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1.
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.
J Clin Nurs ; 28(21-22): 4119-4127, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31216388

RESUMO

AIMS AND OBJECTIVE: To describe the prevalence and predictors of pressure injuries among older adults with limited mobility, within the first 36 hr of their hospital admission in Australia. BACKGROUND: Pressure injuries are significant health, safety and quality of care issues for patients and healthcare organisations. The early implementation of the recommended pressure injury prevention international clinical practice guidelines is a way to reduce hospital-acquired pressure injuries. There is a paucity of evidence on the number of older persons who are admitted hospital with a pre-existing pressure injury. DESIGN: Prospective correlational study conducted in eight tertiary referral hospitals across Australia. Our sample comprised of 1,047 participants aged ≥65 years with limited mobility, drawn from a larger Australian pragmatic cluster randomised trial. METHODS: Using the STROBE statement, observational data were collected on participants' age, gender, presence of a pressure injury, Body Mass Index score, number of comorbidities and place of residence. These variables were analysed as potential predictors for pressure injuries within the first 36 hr of hospitalisation. RESULTS: From our sample, 113/1047 (10.8%) participants were observed to have a pressure injury within the first 36 hr of hospital admission. Age, multiple comorbidities and living in an aged care facility predicted the prevalence of pressure injury among older people within the first 36 hr of hospitalisation. CONCLUSIONS: Our findings confirm that older adults, those with multiple comorbidities and individuals living in aged care facilities are more likely to come to hospital with a pre-existing pressure injury or develop one soon after admission. RELEVANCE TO CLINICAL PRACTICE: Many older patients come to hospital with a community-acquired pressure injury or develop a pressure injury soon after admission. This highlights the importance of the early detection of pressure injuries among older persons so that timely management strategies can be implemented along with the potential to reduce unnecessary financial penalties.


Assuntos
Hospitalização/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Lesão por Pressão/diagnóstico , Lesão por Pressão/terapia , Prevalência , Estudos Prospectivos , Medição de Risco
5.
Adv Skin Wound Care ; 32(8): 365-369, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162147

RESUMO

OBJECTIVE: To evaluate if the use of a pressure injury (PI) risk assessment is associated with the more frequent use of international evidence-based guideline interventions in patients at risk of PI. METHODS: Data were collected through a multicenter cross-sectional prevalence study conducted on November 14, 2017. Study authors analyzed data from 532 patients 65 years at risk of PI or older in Austrian hospitals. MAIN OUTCOME MEASURES: Repositioning, mobilization, floating heels/heel devices, moisture/barrier cream, patient education, malnutrition screening, referral to a dietitian, and hydration/nutrition management. MAIN RESULTS: The risk assessment was documented on admission for 80% (n = 435) of the at-risk patients. Patients for whom a PI risk assessment was conducted were older and more care dependent, and nearly 20% had a PI compared with patients for whom no risk assessment was conducted upon admission. Conducting a risk assessment led to a statistically significantly higher number of internationally recommended PI preventive interventions being performed for at-risk patients, such as provision of moisture/barrier cream, mobilization specific for PI, malnutrition screening, and floating heels or heel suspension devices. CONCLUSIONS: These results showed that conducting and documenting a risk assessment led to more recommended interventions being performed. Although such interventions are recommended for all patients, these findings are especially relevant for patients at mild or moderate risk of PI who might be otherwise overlooked, which in turn could reduce hospital-acquired PI rates.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Lesão por Pressão/diagnóstico , Lesão por Pressão/prevenção & controle , Medição de Risco/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Lesão por Pressão/epidemiologia , Prevalência , Fatores de Risco
6.
Crit Care Nurse ; 39(3): 44-50, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154330

