Each year, approximately 3 million people in the United States develop a pressure ulcer. Although a preventable complication, pressure ulcers are among the top 5 adverse outcomes in the acute care setting with the prevalence as high as 42% in the intensive care unit (ICU). The purpose of this systematic review was to evaluate the inclusion of the Braden Scale as part of a multicomponent pressure ulcer intervention protocol, or care bundle, to identify geriatric patients hospitalized in the ICU who were at risk for pressure ulcers. The Cochrane protocol guided this review; findings were reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Through a structured search strategy in 6 electronic databases, 409 studies were reviewed, of which 11 studies were analyzed and the data included in a literature review matrix for synthesis. Four key findings emerged from the data analysis: effective pressure ulcer prevention programs use a risk assessment, daily reassessment of risk, daily skin inspections, moisture removal strategies, nutritional support and hydration, and offloading pressure; the Braden Scale is effective in detecting pressure ulcer risk in the ICU; an evidence-based bundle is effective in preventing pressure ulcer development; and decreased risk for pressure ulcer development increases patient safety, improves quality of care, and reduces the overall cost of care. The findings from this project can result in positive change by providing the evidence to guide improvements in pressure ulcer protocols to increase the quality of care and decrease the incidence of pressure ulcers in the ICU.

<p>Förekomst av trycksår utgör ett omfattande problem inom hälso- och sjukvården fortfarande trots</p><p>kunskap om förebyggande faktorer som presenteras i litteraturen. Detta medför att det</p><p>förebyggande omvårdnadsarbetet avseende trycksår även i fortsättning kan vara en mycket</p><p>angelägen fråga för sjuksköterskan. Syftet i föreliggande studie är därför att belysa</p><p>omvårdnadsåtgärder som kan utföras i vårdbädden för att förebygga trycksår hos äldre.</p><p>Litteraturstudie valdes som metod. Sökorden; pressure ulcer, prevention, bed and mattresses,</p><p>scoles, skin-care, decubitus ulcer, aged och nursing används. För att elektronisk söka relevanta,</p><p>vetenskapliga artiklar i databaserna CINAHL och MEDLINE. Resultatet bygger på åtta</p><p>vetenskapliga artiklar som kvalitetsgranskades. Vid dataanalysen användes en modifierad form av</p><p>komponenten nr 4 i Viginia Hendersons omvårdnadsteori som teoretisk utgångspunkt. Resultatet</p><p>redovisas utifrån två huvudrubriker med två respektive tre underrubriker. Den första</p><p>huvudrubriken är: Hur kan patienter med risk för utveckling trycksår identifieras? Med</p><p>underrubrikerna: Sjuksköterskans kunskaper och bedömningsinstrument. Resultatet visar att</p><p>sjuksköterskan utför riskbedömningar för att identifiera patienter i riskzon men att dessa inte är</p><p>tillräckligt omfattande och att visa faktorer såsom födo-och vätskeintag saknas i bedömning.</p><p>Studien visar också att det finns många olika riskbedömningsinstrument (skalor) med olika</p><p>variabler för att identifiera patienter som ligger i riskzonen för att utveckla trycksår. Den andra</p><p>huvudrubriken är: Att hjälpa patienten inta lämplig kroppsställning när han / hon ligger samt att</p><p>växla ställning, omfattar underrubrikerna: intervall, position och hjälpmedel. Resultatet visar att</p><p>vändning på en tryckreducerande madrass leder till minskning av trycksår grad II-IV. Litteraturen</p><p>visar även att patientens position i vårdbädden inte bör överstiga 30 grader av huvudändan för att</p><p>undvika för höga tryck mot korsbenet generellt ger lägre tryck på patientens hud. Hjälpmedel som</p><p>rekommenderas för tryckavlastning på häl och korsben är exempelvis gelkuddar.</p>

