Healthcare quality and safety assessment based on annual scorekeeping.

Objective: To explore the practice of medical quality and safety evaluation system based on annual score under the background of establishing modern hospital management system and strengthening national public hospital performance evaluation. Methods: Statistical analysis was used to study the improvement of medical quality and safety in hospitals after the implementation of score evaluation, and the existing problems were analyzed according to the actual situation and related requirements. Results: The hospital's medical quality and safety evaluation system ran smoothly, the evaluation indexes could be implemented, and the evaluation results were used properly. The improvement of hospital medical quality and operation efficiency has achieved good results. Conclusion: The evaluation system of medical quality and safety for physicians and medical technicians based on annual score can achieve the whole process, all-round, personalized and information-based evaluation, and promote the high-quality development of hospitals. It is necessary to further improve the range of evaluation and carry out the evaluation of the evaluation system by relevant personnel.

Evaluation of the Safety and Ochratoxin A Degradation Capacity of Pediococcus pentosaceus as a Dietary Probiotic with Molecular Docking Approach and Pharmacokinetic Toxicity Assessment.

The present study evaluated the properties and ochratoxin A (OTA) degradation capacity of the dietary probiotic Pediococcus pentosaceus BalaMMB-P3, isolated from a milk coagulant. The acidic tolerance of the isolate at pH 2-3 was checked with bile salts. No hemolytic activity was noted, which confirmed the nonpathogenicity of the strain. The isolate was tested in vitro for antibiotic susceptibility, enzymatic activity, bile salts hydrolase activity and antifungal activity against Penicillium verrucosum, Fusarium graminearum and Aspergillus ochraceus. A molecular docking-based OTA toxicity assessment was carried out for multitargeted proteins. The 16S rRNA gene-based phylogenetic assessment identified the strain as P. pentosaceus, and was authenticated in GenBank. The carboxylesterase and glutathione s-transferase enzymes showed active and strong interactions with esters and amide bonds, respectively. The compound exhibited carcinogenic and cytotoxicity effects at an LD50 value of 20 mg/kg. Furthermore, the strain showed a potent ability to reduce OTA and suggested the prospects for utilization in nutritional aspects of food.

Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis aimed to estimate the pooled prevalence of dysphagia in older adults, subgrouping by recruitment settings and varying dysphagia assessment methods. METHODS: Five major databases were systematically searched through January 2022. A random-effects model for meta-analysis was conducted to obtain the pooled prevalence. RESULTS: Prevalence of dysphagia in the community-dwelling elderly screened by water swallow test was 12.14% (95% CI: 6.48% to 19.25%, I2 = 0%), which was significantly lower than the combined prevalence of 30.52% (95% CI: 21.75% to 40.07%, I2 = 68%) assessed by Standardized Swallowing Assessment (SSA) and volume-viscosity swallow test (V-VST). The dysphagia prevalence among elderly nursing home residents evaluated by SSA was 58.69% (95% CI: 47.71% to 69.25%, I2 = 0%) and by the Gugging Swallowing Screen test (GUSS) test was 53.60% (95% CI: 41.20% to 65.79%, I2 = 0%). The prevalence of dysphagia in hospitalized older adults screened by the 10-item Eating Assessment Tool was 24.10% (95% CI: 16.64% to 32.44%, I2 = 0%), which was significantly lower than those assessed by V-VST or GUSS tests of 47.18% (95% CI: 38.30% to 56.14%, I2 = 0%). CONCLUSIONS: Dysphagia is prevalent in the elderly, affecting approximately one in three community-dwelling elderly, almost half of the geriatric patients, and even more than half of elderly nursing home residents. The use of non-validated screening tools to report dysphagia underestimates its actual prevalence.

[Status of soil fertility, nutrient balance, and environmental risk assessment in yam production of North China Plain]. / åŽåŒ—å¹³åŽŸå±±è¯ä¸»äº§åŒºåœŸå£¤è‚¥åŠ›å’Œå »åˆ†å¹³è¡¡çŽ°çŠ¶åŠçŽ¯å¢ƒé£Žé™©è¯„ä»·.

