Pressure Ulcers In Patients Research Articles

Neutrophil to lymphocte ratio and mean platelet volume may predict the development of the pressure ulcers

Aim: Inflammation may have deleterious effects on tissue healing. Pressure ulcers impair the quality of life of the patients admitted to intensive care unit (ICU) besides increasing the health costs. Neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) are simple and readily available markers proinflammatory state. This study aimed to investigate whether measurement of admission NLR and MPV could be useful in identification of the patients who are at elevated risk for the development of the pressure ulcers. Methods: This retrospective cohort study evaluated 104 patients admitted to the intensive care unit of a tertiary center. Patients were divided into two groups according to the presence of pressure ulcers as follows: Patients without pressure ulcers throughout hospitalization and patients who developed pressure ulcers while hospitalized. The two groups were compared with respect to the demographic features and complete blood count parameters at admission. Results: The NLR [8.8 (6.6) vs. 5.3 (2.6), P<0.001], platelet to lymphocyte ratio [322(125) vs. 234(116), P=0.023] and MPV [10.5 (1.5) fl vs. 9.8 (1.1) fl, P<0.001] were significantly higher, and length of ICU stay was significantly longer in patients with pressure ulcers than those without [16.1 (3.8) days vs. 12.5 (2.9) days, P<0.001]. Logistic regression analysis revealed that age (P=0.03), length of ICU stay (P=0.01), NLR (P=0.01) and MPV (P=0.01) were significantly predictive for the presence of pressure ulcers. Conclusions: Our findings indicate that age, length of ICU stay, and NLR, and MPV, which are indicative for the preexisting inflammatory state, are independent predictors for the development of pressure ulcers in patients admitted to the ICU

The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis

BackgroundPressure ulcers (PU), one of the common challenging public health problems affecting patient with spinal cord injury. PUs occurs over bony areas of the body where pressure and tissue distortion is greatest. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, this review and meta-analysis aimed to estimate the global magnitude of pressure ulcers among patient with spinal cord injury.MethodsPubMed, Scopus, Google Scholar, African Journals Online, PsycINFO, and Web of Science were systematically searched to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. DerSimonian and Laird random-effects model was applied to obtain the pooled effect size. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Egger’s regression test statistic. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software.ResultsA total of 24 studies which comprises of 600,078 participants were included in this study. The global pooled magnitude of pressure ulcers among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18).ConclusionThis systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policy maker and other concerned body should be design country context- specific preventive strategies to reduce the burden of pressure ulcers in patients with spinal cord injury.

Úlceras por presión en pacientes en un Hospital General de Zona

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt;determinar la prevalencia de úlceras por presión en pacientes en el Hospital General de Zona no. 30 del Instituto Mexicano del Seguro Social, en Baja California, México. &lt;strong&gt;Metodología:&lt;/strong&gt; se realizó un estudio transversal, mediante la revisión y recolección de datos de los pacientes con reporte de úlceras por presión en el registro de la Clínica de Heridas. Los datos fueron analizados mediante estadística descriptiva, se utilizó el programa spss v. 21; se obtuvieron medidas de tendencia central, porcentajes y frecuencias. &lt;strong&gt;Resultados:&lt;/strong&gt; se encontraron 470 casos de úlceras por presión. Predominó el sexo femenino y la mayoría de casos se registraron en pacientes &amp;gt;70 años. El servicio de Medicina Interna tuvo el mayor número de casos, 79.15% (n=372). La localización anatómica más frecuente fue en la región sacra 58.94% (n=277). El grado de severidad más común fue el grado ii en 61.06% de pacientes (n=287). El rango de estancia hospitalaria con mayor número de casos fue de dos a siete días con 37.87% casos reportados (n=178). &lt;strong&gt;Conclusiones:&lt;/strong&gt; las úlceras por presión afectaron con mayor frecuencia a personas de la tercera edad. Su localización y grado de severidad son complicaciones recurrentes en este tipo de padecimientos. La prevención y las estrategias de identificación temprana deben ser implementadas para disminuir su incidencia.&lt;/p&gt;

