Pressure Ulcer Development Research Articles

Do clinical practice guidelines for the prevention of pressure ulcers really prevent pressure ulcers? An analysis of the guidelines

This review article aims to analyze sections of the 2012 Australian Wound Management Association, Pan Pacific, Clinical Practice Guideline for the Prevention and Management of Pressure Injury, the “Guide,” mandated for use in all Australian residential aged care facilities to explain why pressure ulcers still occur, I considered two sections of the “Guide:” a) “Assess all patients as soon as possible following admission to service and within a minimum of 8 h;” and b) “Implement a prevention plan – strategies for patients at high risk: Use a high specification foam reactive (constant low pressure) support surface OR consider using an (active alternate pressure) support surface.” Nowhere in the “Guide” is there an explanation for a) “Assessing all patients as soon as possible following admission and within a minimum of 8 h.” Similarly, there is no explanation for why b) “a high specification foam reactive (constant low pressure) support surface” is recommended to prevent pressure ulcers. The evidence for screening “within a minimum of 8 h,” does not consider the speed at which pressure ulcers develop. If the resident is lying in one position for 30 min or more and a “constant low pressure” mattress is used, residents may still develop pressure ulcers because a “constant low pressure” does not relieve pressure.

Cost Comparison of Pressure Sores in the Last 4 Years and Evaluation of the Status of Patients Diagnosed with COVID: Acıbadem Healthcare Group Example

It was designed as a retrospective study. Between January 2018 and June 2021, 590 patients who developed pressure ulcers from 16 hospitals affiliated with Acıbadem Healthcare Group (AHG) were identified and classified as Stage 1, Stage 2, Stage 3, Stage 4 and Unstageable pressure ulcer, suspected of deep tissue damage. The cost of treatment was calculated in each category and the total cost per patient for the company was determined.
 There are two main ways to get data for analysis; 1- Sentinel Event System Reports (for determining the number of patients with pressure ulcers) and 2- Patient Services Pricing Department (for defining the cost of treatment). Costs and costing given by the pricing department with a bottom-up approach are calculated from the patient perspective.
 Pressure sore cost calculation for COVID-19 patients covers the period from March 2020 to June 2021.
 Data analysis: Two main ways were used to collect data for analysis; 1- Sentinel Event Notification System Reports (for determining the number of patients with pressure ulcers) and 2- Patient Services Pricing Department (for defining the cost of treatment).
 Population: All patients who developed pressure ulcers in 16 hospitals affiliated to Acıbadem Healthcare Group since 2018

Evaluating the Efficacy of a New Alternating Pressure Air Mattress Aimed at Reducing Pressure Injuries During the Transport of Combat Casualties.

The development of pressure ulcers during aeromedical transport of combat casualties is an issue that continues to exist, especially during long transport flights. This study investigated the potential for a new intervention, an air-inflated insulating mattress pad (IMP) that has a pump system designed to alternate the pressurization of air cells under the patient, thus temporally shifting the pressure concentration locations. In a repeated measures design study, 12 participants experienced the following four simulated transport conditions, each for 90 minutes: (1) The North Atlantic Treaty Organization (NATO) litter by itself (control condition), (2) the NATO litter covered with the standard mattress pad (Warrior Evacuation Pad), (3) the NATO litter covered with the air-inflated mattress (IMP), and (4) the NATO litter, covered with the standard mattress pad that was covered by the insulating mattress pad. Peak pressure readings were obtained every 15 seconds under the head, torso, pelvis, legs, and heels. While both mattress pads significantly reduced the peak pressures relative to the litter-only condition, the new IMP with the alternating cell pressurizations, by itself or in combination with the standard mattress pad, further reduced the peak pressures under the regions with the localized highest pressures, namely the head, pelvis, and heels. Moreover, the IMP with alternating pressure introduced the most variability in the peak pressure readings, which reduces the peak pressure exposure periods for specific tissue locations. The IMP with alternating cell pressurizations could further reduce the likelihood of pressure injuries during aeromedical transport of combat casualties.

