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Durmuş Sarıkahya S. Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis. J Tissue Viability 2024:S0965-206X(24)00005-6. [PMID: 38326162 DOI: 10.1016/j.jtv.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/04/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
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.
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Affiliation(s)
- Selma Durmuş Sarıkahya
- Artvin Coruh University, Faculty of Health Sciences, Department of Public Health Nursing, Artvin, Turkey.
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Morsli M, Salipante F, Gelis A, Magnan C, Guigon G, Lavigne J, Sotto A, Dunyach‐Remy C. Evolution of the urinary microbiota in spinal cord injury patients with decubitus ulcer: A snapshot study. Int Wound J 2024; 21:e14626. [PMID: 38272816 PMCID: PMC10805533 DOI: 10.1111/iwj.14626] [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: 10/05/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Current microbiome investigations of patients with pressure ulcers (PU) are mainly based on wound swabs and/or biopsy sequencing, leaving the colonization scenario unclear. Urinary microbiota has been never studied. As a part of the prospective ESCAFLOR study, we studied urinary microbiota of spinal cord injury (SCI) patients with PU without any urinary tract infection at the inclusion, collected at two times (at admission [D0] and after 28 days [D28]) during the patient's care, investigated by 16S rDNA metagenomics next generation sequencing. Subgroup analyses were carried out between patients with wounds showing improved evolution versus stagnated/worsened wounds at D28. Analysis was done using EPISEQ® 16S and R software. Among the 12 studied patients, the urinary microbiota of patients with improved wound evolution at D28 (n = 6) presented a significant decrease of microbial diversity. This modification was associated with the presence of Proteobacteria phylum and an increase of Escherichia-Shigella (p = 0.005), as well as the presence of probiotic anaerobic bacteria Lactobacillus and Bifidobacterium. In contrast, Proteus abundance was significantly increased in urine of patients with stagnated/worsened wound evolution (n = 6) (p = 0.003). This study proposes urinary microbiota as a complementary factor indirectly associated with the wound evolution and patient cure. It opens new perspectives for further investigations based on multiple body microbiome comparison to describe the complete scenario of the transmission dynamics of wound-colonizing microorganisms.
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Affiliation(s)
- Madjid Morsli
- Department of Microbiology and Hospital HygieneCHU Nîmes, Univ MontpellierNîmesFrance
| | - Florian Salipante
- Department of Biostatistics, Epidemiology, Public Health, and Innovation in Methodology (BESPIM)CHU Nîmes, Univ MontpellierNîmesFrance
| | - Anthony Gelis
- Centre Mutualiste Neurologique ProparaMontpellierFrance
| | - Chloé Magnan
- VBIC, INSERM U1047, Department of Microbiology and Hospital HygieneCHU Nîmes, Univ MontpellierNîmesFrance
| | | | - Jean‐Philippe Lavigne
- VBIC, INSERM U1047, Department of Microbiology and Hospital HygieneCHU Nîmes, Univ MontpellierNîmesFrance
| | - Albert Sotto
- VBIC, INSERM U1047, Department of Infectious and Tropical DiseasesCHU Nîmes, Univ MontpellierNîmesFrance
| | - Catherine Dunyach‐Remy
- VBIC, INSERM U1047, Department of Microbiology and Hospital HygieneCHU Nîmes, Univ MontpellierNîmesFrance
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Lartigau M, Barateau M, Rosé M, Petricã N, Salles N. Pressure ulcer prevention devices in the management of older patients at risk after hospital discharge: an SNDS study. J Wound Care 2023; 32:clxxi-clxxx. [PMID: 37703220 DOI: 10.12968/jowc.2023.32.sup9a.clxxi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
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.
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Affiliation(s)
- Marion Lartigau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
| | - Martine Barateau
- Department of Clinical Gerontology, University Hospital, Bordeaux, 33000 France
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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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Mukhina E, Trebbi A, Rohan PY, Connesson N, Payan Y. In vivo quantification of 3D displacement in sacral soft tissues under compression: Relevance of 2D US-based measurements for pressure ulcer risk assessment. J Tissue Viability 2022; 31:593-600. [DOI: 10.1016/j.jtv.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
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Abstract
Bacterial species and their role in delaying the healing of pressure ulcers (PU) in spinal cord injury (SCI) patients have not been well described. This pilot study aimed to characterise the evolution of the cutaneous microbiota of PU in SCI cohort. Twenty-four patients with SCI from a French neurological rehabilitation centre were prospectively included. PU tissue biopsies were performed at baseline (D0) and 28 days (D28) and analysed using 16S rRNA gene-based sequencing analysis of the V3–V4 region. At D0, if the overall relative abundance of genus highlighted a large proportion of Staphylococcus, Anaerococcus and Finegoldia had a significantly higher relative abundance in wounds that stagnated or worsened in comparison with those improved at D28 (3.74% vs 0.05%; p = 0.015 and 11.02% versus 0.16%; p = 0.023, respectively). At D28, Proteus and Morganella genera were only present in stagnated or worsened wounds with respectively 0.02% (p = 0.003) and 0.01% (p = 0.02). Moreover, Proteus, Morganella, Anaerococcus and Peptoniphilus were associated within the same cluster, co-isolated from biopsies that had a poor evolution. This pathogroup could be a marker of wound degradation and Proteus could represent a promising target in PU management.
