Pressure ulcer prevention using an alternating-pressure mattress overlay: the MATCARP project

Objective: The primary objective was to assess the incidence of pressure ulcer (PU) in patients at high risk of PU and lying between 15–20 hours per day on an alternating-pressure mattress overlay (APMO). Secondary objectives were the patient's satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use and the moisture level. Method: This prospective observational study was conducted in three rehabilitation centres and two nursing homes between June 2016 and March 2017. To be included, patients should not have PU at baseline and present a high risk of PU (Braden score between 10–15). The primary endpoint was the percentage of patients in whom a PU developed over a 35-day period. Results: A total of 83 patients were included in the study. Neurological disease was responsible for the reduced mobility of 44 (53.7%) patients, 10 patients (12.0%) dropped out (one patient for a serious adverse event (femoral neck fracture) considered not to be related to the APMO, four patients for adverse events, two of which were considered to be related to APMO and five for other reasons, including, in one case, discomfort with the APMO. These patients were considered in the analysis. Over the study period, 1.2% (1/83) (95% confidence interval (CI): 0.03 to 6.53) of patients developed a PU. Patient satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use were considered satisfying for most patients. Conclusion: Based on the findings of this study of a low incidence of PU in participating patients, the use of an AMPO is recommended in high-risk patients lying for between 15–20 hours a day.

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Incidence of pressure ulcer in patients using an alternating pressure mattress overlay: the ACTIVE study

Journal of Wound Care ◽

10.12968/jowc.2021.30.2.143 ◽

2021 ◽

Vol 30 (2) ◽

pp. 143-149

Author(s):

Sylvie Meaume ◽

Chantal Rousseaux ◽

Marc Marty

Keyword(s):

High Risk ◽

Pressure Ulcer ◽

Primary Objective ◽

Sitting Position ◽

Average Standard Deviation ◽

Risk Patients ◽

Low Incidence ◽

Pressure Mattress ◽

Sacral Spine

Objective: The primary objective was to determine the clinical benefit of using a specific alternating-pressure mattress overlay (APMO) in the prevention of pressure ulcer (PU) in patients at medium to high risk. Method: This prospective study was conducted in five rehabilitation centres and three nursing homes. Patients at medium to high risk of PU, but without PU at baseline, and lying between 15 and 20 hours per day on a specific APMO were included. The primary endpoint was the percentage of patients who developed a sacral, spine, heel or trochanteric PU (supine support areas) of at least category II, at day 35. All patients were included in the analysis. Results: A total of 89 patients were included; of whom six patients (6.7%) dropped out of the study (average (±standard deviation) follow-up 32±5.4 days). No sacral, spine, heel or trochanteric PU of at least category II was reported (i.e., an incidence of 0% [95% Confidence Interval: 0–4.1%] according to the exact Clopper–Pearson method]. Patients were ‘satisfied’ or ‘very satisfied’ with the comfort and stability of the APMO. The caregivers assessed as ‘very easy’ or ‘easy’ the implementation, maintenance and use of the APMO (turning over, moving to a sitting position). Conclusion: In combination with the usual measures to prevent PU, the results of our study showed a low incidence of PU in high-risk patients lying for between 15 and 20 hours a day on an APMO, use of which is therefore recommended in these patients.

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828 Is Isolation Before Elective Surgery the Way Forward During The COVID-19 Pandemic?

British Journal of Surgery ◽

10.1093/bjs/znab134.091 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S James ◽

G Lafaurie ◽

R Hafeez

Keyword(s):

High Risk ◽

General Surgery ◽

Elective Surgery ◽

Patient’S Satisfaction ◽

Anonymous Questionnaire ◽

Nice Guidance ◽

Main Factors ◽

Mode Of Transport ◽

Isolation Period ◽

The Way

Abstract Introduction The COVID-19 pandemic is here to last, and services must adapt to enable elective surgery to continue. Surgery involves high-risk aerosol generating procedures, potentially harmful to staff and patients. The current NICE guidance is for the patient to self-isolate for 72 hours prior to surgery. A question persists: Is 72-hour isolation the way forward in elective general surgery? Method In a DGH centre, using an anonymous questionnaire, we prospectively collected data on isolation for 36 elective general surgery patients during the 72h isolation period. The data was analysed to assess the concordance with isolation as well as patient's satisfaction with the process. Results 75% of patients were concordant with 72 hours of isolation pre-operatively. This was an increase from 35% when compared to patients questioned during the 14 day isolation period. The main factors contributing to isolation breech were visitors to the house and the mode of transport used to attend hospital. Conclusions The protocol is now for a COVID swab 72 hours pre-operatively followed by isolation until the operation. Our results show that still significant breaches in isolation remain and patients welfare is adversely affected during that period. Further research and consideration is needed to optimise the COVID isolation protocol.

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Pressure Ulcer Prevention in High-Risk Postoperative Cardiovascular Patients

Critical Care Nurse ◽

10.4037/ccn2011830 ◽

2011 ◽

Vol 31 (4) ◽

pp. 44-53 ◽

Cited By ~ 16

Author(s):

M. Jackson ◽

T. McKenney ◽

J. Drumm ◽

B. Merrick ◽

T. LeMaster ◽

...

