Estudio comparativo de efectividad de un apósitode plata nanocristalina frente a sulfadiazinaargéntica en el tratamiento de pacientes quemados / Comparative study on the effectiveness of a dressing of nanocrystalline silver opposite to the use of silver sulfadiazine in burned patients treatment

La plata es un producto utilizado como agente antimicrobiano desde la antigüedad y ya a finales del siglo XIX se empezaron a utilizar compuestos de plata con finalidades médicas. La utilización tópica de la crema de sulfadiazina argéntica al 1% se considera mayoritariamente como tratamiento de elección para las quemaduras a fin de tratar o prevenir la infección local. El objetivo de este artículo es comparar el tratamiento con Acticoat® (plata nanocristalina 15 nanómetros) frente al tratamiento con sulfadiazina argéntica, ambos regímenes en igualdad de condiciones y un mismo centro de quemados. También se realiza una revisión de la literatura reciente sobre los factores de riesgo para la infección en quemaduras, las medidas que se utilizan para prevenirla y su importancia en la disminución de la morbi-mortalidad (AU)

Silver is a product that has been used as antimicrobialagent from ancient times; at the end of the XIXth century silver compounds were used with medical purposes. The use of silver sulfadiazine to 1 % cream is considered as gold standard for local treatment of burns in order to prevent or to treat local infection We compare treatment with Acticoat ® (nanocrystalline silver 15 nanometers) and silver sulfadiazine, both systems on equal terms and in the same medical burned enter. We review recent literature of risk factors for burn infection, methods to prevent it and to diminish morbimortality in burned patients (AU)

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.

Estudio "Auriga-04" sobre la utilización de la gama de apósitos hidrocelulares Allevyn® en el tratamiento de heridas agudas por parte de profesionales de Atención Primaria / The use of Allevyn(R) hydrocellular dressings range in acute wounds– AURIGA-04 study in primary care

Aunque los apósitos de cura en ambiente (CAH) húmedo se han utilizado predominantemente en heridas crónicas, ello no es óbice para que su uso en heridas agudas permita solucionar algunos problemas, como el conseguir un ambiente óptimo que facilite la migración epitelial, así como una adecuada protección de las heridas y una correcta gestión del exudado. Es por ello que, dentro del marco del estudio AURIGA-04, nos planteamos la realización de un estudio prospectivo observacional, abierto y multicéntrico, de medidas repetidas en una cohorte de pacientes que presentan heridas agudas de diversa etiología en el que se incluyeron pacientes con heridas traumáticas, quirúrgicas o quemaduras tratados por profesionales de Atención Primaria, con el objetivo de generar evidencias acerca de la utilización de apósitos de CAH, en concreto, de la gama de apósitos hidrocelulares Allevyn®, en el tratamiento de heridas agudas. Se consideraron como criterios de exclusión heridas con signos clínicos de infección. Solo se incluyó una lesión por paciente. En el caso de los pacientes con heridas agudas, la muestra a estudio quedó compuesta por 61 pacientes con una edad media de 71,1 años; 36 casos corresponden a mujeres (60%). El estado general de salud de la muestra era bueno en un 49,1% de los casos y prácticamente la totalidad de los pacientes presentaba pluripatología. Un 10% de los pacientes consumía fármacos que podían interferir en la cicatrización y un 6% presentaba malnutrición. El 67,2% de las lesiones eran heridas traumáticas, el 24,6% quirúrgicas y un 8,2% quemaduras. Un 37% de las lesiones fueron clasificadas como superficiales y el 63% restante como profundas. Presentaban 64 días de evolución previa a su inclusión en el estudio y una superficie media de 23,34 cm2. Los pacientes permanecieron en el estudio un promedio de 43,6 días, con una cadencia de cambios de apósito cada 2,7 días. Durante el estudio cicatrizaron el 63,9% de las heridas, en un promedio de 40,9 días. La superficie inicial de las lesiones mostró una reducción significativa a lo largo del seguimiento (inicial: 23,34 cm2, final: 4,27 cm2, p< 0,001). En los modelos de regresión de Cox, sólo resultó estadísticamente significativa la edad del paciente, en el grupo de lesiones traumáticas (RR: -0,03, p= 0,039). Durante el período de seguimiento, un 80,3% de los pacientes fue tratado en combinación con Intrasite Conformable®, Iruxol Mono® o la combinación de ambos productos. Los profesionales que realizaron las curas con Allevyn® valoraron muy favorablemente su manejo durante todo el estudio; así, en más del 96% de los cambios se consideró fácil de colocar, en el 100% indoloro y también en el 100% de fácil retirada. A la vista de los resultados, los apósitos de CAH y, en concreto, la gama de apósitos Allevyn®, tienen una clara aplicación en el caso de las heridas agudas, permitiendo un óptimo abordaje local de las lesiones, proporcionando unos niveles óptimos de humedad, pH y temperatura para las células implicadas en el proceso de cicatrización. Así, se promueve la formación de tejido de granulación y facilita la epitelización, además de proteger la herida ante traumatismos y gérmenes