Taking the main production area of yam in North China Plain as the research area, we analyzed the status of soil fertility and fertilizer application in yam production through field investigation and tracking monitoring, examined soil nutrient balance using the input-output model of nutrients in agricultural system, and assessed the environmental risks in the yam planting system. The results showed that: 1) the contents of soil organic matter and total N were extremely low, and the contents of available P and available Zn were both low; both nitrate and available Cu contents were at the middle level, the contents of soil slowly available K, available S, and exchangeable Ca and Mg were all extremely high, the contents of available K, available Fe, and available Mn were all at high level; 2) The nitrogen (N), phosphorus (P2O5), and potassium (K2O) inputs were 575-943 kg·hm-2, 341-981 kg·hm-2, and 655-1219 kg·hm-2 during the whole growth period of yam, with chemical fertilizer accounting for 83.0%, 88.6%, and 91.3%, respectively; The input imbalance between organic and inorganic fertilizer, as well as the excessive nutrients input were prominent; 3) The surplus rate of soil nitrogen, phosphorus and potassium reached 271.14 kg·hm-2, 466.34 kg·hm-2, and 739.97 kg·hm-2, with corresponding surplus ratio of 48.7%, 258.1%, and 324.5%, respectively, which all exceeded the environmental safety threshold and were classified as moderate risk, severe risk, and severe risk, respectively. The overall environmental risk caused by chemical fertilizer application in yam production had reached severe risk level.

The Integration of Recipes with a Standardizable Food Description FACET for Cadmium Exposure Risk Assessment.

Existing food classification and description systems provide users with limited information related to exposure assessment. Our aim in this work is to propose a standardized food description facet called the Taiwan Food Recipe (TFR) system as an emerging tool for food composition, with detailed food ingredient information, including names, proportions, weights of uncooked and cooked foods, etc. The composite foods listed in the Taiwan Nutrition and Health Survey were collected into a list and as consumption data. The TFR system is intended to help analysts reduce potential estimation bias, where, for example, risk assessment results may be overestimated or underestimated due to the complexity of the composition in the composite foods. Based on a Taiwanese food database, we further illustrate and demonstrate how the TFR system can be applied to the assessment of risk of cadmium (Cd) exposure in rice ingredients in the composite food products. In the original system (HFDFC system), the composite food intakes used total weight to estimate the hazard index (HI) of cadmium in the exposure risk assessment, but the percentage of rice was not 100%. The proposed TFR system estimates the percentage of rice and actual intakes in composite foods. Fried rice, sushi, and rice balls in the study were the most common foods containing rice and had higher consumption rates among Taiwan's rice-based composite foods. The HIs of fried rice, sushi, and rice balls were 0.09, 0.10, and 0.13, respectively, in the HFDFC system. In the TFR system, the HIs of rice in fried rice, sushi, and rice balls were 0.06, 0.04 and 0.05, respectively. The HI of other components in fried rice, sushi, and rice balls were 0.03, 0.06 and 0.08, respectively. More precise HIs were thus shown. The TFR system contributes to global food classification and description systems by providing an appropriate, standardized, and generalized framework for exposure assessments.

[Development of teaching training and assessment system for warming acupuncture].

A teaching training and assessment system for warming acupuncture is developed. This system is suitable for the technique operation of multi-acupoint warming acupuncture, and could evaluate the training effects of warming acupuncture at each acupoint. The hardware structure of this system is mainly composed of man-machine interface, control unit and training unit. The software program includes reset module, system clock module, needle depth signal control module, vibration control module and communication module. The teaching training and assessment system of warming acupuncture adopted touch-screen human-machine interface, which is simple to operate. The basic training unit, through multi-angle and multi-dimension adjustment of universal base, could realize the simulation training of warming acupuncture at different acupoints and angles of human body. Each training unit is relatively independent, and relevant parameters are set separately; the relevant parameters information is displayed in real time. The parameters of training unit includes needling time, vibration frequency and vibration time. In conclusion, the teaching training and assessment system for warming acupuncture could be used in the teaching and assessment of warming acupuncture. According to the criteria including operation time and effect, the students' technique ability of warming acupuncture could be evaluated objectively, which is helpful to set teaching objectives and technical operation requirements in warming acupuncture teaching.

Application of food description to the food classification system: Evidence of risk assessment from Taiwan as Acrylamide of grain products.

