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This article describes the contemporary bioengineering theory and practice of evaluating the fluid handling performance of foam-based dressings, with focus on the important and clinically relevant engineering structure-function relationships and on advanced laboratory testing methods for pre-clinical quantitative assessments of this common type of wound dressings. The effects of key wound dressing material-related and treatment-related physical factors on the absorbency and overall fluid handling of foam-based dressings are thoroughly and quantitively analysed. Discussions include exudate viscosity and temperature, action of mechanical forces and the dressing microstructure and associated interactions. Based on this comprehensive review, we propose a newly developed testing method, experimental metrics and clinical benchmarks that are clinically relevant and can set the standard for robust fluid handling performance evaluations. The purpose of this evaluative framework is to translate the physical characteristics and performance determinants of a foam dressing into achievable best clinical outcomes. These guiding principles are key to distinguishing desirable properties of a dressing that contribute to optimal performance in clinical settings.
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Vendajes , Cicatrización de Heridas , Humanos , Exudados y Transudados , Examen FísicoRESUMEN
Pressure injuries affect 1 to 46% of residents in aged care (long term) facilities and cause a substantial economic burden on health care systems. Remote expert wound nurse consultation has the potential to improve pressure injury outcomes; however, the clinical and cost effectiveness of this intervention for healing of pressure injuries in residential aged care require further investigation. We describe the remote expert wound nurse consultation intervention and the method of a prospective, pilot, cluster randomised controlled trial. The primary outcome is number of wounds healed. Secondary outcomes are wound healing rate, time to healing, wound infection, satisfaction, quality of life, cost of treatment and care, hospitalisations, and deaths. Intervention group participants receive the intervention over a 12-week period and all participants are monitored for 24 weeks. A wound imaging and measurement system is used to analyse pressure injury images. A feasibility and fidelity evaluation will be concurrently conducted. The results of the trial will inform the merit of and justification for a future definitive trial to evaluate the clinical and cost effectiveness of remote expert wound nurse consultation for the healing of pressure injuries in residential aged care.
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Análisis de Costo-Efectividad , Úlcera por Presión , Humanos , Anciano , Úlcera por Presión/terapia , Estudios Prospectivos , Calidad de Vida , Cicatrización de Heridas , Derivación y Consulta , Análisis Costo-Beneficio , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.
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COVID-19 , Úlcera por Presión , Humanos , COVID-19/prevención & control , Análisis de Costo-Efectividad , Úlcera por Presión/prevención & control , Pandemias , Estudios Prospectivos , Unidades de Cuidados Intensivos , HospitalesRESUMEN
AIM: The aim of this project was to develop a core outcome set (COS) for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds. METHODS: The research project followed the Core Outcome Measures in Effectiveness Trials (COMET) initiative and consisted of two phases. The first phase prepared the background and process, while the second phase had three steps: outcome list generation via systematic review and qualitative study, Delphi consensus study, and consensus meeting. The study has been registered in the Core Outcome Measures in Effectiveness Trials database. RESULTS: The systematic review resulted in 82 outcomes and 20 additional outcomes were obtained during the interviews. After refinement, 111 panellists from 23 countries rated a list of 51 outcomes. In the following consensus meeting, six outcomes were prioritized to be included in the core outcome set. After the consensus meeting, a patient-reported outcome was added to the core outcome set. CONCLUSION: The COS for evaluating the effectiveness of bordered foam dressings in treating complex wounds includes 7 outcomes: "ability to stay in place", "leakage", "pain", "dressing related periwound skin changes", "change in wound size over time", and "overall satisfaction". These identified outcomes are correlated with contemporary bioengineering testing and evaluation methods for dressing performance, which underpins the need for a close multidisciplinary collaboration to advance the field of wound dressings. The outcome 'overall satisfaction' reflects the impact of complex wounds and their treatment on a patient's daily life. The use of these outcomes is recommended to improve data synthesis and promote evidence-based practice. Future developments in COS development involve creating measurement instruments and relevant endpoints for these outcomes.
