A novel in-bed body posture monitoring for decubitus ulcer prevention using body pressure distribution mapping.

BACKGROUND: Decubitus ulcers are prevalent among the aging population due to a gradual decline in their overall health, such as nutrition, mental health, and mobility, resulting in injury to the skin and tissue. The most common technique to prevent these ulcers is through frequent repositioning to redistribute body pressures. Therefore, the main goal of this study is to facilitate the timely repositioning of patients through the use of a pressure mat to identify in-bed postures in various sleep environments. Pressure data were collected from 10 healthy participants lying down on a pressure mat in 19 various in-bed postures, correlating to the supine, prone, right-side, and left-side classes. In addition, pressure data were collected from participants sitting at the edge of the bed as well as an empty bed. Each participant was asked to lie in these 19 postures in three distinct testing environments: a hospital bed, a home bed, and a home bed with a foam mattress topper. To categorize each posture into its respective class, the pre-trained 2D ResNet-18 CNN and the pre-trained Inflated 3D CNN algorithms were trained and validated using image and video pressure mapped data, respectively. RESULTS: The ResNet-18 and Inflated 3D CNN algorithms were validated using leave-one-subject-out (LOSO) and leave-one-environment-out (LOEO) cross-validation techniques. LOSO provided an average accuracy of 92.07% ± 5.72% and 82.22% ± 8.50%, for the ResNet-18 and Inflated 3D CNN algorithms, respectively. Contrastingly, LOEO provided a reduced average accuracy of 85.37% ± 14.38% and 77.79% ± 9.76%, for the ResNet-18 and Inflated 3D CNN algorithms, respectively. CONCLUSION: These pilot results indicate that the proposed algorithms can accurately distinguish between in-bed postures, on unseen participant data as well as unseen mattress environment data. The proposed algorithms can establish the basis of a decubitus ulcer prevention platform that can be applied to various sleeping environments. To the best of our knowledge, the impact of mattress stiffness has not been considered in previous studies regarding in-bed posture monitoring.

Determinants of pressure injury development in patients with COVID-19.

OBJECTIVE: Pressure injuries (PIs) often develop in critically ill patients due to immobility, and underlying comorbidities that decrease tissue perfusion and wound healing capacity. This study sought to provide epidemiological data on determinants and current managements practices of PI in patients with COVID-19. METHOD: A US national insurance-based database consisting of patients with coronavirus or COVID-19 diagnoses was used for data collection. Patients were filtered by International Classification of Diseases (ICD) codes corresponding to coronavirus or COVID-19 diagnosis between 2019-2020. Diagnosis of PI following COVID-19 diagnosis was queried. Demographic data and comorbidity information was compared. Logistic regression analysis was used to determine predictors for both PI development and likelihood of operative debridement. RESULTS: A total of 1,477,851 patients with COVID-19 were identified. Of these, 15,613 (1.06%) subsequently developed a PI, and 8074 (51.7%) of these patients had an intensive care unit (ICU) admission. The average and median time between diagnosis of COVID-19 and PI was 39.4 and 26 days, respectively. PI was more likely to occur in patients with COVID-19 with: diabetes (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.49; p<0.001); coronary artery disease (OR: 1.11, 95% CI: 1.04-1.18, p=0.002), hypertension (OR: 1.43, 95% CI: 1.26-1.64; p<0.001); chronic kidney disease (OR: 1.18, 95% CI: 1.10-1.26; p<0.001); depression (OR: 1.45, 95% CI 1.36-1.54; p<0.001); and long-term non-steroidal anti-inflammatory drug use (OR: 1.21, 95% CI: 1.05-1.40; p=0.007). They were also more likely in critically ill patients admitted to the ICU (OR: 1.40, 95% CI: 1.31-1.48; p<0.001); and patients requiring vasopressors (OR:1.25, 95% CI: 1.13-1.38; p<0.001), intubation (OR: 1.21, 95% CI 1.07-1.39; p=0.004), or with a diagnosis of sepsis (OR: 2.38, 95% CI 2.22-2.55; p<0.001). ICU admission, sepsis, buttock and lower back PI along with increasing Charlson Comorbidity Index (CCI) (OR: 1.04, 95% CI 1.00-1.08; p=0.043) was associated with surgical debridement. The vast majority of patients with COVID-19 did not undergo operative debridement or wound coverage. CONCLUSION: PIs are widely prevalent in patients with COVID-19, especially in those who are critically ill, yet the vast majority do not undergo operative procedures. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.

Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database.

In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.

Patient and carer experience of living with a pressure injury: A meta-synthesis of qualitative studies.

INTRODUCTION: Pressure injuries are a significant cause of harm, contributing to increased mortality and financial burden on the healthcare system. Significant research on pressure injury risk assessment, prevention and treatment exists, but limited research exploring the patient and carer experience of living with pressure injury. AIMS: The aim of this meta-synthesis was to describe the patient and carer experience of living with a pressure injury. DESIGN: Meta-synthesis. METHODS: A prospective review protocol was registered, and systematic search conducted across five electronic databases. The PRISMA 2020 checklist for reporting systematic reviews was used. Two reviewers independently undertook screening and review of articles, using the CASP checklist for evaluating qualitative research. A meta-synthesis using thematic content analysis was undertaken. RESULTS: Twelve studies met the inclusion criteria. Meta-synthesis led to the construction of three primary themes: loss of autonomy and independence, psychological effects, and adjustment. Within these primary themes, sub-themes of dependence, social isolation and social avoidance behaviours, feelings and emotions, loss, managing, physical consequences, service provision, and functional challenges, were identified. CONCLUSION: The psychology and mindset of those involved, and support to navigate the challenges that arise are two unique and clinically relevant categorisations to guide provision of pressure injury care. Adaptation to a pressure injury is multi-faceted and contextual, challenges to adaptation create additional psychological burden. Interventions encompassing all facets of the experience are necessary. Current research into experiences is limited, and further research to support interventions is necessary.

Iodine-containing ointment-induced hypothyroidism in a patient with anorexia nervosa and sacral decubitus ulcer: a case report with literature review.

We present a case of a 58-year-old woman with anorexia nervosa and a sacral decubitus ulcer who developed hypothyroidism because of an iodine-containing ointment. Considering the absence of autoimmune thyroid diseases, the development of hypothyroidism after the use of an iodine-containing ointment, and the recovery of thyroid function after the discontinuation of the ointment, we presumed that her hypothyroidism was induced by the iodine-containing ointment. Although the hypothyroidism improved after discontinuing the iodine-containing ointment, she developed aspiration pneumonia and required long-term hospitalization. Many patients with autoimmune thyroid diseases develop hypothyroidism after excessive iodine intake. However, anorexia nervosa may have exacerbated the iodine-induced hypothyroidism in our patient. To the best of our knowledge, no previous study has reported a case of hypothyroidism caused by iodine-containing ointment in a patient with anorexia nervosa. Hence, physicians must pay careful attention to a patient's background factors to ensure the early diagnosis of hypothyroidism due to iodine-containing ointments.

Effects of vasopressor agents on the development of pressure ulcers in critically ill patients: a systematic review.

OBJECTIVE: The primary objective of this systematic review was to determine the effect of vasopressor agents on the development of pressure ulcers (PUs) among critically ill patients in intensive care units (ICUs). The secondary outcome of interest was length of stay in the ICU. METHOD: A systematic review was undertaken using the databases searched: Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to formulate the review. Data were extracted using a predesigned data extraction table and analysed as appropriate using RevMan. Quality appraisal was undertaken using the EBL Critical Appraisal Tool. RESULTS: The inclusion criteria were met by 13 studies. Two studies provided sufficient data to compare the number of patients who developed a PU with and without the use of vasopressors. Consistently, within these two studies, being treated with a vasopressor increased the likelihood of PU development. RevMan analysis identified that shorter duration of administration of vasopressors was associated with less PU development (mean difference (MD) 65.97 hours, 95% confidence interval (CI): 43.47-88.47; p=0.0001). Further, a lower dose of vasopressors was also associated with less PU development (MD: 8.76µg/min, 95% CI: 6.06-11.46; p<0.00001). Mean length of stay increased by 11.46 days for those with a PU compared to those without a PU (MD: 11.46 days; 95% CI: 7.10-15.82; p<0.00001). The overall validities of the studies varied between 45-90%, meaning that there is potential for bias within all the included studies. CONCLUSION: Vasopressor agents can contribute to the development of PUs in critically ill patients in ICUs. Prolonged ICU stay was also associated with pressure ulcers in this specific patient group. Given the risk of bias within the included studies, further studies are needed to validate the findings of this review paper.

