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Hiromi Sanada

Publications and source records attributed to Hiromi Sanada.

15 recordsLinked to original sources
PubMed2006

A new instrument for predicting pressure ulcer risk in an intensive care unit.

The purpose of this study was to assess the utility of two instruments (the Braden scale and a multi-pad pressure evaluator) for predicting pressure ulcer development. A prospective cohort design was used and 105 intensive care unit patients participated in this study. The result was a 33% incidence of pressure ulcers. Both the Braden score and the multi-pad pressure evaluator instruments gave significant differences between patients who did and did not develop pressure ulcers. The predictive validity of these tools was calculated. The results indicated that the multi-pad pressure evaluator provided the best balance between sensitivity and specificity. We suggest that the multi-pad pressure evaluator may be better suited for assessing the risk of pressure ulcers in intensive care units.

Adolescent↗
PubMed2006

A prospective cohort study of lower-extremity pressure ulcer risk among bedfast older adults.

OBJECTIVE: To estimate the incidence and identify risk factors for lower-extremity pressure ulcers in bedfast older adult patients. DESIGN: Prospective cohort study. SETTING: A 500-bed long-term-care facility in Japan. PATIENTS: A total of 259 patients who were aged 65 years or older, confined to bed, and without lower-extremity pressure ulcers at enrollment participated in the study. MAIN OUTCOME MEASURES: Incidence of occurrence, wound characteristics, and risk factors for lower-extremity pressure ulcers. The incidence of lower-extremity pressure ulcers per 100 person-years was 16.8 (n = 33). The most common sites of lesions were the toes and heels. Cox regression analysis indicated that 3 factors were independently related to new lower-extremity pressure ulcer risk: low ankle-brachial index value (hazards ratio 0.075; 95% confidence interval [CI], 0.023-0.242), length of bedfast period (hazards ratio 1.010; 95% CI, 1.004-1.015), and male gender (hazards ratio 2.951; 95% CI, 1.450-6.009). Receiver operating characteristic curve analysis showed the area under the curve was 0.760 (95% CI, 0.675-0.844) for the ankle-brachial index. Therefore, an ankle-brachial index cutoff level of 0.8 provided high sensitivity and adequate specificity. CONCLUSION: Lower-extremity pressure ulcers are a significant problem in bedfast older adult patients aged 65 years or older. Bedfast older adult patients who developed lower-extremity pressure ulcers in this study were believed to have arteriosclerosis; the patients' ulcers exhibited features of ischemic ulcers. The findings of the present study suggest that bedfast older adult patients with a low ankle-brachial index value, a long bedfast period, or male gender should be closely monitored for lower-extremity pressure ulcer development on admission to long-term-care facilities. In particular, the ankle-brachial index is recommended as a screening tool in this practice setting.

Age Distribution↗
PubMed2006

Prognosis of stage I pressure ulcers and related factors.

The prognosis of stage I pressure ulcers cannot be predicted; therefore, nursing interventions for preventing their deterioration have not been clearly established. This study describes the clinical course of stage I pressure ulcers and prospectively investigates the factors related to their deterioration. Thirty-one stage I pressure ulcers in 30 patients in a long-term care facility were studied, and morphological changes were assessed every day until the ulcers healed or deteriorated. The physiological changes were assessed by ultrasonography and thermography. Twenty ulcers healed, and 11 deteriorated. The characteristics of deterioration were as follows: (1) double erythema; (2) non blanchable erythema across the whole area determined by glass plate compression; (3) erythema away from the tip of the bony prominence; and (4) expanding erythema on the following day. We analysed the sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio for the diagnostic utility of the indicators of deterioration double erythema and distance from the tip of bony prominence, which can be instantly assessed without the use of any special device. The values were 36.4%, 95.0%, 80.0%, 73.1% and 7.28, respectively. These results suggest that clinicians can predict the prognosis of stage I pressure ulcers by initial assessment and provide appropriate care based on the assessment.

Aged↗
PubMed2006

Incontinence induces stratum corneum vulnerability and impairs the skin barrier function in the perianal region.

BACKGROUND: Incontinence leads to a reduced skin barrier function, while also increasing the risk of skin breakdown. AIM: To investigate the perianal skin barrier function of elderly patients with or without incontinence. METHODS: We compared the skin barrier function by investigating the skin hydration, the skin pH, the amount of ceramide and by making a dermatological skin inspection of the perianal region in patients with and without incontinence. RESULTS: Twenty-one incontinent patients (70.0%) showed a glossy skin, which indicates impairment of the skin barrier while none of the patients in the continence group did so. In the incontinence group, those who had a glossy skin showed a significantly greater skin pH and total amount of ceramide than those with a normal skin (p = 0.0099, p = 0.0179, respectively). CONCLUSIONS: These results demonstrate that a glossy skin may be a useful indicator of a reduced perianal skin barrier function.

Aged, 80 and over↗
PubMed2006

Structured visualization of expert nursing--An educational program for stoma self-care.