Förekomst av trycksår utgör ett omfattande problem inom hälso- och sjukvården fortfarande trots kunskap om förebyggande faktorer som presenteras i litteraturen. Detta medför att det förebyggande omvårdnadsarbetet avseende trycksår även i fortsättning kan vara en mycket angelägen fråga för sjuksköterskan. Syftet i föreliggande studie är därför att belysa omvårdnadsåtgärder som kan utföras i vårdbädden för att förebygga trycksår hos äldre. Litteraturstudie valdes som metod. Sökorden; pressure ulcer, prevention, bed and mattresses, scoles, skin-care, decubitus ulcer, aged och nursing används. För att elektronisk söka relevanta, vetenskapliga artiklar i databaserna CINAHL och MEDLINE. Resultatet bygger på åtta vetenskapliga artiklar som kvalitetsgranskades. Vid dataanalysen användes en modifierad form av komponenten nr 4 i Viginia Hendersons omvårdnadsteori som teoretisk utgångspunkt. Resultatet redovisas utifrån två huvudrubriker med två respektive tre underrubriker. Den första huvudrubriken är: Hur kan patienter med risk för utveckling trycksår identifieras? Med underrubrikerna: Sjuksköterskans kunskaper och bedömningsinstrument. Resultatet visar att sjuksköterskan utför riskbedömningar för att identifiera patienter i riskzon men att dessa inte är tillräckligt omfattande och att visa faktorer såsom födo-och vätskeintag saknas i bedömning. Studien visar också att det finns många olika riskbedömningsinstrument (skalor) med olika variabler för att identifiera patienter som ligger i riskzonen för att utveckla trycksår. Den andra huvudrubriken är: Att hjälpa patienten inta lämplig kroppsställning när han / hon ligger samt att växla ställning, omfattar underrubrikerna: intervall, position och hjälpmedel. Resultatet visar att vändning på en tryckreducerande madrass leder till minskning av trycksår grad II-IV. Litteraturen visar även att patientens position i vårdbädden inte bör överstiga 30 grader av huvudändan för att undvika för höga tryck mot korsbenet generellt ger lägre tryck på patientens hud. Hjälpmedel som rekommenderas för tryckavlastning på häl och korsben är exempelvis gelkuddar.

Syftet med denna litteraturstudie var att beskriva riskfaktorer som påverkade uppkomsten av trycksår samt de vanligaste förekommande preventiva åtgärderna. Vidare var syftet att beskriva sjuksköterskans roll vid förebyggandet samt behandlingen av trycksår. De vetenskapliga artiklar (n=21) som ingick i studien söktes manuellt samt datoriserat via databaserna Blackwell Synergy, CHINAL, Elin@Dalarna och Elsiever. Inklusionskriterierna var att de skulle vara vetenskapliga samt av kvalitativ och kvantitativ design. Även litteraturstudier inkluderades. Artiklarna skulle vara publicerade 1990 eller senare och vara svensk eller engelskspråkiga. Resultatet visade att patienter med lågt nutritionsstatus och låga serum albuminvärden riskerade att utveckla trycksår. En annan stor riskgrupp var patienter i peri- och postoperativa skeden där operationstiden kraftigt inverkade på uppkomsten av sår. Även anestesiformen spelade roll. Trycksåren uppkom vanligen på hälarna och korsbenet. I preventativt syfte var evidensbaserade mätskalor viktiga. Även trycksårsreducerande madrasser visade sig vara betydelsefulla. Vidare framkom att hälso- och sjukvårdspersonalen visade ett svalt intresse för trycksår och att kvalitetssäkringen var bristfällig. Sjuksköterskan hade främst en informerande roll inom trycksårspreventionen. Såren rengjordes lämpligast med fysiologisk koksaltlösning och omlades med våt omläggning. Resultatet visade även att smärtanalyser i högre grad borde involveras i trycksårsbehandlingen.

The purpose of this thesis is to design an innovative sickbed for the paralyzed patients. One goal of the sickbed is to avoid the occurrence of pressure ulcers. The other one is to tune the tensions of patient¡¦s muscles. To analyze the muscle tension, a simplified model for human body was proposed. This model divided the human body into 5 blocks when ignoring the arms and hands. It described the geometric relationships between the blocks and muscles under different body postures and external supports from the design sickbed. It was noted that the number of unknowns of the model was larger than the number of equations derived from the equilibrium conditions. An optimization method, which was to obtain a desired distribution of muscle tensions, was adopted to find the solutions for the unknowns. Among the possible supporting states, which included the body postures and supporting locations, the ones that met the desired tension distribution were searched. Then, the technique of Graph theory was used to obtain a set of supporting states that could avoid the occurrence of pressure ulcers. Finally, a preliminary design of the sickbed structure was discussed. If the relaxed condition of muscles was desired, the simulation study indicated that large number of supporting states could meet the purpose. That means there exist many body postures or supporting locations allowing the muscles of body in the relaxed condition. This feature allows one to choose a set of supporting states that two consecutive states own different supporting locations and prevents any spot of body from continuous loading. Such a supporting scheme should minimize the occurrence of pressure ulcers.

Thesis (M. Phil.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 105-136).

Thesis (Ph. D.)--University of Hong Kong, 1987.