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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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Moore Z, Avsar P, Conaty L, Moore DH, Patton D, O'Connor T. The prevalence of pressure ulcers in Europe, what does the European data tell us: a systematic review. J Wound Care 2020; 28:710-719. [PMID: 31721669 DOI: 10.12968/jowc.2019.28.11.710] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The main aim of this systematic review was to establish the prevalence of pressure ulcers (PU) within published studies from Europe. METHOD Using systematic review methodology, quantitative design studies which explored prevalence data and/or the epidemiology of PUs in Europe were considered. The primary outcome was PU prevalence. The search, conducted in April 2019, using Cochrane, Medline, Embase, CINAHL, PubMed, Scopus and Web of Science databases, returned 3065 records, of which 79 met the inclusion criteria. Data were extracted using a pre-designed extraction tool, and validity analysis was undertaken using the Evidence-Based Librarianship (EBL) Critical Appraisal Checklist. RESULTS We included 79 articles in this review. Across the studies, the median prevalence was 10.8% (standard deviation: 7%; range: 4.6-27.2%). The highest PU prevalence reported was from the Netherlands (27.2%; n=17,494 participants), and the lowest was reported from Finland (4.6%; n=629 participants). Almost 32.4% (n=151,195) of the PUs were category I and the most common site for PUs was the sacrum. CONCLUSION The prevalence data is consistently high. These data indicate the continued need for further resource allocation into PU prevention and management.
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Affiliation(s)
- Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI.,Adjunct Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Professor Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University.,Honorary Professor, Lida Institute, Shanghai, China.,Senior Tutor, University of Wales
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI
| | | | | | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI).,Skin Wounds and Trauma (SWaT) Research Centre, RCSI
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Kim GH, Lee JY, Kim J, Kim HJ, Park JU. Prevalence of Pressure Injuries Nationwide from 2009 to 2015: Results from the National Inpatient Sample Database in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050704. [PMID: 30818780 PMCID: PMC6427666 DOI: 10.3390/ijerph16050704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate the prevalence pattern of pressure injuries (PIs), or ‘sores’, in South Korea and investigate the factors affecting its development. We estimated the annual prevalence of PIs using the National Inpatient Sample (NIS) data extracted from the Health Insurance Review and Assessment Service (HIRA) database from 2009 to 2015. Multivariable logistic regression was performed to examine the association between hospitalization and socio-demographic characteristics, such as sex, age, type of health insurance, Charlson Comorbidity Index (CCI), and plegia comorbidity. We found that inpatients with PIs make up to 0.86% of the total population in South Korea in 2015, which had shown a steady increase from the previous years. And male, old age, low socioeconomic status (SES), and the patients’ severity such as high CCI and the plegia comorbidity were strongly associated with hospitalization due to PI. Based on our results, it would be anticipated that the medical cost for treatment and management of PIs will increase in the future, and it will be accelerated due to the rapidly aging society. In addition, patients in low SES and patients with severe comorbidities would be relatively more burdensome, threatening their household economy and further reducing the quality of life. Therefore, PIs should not be overlooked as the responsibility of just the nursing care professionals but should be recognized as one of the serious societal problems. The establishment of an intense medical care system is needed not only to reduce the prevalence of PIs but also to increase the awareness in people with PI patients.
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Affiliation(s)
- Gyeong Hoe Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul 03080, Korea.
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul 07061, Korea.
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul 03080, Korea.
| | - Jayeun Kim
- Institute of Health and Environment, Seoul National University, Seoul 08826, Korea.
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin 31801, Korea.
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Korea.
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Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol 2019; 29:8-15. [DOI: 10.1016/j.annepidem.2018.10.005] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 09/20/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022]
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Pickham D, Berte N, Pihulic M, Valdez A, Mayer B, Desai M. Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). Int J Nurs Stud 2018; 80:12-19. [DOI: 10.1016/j.ijnurstu.2017.12.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/23/2017] [Accepted: 12/24/2017] [Indexed: 11/27/2022]
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Barrois B, Colin D, Allaert FA. Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France. Hosp Pract (1995) 2018; 46:30-36. [PMID: 29241381 DOI: 10.1080/21548331.2018.1418139] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study conducted in 2014 was to describe the prevalence of pressure ulcers in different types of French hospital unit at the national level to compare them with data from the 1994 and 2004 study. METHODS This cross-sectional study was conducted over a single day. All care units were invited to participate by drawing lots stratified by region in successive waves until 1,200 agreements were obtained. Lots were drawn for towns with more than 10,000 inhabitants. All public- and private-sector hospital facilities in each town drawn by lot were invited to participate in the survey. RESULTS 776 hospital services throughout France took part and accommodated 21,538 patients: 12,752 women (59.2%) and 8,786 men (40.8%). Of these patients, 1,753 (8.1%; IC95% = 7.7; 8.5) had pressure ulcers. The pressure-ulcer rate was 7.8% (IC95% = [7.3; 8.3] (n = 997)) for hospitalized women and 8.6% (IC95% = [8.0; 9.2] (n = 756)) for men (p = 0.0381). The 8.1% level reported in 2014 therefore points to a reduction in pressure-ulcer prevalence; 8.6% in 1994 and 8.9% in 2004. CONCLUSIONS The actions performed daily by healthcare professionals to prevent pressure ulcers, supported by research and training programs, including those by PERSE, are having a real impact over time.
