Pressure Ulcer: An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stays in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure.Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in PRESSURE ULCER.Pressure: A type of stress exerted uniformly in all directions. Its measure is the force exerted per unit area. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed)Stomach Ulcer: Ulceration of the GASTRIC MUCOSA due to contact with GASTRIC JUICE. It is often associated with HELICOBACTER PYLORI infection or consumption of nonsteroidal anti-inflammatory drugs (NSAIDS).Duodenal Ulcer: A PEPTIC ULCER located in the DUODENUM.Beds: Equipment on which one may lie and sleep, especially as used to care for the hospital patient.Blood Pressure: PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS.Peptic Ulcer: Ulcer that occurs in the regions of the GASTROINTESTINAL TRACT which come into contact with GASTRIC JUICE containing PEPSIN and GASTRIC ACID. It occurs when there are defects in the MUCOSA barrier. The common forms of peptic ulcers are associated with HELICOBACTER PYLORI and the consumption of nonsteroidal anti-inflammatory drugs (NSAIDS).Nursing Assessment: Evaluation of the nature and extent of nursing problems presented by a patient for the purpose of patient care planning.Leg Ulcer: Ulceration of the skin and underlying structures of the lower extremity. About 90% of the cases are due to venous insufficiency (VARICOSE ULCER), 5% to arterial disease, and the remaining 5% to other causes.Nursing Evaluation Research: Research carried out by nurses that uses interviews, data collection, observation, surveys, etc., to evaluate nursing, health, clinical, and nursing education programs and curricula, and which also demonstrates the value of such evaluation.Skin UlcerPeptic Ulcer Hemorrhage: Bleeding from a PEPTIC ULCER that can be located in any segment of the GASTROINTESTINAL TRACT.Hydrostatic Pressure: The pressure due to the weight of fluid.Bandages: Material used for wrapping or binding any part of the body.Nursing Service, Hospital: The hospital department which is responsible for the organization and administration of nursing activities.Nursing Homes: Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.Nursing Audit: A detailed review and evaluation of selected clinical records by qualified professional personnel for evaluating quality of nursing care.Peptic Ulcer Perforation: Penetration of a PEPTIC ULCER through the wall of DUODENUM or STOMACH allowing the leakage of luminal contents into the PERITONEAL CAVITY.Bandages, Hydrocolloid: Dressings comprised of a self-adhesive matrix to which hydrophilic absorbent particles are embedded. The particles consist of CELLULOSE derivatives; calcium ALGINATES; PECTINS; or GELS. The utility is based on providing a moist environment for WOUND HEALING.Nursing Education Research: Investigations into the problems of integrating research findings into nursing curricula, developing problem solving skills, finding approaches to clinical teaching, determining the level of practice by graduates from different basic preparations, etc.Occlusive Dressings: Material, usually gauze or absorbent cotton, used to cover and protect wounds, to seal them from contact with air or bacteria. (From Dorland, 27th ed)Nursing Records: Data recorded by nurses concerning the nursing care given to the patient, including judgment of the patient's progress.Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., WOUNDS, GUNSHOT; WHIPLASH INJURIES; etc.).Operating Tables: A raised flat surface on which a patient is placed during surgical procedures.Bedding and Linens: Articles of cloth, usually cotton or rayon and other synthetic or cotton-blend fabrics, used in households, hospitals, physicians' examining rooms, nursing homes, etc., for sheets, pillow cases, toweling, gowns, drapes, and the like.Wound Healing: Restoration of integrity to traumatized tissue.Clinical Nursing Research: Research carried out by nurses in the clinical setting and designed to provide information that will help improve patient care. Other professional staff may also participate in the research.Buruli Ulcer: A lesion in the skin and subcutaneous tissues due to infections by MYCOBACTERIUM ULCERANS. It was first reported in Uganda, Africa.Blood Pressure Determination: Techniques for measuring blood pressure.Pediatric Nursing: The nursing specialty concerning care of children from birth to adolescence. It includes the clinical and psychological aspects of nursing care.Air Pressure: The force per unit area that the air exerts on any surface in contact with it. Primarily used for articles pertaining to air pressure within a closed environment.Debridement: The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed)Balsams: Resinous substances which most commonly originate from trees. In addition to resins, they contain oils, cinnamic acid and BENZOIC ACID.Skilled Nursing Facilities: Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis.Education, Nursing, Continuing: Educational programs designed to inform nurses of recent advances in their fields.Buttocks: Either of two fleshy protuberances at the lower posterior section of the trunk or HIP in humans and primate on which a person or animal sits, consisting of gluteal MUSCLES and fat.Negative-Pressure Wound Therapy: The application of a vacuum across the surface of a wound through a foam dressing cut to fit the wound. This removes wound exudates, reduces build-up of inflammatory mediators, and increases the flow of nutrients to the wound thus promoting healing.Nurse Clinicians: Registered nurses who hold Master's degrees in nursing with an emphasis in clinical nursing and who function independently in coordinating plans for patient care.Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.Heel: The back (or posterior) of the FOOT in PRIMATES, found behind the ANKLE and distal to the TOES.Homes for the Aged: Geriatric long-term care facilities which provide supervision and assistance in activities of daily living with medical and nursing services when required.Transducers, Pressure: Transducers that are activated by pressure changes, e.g., blood pressure.Hypertension: Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity.Intraocular Pressure: The pressure of the fluids in the eye.Wheelchairs: Chairs mounted on wheels and designed to be propelled by the occupant.Blood Pressure Monitoring, Ambulatory: Method in which repeated blood pressure readings are made while the patient undergoes normal daily activities. It allows quantitative analysis of the high blood pressure load over time, can help distinguish between types of HYPERTENSION, and can assess the effectiveness of antihypertensive therapy.Nurse's Role: The expected function of a member of the nursing profession.Foot Orthoses: Devices used to support or align the foot structure, or to prevent or correct foot deformities.Soft Tissue Injuries: Injuries of tissue other than bone. The concept is usually general and does not customarily refer to internal organs or viscera. It is meaningful with reference to regions or organs where soft tissue (muscle, fat, skin) should be differentiated from bones or bone tissue, as "soft tissue injuries of the hand".Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned.Patient Positioning: Moving a patient into a specific position or POSTURE to facilitate examination, surgery, or for therapeutic purposes.Nursing Staff, Hospital: Personnel who provide nursing service to patients in a hospital.Moving and Lifting Patients: Moving or repositioning patients within their beds, from bed to bed, bed to chair, or otherwise from one posture or surface to another.Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with SPINAL CORD DISEASES, although BRAIN DISEASES; PERIPHERAL NERVOUS SYSTEM DISEASES; NEUROMUSCULAR DISEASES; and MUSCULAR DISEASES may also cause bilateral leg weakness.Venous Pressure: The blood pressure in the VEINS. It is usually measured to assess the filling PRESSURE to the HEART VENTRICLE.Severity of Illness Index: Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Nursing Care: Care given to patients by nursing service personnel.Practice Guidelines as Topic: Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Arterial Pressure: The blood pressure in the ARTERIES. It is commonly measured with a SPHYGMOMANOMETER on the upper arm which represents the arterial pressure in the BRACHIAL ARTERY.Ventricular Pressure: The pressure within a CARDIAC VENTRICLE. Ventricular pressure waveforms can be measured in the beating heart by catheterization or estimated using imaging techniques (e.g., DOPPLER ECHOCARDIOGRAPHY). The information is useful in evaluating the function of the MYOCARDIUM; CARDIAC VALVES; and PERICARDIUM, particularly with simultaneous measurement of other (e.g., aortic or atrial) pressures.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Diabetic Foot: Common foot problems in persons with DIABETES MELLITUS, caused by any combination of factors such as DIABETIC NEUROPATHIES; PERIPHERAL VASCULAR DISEASES; and INFECTION. With the loss of sensation and poor circulation, injuries and infections often lead to severe foot ulceration, GANGRENE and AMPUTATION.Surgical Flaps: Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region.Hospitals, University: Hospitals maintained by a university for the teaching of medical students, postgraduate training programs, and clinical research.Heart Rate: The number of times the HEART VENTRICLES contract per unit of time, usually per minute.Total Quality Management: The application of industrial management practice to systematically maintain and improve organization-wide performance. Effectiveness and success are determined and assessed by quantitative quality measures.Ischium: One of three bones that make up the coxal bone of the pelvic girdle. In tetrapods, it is the part of the pelvis that projects backward on the ventral side, and in primates, it bears the weight of the sitting animal.Education, Nursing, Baccalaureate: A four-year program in nursing education in a college or university leading to a B.S.N. (Bachelor of Science in Nursing). Graduates are eligible for state examination for licensure as RN (Registered Nurse).Sacrococcygeal Region: The body region between (and flanking) the SACRUM and COCCYX.
