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1.
Zhonghua Shao Shang Za Zhi ; 36(7): 610-611, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842413

RESUMO

On February 11, 2019, a 37-year-old female patient with neuromyelitis optica spectrum disorders was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine, and her acute osteomyelitis was caused by infection of multiple pressure ulcer wounds with Staphylococcus aureus. The patient was diagnosed and treated with multidisciplinary cooperation. The nurses focused on the strict observation of the syndrome of neuromyelitis optica spectrum disorders during hormone reduction therapy, guarded against the rebound of condition, implemented wound care in stages according to the diagnosis and treatment plan, maintained effective drainage, ensured appropriate negative pressure, and strengthened nutrition to promote wound healing. After active treatment and careful nursing care, the patient recovered and was discharged on the 39th day after admission.


Assuntos
Neuromielite Óptica , Lesão por Pressão , Adulto , Feminino , Humanos , Neuromielite Óptica/complicações , Lesão por Pressão/complicações
2.
Medicine (Baltimore) ; 99(21): e20417, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481344

RESUMO

BACKGROUND: Pressure ulcers (PU) bring a considerable physical and mental burden on patients and their families, and have put families and government under tremendous pressure to cover the cost for treatment. Therefore, this protocol proposes to evaluate the quality of existing PU clinical practice guidelines (CPGs) and compare the similarities and differences between its recommendations in order to improve the treatment efficacy and reduce the PU treatment cost. METHODS: Electronic databases and specific databases of CPGs will be searched. Study selection and data collection will be performed independently by two reviewers. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument and Reporting Items for Practice Guidelines in Healthcare (RIGHT) will be used to assess the methodological quality and reporting quality of included CPGs. Bubble plot will be used to describe the difference of the quality, and mind mapping will be plotted to illustrate the comparison of recommendations of a guideline when needed. R software, MindMaster and Excel will be used. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSION: This systematic review will provide comprehensive evidence of CPGs of PU. PROSPERO REGISTRATION NUMBER: CRD42020149176.


Assuntos
Guias como Assunto , Lesão por Pressão/terapia , Protocolos Clínicos , Consenso , Gerenciamento Clínico , Humanos , Lesão por Pressão/complicações , Revisões Sistemáticas como Assunto , Resultado do Tratamento
3.
Gerokomos (Madr., Ed. impr.) ; 31(2): 98-106, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193891

RESUMO

OBJETIVO: Determinar la prevalencia hospitalaria de lesiones relacionadas con la dependencia (LRD) en la provincia de Burgos. Determinar las características de las LRD. Identificar las valoraciones del riesgo de padecer lesión por presión (LPP) y el uso de dispositivos de prevención de LPP. Cuantificar los registros de enfermería de LRD. METODOLOGÍA: Estudio observacional, descriptivo, transversal y multicéntrico, realizado mediante observación directa y revisión de la historia clínica de adultos ingresados en unidades de hospitalización. Realizado en tres hospitales de Burgos en 2018. RESULTADOS: La población sumó 511 pacientes; presentaron LRD: 188. Se detectaron 328 LRD: 176 (53,65%) LPP, 48 (14,63%) lesiones por humedad, 81 (24,69%) lesiones por fricción, 11 (3,35%) lesiones combinadas y 12 (3,65%) lesiones multicausales. Las LPP de categoría 1 fueron las más numerosas, sumando un 35,36%. El 78,96% de las LRD se consideraron adquiridas en el hospital. La prevalencia de LRD es del 36,79%. Las prevalencias por tipos de LRD son: LPP 20,93%, lesiones por humedad 9%, fricción 12,72%, combinadas 1,76% y multicausales 1,56%. El 35,61% de los pacientes presentaba algún tipo de dispositivo preventivo; el 60,07% presentaba valoración del riesgo de padecer LPP; el 30,31% presentaba registro de la lesión, y el 18,37% contaba con plan de cuidados específico. CONCLUSIONES: La prevalencia e LRD, obtenida por inspección directa, cuadruplica los resultados nacionales, pero parece reflejar con mayor exactitud la realidad que los datos obtenidos mediante los registros de enfermería. Es aconsejable universalizar la valoración del riesgo de padecer LPP a todos los pacientes, la mejora de los registros de enfermería y reforzar los esfuerzos preventivos


