Clinical evaluation with long-term follow-up of patients with pressure ulcers in one Swedish county

2020 ◽  
Vol 29 (8) ◽  
pp. 472-478
Author(s):  
Rut Frank Öien ◽  
Hanna Wickström ◽  
Nina Åkesson ◽  
Suzana Selan ◽  
Linda Söderlundh
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Mortality Rate ◽  
Ulcer Healing ◽  
Pressure Ulcers ◽  
Community Care ◽  
Preventive Measures ◽  
Advisory Panel ◽  
Skin Examination

Objective: To conduct a screening, skin examination and risk assessment of patients with pressure ulcers (PUs) in one Swedish county (inpatient, primary and community care) with follow-up after six months to investigate ulcer healing, frequency of amputation and mortality rate linked to preventive measures. Method: The methodology recommended by the European Pressure Ulcer Advisory Panel was used. Screening, risk assessment and skin examination were performed during March 2017. The modified Norton scale was used to assess PU risk, with a score of ≤20 indicating presence of risk. A research questionnaire was used to document prevention and treatment. Follow-up was performed after six months, during September 2017. The same research questionnaire was used to capture the current situation of the patients, including ulcer healing, frequency of amputation, and mortality rate. Results: Screening covered 464 patients: 303 hospitalised, 68 in community care, and 93 in primary care. A total of 110 patients—55 at risk of PU and 55 with PUs, the majority of which were category 2–4 PUs—were included in the study. At follow-up, 67% were treated in community care, 32% in primary care, and 1% in hospital. Mortality rate for patients with PUs was 44%. Of the remaining 31 patients, 17 had unhealed PUs, 10 had healed PUs, two had undergone amputation, and complete follow-up data was missing in the remaining two patients. Conclusion: These results reflect the complex situation of an aged and frail patient group, including a lack of preventive measures and follow-up routines in community and primary care.

scholarly journals Cost-effectiveness of a stepwise cardiometabolic disease prevention program: results of a randomized controlled trial in primary care

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Daphne M. Stol ◽  
Eelco A. B. Over ◽  
Ilse F. Badenbroek ◽  
Monika Hollander ◽  
Mark M. J. Nielen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Prevention Program ◽  
Healthcare Costs ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group

Abstract Background Cardiometabolic diseases (CMD) are the major cause of death worldwide and are associated with a lower quality of life and high healthcare costs. To prevent a further rise in CMD and related healthcare costs, early detection and adequate management of individuals at risk could be an effective preventive strategy. The objective of this study was to determine long-term cost-effectiveness of stepwise CMD risk assessment followed by individualized treatment if indicated compared to care as usual. A computer-based simulation model was used to project long-term health benefits and cost-effectiveness, assuming the prevention program was implemented in Dutch primary care. Methods A randomized controlled trial in a primary care setting in which 1934 participants aged 45–70 years without recorded CMD or CMD risk factors participated. The intervention group was invited for stepwise CMD risk assessment through a risk score (step 1), additional risk assessment at the practice in case of increased risk (step 2) and individualized follow-up treatment if indicated (step 3). The control group was not invited for risk assessment, but completed a health questionnaire. Results of the effectiveness analysis on systolic blood pressure (− 2.26 mmHg; 95% CI − 4.01: − 0.51) and total cholesterol (− 0.15 mmol/l; 95% CI − 0.23: − 0.07) were used in this analysis. Outcome measures were the costs and benefits after 1-year follow-up and long-term (60 years) cost-effectiveness of stepwise CMD risk assessment compared to no assessment. A computer-based simulation model was used that included data on disability weights associated with age and disease outcomes related to CMD. Analyses were performed taking a healthcare perspective. Results After 1 year, the average costs in the intervention group were 260 Euro higher than in the control group and differences were mainly driven by healthcare costs. No meaningful change was found in EQ 5D-based quality of life between the intervention and control groups after 1-year follow-up (− 0.0154; 95% CI − 0.029: 0.004). After 60 years, cumulative costs of the intervention were 41.4 million Euro and 135 quality-adjusted life years (QALY) were gained. Despite improvements in blood pressure and cholesterol, the intervention was not cost-effective (ICER of 306,000 Euro/QALY after 60 years). Scenario analyses did not allow for a change in conclusions with regard to cost-effectiveness of the intervention. Conclusions Implementation of this primary care-based CMD prevention program is not cost-effective in the long term. Implementation of this program in primary care cannot be recommended. Trial registration Dutch Trial Register NTR4277, registered on 26 November 2013

A clinimetric analysis of the Pressure Ulcer Risk Primary or Secondary Evaluation Tool: PURPOSE-T

