataset From 2016 to 2020 in US Hospitals

OBJECTIVE

The aim of the study is to identify vulnerable populations at risk of developing decubitus ulcers and their resultant increase in healthcare utilization to promote the use of early prevention methods.

METHODS

The National Inpatient Sample of the United States was used to identify hospitalized patients across the country who had a length of stay of 5 or more days (N = 9,757,245, weighted N = 48,786,216) from 2016 to 2020. We examined the characteristics of the entire inpatient sample based on the presence of decubitus ulcers, temporal trends, risk of decubitus ulcer development, and its association with healthcare utilization, measured by discounted hospital charges and length of stay. The multivariate survey logistic regression model was used to identify predictors for decubitus ulcer occurrence, and the survey linear regression model was used to measure how decubitus ulcers are associated with healthcare utilization.

RESULTS

Among 48,786,216 nationwide inpatients, 3.9% had decubitus ulcers. The percentage of inpatients with decubitus ulcers who subsequently experienced increased healthcare utilization rose with time. The survey logistic regression results indicate that patients who were Black, older, male, or those reliant on Medicare/Medicaid had a statistically significant increased risk of decubitus ulcers. The survey linear regression results demonstrate that inpatients with decubitus ulcers were associated with increased hospital charges and longer lengths of stay.

CONCLUSIONS

Patients with government insurance, those of minority races and ethnicities, and those treated in the Northeast and West may be more vulnerable to pressure ulcers and subsequent increased healthcare utilization. Implementation of early prevention methods in these populations is necessary to minimize the risk of developing decubitus ulcers, even if upfront costs may be increased. For example, larger hospitals were found to have a lower risk of decubitus ulcer development but an increased cost of preventative care. Hence, it is imperative to explore and use universal, targeted preventative methods to improve patient safety.

Complementing Braden scale for pressure ulcer risk with clinical and demographic-related factors in a large cohort of hospitalized Italian patients

AIMS

To determine the prevalence, risk, and determinants of pressure ulcer risk in a large cohort of hospitalized patients.

DESIGN

A prospective cross-sectional study with data collection in January 2023.

METHODS

Registered nurses collected data from 798 patients admitted to 27 health care units of an Italian hospital. The pressure ulcer risk was assessed using the Braden scale. The presence of comorbidities was collected from clinical reports. Obesity was assessed according to international indicators (Body Mass Index). The receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of different Braden scores for identifying participants with pressure ulcers.

RESULTS

The prevalence of pressure ulcers was 9.5%, and 57.4% of the sample were at risk of developing pressure ulcers. The area under the ROC curve was 0.88. The best sensitivity and specificity were found for a Braden cutoff score of 15.5 (sensibility = 0.76; specificity = 0.85). The determinants of lower Braden scores were older age (p < 0.001), comorbidities (p < 0.001), wounds of other nature (p = 0.001), urinary incontinence (p < 0.001), fecal incontinence (p < 0.001), and urinary catheterization (p < 0.001).

CONCLUSION

Several demographic factors and specific clinical indicators have been identified as determinants of the risk of developing pressure ulcers, which are easily ascertainable by healthcare providers; thus, they may routinely complement the Braden Scale in the assessment of pressure ulcer risk in order to reinforce and accelerate clinical judgment.

Evaluating Natural Language Processing Packages for Predicting Hospital-Acquired Pressure Injuries From Clinical Notes

Incidence of hospital-acquired pressure injury, a key indicator of nursing quality, is directly proportional to adverse outcomes, increased hospital stays, and economic burdens on patients, caregivers, and society. Thus, predicting hospital-acquired pressure injury is important. Prediction models use structured data more often than unstructured notes, although the latter often contain useful patient information. We hypothesize that unstructured notes, such as nursing notes, can predict hospital-acquired pressure injury. We evaluate the impact of using various natural language processing packages to identify salient patient information from unstructured text. We use named entity recognition to identify keywords, which comprise the feature space of our classifier for hospital-acquired pressure injury prediction. We compare scispaCy and Stanza, two different named entity recognition models, using unstructured notes in Medical Information Mart for Intensive Care III, a publicly available ICU data set. To assess the impact of vocabulary size reduction, we compare the use of all clinical notes with only nursing notes. Our results suggest that named entity recognition extraction using nursing notes can yield accurate models. Moreover, the extracted keywords play a significant role in the prediction of hospital-acquired pressure injury.

