PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Pressure Ulcer”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 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↗
PubMed1998

Pressure ulcer research: pressure ulcer treatment. A monograph from the National Pressure Ulcer Advisory Panel.

The AHCPR guideline on Treatment of Pressure Ulcers was released in December 1994. This guideline was based on the best available scientific evidence published between 1966 and May 1, 1993. Over 45,000 abstracts were reviewed in the literature analysis. Yet only 63.2% of the guideline recommendations were based on research of any type, and only 4.5% of the recommendations were supported by two or more randomized clinical trials. A more recent literature review (covering articles on pressure ulcers listed in the MEDLINE database between May 1, 1993, and December 1, 1996), revealed minimal advances in the scientific body of knowledge on pressure ulcer treatment. Advances have been made in the knowledge of electrical therapy and growth factors, and efforts are under way to enhance tools for monitoring healing. In an era of limited research funding, we need to carefully target our research efforts to maximize the advancement of our knowledge of pressure ulcer treatment. It is the hope of the NPUAP that this monograph will guide the research needed to ensure the most efficient utilization of funds to improve patient outcomes.

Evidence-Based Medicine↗
PubMed2003

Healing of elderly patients with diabetic foot ulcers, venous stasis ulcers, and pressure ulcers.

Although elderly patients have physiologic impairments in wound healing, their wounds should be expected to heal with the same frequency of closure as those in younger populations, albeit at a slower rate. However, compared to the general population, the elderly population has a higher incidence of chronic wounds: diabetic foot ulcers, pressure ulcers, and venous stasis ulcers. Experimental and clinical data indicate physiologically impaired healing is characterized by decreased angiogenesis and synthesis of critical growth factors. Further, compared to younger populations, the elderly have a higher rate of mortality associated with specific morbidities, such as sepsis and acute respiratory distress. As these morbidities may develop directly from the wound, early intervention is mandated. In this report, 40 consecutive elderly patients (65-102 years old) with chronic wounds were analyzed. All patients were provided the same treatment protocol and healing was defined as 100% epithelization and no drainage. Despite the wounds presenting in a nonhealing and/or infected state, 73% of these chronic wounds in elderly patients healed. This suggests that elderly patients with diabetic foot ulcers, pressure ulcers, and venous stasis ulcers close their wounds at a similar frequency as younger patients. Therefore, early intervention and comprehensive treatment that includes safe topical therapies, in addition to growth factors and cellular therapy used for chronic wounds, ensure these patients will be spared the morbidities of pain, amputation, osteomyelitis, and even death. We hypothesize that if all elderly patients with chronic wounds are provided early treatment, morbidities (e.g., amputation, sepsis, pain) and associated costs will decrease.

Age Factors↗
PubMedDate not supplied

The effectiveness of skin care protocols for pressure ulcers.

Pressure ulcers (PU) remain a serious healthcare problem in the United States. This study investigated the effectiveness of a prevention and early intervention program in reducing the prevalence of pressure ulcers (i.e., the number or the percentage of persons with pressure ulcers at a given time) in a rehabilitation hospital. The Braden Scale for Predicting Pressure Sore Risk was used to assess subjects' PU risk. Protocols were established for PU stages consistent with the National Pressure Ulcer Advisory Panel consensus statement on pressure ulcers. Staff were educated about PUs and the specific protocols for prevention and treatment. Concurrent quarterly prevalence audits on a total of 116 patients were conducted for 1 year. An audit also was done 16 months after protocols had been established. There was a 60% decrease in pressure ulcer prevalence from the 25% baseline to the 10% found at the audit following implementation of the protocols.

Aged↗
PubMed2001

Management of pressure ulcers.

Pressure ulcers are a common problem, with about 1.5 to 3 million individuals in the United Stated affected. Treatment may be costly, requiring lengthy periods of hospitalization. Central to the development of pressure ulcers is the loss of the ability of bedridden patients to move spontaneously. When this ability is impaired by neurologic injury or debility, damage caused by unrelieved pressure against tissue trapped between the support surface and a bony prominence becomes evident. Current recommendations for prevention advise providing optimal skin care to those at risk of tissue breakdown. Once a pressure ulcer is diagnosed, an initial assessment, including staging the ulcer and a comprehensive assessment, is required. A treatment plan can then be devised. Planning should include management of tissue loads, ulcer care, and nutritional support. The dogma that all pressure ulcers are caused by poor care should be recognized as incorrect. Even the most exemplary care may not prevent the development of, or heal existing, pressure ulcers in high-risk patients.

