Training program for caregivers to prevent pressure ulcers among elderly residents at geriatric homes

Objectives:Pressure ulcer(PU)is one of the most common problem among the bedridden elderly and has significantly more burden on elderly and caregivers.This study is aimed to evaluate the effects of the training program for caregivers to prevent PUs among elderly residents at geriatric homes.Methods:A quasi-experimental design was used to carry out the current study.A purposive sample comprised of all formal(39 nurses)or informal caregivers(39)and all immobilized elderly residents(35)who are found in all geriatric centers in Helwan district.A structured questionnaire was used to assess caregivers’socio-demographic characteristics,knowledge,attitude,and observational checklists for their practice for prevention of PU at pre-and posttest and during follow-up.Results:After the training program,there were improvements in the level of knowledge,practice,and positive attitude of caregivers about PU prevention with a statistically significant difference between pre-,post-,and follow-up training programs(P<0.001).Conclusions:The study revealed that the training program seemed to change the knowledge,practice,and attitude of the subjects to PU prevention.This,in turn,implies that adequate knowledge affects directly the elderly caregivers’attitudes as well as practice for prevention could be important in reducing the burden of PU among the elderly.Thus,conducting a training program for caregivers at different geriatric homes about caring skills for elders can prevent PU,and using spontaneous reposition is very effective to prevent PUs.

Autologous mesenchymal stem cells applied on the pressure ulcers had produced a surprising outcome in a severe case of neuromyelitis optica

Recent studies provided evidence that mesenchymal stem cells（MSCs） have regenerative potential in cutaneous repair and profound immunomodulatory properties making them a candidate for therapy of neuroimmunologic diseases. Neuromyelitis optica（NMO） is an autoimmune, demyelinating central nervous system disorder characterized by a longitudinally extensive spinal cord lesion. A 46-year-old male diagnosed with NMO had relapses with paraplegia despite treatment and developed two stage IV pressure ulcers（PUs） on his legs. The patient consented for local application of autologous MSCs on PUs. MSCs isolated from the patient＇s bone marrow aspirate were multiplied in vitro during three passages and embedded in a tridimensional collagen-rich matrix which was applied on the PUs. Eight days after MSCs application the patient showed a progressive healing of PUs and improvement of disability. Two months later the patient was able to walk 20 m with bilateral assistance and one year later he started to walk without assistance. For 76 months the patient had no relapse and no adverse event was reported. The original method of local application of autologous BM-MSCs contributed to healing of PUs. For 6 years the patient was free of relapses and showed an improvement of disability. The association of cutaneous repair, sustained remission of NMO and improvement of disability might be explained by a promotion/optimization of recovery mechanisms in the central nervous system even if alternative hypothesis should be considered. Further studies are needed to assess the safety and efficacy of mesenchymal stem cells in NMO treatment.

Nurses’ Knowledge, Attitudes and Practice regarding Pressure Ulcers Prevention and Treatment

Pressure ulcers (PU) are one of the most common hospital-acquired problems that occur in patients with mobility limitations. Such wounds can produce pain and deterioration of the underlying condition. Sometimes, they can be life-threatening, and their treatment can impose a financial burden on both the patient’s family and society. Nurses’ knowledge, attitude, and practice are the most important weapons to fight this preventable burden of PU among patients with impaired mobility. The purpose of this study was to assess nurses’ knowledge, attitude, and practice regarding PU prevention and treatment at Clinique Prince Louis Rwagasore (CPLR) in Bujumbura, Burundi. A cross-sectional study design was used. Convenience sampling was used to invite all 28 qualified nurses and nurses’ aids who work in the services where critically ill patients are admitted to participate. A questionnaire was created, and underwent evaluation of face validity before using it to collect data which was analysed using SPSS 21.0. Results revealed that nurses’ knowledge and practice scores were low as participants scored less than 50% on the six knowledge items and the six practice items. However, the attitude scores were greater than 65% on the five items used to evaluate attitude. A strong negative correlation was found between nurses’ knowledge and their attitude scores (r = ?0.479, p = 0.015). Education level was negatively associated with nurses’ knowledge and practice scores of PU prevention and treatment. A high attitude score did not correlate with a higher practice score which might be explained by low knowledge scores (less than 50% on knowledge items). Continuous professional development (CPD) was recommended to improve nurses’ knowledge scores and implementation of PU preventive practices at CPLR.

