Pressure Sore Risk Research Articles

Implementasi Masase Neuroperfusi dan Alih Baring Terhadap Risiko Dekubitus Pasien Post Stroke

Decubitus is a problem in post-stroke patients that has yet to be resolved. The risk of pressure sores can be overcome with neuroperfusion massage therapy and bed rest. The purpose of this study was to determine the implementation of neuroperfusion massage and bed transfer on the risk of pressure sores in post-stroke patients. The design of this research is Quasy-Experiment with pre post test control group design. The population of all post-stroke patients treated at the Arosbaya Health Center in the Bangkalan Madura area was 30 people. A sample of 28 stroke patients was taken using a simple random sampling technique. The independent variable is neuroperfusion massage and bed transfer, the dependent variable is the risk of pressure sores. Data were analyzed using the Wilcoxon Signed Rank Test. The results showed that after the intervention of neuroperfusion massage (p value 0.000) and bed transfer (0.000) there was a reduction in the risk of pressure sores in post-stroke patients. Neuroperfusion massage and bed transfer are effective in preventing the risk of pressure ulcers in post-stroke patients. It is hoped that health workers can apply bed transfer therapy with neuroperfusion massage so that pressure sores can be handled optimally.

Effect of institution volume on mortality and outcomes in osteoporotic hip fracture care.

An inveterate link has been found between institution case volume and a wide range of clinical outcomes; for a host of medical and surgical conditions. Hip fracture patients, notwithstanding the significance of this injury, have largely been overlooked with regard to this important evaluation. We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 institutions to determine if the unit volume was associated with performance in each particular outcome. There were 175 institutions with included 67,673 patients involved. The number of hip fractures between units ranged from 86 to 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. However, patients treated at large institutions did not have any shorter lengths of stay. With regard to most other outcomes there was no association between the unit number of cases and performance; notably mortality, compliance with best practice tariff, time to surgery, the proportion of eligible patients undergoing total hip arthroplasty, length of stay delirium risk and pressure sore risk. There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.

775 Impact of frailty on medium-term follow-up in patients undergoing transcatheter aortic valve implantation in a high flow referral centre with high volumes

Abstract Aims Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. To assess the impact of frailty status on a composite endpoint comprising all-cause death and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care centre. Methods and results Consecutive patients >80 years referred to TAVI from January to December 2019 at our institution were screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the multidimensional prognostic index (MPI). Physical function was evaluated by the short physical performance battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB <6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate, or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy, and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Overall, 134 patients were referred for TAVI (mean age: 84 ± 4 years; >90 years: 12%, women 67%). The STS risk score was 4.6 ± 3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3 ± 3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R = 0.31, P = 0.01, MPI R = 0.29, P = 0.03, Figure 1A and B). At 1 year, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N = 6(4.5%); stroke: N = 4 (3.0%); re-do: N = 1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs. low risk: HR: 2.9, 95% CI: 1.1–6.8, P = 0.031, Figure 1C), while no association with STS (P = 0.332) was found. Conclusions In a prospective cohort of TAVI candidates, frailty stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. 120 Figure

Impact of frailty status on medium-term follow up in patients undergoing percutaneous transcatheter aortic valve implantation in a high-flow referral center with high procedural volumes

