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Chen S, Chen M, Han Y, Chen Z, Mu X, He C, Zhao J, Zhang L, Huang Z. Analysis of microbial environment changes in wound healing of pressure ulcers in rats promoted by moist exposed burn ointment. Arch Dermatol Res 2025; 317:451. [PMID: 39985596 DOI: 10.1007/s00403-025-03913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 12/20/2024] [Revised: 01/20/2025] [Accepted: 01/27/2025] [Indexed: 02/24/2025]
Abstract
This study explored the effects of Moist Exposed Burn Ointment (MEBO) on the healing process of pressure-induced wounds. Using a stage IV pressure ulcer model established in 42 rats, divided equally into a control gel group and an MEBO group, we investigated the efficacy of MEBO through topical application. The control group received Carbomer gel, while the MEBO group was treated with MEBO until complete wound healing. Results showed that MEBO significantly accelerated wound healing compared to the control group. Histological analysis, including hematoxylin and eosin (HE) staining and Masson's trichrome staining, revealed enhanced epithelialization and collagen deposition in the MEBO group. Furthermore, 16S rRNA sequencing indicated that MEBO reduced microbial diversity at the wound site and reshaped the microbial composition. Notably, The increased abundance of Acinetobacter and Staphylococcus, coupled with a reduction in Pseudomonas, may reflect a shift in the wound microbiome that could be conducive to healing. However, the exact role of these microbial shifts in promoting wound healing requires further investigation, as microbial dynamics in wound environments are complex and context-dependent. These findings suggest that MEBO facilitates wound healing by optimizing the wound microbiome, thereby offering a promising therapeutic approach for managing pressure ulcers.
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Affiliation(s)
- Shenghua Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Mingheng Chen
- People's Hospital of Yingde City Guangdong Province, Qingyuan, Guangdong, China
| | - Yuyang Han
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiquan Chen
- People's Hospital of Yingde City Guangdong Province, Qingyuan, Guangdong, China
| | - Xu Mu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Chunjing He
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Jing Zhao
- People's Hospital of Yingde City Guangdong Province, Qingyuan, Guangdong, China
| | - Lin Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhifeng Huang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.
- Department of Burns Plastic and Wound Repair Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital, Ganzhou, Jiangxi, China.
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Fulbrook P, Butterworth J. Incidence and characteristics of device-related pressure injuries in intensive care: A four-year analysis. Intensive Crit Care Nurs 2025; 87:103955. [PMID: 39904075 DOI: 10.1016/j.iccn.2025.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/30/2024] [Revised: 01/11/2025] [Accepted: 01/15/2025] [Indexed: 02/06/2025]
Abstract
OBJECTIVES To describe and analyse the incidence and characteristics of intensive care-acquired device-related pressure injuries. DESIGN Secondary data analysis of intensive care-acquired pressure injuries during 2019-2022. SETTING Single general intensive care unit in Brisbane, Australia. MAIN OUTCOME MEASURES Intensive care-acquired pressure injury incidence, device-related pressure injury incidence, non-device-related pressure injury incidence, pressure injury category and location, device associated with pressure injury. RESULTS During the 4-year period, there were 7343 intensive care admissions of whom 413 (5.6 %) patients developed an intensive care-acquired pressure injury. The incidence of device-related pressure injury was 4.0 % compared to 2.7 % non-device-related pressure injury. In total there were 461 device-related pressure injuries, which were mostly (55 %) associated with endotracheal tubes or the methods used to secure them. Consequently, the majority of injuries were found on the mucous membranes (lips, mouth and tongue). The other main devices associated with injuries were high-flow nasal prongs (9.3 %), indwelling urinary catheters (6.7 %), nasogastric tubes (6.5 %) and oxygen masks (5.0 %). Overall, device-related pressure injuries were less severe than non-device-related pressure injuries, however they occurred in a shorter time frame (median 4 days versus 6 days). A range of factors was associated with device-related pressure injuries but overall, their presence or duration was less than with non-device-related pressure injuries. CONCLUSION The study results provide rigorous evidence of the incidence and characteristics of device-related pressures injuries, that can be used to benchmark with other intensive care units nationally and internationally. IMPLICATIONS FOR CLINICAL PRACTICE Endotracheal tube-associated pressure injuries were the most common type of device-related injury, providing a clear focus for preventative intervention. Given the high proportion of these device-related injuries, effective interventions would have a significant impact on overall reduction of intensive care-acquired pressure injuries. Since most injuries occur within three days of device insertion, early preventative intervention is time-critical.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.
| | - Jacob Butterworth
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
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Mahmoodpoor A, Chalkias A, Izadi M, Gohari-Moghadam K, Rahimi-Bashar F, Karadağ A, Khosh-Fetrat M, Vahedian-Azimi A. Association of norepinephrine with pressure ulcer development in critically ill patients with COVID-19-related acute respiratory distress syndrome: A dose-response analysis. Intensive Crit Care Nurs 2025; 86:103796. [PMID: 39117534 DOI: 10.1016/j.iccn.2024.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/04/2024] [Revised: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To investigate the correlation between varying doses of norepinephrine (NE) and the incidence of pressure injuries (PIs) in COVID-19 patients in intensive care units (ICUs). DESIGN A retrospective multicenter study was conducted on 1,078 COVID-19 patients admitted to ICUs with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. The research spanned from March 2020 to April 2021 across five university-affiliated hospitals in Iran. Univariate and multivariate binary logistic regression analyses, along with linear and non-linear dose-response assessments, were utilized to evaluate the relationship between NE dosages and the probability of PI development. FINDINGS The multivariate analysis revealed a significant association between higher doses of NE administered over 24 h (OR: 1.832, 95 % CI: 1.218-2.754, P=0.004) and cumulative doses (OR: 1.408, 95 % CI: 1.204-1.975, P=0.048) with the occurrence of PIs. Moreover, patients receiving high NE doses had a nearly fourfold increased risk of developing PIs, regardless of PIs stage, compared to those on low or moderate doses (>15 µg/min vs. ≤ 15 µg/min; OR: 4.401, 95 % CI: 3.339-5.801, P=0.001). Although the linear dose-response analysis did not show a significant correlation between NE doses and PI development (P>0.05), the non-linear analysis indicated that NE doses ≤ 9 µg/min were associated with a reduced risk of PI development. CONCLUSION Maintaining NE infusion within the range of 1-9 µg/min appears to be most effective in reducing the likelihood of PIs in ICU patients with COVID-19. Lower NE doses (≤9 µg/min) were associated with a lower risk of PI development, suggesting that factors beyond NE dosage or the use of other vasopressors may play a crucial role in PI formation in this patient cohort. IMPLICATIONS FOR CLINICAL PRACTICE Rather than suggesting a specific threshold, clinicians should consider further studies to determine the optimal dose that balances microvascular perfusion and patient outcomes. It is crucial to comprehensively evaluate additional factors and selectively use vasopressors. Individualized care, including regular monitoring and personalized treatment plans, is essential for achieving the best outcomes in this patient population.
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Affiliation(s)
- Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Athanasios Chalkias
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Outcomes Research Consortium, Cleveland, OH 44195, USA.
| | - Morteza Izadi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Kievan Gohari-Moghadam
- Medical ICU and Pulmonary Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Ayişe Karadağ
- Koc University School of Nursing, 34010 Istanbul, Türkiye.
| | - Masoum Khosh-Fetrat
- Department of Anesthesiology and Critical Care, Khatamolanbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Amir Vahedian-Azimi
- Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Bi L, Liu Y, Zhang L, Zhang X, Wang D. High expression of SERPINE1 and CTSL in keratinocytes in pressure injury caused by ischemia-reperfusion injury. Tissue Cell 2025; 93:102746. [PMID: 39864211 DOI: 10.1016/j.tice.2025.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/25/2024] [Revised: 01/14/2025] [Accepted: 01/15/2025] [Indexed: 01/28/2025]
Abstract
INTRODUCTION Pressure Injury (PI) is a complex disease process which is influenced by multiple factors, among which ischemia-reperfusion (I/R) injury is closely related to the progression of PI. But its biomarkers are still unclearly. Understanding its physiological mechanisms and related molecular biomarkers is a key to developing effective prevention and therapeutic strategies. METHODS This study through obtained the candidate genes of the differentially expressed genes (DEGs) from the PI rat model by transcriptome sequencing, PI single-cell sequencing database, and genes related to I/R injury from GeneCards database to analyze and screen prognostic related target genes. Gene Ontology (GO) and Kyoto Encyclopedia of Genomes (KEGG) pathway analysis were performed using clusterProfiler package, and a protein-protein interaction (PPI) network was constructed to identify hub genes. The genes related to I/R injury were identified and analyzed using three machine learning algorithms. Then, the hub genes were evaluated using nomogram and receiver operating characteristic (ROC) curves, and validated using immunohistochemistry in the PI rat model. RESULTS There were finally 7 candidate genes obtained from the intersection of the three datasets. GO and KEGG pathway analysis revealed that the DEGs were enriched in complement and coagulation cascades, and the keratinocyte differentiation is a significant factor. Then, two hub genes Serine protease inhibitor clade E member 1 (SERPINE1) and Cathepsin L (CTSL) were identified through three machine learning algorithms. The two hub genes were indicated had a high prognosis value by nomogram and ROC curves. SERPINE1 and CTSL both play crucial roles in vasculogenesis, coagulation and degradation of the extracellular matrix, which is essential for wound healing. The results of immunohistochemistry demonstrated that SERPINE1 and CTSL are significantly upregulated in skin tissue from PI caused by I/R injury, and their mRNA expression levels significantly correlate with PI outcomes. CONCLUSION According to our research we referred that the SERPINE1 and CTSL might be the potential biomarkers of PI.
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Affiliation(s)
- Lexuan Bi
- School of Nursing, Binzhou Medical University, Yantai, Shandong 264003, PR China; Institute of Regenerative Medicine, Binzhou Medical University, Yantai, Shandong 264003, PR China
| | - Yaxin Liu
- School of Nursing, Binzhou Medical University, Yantai, Shandong 264003, PR China
| | - Lei Zhang
- Second Clinical Medical College, Binzhou Medical University, Yantai, Shandong 264003, PR China
| | - Xiaoli Zhang
- School of Nursing, Binzhou Medical University, Yantai, Shandong 264003, PR China.
| | - Dong Wang
- Institute of Regenerative Medicine, Binzhou Medical University, Yantai, Shandong 264003, PR China; Department of Histology and Embryology, Binzhou Medical University, Yantai, Shandong 264003, PR China.
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Kandula UR. Impact of multifaceted interventions on pressure injury prevention: a systematic review. BMC Nurs 2025; 24:11. [PMID: 39762920 PMCID: PMC11702047 DOI: 10.1186/s12912-024-02558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/05/2024] [Accepted: 11/27/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Pressure injuries are a significant concern in healthcare settings, leading to increased morbidity, healthcare costs, and patient suffering. This systematic review aims to evaluate the impact of multifaceted interventions on the prevention of Pressure injuries and improvements in nursing practices. METHODS A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across multiple databases, including studies from Google Scholar (332), Science Direct (14), grey literature sources (45), PubMed (0), Cochrane Library (437), and Hinari (322). Studies included in the review examined the effectiveness of various interventions, including educational programs, care bundles, and positioning strategies, on Pressure injury prevention. RESULTS The interventions significantly reduced Pressure injury prevalence from 60.9 to 28.7%, with hospital-acquired injuries decreasing from 52.9 to 21.3%. The mean national prevalence of Pressure injuries was 17.6%, with 58.1% being community-acquired. Educational programs greatly enhanced nurses' knowledge and practices, particularly regarding the Braden scale and wound care protocols. Key risk factors identified were patient age, sex, and chronic diseases. Effective strategies included the use of air cushions and specific positioning techniques. Care bundles were found to prevent pressure ulcers in 90% of patients in the study group, and medical device-related Pressure Injuries were reduced to 5.01%. CONCLUSION Multifaceted interventions, including education, care bundles, and positioning strategies, are highly effective in reducing the prevalence of Pressure Injuries and improving nursing practices. Implementing comprehensive prevention strategies is essential for mitigating Pressure Injury risks in healthcare settings.
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Affiliation(s)
- Usha Rani Kandula
- Department of Adult Health Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia.