Harmonization of national consumption data for international comparison is an important but challenging work, yet to date there is a lack of comparable food classification system that incorporates food description in Taiwan. In 2015, European Food Safety Authority (EFSA) released a new standardized food classification and description system called FoodEx2, which provides a flexible combination of classifications and descriptions. Based on FoodEx2 and a unique data set of daily food consumption offered by Taiwan Food Consumption Database, this study aims to provide a harmonized, food description incorporated, food classification system (HFDFC system) that captures all the useful details of food groups in exposure assessments. The HFDFC system was built according to six risk-assessment-related facets including food sources, processed products, cooking methods, manufacturers (brand), food additives and specialty foods. The HFDFC system includes 199 foods in the core list and 131 foods in the extended list. This study also compared the Acrylamide hazard index estimated under the HFDFC system with that under the National Food Consumption Database in Taiwan (NFCDT). The findings indicated that the HFDFC system provides useful and detailed information that helps the users to quickly identify food information in a harmonized manner and to reduce estimation bias. The HFDFC system is expected to facilitate global comparisons in the food risk assessment because it is built based upon EU Foodex2.

Occurrence and health risk assessment of organotins in waterworks and the source water of the Three Gorges Reservoir Region, China.

The occurrence and health risks of organotins (OTs) in the waterworks and source water in the Three Gorges Reservoir Region (TGRR), China were assessed in this study. Water samples were collected at four waterworks (A, B, C, and D) in March and July 2012 to analyze butyltins (BTs) and phenyltins (PTs) using a gas chromatography-mass spectrometry (GC-MS) system. Our results showed that both the waterworks and their nearby water sources were polluted by OTs, with PTs being the most dominant species. Monobutyltin (MBT), monophenyltin (MPT), diphenyltin (DPT), and triphenyltin (TPT) were detected in most of the analyzed water samples. The highest concentrations of OTs in influents, effluents, and source water in March were 52.81, 17.93, and 55.32 ng Sn L-1, respectively. Furthermore, significant seasonal changes in OTs pollution were observed in all samples, showing pollution worse in spring compared with summer. The removal of OTs by the conventional treatment processes was not stable among the waterworks. The removal efficiency of OTs in July reached 100% at plant B, while that at plant C was only 38.8%. The source water and influents shared similar composition profiles, concentrations, and seasonal change of OTs, which indicated that OTs in the waterworks were derived from the source water. A health risk assessment indicated that the presence of OTs in the waterworks would not pose a significant health risk to the population, yet their presence should not be ignored.

Risk of major comorbidities among workers with hemophilia: A 14-year population-based study.

Multiple comorbidities, especially musculoskeletal dysfunction and cerebrovascular disease, remain barriers to normal social participation among persons with hemophilia (PWH). However, the relative health effects of such comorbidities on workers with hemophilia have seldom been explored. In this study, we investigated the incidence of comorbidities and their risk factors among workers with hemophilia.The study compared the incidence and risk factors of the major comorbidities of 411 workers with hemophilia enrolled in Taiwan's National Health Insurance Research Database between 1997 and 2010 with an age- and sex-matched general population.Compared with the general population, workers with hemophilia had higher risks for hemorrhagic stroke, arthritis/arthropathy, and knee/hip replacement among workers with hemophilia after multivariate adjustment, with hazard ratios (95% CI) of 4.60 (2.81-7.53), 4.03 (3.34-4.87), and 1.29 (1.10-1.41), respectively.Disorder of joints, hemophilia-related arthritis/arthropathy, hemorrhagic stroke, and knee/hip replacement remain significant comorbidities among workers with hemophilia, which will result in increased social burden. Policymakers and employers should apply appropriate interventions to help prevent productivity losses, reduced workforce participation, sick leave, and work disability among hemophilia workers.

[The application of subjective visual gravity in assessment of vestibular compensation: a pilot study].