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Vendajes , Evaluación de Resultado en la Atención de Salud , Humanos , Técnica Delphi , Determinación de Punto Final/métodos , Resultado del Tratamiento , Revisiones Sistemáticas como AsuntoRESUMEN
The aim of this article is to identify and describe clinical practice performance characteristics for bordered foam dressings in the treatment of complex wounds. Our recently published systematic review of outcomes and applied measurement instruments for the use of bordered foam dressings in complex wounds has led to us identifying a range of important clinical and patient-centred issues related to this dressing class. Specifically, here, we focus on an overview of performance criteria in the areas of application, adhesion, exudate management and debridement functions of bordered foam dressings. Our hope is that by highlighting the clinical performance criteria, future testing standards for wound dressings will more closely match our clinical expectations and, thereby, assist clinicians to make better wound treatment choices based on meaningful and clinically relevant dressing product performance standards. complex wounds, complex wound care, treatment, bordered foam dressings, dressing performance.
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Vendajes , Cicatrización de Heridas , Humanos , Selección de Paciente , Exudados y TransudadosRESUMEN
OBJECTIVE: The aim of this review article was to identify reported outcomes and measurement instruments used in clinical research on bordered foam dressings in the treatment of complex wounds. METHODS: MEDLINE (PubMed interface), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and The Cochrane Library were systematically searched using a combination of key terms including; wounds, bordered foam dressing, and treatment. Studies were included if they (1) targeted an adult population, (2) addressed the treatment of complex wounds with a bordered foam dressing as the primary wound dressing, (3) were retrieved from original research, and (4) were published between 2000 and 2022. There were no restrictions on language or study design. Studies that focused primarily on the prevention of complex wounds were excluded. Data extraction included outcome domains, outcomes, instruments, time points, and outcome measures. The OMERACT Filter 2.0 was used as a conceptual framework for the extraction of outcomes. RESULTS: A total of 24 outcome domains and 82 outcomes were identified. The outcomes were categorised into five core areas: (1) impact on life, (2) dressing performance, (3) pathophysiological manifestations, (4) resource use, and (5) adverse events. Thirtynine outcomes (47.0%) were measured at more than one time point. The most frequently reported time point was 'at the end of treatment' (62.7%). Outcomes were measured using self-report instruments, clinical observations, and bio-physiological instruments. CONCLUSION: This systematic review identified reported outcomes and measurement instruments in research on bordered foam dressings in the treatment of complex wounds. The variety and lack of consistency in terms of instruments, time points and outcome measurements made it difficult to compare data directly across different reported studies. A solution to the variety in outcome reporting across studies in complex wound care, and moreover for the treatment with bordered foam dressings, is the development of a Core Outcome Set (COS). The outcomes in this review article will inform the next steps of developing a COS, where patients, clinicians and researchers will be involved to decide on the final outcomes included in a COS for the treatment of complex wounds with bordered foam dressings.
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Vendajes , Cicatrización de Heridas , Adulto , Humanos , Medición de Resultados Informados por el PacienteRESUMEN
Patients who have chronic wounds such as leg ulcers should be active participants in their treatment and care. This participation may include self-treatment of the wound which involves the patient cleaning the wound, applying and removing wound dressings, and/or applying and removing compression therapy. The aim of the study was to develop a Checklist to assist nurses to appraise the conduct of wound treatment when undertaken by the patient. A three-phase mixed methods study was conducted. A systematic and evidence-based approach to developing and using structured observations for the study of health behaviour guided the process of developing, piloting and refining the Checklist. The resulting "Self-Treatment of Wounds for Venous Leg Ulcers Checklist" (STOW-V Checklist V1.0) can assist the nurse to evaluate the conduct of key self-treatment behaviours in the areas of equipment and workspace, hand hygiene, wound dressing removal, skin care, wound cleansing and debridement, wound assessment, wound dressing application, and compression therapy application. The growing recognition that patients can benefit when involved in care, the need to enact self-management because of COVID-19, and the ever present competition for healthcare funding and resources are compelling reasons for patients, care providers, and healthcare services to afford the self-management approach, and associated interventions such as self-treatment, greater consideration. It is recommended that the STOW-V Checklist is used with patients in a shared-care model, with nurses and other healthcare professionals providing supervision and oversight of self-treatment practices whenever this is feasible and acceptable to the patient.
