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Pressure injuries are a significant concern for patients undergoing neurosurgical procedures due to prolonged immobility and the complexity of care. This study evaluates the efficacy of standardized pressure ulcer management protocols in preventing pressure injuries and enhancing patient care in a neurosurgical context. A comprehensive retrospective analysis was conducted at a single institution from December 2020 to December 2023, comparing 50 patients who received standardized pressure ulcer management (intervention group) with 50 patients who received conventional care (control group). The study assessed the incidence of pressure ulcers, patient comfort levels using the Kolcaba Comfort Scale and sleep quality using the Richards‐Campbell Sleep Questionnaire (RCSQ). Statistical analysis was performed using SPSS software, version 27.0, applying t‐tests and chi‐square tests as appropriate. The intervention group exhibited a significantly lower incidence of pressure ulcers at all measured time points post‐surgery compared to the control group. Patient comfort levels in the intervention group were consistently higher across psychological, environmental, physiological and socio‐cultural domains. Sleep quality metrics, including sleep depth, latency to sleep onset and overall sleep quality, were significantly improved in the intervention group. The implementation of standardized pressure ulcer management protocols in neurosurgical care significantly reduces the incidence of pressure injuries, enhances patient comfort and improves sleep quality. These findings highlight the importance of adopting structured care protocols to improve postoperative outcomes and patient well‐being in neurosurgical settings.

Purpose Placing patients with severe acute respiratory distress syndrome (ARDS) in the prone position has been shown to improve survival as compared to the supine position. However, a higher frequency of pressure ulcers has been reported in patients in the prone position. The objective of this study was to verify the impact of prone positioning on pressure ulcers in patients with severe ARDS. Methods This was an ancillary study of a prospective multicentre randomised controlled trial in patients with severe ARDS in which the early application of long prone-positioning sessions was compared to supine positioning in terms of mortality. Pressure ulcers were assessed at the time of randomisation, 7 days later and on discharge from the intensive care unit (ICU), using the four-stage Pressure Ulcers Advisory Panel system. The primary end-point was the incidence (with reference to 1,000 days of invasive mechanical ventilation or 1,000 days of ICU stay) of new patients with pressure ulcers at stage 2 or higher from randomisation to ICU discharge. Results At randomisation, of the 229 patients allocated to the supine position and the 237 patients allocated to the prone position, the number of patients with pressure ulcers was not significantly different between groups. The incidence of new patients with pressure ulcers from randomisation to ICU discharge was 20.80 and 14.26/1,000 days of invasive mechanical ventilation ( P  = 0.061) and 13.92 and 7.72/1,000 of ICU days ( P  = 0.002) in the prone and supine groups, respectively. Position group [odds ratio (OR) 1.5408, P  = 0.0653], age >60 years (OR 1.5340, P  = 0.0019), female gender (OR 0.5075, P  = 0.019), body mass index of >28.4 kg/m 2 (OR 1.9804, P  = 0.0037), and a Simplified Acute Physiology Score II at inclusion of >46 (OR 1.2765, P  = 0.3158) were the covariates independently associated to the acquisition of pressure ulcers. Conclusion In patients with severe ARDS, prone positioning was associated with a higher frequency of pressure ulcers than the supine position. Prone positioning improves survival in patients with severe ARDS and, therefore, survivors who received this intervention had a greater likelihood of having pressure ulcers documented as part of their follow-up. There are risk groups for the development of pressure ulcers in severe ARDS, and these patients need surveillance and active prevention.

