Update on Pressure Injuries: A Review of the Literature.

GENERAL PURPOSE: To provide information about the latest evidence-based practice related to pressure injuries (PIs). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Identify risk factors and prevention strategies for PI.2. Explain issues related to the treatment of PI. ABSTRACT: The literature on pressure injuries continues to expand at a rapid rate, and keeping up to date with the current knowledge base is challenging. This summary describes six important new articles published in 2018 or 2019 about pressure injury pathophysiology, prevention, treatment, and epidemiology. For each article, a description of the results is provided, and then a comment about the significance of the results is offered. The new knowledge contained in this review should impact how clinicians incorporate the latest evidence-based practice for pressure injuries.

The literature on pressure injuries continues to expand at a rapid rate, and keeping up to date with the current knowledge base is challenging. This summary describes six important new articles published in 2018 or 2019 about pressure injury pathophysiology, prevention, treatment, and epidemiology. For each article, a description of the results is provided, and then a comment about the significance of the results is offered. The new knowledge contained in this review should impact how clinicians incorporate the latest evidence-based practice for pressure injuries.

Braden scale for pressure ulcer risk predicts rehabilitation placement after pancreatic resection.

BACKGROUND: Patients undergoing pancreatic resection frequently require rehabilitation facilities after hospital discharge. We evaluated the predictive role of validated markers of frailty on rehabilitation facility placement to identify patients who may require this service. METHODS: Single-center retrospective cohort study of patients who underwent pancreatic resection from 2010 to 2015. 90-day morbidity and mortality were calculated. Postoperative validated markers of frailty (Activities of Daily Living scale, Braden scale [assesses pressure ulcer risk, lower scores = higher risk] and Morse fall scale) were evaluated via multivariate regression to identify predictors of discharge to rehabilitation facility. RESULTS: 470 patients with complete data were included. Mean age was 62 and 49.2% were male. Postoperative median length of stay (LOS) was 8 (IQR 7-10). 92 (19.66%) patients were discharged to rehabilitation facilities and 138 (29.49%) patients were readmitted within 90 days. On multivariate analysis, age, sex, LOS > 8 days, inpatient Comprehensive Complication Index (CCI) and initial Braden scale were predictive of rehabilitation placement. CONCLUSION: A marker of frailty routinely collected daily by nursing staff, the Braden scale, is available to help surgeons predict the need for postoperative rehabilitation placement after pancreatic resection. Engaging discharge planning services for at-risk patients may help prevent delayed hospital discharge and should be further evaluated.

Rehabilitation nutrition in pressure ulcer management with type 2 diabetes: a case report.

BACKGROUND AND OBJECTIVES: Severe infection, inadequate food intake, and pressure ulcers in patients with type 2 diabetes can result in malnutrition. We describe a case in which rehabilitation nutrition was effective for treat-ing a pressure ulcer in a malnourished patient with type 2 diabetes. METHODS AND RESULTS: A 58-year-old man with type 2 diabetes was diagnosed with hidradenitis suppurativa on the left buttock and thigh and a severe pres-sure ulcer on his left kneecap. Malnutrition was related to hypermetabolism caused by chronic hidradenitis suppu-rativa and inadequate protein-energy intake before admission. We initiated a rehabilitation nutrition intervention to improve physical function and to treat a pressure ulcer by prescribing 2,000 kcal/day of food, including 80 g of protein, and physical rehabilitation for 40 minutes/day. The patient showed good progress in terms of his physical function and healing of the pressure ulcer. After prescribing 2,250 kcal/day of food, including 85 g of protein, and physical rehabilitation for 60 minutes/day, HbA1c levels increased to 7.4%. The energy prescription was de-creased to 2,000 kcal/day to improve glycemic levels. Then, the patient's weight decreased and his hand grip strength became weaker. On day 134 and discharge the patient could walk independently with a t-cane and ankle supporter. By day 14 after discharge, the pressure ulcer had epithelialized. CONCLUSION: Rehabilitation nutrition management improved physical function and facilitated pressure ulcer healing in a malnourished patient with type 2 diabetes. Close conjoint management of hyperglycemia was also necessary.

Mandated Quality of Care Metrics for Medicare Patients: Examining New or Worsened Pressure Ulcers and Rehabilitation Outcomes in United States Inpatient Rehabilitation Facilities.

