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2.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(6): 722-732, 2020 Jun 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879131

RESUMO

OBJECTIVES: To investigate the status and the related factors of nursing behaviors for pressure injury, and to provide the evidence for standardizing pressure injury management. METHODS: A total of 1 039 clinical nursing staff from 4 general hospitals in Changsha from December 1 to 30, 2017 were selected by a stratified random sampling procedure. Nurses' demographic information such as age, gender, title, educational attainment, and department were collected. We investigated the status of nursing behaviors on pressure injury by a self-designed questionnaire, assessed nurses' knowledge of pressure injury and nurses' attitude of pressure injury using the Pressure Ulcer Knowledge Test and Attitude towards Pressure Ulcer Prevention Instrument, respectively, compared the nursing behaviors on pressure injury with different backgrounds, used multiple linear regression to analyze the influential factors for nursing behaviors on pressure injury, and conducted the Pearson correlation analysis for nurses' knowledge, attitude, and behaviors on the pressure injury. RESULTS: The overall nursing behaviors score on pressure injury was 155.96±17.29. The 5 dimensional scores from high to low were: risk assessment (4.42±0.49), prevention actions (4.40±0.50), risk understanding (4.35±0.52), injury assessment and interventions (4.27±0.55), and health education (4.25±0.63). A significant difference was found in the nursing behavior scores of pressure injury among ages, lengths of service, education, and training times (all P˂0.05). There was no correlation between nurses' knowledge and behaviors (P=0.606). The nurses' attitude was positively correlated with their behaviors (r=0.307, P˂0.001), and the nurses' knowledge was also positively correlated with their attitudes (r=0.212, P˂0.001). The results of multiple linear regression showed that the length of service (≤5 years), training times (1-2 times), education (diploma or below), the scores of nurses' knowledge, and the scores of nurses' attitude were independent influencial factors of nurses' behaviors on pressure injury. CONCLUSIONS: The nursing staff in the general hospital of Changsha has a high level of nursing behaviors on pressure injury, and they has good sense of responsibility and confidence. However, personal competence in pressure injury is insufficient and still needs to be improved. The nursing managers should focus on the nurses' attitude and training frequency, increasing the experience in nursing the pressure injury and practical level, and arouse the highly educated nurses' enthusiasm and sense of accomplishment to prevent pressure injury, thus reducing the incidence of pressure injury.


Assuntos
Recursos Humanos de Enfermagem no Hospital , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Atitude do Pessoal de Saúde , China/epidemiologia , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Gerais , Humanos , Inquéritos e Questionários
3.
J Stroke Cerebrovasc Dis ; 29(10): 105112, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912565

RESUMO

BACKGROUND: Medical complications often occur, particularly in the acute phase of severe stroke, and lead to poor outcomes. However, it is unclear whether out-of-bed mobilization (OM) reduces such complications or not in the acute phase of severe stroke. Thus, we investigated the association between OM and complications of immobility in the acute phase of severe stroke. METHODS: We enrolled 407 patients diagnosed with ischemic stroke or intracerebral hemorrhage and patients with modified Rankin Scale 5 at discharge in this study. Patients were divided into two groups: OM (303 patients) and bed rest (BR; 104 patients) at discharge based on their medical records. Complications of immobility (such as pneumonia, urinary tract infection, pressure sore, and falls) during hospitalization in each group were recorded. RESULTS: The total complication rate of immobility, incidence of pneumonia, and the incidence of pressure sores were significantly lower in the OM group than in the BR group [60.7% vs. 88.5%, 45.5% vs. 62.5%, and 3.6% vs. 12.5%; odds ratio, 0.20, 0.50, and 0.26; and 95% confidence intervals, 0.11-0.39, 0.32-0.79, and 0.11-0.61, respectively]. Urinary tract infection and falls did not differ significantly between the two groups. CONCLUSIONS: In the acute phase of severe stroke, OM was significantly associated with a lower risk of total complication rate of immobility, incidence of pneumonia, and incidence of pressure sore without increasing falls.


Assuntos
Repouso em Cama/efeitos adversos , Isquemia Encefálica/reabilitação , Deambulação Precoce , Hemorragias Intracranianas/reabilitação , Limitação da Mobilidade , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Acidentes por Quedas/prevenção & controle , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/fisiopatologia , Avaliação da Deficiência , Deambulação Precoce/efeitos adversos , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/fisiopatologia , Japão/epidemiologia , Alta do Paciente , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Resultado do Tratamento
4.
Gerokomos (Madr., Ed. impr.) ; 31(3): 180-192, sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197354

