共查询到20条相似文献，搜索用时 352 毫秒
1.
Anke Scheel-Sailer Angela Frotzler Gabi Mueller Simon Annaheim René Michel Rossi Siegfried Derler 《Journal of tissue viability》2017,26(2):89-94
Aim of the study
To examine biophysical skin properties in the sacral region in spinal cord injury (SCI) patients suffering from a grade 1 pressure ulcer (PU) defined as non-blanchable erythema (SCI/PU), SCI patients in the post-acute phase (SCI/PA) and able-bodied participants (CON). Also, for SCI/PU patients, both the affected skin and healthy skin close to the PU were examined.Study design
An experimental controlled study with a convenience sample.Setting
A Swiss acute care and rehabilitation clinic specializing in SCIs.Materials and methods
We determined hydration, redness, elasticity and perfusion of the unloaded skin in the sacral region of 6 SCI/PU patients (affected and healthy skin), 20 SCI/PA patients and 10 able-bodied controls. These measures were made by two trained examiners after the patients were lying in the supine position.Results
The affected skin of SCI/PU patients showed elevated redness: median 595.5 arbitrary units (AU) (quartiles 440.4; 631.6) and perfusion: 263.0 AU (104.1; 659.4), both significantly increased compared to the healthy skin in SCI/PA patients and CON (p < 0.001). Similarly, healthy skin of SCI/PA patients showed elevated redness (p = 0.016) and perfusion (p < 0.001) compared to CON. On the other hand, differences in redness and perfusion between the affected and unaffected skin in SCI/PU patients were not significant. The results for skin hydration and skin elasticity were similar in all groups.Conclusions
Skin perfusion and redness were significantly increased in grade 1 PUs and for healthy skin in both SCI/PA patients and CON participants; thus, these are important in understanding the pathophysiology of PUs and skin in SCI. 相似文献2.
Christopher Heard Wendy Chaboyer Vinah Anderson Brigid M. Gillespie Jennifer A. Whitty 《Journal of tissue viability》2017,26(1):79-84
Background
Negative pressure wound therapy (NPWT) is increasingly used prophylactically following surgery despite limited evidence of clinical or cost-effectiveness.Objective
To evaluate whether NPWT is cost-effective compared to standard care, for the prevention of surgical site infection (SSI) in obese women undergoing elective caesarean section, and inform development of a larger trial.Methods
An economic evaluation was conducted alongside a pilot randomised controlled trial at one Australian hospital, in which women were randomised to NPWT (n = 44) or standard care (n = 43). A public health care provider perspective and time horizon to four weeks post-discharge was adopted. Cost-effectiveness assessment was based on incremental cost per SSI prevented and per quality-adjusted life year (QALY) gained.Results
Patients receiving NPWT each received health care costing AU$5887 (±1038) and reported 0.069 (±0.010) QALYs compared to AU$5754 (±1484) and 0.066 (±0.010) QALYs for patients receiving standard care. NPWT may be slightly more costly and more effective than standard care, with estimated incremental cost-effectiveness ratios (ICERs) of AU$1347 (95%CI dominant- $41,873) per SSI prevented and AU$42,340 (95%CI dominant- $884,019) per QALY gained. However, there was considerable uncertainty around these estimates.Conclusions
NPWT may be cost-effective in the prophylactic treatment of surgical wounds following elective caesarean section in obese women. Larger trials could clarify the cost-effectiveness of NPWT as a prophylactic treatment for SSI. Sensitive capture of QALYs and cost offsets will be important given the high level of uncertainty around the point estimate cost-effectiveness ratio which was close to conventional thresholds.Australian and New Zealand trial registration number
ACTRN12612000171819. 相似文献3.