Braden Scale for Predicting Pressure Ulcer Risk: The Braden Scale for Predicting Pressure Ulcer Risk, is a tool that was developed in 1987 by Barbara Braden and Nancy Bergstrom.Transpulmonary pressure: Transpulmonary pressure is the difference between the alveolar pressure and the intrapleural pressure in the lungs. During human ventilation, air flows because of pressure gradients.Gastric erosion: Gastric erosion occurs when the mucous membrane lining the stomach becomes inflamed. Some drugs, as tablets, can irritate this mucous membrane, especially drugs taken for arthritis and muscular disorders, steroids, and aspirin.Mattress protector: A mattress protector is an item of removable bedding that sits on top of or encases a mattress to provide protection to the mattress. Some mattress protectors also provide protection to the individual sleeping on the mattress from allergens and irritants such as dust mites, bed bugs, mold, and dead skin (like dandruff).Aortic pressure: Central aortic blood pressure (CAP or CASP) is the blood pressure at the root of aorta. Studies have shown the importance of central aortic pressure and its implications in assessing the efficacy of antihypertensive treatment with respect to cardiovascular risk factors.John Lykoudis: John Lykoudis (1910 in Missolonghi – 1980) was a general practitioner in Greece who treated patients suffering from peptic ulcer disease with antibiotics long before it was commonly recognized that bacteria were a dominant cause for the disease.The International Journal of Lower Extremity Wounds: The International Journal of Lower Extremity Wounds is a peer-reviewed academic journal that publishes papers four times a year in the field of Medical Sciences. The journal's editor is Raj Mani, PhD, FACA (Southampton University Hospital).Ulcerative dermatitis: Ulcerative dermatitis is a skin disorder in rodents associated with bacterial growth often initiated by self-trauma due to a possible allergic response. Although other organisms can be involved, bacteria culture frequently shows Staphylococcus aureus.Forrest classification: Forrest classification is a classification of upper gastrointestinal hemorrhage used for purposes of comparison and in selecting patients for endoscopic treatment.http://books.EdemaElastic bandage: An elastic bandage is a "stretchable bandage used to create localized pressure". Elastic bandages are commonly used to treat muscle sprains and strains by reducing the flow of blood to a particular area by the application of even stable pressure which can restrict swelling at the place of injury.Home of the future: The home of the future, similar to the office of the future, is a concept that has been popular to explore since the early 20th century, or perhaps earlier. There have been many exhibits, such as at World's Fairs and theme parks, purporting to show how future homes will look and work, as well as standalone model "homes of the future" sponsored by builders, developers, or technology companies.Perforated ulcer: A perforated ulcer, is a condition where an untreated ulcer can burn through the wall of the stomach (or other areas of the gastrointestinal tract), allowing digestive juices and food to leach into the abdominal cavity. Treatment generally requires immediate surgery.Rehabilitation in spinal cord injury: When treating a person with a spinal cord injury, repairing the damage created by injury is the ultimate goal. By using a variety of treatments, greater improvements are achieved, and, therefore, treatment should not be limited to one method.Wound healing: Wound healing is an intricate process where the skin or other body tissue repairs itself after injury. In normal skin, the epidermis (surface layer) and dermis (deeper layer) form a protective barrier against the external environment.Paradoxical reaction: A paradoxical reaction or paradoxical effect is an effect of medical treatment, usually a drug, opposite to the effect which would normally be expected. An example of a paradoxical reaction is pain caused by a pain relief medication.Pediatric nursing: 'Pediatrics' comes from the Greek words 'pedia' which means child, 'iatrike' which means treatment and 'ics' which means branch of science. This means Pediatric nursing is the science of child care and scientific treatment of childhood.BalloonDebridement (dental)Black Balsam KnobBloody Buttocks: Bloody Buttocks was a British Thoroughbred sire who was the leading sire in Great Britain and Ireland in 1739. He was owned by Mr.Boehringer Laboratories: Boehringer Laboratories, LLC. is a Family owned American medical technology company with headquarters in Phoenixville, Pennsylvania.Heel: The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg.HypertensionIntracranial pressure monitoringIntraocular pressureMotorized wheelchair: A motorized wheelchair, powerchair, electric wheelchair or electric-powered wheelchair (EPW) is a wheelchair that is propelled by means of an electric motor rather than manual power. Motorized wheelchairs are useful for