Although moist environment dressings have mainly been used for chronic wounds, they can also be used on acute wounds in order to achieve an optimum atmosphere that facilitates epithelial migration, providing adequate protection for the wounds as well as good exudate management. Hence, as part of the AURIGA-04 study, an observational study was carried out at different centres, involving repeated measures on a group of patients who presented diverse acute wounds, including patients with traumatic wounds, surgical wounds or burns treated by primary care professionals. The aim of this study was to find evidence about the use of moist environment dressings, specifically the Allevyn® range of hydrocellular dressings, in the treatment of acute wounds. The exclusion criterion considered was if the wounds had clinical signs of infection. Only one wound was included per patient. In the case of patients with acute wounds, the study sample was made up of 61 patients with an average age of 71.1; 36 cases were women (60%). The patient’s general state of health was good in 49.1% of cases and practically all the patients presented multiple pathologies. 10% of the patients were taking medication that could interfere with the healing process and 6% of the patients presented signs of malnutrition. 67.2% of the wounds were traumatic in origin, 24.6% were surgical and 8.2% were burns. 37% of the wounds were classified as superficial and the remaining 63% were deep. The wounds had been present for 64 days before the patient’s inclusion in the study and the average surface area was 23.34 cm2. The patients remained in the study programme for an average of 43.6 days and their dressings were changed every 2.7 days. During the study, 63.9% of the wounds healed in an average of 40.9 days. The initial surface area of the wounds was reduced significantly over the monitoring period (initial: 23.34 cm2, final: 4.27 cm2, p ≤ 0.001). When Cox regression models were applied, the age of the patient was only statistically significant in the group with traumatic wounds (RR: –0.03, p= 0.039). During the monitoring period, 80.3% of the patients were also treated with Intrasite Conformable®, Iruxol Mono® or a combination of both products. The professionals that treated the wounds with Allevyn® rated the product very highly throughout the study; in over 96% of dressing changes, they were assessed as very easy to apply, 100% painless and also 100% easy to remove. Given these results, moist environment dressings, particularly the Allevyn® range of dressings, have a clear application in the case of acute wounds, permitting optimum local treatment of the wounds, providing optimum levels of moisture, pH and temperature for the cells involved in the healing process. Thus the formation of granulation tissue is promoted and epithelisation is facilitated. Furthermore, the wound is also protected from traumas and germs

2º Estudio Nacional de Prevalencia de Úlceras por Presión en España, 2005. Epidemiología y variables definitorias de las lesiones y pacientes / 2nd National Study of Pressure Ulcers Prevalence in Spain, 2005. Epidemiology and defining variables of lesions and patients

