Pressure Ulcer Risk Research Articles

Assessment of nurses’ knowledge and practice of pressure injuries prevention for critically ill patients in Rwanda: a cross-sectional study

BackgroundPressure injuries are costly and can lead to mortality and psychosocial consequences if not managed effectively. Proper management of pressure injuries is crucial for quality nursing care. However, there is limited research on nurses’ knowledge and practices in preventing and managing pressure injuries among critically ill patients in Rwanda. In addition, barriers affecting nurses’ practices in this area also need further investigation in order to inform the interventions to improve nursing care of patients with pressure injuries in Rwandan hospitals.MethodologyA cross-sectional study involving 129 health nurses was conducted to determine their knowledge and practice levels regarding the prevention of pressure injuries in critically ill patients, and barriers impeding practice in this area. The research modified the Pieper-Zulkowski Pressure Ulcer Knowledge Test to evaluate the knowledge of nurses concerning the prevention of pressure injuries. A 33-item instrument drawn from pressure ulcer risk assessment and prevention toolkits established by the Agency for Healthcare Research and Quality was used to assess nurses’ practices. Additionally, barriers influencing nurses’ knowledge and practices related to the prevention of pressure injuries were evaluated through questions derived from a comparable study conducted in Ethiopia. Descriptive statistics were computed for each variable. Mean scores were computed to categorize nurses’ level of knowledge and practice. Logistic regression analysis was employed to examine the influence of sociodemographic factors and training on the nurses’ knowledge and practice, with a statistical significance set at a p-value less than 0.05.ResultsThe study found that 40.0% of nurses had inadequate knowledge towards pressure injury prevention, and 60.0% reported that they inadequately practiced pressure injury prevention among critically ill patients. Nurses who have not been trained in pressure injury prevention have a 52.4% reduction in the odd of having adequate practice compared to those who have been trained (OR 0.476; 95% CI 0.211–0.996). Heavy workload, inadequate staff, shortage of equipments, presence of other priorities than pressure injury prevention, inadequate training coverage of pressure injury prevention were the most prevalent barriers reported.ConclusionThe evaluation of nurses’ knowledge and practices on pressure injury prevention in critically ill patients at the study setting found that while nurses have satisfactory knowledge, their practical application is lacking due to factors like high workloads and insufficient staffing. The study recommends caution in interpreting the results due to a limited sample size, suggesting further research to guide improvements in nursing practices.

Honduran nursing care to pressure injuries in patients with invasive mechanical ventilation: A qualitative study.

Although substantial evidence exists regarding the treatment of pressure ulcers, there is a lack of studies demonstrating a comprehensive nursing approach for managing pressure ulcers in the ICU, particularly among patients with invasive mechanical ventilation from developing countries like Honduras. This gap in research is significant as the risk and impact of pressure ulcers on health recovery cannot be disregarded. This study aimed to analyze Honduran nursing care for pressure ulcers in patients with invasive mechanical ventilation admitted to Intensive Care Units. A qualitative study approach was used, with in-depth interviews conducted with 12 critical care nurses from July to September 2022. The interviews were recorded, and data analysis was performed using the participants' narratives following Colaizzi's steps. Three themes were obtained, which provide insight into the phenomenon: "The strengths in Honduran nursing interventions," "Negligence in the Honduran nursing care processes," and "Vulnerabilities in the organizational structures." Nurses' experiences highlighted their timely reports and comprehensive, holistic care. However, they undergo negligence in their caring processes, such as low frequency of repositioning, lack of caring plans, and absence of self-training, leading to interdisciplinary work codependency for decision-making. Allocating resources toward nursing care and their professional growth is an investment in providing humane treatment and ensuring the prevention and management of pressure injuries in critical care patients. This study highlights the importance of comprehensive training and standardized protocols for intensive care nurses to improve pressure injury prevention and management in mechanically ventilated patients, emphasizing the need for regular patient repositioning, effective communication, and adequate resources to enhance patient care quality.

Factors Reducing Pressure Ulcer Risk and the Importance of Care in ALS Patients: A Comprehensive Review

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease characterized by muscle atrophy, weakness, and loss of motor function. ALS patients are often bedridden for extended periods, increasing their risk of pressure ulcers. However, clinical data suggests that the incidence of pressure ulcers in ALS patients is lower compared to other bedridden patients. This review analyzes the factors contributing to reduced pressure ulcer risk in ALS patients, focusing on "pressure redistribution due to muscle atrophy," "stabilized postures caused by joint contractures," and "comprehensive care provided by caregivers." Additionally, this paper discusses a comprehensive approach to pressure ulcer prevention, including nutritional management, skincare, pressure redistribution techniques, and advanced technologies. Challenges in pressure ulcer prevention and the importance of ALS-specific care are also emphasized.

