Pressure Ulcer Development Research Articles

Severe Pressure Ulcers in Two Patients With Adrenoleukodystrophy

Adrenoleukodystrophy (ALD) is a rare X-linked disease that affects the metabolism of very long-chain fatty acids (VLCFAs), leading to cognitive deterioration, progressive spastic paraplegia, sensory disturbance, adrenocortical insufficiency, and bladder and bowel abnormalities. Although the symptoms of ALD correspond to the risk of developing pressure ulcers, a pressure ulcer has never been listed as a complication of ALD. We present two cases of ALD with severe pressure ulcers in the pelvic region and feet. The first case was a 27-year-old male patient with adolescent cerebral-type ALD who had pressure ulcers with bone exposure on the sacral and bilateral greater trochanter region. The second case was a 64-year-old male patient with adrenomyeloneuropathy (AMN) phenotype who had pressure ulcers on the sacral region and both feet. Both patients had VLCFA accumulation and a likely pathogenic variant in the ABCD1 gene, the causative gene of ALD. These cases indicate that ALD patients with immobility and incontinence have a higher risk of developing severe pressure ulcers, which requires the proactive identification of ALD patients and early multidisciplinary intervention for patients and their families to prevent the development of pressure ulcers.

Pressure ulcers in critically ill: correlation with Intensive Care conditions

Introduction: Critically ill are a special category of patients in need of high standards medical and nursing care. Multiple intrinsic and extrinsic factors that characterize these patients tend to contribute into the development of pressure ulcers. Despite the fact that the implementation of preventive measures seems to inhibit the development of pressure ulcers in a significant percentage, there are often conditions that cannot be surpassed and result to the appearance of unavoidable pressure ulcers. Aim: Study of the factors that contribute to the development of pressure ulcers for the critically ill and the effectiveness of the preventive measures applied in ICU. Method: Information regarding hospitalization data was obtained for all 351 critically ill admitted in an ICU of a regional university hospital during a one year period (May 2021-April 2022). Subsequently, a statistical analysis was performed in order to relate the development of pressure ulcers and intrinsic factors as well as other factors such as medication administered, feeding and preventive measures applied. Results: Incidence of decubitus ulcers was estimated at 23%, first noticed on the 10th day from admission, located in the coccyx at a rate above 50%. Extrinsic factors that seem to contribute to the development of pressure ulcers appear to be the length of ICU stay, the administration of vasoactive drugs and the insufficient caloric and protein coverage through feeding. Use of preventive surfaces, seem to act as a deterrent for pressure ulcer development for the majority of the patients. Most of the pressure ulcers developed during ICU stay, were evaluated as stable or improved during ICU discharge. Conclusions: Improvement of the parameters involved in pressure ulcer development for the critically ill, contribute to the reduction of their occurrence in ICU. Despite the use of advanced pressure reducing surfaces, tissue ischemia may occur even after mild pressure applied. However, high percentage of pressure ulcers could be prevented with appropriate medical care.

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data

PurposeTo identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs). MethodsData were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 – 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI). ResultsAltogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 – 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 – 1.09, p < 0.001) maintained significance. ConclusionsThese data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.

Prone positioning in COVID-19 patients with acute respiratory distress syndrome and invasive mechanical ventilation

ObjectiveTo identify adverse events related to prone positioning in COVID-19 patients with severe disease and acute respiratory distress syndrome, to analyze the risk factors associated with the development of anterior pressure ulcers, to determine whether the recommendation of prone positioning is associated with improved clinical outcomes. MethodsRetrospective study performed in 63 consecutive patients with COVID-19 pneumonia admitted to intensive care unit on invasive mechanical ventilation and treated with prone positioning between March and April 2020. Association between prone-related pressure ulcers and selected variables was explored by the means of logistic regression. ResultsA total of 139 proning cycles were performed. The mean number of cycles were 2 [1–3] and the mean duration per cycle was of 22h [15–24]. The prevalence of adverse events this population was 84.9 %, being the physiologic ones (i.e., hypo/hypertension) the most prevalent. 29 out of 63 patients (46%) developed prone-related pressure ulcers. The risk factors for prone-related pressure ulcers were older age, hypertension, levels of pre-albumin <21mg/dl, the number of proning cycles and severe disease. We observed a significant increase in the PaO2/FiO2 at different time points during the prone positioning, and a significant decrease after it. ConclusionsThere is a high incidence of adverse events due to PD, with the physiological type being the most frequent. The identification of the main risk factors for the development of prone-related pressure ulcers will help to prevent the occurrence of these lesions during the prone positioning. Prone positioning offered an improvement in the oxygenation in these patients.

