Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds

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Pressure Relieving Support Surfaces for Pressure Ulcer Prevention (PRESSURE 2): Clinical and Health Economic Results of a Randomised Controlled Trial

Background Pressure ulcers (PUs) are complications of serious acute/chronic illness. Specialist mattresses used for prevention lack high quality effectiveness evidence. We aimed to compare clinical and cost effectiveness of 2 mattress types. Methods Multicentre, Phase III, open, prospective, parallel group, randomised controlled trial in 42 UK secondary/community in-patient facilities. 2029 high risk (acutely ill, bedfast/chairfast and/or Category 1 PU/pain at PU site) adult in-patients were randomised (1:1, allocation concealment, minimisation with random element) factors including: centre, PU status, facility and consent type. Interventions were alternating pressure mattresses (APMs) or high specification foam (HSF) for maximum treatment phase 60 days. Primary outcome was time to development of new PU Category ≥ 2 from randomisation to 30 day post-treatment follow-up in intention-to treat population. Trial registration: ISRCTN 01151335. Findings Between August 2013 and November 2016, we randomised 2029 patients (1016 APMs: 1013 HSF) who developed 160(7.9%) PUs. There was insufficient evidence of a difference between groups for time to new PU Category ≥ 2 Fine and Gray Model Hazard Ratio HR = 0.76, 95%CI0.56–1.04); exact P = 0.0890; absolute difference 2%). There was a statistically significant difference in the treatment phase time to event sensitivity analysis, Fine and Gray model HR = 0.66, 95%CI, 0.46–0.93; exact P = 0.0176); 2.6% absolute difference). Economic analyses indicate that APM are cost-effective. There were no safety concerns. Interpretation In high risk (acutely ill, bedfast/chairfast/Category 1 PU/ pain on a PU site) in-patients, we found insufficient evidence of a difference in time to PU development at 30-day final follow-up, which may be related to a low event rate affecting trial power. APMs conferred a small treatment phase benefit. Patient preference, low PU incidence and small group differences suggests the need for improved targeting of APMs with decision making informed by patient preference/comfort/rehabilitation needs and the presence of potentially modifiable risk factors such as being completely immobile, nutritional deficits, lacking capacity and/or altered skin/Category1 PU

The Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) is not an adequate outcome measure of pressure ulcer-related neuropathic pain

Background: Few pain assessment scales have been used in Pressure Ulcer (PU) research and none developed or validated for people with PUs. We examined the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale to determine its utility as an outcome measure for people with pressure-area related pain. Methods: LANSS data from 728 participants underwent psychometric analyses: traditional tests for data quality, scaling assumptions, reliability and validity and a Rasch analysis including tests of fit, spread and targeting of item locations, response dependency, person separation index (reliability) and differential item functioning. Results: Our findings offer support for a unidimensional scale; confirmatory factor analysis indicated a non-significant Chi-Square test of model fit ((df =14) 23.48, p= 0.053). However, some misfit was identified at the overall scale and individual item levels, and internal construct validity of the LANSS as an outcome measure for neuropathic pain in people with pressure-area related pain was not supported; low to moderate item-total correlations (Chi Square (df = 28) 55.546, p = 0.002) and inter-item correlations (mean 0.117 and range from 0.063 - 0.415); and low Cronbach’s alpha (0.549) and Person Separation Index (0.334). Conclusions: Requirements for reliable and valid measurement do not support the use of the LANSS as an outcome measure in people with PUs at the individual level or as a generalised measurement scale of neuropathic pain across ulcer severity groups. Expanding the number of items to aid differentiation between neuropathic pain levels and improving scale reliability is recommended

Aging and nutrition. Paving the way to better health.

AbstractSufficient caloric intake is important to maintain the balanced health status, especially during the period of aging, as aging and sickness share paths. Maintaining adequate nutritional balance is the best preventive measure to counteract the risk of malnutrition. There are several causes for malnutrition in elderly people, and some techniques such as anthropometric measurements, laboratory and clinical parameters could help to diagnose malnutrition in these patients. The use of a simple validated questionnaire called the 'Mini Nutritional Assessment' measures the nutritional status of elderly patients. In this review, we discuss about the malnutrition in elderly people with and without a known cause and we present some of nutritional intervention. There are promising strategies that help overcoming malnutrition

Exploring Methods to Improve Pressure Ulcer Detection: Spectroscopic Assessment of the Blanch Response