Integration of the aSSKINg framework into the electronic patient record: a quality improvement project.

Assessment of pressure ulcer (PU) risk is important in clinical practice and the need to document it in the patient's record is paramount. Despite national and international guidelines highlighting the need to document PU risk, nursing documentation remains variable. The first article in this series discussed the evidence base underpinning the development of clinical guidelines for PUs, alongside the creation of bundle approach for PU prevention. The second article presented the results of a clinical audit exploring compliance against a PU prevention bundle (aSSKINg framework) in an adult community nursing setting in the South East of England. This final article in the series presents the results of a quality improvement project that involved a clinical audit following the implementation of the aSSKINg framework into the electronic patient record (EPR). The aim was to improve nursing documentation for patients with PU risk. The clinical audit was conducted in two parts, with a pilot phase running between 6 February 2023 and 15 April 2023. After the template implementation into the EPR, a follow-up audit was undertaken between 1 November 2023 and 31 January 2024. Overall compliance against the aSSKINg framework improved, especially the completion of the PURPOSE-T on the first visit, full skin assessment and repositioning advice. Following the pilot phase, the aSSKINg template was rolled out in a phased approach to the adult community nursing, enhanced care home matrons and urgent community response teams.

Impact of Nutritional Status on Pressure Ulcers and Death among Critically Ill Patients

Objectives: This study determined the impact of nutritional status on pressure ulcers and death among critically ill patients. Methods: The secondary data of 247 critically ill patients were retrospectively collected from the electronic medical record at a university hospital-affiliated intensive care units. Nutritional status was classified by normal nutrition, moderate malnutrition, and severe malnutrition using the Patient Generative Global Subjective Assessment. Pressure ulcers was assessed using the Braden Scale at the admission day and day 7. The 3-month death was evaluated from the intensive care units admission. Data were analyzed χ<sup>2</sup> test, McNemar test, Kruskal-Wallis test with Bonferroni’s comparison and logistic regression. Results: Moderate and severe malnourished patients were 60.2% and 13.4%, respectively. The prevalence of pressure ulcer was 20.3% at day 7. The 3-month death rate was 21.1%. Body weight loss, oral intake reduction, poor masticatory function, nausea, prevalence of pressure ulcers, and death rate were higher in the severe malnourished patients. Moderate and severe malnutrition affected higher prevalence of pressure ulcers (odds ratio, OR: 3.83, 95% confidence interval [CI]: 1.20-12.20; 2.83, 95% CI: 1.23-6.49). Pressure ulcers affected higher death rate (OR: 2.48, 95% CI: 1.22-5.08). Moderate and severe malnutrition were associated with higher death rate (OR: 7.14, 95% CI: 2.17-23.81; OR: 2.46, 95% CI: 1.09-5.53). Conclusions: A targeted nutritional management program based on malnourished stages may be helpful to reduce the risks of pressure ulcers and death among critically ill patients.

Determination the incidence of pressure injury development during the surgical process and to examine the effects of risk factors on pressure injury formation

Surgical patients are at risk for pressure injuries throughout the entire surgical process. Prevalence and incidence studies are critical to determine risk groups in surgical patient groups. This study was conducted to determine the incidence of pressure injury development in patients hospitalized in surgical clinics and to examine the effects of risk factors on it. The sample of this descriptive study consisted of 138 patients hospitalized in surgical wards. Data collection tools included a patient information questionnaire, The National Pressure Injury Advisory Panel (NPIAP) Pressure Injury and Stages Form, and the Munro Perioperative Pressure Ulcer Risk Assessment Scale. Data were analyzed on the SPSS 24.0 software package by using descriptive statistical tests such as frequency and percentage distribution, chi-square test, independent groups t-test, and univariate logistic regression analysis. The incidence of surgery-related pressure injuries was found to be 18.8%. Patients' mean scores on the Munro scale were 10.23±0.2.95 before surgery, 12.80±2.57 during surgery, and 23.03±5.07 following surgery, with the mean total score being 24.47±5.44. The mean score on the total Munro scale was statistically significantly higher in patients who developed pressure injuries than in those who did not. Patients' age, blood albumin level, body mass index, presence of oedema, use of medical equipment, mobility status, type of anaesthesia used in surgery, and duration of surgery were determined as effective risk factors in pressure injury development. In conclusion, it was found that pressure injuries developed at a considerable rate in patients undergoing surgical operations. It is recommended that surgical nurses should take the necessary precautions in time.

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.