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Pressure ulcer references
This month's pressure ulcer references continues the Australian theme of this newsletter by reporting studies on pressure ulcers conducted in, or related to Australia.
Anonymous (1989). "Caring for people at home." Australian Family Physician 18(3): 241.
This new series presents advice and interesting tips on caring for sick, elderly and disabled people in their homes. Although it is written mainly for people who care for others at home the advice is useful knowledge for the attending medical practitioner. The topics are reproduced from the Australian Red Cross Society 'Caring For People At Home' manual. The Red Cross programme has three components--the manual, a practical course, and an advisory or information service. The manual can be purchased from the Red Cross at a reduced price of $12.95.
Bedbrook, G. M. (1976). "The final responsibility of emergency." Medical Journal of Australia 1(5): 107-10.
Childs, L. and P. M. Rimmington (1983). "Decubitus ulcers: a survey picture at two hospitals." Australian Nurses' Journal 13(1): 35.
Ewing, M. R., C. Garrow, et al. (1964). "Further Experiences in the Use of Sheepskins as an Aid in Nursing." Medical Journal of Australia 2: 139-41.
Graves, N., F. Birrell, et al. (2005). "Effect of pressure ulcers on length of hospital stay." Infection Control & Hospital Epidemiology 26(3): 293-7.
OBJECTIVE: To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not. DESIGN: Cross-sectional, observational study. SETTNG: Tertiary-care referral and teaching hospital in Australia. PATIENTS: Two thousand hospitalized patients 18 years and older who had a minimum stay in the hospital of 1 night and admission to selected clinical units. METHODS: Two thousand participants were randomly selected from 4,500 patients enrolled in a prospective survey conducted between October 2002 and January 2003. Quantile median robust regression was used to assess risk factors for excess length of hospital stay. RESULTS: Having a pressure ulcer resulted in a median excess length of stay of 4.31 days. Twenty other variables were statistically significant at the 5% level in the final model. CONCLUSIONS: Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis. However, our estimates were substantially lower than those currently used to make predictions of the economic costs of pressure ulcers; existing estimates may overstate the true economic cost.
Graves, N., F. A. Birrell, et al. (2005). "Modeling the economic losses from pressure ulcers among hospitalized patients in Australia." Wound Repair & Regeneration 13(5): 462-7.
The objective of this study was to predict the number of cases of pressure ulcer, the bed days lost, and the economic value of these losses at Australian public hospitals. All adults (>or= 18 years of age) with a minimum stay of 1 night and discharged from selected clinical units from all Australian public hospitals in 2001-02 were included in the study. The main outcome measures were the number of cases of pressure ulcer, bed days lost to pressure ulcer, and economic value of these losses. We predict a median of 95,695 cases of pressure ulcer with a median of 398,432 bed days lost, incurring median opportunity costs of AU$285 M. The number of cases, and so costs, were greatest in New South Wales and lowest in Australian Capitol Territory. We conclude that pressure ulcers represent a serious clinical and economic problem for a resource-constrained public hospital system. The most cost-effective, risk-reducing interventions should be pursued up to a point where the marginal benefit of prevention is equalized with marginal cost. By preventing pressure ulcers, public hospitals can improve efficiency and the quality of the patient's experience and health outcome.
Hoskins, A. (1999). "Risk assessment for pressure ulcers: a comparison of two tools." Australian Nursing Journal 7(6): 41.
Huckson, S. D. (2004). "Pressure ulcer resource guide.[comment]." Medical Journal of Australia 181(1): 55.
Lewis, M., A. Pearson, et al. (2003). "Pressure ulcer prevention and treatment: transforming research findings into consensus based clinical guidelines." International Journal of Nursing Practice 9(2): 92-102.
The translation of research findings into practice guidelines is an important aspect in maintaining the currency of practice and adding value to research. While there has been a large amount of published literature regarding the treatment and prevention of pressure ulcers, very few studies have attempted to provide clear clinical guidelines. The present study proposes a model to transform research into clinical guidelines whilst developing a series of guidelines that can be applied to a variety of clinical settings.
Ramstadius, B. (2000). "Preventing institution--acquired pressure ulcers." Australian Nursing Journal 7(10): 34.
Torrance, C. (2000). "The perennial pressure sore revisited." Australian Nursing Journal 7(10): 31.
Torrance, C. (2001). "Reflections on wound care in Australia." British Journal of Nursing 10(6 Suppl): S66,S68.
Wellard, S. J. (2001). "An Australian experience of managing pressure ulcers in persons with SCI." SCI Nursing 18(1): 11-7.
Pressure ulcers are a difficult and complex problem, frequently resulting in poor patient outcomes and significantly increased cost of care. This project evolved from a desire to improve the management and subsequent outcomes for persons with spinal cord injury (SCI) who experience pressure ulcers acquired in the community. The vast body of work related to pressure ulcers has focused on risk assessment and prevention. However, there has been little interest in the management of prevailing pressure ulcers. Using a retrospective case history audit and interviews with patients and health care workers from an Australian spinal services unit, current practices associated with the care of pressure ulcers are described. A number of issues are identified that relate to funding, diet, attitudes, consistency of care, and low levels of staff interest in pressure ulcer management. This work provides baseline data from which current management practices can be reviewed, revised, and empirically evaluated.
Young, J., S. Nikoletti, et al. (2002). "Risk factors associated with pressure ulcer development at a major western Australian teaching hospital from 1998 to 2000: secondary data analysis." Journal of Wound, Ostomy, & Continence Nursing 29(5): 234-41.
OBJECTIVE: The purpose of this study was to identify risk factors associated with the presence of pressure ulcer development in adult patients at an acute care teaching hospital. DESIGN: The database was established by combining the results from 3 annual cross-sectional pressure ulcer prevalence studies conducted between 1998 and 2000. SETTING AND SAMPLE: The sample consisted of all medical and surgical patients who were inpatients on the day of the pressure ulcer surveys. The sample includes a total of 1394 patients. METHODS: This study undertook secondary data analysis with use of logistic regression and descriptive statistics. RESULTS: Overall pressure ulcer prevalence was calculated at 15.9%, with this figure decreasing slightly to 12.7% when pressure ulcers present on admission were excluded. Initial analysis identified several variables as significant risk factors for pressure ulcer development (age, Braden Scale risk category, and admission type and specialty). However, when entered into a final multivariate model, only 2 factors, age and Braden Scale risk category, were found to be significant. The odds ratio matrix revealed a consistent trend toward increasing odds ratios with increasing Braden Scale risk category within each age group. The magnitude of this trend was more pronounced in the younger age groups, highlighting the importance of undertaking Braden Scale assessments of younger patients, some of whom may be at greater risk of having a pressure ulcer develop than would otherwise be expected. CONCLUSION: Pressure ulcer prevalence in this acute care setting is high when compared with other Australian data. However, comparisons of pressure ulcer prevalence across studies are difficult to interpret because of different reporting methods. Although predictor variables for pressure ulcers have been identified in a number of studies, longitudinal studies are needed to identify the cause-and-effect relationships for potential predictor variables. In addition, more sophisticated statistical analyses such as the use of the odds ratio matrix may help guide further research into interaction effects between predictor variables and how these might affect the psychometric properties of risk assessment tools such as the Braden Scale. Pressure ulcer interventions should be targeted at the sacrum and heel, because these appear to be the most frequently observed locations for pressure ulcers.
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