Prevalence of Pressure Ulcers among patients in Ibn e Sina Hospital

Background: Pressure is a localized injury to the skin and underlying tissue usually over a bony prominence, as a result of pressure, or pressure contributing to shear. Objective: The main objective was to determine the prevalence of pressure ulcers in the patients of Ibn e Sina hospital Multan and to determine the risk factors contributing to pressure ulcers by using Braden Scale. Methodology: It was a cross-sectional observational study conducted on 246 patients of Ibn e Sina hospital Multan. During the 6 months of the study, patients were interviewed regarding their demographics and risk factors for pressure ulcers according to the Braden scale. Spss21 was used to analyze the data. Results: Out of 246 patients, 74.8% of male patients had pressure ulcers. The patients were from 25 to 85 years old. The pressure ulcers were more frequent among the 45 to 65 years age group (i.e., 44.7%) and married patients (95.5%). Among 246 patients only 4.5% patients were at extra high risk and most of the patients were at low risk (69.5%) by using the Braden scale. This data will help physicians, researchers, and policymakers in Pakistan and other nations advocate for the needs of pressure ulcer patients. Conclusion: According to this study pressure ulcers were more frequent in male married patients of the middle age group. Most of the patients were at low risk of developing pressure ulcers on the Braden Scale. Keywords: Pressure ulcer PU, Pressure sores, Pressure Injuries, Prevalence, Risk factors, Braden Scale, Braden score, Hospitals, Intensive care units

Unhealed pressure ulcers among nursing home residents with diabetes

Introduction: Nearly a third of US nursing home residents have diabetes mellitus. These residents have an increased risk of pressure ulcer (PU) development and progression; however, little is known about the characteristics of their PUs or the role of other risk factors. This study estimates the prevalence of PUs, describes characteristics of PUs, and quantifies associations between risk factors and PUs in nursing home residents with diabetes.Methods: We conducted a cross-sectional study of nursing home residents aged ≥50 years with diabetes mellitus using national 2016 Minimum Data Set 3.0 data. Pressure ulcers were defined as the presence of any stage PU and by subgroups of stage and tissue type. Prevalence estimates of PUs were calculated overall and by covariate subgroups. Unadjusted and adjusted odds ratios were calculated using logistic regression.Results: The prevalence of any unhealed PU was 8.1%. Of those with a PU, 19.4% had at least two ulcers and the most common subtypes were identified as unstageable and stage 2 ulcers. These were most often treated by pressure reducing devices. In our fully adjusted model, risk factors that were strongly associated with PUs were related to mobility, nutrition, incontinence, and infections.Conclusion: We observed that the prevalence of PUs remains high in nursing home residents with diabetes and that higher stage ulcers were common in this population. Our adjusted model highlights the importance of suspected risk factors in the development of PUs. Further research is needed to understand the unique needs of nursing home residents with diabetes.

Multi-Mode Electric Wheelchair with Health Monitoring and Posture Detection Using Machine Learning Techniques

