Economics of pressure-ulcer care: review of the literature on modern versus traditional dressings.

Published evidence suggests that some of the benefits of modern dressings--longer wear times and less frequent dressing changes--make them more cost-effective than traditional gauze dressings in pressure ulcer management.

The effectiveness of a hyperoxygenated fatty acid compound in preventing pressure ulcers.

OBJECTIVE: To compare the effects of Mepentol, a hyperoxygenated fatty acid preparation, with a placebo treatment in preventing the development of pressure ulcers. METHOD: The research study consisted of a multicentre double-blind randomised clinical trial. The incidence of pressure ulcers, relative risk (RR), preventable fraction and number necessary to treat (NNT) were calculated. In addition, Kaplan-Meier survival curves, with log-rank test, and Cox's proportional hazards regression model were used to compare both groups. RESULTS: A total of 331 patients completed the study: 167 in the control group and 164 in the study group. Pressure-ulcer incidence during the study was 7.32% in the intervention group versus 17.37% in the placebo group (p 0.006). These results show that for each 10 patients treated with Mepentol one pressure ulcer was prevented (NNT = 9.95). Survival curves and the regression model showed a significant statistical difference for both groups (p < or = 0.001). The average cost of Mepentol during the study was 7.74 Euro. CONCLUSION: Mepentol is an effective measure for pressure ulcer prevention. It was more effective than a greasy placebo product, and was found to be cost-effective.

Hot sand burns on the sole of a patient with diabetes.

A patient with diabetes who burnt his feet by walking on hot sand was treated with an amorphous hydrogel, which resulted in full wound healing within four weeks. These patients should avoid walking barefoot on sand whenever possible.

[Skin care and pressure ulcer. Hyperoxygenated fatty acids in the prevention of pressure ulcers and treatment of stage I lesions]. / Cuidado de la piel y úlceras por presión. Los ácidos grasos hiperoxigenados en la prevención de UPP y el tratamiento de lesiones de estadio I.

UNLABELLED: Skin care in general and, more specifically, the use of hyper-oxygenated fatty acids to protect zones at risk, constitute a very useful method in the prevention of dedubitus ulcers and to reverse stage one lesions. PATIENTS AND METHODS: Retrospective evaluation on the systematic use of hyper-oxygenated fatty acids inside the parameters accepted for the prevention and care of decubitus ulcers at the Clinical University Hospital Puerta de Hierro in Madrid in its Internal Medicine Nursing Unit during 1999 and 2000. RESULTS: 853 patients were studied, of whom 524 entered the hospital without any bedsore. Of these 524 patients who entered without a bedsore, 5, or 1% of these cases, developed new lesions. Of the 163 patients suffering a stage one decubitus ulcer upon entering the hospital, 131 or 80% saw their status reserve to not being a bedsore. COMMENTARY: The use of hyper-oxygenated fatty acids is an effective measure in the prevention of bedsores and in the reversal of stage one lesions.

[Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers]. / Comparación de la efectividad y coste de la cura en ambiente húmedo frente a la cura tradicional. Ensayo clinico en pacientes de atención primaria con úlceras vasculares y por presión.

INTRODUCTION: The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. PATIENTS, MATERIALS AND METHODS: The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. MAIN RESULTS: 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18.22 days, 4.54 treatment sessions and a cost of 2409 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. In the pressure ulcers study group, the authors conclusions were an average of 12.18 days, 12.1 treatment sessions and a cost of 15,490 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 7.12 days, 1.86 treatment sessions and a cost of 2610 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. COMMENTS: The results of this randomized clinical trial demosntrated that the moist environment treatment group was more effective and had a better cost-benefit ratio than the traditional treatment group in the treatment of pressure ulcers and venous leg ulcers on patients cared for by nursing personnel in primary health care centers all of which agrees with publications consulted by authors.

[Experimental study. Reduction of pressure in areas of risk of developing pressure ulcers with a hydrocellular dressing]. / Estudio experimental. Reducción de la presión en zonas de riesgo para desarrollar úlceras por presión con un apósito hidrocelular.

INTRODUCTION: The handling of pressure is a basic measure in the prevention and treatment of bed sores. It is possible to reduce and ease pressure by various means including changes in posture, use of special surfaces for handling pressure as well as the use of local applications or external applications which reduce pressure. Today nurses have a large quantity of external applications available to use although only some hydrocellular ones are capable to reduce pressure due to their hydrocellular structure. METHODS AND MATERIALS: An experimental study was designed to calculate the level of pressure before and after applying an Allevyn hydrocellular external application in the area of the sacrum, ischium, and heel of three healthy volunteers; first, Volunteer A, a 85 kg. 170 cm man; second, Volunteer B, a 54.3 kg. 159 cm woman; and third, Volunteer C, a 69.4 kg 164 cm man. Measures were taken on two types of surfaces: a viscoelastic foam mattress and a conventional hospital mattress. All measurements were repeated at 0, 30, 45 and 60 degrees of inclination. Pressure was determined by means of a Talley pressure monitor, Oxford Pressure Monitor MK II. RESULTS: A total of 144 pressure reading were taken. The overall average reduction after applying a external hydrocellular application on all volunteers, at all inclinations and on all surfaces for each of the three zones were 19.5% in the sacrum, 13.8% in the ischium and 20.15% in the heel. COMMENTARY: Even though our study has its limitations, such as young, healthy volunteers, we can establish that the external hydrocellular application studied does have a local reducing effect on pressure. Since every external hydrocellular application has its own specific structure, the results of our study can not be applied with certainty to other external applications inside the hydrocellular group.