M. Schario T. Tomova-Simitchieva A. Lichterfeld H. Herfert G. Dobos N. Lahmann U. Blume-Peytavi J. Kottner 《Journal of tissue viability》2017,26(2):150-155
Background
Pressure Ulcers (PUs) are a severe form of skin and soft tissue lesions, caused by sustained deformation. PU development is complex and depends on different factors. Skin structure and function change during prolonged loading on PU predilection sites and surfaces being in direct contact with skin are likely to have an impact as well. Little is known about the influence of fabrics on skin function under pressure conditions.Objectives
To investigate skin responses to sustained loading in a sitting position and possible differences between two fabrics.Methods
Under controlled conditions 6 healthy females (median age 65.0 (61.0–67.8) years) followed a standardized immobilization protocol of a sitting position for 45 min on a spacer and on a cotton fabric. Before and after the loading period skin surface temperature, stratum corneum hydration, transepidermal water loss (TEWL), erythema, skin elasticity and ’relative elastic recovery‘ were measured at the gluteal areas.Results
A 45 min sitting period caused increases of skin surface temperature and erythema independent of the fabric. Loading on spacer fabric showed a two times higher increase of TEWL compared to cotton. Stratum corneum hydration showed slight changes after loading, skin elasticity and ’relative elastic recovery’ remained stable.Conclusions
Sitting on a hard surface causes skin barrier changes at the gluteal skin in terms of stratum corneum hydration and TEWL. These changes are influenced by the fabric which is in direct contact to the skin. There seems to be a dynamic interaction between skin and fabric properties especially in terms of temperature and humidity accumulation and transport. 相似文献4.
5.
J. Hosking 《Journal of tissue viability》2017,26(3):189-195
Purpose
Custom contouring techniques are effective for reducing pressure ulcer risk in wheelchair seating. These techniques may assist the management of pressure ulcer risk during sleep for night time postural management.Objectives
To investigate the effectiveness of custom contoured night time postural management components against planar support surfaces for pressure ulcer risk measures over the heels.Method
Supine posture was captured from five healthy participants using vacuum consolidation and 3-dimensional laser scanning. Custom contoured abduction wedges were carved from polyurethane and chipped foams. Pressure mapping and the visual analog scale were used to evaluate the effectiveness of the contoured foams in reducing pressure and discomfort under the posterior heel against standard planar support surfaces.Results
Custom contoured shapes significantly reduced interface pressures (p < 0.05) and discomfort scores (p < 0.05) when compared to planar support surfaces. Polyurethane foam was the most effective material but it did not differ significantly from chipped foam. Linear regression revealed a significant relationship between the Peak Pressure Index and discomfort scores (r = 0.997, p = 0.003).Conclusions
The findings of this pilot study suggested that custom contoured shapes were more effective than planar surfaces at reducing pressure ulcer risk surrogate measures over the posterior heels with polyurethane foam being the most effective material investigated. It is recommended that Evazote foam should not be used as a support surface material for night time postural management. 相似文献6.
Manuel Escamilla Cardeñosa Gabriel Domínguez-Maldonado Antonio Córdoba-Fernández 《Journal of tissue viability》2017,26(2):138-143
Objectives
The aim of this study was to analyse the efficacy and safety of using platelet rich in growth factor (PRGF) as a local treatment for venous ulcers.Methods
In a clinical trial 102 venous ulcers (58 patients) were randomly assigned to the study group (application of PRGF) or the control group (standard cure with saline). For both groups the healed area was calculated before and after the follow up period (twenty-four weeks). The Kundin method was used to calculate the healed area (Area = Length × Width × 0.785). Pain was measured at the start and end of treatment as a secondary variable for each group by record obtained by means of self-evaluation visual analogue scale.Results
The average percentage healed area in the platelet rich plasma group was 67.7 ± 41.54 compared to 11.17 ± 24.4 in the control group (P = 0.001). Similarly, in the experimental group a significant reduction in pain occurred on the scale (P = 0.001). No adverse effects were observed in either of the two treatment groups.Conclusions
The study results reveal that application of plasma rich in platelets is an effective and safe method to speed up healing and reduce pain in venous ulcers. 相似文献7.