Patients with cognitive difficulties and impairments must be given innovative wheelchair systems to ease navigation and safety in today’s technologically evolving environment. This study presents a novel system developed to convert a manual wheelchair into an electric wheelchair. A portable kit has been designed so that it may install on any manual wheelchair with minor structural changes to convert it into an electric wheelchair. The multiple modes include the Joystick module, android app control, and voice control to provide multiple features to multiple disabled people. The proposed system includes a cloud-based data conversion model for health sensor data to display on an android application for easy access for the caretaker. A novel arrangement of sensors has been applied according to the accurate human body weight distribution in a sitting position that has greatly enhanced the accuracy of the applied model. Furthermore, seven different machine learning algorithms are applied to compare the accuracy, i.e., KNN, SVM, logistic regression, decision tree, random forest, XG Boost, and NN. The proposed system uses force-sensitive resistance (FSR) sensors with prescribed algorithms incorporated into wheelchair seats to detect users’ real-time sitting positions to avoid diseases, such as pressure ulcers and bed sores. Individuals who use wheelchairs are more likely to develop pressure ulcers if they remain in an inappropriate posture for an extended period because the blood supply to specific parts of their skin is cut off owing to increased pressure. Two FSR configurations are tested using seven algorithms of machine learning techniques to discover the optimal fit for a high-efficiency and high-accuracy posture detection system. Additionally, an obstacle detection facility enables one to drive safely in unknown and dynamic environments. An android application is also designed to provide users of wheelchairs with the ease of selecting the mode of operation of the wheelchair and displaying real-time posture and health status to the user or caretaker.

The role of proinflammatory cytokines in the detection of early pressure ulcer development: a systematic review

Pressure ulcers (PUs) commonly occur over bony prominences and are notoriously difficult to treat. Proinflammatory cytokines are substances that initiate the inflammatory process preceding PU development. The aim of this review was to assess whether the increased presence of proinflammatory cytokines could potentially be used as an early detection system for PU development. A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in August 2020. Data were extracted and a narrative synthesis was undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. The systematic review included original research studies, prospective design, and human studies written in English. Retrospective studies, animal studies, conference papers, opinion papers and qualitative methodology were excluded. No restrictions on the date of publication and study setting were applied. The six studies included were conducted between 2015 and 2019, 50% (n=3) used an experimental study design. The mean sample size was 15 participants (standard deviation=1.72). A total of seven proinflammatory cytokines were analysed. Statistically significant differences were found among inflammatory mediators. Overall results showed that the concentration of interleukin (IL)-1α significantly increased in each study. The EBL score varied between 77-88%. In total, 100% (n=6) of the studies scored ≥75%, reflecting validity. It is not yet certain that monitoring proinflammatory cytokines represents a noninvasive method that could potentially direct preventative measures to those who are identified as at high risk for developing PUs. IL-1α potentially may be elevated for other health conditions, not just PUs. Future studies are therefore recommended.

Using pressure mapping intraoperatively to prevent pressure ulcers-A quasi-experimental study.

Patients undergoing surgery are at high risk of developing pressure ulcers. However, pressure ulcer prevention in the operating room department is demanding and restricted. New techniques, such as continuous pressure mapping that visualizes interface pressure, are now available. The aim of the study was to determine whether pressure mapping information of interface pressure intraoperatively leads to (1) more frequent intraoperative micro repositioning and a reduced amount of pressure on the sacrum area and (2) a lower frequency of pressure ulcer development. A quasi-experimental ABA design was used. A total of 116 patients undergoing surgery were included. During the B phase, the need to consider repositioning the patient according to interface pressure readings was initiated. The result showed that there was significantly higher interface pressure in the A2 phase than in the B phase. Micro repositioning of the patient during surgery was performed in the B phase, but not in the A phase. The regression model showed that a higher BMI was associated with higher interface pressure. None of the patients developed hospital-acquired pressure ulcers up to Day 1 postoperatively. Pressure mapping involves moving away from expert opinion and tradition towards objective assessment and flexibility and we see the benefits of using pressure-mapping equipment in operating room contexts. However, more research is needed in this area.

Effect of Intervention Training on Nurses’ Knowledge of Pressure Ulcer Risk Assessment and Prevention at a Tertiary Hospital, Nigeria

