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[PMID]: 29098740
[Au] Autor:Wiegand C; Bittenger K; Galiano RD; Driver VR; Gibbons GW
[Ad] Address:Department of Dermatology, University Hospital Jena, Jena, Germany.
[Ti] Title:Does non-contact low-frequency ultrasound (NLFU) therapy contribute to wound healing at the molecular level?
[So] Source:Wound Repair Regen;, 2017 Nov 02.
[Is] ISSN:1524-475X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Non-contact low frequency ultrasound (NLFU) is used to treat various types of chronic wounds including venous, diabetic and pressure ulcers. The objective for this sub study of the IN BALANCE RCT VLU trial was to characterize and compare the NLFU treatment group and patients receiving standard of care (SOC) with respect to the effect of the assigned study treatment on content/quantity of inflammatory cytokines and fibrinogen as well as bacteria. Higher mean wound area reduction was observed in the NLFU treatment group (67.0%) compared to the SOC group (41.6%, p<0.05). Hypertension, diabetes type II, coronary artery disease, and anaemia were identified as the most common co-morbidities of the CVLU patients included in the study. Pseudomonas, Corynebacterium, and unclassified Enterobacteriaceae were dominant in the highest number of samples. Anaerococcus, Peptoniphilus, and Finegoldia, had the highest median proportion in the samples overall. Peptoniphilus abundance decreased more in the NLFU treatment group relative to SOC; similar trends were observed for Anaerococcus and Finegoldia. Progression of mediators like TNF-alpha, IL-1beta, IL-6, IL-8, and IL-10 as well as PF4, TGF-beta, and fibrinogen was monitored and trends for several of the mediators were identified. Fibrinogen amounts were significantly reduced over time in the NLFU treatment group (p<0.05). IL-8 levels declined in wound fluid from NLFU responders as well as SOC responders. Bacterial load (total bacterial abundance) determined local parameters of ulcer inflammation. If a bioburden of ≥ 10E was found compared to < 10E , levels of IL-1beta, IL-8, and TNF-alpha were significantly higher. In conclusion, NLFU treatment is an effective adjuvant tool for CVLU therapy. This study demonstrates that it improves wound healing by equally inhibiting abundant levels of pro-inflammatory cytokines as well as by reducing the overall bacterial burden. This article is protected by copyright. All rights reserved.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171103
[Lr] Last revision date:171103
[St] Status:Publisher
[do] DOI:10.1111/wrr.12595

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[PMID]: 28877112
[Au] Autor:Schmitt S; Andries MK; Ashmore PM; Brunette G; Judge K; Bonham PA
[Ad] Address:Shawneen Schmitt, MSN, MS, RN, CWOCN, CFCN, FACCWS, Froedtert Health-CHD-Community Memorial Hospital, Menomonee Falls, Wisconsin. Marti K. Andries, MSN, ANP-BC, FNP-BC, CWCN-AP, Central Control, Inc, Pineville, Louisiana. Patti M. Ashmore, BSN, RN, CWOCN, Wound, Ostomy, Continence Care Nurse Consultant and Educator, Evans, Georgia. Glenda Brunette, MSN, RN, CWON, Wound & Ostomy Nurse, Medical University of South Carolina, Charleston, South Carolina. Kathleen Judge, MSN, RN, APN-C, NP-C, NEA-BC, ACNS-BC, CWON-AP, CCCN, Virtua Health, Voorhees, New Jersey. Phyllis A. Bonham, PhD, MSN, RN, CWOCN, DPNAP, FAAN, Professor Emerita, Medical University of South Carolina, College of Nursing, Charleston, South Carolina.
[Ti] Title:WOCN Society Position Paper: Avoidable Versus Unavoidable Pressure Ulcers/Injuries.
[So] Source:J Wound Ostomy Continence Nurs;44(5):458-468, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The issue of whether pressure injuries are avoidable or preventable has been and continues to be an issue of great debate and discussion for many years, and it has significant legal and regulatory implications related to prevention of wounds due to pressure. The following position paper outlines the position of the Wound, Ostomy and Continence Nurses Society (WOCN) on avoidable versus unavoidable pressure injuries. It includes the following information: statement of position, purpose/rationale for the position, definitions of avoidable versus unavoidable pressure injuries, alternative definitions, historical overview, supportive statements from expert opinion and research in the literature, and recommendations for research.
