Sensing Senses: Tactile Feedback for the Prevention of Decubitus Ulcers

Decubitus ulcers, also known as pressure sores, is a major problem in health care, in particular for patients with spinal cord injuries. These patients cannot feel the discomfort that would urge healthy people to change their posture. We describe a system that uses a sensor mat to detect problematic postures and provides tactile feedback to the user. The results of our preliminary study with healthy subjects show that the tactile feedback is a viable option to spoken feedback. We envision the system being used for rehabilitation games, but also for everyday Decubitus ulcers prevention.     

预防压疮管理路径表的设计与应用

目的：探讨压疮管理的方法和路径。方法：制定并应用神经外科压疮管理路径表。选择2010年3月至2011年3月神经外科入院的1400例患者,分为对照组与观察组,观察组755例,入院后常规护理基础上应用路径表;对照组为645例,常规护理。结果：对照组645例患者中,发生压疮例数Ⅱ期压疮5例;观察组755例患者中,发生Ⅰ期压疮1例。P〈0．05,有显著统计学意义。结论：应用压疮管理路径表可以预防神经外科患者压疮的发生,有效降低患者压疮发生率。     

Efficacy of operative cure in pressure sore patients.

The advent of air flotation-type beds and purified growth factors that may accelerate open wound contraction, coupled with very high recurrence rates and decreasing health resources, suggests that surgical reconstruction of pressure sores may not be indicated in all patients. In an effort to define which patients might benefit from operation, we reviewed the data from 40 consecutive patients with 68 pressure sores operated on under the direction of a single surgeon between 1981 and 1989. Patients were categorized on the basis of the presence or absence of paraplegia and its etiology. Sixty-six operations were performed, 55 muscle or fasciocutaneous flaps and 11 cutaneous flaps. There was a 36 percent operative complication rate, with no operative mortalities. Follow-up ranged from 1 to 71 months, with a mean of 21 months. Despite an 80% healed rate at the time of discharge, 61% of sores and 69% of patients had recurrent ulceration within a mean of 9.3 months. Analysis of these data indicates that surgical reconstruction of pressure sores does not appear to be efficacious in young posttraumatic paraplegics or cerebrally compromised elderly patients. Further review of the data failed to identify those patients likely to remain healed after operative repair of their pressure sores.     

气垫床在预防压疮中的效果评价

目的：探讨气垫床在预防压疮中的应用,为减少住院患者压疮的发生提供科学依据,提高患者生存质量。方法：选择我院2011年6月-2012年6月住院患者116例为研究对象,对患者进行褥疮风险评估后将116例患者随机分为两组,一组患者使用气垫床,另一组患者普通褥疮预防和护理,对两组患者发生褥疮的情况进行比较。结果：普通组患者发生压疮26例,对照组患者发生压疮5例,经卡方比较,对照组好于普通组,P〈0.05。结论：气垫床的使用不仅可以很好的杜绝压疮的发生,还可以提高患者的生存质量。     

Prevention of pressure sores by identifying patients at risk.

The risk of pressure sores developing in patients admitted with acute conditions was assessed by a simple risk score system based on age, reduced mobility, incontinence, pronounced emaciation, redness over bony prominences, unconsciousness, dehydration, and paralysis in a prospective clinical study. During seven months in 1977, 600 of 3571 patients were classified as at risk. Of these 35 (5.8%) developed sores compared with five (0.2%) of those not at risk. The results of this study compared with those over the same period in 1976 show that close observation of at-risk patients and early detection of pressure sores prevents their development.     

Aetiology of pressure sores in patients with spinal cord injury.

One hundred consecutive patients admitted to the National Spinal Injuries Centre, Stoke Mandeville Hospital, with pressure sores were studied to assess the relative importance of factors known to predispose to the development of scores. Loss of feeling was critical, because patients were unable to appreciate pain when the sore was developing. Risk of developing a sore increased with age, but duration of the paralysis was of equal importance. After discharge from hospital the presence of a caring relative or friend was essential for survival. Many patients developed sores because of poor facilities at home or inappropriate advice from those who looked after them. An even more distressing factor was the number of patients who developed sores in hospital owing to inadequate nursing care. There are relatively few paralysed patients in the community, but the lessons learnt in this study may be applied to all patients with orthopaedic injuries and to geriatric patients with limited mobility. Nursing and medical staff must turn patients regularly and ensure that there is proper equipment to relieve pressure on the skin. Patients should not be allowed to sit in a chair if they develop a sacral or trochanteric sore. More effort should be directed towards the appropriate education of patients, their relatives, and all those who are concerned with their welfare.     

Surgical reconstruction of pediatric pressure sores: long-term outcome.