RESUMO

BACKGROUND: Pressure injuries, also known as pressure ulcers, are a serious complication of immobility. Patients should be thoroughly examined for pressure injuries when admitted to the intensive care unit to optimize treatment. Whether community-acquired pressure injuries correlate with poor hospital outcomes among critically ill patients is understudied. OBJECTIVES: To determine whether pressure injuries present upon admission to the intensive care unit can serve as a predictive marker for longer hospitalization and increased mortality. METHODS: This study retrospectively analyzed admissions of adult patients to a 24-bed medical-surgical intensive care unit in a large level I trauma center in the northeast United States from 2010 to 2012. The association of pressure injuries with mortality and length of stay was assessed, using multivariable logistic regression and generalized linear models, adjusted for age, comorbidities, Acute Physiology and Chronic Health Evaluation III score, and other patient characteristics. RESULTS: Among 2723 patients, 180 (6.6%) had a pressure injury at admission. Patients with a pressure injury had longer mean unadjusted stay (15.6 vs 10.5 days; P < .001) and higher in-hospital mortality rate (32.2% vs 18.3%; P < .001) than did patients without a pressure injury at admission. After multivariable adjustment, pressure injuries were associated with a mean increase in length of stay of 3.1 days (95% CI 1.5-4.7; P < .001). Pressure injuries were not associated with mortality after adjusting for the Acute Physiology and Chronic Health Evaluation III score, but they may serve as a marker for increased risk of mortality if an Acute Physiology and Chronic Health Evaluation III score is unavailable. CONCLUSION: Pressure injuries present at admission to the intensive care unit are an objective, easy-to-identify finding associated with longer stays. Pressure injuries might have a modest association with higher risk of mortality.


Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva , Tempo de Internação , Admissão do Paciente/estatística & dados numéricos , Lesão por Pressão/diagnóstico , APACHE , Adulto , Estudos de Coortes , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , New England , Valor Preditivo dos Testes , Lesão por Pressão/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco
8.
Intensive Crit Care Nurs ; 53: 68-72, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31036423

RESUMO

OBJECTIVE: Determine the incidence and risk factors for pressure ulcers in a paediatric intensive care unit. Use the information gathered to develop preventive pressure ulcer care bundles. RESEARCH METHODOLOGY: Prospective cohort study using Braden Q Scale for Predicting Pressure Sore Risk and European Pressure Ulcer Advisory Panel Pressure Ulcer Staging tool. SETTING: General paediatric intensive care unit in a tertiary level hospital between May and October 2017. RESULTS: Seventy-seven children were recruited. Most children were male (n = 42, 54.5%) and all nine children (11.7%) that developed a pressure ulcer were male. The main risk factor for developing a pressure ulcer was lack of physical activity. None of the children assessed as high or severe risk developed a pressure ulcer. Eight (89%) pressure ulcers were assessed as grade one. Seven pressure ulcers (77.8%) were on the facial and scalp area and all seven children were receiving airway support at the time the pressure ulcers developed. CONCLUSION: Incidence of pressure ulcers was 11.7%, with the facial and scalp area the most common anatomical areas affected. Medical devices appeared to be the prime causative factor. Based on our data we have modified and launched the SSKIN care bundle for the paediatric intensive care unit setting.


Assuntos
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pacotes de Assistência ao Paciente/normas , Lesão por Pressão/diagnóstico , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/normas , Irlanda/epidemiologia , Masculino , Pacotes de Assistência ao Paciente/métodos , Pacotes de Assistência ao Paciente/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Estudos Prospectivos , Fatores de Risco
9.
J Wound Care ; 28(5): 278-282, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31067157

RESUMO

OBJECTIVE: An in-practice evaluation of an sub-epidermal moisture (SEM) scanner, to detect non-visible pressure damage, allowing appropriate, targeted pressure ulcer (PU) prevention interventions. METHOD: The evaluation included patients on a single medical-surgical ward over a period of two months. RESULTS: The evaluation included 35 patients. The outcomes of the evaluation suggest that the SEM scanner provided objective evidence that both the interventions being employed and the increase in repositioning and assessment prevented further incipient skin damage. CONCLUSION: We conclude that the early detection of non-visible tissue injury using the SEM scanner as an adjunct to the usual PU risk assessment strategies can reduce PU incidence, leading to improved patient outcomes and released productivity.