AIM: To determine the hospital prevalence of dependence-related lesions (DRL) in the province of Burgos. Determine the characteristics of the DRL. Identify the risk assessments of pressure ulcer (PU) and the use of PU prevention devices. Quantify the DRL nursing records. METHODOLOGY: Observational, descriptive, cross-sectional and multicenter study, performed through direct observation and review of the health record of adults admitted to hospitalization units. RESULTS: The population totaled 511 patients, of wich 188 presented DRL. 328 DRL were detected: 176 (53.65%) PU, 48 (14.63%) moisture lesions, 81 (24,69%) friction lesions, 11 (3.35%) combined lesions, and 12 (3.65%) multifactorial lesions. The most numerous was PU category 1 totaling 35.36%. 78.96% of the DRL were determined to be hospital acquired. The prevalence of DRL is 36.79%. The prevalences for DRL types are: PU 20.93%, moisture lesions 9%, friction 12.72%, combined 1.76% and multifactorial 1.56%. 35.61% of patients had some type of preventive device, 60.07% had a risk assessment for PU, 30.31% had a record of the lesion and 18.37% had a specific care plan. CONCLUSIONS: The prevalence of DRL, obtained by direct inspection, quadruples national results, but it seems to be more accurate than the data obtained through nursing records. It is advisable to universalize the assessment of the risk of suffering PU to all patients, to improve nursing records and to reinforce preventive efforts


Assuntos
Humanos , Masculino , Feminino , Idoso , Lesão por Pressão/complicações , Úlcera Cutânea/classificação , Úlcera Cutânea/prevenção & controle , Segurança do Paciente , Registros de Enfermagem/normas , Enfermagem Geriátrica , Autocuidado/métodos , Autocuidado/normas , Enfermagem Geriátrica/métodos
5.
Arch Pediatr ; 27(2): 95-103, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31791829

RESUMO

BACKGROUND AND AIMS: Malnutrition is common in neurologically impaired (NI) children. It is, however, ill-defined and under-diagnosed. If not recognized and treated, it increases the burden of comorbidities and affects the quality of life of these children. The aim of this study was to characterize the nutritional status of a cohort of children followed up at a reference center for cerebral palsy (CP) in Brussels, Belgium, and to investigate possible links with the occurrence of comorbidities. MATERIAL AND METHODS: We conducted a single-center retrospective study including all the children followed up at the Inter-university Reference Center for Cerebral Palsy ULB-VUB-ULg. The data were obtained by reviewing medical files. Anthropometric measurements as well as the etiology of neurological impairment, comorbidities, feeding patterns, and laboratory test results were collected. The children were assigned a nutritional diagnosis according to the World Health Organization and Waterlow definitions. RESULTS: A total of 260 children with cerebral palsy were included, 148 males and 112 females. Their mean age was 10.9±4.3 years. The gross motor function classification system (GMFCS) level was I for 79 children, II for 63 children, III for 35 children, IV for 33 children, and V for 50 children. Of the children, 54% had a normal nutritional status, 34% showed malnutrition, and 8% were obese; 38% had oropharyngeal dysphagia. The sensitivity of mean upper arm circumference of

Assuntos
Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Transtornos de Deglutição/complicações , Obesidade Pediátrica/complicações , Adolescente , Bélgica , Criança , Pré-Escolar , Feminino , Fraturas Espontâneas/complicações , Gráficos de Crescimento , Humanos , Lactente , Masculino , Estado Nutricional , Obesidade Pediátrica/diagnóstico , Pneumonia/complicações , Lesão por Pressão/complicações , Estudos Retrospectivos , Extremidade Superior/anatomia & histologia
6.
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
7.
Wound Manag Prev ; 65(10): 30-36, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31702987

