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Negative pressure wound therapy versus healing by secondary intention in pressure ulcers

Negative pressure wound therapy versus healing by secondary intention in pressure ulcers

A systematic literature search in accordance with the Preferred Reporting Items for Systematic Reviews and Meta- analyses (PRISMA) standards, 11 was conducted using the PubMed and Scopus search engine up until the 20 Th January 2017 including the terms: “negative pressure wound therapy” and “pressure ulcers”. No language, publication date, restrictions were imposed. All titles and abstracts of the considered studies were analysed to select only the studies that reported the PICO (P = Patient, Population or Problem; I = Intervention; C = Comparison; O = Outcome). 12 When
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Early Prevention of Pressure Ulcers in the Emergency Department

Early Prevention of Pressure Ulcers in the Emergency Department

The project would significantly impact an area of nursing, pressure ulcers prevention, considered a major nurse-sensitive outcome. Because, nursing care has a major effect on pressure ulcer development and prevention (Lyder & Ayello, 2008). Pressure ulcer prevention ranges from (1) the simple and cost effective method of implementing a turning schedule for patients, (2) to providing at-risk patients with a pressure redistribution device described above, (3) to the use of high technology beds. The most important educational tool is to teach nurses and technicians how to recognize at-risk individuals and when to begin interventions so that they are early and effective. The literature suggests that not all pressure ulcers can be prevented; however they can be reduced by a comprehensive pressure ulcer prevention programs facility wide (Black, Edsberg, Baharestani, Langemo, Goldberg, McNichol, Cuddigan, 2011).
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The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care

The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care

However, there was also a strong view that there are people who are categorically not vulnerable to developing pressure ulcers, for example, most day-stay, most maternity - although those with sensory loss due to epidural anaesthesia and analgesia may be at risk - and most psychiatric patients, who are relatively easy to identify. Therefore to reduce the possibility that patients unlikely to develop pressure ulcers are allocated costly devices, it was agreed that the recommendation should be applicable to those vulnerable to pressure ulcers. Most of the trials included in the clinical effectiveness review were conducted on ‘high-risk’, non-paediatric populations such as those admitted to orthopaedic, neurology, geriatric and critical care units, which is why the recommendation attracted a lower recommendation grading. The GDG was aware that the studies reviewed did not apply to the paediatric population and the findings may not be appropriate to this group.
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Recent advances in three-dimensional pressure relieving cushions for the prevention of pressure ulcers

Recent advances in three-dimensional pressure relieving cushions for the prevention of pressure ulcers

Polyurethane (PU) foam is one of the most common materials used in the development of pressure relieving cushions. However, it suffers from reduced efficiency in terms of thermophysiological comfort, cost, recycling and importantly, creating a suitable environment for the prevention of pressure ulcers. The paper presents research carried out at the University of Bolton, in the development of pressure relieving cushion applications using three-dimensional (3D) warp knitted spacer fabrics. Three properties, pressure distribution, air permeability, and heat resistance of 3D warp knitted spacer fabrics are focused on, with particular emphasis on pressure distribution in the development of improved performance and efficacy of cushion applications. This research includes the development of a novel technique for measuring pressure distribution while under simulated loading conditions.
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Pressure ulcers : predicting factors, prevention and costs

Pressure ulcers : predicting factors, prevention and costs

many other European countries, the treatment of hospital-acquired pressure ulcers is financially penalised in the United States (Gunningberg et al. 2012; NPUAP, 2011). Changes in reimbursement policy and hospital staffing in the United States seem to have increased the awareness hospital-acquired pressure ulcers as a negative patient outcome and may have prompted more systematic risk assessment and a more timely start of preventive measures (Gunningberg et al. 2012). It is not clear to what extent the United States reimbursement policy has led to the allocation of preventive measures to patients not at risk for pressure ulcer development and associated futile costs. Our study on cost of pressure ulcer prevention in Flemish hospitals and nursing homes reported on the extent of the futile costs (of which the avoidance may result in cost savings) and opportunity costs (of which the avoidance may result in a better allocation of resources) related to the pressure ulcer prevention in patients not at risk. Therefore, adopting United States alike reimbursement policies seems not recommended at this time. Other possibilities to increase the awareness can be explored, such as the creation of an edifying award for hospitals, nursing homes and home care organisations with low nosocomial pressure ulcer incidences (for example “skin friendly hospital” by analogy with “baby friendly hospital”).
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Preventing Pressure Ulcers and Assisting With Wound Care

