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The Pan African Medical Journal 2020Pressure ulcers (PUs) are defined as localised injuries to the skin and/or underlying tissue as a result of pressure or pressure together with shear. PUs present... (Review)
Review
Pressure ulcers (PUs) are defined as localised injuries to the skin and/or underlying tissue as a result of pressure or pressure together with shear. PUs present significant health implications to patients; costing billions to manage and/or treat. The burden of PU prevention in hospitals must be the concern of all healthcare professionals, including radiographers. The purpose of this narrative review article was to identify and critically evaluate relevant literature and research conducted into pressure ulcers (PUs) relevant to medical imaging. It is expected that this review article will increase the level of awareness about PUs amongst radiographers and help to develop appropriate interventions to minimise the risk of PUs. A literature search was conducted in PubMed/Medline, Scopus, CINAHL, and Google Scholar to retrieve relevant articles. Also, books, professional body guidelines, magazines, grey and unpublished literatures were also searched. The search was limited to English Language articles. Only five articles were retrieved and reviewed. There are limited studies on PUs relevant to medical imaging. Available studies provide some evidence that radiographic procedures and settings subject patients attending for radiographic procedures to the risk of PUs. Further studies are needed into PU risk assessment, minimisation and management in medical imaging to help raise awareness and address the problem of the potential for PU development.
Topics: Humans; Pressure Ulcer; Radiography; Risk Assessment; Risk Factors; Risk Management
PubMed: 32754293
DOI: 10.11604/pamj.2020.36.66.19431 -
Intensive & Critical Care Nursing Feb 2024To describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit. (Review)
Review
AIM
To describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit.
BACKGROUND
Device-related pressure injuries in critically ill patients are mostly focused on skin surface injuries, and less attention is paid to mucosal membrane pressure injury.
METHODS
We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane Library from database construction until March 1, 2023. Two researchers independently screened and extracted data.
RESULTS
Eighteen articles met our criteria and were published in 2014-2023. The included studies showed that the incidence of mucosal membrane pressure injury in critically ill patients ranged from 0.83% to 88.2%, and the prevalence ranged from 0.16% to 55.6%. The most frequently reported site of mucosal injury is the oral mucosa, followed by the nasal mucosa. Ten studies used Braden to assess the risk of mucosal membrane pressure injury, and only six studies reported specific stages of mucosal membrane pressure injury. Thirteen studies described 30 risk factors for mucosal membrane pressure injury, with albumin being the most frequently reported risk factor, followed by the vasoconstrictive drugs use. Thirty risk factors were summarized in six aspects: medical device-related factors, disease-related factors, treatment- related factors, physiological and biochemical parameters, demographic-related factors, and microbial colonisation.
CONCLUSIONS
The incidence or prevalence of mucosal membrane pressure injury varies widely, and specific risk assessment tools and standardized staging criteria need to be further determined. The risk factors of mucosal membrane pressure injury involve multiple aspects, and some risk factors have only been explored in few studies and need to be further verified, in order to detect the risk group of mucosal membrane pressure injury early and take targeted preventive measures.
IMPLICATIONS FOR CLINICAL PRACTICE
We synthesized the current research status of mucosal membrane pressure injury in critically ill patients, which can provide a valuable reference for the clinical staff to develop preventive and management measures for such patients.
Topics: Humans; Pressure Ulcer; Critical Illness; Intensive Care Units; Risk Factors
PubMed: 37918080
DOI: 10.1016/j.iccn.2023.103560 -
International Wound Journal Oct 2023This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the... (Review)
Review
This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the earliest date to February 1, 2023 using keywords extracted from Medical Subject Headings such as "Caregivers", "Knowledge", and "Pressure ulcer" in various international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and Scientific Information Database. The quality of the studies included in this systematic review was evaluated using an appraisal tool for cross-sectional studies (AXIS tool). In total, 927 caregivers participated in the eight studies. The average age of the participants was 40.50 (SD = 12.67). Among the participants, 61.87% were women. The average caregiver's knowledge of PU prevention was 53.70 (SD = 14.09) out of 100, which suggests a moderate level of knowledge. Factors such as level of education, age, occupation, information about PUs, attitude, and practice had a significant positive relationship with caregivers' knowledge related to the prevention of PUs. Knowledge had a significantly negative relationship with age. In addition, marital status, type of relationship, age, gender, occupation, level of education, and inpatient wards had a significant relationship with caregivers' knowledge regarding PUs prevention. Therefore, managers and policymakers in the medical field can help increase caregivers' knowledge by providing an online or in-person educational platform relevant to PU prevention.