RESUMO

Evaluating the healing status of pressure injuries is important to planning medical and nursing care. PURPOSE: A descriptive, retrospective study was conducted to determine the healing status of pressure injuries among critically ill immobile patients. METHODS: Data were obtained via medical record review of all patients admitted to a Turkish university hospital's anesthesiology intensive care unit (ICU) between January 2008 and December 2015. Demographic (age, gender), medical (comorbidities, diagnosis, length of ICU stay), and pressure injury characteristics (number, location, stage, healing status, length, width, exudate amount, tissue type) were evaluated along with Pressure Ulcer Scale for Healing (PUSH) Tool scores. Data from all patients >18 years of age with an ICU stay >24 hours who had a pressure injury and whose records were complete were included in the study. Data were expressed as number, percentage, and mean and median values. Wilcoxon test, Spearman's correlation analysis, and chi-square test were performed as appropriate. Pressure injuries were considered healed when the PUSH score equaled zero. RESULTS: The study sample comprised 359 patients (60.97 ± 19.31 [range 19-95] years, 217 men, median length of stay 25 [range 1-363] days) with 672 pressure injuries. Most pressure injuries were located on the coccyx (278 [41.4%]), and 153 (22.8%) healed during ICU stay. Older age (r = 0.167; P = .002) and length of ICU stay (r = 0.238; P = .0001) were significantly correlated with having multiple pressure injuries. There was a statistically significant relationship between pressure injury location and stage and healing status (χ2 = 28.993, P = .0001; and χ2 = 60.200, P = .001, respectively). The lowest percentage of injuries healed were on the coccyx and were stage 4 and unstageable. Overall, the mean first PUSH score was significantly higher than the last assessment score (8.99 ± 3.82 to 7.28 ± 5.22, respectively; z = -10.807; P = .0001). CONCLUSION: Many immobile ICU patients had multiple pressure injuries, especially patients who were older and who had a longer length of stay. Healing scores for pressure injuries were better at discharge or transfer and 22% of injuries were healed. Prospective studies comparing all factors that may contribute to pressure injury healing are warranted. .


Assuntos
Estado Terminal/reabilitação , Lesão por Pressão/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/fisiopatologia , Estudos Prospectivos , Estudos Retrospectivos , Turquia
8.
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
9.
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
11.
Int Wound J ; 16(6): 1533-1544, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606950

RESUMO

Pressure injuries (PIs) have now become a common complication of the elderly patients. Some studies have observed that pressure injuries may increase mortality, but this area of evidence has not been evaluated and summarised. The aim of this study was to compare the mortality of patients with pressure injuries and those without pressure injuries. A meta-analysis of observational studies was performed. PubMed, Cochrane Library, Embase, and Web of Science were searched up to April 2019. Studies about mortality among the elderly patients with and without pressure injuries were included. Methodological quality was assessed by the Newcastle-Ottawa Scale (NOS). The fixed effect or random effect model was determined by the test of heterogeneity. The subgroup analysis was performed based on the pressure injuries stages, the region, and the type of study design. The meta-regression analysis was performed to investigate the relationship between the mortality and patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio. The sensitivity analysis was used to explore the impact of an individual study by excluding one at a time. The hazard ratio (HR) and 95% confidence intervals (CIs) in terms of the comparison of two groups were extracted for meta-analysis. A survival curve between two groups by individual patient-level was drew. Eight studies with 5523 elderly patients were included in the analysis. Follow-up periods for the included studies ranged from about 0.5 to 3 years. The elderly patients who complicated with pressure injuries had a higher risk of death. The pooled HR was 1.78 (95% CI 1.46-2.16). A funnel plot showed no publication bias. Further subgroup analysis showed that HR values for the patient stage 3 to 4 pressure injuries (HR:2.41; 95% CI:1.08-5.37) were higher than stage 1-4 and 2-4 pressure injuries (HR: 1.66; 95% CI: 1.35-2.05; HR: 1.74; 95% CI: 1.16-2.60). The meta-regression analysis found that patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio were not the sources of heterogeneity. Sensitivity analyses showed that the outcomes of the study did not change after removing the Onder's article. The survival curve at the individual patient-level also indicated that patients complicated with pressure injuries significantly increased the risk of death (HR: 1.958; 95% CI: 1.79-2.14) in elderly patients. Our meta-analysis indicated that patients complicated with pressure injuries are estimated to have a two times higher risk on mortality compared with patients without pressure injuries during the 3 years follow-up period. Particular attention should be given to the elderly patients who are at higher risk for mortality.