Hematologic and Serum Biochemical Values Associated With Different Stages of Hospital-Acquired Pressure Injuries in Patients: A Retrospective Study

PURPOSE

The primary purpose of this study was to determine whether hematologic and serum biochemical values used as indicators of nutritional status, anemia, and/or infection were associated with the risk of hospital-acquired pressure injuries (PIs) and stage of PIs in patients.

DESIGN

A retrospective review of medical records.

SUBJECTS AND SETTING

Data were collected from medical records including official PI records and PI incident reports of inpatients at a teaching hospital in Taiwan between January 2019 and October 2020.

METHODS

We collected demographic variables of the inpatients and their hematologic and serum biochemical values within 1 day of PI occurrence (including the day of PI occurrence), 6 to 7 days before PI occurrence, and 13 to 14 days before PI occurrence.

RESULTS

Among the 309 inpatients with official PI records, 105 (34.0%) had Stage 1 PIs, 131 (42.4%) had Stage 2 or 3 PIs, and 73 (23.6%) had unstageable or suspected deep tissue injuries. After controlling for the type of department where PIs occurred and length of hospital stay up to the day of PI occurrence, we found significant differences in levels of hemoglobin (odds ratio [OR] = 0.47, P = .009) within 1 day of PI occurrence and in albumin (OR = 0.30, P = .001) 13 to 14 days before PI occurrence.

CONCLUSIONS

Study findings suggest that lower hemoglobin levels on the day of PI occurrence and lower albumin levels 2 weeks before PI occurrence resulted in a significantly higher risk of developing unstageable or suspected deep tissue injuries than of developing Stage 1 PIs.

Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis

To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.

Effects of predictive nursing interventions on pressure ulcer in elderly bedridden patients

The study explores the impact of predictive nursing interventions on pressure ulcers (PUs) in elderly bedridden patients. A total of 120 elderly bedridden patients from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between August 2019 and August 2023 were selected as the subjects of the study and were randomly divided into an observation group and a control group using a random number table method. The control group received conventional nursing care, while the observation group received predictive nursing interventions. The study compared the incidence of PUs, Braden scale scores, the onset time of PUs, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, and nursing satisfaction between the two groups. In elderly bedridden patients, the application of predictive nursing interventions significantly reduced the incidence of PUs (p < 0.001), significantly lowered the SAS and SDS scores (p < 0.001), and also significantly increased Braden scale scores (p < 0.001) and delayed the onset time of PUs (p < 0.001). Additionally, it improved patients' nursing satisfaction (p = 0.008). Predictive nursing interventions in elderly bedridden patients have good application effects, reducing the occurrence of PUs, delaying the time of onset in patients, improving patients' negative emotions and enhancing nursing satisfaction rates. It is worthy of widespread use.

Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review

Objective

This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated.

Methods

Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included.

Results

Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy.

Conclusion

The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.

Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study

BACKGROUND

Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals.

METHODS

A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis.

RESULTS

The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied.

CONCLUSIONS

The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.

Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis

BACKGROUND

Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting.

OBJECTIVE

The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services.

METHOD

This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale."

FINDINGS

In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale.

CONCLUSION

The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.

Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors

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.].

Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study

AIMS

To: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home.

METHODS

This mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home.

RESULTS

The CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management.

CONCLUSION

CAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care.

Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada

Pressure ulcers and dehydration are common conditions among residents of long-term care facilities that result in negative health effects. They have been associated with signs of neglect and increased 30-day mortality among LTC residents. However, they are both preventable and with proper care can be effectively managed and treated. We conducted a retrospective cohort study to examine factors associated with pressure ulcers and dehydration among long-term care residents in the province of Ontario, Canada. Results indicated that close to one-fifth of residents were dehydrated (17.3%) or had a pressure ulcer (18.9%) during the study period. Advanced age was significantly associated with the presence of pressure ulcers and dehydration for both men and women. However, men were more likely to present with a pressure ulcer while women were more likely to exhibit symptoms of dehydration. Study findings also demonstrate the presence of both conditions being higher in municipal and not-for-profit homes compared to for-profit homes. The significant differences observed in relation to home ownership which require further investigation to identify the most relevant factors in explaining these differences. Overall, pressure ulcers and dehydration are preventable conditions that warrant attention from policymakers to ensure quality of care and resident safety are prioritized.

