Pressure Ulcer Risk Research Articles

Causal associations between type 2 diabetes mellitus, glycemic traits, dietary habits and the risk of pressure ulcers: univariable, bidirectional and multivariable Mendelian randomization.

Previous research has established a connection between Type 2 Diabetes Mellitus (T2DM), glycemic traits, dietary habits, and the risk of Pressure Ulcers (PUs). The aim of our study is to disentangle any potential causal relationship between T2DM, glycemic traits, and dietary factors, and the risk of PUs. The exposure and outcome datasets were sourced from the IEU Open GWAS project, the Meta-Analyses of Glucose and Insulin-related traits Consortium (MAGIC), and the FinnGen biobank, respectively. The primary MR analysis method employed was the inverse variance-weighted method. Furthermore, we employed multivariable MR (MVMR) adjusting for BMI. Then, we investigated the possibility of a reverse association between glycemic traits and PUs through bidirectional MR. Finally, Heterogeneity and pleiotropic analysis were conducted to ensure the accuracy and robustness of the results. The findings revealed that T2DM (OR = 1.282, 95% CI: 1.138-1.445, p < 0.001) and Fasting Glucose (FG; OR = 2.111, 95% CI: 1.080-4.129, p = 0.029) were associated with an increased risk of PUs, while salad/raw vegetable intake (OR: 0.014; 95% CI: 0.001-0.278; p = 0.005) was identified as a protective element. However, no other dietary elements demonstrated a statistically significant causality with PUs. In addition, in the reverse direction, there were positive correlation between genetic susceptibility to PUs and an increase in FG (OR: 1.007, 95% CI: 1.000-1.013, p = 0.048) and Fasting Insulin (FI; OR: 1.012, 95% CI: 1.003-1.022, p = 0.011). MVMR results indicated that the causal effect of T2DM on PUs was independent of BMI (OR: 1.260, 95% CI: 1.112-1.427, p < 0.001). These results remained robust when considering weak instrument bias, pleiotropy, and heterogeneity. This study establishes a causal link between genetically predicted T2DM, FG and an increased risk of PUs. Conversely, Salad/raw vegetable intake is significantly inversely associated with PUs. Simultaneously, we identified two downstream effector factor (FG and FI) that were associated with PUs. These findings may have clinical implications for both prevention and treatment.

Implementing the PURPOSE T pressure ulcer risk assessment tool into clinical practice.

The first intervention in pressure ulcer prevention is often the completion of a pressure ulcer risk assessment, which aims to identify a patient's level of risk of developing a pressure ulcer. Appropriate care planning should then follow. There are several pressure ulcer risk assessment tools that nurses can use in their clinical practice, but it has not always been clear which is the most effective. One of these tools - the PURPOSE T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool) - has recently been recommended in national guidelines and is now considered to be the only tool with an up-to-date evidence base. This article examines some of the risk assessment tools used to assess pressure ulcer risk, as well as providing an overview of the PURPOSE T and explaining its significance in pressure ulcer prevention.

Evaluation of Nutrition, Pressure Ulcer and Fall Risk Status and Related Factors in Individuals Receiving Home Health Care Services

Objective: In this study, the aim is to evaluate the factors associated with nutrition, pressure ulcers, and fall risks in individuals receiving home health care. Methods: A retrospective study was designed by examining the files of the patients registered in the Home Health Care. Mini Nutritional Assessment Short Form, Modified Norton Scale and Itaki Fall Risk Scale scores were recorded. Results: The study included 334 patients. 197 (59%) of them were female and the mean age was 74.15±16.12 (min: 18, max: 101). The most common chronic diseases was hypertension (HT) (n=167, 50%), whereas the two most common comorbidities were DM and HT (n=77,23.1%). Patients receiving home health care were found to be at risk for malnutrition, pressure ulcers and falls. Being semi-bedridden and wheelchair bound were found to be predictors for the risk of developing pressure ulcers according to regression analysis results. Also it was identified that the age and dependency levels of the patients receiving home health care explained 12% of the falling behaviours of the older people. Conclusion: Necessary warnings should be given at every visit, so that receiving home health care should not be neglected in terms of risks and preventive measures should be taken for this patient group.