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COVID-19 , Úlcera de la Pierna , Úlcera Varicosa , Lista de Verificación , Humanos , Úlcera de la Pierna/terapia , SARS-CoV-2 , Úlcera Varicosa/terapia , Cicatrización de HeridasRESUMEN
The "Self-Treatment of Wounds for Venous Leg Ulcers Checklist" (STOW-V Checklist V1.0) is an evidence-based, standardised tool designed to assist nurses to appraise the conduct of wound treatment when undertaken by patients who have venous leg ulcers. A prospective reliability study was conducted to determine the reliability of the STOW-V Checklist V1.0. Video-recordings of patients who self-treated their leg ulcer were obtained (n = 5) and nurses (n = 15) viewed each video-recording three times and concurrently completed the Checklist. Internal consistency, inter-rater reliability and intra-rater reliability were evaluated. Cronbach's alpha for items in the Checklist was 0.792, 0.791 and 0.783 for Occasions 1, 2 and 3, respectively, indicating good reliability. Inter-rater reliability was 0.938, 0.958 and 0.927 for Occasions 1, 2 and 3, respectively; these results were statistically significant and indicative of excellent reliability. Intra-rater reliability was 0.403 to 0.999; these results were statistically significant and meeting or exceed adequacy in the case of all except two raters. The study provides preliminary evidence that the Checklist is measuring the concepts that it intends to measure and that there is a high level of agreement among raters. It is recommended that the STOW-V Checklist V1.0 is utilised with patients in a shared-care model, with nurses and other healthcare professionals providing supervision and oversight of self-treatment practices whenever this is feasible and acceptable to the patient.
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Lista de Verificación , Úlcera de la Pierna , Humanos , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/terapia , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: The purpose of this study was to compare the psychometric data and feasibility and clinical utility of the Face Legs, Activity, Cry and Consolability scale (FLACC), the Modified Behavioral Pain Scale (MBPS) and the Visual Analogue Scale for observers (VASobs) used to assess procedural pain in infants and young children. PATIENTS AND METHODS: Twenty-six clinicians assessed videorecorded segments of 100 infants and young children who underwent a painful and/or distressing procedure in the emergency department using the FLACC scale, the MBPS and the VASobs pain and VASobs distress. RESULTS: VASobs pain scores were lowest across all procedures and phases of procedures (p < 0.001). Inter-rater reliability was lowest for VASobs pain scores (ICC 0.55). Sensitivity and specificity were highest for FLACC scores (94.9% and 72.5%, respectively) at the lowest cut-off score (pain score two). Observers changed their MBPS scores more often than they changed FLACC or VASobs scores, but FLACC scores were more often incomplete. Reviewers did not consider any scale of use for procedural pain measurement. CONCLUSION: The reliability and sensitivity of the FLACC and MBPS were supported by study data but concerns about the capacity of these scales to distinguish between pain- and non-pain-related distress were raised. The VASobs cannot be recommended. Despite its limitations, the FLACC scale may be better suited than other scales for procedural pain measurement.
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PURPOSE: The Visual Analogue Scale applied by an observer (VASobs) is widely used to quantify pain but the evidence to support validity is poor. The aim of this study was to evaluate the psychometric and practical properties of the VASobs used to assess procedural pain in infants and young children. DESIGN AND METHODS: In an observational study, 26 clinicians applied the VASobs independently to video segments of 100 children aged six to 42 months undergoing a procedure to generate pain and distress scores. Each video segment was scored by four randomly selected reviewers. RESULTS: Reliability for pain scores was poor to fair (ICC 0.35 to 0.55) but higher for distress scores (ICC 0.6 to 0.89). At a cut-off score of 3, sensitivity and specificity were 84.7% and 95.0%, respectively for pain and 91.5% and 77.5% respectively for distress. Linear mixed modelling confirmed responsiveness. An increase in pain scores (regression slope 4.95) and distress scores (regression slope 5.52) across phases (baseline to procedure) was seen for painful procedures. The correlation between VASobs pain and FLACC scores was good (r = 0.74) and correlations between VASobs distress and FLACC scores were excellent (r = 0.89). CONCLUSION: VASobs was easily applied and preferred by clinicians. Despite evidence of sensitivity and responsiveness to pain, the reliability results were poor, and this scale cannot be recommended for use. PRACTICE IMPLICATIONS: The results of this study prevent recommending the VASobs for assessing procedural pain in infants and young children for clinical or research purposes.