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Yang X, Yan F, Xie S, Shang Y, Wang M, Wen D, He H. Acute skin failure knowledge, attitudes and practices amongst intensive care unit nurses in China: A multicentre cross-sectional survey. Int Wound J 2025; 22:e70099. [PMID: 39800335 PMCID: PMC11725354 DOI: 10.1111/iwj.70099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/14/2024] [Revised: 09/28/2024] [Accepted: 09/30/2024] [Indexed: 01/16/2025] Open
Abstract
PURPOSE To investigate the knowledge, attitudes and practices of intensive care unit (ICU) nurses regarding acute skin failure (ASF) and analyse the influencing factors thereof. METHODS From 22 December 2023 to 24 January 2024, a cross-sectional study was conducted amongst ICU nurses from 21 hospitals in eight provinces in China. The ASF knowledge, attitude and practice scores were determined using questionnaires, and multiple linear regression was used for further analysis. RESULTS Overall, 304 ICU nurses completed the survey. The knowledge, attitude and practice scores were 24.89 ± 10.93, 40.67 ± 5.93 and 43.47 ± 9.19, with scoring rates of 45.25%, 81.34% and 72.45%, respectively. Multiple linear regression analysis showed that being a wound ostomy specialist nurse was positively correlated with the knowledge dimension score (p < 0.05). Nurses' professional titles significantly affected attitude scores (p < 0.05); the higher the professional title, the more positive the attitude towards ASF. CONCLUSION The attitudes and practices of ICU nurses in China towards ASF were found to be positive; however, their knowledge levels need improvement. Nursing managers should conduct targeted training, especially for entry-level nurses.
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Affiliation(s)
- Xiuru Yang
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Fenglin Yan
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Sha Xie
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Yinju Shang
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Mei Wang
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Dan Wen
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
| | - Haiyan He
- Intensive Care Unit, Mianyang Central Hospital, School of MedicineUniversity of Electronic Science and Technology of ChinaMianyangChina
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Lovegrove J, Fulbrook P, Yuan C, Lin F, Liu XL. The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study. Aust Crit Care 2025; 38:101093. [PMID: 39129066 DOI: 10.1016/j.aucc.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/01/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND The COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use. OBJECTIVES This study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale. METHODS The study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales. RESULTS Inter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949-0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values >0.6, whereas two Braden Scale subscales (Mobility, Activity) were below this threshold. Instrument sum scores were strongly correlated (Pearson's r = -0.76 [r2 = 0.58]; p < 0.001), as were three subscale item pairs (mobility rs= -0.56 [r2 = 0.32]; nutrition rs= -0.63 [r2 = 0.39]; level of consciousness/sensory perception rs= -0.67 [r2 = 0.45] p < 0.001). CONCLUSION Both the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.
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Affiliation(s)
- Josephine Lovegrove
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Southport, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Australia; School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioral Sciences, The University of Queensland & UQCCR, Herston, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cui Yuan
- Peking University First Hospital, Beijing, China
| | - Frances Lin
- Peking University First Hospital, Beijing, China; Flinders University, Adelaide, Australia
| | - Xian-Liang Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong SAR, China
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Sichieri K, De Matos TM, Santos TR, Secoli SR. Pressure injury prevention in an intensive care unit: implementing the best practices. Rev Gaucha Enferm 2024; 45:e20240166. [PMID: 39699339 DOI: 10.1590/1983-1447.2024.20240166.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/13/2024] [Accepted: 09/19/2024] [Indexed: 12/20/2024] Open
Abstract
OBJECTIVE to implement the best evidence in preventing pressure injuries in patients in the intensive care unit of a university hospital in the city of São Paulo/Brazil. METHOD a quasi-experimental study whose intervention was implementing evidence based on the Joanna Briggs Institute methodology, which includes auditing and feedback. Ten audit criteria were used, which were verified in patient records and training records of the teaching and quality service. The intervention was assessed by comparing the percentage of compliance with audited criteria before and after implementing the best practices. Pearson's chi-squared test was used. RESULTS 2,677 days of baseline and follow-up audit records were evaluated, regarding 340 patients. Compliance baseline and follow-up audits differed for most criteria (p-value <0.001). The main barriers were the lack of records of essential information on pressure injuries in the medical records, and strategies for overcoming these barriers included a review of the pressure injury prevention protocol and training of the nursing team. CONCLUSION the intervention adopted contributed to improving practices regarding the prevention of pressure injuries, expressed by the increase in the rate of compliance with the criteria and the proposal of improvement strategies to overcome barriers.
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Affiliation(s)
- Karina Sichieri
- Universidade de São Paulo. Hospital Universitário, Departamento de Enfermagem, São Paulo, São Paulo, Brasil
- Universidade de São Paulo. Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, São Paulo, Brasil
| | - Tatiane Martins De Matos
- Universidade de São Paulo. Hospital Universitário, Departamento de Enfermagem, São Paulo, São Paulo, Brasil
| | - Talita Raquel Santos
- Universidade de São Paulo. Hospital Universitário, Departamento de Enfermagem, São Paulo, São Paulo, Brasil
| | - Sílvia Regina Secoli
- Universidade de São Paulo. Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, São Paulo, Brasil
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Fang W, Zhang Q, Chen Y, Qin W. Knowledge, attitude, and practice of clinical nurses towards medical device-related pressure injury prevention: A systematic review. J Tissue Viability 2024; 34:100838. [PMID: 39668092 DOI: 10.1016/j.jtv.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/26/2024] [Revised: 11/26/2024] [Accepted: 12/03/2024] [Indexed: 12/14/2024]
Abstract
OBJECTIVE To evaluate clinical nurses' knowledge, attitude, and practice toward MDRPI prevention. BACKGROUND Medical device-related pressure injury (MDRPI) is a significant concern in healthcare, serving as a critical indicator of patient safety and the quality of nursing care. METHODS This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed on PubMed, Embase, Web of Science, the Cochrane Library, and CINAHL, as well as Chinese databases including China Biology Medicine Disc (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database using the relevant keywords, from the earliest available records to June 27, 2024. The quality of the studies was appraised using the Joanna Briggs Institute (JBI) literature evaluation tool. FINDINGS A total of 8847 clinical nurses from 18 studies were included. Of these, 6502 working in intensive care units. While nurses generally exhibited a positive attitude, their knowledge and practice were insufficient. Several factors positively influenced nurses' knowledge, attitude, and practice regarding MDRPI prevention, which include the level of education, work experience, previous training on MDRPU, caring for MDRPI patients, being an ICU specialist nurse, working in tertiary hospitals, and holding wound care certifications. CONCLUSION This review underscores the critical need to develop educational training programs to enhance nurses' competencies in MDRPI prevention. It also highlights the importance of addressing the challenges in implementing these strategies to ensure their effectiveness in clinical practice.
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Affiliation(s)
- Wanwan Fang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Qi Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yuxuan Chen
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Wei Qin
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
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Cowart JB, De Frías JS, Pollock BD, Knepper C, Sammon N, Jonna S, Singh T, Bhakta S, Olivero L, Ochoa S, Ramar K, Franco PM. Increased Risk and Unique Clinical Course of Patient Safety Indicator-3 Pressure Injuries Among COVID-19 Hospitalized Patients. J Patient Saf 2024; 20:e128-e134. [PMID: 39269226 DOI: 10.1097/pts.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND The COVID-19 pandemic introduced unique challenges to healthcare systems, particularly in relation to patient safety and adverse events during hospitalization. There is limited understanding of COVID-19's association with some patient safety indicators (PSIs). OBJECTIVES This study aimed to investigate the impact of COVID-19 infection on the rate of PSI-3 events and its implications on quality metrics. We compared PSI-3 event rates between COVID-19-infected and uninfected patients and examined the clinical characteristics of COVID-19 patients experiencing PSI-3 events. METHODS This is a retrospective study at Mayo Clinic hospitals between January 2020 and February 2022, analyzing patients meeting PSI-3 denominator eligibility criteria. PSI-3 events were identified using AHRQ WinQI software. Patients were categorized based on COVID-19 status. Patient demographics, characteristics, and PSI-3 rates were compared. A case series analysis described clinical details of COVID-19 patients with PSI-3 events. RESULTS Of 126,781 encounters meeting PSI-3 criteria, 8674 (6.8%) had acute COVID-19 infection. COVID-19-infected patients were older, more likely to be male, non-white, and had private insurance. PSI-3 rates were significantly higher in COVID-19 patients (0.21% versus 0.06%, P < 0.0001), even after risk adjustment (adjusted risk ratio, 3.24, P < 0.0001). The case series of 17 COVID-19 patients with PSI-3 events showed distinctive clinical characteristics, including higher medical device-related pressure injuries, and greater predisposition for head, face, and neck region. CONCLUSIONS Acute COVID-19 infection correlates with higher PSI-3 event rates. Current quality indicators may require adaptation to address the pandemic's complexities and impact on patient safety. Further research is needed to comprehensively understand the intricate relationship between COVID-19 and patient outcomes.
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Affiliation(s)
| | | | | | | | | | - Sadhana Jonna
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Trisha Singh
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Shivang Bhakta
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Lorenzo Olivero
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
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Ross P, Du Plooy D, Sheldrake J, Ronayne L, Keogh P, Collins K, Simpson A, Pilcher D, Udy A. The epidemiology of pressure injuries in adult intensive care unit patients supported with extracorporeal membrane oxygenation. CRIT CARE RESUSC 2024; 26:227-240. [PMID: 39781497 PMCID: PMC11704423 DOI: 10.1016/j.ccrj.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/13/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 01/04/2025]
Abstract
Objective To describe the epidemiology and clinical features of pressure injury (PI) development in adult patients supported with extracorporeal membrane oxygenation (ECMO). Design Retrospective, observational, cohort study from January 2018 to May 2023. Setting A single-centre high-volume ECMO specialist intensive care unit (ICU). Participants All adults (aged 18 y or more) admitted to ICU for more than 24 h. Main Outcome Measures Any PI developing more than 24 h after ICU admission. Results Five-hundred ICU patients were supported with ECMO during the study period. Excluding those <18 years of age and with an ICU length of stay of <24 h, 466 patients were included in the analysis. One-hundred-thirty-five (29.0%) patients acquired at least one PI during their ICU stay, with PI occurring in 80 patients (17.2%) whilst supported on ECMO. The PI incidence rate was 1.7 per 100 ECMO patient-days (confidence interval: 1.3-2.0). Patients with a PI were mechanically ventilated for longer, received more renal replacement therapy, manifested more delirium, and stayed longer in the ICU and hospital. Conversely, crude ICU and in-hospital mortality was lower in the PI group. A longer ECMO run time and a higher proportion of veno-venous ECMO was also noted in those with a PI. Factors independently associated with the acquisition of a PI were male gender, oral dietary intake, renal replacement therapy, and prolonged mechanical ventilation. The majority of the PIs acquired during ECMO were stage-two and were most commonly located on the neck and head (n = 25/96 PIs, 26.0%) and sacral region (n = 31/96 PIs, 32.3%). Only three PIs were in relation to the ECMO cannula, circuit, or dressing. Conclusion A significant proportion of patients develop PIs while receiving ECMO. Vigilance on the prevention of medical device related PI is required. Gender, renal replacement therapy, oral diet, and length of mechanical ventilation were independent predictors for PI development in this population.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Darrel Du Plooy
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Jayne Sheldrake
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Laura Ronayne
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Padraig Keogh
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Kathleen Collins
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Alex Simpson
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - David Pilcher
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia
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12
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Chen L, Zhang Y, Wang K, Jin M, Chen Q, Wang S, Hu W, Cai Z, Li Y, Li S, Gao Y, Zhou S, Peng Q. A patch comprising human umbilical cord-derived hydrogel and mesenchymal stem cells promotes pressure ulcer wound healing. ENGINEERED REGENERATION 2024; 5:433-442. [DOI: 10.1016/j.engreg.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/04/2025] Open
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13
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Fu L, Zheng X, Luo J, Zhang Y, Gao X, Jin L, Liu W, Zhang C, Gao D, Xu B, Jiang Q, Chou S, Luo L. Machine learning accelerates the discovery of epitope-based dual-bioactive peptides against skin infections. Int J Antimicrob Agents 2024; 64:107371. [PMID: 39486466 DOI: 10.1016/j.ijantimicag.2024.107371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/28/2024] [Revised: 09/03/2024] [Accepted: 10/22/2024] [Indexed: 11/04/2024]
Abstract
OBJECTIVES Skin injuries and infections are an inevitable part of daily human life, particularly with chronic wounds, becoming an increasing socioeconomic burden. In treating skin infections and promoting wound healing, bioactive peptides may hold significant potential, particularly those possessing antimicrobial and anti-inflammatory properties. However, obtaining these peptides solely through traditional wet laboratory experiments is costly and time-consuming, and peptides identified by current computer-assisted predictive models largely lack validation of their effects via wet laboratory experiments. Consequently, this study aimed to integrate computer-assisted methods and traditional wet laboratory experiments to identify anti-inflammatory and antimicrobial peptides. METHODS We developed a computer-assisted mining pipeline to screen potential peptides from the epitopes of the major histocompatibility complex class II. RESULTS The peptide AIMP1 was identified, with the ability to physically damage Escherichia coli by increasing bacterial cell membrane permeability, and with the ability to inhibit inflammation by binding to endotoxin-lipopolysaccharide. Additionally, in an LPS-induced inflammation animal model, AIMP1 slightly increased levels of proinflammatory cytokines (TNF-α, IL-1β, and IL-6), and in a skin wound infection animal model, AIMP1 effectively accelerated healing, reduced levels of these pro-inflammatory cytokines, and showed no acute hepatotoxicity or nephrotoxicity. CONCLUSIONS In conclusion, this study not only developed a computer-assisted mining pipeline for identifying anti-inflammatory and antimicrobial peptides but also successfully pinpointed the peptide AIMP1, demonstrating its therapeutic potential for skin injury treatment.
