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Na HJ, Yoo SH, Kweon YR. Exploring nurses' experiences in pressure sore care in long-term care facilities. Int J Qual Stud Health Well-being 2024; 19:2324495. [PMID: 38431906 PMCID: PMC10911102 DOI: 10.1080/17482631.2024.2324495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/25/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND This study uses an interpretive description approach to explore nurses' experiences with pressure sore care in long-term care facilities, highlighting the complexity of their encounters. METHODS 10 experienced nurses from South Korean small to medium-sized hospitals were chosen via purposive sampling for interviews. Data analysis utilized Braun and Clarke's reflexive thematic analysis. RESULTS The study's findings collectively reflect the intricate journey of nurses in Long-term care facilities as they grapple with the challenges of pressure sore care. These nurses transform their perception of pressure sores, encountering a dynamic shift in their understanding. They face multifaceted challenges in providing optimal care, marked by resource constraints and the absence of standardized guidelines. Emotionally, they navigate a complex terrain of sentiments, oscillating between feelings of accomplishment and helplessness. Despite these hurdles, they persistently strive for excellence in pressure sore nursing, driven by an unwavering commitment to delivering the best possible care within the confines of their healthcare environment. CONCLUSION The study enhances understanding of pressure sore care in long-term facilities and suggests avenues for improving nursing practices and care quality through targeted interventions.
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Affiliation(s)
- Hyung-Ju Na
- Department of nursing, Seoul Metropolitan Dongbu Hospital, Seoul, Korea
| | - Sung-Hee Yoo
- Department of Nursing, Chonnam National University, Gwangju, ROK
| | - Young-Ran Kweon
- Department of Nursing, Chonnam National University, Gwangju, ROK
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Ottaviani S, Rondanina E, Arnone F, Brucato V, Campigli R, Bona MD, Tagliafico L, Ottaviani E, Nencioni A, Monacelli F. Multidimensional-Based Prediction of Pressure Ulcers Development and Severity in Hospitalized Frail Oldest Old: A Retrospective Study. Clin Interv Aging 2024; 19:1509-1517. [PMID: 39253399 PMCID: PMC11381216 DOI: 10.2147/cia.s440943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/27/2024] [Indexed: 09/11/2024] Open
Abstract
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.
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Affiliation(s)
- Silvia Ottaviani
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eleonora Rondanina
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | | | - Luca Tagliafico
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ennio Ottaviani
- Department of Mathematics (DIMA), University of Genoa, Genoa, 16132, Italy
| | - Alessio Nencioni
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Sugathapala RDUP, Latimer S, Gillespie BM, Balasuriya A, Chaboyer W. Prevalence and incidence of pressure injuries among nursing home residents with darker skin tones: A prospective cohort study. J Nurs Scholarsh 2024. [PMID: 39129213 DOI: 10.1111/jnu.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024]
Abstract
AIM To measure the prevalence and incidence of nursing home-acquired pressure injuries in older adults residing in Sri Lankan nursing homes. BACKGROUND Pressure injury prevalence and incidence are indicators of safety and quality of care. A significant portion of the global population has a skin color dominated by the presence of melanin. Yet, the number of nursing home residents with darker skin tones who develop pressure injuries in nursing homes is relatively unknown. DESIGN Prospective multisite cohort study conducted in nine nursing homes in Sri Lanka. The sample comprised 210 residents aged ≥60 years old. METHODS Semi structured observations and chart audits were used to gather data from July to October 2023. Head-to-toe visual skin assessment to check for nursing home- acquired pressure injuries, Braden pressure injury risk scale and Fitzpatrick skin tone assessments were conducted on all recruited residents at baseline. All recruited residents were followed-up weekly for 12 weeks until detection of a new pressure injury, death, discharge, or transfer. RESULTS Pressure injury point prevalence at baseline was 8.1% (17/210). Cumulative incidence was 17.1% (36/210). Incidence density was 15.8 per 1000 resident weeks. Most nursing home-acquired pressure injuries were located on the ankle at baseline (29.4%; 5/17) and in the follow-up period (27.8%; 10/36). Stage I pressure injuries were most common: 58.8% (10/17) and 44.4% (16/36) at baseline and during follow-up respectively. CONCLUSIONS About one in six nursing home residents developed a new pressure injury over the 12-week follow-up period. Despite staff and resource constraints, there remains a need to focus on the prevention of pressure injuries in Sri Lankan nursing homes. CLINICAL RELEVANCE Studies on the burden of pressure injuries among darker skin tone nursing home residents are lacking and the current evidence available are predominantly from Western countries. The findings of this study highlight the need of targeted preventive measures for nursing home residents with darker skin tones.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
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Zuniga J, Mungai M, Chism L, Frost L, Kakkar R, Kyololo O. Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review. Nurs Outlook 2024; 72:102151. [PMID: 38490058 DOI: 10.1016/j.outlook.2024.102151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
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.
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Affiliation(s)
- Julie Zuniga
- School of Nursing, The University of Texas at Austin, Austin, TX.
| | | | - Lucy Chism
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Livia Frost
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Reha Kakkar
- College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - O'Brien Kyololo
- School of Nursing and Midwifery, Moi University, Eldoret, Kenya
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5
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Yang LF, Mu JX, Zhang J, Zang S, Zhang L, Qi JH, Ni CP, Liu Y. Interventions to promote the implementation of pressure injury prevention measures in nursing homes: A scoping review. J Clin Nurs 2024; 33:1709-1723. [PMID: 38156732 DOI: 10.1111/jocn.16983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/18/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
AIMS To identify studies and the content of the interventions that have facilitated the implementation of pressure injury (PI) prevention measures in nursing home settings. DESIGN AND METHOD A scoping review methodology was employed. The author has carried out the following steps successively: Identified this scoping review's questions, retrieved potentially relevant studies, selected relevant studies, charted the data, summarised the results, and consulted with stakeholders from nursing homes in China. DATA SOURCES Six electronic databases and three resources of grey literature-PubMed, CINAHL, Web of Science Core Collection, Embase, Cochrane Central Register of Controlled Trials, Psych INFO, Open Grey, MedNar, ProQuest Dissertations, and Theses Full Texts were searched from January 2002 through May 2022. RESULTS Forty articles were included, among which the primary interventions were quality improvement, training and education, evidence-based practice, device-assisted PI prophylaxis, nursing protocols, and clinical decision support systems. Twenty-three outcome indicators were summarised in 40 articles, which included 10 outcome indicators, seven process indicators, and six structural indicators. Furthermore, only five articles reported barriers in the process of implementing interventions. CONCLUSION The common interventions to promote the implementation of PI prevention measures in nursing homes are quality improvement, training, and education. Relatively limited research has been conducted on evidence-based practice, clinical decision support systems, device-assisted PI prophylaxis, and nursing protocols. In addition, there is a paucity of studies examining the impediments to implementing these measures and devising targeted solutions. Therefore, it is recommended that future studies include analysis and reporting of barriers and facilitators as part of the article to improve the sustainability of the intervention. IMPACT This article reminds nursing home managers that they should realise the importance of implementation strategies between the best evidence of PI prevention and clinical practice. Also, this review provides the types, contents, and outcome indicators of these strategies for managers of nursing homes to consider what types of interventions to implement in their organisations. TRIAL AND PROTOCOL REGISTRATION The protocol of this scoping review was published as an open-access article in June 2022 (Yang et al., 2022).
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Affiliation(s)
- L F Yang
- Department of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - J X Mu
- Department of Nursing, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - J Zhang
- The Operating Room, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - S Zang
- Department of Nursing, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - L Zhang
- Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province, China
| | - J H Qi
- Department of Pharmacy and Health Management, Hebei Chemical & Pharmaceutical College, Shijiazhuang, Hebei Province, China
| | - C P Ni
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
| | - Y Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
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St Clair B, Nguyen A, Jorgensen M, Georgiou A. Adverse impacts in residential aged care facilities: The resident perspective. Australas J Ageing 2024. [PMID: 38595217 DOI: 10.1111/ajag.13306] [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: 05/14/2023] [Revised: 01/21/2024] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Inclusion of consumer perspectives is a key component to person-centred health-care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents. METHODS The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory. RESULTS Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self-determination, (iii) the impact of COVID-19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents. CONCLUSIONS This research highlights the difference between health-care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well-being measures that capture elements that matter to older people.
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Affiliation(s)
- Bella St Clair
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Health, Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Amy Nguyen
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Mikaela Jorgensen
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Ibeh C, Hambridge K. A narrative review of patients' lived experience of having a pressure injury. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S10-S23. [PMID: 38386534 DOI: 10.12968/bjon.2024.33.4.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
AIM To explore patients' experiences of living with pressure injuries. DESIGN A qualitative narrative review and thematic synthesis of qualitative research studies. DATA SOURCES Six electronic databases were searched: Medline, CINAHL, Scopus, Web of Science, Embase, and Google Scholar (for grey literature). The search was conducted between October 2022 and April 2023. Setting: Acute, community and care home settings across the UK, France, Belgium and the US. REVIEW METHODS The PRISMA checklist for reporting systematic reviews was used. The included studies were evaluated for quality using the CASP tool. The Joanna Briggs Institute data extraction tool was used to extract data from the included studies. Thematic synthesis was used to identify themes to present a coherent and nuanced understanding of patients' experiences of living with pressure injuries. RESULTS Nine studies involving 244 participants, aged 21 to 101, with pressure injuries, met the inclusion criteria. Three key themes emerged using thematic analysis: physiological, emotional and psychological, and social effects. Within these themes, subthemes such as endless pain and discomfort, loss of mobility and independence, and social isolation were dominant in all aspects of the lives of patients living with pressure injuries. CONCLUSIONS This narrative review gives clear and multifaceted insight into the impact of pressure injuries on individuals' lives, emphasising the necessity for patient-centred care and the integration of evidence-based tools for effective pain management and risk assessment. The impact of pain on emotional and psychological wellbeing was significant, and the financial implications are scarcely known. Future research is needed to explore the experiences of younger adults and the financial consequences of living with pressure injuries.