Keyword(s):

High Risk ◽

Pressure Ulcer ◽

Pressure Ulcer Prevention ◽

Cardiovascular Patients ◽

Ulcer Prevention

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Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review

AMRC Open Research ◽

10.12688/amrcopenres.12860.1 ◽

2019 ◽

Vol 1 ◽

pp. 4

Author(s):

Margaret G. Keane ◽

Hannah R. Dadds ◽

Ghassan El Sayed ◽

Tu Vinh Luong ◽

Brian R. Davidson ◽

...

Keyword(s):

High Risk ◽

Malignant Transformation ◽

Cystic Lesions ◽

Retrospective Case ◽

Radiological Features ◽

Multidisciplinary Meeting ◽

Mucinous Neoplasms ◽

Low Incidence ◽

Immediate Surgery

Background: Pancreatic cystic lesions (PCL) are being detected with increasing frequency. Current methods of stratifying risk of malignant transformation are imperfect. This study aimed to determine the frequency of pancreatic malignancy in patients with PCL and define clinical and radiological features that predict malignant transformation in patients managed by surgery and/or surveillance. Methods: A retrospective cohort of adults who were evaluated in a tertiary hepatopancreaticobiliary centre between January 2000 - December 2013 with a confirmed PCL and followed up for at least 5 years. All cystic lesions were discussed at a weekly multidisciplinary meeting. Results: Of the 1,090 patients diagnosed with a PCL, 768 patients were included in the study: 141 patients were referred for immediate pancreatic resection, 570 entered surveillance while 57 had a malignant PCL which was unresectable at diagnosis (n=47) or were unfit for surgery (n=10). In those who were resected following presentation, malignancy was present in 38%. During follow-up 2% of those entering a surveillance programme underwent malignant transformation. Clinical and radiological features associated with a high-risk PCL included older age, symptoms, associated solid component or dilated main pancreatic duct. In intraductal papillary mucinous neoplasms, larger size was not a feature of malignant transformation (benign vs. malignant 30mm vs. 23mm; P= 0.012). Conclusion: The sensitivity of standard diagnostic tests leading to immediate surgery for high-risk PCL (malignant or mucinous) was 92% but with a specificity of just 5%. Surveillance of PCL without high-risk features within a multidisciplinary meeting was associated with a low incidence of cancer development, supporting the use of worrisome clinical and radiological features in the initial stratification of PCL.

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Changes in the Antenatal Utilization of High-Risk Obstetric Services and Stillbirth Rate during the COVID-19 Pandemic

American Journal of Perinatology ◽

10.1055/s-0041-1740212 ◽

2021 ◽

Author(s):

Megan C. Oakes ◽

Fan Zhang ◽

Lori Stevenson ◽

Bree Porcelli ◽

Ebony B. Carter ◽

...

Keyword(s):

High Risk ◽

Study Design ◽

Linear Models ◽

Care Center ◽

Tertiary Care ◽

Perinatal Outcomes ◽

Well Being ◽

Primary Objective ◽

Stillbirth Rate ◽

Obstetric Services

Objective The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic–related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic. Study Design This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed. Results While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect. Conclusion The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes. Key Points

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Abstract 16469: One Hundred Consecutive Patients With Perceval Sutureless Valve: A Good Alternative to Standard Avr and Tavr

Circulation ◽

10.1161/circ.132.suppl_3.16469 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Paolo Piccoli ◽

Annalisa Moggi ◽

Nicola Camurri ◽

Vinicio Fiorani ◽

Jacopo Manfredi ◽

...

Keyword(s):

High Risk ◽

Aortic Valve ◽

Good Alternative ◽

Valvular Regurgitation ◽

Paravalvular Leakage ◽

Thoracic Epidural ◽

Single Center Experience ◽

Risk Patients ◽

Low Incidence ◽

High Thoracic Epidural

Introduction:The recently introduced sutureless prostheses for aortic valve replacement allow short cross-clamp and CPB times with good clinical and haemodynamic performances. It is arguable that these factors can positively impact on post-operative morbidity and mortality, in particular in those patients with a medium- high risk profile. This study shows the mid-term results of a single center experience in patients undergoing AVR. with the Perceval sutureless bioprosthesis (Sorin Group, Saluggia, Italy) Methods:One hundred patients (64 female; mean age 78.2±4.7 years) with aortic valve stenosis (mean gradient of 51.3±14,2 mmHg) underwent aortic valve implantation with the sutureless Perceval bioprosthesis. High-thoracic epidural analgesia was used in 31 patients (31%). Associated CABG surgery was performed in 29 patients (29,%). The mean logistic EuroSCORE was 14.9±9.4% and the STS score was 3,3±1,7. Results:Thirty-day mortality was 2% (n=2). Mean CPB and cross-clamp times for isolated AVR were 38,1±18,6 and 24,2±9,8 minutes respectively. Perioperative echocardiography revealed significant paravalvular leakage in three patients (3%). Postoperative mean trans-valvular gradient was 13.6±5.2 mmHg. AV block requiring PM implantation occurred in 2 patients (2%). No thrombosis and no post-operative strokes were observed. At a mean follow-up of 13±6.7 months, no significant paravalvular leakage or valvular regurgitation was observed, and no migration or dislodgement of the prosthesis occurred. Conclusions:This study shows that sutureless implantation of the Perceval aortic valve bioprosthesis provides a simple and reproducible alternative for standard AVR and TAVR in medium-high risk patients eligible for AVR. The use of this self-anchoring valve was also associated in our patients with absence of embolic events and a very low incidence of AV blocks requiring PM implantation. These findings encourage the use of this valve in a broader spectrum of patients A control randomized trial is needed to confirm these promising findings.

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