[Mh] MeSH terms primary: Organizational Objectives
Pressure Ulcer/classification
Pressure Ulcer/prevention & control
Societies, Nursing/organization & administration
[Mh] MeSH terms secundary: Humans
Iatrogenic Disease/prevention & control
Nurses/organization & administration
Nurses/trends
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170906
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000361

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[PMID]: 28877111
[Au] Autor:Guo Y; Li Y; Zhao K; Yue X; Yu Y; Kuang W; Liu J; Li X; Zhao T
[Ad] Address:Yue Guo, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Yan Li, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Kuaile Zhao, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Xiao Yue, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Yunhong Yu, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Wan Kuang, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Jing Liu, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Xiangyan Li, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China. Tiyu Zhao, MD, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology.
[Ti] Title:Effects of Curvilinear Supine Position on Tissue Interface Pressure: A Prospective Before-and-After Study.
[So] Source:J Wound Ostomy Continence Nurs;44(5):450-454, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: To determine whether a curvilinear supine position increases the contact area between the subject and the surgical table, reduces interface pressures within contact areas, and improves comfort. DESIGN: This observational study was completed to establish proof-of-concept to determine differences between 2 positions (supine and curvilinear) on interface pressure of 5 at-risk anatomical locations, overall contact area, and subjects' comfort level. SUBJECTS AND SETTING: The study was conducted at the operating theater of a tertiary teaching hospital in Wuhan, China. The sample comprised 145 healthy Asian volunteers between 18 and 60 years of age. METHODS: Subjects were placed in the supine and curvilinear supine positions on a surgical table. Contact area and peak interface pressures of 5 at-risk anatomical locations (occiput, scapula, sacrum, calf, and heel) were measured using a pressure mapping system, and the mean and maximum pressures of the overall contact area were calculated. Comfort was assessed by self-report using a Likert scale of 1 to 5. The Wilcoxon paired signed rank test was used to compare differences between the 2 positions, and the Spearman correlation analysis was used to identify associations among outcome variables. RESULTS: Results indicated that whole-body (overall) maximum, average interface pressures, and maximum interface pressures of the sacrum and the heel were decreased significantly, with contact area and comfort-level score increasing from 2438.71 to 2709.68 cm and 3.00 to 4.00, respectively (P < .001). Statistically significant associations were found between the contact area and measures of body morphology; correlation coefficients varied from 0.409 to 0.740 (P < .001). CONCLUSIONS: Curvilinear supine position increased overall contact area with the support surface, reduced interface pressures over contact areas (bony prominences), improved comfort, and enhanced pressure redistribution. Additional research is needed to determine if these effects will reduce intraoperative pressure injury occurrence.
[Mh] MeSH terms primary: Patient Positioning/classification
Patient Positioning/standards
Pressure/adverse effects
Supine Position/physiology
[Mh] MeSH terms secundary: Adult
Beds/standards
Body Mass Index
China
Equipment Design/standards
Female
Humans
Male
Patient Positioning/methods
Pressure Ulcer/prevention & control
Prospective Studies
[Pt] Publication type:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170906
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000360

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[PMID]: 28877110
[Au] Autor:Chen Y; He L; Qu W; Zhang C
[Ad] Address:Yan Chen, MD, PhD, Anesthesia and Operation Center, Department of Anesthesiology, Chinese PLA General Hospital, Beijing, China. Li He, BS, Anesthesia and Operation Center, Department of Nursing, Chinese PLA General Hospital, Beijing, China. Wei Qu, BS, Anesthesia and Operation Center, Department of Nursing, Chinese PLA General Hospital, Beijing, China. Chen Zhang, BS, Anesthesia and Operation Center, Department of Anesthesiology, Chinese PLA General Hospital, Beijing, China.
[Ti] Title:Predictors of Intraoperative Pressure Injury in Patients Undergoing Major Hepatobiliary Surgery.