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Affiliation(s)
- Le Fu
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Xu Zheng
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Jiawen Luo
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Yiyu Zhang
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Xue Gao
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, PR China
| | - Li Jin
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, PR China
| | - Wenting Liu
- Shenzhen Key Laboratory for Systems Medicine in Inflammatory Diseases, School of Medicine, Shenzhen Campus of Sun Yat-Sen University, Shenzhen, PR China
| | - Chaoqun Zhang
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Dongyu Gao
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Bocheng Xu
- Hangzhou Shenji Technology Co. Ltd, Hangzhou, PR China
| | - Qingru Jiang
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China.
| | - Shuli Chou
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China
| | - Liang Luo
- Department of Critical Care Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, PR China.
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Guerrero-Toapanta F, Sandoval-Cóndor M, Usuay-Usuay M, Paida-Cañar C, Cuenca-Bermúdes E. Capacidad de discriminación de la escala de valoración actual del riesgo de desarrollar úlcera por presión en pacientes críticos de Quito, Ecuador. ENFERMERIA INTENSIVA 2024:100505. [DOI: 10.1016/j.enfi.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/04/2025]
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15
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Latimer S, Chaboyer W, Walker RM, Thalib L, Deakin JL, Gillespie BM. Prophylactic dressings for preventing sacral pressure injuries in adult intensive care unit patients: A randomised feasibility trial. Aust Crit Care 2024; 38:101133. [PMID: 39550337 DOI: 10.1016/j.aucc.2024.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/18/2024] [Revised: 10/07/2024] [Accepted: 10/07/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Prophylactic dressings are used to prevent sacral pressure injuries (PIs) in intensive care unit (ICU) patients. Bedside clinicians are responsible for selecting these dressings despite the lack of comparative evidence. OBJECTIVES The objective of this study was to assess the feasibility of undertaking a larger multisite comparative effectiveness trial of two prophylactic sacral dressings in adult ICU patients. METHODS Using a two-arm pilot randomised feasibility trial design, we randomly allocated adult ICU patients to the Mepilex® Border Sacrum dressing or Allevyn™ Life Sacrum dressing plus usual PI prevention care. Our primary study outcomes were study eligibility, recruitment, retention, intervention fidelity, and missing data criteria. Participants were followed up for up to 14 days or a study endpoint: new sacral PI, ICU discharge, death, prone positioning, urine/faecal incontinence, or withdrawal. Daily clinical data were collected including a deidentified sacral photograph, sacral visual skin assessment, dressing failure rates (rolled edges, adhesion loss), and dressing-related harm (e.g., blisters). The blinded outcome assessor used these data to determine the presence of a new sacral PI. RESULTS From January to September 2023, 1069 ICU patients were screened; 77 (7.2%) were eligible, and 68 (88.3%) were recruited. Half of our feasibility criteria were met. One participant (1.5%) developed a sacral PI. Throughout the study, half (n = 54; 49.5%) of the dressing changes were due to dressing failure (rolled edges: n = 43; 79.5%, adhesion failure: n = 11; 20.5%). CONCLUSIONS Several prophylactic sacral dressings are available; however, comparative effective evidence between brands relative to performance, benefits, and harms is lacking. Following minor study criteria modifications, we found that a larger multisite comparative trial is feasible. Sacral prophylactic dressing failure and dressing-related harms are care quality and patient safety issues requiring further investigation regarding performance, harm, and costs. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registration number: ACTRN12622000793718 and World Health Organization Universal Trial number: U1111-1278-6055.
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Affiliation(s)
- Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Rachel M Walker
- Division of Surgery, Metro South Health, Princess Alexandra Hospital, Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Jodie L Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
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16
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Cobos-Vargas A, Fulbrook P, Lovegrove J, Acosta-Romero M, Camado-Sojo L, Colmenero M. Implementation of a risk-stratified intervention bundle to prevent pressure injury in intensive care: A before-after study. Aust Crit Care 2024; 38:101123. [PMID: 39516150 DOI: 10.1016/j.aucc.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/25/2024] [Revised: 08/22/2024] [Accepted: 09/17/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Hospital-acquired pressure injury is an enduring problem in intensive care. Several intensive care-specific pressure injury risk assessment tools have been developed, but to date, only the COMHON Index has been aligned with risk-stratified preventative interventions. OBJECTIVES The aim of this study was to evaluate the effectiveness of a risk-stratified intervention bundle to reduce pressure injury in intensive care and to assess compliance with bundled interventions. METHODS A controlled before-after study was undertaken. All patients admitted to a single intensive care unit were included. Standard care was provided in the before phase, and the risk-stratified intervention bundle was implemented in the after phase. The primary outcome measure was pressure injury incidence. RESULTS The sample comprised 761 intensive care admissions. In the after phase, pressure injury incidence was reduced (2.1% vs 3.9%; 46% relative risk reduction), injury severity was lower, and there were fewer pressure injuries on the sacrum, buttocks, and heels. Logistic regression modelling identified three significant factors associated with pressure injury development: intensive care length of stay (odds ratio: 1.2); COMHON Index admission score (odds ratio: 1.2), and the before phase (odds ratio: 4.2). In the after phase, individual intervention compliance was variable (range: 40%-100%), but the all-or-nothing compliance was poor (33%). CONCLUSIONS Implementation of bundled preventive measures associated with COMHON Index risk level reduced pressure injury incidence. Likewise, injury severity decreased, and the location of pressure injuries changed following the intervention. The results from this study support the use of risk-stratified interventions to prevent pressure injury in intensive care. However, further research is needed to examine the effectiveness of the COMHON Index bundle before it can be recommended for widespread clinical practice.
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Affiliation(s)
- Angel Cobos-Vargas
- Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Paul Fulbrook
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland 4014, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia; School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Josephine Lovegrove
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland 4222, Australia; School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, Queensland 4006, Australia.
| | - María Acosta-Romero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain.
| | - Luís Camado-Sojo
- Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain.
| | - Manuel Colmenero
- Critical Care Department, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
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Aljezawi M, Al Qadire M, Al Omari O, Al Sabei S, Hani SB, Suliman M, Alaloul F, Abdelrahman H. Hospital acquired pressure injuries prevalence and preventive measures in Omani critical care units: A multicenter cross-sectional study. J Tissue Viability 2024; 33:808-813. [PMID: 39578150 DOI: 10.1016/j.jtv.2024.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/22/2024] [Revised: 09/28/2024] [Accepted: 11/05/2024] [Indexed: 11/24/2024]
Abstract
BACKGROUND Pressure Injuries are a prevalent and concerning issue in critical care settings, impacting patient well-being and healthcare systems. PURPOSE Measure the point prevalence of acquired pressure injuries in Omani critical care units and assess the adequacy of preventive measures. METHODS A multicenter cross-sectional survey was conducted in four major Omani hospitals, encompassing various geographical regions and health sectors. A convenient sample of 156 adult patients in critical care units was examined using the European Pressure Ulcer Advisory Panel methodology. Data on prevalence, risk assessment, and prevention measures were collected and analyzed. RESULTS The study revealed a prevalence rate of 21.8 % for hospital-acquired pressure injuries (including stage I) and 19.2 % (excluding stage I) in Omani critical care units. The sacrum was the most affected area, with stage II being predominant. Alarmingly, some at-risk patients did not receive appropriate preventive equipment, while low-risk patients received unnecessary measures. Approximately 73.3 % of at-risk patients received adequate prevention. CONCLUSION This pioneering study in Oman addresses the prevalence of Pressure Injuries, revealing rates that are higher than international norms. Additionally, the research underscores deficiencies in preventive measures, such as inadequate prevention for at-risk patients and unnecessary measures for low-risk individuals.
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Affiliation(s)
- Ma'en Aljezawi
- Community & Mental Health Department, Faculty of Nursing, Al Al-Bayt University, P.O.Box 130040, Mafraq, 25113, Jordan.
| | - Mohammad Al Qadire
- Adult Health Department, Faculty of Nursing, Al Al-Bayt University, P.O.Box 130040, Mafraq, 25113, Jordan.
| | - Omar Al Omari
- Sultan Qaboos University, P.O. Box 66, PC 123, Muscat, Sultanate of Oman.
| | - Sulaiman Al Sabei
- Sultan Qaboos University, P.O. Box 66, PC 123, Muscat, Sultanate of Oman.
| | - Salam Bani Hani
- Adult Health Department, Faculty of Nursing, Al Al-Bayt University, P.O.Box 130040, Mafraq, 25113, Jordan.
| | - Mohammad Suliman
- Al al-Bayt University/ Faculty of Nursing, Community and Mental Health department, P.O. Box 130040, Mafraq, 25113, Jordan.
| | - Fawwaz Alaloul
- College of Nursing, Sultan Qaboos University, P.O. Box 66, PC 123, Muscat, Sultanate of Oman.
| | - Hanan Abdelrahman
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Faculty of Nursing, Suez Canal University, Ismailia, Egypt
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18
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Alves P, Bååth C, Manuel T, Almeida S, Källman U. Pressure ulcers during the COVID-19 pandemic in intensive care:A multicenter cohort study. J Tissue Viability 2024; 33:642-651. [PMID: 38937249 DOI: 10.1016/j.jtv.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/29/2023] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
AIM The objective of the present study is twofold: to describe the prevalence and incidence of pressure ulcers (PUs) among ICU patients during the COVID-19 pandemic, and to identify the risk factors associated with the development of PUs in this cohort of ICU patients. MATERIALS AND METHODS Retrospective cohort study of adult critical care patients admitted in two general ICUs of two different countries (Sweden and Portugal) between March 1st, 2020, and April 30th, 2021, through the analysis of the electronic health record database. The prevalence and incidence were calculated, and a multivariate logistic-regression model was used to calculate odds ratios (ORs), of possible risk factors of PU development. RESULTS The sample consisted of 1717 patients. The overall prevalence of PU was 15.3 %, and the incidence of ICU-acquired PUs was 14.1 %. Most of the pressure ulcers documented in this study were at the anterior part of the body (45.35 %) and regarding classification, Category 2 (38.40 %) and Category 3 (22.71 %) pressure ulcers together accounted for over fifty percent of the cases recorded. In the multivariate logistic regression model for PU, age, having COVID-19 (OR = 1.58, 95 % CI: 1.20-2.09), use of mechanical ventilation (OR = 1.49, 95 % CI: 1.13 = 1.97), use of vasopressors (OR = 1.31, 95 % CI: 1.00-1.70), having a Braden risk score ≤16 at admission (OR = 1.63; 95 % CI: 1.04-2.56), and length of stay (LOS) (OR = 1.43, 95 % CI 1.03-2.00 if LOS 90-260 h, OR = 2.34, 95 % CI: 1.63-3.35 if LOS >260 h) were associated with the likelihood of developing an ICU-acquired PUs. CONCLUSION When adjusted for covariates patients with COVID-19 had a higher risk for PU development during the ICU stay compared to patients without COVID-19. Health care personnel in ICU may consider incorporating COVID-19, age, use of mechanical ventilation, vasopressors and estimated LOS in addition to a comprehensive risk assessment including both a risk score and clinical assessment.