PIH28 MEASURING THE COST OF PRESSURE ULCERS AMONG US HOSPITAL PATIENTS: A CLUSTERING APPROACH

Existing evidence shows that hospital-acquired pressure ulcers lead to poor health outcomes and result in additional costs of up to $70,000 per patient because of high treatment costs and extended hospital stays. However, current studies may not adequately adjust for differences in health and disease status between patients who do and do not develop pressure ulcers during their hospital stay. This study estimated the cost of pressure ulcers while improving controls for patient comorbidities and procedures. The study used data from 21,043 inpatient admissions from 2018 Truven Health Marketscan Commercial Claims and Encounters. A Jaccard dissimilarity score was employed to cluster patients with similar demographics, disease, and treatment status. The incremental cost of pressure ulcers was determined by calculating the difference in average cost of pressure ulcer and non-pressure ulcer patients within each cluster. Examining five different clustering scenarios showed that there is heterogeneity in the impact of pressure ulcers on patients’ costs. The average difference in cost for pressure ulcer and control patients in a cluster varied between $0 and $96,000. In all iterations, the additional total cost of pressure ulcers was positive; the average additional cost per pressure ulcer patient varied from $4,400 to $24,000 depending on the number of clusters into which the data is grouped. Previous research has shown a wide variance in the estimated cost of pressure ulcers. Our results further support this and suggest that the impact of pressure ulcers on costs varies with complex interaction of comorbidities, procedures, and patient characteristics. Further studies are needed to identify the comorbidities, procedures, and patient characteristics for which pressure ulcers have the greatest impact on patient costs and inform effective nutrition interventions to reduce the incidence of pressure ulcers and its economic burden.

Associated factors of facial pressure ulcers in patients under non-invasive ventilation during hospital stay in an intermediate care facilities of a Portuguese hospital

Background &amp; Aim: Non-invasive ventilation is a procedure that reduces respiratory stress and improves gas exchange, using a patient-ventilator interface; however, it presents consequences such as the development of facial pressure ulcers. We aim to identify the factors associated with facial pressure ulcers in Intermediate Care Facilities patients submitted to non-invasive ventilation. Methods &amp; Materials: A cross-sectional descriptive and analytic study was performed in an intermediate care facilities, of a Portuguese hospital, from August to October of 2018, the study population consisted of patients hospitalized in this unit, who underwent to non-invasive ventilation. Data were collected through an observational form developed to obtain the information of the entire period of hospitalization of the patient. The software used to analyze the data was IBM SPSS Statistics for Windows, Version 23.0. For the descriptive analysis, absolute and relative frequencies also means and standard deviations were computed. Also, to describe the association between the variables, The point biserial correlation coefficient (rpb) were calculated. For data analysis, a significance level of .05 (α) was used. Results: 14.6% of the individuals developed PU, all in the nasal pyramid. NIV was used for 6.07±3.91 days, and PU developed between the 3rd and the 20th day. It was observed that the presence of PU had a significant positive correlation with the GCS score (rpb=0.390, p=0.012) and a significant negative correlation with the duration of NIV (rpb=-0.438, p=0.004). Dependency level, PU risk, and nutritional risk did not correlate with the development of PU. Conclusion: The pressure ulcers associated with non-invasive ventilation appear to be more frequently developed on the nasal pyramid and between the 3rd and the 20th day. Moreover, the level of consciousness and the time of administration of non-invasive ventilation are associated with the development of pressure ulcers.

Comprehensive Proteomic Profiling of Pressure Ulcers in Patients with Spinal Cord Injury Identifies a Specific Protein Pattern of Pathology.

Objective: Severe pressure ulcers (PUs) do not respond to conservative wound therapy and need surgical repair. To better understand the pathogenesis and to advance on new therapeutic options, we focused on the proteomic analysis of PU, which offers substantial opportunities to identify significant changes in protein abundance during the course of PU formation in an unbiased manner.Approach: To better define the protein pattern of this pathology, we performed a proteomic approach in which we compare severe PU tissue from spinal cord injury (SCI) patients with control tissue from the same patients.Results: We found 76 proteins with difference in abundance. Of these, 10 proteins were verified as proteins that define the pathology: antithrombin-III, alpha-1-antitrypsin, kininogen-1, alpha-2-macroglobulin, fibronectin, apolipoprotein A-I, collagen alpha-1 (XII) chain, haptoglobin, apolipoprotein B-100, and complement factor B.Innovation: This is the first study to analyze differential abundance protein of PU tissue from SCI patients using high-throughput protein identification and quantification by tandem mass tags followed by liquid chromatography tandem mass spectrometry.Conclusion: Differential abundance proteins are mainly involved in tissue regeneration. These proteins might be considered as future therapeutic options to enhance the physiological response and permit cellular repair of damaged tissue.

Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence

AimTo analyse patient factors and nurse staffing‐related issues involving hospital‐acquired pressure ulcers in patients at two types of hospital.BackgroundHospital‐acquired pressure ulcers are important for the safety of hospitalized patients. Hospital‐acquired pressure ulcers not only cause health problems, but also pose an economic burden to patients. In addition to patient factors such as mobility and skin integrity, hospital factors such as nurse staffing can also affect the management of such patients.MethodsThis study is a retrospective review of patient data and analysis of factors related to hospital‐acquired pressure ulcers using stratified Cox proportional hazards regression.ResultsA total of 53,923 patients were included. The incidence of hospital‐acquired pressure ulcers was 0.98 per 1,000 days. Hospital‐acquired pressure ulcers were affected by gender, age, previous falls, low oxygen levels, positioning and toilet use. When the levels of nurse staffing were determined as one of the hospital factors, the daily hours of patient care was increased thereby contributing to the reduced incidents of hospital‐acquired pressure ulcers.ConclusionStrategies for preventing hospital‐acquired pressure ulcers should be based on the analysis of risk factors.Implications for Nursing ManagementMost individual risk factors for hospital‐acquired pressure ulcers identified cannot be modified easily in a short time. Nurse staffing should be set at adequate levels to prevent hospital‐acquired pressure ulcers.

Complications after pressure ulcer surgery – a study of 118 operations in spinal cord injured patients

Our aim in this study was to examine which factors are associated with post-operative complications after surgery for pressure ulcers in individuals with spinal cord injury. We performed a retrospective cohort study including all spinal cord injured patients undergoing pressure ulcer surgery in our department between 2002 and 2019. Patient demographics and comorbidity were collected from medical records, as were treatment data and information on post-operative complications within 30 days. Assessment of outcomes was performed through t-tests, χ2-tests and ANOVA. Out of 118 operations, 51 (43%) had a post-operative complication of any kind. The vast majority (44 cases, 86% of all complications) had minor complications (Clavien–Dindo grade I or II). Seven patients (6%) had a complication of Clavien–Dindo grade III or higher, requiring return to theatre or ICU care. We found that a higher age, a low serum albumin (<3.5 g/dl), and over or underweight, were associated with an increased risk of complications (p < 0.05). Out of 143 treated ulcers, 132 were evaluated at a follow-up visit one to two months after surgery, and 99 of these (75%) were healed. Surgery of pressure ulcers in patients with spinal cord injury is not a low-risk venture, however, few patients will suffer serious post-operative complications. A majority of treated ulcers will heal shortly post-operatively. A number of risk factors are associated with post-operative complications, which can be of help to guide patient selection in the future.

Intervención educativa en cuidadores para prevenir úlceras por presión en adultos con inmovilidad prolongada

Introducción: El conocimiento de los cuidadores acerca de la prevención de úlceras por presión en pacientes con inmovilidad es útil para evitar la aparición de lesiones, mediante la planificación, implementación y evaluación de un programa educativo en el domicilio. Objetivo: Determinar la eficacia de la intervención educativa sobre los conocimientos en la prevención de úlceras por presión en los cuidadores primarios de pacientes con inmovilidad prolongada. Metodología: diseño cuasi-experimental, muestreo aleatorio simple, se consideró al grupo de intervención como su propio control bajo un tratamiento estadístico test, re-test, con intervención simple ciego a 15 cuidadores de pacientes adultos, hospitalizados con indicación de alta y con riesgo de padecer úlceras por presión. La intervención se implementó en tres fases en cuatro sesiones, que se impartieron como taller, con una duración de treinta minutos. El análisis de los datos fue descriptivo, para comparar el test y re-test, se aplicó una t de Student. Se consideraron aspectos éticos para un estudio de bajo riesgo. Resultados: En la fase diagnóstica el 80% de los cuidadores no tenían conocimientos, en el re-test en el 100% los incrementó, con efecto positivo y significativo (p=.000). Conclusión. El resultado obtenido muestra eficacia estadísticamente significativa de las cuatro sesiones que conformaron el programa educativo para aumentar el nivel de conocimiento de los cuidadores para la prevención de úlceras por presión.

Prevention of Hospital-acquired Pressure Ulcers in Patients with Prone Ventilation: A Retrospective Observational Study

Prevention of Hospital-acquired Pressure Ulcers in Patients with Prone Ventilation: A Retrospective Observational Study

Incidence of hospital-acquired pressure ulcers in patients with "minimal risk" according to the "Norton-MI" scale.

