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Biomedical subjects

N A Stotts

Publications and source records attributed to N A Stotts.

At least 19 recordsLinked to original sources
PubMed2001

Gastric versus duodenal feeding in patients with neurological disease: a pilot study.

Both gastric and duodenal feeding tubes are used to provide enteral nutrition. Most studies comparing the two methods have focused primarily on rates of complications, rather than on nutritional outcomes, and show no difference in complications between the two methods. It is not clear which feeding route provides the best nutritional outcomes. The primary purpose of this randomized clinical pilot study was to compare the percentage of recommended calories and protein received by patients with neurological disease being fed enterally via gastric or duodenal feeding tubes. Secondary aims were to compare the following between groups: physiological effects of feeding, reasons for delay in feeding, volume of feeding residual, number of feeding tubes replaced, cost of feeding, and number and types of complications. A convenience sample of 25 neuro intensive care unit patients was randomly assigned to gastric or duodenal feeding. Enteral feeding was ordered by using a standardized prescription formula and provided by the nursing staff. Serum albumin and prealbumin levels were measured at baseline, day 3, and day 10. Nitrogen balance was measured on day 10. Enteral feeding data were collected daily. No significant differences were found between gastric and duodenal groups in nutritional outcomes, including percentage of recommended calories and protein received, physiological effects of feeding, reasons for delay in feeding, feeding residual, number of feeding tubes replaced, cost of feeding, and number and types of complications. Neither group achieved mean recommended caloric or protein intake during the 10 days of the study. Further research is needed to address how recommended nutrients can be provided enterally in a more timely and complete manner in critically ill NICU patients.

Adult↗
PubMed2000

Patients with existing pressure ulcers admitted to acute care.

PURPOSE: This study describes the characteristics of patients with pressure ulcers present on admission to the hospital and predictors of pressure ulcer presence and severity. DESIGN: Prospective cohort study. SETTING AND SUBJECTS: Adults (n = 267) admitted to a Pacific Basin military hospital who were expected to stay more than 24 hours. INSTRUMENTS: Braden scale, portable vital sign machine, and pulse oximeter. METHODS: Pressure ulcer risk was evaluated and skin inspection was performed. Demographic, physiologic, and laboratory data were obtained. Medical history and patient acuity were recorded. RESULTS: Thirty-four of 267 subjects (12.8%) had a pressure ulcer. Most were male and white. Their mean age was 65.7 years; mean albumin level, 2.9 g/dL: mean hematocrit level, 31.9 vol%; mean oxygen saturation, 95.3 mm Hg; and mean hemoglobin level, 10.7 g/dL. The mean Braden scale score for subjects without ulcers on admission was 19.7, and it was 15.9 for those with ulcers (P < .05). Analysis of variance showed that subjects with pressure ulcers had a significantly lower albumin level, total lymphocyte count, hematocrit level, and hemoglobin level. These subjects were significantly older and had a longer hospital length of stay. Regression showed that albumin level, oxygen saturation, and length of stay (P < .01) accounted for 11.3% of the variance of pressure ulcer presence and that albumin level and length of stay (P < .001) accounted for 11.2% of the variance in ulcer severity. CONCLUSIONS: Poorer nutritional status and decreased oxygen perfusion were predictors of pressure ulcers on admission. Nutrition and length of stay were predictors of ulcer severity. Further research is warranted.

Aged↗
PubMed1999

Identifying and evaluating wound infection.

Wound infection is a serious problem in the home care patient. Early detection of infection, prompt treatment, and continuous surveillance are pivotal to elimination of the infection and prevention of complications. This article addresses identification of wound infection in postsurgical and chronic wounds based on data obtained from the patient's history, physical examination, and diagnostic tests. Appreciating the overt and subtle signs and symptoms of wound infection and acting on them is critical to timely diagnosis and treatment.

Acute Disease↗
PubMed1999

Assessing the patient with a wound.

Assessment of the home care patient with a wound is critical to the planning and evaluation of care. This article presents the components of a comprehensive assessment that can be used as a guide to assessment of a patient with a wound. Topics include collection of a baseline history and physical examination, wound assessment, treatment plan and documentation, wound care orders, and follow-up visits.

Community Health Nursing↗
PubMed1999

Evidence-based practice: what is it and how is it used in wound care?

Evidence-based practice is an approach to providing clinical care based on research and scientific knowledge. Nurses who work with patients with wounds need to understand and apply evidence-based principles. This article provides guidelines for critical analysis of the literature using the principles of evidence-based practice.

Evidence-Based Medicine↗
PubMed1999

Risk of pressure ulcer development in surgical patients: a review of the literature.