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Affiliation(s)
- Paulo Alves
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal.
| | - Carina Bååth
- Karlstad University, Department of Health Sciences, Karlstad, Sweden; Østfold University College, Faculty of Health, Welfare and Organization, Fredrikstad, Norway
| | - Tânia Manuel
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal; Portuguese Wound Management Association (APTFeridas), Portugal
| | - Sofia Almeida
- Universidade Católica Portuguesa | Wounds Research Lab - Centre for Interdisciplinary Research in Health, Portugal; Universidade Católica Portuguesa | School of Nursing of the Institute of Health Sciences, Porto, Portugal
| | - Ulrika Källman
- Research Unit, FoUI Department, Södra Älvsborgs Hospital, Borås, Sweden; University of Gothenburg, Faculty of Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden
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Shi L, Shao J, Luo Y, Liu G, OuYang M. The incidence and risk factors of gastrointestinal dysfunction during enteral nutrition in mechanically ventilated critically ill patients. Nurs Open 2024; 11:e2247. [PMID: 39474999 PMCID: PMC11523002 DOI: 10.1002/nop2.2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/31/2022] [Revised: 06/06/2023] [Accepted: 06/12/2024] [Indexed: 11/02/2024] Open
Abstract
AIM To assess the occurrence and risk factors of gastrointestinal (GI) dysfunction during enteral nutrition (EN) in critically ill patients supported with mechanical ventilation. DESIGN Prospective observational study. METHODS Totally 252 patients admitted at a mixed medical-surgical ICU were enrolled. GI symptoms and the potential risk variables were recorded during the first 14 days of EN. RESULTS The incidence of GI dysfunction was 65.5%, and the incidence of diarrhoea, constipation, abdominal distension, and upper GI intolerance was 28.2%, 18.3%, 6.7% and 12.3%, respectively. The median onset days of constipation, diarrhoea, abdominal distension and UDI was 3, 5, 5 and 6 days, respectively. Multivariable Cox regression analysis showed a significant relationship between GI dysfunction and age (HR = 2.321, 95% CI: 1.024-5.264, p = 0.004), APACHE-II score at ICU admission (HR = 7.523, 95% CI: 4.734-12.592, p = 0.018), serum albumin level (HR = 0.594, 95% CI: 0.218-0.889, p = 0.041), multidrug-resistant bacteria-positive culture (HR = 6.924, 95% CI: 4.612-10.276, p<0.001), negative fluid balance (HR = 0.725, 95% CI: 0.473-0.926, p = 0.037), use of vasopressor drugs (HR = 1.642, 95% CI: 1.297-3.178, p<0.001), EN way (HR = 6.312, 95% CI: 5.143-11.836, p<0.001), infusion rate (HR = 1.947, 95% CI: 1.135-3.339, p<0.001), and intra-abdominal hypertension (HR = 3.864, 95% CI: 2.360-5.839, p<0.001). CONCLUSION Critically ill patients supported with mechanical ventilation are at a high risk of GI dysfunction. Interventions such as the use of laxatives or prokinetic agents, control of EN infusion rate, and maintaining a normal state of hydration, might be beneficial for the prevention of GI dysfunction in critically ill patients. PATIENT OR PUBLIC CONTRIBUTION No.
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Affiliation(s)
- Ling Shi
- Huizhou Central People's HospitalHuizhouGuangdongChina
| | - Jianmei Shao
- The First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Yuxia Luo
- Huizhou Central People's HospitalHuizhouGuangdongChina
| | - Guiyan Liu
- Huizhou Central People's HospitalHuizhouGuangdongChina
| | - Miao OuYang
- Huizhou Central People's HospitalHuizhouGuangdongChina
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20
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Coventry L, Towell-Barnard A, Winderbaum J, Walsh N, Jenkins M, Beeckman D. Nurse knowledge, attitudes, and barriers to pressure injuries: A cross-sectional study in an Australian metropolitan teaching hospital. J Tissue Viability 2024; 33:792-801. [PMID: 39448363 DOI: 10.1016/j.jtv.2024.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/10/2024] [Revised: 09/06/2024] [Accepted: 10/04/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Pressure injuries are associated with significant clinical complications with negative effects on the patient's emotional, psychological, social and physical wellbeing. However, in Australia little is known about the knowledge and attitudes of nurses towards hospital-acquired pressure injuries. OBJECTIVE To determine nurse knowledge and attitudes towards hospital-acquired pressure injuries and to identify barriers towards prevention. METHODS A cross-sectional study following the STROBE statement was conducted between May to July in 2017. All nurses at a major metropolitan teaching hospital in Western Australia were invited to participate. Nurse knowledge and attitude to pressure injury were assessed using validated Pressure Ulcer Knowledge Assessment tool, and Attitude towards Pressure Ulcer Prevention tool. An open-ended question asked about the barriers to pressure injury prevention. Quantitative data were analysed using descriptive and inferential statistics and answers for the open-ended question were analysed using thematic analysis. RESULTS Data from 224 nurses (response rate 19.0 %) were analysed. While nurses displayed a satisfactory attitude towards hospital-acquired pressure injury prevention, most nurses lacked adequate knowledge of the stages, causes and prevention of pressure injuries. Thematic analysis of responses to the open-ended question yielded two main themes: modifiable barriers to pressure injury prevention were lack of knowledge, attitude of pressure injury prevention and the scarcity of resources. Non-modifiable barriers to pressure injury prevention were the nursing environment and patient characteristics. CONCLUSION Most nurses have satisfactory attitude towards pressure injury prevention, but inadequate knowledge about pressure injuries. Barriers to pressure injury prevention are attributed to nurse working environments, particularly impeded by staffing, time constraints and resources.
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Affiliation(s)
- Linda Coventry
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Perth, 6009, Australia; School of Nursing and Midwifery, Building 21, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, 6027, Australia; Centre for Research in Aged Care Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, 6027, Australia.
| | - Amanda Towell-Barnard
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Perth, 6009, Australia; School of Nursing and Midwifery, Building 21, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, 6027, Australia
| | - Joelle Winderbaum
- School of Nursing and Midwifery, Building 21, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, 6027, Australia
| | - Nicole Walsh
- Wound Management, Corporate Nursing, Sir Charles Gairdner Hospital, Nedlands, Perth, 6009, Australia
| | - Mark Jenkins
- School of Nursing and Midwifery, Building 21, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, 6027, Australia
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Gent, Belgium; Swedish Centre for Skin and Wound Research, Nursing Science Unit, School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Vieira S, Mostardinha A, Alves P. Unveiling the Burden: A Six-Year Retrospective Analysis of Pressure Ulcer Epidemiology in a ICU. NURSING REPORTS 2024; 14:3291-3309. [PMID: 39585130 PMCID: PMC11587432 DOI: 10.3390/nursrep14040239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/03/2024] [Revised: 10/18/2024] [Accepted: 10/30/2024] [Indexed: 11/26/2024] Open
Abstract
OBJECTIVE This study describes the epidemiological changes in pressure ulcers (PUs) in a Portuguese intensive care unit (ICU) from January 2017 to June 2023, characterizes critically ill patients with PUs, identifies specific risk factors, and assesses the effectiveness of implemented preventive measures. MATERIALS AND METHODS A retrospective observational cohort study was conducted, analyzing records of ICU patients with PUs during the specified period. Data were extracted from the institution's Global Risk Management application and the ICU's electronic PU registry. The study included patients with ICU stays longer than 24 h and excluded those with ineligible clinical records or incomplete characterization data. RESULTS Among 3816 evaluated patients, 257 developed a total of 345 PUs, averaging 1.4 PUs per patient. The average PU prevalence rate was 6.81%, with the highest prevalence in 2020 (11.0%) and the lowest in 2022 (3.48%). The average incidence rate was 3.76%, peaking at 5.71% in 2020 and declining to 2.54% in 2023. The sacrum and heels were the most commonly affected areas, with Category 2 PUs being the most frequent. Key intrinsic risk factors included systemic diseases and sensory deficits, with pressure identified as a significant extrinsic factor. Preventive measures focused on risk assessment and pressure control. CONCLUSIONS The study reveals a PU prevalence of 6.81% and an average incidence of 3.76%, underscoring the need for enhanced preventive strategies, especially in anatomical areas like the sacrum and heels. It emphasizes the importance of personalized assessments, continuous education for nursing staff, and a multidisciplinary approach to improve patient outcomes and care quality in the ICU.
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Affiliation(s)
- Sofia Vieira
- Center for Interdisciplinary Research in Health|CIIS, Wounds Research Lab, Faculdade de Ciências da Saúde e Enfermagem, Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (A.M.); (P.A.)
- Intensive Care Department, Hospital Dr. Nélio Mendonça, Serviço de Saúde da Região Autónoma da Madeira, EPERAM, 9000-177 Funchal, Portugal
| | - António Mostardinha
- Center for Interdisciplinary Research in Health|CIIS, Wounds Research Lab, Faculdade de Ciências da Saúde e Enfermagem, Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (A.M.); (P.A.)
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Ave, 4835-044 Guimarães, Portugal
| | - Paulo Alves
- Center for Interdisciplinary Research in Health|CIIS, Wounds Research Lab, Faculdade de Ciências da Saúde e Enfermagem, Universidade Católica Portuguesa, 4169-005 Porto, Portugal; (A.M.); (P.A.)
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22
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Roberts CJ, Popies JA, Razzak AN, Fang X, Falcucci OA, Pearson PJ, Szabo A. Skin injury: Associations with variables related to perfusion and pressure. Anaesth Intensive Care 2024; 52:386-396. [PMID: 39394874 PMCID: PMC11816658 DOI: 10.1177/0310057x241264575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/14/2024]
Abstract
Skin injuries are a major healthcare problem that are not well understood or prevented in the critically ill, suggesting that underappreciated variables are contributing. This pilot study tested the hypothesis that perfusion-related factors contribute to skin injuries diagnosed as hospital-acquired pressure injuries (HAPIs). A total of 533 adult patients were followed over 2574 critical care days (mean age 62.4, standard deviation (SD) 14.3 years, mean body mass index 30.4 (SD 7.4) kg/m2, 36.4% female). This was a secondary analysis of prospective, non-randomised clinical data from an intensive care unit at a large urban teaching hospital. Factors related to perfusion, specifically two or more infusions of vasopressors/inotropes, temporary mechanical circulatory support (MCS), extracorporeal membrane oxygenation, and durable MCS, were analysed to determine whether they were more strongly associated with HAPIs than immobility due to prolonged mechanical ventilation (>72 h) or operating room time (>6 h). Patients diagnosed with a HAPI had a statistically significant higher risk of being exposed to variables related to perfusion and immobility (P < 0.05 for each variable). Perfusion-related variables, except durable MCS, had a larger effect on skin breakdown (number needed to harm (NNH) 4-10) than immobility-associated variables (NNH 12-17). The finding that perfusion-related variables predicted HAPIs may warrant consideration of alternative diagnoses, such as skin failure due to impaired perfusion as a pathophysiological process that occurs concurrently with multisystem organ failure. Differentiation of skin injuries primarily from circulatory malfunction, rather than external pressure, may guide the development of more effective treatment and prevention protocols. This pilot study suggests that the contribution of perfusion to skin injuries should be explored further.
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Affiliation(s)
- Christopher J Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
| | - Jennifer A Popies
- Department of Advanced Practice Nursing, Froedtert Hospital, Milwaukee, WI 53226, USA
| | - Abrahim N Razzak
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
| | - Xi Fang
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Octavio A Falcucci
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Current Affiliation: Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Paul J Pearson
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Aniko Szabo
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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23
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Chen Z, Shen Z, Zhong X, Chen M. Effect of graded nursing based on risk early warning concept on the incidence of pressure injury, quality of life, and negative affect of long-term bedridden patients. Am J Transl Res 2024; 16:5454-5465. [PMID: 39544788 PMCID: PMC11558442 DOI: 10.62347/wyqm8037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/15/2024] [Accepted: 08/28/2024] [Indexed: 11/17/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of graded nursing based on the risk early warning concept in long-term bedridden patients. METHODS The medical records of 124 long-term bedridden patients admitted to the Department of Orthopaedics at the Yongzhou Hospital of Traditional Chinese Medicine from April 2022 to March 2024 were collected retrospectively. Patients were separated into two groups: the control group which received routine nursing, and the study group which received graded nursing based on the "risk early warning" concept. Key metrics recorded included turnover frequency and time to first out-of-bed activity, Braden score, incidence of pressure injury (PI), activities of daily living (ADL), motor function, quality of life, negative emotions, complications, and patient satisfaction. RESULTS Low Barden score was a risk factor for PI in long-term bedridden patients (P<0.05, OR=0.040, 95% CI: 0.006-0.254). The turnover interval time and the time to first out-of-bed activity in the study group were shorter than those of the control group (all P<0.05). Compared to the control group, the Braden score, modified Barthel index score, Fugl-Meyer assessment score and quality of life scores of the study group were substantially higher (all P<0.05). The incidence of PI in the study group (4.62%) was lower than that of the control group (22.03%), and the area of PI in the study group was smaller than that of the control group (all P<0.05). Compared to the control group, the scores of self-rating anxiety scale and self-rating depression scale in the study group were substantially lower (all P<0.05). The study group had lower total incidence of complications (3.08% vs. 20.34%) and higher total satisfaction (95.38% vs. 79.66%) than the control group (all P<0.05). CONCLUSION Graded nursing based on the risk early warning concept is highly effective in managing long-term bedridden patients. It reduces the occurrence of PI and complications, shortens the turnover interval time and the time to first out-of-bed activity, improves activities of daily living and motor function as well as quality of life, relieves negative emotions, and improves patient satisfaction.
