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1.
Mil Med ; 186(Suppl 1): 651-658, 2021 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-33499541

RESUMO

BACKGROUND: Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran's Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. METHODS: The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans' EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort's free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. RESULTS: The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. CONCLUSION: The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.


Assuntos
Traumatismos da Medula Espinal , Comportamento de Utilização de Ferramentas , Veteranos , Registros Eletrônicos de Saúde , Humanos , Lesão por Pressão/epidemiologia , Lesão por Pressão/terapia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/terapia
2.
Int J Mol Sci ; 22(1)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33374656

RESUMO

Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.


Assuntos
Regulação da Expressão Gênica , Imunidade , MicroRNAs/genética , Lesão por Pressão/etiologia , Lesão por Pressão/terapia , Animais , Apoptose , Gerenciamento Clínico , Suscetibilidade a Doenças , Matriz Extracelular , Redes Reguladoras de Genes , Humanos , Imunidade/genética , Estresse Oxidativo , Lesão por Pressão/metabolismo , Lesão por Pressão/patologia , Interferência de RNA , Traumatismo por Reperfusão/complicações , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/metabolismo , Transdução de Sinais , Cicatrização/genética
3.
Stud Health Technol Inform ; 275: 1-5, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33227729

RESUMO

Though a preventable risk, the management of pressure ulcers (PUs) in nursing homes is not satisfactory due to inadequate prevention and complex care plans. PUs early detection and wound assessment require to know the patient condition and risk factors and to have a good knowledge of best practices. We built a guideline-based clinical decision support system (CDSS) for the prevention, the assessment, and the management of PUs. Clinical practice guidelines have been modeled as decision trees and formalized as IF-THEN rules to be triggered by electronic health record (EHR) data. From PU assessment yielded by the CDSS, we propose a synthetic visualization of PU current and previous stages as a gauge that illustrates the different stages of PU continuous evolution. This allows to display PU current and previous stages to inform health care professionals of PU updated assessment and support their evaluation of previously delivered care efficiency. The CDSS will be integrated in NETSoins nursing homes EHR where gauges for several health problems constitute a patient dashboard.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Lesão por Pressão , Registros Eletrônicos de Saúde , Pessoal de Saúde , Humanos , Casas de Saúde , Lesão por Pressão/diagnóstico , Lesão por Pressão/terapia
4.
Medicine (Baltimore) ; 99(45): e23079, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157974

RESUMO

OBJECTIVE: The objective of this current research is to investigate the effectiveness of the nursing intervention of combination gelatin sponge and moist wound healing in treating the pressure ulcers (PUs). METHODS: This is a randomized controlled trial to be carried out from January 2021 to May 2021. This trial is implemented in accordance with the SPIRIT Checklist for the randomized researches and was granted through the Ethics Committee of 5th Medical Center of Chinese PLA General Hospital (No. 0624876). This study includes 80 PU participants. The patients meet the following criteria will be included. All participants meet the diagnostic criteria recommended via the National Pressure Ulcer Advisory Panel Society: complete skin defect, no bones, tendons and muscles exposure, no subcutaneous tunnel or scale; the patients selected are between 40 and 60 years old. The patients with the following criteria will be excluded: receiving other treatments that may influence the healing, for instance, radiation therapy and corticosteroids; patients with the complications of infection, malignant tumors, as well as peripheral vascular disease; and patients with serious diseases, containing kidney, cardiac, and liver diseases. The patients are randomly divided into 2 groups, the control group and study group, with 40 members in each group. In control group, the patients are given the routine nursing care. And in study group, the patients are given the nursing of gelatin sponge combined with moist wound-healing. After 28 days, the state of the patients healing is observed closely, containing the dressing change frequency, curative effects, and the end-point efficiency. On the basis of the Pressure Ulcer Healing Scale developed by the American pressure sore expert group, the quantitative scoring can be implemented, and therapeutic effects are assessed. RESULTS: The variables of clinical result among the groups are illustrated in the Table. CONCLUSION: The nursing intervention of gelatin sponge combined with the moist wound- healing may evidently increase the healing efficiency of PU. TRIAL REGISTRATION NUMBER: researchregistry 6091.