Background: Despite advances in healthcare, inadequate knowledge of pressure ulcer risk assessment (PURA) and prevention strategies among nurses as a major contributory factor to development of pressure ulcers among “at risk” patients has been identified by previous studies. Aim: This study evaluated effect of intervention training on nurses’ knowledge of pressure ulcer risk assessment and prevention strategies at University College Hospital, (UCH) Nigeria. Methods: A randomized controlled trials research design. Sample size was 268 (134 participants each in intervention and control groups) nurses selected through simple random and systematic sampling techniques. A structured pre-tested questionnaire was used for data collection. Data were analyzed using descriptive and inferential statistics. Level of significance set at p-value &lt;0.05. Results: Mean ages of participants were 42.45±8.89 and 38.81±10.56 years for intervention and control groups respectively. Almost all participants in intervention group during pre-test had adequate knowledge of pressure ulcer risk assessment, and pressure ulcers prevention strategies compared to during pre-test in which poor knowledge of those areas was recorded among majority of them. Also, adequate knowledge of pressure ulcers prevention strategies was observed among intervention group after the training as compared to control group in which poor knowledge was recorded. Furthermore, intervention training was highly statistically significant with all studied domains at p&lt;0.001. Conclusion: The intervention training on nurses’ knowledge regarding PURA and prevention strategies was positive at a high rate. Regular training programs on the subject matter for all nurse clinicians to promote quality nursing care according to international best practices is crucial.

Experimental Investigation of Subcutaneous Pressure and Shear Force Changes Using a Bone Protrusion Model as a Risk Factor for Pressure Ulcer Development

Objectives: Subcutaneous pressure and subcutaneous shear force were investigated using a bone protrusion model to investigate a polyurethane film dressing (hereinafter referred to as adhesive film) for preventing shear force. Our hypothesis was that when pressure or shear force was applied to the body surface, the adhesive film would 1) decrease the shear force on the skin surface and 2) decrease the effect of the external force on the subcutaneous layer.

Feasibility and clinical utility of Bates-Jensen wound assessment tool among nurses caring of patients having pressure ulcers

Aims: One of the vital roles of nurses is to perform pressure ulcer risk assessment that enables them to appropriately assess and track healing progress of wound and pressure ulcers among patients. Our aim was to assess the feasibility and clinical utility of the Bates-Jensen Wound Assessment Tool (BWAT) among nurses caring of patients with pressure ulcer. Methods: A descriptive cross-sectional design used to collect data from 177 registered nurses caring of patients who developed or have a risk of developing pressure ulcers working in three hospitals in Jordan. Results: The mean feasibility score of the BWAT was 28.3 out of 36 (SD=3.4) with a median score of 29. Most of nurses reported that the BWAT was easy to use on a scale of 1-4 (best) (M=3.40/4, SD=0.62) and can successfully assess wound characteristics (M=3.40/4, SD=0.59). The mean utility score of the BWAT was 21.3 out of 28 (SD=2.7) with a median of 21. Nurses had a perception that using the BWAT enhances care of patients with wounds (M=3.36/4, SD=0.61) and makes communication easier between nurses and physicians. Conclusion: This study provided evidence that support the use of the Bates-Jensen Wound Assessment Tool for patients with pressure ulcer. Nurses perceived BWAT as easy to use, understandable, and relevant for assessing patients with pressure ulcers. Funding statement: This work was supported by supported and funded by The Deanship of Scientific Research at The University of Jordan, Amman, Jordan [number1953/2017/19].

Multi-objective Optimization of Multi-cells Foam Mattress

Body pressure dispersion mattresses are useful tools for preventing pressure ulcers in patients with limited mobility who experience prolonged body weight-related compression loads at their body contact areas over time. The objective of this study is to propose and optimize a multicell finite element (FE) model of foam mattress to prevent patients from developing pressure ulcers (bed sores), by improving the contact pressure distribution on the upper mattress surface and immersion in the mattress. The NSGA-II multi-objective genetic algorithm was used to predict different configurations of cell materials to provide a more comfortable sleep. Our mattress model contains many cells (50 × 50 × 50), each of which can contain one of the nine different foam firmnesses. The NSGA-II algorithm attempts to combine the properties of soft and firm foams into a single mattress. however, the complexity and intersection of the fitness function objectives and the high number of possible chances forced the optimal solutions set to extend into the area under the result of foams that have a compressive strength between soft and firm. Based on the overall optimization results, the standard deviation ranged from 0.00325 to 0.00175 MPa and the maximum mattress immersion ranged from 50 mm to less than 20 mm. Mattresses with optimal configurations disperse body pressure smoothly to fit the patient's body shape.