Application Experience of Moist Wound Healing Theory Combined with Modern New Dressings in the Treatment of Pressure Ulcers

Objective:Research on the effect of moist wound healing theory in a combination with modern new dressing treatment in patients diagnosed with pressure ulcers.Method:Selected 30 patients with pressure ulcers from our hospital,which is Shandong Tai an Municipal Hospital,from January 2019 to January 2021 were divided into experimental group(15 cases,treated with moist wound healing theory combined with modern new dressings)and control group(15 cases,applied conventional treatments).The treatment effect,time of wound edema subsidence,wound healing time,number of dressing changes,granulation tissue growth time,and diameter reduction time were compared between the two groups.Results:The total effective rate of the experimental group(93.33%,14/15)was higher than that of the control group(53.33%,8/15),P<0.05;the time to subsidence of wound edema in the experimental group was(3.11±0.22),and the time for wound healing was(12.78±0.45),the number of dressing changes(7.13±0.34)times,the growth time of granulation tissue(5.43±2.22),the diameter reduction time(6.25±3.75),compared with the control group,P<0.05.Conclusion:In the clinical treatment of patients diagnosed with pressure ulcers,the effective combination of moist healing theory and modern new dressing therapy has significant effects,whereby it speeds up the healing process of the pressure ulcers,and it is proven to be worthy to be promoted for usage.

Prevalence and Risk Factors of Postoperative Pressure Ulcers:A Systematic Review and Meta-analysis of Diagnostic Test

[Objectives]The paper was to analyze the total prevalence of postoperative pressure ulcers in patients and to reveal the epidemic law.[Methods]By searching English databases such as PubMed,Google Academics,Scopus,Science Direct and Web of Science(WOS),a total of 2018 English articles on pressure ulcers published from January 2015 to December 2020 were selected.According to the inclusion criteria,19 high-quality literatures were selected for the study,and the extended function of meta-analysis software of Review Manager 5.1 diagnostic test was used for data statistics and meta analysis of the results.[Results]There were 19 literatures with a total of 9400 patients included in the meta-analysis.The results showed that the total prevalence estimate of postoperative pressure ulcers was 20.00%(CI 95%:15.3-24.1).The total prevalence estimate of postoperative pressure ulcers in males was 10.1%(CI 95%:7.2-13.02),and that in females was 12.8%(CI 95%:8.1-17.3).The total prevalence estimates of stage I to IV postoperative pressure ulcers were 17.02%(CI 95%:11.06-22.09),6.7%(CI 95%:3.76-9.69),0.9%(CI 95%:0.21-1.26)and 0.4%(CI 95%:-0.05-0.8),respectively.[Conclusions]The prevalence of postoperative pressure ulcers is generally high.The prevalence of postoperative pressure ulcers in females is higher than that in males,and the prevalence of stage I pressure ulcers is higher than that of other stages,which is related to age,gender and other related risk factors.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

Predictive risk scales for development of pressure ulcers in pediatric patients admitted to general ward and intensive care unit

BACKGROUND More than ten special scales are available to predict the risk of pressure ulcers in children.However,the performances of those scales have not yet been compared in China.AIM To compare the Waterlow,Braden Q,and Glamorgan scales,and identify more suitable pressure ulcer evaluation scale for the pediatric intensive care unit(PICU).METHODS Trained nurses used the Waterlow,Braden Q,and Glamorgan scales to assess pediatric patients at Sun Yat-sen Memorial Hospital(China)within 24 h of admission from May 2017 to December 2020 in two stages.Skin examination was carried out to identify pressure ulcers every 3 d for 3 wk.RESULTS The incidence of pressure ulcers was 3/28(10.7%)in the PICU and 5/314(1.6%)in the general pediatric ward.For children in the general ward,the Waterlow,Braden Q,and Glamorgan scales had comparable area under the operating characteristic curve(AUC)of 0.870,0.924,and 0.923,respectively,and optimal cut-off values of 14,14,and 29 points.For PICU,the Waterlow,Braden Q,and Glamorgan scales had slightly lower AUC of 0.833,0.733,and 0.800,respectively,and optimal cut-off values of 13,16,and 27 points.Braden Q demonstrated a satisfactory specificity,and during the second stage of the study for PICU patients,the AUC of the Braden Q scale was 0.810,with an optimal cut-off value of 18.35 points.CONCLUSION The Waterlow,Braden Q,and Glamorgan scales have comparable performance while the Braden Q scale demonstrates a better specificity and can be successfully used by pediatric nurses to identify patients at high risk of pressure ulcers in PICU.

