Use of a novel pressure distribution system for severely ill neonates: a clinical pilot study carried out by the PREPICare consortium.

BACKGROUND: Pressure Injuries are not exclusively an adult phenomenon; various risk factors contribute to a high prevalence rate of 43% in the neonatal and pediatric intensive care population. Effective preventive measures in this population are limited. METHODS: We performed a pilot study to analyze the distribution and localization of support surface interface pressures in neonates in a pediatric intensive care unit (PICU). The hypothesis was that pressure redistribution by a novel air mattress would reduce pressure peaks in critical neonates. The measurements were conducted in a 27-bed level III PICU between November and December 2020. This included measuring pressure distribution and pressure peaks for five neonates positioned on either a state-of-the-art foam mattress or a new prototype air mattress. RESULTS: We confirmed that the pressure peaks were significantly reduced using the prototype air mattress, compared with the state-of-the-art foam mattress. The reduction of mean pressure values was 9-29%, while the reduction of the highest 10% of pressure values was 23-41%. CONCLUSIONS: The journey to an effective, optimal, and approved product for severely ill neonates to reduce Pressure Injuries is challenging. However, a crucial step was completed by this pilot study with the first pressure measurements in a real-world setting and the successful realization of a decrease in pressure peaks obtained using a prototype air mattress.

Video-Based Education with Storytelling Reduces Parents' Fear of Topical Corticosteroid Use in Children with Atopic Dermatitis: A Randomized Controlled Trial (The EduDerm Study Part II).

OBJECTIVE: To investigate the efficacy of educational videos using storytelling to reduce parents' fear of topical corticosteroid (TCS) use in children affected by atopic dermatitis (AD). METHODS: Children aged 0 to 5 years who had AD were included. The primary outcome measures were parental fear of TCSs, as determined by Topical Corticosteroid Phobia score, and quality of life according to the Family Dermatology Life Quality Index. Disease severity, assessed by the Scoring Atopic Dermatitis tool, served as a secondary outcome measure. Assessments were performed at baseline (T1), 1 to 4 weeks later (T2), and at 3-month follow-up (T3). The intervention group was exposed to the videos between baseline and T2. RESULTS: Forty patients were recruited: 21 in the intervention group and 19 in the control group. A statistically significant decrease in parental TCS fear was found in the intervention group at T2 after video education as compared with the control group (P < .0001); this was maintained at T3 (P = .001). The groups did not significantly differ in FDLQI or SCORAD scores at any point. CONCLUSIONS: These findings suggest that video education based on the method of storytelling is effective in reducing TCS fear. Although the education did not impact disease severity or quality of life, effectively reducing TCS fear remains an important aspect for AD management.

[Self-efficacy expectancy in adolescents with anorexia nervosa in the outpatient setting: A cross-sectional study]. / Die Selbstwirksamkeitserwartung von Jugendlichen mit Anorexia nervosa im poststationären Setting.

Self-efficacy expectancy in adolescents with anorexia nervosa in the outpatient setting: A cross-sectional study Abstract: Introduction: The population involved in this study are individuals with anorexia nervosa (AN). AN is a disease with sometimes life-threatening underweight. Self-esteem problems, anxiety and social problems accompany those affected. AN is often chronic. Hospitalized patients quickly gain weight, but often the underlying eating problem persists, which leads to rehospitalization. Studies on the self-efficacy expectation (SWE) of those affected are largely lacking. Aim: The aim of this study is to examine the SWE in those affected in the post-hospital setting with reference to the age of the affected persons, the number of hospitalizations and the course of the disease. Method: As part of this cross-sectional study, those affected were interviewed in the post-hospital, psychosomatic setting using a standardized questionnaire "General SWE". The data were evaluated descriptively and by means of inferential statistics. Result: 85 young people were interviewed. In the sample, the SWE score averaged = 28.53 with up to and including three hospitalizations and = 24.68 with four or more hospitalizations. If the inpatient stay was only recently, the SWE score shows a lower value (= 26.08) than for those with a longer stay (= 29.00). Conclusion: The results indicate that SWE can influence the course of the disease in those affected. People with higher SWE values show a more favorable course of the disease with fewer rehospitalizations. The strengthening of the SWE is therefore of great importance in the inpatient and outpatient setting through targeted interventions by specialists.