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Dolor Asociado a Procedimientos Médicos , Niño , Preescolar , Humanos , Lactante , Dimensión del Dolor , Dolor Asociado a Procedimientos Médicos/diagnóstico , Psicometría , Reproducibilidad de los Resultados , Escala Visual AnalógicaRESUMEN
Wound-dressing performances are affected by exudate viscosity, resistance to flow because of gravity, and bodyweight loads, the level of which is related to the body position. Here, we focussed on two dressing properties: (a) Sorptivity-the ability of dressings to transfer exudate away from the wound bed by capillary action-and (b) Durability-the capacity of dressings to maintain their integrity over time and during their removal. Both properties are critically important for avoiding further tissue damage but require the development of new laboratory tests for their measurement. A computer-controlled phantom of an exuding sacral pressure ulcer has therefore been developed and used to compare the performances of Exufiber (Mölnlycke Health Care) vs an alternative market-leading dressing. Sorptivity was determined using weight tests, and durability was measured through tensile tests of the used dressings. For a supine configuration, the Exufiber dressing demonstrated ~three times higher sorptivity and better durability, withstanding ~five times greater strain energy than the other product before failure occurred. This work paves the way for quantitative, standardised testing of dressings in all aspects of exudate management. The reported tests are further suitable for testing dressing combinations or how dressings interact with negative pressure wound therapy.
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Geles , Apósitos Oclusivos , Úlcera por Presión , Simulación por Computador , Exudados y Transudados , Humanos , Cicatrización de HeridasRESUMEN
BACKGROUND: A continuing complication, pressure injuries are due to sustained mechanical loading and tissue deformations, which can then be exacerbated by additional intrinsic and extrinsic risk factors. Although support surfaces are designed to mitigate risk factors for pressure injuries, the presence of a turn and position device (TPD) between the patient and support surface may interfere with how support surfaces affect these risk factors. OBJECTIVE: Report the use of the NPIAP's S3I standard test methods to characterize the performance of a support surface when used in conjunction with three different TPDs. DESIGN: Laboratory testing compared three TPDs for Immersion, Envelopment, and Horizontal Stiffness in each of five surface combinations. MAIN OUTCOME MEASURE: Immersion test measures how far mannequin indenter immerses into surface. Envelopment test measures immersion and pressure distribution with hemispherical-indenter with mounted sensor rings. Horizontal Stiffness test measures the shear modulus of the support surface with epicondyle indenter. MAIN RESULTS: For the specific TPDs tested here, the one with an adjustable integrated air bladder improved rather than compromised both the envelopment and the immersion of the support surface alone. Additionally, this TPD provided potential protection against sliding and the associated frictional shear forces. CONCLUSIONS: This paper describes how TPDs should perform in order to help establish which features are needed in a new medical device of this type. Laboratory testing demonstrates it is possible to improve performance of a support surface by applying a TPD as an add-on, thus relieving tissue deformation exposure through more effective pressure redistribution.