Relationship between predisposing and facilitating factors: Does it influence the risk of developing peri-operative pressure injuries?

This study examined the relationship between the personal predisposing factors of patients and the severity of pressure injuries (PIs) developed during surgery. This retrospective cohort study collected 439 cases of peri-operative PIs. Using binary logistic regression to identify the variables associated with PI severity, the effects of interactions between associated variables were then tested. The results of this study revealed that among the personal predisposing factors, only higher patient age (P = .001) and higher body mass index (P < .001) posed a greater risk of stage 2 PIs or higher. Among the surgery-related facilitating factors, only patients who were placed in the prone position during surgery and patients who lost ≥1000 mL of blood during surgery were at greater risk of stage 2 PIs or higher, compared, respectively, to those placed in the supine position and those who lost ≤100 mL of blood. Furthermore, the amount of blood lost during surgery moderated the influence of age on PI severity. For elderly patients who are expected to lose a large blood volume during surgery or lose an immeasurable amount of blood due to the use of cardiopulmonary bypass, taking more precautionary measures to prevent PIs is recommended.

Vagococcus fluvialis as a causative pathogen of bloodstream and decubitus ulcer infection: Case report and systematic review of the literature.

BACKGROUND: Vagococcal infections are uncommon in humans; there are limited studies on the clinical manifestations, the optimal methods for identifications, and antimicrobial susceptibility testing for vagococcal infections. Here, we have reported a case of Vagococcus fluvialis-induced bacteremia and decubitus ulcer and have systematically reviewed other reported Vagococcus infections. CASE PRESENTATION: A 74-year-old man presented to our emergency department with muscle weakness on his left extremities, dysarthria, and altered mental status along with fever for the past 4 days. Physical examination revealed a decubitus ulcer with foul smelling and yellowish exudative pus on his left chest wall and abdomen, forearm, thigh, and lower leg. He was empirically treated with 2.25 mg of piperacillin/tazobactam every 8 hours and 0.5 g of vancomycin every 24 hours intravenously (IV) for his decubitus ulcer. Vagococcus fluvialis was detected in both aerobic and anaerobic blood cultures (upon admission) using the VITEC 2 GP ID card (bioMérieux) and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). We continued the mentioned IV antimicrobial therapies for 4 weeks following which the patient was transferred to a long-term care facility for further rehabilitation. CONCLUSIONS: To our best knowledge, this is the first literature review of Vagococcus infections in humans. Since it is challenging to distinguish Vagococcus from Enterococcus by a conventional method due to the similarity of its biochemical properties to those of Enterococcus, based on our literature review, 16S rRNA sequencing or analysis of bacterial protein profile using MALDI-TOF MS may be useful for the precise identification.

Prevalence of pressure ulcers among hospitalized adult patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Globally, PUs are recognized as one of the five most frequent causes of harm to clients. With millions affected globally, the national pooled prevalence of pressure ulcers in Ethiopia remains unknown. Hence, this review and meta-analysis aimed to determine the prevalence of pressure ulcers among hospitalized clients in Ethiopia. METHODS: Studies were retrieved through search engines in PubMed, Scopus, WHO Afro Library, Google Scholar, Africa Journals Online, and Web of Science. Heterogeneity between-studies were checked using the I2 test. A funnel plot and Egger's regression test was used to assess the presence of publication bias. The random-effect model was fitted to estimate summary effects and 95% confidence intervals (CIs) across studies. The analyses were performed using STATA™ Version 14 software. RESULTS: The pooled prevalence of pressure ulcer in Ethiopia was assessed using seven studies involving a total of 1881 participants. The pooled prevalence of pressure ulcers in Ethiopia was 11.7% (95% CI: 7.28, 16.13). The subgroup analysis showed that the estimated magnitude of pressure ulcers was 15.89% (95% CI: 13.32, 18.46); among studies, their sample size was greater than or equal to 250. CONCLUSION: The current review reported that the pooled prevalence of pressure ulcers in Ethiopia was relatively high. Hence, policymaker and healthcare providers should give attention to reduce the magnitude of pressure ulcers. Furthermore, further a meta-analysis study could be conducted to identify individual and health care service-related factors related to the occurrence of pressure ulcers.

