Pressure Ulcers In Persons Research Articles

“What pressure ulcers mean to me?” Representations of pressure ulcer in persons with spinal cord injury: A qualitative study

ObjectivesExplore the perceptions and beliefs related to pressure ulcers (PU), their prevention and treatment strategies, in order to discuss potential learning objectives for PU-related therapeutic education in persons with spinal cord injury (SCI). DesignQualitative study, using grounded theory for the analysis of data collected via a questionnaire. SettingNine SCI referral centers, inpatient care. Participants131 persons with SCI were included. 76% were male, and 65% presented with paraplegia. The median age was 48 years (33.5; 58) and median time since injury was 11 years (3; 24.5). 70% had experience with PU. InterventionsNone. Main outcome measuresData collection via an open-ended questionnaire on the representation of PU, its prevention and life experience of having a PU. ResultsSix categories were identified: (1) identifying what might become problematic, (2) daily preventive actions, (3) detecting the early signs, (4) managing the early signs, (5) need for care, (6) experience with PU and being bedridden. Pressure ulcers have dramatic consequences on psychosocial health. Prevention and treatment require self-management skills, such as self-risk assessment abilities, self-detection skills and problem-solving strategies, to optimise daily PU prevention in persons with SCI. ConclusionPU prevention tackled by persons with SCI bears some specificities that the physician must take into account in the construction of a self-management program in this high-risk population.

Risk of pressure ulcers in persons with tetraplegia and regional experience: Analysis of a long-term French survey

Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The predictive value of clinical assessment tools is lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in traumatic SCI patients with tetraplegia (TSCIt) who were initially managed in French regions with a high level of specialized SCI rehabilitation experience. First, we used the most recent French epidemiological survey of patients with SCI to determine a “Level of Regional Experience in Specialized Physical Medicine and Rehabilitation” (LRE). We then studied the medical and social variables reported in the Tetrafigap survey (which compiled a cohort of TSCIt, to assess their trajectory and life conditions following the return to community life) using univariate analysis according to these LREs (Chi 2 test using a significance threshold of P < 0.05). We finally performed a series of logistic regressions to determine the link between LREs and pressure ulcers. Management in high-LRE regions was associated with a lower occurrence of pressure ulcers during early treatment and in the long-term (on average, 8 years post-trauma). Using pressure ulcers as a marker, our study demonstrated the protective link of regional experience of the early management of TSCIt. In our opinion, efforts should first prevent a dilution effect through holistic health care for SCI, within the scope of a regional organization that would link referral centers and local health care networks.

Using a Modified ADAPTE Process to Enable Effective Implementation of Electrical Stimulation Therapy for Treating Pressure Ulcers in Persons With Spinal Cord Injury

Objectives: To apply a modified ADAPTE process to adapt best practices to a local context for successful implementation of electrical stimulation therapy (EST) for treating pressure injuries in persons with spinal cord injury (SCI). Participants: An expert team of health care professionals and a consumer participated in a 2-day workshop to assist in the development of the locally adapted EST document in Southwest Ontario, Canada. Results: A process map illustrating the flow of activities to initiate EST for treating pressure injuries in persons with SCI based on the challenges and opportunities existing within this region was created. The team also developed a summary of roles and responsibilities delineating tasks specific to providing EST and identified a set of challenges likely to be encountered. Conclusions: The modified ADAPTE process provided a clear and flexible structure to adaptation when used for implementation planning. This article shares some challenges associated with using this process for local adaptation and shares strategies of improvement for future studies aimed at adapting a practice to their local environment.