Topics: Humans; Female; Male; Caregivers; Cross-Sectional Studies; Ulcer; Pressure Ulcer; Suppuration
PubMed: 36960763
DOI: 10.1111/iwj.14168 -
Neurology India 2022Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps....
Occipital pressure ulcers and wound gaping may occur in unconscious and malnourished patients. Most of the time, a large defect requires wound coverage by scalp flaps. This video describes a rotational occipital scalp flap for occipital pressure ulcer and wound gaping in a patient of operated midline posterior fossa mass & ventriculoperitoneal shunt. The defect measured 2.25 × 2.5 cm with exposed inion. The wound was included in an imaginary triangle, and the horizontal and vertical incision lengths were about four times the base of the triangle. The flap was based on the left occipital artery and raised in an avascular plane above the periosteum. The wound margins were freshened and undermined. The flap was rotated to bring it over the defect, and suturing was done in the standard manner. The flap had good healing, and the patient continued to be under care for his cerebellar medulloblastoma.
Topics: Arteries; Humans; Pressure Ulcer; Plastic Surgery Procedures; Scalp; Surgical Flaps
PubMed: 35864612
DOI: 10.4103/0028-3886.349590 -
Wound Management & Prevention Aug 2019Existing evidence is inadequate to assume increased skin temperature is a risk factor for the development of pressure ulcers (PUs).
UNLABELLED
Existing evidence is inadequate to assume increased skin temperature is a risk factor for the development of pressure ulcers (PUs).
PURPOSE
The purpose of this prospective, descriptive study was to examine the relationship between sacral skin temperature and PU development.
METHODS
Using convenience sampling methods, patients who were hospitalized in the tertiary intensive care unit (ICU) of the internal medicine department of a university hospital in İzmir, Turkey, between April and December 2015 were eligible to participate if they were ⟩18 years of age, had an expected hospital stay of at least 5 days, a Braden score ≤12, and were admitted without a PU. Demographic and clinical data collected included age, gender, body mass index, diagnosis, mattress type, length of follow-up (days), systolic and diastolic blood pressure, body temperature, hemoglobin level, sacral skin temperatures in the supine and lateral positions, room temperature, PU stage and duration, and Braden score. Temperature was measured the day of hospitalization as a baseline measurement (day 1) and once every day thereafter up to 22 days, until the patient did or did not develop a PU, died, was no longer undergoing position change, or was discharged. Sacral skin temperature was taken immediately after the patient was moved to a lateral position following 120 minutes of supine position (referred to as sacral skin temperature measurement) and after 30 minutes in lateral position (referred to as sacral skin temperature measurement). Data were collected using paper-and-pencil questionnaires and entered into a software program for analysis. Descriptive statistics, Student's test, one-way analysis of variance test, Pearson product-moment correlation analysis, and Spearman's rank-order correlation analysis were used for data analysis.