Assuntos
Esponja de Gelatina Absorvível/uso terapêutico , Hemostáticos/uso terapêutico , Lesão por Pressão/enfermagem , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Cicatrização , Adulto , Terapia Combinada , Humanos , Umidade , Pessoa de Meia-Idade , Lesão por Pressão/terapia , Resultado do Tratamento
5.
Gerokomos (Madr., Ed. impr.) ; 31(extr.1): 2-11, nov. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197648

RESUMO

OBJETIVOS: Evaluar el impacto en la frecuencia de cambio de apósito y en el coste del tratamiento de las heridas que tiene la utilización de un apósito de espuma hidrocelular con indicador de cambio y capa enmascaradora de exudado, y valorar la satisfacción del paciente y la opinión del profesional de enfermería con el apósito de estudio frente a los tratamientos previos. METODOLOGÍA: Estudio observacional, ambispectivo, multicéntrico, realizado en atención primaria y sociosanitaria, en cuatro regiones de España. Participaron pacientes con heridas exudativas, en las que se fuera a sustituir apósitos previos por el apósito del estudio (ALLEVYN Life) según práctica clínica habitual. En cada región, se recogieron y analizaron características de las heridas (antigüedad, localización, tratamientos anteriores, área de la herida), frecuencia de cambio de apósito, coste semanal por paciente (apósitos utilizados y tiempo de enfermería dedicado a curas), satisfacción del paciente y opinión del profesional de enfermería. RESULTADOS: Se incluyó un total de 128 heridas (Galicia: 29; País Vasco: 30; Extremadura: 25, y Comunidad Valenciana: 44). Tras 4 semanas de uso del apósito del estudio se redujo significativamente la frecuencia de cambio (29-58%) y el coste semanal por paciente (apósitos utilizados: 11-61%; apósitos + tiempo de enfermería: 27-59%). En la mayoría de regiones, la reducción del área fue superior al 30%. La experiencia global de los pacientes mejoró con el apósito de estudio frente al tratamiento previo, y fue buena o muy buena en el 60-78% de los casos. En todas las regiones, el profesional de enfermería consideró los apósitos ALLEVYN Life superiores en rendimiento global, indicación de idoneidad de cambio y enmascaramiento del exudado. CONCLUSIONES: El uso del apósito con indicador de cambio y capa enmascaradora disminuyó la frecuencia de cambio de apósito, lo que permitió prolongar los intervalos entre visitas y reducir costes asociados. Al mismo tiempo, mejoró la opinión del profesional de enfermería, y aumentó la satisfacción del paciente


OBJECTIVES: To assess the impact on the dressing change frequency and cost of wound management of using a hydrocellular foam dressing with change indicator and exudate masking layer, and to evaluate the patient's satisfaction and nurse's opinion of the study dressing versus previous treatments. METHODS: Observational, ambispective, multicenter study conducted in primary care and social health care, in four regions of Spain. Patients with acute or chronic exuding wounds, in which previous dressings were to be replaced by the study dressing (ALLEVYN Life) according to usual clinical practice, participated. In each region, wound characteristics (evolution period, location, previous dressings, wound area), dressing change frequency, weekly cost per patient (dressings used and nursing time spent), patient satisfaction and nursing staff opinion were collected and analysed. RESULTS: A total of 128 wounds were included (Galicia: 29; Basque Country: 30; Extremadura: 25; and Valencia: 44). After four weeks of use of the study dressing the frequency of change (29-58%) and the weekly cost per patient were significantly reduced (dressings used: 11-61%; dressings + nursing time: 27-59%). In most regions, the area reduction was more than 30%. The overall patient satisfaction with the study dressing was improved, being good or very good in 60-78% of cases. In all regions, nurses considered ALLEVYN Life dressings superior in overall performance, indication of change adequacy and exudate masking. CONCLUSIONS: The use of the dressing with change indicator and masking layer decreased the frequency of dressing changes, allowing for longer intervals between visits and reducing associated costs. At the same time, they improve the opinion of the nursing staff, and increased patient satisfaction