Cysteine/cystine-rich undenatured whey protein supplement in patients' pressure ulcers outcomes: an open label study.

OBJECTIVE: The prevalence and costs associated with treating pressure ulcers (PU) are at high levels. Frequently, PUs heal slowly or not at all, which may be due to the patient's catabolic state which may include protein energy malnutrition. The objective of this open label clinical trial was to improve healing rates by providing patients with a patented, high-quality protein containing all essential amino acids to ensure positive nitrogen balance. An additional benefit of this protein is the delivery of bioavailable cysteine (cystine) to promote glutathione (GSH) synthesis which supports immune function and heightens antioxidant defences. METHODS: Patients with category II, III and IV PUs were fed 20g BID whey protein dietary supplement for 16-120 days, without change in ongoing 'best practice' PU management and their progress recorded. RESULTS: A total of 10 patients were recruited, with an average age of 77 years. Most had shown no improvement in healing for ≥2 months before treatment and usually had other complications including chronic obstructive pulmonary disease (COPD), diabetes and various cardiovascular diseases. There were a total of 23 PUs, with some patients having more than one. Of these, 44% (n=10) showed complete resolution 83% (n=19) had better than 75% resolution over the observation period. Healing rates ranged from 16.9-0.2cm2/month (healed PUs) and 60.0-1.6cm2/month for resolving PUs. CONCLUSION: By providing the necessary amino acids to rebuild tissues and bioactive cysteine (cystine) to promote synthesis of intracellular GSH and positive nitrogen balance, improvement in PUs healing was achieved.

An extracellular matrix graft (Oasis® wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial.

AIM: The purpose of the study was to evaluate clinical safety and effectiveness of Oasis® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care. METHODS: A total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures. RESULTS: The proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037). CONCLUSIONS: The results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone.

Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019.

AIM: The European Pressure Ulcer Advisory Panel, the Pan Pacific Pressure Injury Alliance, and the National Pressure Ulcer Advisory Panel are updating the 'Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline' (CPG) in 2019. The aim of this contribution is to summarize and to discuss the guideline development protocol for the 2019 update. METHODS: A guideline governance group determines and monitors all steps of the CPG development. An international survey of consumers will be undertaken to establish consumer needs and interests. Systematic evidence searches in relevant electronic databases cover the period from July 2013 through August 2018. Risk of bias of included studies will be assessed by two reviewers using established checklists and an overall strength of evidence assigned to the cumulative body of evidence. Small working groups review the evidence available for each topic, review and/or draft the guideline chapters and recommendations and/or good practice statements. Finally, strength of recommendation grades are assigned. The recommendations are rated based on their importance and their potential to improve individual patient outcomes using an international formal consensus process. DISCUSSION: Major methodological advantages of the current revision are a clear distinction between evidence-based recommendations and good practice statements and strong consumer involvement. CONCLUSION: The 2019 guideline update builds on the previous 2014 version to ensure consistency and comparability. Methodology changes will improve the guideline quality to increase clarity and to enhance implementation and compliance. The full guideline development protocol can be accessed from the guideline website (http://www.internationalguideline.com/).

Persons With Chronic Spinal Cord Injuries in the Emergency Department: a Review of a Unique Population.

BACKGROUND: Persons with spinal cord injuries (SCIs) are frequent utilizers of emergency medical services but are a poorly understood and medically complex population. As the treatment of acute spinal cord injuries improves, there is a growing population of patients suffering from the chronic neurological deficits and altered homeostasis resulting from those injuries. OBJECTIVES: We sought to highlight the unique diagnostic challenges of treating persons with SCIs and to review ailments uncommon in the general population but often encountered in this population. DISCUSSION: Spinal cord anatomy is briefly reviewed and commonly used nomenclature and grading scales are defined. An organ by organ review is offered detailing unique clinical issues that pertain to those systems. Practice pearls and pitfall are elucidated when relevant. Psychiatric complications of this disease entity are also discussed. CONCLUSION: A SCI is a devastating but increasingly survivable event. The long-term care of persons with SCIs is challenging because of the unique pathologies encountered in this population and the disruption of normal and expected physiological responses to common ailments. This review will facilitate a better understanding of the emergency care needs of this unique patient population.

