Decubitus最新文献

One of the goals of the Agency for Health Care Policy and Research (AHCPR) is to improve the quality of medical care by developing and disseminating clinical practice guidelines. One indication of the effectiveness of a clinical guideline is the relationship between the costs of current practice and the costs of using the guideline. Using four model cases of patients at high risk for pressure ulcers, the costs of implementing the appropriate prevention and treatment procedures for each model were identified and compared to current practice costs. On the average, the overall cost of implementing the guideline is not much different from that of current practice.

Because of their angular conformation, short hair, and thin skin, greyhounds are particularly subject to development of pressure ulcers. Greyhounds, therefore, can serve as a model to study pressure ulcers, either naturally occurring pressure ulcers or induced dermal pressure lesions. A method for inducing dermal pressure lesions was developed using a short-limb walking cast on one pelvic limb of the dog. Physical characteristics, dermal thromboxane B2 concentrations, and histopathologic changes were used to determine the severity of the lesions. Different lesion severities can be induced over the calcaneal tuberosity depending upon the amount of padding in the cast and the length of time the cast is in place. The technique for inducing a mild dermal pressure lesion is described.

To investigate the patient and healing characteristics related to full-thickness pressure ulcers, 119 consecutive patients admitted with ulcers in three acute care, four longterm care, and one rehabilitation agency were studied. Of the 119 patients with 153 pressure ulcers, only 48 (40%) had full-thickness ulcers. Compared to patients with partial-thickness ulcers, patients with full-thickness ulcers were more likely to have multiple ulcers, occasional incontinence of urine and feces, a compromised overall skin condition, and a less than optimal nutritional status at baseline. Full-thickness ulcers treated with a hydrocolloid dressing (DuoDERM Hydroactive) did not develop adverse reactions; clinicians perceived the dressing to be efficacious. Ulcers that healed during the study decreased 47% in area in two weeks. This distinguished ulcers that healed from those that did not heal. The findings suggest that ulcers that do not decrease in size within two weeks should be reevaluated for additional or alternate treatments.

This descriptive, comparative study examined the relationship between three body positions, body weight, and tissue interface pressure measurement on three support surfaces among residents who were 65 years of age or older. The support surfaces included the Sof. Care bed cushion, Biogard foam mattress, and hospital mattress. Subjects included 12 ideal body-weight and six less-than-ideal body-weight individuals from a long-term care facility in a Mid-western state. Results indicated no significant difference in sacral tissue interface difference between ideal body weight and less-than-ideal body weight subjects. However, the sacral measurements were significantly greater in the supine position than those taken in the Fowler's and semi-Fowler's positions. A significant interaction was found between position and support surface with subjects in Fowler and semi-Fowler positions on the Sof. Care Surface exhibiting the lowest mean tissue interface pressure at the sacrum.

Improving quality care for patients with pressure ulcers resulted in a two-year intensive effort to educate staff, keep morale high, standardize care plans by stage of ulcer, and participate in a comparison study of two support surfaces (Thera-Pulse, Kinetic Concepts and Geo-Matt, SpanAmerica). When all pressure ulcers were considered, the analysis of covariance revealed no statistically significant difference in the healing of pressure ulcers with respect to type of support surface used (F[1, 78] = 0.35, p > .05). For patients with stage III and IV pressure ulcers, the proportion of patients improving more than 10cm2 was higher in the air-suspension group. There was relatively little difference in the Stage II ulcer patients.

The use of genuine sheepskin was compared to the use of synthetic sheepskin in two long term care institutions. Data for the control group of 44 residents placed on synthetic sheepskin were obtained by retrospective chart audit. Sixty-four residents were randomly placed on genuine merino sheepskin (WoolTec USA, Maspeth, NY). The two groups were similar in age, diagnosis, polypharmacy, and risk assessment score. In the control group 41% maintained skin integrity, 38% improved, and 21% deteriorated; in the study group 63% maintained skin integrity, 37% improved, and none deteriorated. The use of genuine sheepskin is recommended to reduce the risk factors of friction and shear.

Osteomyelitis is recognized as an often intractable hindrance to healing in the deep pressure ulcer. The mainstays of treatment of this disease have traditionally been surgical debridement followed by muscle flap revascularization, supplemented by antibiotic coverage. Hyperbaric oxygenation has also been shown to be effective in healing refractory osteomyelitis when used as an adjunct to surgical and medical therapy. This review defines the disease, and presents a current literature review and discussion of its treatment, including adequacy of debridement, options for wound closure, appropriate antimicrobial strategy, and the role of hyperbaric oxygenation. A short review of investigational modalities is also included.

As one way to meet the standards of quality patient care, a new tool was developed to document the clinical competence of healthcare providers in preventing and managing care for patients with pressure ulcers. The "Clinical Competency Tool for Documentation of Pressure Ulcer Prevention and Management" is described as well as suggestions for incorporating its use in the education of healthcare providers.