Friction and shear highly associated with pressure ulcers of residents in long‐term care – Classification Tree Analysis (CHAID) of Braden items

Aims Among various risk assessment scales for the development of pressure ulcers in long‐term care residents that have been published in the last three decades, the Braden scale is among the most tested and applied tools. The sum score of the scale implies that all items are equally important. The aim of this study is to show whether specific items are of greater significance than others and therefore have a higher clinical relevance. Design Data analysis of six pressure ulcer prevalence studies (2004–2009). Methods A total of 17 666 residents (response rate 79.6%) in 234 long‐term care facilities participated in 6 annual point prevalence studies that were conducted from 2004 to 2009 throughout Germany. For the classification of the sample regarding pressure ulcers as a dependent variable and the Braden items as predictor variables, Chi‐square Automatic Interaction Detector (CHAID) for modelling classification trees has been used. Results Pressure ulcer prevalence was 5.4% including pressure ulcer grade 1 and 3.4% for pressure ulcer grades 2–4. CHAID analysis for the classification tree provided the item ‘friction and shear’ as the most important predictor for pressure ulcer prevalence. On the second level, the strongest predictors were ‘nutrition’ and ‘activity’ and on the third level they were ‘moisture’ and ‘mobility’. Residents with problems regarding ‘friction and shear’ and poor nutritional status present with an 18.0 (14.8) pressure ulcer prevalence which is 3–4 times higher than average. Conclusion CHAID analyses have shown that all items of the Braden scale are not equally important. For residents in long‐term care facilities in Germany, the existence of ‘friction and shear’ as a potential and especially as a manifest problem has had the strongest association with pressure ulcer prevalence.     

Multiple injections for low back pain: What’s the future?

To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS England framework using the getting it right first time (GIRFT) data. Systematic review using patient, intervention, comparison, outcome and study strategy. The literature search using Cochrane, MEDLINE and EMBASE databases using MeSH terms: lumbar spine, spinal injection and facet joint (“Appendix A”). Three studies were identified that investigated the efficacy of multiple FJIs or MBBs. None of these studies reported sustained positive outcomes at long-term follow-up. There is a paucity of levels I and II evidence available for the efficacy of multiple FJIs and MBBs in treating low back pain. GIRFT data show a high degree of variation in the use of multiple FJIs, which would not be supported by the literature. These slides can be retrieved under Electronic Supplementary Material.     

Duplication of chromosome region 8p23.1-->p23.3: a benign variant?

Chromosome analysis was performed in a 34-year-old man who was phenotypically normal except for oligoasthenozoospermia. In this patient, analysis of GTG-banded chromosomes showed in one chromosome 8 additional chromosomal material of unknown origin. To characterize the aberrant chromosome more precisely, a paint specific for chromosome region 8pter-->8p23.1 was generated by microdissection and degenerated oligonucleotide primed-polymerase chain reaction (DOP-PCR) and used as fluorescence in situ hybridization (FISH) paint. After reverse painting, hybridization signals were only found on the short arm of the two chromosomes 8, with an enlarged signal on the derivative chromosome 8. The duplication was characterized further with band-specific FISH probes. We concluded that (part of) chromosome region 8p23.1-->p23.3 was duplicated. Chromosome analysis of the parents showed that the dup(8) was of maternal origin and that the fertile brother of the index patient also was a carrier of the chromosome aberration. There was no history of miscarriages. We suggest that duplication of region 8p23.1-->p23.3 can be regarded as euchromatic variant or duplication with no phenotypic effect.     

Factors related to the acceptance of home care and nursing homes among older Egyptians: A cross-sectional study

Background

Socio-demographic changes may deprive older Egyptians from receiving care by family members and raise the question of how they react if they become dependent on help.

Objective

The objective of this study was to determine factors related to the acceptance of home care and nursing homes among older Egyptians.

Design

A two group comparative design based on self-reports.

Participants

The sample was composed of 344 older persons receiving home care or staying in a nursing home and 267 non-care recipients.

Setting

The study was conducted in Greater Cairo.

Methods

Factors related to the acceptance of home care and nursing homes were determined separately for each group by logistic regression.

Results

Lesser feelings of shame while receiving care from non-family members were related to an increased acceptance of both kinds of care. For non-care recipients disagreement to the traditional idea of family care had a similar effect. For care recipients the experience made with a particular kind of care was strongly related to its acceptance.

Discussion

Home care is a new phenomenon in Cairo and in contrast to nursing homes it was unknown to most study participants. For this reason any conclusion about which kind of service is preferred by older Egyptians would be a premature one.

Conclusion

Feelings of shame while receiving care from a non-family member are more important than functional limitations when older Egyptians are considering the options of home care and nursing homes.     

Frequency of pressure ulcers in the paediatric population: A literature review and new empirical data

Background

Published pressure ulcer incidence and prevalence figures in the paediatric population vary widely. The frequency of pressure ulcers in the German paediatric population is unknown. Currently, a systematic synthesis of PU incidence and prevalence studies in paediatric settings is missing.

Objectives

To determine the prevalence and incidence of pressure ulcers in the paediatric population and the anatomic sites that are most often affected; and whether pressure ulcer occurrence in German paediatric hospital samples is comparable to international figures.

Design

A systematic literature review and a secondary data analysis were conducted.

Methods

The MEDLINE und CINAHL databases were searched. Methodological quality of relevant studies was systematically evaluated, relevant data extracted and synthesised. Data from five German-wide pressure ulcer prevalence studies were analysed.

Results

In total, 19 studies were identified containing any information about pressure ulcer frequency in the paediatric population. Methodological quality of many studies was low. Taking only higher quality studies into account, pressure ulcer incidence was approximately 7% in the total paediatric population and 26% in the ICU setting. Prevalence estimates varied between 2% and 28%. Excluding grade 1 pressure ulcers, prevalence ranged from 1% to 5%. Especially in newborns and infants, the head was most often affected by pressure injuries. Many pressure ulcers were caused by medical devices. In Germany, pressure ulcer prevalence grade 1-4 in the general paediatric population was 2.3% (95% CI 1.4-3.6%). Excluding grade 1 pressure ulcer, prevalence was 0.8% (95% CI 0.4-1.8%).

Conclusions

Due to considerable methodological limitations and insufficient reporting there is a dearth of sound empirical evidence about pressure ulcer frequency in the paediatric population. Conducting and reporting of future studies must be improved. Pressure ulcer prevalence in German hospital samples was comparable to international figures. Newborns, infants, and small children are at higher risk to develop pressure ulcers at the occipital region as compared to other anatomic locations. The likelihood of developing sacral and heel pressure ulcers increases with increasing age and growth.