To provide an adequate educational program for patients with a stoma, we have developed an algorithm which was divided into three parts according to the period, i.e., the preoperative period, postoperative period, and rehabilitation period. It was composed of action nodes, thinking nodes, choice branches, assessment item tables, reference tables, and candidate logic tables. Wound Ostomy Continence Nurses (WOCNs) used this algorithm. The results indicated that the algorithm did not omit any important points involved in stoma care, and that it could therefore be successfully applied to patients with a stoma.

Humans↗
PubMed2006

Structured visualization of expert nursing: Prevention of pressure ulcers.

We made an algorithm by extracting the caring elements for the patients to develop a program for pressure ulcer prevention. The algorithm consisted of observation of the patient skin as a beginning point, extraction of the risk factors for pressure ulcer development, intervention to each risk factor, and evaluation. The expert panel identified this algorithm as adequate enough to adopt to the patients.

Algorithms↗
PubMed2005

Measuring the pressure applied to the skin surrounding pressure ulcers while patients are nursed in the 30 degree position.

The 30 degree laterally inclined and 30 degree head elevated positions (hereafter referred as the 'rule of 30' unless otherwise specified) are widely used as a means of both primary and secondary prevention of pressure ulcers as a result of reductions in localised pressures over bony prominences. However, the authors observed that some some parts of the wound margin were thickened. These thickened edges may be caused by use of the rule of 30 positioning and may also be responsible for a delay in the healing process. This study included five bedbound elderly patients with pressure ulcers located at the sacrum and coccyx. The local pressure was measured at the thickened edges and normal edges of the subjects' wounds by a newly developed sensor while the subjects were positioned according to the rule of 30. The results showed the maximum pressure as well as the average pressure of the thickened edges to be significantly greater than that of the normal edges. Thus, it is suggested that higher pressure on different areas of the wound margin may be responsible for the thickened edges phenomenon, which may consequently delay the healing process. Clinical use of the rule of 30 for patients with pressure ulcers in the sacrum and coccyx regions should be reconsidered.

Aged↗
PubMed2005

Skin debris and micro-organisms on the periwound skin of pressure ulcers and the influence of periwound cleansing on microbial flora.

Many clinicians use the same solution, most often normal saline, to cleanse the periwound skin and the wound bed itself. However, skin debris such as water-insoluble proteins and lipids are not efficiently removed by normal saline solutions. To analyze the skin debris and micro-organisms found on the periwound skin of pressure ulcers and to evaluate the effect of periwound cleansing on the microbial flora, a descriptive study was conducted among 17 long-term care residents with Stage III and IV pressure ulcers. Skin debris from both the periwound area and normal skin was collected from all 17 residents. In addition, micro-organisms from the wound bed, periwound, and normal skin of five residents were collected before, immediately after, and 6 hours and 24 hours after periwound cleansing using a skin cleanser. All microbial species were identified by cultivation. Cholesterol and nitrogen-containing substances were found in greater quantity on the periwound than on normal skin (P = 0.0027 and P = 0.0054, respectively) and the number of isolated micro-organisms from the periwound area was larger than that from normal skin. Protein showed the highest correlation to the microbial count present on the periwound (r = 0.71, P = 0.0014). The microbial counts of all isolated micro-organisms decreased immediately after cleansing but the number of isolates with high microbial counts increased over time. In the wound bed, the number of isolates with decreasing microbial counts was larger than the number of isolates with increasing microbial counts. Both numbers returned to pre-cleansing values after 24 hours, suggesting that periwound cleansing only (without directly cleansing the wound bed) is effective at reducing the microbial counts in the wound bed for up to 24 hours. Further research is needed to evaluate the effects of periwound cleansing on healing time.

Administration, Cutaneous↗
PubMed2004

Long-term survivors after resection of carcinoma of the head of the pancreas: significance of histologically curative resection.

BACKGROUND/PURPOSE: The prognosis of patients with pancreatic cancer is said to have not been improved markedly by any procedures in the past 20 years. Since 1973, we have gradually extended the area of dissection when performing curative resection for pancreatic cancer to improve the resection rate and prognosis. Nineteen patients have survived for 3 years or more, and the 5-year survival rates of patients with cancer of the head of the pancreas were 23.9% for macroscopically curative resection and 34.3% for histologically curative resection. METHODS: We histologically observed surgical specimens, cut into 3- to 5-mm sections and compared the histologic characteristics of the 19 patients who survived for 3 years or more with those of 41 patients who died of cancer within 3 years (excluding 6 operative and hospital deaths), in order to find the conditions required for long-term survival. RESULTS: The following conditions were associated with long-term survival: (1) tumor diameter 3 cm or less; (2) either absence of lymph node metastasis or metastasis limited to the n(1) group; (3) degree of invasion of the anterior pancreatic capsule of zero (s0); and (4) either no retropancreatic invasion (rp0) or exposed retropancreatic invasion (rpe) with no cancer invasion of dissected peripancreatic tissue ew(-). CONCLUSIONS: At present, because the rpe rate is more than 70%, resection of the pancreas, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection, because the retropancreatic tissue between the back of the pancreas and this fascia is anatomically considered to be in the position of the subserosal tissue in the gallbladder or stomach. Combined resection of the superior mesenteric artery may further improve the results of resection for pancreatic cancer, from the anatomical viewpoint.