Advances and trends in pressure ulcer care research over the last 20 years: A bibliometric and visual analysis

ObjectiveThis study aims to investigate the current status and trends of pressure ulcer care studies over the past two decades using bibliometric and visual analysis, with the objective of providing guidelines for the development of relevant clinical practices or further research. MethodsWe conducted a search on the Web of Science Core Collection database using the subject terms “pressure ulcers” or “pressure injuries” for the period from January 2002 to December 2021. Bibliometric tools such as CiteSpace (version 5.8.R3), VOS viewer (version 1.6.17) and the R software 4.0.3 were used to visualize and analyze annual publications, country, institution, author, keyword and cited literature. ResultsWe identified 5102 publications related to pressure ulcers during the 20-year period, including 4034 articles published in 1557 journals. The number of annual publications on the relevant topics has been increasing annually at an annual growth rate of 4.89 %. The keyword cluster analysis of these studies can be divided into four areas: epidemiology, risk assessment, caring intervention and prognostic analysis. Keyword temporal analysis revealed that the “Braden score” was the most commonly used keyword over a long-term span. The dissemination of knowledge and student training on pressure ulcers have become hot topics of research in recent years. Additionally, pressure ulcer care in COVID-19 patients has emerged as another research hotspot due to the pandemic. ConclusionBibliometric analyses have shown that there has been a steady increase in research on pressure ulcer care, with studies related to pressure ulcer risk scores accounting for a large portion of this research. In recent years, education on pressure ulcer-related knowledge and pressure ulcer care in COVID-19 patients have emerged as research hotspots. Future research on pressure ulcer care in the elderly may be a research hotspot as the aging population progresses.

Effects of loading processes on contact forces when simulating static seating with a finite element human body model

Seat interface forces, particularly shear forces, play an essential role in predicting the risk of pressure ulcers and seating discomfort. When a finite element human body model (HBM) is used for static seating simulation, the most common loading method is to put the model in a position close to the desired final posture and then ‘drop’ it from just above the seat by applying the gravity (DROP). This does not represent how people sit in a seat. In addition, high coefficients of friction (COF) are often used to prevent sliding, which may lead to unrealistically high tangential forces. This study aims to investigate the effects of the loading process and the COF on seating simulations with a HBM. We propose a new loading approach called ‘drop and rotate’ (D&R) to better mimic people sitting on a seat. With the trunk more flexed than the desired posture, the model is dropped to establish the contact between the buttocks and thighs, and the seat pan first, and then between the back and the backrest by rotating the hip. Simulations were performed using a recently developed and validated adult male model in two different seat configurations. Results show that the proposed D&R method was less sensitive to COF and gave a better prediction of contact forces, especially on the seat pan. However, its computational time is higher than the DROP method. The study highlights the importance of the loading process when simulating static seating.

Impact of head-of-bed elevation angle on the development of pressure ulcers and pneumonia in patients on mechanical ventilation: a systematic review and meta-analysis

BackgroundMechanical ventilation is crucial for patient management in intensive care units, but it comes with complications such as pressure ulcers and ventilator-associated pneumonia (VAP). The impact of head-of-bed elevation angles on these complications remains a critical area for investigation.MethodsThis systematic review and meta-analysis followed PRISMA guidelines and involved searches across PubMed, Embase, Web of Science, and Cochrane Library, conducted on September 19, 2023, with no date or language restrictions. We included randomized controlled trials that compared different head-of-bed elevation angles in adult ICU patients on mechanical ventilation. Data were extracted on study characteristics, quality assessed using the Cochrane risk of bias tool, and statistical analyses performed using chi-square tests for heterogeneity and fixed or random-effects models based on heterogeneity results.ResultsSix studies met inclusion criteria out of an initial 601 articles. These studies showed minimal heterogeneity (I2 = 0.0% for pressure ulcers, p = 0.930; and for VAP, p = 0.797), supporting the use of fixed-effect models. Results indicated that a higher elevation angle (45°) significantly increased the risk of pressure ulcers (OR = 1.95, 95% CI: 1.12–3.37, p < 0.05) and decreased the incidence of VAP compared to a lower angle (30°) (OR = 0.51, 95% CI: 0.31–0.84, p < 0.05).ConclusionsWhile higher head-of-bed elevation can reduce the risk of VAP in mechanically ventilated patients, it may increase the risk of pressure ulcers. Clinical strategies should carefully balance these outcomes to optimize patient care in ICU settings.RegistrationPROSPERO 2024 CRD42024570232.

Multidimensional-Based Prediction of Pressure Ulcers Development and Severity in Hospitalized Frail Oldest Old: A Retrospective Study.