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Affiliation(s)
- Zheng Chen
- Department of Hospital Administration, Yongzhou Hospital of Traditional Chinese MedicineYongzhou 425000, Hunan, China
| | - Zongying Shen
- Department of Operation, Yongzhou Hospital of Traditional Chinese MedicineYongzhou 425000, Hunan, China
| | - Xiaolong Zhong
- Department of Science and Education, Yongzhou Hospital of Traditional Chinese MedicineYongzhou 425000, Hunan, China
| | - Ming Chen
- Department of Orthopedics, Yongzhou Hospital of Traditional Chinese MedicineYongzhou 425000, Hunan, China
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24
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Wang Y, Li Y, Zhang Y, Wang H, Li Y, Zhang L, Zhang C, Gao M, Li H, Zhang D. Development and validation of a nomogram for predicting 28-day mortality in critically ill patients with acute gastrointestinal injury: prospective observational study. Front Nutr 2024; 11:1469870. [PMID: 39449820 PMCID: PMC11499162 DOI: 10.3389/fnut.2024.1469870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/24/2024] [Accepted: 09/30/2024] [Indexed: 10/26/2024] Open
Abstract
Objective Developing and validating a clinical prediction nomogram of 28-day mortality in critically ill patients with acute gastrointestinal injury (AGI). Methods Firstly, the construction of a clinical prediction model was developed using data obtained from a prospective observational study from May 2023 to April 2024. Then, data from a prospective multicenter observational study conducted in the intensive care units of 12 teaching hospitals in 2014 were utilized to independently and externally validate the clinical prediction model developed in the first part. We first screened the covariates of the development cohort by univariate cox regression, and then carried out cox regression analysis on the development cohort by backward stepwise regression to determine the optimal fitting model. Subsequently, a nomogram was derived from this model. Results A total of 1102 and 379 patients, 28-day mortality occurred in 20.3% and 15.8% of patients respectively, were included in the development and validation cohort, respectively. We developed a nomogram in critically ill patients with AGI and the AGI grade, APACHE II score, Mechanical ventilation (MV), Feeding intolerance (FI) and daily calorie intake (DCI) in 72 h, were independent predictors of 28-day mortality, with the OR of the AGI grade was 1.910 (95% CI, 1.588-2.298; P < 0.001), the OR of APACHE II score was 1.099 (95% CI, 1.069-1.130; P < 0.001), the OR of MV was 1.880 (95% CI, 1.215-2.911; P = 0.005), the OR of FI was 3.453 (95% CI, 2.414-4.939; P < 0.001) and the DCI > 0.7 or < 0.5 of calorie target is associated with increased 28-day mortality, with OR of 1.566 (95% CI, 1.024-2.395; P = 0.039) and 1.769 (95% CI, 1.170-2.674; P = 0.007), respectively. Independent external validation of the prediction model was performed. This model has good discrimination and calibration. The DCA and CIC also validated the good clinical utility of the nomogram. Conclusion The prediction of 28-day mortality can be conveniently facilitated by the nomogram that integrates AGI grade, APACHE II score, MV, FI and DCI in 72 h in critically ill patients with AGI.
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Affiliation(s)
- Youquan Wang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Yanhua Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Yuhan Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Huimei Wang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
| | - Yuting Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Liying Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Chaoyang Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Meng Gao
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Hongxiang Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China
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25
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Latimer S, Walker RM, Chaboyer W, Thalib L, Coyer F, Deakin JL, Gillespie BM. Prophylactic dressings to prevent sacral pressure injuries in adult patients admitted to intensive care units: A three-arm feasibility randomized controlled trial. Intensive Crit Care Nurs 2024; 84:103746. [PMID: 38896962 DOI: 10.1016/j.iccn.2024.103746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/11/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Pressure injuries in intensive care patients are a safety issue. Specialized foam sacral prophylactic dressings prevent pressure injuries with several products available for clinicians to choose from. OBJECTIVES Assess the feasibility of conducting a multisite trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients. METHODS Using a three-arm pilot randomized trial design, adult intensive care unit patients at risk for pressure injuries were randomly allocated to the Mepilex® Sacrum dressing, the Allevyn™ Life Sacrum dressing or the control group. Daily pressure injury data were collected including a de-identified sacral photograph, which the blinded outcome assessor used to determine the study end point: a new sacral pressure injury. Pre-determined feasibility criteria were measured in terms of eligibility, recruitment, retention, intervention fidelity and missing data. RESULTS From May-September 2021, we screened 602 intensive care unit adult patients for eligibility with 93 % (n = 558) excluded. Forty-four (7 %) were eligible, and all were recruited and randomized (100 %). After receipt of the intervention two participants withdrew from the study. Our final sample of 42 participants were randomly allocated to the Mepilex® (n = 12), Allevyn™ (n = 14) or control (n = 16) group. The interventions were delivered as intended and there were 11 (6 %) cases of missing outcome data. Five participants (12 %) developed a sacral pressure injury, four of whom received a sacral dressing. CONCLUSIONS A larger trial is feasible with minor refinement to the length of stay eligibility criterion. IMPLICATIONS FOR PRACTICE Prophylactic sacral dressings are recommended for pressure injury prevention. Determining the feasibility of a larger trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients can provide evidence to aid clinicians, policy makers and managers make value-based care decisions.
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Affiliation(s)
- Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Division of Surgery, Metro South Health, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, St. Lucia, QLD, Australia.
| | - Jodie L Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
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26
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Al-Mamari F, Al-Rawajfah O, Al Sabei S, Al-Wahaibi K. Hospital-acquired pressure ulcers among adult ICU patients in tertiary hospitals in Oman: a one-year prevalence study. J Wound Care 2024; 33:S10-S16. [PMID: 39388239 DOI: 10.12968/jowc.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 10/12/2024]
Abstract
BACKGROUND Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman. METHOD A retrospective, cross-sectional, nested, case-control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January-31 December 2019) in two tertiary hospitals in Oman. RESULTS The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001). CONCLUSION HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs.
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Affiliation(s)
| | - Omar Al-Rawajfah
- College of Nursing, Al al-Bayt University, Jordan
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | | | - Khalifa Al-Wahaibi
- General and Vascular Surgery, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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27
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Lian C, Zhang J, Wang P, Mao W. 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. BMC Pulm Med 2024; 24:462. [PMID: 39300424 PMCID: PMC11411915 DOI: 10.1186/s12890-024-03270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/04/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Mechanical 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. METHODS This 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. RESULTS Six 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). CONCLUSIONS While 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. REGISTRATION PROSPERO 2024 CRD42024570232.
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Affiliation(s)
- Chan Lian
- Department of Respiratory and Critical Care Medicine, Wenling First People's Hospital, No. 333 Chuanan South Road, Chengxi Sub-district, Wenling, Zhejiang Province, 317500, China
| | - Jiangnan Zhang
- Department of Respiratory and Critical Care Medicine, Wenling First People's Hospital, No. 333 Chuanan South Road, Chengxi Sub-district, Wenling, Zhejiang Province, 317500, China
| | - Pengfei Wang
- Digital Medicine Center, Pingyu People's Hospital, No. 116 Jiankang Road, Guhuai Sub- district, Pingyu, Henan Province, 463400, China.
| | - Wenwei Mao
- Department of Respiratory and Critical Care Medicine, Wenling First People's Hospital, No. 333 Chuanan South Road, Chengxi Sub-district, Wenling, Zhejiang Province, 317500, China.
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Ramadan D, Metin Akten İ. Prevalence and Risk Factors of Pressure Injury in Home Care Patients. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2024. [DOI: 10.1177/10848223241282008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/04/2025]
Abstract
The present study aimed to determine the prevalence of pressure injury in home care patients and the risk factors that affected its occurrence. The study was conducted in a descriptive-cross-sectional design to 6 months between November 2021 and May 2022 with 170 home care patients who were registered to the Home Health Care Service at a public hospital a city western in Turkey and met the inclusion criteria. The data were collected with the in-person interview method by using the investigator-created Patient Evaluation Form, National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System, and Glasgow Coma Scale (GCS). The prevalence of pressure injury was found to be 33.5% in the study. The prevalence of pressure injury was statistically and significantly higher in the patients younger than 75 years of age ( p = .043), underweight, and with normal Body Mass Index (BMI) ( p = .009). The prevalence of pressure injury was found to be lower in those who were oriented according to GCS ( p = .000). No statistically significant differences were detected between the presence of pressure injury and gender, education levels, marital status, income status, presence of systemic or chronic disease, continuous medication use, type of medication used, and duration of receiving home care services ( p > .05). The results of the present study showed that the prevalence of pressure injury was high in home care patients and that age, BMI, and level of consciousness variables were factors that influenced the development of pressure injury.
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Affiliation(s)
- Dilara Ramadan
- Lüleburgaz District Health Directorate, Lüleburgaz/Kırklareli, Turkey
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29
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Sim J, Tuqiri K, Hoban K, Mueller K, Birrell E. The Pressure Injury Prevention and Practice Improvements in Nursing - Intensive Care Unit (PIPPIN-ICU) Study. J Wound Care 2024; 33:673-674. [PMID: 39287038 DOI: 10.12968/jowc.2024.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 09/19/2024]
Affiliation(s)
- Jenny Sim
- Australian Catholic University, North Sydney Campus, School of Nursing, Midwifery & Paramedicine, North Sydney, Australia
| | - Karen Tuqiri
- South Eastern Sydney Local Health District, NSW Health, Australia
| | - Kathryne Hoban
- South Eastern Sydney Local Health District, NSW Health, Australia
| | - Karlee Mueller
- South Eastern Sydney Local Health District, NSW Health, Australia
| | - Emma Birrell
- South Eastern Sydney Local Health District, NSW Health, Australia
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30
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Lane B, Loftus NW, Thomas A, Kalakoutas A, Wells J. Effectiveness of specialised support surface modes in preventing pressure injuries in intensive care: A systematic review and meta-analysis. Intensive Crit Care Nurs 2024; 83:103713. [PMID: 38749261 DOI: 10.1016/j.iccn.2024.103713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/17/2023] [Revised: 03/31/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Patients in intensive care units (ICU) are at an increased risk of pressure injuries. In ICUs, specialised support surfaces are an intervention often used to prevent pressure injuries. This systematic review and meta-analysis aimed to ascertain the effectiveness of different specialised support surface modes for preventing pressure injuries to adult ICU patients. METHODS Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, PEDro, Cochrane Library, Clinicaltrials.gov and eligible paper references were searched for appropriate studies. Studies were included if they investigated both dynamic support surface modes low-air-loss (LAL) and alternating pressure (AP), involved adult ICU patients (≥18 years old), and investigated pressure injury incidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Mixed Methods Appraisal Tool (MMAT) checklists were used for reporting and quality assessment. Risk ratios (RRs) with 95 % Confidence Intervals (CIs) were used to summarise pressure injury incidence. The pooled RR was calculated with the random-effects model using the Mantel-Haenszel method. Further secondary analysis examined length of stay (LoS) and severity of illness. RESULTS The four included studies involved 3,308 patients. These studies were heterogeneous in design. When AP surface mode was compared with LAL surface mode, there was no significant difference in the occurrence of pressure injury (8.9 % versus 10.9 %, RR 0.64). Mattress mode also had no direct association with length of stay and severity of illness. CONCLUSION This systematic review and meta-analysis found no significant difference in the effectiveness of LAL and AP support surface modes in preventing pressure injuries in adult ICU patients. IMPLICATIONS FOR CLINICAL PRACTICE Clinicians should remember that mattresses are just one element within strategies to prevent pressure injuries in ICUs. The equivocal findings of this systematic review highlight the complexity of preventing pressure injuries and underscore the importance of holistic nursing care.