Dissection↗
PubMed2004

A dressing history.

Over the past 30 years as caregivers, clinicians have been exposed to a plethora of new advanced wound dressings. The moist wound care revolution began in the 1970s with the introduction of film and hydrocolloid dressings, and today these are the traditional types of dressings of the advanced dressing categories. Wound-healing science has progressed significantly over the same period, as a result of intense clinical and scientific research around these product introductions. Today, the clinician understands moist wound healing, occlusion, cost effectiveness, wound bed preparation and MMP activity to name but a few of the many concepts in wound care that have flourished as a result of technology and product advancement. This review article presents a condensed history of dressing development over the past 30 years. However, in addition, such advancement is discussed in respect to its adoption in different parts of the world. The largest single markets of the world are generally the United States of America and Europe; as such, the development of both practice and technology generally begins there. Much has been written about these markets in previous review articles. For the purposes of this review, the development of wound care and the maturing of practice is discussed in respect to Canada, Japan and Australia representing smaller geographical areas where the development has been more recent but nonetheless significant.

Alginates↗
PubMed2004

[Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.

Algorithms↗
PubMed2003

Randomised controlled trial to evaluate a new double-layer air-cell overlay for elderly patients requiring head elevation.

A clinical investigation was conducted concerning the effects of a newly designed double-layer air-cell overlay in preventing the onset of pressure ulcers for patients with a Braden scale score of < or = 16, and who require a head-elevated position of 45 degrees or higher. A randomised controlled trial was undertaken involving 82 patients from a general hospital ward using one of the following three support surfaces: a double-layer air-cell overlay, a single-layer air-cell overlay or a standard hospital mattress. A significantly lower percentage of patients using the double-layer air-cell overlay developed pressure ulcers (3.4%) compared to 19.2% and 37.0% for those patients using the single-layer air-cell overlay and standard mattress respectively. Based on these findings, a double-layer air-cell overlay should be more effective in preventing the onset of pressure ulcers than either a single-layer air-cell overlay or a standard hospital mattress for subjects requiring head elevation.

Age Factors↗
PubMed2002

Reliability and validity of a multi-pad pressure evaluator for pressure ulcer management.

It is often helpful to assess the pressures exerted upon the bony prominences when monitoring the likely outcome of pressure ulcer prevention or treatment. However, in the clinical setting, hard pressure sensors may damage the skin and operational difficulties may influence their reliability and validity. The authors have developed a multi-pad pressure sensor and tested its clinical reliability and validity. The inter-rater and intra-rater reliability were calculated using the coefficient of variation data from 10 patients. After a comparison analysis, the multi-pad was more reliable than a single-pad type pressure sensor. A validation test was conducted in 79 elderly patients. The mean interface pressures recorded among patients who had erythema or stage I pressure ulcers at the sacrum were significantly higher than were the contact pressures measured in patients with no pressure damage. The pressure sensor exhibited satisfactory clinical reliability and validity. Furthermore, it may be that for Japanese elderly patients the maximum pressure that can be tolerated by the tissues around the sacrum may be 40-50 mmHg.

Aged↗
PubMedDate not supplied

Comparison of two pressure ulcer preventive dressings for reducing shear force on the heel.

OBJECTIVE: We compared the shear forces exerted over the heel between a pressure ulcer preventive dressing and a thin-film dressing in a clinical setting. Interface pressures were measured as well. DESIGN: Quasi-experimental clinical trial. SETTING AND SUBJECTS: Participants were 30 elderly patients (5 men, 25 women; mean age, 86.4 +/- 8.0 years) hospitalized in a geriatrics hospital in Japan; all had a Braden score of less than 14 (mean, 10.1 +/- 1.1). Informed consent was obtained from all the patients.A shear force and pressure sensor including a strain gauge, and an oval airbag-type pressure sensor were used. METHODS: The sensor was attached to one heel using double-sided tape; then the target dressing was applied over the sensor and on the opposite heel to avoid the influence of the opposite heel on the shear force measurement. Interface pressures were measured with the patient in a stationary supine position; shear force was then measured at 0.2-second intervals, while the sheet was manually pulled at a velocity of around 5 cm/second. Shear force was determined by averaging the stable shear force lasting for 10 measurement points. RESULTS: The mean interface pressures with the PPD and the film dressings were 70.7 +/- 16.5 and 70.2 +/- 15.2 mmHg, respectively; this difference was not statistically significant. The shear force produced during the pulling of the sheet was 2.2 +/- 1.4 and 11.7 +/- 5.8 N, respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS: The results of this study suggest that a dressing with a low-friction external surface (such as the pressure ulcer preventive dressing) can significantly reduce shear force. However, results also suggest that external dressings do not significantly reduce interface pressures and cannot be used as a substitute for heel elevation in an immobile patient.

Bandages, Hydrocolloid↗