Inter-Rater Reliability of a Pressure Injury Risk Assessment Scale for Home Care: A Multicenter Cross-Sectional Study.

PURPOSE: The aim of the current study was to assess the inter-rater reliability and agreement of the Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home), a risk assessment scale recently developed for Japan-specific social welfare professionals called care managers, to predict pressure injury risk in geriatric individuals who require long-term home care needs. METHODS: A multicenter cross-sectional study was conducted at 30 home-based geriatric support services facilities located at four local districts in Japan. Eligible participants were individuals who needed partial or full assistance for daily living under Japan's long-term care insurance system (care levels 1-5). The degree of agreement and kappa coefficient were calculated for each item and the total score, after which inter-rater reliability was determined. The effect of the participant's care level on reliability was also evaluated as secondary analysis. RESULTS: A total of 96 participants were assessed by 83 care managers (two assessors scored each participant). The degree of agreement and calculated kappa coefficient of the PPRA-Home total score were 59% and 0.72, respectively, with the inter-rater reliability for the total score determined to be "Substantial". Our subgroup analysis showed that the inter-rater reliability differed according to the participant's care level. Accordingly, the kappa coefficient for the total score was lower in subgroup "care level 1-3" than in subgroup "care level 4-5" (0.51 and 0.76, respectively). CONCLUSION: Our result showed that the PPRA-Home has substantial inter-rater reliability for evaluation of risks of pressure injury development at home care. However, some research focusing on intra-later reliability and validity of the PPRA-Home with adequate sample sizes are required to provide categorical conclusions on whether it can be used for the risk assessment scale in actual clinical settings.

[Pressure Injury Is Our Own Problem: Substantial Wrong Treatment Exists-You will Become an Expert Medical or Healthcare Provider after Understanding the Essence of Pressure Injury].

Pressure injury occurs in bedridden persons. Before dying, almost all people become bedridden. Etiology of pressure injury is injury caused by pressure, shear forces, and malnutrition. Pressure injury is a painful wound if not appropriately treated by medical staff or caregivers. Hence, it is important to recognize that pressure injury will be own problem. Wound treatment recommended at home is shown below. Close observation is important for the early stage pressure injury. The dermis of stage 2 pressure injury must be protected. The pressure injury with cellulitis must be incised promptly. Necrotic tissue in the wound should be removed safely and immediately. It is important that the wound is covered by granulation tissue and epithelized effectively.

Peristomal Moisture-Associated Skin Damage and Independence in Pouching System Changes in Persons With New Fecal Ostomies.

PURPOSE: The purpose of this study was to evaluate factors related to peristomal moisture-associated skin damage (MASD) in patients who underwent ostomy surgery because of colorectal cancer, and their independence in pouching system changes. Findings were used to determine pre- and postsurgical care for these patients. DESIGN: Retrospective review of medical records. SUBJECTS AND SETTING: The study setting was an 800-bed hospital in metropolitan Tokyo, Japan. The sample comprised 89 patients (median age: 65 years; male vs female: 58 vs 31) who visited a stoma clinic within 8 weeks of ostomy surgery. Fifty-two subjects had ileostomies and 37 had colostomies; data were collected between January 2008 and July 2014. METHODS: Data were collected from outpatient and inpatient records. Potential relationships between MASD and independence in pouching system changes were evaluated via univariate tests to identify possible associations, followed by logistic regression analysis. RESULTS: Patients living with an ileostomy were more likely to experience peristomal MASD than were patients living with a colostomy (odds ratio [OR] = 3.782; 95% confidence interval [CI]: 1.34-10.64; P = .012). Analysis also found that patients with postsurgical chemotherapy were more than 2.5 times more likely to experience peristomal MASD than patients who did not require postoperative chemotherapy (OR = 2.702; 95% CI: 1.02-7.18; P = .046). We also found that patients 65 years or older were significantly more likely to have difficulty in changing their pouching system than were younger patients (OR = 7.193; 95% CI: 2.21-23.41; P = .001), as were those with diabetes mellitus (OR = 11.842; 95% CI: 2.56-54.77; P = .002). CONCLUSIONS: Patients undergoing ileostomy and those receiving postoperative chemotherapy are more likely to experience peristomal MASD. Older patients (>65 years) and those with diabetes mellitus are less likely to achieve independence. These findings influenced our management of persons undergoing ostomy surgery for management of colorectal cancer in our clinic. We recommend additional research using a larger and more diverse sample to confirm our findings.

[Difficulty of the pressure ulcer care at home--from a doctor's point of view].

The early finding and prevention of the pressure ulcers is very important both in hospital and at home. But it is difficult to find pressure ulcer in earlier stage at home. Ordinary, the treatment would start after the pressure ulcers got progressed or pneumonia was coming down. The most important solution must be an education to the family and care worker. So, I started the regional educational meeting since 2002. Nutritional improvement of the patient is also important for the pressure ulcer treatment at home. For doing so, assessing the nutritional state by a registered dietitian is especially important. Although homecare specialists from different occupations should be involved for the treatment of a pressure ulcer, we must keep a close cooperation each other to lighten the burden of the family.

Human colorectal malignancy and oral UFT.

Thymidylate synthase (EC 2.1.1.45) and thymidine kinase (EC 2.71.21) are key enzymes involved in de novo and salvage pathways for pyrimidine nucleotide synthesis. Both enzyme activities are increased in rapidly proliferating normal, fetal and neoplastic tissues. In a previous study, the activities of thymidylate synthase and thymidine kinase were relatively predominant in the poorly-and well-differentiated types of a gastric cancer. In the present study of patients with colorectal cancer, the serum thymidine kinase activities are elevated in cases at a clinically late stage, and in cases with a recurrence and a distant metastasis associated with abundant blood supply, i.e. metastasis to the liver, lung and bone. Well-differentiated colorectal cancer shows higher thymidine kinase activity than moderately-well-differentiated type as was previously shown in gastric cancer patients. Furthermore, neoadjuvant chemotherapy using the 5-fluorouracil derivative UFT demonstrates a stronger suppression of increased activities of thymidylate synthase in the tumorous tissues than in the non-tumorous mucosa.