[So] Source:J Wound Ostomy Continence Nurs;44(5):445-449, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of this study was to identify risk factors associated with pressure injury (PI) development in patients undergoing major hepatobiliary surgery requiring general anesthesia. DESIGN: Retrospective medical review and analysis. SUBJECTS AND SETTING: Medical records from 803 patients undergoing hepatobiliary surgery from October 2015 to October 2016 were reviewed. The study setting was a 3400-bed military academic medical center in the northeast region of China. METHODS: Demographic variables, comorbid conditions, preoperative Braden Scale for Pressure Sore Risk scores, preoperative serum hemoglobin and albumin levels, type of surgery, positioning, surgical time, hypotensive episodes, blood loss, body temperature, and other potential risk factors for PI development were collected. Pressure injury occurrences during a 48-hour period after surgery were recorded along with stage. Data were analyzed using univariate analyses and multivariate logistic regression analysis to build a predictive model for factors associated with PI occurrences. RESULTS: The prevalence of PIs in major hepatobiliary surgery patients was 19.8%, 4.9%, and 4.1% in the immediate postoperative period, on the first day and the second day after surgery, respectively. Pancreaticoduodenectomy surgery (odds ratio [OR]: 3.957, 95% confidence interval [CI]: 2.145-7.302, P < .001), open surgery (OR: 2.917, 95% CI: 1.558-5.463, P = .001), surgical time (cutoff point at 197 minutes for increased risk of PI, OR: 1.004, 95% CI: 1.002-1.006, P = .001), and intraoperative hypotensive episodes (OR: 1.022, 95% CI: 1.005-1.039, P = .010) were associated with an increased likelihood of PI development. CONCLUSION: Among patients undergoing major hepatobiliary surgery such as pancreaticoduodenectomy, prolonged surgical time, open surgery, and intraoperative hypotension were found to be associated with an increased likelihood of developing a PI. Maintaining hemodynamic stability and taking more effective measures for skin care during these procedures may reduce the risk of PI in this vulnerable population.
[Mh] MeSH terms primary: Postoperative Complications/epidemiology
Pressure Ulcer/epidemiology
Prevalence
Surgical Procedures, Operative/adverse effects
[Mh] MeSH terms secundary: Adolescent
Adult
Aged
Biliary Tract Surgical Procedures/adverse effects
China/epidemiology
Female
Humans
Hypotension/complications
Hypotension/etiology
Male
Middle Aged
Pancreaticoduodenectomy/adverse effects
Retrospective Studies
Risk Factors
Skin Care/standards
Time Factors
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170906
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000356

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[PMID]: 28877109
[Au] Autor:Park KH; Park J
[Ad] Address:Kyung Hee Park, PhD, RN, CWOCN, KGNP, Department of Nursing Science, The University of Suwon, Hwaseong-si, South Korea. Joohee Park, RN, CWON, Department of Nursing, Samsung Medical Center, Seoul, Korea.
[Ti] Title:The Efficacy of a Viscoelastic Foam Overlay on Prevention of Pressure Injury in Acutely Ill Patients: A Prospective Randomized Controlled Trial.
[So] Source:J Wound Ostomy Continence Nurs;44(5):440-444, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of this study was to compare a viscoelastic foam overlay (VEFO) to a standard hospital mattress for pressure injury (PI) prevention. We also compared interface pressures (IPs) of the VEFO to our facility's standard hospital mattress. DESIGN: Prospective, randomized controlled trial. SUBJECTS AND SETTING: Data analysis was based on 110 participants (55 in each group) who were 19 years or older, had a Braden Scale for Pressure Sore Risk score of 16 or less, and were cared for on a neurology, oncology, or pulmonology inpatient care unit. The research setting was the Samsung Medical Center in Seoul, South Korea. METHODS: Participants were divided into 2 groups: the experimental group were based on a VEFO on top of the standard hospital mattress used in our facility. Participants in the control group were placed on a standard hospital mattress with/without air overlay. All patients were given standard nursing care for prevention of PI. Skin assessments were completed daily over a period of 2 weeks. In addition, we compared IPs of the standard hospital mattress and the VEFO in participants randomly allocated to the intervention group. Interface pressure was measured over the sacral/coccygeal area with subjects in the supine position. Pressures were measured immediately before and immediately following placement of the VEFO and just before data collection began. Data were collected between October 2013 and November 2014. Pressure injury incidence was compared between groups using the χ test, and IPs were compared using the paired t test. INSTRUMENTS: Pressure injury development was determined using the staging system described in guidelines from the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance in 2014. Interface pressure was measured using a device manufactured for this purpose. RESULTS: The incidence of PI development was significantly lower in subjects assigned to the experimental group as compared to those in the control group (3.6%-27.3% over the 2-week data collection period; P = .001). The maximum IP was significantly lower on the VEFO with standard hospital mattress than on the standard hospital mattress (paired t = 8.87, P < .001). CONCLUSIONS: Patients managed with a VEFO had a significantly lower incidence of PI than those managed with a standard hospital mattress. Additional research is needed to further characterize the efficacy of the VEFO, its effect on PI healing, and its effect of PI prevention in high-risk populations such as critically ill patients.
