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1.
Rev. bras. cir. plást ; 34(4): 582-583, oct.-dec. 2019.
Artigo em Inglês, Português | LILACS | ID: biblio-1047937

RESUMO

As informações no leito, sobre a necessidade de manobras do paciente, em intervalos de 2 h, para evitar o aparecimento de lesões por pressão podem reduzir o tempo de permanência, diminuir o risco de lesões de pele e os custos de manutenção do paciente.


Bedside information on the need for repositioning the patient at 2 h intervals to avoid the appearance of pressure ulcers can reduce hospitalization time, risk of skin lesions, and maintenance costs.


Assuntos
Humanos , Cirurgia Plástica , Ferimentos e Lesões , Lesão por Pressão , Tempo de Internação , Cirurgia Plástica/reabilitação , Ferimentos e Lesões/terapia , Lesão por Pressão/cirurgia , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Lesão por Pressão/terapia
2.
Mayo Clin Proc ; 94(10): 1994-2003, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31585582

RESUMO

OBJECTIVE: To determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities. PATIENTS AND METHODS: This retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality. RESULTS: The study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001). CONCLUSION: The admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.


Assuntos
Fragilidade/diagnóstico , Fragilidade/mortalidade , Avaliação Geriátrica/métodos , Mortalidade Hospitalar , Lesão por Pressão/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos de Coortes , Unidades de Cuidados Coronarianos , Feminino , Fragilidade/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Lesão por Pressão/complicações , Prognóstico , Estudos Retrospectivos
4.
Zhonghua Shao Shang Za Zhi ; 35(9): 690-691, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594188

RESUMO

A 67-year-old female patient with incontinent dermatitis complicated with sacrococcygeal pressure ulcer was admitted to our unit in November 2017. The wound was treated with a new dressing based on the concept of wet healing, management of exudation, prevention of infection to promote wound healing. Meanwhile, the fecal incontinence was properly treated with colostomy bag combined with disposable negative pressure drainage device to avoid fecal contamination and aggravation of pressure ulcer. Incontinent dermatitis was treated with wound protective powder and wound protective film. After 14 days of treatment, the wound of pressure ulcer was reduced and the incontinent dermatitis was cured.


Assuntos
Dermatite/enfermagem , Incontinência Fecal/enfermagem , Lesão por Pressão/enfermagem , Idoso , Bandagens , Dermatite/complicações , Feminino , Humanos , Lesão por Pressão/complicações
6.
Br J Community Nurs ; 24(7): 332-337, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31265344

RESUMO

An estimated 14 million adults experience incontinence in England alone, and this population is at a very high risk of developing incontinence-associated dermatitis (IAD). The risk associated with developing IAD is further increased among older adults, due to the effects of the ageing process, which leave the skin thinner and more fragile. Understanding the causative factors of IAD in addition to understanding the impact of IAD on the skin enable the clinician to make informed choices regarding treatment, management and prevention. Additionally, understanding the association between IAD and pressure ulcers is a critical component of IAD management, as IAD and pressure ulcers often coexist or develop alongside each other.


Assuntos
Dermatite Irritante/enfermagem , Envelhecimento da Pele/fisiologia , Dermatite Irritante/etiologia , Dermatite Irritante/fisiopatologia , Dermatite Irritante/prevenção & controle , Incontinência Fecal/complicações , Humanos , Lesão por Pressão/complicações , Incontinência Urinária/complicações
7.
Nursing (Säo Paulo) ; 22(253): 2927-2931, jun.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1023875

RESUMO

As lesões por pressão (LPP) representam importantes causas de morbimortalidade a nível mundial. Assim, objetivou-se identificar a ocorrência e características das LPP bem como, o perfil do paciente acometido. Trata-se de uma pesquisa descritiva, longitudinal e quantitativa, realizada em uma unidade de terapia intensiva adulto. A população foi constituída de registros de internações em prontuários no período de maio a dezembro de 2014 e a coleta de dados foi realizada em agosto de 2014 a janeiro de 2015. Identificou-se uma ocorrência de 22,07% com predomínio de lesões em mulheres idosas, com distúrbios respiratórios e presença de co-morbidades. Sete pacientes já apresentavam a lesão na admissão e 10 desenvolveram na UTI. A maioria das lesões estava no estágio II e na região sacral e, em relação ao desfecho clínico, 52,94% deles evoluiu para o óbito. O estudo evidenciou a importância da capacitação profissional como estratégia para reduzir a incidência dessas lesões.(AU)