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Affiliation(s)
- Chioma Ibeh
- Final-year Student Nurse, School of Nursing and Midwifery, University of Plymouth
| | - Kevin Hambridge
- Lecturer in Adult Nursing, School of Nursing and Midwifery, University of Plymouth
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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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Völzer B, El Genedy-Kalyoncu M, Fastner A, Tomova-Simitchieva T, Neumann K, Hillmann K, Blume-Peytavi U, Hahnel E, Sill J, Balzer K, Kottner J. Enhancing skin health and safety in aged care (SKINCARE trial): A cluster-randomised pragmatic trial. Int J Nurs Stud 2024; 149:104627. [PMID: 37956524 DOI: 10.1016/j.ijnurstu.2023.104627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package. TRIAL DESIGN A two-arm cluster-randomised controlled trial was conducted. METHODS In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed. RESULTS A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial. CONCLUSIONS The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function. TRIAL REGISTRATION This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
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Affiliation(s)
- Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Alexandra Fastner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Konrad Neumann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany
| | - Kathrin Hillmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Elisabeth Hahnel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Charitéplatz 1, 10117 Berlin, Germany
| | - Janna Sill
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Katrin Balzer
- University of Lübeck, Nursing Research Unit, Institute for Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany; Ghent University, Faculty of Medicine and Health Sciences, Belgium.
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10
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Sugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud 2023; 148:104605. [PMID: 37801939 DOI: 10.1016/j.ijnurstu.2023.104605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN Systematic review and meta-analysis. SETTING(S) Nursing homes, aged care, or long-term care facilities. PARTICIPANTS Older people, 60 years and older. METHODS Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER PROSPERO CRD42022328367. TWEETABLE ABSTRACT Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
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11
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Healy CR, Gethin G, Pandit A, Finn DP. Chronic wound-related pain, wound healing and the therapeutic potential of cannabinoids and endocannabinoid system modulation. Biomed Pharmacother 2023; 168:115714. [PMID: 37865988 DOI: 10.1016/j.biopha.2023.115714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Chronic wounds represent a significant burden on the individual, and the healthcare system. Individuals with chronic wounds report pain to be the most challenging aspect of living with a chronic wound, with current therapeutic options deemed insufficient. The cutaneous endocannabinoid system is an important regulator of skin homeostasis, with evidence of system dysregulation in several cutaneous disorders. Herein, we describe the cutaneous endocannabinoid system, chronic wound-related pain, and comorbidities, and review preclinical and clinical evidence investigating endocannabinoid system modulation for wound-related pain and wound healing. Based on the current literature, there is some evidence to suggest efficacy of endocannabinoid system modulation for promotion of wound healing, attenuation of cutaneous disorder-related inflammation, and for the management of chronic wound-related pain. However, there is 1) a paucity of preclinical studies using validated models, specific for the study of chronic wound-related pain and 2) a lack of randomised control trials and strong clinical evidence relating to endocannabinoid system modulation for wound-related pain. In conclusion, while there is some limited evidence of benefit of endocannabinoid system modulation in wound healing and wound-related pain management, further research is required to better realise the potential of targeting the endocannabinoid system for these therapeutic applications.
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Affiliation(s)
- Catherine R Healy
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - Georgina Gethin
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland; School of Nursing and Midwifery, University of Galway, Galway City, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway City, Ireland
| | - Abhay Pandit
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, University of Galway, Galway City, Ireland; Galway Neuroscience Centre, University of Galway, Galway City, Ireland; Centre for Pain Research, University of Galway, Galway City, Ireland; CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway City, Ireland.
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12
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Bottega M, Tempesta M, Piovesan C, Rigo F, Bordignon J, Vedelago D, Calo L, Marchet P, Dorigo M, Scarpa G, Barba LD, Coppe A. The risk and prevalence of pressure injuries in older people in the home care service: a cross-sectional study. J Wound Care 2023; 32:ccxi-ccxviii. [PMID: 37830802 DOI: 10.12968/jowc.2023.32.sup10.ccxi] [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: 10/14/2023]
Abstract
OBJECTIVE This study aimed to understand the risk of developing pressure injuries (PIs) and their prevalence rate in older adults in Italy who received public funded home care services and who were often living alone. METHOD In May 2019, a cross-sectional study was performed according to the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. The data collection included demographic variables, a PI risk assessment using the Braden Scale score, the type of mobility devices available, the wound description detailing the PI category, body location and ongoing treatment. Data analysis was conducted using non-parametric descriptive statistics. RESULTS Of the 2223 patients who participated in the study, the risk of developing a PI as measured with the Braden Scale sore was: 'absent' for 37.7%; 'mild' for 25.8%; 'moderate' for 13.8%; 'high' for 15.5%; and 'severe' for 7.1% of patients. The PI prevalence in the sample of home care service patients was 26%, of which 46% were inpatients with a Braden Scale score of <14. Of the PIs that developed during the study, 65% of these developed in patients in home care and of these, 81% had a Braden Scale score of ≤9. CONCLUSION PIs developed not only during hospitalisation but at home. Assessing the commitment of patients and caregivers to PI prevention and treatment strategies in home care services could be key to reducing PI prevalence, hospital admissions for PIs, related complications for older people living at home, and the severity of the PI category.
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Affiliation(s)
- Michela Bottega
- Department of the Health Care Professions, Azienda Unita Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, Treviso, Italy
| | - Marco Tempesta
- Department of the Health Care Professions, AULSS 5 Polesana, Rovigo, Italy
| | - Cinzia Piovesan
- Epidemiological Service, Department of Health Prevention, AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Francesca Rigo
- Home Care Nursing, AULSS 2 Marca Trevigiana, Treviso, Italy
| | | | - Dalmazio Vedelago
- Cardiac Surgery Intensive Care Unit, AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Luca Calo
- Department of the Health Care Professions, Azienda Unita Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, Treviso, Italy
| | - Paola Marchet
- Department of the Health Care Professions, Azienda Unita Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, Treviso, Italy
| | - Mara Dorigo
- Department of the Health Care Professions, Azienda Unita Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, Treviso, Italy
| | - Giovanna Scarpa
- Department of the Health Care Professions, Azienda Unita Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, Treviso, Italy
| | | | - Alberto Coppe
- Department of the Health Care Professions, Azienda Unita Locale Socio Sanitaria (AULSS) 2 Marca Trevigiana, Treviso, Italy
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13
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Sanchez M, Courtois-Amiot P, Capdepon A, Neveux N, Gautry J, Dorigny B, Brossault L, Bouillanne O, Aussel C, Raynaud-Simon A, Cynober L. Four-week administration of an energy and protein dense oral nutritional supplement improves micronutrient concentrations but does not completely correct deficiencies in institutionalized malnourished older adults. Front Nutr 2023; 10:1249936. [PMID: 37829732 PMCID: PMC10565821 DOI: 10.3389/fnut.2023.1249936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/25/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Poor food intake is common among elderly living in nursing homes, leading to micronutrient deficiency (MD). There are no recommendations for the management of MD in malnourished older adults. Methods We conducted a single arm, open-label, multicenter interventional study in institutionalized malnourished older adults to describe the effect of a 4-week daily energy and protein dense oral nutritional supplementation (ONS, 600 kcal, 30 g protein per unit) containing 50% of the recommended daily micronutrient intake on micronutrient status. Plasma concentrations of vitamins (A, B9, B12, C, E), magnesium (Mg), selenium (Se) and zinc (Zn), and erythrocyte vitamin B9 were measured at baseline and after 4 weeks. Results Forty-six participants completed the study (age 87.4 ± 6.6). At baseline, the most frequent MD were Se (48%), Zn (35%), Mg (24%) and vitamin C (24%). Plasma concentrations of vitamins B9, B12, C and E, Mg, Se and Zn significantly increased and the proportion of subjects with at least one MD decreased (p = 0.006). However, after 4 weeks, 40% of subjects still had at least one MD. Discussion ONS consumption improved micronutrient status but did not correct MD in all participants. Our data suggest that the prescription of vitamin, mineral and trace element supplementation should be considered in institutionalized malnourished older adults in addition to high energy and high protein ONS.