[Mh] MeSH terms primary: Bandages/standards
Critical Illness/therapy
Pressure Ulcer/prevention & control
Viscoelastic Substances/pharmacology
[Mh] MeSH terms secundary: Aged
Aged, 80 and over
Bedding and Linens/standards
Female
Humans
Iatrogenic Disease/prevention & control
Incidence
Injury Severity Score
Male
Middle Aged
Prospective Studies
Republic of Korea
Risk Factors
Viscoelastic Substances/therapeutic use
[Pt] Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Name of substance:0 (Viscoelastic Substances)
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170906
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000359

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[PMID]: 28877108
[Au] Autor:Meyers T
[Ad] Address:Tina Meyers, MBA, BSN, CWOCN, Harris Health Systems, Landscape Court, Conroe, Texas.
[Ti] Title:Prevention of Heel Pressure Injuries and Plantar Flexion Contractures With Use of a Heel Protector in High-Risk Neurotrauma, Medical, and Surgical Intensive Care Units: A Randomized Controlled Trial.
[So] Source:J Wound Ostomy Continence Nurs;44(5):429-433, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of this study was to compare the use of a heel protector to standard of care (pillows) in the prevention of hospital-acquired pressure injuries (HAPI) of the heels and prevention of plantar flexion contractures. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The study took place on a surgical intensive care unit, medical intensive care unit, and neurotrauma intensive care unit. Inclusion criteria were a minimum of 5 days of sedation related to care for a critical illness, immobility for 6 to 8 hours before study initiation, a Braden Scale for Pressure Sore Risk score 18 or less, and a mobility subscale score 2 or less. Patients were included if they had preexisting heel pressure injury or plantar flexion contracture. The sample comprised 54 subjects; 37 were randomly allocated to the intervention group and 17 to the control group. Their average age-mean (standard deviation)-was 40.7 (14.96) years in the control group and 44.6 (17.15) years in the intervention group. METHODS: Data were collected from patients' electronic medical records. We recorded subject demographics, presence of diabetes mellitus or peripheral vascular disease, Glasgow Coma Scale scores (every shift), Braden Scale for Pressure Sore Risk scores (every shift), heel skin assessments (every shift), goniometric measurements (every other day), and adverse events (every shift). Assessments and measurements were continued until the patient was discharged from the study. RESULTS: None of the patients in the intervention group developed HAPI of the heels, as compared to 7 in the control group (0% vs 41%, P < .001). Patients in the intervention group had a significantly greater decrease in goniometric scores (mean decrease = 1.4 ± 2.25) compared to the control group by day 3 (mean decrease = 0.1 ± 0.52 P = .004) and the last study day (mean decrease = 2.0 ± 3.02 for the intervention group vs 0.07 ± 0.96 for the control group; P < .001). CONCLUSIONS: Study findings indicate that a heel protector that ensures off-loading and maintains the foot in a neutral position is more effective for prevention of HAPI of the heel and contractures as compared to standard care using pillows to position the heel and redistribute pressure.
[Mh] MeSH terms primary: Contracture/prevention & control
Pressure Ulcer/prevention & control
Skin Care/instrumentation
[Mh] MeSH terms secundary: Adult
Aged
Aged, 80 and over
Critical Care Nursing/methods
Diabetes Complications
Female
Heel/injuries
Humans
Injury Severity Score
Intensive Care Units/organization & administration
Intensive Care Units/statistics & numerical data
Male
Middle Aged
Peripheral Vascular Diseases/complications
Plantar Plate/injuries
Prospective Studies
[Pt] Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170906
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000355

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[PMID]: 28816929
[Au] Autor:Padula WV
[Ad] Address:William V. Padula, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
[Ti] Title:Effectiveness and Value of Prophylactic 5-Layer Foam Sacral Dressings to Prevent Hospital-Acquired Pressure Injuries in Acute Care Hospitals: An Observational Cohort Study.