Abstract Background Transcatheter strategies to treat aortic stenosis (AS) are an established therapeutic option in older patients not candidate for open heart surgery. Current guidelines recommend the adoption of surgical scores like the Society of Thoracic Surgeons (STS) as tools for risk stratification. However, these scores may have limited predictive value in older patients. Purpose To assess the impact of frailty status on a composite endpoint comprising mortality and cardiovascular (CV) events in patients with severe AS evaluated for transcatheter aortic valve implantation (TAVI) in a high-flow and high-volume tertiary care center. Methods Consecutive patients >80 years referred to TAVI from January to December 2019 at our tertiary care institution were prospectively screened for frailty through a comprehensive geriatric assessment (CGA) based on physical function and the Multidimensional Prognostic Index (MPI). Physical function was evaluated by the Short Physical Performance Battery (SPPB), a tool exploring balance, gait speed, strength and endurance that produces a score ranging from 0 to 12 (lowest to highest performance). The SPPB <6 is an established strong predictor of mortality and disability. The MPI is a three-level score used to stratify risk of mortality (low, intermediate or high risk) based on eight key domains for frailty assessment (functional and cognitive status, nutrition, mobility and risk of pressure sores, multimorbidity, polypharmacy and co-habitation). Data on mortality and CV events at 6 and 12 months were retrieved via administrative records and/or telephone follow-up. Results Overall, 134 patients were referred for TAVI (mean age: 84±4 years; >90 years: 12%, women 67%). The average STS risk score was 4.6±3.0 (low risk: 49%; intermediate: 39%, high risk: 12%). Mean SPPB was 6.3±3.7 (SPPB <6: 32%). Ninety-five (71%) patients belonged to the MPI-low risk group, 30 (22%) to the MPI intermediate risk group and nine (7%) to the MPI high risk group. SPPB and MPI scores were moderately correlated with STS (Spearman correlation coefficient: SPPB R=0.31, p=0.01, MPI R=0.29, p=0.03, Figure Panel A and B). At 12 months, 3 (2.2%) patients died, and 11 (8.2%) were hospitalized for CV events: major bleeding, N=6 (4.5%); stroke: N=4 (3.0%); re-do: N=1 (0.7%). The probability of the composite endpoint was higher for patients at intermediate/high MPI risk (HR intermediate/high risk vs low risk: HR 2.9, 95% CI 1.1–6.8, p=0.031, Figure 1 Panel C), while no association with STS (p=0.332) was found. Conclusions In a prospectively enrolled cohort of TAVI candidates, frailty indices stratified short- and medium-term prognosis. The integrated frailty assessment could be a useful tool for early detection of patients at risk of disability, and potentially, for preventing the futility of the TAVI procedure. Funding Acknowledgement Type of funding sources: None. Figure 1

The effects of the 45° semi-recumbent position on the clinical outcomes of mechanically ventilated patients: a systematic review and meta-analysis study.

A meta-analysis was conducted to investigate the effects of the 45° semi-recumbent position on the clinical outcomes of mechanically ventilated patients. The PubMed, Embase, and Cochrane medical databases were searched using the keywords "45°", "head-of-bed elevation", and "semi-recumbent". All relevant randomized controlled trials (RCTs) published between 2005 and 2021 were obtained. The Cochrane system for randomized intervention was adopted and the RevMan 5.3.5 software was used to construct forest plots and funnel plots to assess the risk of bias for the included studies. A total of 128 literatures were initially screened for this meta-analysis, and 7 studies were finally included, with a total of 740 patients. Meta-analysis revealed that the incidence of ventilator-associated pneumonia (VAP) was significantly lower in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position [odds ratio (OR) =0.48; 95% confidence interval (CI): 0.28 to 0.84; Z=2.59; P=0.009]. Furthermore, the incidence of gastric reflux was significantly lower in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position (OR =0.50; 95% CI: 0.27 to 0.96; Z=2.09; P=0.04). Meta-analysis demonstrated that the incidence of pressure sores was significantly higher in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position (OR =1.88; 95% CI: 1.05 to 3.36; Z=2.11; P=0.03). The 45° semi-recumbent position can reduce the incidence of VAP and gastric reflux in patients undergoing mechanical ventilation (MV), but it may also increase the risk of pressure sores. Thus, consideration should be made based on a comprehensive understanding of the patient's condition and physical state.

Risk and staging of postoperative bleeding and pressure sores in elderly urological patients.

Risk and staging of postoperative bleeding and pressure sores in elderly urological patients.

A Study to Evaluate the Effectiveness of Structured Teaching Programme (STP) on Knowledge Regarding Use of Braden Scale for Predicting Pressure Sore Risk Among Student Nurses in KLEs Institute of Nursing Sciences, Hubballi

A Study to Evaluate the Effectiveness of Structured Teaching Programme (STP) on Knowledge Regarding Use of Braden Scale for Predicting Pressure Sore Risk Among Student Nurses in KLEs Institute of Nursing Sciences, Hubballi

Physiotherapeutic and rehabilitative options for neuromuscular scolioses : Areas of physiotherapy techniques in the field of tension between hypertonic and hypotonic forms of neuromuscular scoliosis