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Maniquíes , Posicionamiento del Paciente , Úlcera por Presión/prevención & control , Prevención Primaria/normas , Equipos de Seguridad/normas , HumanosRESUMEN
OBJECTIVE: Skin wounds, such as leg ulcers and pressure ulcers (PUs), can have a negative effect on quality of life (QoL). This effect has been confirmed among self-treaters of wounds, specifically. The aim of the study was to investigate the effect of self-treatment of wounds on the physical, emotional, lifestyle and financial domains of QoL. The findings of the study may be used to optimise the wellbeing of people who have wounds. METHOD: A qualitative study was conducted with people who were 18 years of age or older; lived in Victoria, Australia; spoke English; and had a wound that they had self-treated. Participants were interviewed and the data thematically analysed to identify themes that represented the effect of self-treatment on the physical, emotional, lifestyle and financial domains of QoL. RESULTS: The participants (n=25) averaged 71 years of age and the majority (n=20) had leg wounds. Participants described mostly positive effects on QoL that were attributable to self-treatment. Self-treatment improved physical wellbeing because it resulted in better pain management and wound healing; however, it was a physical challenge for some. Self-treatment enhanced emotional wellbeing because it helped to manage worry about infection and resolve dissatisfaction with professional care. Self-treatment lessened the social consequences of the wound by enabling participants to create an acceptable appearance, maintain their lifestyle and minimise time receiving professional care. Self-treatment reduced the financial cost of wound dressings and the expense associated with receiving professional care. CONCLUSION: As an approach to care, self-treatment of wounds may offer QoL gains that might otherwise be unachievable. The importance of engaging patients in their own management, and the increasing accountability of healthcare providers to report consumer-focused outcomes, are further reasons to consider self-treatment of wounds as an approach to care in the community setting.
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Úlcera por Presión/terapia , Calidad de Vida , Autocuidado , Úlcera Cutánea/terapia , Anciano , Femenino , Humanos , Úlcera de la Pierna/terapia , Masculino , Investigación CualitativaRESUMEN
The prevalence of pressure injuries in the intensive care unit (ICU) setting is high with rates ranging from 13.1% to 45.5%. Evaluation of interventions to prevent pressure injuries should be informed by preliminary research to identify factors that should be considered during the design of future trials. The study objectives were to evaluate the process of participant recruitment and monitoring in the ICU; measure the maintenance of body angle (in the side-lying lateral tilt position) and head and neck alignment angle (in the supine position) among immobile critically ill patients when using a purpose-designed positioning device and usual care equipment, and; ascertain the time required to position patients with the purpose-designed positioning device and the usual care equipment. A prospective, observational, feasibility study was conducted in an ICU in Victoria, Australia. The sample was immobile critically ill adults at high-risk of developing pressure injuries. The usual care interventions were pillows, foam wedges, and rolled towels, and the intervention device was the Z-Flo Fluidized Positioner. The body angle and head and neck alignment were measured on six occasions (at baseline, 1 hour, and 2 hours). The time required for positioning was also measured. The sample was predominately male (n = 5, 62%) with a mean age of 59 years. The majority of patients (n = 106, 92.2%) were not immobile and therefore were ineligible to participate. A total of 48 turning and positioning interventions were observed. For the side-lying lateral tilt position, the degree of difference from baseline to 2 hours was no more than three degrees for all the devices (the Fluidized Positioner 25°-26°, the foam wedge 29°-27°, and the pillow 23°-21°). For the head and neck position, the degree of difference from baseline to 2 hours was the greatest for the pillow and rolled towel (78°-71°, a difference of 7°) and the pillow alone (79°-74°, a difference of 5°). The degree of difference was the lowest for the Fluidized Positioner (84°-86°, a difference of 2°). Future research to evaluate positioning equipment in the ICU should consider patient eligibility characteristics, particularly immobility. The conduct of preliminary studies to inform the design of larger pressure injury prevention trials is recommended.