Pressure lesions (LPP) represent important causes of morbidity and mortality worldwide. Thus, the objective was to identify the occurrence and characteristics of LPP in critically ill patients. This is a descriptive, longitudinal and quantitative study performed in an adult intensive care unit (ICU). The population was composed of records of hospitalizations in medical records from May to December 2014 and the data collection was performed in August 2014 to January 2015. An occurrence of 22.07% was identified with a predominance of lesions in women elderly, with respiratory disorders and presence of comorbidities. Seven patients already had the lesion on admission and 10 developed in the ICU. The majority of the lesions were in stage II and in the sacral region and, in relation to the clinical outcome, 52.94% of them evolved to death. The study evidenced the importance of professional training as a strategy to reduce the incidence of LPP in the unit.(AU)


Las lesiones por presión (LPP) representan importantes causas de morbimortalidad a nivel mundial. Así, se objetivó identificar la ocurrencia y características de las LPP en el paciente gravemente enfermo. Se trata de una investigación descriptiva, longitudinal y cuantitativa, realizada en una unidad de terapia intensiva adulto (UTI). La población fue constituida de registros de internaciones en prontuarios en el período de mayo a diciembre de 2014 y la recolección de datos fue realizada en agosto de 2014 a enero de 2015. Se identificó una ocurrencia del 22,07% con predominio de lesiones en mujeres ancianos, con disturbios respiratorios y presencia de comorbilidades. Siete pacientes ya presentaban la lesión en la admisión y 10 desarrollaron en la UTI. La mayoría de las lesiones estaban en la etapa II y en la región sacral y, en relación al desenlace clínico, el 52,94% de ellos evolucionó hacia el óbito. El estudio evidenció la importancia de la capacitación profesional como estrategia para reducir la incidencia de la UPP en la unidad.(AU)


Assuntos
Humanos , Fatores de Risco , Lesão por Pressão , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Unidades de Terapia Intensiva , Cuidados de Enfermagem
8.
Gerokomos (Madr., Ed. impr.) ; 30(2): 93-97, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183948

RESUMO

Objetivo: analizar el riesgo de aparición y la prevalencia de lesión por presión en personas encamadas asistidas por las unidades de atención primaria en el domicilio, además de describir las características sociodemográficas de los participantes del estudio, así como las condiciones clínicas y de tratamiento de los pacientes con lesiones por presión. Método: se trata de un estudio transversal, con 79 participantes encamados y englobados en el programa Estrategia de Salud Familiar. Los datos fueron recogidos mediante entrevista semiestructurada, y el riesgo de aparición de lesiones por presión se estimó mediante la aplicación de la escala de Braden. Resultados: se verificó que la condición clínica de los usuarios que necesitaron cuidados en el domicilio supone un riesgo significativo para el desarrollo de la úlcera por presión o agravamiento de estas lesiones, especialmente en los ancianos. Se evidenció la presencia de lesión por presión en el 15,1%. Conclusión: el estudio pone de relieve el elevado riesgo para el desarrollo de úlcera por presión en la población del municipio


Objective: to analyze the risk of occurrence and the prevalence of pressure ulcer in bedridden people attended by primary care teams. Method: this is a cross-sectional study, with 79 participants bedridden and included in the Family Health Strategy program. The data were collected through a semi-structured interview with the risk of occurrence of pressure ulcer estimated through the application of the Braden Scale. Results: it was verified that the clinical condition of the users who needed home care supposes a significant risk factor for the development of ulcer due to pressure or aggravation of these lesions, especially in the elderly. The presence of pressure injury was evidenced in 15.1%. Conclusion: the study highlights the high risk for the development of ulcer by pressure in the population of the municipality