Conservative treatment and physiotherapy (PT) of neuromuscular scoliosis and its underlying systemic causes is dominated by apragmatic approach. In the choice of treatment, the observance of the underlying muscle tone sets the essential course to select an appropriate PT technique. Hypertonic forms need the reflex-modulation techniques included in Bobath or Vojta programmes. They sometimes necessitate tone-reducing medication and additional orthotics with alikely risk of pressure sores. In hypotonic forms of scoliosis on the other hand, gravity and spine collapse with pulmonal dysfunction are the key issues addressed by conservative treatment. Sustained quality of life and supported partaking in social life through maintenance of pulmonary function and upright sitting ability are of continuing concern. PT programmes with a neurophysiologic background such as those of Bobath and Vojta are of central significance.

A rapid and feasible tool for clinical decision making in community-dwelling patients with COVID-19 and those admitted to emergency departments: the Braden-LDH-HorowITZ Assessment-BLITZ.

There is no univocal standardized strategy to predict outcomes and stratify risk of SARS-CoV-2 infected patients, notably in emergency departments. Our aim is to develop an accurate indicator of adverse outcomes based on a retrospective analysis of a COVID-19 database established at the Emergency Department (ED) of a North-Italian hospital during the first wave of SARS-CoV-2 infection. Laboratory, clinical, psychosocial and functional characteristics including those obtained from the Braden Scale—a standardized scale to quantify the risk of pressure sores which takes into account aspects of sensory perception, activity, mobility and nutrition—from the records of 117 consecutive patients with swab-positive COVID-19 disease admitted to the Emergency Medicine ward between March 1, 2020 and April 15, 2020 were included in the analysis. Adverse outcomes included admission to the Intensive Care Unit (ICU) and in-hospital death. Among the parameters collected, the highest cutoff sensitivity and specificity scores to best predict adverse outcomes were displayed by lactate dehydrogenase (LDH) blood value at admission > 439 U/L, Horowitz Index (P/F Ratio) < 257 and Braden score < 18. The estimation power reached 93.6%. We named the assessment BLITZ (Braden-LDH-HorowITZ). Despite the retrospective and preliminary nature of the data, a multidimensional tool to assess overall functions, not chronological age, produced the highest prediction power for poor outcomes in relation to SARS-CoV-2 infection. Further analyses are now needed to establish meaningful correlations between ventilation therapies and multidimensional frailty as assessed by ad-hoc validated and standardized tools.

Hospitalization-associated muscle weakness and functional outcomes among oldest old patients: A hospital-based cohort study.

To investigate the prognostic significance of hospitalization-associated muscle weakness for short-term and long-term functional declines among oldest old hospitalized patients. We conducted a retrospective cohort study in the Geriatric Evaluation and Management Unit (GEMU) of a tertiary medical center in Taiwan. Data from patients admitted to the GEMU were collected, including demographic characteristics, underlying diseases, functional assessments, and nutritional status. Handgrip strength was measured at admission and before discharge, and hospitalization-associated muscle weakness was defined accordingly. Functional status was ascertained by a telephone survey, and functional decline was defined based on a comparison with each patient's functional status before discharge. Overall, data from 555 patients were retrieved, and 431 patients (mean age: 86.0±6.2years, 78.5% males) were included in the study, with a mean Barthel Index score of 74.7±20.8, Mini-Mental State Examination (MMSE) score of 19.1±6.8, Geriatric Depression Scale (GDS-5) score of 2.2±1.6, Mini-Nutritional Assessment-Short Form (MNA-SF) score of 8.9±3.0, Cumulative Illness Rating Scale-Geriatric (CIRS-G) score of 2.2±0.9, and the regular use of 6.7±3.5 medications. Patients with a 1-month postdischarge functional decline had significantly lower body weight and body mass index, more severe frailty and more hospitalization-associated muscle weakness. Patients with a 6-month postdischarge functional decline had lower body weight, BMI, MMSE scores, MNA-SF scores, handgrip strength, Barthel Index scores, and Braden Scale scores. BMI (OR: 0.815, 95% CI: 0.691-0.962, P=0.015) and hospitalization-associated muscle weakness (OR: 1.227, 95% CI: 1.147-1.332, P<0.001) were significantly associated with a 1-month postdischarge functional decline. Hospitalization-associated muscle weakness (OR: 1.067, 95% CI: 1.035-1.101, P<0.001), the risk of pressure sores (Braden Scale, OR: 0.767, 95% CI: 0.646-0.910, P=0.002), and BMI (OR: 0.914, 95% CI: 0.838-0.998, P=0.045) were independently associated with a 6-month postdischarge functional decline. Hospitalization-associated muscle weakness significantly predicts functional decline among oldest old patients hospitalized for acute conditions. Further interventional studies are needed to examine the causal relationship between hospitalization-associated muscle weakness and clinical outcomes.