[So] Source:J Wound Ostomy Continence Nurs;44(5):413-419, 2017 Sep/Oct.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of this study was to examine the effectiveness and value of prophylactic 5-layer foam sacral dressings to prevent hospital-acquired pressure injury rates in acute care settings. DESIGN: Retrospective observational cohort. SAMPLE AND SETTING: We reviewed records of adult patients 18 years or older who were hospitalized at least 5 days across 38 acute care hospitals of the University Health System Consortium (UHC) and had a pressure injury as identified by Patient Safety Indicator #3 (PSI-03). All facilities are located in the United States. METHODS: We collected longitudinal data pertaining to prophylactic 5-layer foam sacral dressings purchased by hospital-quarter for 38 academic medical centers between 2010 and 2015. Longitudinal data on acute care, hospital-level patient outcomes (eg, admissions and PSI-03 and pressure injury rate) were queried through the UHC clinical database/resource manager from the Johns Hopkins Medicine portal. Data on volumes of dressings purchased per UHC hospital were merged with UHC data. Mixed-effects negative binomial regression was used to test the longitudinal association of prophylactic foam sacral dressings on pressure injury rates, adjusted for hospital case-mix and Medicare payments rules. RESULTS: Significant pressure injury rate reductions in US acute care hospitals between 2010 and 2015 were associated with the adoption of prophylactic 5-layer foam sacral dressings within a prevention protocol (-1.0 cases/quarter; P = .002) and changes to Medicare payment rules in 2014 (-1.13 cases/quarter; P = .035). CONCLUSIONS: Prophylactic 5-layer foam sacral dressings are an effective component of a pressure injury prevention protocol. Hospitals adopting these technologies should expect good value for use of these products.
[Mh] MeSH terms primary: Bandages/standards
Pressure Ulcer/prevention & control
[Mh] MeSH terms secundary: Academic Medical Centers/organization & administration
Academic Medical Centers/statistics & numerical data
Bandages/economics
Bandages/statistics & numerical data
Cohort Studies
Female
Hospitals/statistics & numerical data
Humans
Iatrogenic Disease/prevention & control
Logistic Models
Longitudinal Studies
Male
Retrospective Studies
Sacrococcygeal Region/physiopathology
United States
[Pt] Publication type:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170817
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000358

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[PMID]: 28682858
[Au] Autor:Terrell C
[Ad] Address:Camillia Terrell, MSN, APRN, NP-C, CWON, WOCNCB, Milwaukee, Wisconsin.
[Ti] Title:Revisions to Pressure Injury Nomenclature (Formerly Known as Pressure Ulcers).
[So] Source:J Wound Ostomy Continence Nurs;44(4):E3-E5, 2017 Jul/Aug.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Mh] MeSH terms primary: Pressure Ulcer/classification
Terminology as Topic
[Mh] MeSH terms secundary: Humans
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170706
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000346

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[PMID]: 28682855
[Au] Autor:Famorca M; Beauchaine D; Angulo N
[Ad] Address:Mary Famorca, MAN, RN, WCC, COCN, Mayo Clinic Arizona, Phoenix, Arizona. Debra Beauchaine, MN, RN, AGPCNP, CWOCN-AP, Mayo Clinic Arizona, Phoenix, Arizona. Nancy Angulo, BS, RN, CWOCN, Cancer Treatment Center of America, Goodyear, Arizona.
[Ti] Title:Management of a Complex Peristomal Calciphylaxis: A Case Study.