Design and evaluation of a dynamic air cushion for pressure ulcers prevention

Wheelchair users have a higher risk of developing pressure ulcers due to prolonged seated pressure. Pressure ulcers can be painful, may require surgical intervention, and even become life-threatening if infection occurs. To prevent pressure ulcers from forming the patient must either offload themselves or rely on a caregiver to move them allowing pressure redistribution over the seated area. In this work, we designed a dynamic air cushion to relieve pressure on loaded areas using sequences of inflation and deflation of the air cushion cells. The purpose of these sequences is to offload pressure from high-risk areas. To evaluate the effect of the alternating sequences on seated pressure and blood perfusion, we recorded interface pressure, skin blood flow, superficial tissue oxygen saturation, blood concentrations of oxygenated hemoglobin, and deoxygenated hemoglobin from twenty-one healthy volunteers who were asked to sit on the air cushion for static mode recording (3 min) and during the inflation/deflation sequences (up to 22 min). The alternating sequences consisted of ten combined inflation and deflation steps. Results showed that, after applying the alternating sequences, interface pressure reduced significantly (p=0.02) compared to the static mode. Moreover, the coefficient of variation of the seated pressure was higher (p<0.001) during the alternation sequence compared to the static mode. However, interface pressure under the right and left ischial tuberosities increased (p<0.001) during the alternation sequence compared to the static mode. In addition, during the alternating sequences, males had larger dispersion index values of both right and left ischial tuberosities pressure compared to females. Furthermore, the maximum value of oxygen saturation (p=0.04) and skin blood flow (p=0.001) increased during the pressure alternation sequences compared to the static mode. The study findings highlighted the positive effects of the designed dynamic air-cushion to relieve pressure on compressed areas and enhance blood perfusion similar to manual offloading approaches. The outcomes of this study are encouraging to evaluate the performance of the designed air cushion in studies involving wheelchair users.

Pressure ulcers from prone positioning in COVID-19 patients: Developing clinical indicators in evidence-based practice: A retrospective study

Background: A notable pandemic arisen during the COVID-19 pandemic has developed globally in intensive care units, with patients developing pressure ulcers (PUs) after being ventilated mechanically in the prone position. Objectives: The aim was to identify risk factors independently predictive of the development of PUs in adult patient populations treated with prone positioning and to evaluate a possible epidemiological association between the prevalence of PUs and specific clinical characteristics so as to develop clinical indicators for the prevention of PUs. Finally, the aim was to examine our study participants against the incidence of PUs with respect to the length of their stay. Methods: : This retrospective study enrolled patients hospitalized during the period of May 2020 through January 2021. Data was collected from 299 patients hospitalized and having required prone positioning ventilatory therapy in critical care areas (short-stay units, emergency units, and intensive care units), all of which had developed Pus of at least grade two according to the classification system proposed by the NPUAP/EPUAP. Results: : Patients who had developed PUs had a longer hospitalization stay overall and were more prone to die during hospitalization. Patients who developed Pus were more frequently males, with higher initial levels of CPK and ferritin. Conclusions: The study reveals valuable information on the most important risk factors in the development of PUs due to prone positioning. We have described how the total number of days of hospitalization is significantly related to the development of PUs. Even a PU is not a life-threatening lesion, the implementation of improved positioning protocols may enhance results in critical patient care. We believe that this is a current, globally underestimated problem as the incidence of COVID-19 patients requiring prone positioning—and, therefore, at risk for PUs—is increasing daily.

What is the better choice for nurses? Alternating air pressure mattresses versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients: A protocol for systematic review and meta-analysis.

Background:Evidence on the comparative effectiveness between commercially available support surfaces in preventing pressure ulcer development is lacking. The purpose of this study was to compare the efficacy and safety of alternating air pressure mattresses (AAPMs) versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients and to provide evidence for clinical practice.Methods:The electronic databases of Cochrane Library, EMBASE, PubMed, and Web of Science will be searched in April 2022 using the following key terms: “pressure ulcers,” “support surface,” and “pressure mattresses,” for all relevant studies. Only English publications are included. The primary outcome is the incidence of pressure ulcers; secondary outcomes include patient satisfaction, cost, and other bedridden complications. The Cochrane risk of bias tool will be independently used to evaluate the risk of bias of included randomized cohort studies by 2 reviewers. A modified version of the Downs and Black tool is adopted to evaluate the quality of nonrandomized cohort studies. All outcomes are pooled on random-effect model.Results:We hypothesized that group with AAPMs will provide better therapeutic benefits compared with control group.Conclusions:It is worthy to critically review the evidence of the assessment of AAPMs and static air mattresses to inform clinical practice.OSF registration number:10.17605/OSF.IO/MYPZ2.

