Pressure Ulcer Scale For Healing Score Research Articles

Dermatology: New approvals, investigational agents helping patients

Interventions aimed at improving dermatologic conditions have been a hot area of research in recent months. FDA has approved novel agents for the management of metastatic basal cell carcinoma and actinic keratosis, and researchers have focused on the use of alternative therapies, off-label use of FDA-approved agents, and on the efficacy and safety of investigational agents for management of select dermatologic conditions.

Effect of maggot therapy on minimally necrotic tissues: characterization of larval enzymatic excretion/secretion

Chronic leg ulcers are a burden for the health system and impact quality of life. The infections, the necrotic tissue and the difficult treatment affects the prognosis and healing time. Maggot therapy is presented as an acceptable alternative for the debridement and treatment of this pathology. The larval therapy was assessed on chronic leg ulcers with little necrotic tissue. Larval excretion and secretion (E/S) was characterized with respect to hemolymph (HL) enzymatic content. Materials and methods. Three patients with chronic leg ulcers and low necrotic tissue were treated with larval therapy and were assessed with the PUSH (pressure ulcer scale for healing) and Wound Bed Score. E/S and HL content was evaluated by SDS PAGE and zymogram. The clinical aspect of the wounds showed improvement, and the scores demonstrated an average decrease of 2.3 for the PUSH and an average increase of 2.7 for the Wound Bed Score. A wide diversity of enzymatic activity in the E/S was demonstrated with major activity belonging to serine protease family. Maggot therapy proved an effective treatment in cases with minimal tissue necrosis and can be considered a viable treatment option.

Promote pressure ulcer healing in individuals with spinal cord injury using an individualized cyclic pressure-relief protocol.

To evaluate whether an individualized cyclic pressure-relief protocol accelerates wound healing in wheelchair users with established pressure ulcers (PrUs). Randomized controlled study. Spinal cord injury clinics. Forty-four subjects, aged 18-79 years, with a Stage II or Stage III PrU, were randomly assigned to the control (n = 22) or treatment (n = 22) groups. Subjects in the treatment group used wheelchairs equipped with an individually adjusted automated seat that provided cyclic pressure relief, and those in the control group used a standard wheelchair. All subjects sat in wheelchairs for a minimum of 4 hours per day for 30 days during their PrU treatment. Wound characteristics were assessed using the Pressure Ulcer Scale for Healing (PUSH) tool and wound dimensions recorded with digital photographs twice a week. Median healing time for a 30% healing relative to initial measurements, the percentage reduction in wound area, and the percentage improvement in PUSH score achieved at the end of the trial were compared between groups. At the end of 30 days, both groups demonstrated a general trend of healing. However, the treatment group was found to take significantly less time to achieve 30% healing for the wound measurement compared with the control group. The percentage improvement of the wound area and PUSH scores were greater in using cyclic seating (45.0 +/- 21.0, P < .003; 29.9 +/- 24. 6, P < .003) compared with standard seating (10.2 +/- 34.9, 5.8 +/- 9.2). The authors' findings show that cyclically relieving pressure in the area of a wound for seated individuals can greatly aid wound healing. The current study provides evidence that the individualized cyclic pressure-relief protocol helps promote pressure wound healing in a clinical setting. The authors concluded that the individualized cyclic pressure relief may have substantial benefits in accelerating the healing process in wheelchair users with existing PrUs, while maintaining the mobility of individuals with SCI during the PrU treatment.

Pressure Ulcer PUSH Score and Traditional Nursing Assessment in Nursing Home Residents: Do They Correlate?

Over a decade ago, the National Pressure Ulcer Advisory Panel (NPUAP, 1997) recommended a new tool, the Pressure Ulcer Scale for Healing (PUSH) tool to document ulcers and monitor the healing process. Yet, traditional nursing observation remains standard practice in chronic care, thus prompting this correlational study between PUSH and traditional documentation of pressure ulcers. Data were cross-tabulated through a retrospective chart review of all residents with stage II-IV decubiti at a 672-bed skilled nursing facility, between January 1, 2004, and December 31, 2006. A correlation analysis was performed between the clinical nursing observation, which was based primarily on ulcer size and documented on the weekly decubiti flow sheets, and the weekly PUSH score over a period of at least 2 months. Agreement was assessed using kappa statistics for a 3 x 3 table between the nurse's impression (improved, unchanged, deteriorating) and the change in PUSH score (+1, 0, or -1). In the 370 observations compiled for the 48 residents, the nurses documented improvement in 212 observations (57%). However, of these 212 traditionally assessed "improved" ulcers, there were only 89 (42%) concordant "better" PUSH scores and 99 (47%) received a "no change" PUSH score. Twenty-four (11%) of the 212 actually received a deterioration of the ulcer rate using the PUSH tool. Of the 110 (30%) traditionally assessed as "unchanged" ulcers, only 45 (42%) matched "unchanged" PUSH scores. Finally, for the 48 (13%) traditionally documented "deteriorating" ulcers, there were only 25 (52%) observations in agreement with the "deteriorating" PUSH scores. Overall, in this longitudinal study, the symmetric measures reports indicated very little agreement between the 2 assessment methods (kappa range: 0.007-0.298). Although the NPUAP has formally recommended the PUSH tool as the pressure ulcer assessment method of choice, our data indicate that the PUSH does not highly correlate with traditional nursing observation. Further study is required to determine the most accurate assessment method. The adoption of a universally accepted tool, together with rigorous documentation methods, will improve the overall clinical care of chronic patients with pressure ulcers.