OBJECTIVE: To examine the association between the Medicare pressure ulcer quality indicator (the development of new or worsened pressure ulcers) and rehabilitation outcomes among Medicare patients seen in an inpatient rehabilitation facility (IRF). DESIGN: Retrospective descriptive study. SETTING: IRFs subscribed to the Uniform Data System for Medical Rehabilitation. PARTICIPANTS: Nearly 500,000 IRF Medicare patients who were discharged between January 2013 and September 2014 were examined. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional independence, functional change (gain), and discharge destination. RESULTS: The pressure ulcer quality indicator was associated with poorer rehabilitation outcomes; patients were less likely to achieve functional independence (odds ratio [OR], .47; 95% confidence interval [CI], .44-.51), were less likely to be discharged to a community setting (OR, .88; 95% CI, .82-.95), and made less functional gain during their IRF stay (a difference of 6 FIM points). CONCLUSIONS: These results support that the pressure ulcer quality indicator is associated with lower quality of rehabilitation outcomes; however, given that those patients with a new or worsened pressure injury still made functional gains and most were discharged to the community, the risk of pressure injury development should not preclude the admission of these cases to an IRF.

Does the presence of pressure ulcers entail «high risk of negative outcomes» in geriatric rehabilitation? Results from a retrospective cohort study / ¿Son las úlceras por presión al ingreso, un factor predictor negativo de los resultados en unidades de rehabilitación geriátrica? Resultados de un estudio de cohortes retrospectivo

Aim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and death (8.4 vs. 4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs. 83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs. 53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. Conclusions: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients (AU)

Objetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables (AU)

Educating Nurses in the United States about Pressure Injuries.

GENERAL PURPOSE: To provide information about the current state of educating nurses about wound care and pressure injuries with recommendations for the future. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Discuss the importance of pressure injury education and wound care for nurses and identify the current state of nursing education on the subject. 2. Identify strategies that can be used to put improved wound care and pressure injury education into practice. ABSTRACT: Wound care nursing requires knowledge and skill to operationalize clinical guidelines. Recent surveys and studies have revealed gaps in nurses' knowledge of wound care and pressure injuries and their desire for more education, both in their undergraduate programs and throughout their careers. Data from baccalaureate programs in the United States can pinpoint areas for improvement in nursing curriculum content. Lifelong learning about wound care and pressure injuries starts with undergraduate nursing education but continues through the novice-to-expert Benner categories that are facilitated by continuing professional development. This article introduces a pressure injury competency skills checklist and educational strategies based on Adult Learning principles to support knowledge acquisition (in school) and translation (into clinical settings). The responsibility for lifelong learning is part of every nurse's professional practice.

Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury.

OBJECTIVE: To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). DATA SOURCES: Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. REVIEW METHODS: Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. RESULTS: The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. CONCLUSIONS: At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.

[Sanatorium-and-surgical treatment of patients with complicated spinal trauma in a specialized department of a sanatorium].

We studied the results of sanatorium treatment of 256 patients with complicated spinal injury and decubital ulcers. 74% of patients were male patients aged 38.5 ± 11.8 years. 89.4% of patients suffered from severe abnormalities, mild abnormalities were registered in 10.6% of patients. In 82.6% of patients decubital ulcers were localized to the skin only on one site, in 17.4% was registered multiple localization. Duration of the patients'follow-up varied from one to three years or more. Patients were divided into 2 clinical groups: the first group consisted of 132 patients who were applied during the preoperative preparation balneological factors and nanosilver, 124 patients included in the second group, which preoperative preparation was carried out in conventional-manner. Using complex medical factors in preparation for operations contributed to reducing the duration of training from 26 ± 3 days to 14 ± 2 days. The application of complex restorative treatment system allowed in the first group compared with the second group increased the number of patients with good results.

Use of the Pressure Ulcer Scale for Healing (PUSH) in Inpatient Rehabilitation: A Case Example.

PURPOSE: Nurses who specialize in rehabilitation frequently assess and treat patients with pressure ulcers. The purpose of this case study is to describe the use of the Pressure Ulcer Scale for Healing (PUSH), which has demonstrated excellent psychometric properties, to assess, monitor progress, and guide clinical decision-making during inpatient rehabilitation. METHODS: The psychometric properties, clinical utility, and data that can be used to interpret the results of the PUSH instrument are presented. Application of the instrument in clinical practice is also described. FINDINGS AND CONCLUSIONS: Systematic measurement of a pressure ulcer using the PUSH has potential to demonstrate change in pressure ulcer status that results from clinical treatment. This case provides an example of how results of a clinical assessment can effectively guide clinical decisions.