Skin Characteristics of Sites Predisposed to Pressure Ulcers among Bedridden Elderly Patients in Japan

Background: Previous studies have not specifically measured skin characteristics at common sites of pressure ulcers in high-risk elderly patients. Therefore, this study aimed to clarify the physiological skin characteristics at common pressure ulcer sites and their relationship with pressure ulcer risk and demographic/laboratory data in bedridden elderly Japanese patients. Methods: This study involved 55 elderly Japanese patients in a long-term care hospital and 25 female Japanese university students. Skin surface temperature, epidermal water content, transepidermal water loss, skin erythema/redness, skin elasticity, and skin thickness were measured using noninvasive devices. The sacral and both heel areas (sites predisposed to pressure ulcers) and mid-to-lower back area (control site) were observed. Results: Elderly patients showed a low epidermal water content at both heels (right heel, 14.8 ± 9.1 arbitrary units, AU.;left heel, 14.4 ± 8.3 AU). Transepidermal water loss remained acceptable at all sites in older patients despite the presence of dry skin (back, 7.1 ± 1.8 g/hm2;sacrum, 7.4 ± 3.0 g/hm2;right heel, 17.7 ± 7.1 g/hm2;left heel, 19.4 ± 8.1 g/hm2). Back (0.61 ± 0.13 AU) and sacral (0.67 ± 0.11 AU) skin elasticity and sacral skin thickness (0.97 ± 0.56 cm) were significantly lower than those of healthy young people (0.86 ± 0.04 AU, 0.87 ± 0.05 AU, and 2.27 ± 0.84 cm, respectively;p < 0.001 for all sites). Moderate positive correlations were observed between back skin elasticity and serum albumin level (r = 0.445, p < 0.001), and between sacral skin thickness and BMI (r = 0.506, p < 0.001) in older patients. Conclusions: Our findings showed that skin thickness and elasticity should be prioritized when evaluating pressure ulcer risk at the sacral region in bedridden elderly Japanese patients. Moreover, skin moisturization should be considered to minimize the risk at the heels in such patients.

Using complementary and alternative medicines to prevent and treat pressure ulcers: a systematic review

Background:Pressure ulcers are skin lesions generated by ischemic conditions caused by pressure on soft tissues.Several studies have investigated complementary and alternative medicine(CAM)as preventative and treatment measures for pressure ulcers.Therefore,we systematically reviewed the CAM literature in preventing and treating pressure ulcers.Methods:All clinical trial studies which used CAM were included.We searched different databases,including Scientific Information Database,Irandoc,Google Scholar,PubMed,Medline,Scopus,Cochrane Library,Embase,and Science Direct.The following keywords were used:“complementary and alternative medicine-CAM”,“integrative medicine”,“traditional medicine”,“pressure ulcer”,“bedsore”,“pressure sore healing”,and“prevention”.A Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2015 checklist was used to perform analyses.Results:After screening,35 studies were selected.Our investigations suggested that honey,medicinal plants,such as resin salve,Angelica dahurica,Aloe vera,fruits,herbal oils,a combination of several traditional medicine methods,sheepskin,maggot therapy,massage,charcoal,and acupuncture were the most common CAM methods.Conclusion:CAM strategies can prevent and treat pressure ulcers.They reduce wound size,exudate and necrotic tissue levels,inflammation,pain,bleeding,and infections.

Pressure Ulcers in Institutionalized Elderly People:Association of Sociodemographic and Clinical Characteristics and Risk Factors

Objective: To evaluate the association of socio-demographic and clinical characteristics, and risk factors with occurrence of pressure ulcers in institutionalized elderly people. Method: This cross-sectional, analytical study, in quantitative approach, performed from the database analysis linked to the project “Pressure Ulcer in institutionalized elderly people: Association of incidence with the risk factors to functional and nutritional assessment” developed in six long-stay institutions for the elderly people in Jo&atildeo Pessoa. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Associations were made through chi square test and Odds Ratio. Results: The clinical conditions of significant associations with the occurrence of pressure ulcers were the variables neurological disorders (p = 0.011) and visual impairment (p = 0.005). As for risk factors, the most important was fecal incontinence (p Conclusion: The analysis of the associations pointed out problems that require intervention in order to prevent health implications of the elderly people and to minimize the risk and occurrence of this injury.