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Affiliation(s)
- Brigitte Barrois
- a Département Qualité , Centre Hospitalier de Gonesse , Gonesse , France
| | - Denis Colin
- b Médecine Physique , Centre de l'Arche , Saint-Saturnin , France
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Moya-Suárez AB, Morales-Asencio JM, Aranda-Gallardo M, Enríquez de Luna-Rodríguez M, Canca-Sánchez JC. Development and psychometric validation of a questionnaire to evaluate nurses' adherence to recommendations for preventing pressure ulcers (QARPPU). J Tissue Viability 2017; 26:260-270. [PMID: 28911962 DOI: 10.1016/j.jtv.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/29/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
AIM OF THE STUDY The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers. MATERIAL AND METHODS An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016. RESULTS From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025-0.054). CONCLUSIONS The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers.
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Affiliation(s)
- Ana Belén Moya-Suárez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, C/Arquitecto Francisco Peñalosa, Ampliación del Campus de Teatinos, 29071, Málaga, Spain.
| | - Marta Aranda-Gallardo
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
| | | | - José Carlos Canca-Sánchez
- Department of Nursing, Agencia Sanitaria Costa del Sol, Ctra. Nacional 340, Km. 187 Marbella, Málaga, Spain.
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Magny E, Vallet H, Cohen-Bittan J, Raux M, Meziere A, Verny M, Riou B, Khiami F, Boddaert J. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos 2017; 12:77. [PMID: 28852954 DOI: 10.1007/s11657-017-0365-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044). INTRODUCTION Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown. METHODS From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge. RESULTS Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated with 6-month mortality (RR 2.38, 95% CI 1.31-4.32, p = 0.044). CONCLUSION In elderly patients with hip fracture managed in an orthogeriatric care pathway, pressure ulcer remained associated with poorly modifiable risk factors and long-term mortality.
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Affiliation(s)
- Emmanuelle Magny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Helene Vallet
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Judith Cohen-Bittan
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Antony Meziere
- Department of Rehabilitation, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Marc Verny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Bruno Riou
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
- Department of Emergency Medicine and Surgery, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Jacques Boddaert
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France.
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France.
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Tubaishat A, Papanikolaou P, Anthony D, Habiballah L. Pressure Ulcers Prevalence in the Acute Care Setting: A Systematic Review, 2000-2015. Clin Nurs Res 2017; 27:643-659. [PMID: 28447852 DOI: 10.1177/1054773817705541] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about the prevalence of pressure ulcer (PrU) in acute care settings. The aim of this study is to determine the prevalence rate of PrU in acute care settings and to assess the methodological quality of the reviewed publications. The Cumulative Index to Nursing and Allied Health Literature, British Nursing Index, MEDLINE, and Cochrane Database of Systematic Reviews were searched using the keywords pressure ulcer or decubitus ulcer or bed sore or pressure sore or pressure injury, with prevalence and acute care, for studies published between January 2000 and December 2015. Nineteen publications met our criteria. These reported a prevalence range of between 7.8% and 54% for those using European Pressure Ulcer Advisory Panel methodology, 6% and 22% for those using National Pressure Ulcer Advisory Panel methodology, and 4.94% for the study that employed the Torrance system. The likely worldwide PrU prevalence rate range in acute care settings is between 6% and 18.5%. Prevalence rate varies between studies depending on the methodology of data collection. Moreover, the methodological quality of the included studies in the review was variable; therefore, it was difficult to compare the prevalence rate between the studies, settings, and countries.
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Laranjeira CA, Loureiro S. [Risk factors of pressure ulcers in hospitalized patients of a Portuguese hospital]. Rev Salud Publica (Bogota) 2017; 19:99-104. [PMID: 30137162 DOI: 10.15446/rsap.v19n1.42251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 09/12/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To identify and characterize the risk factors of pressure ulcers (PU) in patients admitted in a Portuguese Hospital. MATERIALS AND METHODS Descriptive and cross-sectional study with a sample consisting of 34 individuals, 70.6 % male and 29.4 % female with a mean age of 78.93 ± 6.05 years. The data collection instrument consisted of an analysis grid that contains socio-demographic, clinical and therapeutic data. Descriptive statistics, and inferential analysis were estimated, the chi-square test of Pearson was used for p≤0.05. RESULTS Data analysis found that individuals already presented with PU upon admission to the hospital, and that most of them stay between 6 days and 1 month; the longer the hospitalization period, the longer the hospitalization time, the greater the number of PU developed by individuals. Most PU patients have a strong prevalence of severe PU in the sacrum and calcaneus region, and hypertension, respiratory disease and Diabetes mellitus are the most frequent pathologies. CONCLUSION The current gloomy picture of PUs can only be changed if there is greater investment in prevention and accurate treatment. In this sense, guidelines should be systematized for families during hospitalization and outpatient monitoring.
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Affiliation(s)
- Carlos A Laranjeira
- Ph.D. RECI. Jean Piaget Higher School of Health Sciences. Jean Piaget College. Alto do Gaio Street, Lordosa. Viseu, Portugal.
| | - Sónia Loureiro
- M.Sc. Otorhinolaryngology, Plastic & Maxillofacial Surgery Ward. Garcia da Orta Hospital. Lisbon, Portugal.