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Lesão por Pressão/complicações , Lesão por Pressão/epidemiologia , Atenção Primária à Saúde , Fatores de Risco , Estudos Transversais , Inquéritos e Questionários
9.
J Wound Ostomy Continence Nurs ; 46(3): 187-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083059

RESUMO

BACKGROUND: The purpose of this article is to examine the evidence related to a unique phenomenon of purple-maroon discoloration of the buttocks found in homecare patients and to recommend a label for this phenomenon. CASES: Initially, we searched the literature to identify and retrieve any evidence related to this unique form of purple-maroon discoloration of the buttocks. No evidence was found. To illustrate the condition, we compared 4 cases of what we have labeled chronic tissue injury to 6 patients with purple-maroon discoloration of the buttocks from different causes. CONCLUSION: Chronic tissue injury is characterized by a persistent purple-maroon discoloration located on the fleshy portion of the buttocks that does not improve or deteriorate. Unlike other causes of purple discoloration such as deep tissue pressure injury, there is minimal change in the discoloration over time. Additional research is needed to further our understanding of the histopathology of this phenomenon.


Assuntos
Nádegas/anormalidades , Lesão por Pressão/classificação , Úlcera Varicosa/classificação , Cicatrização/fisiologia , Idoso , Idoso de 80 Anos ou mais , Nádegas/irrigação sanguínea , Feminino , Humanos , Masculino , Lesão por Pressão/complicações , Lesão por Pressão/fisiopatologia , Úlcera Varicosa/complicações , Úlcera Varicosa/fisiopatologia
10.
J Wound Ostomy Continence Nurs ; 46(3): 194-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083062

RESUMO

PURPOSE: The purpose of this study was to compare the effect of pressure injuries on mortality, hospital length of stay, healthcare costs, and readmission rates in hospitalized patients. DESIGN: A case-control study. SUBJECTS AND SETTING: The sample comprised 5000 patients admitted to a tertiary hospital located in Seoul Korea; 1000 patients with pressure injuries (cases) were compared to 4000 patients who acted as controls. METHODS: We retrospectively extracted clinical data from electronic health records. Study outcomes were mortality, hospital length of stay, healthcare costs, and readmission rates. The impact of pressure injuries on death and readmission was analyzed via multiple logistic regression, hospital deaths within 30 days were analyzed using the survival analysis and Cox proportional hazards regression, and impact on the length of hospitalization and medical costs were analyzed through a multiple linear regression. RESULTS: Developing a pressure injury was significantly associated with an increased risk of in-hospital mortality (odds ratio [OR], 3.94; 95% confidence interval [CI], 2.91-5.33), 30-days in-hospital mortality (OR, 2.18; 95% CI, 1.59-3.00), and healthcare cost (ß = 11,937,333; P < .001). Pressure injuries were significantly associated with an extended length of hospitalization (ß = 20.84; P < .001) and length of intensive care unit (ICU) stay (ß = 8.16; P < .001). Having a pressure injury was significantly associated with an increased risk of not being discharged home (OR, 5.55; 95% CI, 4.35-7.08), along with increased risks of readmission (OR, 1.30; 95% CI, 1.05-1.62) and emergency department visits after discharge (OR, 1.70; 95% CI, 1.29-2.23). CONCLUSIONS: Development of pressure injuries influenced mortality, healthcare costs, ICU and hospital length of stay, and healthcare utilization following discharge (ie, readmission or emergency department visits). Hospital-level efforts and interdisciplinary approaches should be prioritized to develop interventions and protocols for pressure injury prevention.