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Affiliation(s)
- Bethany Lane
- St. Bartholomew's Hospital, London, UK; Imperial College, London, UK; City, University of London, UK.
| | | | - Ashley Thomas
- St. Bartholomew's Hospital, London, UK; Queen Mary University London, UK
| | - Antonis Kalakoutas
- St. Bartholomew's Hospital, London, UK; Barking, Havering and Redbridge University Hospitals NHS Trust, UK
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31
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Mellinghoff J, Lin F, Blot S. Vasopressor use and pressure injury risk. Only in the eye of the beholder? Intensive Crit Care Nurs 2024; 83:103702. [PMID: 38636294 DOI: 10.1016/j.iccn.2024.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 04/20/2024]
Affiliation(s)
- Johannes Mellinghoff
- School of Sports & Health Sciences, University of Brighton, Brighton, United Kingdom
| | - Frances Lin
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia; Caring Futures Institute, Flinders University, South Australia, Australia
| | - Stijn Blot
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
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32
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Kyung DE, Shin YS. Associations between body mass index and interface pressure after 3 h loading in healthy adults. J Tissue Viability 2024; 33:399-404. [PMID: 38908987 DOI: 10.1016/j.jtv.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/07/2024] [Revised: 05/17/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
AIM OF THE STUDY The purpose of this study was to determine the associations between body mass index and interface pressure after 3 h loading in healthy adults and to establish a foundation for the development of interventions tailored to body mass index. MATERIAL AND METHODS A secondary data analysis based on a clinical trial involving 75 adults was conducted. Data were analyzed using descriptive statistics, repeated measure ANOVA, and ANCOVA. The statistics program IBM SPSS Statistics 27.0 was used for data analysis. RESULTS Loading caused a significant increase in average pressure in the obesity group compared to the underweight group. There was a significant increase in risk area ratio calculated based on 30 mmHg and 45 mmHg in both obesity and overweight groups compared to the underweight group. On both support surfaces, average pressure, peak pressure, and risk area ratio were higher in the obese group compared to the normal weight group. However, these differences were not statistically significant. CONCLUSION Given the emphasized risk of pressure injuries, long-term observation of body mass index-specific changes in interface pressure can provide crucial evidence for pressure injury prevention nursing. The results of this study suggest the need to implement pressure injury prevention interventions that consider the pressure characteristics according to BMI.
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Affiliation(s)
- Do Eun Kyung
- Graduate School of Nursing, Hanyang University, Seoul, South Korea.
| | - Yong Soon Shin
- College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.
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Mehicic A, Burston A, Fulbrook P. Psychometric properties of the Braden scale to assess pressure injury risk in intensive care: A systematic review. Intensive Crit Care Nurs 2024; 83:103686. [PMID: 38518454 DOI: 10.1016/j.iccn.2024.103686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/09/2023] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To analyse the psychometric properties of the Braden scale to assess pressure injury risk in adults in intensive care. DESIGN A systematic review was conducted, with literature searches undertaken in five electronic databases. No date limits were applied. Selection, data extraction and risk of bias assessment were completed by two reviewers independently. A customised data extraction template was used, with risk of bias conducted using the COSMIN Risk of Bias checklist. Data were analysed using narrative synthesis. RESULTS Thirty-four studies met inclusion criteria. Two studies reported internal consistency with Cronbach's alpha ranging from poor (0.43) to good (0.85). For interrater reliability, only four studies reported intraclass correlation, ranging from 0.66 to 0.96 for Braden sum score. Three studies reported convergent validity, with strong associations found between the COMHON Index (r = 0.70), Cubbin-Jackson scale (r = 0.80), and Norton scale (r = 0.77), but contrasting associations with the Waterlow score (r = 0.22 to 0.72). A large majority of studies reported predictive validity (n = 29), with wide variability. Several studies investigated optimal cut-off scores, with the majority indicating this was in the range of 12-14. CONCLUSIONS This review demonstrates inconsistency in the psychometric properties of the Braden scale in ICU settings. Further research is needed to determine suitability of the Braden scale for ICU before it can be recommended as standard for clinical practice, including comparison with other ICU-specific risk assessment tools. IMPLICATIONS FOR CLINICAL PRACTICE When used in ICU, the reliability, validity and reported cut-off scores of the Braden scale are variable. As a predictive tool, the scale should be used cautiously. In ICU, the value of the Braden scale resides in its ability to identify patients that are most at risk of developing a pressure injury and to implement preventative measures to mitigate identified risk factors.
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Affiliation(s)
- Aldiana Mehicic
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Faculty of Health Sciences, Australian Catholic University, Australia
| | - Adam Burston
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Faculty of Health Sciences, Australian Catholic University, Australia.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia; School of Nursing, Midwifery and Paramedicine (Brisbane), Faculty of Health Sciences, Australian Catholic University, Australia; School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jia YJ, Yu HR, Hu FH, Tang W, Zhang WQ, Ge MW, Shen LT, Du W, Cai B, Xu H, Xia XP, Chen HL. Body mass index and pressure injuries risk in hospitalized adult patients: A dose-response analysis. J Tissue Viability 2024; 33:405-411. [PMID: 38886143 DOI: 10.1016/j.jtv.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/31/2024] [Revised: 05/13/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The association between underweight and pressure injuries (PIs) has been established in several studies. However, there is a lack of well-designed research investigating the connection between overweight and obesity with these injuries. OBJECTIVE This meta-analysis aims to investigate the dose-response relationship between body mass index (BMI) and the risk of PIs in adult hospitalized patients. METHODS PubMed, Web of Science, and MEDLINE Databases were searched from inception to May 2024. Observational articles with at least three BMI categories were included in the study. BMI was defined as underweight, normal weight, overweight, and morbid obesity for the meta-analysis. The non-linear relationship between BMI and the risk of PIs in hospitalized adults was investigated using restricted cubic spline models. Fractional polynomial modeling was used. RESULTS Eleven articles reporting at least 3 categories of BMI met the inclusion criteria, including 31,389 participants. Compared to patients with normal weight, those with underweight, obesity, and morbid obesity exhibited an increased risk of PIs, with odds ratios of 1.70 (95%CI:1.50-1.91), 1.12 (95%CI:1.02-1.24), 1.70 (95%CI:1.13-2.55), respectively. A J-shaped dose-response model was established for the relationship between PI risk and BMI (Pnon-linearity < 0.001, Plinearity = 0.745). CONCLUSION The J-shaped dose-response pattern revealed that underweight, obesity and morbid obesity heightened the risk of PIs in hospitalized adults. Lower and higher BMI values may signify an increased risk for PIs, particularly among the elderly with lower BMI, providing valuable guidance for medical staff.
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Affiliation(s)
- Yi-Jie Jia
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Hai-Rong Yu
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Fei-Hong Hu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Lu-Ting Shen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China
| | - Bo Cai
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Hong Xu
- Nantong Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, PR China
| | - Xiao-Peng Xia
- Nantong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, PR China.
| | - Hong-Lin Chen
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, PR China.
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Xu J, Chen T, Fang X, Xia L, Pan X. Prediction model of pressure injury occurrence in diabetic patients during ICU hospitalization--XGBoost machine learning model can be interpreted based on SHAP. Intensive Crit Care Nurs 2024; 83:103715. [PMID: 38701634 DOI: 10.1016/j.iccn.2024.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/01/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND The occurrence of pressure injury in patients with diabetes during ICU hospitalization can result in severe complications, including infections and non-healing wounds. AIMS The aim of this study was to predict the occurrence of pressure injury in ICU patients with diabetes using machine learning models. STUDY DESIGN In this study, LASSO regression was used for feature screening, XGBoost was employed for machine learning model construction, ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score were used for evaluating the model's performance. RESULTS Out of the 503 ICU patients with diabetes included in the study, pressure injury developed in 170 cases, resulting in an incidence rate of 33.8 %. The XGBoost model had a higher AUC for predicting pressure injury in patients with diabetes during ICU hospitalization (train: 0.896, 95 %CI: 0.863 to 0.929; test: 0.835, 95 % CI: 0.761-0.908). The importance of SHAP variables in the model from high to low was: 'Days in ICU', 'Mechanical Ventilation', 'Neutrophil Count', 'Consciousness', 'Glucose', and 'Warming Blanket'. CONCLUSION The XGBoost machine learning model we constructed has shown high performance in predicting the occurrence of pressure injury in ICU patients with diabetes. Additionally, the SHAP method enables the interpretation of the results provided by the machine learning model. RELEVANCE TO CLINICAL PRACTICE Improve the ability to predict the early occurrence of pressure injury in diabetic patients in the ICU. This will enable clinicians to intervene early and reduce the occurrence of complications.
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Affiliation(s)
- Jie Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Tie Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xixi Fang
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Limin Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| | - Xiaoyun Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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McEvoy NL, Patton D, Curley GF, Moore Z. Pressure ulcer risk assessment in the ICU. Is it time for a more objective measure? Intensive Crit Care Nurs 2024; 83:103681. [PMID: 38518456 DOI: 10.1016/j.iccn.2024.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/07/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND The Braden scale, one of the most widely used risk assessment tools is often criticized when used in the Intensive Care Unit. Most patients in the Intensive Care Unit are at risk of pressure ulcer development meaning that the Braden score will usually indicate high risk for these patients. This study set out to determine the correlation between Sub-Epidermal Moisture measurements and Braden scores among Intensive Care Unit patients. METHODS This study employed an observational research design. Braden score was assessed on all study days (1-5), in addition to visual skin assessment and Sub-Epidermal Moisture measurements at the sacrum and heels. Sub-Epidermal Moisture measurements were categorised as low (<0.5), borderline abnormal (≥0.5), and high (≥0.8). Correlation was assessed between Sub-Epidermal Moisture levels and Braden scores. RESULTS A total of 53 participants were recruited. The median (interquartile range) baseline Braden score was 9 (9-10) and 81 % (n = 43) of participants were at very high/high risk of pressure ulcer development. Braden scores remained relatively constant over time with little fluctuation in scores. 19 % (n = 10) of patients had normal (<0.5) Sub-Epidermal Moisture delta measurements on enrolment, and all developed abnormal measurements by day 2. There were no significant correlations between Braden scores and Sub-Epidermal Moisture measurements. CONCLUSION Although this was not its original intention, a missing link with the Braden scale is that it does not provide information on how patients are responding to the adverse effects of pressure and shear forces. Furthermore, in patients who are critically unwell, most patients are classified as being "at risk" of pressure ulcer development. Therefore, an objective measure of how patients are responding to pressure and shear forces at different anatomical areas is needed. IMPLICATIONS TO CLINICAL PRACTICE Sub-Epidermal Moisture measurements can offer more information, not only on identifying those who are at risk, but also how those patients are tolerating this risk at different anatomical sites.
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Affiliation(s)
- Natalie L McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.
| | - Declan Patton
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences
| | - Zena Moore
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium; Lida Institute, Shanghai, China; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
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Radovanović N, Krajnc M, Gorenjak M, Strdin Košir A, Markota A. Adverse Events during Prone Positioning of Patients with COVID-19 during a Surge in Hospitalizations-Results of an Observational Study. NURSING REPORTS 2024; 14:1781-1791. [PMID: 39051368 PMCID: PMC11270212 DOI: 10.3390/nursrep14030132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/22/2024] [Revised: 07/03/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
This study aimed to determine the prevalence of adverse events in mechanically ventilated adults with COVID-19 who have undergone prone positioning. A total of 100 patients were included retrospectively; 60% were males, the mean age was 64.8 ± 9.1 years, and hospital mortality was 47%. In all, we recorded 118 removals of catheters and tubes in 66 patients; 29.6% were removals of a nasogastric tube, 18.6% of an arterial line, 14.4% of a urinary catheter, and 12.7% of a central venous catheter. Reintubation or repositioning of a tracheotomy tube was required in 19 patients (16.1%), and cardiopulmonary resuscitation in 2 patients (1.7%). We recorded a total of 184 pressure ulcers in 79 patients (on anterior face in 38.5%, anterior thorax in 23.3% and any extremity anteriorly in 15.2%). We observed that body weight (p = 0.021; β = 0.09 (CI95: 0.01-0.17)) and the cumulative duration of prone positioning (p = 0.005; β = 0.06 (CI95: 0.02-0.11)) were independently associated with the occurrence of any adverse event. The use of prone positioning in our setting was associated with a greater number of adverse events than previously reported. Body weight and cumulative duration of prone positioning were associated with the occurrence of adverse events; however, other factors during a COVID-19 surge, such as working conditions, staffing, and staff education, could also have contributed to a high prevalence of adverse events.