An international consensus on device-related pressure ulcers: SECURE prevention.

Catherine Milne and colleagues present the findings of their review, ccna2@juno.com.

Storytelling als innovative Methode zur videobasierten Edukation für Eltern von Kindern mit atopischer Dermatitis.

Storytelling as an innovative method of video-based education for parents of children with atopic dermatitis Abstract. Background: Atopic Dermatitis (AD) is the most chronic skin disease in children and affects up to 20 % of children in developed countries. Chronic inflammation of the skin, itching, redness, and non-dermatologic symptoms like sleep disturbance are frequent and have a negative impact on the child's quality of life and their family. Education is one of the most important aspects of managing AD. Aim: Production and evaluation of educational videos with the method storytelling for parents of children aged 0 to 5 years with atopic dermatitis. Methods: We produced the videos with the method of storytelling. The aim of storytelling is to help to recall important information more easily. A multi-professional team and parents of affected children tested the videos to ensure the understandability, the helpfulness and importance of the educational videos. Results: We created six different videos in all. The content of the educational videos includes information on the causes of AD, symptoms, skin care, treatment instruction and living with AD. We implemented the method of storytelling by two families with affected children who reported about their experience with the disease and the treatment. Three different specialists gave expert information. The evaluation showed that the information in the videos is simple, understandable and relevant. Conclusions: Evidence-based videos are an innovative, creative and modern method to support education. Storytelling is a user-friendly method to give simple and understandable information.

Pressure ulcers in maturing skin - A clinical perspective.

While the problem of Pressure Ulcers (PU) in adults has received a great deal of attention, far less is known about PUs in neonates and children. The overall health status of children is generally better and multi-morbidity is limited to a small percentage of patients, like very low term neonates (born before 32 weeks of gestation age), newborns with congenital abnormalities, genetic disorders, perinatal distress syndrome or children with a limited immunity. Survival rates of both critically and chronically ill neonates, infants and children have improved dramatically in recent years, introducing new challenges for medical and nursing care. Children's skin undergoes several changes throughout the first 18 years of life. The most important function of the skin is to protect against water loss, absorptions of noxious substances, intrusions of microorganisms and physical trauma. Effective PU prevention includes device related under-padding and careful positioning and fixation of such devices. At least regular head-to-toe-skin assessment of neonates and infants at risk of PUs should be performed.

Pressure ulcer treatment in pediatric patients.

OBJECTIVE: To assess pressure ulcer (PrU) treatment in Swiss hospitalized pediatric patients and to determine whether there are differences in PrU treatment, according to demographic characteristics of the patients. DESIGN: A descriptive multicenter point prevalence study was conducted in June 2009 in all German-speaking pediatric hospitals in Switzerland. SETTING: All hospitalized patients from birth up to 17 years or younger in 14 Swiss pediatric hospitals, including all pediatric departments, were assessed. PATIENTS: A total of 412 patients participated in this study. MAIN OUTCOME MEASURES: The instrument and method of the Dutch National Prevalence Measurement of Care Problems were used. MAIN RESULTS: Thirty-five percent of the patients had a PrU. Almost all of these PrUs (94.1%) were of category 1. The most severe PrUs occurred in patients older than 8 years. Age of the patient and department were the only characteristics that significantly influenced the occurrence of PrU categories 2 to 4. Pressure ulcer categories 2 to 4 were mostly covered with hydrocolloid or polyurethane foam dressings. No pediatric-specific guideline regarding PrU treatment is used in the involved hospitals. CONCLUSION: Most patients had category 1 PrUs, so appropriate prevention to decrease any further trauma in these patients was necessary. Severe PrUs (categories 2-4) are mostly limited to older pediatric (aged >8 years) patients with chronic conditions or after surgery intervention. A PrU treatment guideline adapted for pediatric needs is recommended.

Assessment of compression forces in a digitally modified short leg cast for pressure injury risk monitoring in healthy children.