Incidence of Pressure Injury Among Older Adults Transitioning from Long-term Care to the ED

OBJECTIVE

To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults' emergency transitions from long-term care (LTC) to the ED.

METHODS

Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban centers located in provinces in Canada. Binary logistic regression was used to examine the influence of sociodemographic, service use, and client health and function factors on the incidence of PIs during transitions from LTC facilities to EDs.

RESULTS

Having a mobility issue (odds ratio [OR], 4.318; 95% CI, 1.344-13.870), transitioning from a publicly owned versus a nonprofit volunteer LTC facility (OR, 4.886; 95% CI, 1.157-20.634), and time from ED arrival to return to LTC being 7 to 9 days (OR, 41.327; 95% CI, 2.691-634.574) or greater than 9 days (OR, 77.639; 95% CI, 5.727-1,052.485) significantly increased the odds of experiencing a new skin injury upon return to LTC. A higher number of reported reasons for emergency transition (up to 4) significantly decreased the odds of a new PI upon return to LTC (OR, 0.315; 95% CI, 0.113-0.880).

CONCLUSIONS

The study findings can be used to identify LTC residents at increased risk for developing new skin injuries during an emergency transition, namely, those with mobility impairment, those requiring inpatient care for 6 or more days, and those transitioning from publicly owned LTC facilities. Evaluating the uptake and effectiveness of single-pronged and multipronged interventions such as visual cues for patient turning through online monitoring, consistent risk assessments, and improved nutrition in all care settings are vital next steps in preventing skin injuries in this population.

Risk factors of carbapenemase-producing Enterobacterales acquisition among adult intensive care unit patients at a Kentucky Academic Medical Center

Background

Acquisition of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are associated with negative health outcomes. Our adult intensive care unit (ICU) population has experienced low levels of CP-CRE acquisition; however, specific risk factors for this population at our medical facility have not been studied.

Aims

To identify risk factors of CP-CRE acquisition and describe CP-CRE epidemiology among adult ICU patients at our medical facility.

Methods

A retrospective cohort study was performed at a Kentucky Academic Medical Center. Surveillance specimens were collected at admission and weekly thereafter to identify CP-CRE colonization. Clinical data were extracted from patient medical records. Cases were defined as those who tested positive for CP-CRE on ICU admission day 3 or greater. Risk of CP-CRE acquisition was calculated using Modified Poisson regression.

Findings

Independent risk factors of CP-CRE acquisition included administration of enteral tube feeds (risk ratio [RR], 4.46; 95% confidence interval [CI], 1.74-11.43); diagnosis of Clostridioides difficile enterocolitis (RR, 3.51; 95% CI, 1.27-9.68), pressure ulcer (RR, 3.48; 95% CI, 1.91-6.36), and morbid obesity (RR, 2.10; 95% CI, 1.12-3.95); having a drainage tube (RR, 2.63; 95% CI, 1.38-4.98); admission to a medical ICU (RR, 2.39; 95% CI, 1.32-4.35); 90-day use of a carbapenem (RR, 2.27; 95% CI, 1.21-4.26); and dialysis procedure (RR, 2.22; 95% CI, 1.15-4.27).

Conclusion

Most CP-CRE risk factors were associated with alteration of colon microbiota and/or invasive procedures/devices. These results will assist in creating a more targeted CP-CRE active surveillance system and highlight areas for infection prevention intervention.

Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture

OBJECTIVE

To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications.

METHODS

In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications.

RESULTS

Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation.

CONCLUSIONS

Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.

Fast track to stroke unit for patients not eligible for acute intervention, a case-control register study on 1066 patients

Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.

Effect of hydrocolloid dressing on pressure ulcer in patients with non-invasive positive pressure ventilation: A meta-analysis

This study systematically evaluated the effect of hydrocolloid dressings on facial pressure ulcers in patients receiving non-invasive positive pressure ventilation (NIPPV). The Embase, PubMed, Cochrane Library, CNKI, VIP, Chinese Biomedical Literature Database and Wanfang databases were searched for randomised controlled trials on the use of hydrocolloid dressings in patients receiving NIPPV published from the inception of each database to August 2023. The literature was independently screened, data were extracted by two authors based on the inclusion and exclusion criteria, and the quality of the included literature was assessed. The meta-analysis was performed using Stata 17.0. Thirteen studies including 1248 patients were included, with 639 patients in the intervention group and 609 patients in the control group. Meta-analysis showed that the hydrocolloid dressing significantly reduced the incidence of facial pressure ulcers in patients with NIPPV (odds ratio = 0.16, 95% confidence intervals: 0.11-0.24, p < 0.001). Hydrocolloid dressings are effective in reducing the incidence of facial pressure ulcers in patients receiving NIPPV. However, because of the small number of included studies, this conclusion needs to be confirmed with larger samples and high-quality clinical studies.