those unable to propel a manual wheelchair or who may need to use a wheelchair for distances or over terrain which would be fatiguing in a manual wheelchair.Ambulatory blood pressure: Ambulatory Blood Pressure Monitoring (ABPM) measures blood pressure at regular intervals. It is believed to be able to reduce the white coat hypertension effect in which a patient's blood pressure is elevated during the examination process due to nervousness and anxiety caused by being in a clinical setting.Soft tissue injuryAtmospheric-pressure laser ionization: Atmospheric pressure laser ionization is an atmospheric pressure ionization method for mass spectrometry (MS). Laser light in the UV range is used to ionize molecules in a resonance-enhanced multiphoton ionization (REMPI) process.List of Action Man charactersList of people with paraplegia: This is a list of people who have or had paraplegia.Temporal analysis of products: Temporal Analysis of Products (TAP), (TAP-2), (TAP-3) is an experimental technique for studyingNational Clinical Guideline CentreGlobal Risks Report: The Global Risks Report is an annual study published by the World Economic Forum ahead of the Forum’s Annual Meeting in Davos, Switzerland. Based on the work of the Global Risk Network, the report describes changes occurring in the global risks landscape from year to year and identifies the global risks that could play a critical role in the upcoming year.QRISK: QRISK2 (the most recent version of QRISK) is a prediction algorithm for cardiovascular disease (CVD) that uses traditional risk factors (age, systolic blood pressure, smoking status and ratio of total serum cholesterol to high-density lipoprotein cholesterol) together with body mass index, ethnicity, measures of deprivation, family history, chronic kidney disease, rheumatoid arthritis, atrial fibrillation, diabetes mellitus, and antihypertensive treatment.Diabetic foot ulcer: Diabetic foot ulcer is a major complication of diabetes mellitus, and probably the major component of the diabetic foot.Rotation flap: A rotation flap is a semicircular skin flap that is rotated into the defect on a fulcrum point. Rotation flaps provide the ability to mobilize large areas of tissue with a wide vascular base for reconstruction.Soonchunhyang University Hospital: Soonchunhyang University Hospital is a hospital in Bucheon, South Korea. It is affiliated with Soonchunhyang University.Interbeat interval: Interbeat interval is a scientific term used in the study of the mammalian heart.HydrosilaNelaton's line: In anatomy, the Nelaton's Line (also known as the Roser-Nélaton line) is a theoretical line, in the moderately flexed hip, drawn from the anterior superior iliac spine to the tuberosity of the ischium.
(1/548) Nursing home characteristics and the development of pressure sores and disruptive behaviour.
OBJECTIVE: To determine how nursing home characteristics affect pressure sores and disruptive behaviour. METHOD: Residents (n = 5518, aged > or =60 years) were selected from 70 nursing homes in the National Health Care chain. Homes were classified as high- or low-risk based on incidence tertiles of pressure sores or disruptive behaviour (1989-90). Point-prevalence and cumulative incidence of pressure sores and disruptive behaviour were examined along with other functional and service variables. RESULTS: The overall incidence of pressure sores was 11.4% and the relative risk was 4.3 times greater in high- than low-risk homes; for disruptive behaviour, the incidence was 27% and the relative risk was 7.1 times greater in the high-risk group. At baseline, fewer subjects in homes with a high risk of pressure sores were white or in restraints, but more had received physician visits monthly and had had problems with transfers and eating. High-risk homes also had fewer beds and used less non-licensed nursing staff time. At follow-up (1987-90), 52% of homes in the low-risk group and 35% of those in the high-risk group had maintained their risk status; low-risk homes were more likely to have rehabilitation and maintenance activities. Having multiple clinical risk factors was associated with more pressure sores in high- (but not low-) risk homes, suggesting a care-burden threshold. By logistic regression, the best predictor of pressure sores was a home's prior (1987-88) incidence status. Interestingly, 67% of homes with a high risk of pressure sores were also high-risk for disruptive behaviour, while only 27% of homes with a low risk of pressure sores were high-risk for disruptive behaviour. A threshold effect was also observed between multiple risk factors and behaviour. More homes with a high risk of disruptive behaviour (68%) remained at risk over 4 years, and the best predictor of outcome was a home's previous morbidity level. CONCLUSION: Nursing-home characteristics may have a greater impact than clinical factors on pressure sores and disruptive behaviour in long-stay, institutionalized elders. (+info)
(2/548) Risk factors for erysipelas of the leg (cellulitis): case-control study.