Plano de almohadas: valoración de su efectividad como sistema preventivo de las úlceras por presión en pacientes con lesión medular / The flat pillow: evaluation of its effectiveness in preventing pressure ulcers in patients with a spinal cord injury

Introducción. Este estudio analiza las diferencias de presión en la interfaz (manta de presiones) en las posiciones de decúbito supino y decúbito lateral sobre 2 planos de apoyo: una cama de hospital estándar y un plano de almohadas. Material y métodos. La presión de la interfaz se registró en 27 pacientes con lesión medular (22 hombres y 5 mujeres). Resultados. Se demuestran disminuciones significativas (p < 0,001) de las presiones máximas, presiones medias y superficies de contacto con riesgo de úlceras por presión (más de 32 mmHg) de las zonas de apoyo con el plano de almohadas para las posturas en decúbito supino. En decúbito lateral, estas diferencias son más pequeñas (p < 0,005). Conclusiones. El plano de almohadas se presenta como un medio alternativo y de bajo costo en la prevención de las úlceras por presión (AU)

Introduction. This study examines differences in interface pressure (rug pressure) in supine and lateral decubitus positions at two levels of support: standard hospital bed and flat pillow. Material and methods. Interface pressure was recorded in 27 patients with a spinal cord injury (22 men and 5 women). Results. Significant decreases (P<.001) were found in peak pressures, average pressures, and contact surfaces with a risk of producing pressure ulcer (more than 32 mmHg) in areas of flat pillow support for supine positions. These differences were smaller (P<.005) in lateral decubitus. Conclusions. The flat pillow is an inexpensive alternative in the prevention of pressure ulcers (AU)

Risk Factors for Development of New or Worsened Pressure Ulcers Among Patients in Inpatient Rehabilitation Facilities in the United States: Data From the Uniform Data System for Medical Rehabilitation.

BACKGROUND: Documentation of a new or worsened pressure ulcer is a new, required quality indicator for all inpatient rehabilitation facilities (IRFs) in the United States; however, there is little research regarding risk factors for pressure ulcers among patients seen in IRFs. OBJECTIVE: To examine the risk factors for development of a new or worsened pressure ulcer among patients seen in IRFs. DESIGN: A retrospective cohort study. SETTING: IRFs in the United States. PARTICIPANTS: IRF patients more than 18 years of age, with documented new or worsened pressure ulcer during their rehabilitation stay (n = 2766) and IRF patients with no new or worsened pressure ulcer documented from admission to discharge (n = 190,996) discharged October 2008 to September 2011, included in the Uniform Data System for Medical Rehabilitation database. METHODS: Multiple logistic regression analysis was used to estimate risk factors for the development of a new or worsened pressure ulcer utilizing data captured in the Centers for Medicare and Medicaid Services (CMS) payment document. Examined were demographic variables, including age and gender, medical variables, including impairment type and presence of comorbidities, and functional status, as measured through the Functional Independence Measure (FIM) instrument. MAIN OUTCOME MEASURES: Development of a new or worsened pressure ulcer in patients during the rehabilitation stay compared to patients with no documented pressure ulcer or no worsened ulcer. RESULTS: Admission FIM total was strongly associated with development of a new or worsened pressure ulcer, P <.001 in analyses of all patients and for each of the 3 impairment-specific groups with the highest rate of ulcer development among spinal cord injury, orthopedic, and amputation cases. CMS comorbidity tier was also significantly associated with ulcers in all models. Other variables that entered one or more models included increased age, male gender, and use of a wheelchair. CONCLUSIONS: Admission FIM total and CMS comorbidity tier may be useful in the identification of patients at risk for development of new or worsened pressure ulcers in IRFs. Identification of pressure ulcer risk factors has important implications for individual plan-of-care decisions as well as for resource provisions during the rehabilitation stay.

The evaluation of daily living activities, pressure sores and risk factors.

