Pressure ulcers

2021 ◽  
pp. 1223-1246
Author(s):  
Donald Hudson ◽  
Sean Moodley
Keyword(s):  
Pressure Ulcers ◽  
Bed Rest ◽  
Extrinsic Factors ◽  
Muscle Flaps ◽  
Preventative Measures ◽  
Patients At Risk ◽  
Cost Implications ◽  
Surgical Guidelines ◽  
Special Risk

Pressure ulcers are a problem worldwide with social and cost implications. Patients at special risk are paraplegics, those in intensive care units who are critically sick, and older patients having prolonged bed rest for whatever reason. The important extrinsic factors are pressure, shear, and friction. There are a number of charts, which endeavour to identify patients at risk, and institute appropriate preventative measures thereby avoiding the long-term sequelae and burden of pressure ulcers. In patients with established pressure ulcers, an accurate patient and wound evaluation is vitally important. The long-term success of management of these ulcers is dependent on good patient rehabilitation and optimization of the wound. Reconstructive success is improved by following surgical guidelines. Use of fasciocutaneous flaps, designed in a V–Y configuration, is the preferred method of reconstruction with muscle flaps reserved as a back-up option. Conscientious postoperative care is equally important at ensuring a successful surgical outcome and minimizing complications

Prevention and Treatment of Pressure Ulcers

2004 ◽  
Vol 17 (2) ◽  
pp. 137-148 ◽  
Author(s):  
Christine K. O’Neil
Keyword(s):  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Health Concern ◽  
Term Care ◽  
Preventative Measures ◽  
Sentinel Event ◽  
Patients At Risk ◽  
Selection Of

Pressure ulcers are a serious health concern for elders in acute care, long-term care, and home care settings. The occurrence of a pressure ulcer is considered a sentinel event in terms of quality of care. Pressure ulcers may result in significant morbidity and mortality and are associated with high cost in terms of human suffering, cost of treatment, and possible litigation. Several risk factors have been identified for the development of pressure ulcers. Identification of elderly patients at risk of pressure and implementation of preventative measures are essential. Management of a pressure ulcer involves debridement, cleansing, selection of an appropriate dressing, and prevention of infection. This article reviews suggested guidelines for the prevention and management of pressure ulcers.

scholarly journals A prospective cohort register-based study of chronic postsurgical pain and long-term use of pain medication after otorhinolaryngological surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nina Graf ◽  
Katharina Geißler ◽  
Winfried Meißner ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Postsurgical Pain ◽  
Average Pain Intensity ◽  
Chronic Postsurgical Pain ◽  
Average Pain ◽  
Patients At Risk ◽  
Perioperative Assessment ◽  
Numeric Rating

AbstractData on chronic postsurgical pain (CPSP) after otorhinolaryngological surgery are sparse. Adult in-patients treated in 2017 were included into the prospective PAIN OUT registry. Patients’ pain on the first postoperative day (D1), after six months (M6) and 12 months (M12) were evaluated. Determining factor for CPSP was an average pain intensity ≥ 3 (numeric rating scale 0–10) at M6. Risk factors associated with CPSP were evaluated by univariate and multivariate analyses. 10% of 191 included patients (60% male, median age: 52 years; maximal pain at D1: 3.5 ± 2.7), had CPSP. Average pain at M6 was 0.1 ± 0.5 for patients without CPSP and 4.2 ± 1.2 with CPSP. Average pain with CPSP still was 3.7 ± 1.1 at M12. Higher ASA status (Odds ratio [OR] = 4.052; 95% confidence interval [CI] = 1.453–11.189; p = 0.007), and higher minimal pain at D1 (OR = 1.721; CI = 1.189–2.492; p = 0.004) were independent predictors of CPSP at M6. Minimal pain at D1 (OR = 1.443; CI = 1.008–2.064; p = 0.045) and maximal pain at M6 (OR = 1.665; CI = 1.340–2.069; p < 0.001) were independent predictors for CPSP at M12. CPSP is an important issue after otorhinolaryngological surgery. Better instrument for perioperative assessment should be defined to identify patients at risk for CPSP.

scholarly journals Implications for health services

1997 ◽  
Vol 352 (1363) ◽  
pp. 1887-1893 ◽  
Author(s):  
John Grimley Evans
Keyword(s):  
Health Services ◽  
Political Thought ◽  
Elderly Population ◽  
Average Duration ◽  
Later Life ◽  
The Elderly ◽  
Services Research ◽  
Extrinsic Factors ◽  
Progressive Loss

Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long–term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer underexploited–unexploited opportunities for the necessary research.

scholarly journals Preventing Contrast-induced Renal Failure: A Guide

2016 ◽  
Vol 11 (2) ◽  
pp. 98 ◽  
Author(s):  
Michela Faggioni ◽  
◽  
Roxana Mehran ◽  
Keyword(s):  
Risk Factors ◽  
Renal Damage ◽  
Preventive Measures ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Kidney Dysfunction ◽  
Percutaneous Coronary ◽  
Patients At Risk ◽  
Short And Long Term

Contrast-induced acute kidney injury (CI-AKI) is characterised by a rapid deterioration of renal function within a few days of parenteral administration of contrast media (CM) in the absence of alternative causes. CI-AKI is the most common form of iatrogenic kidney dysfunction with an estimated prevalence of 12 % in patients undergoing percutaneous coronary intervention. Although usually selfresolving, in patients with pre-existing chronic kidney disease (CKD) or concomitant risk factors for renal damage, CI-AKI is associated with increased short- and long-term morbidity and mortality. Therefore, risk stratification based on clinical and peri-procedural characteristics is crucial in selecting patients at risk of CI-AKI who would benefit the most from implementation of preventive measures.