OBJECTIVE: The purpose of this paper is to review the scientific knowledge about risk factors for pressure ulcer development in the surgical population. DATA SOURCE: A literature review was conducted from 1960 to present using MEDLINE and the key words pressure ulcer, decubitus ulcer, surgery, surgical patient, research, clinical research, and human. All sources were English. STUDY SELECTION: Included were articles that specifically addressed the risk of pressure ulcers in the surgical population and had ulcer formation as an outcome measure. DATA EXTRACTION: All data were reviewed and extracted by the author. DATA SYNTHESIS: The development of pressure ulcers has been explored in only a small proportion of surgical patients. Few groups of surgical patients have been addressed. Major surgical populations potentially at risk because of their immobility, debility, and therapy have not been studied. A portion of the literature is quite old and one issue is whether the older studies are relevant, considering the rate of change in treatment. Pressure relief, seen as the single most important factor in pressure ulcer prevention, is underrepresented in the analysis of factors leading to pressure ulcer development. CONCLUSION: There is limited information about pressure ulcer risk in the preoperative, intraoperative, and postoperative periods. Because the surgical period is defined temporally, and more so than pressure ulcers in the chronically ill, this paradigm must be examined using a time-based evaluation. The Agency for Health Care Policy and Research guideline for pressure ulcer prevention needs to be tested in surgical patients.

Algorithms↗
PubMed1998

Nutrition, tissue oxygenation, and healing of venous leg ulcers.

The purpose of the prospective study described in this article was to explore nutrition, tissue oxygenation, and healing in venous ulcer patients. Nutritional risk, anthropometric measures, biochemical indices, two 3-day dietary records, and transcutaneous tissue oxygen levels were obtained. Wound surface area was evaluated 2 times, 4 weeks apart. A convenience sample of 25 English-speaking persons with 1 or more venous ulcers participated (mean age 59.8 years, 60% men, 48% white). Moderate or high nutritional risk existed in 84% of the persons in the sample. Based on body mass index, more than 50% of the persons in the sample were obese. Nonetheless, 17 of 25 persons in the sample had 1 or more abnormal biochemical nutritional indices. In addition, caloric intake (17 of 20), protein intake (15 of 20), and zinc intake (17 of 20) were inadequate to meet the needs for healing. No statistically significant relationships were found between biochemical nutritional indices, tissue oxygenation, and healing. The women in the sample were more likely to heal than were the men (P < 0.05). This study begins to document the problems of overnutrition and undernutrition in the venous ulcer population. Future studies need to explore the effects of obesity and inadequate intake on the healing of venous ulcers. Additional examination of the differences between men and women also is warranted to identify predictors of venous ulcer healing.

Adult↗
PubMed1998

Effect of dressings on saphenous vein harvest incision pain, distress and cosmetic result.

Little research has examined the healing and pain associated with saphenous vein (SV) harvest incisions, and no literature has addressed the associated distress and cosmetic result. The purpose of this study was to determine whether dry sterile gauze dressings, transparent film dressings or no dressings were more effective in hospitalized patients undergoing coronary artery bypass graft (CABG), in terms of minimizing leg incisional pain, minimizing the distress of a leg scar and improving the cosmetic appearance of the leg incision scar. Patients were randomized to dressing type on postoperative day (POD) 1, completed a pain and distress visual analogue scale (VAS) on PODs 1, 3 and 5, and a cosmetic result VAS upon discharge. Overall, leg incisional pain decreased over time (p < 0.05). Females reported decreasing pain between PODs 1 and 3, while males reported increasing pain between PODs 1 and 3 (p < 0.05). The film-dressing group reported decreasing pain from PODs 1 to 3, while the no-dressing and gauze-dressing groups reported increasing pain from PODs 1 to 3 (p < 0.05). Pain on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.42, p < 0.05), and distress on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.44, p < 0.05). The results of this study are encouraging and support the continued testing of dressings to minimize pain and distress, as well as enhancing cosmetic result.

Adult↗
PubMed1997

Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: a pilot study.

PURPOSE: This study was completed to determine whether there were differences between sterile versus clean dressing change technique for open surgical wounds in the postoperative period with respect to (1) rate of wound healing and (2) cost of supplies. METHODS: A two-group design was used for this pilot study. Of a sample of 30 patients undergoing elective gastrointestinal operations with wounds healing by secondary intention, 15 were men and 15 were women. Mean age was 40.6 years (SD 13.0 years). Patients were randomly assigned to receive clean or sterile dressings, and the intervention was begun on the first postoperative day and repeated three times a day until discharge from the hospital. Analysis of rate of healing was performed with the Mann-Whitney U test: cost analysis was completed with a t test. FINDINGS: Subjects were studied for 3 to 9 days. Groups were homogeneous of the start of treatment with respect to age, length of operation, wound volume, nutritional status, and perfusion. There was no difference in rate of wound healing between the clean and sterile groups. Mean cost was significantly less for the clean group than for the sterile group. CONCLUSION: These pilot study data show no difference in rate of wound healing with clean versus sterile technique, and clean technique is less expensive. These findings need to be confirmed with a larger sample; type II error cannot be ruled out.

Adult↗
PubMed1997

Pressure ulcers. Managing bacterial colonization and infection.

High levels of contamination are associated with delayed healing of pressure ulcers, and problems occur when surface contaminants invade the tissues and produce infection. This article addresses differentiating contamination from infection, identifying infection when it is present, and treating the patient with a contaminated or infected pressure ulcer. Systemic support for healing is discussed with a focus on oxygenation and nutrition. A comprehensive plan for the concomitant treatment of all factors contributing to pressure ulcer infection is recommended.

