Development and validation of a pressure ulcer risk assessment tool for acute hospital patients

The purpose of this study was to develop and validate a pressure ulcer risk assessment for acute hospitals. This tool was developed in a cohort of 342 patients with a mean age 63 years (SD 19.82) and validated in a second cohort of 165 patients with a mean age 68 years (SD 18.40). Risk factors for inclusion on The Northern Hospital Pressure Ulcer Prevention Plan (TNH‐PUPP) were identified from the literature then examined and weighted using logistic regression. Risk factors included on the TNH‐PUPP were requires assistance to move in bed (odds ratio [OR] 5.15; 95% confidence interval [CI]: 2.49–10.65), admission to intensive care during current admission (OR 2.98; 95% CI: 1.33–6.67), aged ≥65 years (OR 2.81; 95% CI: 1.24–6.36), reduced sensation (OR 2.29; 95% CI: 1.19–4.42), and cognitive impairment (OR 2.26; 95% CI: 1.09–4.67). The TNH‐PUPP was validated in a prospective sample. The new tool had high diagnostic validity (area under the receiver operating curve=0.86), consistent in the validation sample (area under the receiver operating curve=0.90). The TNH‐PUPP has a moderate positive predictive value (development=0.50; validation=0.13), and a high negative predictive value (development=0.94; validation=0.99) enabling low‐risk patients to be screened out, as noncandidates for pressure ulcer prevention interventions. An accurate pressure ulcer risk assessment has been developed and validated, which identifies a high‐risk group to whom limited pressure ulcer prevention resources should be directed. The TNH‐PUPP facilitates effective resource allocation and is likely to reduce unnecessary patient harm and costs from pressure ulcers in acute hospitals.     

Effect of Multiple Physiotherapy Sessions on Functional Outcomes in the Initial Postoperative Period After Primary Total Hip Replacement: A Randomized Controlled Trial

Stockton KA, Mengersen KA. Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial.

Objective

To determine whether increasing physiotherapy input from once to twice per day will result in earlier achievement of functional milestones (ie, independence in mobility and transfers) and decreased length of stay (LOS) in patients undergoing a primary total hip replacement.

Design

Randomized controlled trial.

Setting

Metropolitan private hospital.

Participants

Patients (N=57) with primary total hip replacement were randomly assigned to the twice daily (treatment, n=30) and once daily (control, n=27) groups. Patients who chose to attend hydrotherapy were excluded from the randomization process; however, they gave consent for outcome measures to be collected for comparison with the randomized groups.

Interventions

The control group received usual care, and the treatment group received twice-daily physiotherapy from day 1 after surgery to discharge.

Main Outcome Measures

The Iowa Level of Assistance at postoperative days 3 and 6 and LOS.

Results

This study demonstrates that patients who received twice-daily land-based physiotherapy after primary total hip replacement attained earlier achievement of functional milestones than patients that received once-daily physiotherapy. A statistically significant (P=.041) but not clinically significant difference was evident in the Iowa Level of Assistance score at day 3. There was no difference between the groups in Iowa Level of Assistance measures on day 6 or on LOS.

Conclusions

Patients who received twice-daily physiotherapy showed a trend toward earlier achievement of functional milestones; however, this finding did not translate to decreased LOS.     

Socio-psychological stressors as risk factors for low back pain in Chinese middle-aged women

AIM(S) OF THE STUDY: This study aims to explore the relationship between socio-psychological stress and low back pain (LBP) prevalence among Chinese middle-aged women. BACKGROUND: Women in mid-life experience increasing socio-psychological stress because of midlife transitions, stressful life events and housework or work factors. Encountering socio-psychological stress itself may result in the manifestation of LBP. DESIGN: A case-control study of Hong Kong community-based middle-aged women was conducted. The study subjects were either from the University Family Medicine Clinic or from a previous population-based cross-sectional study of middle-aged women conducted by Department of Community and Family Medicine. Among the 928 potential eligible subjects from both sources, a total of 182 cases and 235 controls participated in this study. Data were collected from face-to-face interviews and included demographic factors, menopausal status, socio-psychological stress and occurrence of LBP. Socio-psychological stress covered social factors, self-reported nature of housework/work, housework/work stress and stressful life events. RESULTS: Among the 182 cases who entered this study, 83 women (45.6%) had experienced 1-<14 days of LBP, and 99 women (54.4%) had at least 14 days of LBP in the previous 12 months. Those who reported that 'their family members, relatives or friends were very sick, died, needed her to take care of them or who they worried about in the past 12 months' had an increased risk of LBP of 67% (95% confidence interval (CI) 1.09-2.55). In addition women with a bad or ordinary relationship with cohabitants had an increased risk of LBP of 70% (95% CI 1.00-3.04). Lastly, women with a high housework or work stress had an increased risk of suffering both types of LBP of nearly two- and half-fold (95% CI 1.61-3.85). CONCLUSIONS: The results indicate that an association exists between high socio-psychological stress and LBP prevalence. Alleviating the impact of housework or work related factors would, however, involve improving both the work and home environment.     

Desensitization of the gag reflex in an adult with cerebral palsy: a case report

Severe oral hypersensltlvlty and averslve oral behaviors present a significant barrier to dental treatment and compromise oral health status. Although several authors have addressed the reduction of oral hypersensltlvlty and averslve behaviors (such as gagging, retching, and vomit-Ing) In the otherwise well dental patient, treatment for patients with severe disability has not been explored. The successful management of oral hypersensltlvlty and averslve behavior can have significant health benefits. These can be described van outcomes paradigm as physical and social benefits for the patient, psychological benefits for the patient, carer, and practitioner, and organizational benefits for the Institutions providing dental care and medical management. This paper summarizes the management of a severely disabled patient whose averslve behaviors were eliminated with non-Invasive therapy techniques. Oral hygiene was facilitated and health benefits were Identified across a number of domains following successful multi-disciplinary management.