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Affiliation(s)
- Manuel Sanchez
- Department of Geriatrics, APHP Bichat Hospital, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
| | | | - Audrey Capdepon
- Nestlé Health Science, Issy-les-Moulineaux, France
- Research Unit in Pharmacology URP4466, Faculty of Pharmacy, Paris Cité University, Paris, France
| | - Nathalie Neveux
- Research Unit in Pharmacology URP4466, Faculty of Pharmacy, Paris Cité University, Paris, France
- Clinical Chemistry Laboratory, APHP Cochin Hospital, Paris, France
| | | | | | | | - Olivier Bouillanne
- Research Unit in Pharmacology URP4466, Faculty of Pharmacy, Paris Cité University, Paris, France
- Department of Geriatrics, APHP Emile Roux Hospital, Limeil-Brévannes, France
| | - Christian Aussel
- Research Unit in Pharmacology URP4466, Faculty of Pharmacy, Paris Cité University, Paris, France
- Clinical Chemistry Laboratory, APHP Saint-Antoine Hospital, Paris, France
| | - Agathe Raynaud-Simon
- Department of Geriatrics, APHP Bichat Hospital, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
- Research Unit in Pharmacology URP4466, Faculty of Pharmacy, Paris Cité University, Paris, France
| | - Luc Cynober
- Research Unit in Pharmacology URP4466, Faculty of Pharmacy, Paris Cité University, Paris, France
- Clinical Chemistry Laboratory, APHP Cochin Hospital, Paris, France
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14
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Gruenerbel L, Heinrich F, Böhlhoff-Martin J, Röper L, Machens HG, Gruenerbel A, Schillinger M, Kist A, Wenninger F, Richter M, Steinbacher L. Wearable Prophylaxis Tool for AI-Driven Identification of Early Warning Patterns of Pressure Ulcers. Bioengineering (Basel) 2023; 10:1125. [PMID: 37892855 PMCID: PMC10603913 DOI: 10.3390/bioengineering10101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
As today's society ages, age-related diseases become more frequent. One very common but yet preventable disease is the development of pressure ulcers (PUs). PUs can occur if tissue is exposed to a long-lasting pressure load, e.g., lying on tissue without turning. The cure of PUs requires intensive care, especially for the elderly or people with preexisting conditions whose tissue needs longer healing times. The consequences are heavy suffering for the patient and extreme costs for the health care system. To avoid these consequences, our objective is to develop a pressure ulcer prophylaxis device. For that, we built a new sensor system able to monitor the pressure load and tissue vital signs in immediate local proximity at patient's predilection sites. In the clinical study, we found several indicators showing correlations between tissue perfusion and the risk of PU development, including strongly reduced SpO2 levels in body tissue prior to a diagnosed PU. Finally, we propose a prophylaxis system that allows for the prediction of PU developments in early stages before they become visible. This work is the first step in generating an effective system to warn patients or caregivers about developing PUs and taking appropriate preventative measures. Widespread application could reduce patient suffering and lead to substantial cost savings.
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Affiliation(s)
- Lorenz Gruenerbel
- Fraunhofer Institute for Electronic Microsystems and Solid State Technologies EMFT, 80686 Munich, Germany; (F.W.); (M.R.)
| | - Ferdinand Heinrich
- Fraunhofer Institute for Electronic Microsystems and Solid State Technologies EMFT, 80686 Munich, Germany; (F.W.); (M.R.)
| | - Jonathan Böhlhoff-Martin
- Department for Plastic Surgery and Hand Surgery, Technical University Munich, Hospital Rechts der Isar MRI, 81675 Munich, Germany (L.S.)
| | - Lynn Röper
- Department for Plastic Surgery and Hand Surgery, Technical University Munich, Hospital Rechts der Isar MRI, 81675 Munich, Germany (L.S.)
| | - Hans-Günther Machens
- Department for Plastic Surgery and Hand Surgery, Technical University Munich, Hospital Rechts der Isar MRI, 81675 Munich, Germany (L.S.)
| | | | - Moritz Schillinger
- Artificial Intelligence in Communication Disorders, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany (A.K.)
| | - Andreas Kist
- Artificial Intelligence in Communication Disorders, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany (A.K.)
| | - Franz Wenninger
- Fraunhofer Institute for Electronic Microsystems and Solid State Technologies EMFT, 80686 Munich, Germany; (F.W.); (M.R.)
| | - Martin Richter
- Fraunhofer Institute for Electronic Microsystems and Solid State Technologies EMFT, 80686 Munich, Germany; (F.W.); (M.R.)
| | - Leonard Steinbacher
- Department for Plastic Surgery and Hand Surgery, Technical University Munich, Hospital Rechts der Isar MRI, 81675 Munich, Germany (L.S.)
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15
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Furtado K, Voorham J, Infante P, Afonso A, Morais C, Lucas P, Lopes M. The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal's Long-Term Care Units. Healthcare (Basel) 2023; 11:1751. [PMID: 37372869 DOI: 10.3390/healthcare11121751] [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: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people's quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. METHODS A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. RESULTS A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 "Floating so that staffing is equalised among units" is strongly associated with a shorter PU healing time. CONCLUSION A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.
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Affiliation(s)
- Katia Furtado
- Out Patient Department, Hospital of Portalegre, Unidade Local de Saúde do Norte Alentejano, 7300-312 Portalegre, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
| | - Jaco Voorham
- DTIRS-Data to Insights Research Solutions, 1750-307 Lisboa, Portugal
| | - Paulo Infante
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Anabela Afonso
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Clara Morais
- Administração Regional de Saúde do Alentejo, Largo do Jardim do Paraíso, nº 1, 7000-864 Évora, Portugal
| | - Pedro Lucas
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
| | - Manuel Lopes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
- São João de Deus School of Nursing, Universidade de Évora, 7000-671 Évora, Portugal
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16
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Hayes C, Fox A, Scott-Thomas J, Graham Y. Pressure ulcer prevention in practice. Br J Community Nurs 2023; 28:S14-S21. [PMID: 37262096 DOI: 10.12968/bjcn.2023.28.sup6.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pressure ulcer avoidance in the context of care has the potential to improve the quality and longevity of lives for those living in residential and non-residential care home settings. This paper reports on an educational intervention in the North East of England, which focused on the initial benchmarking of self-reported knowledge levels of healthcare workers, who regularly work with people living within this context. Using a longitudinal study design, a series of three questionnaires were used to collate data from research participants. The study revealed a disparity between what healthcare workers perceived their knowledge to be versus what it was, in terms of application to practice at the front line of patient care. The study reveals that confidence levels in dealing with pressure ulceration had been significantly altered by the training session that was being implemented. It also raised concerns on the methodological approaches being used in the education and training of care staff, which should ideally lead them to be proactive with patients in their care. The study provides an insight into the need for a strategic and targeted approach to pressure ulceration avoidance education, which is tailored to individual learning needs through supervision and mentorship as part of clinical education.
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Affiliation(s)
- Catherine Hayes
- Professor of Health Professions Pedagogy and Scholarship, University of Sunderland, Faculty of Health Sciences and Wellbeing
| | - Ann Fox
- Executive Director of Nursing, NHS Sunderland CCG
| | - Jeanette Scott-Thomas
- Executive Director of Nursing, Quality and Patient Safety at South Tyneside Clinical Commissioning Group
| | - Yitka Graham
- Associate Professor of Health Services Research and Head of the Helen McCardle Nursing and Research Care Institute
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17
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Perez-Lopez S, Perez-Basterrechea M, Garcia-Gala JM, Martinez-Revuelta E, Fernandez-Rodriguez A, Alvarez-Viejo M. Stem cell and tissue engineering approaches in pressure ulcer treatment. J Spinal Cord Med 2023; 46:194-203. [PMID: 33905315 PMCID: PMC9987762 DOI: 10.1080/10790268.2021.1916155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT Pressure ulcers or injuries, arise from ischemic damage to soft tissues induced by unrelieved pressure over a bony prominence. They are usually difficult to treat with standard medical therapy and often they recur. In the search for better treatment options, promising alternative forms of treatment are today emerging. Within the field of regenerative medicine, ongoing research on advanced therapies seeks to develop medicinal products based on gene therapy, somatic cell therapy, tissue-engineering and combinations of these. OBJECTIVE The main objective is to perform an overview of experimental and clinical developments in somatic cell therapy and tissue engineering targeting the treatment of pressure injuries. METHODS Searching terms as "PRESSURE ULCER", "STEM CELL THERAPY", "TISSUE ENGINEERING" or "WOUND HEALING" were used in combination or alone, including publications refered to basic and clinical research and focusing on articles showing results obtained in a clinical context. A total of 80 references are cited, including 23 references published in the 3 last years. RESULTS The results suggest that this form of treatment could be an interesting option in patients with difficult-to-treat ulcers as spinal cord injury patients. CONCLUSION This field of regenerative medicine is very broad and further research is warranted.
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Affiliation(s)
- Silvia Perez-Lopez
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, FINBA, Oviedo, Asturias, Spain
| | - Marcos Perez-Basterrechea
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, FINBA, Oviedo, Asturias, Spain
| | - Jose Maria Garcia-Gala
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, FINBA, Oviedo, Asturias, Spain
| | - Eva Martinez-Revuelta
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, FINBA, Oviedo, Asturias, Spain
| | - Angeles Fernandez-Rodriguez
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, FINBA, Oviedo, Asturias, Spain
| | - Maria Alvarez-Viejo
- Unidad de Terapia Celular y Medicina Regenerativa, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, FINBA, Oviedo, Asturias, Spain
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18
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Mäki-Turja-Rostedt S, Leino-Kilpi H, Koivunen M, Vahlberg T, Haavisto E. Consistent pressure ulcer prevention practice: The effect on PU prevalence and PU stages, and impact on PU prevention-A quasi-experimental intervention study. Int Wound J 2022. [PMID: 36584884 DOI: 10.1111/iwj.14067] [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: 03/12/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023] Open
Abstract
This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n = 115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.