OBJECTIVE: To discuss the characteristics of subjective visual gravity (subjective visual vertical/horizontal, SVV/SVH) and assess its clinical application for peripheral unilateral vestibular compensation. METHODS: 69 cases of acute peripheral unilateral vestibular dysfunction patients (case group) accepted SVV/SVH, spontaneous nystagmus (SN), caloric test (CT) and other vestibular function tests. 49 healthy people (control group) accepted SVV/SVH only. SVV/SVH, SN and unilateral weakness (UW) were selected as for the observation indicators. The correlations between SVV/SVH, SN, UW and courses were investigated respectively, as well as the characteristic of SVV/SVH, SN in period of vestibular compensation. RESULTS: Among case group SVV, SVH positive in 42 patients(60.9%) and 44 patients(63.8%), the absolute values of the skew angle were in the range between 2.1°-20.0°, 2.1°-22.2°. Skew angles of SVV/SVH in control were in the range between -1.5°-2.0° and -2.0°-1.6°, and had no statistical significance with case group(t=5.336 and 5.864, P<0.05). SN-positive 28 cases (40.6%), the range of intensities at 2.4°-17.1°; UW-positive 50 cases (72.5%). In case group, positive correlation between SVV and SVH(r=0.948, P=0.00), negatively correlated between SVV/SVH and SN respectively(r values were -0.720, -0.733, P values were 0.00), no correlation between the skew angle of SVV/SVH, strength of SN and UW value(r values were 0.191, 0.189, and 0.179, P>0.05), there was no correlation between the absolute value of SVV, SVH, SN, UW with the duration (rs values were -0.075, -0.065, -0.212, and 0.126, P>0.05). CONCLUSION: Subjective visual gravity can be used not only to assess the range of unilateral peripheral vestibular dysfunction, but also help assess the static compensatory of otolithic, guidance and assessment of vestibular rehabilitation.

Fractional Flow Reserve Guided Percutaneous Coronary Intervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice.

BACKGROUND: Fractional flow reserve (FFR) is currently considered as the gold standard for evaluating the functional significance of coronary stenosis. However, its potential benefits in real-world practice remain unknown in China. This study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical practice. METHODS: A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University, a tertiary and high-volume center in China. Clinical events were compared using the Cox proportional hazards model during a median follow-up of 13 months. RESULTS: The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls, from 2010 to 2014. Major adverse cardiac events (MACEs) (death, myocardial infarction, repeated revascularization, or hospitalization for angina) at 4 years were found in 12.0% of angiography-guided patients and 4.9% in the FFR-guided group (P < 0.001). The mean number of implanted stents was significantly lower in FFR treated subjects (0.52 ± 0.82 stents) compared with the angiography-guided group (0.93 ± 0.96 stents) (P < 0.001). No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention (PCI) compared with FFR-guided PCI (RMB 33,000 Yuan, range: RMB 7393-44,700 Yuan) versus RMB 21,200 Yuan (RMB 19,100-47,100 Yuan) (P = 0.54). However, costs for MACEs during follow-up were significantly reduced in the FFR-guided arm (P < 0.001). CONCLUSIONS: In the contemporary clinical practice, FFR-guided PCI is associated with decreased use of stents, improved clinical outcome, and reduced costs, compared with angiography-guided PCI.

[Distribution Characteristics of Heavy Metals in the Street Dusts in Xuanwei and Their Health Risk Assessment].

Relationship between high lung cancer incidence in Xuanwei residents and environmental pollution has been a hot topic in the field of environmental sciences. Street dusts in Xuanwei power plant area as well as its upwind area (Banqiao town) and downwind area (Laibin town, Tangtang town) were collected. Chemical elements in the street dust samples were investigated using ICP-MS. Health risk assessment of heavy metals in the street dusts was carried out using the US EPA Health Risk Assessment Model. Our results showed that the mass level of Al, V, Ni, Co, Zn and Cd in street dusts followed the order of Xuanwei power plant > Laibin town > Tangtang town. The mean concentrations of V, Cd, Cr, Cu, Mn, Co, Ni, Pb, As and Zn were all higher than the background values in Yunnan soil, indicating that the street dusts of Xuanwei city have been heavily polluted by those metals. The health risk assessment results showed that the non-cancer hazard risks induced by the 10 heavy metals were higher to children compared to adults. The heavy metals in street dust were mainly ingested by human bodies through hand-mouth ingestion. The 5 carcinogenic metals, including Cd, Cr, Ni, Cr and As, had a potential risk of carcinogenicity in human after exposed to the dusts. Cr was the major toxic element to the local children's health.

[Ecological risk assessment of land use based on exploratory spatial data analysis (ESDA): a case study of Haitan Island, Fujian Province].