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Worsley PR, Smith G, Schoonhoven L, Bader DL. Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis. Nurs Open 2016; 3:152-158. [PMID: 27708825 PMCID: PMC5047347 DOI: 10.1002/nop2.50] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022] Open
Abstract
Aim The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). Design A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. Methods Demographic and pressure ulcer related data were collected from patients at risk of developing a pressure ulcer, collated by a single observer using a standardized tool. Comparisons were made within and between patient groups (no PU, CAPU and HAPU). Results CAPU and HAPU patient groups were significantly (P < 0·001) older, had extended lengths of hospital stay and were less likely to be provided quickly with a pressure relieving support surface than those with no PU. HAPU patients had a longer length of stay and a higher proportion of heel PUs compared to CAPU.
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Affiliation(s)
- Peter R Worsley
- Skin Health and Continence Technology Research Group Clinical Academic Facility Faculty of Health Sciences University of Southampton Southampton SO16 6WD UK
| | - Glenn Smith
- Skin Health and Continence Technology Research Group Clinical Academic Facility Faculty of Health Sciences University of Southampton Southampton SO16 6WD UK; Nutrition and Tissue Viability Service OfficeTop Floor GMO offices North Block St Mary's Hospital Parkhurst Road NewportIsle of Wight PO30 5TG UK
| | - Lisette Schoonhoven
- Skin Health and Continence Technology Research Group Clinical Academic Facility Faculty of Health Sciences University of Southampton Southampton SO16 6WDUK; NIHR CLAHRC Wessex University of Southampton Southampton SO17 1BJ UK
| | - Dan L Bader
- Skin Health and Continence Technology Research Group Clinical Academic Facility Faculty of Health Sciences University of Southampton Southampton SO16 6WD UK
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Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC, Reed LF. Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis. BMJ Open 2015; 5:e008544. [PMID: 26597864 PMCID: PMC4663442 DOI: 10.1136/bmjopen-2015-008544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity). METHODS A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available. RESULTS Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001). CONCLUSIONS This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Podiatry Service, Kirwan Community Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Scott D Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Ipswich, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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A Survey of Australian Nurses' Knowledge of Pressure Injury/Pressure Ulcer Management. J Wound Ostomy Continence Nurs 2015; 42:450-60. [DOI: 10.1097/won.0000000000000141] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tubaishat A, Tawalbeh LI, AlAzzam M, AlBashtawy M, Batiha AM. Electronic versus paper records: documentation of pressure ulcer data. ACTA ACUST UNITED AC 2015; 24:S30, S32, S34-7. [PMID: 25816001 DOI: 10.12968/bjon.2015.24.sup6.s30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The documentation of patient data on health records is a vital component of the care process. Accurate and complete recording of this data is a necessary practice. The adoption of electronic health records to improve the quality of nursing documentation is on the rise. OBJECTIVES This study compares the accuracy and completeness of pressure ulcer data documentation between electronic and paper records. DESIGN A descriptive, comparative design with a retrospective review of patient records. Settings and sample: Two hospitals were chosen purposefully, one using electronic recording of patient data and the other using paper records. METHODS In the first phase, all hospitalised patients aged 18 years and over were inspected for pressure ulcers. In the second phase, the files of patients with pressure ulcers were audited. RESULTS Of the 52 patients with ulcers found in the hospital that used an electronic system, 43 of their records documented the pressure ulcers (83%). Of the 55 patients with pressure ulcers in the hospital using paper records, 39 files had corresponding documentation of the presence of a pressure ulcer (71%). CONCLUSION In terms of accuracy and completeness, more comprehensive documentation practice was found on the electronic health records compared with paper records. However, both types of systems have shortcomings in the practice of pressure ulcer data documentation.
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Simonetti V, Comparcini D, Flacco ME, Di Giovanni P, Cicolini G. Nursing students' knowledge and attitude on pressure ulcer prevention evidence-based guidelines: a multicenter cross-sectional study. NURSE EDUCATION TODAY 2015; 35:573-579. [PMID: 25600210 DOI: 10.1016/j.nedt.2014.12.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/27/2014] [Accepted: 12/18/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pressure ulcers still remain a significant problem in many healthcare settings. Poor knowledge and negative attitudes toward pressure ulcer prevention could undesirably affect preventive care strategies. OBJECTIVE To assess both knowledge and attitudes among nursing students on Pressure Ulcer Prevention Evidence-Based Guidelines. DESIGN A multicenter cross-sectional survey was carried out from December 2012 to August 2013. SETTINGS The study was carried out in seven Italian nursing schools. PARTICIPANTS We involved a convenience sample of nursing students (n=742) METHODS: Data were collected using two validated questionnaires to assess students' knowledge and attitudes on pressure ulcer prevention. RESULTS The overall Knowledge and Attitude scores were 51.1% (13.3/26) and 76.7% (39.9/52), respectively. We found a weak correlation between total Knowledge scores and total Attitude scores (rho=0.13, p<0.001). We also observed that nursing students' year of education, training experience and number of department frequented during their clinical placement were significantly related to both the Knowledge and the Attitude total scores (p<0.05). CONCLUSIONS Nursing students' knowledge on pressure ulcer prevention was relatively low. However, we observed an association between a high level of education/training experience and higher knowledge scores. Most of the participants showed high attitude scores. These results suggest that positive attitudes toward pressure ulcer prevention may contribute to the compliance with the guidelines in clinical practice.
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Affiliation(s)
- Valentina Simonetti
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy.
| | - Dania Comparcini
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy.