High Voltage Monophasic Pulsed Current (HVMPC) for stage II-IV pressure ulcer healing. A systematic review and meta-analysis.

This review was conducted to determine and quantify the efficacy of high-voltage monophasic pulsed current (HVMPC) in the treatment of stage II-IV pressure ulcers (PrUs), identify the details of HVMPC intervention parameters and the superior protocol, and ascertain other potential benefits and the safety of HVMPC intervention. Eleven studies, nine randomized controlled trials (RCTs) and two case series studies, matched the criteria and were included in the systematic review, whereas, only level 1 evidence RCTs were included in the meta-analysis. The percentage of wound surface area reduction per week was 12.39%; 95% CI, [10.43-14.37] for HVMPC plus standard wound care (SWC) and 6.96%; 95% CI, [5.56-8.38] for SWC alone or SWC plus sham HVMPC. The net effect of HVMPC was 5.4% per week (an increase of 78% greater than SWC alone or SWC plus sham HVMPC). Level 1, 2 and 4 evidence studies have consistently indicated that HVMPC plus SWC were more effective than SWC alone or SWC plus sham HVMPC in treating stage II-IV PrUs. Level 1 evidence studies showed that HVMPC intervention improved the healing of PrUs (reduced wound surface area), and combined with SWC, increased the probability of complete healing and almost eliminated the probability of worsening of healing. HVMPC intervention was shown to be relatively safe, with rare adverse reactions.

Decubitus Ulcer Development: An Investigation on Its Effect and Evidence in Home Care Patients.

BACKGROUND AND AIMS: Decubitus ulcer (DU) is one of the commonly observed health problems among home care patients. As well as deteriorating social, physical, and psychological conditions of the patients, it is a cause of severe economic loss due to long-term bed occupancy and high care costs. This study aimed to examine the factors which affect the development of decubitus ulcer among home care patients and provide extensive data to the literature. PATIENTS AND METHODS: This study was conducted with on home care patients aged over 40 years old who were registered at Etimesgut Ankara Sehit Sait Erturk State Hospital. Following the face-to-face interviews with the patients at home, the scores of Subjective Global Assessment (SGA), Mini Nutritional Assessment (MNA), Daily Life Activities (DLA), and Geriatric Depression Scale (GDS) were recorded. Development of DU was monitored through routine examinations in the home care patients. It was encountered how SGA, MNA, DLA and GDS functioned in predicting the development of DU using logistic regression during effort and also how status of equipment and presence of comorbid diseases affected its development. RESULTS: It was determined that malnutrition affected development of DU by decreasing mobility while the presence of psychological problems increased the risk for development. Furthermore, number of comorbid diseases and status of health equipment used by the patients were found effective in the development of DU. CONCLUSION: It is obvious that decreased inability of independent mobility in DLA increase the risk for malnutrition and consequently two assessments show a negative impact on psychology of the patient.

Weight loss and decubitus duodenal ulcer in Parkinson's disease treated with levodopa-carbidopa intestinal gel infusion.

Apparently, unexplained weight loss is a common symptom experienced by patients affected by Parkinson's disease, especially in those treated by levodopa-carbidopa infusion gel (LCIG) with a poor control of dyskinesias. Weight loss is considered part of gastrointestinal dysfunction seen in patients affected by Parkinson's disease, along with gastroparesis and reduced bowel peristalsis. In patients treated with LCIG, weight loss needs to be accurately evaluated, because of possible underlying life-threatening adverse events, like duodenum decubitus ulcer.

Oestrogen-soaked vaginal packing for decubitus ulcer in advanced pelvic organ prolapse: a case series.