Assuntos
Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cicatrização/fisiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/terapia , Bandagens/economia , Satisfação do Paciente , Atenção Primária à Saúde , Lesão por Pressão/terapia , Qualidade da Assistência à Saúde/organização & administração , Cuidados de Enfermagem , Inquéritos e Questionários
6.
Medicine (Baltimore) ; 99(41): e22699, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031342

RESUMO

BACKGROUND: Pressure ulcer (PU) is defined as a lesion or trauma to the skin and underlying tissue resulting from unrelieved pressure, shear, friction, moisture, or a combination of all these, usually appearing over a bony prominence. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness, safety, and economy of the dressing treatments for PU through an overview. METHODS: We searched the following electronic bibliographic databases: PubMed, Embase, Cochrane Library, CINAHL Complete, PsycARTICLES, PsycINFO, DynaMed Plus, as well as the Chinese databases without any language restriction. We will include meta-analyses that dressings treatments in the management of PUs. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane's Q and I statistics) and small-study effect (Egger's test); we will also estimate the evidence of excess significance bias. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. RESULTS: This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION: Ethical approval is not applicable, since this is an overview based on published articles. PROTOCOL REGISTRATION NUMBER: The protocol has been registered on PROSPERO under the number CRD42020161232.


Assuntos
Bandagens , Lesão por Pressão/terapia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
7.
J Wound Ostomy Continence Nurs ; 47(5): 450-455, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970030

RESUMO

BACKGROUND: Managing patients during the coronavirus disease-2019 (COVID-19) pandemic, and the associated severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) in particular, required the nimble responsiveness for which WOC nurses are known. Problem-solving skills were needed to continue the level of WOC nursing services expected by patients, families, and professional colleagues, while reducing the hours we were physically present at our clinical facility. In order to respond to these demands, our team realized it must create an innovative approach to provide efficient, cost-effective consultations during this global crisis. This Challenges in Practice article summarizes our experience with use of telemedicine technologies to perform remote consultations within the acute care setting. CASES: Case 1 was a 52-year-old woman with a history of paraplegia. She had several pressure injuries but had not received topical care for these wounds prior to admission. A consultation for the WOC nurse was requested and performed via telehealth services on a day our team was working off-site. This case illustrates the process our team used to perform a virtual consultation and demonstrates how the use of images placed in the electronic medical record aided in developing an effective plan of care. Case 2 was a 48-year-old man who tested positive for COVID-19. He developed bilateral unstageable pressure injuries on his cheeks after being placed in the prone position for a prolonged period while critically ill. This case describes multiple technologic platforms used for telemedicine consults in a patient with COVID-19 requiring isolation. CONCLUSIONS: Remote consultation by WOC nurses was possible in our healthcare system because of previous experience using telemedicine technology and well-established collaborative relationships with providers and bedside nurses. By expanding our use of telemedicine technology, we were able to provide ongoing care to a patient without COVID-19 who had WOC consultation needs, and a patient with strict isolation demands due to COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Lesão por Pressão/terapia , Consulta Remota/organização & administração , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Lesão por Pressão/etiologia , Lesão por Pressão/patologia
10.
Zhonghua Shao Shang Za Zhi ; 36(7): 540-546, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842400