Psychosocial factors impacting community-based pressure ulcer prevention: A systematic review

BACKGROUND

Pressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership.

OBJECTIVE

To synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour.

DESIGN

Mixed methods systematic review and narrative synthesis.

METHOD

Systematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model.

RESULTS

Thirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport.

CONCLUSIONS

Several psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.

Characteristics and risk factors of facial pressure injuries in acute inpatients using noninvasive positive pressure ventilation: A retrospective case control study

OBJECTIVE

To explore the characteristics and risk factors of facial pressure injuries in patients using noninvasive positive pressure ventilation.

SETTING AND SAMPLE

Patients who developed facial pressure injuries due to non-invasive positive pressure ventilation at a teaching hospital in Taiwan from January 2016 to December 2021 were selected, resulting in a total of 108 patients in our case group. A control group was formed by matching each case by age and gender to three acute inpatients who had used non-invasive ventilation but had not developed facial pressure injuries, resulting in 324 patients in the control group.

RESEARCH METHODOLOGY

This study was a retrospective case-control study. The characteristics of the patients who developed pressure injuries at different stages in the case group were compared, and the risk factors of non-invasive ventilation-related facial pressure injuries were then determined.

RESULTS

Higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale score, and lower albumin levels in the former group. The results of multivariate analysis from binary logistic regression involving the duration of non-invasive ventilation usage demonstrated that the patients who used this device for 4-9 days and 16 days were at greater risk of facial pressure injuries than those who used it for 3 days; in terms of the Braden scale score, higher Braden scale scores were correlated with a higher risk of facial pressure injuries. In addition, albumin levels lower than the normal range were correlated with a higher risk of facial pressure injuries.

CONCLUSION

Patients with pressure injuries at higher stages had a higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale scores, and lower albumin levels. Thus, a longer duration of non-invasive ventilation use, lower Braden scale scores, and lower albumin levels were also risk factors for non-invasive ventilation-related facial pressure injuries.

IMPLICATIONS FOR CLINICAL PRACTICE

Our results serve as a useful reference for hospitals, both in creating training programs for their medical teams to prevent and treat facial pressure injuries and in drafting guidelines for assessing risk in order to prevent facial pressure injuries caused by non-invasive ventilation. The duration of device usage, Braden scale scores, and albumin levels in particular should be seriously monitored to reduce the occurrence of facial pressure injuries in acute inpatients treated with non-invasive ventilation.

[One-year outcomes after proximal humeral fractures : A risk-adjusted regression analysis of routine data based on 17,322 cases]

BACKGROUND

Proximal humeral fractures (PHF) are the third most common fracture in geriatric traumatology. No standard evidence-based treatment has been established so far. The epidemiology and economic burden highlight the importance of a targeted treatment strategy.

OBJECTIVE

Epidemiology of PHF and analysis of the influence of preoperative length of stay, comorbidities and quality of patient life. Additionally, a comparison to the more frequently studied proximal femoral fractures.

MATERIAL AND METHODS

A routine data analysis of 17,322 cases admitted for inpatient treatment with an observational period of 1 year was performed following an established model. Descriptive statistics included comorbidities, treatment procedures and mortality. Analytical statistics using logistic regression with the primary endpoints of early revision, mortality and decubitus within 1 year.

RESULTS

In the investigated PHFs there was a mortality of 13% within 1 year, which is increased three-fold in patients with comorbidities such as cancer. There was an increase of 57% in patients who first received a care level following PHF. A preoperative care level in general significantly decreased survival. The most frequently used surgical procedure was fixation via stable-angle plate (used in 43%). The preoperative length of stay did not impact survival.