Long-term results of acetabular reconstruction using irradiated allograft bone

2018 ◽  
Vol 100-B (11) ◽  
pp. 1449-1454 ◽  
Author(s):  
C. M. Green ◽  
S. C. Buckley ◽  
A. J. Hamer ◽  
R. M. Kerry ◽  
T. P. Harrison
Keyword(s):  
At Risk ◽  
Aseptic Loosening ◽  
Acetabular Component ◽  
Long Term Results ◽  
Acetabular Reconstruction ◽  
Allograft Bone ◽  
Patients At Risk ◽  
Irradiated Allograft

Aims The management of acetabular defects at the time of revision hip arthroplasty surgery is a challenge. This study presents the results of a long-term follow-up study of the use of irradiated allograft bone in acetabular reconstruction. Patients and Methods Between 1990 and 2000, 123 hips in 110 patients underwent acetabular reconstruction for aseptic loosening, using impaction bone grafting with frozen, irradiated, and morsellized femoral heads and a cemented acetabular component. A total of 55 men and 55 women with a mean age of 64.3 years (26 to 97) at the time of revision surgery are included in this study. Results At a mean follow-up of 16.9 years, there had been 23 revisions (18.7%), including ten for infection, eight for aseptic loosening, and three for dislocation. Of the 66 surviving hips (58 patients) that could be reassessed, 50 hips (42 patients; 75.6%) were still functioning satisfactorily. Union of the graft had occurred in all hips with a surviving implant. Survival analysis for all indications was 80.6% at 15 years (55 patients at risk, 95% confidence interval (CI) 71.1 to 87.2) and 73.7% at 20 years (eight patients at risk, 95% CI 61.6 to 82.5). Conclusion Acetabular reconstruction using frozen, irradiated, and morsellized allograft bone and a cemented acetabular component is an effective method of treatment. It gives satisfactory long-term results and is comparable to other types of reconstruction. Cite this article: Bone Joint J 2018;100-B:1449–54.

scholarly journals Mesenchymal Stem Cells and Transforming Growth Factor-β3 (TGF-β3) to Enhance the Regenerative Ability of an Albumin Scaffold in Full Thickness Wound Healing

2018 ◽  
Vol 9 (4) ◽  
pp. 65 ◽  
Author(s):  
Dale Feldman ◽  
John McCauley
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Surgical Treatment ◽  
Growth Factor ◽  
Healing Rate ◽  
Pressure Ulcers ◽  
Transforming Growth Factor ◽  
Bed Rest ◽  
Full Thickness ◽  
Non Surgical Treatment

Pressure ulcers are one of the most common forms of skin injury, particularly in the spinal cord injured (SCI). Pressure ulcers are difficult to heal in this population requiring at least six months of bed rest. Surgical treatment (grafting) is the fastest recovery time, but it still requires six weeks of bed rest plus significant additional costs and a high recurrence rate. A significant clinical benefit would be obtained by speeding the healing rate of a non-surgical treatment to close to that of surgical treatment (approximately doubling of healing rate). Current non-surgical treatment is mostly inactive wound coverings. The goal of this project was to look at the feasibility of doubling the healing rate of a full-thickness defect using combinations of three treatments, for the first time, each shown to increase healing rate: application of transforming growth factor-β3 (TGF-β3), an albumin based scaffold, and mesenchymal stem cells (MSCs). At one week following surgery, the combined treatment showed the greatest increase in healing rate, particularly for the epithelialization rate. Although the target level of a 100% increase in healing rate over the control was not quite achieved, it is anticipated that the goal would be met with further optimization of the treatment.

scholarly journals Early Predictors of Long-Term Disability After Injury

2003 ◽  
Vol 12 (3) ◽  
pp. 197-205 ◽  
Author(s):  
Therese S. Richmond ◽  
Donald Kauder ◽  
Janice Hinkle ◽  
Justine Shults
Keyword(s):  
At Risk ◽  
Structural Equation Modeling ◽  
Psychological Distress ◽  
Structural Equation ◽  
Equation Modeling ◽  
Specific Information ◽  
Care Providers ◽  
Early Predictors ◽  
Patients At Risk

• Background Improving outcomes after serious injury is important to patients, patients’ families, and healthcare providers. Identifying early risk factors for long-term disability after injury will help critical care providers recognize patients at risk. • Objectives To identify early predictors of long-term disability after injury and to ascertain if age, level of disability before injury, posttraumatic psychological distress, and social network factors during hospitalization and recovery significantly contribute to long-term disability after injury. • Methods A prospective, correlational design was used. Injury-specific information on 63 patients with serious, non–central nervous system injury was obtained from medical records; all other data were obtained from interviews (3 per patient) during a 2½-year period. A model was developed to test the theoretical propositions of the disabling process. Predictors of long-term disability were evaluated using path analysis in the context of structural equation modeling. • Results Injuries were predominately due to motor vehicle crashes (37%) or violent assaults (21%). Mean Injury Severity Score was 13.46, and mean length of stay was 12 days. With structural equation modeling, 36% of the variance in long-term disability was explained by predictors present at the time of injury (age, disability before injury), during hospitalization (psychological distress), or soon after discharge (psychological distress, short-term disability after injury). • Conclusions Disability after injury is due partly to an interplay between physical and psychological factors that can be identified soon after injury. By identifying these early predictors, patients at risk for suboptimal outcomes can be detected.

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