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Affiliation(s)
- Nataša Radovanović
- Infectious Diseases Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Mateja Krajnc
- Medical Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Mario Gorenjak
- Centre for Human Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia;
| | - Alenka Strdin Košir
- Infectious Diseases Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Andrej Markota
- Medical Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia
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Yu H. Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings. World J Clin Cases 2024; 12:3873-3881. [PMID: 38994315 PMCID: PMC11235428 DOI: 10.12998/wjcc.v12.i19.3873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pressure ulcer (PU) are prevalent among critically ill trauma patients, posing substantial risks. Bundled care strategies and silver nanoparticle dressings offer potential solutions, yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated. AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients. METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit (ICU) were included in this study. Patients were randomly assigned to either the control group (conventional care with silver nanoparticle dressing, n = 49) or the intervention group (bundled care with silver nanoparticle dressing, n = 49). The PU Scale for Healing (PUSH) tool was used to monitor changes in status of pressure injuries over time. Assessments were conducted at various time points: Baseline (day 0) and subsequent assessments on day 3, day 6, day 9, and day 12. Family satisfaction was assessed using the Family Satisfaction ICU 24 questionnaire. RESULTS No significant differences in baseline characteristics were observed between the two groups. In the intervention group, there were significant reductions in total PUSH scores over the assessment period. Specifically, surface area, exudate, and tissue type parameters all showed significant improvements compared to the control group. Family satisfaction with care and decision-making was notably higher in the intervention group. Overall family satisfaction was significantly better in the intervention group. CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients. This approach holds promise for improving PUs management in the ICU, benefiting both patients and their families.
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Affiliation(s)
- Hong Yu
- Department of Intensive Care Unit, The First People's Hospital of Ziyang, Ziyang 641300, Sichuan Province, China
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Zhang R, Ma PX, Zhang JJ. Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit. World J Clin Cases 2024; 12:3807-3814. [PMID: 38994320 PMCID: PMC11235454 DOI: 10.12998/wjcc.v12.i19.3807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 04/07/2024] [Revised: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Patients in neurology intensive care units (ICU) are prone to pressure injuries (PU) due to factors such as severe illness, long-term bed rest, and physiological dysfunction. PU not only causes pain and complications to patients, but also increases medical burden, prolongs hospitalization time, and affects the recovery process. AIM To evaluate and optimize the effectiveness of pressure injury prevention nursing measures in neurology ICU patients. METHODS A retrospective study was conducted, and 60 patients who were admitted to the ICU of the Department of Neurology were selected and divided into an observation group and a control group according to the order of admission, with 30 people in each group. The observation group implemented pressure injury prevention and nursing measures, while the control group adopted routine care. RESULTS Comparison between observation and control groups following pressure injury prevention nursing intervention revealed significantly lower incidence rates in the observation group compared to the control group at 48 h (8.3% vs 26.7%), 7 d (16.7% vs 43.3%), and 14 d (20.0% vs 50.0%). This suggests a substantial reduction in pressure injury incidence in the observation group, with the gap widening over time. Additionally, patients in the observation group exhibited quicker recovery, with a shorter average time to get out of bed (48 h vs 72 h) and a shorter average length of stay (12 d vs 15 d) compared to the control group. Furthermore, post-intervention, patients in the observation group reported significantly improved quality of life scores, including higher scores in body satisfaction, feeling and function, and comfort (both psychological and physiological), indicating enhanced overall well-being and comfort following the implementation of pressure injury prevention nursing measures. CONCLUSION Implementing pressure injury preventive care measures for neurology ICU patients will have better results.
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Affiliation(s)
- Rong Zhang
- Intensive Medicine Department, The First People’s Hospital of Jiangxia District, Wuhan 430000, Hubei Province, China
| | - Peng-Xin Ma
- Intensive Medicine Department, The First People’s Hospital of Jiangxia District, Wuhan 430000, Hubei Province, China
| | - Juan-Juan Zhang
- Department of Neurology, The First People’s Hospital of Jiangxia District, Wuhan 430000, Hubei Province, China
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Chaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, Moore Z, Deakin J, Carlini J, Lovegrove J, Jahandideh S, Gillespie BM. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104768. [PMID: 38642429 DOI: 10.1016/j.ijnurstu.2024.104768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Numerous interventions for pressure injury prevention have been developed, including care bundles. OBJECTIVE To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. DATA SOURCES The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). STUDY ELIGIBILITY CRITERIA Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. PARTICIPANTS AND INTERVENTIONS Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. STUDY APPRAISAL AND SYNTHESIS METHODS Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42023423058. TWEETABLE ABSTRACT Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/SharonLLatimer
| | - Udeshika Priyadarshani
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Emma Harbeck
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jenny Sim
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney Australia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jodie Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/jodie_deakin3
| | - Joan Carlini
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Health Consumer and Department of Marketing, Griffith Business School, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Josephine Lovegrove
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Sepideh Jahandideh
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia. https://twitter.com/bgillespie6
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Bavaresco T, Menegon DB, Macedo ABT, Tanaka RY, Candaten AE. Association between clinical characteristics of patients with pressure ulcer in the COVID-19 pandemic. Rev Gaucha Enferm 2024; 45:e20230086. [PMID: 38922229 DOI: 10.1590/1983-1447.2024.20230086.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/11/2023] [Accepted: 11/07/2023] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To analyze the associations between the clinical characteristics of patients hospitalized with pressure injuries (PI) during the COVID-19 pandemic. METHOD Cross-sectional study of 237 PI notifications in a hospital in southern Brazil. Collection took place in 2021 in an institutional management program, with interlocution to the patient's medical record. Analysis using descriptive statistics, Student's t-test, Pearson's chi-square and Wilcoxon. RESULTS The mean age was 59.4±14.4 years, with 59.7% male, 74.7% diagnosed with COVID-19. High risk (57.8%), stage 2 (80.2%), sacral region, intergluteal/gluteal region (73.0%) were predominant and death was the prevalent outcome (51.1%), with a median of 9.5 (0-217) days after notification. There was no association of death with diabetes, systemic arterial hypertension, smoking and reason for hospitalization. CONCLUSION The association between the clinical characteristics of hospitalized patients with pressure injuries reflects the systemic inflammation of patients affected by COVID-19.
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Affiliation(s)
- Taline Bavaresco
- Universidade Federal do Rio Grande do Sul. Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Dóris Baratz Menegon
- Hospital de Clínicas de Porto Alegre. Comissão de Prevenção e Tratamento de Feridas. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Raquel Yurika Tanaka
- Hospital de Clínicas de Porto Alegre. Comissão de Prevenção e Tratamento de Feridas. Porto Alegre, Rio Grande do Sul, Brasil
| | - Angela Enderle Candaten
- Hospital de Clínicas de Porto Alegre. Comissão de Prevenção e Tratamento de Feridas. Porto Alegre, Rio Grande do Sul, Brasil
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Lucchini A, Villa M, Maino C, Alongi F, Fiorica V, Lipani B, Ponzetta G, Vigo V, Rezoagli E, Giani M. The occurrence of pressure injuries and related risk factors in patients undergoing extracorporeal membrane oxygenation for respiratory failure: A retrospective single centre study. Intensive Crit Care Nurs 2024; 82:103654. [PMID: 38387296 DOI: 10.1016/j.iccn.2024.103654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/28/2023] [Revised: 01/03/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Limited data is available regarding the incidence of pressure injuries in patients who have undergone Extracorporeal Membrane Oxygenation (ECMO), a life-saving technique that provides respiratory support for hypoxemia that does not respond to conventional treatment. AIM To assess the incidence of pressure injuries and identify the risk factors in Acute Respiratory Distress Syndrome patients receiving ECMO. METHODS A retrospective observational study utilizing prospectively collected data was performed in an Italian intensive care unit, between 1 January 2012 and 30 April 2022 enrolling all consecutive patients with Acute Respiratory Distress Syndrome who underwent ECMO. RESULTS One hundred patients were included in this study. 67 patients (67%) developed pressure injuries during their intensive care unit stay, with a median of 2 (1-3) sites affected. The subgroup of patients with pressure injuries was more hypoxic before ECMO implementation, received more frequent continuous renal replacement therapy and prone positioning, and showed prolonged ECMO duration, intensive care unit and hospital length of stay compared to patients without pressure injuries. The logistic model demonstrated an independent association between the pO2/FiO2 ratio prior to ECMO initiation, the utilization of the prone positioning during ECMO, and the occurrence of pressure injuries. CONCLUSIONS The incidence of pressure injuries was elevated in patients with Adult Respiratory Distress Syndrome who received ECMO. The development of pressure injuries was found to be independently associated with hypoxemia before ECMO initiation and the utilization of prone positioning during ECMO. IMPLICATIONS FOR CLINICAL PRACTICE Patients who require ECMO for respiratory failure are at a high risk of developing pressure injuries. To ensure optimal outcomes during ECMO implementation and treatment, it is vital to implement preventive measures and to closely monitor skin health in at-risk areas.
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Affiliation(s)
- Alberto Lucchini
- Direction of Health and Social Professions, General Adult and Pediatric Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori - Monza - University of Milano-Bicocca, Italy.
| | - Marta Villa
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Clara Maino
- Direction of Health and Social Professions, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Francesca Alongi
- Cardiologic Intensive Care Unit, ASST GOM Niguarda, Milano, Italy
| | | | - Barbara Lipani
- General ICU - A.O.U.I. Verona Policlinico G.B. Rossi, Italy
| | - Giuseppe Ponzetta
- Centro Sanitario Bregaglia - Pronto Soccorso, Promontogno, Svizzera, Switzerland.
| | - Veronica Vigo
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Marco Giani
- Department of Emergency and Intensive Care, General Adult and Pediatric Intensive Care Unit Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
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Craven BC, Bateman EA, Flett H, Farahani F, Wolfe DL, Askari S, Omidvar M, Alavinia M. The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement. Healthcare (Basel) 2024; 12:1084. [PMID: 38891159 PMCID: PMC11171508 DOI: 10.3390/healthcare12111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Despite preventability, 20-50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. METHODS This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs. RESULTS Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation. CONCLUSIONS PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes.
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Affiliation(s)
- Beverley Catharine Craven
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Emma A. Bateman
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Heather Flett
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Farnoosh Farahani
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Dalton L. Wolfe
- Parkwood Institute Research, St Joseph’s Health Care London, London, ON N6A 4V2, Canada; (E.A.B.); (D.L.W.)
- Faculty of Health Sciences, School of Health Studies, Western University, London, ON N6A 5C1, Canada
| | - Sussan Askari
- Faculty of Physical Medicine and Rehabilitation, Providence Care Hospital, Queen’s University, Kingston, ON K7L 4X3, Canada;
| | - Maryam Omidvar
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
| | - Mohammad Alavinia
- Lyndhurst Centre, The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 3V9, Canada; (B.C.C.); (H.F.); (F.F.); (M.O.)
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Donaldson C, de Abreu MG, Mascha EJ, Rowbottom J, Harvester E, Khanna A, Sura T, Sessler DI, Patarroyo FR, Gulluoglu A, Zajic P, Chauhan U, Essber H, Kurz A. Pressure injury treatment by intermittent electrical stimulation (PROTECT-2): protocol for a multicenter randomized clinical trial. Trials 2024; 25:313. [PMID: 38730383 PMCID: PMC11083768 DOI: 10.1186/s13063-024-08085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/28/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Pressure ulcers account for a substantial fraction of hospital-acquired pathology, with consequent morbidity and economic cost. Treatments are largely focused on preventing further injury, whereas interventions that facilitate healing remain limited. Intermittent electrical stimulation (IES) increases local blood flow and redistributes pressure from muscle-bone interfaces, thus potentially reducing ulcer progression and facilitating healing. METHODS The Pressure Injury Treatment by Intermittent Electrical Stimulation (PROTECT-2) trial will be a parallel-arm multicenter randomized trial to test the hypothesis that IES combined with routine care reduces sacral and ischial pressure injury over time compared to routine care alone. We plan to enroll 548 patients across various centers. Hospitalized patients with stage 1 or stage 2 sacral or ischial pressure injuries will be randomized to IES and routine care or routine care alone. Wound stage will be followed until death, discharge, or the development of an exclusion criteria for up to 3 months. The primary endpoint will be pressure injury score measured over time. DISCUSSION Sacral and ischial pressure injuries present a burden to hospitalized patients with both clinical and economic consequences. The PROTECT-2 trial will evaluate whether IES is an effective intervention and thus reduces progression of stage 1 and stage 2 sacral and ischial pressure injuries. TRIAL REGISTRATION ClinicalTrials.gov NCT05085288 Registered October 20, 2021.