IntroductionPressure ulcers (PUs) nowadays are a major health problem in society, associated with increased morbidity and increased health care costs. The incidence of HAPU is an indicator of health care quality.ObjectiveTo describe the profile of patients with minimal risk on the Norton-MI scale who developed PUs during hospitalization, and to identify the incidence of hospital-acquired pressure ulcers (HAPU).MethodsRetrospective cohort study conducted between 2014 and 2017.Study populationPatients over 18 years of age classified as "minimum risk" according to Norton-MI, admitted to acute hospital units of the Severo Ochoa University Hospital—Madrid-Spain. Patients were classified as patients with hospital-acquired pressure ulcers (PWHAPU) if they developed one or more new PU during their hospitalization.VariablesSociodemographic variables, hospitalization units, Morton-MI score and characteristics of the risk factors of HAPU were studied.ResultsThe risk of PU was evaluated in 5530 patients, being 1260 patients classified as "minimum risk", with a median of 16 points in the Norton-MI scale. The average age was 76 years old and 52.5% were women. Principal causes of admission: traumatological pathologies (20.8%) and cardiovascular pathologies (20%). 129 HAPU were diagnosed in 112 patients, implying an incidence of HAPU of 8.89% (CI95%: 7.44–10.59). 106 PWHAPU (94.6%) presented up to 6 risk factors. The excess pressure and altered skin sensibility were identified as statistically significant risk factors as predictive factors of HAPU. In terms of severity, 55% of the HAPU were category I and 42.6% were category II, mainly with anatomical sacro-coxygeal location. In 65.2% of the patients the HAPU appeared in the first week of hospitalization.ConclusionIn our study the incidence of HAPU in patients classified as minimum risk with Norton-MI scale was 8.89%. This elevated risk suggests for future investigations to develop new validity studies of the Norton-MI scale and to maintain a continuo training of professionals in the knowledge of PU risk assessment scales for their safe application in the patients, since it directs the practice of care in the prevention of PUs. It would be advisable to specially control the risk of PUs in care units, mainly in the first week of their hospital stay to minimize the HAPU incidence.

Risk factors for the development and recurrence of pressure ulcers in patients with spinal cord injury: A systematic review.

A spinal cord injury refers to the damage suffered in the spinal cord as a result of trauma, disease or degeneration. Every person with spinal cord injury is at risk of developing pressure ulcers, and almost everyone will develop at least one ulcer due to severe pressure during his or her life. To identify the studies that detected risk factors for the development and recurrence of pressure ulcers in patients with spinal cord injury; and, if possible, synthesize the evidence to determine whether an association exists between them. A systematic search was conducted in Medline, LILACS, SciELO and Cochrane until December 4, 2018. The following studies were included: observational studies, case-control studies, and prospective or retrospective cohort studies, which provided an adjusted analysis of the risk factors associated with the development and recurrence of pressure ulcers in patients with spinal cord injury. 25 articles met the eligibility criteria and were included for analysis. A total of 30 risk factors were identified: 4 were demographic factors, 8 were related to the injury, 5 belonged to medical comorbidities, 3 to nutritional factors, 9 were psychological, cognitive, contextual and social factors and 1 was related to support surface. As regards the factors, 56.67 percent of them were classified as non-modifiable. 30 risk factors were identified for the development and recurrence of pressure ulcers in patients with spinal cord injury. However, we were not able to synthesize the evidence due to the heterogeneity of the articles included in this review.

Evaluation of infrared technology to detect category I and suspected deep tissue injury in hospitalised patients.