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Affiliation(s)
- Sirpa Mäki-Turja-Rostedt
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Central Hospital, Pori, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Marita Koivunen
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| | - Tero Vahlberg
- Turku University Hospital, Turku, Finland.,Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku, Finland
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Cuddigan J, Haesler E, Moore Z, Carville K, Kottner J. Development, dissemination and evaluation of a smartphone-based app for pressure ulcer/injury prevention and treatment for use at the bedside. J Wound Care 2022; 31:S29-S39. [PMID: 36475841 DOI: 10.12968/jowc.2022.31.sup12.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE After launching the 2019 International Pressure Ulcer/Injury Guideline, the National Pressure Injury Advisory Panel (NPIAP), the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) collaborated with Sensorydata Corp., US, to develop a guideline app (InterPIP App). The app was designed to: present evidence-based guideline recommendations; incorporate search capacities and functionality to facilitate easy access to clinical guidance; provide accessibility in multiple languages; and to be available worldwide at a reasonable price, including opportunities for free access in low-resource countries. This paper describes the development, dissemination and formative evaluation of a mobile app providing evidence-based recommendations for pressure injury prevention, assessment/classification, and treatment at the point of care. METHOD An evaluation tool was designed based on a framework developed by Nouri et al. and made available to all app subscribers. RESULTS The InterPIP App is currently available in 11 languages and had been downloaded 3616 times by February 2022 in 78 countries. A total of 62 individuals responded to the survey of end-users. In this formal evaluation of user experiences, the app was rated positively on criteria of: information/content; usability; design; functionality; ethics; and security/privacy (median=4 on a 1-5 Likert scale). Overall perceived value was ranked lower with a median of three. Users provided suggestions for ongoing app enhancement. CONCLUSION The InterPIP App offers a unique opportunity to bring evidence-based guidance to the point of care. Formal evaluation of end-user experiences identified opportunities for quality improvement, and informed plans for future development and evaluation.
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Affiliation(s)
- Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, US
| | - Emily Haesler
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,Australian Centre for Evidence Based Aged Care, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Canberra, Australian Capital Territory, Australia
| | - Zena Moore
- Royal College of Surgeon in Ireland University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Queensland, Australia.,School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland.,Cardiff University, Cardiff, Wales.,Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Department of Public Health; Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai, China
| | - Keryln Carville
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Australia
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
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20
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Abstract
Chronic wounds are characterized by their inability to heal within an expected time frame and have emerged as an increasingly important clinical problem over the past several decades, owing to their increasing incidence and greater recognition of associated morbidity and socio-economic burden. Even up to a few years ago, the management of chronic wounds relied on standards of care that were outdated. However, the approach to these chronic conditions has improved, with better prevention, diagnosis and treatment. Such improvements are due to major advances in understanding of cellular and molecular aspects of basic science, in innovative and technological breakthroughs in treatment modalities from biomedical engineering, and in our ability to conduct well-controlled and reliable clinical research. The evidence-based approaches resulting from these advances have become the new standard of care. At the same time, these improvements are tempered by the recognition that persistent gaps exist in scientific knowledge of impaired healing and the ability of clinicians to reduce morbidity, loss of limb and mortality. Therefore, taking stock of what is known and what is needed to improve understanding of chronic wounds and their associated failure to heal is crucial to ensuring better treatments and outcomes.
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21
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Yang LF, Liu YL, Wu CT, Ni CP, Liu Y. Interventions to promote the implementation of pressure injuries prevention measures in nursing homes: a scoping review protocol. BMJ Open 2022; 12:e052469. [PMID: 36691232 PMCID: PMC9171172 DOI: 10.1136/bmjopen-2021-052469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/17/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Currently, various guidelines and documents on the prevention of pressure injuries have been published, but there are many serious lags in the actual practice in nursing homes. So some interventions are required to promote the implementation of normative practices. There was a review of preventive interventions for pressure injuries in long-term care facilities, but there is no systematic review of how to promote the implementation of preventive measures. This review aims to summarise interventions that promote the implementation of pressure injuries prevention measures in nursing homes, explore the research scope and gaps in this field and provide evidence and striving direction for global nursing homes to improve existing preventive behaviours. METHODS AND ANALYSIS This scoping review will combine the Arksey and O'Malley framework with further clarification and advice of the scoping review by Levac et al as methodological guidance. Systematic retrieval of relevant literature databases, grey literature and references included studies will be conducted. Two reviewers will screen titles and abstracts independently, and then screen the full text of potentially relevant articles to determine final inclusion. After that, two reviewers will extract data based on a predesigned data extraction table independently. Inductive analysis and narrative analysis will be used to collate, summarise and report the results. Finally, managers of nursing homes in China will be consulted for additional information and their viewpoints on the research findings. ETHICS AND DISSEMINATION Since the scoping review is a secondary analysis of the literature, there is no need to apply for ethical approval. Our goal is to share the results with key stakeholders to help them find the direction of effort and improve clinical practice. Therefore, dissemination plans include publication in international journals and sharing it at conferences to inform more healthcare workers about the scope and gaps of the studies.
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Affiliation(s)
- Long-Fei Yang
- Nursing Department, Peking Union Medical College Hospital, Beijing, China
| | - Yan-Ling Liu
- Nursing Department, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chun-Tao Wu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
| | - Cui-Ping Ni
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, China
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22
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Wang F, Chen M, Du J. Effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing: A meta-analysis. Int Wound J 2022; 19:2031-2038. [PMID: 35396823 DOI: 10.1111/iwj.13803] [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: 03/08/2022] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
We performed a meta-analysis to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing. A systematic literature search up to January 2022 was done and 13 studies included 1073 subjects with pressure ulcer wound at the start of the study; 593 of them were using traditional Chinese medicine treatments, and 480 were control for pressure ulcer wound. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing by the dichotomous methods with a random or fixed-influence model. Traditional Chinese medicine treatments had significantly higher complete healing (OR, 5.94; 95% CI, 3.94-8.95, P < .001), and curative ratio post-treatment (OR, 4.79; 95% CI, 2.62-8.76, P < .001) compared with control for subjects with pressure ulcer wound. Traditional Chinese medicine treatments had a significantly higher complete healing and curative ratio post-treatment compared with control for subjects with pressure ulcer wounds. Further studies are needed to validate these findings.
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Affiliation(s)
- Feida Wang
- Department of Traditional Chinese Medicine, Tongde Hospital of Zhejiang Province, Zhejiang, China
| | - Mingxu Chen
- Department of Rehabilitation Medicine, Hangzhou Xiacheng Hospital of integrated Traditional Chinese and Western Medicine, Zhejiang, China
| | - Jia Du
- Department of Acupuncture, Tongde Hospital of Zhejiang Province, Zhejiang, China
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23
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Arensberg MB, Brunton C, Drawert S, Richardson B. Prevalence Rates and Characteristics of Malnutrition, Frailty, and Other Nutrition and Muscle Mass-Related Conditions Document Potential Quality of Care Gap for Medicare Patients in US Skilled Nursing Facilities. Geriatrics (Basel) 2022; 7:geriatrics7020042. [PMID: 35447845 PMCID: PMC9027965 DOI: 10.3390/geriatrics7020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Changes to the payment structure of the United States (U.S.) healthcare system are leading to an increased acuity level of patients receiving short-term skilled nursing facility care. Most skilled nursing facility patients are older, and many have medical conditions that cannot be changed. However, conditions related to nutrition/muscle mass may be impacted if there is early identification/intervention. To help determine the diagnosis and potential impact of nutrition/muscle mass-related conditions in skilled nursing facilities, this study evaluated 2016–2020 US Medicare claims data. Methods aimed to identify a set of skilled nursing facility claims with one or more specific diagnoses (COVID-19, malnutrition, sarcopenia, frailty, obesity, diabetes, and/or pressure injury) and then to determine length of stay, discharge status, total charges, and total payments for each claim. Mean values per beneficiary were computed and between–group comparisons were performed. Results documented that each year, the total number of Medicare skilled nursing facility claims declined, whereas the percentage of claims for each study diagnosis increased significantly. For most conditions, potentially related to nutrition/muscle mass, Medicare beneficiaries had a shorter length of skilled nursing facility stays compared to those without the condition(s). Furthermore, a lower percentage of these Medicare beneficiaries were discharged home (except for those with claims for sarcopenia and obesity). Total claim charges for those with nutrition/muscle mass-related conditions exceeded those without (except for those with sarcopenia). We conclude that although the acuity level of patients in skilled nursing facilities continues to increase, skilled nursing facility Medicare claims for nutrition/muscle mass-related conditions are reported at lower levels than their likely prevalence. This represents a potential care gap and requires action to help improve patient health outcomes and skilled nursing facility quality metrics.