Surface Pressures in Lower Extremity Splints: A Biomechanical Study.

Though ubiquitously used in orthopaedic trauma, lower extremity splints may have associated iatrogenic risk of morbidity. Although clinicians pad bony prominences to minimize skin pressure, the effect of joint position on skin pressure and, more specifically, changing joint position, is understudied. The purpose of this biomechanical study is to determine the effect of various short-leg splint application techniques on anterior ankle surface pressure in the development of iatrogenic skin pressure ulcers. Various constructs of lower extremity, short-leg splints were applied to 3 healthy subjects (6 limbs total) with an underlying pressure transducer (Tekscan I-Scan system) on the skin surface centered on the tibialis anterior tendon at the level of the ankle. All subjects underwent anterior ankle surface pressure assessment when padding was applied in maximum plantar flexion and neutral position for conventional short-leg splints application in clinically relevant patient scenarios. Percentage change from initial contact pressure centered on the tibialis anterior with cast padding were calculated. The percentage change in anterior ankle contact pressure when padding was applied in maximum plantar flexion (PF) and then definitively placed in neutral was increased at least 2-fold without the addition of plaster in lower extremity short-leg splints. Removing anterior ankle padding following final splint application in neutral reduced contact forces at the anterior ankle 46% and 59% in splints applied in maximum PF and neutral ankle position, respectively. The present study is the first of its kind to underscore and quantify clinically relevant technical pearls that can be useful in reducing risk of iatrogenic risk of skin breakdown at the anterior ankle when placing short-leg splints, mainly, that it is imperative to apply padding in the intended final splint position and to remove anterior ankle padding following splint application when able. Level IV, biomechanical study with clear hypothesis.

Risk Factors for Pressure Ulcer Development in Medical Intensive Care Units: an Observational Study

Risk Factors for Pressure Ulcer Development in Medical Intensive Care Units: an Observational Study

Risk factors for developing pressure ulcers in neonates and novel ideas for developing neonatal antipressure ulcers solutions

Pressure Ulcers (PU) are highly prevalent iatrogenic occurrences among hospitalized adults and neonatal patients. These decubitus ulcers are progressive in nature and are mostly seen in patients that are immobile for prolonged periods, either by virtue of being bedridden or chair bound. The continual pressure on the skin surfaces disrupts blood supply from the subcutaneous regions and leads to the development of PUs. Several treatment and prevention protocols have been defined for adult patients. However, there is a dearth of literature available for critically ill pediatrics or neonates and often adult practices are used to treat pressure injuries in them. There is a significant physiological and anatomical difference between the skin of newborns and adults or even older children. The dermal layer of a preterm neonate is <60% of the thickness of an adult and has a much higher susceptibility for developing pressure ulcers. The immune system of premature infants lacks an efficient antigenic specificity, diversity or immunologic memory, making them prone to lethal infections. The study was performed using search engines like PubMed, EMBASE and Google Scholar, with the focus of the search strategy being the breadth rather than the details of the study. Selected keywords were used alone or in combination with each other to retrieve relevant articles. This review focuses on the risk of developing PUs in neonates, explains the currently available solutions of PU prevention in adults, emphasizes the need for neonatal specific solutions and presents novel ideas for developing antisore bed for neonates.

Sub epidermal moisture measurement and targeted SSKIN bundle interventions, a winning combination for the treatment of early pressure ulcer development.

This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. A quantitative quasi-experimental observational approach was used. A total of 149 at risk acute hospital patients took part, 78 treatment, and 71 control. SEM deltas were recorded daily for a maximum of 5 days using the SEM Scanner (Bruin Biometrics LLC, Los Angeles, California), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted PU prevention interventions occurring in those with an elevated SEM delta scores in the treatment group. Intention to treat analysis was used to guide the final composition of results. SEM PU represents PU development as identified by 2 days of sustained abnormal SEM delta scores, ≥0.5, after day one. The mean number of days completed by participants was just under 4 days, participants had many different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. Results showed that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD: 0.49; 95% CI: 0.59, 0.39; P< .0001), and in the odds of developing a SEM PU (OR: 0.59, 95% CI: 0.24 to 1.00; P= .05). In the treatment group, none of the participants developed a visual PU, whereas, in the control group, 1.41% (n=1/71) developed a visual PU. Based on all the results, the following is concluded, (1). There was a greater reduction in mean SEM delta scores among those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta scores was statistically significantly lower at the study end for those who received targeted treatments based on abnormal SEM scores. More research is now needed in other and larger at-risk groups to further validate what was found in this study.