RESUMO

Objective: To investigate the effect of modified double negative-pressure wound therapy combined with debridement and tension-reduced suture in treatment of stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area. Methods: From January 2015 to June 2019, 20 patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area were admitted to Department of Burns and Plastic Surgery and Cosmetology of Linyi People's Hospital. Among them, there were 11 males and 9 females, aged 48 to 88 years. The wounds of 13 patients were located in the sacrococcygeal region, and 8 of them had exposed sacrococcyx. The wounds of 4 patients were located in the greater trochanter area of femur, and the wounds of 3 patients were located in the ischial tuberosity area. All the patients had fever in different degree, bacterial infection, hypoproteinemia, and electrolyte imbalance, etc. at admission. After thorough debridement and dressing change, routine negative-pressure wound therapy with negative pressure value of -16.6 kPa was performed according to the scope of lesions in period Ⅰ. When granulation tissue was fresh with less exudate and without residual necrotic tissue, modified double negative-pressure wound therapy in combination with debridement and tension-reduced suture was performed immediately in period Ⅱ. Modified double negative-pressure wound therapy were persistently performed through negative pressure drainage tube inserted into deep part of wounds and negative pressure drainage tube on surface at the same time, with superficial negative pressure value of -19.9 kPa. Meanwhile, systemic anti-infection and nutritional supports were given. The wounds were monitored for the grade of wound healing and whether skin necrosis, split, or fluid accumulation develop at the suture site. The patients were followed up for 1 to 6 months after discharge to monitor wound healing. Length of hospital stay, infection condition before and after the debridement and tension-reduced suture, and complications during treatment were recorded. Results: All wounds achieved first grade healing, with the skin at the suture site healed without split, fluid accumulation, or necrosis. The patients were followed up for 1 to 6 months after discharge, with good shape of surgical incision, little pigmentation on the skin, no hypertrophic scar or contracture, and no recurrence of pressure sores. Length of hospital stay of patients was 24 to 33 d, with an average of 28.5 d. Before debridement and tension-reduced suture, 2 cases were infected with Pseudomonas aeruginosa, 1 case was infected with Escherichia coli and Staphylococcus aureus, and 1 case was infected with Proteus mirabilis. The results of bacterial culture were all negative after debridement and tension-reduced suture. During the treatment, all patients were not complicated with bone or joint infection, necrotizing fasciitis, septicemia, etc. Conclusions: Modified double negative-pressure wound therapy combined with debridement and tension-reduced suture for treatment of patients with stage 4 pressure sores and infection in sacrococcygeal region and its surrounding area is easy to operate with minimal injury, easy for patients to accept with a very high level of satisfaction, and is suitable to popularize and applicate for primary hospitals.


Assuntos
Infecções , Tratamento de Ferimentos com Pressão Negativa , Lesão por Pressão , Idoso , Idoso de 80 Anos ou mais , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/terapia , Região Sacrococcígea , Transplante de Pele , Suturas , Resultado do Tratamento
12.
Adv Skin Wound Care ; 33(8): 410-417, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32701252

RESUMO

Telemedicine use in the field of wound care had been increasing in popularity when the novel coronavirus 2019 paralyzed the globe in early 2020. To combat the constraints of healthcare delivery during this time, the use of telemedicine has been further expanded. Although many limitations of telemedicine are still being untangled, the benefits of virtual care are being realized in both inpatient and outpatient settings. In this article, the advantages and disadvantages of telemedicine are discussed through two case examples that highlight the promise of implementation during and beyond the pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Lesão por Pressão/terapia , Deiscência da Ferida Operatória/cirurgia , Telemedicina/organização & administração , Cicatrização/fisiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Lesão por Pressão/diagnóstico , Melhoria de Qualidade , Medição de Risco , Deiscência da Ferida Operatória/diagnóstico , Resultado do Tratamento
13.
Zhonghua Shao Shang Za Zhi ; 36(6): 476-479, 2020 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-32594706