The Risk Factors-Based Nursing Case Management Could Effectively Reduce the Incidence of Pressure Sores in Hospitalized Patients.

Background:To explore the effects of risk factors-based nursing management on the occurrence of pressure sores in hospitalized patients.Methods:From Jan 2018 to Jun 2018, 289 hospitalized patients were divided into pressure sores group [100] and control group [189] for retrospective analysis. Overall, 260 hospitalized patients from Jun 2018 to Dec 2018 were followed up for nursing intervention. Overall 130 patients received risk factors-based nursing case management were in the intervention group, whereas 130 patients who received routine nursing care were in the control group. The chi-square test and t-test were used to compare the count data and the measurement data between groups, respectively.Results:Age, body weight and proportions of patients with impaired nutritional intake, diabetes or stroke in pressure sores group were higher than those in normal group (P<0.05). Hospital stay and operative time in pressure sores group was longer than those in normal group (P<0.05). The frequency of assistant activity in pressure sores group was significantly lower than that in control group (P<0.05).In addition, the score of uroclepsia in pressure sores group was lower than that in normal group (P<0.05). Patients in the intervention group showed lower risk for pressure sores and more satisfied than patients in control group (P<0.001).Conclusion:Advanced age, high body weight, diabetes and stroke, long hospital stay, long operative time, poor nutritional status and severe uroclepsia were independent risk factors of pressure sores. Risk factors-based nursing case management can effectively reduce the occurrence and risk of pressure sores for hospitalized patients.

P0531 / #626: TAKING THE PRESSURE OFF! REDUCING PRESSURE SORES IN THE PAEDIATRIC CRITICAL CARE UNIT (PCCU): A QUALITY IMPROVEMENT PROJECT

Aims & Objectives: Pressure sores cause significant morbidity and increase length of stay. Our PCCU had a high incidence of pressure sores at 58 per 1000 bed days. We aimed to reduce this by 30% over six months. Methods: Using Quality Improvement methodology, our project was conducted at an 8-bedded inner-city PCCU. A task team consisting of nurses and doctors with the input of the whole unit developed a driver diagram as well as change ideas. Change ideas consisted of - pressure sore education to nurses, testing knowledge and confidence; pressure sore information placed at the bedside to aid identification and grading and the requirement for two senior nurses to grade pressure sores. Outcome data were collected monthly whilst process data such as the completion of risk assessment were collected weekly. Qualitative data following “plan-do-study-act” cycles were used to fine-tune our interventions. Results: Following the education package, pressure sore incidence fell to 19.3 per 1000 bed days in the first three months and subsequently to 4 per 1000 bed days after the addition of further interventions. Compliance with daily risk assessment improved from 24% to 87% post intervention. Pressure sore knowledge test scores improved by 15% with the roll out of the pressure sore education package. Conclusions: Targeted interventions identified using QI methodology significantly reduced pressure sore incidence, however, further data is required to conclude sustainability of the improvement. Further targets for reducing specific pressure sore risk, such as ETT strapping and non-invasive ventilation masks, have now been identified.

Family Knowledge in Post-Stroke Pressure Wound Prevention in the Working Area of the Balowerti Health Center, Kediri

The ability of families to provide care for family members after stroke as a rehabilitation effort based on family knowledge in caring for family members with post-stroke, especially in preventing pressure sores. One of the duties of the family is to provide care to family members who are sick. This means that the family has an important role in providing post-stroke family members and care associated with community nurses. With families who do not have the knowledge and ability to care for family members after stroke on new problems, one of which is suffering related to many problems for post-stroke patients. This study aims to determine the level of family knowledge on the prevention of post-stroke pressure sores. This research is a quantitative research with descriptive methods. The research was conducted in the working area of the Balowerti Health Center, Kediri . The study was conducted on 15 post-stroke patients. Data collection using total sampling technique. The research instrument used a questionnaire. Data were analyzed univariately in the form of a frequency distribution. The results of the study showed majority of the respondent were male and majority age were 60, the level of family knowledge about the prevention of post-stroke pressure sores is very low, this will increase the risk of pressure sore while the patient is treated at homeKeywords: Family Knowledge, pressure Sore, Post Stroke