Feasibility of a repositioning schedule on pressure ulcer prevention in a French Intensive Care Unit: A pre and post-intervention pilot study

AimsAs a prerequisite of a multicentre study, we conducted a pilot study to assess the feasibility of a daily repositioning schedule in critically ill patients. The schedule was adapted to the patient's clinical condition, and the estimated risk for developing a pressure ulcer using the Braden scale. DesignA single-center pre and post-intervention pilot study in a French Intensive Care Unit of a university teaching hospital. This study followed TREND guidelines. MethodsDuring the first period (March to May 2018), pressure ulcer prevention was performed according to usual care. During the second period (June to August 2018), the repositioning schedule was adapted to the estimated risk for developing a pressure ulcer according to the Braden scale. Eligible patients had no pressure ulcer at baseline, were intubated within 24 hours of admission and expected to receive mechanical ventilation for at least 24 hours. The primary outcome was the rate of pressure ulcer development at 28 days of hospitalization or at discharge or death, as compared with usual care. Secondary outcomes included the feasibility and safety of the schedule, as assessed by caregivers’ adherence and workload, and the rate of adverse events. ResultsIn the pre-intervention period 20 participants were included, and 14 patients were included in the post-intervention period. There was no decrease in the pressure ulcers incidence with the intervention (25% vs. 28.6%; P = 1). The number of daily repositioning performed increased from 3.3 [IQR 3.0; 3.9] during the pre-intervention period to 4.3 [IQR 3.8; 5.2] during the post-intervention period (P < 0.05), where it differed from the number scheduled by 0.6 [IQR 0.1; 1.4] per day, indicating satisfactory adherence of caregivers to the protocol. Adverse events rate did not differ between the two periods (55.9% vs. 57.1%; P = 0.90). ConclusionA personalised daily repositioning schedule in critically ill patients is feasible and safe. The efficacy of such a strategy, together with its economic impact, need to be assessed in a multicentre randomized trial.

Managing fire risk in housebound people who smoke and require air-alternating pressure-relieving equipment

Air-alternating pressure mattresses are advised for housebound patients with poor mobility and at risk of developing pressure ulcers. However, those patients who smoke are under significant dangers of fire risks, especially as the pump to provide alternating pressure requires oxygen. This article describes the development and introduction of a comprehensive risk assessment to help guide community nurses' discussions with any patient on their caseload who smokes and also requires air alternative mattresses. A questionnaire was developed by the Task and Finish Group comprising of nurses from the community and tissue viability teams, members from South Yorkshire Fire and Rescue and a trust fire officer. This questionnaire was developed to guide clinicians when discussing the problem of smoking and the risk of fire with patients, their families and general practitioners. The questionnaire was shared with all teams who visited patients at home, who met the criteria to promote its use. Further work is planned to audit the use of this questionnaire and to ascertain how it can help the decision-making process when discussing risks with this vulnerable and at-risk group of patients.

Nutrition in the prevention and treatment of pressure ulcers in stroke patients

Stroke is one of the most important causes of mortality and disability of the population worldwide. In 16–20% of patients with acute stroke at admission, during hospitalization and rehabilitation, protein-energy deficiency, as well as micronutrient insufficiency is observed, which is associated with an unfavorable prognosis and the development of pressure ulcers. The widespread use of high-calorie mixtures for oral or probe enteral nutrition for such patients, containing increased amounts of protein, arginine, vitamins A, E, C and minerals (zinc and selenium) of an antioxidant orientation, can have a positive effect on the healing of pressure ulcers. The inclusion of specialized therapeutic mixtures in diet therapy can also potentially reduce the risk of developing pressure ulcers.