OBJECTIVE: To assess risk factors for erysipelas of the leg (cellulitis). DESIGN: Case-control study. SETTING: 7 hospital centres in France. SUBJECTS: 167 patients admitted to hospital for erysipelas of the leg and 294 controls. RESULTS: In multivariate analysis, a disruption of the cutaneous barrier (leg ulcer, wound, fissurated toe-web intertrigo, pressure ulcer, or leg dermatosis) (odds ratio 23.8, 95% confidence interval 10.7 to 52.5), lymphoedema (71.2, 5.6 to 908), venous insufficiency (2.9, 1.0 to 8.7), leg oedema (2.5, 1.2 to 5.1) and being overweight (2.0, 1.1 to 3.7) were independently associated with erysipelas of the leg. No association was observed with diabetes, alcohol, or smoking. Population attributable risk for toe-web intertrigo was 61%. CONCLUSION: This first case-control study highlights the major role of local risk factors (mainly lymphoedema and site of entry) in erysipelas of the leg. From a public health perspective, detecting and treating toe-web intertrigo should be evaluated in the secondary prevention of erysipelas of the leg. (+info)
(3/548) Butorphanol tartrate acts to decrease sow activity, which could lead to reduced pig crushing.
The objective of this study was to determine whether administration of an analgesic to sows immediately after farrowing would allow them to lie more restfully. Sows lying on their pigs, causing them to be "crushed," is a major cause of pig mortality. Most deaths due to crushing occur during the first 3 d postpartum. For modern, lean-type sows, farrowing crates are relatively hard and unforgiving, even though they may be equipped with plastic-coated, expanded metal flooring. Indeed, many sows develop pressure sores on their shoulders, and this may contribute to the sows' discomfort. These sores may cause a sow to change position frequently to alleviate pain, thus increasing its chances of crushing pigs. Sixteen production sows were assigned to either a control group (C, n = 8) with litter size 11.71+/-.78 or an experimental group (B, n = 8) with litter size 11.63+/-1.22. Pigs born to C and B sows weighed 1.60+/-.04 and 1.37+/-.04 kg, respectively. The C sows were given no treatment, whereas the B sows were administered an i.m. injection of butorphanol tartrate at a dose of .15 mg/kg BW every 6 h until 3 d after farrowing. Data were collected on all sows using time-lapse photography (1 frame/.4 s) for a 3-d duration upon the initiation of farrowing. To assess the degree of comfort of each sow, body position changes were recorded when sows switched between lying, sitting, and standing. Data were analyzed by 12-h periods using Wilcoxon-Mann-Whitney equations. During the 72-h period, B sows tended to perform fewer position changes than C sows (P = .10). Specifically, position changes were fewer for B sows from 48 to 72 h postpartum (P<.06). There were no differences in position changes between treatments from 0 to 48 h postpartum (P>.50). There was no difference in the rate of crushing between treatments (C = 5, B = 5). The butorphanol did not seem to affect pig activity or normal behaviors or to create adverse effects, such as diarrhea. Although the sows given butorphanol showed a reduced number of position changes, the dose was intermediate, and a higher dose may have a greater effect. If pig mortality can be decreased, an analgesic protocol that is simple to administer and readily available to producers can be developed. Alternatively, using of more pliable flooring or an increase in sow body fat may allow sows to lie more stationary. (+info)
(4/548) The Dutch pressure sore assessment score or the Norton scale for identifying at-risk nursing home patients?