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy.
| | | | - Giancarlo Cicolini
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, Italy; ASL 02 Abruzzo, Italy.
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Samuriwo R, Dowding D. Nurses’ pressure ulcer related judgements and decisions in clinical practice: A systematic review. Int J Nurs Stud 2014; 51:1667-85. [DOI: 10.1016/j.ijnurstu.2014.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 04/07/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
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Gunningberg L, Carli C. Reduced pressure for fewer pressure ulcers: can real-time feedback of interface pressure optimise repositioning in bed? Int Wound J 2014; 13:774-9. [PMID: 25224508 DOI: 10.1111/iwj.12374] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to (i) describe registered nurses' and assistant nurses' repositioning skills with regard to their existing attitudes to and theoretical knowledge of pressure ulcer (PU) prevention, and (ii) evaluate if the continuous bedside pressure mapping (CBPM) system provides staff with a pedagogic tool to optimise repositioning. A quantitative study was performed using a descriptive, comparative design. Registered nurses (n = 19) and assistant nurses (n = 33) worked in pairs, and were instructed to place two volunteers (aged over 70 years) in the best pressure-reducing position (lateral and supine), first without viewing the CBPM monitor and then again after feedback. In total, 240 positionings were conducted. The results show that for the same person with the same available pressure-reducing equipment, the peak pressure varied considerably between nursing pairs. Reducing pressure in the lateral position appeared to be the most challenging. Peak pressures were significantly reduced, based on visual feedback from the CBPM monitor. The number of preventive interventions also increased, as well as patients' comfort. For the nurses as a group, the knowledge score was 59·7% and the attitude score was 88·8%. Real-time visual feedback of pressure points appears to provide another dimension to complement decision making with respect to PU prevention.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Cheryl Carli
- Department of Haematology, Uppsala University Hospital, Uppsala, Sweden.,Department of Dermatology, Uppsala University Hospital, Uppsala, Sweden.,Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
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Florin J, Bååth C, Gunningberg L, Mårtensson G. Attitudes towards pressure ulcer prevention: a psychometric evaluation of the Swedish version of the APuP instrument. Int Wound J 2014; 13:655-62. [PMID: 25124833 DOI: 10.1111/iwj.12338] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/25/2014] [Indexed: 11/28/2022] Open
Abstract
The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.
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Affiliation(s)
- Jan Florin
- Department of Health and Social Sciences, Dalarna University, Falun, Sweden.
| | - Carina Bååth
- Faculty of Health, Sciences, and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.,County Council of Värmland, Värmland, Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Mårtensson
- Department of Public Health and Caring Sciences, Caring Sciences, Uppsala University, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
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VanDenKerkhof EG, Friedberg E, Harrison MB. Prevalence and risk of pressure ulcers in acute care following implementation of practice guidelines: annual pressure ulcer prevalence census 1994-2008. J Healthc Qual 2014; 33:58-67. [PMID: 23845134 DOI: 10.1111/j.1945-1474.2011.00127.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hospital-acquired pressure ulcers in the United States were estimated to cost US$2.2 to US$3.6 billion per year in 1999. In the early 1990s clinical practice guidelines for the prevention and treatment of pressure ulcers were introduced. The purpose of this study was to examine the epidemiology of pressure ulcers in acute care in Canada. The current study is based on 12,787 individuals who were inpatients during a 1-day annual census conducted in an acute care facility in Ontario between 1994 and 2008. The prevalence and incidence of pressure ulcer decreased slightly over time while the risk of pressure ulcer increased. The coccyx sacrum (~27%), heel (13%), ankle (~12%), and ischial tubersosity (~10%) were the most common ulcer sites. The implementation of clinical practice guidelines appears to have improved the quality of patient care, as demonstrated by increasing pressure ulcer risk while the prevalence and incidence of pressure ulcers has remained somewhat constant. From a policy perspective the importance of monitoring and tracking the risk and occurrence of this adverse event provides a general indicator of care, considering the many organizational aspects that may ameliorate risk.
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Sving E, Idvall E, Högberg H, Gunningberg L. Factors contributing to evidence-based pressure ulcer prevention. A cross-sectional study. Int J Nurs Stud 2014; 51:717-25. [DOI: 10.1016/j.ijnurstu.2013.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 08/13/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
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Lazzarini PA, Ng V, Kinnear EM, Kamp MC, Kuys SS, Hurst C, Reed LF. The Queensland high risk foot form (QHRFF) - is it a reliable and valid clinical research tool for foot disease? J Foot Ankle Res 2014; 7:7. [PMID: 24468080 PMCID: PMC3906769 DOI: 10.1186/1757-1146-7-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/22/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Foot disease complications, such as foot ulcers and infection, contribute to considerable morbidity and mortality. These complications are typically precipitated by "high-risk factors", such as peripheral neuropathy and peripheral arterial disease. High-risk factors are more prevalent in specific "at risk" populations such as diabetes, kidney disease and cardiovascular disease. To the best of the authors' knowledge a tool capturing multiple high-risk factors and foot disease complications in multiple at risk populations has yet to be tested. This study aimed to develop and test the validity and reliability of a Queensland High Risk Foot Form (QHRFF) tool. METHODS The study was conducted in two phases. Phase one developed a QHRFF using an existing diabetes foot disease tool, literature searches, stakeholder groups and expert panel. Phase two tested the QHRFF for validity and reliability. Four clinicians, representing different levels of expertise, were recruited to test validity and reliability. Three cohorts of patients were recruited; one tested criterion measure reliability (n = 32), another tested criterion validity and inter-rater reliability (n = 43), and another tested intra-rater reliability (n = 19). Validity was determined using sensitivity, specificity and positive predictive values (PPV). Reliability was determined using Kappa, weighted Kappa and intra-class correlation (ICC) statistics. RESULTS A QHRFF tool containing 46 items across seven domains was developed. Criterion measure reliability of at least moderate categories of agreement (Kappa > 0.4; ICC > 0.75) was seen in 91% (29 of 32) tested items. Criterion validity of at least moderate categories (PPV > 0.7) was seen in 83% (60 of 72) tested items. Inter- and intra-rater reliability of at least moderate categories (Kappa > 0.4; ICC > 0.75) was seen in 88% (84 of 96) and 87% (20 of 23) tested items respectively. CONCLUSIONS The QHRFF had acceptable validity and reliability across the majority of items; particularly items identifying relevant co-morbidities, high-risk factors and foot disease complications. Recommendations have been made to improve or remove identified weaker items for future QHRFF versions. Overall, the QHRFF possesses suitable practicality, validity and reliability to assess and capture relevant foot disease items across multiple at risk populations.