Preventing Pressure Ulcers and Assisting With Wound Care

Pressure ulcers are very painful and difficult to treat. Ultimately, they can cause a person to die. For these reasons, every effort must be made to prevent a pressure ulcer from forming. As a nursing assistant, there are many things that you can do to help keep a person’s skin healthy (Fig. 19-2). General guidelines for preventing pressure ulcers are given in Guidelines Box 19-1.

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Prevention of Tracheostomy-related Pressure Ulcers in Children

Prevention of Tracheostomy-related Pressure Ulcers in Children

cycles are designed to establish rela- tionships between process changes and outcomes by trialing and adapting small-scale interventions over time. This process was used both to de- termine the interventions most bene- fi cial to prevent TRPU and to effectively implement a TRPU-prevention bundle. PDSA cycles were planned and exe- cuted by a multidisciplinary team in- cluding the medical director of the unit, bedside nurse and respiratory therapist, nurse educator, and the unit ’ s skin care champion. Based on knowledge gained from the literature, as well as results previously obtained from our institu- tion ’ s pressure ulcer collaborative (preliminary work to reduce pressure ulcers of all types), key drivers thought to prevent TRPU development were identi fi ed to guide our interventions. These included (1) pressure ulcer risk and skin assessment, (2) moisture-free device interface, and (3) pressure-free device interface. PDSA cycles testing interventions in each of these drivers
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A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.

A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.

183 pressure ulcers: 77 ulcers healed, 5 were on limbs amputated prior to ulcer healing, 88 were on patients who died prior to healing, 11 were present at the end of the study and 2 were lost to follow-up. The median time to healing was 121 (range 8–440) days. Of 12 variables associated with healing (P ≤ 0.2), multi-variable analysis identified two factors which were independently predictive of healing

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The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients

The prevalence of pain at pressure areas and pressure ulcers in hospitalised patients

Pain has been reported by patients to be a major symptom associated with PUs, with dressing changes be- ing particularly painful times [6]. PU pain can be debili- tating, reducing the individual ’ s ability to participate in physical and social activities, adopt comfortable posi- tions, move, walk, and under-go rehabilitation. People with PU pain describe their experience as “ endless pain ” characterised by constant presence, needing to keep still, equipment and treatment pain [3,7,8]. The desire of healthcare professionals to understand the extent of this problem is demonstrated by a number of reviews rele- vant to the topic of pain and pressure ulcers [5,6,9,10].
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The Role of Modern Wound Dressings in Stage I Pressure Ulcers and Patients at Risk of Pressure Ulcer Formation

The Role of Modern Wound Dressings in Stage I Pressure Ulcers and Patients at Risk of Pressure Ulcer Formation

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining or tunnelling. The depth of a Category / Stage III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and Category / Stage III ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category / Stage III pressure ulcers. Bone / tendon is not visible or directly palpable.
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Original Article Risk factors for intraoperative pressure ulcers in surgical patients

Original Article Risk factors for intraoperative pressure ulcers in surgical patients

Our study showed that intraoperative physical maneuvering is a risk factor for the occurrence of pressure ulcers (OR, 4.81; P < 0.001). Manipulation during surgery, such as for instru- ment placement and retractors, is another fac- tor contributing to an increased pressure ulcer occurrence. Hu et al. stated that surgical staff press against a patient’s limb during surgery is another cause of intraoperative pressure ulcers [24]. Intraoperative physical maneuvers include the additional impact and vibration to the surgi- cal sites by nails, chisels, drills, and saws [25], all of which increase the pressure and shear force upon the surgical site and greatly increase the risk of intraoperative pressure ulcers. Routine usage of pressure to stop bleeding, restraints, and fasteners are common physical maneuvers in our practice. The use of pressure to stop bleeding will directly cause capillary shutdown and hypoxia when the physical pres- sure exceeds the normal capillary interface pressure (23-32 mmHg) [26]. Likewise, inap- propriate application of fasteners causes ex- cessive restraint force and exceeds the capil- lary interface pressure.
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Reducing hospital acquired pressure ulcers in intensive care