Subepidermal moisture surrounding pressure ulcers in persons with a spinal cord injury: A pilot study

ObjectiveCharacterization of a non-invasive method of quantifying subepidermal moisture (SEM) surrounding stages III and IV pressure ulcers (PrUs) in spinal cord injury (SCI).DesignProspective, single-visit, single-rater, observational study, using repeated-measures analysis.MethodSetting-inpatient units of one VA SCI Center.ParticipantsConvenience sample of 16 subjects with SCI with stage III or IV PrUs over sacrum or ischium.InterventionsMeasurement with the MoistureMeter-D, a hand-held device using 300 MHz electromagnetic waves.Outcome measuresDielectric constant, a dimensionless number which increases with the moisture content. Each subject had a PrU site and a control site. Measurements were made at each site, on intact skin, at four points spaced angularly around the site, in triplicate.Results(1) Short-term, single-rater relative error was 2.5%. (2) Order effect: first readings were higher than second readings in 55 of 64 measurement sets. Order effect was significant for control sites (P < 0.0001) but not for PrU sites. (3) Angular effect: SEM varied by angle at the PrU sites (P < 0.01); 12 o'clock position the highest and 6 o'clock the lowest. (4) Ability to differentiate PrUs from intact skin: SEM at PrU sites was greater by 9.0% than control sites (P < 0.05). (5) Site effect: SEM was higher at sacral locations than ischial at control sites by 20% (P < 0.005).ConclusionsSEM differentiates PrUs from intact skin. Future study designs must take into account order, angular, and site effects on this measure. This information will inform designers of future studies of SEM in healing of PrUs.

Projet REFESCAR : expériences éducatives dans le champ de l’escarre de la personne lésée médullaire en France

In order to establish guidelines for patient’s therapeutic education within the field of pressure ulcer in persons with spinal cord injury, a survey of self-management practices has been carried out in 2012. This work summarizes the results of educational experiences, which included eight physical medicine and rehabilitation teams specialized in spinal cord injured patients management.

Pressure ulcer prevention in patients with advanced illness

Pressure ulcers can be challenging to prevent, particularly in patients with advanced illnesses. This review summarizes the relevant literature since 2011. Through a MEDLINE and CINAHL database search from January 1, 2011 to June 1, 2012, a total of 14 abstracts were found addressing the prevention of pressure ulcers in persons with advanced illness. Search terms included pressure ulcer, prevention, and control. Advanced illness was defined as patients transitioning from curative to supportive and palliative care. Ten original studies and four review articles specifically addressed pressure ulcer prevention. There were four articles that specifically addressed patients with advanced illness. The studies varied in quality. One systematic review, one randomized controlled trial, three prospective trials, two retrospective trials, one cost-effectiveness analysis, one quality improvement project, one comparative descriptive design, and four review articles were found. The interventions for pressure ulcer prevention were risk assessment, repositioning, surface selection, nutritional support and maintenance of skin integrity with or without incontinence. The quality of pressure ulcer prevention studies in persons with advanced illness is poor. Increased number and higher quality studies are needed to further investigate this important topic for these fragile patients.

What is the role of TPE in management of patients at risk or with pressure ulcer as of 2012? Towards development of French guidelines for clinical practice

Pressure ulcer (PU) is a common complication in chronic affection, especially neurological disorders and diseases commonly diagnosed in the elderly. For a long period of time, the prevention of skin lesions was taught only in an empirical manner. The development of therapeutic patient education (TPE) sheds a new light on care management for patients with chronic pathologies. Determine the place of TPE in persons at risk of and/or already suffering from pressure ulcer (PU) as of 2012. The methodology used is the one promoted by SOFMER, including: a systematic review of the literature with a query of the PASCAL Biomed, PubMed and Cochrane Library databases for data from 2000 through 2010; a compendium of prevailing professional practices and advice from a committee of experts. The review of the literature found six studies including four controlled trials in patients with chronic neurological impairments (most of them with spinal cord injury). No studies were found regarding the elderly. The level of evidence for efficacy in persons with spinal cord injury (SCI) is moderate. The clinical practice study focuses on programs currently underway, dedicated to SCI patients or elderly populations. The approach proposed through TPE has its role in a strategy aimed at preventing PU in persons at chronic risk of developing PU. The educational objectives and techniques used must be adapted to the clinical and psychological context and are debated in this review. The co-construction of programs, recommended in the official texts on therapeutic education in France, should help to tailor these programs to the patients' needs. TPE is relevant in care management or prevention of PU in persons at chronic risk, patients with spinal cord injury (Grade B) or elderly subjects (Grade C).

