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Pressure ulcer management

Sérgio Dos Anjos Garnes, Adriana Bottoni, Fernanda Lasakosvitsch, Andrea Bottoni
OBJECTIVE: This study developed an instrument in table format to help determine the energy requirements of patients in adverse situations. The instrument allows for the weekly adjustment of nutrition therapy and energy intake, advocating a new approach to treatment based on clinical observation performed by staff specialized in individualized nutrition therapy. METHODS: The table was elaborated by grouping patients according to the following criteria: criticality, chronicity, and stability of the clinical status...
February 3, 2018: Nutrition
Bastiaan Van Grootven, Lynn McNicoll, Daniel A Mendelson, Susan M Friedman, Katleen Fagard, Koen Milisen, Johan Flamaing, Mieke Deschodt
OBJECTIVE: To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. DESIGN: An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). SETTING: Western Europe and the USA. PARTICIPANTS: Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited...
March 16, 2018: BMJ Open
Marco Artico, Daniela D'Angelo, Michela Piredda, Tommasangelo Petitti, Luciano Lamarca, Maria Grazia de Marinis, Angelo Dante, Maura Lusignani, Maria Matarese
CONTEXT: Patients with advanced illnesses show the highest prevalence for pressure ulcers. In the palliative care setting the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. OBJECTIVES: To describe the course of healing for pressure ulcers in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement...
March 13, 2018: Journal of Pain and Symptom Management
Zhen Li, Xinmei Zhou, Jing Cao, Zheng Li, Xia Wan, Jiaqian Li, Jing Jiao, Ge Liu, Ying Liu, Fangfang Li, Baoyun Song, Jingfen Jin, Liu Yilan, Xianxiu Wen, Shouzhen Cheng, Xinjuan Wu
AIMS AND OBJECTIVES: To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications. BACKGROUND: Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking...
March 15, 2018: Journal of Clinical Nursing
Daniel Podd
Pressure injuries (previously called pressure ulcers) are a common finding among patients in acute, long-term, or home settings. Numerous pathophysiologic and risk mechanisms factor into the development of pressure injuries. The timely recognition of these injuries is imperative. Many treatments exist for pressure injuries but the focus of patient management should be on preventing injury-related complications.
March 6, 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
Hideyuki Yanagi, Hiroto Terashi, Yoshimitsu Takahashi, Katsuyuki Okabe, Katsumi Tanaka, Chu Kimura, Norihiko Ohura, Takahiro Goto, Ichiro Hashimoto, Madoka Noguchi, Junichi Sasayama, Kenichi Shimada, Ayumi Sugai, Mitsuko Tanba, Takeo Nakayama, Ryoji Tsuboi, Junko Sugama, Hiromi Sanada
OBJECTIVE: To clarify the surgical indications and the appropriate perioperative management of ischial pressure ulcers (PUs). METHOD: A two-year prospective, nationwide registry study was carried out across 26 medical institutions in Japan. All participating institutions managed ischial PUs according to the standardisation of total management and surgical application for the refractory decubitus (STANDARDS-I) perioperative protocol. Analysis was conducted on a range of clinically or statistically important variables for the achievement of primary or secondary endpoints: complete wound healing and hospital discharge at three months, and complete wound healing at one month after surgery, respectively...
March 2, 2018: Journal of Wound Care
Muhammad Asif Rasheed, Ali Kashif, Aneeqa Naz, Sikandar Ali
Toothbrush is a rare foreign body to be ingested accidentally. The unusual shape of the toothbrush with no theoretical possibility of spontaneous passage mandates an interventional approach. If left untreated, it can lead to pressure necrosis, bleeding, perforation and ulceration. An endoscopic attempt in an expert clinic if available is the ideal approach. If failed, surgical management by laparoscope or mini laparotomy should be done. The evaluation for underlying psychiatric disorders like bulimia, schizophrenia or generalized eating disorder should be considered to prevent such recurrence...
January 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Raymond Cavaliere, Danielle M Mercado, Malary Mani
Squamous cell carcinoma (SCC) has been commonly reported by foot and ankle specialists. Marjolin's ulcer is a malignancy that involves a posttraumatic scar or ulceration that can develop into SCC from chronic neuropathic pedal wounds, venous stasis, or decubitus ulcerations. Most Marjolin's ulcers are found in the lower extremity, specifically the feet, and it is twice as common in females as males. Biopsy of the tumor is the reference standard to diagnose SCC, and wide excision of SCC is the most common treatment option...
March 2, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Peter Vowden, Kath Vowden
Recent health economic publications have highlighted the cost of wound care and demonstrated the important role played by community and practice nurses in delivering care. Leg ulcers form a significant proportion of the wounds managed in the community. Data indicates that many patients are managed with no specific diagnosis or without calculation of the ankle brachial pressure index (ABPI), despite care guidelines emphasising the importance of a full assessment including Doppler ABPI calculation in patient management...
March 2, 2018: British Journal of Community Nursing
Abhishek Jairam, Ping Song, Nirav B Patel, Michael S Wong
BACKGROUND: The National Pressure Ulcer Advisory Panel estimates pressure sore care to approach $11 billion annually. It is not uncommon for these patients to present to the emergency department (ED) with a chief concern of a pressure sore, while concurrently carrying an undiagnosed infectious process that is the culprit for the acute presentation, rather than the chronic pressure injury. We aim to identify patients who met systemic inflammatory response syndrome (SIRS) criteria at ED presentation who were referred to plastic and reconstructive surgery for pressure sore debridement prior to a complete medical workup...