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Affiliation(s)
- Peter A Lazzarini
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Ewan M Kinnear
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Maarten C Kamp
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Endocrinology, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Cameron Hurst
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Moore Z, Johanssen E, van Etten M. A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I). J Wound Care 2013; 22:361-2, 364-8. [PMID: 24159658 DOI: 10.12968/jowc.2013.22.7.361] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide a critical appraisal and synthesis of the published literature pertaining to pressure ulcer (PU) prevalence, incidence and prevention practices from the context of Scandinavia, Iceland and Ireland. METHOD An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU prevalence or incidence in adults or children, in any care setting, were included. RESULTS Fifty-five papers were data extracted, quality appraised and included in the qualitative synthesis of the review. Mean prevalence in Norway was 17% (4.8-29%) in Ireland was 16% (4-37%), in Denmark was 15% (2.2-35.5%) and in Sweden was 25%, (0.04-42.7%). Prevalence in Iceland was 8.9%. In acute care, mean prevalence was 21% (0-42.7%) and in long stay was 12% (2.4-23.7%). Prevalence among hospice patients was 35.7%, and in community care was 0.04% and 4%. No incidence study from Iceland was identified; the single incidence study from Norway noted a figure of 16.4%. The mean incidence from Ireland was 11% (8-14.4%) from Sweden was 20% (3.1-49%) and Denmark was 1.8% (1.4-2.7%). Mean incidence in acute care setting was 17.6%, (1.4-49%); in long stay was 6.63% (3.1-8.4%). Incidence in the hospice setting was 20.4%. No study reported PU incidence figures from the community setting. CONCLUSION Figures for both prevalence and incidence were similar in Ireland and Norway and highest in Sweden, whereas Denmark demonstrated the lowest incidence rates and Iceland demonstrated the lowest prevalence rates. Figures were consistently highest in acute care and hospice settings, and lowest in the care of the older person setting.
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Affiliation(s)
- Z Moore
- School of Nursing, Royal College of Surgeons of Ireland, Dublin, Ireland.
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Tubaishat A, Aljezawi M. The prevalence of pressure ulceration among Jordanian hospitalised patients. J Wound Care 2013; 22:305-6, 308-10. [PMID: 24049813 DOI: 10.12968/jowc.2013.22.6.305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To measure the prevalence rate of pressure ulcers (PUs) among hospitalised patients and to assess the adequacy of preventative care provided to patients at-risk for PUs. METHOD A cross-sectional survey was conducted by inspecting the skin of each patient included; if a PU was noted, it was classified according to the European Pressure Ulcer Advisory Panel grading system. Risk was assessed using the Braden scale and the use of preventative interventions was also documented. RESULTS The sample included was 295 patients; mean age of the patients was 49.1 +/- 18.6 years (range 18-87 years) and 55% (n = 162) were male. The prevalence rate was 16% (8.8% excluding category I). Category I was the most common grade of PU (n = 22; 46%). The heels were the most commonly affected sites (n = 23; 49%). Only 19% of patients in need of prevention actually received proper adequate prevention. CONCLUSION PU prevalence rate was lower than published rates in studies that employed the same method. The young age and general health of our sample could be the best explanation. A very small percentage of at-risk patients receive adequate prevention. This should open the door to scrutinising the provision of PU prevention in Jordan.
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Affiliation(s)
- A Tubaishat
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
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Gunningberg L, Hommel A, Bååth C, Idvall E. The first national pressure ulcer prevalence survey in county council and municipality settings in Sweden. J Eval Clin Pract 2013; 19:862-7. [PMID: 22640165 DOI: 10.1111/j.1365-2753.2012.01865.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To report data from the first national pressure ulcer prevalence survey in Sweden on prevalence, pressure ulcer categories, locations and preventive interventions for persons at risk for developing pressure ulcers. METHODS A cross-sectional research design was used in a total sample of 35,058 persons in hospitals and nursing homes. The methodology used was that recommended by the European Pressure Ulcer Advisory Panel. RESULTS The prevalence of pressure ulcers was 16.6% in hospitals and 14.5% in nursing homes. Many persons at risk for developing pressure ulcers did not receive a pressure-reducing mattress (23.3-27.9%) or planned repositioning in bed (50.2-57.5%). CONCLUSIONS Despite great effort on the national level to encourage the prevention of pressure ulcers, the prevalence is high. Public reporting and benchmarking are now available, evidence-based guidelines have been disseminated and national goals have been set. Strategies for implementing practices outlined in the guidelines, meeting goals and changing attitudes must be further developed.