8.
I.C. Chetter A.V. Oswald M. Fletcher J.C. Dumville N.A. Cullum 《Journal of tissue viability》2017,26(2):103-107
Background
Surgical wounds healing by secondary intention (SWHSI) are often difficult and costly to treat. There is a dearth of clinical and research information regarding SWHSI. The aim of this survey was to estimate the prevalence of SWHSI and to characterise the aetiology, duration and management of these wounds.Methods
Anonymised data were collected from patients with SWHSI receiving treatment in primary, secondary and community settings. Over a two weeks period, data were collected on the patients, their SWHSI, clinical and treatment details.Results
Data were collected from 187 patients with a median age of 58.0 (95% CI = 55 to 61) years. The prevalence of SWHSI was 0.41 (95% CI = 0.35 to 0.47) per 1000 population. More patients with SWHSI were being treated in community (109/187, 58.3%) than in secondary (56/187, 29.9%) care settings. Most patients (164/187, 87.7%) had one SWHSI and the median duration of wounds was 28.0 (95% CI = 21 to 35) days. The most common surgical specialities associated with SWHSI were colorectal (80/187, 42.8%), plastics (24/187, 12.8%) and vascular (22/187, 11.8%) surgery. Nearly half of SWHSI were planned to heal by secondary intention (90/187, 48.1%) and 77/187 (41.2%) were wounds that had dehisced. Dressings were the most common single treatment for SWHSI, received by 169/181 (93.4%) patients. Eleven (6.1%) patients were receiving negative pressure wound therapy.Conclusions
This survey provides a previously unknown insight into the occurrence, duration, treatment and types of surgery that lead to SWHSI. This information will be of value to patients, health care providers and researchers. 相似文献9.
Background
The variation in the management of venous leg ulceration in the UK is partly attributable to an uncertain clinical environment but the quality of judgements is influenced by the how well nurses' confidence and accuracy are aligned.Objectives
To assess UK community nurses' confidence in the accuracy of their diagnostic judgements and treatment choices when managing venous leg ulceration.Design
Judgement Analysis.Setting
UK community and primary care nursing services.Participants
18 community non-specialist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses.Methods
Using judgement analysis methods, 18 community non-specialist nurses and 18 community tissue viability specialist nurses made diagnoses and treatment judgements about compression therapy for 110 clinical scenarios and indicated their confidence for each judgement. An expert panel made consensus judgements for the same scenarios and these judgements were used as a standard against which to compare the participants. Confidence analysis was used to assess the nurses' confidence about their diagnostic judgements and treatment choices.Results
Despite being very experienced, both non-specialist nurses' and specialist tissue viability nurses' levels of confidence were not well calibrated with their levels of accuracy.Conclusion
The results of this study are important as errors resulting from both over and under-confidence at the diagnostic phase of management may influence treatment choices, and thus increase the chances of treatment error. 相似文献10.
Ana Belén Moya-Suárez José Miguel Morales-Asencio Marta Aranda-Gallardo Margarita Enríquez de Luna-Rodríguez José Carlos Canca-Sánchez 《Journal of tissue viability》2017,26(4):260-270
Aim of the study
The main objective of this work is the development and psychometric validation of an instrument to evaluate nurses' adherence to the main recommendations issued for preventing pressure ulcers.Material and methods
An instrument was designed based on the main recommendations for the prevention of pressure ulcers published in various clinical practice guides. Subsequently, it was proceeded to evaluate the face and content validity of the instrument by an expert group. It has been applied to 249 Spanish nurses took part in a cross-sectional study to obtain a psychometric evaluation (reliability and construct validity) of the instrument. The study data were compiled from June 2015 to July 2016.Results
From the results of the psychometric analysis, a final 18-item, 4-factor questionnaire was derived, which explained 60.5% of the variance and presented the following optimal indices of fit (CMIN/DF: 1.40 p < 0.001; GFI: 0.93; NFI: 0.92; CFI: 0.98; TLI: 0.97; RMSEA: 0.04 (90% CI 0.025–0.054).Conclusions
The results obtained show that the instrument presents suitable psychometric properties for evaluating nurses' adherence to recommendations for the prevention of pressure ulcers. 相似文献11.
