Predictive validity of the Braden Scale,Norton Scale,and Waterlow Scale in the Czech Republic

The aim of this study was to determine the predictive validity of the Braden, Norton, and Waterlow scales in 2 long‐term care departments in the Czech Republic. Assessing the risk for developing pressure ulcers is the first step in their prevention. At present, many scales are used in clinical practice, but most of them have not been properly validated yet (for example, the Modified Norton Scale in the Czech Republic). In the Czech Republic, only the Braden Scale has been validated so far. This is a prospective comparative instrument testing study. A random sample of 123 patients was recruited. The predictive validity of the pressure ulcer risk assessment scales was evaluated based on sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve. The data were collected from April to August 2014. In the present study, the best predictive validity values were observed for the Norton Scale, followed by the Braden Scale and the Waterlow Scale, in that order. We recommended that the above 3 pressure ulcer risk assessment scales continue to be evaluated in the Czech clinical setting.     

压疮评估对肿瘤骨转移患者压疮预防的效果评价

目的：为肿瘤骨转移患者压疮预防的方法进行总结评价以达到对临床肿瘤压疮进行指导。方法：采用改良后的诺顿评估表（信度0．80,效度0．84）作为压疮易患患者评估工具。评估内容包括患者年龄、身体状况、意识、活动能力、运动受限情况、疼痛、皮肤情况、大小便失禁、饮食、进食能力、口腔情况、牙齿及患者血色素、蛋白等资料。评估时间从患者人院开始,对30例肿瘤全身多处骨转移患者进行评估,有预见性、计划性,针对性及个体化对患者制订护理计划及措施,并督促实施,对效果进行评价分析。结果：≤25分高危险性患者（难以避免）发生率50％,26～29分中度危险性患者（可避免）发生率0,≥30分低危险性患者发生率14．2％。效果评价：压疮预防评估对肿瘤骨转移患者压疮的预防是有效的,压疮评估有助于规范护理行为和护理管理;通过分析找出护理过程中的薄弱环节,以利于指导临床工作。     

高龄患者发生压疮的风险评估与预防

目的评估高龄患者发生压疮的风险性,并针对其风险进行分层护理干预,以期减少压疮的发生。方法对127例高龄患者运用Braden量表进行评分,评估其压疮发生的风险性,并按危险程度分组,分别采取针对性护理措施,观察患者压疮发生的情况。结果人院24h内,127例患者Braden量表总评分为6～18分,平均（11．1±3．5）分,其中高危组患者最多,占37．8％;极高危组占18．1％;低危组占21．3％。经过护理干预后,患者在住院第7、28天极高危和高危组患者明显减少,且Braden评分提高。127例患者中共有7例在院内发生压疮,其中6例发生在人院2周内,1例在人院4周后发生,经治疗均痊愈。结论Braden量表预测显示高龄患者有发生压疮高危险性;通过针对性护理干预可显著降低压疮的发生。     

压疮高危患者临床特征及危险因素分析

目的分析压疮高危患者的临床特征、管理现状及高危患者压疮发生的影响因素,探讨切实的压疮预防对策。方法采用压疮危险因素评估表筛选压疮高惫患者,并对其临床特征、压疮发生的危险因素和管理现状进行分析。结果2007年3-12月共有315例压疮高危患者,以ICU分布最多,占32．4％,其次为神经外科,占18．74％;初评分（16．91±2．29）分;压疮高危期持续时间（13．00±18．00）d;315例压疮高危患者中共发生压疮19例。高危期持续时间是高危患者发生压疮的危险因素,意识清醒、扶助行走、体温正常和压疮终评分是发生压疮的保护因素。压疮高危患者管理中仍存在忽视高危患者家属教育及预防措施落实、记录不全等问题。结论重视ICU等压疮高危高发科室和压疮高危持续期长患者的管理,根据压疮发生的危险因素科学定义难免压疮,建立护理会诊制度和压疮护理指南等规范压疮高危患者的过程管理,可有效预防和减少压疮的发生。     

两种压疮危险评估表预测效果的比较研究

[目的]测量并比较Waterlow压疮危险评估表和Braden修订版压疮危险评估表的预测效果。[方法]分别用两种评估表对332例病人进行评分，分析不同临界值时敏感性、特异性、阳性预测价值、阴性预测价值。[结果]Braden修订版压疮危险评估表以19分为临界值、Waterlow压疮危险评估表以15分为临界值时敏感性、特异性、阳性预测价值、阴性预测价值等指标间能达到较好的平衡，且Braden修订版压疮危险评估表各指标均大于Waterlow压疮危险评估表；Braden修订版压疮危险评估表的ROC曲线下面积略高于waterlow压疮危险评估表。[结论]Braden修订版压疮危险评估表和Waterlow压疮危险评估表都有较好的预测效果，尤其以Braden修订版效果更优。     