The effects of polarized light therapy in pressure ulcer healing

Neglecting polarized light as an adjuvant therapy for pressure ulcers and methodology distinctions in the trials engaging polarized light are the reasons for many dilemmas and contradictions. The aim of this study was to establish the effects of polarized light therapy in pressure ulcer healing. This prospective randomized single-blind study involved 40 patients with stage I-III of pressure ulcer. The patients in the experimental group (E) were subjected, besides polarized light therapy, to standard wound cleaning and dressing. Standard wound cleaning and dressing were the only treatment used in the control group (C). A polarized light source was a Bioptron lamp. Polarized light therapy was applied for six min daily, five times a week, four weeks. The Pressure Ulcer Scale for Healing (PUSH) was used in the assessment of outcome. Statistic analysis included Mann Whitney Test, Fisher Exact Test, Wilcoxon Signed Rank test. There were significant differences between the groups at the end of the treatment regarding the surface of pressure ulcer (E: 10.80 +/- 19.18; C: 22,97 +/- 25,47; p = 0.0005), rank of pressure ulcer (E: 5.90 +/- 2.48; C: 8.6 +/- 1.05; p = 0.0005) and total PUSH score (E: 7.35 +/- 3.17; C: 11.85 +/- 2.35; p = 0,0003). The patients in the experimental group had significantly better values of the parameters monitored than the patients in the control group. After a four-week polarized light therapy 20 patients with stage I-III ulcer had significant improvement in pressure ulcer healing, so it could be useful to apply polarized light in the treatment of pressure ulcers.

The PUSH Tool

To determine the perceived usefulness of the Pressure Ulcer Scale for Healing (PUSH). A convenience sample identified through the National Pressure Ulcer Advisory Panel Web site as users or registered users of the PUSH tool. A survey instrument was developed to capture experience, ease of use, and perceived utility and weakness of the PUSH tool. Of 103 respondents, most (79) agreed or strongly agreed that PUSH required an appropriate amount of time to complete. It was also found to be reliable and easy to use and teach to others. Respondents were not as positive regarding usefulness, with 75% indicating that increased PUSH scores prompt patient and treatment reassessment. Respondents agreed or strongly agreed that improvement is possible in the size subscale (59%), the tissue type subscale (49%), and the exudate amount subscale (32%). Most commonly indicated for improvement was the addition of wound depth information. Respondents generally found PUSH easy to use and helpful in pressure ulcer management. Specific areas of improvement were also identified.

A Prospective Study of the Pressure Ulcer Scale for Healing (PUSH)

Although the recently developed Pressure Ulcer Scale for Healing (PUSH) was created to monitor healing over time, prospective evidence of its validity in measuring healing is lacking. The purpose of this study was to assess the validity of PUSH (version 3.0) when used to assess pressure ulcers in clinical practice. The authors chose a prospective research design using a convenience sample of nursing home residents with pressure ulcers. The patients' pressure ulcers were assessed each week with the PUSH and the Pressure Sore Status Tool. Surface area measurements derived from wound tracings were also obtained. Weekly assessments continued until the ulcer healed, the resident died, the resident transferred from the nursing home, or 6 months of assessments were complete. Thirty-two pressure ulcers comprised the study sample. Twenty-one (66%) healed during the 6-month study period and 11 (34%) did not heal. The PUSH scores decreased significantly over time among the healed ulcers but did not among the unhealed ulcers. Similarly, PUSH scores were significantly lower among the healed compared with the unhealed ulcers. Finally, total scores on PUSH were highly correlated with both the Pressure Sore Status Tool and surface area measurements. The PUSH provides a valid measure of pressure ulcer healing over time and accurately differentiates a healing from a nonhealing ulcer. It is a clinically practical, evidence-based tool for tracking changes in pressure ulcer status when applied at weekly intervals.