Julieta M.F. Chacon Leila Blanes Luis G. Borba Luis R.M. Rocha Lydia M. Ferreira 《Journal of tissue viability》2017,26(2):108-112
Aim
to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time.Materials and methods
Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses.Results
The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834).Conclusion
The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37. 相似文献12.
13.
Regis Ernest Mendame Ehya Yong Zhao Xun Zheng Wanrong Yi Guy-Armel Bounda Zonghuan Li Weidong Xiao Aixi Yu 《Journal of tissue viability》2017,26(4):282-288
Background
Perforator flap techniques with conventional wound dressing have being extensively used in the management of soft-tissue defects. However; the flap's survival rate is not always guaranteed and the wound healing time always long. The aim of this study was to investigate the clinical effectiveness use of a freshly transplanted perforator flap in conjunction with Vacuum-assisted closure (VAC) for better clinical outcomes.Methods
A prospective, randomized, effectiveness study comparing the clinical outcomes of VAC versus traditional wrap and bandages for the treatment of open wounds that required hospital admission and operative debridement using perforator flaps, was carried out from March 1, 2014 to March 31, 2016 at Wuhan University Zhongnan Hospital. Fifty-one eligible patients were randomized into two groups; study group (perforator flaps covered by VAC) and control group (perforator flaps covered by traditional wrap and bandages). The measured clinical endpoints included the time of the first post-operative dressing change, pain visual analogical scale, perforator flap infection rate, 95% perforator flap healing time and percentage of survived perforator flap.Results
There was no statistically significant difference in the demographic profiles in the two cohorts. There were statistically significant differences in the clinical endpoints in the two groups (p < 0.001; p < 0.05, Table 2).Conclusions
In summary, VAC combining with perforator flap technique, can diminish accumulated exudation of the transferring flap, protect against postoperative infection, prolong the interval between perforator flap relocation and first postoperative dressing change, decrease pain during removal of dressing, increase perforator flap survival rate, and shorten wound healing time, with a good aesthetic outcome, a good mobility and a satisfactory therapeutic result. 相似文献14.
Susanne Coleman E. Andrea Nelson Peter Vowden Kathryn Vowden Una Adderley Lesley Sunderland Judy Harker Tracy Conroy Sarah Fiori Nicola Bezer Emma Holding Leanne Atkin Emma Stables Jo Dumville Sue Gavelle Heidi Sandoz Keith Moore Tina Chambers Jane Nixon 《Journal of tissue viability》2017,26(4):226-240
Background
At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment.Aim
To establish a generic wound assessment MDS to underpin clinical practice.Method
The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS.Results
The literature review identified 24 papers that contained criteria which might be considered as part of generic wound assessment. From these papers 68 potential assessment items were identified and the expert group agreed that 37 (relating to general health information, baseline wound information, wound assessment parameters, wound symptoms and specialists) should be included in the MDS.Discussion
Using a structured approach we have developed a generic wound assessment MDS to underpin wound assessment documentation and practice. It is anticipated that the MDS will facilitate a more consistent approach to generic wound assessment practice and support providers and commissioners of care to develop and re-focus services that promote improvements in wound care. 相似文献15.