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Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Posicionamiento del Paciente/instrumentación , Posicionamiento del Paciente/métodos , Úlcera por Presión/prevención & control , Úlcera por Presión/terapia , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Victoria , Adulto JovenRESUMEN
We reported the efficacy of soft silicone multilayered foam dressings in preventing intraoperatively acquired pressure injuries (IAPIs) in the prone position using a Relton-Hall frame (BOSS trial). The aim of this study was to clarify the incidence and extract the risk factors for IAPIs in cases in which polyurethane film dressing was used against IAPIs before the BOSS trial period. This study conducted as a retrospective dual-center cohort study between August 2014 and Jun 2015 using the medical records in the operating room. The incidence of IAPIs that developed within 24 hours after surgery was 7.1% (7/99). The multivariate logistic regression analysis revealed that body mass index (BMI) (P = .0016, odds ratio [OR]: 1.22, 95% confidence interval (CI) 1.08-1.4) and length of surgery (P < .0001, OR 2.47, 95% CI 1.86-3.51) were independently associated with the development of IAPIs. Since high BMI was not extracted in BOSS trial, we conclude that the application of soft silicone multilayer foam dressings is important for preventing the development of IAPIs in patients with high BMI values.
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Vendajes , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/prevención & control , Úlcera por Presión/epidemiología , Úlcera por Presión/prevención & control , Columna Vertebral/cirugía , Anciano , Índice de Masa Corporal , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Tempo Operativo , Poliuretanos , Posición Prona , Estudios Retrospectivos , Factores de Riesgo , Soporte de PesoRESUMEN
The BORDER III trial found that five-layer silicone border dressings effectively prevented pressure injuries in long-term care, but the value of this approach is unknown. Our objective was to analyse the cost-effectiveness of preventing facility-acquired pressure injuries with a quality improvement bundle, including prophylactic five-layer dressings in US and Australian long-term care. Markov models analysed the cost utility for pressure injuries acquired during long-term care from US and Australian perspectives. Models calibrated outcomes for standard care compared with a dressing-inclusive bundle over 18 monthly cycles or until death based on BORDER III outcomes. Patients who developed a pressure injury simulated advancement through stages 1 to 4. Univariate and multivariate probabilistic sensitivity analyses tested modelling uncertainty. Costs in 2017 USD and quality-adjusted life years (QALYs) were used to calculate an incremental cost-effectiveness ratio (ICER). Dressing use yielded greater QALYs at slightly higher costs from perspectives. The US ICER was $36 652/QALY, while the Australian ICER was $15 898/QALY, both of which fell below a willingness-to-pay threshold of $100 000/QALY. Probabilistic sensitivity analysis favoured dressings as cost-effective for most simulations. A quality improvement bundle, including prophylactic five-layer dressings, is a cost-effective approach for pressure injury prevention in all US and Australia long-term care residents.
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Vendajes/economía , Análisis Costo-Beneficio , Casas de Salud , Úlcera por Presión/economía , Úlcera por Presión/prevención & control , Instituciones de Cuidados Especializados de Enfermería , Australia , Humanos , Cadenas de Markov , Modelos Económicos , Personal de Enfermería/economía , Mejoramiento de la Calidad , Años de Vida Ajustados por Calidad de Vida , Cuidados de la Piel/economía , Estados UnidosRESUMEN
The aim of the study was to evaluate the maintenance of the 30° side-lying lateral tilt position among aged care residents at the risk of developing pressure injuries when using the standard care pillow and a purpose-designed positioning device. An observational study was conducted. Participants were monitored during positioning under two conditions, with pillows and with a fluidised positioner. Body angle measurements were taken at three time points (baseline, 1 hour, and 2 hours) on 10 occasions. Repeated-measures analysis assessed the difference in the degree of the angle of the body. The sample (n = 12) had an average age of 83 years, and the participants were immobile when in bed. The average angle with the pillow condition was 26.7° at baseline, 21.5° at 1 hour, and 16.6° at 2 hours. The average angle with the fluidised positioner condition was 30.7° at baseline, 29.3° at 1 hour, and 26.8° at 2 hours. The main effects of Condition and Time were significant: Condition: F(1,11) = 14.378, P < .001, Time: F(2,22) = 45.858, P < .001. There was a statistically significant interaction between the effects of Condition and Time on the average lateral tilt position, F(2,22) = 15.574, P < .001. The lateral tilt body position was better maintained with the positioning device than the pillow. Further research is required to determine the effectiveness of the fluidised positioner for pressure injury prevention.