This project sought to develop a system that facilitated the visual inspection of venous leg ulcers by establishing a selection of reliable parameters. The project had three principal aims: to develop a reliable method for capturing the colours exhibited by a venous leg ulcer; to establish a colour range that experienced clinicians believed represented wet necrotic tissue and erythema; and to develop software that highlighted the two manifestations in digital photographs. The project method was divided into three phases. The first phase examined images taken from twenty-two patients over forty-seven episodes of care. During each episode three sequential images were captured using a frame to control for orientation, magnification and lighting resulting in a bank of 141 images. The reliability of the system to accurately capture colour was then determined by examining the amount of colour variation recorded across the set of three images taken at each episode. The second phase asked eight experienced clinicians to examine a set of twenty photographs taken from the bank established in phase one. On each photograph the clinicians were asked to identify areas of wet necrotic tissue or erythema and outline the areas with a colour pen supplied for each manifestation. A colour range was then constructed to represent each manifestation by measuring the range, mean and standard deviation of pixels that were located within the outlined areas. The third phase developed a computerised system that used the colour range established in phase two to highlight areas of a digital image that represented either erythema or wet necrotic tissue. The validity of the highlighted areas was then tested by asking experienced clinicians to identify their level of agreement with the areas selected by the computer system. Analysis of the results from phase one indicated that the system used to record images at each episode of care provided a reliable method for maintaining consistent orientation, magnification and replication of colour. Results from phase two yielded a two distinct colour representation of erythema and wet necrotic tissue. Erythema ranged from 3600 to 3780 of hue with a mean of 369.210, and wet necrotic tissue ranged from 3670 to 3900 of hue with a mean of 387.730. Results from phase three indicated that whilst clearly delineated areas of erythema and wet necrotic tissue were visible, the validity of the representations was varied. 50 per cent of experienced clinicians agreed with the areas selected as erythema and 60 per cent agreed with the areas selected by the computer system as wet necrotic tissue. The system developed during this study for recording images of venous leg ulcers provides a reliable method for further research into the visual progression of this disease. However, the colour range identified as being representative of erythema or wet necrotic tissue and the computer system developed to highlight such areas in a digital image, requires further investigation before it is applicable to the clinical setting. The findings do however provide further insights into the varied nature of expert opinion when judging the colour of venous leg ulceration.