In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale. The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale. Within the population, 152 subjects (48%) developed PU at different levels of severity. The results showed that age, Braden scale (subscales of mobility and friction/shear), Barthel scale, Mini Nutritional Assessment, hemoglobin, and albumin are predictors associated with the development of PU (AUC 85%). The result is an improvement over the use of the Braden scale alone (AUC 75%). Regarding the identification of predictive factors for PU severity, 4AT also emerges as potentially relevant. Assessing the subject's nutritional status, physical performance, and functional autonomies enables the effective integration of the Braden scale in identifying patients most susceptible to developing PU. Our findings support the integration of a comprehensive set of methodologically robust frailty determinants into traditional risk assessment tools. This integration reflects the mutual interplay between patients' frailty, skin frailty, and PU development in very old hospitalized patients.

Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home

AimTo develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. MethodsA participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP):•WP1 – Development of two co-operative Inquiry Groups (CIGs)•WP2 - Semi-structured interviews and/or app participation•WP3– Professional and strategic stakeholder engagement•WP4–Systems mapping and Theory of Change (ToC pathway developmentIterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FindingsOverall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. ConclusionsThe study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.

Nurse understaffing associated with adverse outcomes for surgical admissions.

Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes. A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions. Increased exposure to registered nurse understaffing was associated with longer hospital stay and increased risk of deep vein thrombosis, pneumonia, and pressure ulcers. This was also true for nurse assistant understaffing, but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for registered nurse understaffing (HR 1.09, 95% c.i. 1.07 to 1.12) and nurse assistant understaffing (HR 1.10, 1.08 to 1.13), whereas the effect size of registered nurse understaffing for readmission (HR 1.02, 1.02 to 1.03) was greater than that seen with nurse assistants (HR 1.01, 1.01 to 1.02). Understaffing by both registered nurses and nursing assistants is associated with increased risks of a range of adverse events, and generally larger effects are seen with registered nurse understaffing.

Case Study of Implementation of Adverse Event Prevention Program: Decubitus Ulcer in Bedrest Patient with Stroke in the ICU Room with S.S.K.I.N Approach

Patient safety is one of the aspects of providing excellent service for patients in hospitals, especially in the ICU. One method of managing patient safety is to prevent pressure ulcers in the ICU. The aim of this study is to explain the management of pressure ulcer prevention in the ICU for bedridden stroke patients using an intervention approach with form chart media. The research method used in this study is a case study design that includes assessment processes, data analysis, diagnostic rehabilitation, intervention, implementation, and evaluation. We collected data through observation, interviews, and physical examinations. We carried out the intervention in two shifts. We measured the risk of pressure ulcers using the Braden scale, provided health education to the family, and ensured the nurse correctly filled out the form. The obstacle to increasing the number of nurses is the workload and the feeling that human resources are still insufficient. There are no signs of pressure sores on the patient's back. In the implementation of the pressure ulcer prevention program using the skin approach, family involvement is necessary to ensure the program continues without adding to the workload of nurses in the ICU. Conclusion: Modifications to the formchart and family involvement in the program are necessary for the implementation of the pressure ulcer prevention program using formchart media in the ICU.

Causal effect of obesity and adiposity distribution on the risk of pressure ulcers and potential mediation by type 2 diabetes mellitus: insights from multivariable mendelian randomization and mediation analysis.

Previous observational studies have identified a link between obesity, adiposity distribution, type 1 Diabetes Mellitus (T1DM), type 2 Diabetes Mellitus (T2DM), and the risk of pressure ulcers (PUs). However, the definitive causality between obesity and PUs, and potential DM mediators remains unclear. Univariable, multivariable, and mediation Mendelian randomization (MR) analyses were conducted to explore the mediating role of T1DM or T2DM in the association between obesity, adiposity distribution, and PUs. Instrumental variables for obesity and adiposity distribution, including Body Mass Index (BMI), waist circumference, hip circumference, trunk fat mass, whole body fat mass, trunk fat percentage, and body fat percentage, were selected from two genome-wide association studies (GWAS). In univariable MR analysis, BMI, hip circumference, and obesity were associated with PUs using inverse variance weighted (IVW) regression. These findings were further corroborated by the replication cohorts and meta-analysis (BMI: OR = 1.537, 95% CI = 1.294-1.824, p < 0.001; Hip circumference: OR = 1.369, 95% CI = 1.147-1.635, p < 0.001; Obesity: OR = 1.235, 95% CI = 1.067-1.431, p = 0.005), respectively. Even after adjusting for confounding factors such as T1DM and T2DM, BMI and hip circumference remained statistically significant in multivariable MR analyses. T2DM may mediate the pathogenesis of BMI-related (OR = 1.106, 95% CI = 1.054-1.160, p = 0.037) and obesity-related PUs (OR = 1.053, 95% CI = 1.034-1.973, p = 0.004). These findings provide insights for the prevention and treatment of PUs, particularly in patients with obesity or DM.