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Affiliation(s)
- Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
- Correspondence:
| | - Cory Brunton
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA;
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24
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Amini M, Mansouri F, Vafaee K, Janbakhsh A, Mahdavikian S, Moradi Y, Fallahi M. Factors affecting the incidence and prevalence of pressure ulcers in COVID-19 patients admitted with a Braden scale below 14 in the intensive care unit: Retrospective cohort study. Int Wound J 2022; 19:2039-2054. [PMID: 35322547 PMCID: PMC9111574 DOI: 10.1111/iwj.13804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
The pandemic of coronavirus (COVID‐19) has significantly increased the admission of patients with extensive complications, especially for respiratory support, to intensive care units (ICUs) worldwide. These patients also suffer from pressure ulcers (PUs) as another complication that occurs due to increased length of hospitalisation and acute conditions of patients. Therefore, this study aimed to evaluate the incidence and prevalence of PU and the factors affecting it in COVID‐19 patients admitted to ICUs. This cohort retrospective study used registry data in Imam Reza Hospital located in west of Iran. Four hundred and forty‐five COVID‐19 patients older than 20 years hospitalised in corona ICUs from 20 March 2020 to 30 December 2020, with a Braden score of less than 14 were included in the study. To investigate the relationship between variables in rate prevalence, univariate logistic regression analysis was used to calculate odds ratio, and for incidence rate in estimating PU risk generated in ICUs, hazard ratio was calculated using cox regression. One hundred and eighty‐three (41.12%) patients were male. The mean age of patients was 63 (SD = ±9.78) years. A total of 1152 cases of PU were generated, with the highest prevalence of PU with 234 cases in the sacrum. One hundred and seventy‐six (55.87%) patients underwent non‐invasive ventilation ulcers. The prevalence of PU was 79.7%. The highest prevalence was found in people over 80 years with 90.67%. The incidence ratio was 46.74%. The highest number of new cases was seen in diabetic patients with 60.96%. First‐degree ulcers were the most common degree of ulceration in 252 (55.38%) patients. Incidence and prevalence excluding first‐degree wounds were 24.04% and 49.66%, respectively. Age, Braden score, BMI, comorbidity, diabetes mellitus, stool incontinence, Glasgow coma scale, vasopressor, and length of hospital stay were significantly associated with PU (P < .05). The incidence and prevalence of PU in patients were high in this study. The length of hospitalisation and Braden score were the most important factors in the development of PU. The widespread prevalence of COVID‐19 and the relatively long stay of patients in the ICU created unfavourable conditions for patients and the treatment system, therefore, it emphasised the use of appropriate measures to prevent PU to avoid double costs and longer stays.
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Affiliation(s)
- Mahin Amini
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Feizollah Mansouri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kamran Vafaee
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Janbakhsh
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Mahdavikian
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences Sciences, Kermanshah, Iran
| | - Yasaman Moradi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Fallahi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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25
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Chen L, Ruan Y, Ma Y, Ge L, Han L. Effectiveness and safety of electrical stimulation for treating pressure ulcers: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13041. [PMID: 35244315 DOI: 10.1111/ijn.13041] [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: 01/04/2021] [Revised: 04/26/2021] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aims to synthesize qualitative evidence on the effectiveness and safety of electrical stimulation for treating pressure ulcers. BACKGROUND Electrical stimulation is often used clinically to treat pressure ulcers, but its effectiveness and safety and some potential problems are not clear. DESIGN This is a qualitative systematic review. DATA SOURCES The data sources are four English databases (PubMed, EMBASE, The Cochrane Library and Web of Science) and four Chinese databases (CNKI, SinoMed, VIP and WANFANG). METHODS Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study. We used the Review Manager 5.3 software to perform data analysis. RESULTS Seventeen randomized controlled trials including 740 patients were included in this study. Meta-analysis of eight randomized controlled trials demonstrated that electrical stimulation significantly reduced the ulcer surface in contrast with standard wound care alone or pulsed sham electrical stimulation. Nine studies showed that electrical stimulation increased the risk of pressure ulcers being completely healed than the controlled group. Three studies reported that adverse reactions were rare. CONCLUSIONS This study demonstrated that electrical stimulation was a relatively effective and safe adjunctive therapy for pressure ulcers treatment.
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Affiliation(s)
- Lian Chen
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China.,Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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26
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Nasir NJM, Corrias A, Heemskerk H, Ang ET, Jenkins JH, Sebastin SJ, Tucker-Kellogg L. The panniculus carnosus muscle: a missing link in the chronicity of heel pressure ulcers? J R Soc Interface 2022; 19:20210631. [PMID: 35193390 PMCID: PMC8864364 DOI: 10.1098/rsif.2021.0631] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chronic and recurring pressure ulcers (PUs) create an unmet need for predictive biomarkers. In this work, we examine the panniculus carnosus, a thin cutaneous muscle, traditionally considered vestigial in humans, and ask whether the panniculus may play a role in the chronicity and reinjury of heel PUs. To determine whether humans have a panniculus muscle layer at the heel, we dissected eight cadavers. To assess the influence of the panniculus layer on PU, we performed computational simulations of supine weight bearing. Finally, we assessed panniculus regeneration in fluorescent mice. Results show a panniculus layer present in all cadavers examined. Simulations show a thin layer of panniculus muscle causes a dramatic decrease in the volume of soft tissue experiencing high strain and stress, compared to a heel without a panniculus. Importantly, in the mouse model, the panniculus fails to regenerate after PU, even when other cutaneous layers had fully regenerated. Our work shows that the panniculus is able to redistribute load around the heel bone, which might allow it to prevent PUs. Moreover, it is highly susceptible to incomplete regeneration after PU. Poor panniculus regeneration after PU might be a predictive anatomical biomarker for recurrence, and this biomarker should be evaluated prospectively in future clinical trials.
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Affiliation(s)
- N Jannah M Nasir
- Cancer and Stem Cell Biology and Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Alberto Corrias
- Department of Biomedical Engineering, National University of Singapore
| | - Hans Heemskerk
- Cancer and Stem Cell Biology and Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - Eng Tat Ang
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Julia H Jenkins
- Cancer and Stem Cell Biology and Centre for Computational Biology, Duke-NUS Medical School, Singapore
| | - S J Sebastin
- Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Lisa Tucker-Kellogg
- Cancer and Stem Cell Biology and Centre for Computational Biology, Duke-NUS Medical School, Singapore
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27
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Völzer B, Kottner J. Associations between skin structural and functional changes after loading in healthy aged females at sacral and heel skin: A secondary data analysis. J Tissue Viability 2022; 31:239-244. [DOI: 10.1016/j.jtv.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/10/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
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28
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Study on the Multitarget Mechanism and Active Compounds of Essential Oil from Artemisia argyi Treating Pressure Injuries Based on Network Pharmacology. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1019289. [PMID: 35096100 PMCID: PMC8791709 DOI: 10.1155/2022/1019289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/23/2021] [Indexed: 02/07/2023]
Abstract
In order to comprehensively explore multitarget mechanism and key active compounds of Artemisia argyi essential oil (AAEO) in the treatment of pressure injuries (PIs), we analyzed the biological functions and pathways involved in the intersection targets of AAEO and PIs based on network pharmacology, and the affinity of AAEO active compounds and core targets was verified by molecular docking finally. In our study, we first screened 54 effective components according to the relative content and biological activity. In total, 103 targets related to active compounds of AAEO and 2760 targets associated with PIs were obtained, respectively, and 50 key targets were overlapped by Venny 2.1.0. The construction of key targets-compounds network was achieved by the STRING database and Cytoscape 3.7.2 software. GO analysis from Matespace shows that GO results are mainly enriched in biological processes, including adrenergic receptor activity, neurotransmitter clearance, and neurotransmitter metabolic process. KEGG analysis by the David and Kobas website shows that the key targets can achieve the treatment on PIs through a pathway in cancer, PI3K-Akt signaling pathway, human immunodeficiency virus 1 infection, MAPK signaling pathway, Wnt signaling pathway, etc. In addition, molecular docking results from the CB-Dock server indicated that active compounds of AAEO had good activity docking with the first 10 key targets. In conclusion, the potential targets and regulatory molecular mechanisms of AAEO in the treatment of PIs were analyzed by network pharmacology and molecular docking. AAEO can cure PIs through the synergistic effect of multicomponent, multitarget, and multipathway, providing a theoretical basis and new direction for further study.
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29
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Cho KS, Lee JH. Incidence and prevalence of pressure ulcers in hospitals: 10-year cohort study. J Wound Care 2021; 30:S38-S45. [PMID: 34882008 DOI: 10.12968/jowc.2021.30.sup12.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcers (PUs) are a serious problem in patients with multiple comorbidities and are associated with a longer duration of hospital stay and higher medical costs. The aetiology and rate of PU occurrence in South Korea remains unclear. Therefore, we aimed to determine the incidence, prevalence, mortality and common comorbidities of hospitalised patients with PUs in the South Korean healthcare system. METHOD A 10-year cohort study using the healthcare insurance reimbursement claims from the South Korean National Health Insurance System database. Patients diagnosed with a PU on admission to hospital [ICD-10: L89 + procedure code] between January 2002 and December 2016 were included and their comorbidities evaluated. Patients <20 years of age and recurrent PU cases were excluded. RESULTS Incidence, prevalence, survival rate and risk factors related to survival rate of patients with PUs were determined. The study population in 2006 was 36,195,121 (all patients admitted to hospital that year), which changed yearly because of the inclusion of additional patients who met the study inclusion criteria, and removal of patients who had died during the year. Standardised PU incidence rate decreased from 17.1 in 2006 to 14.9 in 2015 per 10,000 people. Standardised PU prevalence also showed a slightly decreasing trend from 20.2 in 2006 to 18.9 in 2015 per 10,000 people. CONCLUSION This findings of this 10-year study showed that incidence and prevalence of PUs markedly increased with age after the seventh decade. Incidence of PUs increased in patients with pneumonia, cerebral infarction, sepsis, femoral neck fracture and malignant neoplasm of the bronchus. Patients with femoral neck fracture and cerebral infarction showed a higher rate of survival than those with other high-risk comorbidities.