Preventing pressure ulcers in aged care by auditing, and changing, work practices

Background: Two nurse consultants concerned with ongoing pressure ulcer development in a 44-bed residential aged care facility in Sydney, Australia, audited pressure ulcers and the use of air mattresses. Aims and Objectives: To measure and reduce the prevalence of pressure ulcers; audit air mattresses in use; reduce the physical workload for care staff repositioning residents; introduce an alternating pressure air mattress, allow residents to sleep undisturbed, and provide bedside education for all nursing staff. Materials and Methods: Pressure ulcer prevalence was determined, “air” mattresses were inspected, and repositioning regimes were considered. All residents at risk of pressure ulcers were provided with a “Nodec A” mattress, allowed to sleep undisturbed, and bedside training was given to staff. Results: Pressure ulcer prevalence was 18.1%. Eight of 44 residents had a total of 10 pressure ulcers; four sacral, three heel ulcers, two buttocks, and one hip. An audit of “air” mattresses showed half, seven of 14 (50%), was not working. Four alarm lights were on; two were set on static mode and one was deflated. Six months after the introduction of the “Nodec A” alternating pressure air mattress all pressure ulcers had healed, and the facility was pressure ulcer free. Conclusion: Residents nursed on the “Nodec A” were pressure ulcer free and slept for hours without being repositioned and woken.

Pressure ulcers from prone positioning in COVID-19 patients: Developing clinical indicators in evidence-based practice: A retrospective study

Background: A notable pandemic arisen during the COVID-19 pandemic has developed globally in intensive care units, with patients developing pressure ulcers (PUs) after being ventilated mechanically in the prone position. Objectives: The aim was to identify risk factors independently predictive of the development of PUs in adult patient populations treated with prone positioning and to evaluate a possible epidemiological association between the prevalence of PUs and specific clinical characteristics so as to develop clinical indicators for the prevention of PUs. Finally, the aim was to examine our study participants against the incidence of PUs with respect to the length of their stay. Methods: : This retrospective study enrolled patients hospitalized during the period of May 2020 through January 2021. Data was collected from 299 patients hospitalized and having required prone positioning ventilatory therapy in critical care areas (short-stay units, emergency units, and intensive care units), all of which had developed Pus of at least grade two according to the classification system proposed by the NPUAP/EPUAP. Results: : Patients who had developed PUs had a longer hospitalization stay overall and were more prone to die during hospitalization. Patients who developed Pus were more frequently males, with higher initial levels of CPK and ferritin. Conclusions: The study reveals valuable information on the most important risk factors in the development of PUs due to prone positioning. We have described how the total number of days of hospitalization is significantly related to the development of PUs. Even a PU is not a life-threatening lesion, the implementation of improved positioning protocols may enhance results in critical patient care. We believe that this is a current, globally underestimated problem as the incidence of COVID-19 patients requiring prone positioning—and, therefore, at risk for PUs—is increasing daily.

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.

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.

598 Reconstruction of Trochanteric Pressure Ulcers with Pedicled Vastus Lateralis-Anterolateral Thigh Flap

IntroductionTrochanteric region is one of the most frequent site for pressure ulcer development. High-voltage electric injuries with neurovascular damage is an important reason of paraplegia. These patients have prolonged hospitalization period and develop cachexia by time. Grade 3-4 sores with thoracanter major of femur exposition generally need flap reconstruction. Musculocutaneous flaps are preferred to cover exposed bone and fill the dead space. Although loco regional flaps such as tensor fasia lata, gluteus Maximus muscle flap have been used for thoracanteric ulcers, these flaps have mandatory muscles for ambulation in the following rehabilitation period. Another disadvantage of these flaps are the possible donor site problems due to pressure loading. Thus, we aimed to used vastus lateralis- anterolateral thigh(VL-ALT) flap for decreasing donor-site morbidity and tension.MethodsBetween 2019 and 2021 we have operated 6 trochanteric pressure ulcers in 5 patients. All patients had history of electric injury related paraplegia. The mean age of the patients was 33 (24-50) The defect size were ranging between 5x4cm and 10x12 cm. Flap size were planned according to exact size of the defect. VL muscle were harvested according to the size of dead space. The donor site was closed primarily in 3 patients. Split thickness skin graft were needed in 2 patients. Patients were hospitalized in lateral decubitus or supine position during follow –up.ResultsMean follow up time was 10 months (6-18). All flaps were survived. Hematoma development were seen in 1 patient in the donor site which were treated with bedside debridement. No recurrence was seen during follow-up period. No restriction or morbidity were encountered during ambulation.ConclusionsVL-ALT musculocutaneous flap provides the required tissue for dead space filling and defect closing simultaneously. The advantages of this flap are; lower donor site morbidity, perfect match in terms of skin quality and bulk, protecting the major muscles such as gluteus maximus and tensor fascia lata. The technique needs knowledge of quadratus femoris anatomy which has a short learning curve.