[Pressure sores: evaluation of the systematic use of special surfaces for managing pressure sores in the intensive care unit of the Tarrasa Hospital, Spain]. / Ulceras por presión: evaluación de la utilización sistemática de un parque de superficies especiales para el manejo de la presión en la unidad de cuidados intensivos del Hospital de Tarrasa.

Pressure sores are a major challenge for healthcare systems. Patients admitted to intensive care units are an important risk group for pressure sores. Systematic use of a protocol employing special surfaces to manage pressure is a basic measure for preventing pressure sores in institutionalized patients. In a study carried out in the Intensive Care Unit of the Hospital of Terrassa (Spain), the incidence of pressure sores before and after introducing a prevention protocol that included the systematic use of special surfaces to manage pressure was compared. The incidence of pressure sores in patients admitted in 1998 and 1999 was studied. Sore locations were recorded. The results of three periods were examined: before introducing the protocol (6.4% incidence), after introducing a protocol (1.1%), and after use of the protocol was consolidated (0%). The results of the study suggest that the systematic use of special surfaces to manage pressure, in accordance with a prevention protocol, is a basic measure for reducing the incidence of pressure sores in patients admitted to intensive care units.

[The use of collagen in the cicatrization of wounds]. / El uso del colágeno en la cicatrización de las heridas.

The authors review the use of collagen in the cicatrization of wounds, analyzing what this process consists of and what its regeneration and reparation phases are. The authors also summarize some fundamental biological aspects collagen has, their functions in hemostasia and in cicatrization; they develop the use of heterologous collagen in the cicatrization process. Expressive illustrations and a selection of bibliographical references accompany this article.

[Clinical evaluation of a hydro-cellular dressing for the treatment of venous leg ulcers]. / Evaluación clínica de un apósito hidrocelular en el tratamiento de úlceras venosas de pierna.

INTRODUCTION: Varicose ulcers (UV) are a serious health problem which produce tremendous pain for those who suffer from them; furthermore, they consume a large amount of health care system resources. Hydro-cellular dressings provide a moist environment cure option as a local treatment of varicose ulcers. MATERIALS AND METHODS: With the purpose of evaluating the use of an Allevyn non-adhesive hydro-cellular dressing under real clinical conditions, an open, observational multi-centric study was carried out. The study group was composed of outpatient care patients or patients hospitalized due to having varicose vein ulcers or having a mixed etiology with an ankle/arm index less than or equal to 0.8. MAIN RESULTS: 24 patients were initially part of this study; two of these abandoned this study group without a justified reason. Of the 22 who finished this study, 16 or 72.7% were women while 6 or 27.3% were men. The mean age in the women patients was 73.07 +/- 9.31 (DS), while among the men patients, the mean age was 67.23 +/- 18.17 (DS). 17 or 77.3% of the ulcers studied were varicose, 1 or 4.5% had a mixed etiology, 1 or 4.5% was due to amputation, and in three cases, the kind of ulcer was not specified. 22 patients finished this study with their lesions healed or in the process of healing; 2 abandoned this study without justification. The patient study group passed from an average initial sore area (IC 95%) or 9.41 or 19.42 cm2 to a final average sore area (IC 95%) of 4.45 or 10.5 cm2 with a mean percent reduction of (IC 95%) 57.22 or 86.22%. In 7 cases or 31.8% of the patients, their lesions healed completely during the course of the study. Inside the group of patients whose lesion did not fully heal during this study, the average initial sore area (IC 95%) was 15.66 +/- 12.75 cm2, a mean of 8.6 or 22.2 cm2 and the medium equaled 9 cm2. The information regarding comfort, absorption quality, ease in application and removal, and its fine results in the presence of pain and in the creation of new lesions once the dressing has been removed as well as the absolute lack of adverse reactions indicates we have discovered an excellent therapeutic option.

[Decubitus ulcers in the sacrum. Evaluation of a specific hydrocolloid hydro-regulatory dressing]. / Ulceras por presión en el sacro. Evaluación multicéntrica de un apósito hidrocoloide hidro-regulador específico.