PURPOSE: This study was conducted to assess daily living activities, pressure sores and risk factors. DESIGN: This was a descriptive study. METHODS: The study was conducted at a rehabilitation center with 188 individuals participating in the study. Data were collected with a questionnaire form, Activities of Daily Living Scale (ADLS), Instrumental Activities of Daily Living Scale (IADLS) and Braden Risk Assessment Scale (BRAS). FINDINGS: Among the participants, 48.9% were dependent according to activities of daily living and 71.8% were dependent on instrumental activities of daily living. It was noted that 4.8% had pressure sores and 38.8% were at high risk. A strong and positive correlation was found among ADLS, IADLS, and BRAS scores (p < .001). Participants who had a low body mass index, had lived at the rehabilitation center for a long time, and were fed on regime 1 or 2, had a higher risk of developing pressure sores (p < .001). CONCLUSION: Individuals who were dependent according to ADLS and IADLS were at increased risk for the development of pressure sores. Individuals who are treated at rehabilitation centers should be periodically assessed in terms of risk. Pressure sore development can be prevented with appropriate nursing interventions. CLINICAL RELEVANCE: To reduce the risk of developing pressure sores, nurses should describe the individual's degree of dependency according to ADLS and IADLS and initiate preventive nursing care.

A pilot study to evaluate the role of the Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) in clinical decisions for pressure ulcer treatment.

The Spinal Cord Impairment Pressure Ulcer Monitoring Tool (SCI-PUMT) was designed to assess pressure ulcer (PrU) healing in the spinal cord impaired (SCI) population. The tool contains 7 variables: wound surface area, depth, edges, tunneling, undermining, exudate type, and necrotic tissue amount. A 2-phased, quantitative pilot study based on the Theory of Reasoned Action and Theory of Planned Behavior was conducted at a large SCI/Disorders Center in the Department of Veterans Affairs (VA). In the first phase of the study, a convenience sample of 5 physicians, 3 advanced practice registered nurses, and 3 certified wound care nurses (CWCN) was surveyed using a 2-part questionnaire to assess use of the SCI-PUMT instrument, its anticipated improvement in PrU assessment, and intent to use the SCI-PUMT in clinical practice. Attitudes, subjective norms, perceived behavioral controls, and barriers related to the intent to use the SCI-PUMT were evaluated using a 5-point Likert scale (range: 1= extremely likely, 5 = extremely unlikely). In the second phase of the study, the electronic health records (EHR) of 24 veterans (with 30 PrUs) who had at least 2 completed SCI-PUMT scores during a 4-week period were used to evaluate whether an association existed between magnitudes of change of total SCI-PUMT scores and ordered changes in PrU treatment. The overall mean score for intent to use SCI-PUMT was 1.80 (SD 0.75). The least favorable scores were for convenience and motivation to use the SCI-PUMT. Analysis of EHR data showed no significant difference in magnitudes of change in the SCI-PUMT score and changes in PrU treatment recommendations made by the CWCNs. The significance was not affected regardless of an increase or no change in the score (χ2 with 1 degree of freedom = 1.158, P = 0.282) or for a decrease in the score (χ2 with 1 degree of freedom = 0.5, P = 0.478). In this pilot study, the expressed intent to use the SCI-PUMT in making clinical decisions was generally positive but reservations remain. Additional research is being conducted to determine the barriers and facilitators to SCI-PUMT implementation. The SCI-PUMT was the first tool found to be valid, reliable, and sensitive to assess PrU healing in persons with SCI, and studies to examine the prospective validity of using this instrument on ulcer treatment decisions and outcomes are warranted.

Casos clínicos sobre el uso terapéutico en heridas crónicas de: apósitos desbridantes de fibras hidrodetersivas de poliacrilato con Tlc apósitos de espuma de poliuretano con Tlc-Nosf / Clinicalcases about the therapeutic use of debriding dressing hidrodetersive polyacrylate fibers with TC and foam dressings TLC-nosf polyurethane in chronic wounds

El tratamiento de heridas crónicas requiere la utilización de productos altamente específicos para las diferentes fases del proceso de cicatrización. En el presente artículo se plantea una serie de casos clínicos con heridas crónicas de origen vascular y úlceras por presión. Dichos casos requerían un desbridamiento previo debido al gran contenido de fibrina que cubría el lecho de la herida; en esta fase se utilizó el apósito de fibras hidrodetersivas de poliacrilato con TLC. Una vez realizado el desbridamiento se prosiguió el tratamiento con un apósito tipo espuma de poliuretano con TLC-NOSF(AU)

The treatment of chronic wounds requires the use of highly specific products for differente phases of the healing process. This article raises a number of clinical cases with chronic wounds of vascular origin and pressure ulcers. Such cases required a initial debridement because of the large content of fibrin covering the wound bed at this stage was used dressing hidrodetersive polyacrylate fibers with TLC. Once the debridement is continued treatment with a polyurethane foam dressing with TLC-NOSF(AU)

Factors associated with physician and nurse practitioner pressure ulcer staging practices in rehabilitative and long term care.