Assuntos
Avaliação de Resultados da Assistência ao Paciente , Lesão por Pressão/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pressão/efeitos adversos , Lesão por Pressão/epidemiologia , Lesão por Pressão/mortalidade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos
11.
J Wound Ostomy Continence Nurs ; 46(3): 207-213, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083063

RESUMO

PURPOSE: We examined the usability, user perceptions, and nursing occupational subculture associated with introduction of a patient monitoring system to facilitate nursing staff implementation of standard care for pressure ulcer/injury prevention in the nursing home setting. DESIGN: Mixed methods, pre-/posttest design. SUBJECTS AND SETTING: Resident (n = 44) and staff (n = 38) participants were recruited from a 120-bed nursing home in the Southeast United States. METHODS: Digital data on frequency and position of residents were transmitted wirelessly from sensors worn on each resident's anterior chest to estimate nursing staff compliance with repositioning standard of care before and after visual monitors were activated to cue staff. The validated Nursing Culture Assessment Tool was used to determine changes in nursing culture. Benefits and challenges of implementation were assessed by 2 focus groups composed of 8 and 5 female members of the nursing staff (RN, LPN, CNA), respectively, and led by the three authors. Descriptive statistics were used for all quantitative variables, and inferential statistics were applied to categorical variables (χ test or Fisher exact test) and continuous variables (analyses of variance or equivalent nonparametric tests), respectively, where a 2-sided P value of <.05 was considered statistically significant. RESULTS: System use significantly (P = .0003) improved compliance with every 2-hour repositioning standards. The nursing culture normative ranking percentage increased from 30.9% to 58.2%; this difference was not statistically significant. Focus groups expressed satisfaction with the monitoring system and recommended improvements to support adaptation and use of technology. CONCLUSIONS: Study findings support the usability of the patient monitoring system to facilitate repositioning. Implementation of multiple strategies for training, supplies, and communication may enhance uptake and effectiveness.


Assuntos
Monitorização Fisiológica/métodos , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/complicações , Lesão por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Casas de Saúde/organização & administração , Postura , Lesão por Pressão/epidemiologia , Pesquisa Qualitativa , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Sudeste dos Estados Unidos/epidemiologia
12.
J Wound Ostomy Continence Nurs ; 46(3): 256-262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083070

RESUMO

BACKGROUND: Recent revisions to the pressure injury staging system include guidance on differential diagnoses for deep tissue pressure injury (DTPI). Accurately identifying DTPI is critical; however, purpura in the setting of vascular disorders and systemic infectious processes can share similar features confounding diagnosis. CASES: In this three-case series, we describe suspected DTPI with an uncharacteristic shape or occurring in the presence of additional lesions distributed outside of typical pressure areas prompted further evaluation. CONCLUSIONS: The interdisciplinary approach we adapted was useful in determining the cause of purpura when the DTPI was ruled out by the certified wound care nurse.


Assuntos
Lesão por Pressão/classificação , Púrpura/etiologia , Região Sacrococcígea/anormalidades , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/complicações , Púrpura/classificação , Região Sacrococcígea/irrigação sanguínea
14.
Nurs Res ; 68(5): 339-347, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829837

RESUMO

BACKGROUND: There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries. OBJECTIVES: We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults. METHODS: This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital's electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis. RESULTS: The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress. DISCUSSION: Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.


Assuntos
Dor/etiologia , Lesão por Pressão/complicações , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Demografia , Registros Eletrônicos de Saúde , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
15.
Rev. clín. med. fam ; 12(1): 24-27, feb. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-182885

RESUMO

La fascitis necrotizante es una infección agresiva y altamente destructiva de la fascia y el músculo con una alta morbimortalidad. Se suele presentar en pacientes inmunocomprometidos tales como VIH, diabéticos, oncológicos o trasplantados, siendo sus localizaciones más habituales las extremidades, pared abdominal y periné; en esta última localización recibe el nombre de gangrena de Fournier. Su asociación con úlceras de decúbito es infrecuente, relacionándose en la mayoría de las ocasiones con procesos osteomielíticos, traumatismos con heridas cutáneas o presencia de cuerpos extraños. Presentamos un caso clínico de un paciente con fascitis necrotizante secundaria a úlcera de decúbito. Nos parece interesante presentar las características clínicas, así como exponer los hallazgos radiológicos de esta entidad y, por otra parte, acentuar la importancia de un adecuado cuidado de las úlceras por presión, ya que pueden ser el origen de la fascitis necrotizante