Assuntos
Diagnóstico Precoce , Microscopia de Força Atômica/métodos , Lesão por Pressão/diagnóstico , Lesão por Pressão/prevenção & controle , Higiene da Pele/métodos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
10.
J Stroke Cerebrovasc Dis ; 28(7): 2026-2030, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005562

RESUMO

BACKGROUND: Acute ischemic stroke patients are a group at high risk for pressure sores. It is important to identify risk factors for pressure sores in acute ischemic stroke patients in order to facilitate early adoption of appropriate preventive and treatment measures. METHODS: Data were derived from the China National Stroke Registry. Acute ischemic stroke patients aged >18 years who presented at the hospital within 14 days after the onset of symptoms were eligible for this study. Comprehensive baseline data were collected. The definition of pressure sores was based on assessment at discharge of whether the patient had pressure sores at any time during hospitalization. RESULTS: 12,415 patients with a mean age of 67 years and a mean length of hospitalization of 14 days were included in the study. Among these patients, 97 (0.8%) had pressure sores during hospitalization. In the multivariate analysis of risk factors for pressure sores, age (each increment of 5 years), being unmarried, NIHSS at admission (each increment of 3 points), mRS at admission (3-5 points), diabetes mellitus, hemoglobin at admission (each incremental reduction of 10 units), and history of peripheral vascular disease all were significantly correlated with the occurrence of pressure sores among acute ischemic stroke patients during hospitalization. CONCLUSIONS: Old age, severe neurological disability, being unmarried, low hemoglobin, and history of diabetes mellitus and peripheral vascular disease were risk factors for pressure sores in acute ischemic stroke patients.


Assuntos
Isquemia Encefálica/epidemiologia , Hospitalização , Pacientes Internados , Lesão por Pressão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Anemia/sangue , Anemia/epidemiologia , Biomarcadores/sangue , Isquemia Encefálica/diagnóstico , China/epidemiologia , Comorbidade , Diabetes Mellitus/epidemiologia , Avaliação da Deficiência , Feminino , Hemoglobinas/análise , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/epidemiologia , Lesão por Pressão/diagnóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Pessoa Solteira , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
12.
J Wound Ostomy Continence Nurs ; 46(2): 117-123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30844868

RESUMO

PURPOSE: The purpose of this study was to determine nurses' knowledge and practices regarding pressure injury and identify relationships between these factors and professional nurse characteristics. DESIGN: Cross-sectional, descriptive study. SETTING AND SUBJECTS: The sample comprised 347 nurses attending the 2013 and 2015 Wound Management Congresses. The meetings were organized by the Wound Management Association located in Antalya, Turkey. METHODS: A 35-item data collection form was designed for purposes of this study. It divided into 2 parts: 8 items queried demographic and professional characteristics of nurse respondents. The second part comprised 9 cases describing patients with pressure injury; these cases were associated with 27 items querying pressure injury-related knowledge and practices. Demographic and professional characteristics of nurse respondents were summarized via descriptive statistics. The Kruskal-Wallis H and Mann-Whitney U tests were used to identify relationships between nurse characteristics and pressure injury knowledge and practices. RESULTS: The mean score for the 27 items related to pressure injury knowledge and practices was 57.37 ± 14.26 out of 100 points. Pressure injury knowledge and practices were positively associated with nurses having a bachelor's and/or postgraduate degree (P = .012), nurses caring for a higher number of patients with pressure injuries per week (P = .042), nurses practicing in intensive care units and wound care clinics (P = .011), nurses with specific education in pressure injury (P = .000), and those indicating adequate skills and knowledge in pressure injury (P = .005). CONCLUSIONS: Nurses' knowledge and practices regarding pressure injuries were lower than anticipated in this sample. We recommend additional education and training activities to increase nurses' knowledge and practices related to pressure injury.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/normas , Lesão por Pressão/diagnóstico , Adulto , Competência Clínica/normas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Lesão por Pressão/fisiopatologia , Estatísticas não Paramétricas , Inquéritos e Questionários , Turquia
13.
Z Evid Fortbild Qual Gesundhwes ; 140: 22-34, 2019 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-30876780