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Affiliation(s)
- Kyu Sang Cho
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
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30
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Oozageer Gunowa N, Hutchinson M, Brooke J, Aveyard H, Jackson D. Pressure injuries and skin tone diversity in undergraduate nurse education: Qualitative perspectives from a mixed methods study. J Adv Nurs 2021; 77:4511-4524. [PMID: 34245169 DOI: 10.1111/jan.14965] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/20/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023]
Abstract
AIMS To, firstly, explore student and academic nurse perceptions of classroom content about the assessment and identification of pressure injuries across skin tone diversity and, secondly, to describe the impact of classroom content on student nurse understanding of pressure injury in people with dark skin tones. DESIGN Qualitative case study employing focus groups and semi-structured interviews. METHODS Five higher education institutions in the United Kingdom were purposively chosen. At each of the five-case sites, one focus group with student nurses and one semi-structured interview with a nurse academic were conducted between May 2018 and April 2019. The participants' narratives were transcribed verbatim and analysed via thematic analysis. RESULTS Classroom learning was predominately framed through a white lens with white normativity being strongly reinforced through teaching and learning activities. This reinforcement of white normativity was evidenced through two main themes: (i) dominance of whiteness in the teaching and learning of pressure injuries in undergraduate nurse education and (ii) the impact and implications for student nurses of whiteness as the norm in pressure injury teaching. CONCLUSION Nurses responsible for the design and delivery of teaching and learning experiences for nursing students need to ensure meaningful teaching and learning experiences. This learning should assist future nurses to interrogate their complicity in a system of white dominance. IMPACT Nurse education delivered today influences and shapes nurses of the future. Nurses are the cornerstone of healthcare and play a significant role in the delivery of equitable healthcare. Nurse academics have a duty of care to inform and highlight health inequities in nursing and ultimately to enhance equity in care.
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Affiliation(s)
- Neesha Oozageer Gunowa
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Joanne Brooke
- Health and Related Research, Birmingham City University, Birmingham, UK
| | - Helen Aveyard
- Faculty of Health & Life Sciences - Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Debra Jackson
- Susan Wakil School of Nursing, University of Sydney Australia, Sydney, NSW, Australia
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31
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Poldrugovac M, Padget M, Schoonhoven L, Thompson ND, Klazinga NS, Kringos DS. International comparison of pressure ulcer measures in long-term care facilities: Assessing the methodological robustness of 4 approaches to point prevalence measurement. J Tissue Viability 2021; 30:517-526. [PMID: 33558099 PMCID: PMC11000144 DOI: 10.1016/j.jtv.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pressure ulcer indicators are among the most frequently used performance measures in long-term care settings. However, measurement systems vary and there is limited knowledge about the international comparability of different measurement systems. The aim of this analysis was to identify possible avenues for international comparisons of data on pressure ulcer prevalence among residents of long-term care facilities. MATERIAL AND METHODS A descriptive analysis of the four point prevalence measurement systems programs used in 28 countries on three continents was performed. The criteria for the description and analysis were based on the scientific literature on criteria for indicator selection, on issues in international comparisons of data and on specific challenges of pressure ulcer measurements. RESULTS The four measurement systems use a prevalence measure based on very similar numerator and denominator definitions. All four measurement systems also collect data on patient mobility. They differ in the pressure ulcer classifications used and the requirements for a head-to-toe resident examination. The regional or country representativeness of long-term care facilities also varies among the four measurement systems. CONCLUSIONS Methodological differences among the point prevalence measurement systems are an important barrier to reliable comparisons of pressure ulcer prevalence data. The alignment of the methodologies may be improved by implementing changes to the study protocols, such as aligning the classification of pressure ulcers and requirements for a head-to-toe resident skin assessment. The effort required for each change varies. All these elements need to be considered by any initiative to facilitate international comparison and learning.
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Affiliation(s)
- Mircha Poldrugovac
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
| | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, United Kingdom
| | - Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Niek S Klazinga
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - Dionne S Kringos
- Amsterdam UMC, Department of Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
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Tsukatani T, Minematsu T, Dai M, Tamai N, Nakagami G, Sugama J, Takada C, Sanada H. Polymorphism analysis of candidate risk genes for pressure injuries in older Japanese patients: A cross-sectional study at a long-term care hospital. Wound Repair Regen 2021; 29:741-751. [PMID: 33819344 DOI: 10.1111/wrr.12912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/26/2020] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
Advances in patient care for pressure injuries (PIs) have reduced the prevalence of PIs in Japan, although not in recent years. Several single-nucleotide polymorphisms (SNPs) have been identified in genes potentially associated with PIs. However, individual variance among PI risks require targeted investigations that may lead to the identification of PI susceptibilities or preventive care options that directly influence PI development pathways. This cross-sectional study examined the association between PIs and SNPs in genes related to tissue tolerance in patients in a long-term care hospital in Japan. A total of 178 participants (130 control, 20 with superficial PI history, and 28 with deep PI history) were enrolled in this study of eight SNPs in hypoxia inducible factor 1 subunit alpha (HIF1A), vascular endothelial growth factor C (VEGFC), heat shock protein 90 alpha family class A member 1 (HSP90AA1), myostatin (MSTN), and vitamin D receptor (VDR). The primary outcome was a history of superficial and deep PIs in the last 6 months. SNPs were examined by real-time polymerase chain reaction, followed by multivariate logistic regression analyses of the associations between the SNPs and PI history. The results showed a significant association between VEGFC rs1485766 and the history of superficial PIs (odds ratio = 2.95; 95% confidence interval = 1.07-8.11; p = 0.04). Stratified analysis using the Braden Scale (≤14) indicated a significant association between HIF1A rs11549465 and deep PIs (p = 0.04). Our study demonstrated that VEGFC rs1485766 and HIF1A rs11549465 were associated with superficial and deep PI susceptibilities, respectively.
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Affiliation(s)
- Toshihiro Tsukatani
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Misako Dai
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Tamai
- Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Advanced Health Care Science Research Unit, Innovative Integrated Bio-Research Core, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Japan
| | - Chika Takada
- The Nursing Department, Sengi Hospital, Kanazawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Dalli ÖE, Yildirim Y, Çalişkan G, Girgin NK. Reliability and validity of the Turkish version of pressure ulcer knowledge assessment tool-updated version (PUKAT 2.0). J Tissue Viability 2021; 31:52-57. [PMID: 34429220 DOI: 10.1016/j.jtv.2021.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to determine the reliability and validity of the Turkish version of the measurement tool developed and updated by Manderlier et al. to evaluate the nurses' evidence-based knowledge about pressure ulcers. MATERIALS AND METHODS A methodological study design was used. The instrument was translated to Turkish and back-translated to English. A group of faculty members, including physicians and nurses who are experts in the subject area, evaluated the content validity of the tool with the Lawshe technique. A group of 240 nurses who met the inclusion criteria were reached, and then a pilot study was conducted with 35 nurses by using the test-retest method to determine the invariance of the tool over time. The nurses in the pilot study were excluded from the overall sample, and the evaluations were performed with 205 nurses. Item difficulty index and discrimination index were used for the validity of the items since they were multiple-choice items; Kuder-Richardson 20 analysis was used to determine the internal consistency. RESULTS The translated and modified instrument demonstrated acceptable psychometric properties as follows: 1) overall content validity index was 0.90, 2) overall test-retest reliability was 0.83 (0.70-0.92 for the sub-themes), 3) item difficulty indexes were 35-75%, 4) discrimination indexes were 0.44-0.92, and 5) overall Cronbach's alfa for the internal consistency was 0.72. CONCLUSIONS Similar to the earlier version, the Turkish version of PUKAT 2.0 was demonstrated to be a valid and reliable tool to evaluate the nurses' knowledge of evidence-based current information about pressure ulcers.
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Affiliation(s)
- Öznur Erbay Dalli
- Uludag University Faculty of Medicine, Department of Anesthesiology and Reanimation, Division of Intensive Care, Nilüfer, BURSA, 16059, TURKEY.
| | - Yasemin Yildirim
- Ege University Faculty of Nursing, Department of Internal Medicine Nursing, Bornova, İZMİR, 35100, TURKEY.
| | - Gülbahar Çalişkan
- Bursa City Hospital, Department of Anesthesiology and Reanimation, Division of Intensive Care, Nilüfer, BURSA, 16059, TURKEY.
| | - Nermin Kelebek Girgin
- Uludag University Faculty of Medicine, Department of Anesthesiology and Reanimation, Division of Intensive Care, Nilüfer, BURSA, 16059, TURKEY.