OBJECTIVE: To investigate the usefulness of a Dutch pressure sore risk assessment scale--the Centraal Begeleidingsorgaan voor de Intercollegiale Toetsing (CBO; National Organization for Quality Assurance in Hospitals) score--in the detection of patients at risk of developing pressure sores after admission to a nursing home. As the Norton score is the standard method of risk assessment, we also investigated which score (Norton or CBO) has the stronger relationship to the development of pressure sores. DESIGN: Longitudinal cohort design. PATIENTS: 220 nursing home patients, 80 men, 140 women, mean age 79 years (standard deviation 3). MEASURES: Admission assessments for the presence of pressure sores, CBO and Norton scores, preventive measures and demographic characteristics. We made observations every week for 4 weeks. MAIN OUTCOME MEASURE: Presence or absence of pressure sores. MAIN RESULTS: 54 patients (25%) developed a pressure sore. A significant, nonlinear relationship was found between the CBO score on admission and the development of pressure ulcers for the first 2 weeks after admission. Multiple logistic regression analysis showed that only mobility (odds ratio = 3.6, P = 0.0001) and mental state (odds ratio = 2.0, P = 0.03) showed a significant relationship with the development of pressure ulcers. The CBO score was no better in risk assessment than the Norton score. CONCLUSIONS: The CBO score can be used for assessment of the risk of developing pressure ulcers in the first 2 weeks after admission to a nursing home, but is no better than the Norton score. Since the Norton score is easier to use, it is slightly preferable for use in this setting. However, neither score is a good indicator of patients at risk. Physicians should not depend solely on risk scores when prescribing preventive measures. (+info)
(5/548) The limits of pressure sore prevention.
Pressure sore prevalence and incidence were assessed in 275 patients who were admitted to a well-staffed internal medicine ward during a 12-month study period or who were present on day 1. Pressure sore risk was assessed by use of the Braden scale and patients scoring 16 or less were provided with intensive preventive care. During the study period 5.1% (95% confidence interval 2.7-7.8) of 275 patients had pressure sores (prevalence) and 4.4% (1.9-6.9) developed sores (incidence). None of the 239 patients who were assessed as not being at risk developed a sore. 36 patients were assessed as being at risk at some time during the study and 12 of these developed sores despite receiving high-quality preventive care. The results suggest that not all pressure sores can be prevented in severely ill patients. We believe that the 4.4% incidence of sores in this study approaches the current limit of prevention. (+info)
(6/548) Sequential cytokine therapy for pressure ulcers: clinical and mechanistic response.
OBJECTIVE: To compare the healing response of sequential topically applied cytokines to that of each cytokine alone and to a placebo in pressure ulcers, and to evaluate the molecular and cellular responses. SUMMARY BACKGROUND DATA: Because of a deficiency of cytokine growth factors in chronic wounds and the reversal of impaired healing in animal models, pressure ulcer trials have been performed with several exogenously applied growth factors. Because single-factor therapy has not been uniformly successful, combination or sequential cytokine therapy has been proposed. Laboratory data have suggested that sequential treatment with granulocyte-macrophage/colony-stimulating factor (GM-CSF)/basic fibroblast growth factor (bFGF) might augment the previously reported effect of bFGF alone. METHODS: A masked, randomized pressure ulcer trial was performed comparing sequential GM-CSF/bFGF therapy with that of each cytokine alone and with placebo during a 35-day period. The primary measure was wound volume decrease over time. Cytokine wound levels and mRNA levels were serially determined. Fibroblast-populated collagen lattices (FPCLs) were constructed from serial fibroblast biopsies. Cellular ultrastructure was evaluated by electron microscopy. Changes in ease of surgical closure and its relative cost were determined. RESULTS: Ulcers treated with cytokines had greater closure than those in placebo-treated patients. Patients treated with bFGF alone did the best, followed by the GM-CSF/bFGF group. Patients treated with GM-CSF or bFGF had higher levels of their respective cytokine after treatment. Patients with the greatest amount of healing showed higher levels of platelet-derived growth factor (PDGF) on day 10 and transforming growth factor beta (TGFbeta1) on day 36. Message for the bFGF gene was upregulated after treatment with exogenous bFGF, suggesting autoinduction of the cytokine. FPCLs did not mimic the wound responses. Ultrastructure of wound biopsies showed response to bFGF. Treatment with any of the cytokines improved the wound by allowing easier wound closure. This was most marked for the bFGF-alone treatment, with a cost savings of $9,000 to $9,200. CONCLUSIONS: Treatment with bFGF resulted in significantly greater healing than the other treatments in this trial. The clinical response appeared to be related to upregulation of the bFGF message and to increased levels of PDGF-AB, bFGF, and TGFbeta1 in the wounds and changes in ultrastructure. The resultant improvements could be correlated with cost savings. (+info)
(7/548) Pressure ulcers--randomised controlled trial comparing hydrocolloid and saline gauze dressings.