Auditing completion of nursing records as an outcome indicator for identifying patients at risk of developing pressure ulcers, falling, and social vulnerability: An observational study.

To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators. Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary. This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave. A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit. The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions. Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.

High-Intensity Post-Stroke Rehabilitation Is Associated with Lower Risk of Pressure Ulcer Development in Patients with Stroke: Real-World Evidence from a Nationwide, Population-Based Cohort Study.

Background and Objectives: Multiple factors are associated with pressure ulcer (PU) development, including limited mobility following stroke. We performed a nationwide cohort study to investigate the impact of rehabilitation intensity on the incidence of post-stroke PU. Materials and Methods: Data of patients diagnosed with stroke between 2000 and 2012 were collected from the 2000 Longitudinal Health Insurance Database (Taiwan). Based on the number of rehabilitation sessions attended within 90 days of discharge, the rehabilitation intensity was classified as low, medium, or high. After adjusting for sociodemographic factors and comorbidities, the Cox proportional hazards model evaluated the risk of PU development during the 12-year follow-up period. Kaplan–Meier curves were used to estimate the cumulative incidence of PUs. Results: Our study included 18,971 patients who had their first episode of stroke. Of these, 9829 (51.8%) underwent rehabilitation therapy after discharge. Female patients and patients with a National Institutes of Health Stroke Scale (NIHSS) score >13 points, who commenced high-intensity post-stroke rehabilitation after discharge had a significantly lower risk of PU development than those who underwent low-intensity post-stroke rehabilitation after discharge. Cumulative survival analysis showed a significantly lower cumulative incidence of PU during the 12-year follow-up period in the high-intensity rehabilitation group. Conclusion: Compared with low-intensity post-stroke rehabilitation, high-intensity post-stroke rehabilitation after discharge from hospital is associated with a lower risk of post-stroke PU development, especially in female stroke patients and patients with a NIHSS score >13 points. High-intensity rehabilitation is also associated with a significantly lower cumulative incidence of PU events during the 12-year follow-up period.

Effects of vasopressor agents on the development of pressure ulcers in critically ill patients: a systematic review.

The primary objective of this systematic review was to determine the effect of vasopressor agents on the development of pressure ulcers (PUs) among critically ill patients in intensive care units (ICUs). The secondary outcome of interest was length of stay in the ICU. A systematic review was undertaken using the databases searched: Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to formulate the review. Data were extracted using a predesigned data extraction table and analysed as appropriate using RevMan. Quality appraisal was undertaken using the EBL Critical Appraisal Tool. The inclusion criteria were met by 13 studies. Two studies provided sufficient data to compare the number of patients who developed a PU with and without the use of vasopressors. Consistently, within these two studies, being treated with a vasopressor increased the likelihood of PU development. RevMan analysis identified that shorter duration of administration of vasopressors was associated with less PU development (mean difference (MD) 65.97 hours, 95% confidence interval (CI): 43.47-88.47; p=0.0001). Further, a lower dose of vasopressors was also associated with less PU development (MD: 8.76μg/min, 95% CI: 6.06-11.46; p<0.00001). Mean length of stay increased by 11.46 days for those with a PU compared to those without a PU (MD: 11.46 days; 95% CI: 7.10-15.82; p<0.00001). The overall validities of the studies varied between 45-90%, meaning that there is potential for bias within all the included studies. Vasopressor agents can contribute to the development of PUs in critically ill patients in ICUs. Prolonged ICU stay was also associated with pressure ulcers in this specific patient group. Given the risk of bias within the included studies, further studies are needed to validate the findings of this review paper.

Effect Evaluation of Platelet-Rich Plasma Combined with Vacuum Sealing Drainage on Serum Inflammatory Factors in Patients with Pressure Ulcer by Intelligent Algorithm-Based CT Image.