RESUMO

Objective: To explore the clinical effect of X-N advancement flap in repairing pressure ulcer on the buttock or back. Methods: From June 2018 to June 2019, 20 patients with grade Ⅳ pressure ulcers on the buttock or back were hospitalized and treated in the Department of Traumatology, Burns and Plastic Surgery of Fourth Affiliated Hospital of Guangxi Medical University, including 15 males and 5 females, aged 48-89 years. The area of the patient's wound was 8 cm×5 cm-15 cm×12 cm after debridement, and all were repaired with the X-N advancement flap designed by the author. The flap was designed according to the direction of skin relaxation on both sides of the wound, and the skin was incised in X-shape and sutured in N-shape. The width and advancement distance of the flap were recorded, and the ratio of the advancement distance to the width of the flap was calculated. The flap survival, complication, and follow-up were observed and recorded. Results: The width of the flap was (5.9±1.2) cm, the advancement distance of the flap was (10.3±2.5) cm, and the ratio of the advancement distance to the width of the flap was 1.8±0.4. All the flaps survived, and none of the flaps had blood flow disorder. Local dehiscence occurred in the flap of one patient 1 week after surgery, which was healed after laying on the floating bed, strengthened care, and wound dressing change. The flap of one patient developed infection 5 days after surgery, which was healed after partial suture removal, smooth drainage, and replacement with sensitive antibiotics. The wounds of the remaining 18 patients were all cured. After 3 months of follow-up, the flaps survived well with good elasticity and texture. Conclusions: The X-N advancement flap can make the skin and soft tissue move forward effectively. It is simple and effective to repair pressure ulcers on the back or buttock of patients with this flap, which is worthy of clinical promotion and application.


Assuntos
Retalho Perfurante , Lesão por Pressão , Lesões dos Tecidos Moles , Idoso , Idoso de 80 Anos ou mais , Nádegas , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/terapia , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Resultado do Tratamento
14.
J Wound Care ; 29(6): 312-320, 2020 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-32530776

RESUMO

OBJECTIVE: Pressure ulcers (PUs) involve the destruction of skin and underlying tissue due to prolonged pressure and shear forces. These ulcers are painful and significantly reduce a person's quality of life. PUs are also expensive to manage and impact negatively on the achievement of cost-effective, efficient care delivery. METHOD: Prone positioning is a postural therapy that aims to enhance respiratory function through increasing oxygenation levels. In contemporary clinical practice, ventilation in the prone position is indicated for patients with severe acute respiratory distress syndrome. However, despite its advantages in terms of respiratory function, several studies have examined complications of prone position ventilation and have identified PUs (facial PUs as well as PUs on other weight-bearing areas of the body) as a frequent complication in patients who are already in a precarious medical situation. International data suggest that up to 57% of patients nursed in the prone position develop a PU. The aim of this clinical review is to identify and review evidence-based recommendations developed to facilitate the selection and application of preventive interventions aimed at reducing PU development in patients ventilated in the prone position. Given the current COVID-19 crisis, this review is timely as intensive care unit (ICU) patients with COVID-19 require ventilation in the prone position at a level that is disproportionate to the general intensive care population. Up to 28% of patients admitted to the ICU with confirmed infection due to severe COVID-19 are cared for in the prone position. The scope of this review is limited to adult individuals only. RESULTS: The skin assessment should be undertaken before proning and following positioning the patient back into the supine position. Although it is essential to keep the skin clean and moisturised, using pH-balanced cleansers, there is inconsistency in terms of the evidence to support the type of moisturiser. Use of positioning devices in addition to repositioning is recommended to offload pressure points on the face and body. Further, using dressings such as hydrocolloids, transparent film and silicone may be of benefit in decreasing facial skin breakdown. CONCLUSION: Given the importance of PU prevention in this cohort of patients, adopting a focused prevention strategy, including skin assessment and care, offloading and pressure redistribution, and dressings for prevention may contribute to a reduction in the incidence and prevalence of these largely preventable wounds.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Lesão por Pressão/prevenção & controle , Decúbito Ventral , Cicatrização/fisiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Emergências , Medicina Baseada em Evidências , Feminino , Custos Hospitalares , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Posicionamento do Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Lesão por Pressão/economia , Lesão por Pressão/terapia
15.
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
17.
Medicine (Baltimore) ; 99(19): e19849, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384429