The long-term outcome after the surgical repair of pressure sores in the adult population has been well studied. Recurrence rates from 25 to 80 percent have been reported, despite improvements in surgical repair and mechanical support devices. Such high recurrence rates have led many investigators to question the rationale for the surgical closure of pressure sores. There are no published long-term data that document pressure sore recurrence after surgical treatment in the pediatric population. A retrospective analysis of all patients who underwent surgical reconstruction of grade III and IV pressure sores at the Children's Hospital of Philadelphia from 1987 to 1999 was performed. During this 12-year period, 19 consecutive patients with a mean age of 16.2 years were operated on for 25 pressure sores. Follow-up was obtained for 15 patients (79 percent), who underwent repair for 20 pressure sores. Mean postoperative follow-up was 5.3 years (range, 11 months to 11 years). Mean age at the time of surgery was 16.5 years. The overall pressure sore recurrence rate was 5 percent (1 of 20 sores). Overall patient recurrence (previous patient who developed a new sore) was 20 percent (3 of 15 patients). In contrast to the recurrence rates reported for the surgical repair of pressure sores in the adult population, the recurrence rate of 5 percent in the pediatric population is significantly lower. This demonstrates that the surgical reconstruction of pressure sores in the pediatric patient can be successful and provide long-term skin integrity.     

两种压疮评估量表在骨科患者中的应用研究

目的:比较分析Waterlow和Norton两种压疮评估量表在预测骨折患者压疮中的临床效果。方法:选取某院骨科患者186例,由2名临床护士分别用2种量表对患者进行皮肤评估和量表评分,两者分别独立进行,比较分析两种量表对患者压疮的预测效果。结果:患者共发生压疮5例,发生率为2.69%(5/186);Waterlow量表和Norton量表的临界预测值分别为17分和14分;而二者的受试者工作特征曲线(Receiver Operator Curve,ROC)下面积分别为0.647和0.439。结论:Waterlow量表包含了与骨科疾病相关的压疮危险因素,更加适用于预测骨科患者压疮,但仍需要做进一步改进。     

Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team

The care given to 26 dying patients, and their families, being nursed in a hospital where there was no specific terminal care facility was studied. These patients were dying from both malignant and non-malignant disease. Anorexia, sleeplessness, coated or infected mouths, pain, and pressure sores were seen in half of the patients. Fear about caring for the patient at home and lack of information were the problems most frequently identified by the relatives.As a result of this study a multidisciplinary team specialising in symptom control and supportive care has been established. On average half of the total number of patients dying from cancer in the hospital are supported by the team. The number of complaints from relatives of dying patients has been drastically reduced since the team was formed.     

预防压疮管理路径表的设计与应用

目的:探讨压疮管理的方法和路径。方法:制定并应用神经外科压疮管理路径表。选择2010年3月至2011年3月神经外科入院的1400例患者,分为对照组与观察组,观察组755例,入院后常规护理基础上应用路径表;对照组为645例,常规护理。结果:对照组645例患者中,发生压疮例数Ⅱ期压疮5例;观察组755例患者中,发生Ⅰ期压疮1例。P<0.05,有显著统计学意义。结论:应用压疮管理路径表可以预防神经外科患者压疮的发生,有效降低患者压疮发生率。     

Management of pressure sores in a specialty center. A reappraisal.

We report a study on the surgical management of 145 pressure sores in 115 patients treated in a spinal cord injury center. There is a definite trend toward better education of these patients, who do not develop their first pressure sores until years following the injury. When the patient comes in for an ulcer, he is usually healthy and the ulcer is small and clean. In such instances the ulcer can be excised and closed, preferably with a myocutaneous flap, and the patient can usually begin sitting by the 21st post-operative day. In the ideal setting he may be discharged to his home on a custom-fitted (for pressure) cushion within 4 to 5 weeks, without increasing the risk of recurrence. Prophylaxis for the future is, probably, the most essential part of the treatment.     

延续护理对改善老年压疮高危感染患者照顾者居家护理行为的研究

目的 探讨延续护理对改善老年压疮高危感染患者照顾者居家护理行为的影响,为临床提供参考依据。方法 选择我院肿瘤科2015年7月至2018年8月收治的100例老年压疮高危患者作为研究对象,通过红篮球随机抽取的方式分成试验组（50例）和对照组（50例）。试验组和对照组分别采取延续护理和常规护理,结果采取对比分析,对比两组患者的压疮感染发生率、护理满意率。结果 试验组患者的压疮感染发生率远远低于对照组（2% vs 14%）,两组患者比较差异有统计学意义（P＜0.05）;试验组患者照顾者居家护理行为得分、护理满意率（90.32±10.92 vs 78.47±10.16,96% vs 78%）均高于对照组,差异具有统计学意义（P＜0.05）;试验组患者的疾病不确定感评分为（56.76±10.98）分,远远低于对照组的（89.06±10.22）分（P＜0.05）,差异有统计学意义,说明延续护理具有较好的应用价值。结论 延续护理对改善老年压疮高危感染患者照顾者居家护理行为具有积极影响,可有效提高照顾者的护理能力,减少压疮的发生,减少患者的疾病不确定感,值得在护理实践中应用和推广。     

Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture.