RESULTS
Of the 37 patients who met the inclusion criteria and were monitored for at least 5 days, 21 (56.8%) developed PUs. No statistically significant difference in supine position sacral skin temperature on day 1 or day 5 was found between patients who did and did not develop a PU (36.90° C ± 0.29° C and 37.15° C ± 0.53° C, respectively, on day 1; = -1.656, = .112; and 37.37° C ± 0.53° C and 37.30° C ± 0.79° C, respectively, on day 5; = 0.259, = .798). Day 5 lateral position skin temperatures also did not differ significantly between the 2 groups (37.44° C ± 0.44° C and 37.31° C ± 0.75° C, respectively; = 1.306, = .621). A statistically significant difference was noted between mean sacral skin temperature in the supine position among patients ages 75 to 90 years compared with patients 38 to 64 years and 65 to 74 years (36.93° C ± 0.39° C; F = 13.221, = .000) and with use of a viscoelastic mattress compared with an alternating pressure air mattress and continuous lateral rotation alternating pressure air mattress (37.85° C ± 0.54° C; F = 14.039, = .000). No statistically significant differences in sacral skin temperatures were found for any of the of the other variables assessed.
CONCLUSION
Sacral skin temperatures were not statistically different between ICU patients who did and did not develop a PU. Additional research may help increase understanding of the relationship between skin temperature and PU development.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pressure Ulcer; Prospective Studies; Risk Factors; Sacrococcygeal Region; Skin Temperature; Turkey
PubMed: 31373568
DOI: No ID Found -
The Journal of Spinal Cord Medicine Nov 2021Clinicians have guidance on prevention and treatment of pressure injuries, but little is known regarding characteristics of patients who develop additional pressure...
Clinicians have guidance on prevention and treatment of pressure injuries, but little is known regarding characteristics of patients who develop additional pressure injuries. Thus, our objective was to explore the first pressure injury and characteristics of individuals who develop subsequent pressure injuries during acute care and inpatient rehabilitation following spinal cord injury. Secondary analysis of longitudinal data from a cohort of adults following initial traumatic spinal cord injury. Urban acute care hospital and inpatient rehabilitation facilities. A convenience sample of adults ( = 38) who developed at least one pressure injury during acute care and inpatient rehabilitation. Not applicable. The primary outcomes were number of additional pressure injuries and stage of care during which they occurred, prior to community discharge. A covariate-adjusted model revealed that participants with ASIA D injury had a 67% decrease in the rate of additional pressure injury incidence compared to participants with ASIA A injury (Rate Ratio = .33, 95% CI [0.13, 0.88]). The severity of the first pressure injury had no significant association with subsequent pressure injury incidence (= .10). These findings indicated that individuals with greater sensory and motor loss had an increased risk of developing additional pressure injuries compared to individuals with less impairment. These results are meaningful for stakeholders interested in understanding factors associated with developing subsequent pressure injuries during the index rehabilitation stay and provide a foundation for future research in this area.
Topics: Adult; Cohort Studies; Humans; Incidence; Inpatients; Pressure Ulcer; Spinal Cord Injuries
PubMed: 32233917
DOI: 10.1080/10790268.2020.1744871 -
International Journal of Environmental... Sep 2022Applications where data mining tools are used in the fields of medicine and nursing are becoming more and more frequent. Among them, decision trees have been applied to...
Applications where data mining tools are used in the fields of medicine and nursing are becoming more and more frequent. Among them, decision trees have been applied to different health data, such as those associated with pressure ulcers. Pressure ulcers represent a health problem with a significant impact on the morbidity and mortality of immobilized patients and on the quality of life of affected people and their families. Nurses provide comprehensive care to immobilized patients. This fact results in an increased workload that can be a risk factor for the development of serious health problems. Healthcare work with evidence-based practice with an objective criterion for a nursing professional is an essential addition for the application of preventive measures. In this work, two ways for conducting a pressure ulcer risk assessment based on a decision tree approach are provided. The first way is based on the activity and mobility characteristics of the Braden scale, whilst the second way is based on the activity, mobility and skin moisture characteristics. The results provided in this study endow nursing professionals with a foundation in relation to the use of their experience and objective criteria for quick decision making regarding the risk of a patient to develop a pressure ulcer.
Topics: Decision Trees; Humans; Nursing Assessment; Pressure Ulcer; Quality of Life; Risk Assessment; Risk Factors
PubMed: 36141434
DOI: 10.3390/ijerph191811161 -
International Wound Journal Aug 2022
Topics: Bandages; Humans; Pressure Ulcer
PubMed: 35698859
DOI: 10.1111/iwj.13859 -
International Journal of Nursing Studies May 2023The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of...
