Biomedical subjects

Gillian Cranny

Publications and source records attributed to Gillian Cranny.

5 recordsLinked to original sources

PubMed2006

Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial.

OBJECTIVE: To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. DESIGN: Pragmatic, open, multicentre, randomised controlled trial. SETTING: 11 hospitals in six NHS trusts. PARTICIPANTS: 1972 people admitted to hospital as acute or elective patients. INTERVENTIONS: Participants were randomised to an alternating pressure mattress (n = 982) or an alternating pressure overlay (n = 990). MAIN OUTCOME MEASURES: The proportion of participants developing a new pressure ulcer of grade 2 or worse; time to development of new pressure ulcers; proportions of participants developing a new ulcer within 30 days; healing of existing pressure ulcers; and patient acceptability. RESULTS: Intention to treat analysis found no difference in the proportions of participants developing a new pressure ulcer of grade 2 or worse (10.7% overlay patients, 10.3% mattress patients; difference 0.4%, 95% confidence interval--2.3% to 3.1%, P = 0.75). More overlay patients requested change owing to dissatisfaction (23.3%) than mattress patients (18.9%, P = 0.02). CONCLUSION: No difference was found between alternating pressure mattresses and alternating pressure overlays in the proportion of people who develop a pressure ulcer. TRIAL REGISTRATION: ISRCTN 78646179.

Adult↗

PubMed2006

Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis.

OBJECTIVE: To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. DESIGN: Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. SETTING: 11 hospitals in six UK NHS trusts. PARTICIPANTS: Intention to treat population comprising 1971 participants. MAIN OUTCOME MEASURES: Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. RESULTS: Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. CONCLUSION: Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.

Adult↗

PubMed2006

Skin alterations of intact skin and risk factors associated with pressure ulcer development in surgical patients: a cohort study.

BACKGROUND: The pathology literature suggests three types of pressure ulcer with six possible mechanisms leading to tissue breakdown. A limitation of current evidence is the difficulty in replicating the clinical situation and in determining the point at which a tissue assault becomes irreversible and results in tissue breakdown. In particular clinical observations of alteration in darkly pigmented skin, blanching erythema, non-blanching erythema and non-blanching erythema with other skin changes including induration, oedema, pain, warmth or discolouration have not been assessed in relation to subsequent skin/tissue loss and their pathophysiological and aetiological importance is not fully understood. OBJECTIVES: To assess the validity of clinical signs of erythema as predictors of pressure ulcer development and identify variables which independently are predictive of Grade 2 pressure ulcer development. DESIGN: Prospective cohort study. PARTICIPANTS: 109 general, vascular and orthopaedic hospital patients, aged over 55 years with an expected length of stay of 5 days were recruited. Of these 97 were pressure ulcer free at baseline and/or had complete follow-up including 59 women and 38 men with a median age of 75 years (range 55-95). SETTING: Single centre large acute UK NHS hospital. METHODS: To identify clinical signs of erythema predictive of skin loss, the odds of pressure ulcer development were examined using logistic regression. To identify variables independently predictive of Grade 2 pressure ulcer development logistic regression modeling was undertaken. RESULTS: There was significantly increased odds of pressure ulcer development associated with non-blanching erythema (7.98, p=0.002) and non-blanching erythema with other skin changes (9.17, p=0.035). Logistic regression modeling identified non-blanching erythema, pre-operative albumin, weight loss, and intra-operative minimum diastolic blood pressure, as independent predictors of Grade > or =2 pressure ulcer development. CONCLUSIONS: Non-blanching erythema with or without other skin changes is distinct from normal skin/blanching erythema and is associated with subsequent pressure ulcer development.

Aged↗

PubMed2004

Assessment of non-ST-segment elevation acute coronary syndromes with cardiac magnetic resonance imaging.

OBJECTIVES: The goal of this study was to determine: 1) if the presence of significant coronary stenosis in patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) can be predicted by cardiac magnetic resonance (CMR) imaging; and 2) if the analysis of several CMR methods improves its diagnostic yield compared with analysis of individual methods. BACKGROUND: With modern acquisition techniques, several CMR methods for the assessment of coronary artery disease (CAD) can be combined in a single noninvasive scanning session. Such a multicomponent CMR examination has not previously been applied to a large patient population, in particular those with a high prevalence of CAD in an acute situation. METHODS: Sixty-eight patients presenting with NSTE-ACS underwent CMR imaging of myocardial function, perfusion (rest and adenosine-stress), viability (by late contrast enhancement), and coronary artery anatomy. Visual analysis of CMR was carried out. First, all CMR data were reviewed in combination ("comprehensive analysis"). In further separate analyses, each CMR method was analyzed individually. The ability of CMR to detect coronary stenosis >/=70% on X-ray angiography was determined. RESULTS: Comprehensive CMR analysis yielded a sensitivity of 96% and a specificity of 83% to predict the presence of significant coronary stenosis and was more accurate than analysis of any individual CMR method; CMR was significantly more sensitive and accurate than the Thrombolysis In Myocardial Infarction risk score (p < 0.001). CONCLUSIONS: Cardiac magnetic resonance imaging accurately predicts the presence of significant CAD in patients with NSTE-ACS. In this study, a comprehensive analysis of several CMR methods improved the accuracy of the test.

Adenosine↗

PubMedDate not supplied

Pathology, diagnosis, and classification of pressure ulcers: comparing clinical and imaging techniques.

Pressure ulcer classification systems are based on the clinical manifestations of the skin and tissue layer affected rather than underlying pathology. The objective of this study was to compare the validity of the clinical grading of erythema (blanching and nonblanching) with a measurement of skin perfusion. Therefore, an exploratory study comparing erythema with laser Doppler imaging of the sacrum and buttock skin areas was undertaken. Acute and major elective general, vascular, and orthopedic surgical in-patients, aged 55 years or over with an expected length of hospital stay of 5 or more days were recruited. Fifty laser Doppler images from 37 patients were obtained and included in a discriminant analysis. Discriminant analysis suggested that blanching and nonblanching erythema were physiologically distinct from "normal" skin; clinically, these could be assessed with reasonable accuracy. Imaging also determined that high blood flow of differing intensity characterized blanching and nonblanching erythema. There was no evidence of the "no flow" phenomenon.

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