To evaluate the use of an infrared thermography device in assessing skin temperature among category I pressure ulcer (PU) and/or suspected deep tissue injuries (SDTI) with intact skin. An observational cross-sectional study design was used. Adult inpatients (cases) who had a category I PU or suspected deep tissue injury (skin intact) on the sacral or heel during the study period (March to April 2018) were recruited. Patients without a PU were also recruited to act as control. Thermal images of the patient's PU site and non-PU site were taken within 24 hours of PU occurrence. Thermal images of the control patients (no PU) were also taken. Each PU case was matched to three control patients in terms of age, gender, race and anatomical sites. All thermal images were taken using a portable CAT S60 Thermal Imaging Rugged Smartphone (Caterpillar Inc., US) that provided readings of the skin temperature in degrees Celsius. A total of 17 cases and 51 controls were recruited. Among the cases, the mean difference in skin temperature between the PU site (mean: 31.14°C; standard deviation [SD]: 1.54) and control site within the cases (mean: 28.93°C; SD: 3.47) was significant (difference: 2.21±3.66°C; p=0·024). When comparing between all cases and controls, the mean temperature difference was non-significant. When comparing between the category I PU and suspected deep pressure injury cases, the mean difference was also non-significant. Using infrared thermography technology at the bedside to measure skin temperature will support the clinical diagnosis of patients with skin types I to III. However, there is a need for a more accurate and objective measurement to identify and diagnose early category I PU or suspected deep tissue injury in adult patients with darker skin types 4 and above, enabling early initiation of preventive measures in the hospital acute care setting.

Implementation of pressure ulcer prevention and management in elderly patients: a retrospective study in tertiary care hospital in Qatar

Objective Preventing pressure ulcers is an essential part of patient care and it is important to be aware of the best way to prevent it. Hence, the present study aims to look for the demographics, clinical characteristics, and risk factors in patients with and without pressure ulcer among elderly patients. Methods A retrospective longitudinal study was conducted in elderly (above 65 years) patients from a period of October 2014 to October 2015 in the medical ward under acute Geriatric care at Hamad General Hospital in Qatar. Results Overall, a total of 90 patients were included with an average age of 79 ± SD 11.3 years of which 45 patients developed pressure ulcer. There was male (64.4%) preponderance in the study population. Most common comorbidity was hypertension (77.8%). Anemia correction (91%), high protein diet supplementation (1.5 g/kg body wt.) (100%), and 2 h repositioning (100%) were implemented for majority of the pressure ulcer patients as preventive intervention. Conclusions From the study finding, it is observed that, anemia correction, high protein diet supplementation and 2 h repositioning are the best practices for the management of pressure ulcer. Hence, these best practices are recommended for the early prevention of pressure ulcer among elderly.

Health and medical device development for fundamental care: Scoping review.

The use of technology and health and medical devices as a part of fundamental nursing care is increasing. Although involving users in the device development process is essential, the role of nurses in the process has not yet been discussed. To examine and map what kind of health and medical devices have been developed specifically for fundamental nursing care and to examine the design and development of the devices, particularly focusing on the role of nurses in the process. Scoping review. The Medline, Cinahl, Web of Science, IEEE Explore and ACM DL databases REVIEW METHODS: The databases were searched to identify studies describing health and medical devices developed for fundamental nursing care published between the years 2008-2018 in English language. References of included articles were reviewed for additional eligible studies. Two research team members screened the abstracts and full articles against the predefined inclusion and exclusion criteria. The PRISMA-ScR checklist was used. Of the 7223 reports identified, a total of 19 were chosen for the scoping review. Of these, five were further analysed regarding the development process. Main focus areas of the included reports were patient monitoring, pressure ulcer prevention and patient transfer and mobility. Device development process, divided into three phases, was mainly driven by technological expertise and healthcare personnel were mainly involved in the evaluation phases. Health and medical devices are a crucial part of the healthcare today and nurses are increasingly involved with their use. Most of the devices have been developed mainly by using technological expertise although they are directly aimed at fundamental aspects of nursing care. The results of our review suggest that the expertise of the nurses as the end-users of the devices could be much more exploited. A combination of expertise of device development from both nursing professionals and technical experts is necessary to disentangle the requirements of increased quality in nursing care combined with the ever-growing technological requirements.

Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study.

To analyse the treatment of pressure ulcers (PU) in long-term care. In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment. In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs. PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.

Prevalence and Risk Factors for Pressure Ulcers in Patients with Enterocutaneous Fistula: A Retrospective Single-Center Study in China.