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Levine JM, Brandeis G, Namagiri S, Spinner R. Wound Care Consultation in Postacute/Long-term Care: Characteristics and Practice Implications. Adv Skin Wound Care 2021; 34:417-421. [PMID: 34260419 DOI: 10.1097/01.asw.0000755932.27249.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the characteristics of residents in postacute (PA)/long-term care (LTC) facilities with wounds and prevalence of wound types other than pressure injuries (PIs). METHODS The authors conducted a retrospective review of all wound care consultations over 1 year at The New Jewish Home, a 514-bed academically affiliated facility in an urban setting. Investigators analyzed residents by age, sex, type of wound, presence of infection, and whether the resident was PA or LTC. Authors designated PIs as facility acquired or present on admission. RESULTS During the study period, 190 wound care consultations were requested; 74.7% of consults were for those in PA care. The average patient age was 76.3 years, and there were 1.7 wounds per resident receiving consultation. Of studied wounds, 53.2% were PIs, 15.8% surgical, 6.8% arterial, 6.3% soft tissue injury, 5.8% venous, 2.6% malignant wounds, and 2.1% diabetic ulcers; however, 11.6% of residents receiving consults had more than one wound type. In this sample, 13.2% of residents had infected wounds, and 76.2% of PIs were present on admission. CONCLUSIONS The wide variety of wounds in this sample reflects the medical complexity of this population. The transformation of LTC into a PA environment has altered the epidemiology of chronic wounds and increased demand for wound care expertise. These results challenge traditional perceptions of wound care centered on PIs. Given its importance, a wound care skill set should be required of all PA/LTC providers.
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Affiliation(s)
- Jeffrey M Levine
- Jeffrey M. Levine, MD, AGSF, CMD, CWS-P, is Associate Clinical Professor, Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York; and Consultant, Advantage Surgical & Wound Care. Gary Brandeis, MD, CMD, is Chief, Geriatrics, Mt Sinai Services, Elmhurst Hospital Center, New York; and Clinical Professor, Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai. At The New Jewish Home in New York, Santhini Namagiri, MD, is Physician; and Ruth Spinner, MD, CMD, is Medical Director. Acknowledgments: The authors thank Orah Burack, Senior Research Associate at The New Jewish Home, who assisted with study design and institutional review board submission; and Shark Bird, MD, Chief Medical Officer of Vohra Wound Physicians, who provided insights into models of wound care. A subset of 27 residents from this database was analyzed and previously published as Levine JM, Menezes R, Namagiri S. Wounds related to malignancy in postacute/LTC: a case series. Adv Skin Wound Care 2020;33:99-102. Parts of this article were presented as an abstract at the AMDA/PALTC Annual Meeting in Atlanta, 2019. The authors have disclosed no financial relationships related to this article. Submitted September 2, 2020; accepted in revised form October 28, 2020
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Ting JJ, Garnett A. E-Health Decision Support Technologies in the Prevention and Management of Pressure Ulcers: A Systematic Review. Comput Inform Nurs 2021; 39:955-973. [PMID: 34132227 DOI: 10.1097/cin.0000000000000780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pressure ulcers are problematic across clinical settings, negatively impacting patient morbidity and mortality while resulting in substantial costs to the healthcare system. E-health clinical decision support technologies can play a key role in improving pressure ulcer-related outcomes. This systematic review aimed to assess the impact of electronic health decision support interventions on pressure ulcer management and prevention. A systematic search was conducted in PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane. Nineteen articles, published from 2010 to 2020, were included for review. The findings of this review showed promising results regarding the usability and accuracy of electronic health decision support tools to aid in pressure ulcer prevention and management. Evidence indicated improved clinician adherence to pressure ulcer prevention practices and decreased healthcare costs postimplementation of an electronic health decision support intervention. However, the studies included in this review did not consistently show reductions in pressure ulcer prevalence, incidence, or risk. Most of the articles included in the review were limited by small sample sizes drawn from single hospitals or long-term care homes. More high-quality studies are needed to determine the types of electronic health decision support tools that can drive sustainable improvements to patient outcomes.
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Affiliation(s)
- Justine Jeanelle Ting
- Author Affiliation: Arthur Labatt School of Nursing, Western University, London, Ontario, Canada
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Ebrahiminaseri A, Sadeghizadeh M, Moshaii A, Asgaritarghi G, Safari Z. Combination treatment of dendrosomal nanocurcumin and low-level laser therapy develops proliferation and migration of mouse embryonic fibroblasts and alter TGF-β, VEGF, TNF-α and IL-6 expressions involved in wound healing process. PLoS One 2021; 16:e0247098. [PMID: 33956815 PMCID: PMC8101758 DOI: 10.1371/journal.pone.0247098] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/01/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Pressure ulcer (PU) is known as the third most costly disorder usually caused by prolonged pressure and stagnation in various parts of the body. Although several therapeutic approaches are employing, obstacles in appropriate healing for skin lesions still exist which necessitates new practical alternative or adjunctive treatments. Low level laser therapy (LLLT) as one of the mentioned new strategies have gained attention. Besides, curcumin is an herbal medicine extracted from turmeric with anti-inflammatory and antioxidative properties with promising beneficial therapeutic effects in wound healing. Employing dendrosomal nanoparticles, we overcome the hydrophobicity of curcumin in the present study. We hypothesized that combination treatment of DNC+LLLT (450 nm) simultaneously may promote the wound healing process. MATERIAL AND METHODS MTT assay, PI staining followed by flowcytometry, scratch assay and intracellular ROS measurement were used to investigate the effects caused by DNC and LLLT (450 nm) alone and in combination, on proliferation, cell cycle, migration and oxidative stress mouse embryonic fibroblast cells, respectively. The levels of growth factors and pro-inflammatory cytokines were evaluated by qRT-PCR and ELISA. RESULTS Our results indicated that combination exposure with DNC and LLLT leads to increased proliferation and migration of MEFs as well as being more efficient in significantly upregulating growth factors (TGF-β, VEGF) and decline in inflammatory cytokines (TNF-α, IL-6). Moreover, findings of this research provide persuasive support for the notion that DNC could reduce the LLLT-induced enhancement in intracellular ROS in mouse embryonic fibroblasts. CONCLUSION Concurrent exposure to anti-oxidant concentrations of DNC and LLLT enriched S phase entry and therefor increased proliferation as well as migration on MEFs through regulating the expression levels growth factors and shortening the inflammatory phase by modulating of cytokines. It should be noted that DNC were able to reduce the laser-induced oxidative stress, during wound healing, representing an informative accompaniment with LLLT.
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Affiliation(s)
- Afsaneh Ebrahiminaseri
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Majid Sadeghizadeh
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ahmad Moshaii
- Department of Physics, Tarbiat Modares University, Tehran, Iran
| | - Golareh Asgaritarghi
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Zohreh Safari
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
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Ariaans M, Linden P, Wendt C. Worlds of long-term care: A typology of OECD countries. Health Policy 2021; 125:609-617. [PMID: 33715875 DOI: 10.1016/j.healthpol.2021.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Abstract
Providing long-term care (LTC) to the elderly is a major challenge for the welfare state. LTC systems differ widely among countries. Due to recent maturation, economization, and marketization processes, earlier LTC comparisons and typologies are no longer suitable to give a comprehensive overview of LTC systems and their major characteristics. In this paper we introduce a new typology of LTC systems in the OECD world, based on most recent OECD data and a unique set of institutional indicators. This typology aims to make LTC systems more comparable to welfare state and healthcare system typologies and thereby improve our understanding of how LTC is embedded in the wider welfare state and how it is related to other welfare state institutions. Based on 24 cluster analyses, we identify six (method-driven) and nine (content-driven) LTC types, which can be adapted in future studies according to the needs. In the six-types solution, we suggest a public supply type (e.g., Sweden), a private supply type (e.g., Germany), a residual public type (e.g., Poland), an evolving public supply type (e.g., Korea), a need-based supply type (e.g., Switzerland), and an evolving private need-based type (e.g., United States).
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Affiliation(s)
- Mareike Ariaans
- University of Mannheim, Mannheim Centre for European Social Research, Germany A5, 6, 68159, Mannheim, Germany; University of Siegen, Department of Social Sciences, Adolf-Reichwein-Str. 2, 57068, Siegen, Germany.
| | - Philipp Linden
- University of Siegen, Department of Social Sciences, Adolf-Reichwein-Str. 2, 57068, Siegen, Germany.
| | - Claus Wendt
- University of Siegen, Department of Social Sciences, Adolf-Reichwein-Str. 2, 57068, Siegen, Germany.
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Eltaybani S, Yamamoto-Mitani N, Ninomiya A, Igarashi A. The association between nurses' burnout and objective care quality indicators: a cross-sectional survey in long-term care wards. BMC Nurs 2021; 20:34. [PMID: 33622305 PMCID: PMC7901176 DOI: 10.1186/s12912-021-00552-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses’ burnout and selected objective quality metrics in long-term care wards in Japan. Methods This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards—the equivalent of skilled nursing homes in Western countries— completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses’ burnout, and other confounders (e.g., ward size, participants’ years of experience, and patients’ conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators. Results Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = −.001, p-value = .019). Conclusions Staff nurses’ burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes—specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Homecare and Long-term Care Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan. .,Department of Critical Care and Emergency Nursing, Alexandria University, Alexandria, Egypt.