RESUMO

OBJETIVOS: Describir la incidencia de lesiones por presión (LPP) en pacientes pediátricos atendidos en unidades de críticos, así como diferentes variables relacionadas con la metodología de su cálculo. INTRODUCCIÓN: Las LPP constituyen un serio problema de salud con importantes repercusiones en los pacientes que las sufren. Las UCI pediátricas (UCIP) y neonatales (UCIN) atienden a pacientes en alto riesgo para el desarrollo de LPP. Existen pocos datos sistematizados acerca de la incidencia y variables definitorias de LPP en UCIP y UCIN. MÉTODOS: Revisión sistemática de la literatura científica publicada entre el 1 de enero de 2000 y el 31 de diciembre de 2016, que incluía artículos que reportaban datos sobre incidencia en UCIP o UCIN. Se han incluido trabajos que notifican datos sobre LPP relacionadas con el apoyo, con o sin lesiones relacionadas con dispositivos sanitarios; se han excluido los artículos que incluían exclusivamente datos de lesiones relacionadas con dispositivos sanitarios. RESULTADOS: La revisión sistemática ha permitido identificar 27 artículos con un total de 53 reportes de incidencia con información sobre 15 587 pacientes. En el caso de las UCIP, la mediana de la incidencia de lesiones por presión es del 19,4% en los trabajos prospectivos que no incluyen de manera implícita lesiones por presión relacionadas con dispositivos sanitarios y del 16,97% en los que incluyen a la vez lesiones relacionadas con dispositivos sanitarios y lesiones por presión por apoyo de los pacientes. En el caso de las UCIN encontramos unos valores del 3,9% y del 23,58%. CONCLUSIONES: Los resultados del presente trabajo permiten definir el alcance de la incidencia de las LPP en pacientes críticos pediátricos y resaltan aspectos relacionados con la metodología utilizada para su cálculo


AIMS: To describe the incidence and main characteristics of pressure injuries in pediatric patients in intensive care units and some variables related to the methodology for pressure injury incidence calculation. BACKGROUND: Pressure injuries (PI) represent a serious health problem with major consequences for the patients affected. Neonatal and pediatric ICU (NICU) (PICU) care for patients at high risk of developing pressure injuries. There is a paucity of systematic data on the incidence and defining variables of injuries in PICU and NICU. METHODS: We conducted a systematic review of the literature published between January 1, 2000 and December 31, 2016, including articles reporting data on the incidence of these injuries in PICU or NICU. We included studies reporting data on pressure injuries related to position, with or without injuries related to medical devices; we excluded studies which only reported data on pressure injuries related to medical devices. FINDINGS: We identified 27 articles with a total of 53 reports on incidence and information on 15,587 patients. In the case of PICU, the mean incidence of PI was 19.4% in prospective studies that did not implicitly include PI related to medical devices, and 16.97% in those which included pressure injuries related both to medical devices and position. For NICU, we found values of 3.9% and 23.58% respectively. CONCLUSIONS: The results of this study shed light on the incidence of pressure injuries in pediatric intensive care patients and highlight aspects related to the methodology used for the calculation of PI incidence


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Lesão por Pressão/epidemiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Cuidados Críticos , Fatores de Risco , Saúde da Criança , Serviços de Saúde da Criança/organização & administração
7.
PLoS One ; 15(5): e0233471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469916

RESUMO

INTRODUCTION: Pressure ulcer is a frequent complication in patients hospitalized in nursing homes and has a serious impact on quality of life and overall health. Moreover, ulcer treatment is highly expensive. Several studies have shown that pressure ulcer prevention is cost-effective. Audit and feedback programmes can help improve professional practices in pressure ulcer prevention and thus reduce their occurrence. The aim of this study was to analyze, with a prospective longitudinal study, the effectiveness of an audit and feedback programme at 1- and 2-year follow-up for reducing pressure ulcer prevalence and enhancing adherence to preventive practices in nursing homes. METHODS: Pressure ulcer point prevalence and preventive practices were measured in 2015, 2016 and 2017 in nursing homes of the Canton of Geneva (Switzerland). Oral and written feedback was provided 2 months after every survey to nursing home reference nurses. RESULTS: A total of 27 nursing homes participated in the programme in 2015 and 2016 (4607 patients) and 15 continued in 2017 (1357 patients). Patients were mostly females, with mean age > 86 years and median length of stay about 2 years. The programme significantly improved two preventive measures: patient repositioning and anti-decubitus bed or mattress. It also reduced acquired pressure ulcers prevalence in nursing homes that participated during all 3 years (from 4.5% in 2015 to 2.9% in 2017, p 0.035), especially in those with more patients with pressure ulcers. CONCLUSION: Audit and feedback is relatively easy to implement at the regional level in nursing homes and can enhance adherence to preventive measures and reduce pressure ulcers prevalence in the homes.