Assessing the feasibility of subepidermal moisture to predict erythema and stage 1 pressure ulcers in persons with spinal cord injury: A pilot study

BackgroundPersons with spinal cord injury (SCI) are at high risk for pressure ulcers (PrUs) throughout their lifetime due to decreased mobility, lack of sensation, and other physiological changes. The high prevalence and recurrence rates, and costs associated with PrUs in veterans with SCI indicate the need for a reliable and practical method of detecting early PrUs.ObjectiveTo assess the feasibility of obtaining biophysical measures of sub-epidermal moisture (SEM) using a handheld dermal phase meter to predict PrUs.Design/methodsProspective observational design. Thirty-four veterans at two VA SCI centers (Hines, Long Beach) received daily (n = 12) or weekly (n = 22) SEM and concurrent visual skin assessment (VSA) across nine anatomic locations for up to 6 weeks.Outcome measuresSEM, visual skin assessment (VSA), and stage I PrUs.Findings/resultsSEM was lowest for normal skin (39.3 dermal phase units (DPU), SD = 12.6) and higher for erythema/stage 1 PrUs (40.8 DPU, SD = 10.4) across all anatomic sites. Buttocks SEM were different between normal skin (40.5 DPU, SD = 10.3) and erythema/stage1 PrUs (43.8, SD = 9.5). SEM taken at heels were lower across all skin conditions (normal skin 28.2 DPU; erythema/stage 1 PrUs 34.7 DPU). SEM was taken when generalized edema present was lower than without generalized edema.ConclusionsPreliminary results of using SEM to detect early PrU damage may translate from nursing home (NH) residents to persons with SCI. This study provides a foundation for a larger study to implement and assess SEM use as a method of prevention of PrUs.

Clinical Skills Development Using On-line Problem-Based Learning for Assessment, Management and Prevention of Pressure Ulcers in Persons With Spinal Cord Injury

Pressure ulcers (PUs) constitute a health problem that is one of the greatest contributors to morbidity secondary to spinal cord injury (SCI). Research efforts in the Rehabilitation Research and Training Center on Secondary Conditions in the Rehabilitation of Individuals with Spinal Cord Injury address the problem by identifying gaps in the knowledge base, specifically, determining the interrelationships between pressure, pressure relief, and skin breakdown in persons with SCI. Education and training efforts complement this research by exploring more effective means of transferring and mobilizing knowledge about PUs in persons with SCI and those who help them manage their health. There is little evidence regarding what constitutes high-quality PU and wound care education for resident physicians and other health care professionals. The purpose of this article is to provide a review of the literature on applications of digital multimedia to facilitate evaluation of clinical skills among medical trainees. We...

Do vascular risk factors contribute to the prevalence of pressure ulcer in veterans with spinal cord injury?

Objective: The overall goal of this observational study was to determine whether modifiable vascular risk factors contribute to the prevalence of pressure ulcers (PrU) in veterans with traumatic spinal cord injury (SCI).Background: Given the increasingly limited financial resources in hospitals and clinics, identifying risk factors associated with the development of PrU in persons with SCI will be a major step in reducing the cost of care for these individuals, and may improve their quality of life.Method: We retrospectively reviewed the electronic charts of 87 veterans with SCI who are being followed regularly in our SCI clinic and are enrolled in the SCI registry. The data collected included the basic demographics, presence of modifiable vascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia, and current smoking; presence of incontinence and depression; and results from blood drawn for hemoglobin level, blood urea nitrogen, creatinine, and albumin levels and lipid profile on veteran's initial enrollment. Local Institution Review Board approval was obtained for the protocol.Results: Of the 87 veterans with SCI, 27 had PrU. Comparisons between those with and without PrU found no significant differences for the demographic variables of age, gender, age of SCI onset, or SCI duration, but there was a trend for the groups to differ in ethnicity (P = 0.05). Similarly, the presence of modifiable vascular risk factors including hypertension, diabetes mellitus, hyperlipidemia, and current smoking did not differ between those with and without PrU. There were 36 pressure ulcer sites observed in 27 people. The proportion of pressure ulcer sites (of the 36) significantly differed by SCI severity based on the American Spinal Injury Association (ASIA) score (P < 0.0001).Conclusion: This study suggests that the presence of PrU was influenced by the severity of the SCI without any contribution from modifiable vascular risk factors.