Prevention of acute pressure injuries (PS) is critical in patients undergoing certain surgeries. This type of pressure injury can develop during and after surgery, causing unnecessary pain and complications for the patient. However, preventing PS in these high-risk patients may present some challenges and require specific nursing measures. To explore the clinical effects of special pressure ulcer intervention combined with gel positioning pad intervention on the prevention of acute stress injury in patients undergoing long-term lateral position spinal surgery. The simple randomization method was used in this study; 100 patients with lateral position spinal surgery from March 2022 to March 2023 were selected as research subjects and were divided into an observation group and control group with 50 cases in each group by the random number table method. The control group was given routine intervention, and the observation group carried out special pressure ulcer intervention and gel positioning pad intervention. Special pressure ulcer intervention was performed, using appropriate surface support to relieve pressure, keeping the patient's skin clean and dry, and turning regularly to relieve pressure. In addition, we use a gel positioning pad intervention to disperse pressure, improve local blood circulation, and reduce the risk of pressure injuries. The occurrence of acute stress injury, VAS scores at different time points after surgery, local skin infrared thermography analysis results at 72 hours after surgery, incidence rates of complications and nursing satisfaction were compared between the two groups of patients. The incidence rates of acute stress injury during surgery, within 2 hours after surgery and within 72 hours after surgery in the observation group were lower than those in the control group (P < .0046). The number and area of injury in the observation group were smaller than those in the control group (P < .0037). The National Pressure Ulcer Advisory Panel (NPUAP) grading of acute stress injury in the observation group was lower compared with that in the control group (P < .0021). The pain VAS scores in the observation group at 2 hours, 24 hours and 72 hours after surgery were lower than those in the control group (P < .001). The local skin infrared thermography analysis temperature values of the neck, shoulder, hip, knee and ankle were lower in the observation group than those in the control group at 72 hours after surgery (P < .001). The incidence rates of postoperative lumbago and shoulder-neck pain in the observation group were lower than those in the control group (P < .001). The scores of three aspects of nursing technology and nursing operation satisfaction, service attitude and humanistic care satisfaction, and nursing environment satisfaction were higher in the observation group than compared to the control group (P < .001). The findings of this study highlight the importance of specific pressure ulcer interventions that can be widely used in clinical practice and have the potential to reduce the incidence of pressure injuries and improve patient satisfaction with care. Special pressure ulcer intervention combined with gel positioning pad intervention has a good preventive effect on acute stress injury in patients undergoing long-term lateral position spinal surgery. Limitations of this study include the small sample size and single study institution, which may affect the external validity of the study. In addition, data collection in this study was limited to a specific time period and does not reflect long-term outcomes. Future studies could consider multi-center, broader samples, and longer follow-up to confirm the benefits of these interventions and to investigate in depth the long-term rehabilitation and quality of life of patients.

Pressure ulcers are a common complication of prone orthopaedic surgery, causing pain and inconvenience to patients. This study aimed to evaluate a comprehensive nursing intervention for pressure ulcer formation in these patients. A total of 120 patients undergoing prone orthopaedic surgery were randomly divided into two groups. The study group (60 patients) received a comprehensive nursing intervention, whereas the control group (60 patients) received a routine nursing intervention. After 2 weeks, the comprehensive nursing intervention significantly reduced the incidence and degree of pressure sores and led to a shorter recovery time than the routine nursing intervention (p < 0.05). The incidence of postoperative wound complications was decreased, and patient satisfaction was significantly improved (p < 0.05). The Hamilton Anxiety Scale, Hamilton Depression Scale and visual analogue scale scores of the study group were significantly lower than those of the control group, and the Short Form 36 Health Survey Questionnaire scores were higher than those of the control group (p < 0.05). A comprehensive nursing intervention can significantly reduce the incidence and degree of pressure ulcers, accelerate recovery time, reduce postoperative wound complications and improve the quality of life and satisfaction of patients undergoing prone orthopaedic surgery.

Background Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. Methods This is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. Discussion This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. Trial registration ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019

This study investigated alterations in the skin microclimate of the sacrococcygeal compression area in patients with malignant head and neck tumours before and after surgery. Additionally, it evaluated the effect of preventive dressings on the skin microclimate in this area and their association with intraoperative acquired pressure injuries (IAPIs), aiming to provide a foundation for preventing and reducing these injuries. Thirty patients were randomly assigned into control and two intervention groups. The sacrococcygeal skin of the control group was not protected by preventive dressing. Intervention group A was protected by silicone foam dressing, and intervention group B received a combination of liquid dressing and silicone foam dressing. Sacrococcygeal skin temperature, skin moisture levels and sebum were measured at admission, before and after surgery, and post‐operative skin and pain were evaluated. There were no significant differences in skin temperature, moisture levels or sebum between the three groups before and after the intervention. The incidence of IAPI was significantly different (χ2 = 6.240, p = 0.044). No significant difference was observed in post‐operative pain incidence. Preventive dressings did not significantly alter the skin microclimate but reduced the risk of IAPIs.

Background Tracheostomy-related pressure injuries (TRPIs) compromise recovery and prolong hospital stay. Methods We conducted a prospective randomized controlled trial at a tertiary hospital to compare the efficacy of petroleum jelly application versus normal saline irrigation in preventing peristomal pressure injuries and promoting tracheostomy wound healing. This study enrolled 28 participants, aged 18–80 years, who underwent tracheostomy procedures at Vajira Hospital, Navamindradhiraj University. They were randomly assigned using a permuted-block randomization methods (block size = 4) to either the petroleum jelly application group or the sodium chloride irrigation (0.9% NaCl solution) group. The outcomes were evaluated by one physician and one nurse at first, second, and fourth weeks postoperatively using the Pressure Ulcer Scale for Healing (PUSH) Tool and Skin Integrity Score. Results The petroleum jelly application group demonstrated significantly lower mean scores on the PUSH Tool at first, second, and fourth weeks than the sodium chloride irrigation group. Moreover, the petroleum jelly application group exhibited significantly higher median scores for skin integrity at first, second, and fourth weeks than the sodium chloride irrigation group. The interrater reliability between the two observers was good to excellent. The petroleum-jelly arm showed faster improvement on both scoring tools across all follow-up points. Conclusions The participants who received petroleum jelly application following tracheostomy demonstrated better results in preventing pressure injuries and maintaining skin integrity compared with those who received sodium chloride irrigation. Trial registration TCTR20240806002 (Thai Clinical Trials Registry), registered on August 6, 2024. Retrospectively registered. ( https://www.thaiclinicaltrials.org/show/TCTR20240806002 ).