Algorithms↗
PubMedDate not supplied

Prevention and management of pressure ulcers.

Pressure ulcers represent a major health problem causing a considerable amount of suffering for patients and a high financial burden for healthcare systems. The geriatric population with an increased risk of pressure ulcer development is rising constantly as a result of chronic degenerative diseases that can lead to prolonged immobilization and poor nutrition. Evidence clearly indicates that preventive measures are essential to reduce the prevalence rates of pressure ulcers; therefore healthcare professionals must be able to identify the appropriate strategies to adopt, in order to meet the individual patient's requirements. Important advances have taken place in the world of pressure ulcer treatment during the past decade. These advances are reflected in the high rate of cures being obtained. This, together with the implementation of prevention guidelines, the excellent cost/effectiveness relationship of the techniques described, and other factors, means that the field of pressure ulcers management is no more an isolated and self-administered issue in medical practice. The areas discussed here are those in which there will be linear or, in some cases, exponential growth in the decades to come.

Chronic Disease↗
PubMed1991

Practice guidelines for management of pressure ulcers.

Pressure ulcers are a significant and increasing source of human suffering. The precise number of people who have pressure ulcers is unknown. However, conservative estimates indicate that well over a million persons in hospitals and nursing homes suffer from pressure ulcers. One large study found that one in four Americans who died in 1987 had a dermal ulcer. The prevalence of pressure ulcers is almost certain to grow due to increasing numbers of fragile elderly and survivors of serious trauma.

Clinical Protocols↗
PubMed2006

Prevention and treatment of pressure ulcers.

Pressure ulcers are complex chronic wounds for which no gold standard for prevention or treatment has yet been established. Several attempts at developing guidelines has been undertaken by different organizations. Pressure ulcers are devastating comorbidities for patients and difficult to prevent or manage. Whether or not pressure ulcers are preventable remains controversial. The strategy for prevention includes recognizing the risk, decreasing the effects of pressure, assessing nutritional status, avoiding excessive bed rest and prolonged sitting, and preserving the integrity of the skin. The principles of treatment of pressure ulcers include assessing severity, reducing pressure, friction and shear forces, optimizing local wound care, removing necrotic debris, managing bacterial contamination, and correcting nutritional deficits.

Bandages↗
PubMed1991

For your information: pressure ulcers.

Pressure ulcers (also called bedsores) affect 3% to 11% of hospital and nursing home patients. Although most seen in the elderly, these ulcers can also occur in younger people who are unable to move about following musculoskeletal or neurological damage. Despite the belief that pressure ulcers are caused by neglect and inattention by hospital or nursing home personnel, even the most diligent nursing care may still not be able to prevent pressure ulcers. Increased understanding of the formation, treatment, and prevention of pressure ulcers by family members, home caregivers, and handicapped individuals can be a great help to those who suffer from these ulcers.

Persons with Disabilities↗
PubMed1989

The prevention and management of pressure ulcers.

Pressure ulcers are a common problem for older persons. Complications associated with pressure ulcers include infection and even death for some patients. Pressure is the primary pathogenic factor, but shearing forces, friction, and moisture are also important. Immobility, nutritional status, and age-related factors seem to be significant risk factors. Preventive care includes use of assessment tools to identify high risk patients, frequent repositioning, air or foam mattresses that reduce pressure over bony prominences, as well as careful attention to optimizing the overall patient condition. When pressure ulcers do develop, the treatment plan should include adequate nutrition including protein, vitamin C, and zinc supplements as indicated; systemic antibiotics for sepsis, cellulitis, osteomyelitis, or the prevention of bacterial endocarditis; and local wound care that eliminates necrotic tissue, decreases bacterial load, and provides a physiologic, pressure-free environment allowing the wound to heal. Specialized beds may be considered in some patients, particularly those with larger ulcers. Surgery is an option in older persons who are operative candidates. For some patients with pressure ulcers, appropriate treatment goals may focus on providing comfort rather than curing the ulcer.

Aged↗
PubMed1992

Portrait of practice: reducing the prevalence of pressure ulcers.

Pressure ulcer prevention and maintenance strategies at a 650-bed tertiary care hospital with a high risk population of patients have resulted in a low prevalence of pressure ulcers (3% to 5%). The steps in achieving a reduction in pressure ulcers were: 1) identification of high risk patients in the institution; 2) updating of knowledge through literature review and attendance at conferences; 3) adoption of a risk assessment scale; 4) standardization of protocols concerning pressure reducing support surfaces, nutritional support, and incontinence strategies; and 5) periodic audits for continuous quality management. This portrait of practice may be similar to other hospitals throughout the country. The future pressure ulcer projects will be enhanced by the recent establishment of an Institute of Nursing Research and Education.