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Homecare and Long-term Care Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Ayako Ninomiya
- The Dia Foundation for Research on Ageing Societies, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Homecare and Long-term Care Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
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Mota-Romero E, Tallón-Martín B, García-Ruiz MP, Puente-Fernandez D, García-Caro MP, Montoya-Juarez R. Frailty, Complexity, and Priorities in the Use of Advanced Palliative Care Resources in Nursing Homes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:70. [PMID: 33466767 PMCID: PMC7830978 DOI: 10.3390/medicina57010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives: This study aimed to determine the frailty, prognosis, complexity, and palliative care complexity of nursing home residents with palliative care needs and define the characteristics of the cases eligible for receiving advanced palliative care according to the resources available at each nursing home. Materials and Methods: In this multi-centre, descriptive, and cross-sectional study, trained nurses from eight nursing homes in southern Spain selected 149 residents with palliative care needs. The following instruments were used: the Frail-VIG index, the case complexity index (CCI), the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal), the palliative prognosis index, the Barthel index (dependency), Pfeiffer's test (cognitive impairment), and the Charlson comorbidity index. A consensus was reached on the complexity criteria of the Diagnostic Instrument of Complexity in Palliative Care that could be addressed in the nursing home (no priority) and those that required a one-off (priority 2) or full (priority 1) intervention of advanced palliative care resources. Non-parametric tests were used to compare non-priority patients and patients with some kind of priority. Results: A high percentage of residents presented frailty (80.6%), clinical complexity (80.5%), and palliative care complexity (65.8%). A lower percentage of residents had a poor prognosis (10.1%) and an extremely poor prognosis (2%). Twelve priority 1 and 14 priority 2 elements were identified as not matching the palliative care complexity elements that had been previously identified. Of the studied cases, 20.1% had priority 1 status and 38.3% had priority 2 status. Residents with some kind of priority had greater levels of dependency (p < 0.001), cognitive impairment (p < 0.001), and poorer prognoses (p < 0.001). Priority 1 patients exhibited higher rates of refractory delirium (p = 0.003), skin ulcers (p = 0.041), and dyspnoea (p = 0.020). Conclusions: The results indicate that there are high levels of frailty, clinical complexity, and palliative care complexity in nursing homes. The resources available at each nursing home must be considered to determine when advanced palliative care resources are required.
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Affiliation(s)
- Emilio Mota-Romero
- Primary Care Center Dr. Salvador Caballero García Andalusian, Health Service, Government of Andalusia, 18012 Granada, Andalusia, Spain;
| | | | | | - Daniel Puente-Fernandez
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Andalusia, Spain
| | - María P. García-Caro
- Department of Nursing, Mind, Brain and Behaviour Research Institute, University of Granada, 18016 Granada, Andalusia, Spain; (M.P.G.-C.); (R.M.-J.)
| | - Rafael Montoya-Juarez
- Department of Nursing, Mind, Brain and Behaviour Research Institute, University of Granada, 18016 Granada, Andalusia, Spain; (M.P.G.-C.); (R.M.-J.)
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Sezgunsay E, Basak T. Is Moulage effective in improving clinical skills of nursing students for the assessment of pressure injury? NURSE EDUCATION TODAY 2020; 94:104572. [PMID: 32919170 DOI: 10.1016/j.nedt.2020.104572] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/24/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In wound care simulations, the practice can be performed on 3D-wounds formed by moulage. Moulage helps the student to perceive the etiology, physiology, and healing processes of the wound, and it can also be used to improve the students' wound assessment skills. OBJECTIVE The aim of this study is to investigate the effectiveness of moulage in the improvement of pressure injury assessment skills of nursing students. DESIGN A quasi-experimental study. SETTINGS A nursing faculty at a public university. PARTICIPANTS All fourth-year students (n = 73) who take the simulation elective course were invited to participate. METHODS Fall semester students (n = 38) constituted the control group and spring semester students (n = 35) formed the intervention group. The coin-flipping method was used to match the education period and student groups. The intervention group simulation was performed using moulage, and the control group simulation was performed using a pressure ulcer visuals. The same simulation scenarios were used for both groups. The data were collected using the Simulation Design Scale, Student Satisfaction and Self-Confidence Scale, and student identification form, knowledge test, performance checklist and feedback form developed by the researchers. RESULTS Students' knowledge scores for pressure injury assessment have improved significantly in both the intervention group (pre-test:61.71 ± 9.77 and post-test 70.57 ± 12.53, t = -4.27, p < 0.001) and the control group (pre-test: 66.81 ± 13.47 and post-test 73.06 ± 15.50, t = -2.34, p = 0.02). Laboratory and clinical pressure injury assessment skill scores of the intervention group students were significantly higher than the control group. Besides, the correct staging percentages of the intervention group students are higher than the control group students during the clinical practice (χ2 = 5.05, p = 0.02). CONCLUSIONS It can be concluded that the simulation with moulage was effective in improving the skills of nursing students who received training for pressure injury assessment and in transferring what they learned to the clinical setting.
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Affiliation(s)
- Emine Sezgunsay
- University of Health Sciences Turkey, Gulhane Training and Research Hospital, Stoma and Wound Care Centre, Ankara, Turkey
| | - Tulay Basak
- University of Health Sciences Turkey, Gulhane Faculty of Nursing, Fundamentals of Nursing Department, Ankara, Turkey.
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Anthony D, Alosaimi D, Shiferaw WS, Korsah K, Safari R. Prevalence of pressure ulcers in africa: A systematic review and meta-analysis. J Tissue Viability 2020; 30:137-145. [PMID: 33129668 DOI: 10.1016/j.jtv.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/10/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND A recent global review of pressure ulcers contained no studies from Africa. OBJECTIVE To identify the prevalence and incidence of pressure ulcers in Africa. DATA SOURCES Bibliographic databases, African specific databases, grey literature. STUDY ELIGIBILITY CRITERIA Studies with prevalence or incidence data of pressure ulcers from Africa since the year 2000. PARTICIPANTS Any age, including children, in any setting, specifically including hospital patients from any clinical area but not restricted to hospital settings. STUDY APPRAISAL AND SYNTHESIS METHODS Hoy score for bias, Joanna Briggs Institute Critical Appraisal Instrument. METHOD We followed the PRISMA guideline for systematic reviews. We searched Embase, Medline, Scopus, CINHAL, Google Scholar, specialist African databases and grey literature for studies reporting incidence or prevalence data. RESULTS Nineteen studies met the inclusion criteria and were included in the study. Point prevalence rates varied from 3.4% to 18.6% for medical/surgical and other general hospital units with a pooled prevalence of 11%, for grades II-IV 5%. For spinal injury units the pooled prevalence was 44%. LIMITATIONS restricted to English, French and Arabic. CONCLUSION Prevalence of pressure ulcers in Africa reported here is similar to figures from a recent review of prevalence in Europe and two recent global reviews of hospitalised patients. Prevalence of pressure ulcers in spinal cord injury patients is similar to figures from a review of developing countries. The reporting of prevalence is lacking in detail in some studies. Studies using an observational design employing physical examination of patients showed higher prevalence than those relying on other methods such as medical notes or databases. IMPLICATIONS OF KEY FINDINGS Further prevalence and incidence studies are needed in Africa. Reporting of such studies should ensure items in the "Checklist for Prevalence Studies" from Joanna Briggs Institute (or similar well regarded resources) are addressed and the PICOS model and PRISMA guidelines are employed. SYSTEMATIC REVIEW REGISTRATION NUMBER Prospero registration number CRD42020180093.
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Affiliation(s)
- Denis Anthony
- Health and Social Care Research Centre, University of Derby, UK.
| | | | | | - Kwadwo Korsah
- School of Nursing and Midwifery, University of Ghana, Ghana.
| | - Reza Safari
- Health and Social Care Research Centre, University of Derby, UK.
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López-Franco MD, Parra-Anguita L, Comino-Sanz IM, Pancorbo-Hidalgo PL. Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093063. [PMID: 32354041 PMCID: PMC7246611 DOI: 10.3390/ijerph17093063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
Pressure injuries (PIs) are a major health problem with severe implications for patients. Professionals who care for people at risk should have high knowledge about PIs prevention. The actual knowledge can be measured using different tools, but we have found no questionnaire to measure the knowledge on PIs prevention developed and validated for Spanish-speaking countries. The aim of this study was to develop a questionnaire in Spanish to measure the knowledge about PIs prevention based on current international guidelines. Content validity was evaluated by 12 experts in wound care. A convenience sample of 438 nursing professionals from Spain participated to evaluate the questionnaire using item analysis, Rasch model, and known-groups validity. The PI Prevention Knowledge (PIPK) questionnaire shows good discrimination and difficulty indices. The 31-item PIPK shows good fit and reliability of 0.98 for items and 0.72 for people; also, it has enough evidence for construct validity. Because the questionnaire has been developed based on the recommendations from international guidelines, the English version of this questionnaire could be used in further studies to test its psychometric properties.
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