Desde el año 1999 el GNEAUPP consideró de vital interés para rescatar y mantener el valor real del problema de las úlceras por presión (UPP), la constitución de un observatorio permanente de la evolución epidemiológica de estos procesos, cuyo siguiente paso ha sido el desarrollo de este 2º Estudio Nacional de Prevalencia que presentamos. Se definieron como objetivos de la investigación obtener indicadores epidemiológicos que permitiesen dimensionar el problema de las UPPen España, así como algunos aspectos relacionados con las tendencias de prevención de las mismas en instituciones de Atención Primaria, atención hospitalaria y asistencia sociosanitaria. Elaboramos un cuestionario postal para estimar la prevalencia puntual y media de UPP a partir de una muestra no aleatoria. En estos cuestionarios se solicitaba a los profesionales de Atención Primaria que informasen acerca de su lista de usuarios mayores de 14 años (Unidades básicas asistenciales de Medicina General) y a los profesionales de unidades de hospitalización o de centros sociosanitarios que informasen acerca de los pacientes de sus respectivas unidades. Se definió la prevalencia como “prevalencia puntual” (información en un solo momento del tiempo). Se calculó la prevalencia cruda (PC) y media (PM). Los cuestionarios contenían preguntas para obtener datos sobre los pacientes con UPP (numerador del indicador), sobre el total de pacientes de esa unidad a estudio (denominador del indicador), sobre las lesiones mismas, así como información de las tendencias de prevención de UPP en las instituciones de los receptores de los cuestionarios. Se reportaron 1.791 pacientes con UPP (39% en hospital, 27% en Atención Primaria y 34% en centros sociosanitarios). En Atención Primaria la PC fue de 3,73% y la PM de 9,11% ± 10,9% para los pacientes mayores de 14 años incluidos en el programa de atención domiciliaria; en las unidades de hospital, la PC fue de 8,24% y la PM de 8,91% ± 12,20%, y en los centros sociosanitarios la PC fue de 6,10% y la PM de 10,9% ± 11,9%. En todos los niveles asistenciales, el grupo de población mayoritariamente afecto era el de los mayores de 65 años (84,7%). Los cuestionarios recibidos proporcionaron información sobre 2.837 lesiones: 23,2% de estadio I, 37,5% de estadio II, 27,0% de estadio III, 11,8% de estadio IV y un 0,5% sin estadiar. La localización más frecuente fue el sacro seguido de los talones, en todos los niveles asistenciales. Puede concluirse que las UPP siguen constituyendo, todavía, un importante problema de salud pública que afecta de manera primordial a personas mayores

Since 1999, GNEAUPP considered it vital to create a permanent observatory of the epidemiological evolution of these processes, in order to rescue and maintain the real value of the problem of Pressure Ulcers, which has given way to the next step, the 2nd National Prevalence Study we now present. The objectives set forth in this study were to obtain epidemiological indicators that would allow us to find the extent of the pressure ulcer problem in Spain, as well as some aspects related to the prevention of such in primary care centers, hospitals and socio-sanitary institutions. We sent out a questionnaire in order to estimate the punctual and average prevalence of PU (initials UPP in Spanish) using non-random sampling. Primary Care professionals were asked to give information about their patients who were over 14 years of age (General Practitioner Surgeries) and professionals from Hospital Units and socio-sanitary centers were asked about their patients respectively. Prevalence was defined as ‘punctual prevalence’ (information in a specific moment in time). The crude prevalence (initials PC in Spanish) and average prevalence (PM) were calculated. The questionnaires only included questions on patients with PU (numerator of the indicator) over the total of patients of the unit being studied (denominator of the indicator) about the wounds caused as well as information on PU prevention in the institutions where each respondant worked. 1,791 patients were reported to have pressure ulcers (39% in hospital, 27% in primary care centers and 34% in socio-sanitary centers). In Primary Care, the PC was 3.73% and the PM was 9.11% ± 10.9% for patients over 14 years who were included in the home care program. In the hospital units, the PC was 8.24% and the PM was 8.91% ± 12.20% and in the socio-sanitary centers, the PC was 6.10% and the PM was 10.9% ± 11.9%. The group most affected of each health care level was the one over 65 years of age (84.7%). The completed questionnaires provided information about 2,837 wounds: 23.2% were stage I, 37.5% stage II, 27.0% stage III, 11.8% stage IV and 0.5% did not state the stage. PU most frequently affected the sacral region, followed by the heels, in all health care levels. It can be concluded that PU are still an important public health problem that affect mainly elderly people

Efectividad de un compuesto de ácidos grasos hiperoxigenados en la prevención de las úlceras por presión / Efficiency of a hyperoxigenated fatty acid compound in the prevention of pressure

Objetivo: Comparar los efectos de Mepentol®, un compuesto de ácidosgrasos hiperoxigenados, frente a placebo en la prevención del desarrollode úlceras por presión. Material y métodos: El estudio de investigaciónconsistió en un ensayo clínico aleatorizado, multicéntrico y dobleciego. Se calculó: la incidencia de úlceras por presión, riesgo relativo(RR), fracción prevenible (FP) y número necesario a tratar (NNT).Además, se aplicaron curvas de supervivencia de Kaplan-Meier conpruebas de log-rank y modelos de riesgos proporcionales de regresión deCox para comparar ambos grupos. Resultados: Completaron el estudioun total de 331 pacientes: 167 en el grupo control y 164 en el grupo aestudio. La incidencia de las úlceras por presión durante el estudio fuede 7,32% en el grupo de intervención frente a 17,37% en el grupo placebo(p= 0,006). Estos resultados muestran que por cada 10 pacientestratados con Mepentol® se previene la aparición de una úlcera por presión(NNT= 9,95). Las curvas de supervivencia y los modelos de regresiónmuestran una diferencia estadísticamente significativa para ambosgrupos (p≤ 0,001). El coste medio del uso de Mepentol® durante elestudio fue de 7,74 €. Conclusión: Mepentol® es una medida efectivapara la prevención de úlceras por presión. Fue más efectiva que un placebograso y demostró ser coste-efectiva. Declaración de interés: elestudio fue esponsorizado por Laboratorios Bama-Geve SA, Barcelona, España