Necrotizing fasciitis is an aggressive and highly destructive infection of the fasciae and muscles with high morbidity and mortality. It usually occurs in immunocompromised patients such as HIV, diabetic, oncology or transplant patients. Its most common locations are the extremities, abdominal wall and perineum; in this latter location it is called Fournier's gangrene. Its association with pressure ulcers is infrequent, being connected in most cases with osteomyelitic processes, traumas with skin wounds or presence of foreign bodies. We present the clinical case of a patient with necrotizing fasciitis secondary to pressure ulcer. We find it interesting to present the clinical characteristics as well as the radiological findings of this entity and, on the other hand, to emphasize the importance of an adequate care of pressure ulcers, since they can be the origin of necrotizing fasciitis


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Fasciite Necrosante/etiologia , Lesão por Pressão/complicações , Cicatrização , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , Doença de Alzheimer/complicações , Fragilidade/complicações
16.
BMJ Support Palliat Care ; 9(4): 363-364, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30612090

RESUMO

Fentanyl has a low molecular weight and is lipophilic making it suitable for transdermal administration. However, multiple factors appear to lead to interindividual variation in absorption via this route. Here we describe an unusual case where a patient was found to have twelve 100 µg/hour fentanyl patches in situ which she was using as background analgesia.


Assuntos
Analgésicos Opioides/administração & dosagem , Caquexia/complicações , Fentanila/administração & dosagem , Analgésicos Opioides/uso terapêutico , Feminino , Fentanila/uso terapêutico , Hospitais para Doentes Terminais , Humanos , Pessoa de Meia-Idade , Naloxona/administração & dosagem , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/administração & dosagem , Antagonistas de Entorpecentes/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Lesão por Pressão/complicações , Absorção Cutânea , Adesivo Transdérmico
17.
Med Mal Infect ; 49(1): 9-16, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29937316

RESUMO

OBJECTIVES: Pressure ulcers are frequently observed in spinal cord injury (SCI) patients. They can be life-threatening and are a major medico-economic burden. Despite their frequency, their pathophysiology and optimal management are still poorly understood. Most available data comes from non-comparative studies, especially in terms of antimicrobial use. METHODS: We performed a critical review of the literature and opinions of infectious disease specialists based in a French expert center for this disease. We mainly focused on antimicrobial treatments prescribed in this situation. RESULTS: These infections are usually clinically diagnosed. Microbiological samples are not the gold standard for this assessment. Furthermore, reliable microbiological identification is a major challenge but should help select antimicrobial treatment. Imaging technique could be helpful but cannot replace the physical examination. The choice of antimicrobials must consider the potential ecological collateral damages in this vulnerable population. Antimicrobial therapy should be as short as possible, adapted to the microbiological identification, and must have suitable bioavailability. CONCLUSION: Management of infected pressure ulcers is a major concern in disabled patients already highly exposed to antimicrobial treatment and multidrug-resistant organisms colonization. Extensive data is required.


Assuntos
Lesão por Pressão/complicações , Lesão por Pressão/terapia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/terapia , Infecção dos Ferimentos/terapia , Anti-Infecciosos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/fisiologia , Humanos , Lesão por Pressão/epidemiologia , Lesão por Pressão/microbiologia , Traumatismos da Medula Espinal/epidemiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/etiologia
18.
Clin Infect Dis ; 68(2): 338-342, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-29986022

RESUMO

The treatment of osteomyelitis in patients with stage IV sacral pressure ulcers is controversial. We conducted a systematic literature review and did not find evidence of benefit of antibacterial therapy in this setting without concomitant surgical debridement and wound coverage. Furthermore, many patients with chronically exposed bone do not have evidence of osteomyelitis when biopsied, and magnetic resonance imaging may not accurately distinguish osteomyelitis from bone remodeling. The goal of therapy should be local wound care and assessment for the potential of wound closure. If the wound can be closed and osteomyelitis is present on bone biopsy, appropriate antibiotic therapy is reasonable. We find no data to support antibiotic durations of >6 weeks in this setting, and some authors recommend 2 weeks of therapy if the osteomyelitis is limited to cortical bone. If the wound will not be closed, we find no clear evidence supporting a role for antibiotic therapy.