Subepidermal Moisture Is Associated With Early Pressure Ulcer Damage in Nursing Home Residents With Dark Skin Tones

To examine the relationship between a measure of skin and tissue water, subepidermal moisture (SEM), and visual assessment of early pressure ulcer (PU) damage in nursing home (NH) residents with dark skin tones. Descriptive, cohort study with 66 residents in 4 US NH. Data were pooled from 2 previous NH studies to evaluate persons with dark skin tones. Data were analyzed for concurrent visual assessments and SEM, which were obtained at the right and left buttocks and sacrum weekly for 20 weeks. Subepidermal moisture was measured with a surface electrical capacitance dermal phase meter, where higher readings indicate greater SEM (range: 0-999 dermal phase units [DPUs]). Visual assessment was rated as normal, erythema/stage I PU, or stage II+ PU. Subepidermal moisture and specific SEM threshold values (50, 150, 300 DPU) were modeled as detectors of visual assessment of early PU 1 week later (controlling for clustering and incontinence); with concurrent SEM, and PU risk status, in separate analyses for persons with light and dark skin tones. Participants had a mean age of 84 years, 83% were female, and 77% were non-Hispanic white. Higher SEM predicted greater likelihood of erythema/stage I PU and stage II+ PU in persons with dark skin tones the next week (OR = 1.88 for every 100 DPU increase in SEM, P = .004). When SEM was greater than 50, 150, and 300 DPU, persons with dark skin tones were 8.5, 13, and 10 times more likely to present with stage II+ PU the following week compared to persons with light skin who were 7.2, 3.5, and 4.3 times more likely to present with stage II PU (50, 150, 300 DPU, respectively). Subepidermal moisture threshold of 50 DPU was also significant for detecting erythema/stage I PU in persons with dark skin tones (OR = 5.3, 95% CI, 1.87-15.11, P < .001). Subepidermal moisture was associated with future (1 week later) PU in persons with dark skin tones. Subepidermal moisture threshold values may assist in detecting early PU in persons with dark skin tones, allowing for earlier intervention to prevent PU. These findings should be further evaluated in persons with dark skin tones.

Poster 193: Pulsatile Lavage as an Adjunct Hydrotherapy Treatment for Pressure Ulcers: A Randomized Controlled Trial

Objective: To test the hypothesis that pulsatile lavage as an adjunct hydrotherapy will enhance the healing rate of stage III or IV pressure ulcers in persons with spinal cord injury (SCI). Design: Randomized, controlled, double-blind study. Setting: Tertiary care SCI inpatient unit. Participants:20 SCI subjects were randomly assigned to pulsatile lavage treatment group (n=10) or sham treatment group (n=10). All had stage III or IV pelvic pressure ulcers with minimum dimension of 3cm and maximum dimension of 15cm (in length, width or depth).

Major risk factors for pressure ulcers in the spinal cord disabled: a literature review.

Pressure ulcers remain a dominant health problem for persons with spinal cord injury despite abundant published research describing risk factors. Although information on these factors is plentiful, its usefulness to the spinal cord disabled is limited by three problems. First, the sheer volume is overwhelming; more than 200 risk factors for pressure ulcers have been described in the published literature. For most health care professionals, finding, no less reading and evaluating, the hundreds of articles published on this topic would be difficult. Second, most studies focused on elderly patients in nursing homes. Pressure ulcer risk factors for the spinal cord disabled are often different from those for the elderly; yet many findings from studies of the elderly provide valuable information. Third, inadequate sample sizes often hamper the usefulness of research on the spinal cord disabled. Drawing valid conclusions from these small studies, especially concerning potential risk factors is difficult. To address these three problems, we critically evaluated the medical, nursing, and nutritional research literature that pertained to risk factors for pressure ulcer development. The purpose of this paper is to provide a review of published reports on the principal risk factors for pressure ulcers in persons with spinal cord injuries.