Andrea Lichterfeld-Kottner Elisabeth Hahnel Ulrike Blume-Peytavi Jan Kottner 《Journal of tissue viability》2017,26(1):6-19
Background
Skin conditions and dermatological diseases associated with advanced age (e.g. fungal infection, dry skin and itch) receive increasingly attention in clinical practice and research. Cost and economic evaluations are important sources to inform priority setting and ressource allocation decisions in healthcare. The economics of skin conditions in aged populations has not been systematically reviewed so far.Objectives
The aim of this mapping review was to summarize the economic evidence of selected skin conditions in the aged (65 + years).Methods
A mapping literature review and evidence summary was conducted. Searches were conducted in data bases Medline and Embase via OVID. Cinahl was searched using EBSCO. References lists of potential eligible studies, reviews, guidelines or other sources were screened for additional literature. For evaluation of methodological quality of full economic analyses the Consensus on Health Economic Criteria (CHEC) checklist was used.Results
Database searches resulted in 1388 records. A total of 270 articles were read in full-text. Thirty-five publications were finally included in the data analysis reporting 38 economic analyses. Ten cost of illness analyses and 26 cost-effectiveness analyses reporting about pressure ulcers, skin tears, pressure ulcers, incontinence associated dermatitis and intertrigo/contact dermatitis/candidiasis treatment and prevention and onychomycosis testing were identified. Limited evidence indicated that low air loss beds were more cost effective than standard beds for prevention of pressure ulcers. Standardized skin care regimens seem to lower the incidence of pressure ulcers, skin tears and IAD but a cost saving effect was not always observed.Conclusions
Findings of this mapping review indicate that there is a paucity of high quality evidence regarding the economic impact of age-associated skin conditions and diseases. Substantial heterogeneity in terms of study design, evaluation perspective, time period, and way of cost estimation was identified. Because of the overall low methodological quality clear cut conclusions cannot be drawn. Robust and large scales economic evaluations about skin conditions and disease in aged populations are needed in the future. 相似文献16.
Donata Maria de Souza Pellegrino Julieta Maria Ferreira Chacon Leila Blanes Lydia Masako Ferreira 《Journal of tissue viability》2017,26(4):241-245
Objective
To identify the incidence and prevalence of pressure injuries (PIs) in children admitted to hospitals in the city of São Paulo, and assess the association between sociodemographic and clinical characteristics with hospital-acquired pressure injuries (HAPIs).Materials and methods
A total of 543 children were evaluated, and their sociodemographic and clinical data were recorded. Student's t, Wilcoxon, chi-square, and Fisher's exact tests were used to assess associations between risk factors and the occurrence of HAPIs. The proportion comparison test was used to assess the difference between the prevalence assessments performed at 2 different time points.Results
The mean prevalence was 7.1% and the mean incidence was 21.8%. Stage 1 PIs totaled 55% of the occurrences, followed by deep tissue injury, stage 2 PIs, and unstageable PIs. Twenty-five percent of PIs were associated with the use of medical devices. The sociodemographic characteristics significantly associated with HAPIs were white skin color and the absence of a parent or guardian as the patient's companion, whereas the clinical characteristics most significantly associated with HAPIs were hospitalization time greater than 30 days, enteral nutrition pathway, a chronic illness of the central nervous system, vasomotor medication, and mechanical ventilation (p < 0.05).Conclusion
The prevalence of PIs among pediatric patients admitted to hospitals in São Paulo was similar to, and the incidence was higher than the reported international rates. Patients not accompanied by a parent, hospitalized for longer periods and in critical condition were those most affected by PIs. 相似文献17.