Assuntos
Instituição de Longa Permanência para Idosos , Casas de Saúde , Lesão por Pressão/prevenção & controle , Programas Médicos Regionais , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Instituição de Longa Permanência para Idosos/economia , Humanos , Estudos Longitudinais , Masculino , Auditoria de Enfermagem/economia , Casas de Saúde/economia , Lesão por Pressão/epidemiologia , Lesão por Pressão/enfermagem , Prevalência , Estudos Prospectivos , Programas Médicos Regionais/economia , Programas Médicos Regionais/estatística & dados numéricos , Programas Médicos Regionais/tendências , Suíça/epidemiologia
8.
Enferm. glob ; 19(58): 257-266, abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195557

RESUMO

OBJETIVO: Evaluar los factores de riesgo para infecciones relacionadas con la asistencia sanitaria causadas por Enterobacteriaceae productoras de carbapenemas. MÉTODO: Este es un estudio retrospectivo de casos y controles que consistió en una muestra de 82 pacientes infectados y 164 controles, totalizando 246 pacientes. La recopilación de datos se realizó entre enero y mayo de 2017 mediante la búsqueda en el Sistema Automatizado de Control de Infecciones Hospitalarias y en los registros electrónicos de pacientes. RESULTADOS: Pacientes previamente colonizados con microorganismos gramnegativos (OR: 10.7, 95% CI: 2-60, p = 0.007), con cáncer (OR: 20.8, 95% CI: 4-120, p < 0.001), utilizando una catéter de doble luz (OR: 30.5, 95% CI: 2-382, p = 0.008), con lesión por presión (OR: 136.2, 95% CI: 11- 1623, p < 0.001) y permanecer en la Unidad de Cuidados Intensivos (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) fueron más propensos a desarrollar infecciones causadas por Enterobacteriaceae productoras de carbapenemas que el grupo control. El área bajo la curva ROC mostró un buen rendimiento general (0,99; IC 95%: 0,992-0,998) del modelo de regresión logística final. CONCLUSIÓN: La colonización previa, el cáncer, el uso de catéteres de doble luz, la lesión por presión y la estadía en la UCI fueron factores de riesgo muy importantes para la adquisición de infecciones en el entorno hospitalario


OBJECTIVE: To evaluate the risk factors for healthcare-associated infections caused by Klebsiella pneumoniae carbapenemase producing Enterobacteriaceae. METHOD: This is a retrospective case-control study that consisted of a sample of 82 infected patients and 164 controls, totaling 246 patients. Data collection was performed between January and May 2017 through search in the Automated Hospital Infection Control System and in the electronic patient records. RESULTS: Patients previously colonized with gram-negative microorganisms (OR: 10.7, 95% CI: 2-60, p = 0.007), with cancer (OR: 20.8, 95% CI: 4-120, p < 0.001), using a double lumen catheter (OR: 30.5, 95% CI: 2-382, p = 0.008), with pressure injury (OR: 136.2, 95% CI: 11- 1623, p < 0.001) and Intensive Care Unit stay (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) had a greater chance of developing Healthcare-associated Infections caused by KPC-producing Enterobacteriaceae than the control group. The area under the ROC curve showed a good overall performance (0.99, 95% CI: 0.992-0.998) of the final logistic regression model. CONCLUSION: Previous colonization, cancer, double lumen catheter use, pressure injury and ICU stay were very important risk factors for the acquisition of infections in the hospital environment


OBJETIVO: Avaliar os fatores de risco para infecções relacionadas à assistência à saúde causadas por Enterobactérias produtoras de Klebsiella pneumoniae carbapenemase. MÉTODO: Estudo de caso-controle, retrospectivo que foi composto por uma amostra de 82 pacientes infectados e 164 controles, totalizando 246 pacientes. A coleta de dados foi realizada entre janeiro e maio de 2017, por meio de busca no Sistema Automatizado de Controle de Infecção Hospitalar e nos prontuários eletrônicos dos pacientes. RESULTADOS: Pacientes previamente colonizados com microrganismos gram-negativos (OR: 10,7, IC 95%: 2-60, p = 0,007), com câncer (OR: 20,8, IC 95%: 4-120, p < 0,001), utilizando cateter de duplo lúmen (OR: 30,5, IC 95%: 2-382, p = 0,008), com lesão por pressão (OR: 136,2, IC 95%: 11-1623, p < 0,001) e internação na Unidade de Terapia Intensiva (OR: 1,4, IC 95%: 1,2-1,6, p < 0,001) tiveram maior chance de desenvolver infecções relacionadas à assistência à saúde causadas por Enterobactérias produtoras de Klebsiella pneumoniae carbapenemase quando comparadas ao grupo controle. A área sob a curva ROC apresentou um bom desempenho geral do modelo final de regressão logística (0,99, IC95%: 0,992-0,998). CONCLUSÃO: Colonização prévia, câncer, uso de cateter de duplo lúmen, lesão por pressão e permanência na UTI foram fatores de risco muito importantes para a aquisição de infecções no ambiente hospitalar