Background In posterior lumbar surgery, overweight patients are more prone to intraoperative acquired pressure injury (IAPI) due to bleeding, longer operative time, and increased pressure. The current prevention strategies have limited effects. Methods This was a single-blind, prospective, randomized controlled trial conducted from April 2023 to September 2024. Eligible participants were overweight patients (BMI ≥ 24 kg/m²) scheduled for lumbar posterior surgery under general anesthesia. Patients were randomly assigned to two groups: the micro-movement group and the silicone foam dressing group. The micro-movement group had regular adjustments to the operating table to change the patient’s position and alleviate pressure. The silicone foam dressing group used standard foam dressings at pressure points. Results A total of 277 patients were included in the analysis (137 in the micromovement group and 140 in the silicone foam dressing group). Compared with the silicone foam dressing group (8.6%), the incidence of IAPI in the micromovement group was significantly reduced (2.9%) ( P  < 0.05). There were no significant differences between the two groups in terms of IAPI stage, duration, or location ( P  > 0.05). Conclusion The micromovement protocol is a safe and effective method for preventing IAPI in overweight patients undergoing posterior lumbar surgery. This simple intervention could significantly improve patient outcomes and reduce healthcare costs associated with IAPI.

The study explores the impact of predictive nursing interventions on pressure ulcers (PUs) in elderly bedridden patients. A total of 120 elderly bedridden patients from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between August 2019 and August 2023 were selected as the subjects of the study and were randomly divided into an observation group and a control group using a random number table method. The control group received conventional nursing care, while the observation group received predictive nursing interventions. The study compared the incidence of PUs, Braden scale scores, the onset time of PUs, self‐rating anxiety scale (SAS) scores, self‐rating depression scale (SDS) scores, and nursing satisfaction between the two groups. In elderly bedridden patients, the application of predictive nursing interventions significantly reduced the incidence of PUs (p < 0.001), significantly lowered the SAS and SDS scores (p < 0.001), and also significantly increased Braden scale scores (p < 0.001) and delayed the onset time of PUs (p < 0.001). Additionally, it improved patients' nursing satisfaction (p = 0.008). Predictive nursing interventions in elderly bedridden patients have good application effects, reducing the occurrence of PUs, delaying the time of onset in patients, improving patients' negative emotions and enhancing nursing satisfaction rates. It is worthy of widespread use.

One in three patients admitted to intensive care will sustain a pressure injury (PI) from a medical device. These injuries are painful and when on the face, head or neck they can result in permanent disfigurement. Preliminary evidence of the efficacy of hyper‐oxygenated fatty acids (HOFAs) to prevent facial pressure injuries from medical devices is promising; however, the feasibility of incorporating HOFAs into current standard care to prevent PI from a medical device of the face, head and neck has not been extensively explored. It is intended that the findings from this phase II feasibility study will inform the design of a larger phase III trial, by addressing two primary aims: (1) to assess the feasibility of incorporating HOFAs into standard care to prevent device‐related pressure ulcers of the skin associated with the face, head and neck assess the feasibility and (2) efficacy preliminary effectiveness of HOFA. This feasibility study is an investigator‐initiated mixed method study incorporating a multi‐centre randomised controlled trial of using HOFAs as an adjunct to standard pressure injury prevention and care, compared with standard care alone to prevent facial, head or neck from medical devices among adults admitted to intensive care. The primary outcome of interest is the incidence of facial, head or neck pressure injuries during the first 14 days in intensive care. Secondary outcomes include PI staging, medical device exposure and intensive care and hospital outcomes. The primary analysis will be undertaken using Cox's Proportional Hazards model, and due to the exploratory nature of this phase II trial, efficacy will be based on a one‐sided p‐value for superiority set at 0.10. Type I and Type II error rates are set at 20%; therefore, a total sample size of 196 study participants is planned. To explore the feasibility of incorporating HOFA into usual care and to design a larger phase III trial, we will aim to interview between 10 and 20 nurses across participating intensive care unit sites. Pressure injuries of the face, head or neck from medical devices, among adults admitted to intensive care, are considered preventable. This phase II study will investigate the feasibility and efficacy of HOFAs as an adjunct to standard care. Importantly, we aim to inform the development of a larger phase III trial.