This work was to explore the efficacy of intelligent algorithm-based computed tomography (CT) to evaluate platelet-rich plasma (PRP) combined with vacuum sealing drainage (VSD) in the treatment of patients with pressure ulcers. Based on the u-net network structure, an image denoising algorithm based on double residual convolution neural network (Dr-CNN) was proposed to denoise the CT images. A total of 84 patients who were hospitalized in hospital were randomly divided into group A (without any intervention), group B (PRP treatment), group C (VSD treatment), and group D (PRP+VSD treatment). Procalcitonin (PCT) was detected by enzyme-linked immunosorbent assay (ELISA) combined with immunofluorescence method, C-reactive protein (CRP) was detected by rate reflectance turbidimetry (RRT), and interleukin-6 (IL-6) was detected by electrochemiluminescence method. The results showed that after treatment, 44 cases (52.38%) of pressure ulcers patients recovered, 24 cases (28.57%) had no change in stage, and 16 cases (19.04%) developed pressure ulcers. The pain scores of group D at 1 week (3.35 ± 0.56 points) and 2 weeks (2.76 ± 0.55 points) after treatment were significantly lower than those in group C (7.77 ± 0.58 points and 6.34 ± 0.44 points, respectively). The time of complete wound healing in group D (24.5 ± 2.32) was obviously lower in contrast to that in groups A, B, and C (35.54 ± 3.22 days, 30.23 ± 2 days, and 29.34 ± 2.15 days, respectively). In addition, the medical satisfaction of group D (8.74 ± 0.69) was significantly higher than that of groups A, B, and C (4.69 ± 0.85, 5.22 ± 0.31, and 5.18 ± 0.59, respectively). The levels of IL-6 and PCT in group D were lower than those in groups A, B, and C, and the differences were statistically significant (P < 0.01). The average values of peak signal to noise ratio (PSNR) and structural similarity index measure (SSIM) of the Dr-CNN network model were 37.21 ± 1.09 dB and 0.925 ± 0.01, respectively, which were higher than other algorithms. The mean values of root mean square error (MSE) and normalized mean absolute distance (NMAD) of the Dr-CNN network model were 0.022 ± 0.002 and 0.126 ± 0.012, respectively, which were significantly lower than other algorithms (P < 0.05). The experimental results showed that PrP combined with VSD could significantly reduce the inflammatory response of patients with pressure ulcers. PRP combined with VSD could significantly reduce the pain of dressing change for patients. Moreover, the performance model of image denoising algorithm based on double residual convolutional neural network was better than other algorithms.

Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients.

To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery. A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge. Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA. Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.

Validez convergente y discriminativa del índice Frágil-VIG con la escala de Braden en personas atendidas en atención domiciliaria

The Frail-VIG index and the Braden scale are validated instruments for assessing frailty and the risk of developing dependency-related skin lesions respectively. The Frail-VIG index is a multidimensional instrument that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. ObjectiveOur aim was to investigate the convergent and discriminative validity of the Frail-VIG index with regard to Braden scale value. MethodsWe carried out a cross-sectional study in 2 primary health care centres of the Catalan Institute of Health, Barcelona (Spain). Participants in the study were all people included under a home care programme during the year 2018. No exclusion criteria were applied. We used the Frail-VIG index to measure frailty and the Braden scale to measure the risk of developing pressure ulcers. Trained nurses administered both instruments during face-to-face assessments in a participant's home during usual care. The relationships between both instruments were examined using Pearson's correlation coefficient. ResultsFour hundred and twelve participants were included. Frail-VIG score and Braden scale value were negatively correlated (r=−0.597; P<.0001). Non-frail people had a lower risk of developing dependency-related skin lesions than moderate to severe frail people. The Braden scale value declined significantly as the Frail-VIG index score increased. ConclusionsFrail-VIG index demonstrated a convergent validity with the Braden scale. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with a higher and lower risk of developing. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery.