Pressure damage in intact skin is difficult to detect, particularly in individuals with dark skin, because color changes and tissue blanching are masked by the skin's pigmentation. Tissue reflectance spectroscopy (TRS) may be able to detect the blanch response regardless of skin color by measuring the change in total hemoglobin (delta tHb) that occurs when pressure is applied to the skin. The objective of this dissertation was to examine the ability of TRS to detect the blanch response at sites at risk for pressure ulcer development in individuals with various levels of skin pigmentation. Three studies were conducted to address this objective. In Study 1, delta tHb was assessed at the heel and sacrum of light and dark-skinned healthy participants using a portable TRS system. Study 1 showed that a significant decrease (p less than 0.001) in tHb could be measured in both light and dark skinned-participants with good intra-rater reliability (ICC greater than or equal to 0.80) at the heel, but not at the sacrum. Study 2 was conducted to identify a reliable method of skin color description for use in subsequent studies of the spectroscopic blanch response. Two examiners (B and C) performed three skin color assessments at the volar forearm of ten healthy participants using Munsell color tile matching and colorimetry. Intra and inter-rater reliability was excellent for colorimetry (ICCs typically greater than or equal to 0.90). Reliability for Munsell color tile matching was highest for Munsell value within Examiner B (93% agreement, kappa 0.87-1.00), which was determined to be sufficiently high for use in subsequent studies. In Study 3, delta tHb was assessed at the heels of light, moderate, and dark-skinned elderly nursing home residents at risk for pressure ulcers. As in the pilot study, a significant decrease in tHb was observed in all skin color groups (p less than 0.05). Intra-rater reliability for delta tHb was moderate or greater (ICC greater than or equal to 0.61). In combination, the results of Study 1 and Study 3 demonstrated that a significant spectroscopic blanch response could be detected with moderate or greater intra-rater reliability at the heel regardless of age or pressure ulcer risk status

Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds

© 2016 John Wiley & Sons Ltd. Aim: To examine the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing the healing progress in acute and chronic wounds. Background: It is important to establish the responsiveness of instruments used in conducting wound care assessments to ensure that they are able to capture changes in wound healing accurately over time. Design: Prospective longitudinal observational study. Method: The key study instrument was the PUSH tool. Internal responsiveness was assessed using paired t-testing and effect size statistics. External responsiveness was assessed using multiple linear regression. All new patients with at least one eligible acute or chronic wound, enrolled in the Nurse and Allied Health Clinic-Wound Care programme between 1 December 2012 - 31 March 2013 were included for analysis (N = 541). Results: Overall, the PUSH tool was able to detect statistically significant changes in wound healing between baseline and discharge. The effect size statistics were large. The internal responsiveness of the PUSH tool was confirmed in patients with a variety of different wound types including venous ulcers, pressure ulcers, neuropathic ulcers, burns and scalds, skin tears, surgical wounds and traumatic wounds. After controlling for age, gender and wound type, subjects in the 'wound improved but not healed' group had a smaller change in PUSH scores than those in the 'wound healed' group. Subjects in the 'wound static or worsened' group had the smallest change in PUSH scores. The external responsiveness was confirmed. Conclusion: The internal and external responsiveness of the PUSH tool confirmed that it can be used to track the healing progress of both acute and chronic wounds.published_or_final_versio

Plan de actuación enfermero para la prevención de úlceras por presión. Caso clínico.

Introducción: Actualmente las úlceras por presión son un problema multifactorial y multicausal con una alta prevalencia en las instituciones hospitalarias. Su prevención es esencial para la salud del paciente debiéndose llevar a cabo diversos cuidados para evitar la aparición de estas lesiones. La enfermería juega un papel muy importante en esta patología, ya que las complicaciones de la misma pueden incrementar la mortalidad hasta un 50%. Objetivo: Diseñar un Procedimiento de Atención Enfermera para prevenir las úlceras por presión, identificando los distintos factores de riesgo y proporcionando los cuidados necesarios. Metodología: Elaboración de un plan de cuidados que ayude a la prevención de las úlceras por presión. Para ello se ha realizado una valoración por dominios NANDA, apoyada en las diferentes escalas recomendadas en la valoración del paciente geriátrico, usando la taxonomía NANDA-NOC-NIC. Resultados: Tras una semana de hospitalización se evaluó al paciente, presentando una alteración en la integridad de la piel. De los objetivos marcados se consiguieron completamente los relacionados con la hidratación de la piel y el de ingesta de líquidos, pero el resto se vieron afectados por la presentación de una complicación respiratoria. Discusión: A pesar de haber llevado a cabo las distintas medidas preventivas, el diagnóstico de riesgo planteado pasó a ser un diagnóstico real. La intervención se centró en actuar sobre los factores de riesgo de aparición de úlceras por presión, llevando a cabo intervenciones preventivas adecuadas, pero no lograron ser suficientes debido a los factores intrínsecos que actuaron favoreciendo la aparición de las úlceras por presión. En este caso nos encontramos con una dificultad añadida debido al afrontamiento familiar comprometido, ya que un buen apoyo familiar facilita en gran medida la aplicación de los cuidados y posibilita una buena continuidad al alta hospitalaria.Grado en Enfermerí