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Affiliation(s)
- Lena Gunningberg
- Associate Professor, Department of Public Health and Caring Sciences, Uppsala University and Uppsala University Hospital, Uppsala, Sweden and Adjunct Assistant Professor, School of Nursing, University of California, San Francisco, CA, USA Assistant Professor, Lund University and Skåne University Hospital, Lund, Sweden Assistant Professor, Karlstad University and County Council of Värmland, Karlstad, Sweden Professor, Faculty of Health and Society, Malmö University and Skåne University Hospital, Malmö, Sweden
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Gunningberg L, Mårtensson G, Mamhidir AG, Florin J, Muntlin Athlin Å, Bååth C. Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses: a descriptive, comparative multicentre study in Sweden. Int Wound J 2013; 12:462-8. [PMID: 23919728 DOI: 10.1111/iwj.12138] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 07/05/2013] [Accepted: 07/08/2013] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.
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Affiliation(s)
- Lena Gunningberg
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Gunilla Mårtensson
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Anna-Greta Mamhidir
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
| | - Jan Florin
- Department of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Åsa Muntlin Athlin
- Department of Public Health and Caring Sciences, Uppsala University and University Hospital, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,School of Nursing, University of Adelaide, Adelaide, Australia
| | - Carina Bååth
- Faculty of Social and Life Sciences, Department of Nursing, Karlstad University, Karlstad, Sweden.,County Council of Värmland, Karlstad, Sweden
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Takahashi Y, Isogai Z, Mizokami F, Furuta K, Nemoto T, Kanoh H, Yoneda M. Location-dependent depth and undermining formation of pressure ulcers. J Tissue Viability 2013; 22:63-7. [DOI: 10.1016/j.jtv.2013.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/29/2022]
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Dugaret E, Videau MN, Faure I, Gabinski C, Bourdel-Marchasson I, Salles N. Prevalence and incidence rates of pressure ulcers in an Emergency Department. Int Wound J 2012; 11:386-91. [PMID: 23043304 DOI: 10.1111/j.1742-481x.2012.01103.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Older patients represent an increasing population in emergency department (ED) with underlying diseases and longer ED length of stay, which are potential risk factors of pressure ulcers (PUs). The aim of the study was to determine the prevalence and incidence rates of PUs in an Emergency Department and to analyse variables related to PUs occurrence. The study was carried out in the Emergency Department of Bordeaux (France), and included 602 patients from 1 to 15 June 2010. All the potential body sites of pressure were examined at admission and discharge for all the patients by trained nurses. Comorbidity score, list of treatment, length of stay (hours), PUs (including stage I) and C-reactive protein (CRP) level were systematically recorded. A total of 47 (7·8%) patients had prevalent PUs at admission and 74 (12·3%) at discharge. The cumulative incidence was 4·9% and the incidence density was 5·4 per 1000 patients per hour. In multivariate analysis, higher comorbidities (OR 1·3; P = 0·014) and CRP levels (OR 1·005; P = 0·017) were both independent risk factors for developing PU. In conclusion, these data show that even a very short stay to the ED is sufficient to induce PUs especially stage I.
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Affiliation(s)
- Elodie Dugaret
- CHU Bordeaux, Pôle de Gérontologie Clinique, Pessac, FrancePôle de Médecine et Urgences, Bordeaux, France
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Meaume S, Kerihuel JC, Fromantin I, Téot L. Workload and prevalence of open wounds in the community: French Vulnus initiative. J Wound Care 2012; 21:62, 64, 66 passim. [PMID: 22584525 DOI: 10.12968/jowc.2012.21.2.62] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To calculate the prevalence of open cutaneous wounds presented on a routine working day in community settings in metropolitan France, and to estimate the workload associated with the care of these wounds by nurses, GPs and specialists (dermatologists, diabetologists and phlebologists). METHOD A transversal epidemiological survey was conducted on a randomly selected sample of the above practitioners between June and July 2008. The percentage of patients presenting on a routine working day with open a cutaneous lesion of any origin, location, size and duration was assessed. All local and systemic care performed on the patient during that day because of the wound was also recorded. RESULTS In total, 475 GPs, 453 specialists and 238 nurses participated (n=1166) and saw a total of 29 663 patients, of whom 3037 presented with one or more cutaneous wound. The overall non-weighted prevalence of patients with a wound was 10.2% (95%CI: 9.9%;10.6%). This prevalence was similar for GPs (6.0%) and for specialists (6.9%), but was higher for nurses (22.0%). Forty-three per cent of all wounds had a duration of over 6 weeks. These chronic wounds were predominantly leg ulcers, diabetic foot ulcers or pressure ulcers, but also included wounds of all aetiologies. For 33% of all patients with wounds, the impact on their health status was serious to severe. The overwhelming majority of wounds (95%) required local care, including in 65% of cases cleansing and debridement. CONCLUSION Despite its limitations, this initiative, the first of its type in France, strongly suggests that wound care constitutes an important part of routine care given by health professionals in the community, and for a substantial number of these patients, wounds represent a serious morbidity. DECLARATION