Effect of Application Bundle Skin Care on Nurses’ Performance and Orthopedic Patients’ Skin Outcome: Quasi-Experimental Study

Treating severe pressure ulcers may consume considerable manpower, time, and medical resources. Pressure ulcers can be avoided and effectively treated when nurses conduct proper skin assessment and care for wounds appropriately. Research hypothesis: There was positive impact of bundle skincare training on nurses' performance and orthopedic patients' skin outcome. quasi-experimental design was utilized at orthopedic units at Shebin El Koum teaching Hospital and Menofia University Hospital. Tools used for data collection were Pre-designed Questionnaire contained on nurses' characteristics, Attitude Rating Scale and Nurses' knowledge, also used Observational Checklist and BRADEN scale. The subject composed of 45 nurses and 90 orthopedic patients. Mean score of total knowledge pre-intervention was 6.83±3.1, while at the post was 9.95±2.1. Also, a mean score of total practice pre-intervention was 7.11±2.6, while at the post was 11.83±3.4, and, a mean score of total attitude pre-intervention was 5.02±2.8, while at the post was 7.82±1.9. Mean score of BRADEN scale at pre-intervention was 12.81±3.04, while at the post was 13.45±1.99. Application bundle skin care had a positive effect on nurses' knowledge, practice and attitude related skincare for orthopedic patients. So, there was an improvement at BRADEN score of patients post-application bundle skincare. Age, gender and previous hospitalization, BMI, and length had positive predictor effect on pressure sore risk. Skincare bundle for orthopedic patients is acceptable and has the potential to improve nursing care.

Application of Goertzel Algorithm to Piezoresistive Pressure Sensing Fabric for Custom Fitting of Wheelchair Cushions

Abstract Pressure sores are a costly, painful problem for wheelchair users, caused by prolonged periods of mechanical loading. A common location of pressure sores in wheelchair users is the tissue between the ischial tuberosities and the seating surface. The pressure exerted on the tissue, or interface pressure, can be measured using piezoresistive fabric. This work demonstrates the use of the Goertzel algorithm for efficiently acquiring interface pressure data from a fabric assembly consisting of a layer of piezoresistive fabric between two layers of fabric with conducting and non-conducting stripes. The Goertzel algorithm was used to sample sums of sine waves from the conductive columns of the fabric assembly and calculate the amplitudes of each component sine wave corresponding to the local interface pressure. The Goertzel algorithm is more efficient for this application than a fast Fourier transform due to the limited number of calculated frequency bins needed for this application and more freedom in choice of sample size. The algorithm was successfully used to generate two-dimensional, 32 × 32 sensel interface pressure maps once per second. The Goertzel algorithm can be used in tandem with generated sine waves to measure interface pressure from piezoresistive fabric. Low-cost, accurate interface pressure measurements will help lessen the risk of pressure sores in wheelchair users.

The Local Skin Blood Flow in Areas at Risk for Pressure Sores Treated With Massage

In order to evaluate methods to prevent pressure sores the effect of massage on the local skin blood flow was studied in normal skin and in skin with discolouration (red or reddish blue). In this study massage is defined as small circular movements with the fingertips using liniment. The cutaneous blood flow was measured with a laser Doppler flowmeter. To study the long term effect of massage on normal skin ten patients were measured over a twenty day period with five days before and after a ten day period with massage. Twenty-nine patients with cerebral haemorrhage were measured for two days each to examine the effect immediately after the massage on normal skin. Fifteen patients with discolouration were measured for one day each both on normal skin and injured skin. The difference in blood flow before and after the ten day period of massage was inconsistent and insignificant. The effect of massage which appeared one to two minutes after the stimulus was implemented varies between individuals and within individuals; significantly more women than men increased their skin blood flow bilaterally after massage. In the centre of the injured skin the basal blood flow was higher than in normal skin and it decreased after the massage was implemented. The results stress the importance of continued research to provide an opportunity for individualization in the selection of methods to prevent and treat pressure sores.