INTRODUCTION: Cervicovaginal decubitus ulceration is a well-known complication of advanced pelvic organ prolapse (POP). There is no consensus for its management. This case series describes the outcome of using repeated vaginal packs soaked with oestrogen cream to reduce POP and promote decubitus ulcer healing. We aimed to investigate the speed of ulcer healing and endometrial safety with this regimen. METHODS: This was a retrospective study of patients with stage 3 or 4 POP and intact uterus with decubitus ulcer who were planned for surgery that included hysterectomy after ulcer healing. Vaginal packs are replaced at least biweekly-or more frequently if extruded-until ulcer resolution. RESULTS: Thirteen patients were studied. Mean age was 69 ± 6 years and mean duration of menopause was 19 ± 6 years. Nine patients had a single ulcer and four had multiple ulcers. Mean ulcer diameter was 2.8 ± 1.5 cm and mean duration for ulcer healing was 26 ± 14 days. Hysterectomy and pelvic floor reconstruction was performed a median of 5 (range 0-153) days after ulcer healing was first noted. Histopathological examination of the endometrium following hysterectomy showed three specimens with endocervical hyperplasia; one had concurrent proliferative endometrium, two had simple endometrial hyperplasia and another two had proliferative endometrium. CONCLUSION: Oestrogen-soaked vaginal packing is a viable option for managing a decubitus ulcer in advanced POP. We document a measurable impact on the endometrium with this short-term preoperative regimen. Further research is needed to evaluate its efficacy in promoting ulcer healing and endometrial safety.

Inter-Rater Agreement of Pressure Ulcer Risk and Prevention Measures in the National Database of Nursing Quality Indicators(®) (NDNQI).

In this descriptive multi-site study, we examined inter-rater agreement on 11 National Database of Nursing Quality Indicators(®) (NDNQI(®) ) pressure ulcer (PrU) risk and prevention measures. One hundred twenty raters at 36 hospitals captured data from 1,637 patient records. At each hospital, agreement between the most experienced rater and each other team rater was calculated for each measure. In the ratings studied, 528 patients were rated as "at risk" for PrU and, therefore, were included in calculations of agreement for the prevention measures. Prevalence-adjusted kappa (PAK) was used to interpret inter-rater agreement because prevalence of single responses was high. The PAK values for eight measures indicated "substantial" to "near perfect" agreement between most experienced and other team raters: Skin assessment on admission (.977, 95% CI [.966-.989]), PrU risk assessment on admission (.978, 95% CI [.964-.993]), Time since last risk assessment (.790, 95% CI [.729-.852]), Risk assessment method (.997, 95% CI [.991-1.0]), Risk status (.877, 95% CI [.838-.917]), Any prevention (.856, 95% CI [.76-.943]), Skin assessment (.956, 95% CI [.904-1.0]), and Pressure-redistribution surface use (.839, 95% CI [.763-.916]). For three intervention measures, PAK values fell below the recommended value of ≥.610: Routine repositioning (.577, 95% CI [.494-.661]), Nutritional support (.500, 95% CI [.418-.581]), and Moisture management (.556, 95% CI [.469-.643]). Areas of disagreement were identified. Findings provide support for the reliability of 8 of the 11 measures. Further clarification of data collection procedures is needed to improve reliability for the less reliable measures. © 2016 Wiley Periodicals, Inc.

A rare location for a common problem: popliteal pressure ulcer.

Pressure ulcer is defined as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. The most frequent sites for pressure ulcers are the occiput, sacrum, ischial tuberosities, trochanters, lateral malleoli and posterior heels. Herein, we present a case of grade III pressure ulcer seen in popliteal region which is an unusual localisation that is rarely seen in the literature. An awareness of this unusual localisation of pressure ulcer is necessary to prevent decrease in quality of life, particularly in the wheelchair-dependent population.

Bodily pain intensity in nursing home residents with pressure ulcers: analysis of national minimum data set 3.0.

Clinical reports suggest that superficial pressure ulcers produce pain, but that pain decreases as the wound advances in stage. This study of the relationship between pressure ulcer stage and bodily pain intensity in nursing home residents was a secondary analysis of the national Minimum Data Set 3.0 assessment data in long-term care facilities, collected from nursing home residents at least 65 years of age. Data were examined from residents with pressure ulcers who completed a bodily pain intensity interview between January and March 2012 (N = 41,680) as part of the MDS comprehensive assessment. After adjusting for other variables (e.g., cognition, functional impairment, presence of comorbidities, use of scheduled pain medication, and sociodemographic variables), bodily pain intensity for those with more severe pressure ulcers in comparison to those with Stage I ulcers was higher by 11% (Stage II), 14% (Stage III), 24% (Stage IV), and 22% (suspected deep tissue injury). Because multivariate analysis showed that greater bodily pain intensity was associated with an advanced stage of pressure ulcer, health care providers should assess bodily pain intensity and order appropriate pain management for nursing home residents with pressure ulcers, particularly for those with advanced pressure ulcers who are vulnerable to greater bodily pain intensity.