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/isolamento & purificação , Fatores de Risco , Farmacorresistência Bacteriana , Infecções Relacionadas a Cateter/epidemiologia , Estudos de Casos e Controles , Estudos Retrospectivos , Lesão por Pressão/epidemiologia
9.
Gerokomos (Madr., Ed. impr.) ; 31(1): 41-50, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192212

RESUMO

INTRODUCCIÓN: Las úlceras por presión (UPP) constituyen un importante problema de salud en todos los sistemas de salud. Es por ello por lo que el Comité de Expertos Enfermeros en Cuidados de UPP y Heridas de la Federación Argentina de Enfermería (CEECUPPYH-FAE) decidió iniciar una estrategia nacional específica acerca del problema de las UPP, "La Maratón Nacional: El primer paso". En el presente artículo presentamos los datos correspondientes al primer estudio nacional de prevalencia de UPP en la República Argentina como punto de partida de nuestra maratón nacional. METODOLOGÍA: Para ello se planteó un estudio nacional con los siguientes OBJETIVOS: obtener indicadores epidemiológicos sobre UPP en instituciones de salud de la República Argentina; identificar el riesgo de padecer UPP; determinar las características demográficas y clínicas de los pacientes prevalentes; determinar las características de las lesiones identificadas, e identificar medidas utilizadas en prevención de UPP. Para ello se realizó un estudio descriptivo transversal mediante encuesta online realizada a profesionales de enfermería entre el 1 de junio y el 30 julio de 2018. Se utilizaron las directrices de clasificación de EPUAP-NPUAP y los indicadores del GNEAUPP. RESULTADOS: Participaron 200 profesionales de enfermería que relevaron 3755 encuestas en 22 de las 24 provincias del país. La prevalencia bruta de UPP fue del 22,55% en pacientes adultos, un 48,3% de los pacientes habían desarrollado UPP nosocomiales; el 57% de la muestra tenía edad para jubilarse (+ 60 años) y el 70% pertenecía a servicios generales. Las localizaciones de las lesiones más frecuentes fueron sacro, talones y trocánteres, respectivamente. La prevalencia de UPP en pacientes pediátricos fue del 8,35%; un 69,44% de los pacientes pediátricos presentaban UPP nosocomiales. El 76% de los pacientes pediátricos estaban internados en cuidados generales y el 66% presentaba riesgo bajo de padecer UPP. Las localizaciones más frecuentes fueron cabeza, sacro y talones. La prevalencia bruta de UPP en neoonatos fue del 4,15%, todos ellos presentaban UPP nosocomiales. El 66% de los neonatos presentaba riesgo de padecer UPP y las localizaciones más frecuentes fueron cabeza y sacro. CONCLUSIONES: "La Maratón Nacional: El primer paso" es el primer estudio de investigación a nivel nacional sobre UPP en el que participaron profesionales de enfermería de todo el país y ha permitido obtener cifras de prevalencia a nivel nacional, así como de tendencias de prevención, lo que sin lugar a dudas es una información de gran utilidad para establecer estrategias nacionales para la mejora del problema de las UPP y monitorizar dicho problema en la Argentina


INTRODUCTION: Pressure ulcers (PU) are a major health problem in all Health Systems. That is why the Committee of Experts in UPP and Wound Nurses of the Argentine Nursing Federation (CEECUPPYH-FAE) decided to initiate a specific national strategy on the UPP problem, "The National Marathon: The First Step". In the present article we present the data corresponding to the first national study of PUs prevalence in the Argentine Republic as the starting point of our national marathon. METHODOLOGY: For this purpose, a national study was proposed with the following OBJECTIVES: to obtain Epidemiological Indicators on PUs in Health Institutions of the Argentine Republic, to identify the risk of suffering PU, to determine the demographic and clinical characteristics of the patients of the prevalent patients, to determine the characteristics of identified lesions and to identify measures used in PU's prevention. A cross-sectional descriptive study was conducted through an online survey of Nursing Professionals between June 1 and July 30, 2018, using EPUAP-NPUAP classification guidelines and GNEAUPP indicators. RESULTS: There were 200 nurses who surveyed 3755 surveys in 22 of the country's 24 provinces. The Gross Prevalence of PUs was 22.55% in adult patients, of which 48.3% of prevalent patients had developed nosocomial PUs.57% of the sample is old enough to retire (+ 60 years), 70% belongs to general services. The most frequent lesion locations were sacrum, heels and trochanteres respectively. The prevalence of PUs in paediatric patients was 8.35%; 69.4% of paediatric prevalent patients presented nosocomial PUs.76% of the prevalent pediatric patients were hospitalized in general care and 66% had a low risk of UPP. The most frequent locations were head, sacrum and heels. The gross prevalence of PUs in neoonates was 4.15%, all of them presenting nosocomial PUs. Sixty-six percent of neonates were at risk of PU and the most frequent locations were head and sacrum. CONCLUSIONS: "The National Marathon: The first step" is the First National Argentinian Research Study on PUs where nurses from all over the country participated and has allowed to obtain national prevalence figures, as well as prevention trends, which without a doubt is a very useful information to establish national strategies for the improvement of the PUs problem and to monitor this problem in Argentina