RESUMO

OBJECTIVE: There are still few epidemiological data on patients with chronic wounds (leg ulcers, diabetic foot ulcers and pressure ulcers). Statutory health insurance (SHI) data is increasingly being used for questions relating to healthcare science. When using this data, which is primarily collected for billing purposes, the methodological procedure for defining cases must be presented transparently. Here, it must be checked whether the target group can be validly defined using the coded diagnoses and, if necessary, further information from routine data. Therefore, the aim of this contribution is, on the one hand, to develop criteria with the help of which patients with a florid (active) chronic wound can be identified safely or as doubtful cases in routine data and, on the other hand, to determine the corresponding frequency estimates. METHODS: Initially, a literature research was carried out to identify parameters relevant to care in patients with chronic wounds. In the next step, these were divided into specific, less specific and non-specific criteria (visual validity) in a multi-stage consensus procedure with regard to the specificity for wound care. On this basis, three different case definitions are used to identify florid chronic wounds. Based on an SHI sample of insured persons, frequency estimates were made for various case definitions (safe and questionable cases). RESULTS: Of the 21 parameters identified in the literature, eight were classified as specific, six as less specific and eight as non-specific criteria for the identification of patients with chronic florid wounds. Using diagnostic coding alone for the target diseases, an administrative prevalence of chronic wounds of 1.13% was observed for the year 2010. If a case is defined using the less specific and/or the specific criteria, prevalence drops to 0.79%; if only the specific criteria are used, prevalence drops only marginally to 0.78%. These changes were observed in patients with leg ulcers and diabetic foot ulcers, but not in patients with pressure ulcers. Here, the lowest administrative prevalence (0.18%) can be seen when only looking at the diagnoses, but this increases slightly when taking wound-relevant treatments into account (specific and less specific criteria: 0.25%). CONCLUSION: It is possible to define patients with a chronic florid wound on the basis of wound-relevant treatments using SHI data and to make estimates of administrative prevalence. Depending on the question, the criteria for defining cases can be narrowed down or broadened. The comparison provides information on the internal validity of diagnostic coding. However, further studies are needed to verify external validity.


Assuntos
Pé Diabético , Programas Nacionais de Saúde/estatística & dados numéricos , Lesão por Pressão , Ferimentos e Lesões/diagnóstico , Doença Crônica , Pé Diabético/diagnóstico , Alemanha , Humanos , Seguro Saúde , Úlcera da Perna/diagnóstico , Lesão por Pressão/diagnóstico , Prevalência , Ferimentos e Lesões/classificação
14.
Adv Skin Wound Care ; 32(4): 157-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30889017

RESUMO

GENERAL PURPOSE: To provide background and examine evidence for the therapeutic application of light energy treatments for wound healing. 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 completing this continuing education activity, you should be better able to:1. Explain the basics of lasers, light-emitting diodes, and light-tissue interactions as they apply to photobiomodulation therapy.2. Summarize the results of the authors' literature review of the evidence regarding the therapeutic applications of photobiomodulation treatments for wound healing. ABSTRACT: To provide background and examine evidence for the therapeutic applications of light energy treatments for wound healing.A search was performed in PubMed for peer-reviewed scientific articles published in the last 5 years using the search terms "photobiomodulation therapy" and "low-level laser therapy," and these terms combined with "wound," using a "human species" filter. This search yielded 218 articles on photobiomodulation therapy or low-level laser therapy and wounds. Of these, only articles on in vivo wound care using light treatments were specifically included in this review (n = 11).The wound healing effects of low-dose laser treatments were first described over 50 years ago. Various doses ranging from 0.1 to 10 J/cm and wavelengths ranging from 405 to 1,000 nm appear to provide therapeutic benefits for a broad range of chronic wounds. A range of light energy sources from LEDs to lasers have been used and have specific advantages and limitations. There is a lack of consensus on standardized treatment parameters such as wavelengths, dose, and therapeutic outcomes in the reviewed studies, preventing direct comparison and clinical protocol recommendation. An expert opinion based on ongoing research studies and reported literature is offered.Noninvasive, economical, and multipurpose light devices are an attractive tool for wound management. However, there is an urgent need in the wound care community to develop optimal clinical protocols for use based on well-designed, rigorous clinical research studies.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Cicatrização/efeitos da radiação , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/radioterapia , Queimaduras/diagnóstico , Queimaduras/radioterapia , Doença Crônica , Pé Diabético/diagnóstico , Pé Diabético/radioterapia , Gerenciamento Clínico , Educação Médica Continuada , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Lesão por Pressão/diagnóstico , Lesão por Pressão/radioterapia , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento , Úlcera Varicosa , Cicatrização/fisiologia
15.
Int Wound J ; 16(3): 665-673, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30734477