2019 ◽  
Vol 28 (20) ◽  
pp. S4-S8
Author(s):  
Matthew Wynn ◽  
Samantha Holloway
Keyword(s):  
Risk Assessment ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Evidence Base ◽  
Assessment Tools ◽  
Future Research ◽  
Advisory Panel ◽  
Evaluation Tool ◽  
Risk Assessment Tools ◽  
Patients At Risk

The assessment of patients' risk for developing pressure ulcers is a routine and fundamental nursing process undertaken to prevent avoidable harm to patients in all care settings. Many risk assessment tools are currently used in clinical practice, however no individual tool is recommended by advisory bodies such as the National Institute for Health and Care Excellence or the European Pressure Ulcer Advisory Panel. The evidence base on the value of structured risk assessment tools in reducing the incidence or severity of pressure ulcers is poor. This purpose of this article is to provide a clinimetric analysis of the recently developed Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) and identify areas for future research to improve the utility of structured risk assessment in identifying patients at risk of developing pressure ulcers.

Risk Assessment for Pressure Ulcers: An Adaptation of the National Pressure Ulcer Advisory Panel Risk Factors to Spinal Cord Injured Patients

1993 ◽  
Vol 16 (3) ◽  
pp. 169-177 ◽  
Author(s):  
Paula A. Rochon ◽  
Marie P. Beaudet ◽  
Regina McGiinchey-Berroth ◽  
Linda A. Morrow ◽  
Margaret M. Ahlquist ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Spinal Cord ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Advisory Panel ◽  
Injured Patients ◽  
Spinal Cord Injured

scholarly journals Cardiovascular risk management in COPD patients: impact of the new Dutch guideline

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101139
Author(s):  
Lonneke Maria Elisabeth Nies ◽  
Looijmans I ◽  
Rozendaal Rozendaal ◽  
Brenda Baar ◽  
Rimke C Vos ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
High Risk ◽  
Care Program ◽  
Qualitative Risk Assessment ◽  
Copd Patients ◽  
Increased Risk ◽  
The Impact ◽  
Very High

Background: Patients with COPD have an independent increased risk of cardiovascular (CV) disease. CV-risk (CVR) assessment should be offered to all COPD-patients according to the new Dutch ‘CVR management’ (CVRM) guideline (May-2019). Aim: To evaluate the impact of this new guideline for the care of COPD-patients in primary care. Design and Setting: A retrospective study within five primary healthcare centres located in the Netherlands. Methods: In accordance with the guideline we estimated and categorized the CVR of all COPD-patients. Data from 2014–2019 were used for the qualitative risk assessment based on comorbidities, and the quantitative Systematic Coronary Risk Assessment (SCORE). In addition, we investigated the guideline-based follow-up. Results: Of the 391 COPD-patients, 84.1% (n=329) had complete data on CVR assessment: 90.3% (n=297) had a (very)-high risk and 9.7% (n=32) a low-to-moderate risk. Of the patients with (very)-high risk, 73.4% (n=218) received guideline-based follow-up (primary care: 95.4%, secondary care: 4.6%). In 15.9% (n=62) of all COPD-patients, the CVR profile was not measured and of the (very)-high-risk patients, 26.6% (n=79) was not enrolled in a CV-care program. Conclusion: Whereas in the majority of patients the CVR is already known, for one out of six COPD-patients this CVR still has to be assessed according to the recently updated guideline. Moreover, once a (very)-high risk has been assessed, as a consequence CV treatment of risk factors should be intensified in one out of four COPD-patients. Adherence to the new CVRM guideline could provide improvement in CVRM in more than a third of all COPD-patients.

Principles and prevention of pressure sores in the ICU

2016 ◽  
Author(s):  
Laura Crawford ◽  
Ruth Kleinpell
Keyword(s):  
Risk Assessment ◽  
Critically Ill ◽  
Pressure Ulcer ◽  
Critically Ill Patients ◽  
Pressure Ulcers ◽  
Critically Ill Patient ◽  
Advisory Panel ◽  
Pressure Sores ◽  
Pressure Ulcer Development ◽  
Preventative Interventions

A pressure ulcer, defined by the National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels as localized injury to the skin or tissue as the result of pressure or pressure in combination with shear, can be an adverse complication of a hospital stay, especially for acute and critically-ill patients. Factors that can contribute to pressure ulcer development include the intensity and duration of pressure, tissue tolerance, shear, and friction. Common anatomical sites for pressure ulcers development are over bony prominences. The National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels define pressure ulcers in six stages according to the degree of tissue damage present in the wound. A risk assessment should be performed to identify the vulnerability of pressure ulcer development and provide guidance for the implementation of preventative interventions. For the critically-ill patient, several specific measures are advocated for preventing pressure ulcers.