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Lesão por Pressão/epidemiologia , Estratégias Nacionais , Lesão por Pressão/enfermagem , Argentina/epidemiologia , Estudos Epidemiológicos , Indicadores Demográficos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Inquéritos e Questionários , Estudos Transversais
10.
Metas enferm ; 23(2): 71-76, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194502

RESUMO

OBJETIVO: establecer los principales determinantes de la estimación de las demandas interpuestas por usuarios del sistema sociosanitario en relación con la aparición de úlceras por presión. MÉTODO: análisis de resoluciones judiciales obtenidas a través de una búsqueda exhaustiva en bases de datos especializadas del sistema jurisprudencial en España entre los años 2007 y 2017 en los órdenes civil, penal y contencioso-administrativo. RESULTADOS: se obtuvieron un total de 22 pronunciamientos, 10 estimatorios y 12 desestimatorios, de los que se extrajeron como principales conclusiones la necesidad de cumplir con la "Lex Artis ad hoc" a través de la aplicación de medidas preventivas y terapéuticas adecuadas, para lo que resulta conveniente el seguimiento de protocolos o guías de práctica clínica, y la relevancia del registro de las intervenciones llevadas a cabo en la historia clínica de los pacientes, documento probatorio de la diligencia de los profesionales en los diferentes procesos judiciales. CONCLUSIONES: además de como medio de aseguramiento de los derechos de los pacientes, el cumplimiento de la "Lex Artis ad hoc", y el registro de la actividad de los profesionales sanitarios en la historia clínica, sirve de defensa de los intereses de los propios profesionales, porque toda actuación ajustada a la "Lex Artis", que conste debidamente diligenciada en la historia clínica, se erige en salvaguarda frente a las demandas judiciales por mala praxis tal y como viene poniendo de manifiesto la jurisprudencia analizada al respecto


OBJECTIVE: to establish the main determining factors used to estimate claims brought by socio-healthcare patients with bed sores. METHOD: analysis of judicial resolutions obtained through an exhaustive search conducted in specialised databases in the Spanish case-law system, between 2007 and 2017, in civil, criminal and contentious-administrative jurisdictions. RESULTS: a total of 22 pronouncements were obtained, 10 ruling in favour and 12 against; the main conclusions drawn included the need to follow "lex artis ad hoc" by applying adequate preventive and therapeutic measures, for which clinical practice protocols or guides are recommended, and the relevance of entering any procedures into each patient's medical records, constituting proof of professional care in various judicial proceedings. CONCLUSIONS: in addition to guaranteeing patient rights, compliance with "lex artis ad hoc" and the entry of healthcare professionals' activity into medical records has become a safeguard to fight malpractice claims in court, as evidenced by the case-law analysed on the matter


Assuntos
Humanos , Responsabilidade Legal , Lesão por Pressão/enfermagem , Segurança do Paciente/legislação & jurisprudência , Lesão por Pressão/epidemiologia , Sistemas de Saúde/legislação & jurisprudência , Segurança do Paciente/normas , Imperícia/legislação & jurisprudência , Fatores de Risco
11.
Enferm. clín. (Ed. impr.) ; 30(supl.3): 87-91, mar. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-196118

RESUMO

OBJECTIVES: The aim of this study was to describe the MDrPU on patients with prolonged bed rest in the ICU. METHOD: A prospective cohort design was used in this study. We used non probabilility consecutive sampling. A total of 32 samples were included in this study. The Braden scale and NPUAP staging were used to predict the risk of pressure ulcers, and ulcers staging in 5 days. Statistical analysis were conducted using Chi-Square, Fisher Exact, and ROC Curve. RESULT: The result showed the prevalence of medical devices was 21.9%. Most pressure ulcers related to medical devices was stage 2 (57.1%) with the most common area for the wounds was on fingers (37.5%). Braden scale prediction score also showed specificity (56%) and sensitivity (92%). CONCLUSION: Numerous risk factors for pressure ulcer development were identified and Braden scale could to predict the risk of pressure ulcers related to medical devices