February 27, 2018: Annals of Plastic Surgery
Catherine R Ratliff
The purpose of this case series was to assess the performance of a concentrated surfactant-based gel (CSG) dressing on 18 patients in the outpatient setting over 4 weeks. Wounds selected were full thickness, had been presented for greater than 4 weeks, and were located on the lower extremities. Patients were given the CSG dressing and instructed on its use. On follow-up clinic visits, the wound was assessed, measurements were obtained, Pressure Ulcer Scale for Healing (PUSH) Tool scores completed, and satisfaction with the dressing was solicited...
March 2018: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
Michael Clark, Trudie Young, Maureen Fallon
Successful prevention of pressure ulcers is the end product of a complex series of care processes including, but not limited to, the assessment of vulnerability to pressure damage; skin assessment and care; nutritional support; repositioning; and the use of beds, mattresses, and cushions to manage mechanical loads on the skin and soft tissues. The purpose of this review was to examine where and how Statistical Process Control (SPC) measures have been used to assess the success of quality improvement initiatives intended to improve pressure ulcer prevention...
February 15, 2018: International Wound Journal
Kim Usher, Cindy Woods, Janie Brown, Tamara Power, Jackie Lea, Marie Hutchinson, Carey Mather, Andrea Miller, Annette Saunders, Jane Mills, Lin Zhao, Karen Yates, Marie Bodak, Joanne Southern, Debra Jackson
AIM: The aim of this study was to assess student nurses' knowledge of and attitudes towards pressure injury prevention evidence-based guidelines. BACKGROUND: Pressure injuries are a substantial problem in many healthcare settings causing major harm to patients, and generating major economic costs for health service providers. Nurses have a crucial role in the prevention of pressure injuries across all health care settings. DESIGN: A multi-centered, cross-sectional study was conducted using a paper-based questionnaire with undergraduate nursing students enrolled in seven universities with campuses across five Australian states (Queensland, New South Wales, Western Australia, Victoria and Tasmania)...
February 2, 2018: International Journal of Nursing Studies
Gary Delhougne, Christopher Hogan, Kim Tarka, Sunitha Nair
Traditional negative pressure wound therapy (NPWT) systems are considered durable. The pump is designed for use by numerous patients over a period of several years. Recently developed smaller, disposable devices are designed for single-patient use. A retrospective analysis of 2012-2014 national Medicare claims data was used to examine payments associated with the use of traditional and disposable NPWT systems. Data extracted included NPWT episodes from the Limited Data Set Standard Analytic Files including the 5% sample for traditional NPWT and 100% sample for disposable NPWT...
January 2018: Ostomy/wound Management
Pedro Miguel Garcez Sardo, Jenifer Adriana Domingues Guedes, José Joaquim Marques Alvarelhão, Paulo Alexandre Puga Machado, Elsa Maria Oliveira Pinheiro Melo
AIM: To study the influence of Braden subscales scores (at the first pressure ulcer risk assessment) on pressure ulcer incidence using a univariate and a multivariate time to event analysis. MATERIALS AND METHODS: Retrospective cohort analysis of electronic health record database from adult patients admitted without pressure ulcer(s) to medical and surgical wards of a Portuguese hospital during 2012. The hazard ratio of developing a pressure ulcer during the length of inpatient stay was calculated by univariate Cox regression for each variable of interest and by multivariate Cox regression for the Braden subscales that were statistically significant...
February 2, 2018: Journal of Tissue Viability
Tatiana V Boyko, Michael T Longaker, George P Yang
Significance: The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately is increasingly important for all professionals in wound care. Recent Advances: Many new dressings and treatment modalities have been developed over the recent years and the goal of this review is to highlight their benefits and drawbacks to help providers choose their tools appropriately. Critical Issues: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming...
February 1, 2018: Advances in Wound Care
Ye Zhang, Hong Deng, Zhouping Tang
Diabetes mellitus is a widely spread chronic disease with growing incidence worldwide, and diabetic foot ulcer is one of the most serious complications of diabetes. Cellular therapy has shown promise in the management of diabetic foot ulcer in many preclinical experiments and clinical researches. Here, we performed a meta-analysis to evaluate the efficacy and safety of cellular therapy in the management of diabetic foot ulcer. We systematically searched PubMed, MEDLINE, EMBASE, and Cochrane Library databases from inception to May 2017 for randomized controlled trials assessing the efficacy of cellular therapy in diabetic foot ulcer, and a meta-analysis was conducted...
December 2017: Cell Transplantation
Paul Wurzer, Raimund Winter, Sebastian O Stemmer, Josipa Ivancic, Patricia B Lebo, Gabriel Hundeshagen, Janos Cambiaso-Daniel, Franz Quehenberger, Lars-Peter Kamolz, David B Lumenta
BACKGROUND: Patients suffering from pressure ulcers remain to be a challenging task for nursing staff and doctors in the daily clinical management, putting - notably in the case of recurrences - additional strain on the constantly reduced resources in public health care. We aimed to assess the risk factors for the recurrence of pressure ulcers at our institution, a tertiary referral center. METHODS: In this retrospective analysis of patients admitted to our division we identified risk factors for pressure ulcer recurrence...
January 30, 2018: Wound Repair and Regeneration
Patricia Finch Guthrie, Shelley Rayborn, Howard K Butcher
Delirium is a common cause of morbidity and mortality in hospitalized older adults often superimposed on dementia. Older patients with delirium are more likely than other populations to develop hospital-acquired infections, pressure ulcers, and immobility and nutritional issues, as well as to have increased health care costs, longer hospital stays, and long-term care following discharge. Interventions that prevent or mitigate the effects of delirium while promoting recovery are essential for caring for hospitalized older patients...
February 1, 2018: Journal of Gerontological Nursing
Estelle Everett, Nestoras Mathioudakis
Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic...
January 2018: Annals of the New York Academy of Sciences
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