RESUMO

The aim of this study was to compare the pressure injury risk predictability between the individual Braden subscales and the total Braden scale in adult inpatients in Singapore. A retrospective 1:1 case-control design was used from a sample of 199 patient medical records. Clinical data were collected from a local university hospital's medical records database. The results showed that, among the six subscales, the activity subscale was the most sensitive and specific in predicting pressure injury (PI). However, the overall results showed that the Braden scale remained the most predictive of PI development in comparison with the individual subscales. The study also found that, among the Singaporean patients, the Braden cut-off score for PI risk was 17 compared with the current cut-off score of 18. Therefore, it may be relevant for local tertiary hospitals to review their respective Braden cut-off scores as the study results indicate an over-prediction of PI risk, which leads to unnecessary utilisation of resources. The hospital may also consider developing a PI prevention bundle comprising commonly used preventive interventions when at least one Braden subscale reflects a suboptimal score.


Assuntos
Lesão por Pressão/diagnóstico , Lesão por Pressão/prevenção & controle , Psicometria/métodos , Medição de Risco/métodos , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Singapura
16.
Adv Skin Wound Care ; 32(3): 109-121, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30801349

RESUMO

GENERAL PURPOSE: To synthesize the literature regarding skin injuries that are found in patients at the end of life and to clarify the terms used to describe these conditions. 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 completing this continuing education activity, you should be better able to:1. Define the terms used to describe pressure injuries and skin changes at the end of life.2. Discuss the concept of skin failure as applied to end-of-life skin injuries and implications for practice. ABSTRACT: This article synthesizes the literature regarding the concepts of "terminal" skin injuries that are found in patients at the end of life, including Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, and skin failure. Also included is a discussion of avoidable and unavoidable pressure injuries as defined and differentiated by the Centers for Medicare & Medicaid Services and the National Pressure Ulcer Advisory Panel. To help clarify the controversy among these terms, a unifying concept of "skin failure" that may occur with an acute illness, chronic illness, or as part of the dying process is proposed. This proposed concept of skin failure is etiologically different than a pressure injury, although pressure injury and skin failure can occur concomitantly. These proposed concepts require further research and validated diagnostic criteria. Consensus around appropriate terminology is essential to reduce confusion among stakeholders and ensure appropriate patient care.


Assuntos
Assistência de Longa Duração/normas , Lesão por Pressão/diagnóstico , Lesão por Pressão/enfermagem , Assistência Terminal/organização & administração , Humanos , Papel do Profissional de Enfermagem , Planejamento de Assistência ao Paciente/organização & administração , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/enfermagem , Úlcera , Cicatrização
18.
BMC Health Serv Res ; 19(1): 23, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626388

RESUMO

BACKGROUND: With few exceptions the International Statistical Classification of Diseases (ICD) codes for diagnoses and official coding guidelines do not distinguish pre-existing conditions from complications or comorbidities which occur during hospitalization. However, information on diagnosis timing is relevant with regard to the case's severity, resource consumption and quality of care. In this study we analyzed the diagnostic value and reliability of the present-on-admission (POA) indicator using routinely collected health data. METHODS: We included all inpatient cases of the department of medicine during 2016 with a diagnosis of deep vein thrombosis, decubitus ulcer or delirium. Swiss coding guidelines of 2016 and the definitions of the Swiss medical statistics of hospitals were analyzed to evaluate the potential to encode information on diagnosis timing. The diagnoses were revised by applying the information present-on-admission by a coding specialist and by a medical expert, serving as Gold Standard. The diagnostic value and reliability were evaluated. RESULTS: The inter-rater reliability for POA of all diagnoses was 0.7133 (Cohen's kappa), but differed between diagnosis groups (0.558-0.7164). The rate of POA positive of the total applied by the coding specialist versus the expert was similar, but differed between diagnoses. In group "thrombosis" SEN was 0.95, SPE 0.75, PPV 0.97 and NPV 0.60, in group "decubitus ulcer" SEN 0.89, SPE 0.82, PPV 0.89 and NPV 0.82, in group "delirium" SEN 0.91, SPE 0.65, PPV 0.71 and NPV 0.88 For all diagnoses SEN 0.92, SPE 0.73, PPV 0.87, NPV 0.82, summing up the cases of all diagnosis groups. CONCLUSIONS: Coding the POA indicator identified diagnoses which were pre-existent with insufficient reliability on individual patient's level. The overall fair to sufficient diagnostic quality is appropriate for screening and benchmarking performance on population level. As the medical statistics of hospitals carries no variable on pre-existing conditions, the novel approach to apply the POA indicator to diagnoses gives more information on quality of hospital care and complexity of cases. By preparing documentation for POA reporting diagnostic quality must be increased before implementation for risk-assessment or reimbursement on the individual patient's level.