Clinical Protocols↗
PubMed1995

An animal model and computer-controlled surface pressure delivery system for the production of pressure ulcers.

Pressure ulcers continue to be a major health care problem. This paper describes an animal model and surface pressure delivery system for the production of experimentally derived pressure ulcers. A method for inducing dermal pressure lesions on the fuzzy rat was developed using a computer-controlled displacement column which produced a constant tissue interface pressure. The pressure column consists of a force transducer located between two 0.5-in (1.27-cm) diameter metal cylinders. The desired cutaneous pressure is maintained by a computer-controlled miniature stepper motor which displaces the column with the aid of interactive software. The force transducer signal is converted from analog to digital form, amplified, and recorded. Blood perfusion is monitored using a laser Doppler flowmeter (located in the tip of the column) during the application of pressure. The application of 145 mmHg pressure for 5 consecutive 6-hr sessions resulted in a greater than 90% incidence of pressure ulcers. The implications of our model and contributions of earlier animal models are discussed. This model provides a tightly controlled and measured environment making possible the scientific study of ulcer development and the evaluation of potential preventative or curative compounds.

Animals↗
PubMedDate not supplied

Fibroblast senescence in pressure ulcers.

Pressure ulcers appear as localized chronic wounds in the middle of normal functioning skin. This study focuses on pressure ulcer fibroblasts cultured from the ulcer bed, ulcer margin, and normal, nonulcerated skin adjacent to the wound. From these areas we show that pressure ulcer fibroblasts become prematurely senescent. Verification of senescence was based on failure of cell populations to undergo a 0.5 population doubling after 1 week in culture, light microscopic appearance of late-passage senescent cells in culture, light microscopic verification of senescence in vivo and in vitro by anti-terminin staining, and ultrastructural identification of senescent fibroblasts by anti-terminin colloidal gold labeling. Although not all ulcer fibroblasts are senescent, there is a range of proliferative ability. The senescent phenotype of ulcer fibroblasts remains intact in vitro as these cells remain viable but are unable to complete DNA synthesis. Fibroblast senescence is not uniform in chronic wounds but varies within areas of the ulcer bed and from patient to patient. Although ulcer fibroblasts exhibit limited proliferative ability, fibroblasts from the ulcer margin and adjacent normal skin show a continued ability to divide. However, in all areas of the wound, the mean generation time of the fibroblast population is longer than commonly observed for cultured human diploid fibroblasts. At first passage, the mean generation time for fibroblasts from all patients is significantly different (p = .001, analysis of variance) among fibroblasts from the ulcer bed (4.2 2.2 days), ulcer margin (2.9 +/- 1.3 days), and adjacent normal skin (1.9 +/- 0.6 days). Analysis of the three cell groups by the post hoc Tukey test, using corrected p values shows that the difference between mean generation times among fibroblast populations from adjacent normal skin and ulcer bed are significantly different (p < 0.05), whereas the difference between fibroblasts from adjacent normal skin and ulcer margin and ulcer margin and ulcer bed are not significantly different (p > 0.05). These data may help to explain the poor response of certain pressure sores to aggressive medical treatment.

Analysis of Variance↗
PubMed1991

Prevention and rehabilitation of pressure ulcers.

Pressure ulcers continue to constitute a major medical problem that interferes with the care of elderly and debilitated patients and patients with paralysis and anesthesia, such as spinal cord-injured patients. In spite of the great advances made in modern medical care, too little attention has been paid to the prevention of pressure ulcers. Preventive measures must be based on education of the patient, the family, and all involved professional personnel. Patients and personnel must be constantly reminded of the etiology, pathology, and cost of ischemic ulcers. They must also be convinced that pressure ulcers can be prevented through diligent and enlightened nursing attention and self-care. The importance of providing pressure relief to the areas supporting the weight of the body must continue to be stressed and materials and methods must never be substituted for sound nursing care.

Humans↗
PubMed1991

Standards of care for hospice patients with pressure ulcers.

Pressure ulcers are a major concern of hospice nurses. A recent survey of hospice agencies in an area of the southwest indicated a lack of specific standards of care for patients with pressure ulcers and no systematic method to identify patients at risk. Standards of care were subsequently developed to identify patients at risk and to manage pressure ulcers of hospice patients.

Hospices↗