Reducing hospital acquired pressure ulcers in intensive care

In relation to risk assessment, it is policy in our hospital to carry out a risk and a skin assessment within six hours of admission to the hospital. Nursing staff were encouraged to risk assess patients within this timeframe and complete a skin assessment every time they repositioned the patient. The hospital uses a validated risk assessment scale called the Braden scale which was developed to identify patients at risk of developing pressure ulcers.[29] The lower the score the higher the risk, and any patient with a score of 18 or below is deemed at risk. However, as most of the ICU patients score below 18 then there needed to be some other method to identify or highlight their risk.
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Evaluation of the bacterial diversity of Pressure ulcers using bTEFAP pyrosequencing

Evaluation of the bacterial diversity of Pressure ulcers using bTEFAP pyrosequencing

extremity, and Pressure ulcers, have proven to be much more of a diverse and complicated microbial ecology than previously recognized. Most interestingly, obligate anaerobes were found to be a significant proportion, if not a clear majority in chronic wounds, in all surveyed wound types. Requiring specialized collection, transport, and analysis methods for culture based diagnostics of anaerobes will remain difficult especially as part of poly- microbial infections. We demonstrate that chronic wounds such as decubitus ulcers are not merely infected by a single pathogenic species of bacteria, but rather by a blending of symbiotic microbes which form a CWPB. Whether termed bioburden or biofilm, the microbial participation in chronic wounds have been shown to represent a major contributing factor to the resistance of natural healing in chronic wounds, [37,49,50] and the great diversity of these microbial communities adds to their resilience against traditional host and medicinal onslaughts [32]. Previous efforts along with the present study indicate that the highly unique profile of each individual wound would require a therapeutic approach specifically tailored to the patient ’ s respective wound microflora in addition to the multitude of procedures already implemented in the assuage of chronic wounds and support of the host and comorbidities [51,52].
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Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

Data were analyzed using Statistica version 10 (StatSoft, Inc., Tulsa, OK, USA). Chi-square test, V-square test, and Fisher’s exact test were used for categorical variables and nonparametric Mann–Whitney U test was used for quantita- tive variables to compare patients who developed decubitus pressure ulcers during hospitalization with those who did not. Multivariate binary logistic regression was performed to assess measures associated with decubitus pressure ulcer development: separately for parameters assessed at admission and for mean values of parameters measured serially during hospitalization. The variables were adjusted for clinical, functional, and laboratory factors. Multivariate analysis with backward elimination included variables that yielded P-values of 0.1 or lower in the initial univariate analysis.
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Dressings and topical agents for preventing pressure ulcers (Review)

Dressings and topical agents for preventing pressure ulcers (Review)

The EPUAP/NPUAP 2009 guidelines suggest that use of film dressings may help to protect the skin against the adverse effects of friction, furthermore, they suggest that use of foam dressings may protect parts of the body at risk of shear injury. It has also been suggested that the application of topical agents directly to the skin will protect against the adverse affects of friction (Reddy 2006). Both friction and shear are included as risk factors for pressure ul- cer development in the Braden pressure ulcer risk assessment scale (Bergstrom 1987). However, the recent EPUAP/NPUAP pressure ulcer prevention and management guidelines have removed fric- tion from their definition of a pressure ulcer (EPUAP/NPUAP 2009), suggesting that although friction forces contribute to tissue damage, they are not a contributory factor in pressure ulcer devel- opment (EPUAP/NPUAP 2009). Nonetheless, the International Review 2010 argues that because friction and shear are closely linked, friction should be discussed in the context of pressure ulcer development (and thus pressure ulcer prevention). One hypothesis upon which the use of dressings/topical agents for the prevention of pressure ulcers is based, relates to their role in the reduction of friction forces (Butcher 2009). Furthermore, Lahmann 2011 identified that friction was a causative factor in the development of superficial wounds resembling grade 1 and 2 pressure ulcers, whereas, pressure and shear were responsible for the development of deeper ulcers (grades 3 and 4). Earlier work by Kottner 2009 supports this argument, in classifying ulcers as superficial - pre-
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Investigating staff knowledge of safeguarding and pressure ulcers in care homes