INTRODUCTION: Sacrum bedsores are lesions having specific cause factors which bear tremendous weight on the possibility of curing these sores. An interesting alternative treatment for these lesions is a moist condition cure which is a new product specifically designed for this kind of sore. MATERIALS AND METHOD: An open, prospective and multicentric study to evaluate the efficiency and the clinical effectiveness of the Comfeel Plus Sacro when used to treat bed sores in the sacrum. RESULTS: Of the 149 patients included in this study, 48 had their sores totally cicatrized in under ten weeks; 58 patients obtained an average sore reduction of IC 95%, average (39.2 63%), in the initial sore surface area during this time period; and of the 20 patients who passed away during this study, 10 of these patients had their sores reduced by more than 20%. COMMENTS: The results obtained from the tests of changing external applications and their use coupled with the clinical results of these external applications lead us to believe we have found an interesting alternative for treatment of bed sores in the sacrum.

[Epidemiology of pressure ulcers or the danger of a new Tower of Babel]. / Epidemiología de las úlceras por presión. O el peligro de una nueva Torre de Babel.

Pressure epidemiology is a fundamental facet in meeting this important challenge to the health care system. The studies done on epidemiology signify an important effort by their authors, although their validity may be conditioned by methodological and conceptual aspects. The proliferation of studies about pressure epidemiology in our country, some of which having methodological conceptions not in agreement with the existing bibliography about this topic in other countries, make it necessary to gain a grasp of the basic epidemiologic aspects applied to the study of pressures as a health problem. This paper presents a bibliographical review on the subject and states proposals adapted to the characteristics of our immediate environs. This paper includes a review of these concepts: prevalence, incidence, recurrence, and severity; in addition to the most utilized variables in describing the pressure problem. Different strategies for the elaboration of epidemiological studies about pressures are also analyzed. Furthermore, the minimum information which authors of said studies need to facilitate in their reports are mentioned.

[Experimental in vitro evaluation of the absorption capacity and control of exudate of 3 wound healing dressings]. / Evaluación experimental "in vitro" de las capacidades de absorción y control del exudado de tres apósitos de cura en ambiente húmedo.

INTRODUCTION: The development of materials based in moist wound healing has meant an important step in wound care. The progressive development of knowledge referred to this issue has showed the importance of the management of wound exudate to obtain an optimal wound healing, which has concluded in a development of dressings orientated to manage exudate. METHODS AND MATERIAL: Experimental "in vitro" study to evaluate the absorption capacity and exudate management of three moist wound healing dressings, Allevyn Adhesive (dressing A), CombiDERM (dressing B) and Tielle (dressing C). For each of this dressings the following parameters have been assessed: rate between the total surface and the absorption surface of the dressing, volume needed to saturate the retention capacity, pH evolution on the absorption surface and macroscopic aspect. RESULTS: Dressing A presents the major value in the rate between the total surface and the absorption surface (with a 64% rate, versus 28.7% for dressing B and 40.5% for dressing C). Dressing B was the one which needed a major quantity of exudate to saturate, with statistical significant differences versus dressings A and C (0.51 ml/cm2 versus 0.40 and 0.37 respectively). Dressing B was also the one that presented a best performance in reference to the leakage of exudate under pressure (with a loss of its initial weight of 8.34%, versus dressing C with a loss of 9.48%, and dressing A with a loss of 24.42%). None of the dressings presented pH modifications in the absorption surface. CONCLUSIONS: The results of this study let us establish that according to the used experimental evaluation methodology and the limitations that have been described in the manuscript, the dressing which presents the best performance in reference to absorption capacity and management of wound exudate is dressing B (CombiDERM) followed by dressing A (Allevyn Adhesive) and dressing C (Tielle). Experimental and clinical research will be required to examine thoroughly the absorption capacity and management of wound exudate of these dressings.

[Evaluating the risks of pressure ulcers. The Braden scale]. / Valorar el riesgo de presentar úlceras por presión. Escala de Braden.

An article which revises the scales used when evaluating the risks pressure sores, the context in which this might arise, and its value in our country as a useful criteria when determining which scale to choose. Also presented is a translation of the Braden Scale into Spanish as well as a comparison of its difference with respect to the Norton Scale.

[Pure calcium-sodium alginate dressing. Multicenter evaluation of chronic cutaneous lesions]. / Apósito de alginato cálcico-sódico puro. Evaluación multicéntrica en lesiones cutáneas crónicas.

By means of a descriptive, non-comparative study of a series of clinical cases, the authors analyze the behavior of a dressing of pure calcic-sodium alginate with a stabilizing network in the treatment of pressure sores and profusely bleeding and/or infected vascular uclers. Based on the results of their studies, the authors confirm the effectiveness of this dressing under these conditions: no adverse reactions; the shrinking of the lesion in area or degree of severity; if there is tissue debridement accompanied by sloughing and necrotic tissue, the elimination of infection; ease of application and the reduction of the lesions; use as part of a non-daily cure treatment plan.