PERSONAL HYGIENE MANDI DALAM PENCEGAHAN DEKUBITUS PASIEN STROKE

Stroke patients are often treated with prolonged bed rest. This condition makes stroke patients vulnerable to pressure sores. Maintaining the patient's hygiene by bathing the patient can be an effort to reduce the risk of pressure sores. The purpose of this study was to determine the effect of personal hygiene bathing with the incidence of pressure sores. The research design used was descriptive-analytic. The study population was all stroke patients who were hospitalized in the Kediri City Regional Hospital. Sampling technique with Purposive Sampling. The sample size obtained was 40 respondents. Data was collected using observation and interview sheets. Data analysis uses ordinal regression analysis. The results of the ordinal regression analysis obtained a p-value of 0,000 which means that bathing the patient will reduce the number of pressure sores in stroke patients. Bathing the patient will increase patient comfort, patient satisfaction, smooth blood flow, and certain tissue pressures can be reduced so that the risk of damage to skin tissue or pressure sores can be prevented. The recommendation that can be given is to bathe the patient must be done routinely and correctly according to the patient's condition.

Evaluation of a Modified Version of the Norton Scale for Use as a Pressure Injury Risk Assessment Instrument in Critical Care: A Quality Improvement Project.

No risk assessment scale exists in the United States specifically designed for use among patients with critical illness. The aim of this project was to modify the Norton Scale for Pressure Sore Risk to improve its predictive power when used in the critical care setting. The setting for this quality improvement project was a 1157-bed academic medical center in the Southeast United States. Data were collected from 114 clinicians; 111 were critical care nurses and 3 were certified wound care nurses. Participants assessed the pressure injury risks of a video-simulated critical care patient using the optimized Norton Scale (oNS); this instrument was modified from the Norton Scale. Data were collected on reliability, validity, usability, and preference. All 114 participants accurately predicted a patient's severe high risk for pressure injury using the oNS. Predictive validity and reliability of the oNS were excellent based on a correlation coefficient of more than 0.6 and a Cronbach α = 0.944, respectively. The intraclass correlation coefficient (ICC) was 0.933 (95% confidence interval, 0.911-0.950). From 71.2% to 84.9% of the participants agreed that the oNS represented the desired characteristics for optimal usability in the critical-care setting. Preference for the oNS was associated with perceptions that it was easier, quicker, and more critical-care-specific than the Braden Scale for Pressure Sore Risk currently used in critical care units in the project facility. The oNS offered critical care nurses in our facility a quick, easy-to-use, critical care- specific risk assessment tool that focused on the unique vulnerabilities of patients with critical illness.

Prone Positioning for Acute Respiratory Distress Syndrome in Adults.

Prone Positioning for Acute Respiratory Distress Syndrome in Adults.

An Unorthodox Skin Traction Technique for the Initial Management of Distal Femur Fractures in a High-volume Trauma Centre: A Technical Review.

Distal femur fractures account for 3% of femur fractures and require definitive fixation to allow for weight-bearing and return of functional capability. However, if these fractures must wait a period of time to be taken to theatre, skin traction is routinely applied in the pre-operative period to maximise pain management, prevent deformity and protect neurovascular status. Pre-made traction kits are usually widely available in emergency departments worldwide, allowing for the rapid application and stabilisation of the limb once analgesia in the form of a femoral block has been delivered. Unfortunately, as in many aspects of healthcare, demand can sometimes outweigh supply. In high-volume-trauma centres or mass-casualty incidents, the pre-made kits designed for skin traction such as Sterotrac (Steroplast Healthcare, Manchester, UK) or Tensoplast (BSN medical GmbH, Hamburg, Germany) kits can be rapidly depleted, leaving emergency and orthopaedic physicians with no means of providing the traction required. Hence, we propose and describe a modified technique that provides a simple and inexpensive way to achieve and maintain skin traction using readily available hospital supplies, which can provide adequate support in a safe manner until definitive surgical fixation. This method not only provides sufficient traction but protects the bony pressure areas around the foot and ankle, thereby reducing the risk of iatrogenic pressure sores.