Objective: To compare the effects of Mepentol®, a hyperoxygenated fatty acidpreparation, with a placebo treatment in preventing the development of pressureulcers. Method: The research study consisted of a multicentre double-blindrandomised clinical trial. The incidence of pressure ulcers, relative risk (RR), preventable fraction and number necessary to treat (NNT) were calculated. Inaddition, Kaplan-Meier survival curves, with log-rank test, and Cox’s proportional hazards regression model were used to compare both groups. Results: Atotal of 331 patients completed the study: 167 in the control group and 164in the study group. Pressure-ulcer incidence during the study was 7.32% inthe intervention group versus 17.37% in the placebo group (p= 0,006). Theseresults show that for each 10 patients treated with Mepentol® one pressure ulcerwas prevented (NNT= 9,95). Survival curves and the regression model showeda significant statistical difference for both groups (p≤ 0,001). The averagecost of Mepentol® during the study was € 7,74. Conclusion: Mepentol® is aneffective measure for pressure ulcer prevention. It was more effective than agreasy placebo product, and was found to be cost-effective.Declaration ofinterest: This study was sponsored by Laboratorios Bama-Geve SA,Barcelona, Spain

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.

Úlceras 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: evaluation of the systematic use of special surfaces for managing pressure sores in the intensive care unit of the Tarrasa Hospital (Spain)

Las úlceras por presión son un importante reto para el sistema de salud. Los pacientes ingresados en unidades de cuidados intensivos constituyen un importante grupo de riesgo para dicho problema. La utilización sistemática dentro de un protocolo de las superficies especiales para el manejo de la presión, es una medida básica para la prevención de las úlceras por presión en pacientes institucionalizados. El estudio ha sido realizado en la Unidad de Cuidados Intensivos del Hospital de Terrassa comparando la incidencia de úlceras por presión antes y después de la implantación de un protocolo de prevención que incluye la utilización sistemática de superficies especiales para el manejo de la presión. Para ello se ha monitorizado la incidencia de úlceras por presión en todos los pacientes ingresados durante los años 1998 y 1999. Para los casos incidentes se ha registrado la localización de las lesiones.Se presentan resultados correspondientes a tres períodos, antes de la intervención con una incidencia del 6,4 por ciento, después de la puesta en práctica del protocolo con una incidencia del 1,1 por ciento y un tercer período de consolidación del protocolo con una incidencia del 0 por ciento. A tenor de los resultados de nuestro estudio podemos destacar que la utilización sistemática de superficies especiales para el manejo de la presión dentro de un protocolo de prevención es una medida básica para reducir la incidencia de úlceras por presión en pacientes ingresados en unidades de cuidados intensivos. (AU)

[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.

[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.

Utilización de un colchón alternante de aire en la prevención y el tratamiento de úlceras por presión en una paciente de atención domiciliaria / Use of alternating pressure air support mattresses for the prevention and treatment of bedsores in home care patients

Introducción La atención a pacientes con úlceras por presión es un importante reto al que se enfrentan los profesionales de la atención primaria dentro de las actividades de atención domiciliaría. Dentro del tratamiento de las úlceras por presión, la utilización de superficies especiales para el manejo de la presión tiene una gran importancia para minimizar el efecto de la presión prolongada en los tejidos. Paciente y métodos Caso clínico correspondiente a la utilización de un colchón alternante de aire en una paciente atendida en atención domiciliaria por parte de un equipo de Atención Primaria. Principales resultados Tras la utilización del colchón alternante de aire no aparecen nuevas lesiones, las que existían evolucionan de manera favorable y se consigue una reducción del tiempo de enfermería que inicialmente requería la atención domiciliaria de la paciente. Conclusiones La utilización de superficies especiales para el manejo de la presión puede ser de gran utilidad en la atención domiciliaria a pacientes con, o en riesgo de padecer úlceras por presión (AU)

[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.