scholarly journals Changes in referral rates following community psychiatric nurse attachment to a primary care team

1992 ◽  
Vol 16 (5) ◽  
pp. 264-265 ◽  
Author(s):  
Andrew D. Wells ◽  
John M. Eagles ◽  
David Hunter ◽  
Douglas G. Fowlie
Keyword(s):  
Primary Care ◽  
Community Care ◽  
Psychiatric Patients ◽  
Psychiatric Nursing ◽  
Psychiatric Nurses ◽  
Psychiatric Nurse ◽  
The Past ◽  
Community Psychiatric ◽  
Nursing Services

Over the past three decades there has been a shift in emphasis from hospital based to community care of psychiatric patients. Central to this change has been the development of the community psychiatric nursing services and an increase in its numbers. Until recently community psychiatric nurses (CPNs) were almost entirely hospital based, working as members of a multidisciplinary team and providing follow-up for psychiatric patients.

scholarly journals Homeopathy for Covid-19 in Primary Care: A structured summary of a study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ubiratan Cardinalli Adler ◽  
Maristela Schiabel Adler ◽  
Livia Mitchiguian Hotta ◽  
Ana Elisa Madureira Padula ◽  
Amarilys de Toledo Cesar ◽  
...  
Keyword(s):  
Primary Care ◽  
Alternative Hypothesis ◽  
University Hospital ◽  
List Type ◽  
Study Medication ◽  
Link Type ◽  
Care Protocol ◽  
Full Protocol ◽  
Isolation Period

Abstract Objectives To investigate the effectiveness and safety of homeopathic medicine Natrum muriaticum (LM2) for mild cases of COVID-19 in Primary Health Care. Trial design A randomized, two-armed (1:1), parallel, placebo-controlled, double-blind, clinical trial is being performed to test the following hypotheses: H0: homeopathic medicines = placebo (null hypothesis) vs. H1: homeopathic medicines ≠ placebo (alternative hypothesis) for mild cases of COVID-19 in Primary Care. Participants Setting: Primary Care of São Carlos – São Paulo – Brazil. One hundred participants aged 18 years or older, with Influenza-like symptoms and a positive RT-PCR for SARS-CoV-2. Willingness to give informed consent and to comply with the study procedures is also required. Exclusion criterium: severe acute respiratory syndrome. Intervention and comparator Homeopathy: 1 globule of Natrum muriaticum LM2 diluted in 20 mL of alcohol 30% and dispensed in a 30 ml bottle. Placebo: 20 mL of alcohol 30% dispensed in a 30 ml bottle. Posology: one drop taken orally every 4 hours (6 doses/day) while there is fever, cough, tiredness, or pain (headache, sore throat, muscle aches, chest pain, etc.) followed by one drop every 6 hours (4 doses/day) until the fourteenth day of use. The bottle of study medication should be submitted to 10 vigorous shakes (succussions) before each dose. Posology may be changed by telemedicine, with no break in blinding. Study medication should be maintained during home isolation. According to the Primary Care protocol, the home isolation period lasts until the 10th day after the appearance of the first symptom, or up to 72 hours without symptoms. Main outcomes The primary endpoint will be time to recovery, defined as the number of days elapsed before all COVID-19 Influenza-like symptoms are recorded as mild or absent during home isolation period. Secondary measures are recovery time for each COVID-19 symptom; score of the scale created for the study (COVID-Simile Scale); medicines used during follow-up; number of days of follow-up; number of visits to emergency services; number of hospitalizations; other symptoms and Adverse Events during home isolation period. Randomisation The study Statistician generated a block randomization list, using a 1:1 ratio of the two groups (denoted as A and B) and a web-based tool (http://www.random.org/lists). Blinding (masking) The clinical investigators, the statistician, the Primary Care teams, the study collaborators, and the participants will remain blinded from the identity of the two treatment groups until the end of the study. Numbers to be randomised (sample size) One hundred participants are planned to be randomized (1:1) to placebo (50) or homeopathy (50). Trial Status Protocol version/date May 21, 2020. Recruitment is ongoing. First participant was recruited/included on June 29,2020. Due to recruitment adaptations to Primary Care changes, the authors anticipate the trial will finish recruiting on April 10, 2021. Trial registration COVID-Simile Study was registered at the University Hospital Medical Information Network (UMIN - https://www.umin.ac.jp/ctr/index.htm) on June 1st, 2020, and the trial start date was June 15, 2020. Unique ID: UMIN000040602. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

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