This study reports the characteristics of patients with dementia or cognitive impairment hospitalized with a proximal femur fracture requiring surgery. Methods: Multicentric descriptive longitudinal study conducted in three traumatology units, representing high-technology public hospitals across Spain. Data collection took place between August 2018 and December 2019 upon admission to hospital, discharge, one month and three months after discharge. Results: Study participants (n = 174) were mainly women (81.6%), and the mean age was 90.7± 6.3 years old. Significant statistical differences were noted in the decline of functional capacity at baseline and one month later, and after three months they had still not recovered. Malnutrition increased from baseline to the one-month follow-up. The use of physical restraints increased during hospitalization, especially bilateral bedrails and a belt in the chair/bed. After one month, 15.2% of patients had pressure ulcers. Although pain decreased, it was still present after three months. Conclusion: Hospitalization after hip surgery for elderly people with dementia or cognitive impairment negatively impacted their global health outcomes such as malnutrition and the development of pressure ulcers, falls, functional impairment and the use of physical restraints and pain management challenges. Hospitals should implement policy-makers’ strategic dementia care plans to improve their outcomes.

Predictors of COVID-19 disease severity augment the Braden scale in the prediction of pressure ulcer development among COVID-19–positive intensive care unit patients: A case-control study

Predictors of COVID-19 disease severity augment the Braden scale in the prediction of pressure ulcer development among COVID-19–positive intensive care unit patients: A case-control study

Efficacy of nutritional support protocol for patients with pressure ulcer: comparison of before and after the protocol

ObjectivesBecause most patients who develop pressure ulcer (PU) are malnourished, additional nutritional support is important for PU improvement. The aim of this study was to investigate the potential benefit of a simple nutritional support protocol in PU improvement. MethodsThis study was a comparative before-and-after study, prospectively performed from May to December 2020. Participants were inpatients of Seoul National University Hospital (SNUH), South Korea. Among the patients who developed PU from May to December 2020, those on enteral nutrition were included in the protocol group. Application of the nutritional support protocol was established in May 2020 in SNUH. Serum levels of prealbumin, transferrin, cholesterol, and zinc were measured initially and 2 and 4 wk after protocol application to evaluate clinical course. A tailored regimen that adjusted the amount of protein and trace elements was provided according to consultation with the nutritional support team. Size and Pressure Ulcer Scale for Healing was evaluated every 2 wk by the same nurse in charge of PU. To validate the efficacy of the protocol, patients who developed PU from May to December 2018, were hospitalized for >2 wk, and who received enteral nutrition were selected as a control group. ResultsSixty-one patients were included in the protocol group and 100 were in the control group. The protocol group had a higher proportion of PU improvement (85.2 versus 50%; P < 0.001), daily protein intake (1.6 ± 3.2 versus 0.9 ± 0.4; P = 0.048), Braden scale (12.9 ± 1.8 versus 12.3 ± 1.8; P = 0.025), and baseline albumin level (3.1 ± 0.5 versus 2.8 ± 0.4; P = 0.001) when compared with the control group. Multivariate analysis showed that implementation of the nutritional support protocol was the most effective factor in improving PU (odds ratio, 0.18; 95% confidence interval, 0.089–0.366; P < 0.001). ConclusionsA simple nutritional support protocol was easy to develop and its application contributed significantly to the recovery of PU.

Risk factors for pressure ulcers in adult patients: A meta-analysis on sociodemographic factors and the Braden scale.

Providing the first meta-analysis of risk factors for pressure ulcer development in adult patients. Pressure ulcers remain a serious health complication for patients and nursing staff. However, there is a lack of statistical evidence for risk factors as previous research did not include any quantitative synthesis. Meta-analysis, using PRISMA guidelines. Studies from PubMed, Embase, CINAHL Complete, Web of Science, Cochrane Library, and other reviews and sources were screened and checked against the inclusion criteria. The risk of bias was evaluated using a slightly modified QUIPS tool. Data regarding population, design, statistical analysis and risk factors were extracted. Meta-analysis with comparable studies was conducted for age, sex, and Braden scale. The sub-group analysis was used to account for heterogeneity. 28studies with 570,162 patients were entered in meta-analysis. Older age and a low total Braden scale score increased the risk for pressure ulcers. All subscales excluding 'moisture' reached significance in meta-analysis based only on few studies, however, limiting overall evidence. Male sex achieved mixed results, too. The first meta-analytic analysis shows evidence for age and Braden scale as risk factors for pressure ulcer development. Limitations regarding study quality and heterogeneity must be considered, highlighting the need for unifying certain conditions in risk factor research. Patients at risk for new pressure ulcers can be identified by their total Braden score and age, whereas the latter is also connected to deeper pressure ulcers. Nurses and health personnel should pay great attention to patients in older age and undergo specific training to utilise and evaluate the Braden scale effectively, if necessary.