Causal association of micronutrients and supplements with pressure ulcer: A Mendelian randomization study.

Pressure ulcer (PU) is known to be associated with abnormalities of micronutrient status. However, to date, it is not clear whether a causal relationship exists between circulating levels of micronutrients and their supplementations and PU. A two-sample Mendelian randomization (MR) study was conducted using summary statistics from Genome-Wide Association Studies (GWAS). Genetic instrumental variables (IVs) for 13 micronutrients were identified from a GWAS of 67582 participants, IVs for supplement zinc were acquired from 18826 cases and 44255880 controls, and IVs for PU were obtained from 663 PUs and 207482 controls. The MR analysis was conducted using the MR base platform. The main analysis method was inverse variance weighted (IVW) analysis, supplemented by MR Egger, Weighted median, Weighted mode, and Simple mode analyses. Heterogeneity was assessed using Cochran's Q statistic for MR-IVW and Rucker's Q statistic for MR-Egger. Pleiotropy was determined bythe MR-Eggerregression. Sensitivityanalysiswasconductedusingthe leave-one-outmethod, and publication bias was evaluated using funnel plots. Genetically predicted lower circulating zinc levels were found to be causally linked to the development of PU (OR=0.758, 95%CI 0.583-0.987, P=0.040). However, there was no significant evidence of a causal relationship between supplemental zinc intake and PU development (P>0.05). Additionally, no causal association was observed between the other circulating micronutrients and the occurrence of PU. Furthermore, there was no indication of horizontal pleiotropy or heterogeneity among genetic variants (P>0.05), and the robustness of the findings was confirmed through leave-one-out tests and funnel plots. Our findings indicate a potential causal association between circulating zinc levels and decreased risk of PU. However, zinc supplementation did not demonstrate a significant reduction in the risk of PU. Further research is warranted to elucidate the underlying mechanisms through which zinc influences the pathogenesis of PU and evaluate the efficacy of zinc supplementation in the prevention and management of PU.

Comparison of the Effectiveness Lateral Position 30 Degrees and 90 Degrees on Decubitus Events in Stroke Patients

Aims: Stroke is the second leading cause of death and disability globally, characterized by sudden neurological deficits. Pressure ulcers, caused by prolonged bed rest, can be managed non-pharmacologically through immobilization and routine tilting to prevent decubitus. To compare the effectiveness of the lateral position with an inclination of 30 and 90 degrees on the risk of decubitus in stroke patients, in this study the control group was tilted 90 degrees and the intervention group was tilted 30 degrees. Method: The sampling method is non-probability sampling with purposive sampling, a sample of 22 patients. Results: Data analysis using Reapeted Measurement Anova resulted in a value in the experimental group resulting in a sum of square value of 24.9, f value 14.3, P &lt; 0.001, while in the control group a sum of square value of 76.5, f value 26.8, P &lt; 0.001 was obtained, so it can be concluded that the lateral position with an inclination of 90 degrees and 30 degrees has the same effect, namely providing a significant influence on reducing the risk of decubitus. Conclusions: The study reveals that stroke patients aged 56-65 have a higher risk of pressure ulcers, with low-weight patients at higher risk. Early lateral position intervention and nutrition can significantly reduce the risk of decubitus, highlighting the importance of early wound healing.

Braden score predicts 30-day mortality risk in patients with ischaemic stroke in the ICU: A retrospective analysis based on the MIMIC-IV database.

Ischaemic stroke remains a significant global health challenge, associated with high mortality rates. While the Braden Scale is traditionally employed to assess pressure ulcer risk, its potential to predict mortality among the intensive care unit (ICU) patients with ischaemic stroke has not been thoroughly investigated. This study evaluates the predictive value of the Braden Scale for 30-day mortality among patients with ischaemic stroke admitted to ICU. We conducted a retrospective analysis of 4710 adult patients with ischaemic stroke from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The association between the Braden Scale scores and 30-day mortality was assessed using receiver operating characteristic (ROC) curve analysis, Cox regression models and Kaplan-Meier survival estimates. Patients with Braden Scale scores ≤ 15.5 showed significantly higher 30-day mortality rates (p-value < 0.001; hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.71-2.53). The area under the ROC curve (AUC) was 0.71, demonstrating good predictive performance. Multivariate analysis confirmed the Braden Scale as an independent predictor of mortality, after adjusting for age, gender and comorbidities. The Braden Scale effectively identifies high-risk ischaemic stroke patients in ICU settings, endorsing its integration into routine assessments to facilitate early intervention strategies. Integrating the Braden Scale into routine ICU evaluations can enhance mortality risk stratification and improve patient care tailoring.