Naomi Fearns Stephen Heller-Murphy Joanna Kelly Jenny Harbour 《Journal of tissue viability》2017,26(4):254-259
Background
Chronic wounds are a major health burden and have a severe impact on well-being. This synthesis of qualitative studies was undertaken to inform a health technology assessment of antimicrobial wound dressings. It aimed to explore patients' experiences of chronic wounds and determine improvements for clinical practice.Method
Inclusion criteria included use of qualitative methods, and English language publication. Databases searched included MEDLINE (Ovid), MEDLINE in Process (Ovid), EMBASE (Ovid), CINAHL (EBSCOHost), and PsychInfo (EBSCOHost). Searches were limited to 1990–2014. The method of analysis was Framework synthesis.Results
A total of 20 studies were included. The synthesis confirmed the severe physical, social and psychological impact of the chronic wound. Inadequately controlled pain and sleeplessness, restrictions to lifestyle, and the loss of previous life roles can lead to feelings of hopelessness and helplessness and therefore depression and anxiety. Dressings and dressing changes are a key aspect of treatment and provide opportunities for positive interaction and person centred-care.Conclusion
People with chronic wounds can be supported to live well within the severe physical, psychological and social restrictions of a chronic wound. Effective clinical pain management and the recognition of the experience of acute and chronic pain are of the utmost importance to people with a chronic wound. Treatment should not be purely focused on healing but incorporate symptom management, coping and wellbeing via person-centred and holistic care. 相似文献18.
Aim of the study
The aim of the study was to evaluate the effect of WaterCell® Technology on pressure redistribution and self-reported comfort and discomfort scores of adults with mobility problems who remain seated for extended periods of time.Methods
Twelve participants, were recruited and ranged in gender, age, height, weight, and body mass index. Five were male, seven were female, and five were permanent wheelchair users. Each participant was randomly allocated a chair, whose seat comprised of visco-elastic memory foam, high-elastic reflex foam, and watercells, to trial for a week. Data collected at day one and day seven included: interface pressure measurements taken across the gluteal region (peak and average); physiological observations of respiratory rate, pulse rate, and blood pressure; skin inspection and comfort and discomfort scores.Results
Watercell® technology was found to offer lower average pressures than those reported to cause potential skin injury. Peak pressure index findings were comparative to other studies. No correlation was found between discomfort intensity rating and pressure redistribution. Discomfort intensity rating was low for all participants and general discomfort ranged from very low to medium. Physiological observations decreased for 50% of participants over the seven days.Conclusion
From our study we have found that WaterCell® technology offers comparable pressure redistribution for people with a disability who need to sit for prolonged periods of time and the chairs were found to be comfortable. 相似文献19.
Dimitri Beeckman 《Journal of tissue viability》2017,26(1):47-56
Background
Incontinence-Associated Dermatitis (IAD) is one of the clinical manifestations of Moisture- Associated Skin Damage (MASD). IAD is a common problem in aged patients with fecal and/or urinary incontinence.Aim
Update about IAD terminology, etiology, epidemiology, observation, prevention, and treatment.Methods
Integrative review.Results
The lack of an ICD-10 code and an internationally validated and standardized method for IAD data collection contribute to a variation in epidemiological data. Frequent episodes of incontinence (especially fecal), occlusive containment products, poor skin condition, reduced mobility, diminished cognitive awareness, inability to perform personal hygiene, pain, pyrexia, certain medications (antibiotics, immunosuppressants), poor nutritional status, and critical illness are associated with IAD. Correctly diagnosing IAD and distinguish it from pressure ulcers is difficult. Even though the clinical presentation of partial thickness pressure ulcers and IAD is similar, the underlying etiologic factors differ. However, incontinence and IAD were found to be risk factors for pressure ulcer development. IAD management should essentially focus on skin cleansing to remove dirt, debris and microorganisms; skin moisturization to repair or augment the skin's barrier; and the application of a skin barrier product to prevent skin breakdown by providing an impermeable or semi-permeable barrier on the skin. The body of evidence is still limited, but growing since the last decade.Conclusion
Incontinence causes disruptions of the skin barrier function and leads to superficial skin damage. Macerated skin and superficial skin changes due to incontinence are associated with pressure ulcer development. Skin maceration, chemical irritation, and physical irritation should be targeted to effectively prevent and treat IAD. 相似文献20.
Yoshiko Takahashi Tetsuya Nemoto Fumihiro Mizokami Katsunori Furuta Yusuke Murasawa Masahiko Yoneda Zenzo Isogai 《Journal of tissue viability》2017,26(1):75-78