In the vast majority of cases, appropriate identification and mitigation of risk factors can prevent or minimize pressure ulcer (PU) formation. However, some PUs are unavoidable. Based on the importance of this topic and the lack of literature focused on PU unavoidability, the National Pressure Ulcer Advisory Panel hosted a multidisciplinary conference in 2014 to explore the issue of PU unavoidability within an organ system framework, which considered the complexities of nonmodifiable intrinsic and extrinsic risk factors. Prior to the conference, an extensive literature review was conducted to analyze and summarize the state of the science in the area of unavoidable PU development and items were developed. An interactive process was used to gain consensus based on these items among stakeholders of various organizations and audience members. Consensus was reached when 80% agreement was obtained. The group reached consensus that unavoidable PUs do occur. Consensus was also obtained in areas related to cardiopulmonary status, hemodynamic stability, impact of head-of-bed elevation, septic shock, body edema, burns, immobility, medical devices, spinal cord injury, terminal illness, and nutrition.

Pressure ulcers (PUs) are a very common health problem. Nurses in clinical practice collect large volumes of PU data every day, which must be recorded and used appropriately. With this in mind, this research explored how PU data is recorded and used in clinical settings. In addition, the magnitude of PU problem in Jordan was assessed. A mixed methods approach was utilised to address the research objectives. As a first stage, Tissue Viability Nurses (TVNs) in the UK from the Tissue Viability Society (TVS) and the National Health Service (NHS) were asked to complete an online questionnaire. Subsequently, a number of them (n=16) participated in semi-structured interviews in order to complement and explain the questionnaire responses. In Jordan, a cross sectional point prevalence survey employing the European Pressure Ulcer Advisory Panel (EPUAP) methodology was conducted to measure the prevalence rate of pressure ulcers. Integration between the questionnaire and interview results occurred on a number of different occasions. The questionnaire findings (n=167) showed there to be a difference in the prevalence rate between the primary and secondary settings (X2=20.59, df=3, p<0.001), with an overall mean of 7%, and a range of 0.5-25%. It was also found that the prevalence survey and clinical audits (71.8%, n=120), conducted annually (40.9%, n=67) or monthly (22.6%, n=37) by TVNs (63.6%, n=105), were the most common methods of calculating the reported prevalence rate. The field notes taken during the interviews, which were analysed thematically using the template analysis approach, highlighted that PU audits can be conducted via additional methods to those reported in the questionnaires. These include: actual audits where patients are inspected by TVNs or link nurses; relying on the nurses to complete audit forms; and, finally, reviewing the recording systems to generate reports. Moreover, the questionnaire findings showed that PU data is mainly recorded on a combination system (48.2%, n=79), or in some cases recorded on a computerised system (9.8%, n=16). The interviews again complement these findings by expanding that PU data can be recorded, reported and referred using paper, electronic or combination records. The advantages and disadvantages of each recording system were explored and defined into separate themes. Additionally, conducting a PU audit requires certain tools. It was clear from the questionnaire that the Waterlow risk assessment scale (RAS) (88.8%, n=142), and the EPUAP classification tool (83%, n=132) were the most commonly used in the UK. Regarding the uses of PU data, the interview findings showed that there are several. For example, it can be used to generate reports about PU in a given organisation, and these reports can be used to provide feedback to the nurses, TVNs, and management, and could also prompt decisions about purchasing equipment, employing nurses or offering training in areas where there are high levels of PU cases. Prevalence and incidence data, in particular, can be used to evaluate intervention, to monitor quality, to ensure best practice is provided, as educational tools for conducting audits, and for initiating safeguarding and investigating procedures. Despite all these potential uses, however, some interviewees think that some PU data, especially the prevalence data, is useless and difficult to capture, and that incidence data is more reliable and powerful. In Jordan, the researcher examined the skin of all inpatients aged eighteen or above, except patients in the emergency, day care and maternity wards, in both university and general hospitals. This yielded a sample of 302 patients. Any PU identified was graded according to the EPUAP grading scale (GS). The risk of PU development was assessed using the Braden scale. Data was also collected on preventive measures used in the clinical setting. Of the patients examined, 11.9% (n=36) had PU grade 1-4 (excluding grade 1: 6.6%, n=20). Interestingly, this PU prevalence rate is lower than that published in most studies which have employed the same methodology but it is thought that the differences in age and frailty in the Jordanian sample, compared with most others, could explain the low prevalence. The sacrum and heel were the most commonly affected sites (55.6%, n=20). Grade one was the most common grade (44.4%, n=16) and 85 (28.1%) patients were considered at risk of developing pressure damages. Despite the relatively low prevalence, very few patients at risk received adequate prevention measures (16.5%, n=14), and there is therefore a need to raise awareness of the need for PU prevention in Jordan.