Assuntos
Mortalidade , Lesão por Pressão/complicações , Idoso , Humanos , Medição de Risco
12.
Wound Manag Prev ; 65(8): 30-37, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31373568

RESUMO

Existing evidence is inadequate to assume increased skin temperature is a risk factor for the development of pressure ulcers (PUs). PURPOSE: The purpose of this prospective, descriptive study was to examine the relationship between sacral skin temperature and PU development. METHODS: Using convenience sampling methods, patients who were hospitalized in the tertiary intensive care unit (ICU) of the internal medicine department of a university hospital in Izmir, Turkey, between April and December 2015 were eligible to participate if they were ⟩18 years of age, had an expected hospital stay of at least 5 days, a Braden score ≤12, and were admitted without a PU. Demographic and clinical data collected included age, gender, body mass index, diagnosis, mattress type, length of follow-up (days), systolic and diastolic blood pressure, body temperature, hemoglobin level, sacral skin temperatures in the supine and lateral positions, room temperature, PU stage and duration, and Braden score. Temperature was measured the day of hospitalization as a baseline measurement (day 1) and once every day thereafter up to 22 days, until the patient did or did not develop a PU, died, was no longer undergoing position change, or was discharged. Sacral skin temperature was taken immediately after the patient was moved to a lateral position following 120 minutes of supine position (referred to as supine position sacral skin temperature measurement) and after 30 minutes in lateral position (referred to as lateral position sacral skin temperature measurement). Data were collected using paper-and-pencil questionnaires and entered into a software program for analysis. Descriptive statistics, Student's t test, one-way analysis of variance test, Pearson product-moment correlation analysis, and Spearman's rank-order correlation analysis were used for data analysis. RESULTS: Of the 37 patients who met the inclusion criteria and were monitored for at least 5 days, 21 (56.8%) developed PUs. No statistically significant difference in supine position sacral skin temperature on day 1 or day 5 was found between patients who did and did not develop a PU (36.90° C ± 0.29° C and 37.15° C ± 0.53° C, respectively, on day 1; t = -1.656, P = .112; and 37.37° C ± 0.53° C and 37.30° C ± 0.79° C, respectively, on day 5; t = 0.259, P = .798). Day 5 lateral position skin temperatures also did not differ significantly between the 2 groups (37.44° C ± 0.44° C and 37.31° C ± 0.75° C, respectively; t = 1.306, P = .621). A statistically significant difference was noted between mean sacral skin temperature in the supine position among patients ages 75 to 90 years compared with patients 38 to 64 years and 65 to 74 years (36.93° C ± 0.39° C; F = 13.221, P = .000) and with use of a viscoelastic mattress compared with an alternating pressure air mattress and continuous lateral rotation alternating pressure air mattress (37.85° C ± 0.54° C; F = 14.039, P = .000). No statistically significant differences in sacral skin temperatures were found for any of the of the other variables assessed. CONCLUSION: Sacral skin temperatures were not statistically different between ICU patients who did and did not develop a PU. Additional research may help increase understanding of the relationship between skin temperature and PU development.


Assuntos
Lesão por Pressão/fisiopatologia , Região Sacrococcígea/irrigação sanguínea , Temperatura Cutânea/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/complicações , Estudos Prospectivos , Fatores de Risco , Região Sacrococcígea/anormalidades , Região Sacrococcígea/fisiopatologia , Turquia
14.
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
15.
Biomech Model Mechanobiol ; 18(6): 1947-1964, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31203488

