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Biomedical subjects

G C Xakellis

Publications and source records attributed to G C Xakellis.

8 recordsLinked to original sources
PubMed1992

A comparison of patient risk for pressure ulcer development with nursing use of preventive interventions.

OBJECTIVE: (1) Determine if the Braden scale or Norton scale predicted the same patients to be at risk for pressure ulcer development as were receiving preventive nursing interventions. (2) Identify the items on the Braden and Norton risk assessment scales that the nurses used intuitively to determine a patient's need for a preventive intervention. DESIGN: Cross-sectional study. SETTING: Six hundred-bed, state-supported, long-term care facility. PATIENTS: War veterans who were 82% male and 97% caucasian, mean age 73. MEASUREMENTS: (1) Patients were categorized as at-risk or not-at-risk by the Norton and Braden scales. (2) The presence of a preventive nursing intervention was noted. Agreement in assignment of at-risk status among the two assessments and presence of a preventive intervention was analyzed using Cohen's Kappa. (3) The staff nurses' use of preventive interventions was modeled using stepwise logistic regression. The items from the Braden and Norton risk assessment scales were used as independent variables with staff nurse implementation of a preventive intervention as the dependent variable. RESULTS: Nurse preventive interventions were found on 45% of patients. The Norton scale identified 38% and the Braden scale identified 27% of patients as at-risk. Agreement among the three methods was 0.53. Agreement between the Braden and Norton scales was 0.73. Agreement between use of a preventive intervention and a classification as at-risk by the Braden or Norton scale was 0.41 and 0.43, respectively. Stepwise logistic regression revealed that low Braden mobility scores (Odds Ratio: 2.74) and low Braden friction/shear scores (Odds Ratio: 3.29) were associated with an increased likelihood of a patient receiving a preventive nursing intervention. CONCLUSIONS: The overall level of agreement among the two scales predicting risk and the presence of a preventive intervention was not high. Agreement, however, between the two risk assessment scales was close. The staff nurses apparently relied on a patients' mobility, their exposure to friction/shear, and additional unidentified factors to guide implementation of a preventive intervention. Further study is needed to define the cost, efficacy, and related cost effectiveness of routine pressure ulcer risk assessment.

Aged↗
PubMed1992

Hydrocolloid versus saline-gauze dressings in treating pressure ulcers: a cost-effectiveness analysis.

The cost effectiveness of using hydrocolloid dressings versus nonsterile saline-gauze wet-to-moist dressings for treatment of pressure ulcers in a long-term care setting was evaluated. During 21 months, 39 subjects were enrolled, and treatment was randomly assigned. Eighty-nine percent of the hydrocolloid subjects and 86% of the saline-gauze subjects healed. Median healing time was shorter for the hydrocolloid group (nine days) than for the saline-gauze group (11 days), although the difference did not reach statistical significance (p = .12). Presence of exudate at baseline was associated with a prolonged time to healing. For the hydrocolloid treatment, the median nursing time was one eighth that of the saline-gauze treatment, but its materials cost was 3.3 times higher. Using local nursing wages, median total cost for treatment with hydrocolloid dressing was $15.58; for the saline gauze, it was $22.65. Using national nursing wages, these costs were $15.90 and $25.31, respectively. The cost savings of the hydrocolloid treatment using local wages did not reach statistical significance. However, using national wages, the cost of the hydrocolloid treatment was significantly less expensive. Nursing home treatment of pressure ulcers was inexpensive overall. Consequently, the absolute cost savings of using hydrocolloid dressings instead of nonsterile saline-gauze dressing, although real, was relatively modest. Physicians can use local nursing wages to calculate the magnitude of savings in their area.

Aged↗
PubMed1992

Expectations and satisfaction of runners with injury treatments.

Seventy-eight runners competing in three Iowa races were surveyed concerning their most recent running injury for which they sought medical care from a family physician, an orthopedic surgeon, or a podiatrist. Their reasons for choosing a doctor, expectations of care, and satisfaction with treatment received were assessed. Most patients selected the orthopedic (50%) or podiatric (42%) physicians upon the recommendation of other runners; only 13% of the family physicians were selected from recommendations. Orthopedic and podiatric patients were more likely than family physician patients to expect x-rays. There was no difference in overall patient satisfaction with treatment received from the three groups of physicians. The runners felt that all physician groups treated their running injuries equally well.

Athletic Injuries↗
PubMed1991

A comparison of changes in the transcutaneous oxygen tension and capillary blood flow in the skin with increasing compressive weights.

Two measures are being advocated to evaluate physiologic changes associated with compression of skin: transcutaneous oxygen tension (tcO2) and laser-Doppler blood flow. This study asked: 1) What changes occur in tcO2 and laser-Doppler blood flow with increasing compressive weight; and 2) do these measures respond differently to increasing weight? An indenter was used to apply incremental weight to the trochanter of healthy volunteers. During the first session, tcO2 was measured, and laser-Doppler blood flow was measured during the second session. The mean values of tcO2 and laser-Doppler blood flow were analyzed for significant changes over the range of applied weight. If significant change occurred, the polynomial that best described the data was determined. Mean values for tcO2 showed a significant decrease with increasing compressive weight. Its decrease was described by a second degree polynomial (quadratic). The weight that resulted in the tcO2 reaching zero for individual subjects ranged from 400-1000. Mean values for laser-Doppler blood flow showed a significant decrease with increased weight. The decrease was best described by a first degree polynomial (line), which is a different pattern from the tcO2. Laser-Doppler blood flow continued to decline with increasing weight beyond the point where tcO2 reached zero. During low-flow states, tissue oxygen utilization may exceed oxygen delivery and lead to ischemia even though capillary closure has not occurred.

Adult↗
PubMed1989

Characteristics of skin blood flow over the trochanter under constant, prolonged pressure.

Although laboratory studies have documented that externally applied pressure disrupts circulation, in clinical practice little is known about the characteristics of blood flow over bony prominences as a function of time. The purpose of this study was to describe the pattern of blood flow over the trochanter when subjected to a constant interface pressure for a prolonged period of time. A quasi-experimental design was used to measure skin blood flow over the left trochanter in a sample of 19 healthy adults. With the use of laser doppler flowmetry, the pattern of blood flow was monitored continuously while subjects lay on a supportive air mattress. Measurement of blood flow was described for three periods: preload with subjects supine, loading with subjects in the left lateral position and hyperemia after subjects returned to the supine position. Rate of blood flow under loading showed a gradual increase from preload. There was a marked initial increase in flow during hyperemia that gradually tapered off, but failed to reach preload levels within 30 min. Individual blood flow tracings revealed an inconsistent pattern of response to loading, suggesting the presence of a range of physiological response to compressive surface pressure. Given the individual variation in response to a common external pressure, further research is recommended to evaluate the pattern of blood flow over bony prominences subjected to known interface pressure.

Adult↗
PubMed1987

Pressure ulcers.

Pressure sores occur when prolonged pressure or shear is applied to the skin of predisposed patients. Prevention requires identification of patients at risk and institution of thorough surveillance and nursing care. Once pressure ulcers occur, treatment decisions are based on the depth of the ulceration. Management consists of motivating the staff, relieving the pressure, debriding the wound, lowering wound bacterial counts and treating complications.

Anti-Infective Agents, Local↗