Improving pressure ulcer care in intensive care units:Evaluating the impact of bundled care and silver nanoparticle dressings

BACKGROUND Pressure ulcer(PU)are prevalent among critically ill trauma patients,posing substantial risks.Bundled care strategies and silver nanoparticle dressings offer potential solutions,yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated.AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients.METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit(ICU)were included in this study.Patients were randomly assigned to either the control group(conventional care with silver nanoparticle dressing,n=49)or the intervention group(bundled care with silver nanoparticle dressing,n=49).The PU Scale for Healing(PUSH)tool was used to monitor changes in status of pressure injuries over time.Assessments were conducted at various time points:Baseline(day 0)and subsequent assessments on day 3,day 6,day 9,and day 12.Family satisfaction was assessed using the Family Satisfaction ICU 24 ques-tionnaire.RESULTS No significant differences in baseline characteristics were observed between the two groups.In the intervention group,there were significant reductions in total PUSH scores over the assessment period.Specifically,surface area,exudate,and tissue type parameters all showed significant improvements compared to the control group.Family satisfaction with care and decision-making was notably higher in the intervention group.Overall family satisfaction was significantly better in the intervention group.CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients.This approach holds promise for improving PUs management in the ICU,benefiting both patients and their families.

Economic evaluation of soft silicon foam dressings versus sterile gauze for the treatment of pressure ulcers in China

The aim of this study was to evaluate the cost and effectiveness of soft silicone foam dressings （SSFD, Mepilex） on the treatment of pressure ulcers. We searched electronic databases and retrieved articles to make a systematic evaluation, and then make a cost-effectiveness analysis by decision tree model combined with data from clinical treatments. The result shows that compared with the common sterile gauze, SSFD possesses an apparent advantage. The effective ratio is 96.3% versus 77.3%, although the cost of SSFD is much higher than that of sterile gauze, Mepilex appears to be more cost-effectiveness for preventive use.

Validation of LPD Scale for the Assessment of Pressure Ulcer at Home

Objectives: This study was designed to test and validate the new LPD scale in a home care setting. The specific objectives are to validate the LPD scale for subjects cared for at home;and to compare LPD to the Braden scale for internal validity. Method: This multicenter, cross-sectional study was conducted in the domestic environment of subjects cared for Home Care services from North to South of Italy. Data collection lasted 8 months, between June 2018 and September 2020, and consisted of the simultaneous compilation of the new LPD, and the Braden scale. Home Care Expert nurses could interface with the recruited subjects and/or caregivers. The parameters considered to validate the new scale were sensitivity (Se), specificity (Sp), positive predictive values (PPV), odds ratio (OR), and the area under the receiver operating characteristic (ROC) curve. Results: Of the 679 recruited subjects, 63.2% were women, and more than 50% did not have a pressure ulcer. 48.2% of the sample aged over 85 years old;69% was affected by multiple disease, and 76.6% took a lot of drugs. 91.6% of the subjects were affected by a partial or total functional dependency. Around 50% of subjects presented double incontinence, and 43% were conscious and collaborated. 85.4% of subjects lived in a healthy environment. The predictive validity parameters showed: Se 77.25%, Sp 84.04%, PPV 91.37%, and the area under the curve (AUC) 0.88% with a confidence interval (CI) 95%. These values mean a moderately accuracy of the test. Conclusions: The new LPD scale has demonstrated a good capacity for identifying the subjects at risk of pressure ulcer and had a better discriminatory power rather than Braden scale.