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Lesão por Pressão/prevenção & controle , Cuidados Críticos , Lesão por Pressão/epidemiologia , Equipamentos de Proteção , Lesão por Pressão/terapia , Indonésia/epidemiologia , Estudos Prospectivos , Sensibilidade e Especificidade , Fatores de Risco
12.
J Wound Ostomy Continence Nurs ; 47(2): 111-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084101

RESUMO

PURPOSE: The aims of this study were to measure the incidence and severity of nasal septum injury in premature infants receiving continuous positive airway pressure (CPAP) via a noninvasive thin-walled cannula, and to evaluate the effect of a polyvinyl chloride foam barrier dressing in reducing these injuries. DESIGN: Retrospective chart review, comparison cohort study. SUBJECTS AND SETTING: The sample comprised 235 neonates with a gestational age of 28 weeks or younger. Their mean gestational age was 26 weeks (range 22-28 weeks) and mean birth weight was 840 g (range 430-1320 g). The study setting was a level 4, regional neonatal intensive care unit housed in a 200-bed freestanding children's hospital located in the Northeastern United States. METHODS: Data were collected during 3 periods. During all 3 data collection periods, we used a soft, thin-walled nasal cannula, with a relatively short, binasal prong interphase and small diameter tubing connected to a ventilator circuit capable of transmitting positive airway pressure in neonates. During data collection periods 1 and 3, we used a polyvinyl foam barrier dressing as a preventive intervention against nasal skin damage; specifically, we placed a precut barrier on the prongs to protect the nasal skin. One side of the barrier foam has an adhesive surface, which was placed against the prongs. Study period 2 differed; during this period neonates were treated with the nasal cannula without the foam barrier based on manufacturer experience suggesting the foam barrier is not needed for prevention of skin damage. Pressure injuries (PIs) that occurred during each study period were staged according to National Pressure Ulcer Advisory Panel definitions. RESULTS: Eighty neonates were evaluated during study period 1 (thin-walled nasal cannula plus foam barrier). We evaluated 27 neonates during period 2 (thin-walled nasal cannula and no foam barrier) and 128 were evaluated during study period 3 (thin-walled nasal cannula plus foam barrier). Six neonates (7%) developed PIs during period 1, and 2 (1.5%) developed during study period 3. All were stage 1 and 2 PIs, no full-thickness injuries, also referred to as columella necrosis developed during use of the thin-walled nasal cannula in combination with the foam barrier dressings. In contrast, 13 PIs (48%) of neonates managed during data collection period 2 (thin-walled nasal cannula with no foam barrier) developed PI, and 40% experienced stage 3 PI or columella necrosis. This difference reflects a 6-fold increase in nasal injury occurred when nasal continuous positive airway pressure (NCPAP) was administered without use of the protective barrier dressing. CONCLUSION: We found clinically relevant difference in the occurrences of nasal PI in neonates managed with NCPAP; occurrences of stage 3 PI were 6-fold higher when a thin-walled cannula was used without a protective foam barrier dressing.


Assuntos
Cânula/efeitos adversos , Nariz/lesões , Lesão por Pressão/etiologia , Cânula/normas , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Septo Nasal/irrigação sanguínea , Septo Nasal/lesões , Septo Nasal/fisiopatologia , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Nariz/irrigação sanguínea , Nariz/fisiopatologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/fisiopatologia , Estudos Retrospectivos
13.
Adv Skin Wound Care ; 33(3): 146-154, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32058440

RESUMO

OBJECTIVE: To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors. METHODS: The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging. MAIN RESULTS: The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein. CONCLUSIONS: The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.


Assuntos
Avaliação da Deficiência , Limitação da Mobilidade , Lesão por Pressão/epidemiologia , Traumatismos da Medula Espinal/complicações , Cadeiras de Rodas/efeitos adversos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Data Warehousing , Bases de Dados Factuais , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paraplegia/complicações , Lesão por Pressão/etiologia , Lesão por Pressão/fisiopatologia , Prevalência , Quadriplegia/complicações , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Traumatismos da Medula Espinal/diagnóstico , Estados Unidos , Cadeiras de Rodas/estatística & dados numéricos
14.
J Wound Ostomy Continence Nurs ; 47(1): 26-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929441