Using PURPOSE-T in clinical practice: A realist evaluation

AimTo explain how the clinical and organisational context influenced the way the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) is used by nursing staff to support their clinical judgement and decision making about care planning and delivery. MethodsA realist process evaluation was undertaken in a large acute hospital trust using mixed methods incorporating organisational policy review, staff semi-structured, ethnographic observation of clinical care and patient record review. Approximately 75 h of ethnographic field work involving 72 patients, 15 patient record reviews and 16 staff interviews were undertaken on 4 wards. FindingsFindings suggest PURPOSE-T assisted nurses differently depending on their level of experience. Those with less experience use it as an educational guide, while those with more experience made an initial clinical judgement and used PURPOSE-T as a safety net to ensure they hadn't missed anything. Nurses were concerned about demonstrating good documentation of assessment, care planning and delivery in order to underpin consistent communication about care and because they had an underlying fear of being blamed if things went wrong. There is an array of other contextual features that impact the planning and delivery of pressure area care that go beyond the use of PURPOSE-T alone, including systematic equipment provision, competing patient safety initiatives and rehabilitation requirements. ConclusionThe findings reinforce the assertion that PU-RAIs are complex interventions and could inform the development of a more integrated system of care which takes into account the contextual features associated with PU prevention in modern hospitals.

Biomechanical design optimization and experimental verification of Bezier curve based two-sectional cervical pillow with variable-density cellular structure

The fundamental function of an optimal cervical pillow is to provide sufficient support to maintain normal spinal alignment and minimize biological stress on the contact surface throughout sleep. The recent advancements in cervical pillows have mainly focused on the subjective and objective evaluations of support comfort, as well as the relationship between pillow height and cervical vertebrae posture. However, only a few studies have addressed shape design guidelines and mechanical performances of the pillows themselves. In this study, a two-sectional contour cervical pillow comprising an arc and a Bezier curve is designed to support the head and neck. The design of the arc-shaped neck section incorporates the Cobb’s angle and Borden value from healthy individuals to reflect the consistency of normal cervical anatomical features. The Bezier curve-based head section takes the head length and neck depth into account as significant individual differences. Static analysis and lattice optimization are performed in ANSYS Workbench to develop a variable-density cellular structure, aimed at improving air permeability and reducing the risk of pressure ulcers associated with the cervical pillow. The rapid prototyping technique fused deposition modeling (FDM) and thermoplastic material polylactic acid (PLA) are employed for fabricating different cellular structures. The results demonstrate that the neck section experiences less stress and greater deformation in comparison to the head section, indicating good comfort and support provided by the designed cervical pillow. Additionally, the compressive, bending, and cushion properties of the 3D-printed cervical pillow with variable-density cellular structure are experimentally validated, further confirming its effectiveness.

Changes of transcutaneous oxygen pressure in compressed areas of surgical patients: A prospective study of influencing factors

ObjectiveTo compare the transcutaneous oxygen pressure (tcpO2) measurement values and changes in compressed areas of surgical patients before and after surgery and to explore the related factors influencing the tcpO2 changes before and after surgery. MethodsResearchers selected 100 patients who underwent elective surgery in a tertiary comprehensive hospital from November 2021 to September 2022. A self-designed general information questionnaire was used to collect patient general information and disease-related data, including gender, age, smoking and drinking history, hypertension, diabetes, local skin temperature and humidity, related biochemical indicators, and activities of daily living score. Researchers used a transcutaneous oxygen pressure meter to measure and record the tcpO2 of the compressed areas (sacrococcygeal area, scapula area, and heel area) before and after surgery. ResultsAmong the 100 patients, 37.00 % (37/100) developed type I/II pressure ulcers after surgery, and 30 patients (81.08 %) showed regression within 2 h after surgery. There was no statistically significant difference in the preoperative tcpO2 measurement values of the scapula and heel areas between the group with and without pressure ulcers, but the preoperative tcpO2 measurement value of the sacrococcygeal area in the group without pressure ulcers was higher than that in the group with pressure ulcers (P < 0.01). The factors affecting the preoperative tcpO2 measurement value of the sacrococcygeal area were smoking and surgical type. After surgery, the tcpO2 measurement values of the three areas in the group with pressure ulcers were significantly lower than those in the group without pressure ulcers (P < 0.01). Comparing the tcpO2 values of different areas, it was found that the tcpO2 value was lowest in the sacrococcygeal area, followed by the heel area, and the tcpO2 value in the scapula area was highest both before and after surgery (P < 0.01). The main factors affecting the postoperative tcpO2 measurement value were diabetes, Glassgow score, surgical time, and intraoperative red blood cell transfusion. ConclusionThe measurement of tcpO2 is related to the incidence of surgically acquired pressure ulcers, and this technology may become an important tool for quantitative assessment of the risk of pressure ulcers.