Risk factors for pressure ulcers in adult patients of cardiac surgery with cardiopulmonary bypass

Pressure ulcers(PUs)are a common complication of surgery.Despite PUs causing a heavy economic burden and diminishing patients’quality of life,their risk factors have not been thoroughly investigated.We aimed to find risk factors for PUs in adult cardiac surgery patients with cardiopulmonary bypass(CPB).Methods:Demographic,laboratory,and surgical data,the score of pressure ulcer(PU)risk tool-Braden Scale of 2307 adult patients who underwent cardiac surgery with cardiopulmonary bypass(CPB)between January 2019 and September 2019 were obtained.The postoperative PU incidence rates were analyzed using binary logistic regression analysis.Receiver operating characteristic curves(ROC)and the areas under the curves(AUC)were calculated to assess the predictive accuracy of PU risk.Results:Of the 2307 patients in this study,176 developed PUs after surgery,PU incidence rate was 7.6%.Univariate analysis showed that sex,emergency status,surgery type,surgery classification,and skin problems before surgery were risk factors for postoperative PUs.In multivariate analysis,emergency surgery,hemoglobin,hematocrit,pro-brain natriuretic peptide(pro-BNP),surgery classification,and skin problems before surgery were risk factors for postoperative PUs.Conclusions:Our findings suggest that emergency surgery,hemoglobin,hematocrit,pro-BNP,surgery classification,and skin problems before surgery are risk factors for PUs in adult cardiac surgery patients with CPB.The widely used Braden Scale is unsuitable for predicting PUs in such patients.

Treating extended stage IV ischial pressure ulcer in patient with spinal cord injury utilizing a multidisciplinary approach:a case report

Background:Pressure ulcers are one of the most common and dangerous sequelae of spinal cord injuries.Pressure ulcers treatment represents one of the most challenging clinical problems faced by clinicians.Method:This report examines a case of complicated stage-4 pressure ulcers in a young adult who had gunshot injury in his spine above T-11 level treated following a multidisciplinary approach.A multidisciplinary team formulated a multifaceted program that includes meticulous pressure relief program,wound care and flap reconstructive surgery,osteomyelitis treatment,nutrition optimization,post-operative physiotherapy,patient education,and psychological support,that recruited for this patient over the course of his stay at our unit.Results:During the third day postoperatively showed good blood circulation without necrosis or hematoma and site of ulcer completely has healed.Conclusion:Implementation of a multidisciplinary approach was key to optimizing surgical outcomes in spinal cord injury patients who have pressure sores,achieving a low recurrence rate and reducing readmissions.

Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: A meta-analysis

Aims:Paediatric pressure ulcers are a serious problem to healthcare service.Thus,effective and early identification of the risk of developing pressure ulcer is essential.The Braden Q scale is a widely used tool in the risk assessment of paediatric pressure ulcer,but its predictive power is controversial.Hence,we performed a meta-analysis to evaluate the predictive power of the Braden Q scale for pressure ulcer in hospitalised children and offer recommendations for clinical decision.Methods:Studies that evaluated the predictive power of the Braden Q scale were searched through databases in English and Chinese,including Medline,Cochrane Library,Embase,CINAHL,SinoMed,CNKI,Wangfang and VIP.The studies were screened by two independent reviewers.QUADAS-2 was used to assess the risk of bias of eligible studies.Demographic data and predictive value indices were extracted.The pooled sensitivity,specificity and receiver operating characteristics(ROC)were calculated by MetaDiSc 1.4 using random-effects models.Results:Cochran Q=26.13(P=0.0036)indicated the existence of heterogeneity;the I2 for pooled DOR was 61.7%,suggesting significant heterogeneity among the included studies.The pooled sensitivity and specificity were 0.73(95%CI:0.67-0.78)and 0.61(95%CI:0.59-0.63),respectively,yielding a combined DOR of 3.47(95%CI:2-6.01).The area under the ROC curve was 0.7078±0.0421,and the overall diagnostic accuracy(Q*)was 0.6591±0.0337.Sensitivity analysis showed the results were robust.Conclusion:The Braden Q scale has moderate predictive validity with medium sensitivity and low specificity for pressure ulcers in hospitalised children.Further development and modification of this tool for use in paediatric population are warranted.

Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients

BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.

Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery

Objectives:This study aimed to develop a nomogram for predicting the risk of pressure injury(PI)in adult patients undergoing abdominal surgery and validate its effectiveness among these patients.Methods:This study retrospectively included 11,247 adult patients,who underwent abdominal surgery and postoperative supervision in ICU,in a tertiary care hospital in western China between January 2017 and December 2020.All datasets were extracted from the patient’s medical records and randomly divided into the training cohort(8,997)and the validation cohort(2,250)by 8:2.The univariable logistic regression was used to select potentially relevant features.Then,multivariable logistic regression was also conducted and utilized to establish the nomogram.The nomogram was compared with the Braden scale for predicting PI in the validation cohort through the area under the curve(AUC)of the receiver operator characteristic(ROC)curve,Hosmer-Lemeshow(H-L)test,and decision curve analysis(DCA).Results:873(7.8%)patients suffered PIs.Logistic regression analysis showed that time of operation,weight,type of operation,albumin,and Braden scale score were independent risk factors for PI.A nomogram integrating five selected characteristics was constructed.The AUC of the ROC curve for the nomogram was 0.831,with a specificity of 85.2%and sensitivity of 63.7%.The AUC of the ROC curve for the Braden scale was 0.567,with a specificity of only 33.0%.The P-values of the H-L test were 0.45(nomogram)and 0.22(Braden scale),both indicating good calibration.The DCA also displayed that the nomogram had better predictive validity.Conclusion:Compared with the Braden scale,the nomogram showed a better predictive performance.This nomogram is informative and has the potential to better guide caregivers for risk stratification and prevention of PI,although it requires further validation.

Translation and piloting of the Chinese Mandarin version of an intensive care-specific pressure injury risk assessment tool(the COMHON Index)

Objective:To translate an intensive care-specific pressure injury risk assessment tool(the COMHON Index)from English into Chinese Mandarin.Methods:A four-step approach to instrument translation was utilised:1)English-Mandarin forward-translation by three independent bilinguists;2)Mandarin-English back-translation by two other inde-pendent bilinguists;3)comparison of forward and back-translations,identification of discrepancies,with required amendments returned to step one;and 4)piloting of the translated instrument.The pilot study was undertaken in a Chinese surgical intensive care unit with a convenience sample of 20 nurses.A five-point ordinal scale(1=very difficult;5=very easy)was used to assess ease-of-use and understanding.Translations were retained where medians4 indicated use and understanding was easy to very easy.Results:Five iterations of steps 1 to 3,and two sets of amendments to the original English instrument,were required to achieve translation consensus prior to pilot testing.Subscale scoring,sum scoring,and risk categorisation were documented in most pilot assessments(≥80%),but three sum scores were incorrectly tallied.The overall tool and all subscales were easy to use and understand(medians≥4),and most assessments(16/20,80%)took5 min to complete.Thus,translations were retained,with minor amendments made to instrument instructions for scoring and risk categorisation.Conclusions:An easy-to-use Chinese Mandarin intensive care-specific pressure injury risk assessment tool has been introduced through cross-cultural translation.However,it requires further testing of interrater reliability and agreement.A rigorous translation and reporting exemplar is presented that provides guidance for future translations.

Predicting Pressure Ulcer Risk with the Braden Q Scale in Chinese Pediatric Patients in ICU

Objective: The purpose of this study was to: ( 1 ) observe the value of the score of Braden Q scale in predicting pressure ulcers in pediatric Intensive Care Unit ( ICU) patients in China, ( 2) determine the critical cutoff point for classifying patient risk, and ( 3) describe the pressure ulcer incidence. Methods: A prospective cohort descriptive study with a convenience sample of 198 patients bed-ridden for at least 24 hours without pre-existing pressure ulcers enrolled from a pediatric intensive care unit ( PICU) . The Braden Q score and skin assessment were independently rated, and data collectors were blinded to the other measures. Patients were observed for up to 3 times per week for 2 weeks and once a week thereafter until PICU discharge. Results: Fourteen patients ( 7. 1%) developed pressure ulcers; 12 ( 85. 7%) were Stage I pres-sure ulcers, 2 ( 14. 3%) were Stage II, and there were no Stage III or IV pressure ulcers. Most pressure ulcers ( 64. 3%) were present at the first observation. The Braden Q Scale has an overall cumulative variance contribution rate of 69. 599%. Using Stage I+ pressure ulcer data obtained during the first observation, a Receiver Operator Characteristic ( ROC) curve for each possible score of the Braden Q Scale was constructed. The area under the curve ( AUC) was 0. 57, and the 95% confidence interval was 0. 50-0. 62. At a cutoff score of 19, the sensitivity was 0. 71, and the specificity was 0. 53. The AUC of each item of the Braden Q Scale was 0. 543-0. 612. Conclusions: PICU patients are susceptible to pressure ulcers. The value of the Braden Q Scale in the studied pediatric population was relatively poor, and it should be optimized before it is used in Chinese pediatric patients.