RESUMO

PURPOSE: The purpose of this study was to calculate incidence, severity, and risk factors of nasal pressure injuries due to nasal continuous positive airway pressure (NCPAP) treatment in newborns. DESIGN: A prospective observational study. SUBJECTS AND SETTING: Newborns admitted between March 2017 and February 2018 to the neonatal intensive care unit of the First Affiliated Hospital of Xiamen University, Xiamen, China. METHODS: All newborns' noses were examined during NCPAP application. Every NCPAP-related nasal pressure injury including occurrence date, injury severity, outcomes, and pressure injury treatment methods was recorded. These data were collected twice a week by a research nurse. Nasal pressure injuries were classified using the National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel pressure injury classification system. RESULTS: During the study period, 429 newborns received NCPAP treatment via nasal prongs. Nasal pressure injuries were observed in 149 (34.7%); 99 (66.44%) were classified as Stage 1, 48 (32.31%) were Stage 2, and 2 (1.25%) cases were classified as deep tissue injury. The risk of nasal pressure injury was significantly higher when gestational age was less than 32 weeks (odds ratio [OR], 3.728; 95% confidence interval [CI], 1.18-11.77; P ≤ .025) and in those who received NCPAP treatment for more than 6 days (OR, 0.262; 95% CI, 0.087-0.787; P ≤ .017). The mean interval between the application of NCPAP and onset of nasal pressure injury was 4.72 days (SD, 4.78; range, 0-30 days). CONCLUSIONS: Nasal pressure injuries are a prevalent complication of NCPAP use, especially in preterm newborns. Our results identified a gestational age of less than 32 weeks and longer use of NCPAP are important factors associated with nasal pressure injuries. Methods to prevent the development of injuries such as the use of a prophylactic dressing along and replacement of binasal prongs with nasal masks are advocated.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Lesão por Pressão/etiologia , China , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Pressão Positiva Contínua nas Vias Aéreas/métodos , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino , Lesão por Pressão/epidemiologia , Estudos Prospectivos , Fatores de Risco
15.
Rev. Rol enferm ; 43(1,supl): 493-499, ene. 2020. tab
Artigo em Português | IBECS | ID: ibc-193425

RESUMO

Introduction: The term senescence translates the natural process of aging, which includes a sum of physiological, anatomical and functional changes. These changes can lead to morbidities and, when associated with chronic diseases, provide a situation of fragility and dependence, which may leave the elderly vulnerable to the appearance of wounds, which usually present a chronic evolution. Objective: to determine the prevalence and characteristics of pressure ulcers among institutionalized elderly people, the association between risk scores and clinical conditions of the elderly, and the measure of intensity of association of these variables with the development of the lesion. Method: This is a cross-sectional, population-based study with a quantitative approach, based on the analysis of part of the database. All the elderly included in the database (N = 324), enrolled in long-term institutions, were included in the study. Results: The prevalence of pressure ulcer was 8% in institutionalized elderly. It can be verified that of the five variables related to clinical conditions, they had a significant association (p≤0.05). The estimates of the coefficients of the binary logistic regression model showed that positive values, such as urinary incontinence, osteoarticular, neurological diseases and negative values for the change in vision, may increase and / or decrease the chance of developing the lesion. Conclusion: Pressure ulcers are preventable wounds that require constant observa-tion by the professionals responsible for the planning and implementation of care


No disponible


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/enfermagem , Saúde do Idoso Institucionalizado , Cuidados de Enfermagem/métodos , Planejamento de Assistência ao Paciente/organização & administração , Fragilidade/enfermagem , Lesão por Pressão/epidemiologia , Fatores de Risco , Fatores Epidemiológicos , Prevalência , População Institucionalizada , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Estudos Transversais , Pessoas Acamadas/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos
16.
J Am Acad Orthop Surg ; 28(8): 342-351, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31567615

RESUMO

INTRODUCTION: The current study sought to determine the factors predictive of postoperative pressure ulcer development by analyzing extensive multicenter outcomes data from the 2016 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS: The 2016 NSQIP Participant Use File and Hip Fracture Procedure Targeted file were used to identify the risk factors for the development of postoperative pressure ulcers after hip fracture surgery in a geriatric cohort. Multivariate regressions were performed to identify preoperative comorbidities and postoperative complications that are risk factors for developing postoperative pressure ulcers. RESULTS: Of 8,871 geriatric hip fracture patients included in the study cohort, 457 (5.15%) developed pressure ulcers. Multivariate regressions identified the following preoperative risk factors for developing a postoperative pressure ulcer (in order of decreasing relative risk): preoperative sepsis, elevated platelet count, insulin-dependent diabetes, and preexisting pressure ulcer. Multivariate regressions also identified the following postoperative complications as risk factors for developing a postoperative pressure ulcer: postoperative sepsis, postoperative pneumonia, urinary tract infection, and postoperative delirium. DISCUSSION: The identified preoperative factors and postoperative complications should help guide quality improvement programs.