Assuntos
Delírio/diagnóstico , Hospitalização , Lesão por Pressão/diagnóstico , Centros de Atenção Terciária , Trombose Venosa/diagnóstico , Benchmarking , Humanos , Classificação Internacional de Doenças , Projetos Piloto , Reprodutibilidade dos Testes
19.
Am J Ther ; 26(1): e5-e11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29642075

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness of topical sucralfate in the management of pressure ulcer (PU) in hospitalized patients. METHODS: Forty hospitalized patients with stage II PU were included in this prospective, double-blind, randomized, placebo-controlled trial and were randomly divided into 2 groups receiving either sucralfate gel or placebo, on a daily basis. The patients were visited every day for 14 days, the ulcer was evaluated using the Pressure Ulcer Scale for Healing (PUSH) and changes to the measured scores over time were used as an indicator of wound healing. RESULTS: There were no statistically significant differences in any of the demographic characteristics between both groups. Both of the interventions reduced the average PUSH score, and at the end of the trial, all but 2 patients were healed. One in each group discontinued the trial because of exacerbation of the ulcer. No significant between-group difference in the average PUSH score reduction was observed (6.36 ± 2.11 vs. 5.89 ± 1.41, P = 0.42). Although the average healing time was less in the sucralfate group (6.05 ± 2.17 vs. 7.78 ± 3.42), the difference was not statistically significant (P = 0.07). CONCLUSIONS: Sucralfate gel does not improve healing of PU compared with placebo.


Assuntos
Antiulcerosos/uso terapêutico , Lesão por Pressão/tratamento farmacológico , Sucralfato/uso terapêutico , Cicatrização/efeitos dos fármacos , Administração Cutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Antiulcerosos/farmacologia , Método Duplo-Cego , Feminino , Géis , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Lesão por Pressão/diagnóstico , Estudos Prospectivos , Sucralfato/farmacologia , Fatores de Tempo , Resultado do Tratamento
20.
J Nurs Manag ; 27(1): 117-124, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30221444

RESUMO

AIM: To study the relationship between pressure ulcer risk evaluated by the Norton Scale and inadequate fulfilment of Need 2 (Eating/Drinking) from the 14-need classification designed by Virginia Henderson. BACKGROUND: Assessing nutritional status and skin condition to implement preventive measures are important nursing interventions. Our hospital's standard procedure requires recording Norton Scale and Henderson Eating/Drinking Assessment results. METHODS: This was a descriptive cross-sectional study, analysing case histories of 219 patients in medical/surgical wards for >24 hr with nursing care recorded in the GACELA Care computer application. Patient sociodemographic variables and evaluation concepts from the Norton Scale and Eating/Drinking were studied. RESULTS: A statistically significant relationship (p < 0.05; 95% CI: 0.61, 2.83) was seen between inadequate Eating/Drinking need fulfilment and increased pressure ulcer risk. Pressure ulcer risk was generally low in the sample, with mainly no or minimum risk (77.3%); the oldest age group had the highest risk. Self-care autonomy was the most frequently assessed item in Eating/Drinking (42%). CONCLUSIONS: A relationship was found between Norton Scale risk results and Eating/Drinking need assessment results. The greater the pressure ulcer risk, the more likely was inadequate need satisfaction (poor nutritional status). IMPLICATIONS: To help identify pressure ulcer risk, nurses should assess patients' eating independence. Safeguarding nutritional status and preventing pressure ulcers are nursing skills associated with quality nursing care.


Assuntos
Comportamento Alimentar/psicologia , Lesão por Pressão/diagnóstico , Medição de Risco/normas , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Avaliação Nutricional , Estado Nutricional , Lesão por Pressão/psicologia , Psicometria/instrumentação , Psicometria/métodos , Medição de Risco/métodos , Fatores de Risco , Autocuidado , Espanha
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