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Posicionamiento del Paciente/instrumentación , Úlcera por Presión/prevención & control , Anciano , Anciano de 80 o más Años , Ropa de Cama y Ropa Blanca , Evaluación Geriátrica , Hogares para Ancianos , Humanos , Casas de Salud , Pronóstico , Medición de RiesgoRESUMEN
OBJECTIVE: The worldwide volume of surgery today is considerable and postoperative wound healing plays a significant part in facilitating a patient's recovery and rehabilitation. While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence (SWD) or breakdown of the incision site may occur despite advances in surgical techniques, infection control practices and wound care. SWD impacts on patient mortality and morbidity and significantly contributes to prolonged hospital stay. Preoperative identification of patients at risk of SWD may be valuable in reducing the risk of postoperative wound complications. METHOD: A three-phase study was undertaken to determine risk factors associated with SWD, develop a preoperative patient risk assessment tool and to prospectively validate the tool in a clinical setting. Phases 1 and 2 were retrospective case control studies. Phase 1 determined variables associated with SWD and these informed the development of a risk assessment tool. Univariate analysis and multiple logistic regression were applied to identify predictors of surgical risk. Phase 2 used the receiver operator curve statistic to determine the predictive power of the tool. Phase 3 involved a prospective consecutive case series validation to test the inter-rater reliability and predictive power of the tool. RESULTS: In addition to those already identified in the literature, one independent risk predictor for SWD was identified: previous surgery in the same anatomical location (p<0.001, odds ratio [OR] 4). Multiple combined factors were integrated into the tool and included: age (p<0.019, OR 3), diabetes (p<0.624, OR 2), obesity (p<0.94, OR 1.4), smoking (p<0.387, OR 2), cardiovascular disease (p<0.381 OR 3) and peripheral arterial disease (p<0.501, OR 3). The predictive power of the tool yielded 71% in a combined data sample. CONCLUSION: Patients with previous surgery in the same anatomical location were four times more likely to incur a dehiscence. Identification of at-risk patients for complications postoperatively is integral to reducing SWD occurrence and improving health-related outcomes following surgery.
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Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Obesidad/epidemiología , Medición de Riesgo/métodos , Fumar/epidemiología , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Dehiscencia de la Herida Operatoria/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/epidemiología , Cuidados Preoperatorios , Estudios Prospectivos , Estudios Retrospectivos , Adulto JovenRESUMEN
This article is a review of the work conducted and published to date in employing computer finite element (FE) modeling for efficacy research of prophylactic dressings in the context of preventing pressure injuries. The authors strive to explain why FE modeling is essential in establishing the efficacy of prophylactic dressings, as it is in the development and evaluation of any other preventive intervention. In particular, FE modeling provides insights into the interactions between dressing structures and weight-bearing body tissues (including susceptible anatomical locations such as the sacrum and heels of supine patients). Modeling further facilitates reliable visualization and quantification of the mechanical loads that develop in superficial and deep tissues as a result of body weight or external forces based on known physical principles. The modeling then helps to determine how these tissue loads are mitigated using prophylactic dressings of different designs, structures, and material compositions and rate performances of existing or new products.All of the work published so far on modeling the modes of action of prophylactic dressings has focused on the Mepilex Border dressing (Mölnlycke Health Care AB, Gothenburg, Sweden). Published work has revealed several key design features that are pivotal for obtaining successful clinical outcomes, namely, (1) a multilayered alternating-stiffness structure with embedded anisotropy; (2) a minimal friction coefficient at the external surface of the dressing; and (3) low impact of fluid retention on the mechanical behavior of the dressing. These features, their importance, and the methods of identifying their roles in the modes of action of effective prophylactic dressings are detailed here.Computer models clearly inform the process of engineering prophylactic dressings, but they may also provide guidance in clinical use, contribute to assessing technologies and products, support purchasing, and describe product endurance. As the methods of FE modeling of dressings improve, simulations may soon incorporate the simultaneous complex interactions among tissue distortion, heat transfer in tissue, and prophylactic dressings to inform patient care.