As a novel environment management tool, ecological risk assessment has provided a new perspective for the quantitative evaluation of ecological effects of land-use change. In this study, Haitan Island in Fujian Province was taken as a case. Based on the Landsat TM obtained in 1990, SPOT5 RS images obtained in 2010, general layout planning map of Pingtan Comprehensive Experimental Zone in 2030, as well as the field investigation data, we established an ecological risk index to measure ecological endpoints. By using spatial autocorrelation and semivariance analysis of Exploratory Spatial Data Analysis (ESDA), the ecological risk of Haitan Island under different land-use situations was assessed, including the past (1990), present (2010) and future (2030), and the potential risk and its changing trend were analyzed. The results revealed that the ecological risk index showed obvious scale effect, with strong positive correlation within 3000 meters. High-high (HH) and low-low (LL) aggregations were predominant types in spatial distribution of ecological risk index. The ecological risk index showed significant isotropic characteristics, and its spatial distribution was consistent with Anselin Local Moran I (LISA) distribution during the same period. Dramatic spatial distribution change of each ecological risk area was found among 1990, 2010 and 2030, and the fluctuation trend and amplitude of different ecological risk areas were diverse. The low ecological risk area showed a rise-to-fall trend while the medium and high ecological risk areas showed a fall-to-rise trend. In the planning period, due to intensive anthropogenic disturbance, the high ecological risk area spread throughout the whole region. To reduce the ecological risk in land-use and maintain the regional ecological security, the following ecological risk control strategies could be adopted, i.e., optimizing the spatial pattern of land resources, protecting the key ecoregions and controlling the scale of construction land use.

Efetividade das práticas de Teleducação por Webconferência no combate à dengue no Estado do Amazonas, Brasil / Effectiveness of practices for Web Conferencing Teleducation to combat dengue in the State of Amazonas, Brazil / Cleinaldo de Almeida Costa1, Wendel Schramm Petrucio2, Pedro Máximo de Andrade Rodrigues

Objetivo: Verificar a efetividade das webconferências educativas na prevenção e combate à dengue, ao compará-las com a modalidade presencial de educação em saúde. Métodos: Participaram da pesquisa 50 alunos do 3º ano do ensino médio de escola pública do município de Itacoatiara, distante 300 quilômetros de Manaus, capital do estado do Amazonas. Os participantes foram divididos em dois grupos, sendo que o primeiro grupo participou de palestras presenciais e o segundo grupo participou de palestras por webconferência sobre o tema da prevenção e combate à dengue. Foram aplicados testes pré e pós-exposições e calculados os índices de rendimento de ambos os grupos. Resultados: Verificou-se que o grupo que participou das webconferências obteve rendimentos pós-teste de 82,8% e o outro grupo obteve rendimento de 78,6%. Conclusões: A Telessaúde, por meio de webconferência possui efetividade no processo de educação em Saúde e, uma vez utilizada em escala, pode contribuir com eficácia para o combate e prevenção da dengue no estado do Amazonas...

Objective: To determine the effectiveness of educational web conferences in preventing and combating dengue by comparing them with the face modality of health education. Methods: Participants were 50 students of the 3rd year of high school to public school in Itacoatiara, distant 300 km from Manaus, capital of Amazonas state. The participants were divided into two groups: the first group participated in lectures and the second group attended lectures by web conference on the topic of prevention and fight against dengue. Tests were performed before and after exposures and calculated the rates of return of both groups. Results: It was found that the group who participated in the web conferencing earned income post-test 82.8% and the other group received 78.6% yield. Conclusions: Telehealth through web conferencing has effectiveness in the process of health education and once used scale, can contribute effectively to the fight and prevention of dengue in the state of Amazonas...