Pressure ulcer (PrU) documentation is a common clinical challenge in long term care and rehabilitative settings. This pilot observational study examined PrU staging documentation practices by physicians and nurse providers in two long term care facilities with short-term rehabilitative units. The study enrolled 57 subjects with PrUs, and only 30 (52.6%) of them had PrU staging documentation by the physician or nurse practitioner. Use of powered mattresses (adjusted relative risk (RR) 2.43 with 95% CI 1.19, 4.97) and physical therapy documentation (RR 1.72 with 95% CI 1.04, 2.81) were factors significantly associated with providers documenting the PrU stage. Inadequate statistical power, due to the small study sample size, may have prevented detecting of other significant associations between patient factors and documentation practices. Future research that is adequately powered is needed to replicate these results and detect other potential factors associated with documentation.

Efectos del ultrasonido terapéutico en el tratamiento de las úlceras por presión en adultos mayores con dependencia severa / Effects of therapeutic ultrasound in the treatment of pressure ulcers in elderly adults with severe dependency

Introducción. En Chile se ha observado que el 50% de las personas que tienen úlceras por presión (UPP) corresponden a adultos mayores (AM). Considerando que esta población muestra un crecimiento sostenido, se hace importante buscar alternativas de solución. Por ello, la presente investigación busca comprobar los efectos de la terapia ultrasónica en el tratamiento de las UPP. Material y métodos. Se intervinieron a 12 AM (17 UPP) provenientes de los centros de salud familiar y hogares de larga estadía de Talca durante 8 semanas, dividiéndolos en 4 grupos (control, luz ultravioleta-C y ultrasonido con densidad energética de 10 y 20J/cm2). Se evaluó una vez por semana el área de las UPP y el puntaje obtenido en el diagrama de valoración de heridas, para comparar sus valores finales, además de estimar tasas de recuperación semanal y final a partir de ellas. Resultados. Todos los grupos mostraron una disminución de áreas y puntajes, siendo los que recibieron terapia ultrasónica quienes presentaron los mayores cambios, sin embargo, estos no fueron significativos con Kruskal-Wallis. La prueba de Wilcoxon mostró diferencias significativas de área para todos los grupos, y de puntaje solo para el grupo 2 (p<0,05). Conclusión. Se observaron tendencias que indican que el ultrasonido junto a la radiación ultravioleta-C aceleran el proceso de reparación, pero sin resultados significativos, probablemente por el reducido tamaño de la muestra. Se sugiere realizar nuevos estudios que incorporen más sujetos y así dilucidar la interrogante presentada en la investigación (AU)

Introduction. In Chile, it has been observed that 50% of the people who have pressure ulcers (PU) are elderly adults (EA). Because this population is showing sustained growth, it would be important to seek solution alternatives. Thus, this study aims to ascertain the effects of therapeutic ultrasound (TU) on the PU healing process in the elderly with severe dependency. Material and methods. Twelve EA (17 PU) from the CESFAM (Family Health Center) and long-stay Nursing Homes from Talca City were treated for 8 weeks. They were distributed into 4 groups (control, ultraviolet therapy and UT with 10 and 20J/cm2 of energy density). The PU area and the score on the wound assessment diagram were evaluated once a week in order to compare their final values. Weekly and final recovery rates were also calculated from them. Results. All the groups showed a decrease of areas and scores. The TU group showed the greatest changes, however, these changes were not significant by the Kruskal-Wallis test. The Wilcoxon test (P<.05) showed significant differences between all the groups between the initial and final values for the area variable, however, the differences of score (P<.05) were only significant for group 2. Conclusion. Tendencies were observed that indicate that the ultrasound together with ultraviolet C radiation accelerate the healing process. However, the difference was not significant, probably because of the small sample size. Thus, new studies are recommended that include more subjects in order to elucidate the question arising in our research (AU)

High-voltage electrical stimulation for the management of stage III and IV pressure ulcers among adults with spinal cord injury: demonstration of its utility for recalcitrant wounds below the level of injury.