DISCUSSION

Intrinsic factors such as preoperative comorbidities are crucial for the mortality after PHF. The PHF affects patients' lives less than proximal femoral fractures. With comparable comorbidity profiles, possible reasons are the lower levels of immobilization and less dependency on care before the fracture in comparison to proximal femoral fractures.

The association between acupuncture therapy and the risk of reduced pressure ulcers in dementia patients: A retrospective matched cohort study

Background

The pressure ulcer is a complication developed from dementia. The aim of this study is to study the association between the development of pressure ulcers and the use of acupuncture therapy in patients with dementia.

Methods

We performed a retrospective 1:1 propensity score-matched cohort study to investigate the association between acupuncture therapy and the risk of pressure ulcers in patients with dementia.

Results

A total of 8,994 patients were identified, 237 patients in the acupuncture cohort and 362 patients in the no-acupuncture cohort developed pressure ulcers. A reduced cumulative incidence of pressure ulcers was observed in the acupuncture cohort (P<0.001). The association between acupuncture and reducing the incidence of pressure ulcers was not affected by sex, age, residence, income, or comorbidities. The variables of etiologies to cause dementia did not change the final result. In the subgroups analyses, the patients without medication for dementia control had a significantly lower rate of pressure ulcers development when they had accepted acupuncture therapy (log-rank test, P<0.001).

Conclusion

Our results revealed the association between acupuncture therapy and a reduced incidence of pressure ulcer development in patients with dementia. This finding offers important ideas for further research.

A systematic review of nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers

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.

Pressure ulcer prevention devices in the management of older patients at risk after hospital discharge: an SNDS study

OBJECTIVE

Our aim was to measure the effectiveness of home healthcare pressure ulcer (PU) prevention devices (PUPDs) for at-risk patients after hospital discharge in France.

METHOD

We conducted a retrospective analysis of PU-associated hospitalisations based on the French medico-administrative database (Système National des Données de Santé, SNDS), which covers the entire French population. All adults >70 years of age, hospitalised from 1 July to 31 December 2015, and equipped with a medical bed at home, were included. Follow-up was for a maximum of 18 months. Propensity score matching allowed the comparison of PUPD equipped and non-equipped groups (No-PUPD), considering sociodemographic characteristics and other factors.

RESULTS

The study included 43,078 patients. Of this population, 54% were PUPD patients and 46% No-PUPD. After matching, PUPD patients had significantly fewer PUs than No-PUPD patients (5.5% versus 8.9%, respectively; p<0.001). The adoption of PUPD reduced by 39% the risk of a PU in hospital. Patients equipped within the first 30 days at home after hospitalisation had fewer PUs than those equipped later (4.8% versus 5.9%, respectively). The estimated PUPD use costs represented 1% of total healthcare expenditure per patient during the study period.

CONCLUSION

The study results demonstrated the effectiveness of the adoption of mattress toppers or prevention mattresses in reducing PU occurrence in patients aged >70 years of age. A short delay in PUPD delivery appeared to have a real impact in the medical setting. Future research on a larger population might provide more evidence on the appropriate support and timeframe to choose based on risk assessment.

Factors affecting severity of pressure ulcers: Impact of number of medications

Polypharmacy, which refers to the situation of a patient taking more medications than is clinically necessary, has become a major problem in recent years. Although the effects of medications on pressure ulcers have been reported, there are no reports on the impact of the total number of medications on pressure ulcers. The purpose of this study was to investigate the effect of number of medications on the severity of pressure ulcers. Participants included 94 patients who were admitted to Chiba University Hospital with pressure ulcers between April 2013 and March 2021. Univariate analysis identified ulcer depth, weight loss and anticoagulant use to be factors that contributed to the severity of pressure ulcers. Multiple regression analysis was performed for six variables, namely, the number of medications, ulcer depth, weight loss and anticoagulant use, as well as diabetes status and total serum protein level, which have been reported to be associated with pressure ulcers in previous studies. The following independent risk factors were identified: weight loss (β 0.207, 95% confidence interval [CI] 0.700-3.193; p = 0.003), anticoagulant use (β 0.161, 95% CI 0.271-3.088; p = 0.020) and ulcer depth (β 0.719, 95% CI 7.172-10.329; p < 0.001). The number of medications was not a significant factor. This study revealed that the number of medications a patient is taking does not affect the severity of pressure ulcers. The findings should provide useful information for the management of pressure ulcers.