Objetivo: Determinar la eficacia de la educación mediadas por conferencias web en la prevención y la lucha contra el dengue mediante la comparación con la modalidad presencial de la educación sanitaria. Métodos: Los participantes fueron 50 estudiantes del 3er año de la escuela secundaria a la escuela pública de Itacoatiara, ciudad distante 300 kilómetros de Manaus, capital del estado de Amazonas. Los participantes fueron divididos en dos grupos: el primer grupo participó en conferencias presenciales y el segundo grupo asistió a conferencias web sobre el tema de la prevención y lucha contra el dengue. Las pruebas se realizaron pré y post-exposición con el fin de calcular el rendimiento de ambos grupos. Resultados: Se encontró que el grupo que participó en la conferencia web tuvo um rendimento posterior a las pruebas de el 82,8% y el otro grupo recibió un rendimiento del 78,6%. Conclusiones: Telemedicina a través de conferencias web tiene eficacia en el proceso de educación para la salud y una vez aplicada en escala, puede contribuir eficazmente a la lucha y prevención del dengue en el estado de Amazonas...

Desenvolvimento de um protocolo para avaliação de pacientes com úlceras de pressão através da telemedicina e imagens digitais / Development of a protocol for the assessment of patients with pressure ulcers through telemedicine and digital images

Introdução: As úlceras de pressão são complicações freqüentes em pacientes com lesão medular. Estas precisam de um diagnóstico precoce e um acompanhamento rigoroso para que não evoluam para um quadro mais grave e para não retardar o processo de reabilitação. Infelizmente, não é sempre que o paciente consegue acesso a um centro especializado no tratamento de feridas e, por isso, a telemedicina pode ser útil nesses casos. Objetivo: Avaliar a eficácia de um protocolo de avaliação de úlceras de pressão através de fotografias digitais. Métodos: Selecionamos 15 pacientes, totalizando 33 úlceras. Os pacientes foram avaliados por 2 médicos fisiatras presenciais, separadamente, que no momento do exame, preencheram a primeira parte do protocolo (dados clínicos do paciente) e tiraram as fotografias. Estas foram encaminhadas aos médicos fisiatras à distância, que avaliaram as feridas através das fotos e dos dados enviados pelo médico presencial. Comparamos as semelhanças e diferenças das avaliações entre os dois médicos presenciais, entre presencial e a distancia e entre os dois médicos à distância nos quesitos grau, necrose, infecção, fístula, secreção, aspecto da borda e do fundo e conduta. A Análise estatística se baseou nos cálculos de Kappa, intervalo de confiança e P valor. Resultados: Encontramos os maiores valores de Kappa quando comparamos as avaliações presenciais. Para necrose, grau e infecção, os kappas Avaliação Presencial (P) x Avaliação à distância (D) foram substantial e moderate. No item conduta, o Kappa variou de fraco a almost perfect. Nas avaliações das bordas, fundo, secreção e fístula foram encontradas divergências. Conclusão: O protocolo é eficaz para avaliar necrose, grau e infecção das úlceras. Existe dificuldade no uso do método para avaliar o aspecto de borda, fundo, secreção e fístula. Houve maior satisfação com o método para úlceras de pressão grau I e II.

Introduction: Pressure ulcers are frequent complications in patients with spinal cord injuries. These ulcers need an early diagnosis and a strict follow-up to prevent a more severe evolution and delays in the rehabilitation process. Unfortunately, patients do not always have access to a center specialized in the treatment of wounds, and thus, telemedicine can be useful in such cases. Objective: To evaluate the effectiveness of a protocol for the assessment of pressure ulcers through digital images. Methods: 15 patients were selected, totaling 33 ulcers. The patients were separately assessed by 2 on-site physiatrists, who filled out the first part of the protocol (patients? clinical data) at the time of the consultation and took the photographs. These were sent to the physiatrists at-distance, who evaluated the wounds through the photographs and the data sent by the on-site physician. The similarities and differences between the two on-site physicians, between the on-site physicians and the physicians at-distance and between the two physicians at-distance were compared regarding the degree, necrosis, infection, fistula, secretion, wound border and depth aspect and conduct. The statistical analysis was based on Kappa calculations, a confidence interval and P value. Results: The highest Kappa values were observed when the on-site assessments were compared. For necrosis, degree and infection, the On-site Assessment (S) x Assessment at distance (D) Kappas were substantial and moderate. For the item conduct, the Kappa varied from weak to almost perfect. As for the evaluations of the borders, depth, secretion and fistula, there were divergences. Conclusion: The protocol is effective to assess wound necrosis, degree and infection. There is some difficulty in using the method to evaluate the border and depth aspect, secretion and fistula. The method showed to be more satisfactory for the assessment of pressure ulcers grade I and II.