OF INTEREST The non-profit organisation 'Association Vivre avec une Plaie' financially supported this study. This association received unrestricted grants from the French Wound Healing Society (SFFPC) and a consortium of private companies (main sponsors: ConvaTec, Genevrier, Hartmann, KCI, Mölnycke, Smith & Nephew, Urgo; minor sponsors: Coloplast, Covidien, HNE) to fund the costs incurred by the methodological process and statistical analysis but had no input into the findings. The National Health Insurance Organisation provided non-financial support to this initiative. J.C. Kerihuel received support for the submitted work from 'Association Vivre avec une Plaie'. S. Meaume, I. Fromantin and L. Téot have no financial relationship with 'Association Vivre avec une Plaie', for either this or any work submitted in the previous 3 years. The authors have no non-financial interests that may be relevant to the submitted work, and their spouses, partners, or children have no financial relationships that may be relevant to the submitted work
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Affiliation(s)
- S Meaume
- Plastic and Reconstructive Surgeon, Head of Wound Healing Unit, 1 Assistance Publique Hôpitaux de Paris, Hôpital Rothschild, Paris, France
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Masaki N, Sugama J, Okuwa M, Inagaki M, Matsuo J, Nakatani T, Sanada H. Heel blood flow during loading and off-loading in bedridden older adults with low and normal ankle-brachial pressure index: a quasi-experimental study. Biol Res Nurs 2012; 15:285-91. [PMID: 22531365 DOI: 10.1177/1099800412437929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to evaluate the differences in heel blood flow during loading and off-loading in bedridden adults older than 65 years. The patients were divided into three groups based on ankle-brachial pressure index (ABI) and transcutaneous oxygen tension (tcPO₂): (1) patients with an ABI ≥ 0.8 (Group A); (2) patients with an ABI < 0.8 and heel tcPO₂ ≥ 10 mmHg (Group B); and (3) patients with an ABI < 0.8 and heel tcPO₂ < 10 mmHg (Group C). Heel blood flow was monitored using tcPO₂ sensors. Data were collected with the heel (1) suspended above the bed surface (preload), (2) on the bed surface for 30 min (loading), and (3) again suspended above the bed surface for 60 min (off-loading). Heel blood flow during off-loading was assessed using three parameters: oxygen recovery index (ORI), total tcPO₂ for the first 10 min, and change in tcPO₂ after 60 min of off-loading. ORI in Group C (n = 8) was significantly shorter than in Groups A (n = 22) and B (n = 15). Total tcPO₂ for the first 10 min of off-loading in Group C was significantly less than that in Groups A and B. Change in tcPO₂ after 60 min of off-loading in Group C was less than in Group A. Based on these findings, additional preventive care against heel blood flow decrease in older adults with an ABI < 0.8 and heel tcPO₂ < 10 mmHg might be necessary after loading.
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Affiliation(s)
- Nami Masaki
- Department of Nursing, Kobe City Medical Center, General Hospital, Kobe City, Japan
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Moore Z, Cowman S. Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland. J Clin Nurs 2011; 21:362-71. [DOI: 10.1111/j.1365-2702.2011.03749.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tubaishat A, Anthony D, Saleh M. Pressure ulcers in Jordan: a point prevalence study. J Tissue Viability 2010; 20:14-9. [PMID: 20880710 DOI: 10.1016/j.jtv.2010.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 08/28/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pressure ulcers are a common problem among hospitalised patients. Several prevalence studies have been conducted internationally but there is a paucity of research on pressure ulcer in the Arab world in general and in Jordan specifically. PURPOSE The aim of this study was to quantify the prevalence rate of pressure ulcers in Jordan, and to compare these figures with other studies conducted using the same methods. DESIGN A cross-sectional survey design. PARTICIPANTS All inpatients older than eighteen in both university and general hospitals in Jordan. Patients in the emergency, day care and maternity wards were excluded. INSTRUMENTS European Pressure Ulcer Advisory Panel (EUPAP) data collection form. METHODS The survey was conducted by examining patients' skin. Pressure ulcers were classified according to the EPUAP grading system. Risk of pressure ulcer development was assessed using the Braden scale. Data were collected on preventive measures recorded in the clinical setting. RESULTS The overall prevalence rate was 12% (All percentages are rounded to the nearest digit) (7% when Grade I excluded). The sacrum and heel were the most common affected sites. Grade one was the most common grade (44%). Only 17% of the patients at risk received adequate prevention. CONCLUSION The pressure ulcer prevalence rate in Jordan is lower than that published in most studies utilising the same methodology. Despite this relatively low prevalence very few patients at risk received adequate prevention, and there is therefore a need to raise the awareness for pressure ulcer prevention in Jordan. Furthermore, differences in age and frailty in the Jordanian sample could explain the low prevalence.
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Posnett J, Gottrup F, Lundgren H, Saal G. The resource impact of wounds on health-care providers in Europe. J Wound Care 2009; 18:154-161. [PMID: 19349935 DOI: 10.12968/jowc.2009.18.4.41607] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most of the literature focuses on the resources required to manage particular wound types, rather than the cost of wounds to health-care organisations. Until this information is available, wound care is unlikely to be a management priority.
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