Prevalence and associations of xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo in aged nursing home residents: A representative prevalence study.
BACKGROUND
The number of elderly and care-dependent people is increasing, leading to increased risks of adverse skin conditions. Skin care, including prevention and treatment of vulnerable skin, is an essential part of daily nursing practice in long-term residential settings. For many years, the research focus has been on individual skin problems including xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers, and intertrigo, although people may be affected by several at the same time.
OBJECTIVES
Aim of the present study was to describe the prevalence and associations of skin conditions relevant to nursing practice in aged nursing home residents.
DESIGN
Analysis of baseline data of a cluster-RCT in long-term residential settings.
SETTING
The study was conducted in a representative sample of n = 17 nursing homes in the federal state of Berlin, Germany.
PARTICIPANTS
Care dependent nursing home residents being 65+ years.
METHODS
A random sample of all eligible nursing homes was drawn. Demographic and health characteristics were collected and head-to-toe skin examinations conducted by dermatologists. Prevalence estimates and intracluster correlation coefficients were calculated, and group comparisons conducted.
RESULTS
Three hundred fourteen residents with a mean age of 85.4 (SD 7.1) years were included. The majority was affected by xerosis cutis (95.9%, 95% CI 93.6 to 97.8), followed by intertrigo 35.0% (95% CI 30.0 to 40.1), incontinence-associated dermatitis 21.0% (95% CI 15.6 to 26.3), skin tears 10.5% (95% CI 7.3 to 13.8), and pressure ulcers 8.0% (95% CI 5.1 to 10.8). In total, more than half of the nursing home residents were affected by two or more skin conditions at the same time. Several associations between skin conditions and mobility, care dependency, or cognitive impairment were observed. There were no associations between xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers or intertrigo.
CONCLUSIONS
The adverse skin and tissue conditions xerosis cutis, incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo are very common in long-term residential settings, placing a high burden on this population. Although care receivers share similar risk factors and may be affected by several skin conditions at the same time, there are no associations indicating separate aetiological pathways.
REGISTRATION
This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29th, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31st, 2019).
Topics: Aged; Humans; Aged, 80 and over; Pressure Ulcer; Cross-Sectional Studies; Prevalence; Nursing Homes; Skin Diseases; Intertrigo
PubMed: 36898269
DOI: 10.1016/j.ijnurstu.2023.104472 -
International Wound Journal May 2022The aim of this national cross-sectional study was to explore the prevalence of pressure injuries and incidence of hospital-acquired pressure injuries, and the relating...
The aim of this national cross-sectional study was to explore the prevalence of pressure injuries and incidence of hospital-acquired pressure injuries, and the relating factors in somatic-specialised inpatient care in Finland. The study was conducted in 16 (out of 21) Finnish health care organisations offering specialised health care services. Data were collected in 2018 and 2019 from adult patients (N = 5902) in inpatient, emergency follow-up, and rehabilitation units. Pressure injury prevalence (all stages/categories) was 12.7%, and the incidence of hospital-acquired pressure injuries was 10%. Of the participants, 2.6% had at least one pressure injury at admission. The risk of hospital-acquired pressure injuries was increased for medical patients with a higher age, the inability to move independently, mode of arrival, being underweight, and the absence of a skin assessment or pressure injury risk assessment at admission. For surgical patients, the risk was associated with the inability to move independently, mode of arrival, and lack of skin assessment at admission, while being overweight protected the patients. Overall, medical patients were in greater risk of hospital-acquired pressure injuries than the surgical patients. An assessment of the pressure injury risk and skin status should be carried out more systematically in Finnish acute care hospitals.
Topics: Adult; Cross-Sectional Studies; Humans; Incidence; Inpatients; Pressure Ulcer; Prevalence; Risk Factors
PubMed: 34605185
DOI: 10.1111/iwj.13692