CONTEXT: patients with spinal cord injury (SCI) have many factors that are associated with pressure ulcer formation, including paralysis, loss of sensation, poor nutrition, anemia, and skin maceration related to incontinence. Treatment of these ulcers involves relieving pressure, improving nutrition and skin hygiene, treating infections, removing necrotic tissues, and applying the appropriate dressings. However, some cases are not responsive to the above treatment. Electrical stimulation (ES) is thought to enhance soft tissue healing through promotion of protein synthesis, inhibition of bacterial growth, facilitation of epithelial tissue migration, improvement of blood flow, and tensile strength. This data is mainly based on evidence from animal studies and very few rigorously controlled studies conducted in humans. OBJECTIVE: To demonstrate the effectiveness of ES in the treatment of recalcitrant pressure ulcers. METHODS: Retrospective case series describing the care of adults with SCI and recalcitrant pressure ulcers. ES was applied directly into the wound bed: 60 minutes per session, 3-5 times per week; with an intensity of 100 milliamperes and a frequency of 100 pulses per second. Polarity was negative initially and was switched weekly. The amplitude and wave form were maintained throughout. RESULTS: The long-standing (11-14 months) pressure ulcers were completely healed after 7 to 22 weeks of treatment with high-voltage ES. CONCLUSION/CLINICAL RELEVANCE: This case series demonstrates the effectiveness of ES for enhanced healing of Stage III-IV ulcers otherwise unresponsive to standard wound care. Further study is needed to identify the most effective protocol for ES therapy in the treatment of recalcitrant pressure ulcers.

Resultados de la intervención de enfermería en rehabilitación de personas que participan en una unidad de cuidados en la comunidad del Ayuntamiento de Matosinhos, Portugal / Results of nursing intervention in rehabilitation of persons that participate in care unit in the community of the city of Matosinhos, Portugal

En Portugal, desde 2004 está en curso una nueva reforma de los cuidados de salud primarios con la finalidad de obtener mejoras en salud. Concretamente en sus unidades funcionales de Cuidados en la Comunidad (UCC), donde la mayoría de las situaciones son del ámbito de la enfermería de rehabilitación, en las cuales se pretende prestar cuidados de salud de ámbito domiciliario y comunitario. En este sentido, el presente estudio tiene el objetivo de identificar y discutir los resultados alcanzados, de acuerdo con el grado de dependencia, los objetivos e indicadores de salud definidos. Material y método: Se trata de un estudio descriptivo y longitudinal, con 56 sujetos. Realizando una evaluación funcional del grado de dependencia, del riesgo para las úlceras de presión, la espasticidad y la fuerza muscular a través de las escalas validadas: índice de Barthel, escala de Braden, escala de Ashworth y Medical Research Council respectivamente, en el momento de la admisión y del alta de los cuidados. Resultados: indican que: (i) en el grado de dependencia, los ítemes que tuvieron una evolución más significativa fueron el traslado sillón/cama, ir al wc; (ii) en el riesgo de úlceras de presión fueron la actividad y movilidad; (iii) en términos de la espasticidad y de la fuerza, estaban más afectados los miembros inferiores derechos; (iv) los ítemes más asociados a dependencia fueron los traslados sillón/cama, ir al baño y deambulación y para la escala de Braden fueron los ítemes humedad y fricción. Conclusión: La monitorización de estos datos puede contribuir a mejorar la educación en la salud.

In Portugal, since 2004, is in progress a new reform of primary health care, in order to achieve improvements in health yelped (MCSP, 2009). Specifically theirs functional units in the Community Care (UCC), where most of the situations are in the field of rehabilitation nursing, in which is intended to provide health care to household and community level. In this sense, the present study has the objective to identify and discuss the results achieved, highlighting their gains populations, according to the degree of dependence, health objectives and indicators defi ned. Specifi cally, their functional units in the Community Care (UCC) in which attempts are made to provide health care home environment and community. Material and method: This is a longitudinal study, with 56 subjects. Conducting a functional assessment of the degree of dependence, risk for pressure ulcers, spasticity and muscle strength through validated scales Barthel Index, Braden Scale, Ashworth Scale and the Medical Research Council, respectively, at the time of admission and discharge care. Results: indicate that: (i) in the dependency ratio, the items that had a most significant developments were the self-care transfer chair / bed and go to the toilet, (ii) in the risk pressure ulcers were the activity and mobility, (iii) in terms of spasticity and strength lower right members were more affected than the right, (iv) the items more related to the dependency were the transfer chair/bed and to use the toilet and to the Braden scale was the humidity and friction items. Conclusion: Monitoring of these data can help improve health education.