BackgroundPrevalence and associated risk factors for pressure ulcers (PU) vary in different body areas and diseases. Few studies have focused on PU in patients with enterocutaneous fistula (ECF). The aim of the present study was to investigate the prevalence and risk factors for PU in patients with ECF.Material/MethodsFrom January 2016 to June 2016, medical records of 140 patients with ECF who were transferred to the Enterocutaneous Fistula Treatment Center, Jinling Hospital, were reviewed and analyzed. The prevalence of PU was investigated. To evaluate the risk factors for PU in patients with ECF, 5 patients with PU before admission were excluded, and the remaining 135 patients were divided into 2 groups: the PU group and the non-PU group. The risk factors for PU were confirmed by multivariate logistic regression analysis of characteristics on admission.ResultsThere were 42 cases with PU (5 cases with PU before admission, 37 cases with PU in the treatment after admission), and the prevalence of PU in patients with ECF was 30%. In addition, Braden risk score <19 (OR=9.33, CI: 2.80–31.08, p<0.001); underweight (BMI<18.5) (OR=5.21, CI: 1.65–16.39, p=0.005); onset of duodenal fistula (OR=4.86, CI: 1.33–17.78, p=0.017); diabetes (OR=4.95, CI: 1.03–23.85, p=0.046); and APACHE II score (OR=1.34, CI: 1.04–1.72, p=0.019) were associated with PU.ConclusionsThe PU prevalence was 30% in patients with ECF. Braden risk score <19, underweight, onset of duodenal fistula, diabetes, and APACHE II score were risk factors for PU in patients with ECF.

Multicenter randomized controlled trial comparing the effectiveness and safety of hydrocellular and hydrocolloid dressings for treatment of category II pressure ulcers in patients at primary and long-term care institutions

BackgroundPressure ulcers are a major burden to patients because they affect health, well-being, and health-related quality of life. Thus, prevention and early treatment of pressure ulcers is a major challenge for health care professionals. ObjectiveTo compare the efficacy of hydrocellular and hydrocolloid dressings after 8 weeks of treatment of category II pressure ulcers. DesignA prospective multicenter clinical trial with blinded outcome assessors. Participants and settingsAdult patients with category II pressure ulcers from primary and long-term care institutions on Majorca island. MethodsCategory II ulcers were treated with ALLEVYN Adhesive® dressings or VARIHESIVE® GEL CONTROL dressings, with the primary outcome being healing of the ulcers in 8 weeks. Blinded confirmation of ulcer healing was performed by a treatment-group assessment committee. Estimates of cumulative survival probabilities were determined using the Kaplan-Meier method and analyses of effectiveness were performed using the chi-squared test. ResultsA total of 169 patients with pressure ulcers were enrolled, 84 of whom received hydrocellular dressings and 85 of whom received hydrocolloid dressings. A total of 58% were women and 56% were from primary care institutions. The hydrocellular dressing group had a higher percentage of healed pressure ulcers at 8 weeks (90.7% vs. 77.1%, p = 0.039) and a shorter average healing time (3 weeks vs. 4 weeks, p = 0.015). Analysis of safety outcomes at 8 weeks indicated that the hydrocellular dressing group had a smaller proportion of ulcers that were unhealed (3.9% vs. 7.1%) and a smaller proportion of ulcers that progressed to a higher category or infection (5.3% vs. 15.7%), although these differences were not statistically significant. ConclusionsThis study of patients with category II pressure ulcers indicated that hydrocellular dressings were superior to hydrocolloid dressings in terms of healing at 8 weeks and time required for healing, although these two dressings had similar safety profiles.

Effects of Hemodynamic Factors and Oxygenation on the Incidence of Pressure Ulcers in the ICU.

To investigate the roles of hemodynamic factors and oxygenation on the incidence of pressure ulcers in patients in the ICU on mechanical ventilation. This prospective analytical cross-sectional study was performed in several ICUs for a period of 8 months in Iran. Researchers checked patients for pressure ulcers on a daily basis. They collected demographic, hemodynamic, and oxygenation data until a pressure ulcer occurred, the patient's artificial airway was removed, the patient died, or the patient was discharged. From August 2017 to February 2018, a total of 2,581 patients were admitted to the study ICUs; of these, 133 patients were eligible for the study. The results indicated that 41.4% (n = 55) of the patients ended up with pressure ulcers. Investigation of the variables using a Cox regression model showed that, among other variables considered in this study, age, mean arterial pressure, and positive end-expiratory pressure in the mechanical ventilator can contribute to the risk of pressure ulcers. Providers should pay attention to changes in hemodynamic parameters, especially mean arterial pressure; carefully determine the most appropriate positive end-expiratory pressure for patients connected to mechanical ventilation; and take special care of susceptible groups such as older adults and hospitalized patients to decrease the incidence of pressure ulcers.

Development and Evaluation of Electronic Health Record Data-Driven Predictive Models for Pressure Ulcers

The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital. A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale. The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model. Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.