OH压疮评估表应用于恶性肿瘤患者的信效度分析

目的：引进OH压疮评估表,测定其中文版信度和效度。方法使用OH压疮评估表对134例恶性肿瘤患者进行压疮评定,对测定结果进行信度、效度分析。结果 OH压疮评估表的Cronbach’s α信度系数为0.694,Spearman相关性系数为0.444～0.697,呈显著相关,具有良好的内部一致性信度;因子分析产生的2个公因子方差累计贡献率为65.577%,各项目均有较高的因子载荷。结论 OH压疮评估表具有较好的信度、效度,能够用于恶性肿瘤患者压疮的评定。     

两种压疮危险评估表预测效果的比较研究

[目的]测量并比较Waterlow压疮危险评估表和Braden修订版压疮危险评估表的预测效果。[方法]分别用两种评估表对332例病人进行评分,分析不同临界值时敏感性、特异性、阳性预测价值、阴性预测价值。[结果]Braden修订版压疮危险评估表以19分为临界值、Waterlow压疮危险评估表以15分为临界值时敏感性、特异性、阳性预测价值、阴性预测价值等指标间能达到较好的平衡,且Braden修订版压疮危险评估表各指标均大于Waterlow压疮危险评估表;Braden修订版压疮危险评估表的ROC曲线下面积略高于Waterlow压疮危险评估表。[结论]Braden修订版压疮危险评估表和Waterlow压疮危险评估表都有较好的预测效果,尤其以Braden修订版效果更优。     

压疮研究进展

对不同病人群体的压疮发生率、病因与发生机制、危险因素评估方法、压疮的护理进行了综述。     

压疮研究进展

对不同病人群体的压疮发生率、病因与发生机制、危险因素评估方法、压疮的护理进行了综述。     

老年压疮高危患者营养风险筛查与评估

在不同的临床环境中,压疮的发生率存在着较大的差异,调查显示,急性护理发生率为0.4%～38.0%,长期护理发生率为2.2%～23.9%,家庭护理发生率为17.0%[1]。由于压疮愈合期较长,治疗难度较大,老年人抵抗力较差,很容易发生感染,因此一旦恶化会加重患者和家属的精神与经济负担[2]。     

Braden压疮预防措施钟表在压疮风险患者中应用效果分析

目的评价Braden压疮预防措施钟表在压疮风险患者中应用的效果。方法 2012年10月~2013年9月在我院住院期间压疮Braden评分≤16分的成人压疮风险患者682例进行观察,2012年10月~2013年3月302例患者作为对照组,按照《基础护理学》第四版为指导对压疮预防实施常规护理;2013年4月~9月380例患者作为实验组,以《成人压疮预测和预防实践指南》为依据制作的Braden压疮预防措施钟表实施护理。比较两组压疮风险患者压疮发生率。结果 Braden压疮预防措施钟表实施后,压疮风险患者院内获得性压疮发生率降低(P0.05)。结论 Braden压疮预防措施钟表的应用,可有效降低院内压疮发生率,规范了护士对不同分值压疮风险患者采取的护理措施,该表内容简洁、使用方便,可应用于临床护理。     

神经内科老年患者压疮危险因素分析及相关护理措施

目的探讨神经内科老年患者压疮的危险因素和护理措施。方法选取神经内科收治的老年患者675例为研究对象,应用自制压疮危险度评估量表动态评估压疮发生的危险性,并根据不同危险度实施护理干预,应用多因素Logistic回归分析筛选出独立危险因素。结果护理干预包括减少受压、皮肤护理、营养支持和健康宣教。观察期内,82例患者发生压疮,其中Ⅰ期压疮61例(74.3%),Ⅱ期压疮18例(22.0%),Ⅲ期压疮3例(3.7%)。多因素Logistic回归分析结果显示,意识障碍、活动能力和移动能力是压疮的独立危险因素(P0.01)。结论意识障碍、活动能力和移动能力降低是影响神经内科老年患者压疮发生的危险因素,应结合压疮危险度动态评估结果制定预防措施。     

修订版跌倒效能量表在我国老年人群中的测试研究

目的测试修订版跌倒效能量表的信度和效度,确定其应用价值,为我国老年人跌倒效能的测评提供有效工具。方法翻译国外的修订版跌倒效能量表,将所形成的中文版量表在广州市3所三级医院118名住院病人、2个社区及1所福利院142名社区老年人,共260名60岁及以上老年人中使用,评价其信度和效度。结果中文版跌倒效能量表简便、易测,具有很高的信度(α=0.9774)和较高的效度。结论中文版跌倒效能量表具有较好的可信度和可靠性,在测定老年人跌倒效能方面具有较高的区分度,有一定的实用价值,适合在我国老年人群中推广使用。     