Thesis (Ph. D.)--University of Hong Kong, 1991.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Ãlcera por pressÃo (UP) à uma lesÃo comum entre idosos e indivÃduos com mobilidade fÃsica prejudicada. Ela afeta a qualidade de vida dos indivÃduos e gera custos considerÃveis, uma vez que està se tornando um problema mundial crescente, devido ao envelhecimento da populaÃÃo. Ciclos de isquemia e reperfusÃo tÃm sido identificados como fatores causais primÃrios, mas existem outros fatores que influenciam a intensidade dos danos. Atualmente, nÃo existe um mÃtodo eficaz e de baixo custo para tratar esta condiÃÃo. O uso clÃnico da fumaÃa de Artemisia vulgaris (FAV) para o tratamento de lesÃes na pele de diversas origens està descrito na literatura. Entretanto à pouco documentado e atualmente nada foi descrito em modelos experimentais de ulcera por pressÃo a respeito da sua atividade cicatrizante, bem como o seu efeito tÃxico. Dessa forma objetivou-se investigar o perfil toxicolÃgico e o efeito cicatrizante da aplicaÃÃo tÃpica da fumaÃa de Artemisia vulgaris em modelo de Ãlcera por pressÃo em camundongos. Este trabalho foi aprovado pelo Comità de Ãtica (89/2011). Foi utilizado um modelo nÃo-invasivo de UP em camundongos Swiss machos, que consiste em 4 ciclos de isquemia e reperfusÃo atravÃs da colocaÃÃo de dois ÃmÃs na superfÃcie da pele dorsal. Cinco grupos experimentais foram testados: (1): com Ãlcera e sem tratamento, (2): com Ãlcera e FAV tÃpico, (3): com Ãlcera, FAV tÃpica e filme de poliuretano, (4): com Ãlcera e tratado com hidrogel e filme de poliuretano e (5) sem Ãlcera, e sem tratamento. A anÃlise foi realizada nos dias 5, 7, 14 e 21 apÃs a induÃÃo da Ãlcera. Foram avaliados parÃmetros macroscÃpicos de cicatrizaÃÃo atravÃs da escala EWAT (Experimental Wound Assessment Tool â Instrumento de avaliaÃÃo de ferida experimental), Ãrea da ferida e porcentagem de contraÃÃo. Nos parÃmetros microscÃpicos foram avaliados: a anÃlise histopatolÃgica, a espessura da camada de colÃgeno e densidade de colÃgeno na derme, a contagem de fibroblastos e fibrÃcitos e a mediÃÃo da espessura da epiderme. AvaliaÃÃo da imunomarcaÃÃo para NOSi e nitrotirosina e ensaio de malondialdeÃdo (MDA) foi realizado para investigar o stress oxidativo. Testes toxicolÃgicos com parÃmetros hematolÃgicos, bioquÃmicos, histopatolÃgicos e comportamentais foram realizados em animais tratados com FAV. Resultados: a FAV nÃo mostrou toxicidade nos parÃmetros avaliados. Em todos os resultados a FAV + filme transparente foi melhor do que a FAV. EWAT macroscÃpica e escores inflamatÃrios mostraram diferenÃas significativas entre o grupo tratado, FAV + filme de poliuretano e grupo controle (p <0,01). Ãrea contraÃÃo da ferida foi aumentada em no grupo FAV grupo + filme de poliuretano, por 99,62% (84,65% vs, controle), bem como a contagem de fibroblastos (112,7  7,9 vs 80,0  6,4; controle, p < 0,01) e densidade de colÃgeno (33,9%  6,6 vs 20,9  8,6%, controle, p <0,01). FAV + filme de poliuretano aumentou a espessura da epiderme (113,2  18,1 vs 52,1  8,9, controle p <0,01) e tambÃm a contagem do nÃmero de vasos sanguÃneo no tecido conjuntivo (142,3  15,1 vs 68, 5  8,6; controle, p <0,01). O nÃmero de cÃlulas marcadas para NOSi e nitrotirosina, foi reduzido no grupo FAV + filme de poliuretano (601,5  94,0 vs 95,7  2005,0, controle, NOSi e 666,0  142,4 vs 1877,2  133, 8; controle, nitrotirosina, p <0,01). O MDA tambÃm foi reduzido pelo tratamento com FAV + filme de poliuretano (0,08  0,03 vs 0,3  0,05; controle, p <0,05). ConcluÃmos que a aplicaÃÃo tÃpica da FAV nÃo produziu efeito tÃxico e acelerou a cicatrizaÃÃo de feridas possivelmente por propriedades antioxidantes. O uso do filme de poliuretano intensificou a aÃÃo da FAV. / Pressure ulcer (PU) is a common injury among elderly and subjects with impaired physical mobility. It affects the quality of life of individuals and generates considerable costs, since it is becoming a worldwide growing problem due to the aging of the population. Cycles of ischemia and reperfusion from pressure have been identified as primary causal factor but other factors influence the intensity of damage. Currently, there is no effective and inexpensive method to treat this condition. For this reason, we aimed to check whether the traditional indication of smoke from Artemisia vulgaris (SAV) really contributes to the wound healing process of the PU. This work was approved by Ethics Committee (89/2011). It was used a non-invasive model of PU in mice which consists of 4 cycles of ischemia and reperfusion by the placement of two magnets on the dorsal skin surface of mice. Five experimental groups were tested: negative control, with ulcer and without treatment; positive control, with ulcer and treated with hydrogel and transparent film; treated group 1, with ulcer and topical SAV, treated group 2, with ulcer and topical SAV and transparent film, and a group without ulcer and without treatment. The analysis was conducted on days 5, 7, 14 and 21 after ulcer induction. Macroscopic parameters of healing were assessed through the EWAT (Experimental Wound Assessment Tool). Wound area, percentage of contraction, histopathological analysis, collagen layer thickness and collagen density in the dermis, counting of fibroblasts and fibrocytes, measurement of epidermis thickness were also assessed. Evaluation of the immunostaining for iNOS and nitrotyrosine and malondialdehyde assay (MDA) was performed to investigate oxidative stress. Toxicological tests were conducted in treated animals and SAV showed no toxic effect. In all the results SAV+film treatment was better than SAV. Results: Macroscopic EWAT and inflammatory scores showed significant differences between SAV+film treated group and control group (p<0,01). Wound contraction area was enhanced in SAV+film group by 99,62% (vs 84,65%, control) as well as fibroblast count (112,7  7,9 vs 80,0  6,4; control, p<0,01) and collagen density (33,9%  6,6 vs 20,9%  8,6; control, p<0,01). Epidermal width was increased by SAV+film (113,2  18,1 vs 52,1  8,9; control p<0.01) and also the blood vessel counting in the conjunctive tissue (142,3  15,1 vs 68,5  8,6; control, p<0.01). The counting of iNOS and nitrotyrosine immunostained cells showed a reduction by SAV+film (601,5  94,0 vs 2005,0  95,7; control, iNOS and 666,0  142,4 vs 1877,2  133,8; control, nitrotyrosine, p<0.01). MDA assay showed also a reduction by SAV+film treatment (0,08  0,03 vs 0,3  0,05; control, p<0.05). In conclusion, SAV topical application promoted wound healing by anti-oxidant properties and by modulating the inflammatory process. The effect of SAV was enhanced when the wound area was covered by the transparent film after smoke application. In addition, this method showed no toxic effect and may be an effective and low cost alternative for PU healing treatment.