RESUMO

Pressure ulcers are devastating injuries that disproportionately affect the older adult population. The initiating factor of pressure ulcers is local ischemia, or lack of perfusion at the microvascular level, following tissue compression against bony prominences. In turn, lack of blood flow leads to a drop in oxygen concentration, i.e, hypoxia, that ultimately leads to cell death, tissue necrosis, and disruption of tissue continuity. Despite our qualitative understanding of the initiating mechanisms of pressure ulcers, we are lacking quantitative knowledge of the relationship between applied pressure, skin mechanical properties as well as structure, and tissue hypoxia. This gap in our understanding is, at least in part, due to the limitations of current imaging technologies that cannot simultaneously image the microvascular architecture, while quantifying tissue deformation. We overcome this limitation in our work by combining realistic microvascular geometries with appropriate mechanical constitutive models into a microscale finite element model of the skin. By solving boundary value problems on a representative volume element via the finite element method, we can predict blood volume fractions in response to physiological skin loading conditions (i.e., shear and compression). We then use blood volume fraction as a homogenized variable to couple tissue-level skin mechanics to an oxygen diffusion model. With our model, we find that moderate levels of pressure applied to the outer skin surface lead to oxygen concentration contours indicative of tissue hypoxia. For instance, we show that applying a pressure of 60 kPa at the skin surface leads to a decrease in oxygen partial pressure from a physiological value of 65 mmHg to a hypoxic level of 31 mmHg. Additionally, we explore the sensitivity of local oxygen concentration to skin thickness and tissue stiffness, two age-related skin parameters. We find that, for a given pressure, oxygen concentration decreases with decreasing skin thickness and skin stiffness. Future work will include rigorous calibration and validation of this model, which may render our work an important tool toward developing better prevention and treatment tools for pressure ulcers specifically targeted toward the older adult patient population.


Assuntos
Hipóxia/complicações , Microvasos/patologia , Modelos Biológicos , Lesão por Pressão/complicações , Algoritmos , Simulação por Computador , Difusão , Análise de Elementos Finitos , Humanos , Oxigênio/metabolismo , Pele/irrigação sanguínea
16.
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
17.
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
18.
Neurourol Urodyn ; 38(6): 1713-1720, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31141236

RESUMO

PURPOSE: To describe the epidemiologic characteristics of urethrocutaneous fistulae (UCF) in sacro-perineal pressure ulcer (SPPU) in neurourological patients and to assess outcomes after surgical urinary diversion. MATERIALS AND METHODS: Through the French-speaking Neurourology Study Group and Association of Urology network, a retrospective multicenter study in nine major urology and physical medicine and rehabilitation (PMR) units was conducted. All patients with SPPU associated with UCF between 2000 and 2016 were included. Data concerning: sociodemography, clinical, medical and biological comorbidities, neurological and urological history, pressure ulcer characteristics, and finally urinary diversion surgery were collected. Complications and SPPU healing/relapse were assessed. RESULTS: In all, 74 patients were included. The median age on diagnosis: 45.9 years (interquartile range [IQR], 38.7-53.4) and median follow-up: 15.1 months (IQR, 5.7-48.8). A psychiatric disorder was the most frequent comorbidity (44.6%). Only 59.5% and 50% had regular PMR and urologic follow-up, respectively. Seventy-one patients (95.9%) underwent urinary diversion surgery. Among those, relapse occurred in 15 (21.1%) at the end of the follow-up. The diversion was noncontinent in 85.9%. The major complications rate was 26.8%. A total of 30 late complications in 21 patients were reported. The most frequent was obstructive pyelonephritis (n = 9). All of the patients who underwent surgical diversion without cystectomy (n = 5) developed a pyocyst. Finally, the pressure ulcer healing rate when patients underwent both urinary diversion and pressure ulcer surgery was 74.4%. CONCLUSIONS: Our retrospective data suggest that UCF complicating SPPU is a rare and severe pathology. The combination of radical urinary diversion with cystectomy and pressure ulcer surgery should be performed as often as possible.


Assuntos
Fístula Cutânea/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Lesão por Pressão/epidemiologia , Doenças Uretrais/epidemiologia , Derivação Urinária/métodos , Adulto , Comorbidade , Fístula Cutânea/complicações , Fístula Cutânea/cirurgia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/cirurgia , Períneo , Lesão por Pressão/complicações , Lesão por Pressão/cirurgia , Estudos Retrospectivos , Região Sacrococcígea , Fatores Socioeconômicos , Resultado do Tratamento , Doenças Uretrais/complicações , Doenças Uretrais/cirurgia
19.
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
20.
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
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