A risk assessment scale for the prediction of pressure sore development: reliability and validity

BACKGROUND: The ability to assess the risk of a patient developing pressure sores is a major issue in pressure sore prevention. Risk assessment scales should be valid, reliable and easy to use in clinical practice. AIM: To develop further a risk assessment scale, for predicting pressure sore development and, in addition, to present the validity and reliability of this scale. METHODS: The risk assessment pressure sore (RAPS) scale, includes 12 variables, five from the re-modified Norton scale, three from the Braden scale and three from other research results. Five hundred and thirty patients without pressure sores on admission were included in the study and assessed over a maximum period of 12 weeks. Internal consistency was examined by item analysis and equivalence by interrater reliability. To estimate equivalence, 10 pairs of nurses assessed a total of 116 patients. The underlying dimensions of the scale were examined by factor analysis. The predictive validity was examined by determination of sensitivity, specificity and predictive value. RESULTS: Two variables were excluded as a result of low item-item and item-total correlations. The average percentage of agreement and the intraclass correlation between raters were 70% and 0.83, respectively. The factor analysis gave three factors, with a total variance explained of 65.1%. Sensitivity, specificity and predictive value were high among patients at medical and infection wards. CONCLUSION: The RAPS scale is a reliable scale for predicting pressure sore development. The validity is especially good for patients undergoing treatment in medical wards and wards for infectious diseases. This indicates that the RAPS scale may be useful in clinical practice for these groups of patients. For patients undergoing surgical treatment, further analysis will be performed.     

Development of the Persian version of the Modified Modified Ashworth Scale: translation,adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity

Purpose: Development of the Persian version of the Modified Modified Ashworth Scale (MMAS), and to investigate the interrater and intrarater reliability of the Persian MMAS when used to quantify elbow flexor spasticity in patients after stroke. Methods: The Persian MMAS was developed by the forward and backward translation procedure, a final review by an expert committee, and testing for acceptability and the clarity of item wording so that the scale could be used by Persian-speaking examiners. Psychometric testing included interrater and intrarater reliability. Elbow flexor spasticity was examined by two raters in 30 patients after stroke twice on two occasions using the Persian MMAS. The weighted κ was used for the statistical analysis. Results: The interrater and intrarater reliability was very good for the Persian MMAS (weighted κ: 0.81–0.91; 95% CI 0.68–0.98) with statistically significant agreement between raters and within raters (all p < 0.001). Conclusions: The Persian version of the MMAS was successfully developed. The Persian MMAS showed very good interrater and intrarater reliability in patients with elbow flexor spasticity after stroke. The results support the use of the Persian version of the MMAS both in clinical and research settings.

Implications for Rehabilitation

• The new Modified Modified Ashworth Scale (MMAS) is a clinical measure of spasticity, which was published in 2006 by Ansari et al.

• The MMAS was successfully translated and adapted into a Persian version. The Persian version of the MMAS showed very good interrater and intrarater reliability comparable to the original English version. The Persian version of the MMAS can be recommended for the assessment of muscle spasticity in Persian-speaking countries.

     

The modified Norton scale and the nutritional state

The Norton scale was devised in 1960 as an additive scale to facilitate the prediction and prevention of pressure sore development. The scale has been used both in the original version and in modified versions both in practice and as an instrument in nursing research. In a previous study the reliability had been analysed. The present investigation comprises 501 patients who were examined weekly by registered nurses with regard to the variables in a modified Norton scale and on admission with regard to the nutritional status. There are significant correlations between the variables establishing the modified Norton scale and the different criteria included in the nutritional assessment form.     

风险管理策略在预防压疮中的应用

[目的]探讨对高危皮肤病人实施风险管理的实用价值.[方法]采用风险管理策略,制定压疮风险管理流程,对皮肤风险进行评估.[结果]98例病人中,96例未发生压疮,2例系院外转入,采用风险管理策略后,压疮痊愈出院.[结论]实施风险管理可增强护理人员的风险意识,是杜绝或减少压疮发生的有效措施.     

Braden量表在骨科压疮预防中的应用

目的：预防骨科患者压疮（pressure ulcer）发生。方法：运用Braden量表对骨科住院患者进行压疮危险因素的评估计分,采取分层护理和干预措施,实行层层监控,把压疮护理管理纳入日常考核中。结果：该院可避免压疮发生率为零。结论：Braden量表的使用,提高了预防压疮的有效性,提高了护士预防压疮的主动性,促进了医患关系的和谐发展。