RESUMO

RATIONALE: Pressure sores are major clinical problems with limited treatment options. PATIENT CONCERN: A 62-year-old man, admitted with unresponsive, indifferent mood, and malnutrition. A noval-shaped skin lesion deeping into the fascia was found in the sacrococcygeal region. DIAGNOSIS: The patient was diagnosed with delayed carbon monoxide poisoning encephalopathy and stage IV sacrococcygeal pressure sores. INTERVENTION: The patient received neurologic rehabilitation therapy and simple debridement dressing care followed by extracorporeal shockwave therapy. OUTCOMES: The scores for the pressure ulcer healing scale were 17 points, 13 points, 9 points, and 5 points, respectively, before treatment and at the 4-, 8-, and 12-week follow-ups. At 2 weeks after discharging the total pressure ulcer healing scale score was 0, which signifies that the sacroiliac decubital necrosis healed without adverse reactions and side effects. LESSONS: This study presents a therapeutic solution for treating older adults with pressure ulcers by using extracorporeal shockwave with alginate dressing, which proved effective and safe.


Assuntos
Bandagens , Tratamento por Ondas de Choque Extracorpóreas/métodos , Lesão por Pressão/terapia , Articulação Sacroilíaca/patologia , Alginatos , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Lesão por Pressão/patologia
18.
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
19.
Am Fam Physician ; 101(3): 159-166, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003952

RESUMO

Chronic wounds are those that do not progress through a normal, orderly, and timely sequence of repair. They are common and are often incorrectly treated. The morbidity and associated costs of chronic wounds highlight the need to implement wound prevention and treatment guidelines. Common lower extremity wounds include arterial, diabetic, pressure, and venous ulcers. Physical examination alone can often guide the diagnosis. All patients with a nonhealing lower extremity ulcer should have a vascular assessment, including documentation of wound location, size, depth, drainage, and tissue type; palpation of pedal pulses; and measurement of the ankle-brachial index. Atypical nonhealing wounds should be biopsied. The mainstay of treatment is the TIME principle: tissue debridement, infection control, moisture balance, and edges of the wound. After these general measures have been addressed, treatment is specific to the ulcer type. Patients with arterial ulcers should be immediately referred to a vascular surgeon for appropriate intervention. Treatment of venous ulcers involves compression and elevation of the lower extremities, plus exercise if tolerated. Diabetic foot ulcers are managed by offloading the foot and, if necessary, treating the underlying peripheral arterial disease. Pressure ulcers are managed by offloading the affected area.


Assuntos
Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Doença Crônica/terapia , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Humanos , Lesão por Pressão/fisiopatologia , Lesão por Pressão/terapia , Úlcera Varicosa/fisiopatologia , Úlcera Varicosa/terapia , Ferimentos e Lesões/prevenção & controle
20.
Adv Skin Wound Care ; 33(3): 123-136, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32058438

RESUMO

GENERAL PURPOSE: To review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline with further discussion of nutrition for pressure injury management in the context of the recommendations. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Distinguish nutrition and malnutrition, especially as they relate to the development and healing of pressure injuries.2. Differentiate the tools and techniques that help clinicians assess nutrition status as well as the causes of pressure injuries in specific populations.3. Identify interventions for improving nutrition status and promoting pressure injury healing. ABSTRACT: Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues. Specifically, nutrition plays an important role in the prevention and treatment of pressure injuries. The purpose of this manuscript is to review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Nutrition for pressure injury management is discussed in the context of the recommendations.


Assuntos
Estado Nutricional , Guias de Prática Clínica como Assunto , Lesão por Pressão/prevenção & controle , Cicatrização/fisiologia , Educação Médica Continuada , Feminino , Humanos , Internacionalidade , Masculino , Equipe de Assistência ao Paciente/organização & administração , Lesão por Pressão/terapia , Prevenção Primária/métodos , Papel (figurativo)
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