Assuntos
Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias , Lesão por Pressão/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Pneumonia , Lesão por Pressão/epidemiologia , Fatores de Risco , Sepse/epidemiologia , Infecções Urinárias
17.
Acta Orthop ; 91(1): 20-25, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31615309

RESUMO

Background and purpose - Hip arthroplasty is one of the most performed surgeries in Sweden, and the rate of adverse events (AEs) is fairly high. All patients in publicly financed healthcare in Sweden are insured by the Mutual Insurance Company of Swedish County Councils (Löf). We assessed the proportion of patients that sustained a major preventable AE and filed an AE claim to Löf.Patients and methods - We performed retrospective record review using the Global Trigger Tool to identify AEs in a Swedish multi-center cohort consisting of 1,998 patients with a total or hemi hip arthroplasty. We compared the major preventable AEs with all patient-reported claims to Löf from the same cohort and calculated the proportion of filed claims.Results - We found 1,066 major preventable AEs in 744 patients. Löf received 62 claims for these AEs, resulting in a claim proportion of 8%. 58 of the 62 claims were accepted by Löf and received compensation. The claim proportion was 13% for the elective patients and 0.3% for the acute patients. The most common AE for filing a claim was periprosthetic joint infection; of the 150 infections found 37 were claimed.Interpretation - The proportion of filed claims for major preventable AEs is very low, even for obvious and serious AEs such as periprosthetic joint infection.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Compensação e Reparação , Luxação do Quadril/epidemiologia , Traumatismos dos Nervos Periféricos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Infecções Relacionadas à Prótese/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hemiartroplastia , Humanos , Desigualdade de Membros Inferiores/epidemiologia , Responsabilidade Legal , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/epidemiologia , Estudos Retrospectivos , Suécia/epidemiologia , Adulto Jovem
19.
Nurse Educ Today ; 84: 104225, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31698290

RESUMO

BACKGROUND: Nurses caring for elderly patients with a high risk of pressure ulcer at long-term care hospitals require the necessary knowledge, behaviors, and attitudes regarding preventing pressure ulcers. OBJECTIVES: To identify the effects of pressure ulcer prevention training on nurses' knowledge, behaviors, and attitudes regarding pressure ulcer prevention. DESIGN: A comparison group pretest-posttest design. SETTINGS: Long-term care hospitals in a metropolitan area of the Republic of Korea. PARTICIPANTS: Participants were conveniently assigned to team-based learning (n = 30) or lecture-based learning (n = 30) groups. METHODS: We examined pre-post differences in the scores for pressure ulcer prevention knowledge, behaviors, and attitudes in each group using the paired t-test. Additionally, pre-post difference scores were compared between the two groups using the independent samples t-test. RESULTS: Both groups exhibited significant increases in scores for pressure ulcer prevention knowledge, behaviors, and attitudes after the intervention as compared before it. However, we found no significant differences in the pre-post difference scores for any of the variables between the two groups. CONCLUSIONS: Pressure ulcer prevention training, regardless of whether it utilizes team-based or lecture-based learning, is useful for enhancing nurses' pressure ulcer prevention knowledge, behaviors, and attitudes. Further study is needed to verify the longitudinal effects of pressure ulcer prevention training on nurses' actual performance and the incidence of pressure ulcers among patients.


Assuntos
Educação Continuada em Enfermagem/normas , Conhecimentos, Atitudes e Prática em Saúde , Assistência de Longa Duração/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Lesão por Pressão/prevenção & controle , Adulto , Educação Continuada em Enfermagem/métodos , Educação Continuada em Enfermagem/estatística & dados numéricos , Feminino , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/epidemiologia , República da Coreia/epidemiologia , Inquéritos e Questionários
20.
Int Wound J ; 17(1): 124-131, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31713351

RESUMO

The primary objective was to study pressure ulcer (PU) category II-IV (including suspected deep tissue injury and unstageable PUs) cumulative incidence and PU incidence density, in a 30day observation period, associated with the use of the CuroCell S.A.M. PRO powered reactive air support surface in nursing home residents at risk for PU development. Secondary objectives were to study (a) PU category I cumulative incidence and PU incidence density and (b) user (caregivers and residents) experiences and perceptions of comfort associated with the use of the support surface under study. A multicentre cohort study was set up in 37 care units of 12 Belgian nursing homes. The sample consisted of 191 residents at risk of PU development (Braden score ≤ 17). The cumulative PU incidence was 4.7% (n = 9). The PU incidence density was 1.7/1000 observation days (9 PU/5370 days). The experience and perceptions of comfort analysis revealed that the CuroCell S.A.M. PRO powered reactive air support surface was comfortable for daily use. The mode of action and the quietness of the pump function had a positive impact on sleep quality. Patient comfort and sleep quality are essential criteria in the selection of a support surface.


Assuntos
Pressão do Ar , Leitos , Casas de Saúde/estatística & dados numéricos , Lesão por Pressão/epidemiologia , Lesão por Pressão/prevenção & controle , Medicina Preventiva/instrumentação , Medicina Preventiva/métodos , Idoso , Idoso de 80 Anos ou mais , Bélgica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino
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