Risk Of Bedsores Research Articles

Predicting the Incidence of Bedsores in Intensive Care Units: Braden Scale versus Waterlow Scale

Background and Objectives Bedsores are one of the major problems observed in patients admitted to intensive care units. Two common tools for assessing the risk of bedsores are Braden and Waterlow scales. Evidence for the agreement between these two scales in predicting the incidence of bedsores is scarce. Subjects and Methods This was a prospective cohort study conducted from July to November 2017 in the ICUs of hospitals affiliated to Isfahan University of Medical Sciences. The risk of bedsores was assessed every two days using two scales, namely Braden and Waterlow, for a maximum of one month or until the patient died or was discharged. Results The findings of the study showed that the mean score of Braden scale in patients who developed bedsores was significantly lower than that of patients who did not develop bedsores (P = 0.002). Also, the mean score of Waterlow scale in patients who developed bedsores was significantly higher than that in patients who did not have bedsores (P <0.001). The sensitivity and specificity of the Braden scale were 82.6% and 53.6%, respectively, and its positive and negative predictive values were 29.7% and 92.9%, respectively. Waterlow scale had a sensitivity of 73.9% and a specificity of 68%, and its positive and negative predictive values were 35.4% and 91.7%, respectively. Conclusion Considering the area under the curve of the two scales and the sum of the two sensitivity and specificity indices, the Waterlow scale is a more suitable tool, compared with the Braden scale, for predicting bedsores in patients.

The role of nutrition in stroke prevention and treatment

Important factors for reducing the risk of stroke, as well as predictors of effective rehabilitation of this group of patients are proper nutrition, regular physical activity, smoking cessation and normalization of body weight. Currently, there is no unambiguous data on the needs of patients who have suffered acute cerebral circulatory disorders for nutrients, which dictates the need to develop a personalized diet for them, which should be calculated taking into account age, gender and body mass index. The intake of energy, proteins, fats, carbohydrates, minerals and vitamins can be carried out not only as part of traditional, but also from specialized food products, including mixtures for etheral nutrition. The use of mixtures helps to reduce the risk of bedsores.

The problem of osteoporotic fractures of the femur in children with cerebral palsy

The problem of osteoporotic fractures of the femur in children with cerebral palsy

Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients

The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 × 10-3 m/s2). Functional decline (defined as a ≥5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, ρ = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.

Un séjour hospitalier sans escarre

A hospital stay without bedsores. The skin of elderly people is thin and fragile. After extended bed-rest, the skin's resources are rapidly depleted. The risk of bedsores becomes imminent. But a high-quality multi-disciplinary partnership can prevent bedsores in elderly patients with multiple illnesses. Example around a clinical case.

Preventing ventilator-associated pneumonia: is it ultimately only a matter of gravity?

Ventilator-associated pneumonia (VAP) is defined aspneumonia that develops 48 h or longer after initiation ofmechanical ventilation via an endotracheal tube (ET). Theincidence of VAP is high, ranging from 10 to 30%. VAPis associated with significantly increased morbidity andmortality, hospital length of stay, and costs [1]. Preven-tion of VAP is therefore one of the foremost aims inmechanically ventilated critically ill patients.The pathogenesis of VAP usually requires that twoimportant processes take place: bacterial colonization ofthe aerodigestive tract and the aspiration of contaminatedsecretions into the lower airway across the ET cuff [2].Controversy exists on the relevance of bacterial coloni-zation of the stomach and gastroesophageal aspiration inthe pathogenesis of VAP [3]. About 20 years ago,experimental studies with radioactive-labeled enteralfeeding suggested that endotracheal aspiration of gastriccontents occurred more frequently when patients wereplaced in the supine rather than semirecumbent position[4]. Thus, placing a patient in the semirecumbent posi-tion—with the head elevated at a 30–45 position—seemed a logical solution to prevent VAP.Nowadays, the semirecumbent position is consideredone of the most effective, easy to implement, and inex-pensive methods for the prevention of VAP inmechanically ventilated patients in the ICU. For thisreason it has been widely adopted not only in practiceguidelines but, recently, in most of the care bundles aimedat preventing VAP [5, 6]. Surprisingly, data supportingthe effectiveness of the semirecumbent position are rela-tively few and conflicting, resulting only from three,rather small, randomized controlled trials [7–9]. More-over, this intervention has an important drawback: Thefeasibility of a 45 bed orientation in ICUs is debatedbecause it depends on nursing tasks, medical interven-tions, and the patient’s wishes [10]. Apart from thisdisadvantage, the semirecumbent position has also beenimplicated in some complications such as venous stasis inthe lower extremities with the risk of venous thrombo-embolism, caudal shift of blood with the risk ofhemodynamic instability, and the risk of bed sores [11].Hence, no clear conclusions about the effect of thesemirecumbent position on VAP prophylaxis can bedrawn.In this issue of Intensive Care Medicine Zanella et al.[12] examine the incidence of VAP in swine placed in aprone position with the orientation of trachea and ETabove horizontal (at 45 ) and below horizontal (at -10 ).Pigs were randomized into four groups and ventilated for72–168 h with and without enteral feeding. At the end ofthe study period, all pigs were killed and the clinicaldiagnosis of VAP was microbiologically evaluated. Thislong-term study, as Zanella et al. note, aimed to modelsome of the determinants of VAP: intubation, deepsedation, mechanical ventilation, and enteral feeding.Their findings were really impressive! All pigs kept ori-ented with trachea 45 above horizontal developed VAP.In contrast, none of the pigs kept oriented with the tracheabelow horizontal developed VAP. Here, we mustemphasize that the above animal model is one of the most

Health and nursing problems of elderly patients related to bio-psycho-social need deficiencies and functional assessment

Elderly population is characterized by larger need for social welfare and medical treatment than other age groups. Along with aging, there is a number of emerging health, nursing, caring, psychological and social problems. Complexity of these problems results from overlapping and advancing involutional changes, multi-illness, decreased functional efficiency and other factors. The aim of the study was the assessment of health problems in geriatric patients as well as bio-psycho-social need deficiencies in a view of selected parameters of functional efficiency. The research group consisted of the Chair and Clinic of Geriatrics, 186 women and 114 men, 300 persons in total. The research was carried out using a diagnostic poll method with the application of the Activities of Daily Living (ADL) questionnaire of assessment of daily efficiency on the basis of the Katz Scale; the Care Dependency Scale (CDS) questionnaire used to measure the level of the care dependency and human needs, Norton's bed sores risk assessment scale, the Nursing Care Category (NCC) questionnaire applied to assess the need for nursing care. In most patients the results unveiled manifestations of three or more illnesses. Functional efficiency was at low and average level. Half of the subjects were endangered by risk of bed sores as well as showed high need fulfillment deficiency. The highest level of the deficiency was observed in patients in the eldest age group as well as suffering from multi-illness. Material status, education, place of residence or gender showed no significant influence on the level of need fulfillment.