Introduction: Casting is an essential treatment for neuro-orthopedic conditions in children with cognitive, sensory, and communicational disabilities. However, a main side-effect is the development of pressure injuries resulting in additional (wound) therapies and prolongation of the hospital stay. The primary aim of our study was to investigate the potential of objective pressure measurements in casts to assess the risk for pressure injury development. Methods: Five pediatric healthy participants were included in this study. We measured the global and the local compression force at body sites prone to pressure injury development for different body positions and the transfer in-between in a cast equipped with pressure sensors. These conditions resulted in partial or full body weight loading. Results and discussion: The global maximum compression force was affected significantly by body postures with partial and full loading of the cast and during transfer. The local compression force significantly correlated with the global compression force at the heel and instep area. In conclusion, the integration of sensing technologies into casts bears a high potential for early recognition of critical conditions inside the cast and inducing preventive measures in the at-risk population.

[The first steps of an ANP-team - challenges and chances of ANP-teams at the Children's University Hospital Zurich]. / «Wie ein ANP-Team laufen lernt¼ - Herausforderungen und Chancen von ANP-Teams am Universitätskinderspital Zürich.

In the past, various individual ANP-roles such as Clinical Nurse Specialist and Nurse Practitioner were developed in the USA and in several countries of Northern Europe. In Switzerland, the number of university-educated nurse specialists is still very limited. In order to promote sustainable progress in nursing practice despite of this background, Advanced Nursing Practice teams (ANP-teams) have continuously been established at Kinderspital Zurich for the last eight years. This approach has proven to be an excellent option especially in highly complex situations where targeted and adequate solutions for patients are a major issue. In this article, the structure of the ANP-teams is discussed, with the personnel mix as a key factor. Important supportive elements are a clear definition of tasks as well as an allocation of individual tasks to either clinical or conceptual groups. The ANP teams are highly motivated and goal-oriented, they integrate nurses with various backgrounds of experience or training whereby mutual learning is being encouraged.

The prevalence of pressure ulcers in four paediatric institutions.

AIM AND OBJECTIVE: Pressure ulcers are a common nursing care issue in hospitals. They are associated with psychological and physical suffering, an increased morbidity and mortality rate and higher overall health care costs. The aim of the current study is to describe the frequency of pressure ulcers in a paediatric care setting and to identify the population at risk, as well as to assess the factors predisposing to the development of pressure ulcers. DESIGN: A point prevalence study. METHODS: The study was conducted in four paediatric hospitals in the German-speaking part of Switzerland and included children from the age of 0-18 years. The method of data collection was a direct systematic inspection and assessment of the skin, taking into account the clinical condition of the patient for risk assessment. A valid risk assessment and data collection instrument was used and, each patient was assessed by a previously instructed rater pair. RESULTS: Of all possible patients, 81% (n = 155) were included. An overall pressure ulcer prevalence of 27.7% (including grade 1) was registered. Thirty-six patients (84%) had grade 1 ulcers, including many caused by external medical devices. Sixty-five per cent (n = 100) of all patients were considered at risk (Braden score < or = 20) of developing a pressure ulcer. Thirty-five per cent of patients in the risk group were afflicted with one or more pressure ulcers. CONCLUSIONS: The prevalence of pressure ulcers in paediatric patients is greater then previously appreciated and the problem requires further exploration. The high percentage of grade 1 pressure ulcers caused by medical devices requires nursing interventions to prevent lesions for these patients. RELEVANCE TO CLINICAL PRACTICE: The high prevalence rate in paediatric patients is disconcerting and requires further exploration in terms of interventions needed to improve outcomes for this patient group.

[Pressure ulcer prevention and therapy: results of a descriptive study]. / Dekubitusprävention und -therapie in der Pä- diatrie: Ergebnisse einer deskriptiven Studie.

Pressure ulcers are a common nursing care issue in hospitals. Sick children, premature infants and toddlers, but also disabled and impaired children are at a high risk of developing pressure ulcers. The aim of this descriptive cross-sectional study was to describe the patients at risk as well as to identify the preventive and therapeutic interventions in a pediatric care setting. Of 213 hospitalised children, 155 (82 percent) from the age of 0 to 18 years could be included in the study. Altogether, preventive actions of any kind were performed with 92 percent of the patients. These were repositioning (84 percent), mobilisation of the patients (75 percent), followed by skin inspection (61 percent) and the application of lotions (56 percent). The high risk rate of pediatric patients considered at risk according to the Braden Scale is disconcerting and requires further exploration in terms of effective preventive and therapeutic interventions to improve the outcome for this patient group.