Assuntos
Antibacterianos/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Lesão por Pressão/complicações , Sacro/patologia , Idoso , Humanos , Masculino , Lesão por Pressão/patologia
19.
Pediatr Neurosurg ; 54(2): 116-120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30481786

RESUMO

We introduce a novel technique for the treatment of severe kyphosis in myelomeningocele. A 5-year-old paraplegic boy with myelomeningocele presented with severe thoracolumbar kyphosis and a chronic ulcus at the site of the gibbus. The myelomeningocele had been treated during his first week of life, and an accompanying Chiari type II malformation had been treated by ventriculoperitoneal shunting. He subsequently developed a rapidly progressive thoracolumbar kyphosis with an angle of 180° between T10 and L5. He also suffered from a chronic superinfected skin ulcus at the site of the gibbus. Since the skin ulcus required plastic surgery reconstruction, we deemed classical posterior fixation after kyphectomy unfeasible. The subsequent operative steps of our novel surgical approach were performed in a single-stage surgery. First, a three-level lumbar corporectomy from L1 to L3 was performed. Subsequently, the body of the removed L2 vertebra was isolated and configured as an autologous graft to bridge the gap between the thoracic and the caudal lumbar spine. The graft was fixed via a transcorporal interbody fusion technique with titanium screws, and chopped autologous bone was added for fusion. The skin was closed using rotation flaps. At the 3-year follow-up, the patient and his family reported marked improvement of quality of life, imaging showed solid fusion and the wound was unremarkable. Our novel technique with transcorporal fixation provides new perspectives in the treatment of severe kyphosis and skin ulceration in myelomeningocele.


Assuntos
Cifose/cirurgia , Vértebras Lombares/cirurgia , Meningomielocele/cirurgia , Lesão por Pressão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vértebras Torácicas/cirurgia , Pré-Escolar , Doença Crônica , Humanos , Cifose/complicações , Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Meningomielocele/complicações , Meningomielocele/diagnóstico por imagem , Lesão por Pressão/complicações , Lesão por Pressão/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Dispositivos de Fixação Cirúrgica , Vértebras Torácicas/diagnóstico por imagem
20.
J Adv Nurs ; 75(6): 1219-1228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30456856

RESUMO

AIMS: To examine the effect of psychological distress in mediating the relationship between the severity of pressure injury and pain intensity in hospitalized adults. BACKGROUND: Despite the prevalence of pressure injury (previously known as pressure ulcers) in hospitalized adults, the current knowledge of pain associated with pressure injury is limited and findings are inconsistent. There is also a lack of understanding of the relationship between psychological distress and pain from pressure injury. DESIGN: Retrospective cross-sectional secondary analysis of data from electronic health records. METHODS: The data were retrieved from the third day of admission in the period between 2013 - 2016 through the Integrated Data Repository (IDR). Electronic health records were reviewed to collect data as needed. The mediation effect was tested by using path analysis implemented through Mplus. RESULTS: Path analysis revealed that the severity of pressure injuries and psychological distress have significant direct effects on pain intensity in hospitalized adults. However, the relationship between the severity of pressure injury and pain intensity was not significantly mediated by psychological distress. CONCLUSION: Hospitalized adults who have more severe pressure injury and more treatments for psychological distress experienced greater pain intensity. Healthcare providers must pay attention to treating psychological distress among hospitalized adults to manage pain. Further study is needed to validate these findings and it should incorporate more appropriate measures of psychological distress. The lack of standardized nursing documentation in electronic health records severely limits the usefulness of data from electronic health records for nursing research.


Assuntos
Pacientes Internados/psicologia , Manejo da Dor/psicologia , Dor/psicologia , Lesão por Pressão/complicações , Lesão por Pressão/psicologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
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