OBJECTIVE--To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores. DESIGN--Observational cohort study. SETTING--St James''s University Hospital, Leeds. SUBJECTS--21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture. MAIN OUTCOME MEASURE--Full thickness epidermal break over a pressure bearing surface. RESULTS--10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not. CONCLUSIONS--Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures.     

Patient satisfaction and quality in home health care of elderly islanders

Patient satisfaction has been a widely investigated subject in health care research. Quality of care from the patient perspective, especially in home health care, however has been investigated only very recently. Home health care is a system of care provided by skilled practitioners to patients in their homes under the direction of a physician. Multidisciplinary nature of home health care services present challenges to quality measurement that differ from those found in a more traditional hospital settings. The aim of the study was to investigate the satisfaction of elderly patients living on islands with home health care. Participants receiving skilled nursing care in their homes, for any diagnosis, who met selection criteria, were surveyed about their perception of the quality of health care. The research was conducted during the year 2010 among the residents of Kvarnerian islands (Krk, Cres and Mali Losinj) under the authority of Croatian Institute for Health Insurance that approved the protocols employed in the investigation. Most older patients (96.2%) reported high levels of satisfaction with health services delivery. Common leading diagnosis among home health care patient include diseases of circulatory system (28.9% of patients), nutritional and metabolic disease (14.5%), malignant diseases (13.2%), musculoskeletal and connective tissue disease (11.8%), diseases of the nervous system (9.2%), followed by injury and poisoning (7.9%). Provision of home health care was well received by elderly patients. Home health care providers seek to provide high quality, safe care in ways that honour patient autonomy and accommodate the individual characteristics of each patients home and family. The demographics of an aging society will sustain the trend towards home-based care. Therefore, research on effective practices, conducted in home health care settings, is necessary to support excellent and evidence-based care.     

Multi-tiered treatment of pressure sores in two cynomologous macaques (Macaca fascicularis)

Successful treatment of one Grade IlI and two Grade IV pressure sores on two female Macaca fascicularis, subsequent to a T11 hemilaminectomy and left spinal cord hemisection, was achieved through a combined strategy of wound care, diet, and husbandry. Wound care consisted of early and thorough debridement of all necrotic tissue, initial twice daily cleaning with an iodine scrub and application of a multi-ingredient ointment. Tissue hydrolyzer, a drying agent, vitamin E, ground selenium, and topical antibiotics were applied to the wound during the respective 45- and 46-day courses of treatment. Oral antibiotics were administered; vitamins C and E, and selenium were increased in the diet. No infection occurred and both animals recovered fully to complete the study. Importantly, pressure sores in subsequent study animals were prevented by post-operative padding of the perch with towel-covered foam and placement of a wheelchair cushion on the floor of the cage.     

Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound

The thickness of soft tissues over the sacrum of elderly hospital in-patients has been measured using B-mode ultrasound. Forty patients were scanned, of which nine had recognizable superficial pressure sores at the sacrum. No correlation was found between the depth of soft tissue and either age or Norton score. Patients with sores had less soft tissue over the sacrum (p < 0.025). Excluding one patient whose sacral sore appeared to be the final stage of the healing process, the remaining eight all had less than 8.5 mm of sacral soft tissue cover. Five patients without sacral sores also had less than 8.5 mm of sacral soft tissue cover. However, a combination of the presence of incontinence and the depth of sacral soft tissue cover identified seven of the eight patients with sacral sores with no inclusion of patients without sores.     

Problems of care in a private nursing home.

To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged 62-90. During the second month a consultant physician visited the home weekly to hold case conferences and assess each patient''s functional ability and drug regimen. Various problems in medical, nursing, and bureaucratic matters were identified--for example, staff failed to understand the appropriate response to various medical symptoms; no clear policy existed for managing pressure sores; and one patient''s anticoagulant state could not be assessed when industrial action meant that transport to take him to hospital was not available--and several changes in drug treatments were recommended. The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes.     

Patients’ Knowledge,Attitudes, Behaviour and Health Care Experiences on the Prevention,Detection, Management and Control of Hypertension in Colombia: A Qualitative Study

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.     

ISCHIECTOMY FOR PRESSURE SORES

Ischiectomy with primary closure was carried out in five paraplegic patients with pressure sores. This operation, less extensive than the wide excision with full thickness graft that is now widely advocated, was successful in four of the five cases. In the fifth case none of the several attempts to heal the sores was in the least successful.     

The alluring myth of private medicine.

Canada''s medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.