Anti-Bacterial Agents↗
PubMed1997

Pressure ulcer scale for healing: derivation and validation of the PUSH tool. The PUSH Task Force.

Measuring progress toward healing is fundamental to the management of pressure ulcers. A method to assess progress of an individual ulcer over time is lacking. Given the limitations of currently available instruments and the need for a precise and practical method of monitoring healing in clinical practice, the National Pressure Ulcer Advisory Panel initiated the development of a new tool for measuring pressure ulcer healing. The key elements in developing an instrument include simplicity of use in clinical settings, validity for measuring whether ulcers are improving or worsening, and sensitivity to changes in the ulcer between observations. A new tool incorporating surface area, exudate amount, and surface appearance is proposed. Content validity, correlation validity, prospective validity, and sensitivity to change can be met by the proposed Pressure Ulcer Scale for Healing instrument.

Humans↗
PubMed1996

Predictors of physical activity in patients with chronic heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy.

To identify predictors of physical activity levels in patients with chronic heart failure, 43 patients, aged 33 to 91 years, who had well-compensated heart failure were asked to perform a symptom-limited exercise treadmill test and to complete activity logs for 2 consecutive days while wearing an ambulatory heart rate activity monitor. Activity logs included information on the type of activity, duration, rating of perceived exertion, symptoms experienced, and the intensity of symptoms. Subjects also completed the Duke Activity Status Index, a brief self-administered questionnaire that assesses physical functioning, and a self-efficacy for general activity questionnaire. Simultaneous multiple regression analysis was used to predict physical activity levels from a model that included: personal variables of physical fitness (peak oxygen consumption); knowledge, attitudes, and beliefs including self-efficacy for general activity, and rating of perceived exertion during daily activity; and environmental factors such as social support (marital status). The overall model explained 38% of the variance (p < 0.001). Self-efficacy (p = 0.015) was the strongest predictor of physical activity in this group. From this initial descriptive study, we conclude that self-efficacy is a better predictor of performance of physical activity than measures of physical fitness or rating of perceived exertion during activity. Additional studies are needed to examine other behavioral and physiologic mediators as well as behavioral strategies that may be used to increase participation in physical activity programs. Particularly promising are strategies to enhance self-efficacy for exercise.

Adult↗
PubMed1996

Nutritional risk, status, and intake of individuals with venous ulcers: a pilot study.

Chronic leg ulcers occur in at least 1% of the adult population. The healing of these ulcers remains a clinical challenge. The purpose of this pilot study was to explore the nutritional risk, status, and intake of seven patients with venous ulcers. The Public Awareness Checklist categorized two subjects as being at low risk, two as moderate risk, and three subjects as high nutritional risk. Biochemical indicators of nutritional status identified abnormalities in hemoglobin and/or hematocrit, albumin, transferrin, zinc, and total lymphocyte count. Mean daily intake was inadequate to meet caloric needs in five of six subjects. By conservative estimates (RDA), two subjects had an inadequate protein intake. Data suggest that at least some individuals with venous ulcers are at nutritional risk, have abnormalities in their nutritional status, and/or have an inadequate intake to support healing. Future research is needed to explore the relationship between nutrition and rate of healing in individuals with venous ulcers.

Adult↗
PubMed1996

Co-factors in impaired wound healing.

Caring for individuals with chronic wounds is a complex process that requires a multi-disciplinary approach. Age, insufficient oxygenation/perfusion, malnutrition, bioburden, excess pressure, psychophysiological stress, concomitant conditions and adverse effects of treatment are the co-factors addressed in this manuscript. The evaluation of these co-factors is typically integrated into the initial history, physical, and ongoing assessment. Early identification of these co-factors allows the practitioner to establish a differential diagnosis, initiate proper referrals, and develop a comprehensive plan of care. Management of local and systemic co-factors that impact repair will mitigate their adverse effects and facilitate healing of the individual's chronic wound.

Chronic Disease↗
PubMed1995

Effects of dynamic exercise on subcutaneous oxygen tension and temperature.

Exercise influences blood flow distribution and may thereby influence tissue oxygen. Given that experimental evidence suggests exercise improves wound healing, this study was undertaken to determine the effect of exercise on subcutaneous tissue oxygen tension (PscO2). Subjects performed a treadmill test to maximum oxygen consumption (VO2) while PscO2 and subcutaneous temperature (Tsc) were measured using a tonometer and optode/thermocouple system. There were no significant differences in PscO2 between measurement points. Mean Tsc had increased 4.8% at maximum VO2, and 6.3% as the cool-down period ended and differed significantly across the exercise period. Changes in PscO2 and Tsc were not correlated. Oxygen availability was neither enhanced nor significantly reduced by exercise. However, PscO2 did not increase as expected in relation to increases in Tsc. Further study will determine the purported beneficial effects of exercise and the mechanism by which it may affect wound healing.

Adult↗