With the prolonged lifespan of the average person, the number of hospital stays have increased. Currently, pressure ulcers are one of the most severe complications associated with prolonged hospital stay. The protocol in today€™s hospital is to rotate bedridden patients once every two hours to prevent pressure ulcers. This puts a strain on attending nurses as the risk of a pressure ulcer for a patient is not universal and therefore, a universal preventative protocol is not the most effective solution. This thesis describes the circuit design and physical implementation of a device to address the issue of pressure ulcers. The device has the form factor of a patch to be placed on specific, at risk areas of the human body. The device was designed and prototyped first on a rigid structure and then on a flexible printed circuit board substrate. A calibration procedure was developed to reduce part to part variability inherent to the pressure sensor. The resistance measurement was achieved through a novel approach including the use of a timer removing the need for an analog-to-digital converter. A seven hour experiment was conducted with live, animal subjects to measure the pressure and temperature of at risk areas of the body. The results of the experiment successfully prove the fundamental approach outlined in this thesis and justify continued research and refinement into the product design.

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.

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.

Although pressure ulcer (PrU) development is now generally considered an indicator for quality of care, questions and concerns about situations in which they are unavoidable remain. Considering the importance of this issue and the lack of available research data, in 2010 the National Pressure Ulcer Advisory Panel (NPUAP) hosted a multidisciplinary conference to establish consensus on whether there are individuals in whom pressure ulcer development may be unavoidable and whether a difference exists between end-of-life skin changes and pressure ulcers. Thirty-four stakeholder organizations from various disciplines were identified and invited to send a voting representative. Of those, 24 accepted the invitation. Before the conference, existing literature was identified and shared via a webinar. A NPUAP task force developed standardized consensus questions for items with none or limited evidence and an interactive protocol was used to develop consensus among conference delegates and attendees. Consensus was established to be 80% agreement among conference delegates. Unanimous consensus was achieved for the following statements: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive. Consensus was not obtained on the practicality or standard of turning patients every 2 hours nor on concerns surrounding the use of medical devices vis-à-vis their potential to cause skin damage. Research is needed to examine these issues, refine preventive practices in challenging situations, and identify the limits of prevention.

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved in pressure ulcer care and prevention have a clear understanding of the definitions and implications of prevalence and incidence rates. In addition, an appreciation of the potential difficulties in conducting prevalence and incidence studies and the possible explanations for differences between studies are important. An international group of experts has worked to produce a consensus document that aims to delineate and discuss the important issues involved, and to provide guidance on approaches to conducting and interpreting pressure ulcer prevalence and incidence studies. The group's main findings are summarised in this paper.

No description available.

No / The establishment of a correct diagnosis links care to established guidelines and underpins all subsequent therapeutic activity. Problems can arise when definitions of disease overlap, as is the case with diabetic foot ulceration and pressure ulcers on the foot occurring in people with diabetes. In such cases, clinicians must ensure that patients receive a care bundle that recognises both the wound causation (pressure and shear) and the underlying pathology (diabetic neuropathy, potential foot architecture disruption and ischaemia). All patients with diabetes that have foot ulceration, irrespective of wound aetiology should, therefore, be seen by the multidisciplinary diabetic foot team. Care can then be optimised to include appropriate assessments, including assessment of peripheral perfusion, correct offloading, appropriate diabetic management, and general foot and skin care.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 195-207). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;