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Affiliation(s)
- Chase Donaldson
- Department of Intensive Care and Resuscitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Marcelo Gama de Abreu
- Department of Intensive Care and Resuscitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Edward J Mascha
- Department of Quantitative Health Sciences and Outcomes Research, Lerner Research Institute; Outcomes Research Consortium, Department of Anesthesiology, Hospital Based Care Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - James Rowbottom
- Department of Intensive Care and Resuscitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Eric Harvester
- Department of Intensive Care and Resuscitation, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ashish Khanna
- Department of Anesthesiology, Section On Critical Care Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Tanmay Sura
- Department of Anesthesiology, 100 Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Daniel I Sessler
- Outcomes Research Consortium, Department of Anesthesiology, Hospital Based Care Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Fabio Rodriguez Patarroyo
- Outcomes Research Consortium, Department of Anesthesiology, Hospital Based Care Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Alper Gulluoglu
- Outcomes Research Consortium, Department of Anesthesiology, Hospital Based Care Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Paul Zajic
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerpl, 5, Graz, 8036, Austria
| | - Utkarsh Chauhan
- University of Alberta Medical School, 1-002 Katz Group Centre for Pharmacy and Health Research, Edmonton, AB, T6G 2E1, Canada
| | - Hani Essber
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerpl, 5, Graz, 8036, Austria
| | - Andrea Kurz
- Departments of General Anesthesiology and Outcomes Research Consortium, Department of Anesthesiology, Hospital Based Care Institute, Cleveland Clinic , 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Reese TJ, Domenico HJ, Hernandez A, Byrne DW, Moore RP, Williams JB, Douthit BJ, Russo E, McCoy AB, Ivory CH, Steitz BD, Wright A. Implementable Prediction of Pressure Injuries in Hospitalized Adults: Model Development and Validation. JMIR Med Inform 2024; 12:e51842. [PMID: 38722209 PMCID: PMC11094428 DOI: 10.2196/51842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/14/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 05/18/2024] Open
Abstract
Background Numerous pressure injury prediction models have been developed using electronic health record data, yet hospital-acquired pressure injuries (HAPIs) are increasing, which demonstrates the critical challenge of implementing these models in routine care. Objective To help bridge the gap between development and implementation, we sought to create a model that was feasible, broadly applicable, dynamic, actionable, and rigorously validated and then compare its performance to usual care (ie, the Braden scale). Methods We extracted electronic health record data from 197,991 adult hospital admissions with 51 candidate features. For risk prediction and feature selection, we used logistic regression with a least absolute shrinkage and selection operator (LASSO) approach. To compare the model with usual care, we used the area under the receiver operating curve (AUC), Brier score, slope, intercept, and integrated calibration index. The model was validated using a temporally staggered cohort. Results A total of 5458 HAPIs were identified between January 2018 and July 2022. We determined 22 features were necessary to achieve a parsimonious and highly accurate model. The top 5 features included tracheostomy, edema, central line, first albumin measure, and age. Our model achieved higher discrimination than the Braden scale (AUC 0.897, 95% CI 0.893-0.901 vs AUC 0.798, 95% CI 0.791-0.803). Conclusions We developed and validated an accurate prediction model for HAPIs that surpassed the standard-of-care risk assessment and fulfilled necessary elements for implementation. Future work includes a pragmatic randomized trial to assess whether our model improves patient outcomes.
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Affiliation(s)
- Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Henry J Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Antonio Hernandez
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel W Byrne
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ryan P Moore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jessica B Williams
- Department of Nursing, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Brian J Douthit
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elise Russo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine H Ivory
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bryan D Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Akpolat R, Sisman H, Alptekin D. The frequency of pressure injury in level 3 intensive care units and determination of risk factors: A cross-sectional study. J Tissue Viability 2024; 33:248-253. [PMID: 38493047 DOI: 10.1016/j.jtv.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/03/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/18/2024]
Abstract
AIM This study was carried out to determine the prevalence of pressure injury and risk factors in patients hospitalized in a university hospital's level 3 intensive care unit. DESIGN It is a descriptive, prospective, observational type study. METHOD The sample of the study consisted of 176 patients aged 18 and over who were admitted to the intensive care units of a University Hospital for at least 24 h. Patient Information Form and Braden Risk Assessment Scale, Glasgow Coma Scale were used to collect data. IBM SPSS Statistics 20 program was used to analyze the data. RESULTS Presence of chronic disease in the development of pressure injury (22.7%), high-risk patients according to the Glasgow Coma Scale (21%), high-risk patients according to the Braden Risk Assessment Scale (84.2%), low hemoglobin (31%), low albumin levels (32.4%) and duration of stay in the intensive care unit until the day of evaluation were found to be independent risk factors (p < 0.05). The prevalence of pressure injury was determined to be 32.4%, and the rate of pressure injury due to medical devices was 7.4%. CONCLUSION Pressure injuries are still common in adult intensive care patients. In terms of patient safety, it is important to give more space to care standards and awareness-raising research and training to prevent pressure injuries.
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Affiliation(s)
- Refiye Akpolat
- Cyprus International University, School of Health Sciences, Nursing Department, Nicosia, Cyprus.
| | - Hamide Sisman
- Cukurova University Abdi Sutcu Health Services Vocational School, Sarıcam, Adana, Turkey.
| | - Dudu Alptekin
- Cukurova University Abdi Sutcu Health Services Vocational School, Sarıcam, Adana, Turkey.
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Eberhardt TD, Lima SBD, Pozzebon BR, Santos KPD, Silveira LBD, Soares RSDÁ, Alves PJ. Heel skin microclimate control: Secondary analysis of a self-controlled randomized clinical trial. J Tissue Viability 2024; 33:305-311. [PMID: 38553355 DOI: 10.1016/j.jtv.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/29/2023] [Revised: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries. METHOD the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5. RESULTS significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (-7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (-0.3 AU) with MPF. CONCLUSIONS The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies.
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Pei J, Zhang H, Ma Y, Wei Y, Tao H, Yang Q, Yang Z, Han L. Dose-response relationships between body-mass index and pressure injuries occurrence in hospitalized patients: A multi-center prospective study. J Tissue Viability 2024; 33:179-184. [PMID: 38553354 DOI: 10.1016/j.jtv.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/01/2024] [Revised: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Pressure injuries (PIs) are one of the leading potentially preventable hospital-acquired complications associated with prolonged hospital length, poor quality of life and financial burden. The relationship between body mass index (BMI) and PIs occurrence is controversial. OBJECTIVE The aim of this study was to further examine relationships between BMI and PIs occurrence in hospitalized patients. DESIGN A multi-center prospective study. SETTING 39 hospitals located in northwest China from April 2021 to July 2023. PARTICIPANTS 175,960 hospitalized patients aged over 18 years were enrolled, and 170,800 patients were included in the final analysis. METHODS BMI and clinical characteristics were assessed at baseline. PIs assessment were performed by trained nurses, with data recorded for the presence, the location and stage of each PI. For staging PIs, the National Pressure Ulcer Advisory Panel(NPUAP) staging system were used. The multivariate logistic regressions analysis and restricted cubic splines (RCS) models were used to explore associations between BMI and PIs, adjusting for potential confounders. RESULTS Of 175,960 participants, 5160 were excluded from analyses. The multivariate logistic regression model identified a positive relationship between under-weight BMI and risk of PIs occurrence (OR = 1.60, 95% CI:1.18-2.17). We also found U shaped association between BMI and PIs occurrence (non-linear P < 0.001). BMI less than 23 kg/m2 significantly increased risk of PIs, and there was a tendency to increase risk of PIs at BMI higher than 30 kg/m2. We stratified participants by sex to further investigate their association and found the risk of PIs increases substantially in women at BMI below 17 kg/m2 and in men at BMI below 23 kg/m2. CONCLUSIONS The present study indicated that there was an approximate U shaped relationship between BMI and PIs occurrence, and this association was potentially different between men and women.
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Affiliation(s)
- Juhong Pei
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuting Wei
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Hongxia Tao
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Qiuxia Yang
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Zhuang Yang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Lin Han
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China; School of Nursing, Lanzhou University, Lanzhou, Gansu, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, China.
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Kiyat I, Ozbas A. Comparison of the Predictive Validity of Norton and Braden Scales in Determining the Risk of Pressure Injury in Elderly Patients. CLIN NURSE SPEC 2024; 38:141-146. [PMID: 38625804 DOI: 10.1097/nur.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 04/18/2024]
Abstract
AIM To compare the reliability and predictive validity of Norton and Braden scales in determining the risk of pressure injury in elderly patients. DESIGN This research used a comparative design. One hundred thirty elderly patients participated in the study. METHODS The daily pressure injury risk of participants was evaluated by a researcher using both the Norton and Braden scales in a consecutive manner. RESULTS The mean age of patients was 75.1 ± 8.5 years, and that for those without and with pressure injury development was 75.0 ± 8.3 years and 76.1 ± 9.7 years (P < .001), respectively. The reliability coefficients of the Norton and Braden scales were .82 and .89, respectively. The sensitivity, specificity, and positive and negative predictive values of the Norton Scale were 100%, 40.7%, 20.2%, and 100%, and those of the Braden Scale were 100%, 32.7%, 18.3%, and 100%, respectively. CONCLUSIONS The reliability of both scales for elderly patients was found to be high, and their ability to differentiate patients at risk was comparable. However, both scales had low specificity. Further research is needed to develop scales that have higher predictive validity for the elderly population, taking into account other risk factors that influence total scale scores.
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Affiliation(s)
- Ibrahim Kiyat
- Author Affiliations: Research Assistant, Kırklareli University, Faculty of Health Sciences, Department Nursing, Kırklareli/Turkey (Kiyat); and Professor, Istanbul University-Cerrahpasa, Faculty of Nursing, Department of Surgical Nursing, Istanbul, Turkey (Ozbas)
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50
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Fu L, Chen Y, Lin L, Xu Z, Zhuang Y. Knowledge, attitude, and practice of critical care nurses and their influence on acute skin failure patients in China: A multicenter cross-sectional study. Jpn J Nurs Sci 2024; 21:e12582. [PMID: 38217104 DOI: 10.1111/jjns.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/05/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/15/2024]
Abstract
AIM Acute skin failure (ASF) can happen in critically ill patients. Therefore, adequate knowledge and skills regarding ASF are essential to manage this disorder. The aim of this work was to investigate the nurses' knowledge, attitude, and practice (KAP) regarding ASF patients and to analyze its influencing factors in the intensive care unit. METHODS A multicenter cross-sectional study was performed in 10 tertiary hospitals in March 2022. Eligible nurses received a survey with a self-designed questionnaire about their KAP regarding ASF, which included three dimensions and a maximum score of 120. A higher score corresponded to better KAP. RESULTS A total of 255 nurses participated in this study. The mean KAP score was 75.6 ± 16.9. The mean scores of the knowledge, attitude, and practice dimensions were 26.2 ± 10.6, 38.2 ± 6.1, and 11.3 ± 4.3, respectively. The dimensions were ranked according to score (from low to high) as follows: knowledge (2.6 ± 1.1), practice (2.8 ± 1.1), and attitude (3.8 ± 0.6). Multivariate linear regression analysis showed that more training sessions and an advanced professional title were associated with higher KAP scores. CONCLUSIONS The overall KAP score on ASF was low in nurses. Nurses had a positive attitude towards ASF, but their knowledge and practice required significant improvement. Those who had received more training and held a more advanced professional title exhibited higher KAP scores regarding ASF. Therefore, nurse managers should establish a relevant knowledge training system, strengthen relevant training, and improve nursing practices for ASF in order to achieve a high level of KAP in nurses who treat ASF patients.
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Affiliation(s)
- Lisang Fu
- Department of Nursing, Hospital of Putian University, Putian, China
| | - Yiyuan Chen
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Libin Lin
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Zhenmei Xu
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
| | - Yaoning Zhuang
- Department of Respiratory Intensive Care Unit, Affiliated Hospital of Putian University, Putian, China
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