Evaluation of Serum Vitamin D Levels and its Association with Increased Risk of Pressure Ulcer among Non-Ambulatory Patients

Background: Pressure ulcers are a significant health concern for non-ambulatory patients, often resulting from prolonged immobility. Vitamin D, recognized for its role in skin health and wound healing, may influence the development of these ulcers. This study examines the relationship between serum vitamin D levels and the prevalence of pressure ulcers in individuals unable to walk or move independently. Objective: To explore the association between serum Vitamin D levels and the risk of pressure ulcers, aiming to contribute to the literature and improve patient outcomes through evidence-based healthcare practices. Methods: A cross-sectional study was conducted at Sheikh Zayed Hospital and Bahria International Hospital, Lahore, from August 2023 to January 2024. Seventy non-ambulatory patients were recruited using a non-probability convenient sampling method. The Braden scale was employed to assess pressure ulcer severity, and serum vitamin D levels were measured through blood samples. Results: Participants had a mean age of 38.5 years (SD = 6.27) and a mean non-ambulatory duration of 13.72 days (SD = 5.22). Gender distribution was 55.7% female and 44.3% male. Historical pressure ulcer incidence was 10%. The leading reasons for hospitalization were stroke (28.6%), neuromuscular conditions (31.4%), and road traffic accidents (38.6%). A significant positive correlation was found between Braden scale scores and vitamin D levels (11.91 ± 3.40 and 11.40 ± 3.40 respectively, Pearson correlation coefficient = 0.71, p &lt; 0.01). Conclusion: There is a significant association between low serum vitamin D levels and an increased risk of developing pressure ulcers in non-ambulatory patients, supporting the need for vigilant monitoring and management of vitamin D levels.

Evaluation of final-year nursing students' attitudes towards preventing medical device‐related pressure ulcers using a ABC model of affect, behavior and cognitive dimensions

IntroductionHalf of the hospital-acquired pressure ulcers are associated with the use of medical devices. Nursing students provide care services to patients in clinical settings and intensive care units who have or are at risk for medical device-related pressure ulcers (MDRPUs). In the prevention and care of MDRPUs, the attitudes of nursing students towards preventing of pressure ulcers are as crucial as their knowledge level and clinical skills. AimThe aim of this descriptive study is to assess the attitudes of final-year nursing undergraduate students towards preventing MDRPUs across cognitive, affective, and behavioral dimensions of ABC model. Materials and methodsData of the study was handed between April 1 and December 31, 2021, with 147 final-year nursing students. Data were collected using the Student Information Form and the Attitude Towards Preventing Medical Device-Related Pressure Ulcers Questionnaire (ATP-MDRPUsQ). ResultsThe mean attitude score towards preventing MDRPUs was 3.98 ± 0.45 on a 5-point Likert scale. The mean scores for the cognitive, affective, and behavioral sub-dimensions were 3.88 ± 0.57, 4.15 ± 0.51, and 4.00 ± 0.672, respectively. A moderate positive relationship was found between the cognitive sub-dimension and both the affective and behavioral sub-dimensions (r = 0.451; r = 0.302; p < 0.01, respectively). Based on cluster analysis, the mean attitude scores of students towards MDRPU prevention were grouped into two clusters. The students in Cluster-2 and female students had higher mean attitude scores (p < 0.01). The item with the lowest mean score in the questionnaire pertained to the item, "I believe that I need training on the etiology and prevention of medical device-related pressure ulcers." ConclusionThe general attitudes of final-year nursing students towards prevention MDRPU were satisfactory. However, their cognitive attitudes were less positive compared to their affective and behavioral attitudes. It is recommended to incorporate theoretical and practical courses focusing on the prevention of these injuries into nursing curricula to enhance students' knowledge and attitudes.

Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study.

To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4-19.9%) and 13.3% (22/164; 95% CI, 8.5-19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.