[So] Source:J Wound Ostomy Continence Nurs;44(4):380-383, 2017 Jul/Aug.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare and serious syndrome of small blood vessels with a high mortality rate. Calciphylaxis lesions require intensive wound management with medical interventions for the patient to survive the sequelae of sepsis and present unique challenges when found in the peristomal skin. CASE: A 33-year-old man presented with multiple malodorous stage 4 pressure injuries of his sacrococcygeal and gluteal area. His medical history included chronic kidney disease requiring hemodialysis since 2007, diabetes mellitus, and incomplete paraplegia. He underwent diverting colostomy to enhance wound healing. His hospital stay was complicated by the development of a peristomal calciphylaxis lesion (PCL) that made ostomy pouching especially challenging for the nursing staff. His care needs were also aggravated by nonadherence to diet restriction, pressure injury prevention efforts, and a continued need for high doses of analgesic medication. Collectively, these issues presented a challenge for the health care team during his hospital course and during safe discharge planning. CONCLUSIONS: The peristomal calciphylaxis lesion decreased in surface area and improved in appearance with the use of various wound care products as his medical condition improved. Skilled nursing management in the context of ongoing interdisciplinary collaboration assisted in managing the patient's peristomal calciphylaxis, ultimately leading to safe discharge from hospital.
[Mh] MeSH terms primary: Calciphylaxis/therapy
Colostomy/adverse effects
Wound Healing
[Mh] MeSH terms secundary: Adult
Calciphylaxis/mortality
Gentian Violet/pharmacology
Gentian Violet/therapeutic use
Humans
Male
Methylene Blue/pharmacology
Methylene Blue/therapeutic use
Paraplegia/complications
Pressure Ulcer/therapy
Renal Dialysis
Renal Insufficiency, Chronic/complications
Renal Insufficiency, Chronic/therapy
Skilled Nursing Facilities/organization & administration
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:J4Z741D6O5 (Gentian Violet); T42P99266K (Methylene Blue)
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170706
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000343

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[PMID]: 28682854
[Au] Autor:Arnold-Long M; Ayer M; Borchert K
[Ad] Address:Mary Arnold-Long, DNP, APRN, CRRN, CWOCN-AP, ACNS-BC, Roper Hospital, Charleston, South Carolina. Melissa Ayer, MS, RN, CRRN, CWOCN, CFCN, Inpatient WOC Nurse, North Shore Medical Center, Lynn, Massachusetts. Kathleen Borchert, MS, RN, ACNS-BC, CWOCN, CFCN, University of Minnesota, Minneapolis.
[Ti] Title:Medical Device-Related Pressure Injuries in Long-term Acute Care Hospital Setting.
[So] Source:J Wound Ostomy Continence Nurs;44(4):325-330, 2017 Jul/Aug.
[Is] ISSN:1528-3976
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of this study was to examine the epidemiology of medical device-related pressure injuries (MDRPIs) in 3 long-term acute care hospitals (LTACHs). DESIGN: Retrospective descriptive study. SUBJECTS AND SETTING: The sample comprised 304 adult inpatients at 3 geographically diverse LTACHs: Spaulding Hospital for Continued Medical Care, Drake Center, and Bethesda Hospital. The facilities are located in the Northeastern, Southeastern, and Midwestern United States. METHODS: Hospital-acquired pressure injury (HAPI) data and MDRPI data were collected and reported for the 3 LTACHs from July 1, 2009, to June 30, 2010. Data were collected by the wound nurses at 2 of the facilities on a daily or weekly basis and quarterly at the remaining site. RESULTS: One hundred forty-two MDRPIs occurred during data collection, representing an occurrence rate of (47%). The proportion of MDRPIs and HAPIs at each of the LTACHs was 38%, 50%, and 47%, respectively. The most commonly reported medical devices causing pressure injury were respiratory devices, splints and braces, and tubing. CONCLUSIONS: The MDRPI rate identified in the LTACH setting was higher than rates reported in the literature. This study's findings confirm the importance of monitoring MDRPIs in order to implement appropriate prevention strategies.
[Mh] MeSH terms primary: Equipment and Supplies/adverse effects
Long-Term Care/standards
Pressure Ulcer/nursing
Pressure/adverse effects
[Mh] MeSH terms secundary: Aged
Hospitals/standards
Hospitals/trends
Humans
Iatrogenic Disease/epidemiology
Iatrogenic Disease/prevention & control
Long-Term Care/methods
Middle Aged
Pressure Ulcer/epidemiology
Pressure Ulcer/prevention & control
Retrospective Studies
United States/epidemiology
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 171102
[Lr] Last revision date:171102
[Js] Journal subset:N
[Da] Date of entry for processing:170706
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000347


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