Investigating staff knowledge of safeguarding and pressure ulcers in care homes

integrity. One manager explained that the discharge notes always stated that pressure areas had broken down or red areas were apparent on pressure areas. However, the grade of ulcer was not clearly defined, with the discharge documentation stating ‘query grade’ rather than explicitly identifying that it was a grade 3 or 4. This lack of clear documentation made it difficult for the staff to order appropriate devices or contact community nurses/tissue viability teams to arrange timely visits. There was concern that when staff checked pressure areas of residents newly arrived at the care home, they would locate pressure damage that had not been documented by hospital staff. The homes (where the interviews took place) had developed guidance for all staff to ensure that prior to a resident being admitted to a hospital, all pressure areas had to be assessed, and written documentation of skin integrity made, including any signs of skin damage, pressure ulcers or reddened areas. This documentation was then referred to when the resident returned home.
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Recent advances in three-dimensional pressure relieving cushions for the prevention of pressure ulcers

Recent advances in three-dimensional pressure relieving cushions for the prevention of pressure ulcers

Polyurethane (PU) foam is one of the most common materials used in the development of pressure relieving cushions. However, it suffers from reduced efficiency in terms of thermophysiological comfort, cost, recycling and importantly, creating a suitable environment for the prevention of pressure ulcers. The paper presents research carried out at the University of Bolton, in the development of pressure relieving cushion applications using three-dimensional (3D) warp knitted spacer fabrics. Three properties, pressure distribution, air permeability, and heat resistance of 3D warp knitted spacer fabrics are focused on, with particular emphasis on pressure distribution in the development of improved performance and efficacy of cushion applications. This research includes the development of a novel technique for measuring pressure distribution while under simulated loading conditions.
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Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers : PRESSURE (pressure relieving support surfaces) trial

Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers : PRESSURE (pressure relieving support surfaces) trial

filled sacs that sequentially inflate and deflate to relieve pressure for short periods. They are provided as either a full size replace- ment mattress or a shallower overlay that is placed on top of a mattress and are commonly used for people at moderate to high risk of pressure ulceration. An important clinical and economic question is whether alternating pressure replacement mattresses (about £4000; $7464; € 5847) confer any advantages over alternating pressure overlays (about £1000). We compared whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability.
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Recent advances in three-dimensional pressure relieving cushions for the prevention of pressure ulcers

Recent advances in three-dimensional pressure relieving cushions for the prevention of pressure ulcers

These new developments have been engineered in order to assist in the prevention and treatment of pressure ulcers as suffered by immobile or wheelchair bound individuals. Pressure ulcers or pressure sores are areas of damage to the skin and underlying tissues that are caused by impaired blood supply and tissue malnutrition as a result of prolonged pressure, friction or shear, moisture and heat (McInnes, et al., 2015). These areas are usually located over bony prominences and their severity is classified by the amount of tissue damage produced in that area (Bergstrom, et al., 1992).
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Utility of a three-dimensional wound measurement device in pressure ulcers

Utility of a three-dimensional wound measurement device in pressure ulcers

Introduction: Depth assessment is important for severe pressure ulcers (PUs); however, a device for the metric measurement of wounds, including depth, is lacking in clinical settings. Recent technological advancements have enabled the evaluation of the depth of wounds, and three-dimensional measurements are now available. The aim of this study was to test the util- ity of a newly developed three-dimensional wound measurement device in the clinical setting. Methods: We recruited three patients, each with a PU, who were being treated by a PU team at a university hospital. We measured the length, width, area, and maximal depth of the ulcers by using the device and with the conventional method. The ulcer volume was measured only with the device. The difference in measurement results of the device before and after debridement was compared in the first patient. The difference in measurement results between the conventional method and the device was compared in the second patient. Correlation coefficients between the conventional method and the device obtained from longitudinal data were calculated in the third patient.
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