An open comparative randomised study comparing the performance of hydrocolloid dressings (DuoDERM CGF) to saline gauze dressings in the treatment of pressure ulcers was done to evaluate the overall dressing performance, wound healing and cost effectiveness. Thirty-four subjects were enrolled at the University Hospital, Kuala Lumpur over a 643 days period. Inclusion criteria were Stage II or III pressure ulcers, at least 18 years of age and written informed consent. Only one pressure ulcer per subject was enrolled in the study. Patients with infected pressure ulcers, diabetes mellitus, an immuno-compromised status and known sensitivity to the study dressings were excluded. Subjects who met the enrollment criteria were randomised to one of the two dressing regimes. They were expected to participate in the study for a maximum of eight weeks or until the pressure ulcer healed, which ever occurred first. Overall subject age averaged 58 years and the mean duration of pressure ulcer existence was about 1 month. Twenty-one of the thirty-four ulcers enrolled were stage II and thirteen were stage III. The majority of the ulcers (88%) were located in the sacral area and seventeen subjects (50%) were incontinent. In the evaluation of dressing performance in terms of adherence to wound bed, exudate handling ability, overall comfort and pain during dressing removal; all favoured the hydrocolloid dressing by a statistically significant margin (p < 0.001). Subjects assigned the hydrocolloid dressing experienced a mean 34% reduction from their baseline surface area measurement compared to a mean 9% increase by subjects assigned gauze dressings. This was not statistically significant (p = 0.2318). In cost evaluation of the study products, there was no statistical significance in the total cost of wound management per subject. When only labour time and cost was evaluated, there was a statistically significant advantage towards hydrocolloid dressings. (+info)
(8/548) Pressure sores among malnourished necropsied adults--preliminary data.
Pressure sores are common among bedridden, elderly, or malnourished patients, and may occur in terminal ill patients because of impaired mobility, fecal or urinary incontinence, and decreased healing capacity. The aim of this study was to compare frequency of pressure sores between malnourished and non-malnourished necropsied adults. METHOD: All (n = 201) adults (age >/= 18 years) autopsied between 1986 and 1996 at the Teaching Hospital of Triangulo Mineiro Medical School (Uberaba) were eligible for the study. Gender, race, weight, height and main diagnoses were recorded. Ninety-six cases were excluded because of probable body water retention (congestive heart failure, hepatic insufficiency, nephrotic syndrome) or pressure sores secondary to peripheral vascular ischemia. Body mass index (BMI) was used to define malnourished (BMI < 18.5 kg/m2) and non-malnourished (BMI > 18.5kg/m2) groups. RESULTS: Except for weight (42.5kg; range: 28-57 vs. 60; 36-134.5kg) and BMI (16.9; range: 12.4-18.5 vs. 22.7; range: 18.5-54.6kg/m2), respectively, there were no statistical differences among 43 malnourished and 62 non-malnourished cases in relation to age (54.9 +/- 20.4 vs. 52.9 +/- 17.9 years), percentage of white persons (74.4 vs. 64.5%), male gender (76.7 vs. 69.3%) and main diagnoses. Five malnourished (11. 6%) and 7 (11.5%) non-malnourished cases had pressure sores (p=0.89). CONCLUSION: Pressure sores were equally common findings in necropsied persons with protein-energy malnutrition, as assessed by body mass index. (+info)
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