Evaluation of the health level of the elderly: patient care team considerations

ABSTRACT Objective: To understand the differences of physicians, nurses, and social workers in the evaluation of the health status of the elderly. Methods: A cross-sectional quantitative study, using descriptive statistics. Non-probabilistic sample, consisting of 291 participants from three professional categories: 71 (24.4%) physicians, 192 (66%) nurses, and 28 (9.6%) social workers. We used a questionnaire including the variables: sociodemographic characteristics and instruments used for evaluation. Results: Instruments with greater utility for the evaluation of the elderly: for physicians, Mini Mental State Examination; for nurses, Braden scale; and for social workers, genogram. In the physical examination, the data most collected by physicians and nurses are the vital signs; and by social workers, the condition for performing the Activities of Daily Living. Conclusions: The evaluation of the elderly is based on a diversity of instruments and is an area in which health and social professionals need to share information.

Relationship between Braden Scale scores and acute kidney injury among patients with acute coronary syndrome: a multicentre retrospective cohort study

ObjectivesTo evaluate the impact of pressure ulcer events assessed by the Braden Scale (BS) on acute kidney injury (AKI) in patients with acute coronary syndrome (ACS).DesignA multicentre retrospective cohort study.SettingChest pain centres from seven tertiary hospitals in China.ParticipantsWe analysed 3185 patients with ACS from the Retrospective Evaluation of Acute Chest Pain study. The patients were divided into three groups (B1, B2 and B3) according to their BS scores (≤12 vs 13–14 vs ≥15, respectively) at admission.Outcome measuresAKI was defined according to the criteria of the 2012 Kidney Disease: Improving Global Outcomes. Multivariate logistic analysis was used to evaluate the relationship between the BS score and AKI.ResultsThere were 461 patients (14.5%) with ACS who had the complication of AKI. Patients with a lower score on the BS had a higher incidence of AKI (p<0.001). Multivariate logistic regression analysis showed that adjusted ORs of the BS score for AKI were 2.242 (B1 vs B3: 95% CI: 1.643 to 3.060, p<0.001) and 1.566 (B2 vs B3: 95% CI: 1.186 to 2.069, p=0.002). The receiver operating characteristic curve analysis showed that the area under the curve of the BS score was 0.719 (95% CI: 0.702 to 0.736; p<0.001) for AKI.ConclusionsThe BS score was independently associated with AKI. It may be a useful tool to identify those who may benefit from further prediction and prevention of AKI in patients with ACS.Trail registration numberChiCTR1900024657 (http://www.chictr.org.cn/). The satge rekates to results.

Risk Factors for Hospital-Acquired Pressure Injury in Adult Critical Care Patients

Background Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Relative contributions of risk factors for the incidence of pressure injury in adult critical care patients are not well understood. Objective To develop and validate a model to identify risk factors associated with hospital-acquired pressure injuries among adult critical care patients. Methods This retrospective cohort study included 23 806 adult patients (28 480 encounters) with an intensive care unit stay at an academic quaternary care center. Patient encounters were randomly split (7:3) into training and validation sets. The training set was used to develop a multivariable logistic regression model using the least absolute shrinkage and selection operator method. The model’s performance was evaluated with the validation set. Results Independent risk factors identified by logistic regression were length of hospital stay, preexisting diabetes, preexisting renal failure, maximum arterial carbon dioxide pressure, minimum arterial oxygen pressure, hypotension, gastrointestinal bleeding, cellulitis, and minimum Braden Scale score of 14 or less. On validation, the model differentiated between patients with and without pressure injury, with area under the receiver operating characteristic curve of 0.85, and performed better than a model with Braden Scale score alone (P &lt; .001). Conclusions A model that identified risk factors for hospital-acquired pressure injury among adult critical care patients was developed and validated using a large data set of clinical variables. This model may aid in selecting high-risk patients for focused interventions to prevent formation of hospital-acquired pressure injuries.

Factors associated with pressure ulcer onset after knee replacement

Objective: The aim of this study was to find the rate of pressure ulcers (PUs) in patients with knee replacements and identify predictive factors. The ability of the Braden scale to predict the onset of PUs was also investigated. Method: A retrospective prognostic cohort study was carried out involving all consecutive patients undergoing knee replacement surgery. The data were collected from patient records. The variables collected were grouped into two categories: those connected to the patient's own characteristics; and those linked to the care methods used. Results: The total number of patients included in the study was 565. Of these, 2.3% had developed a PU: 0.5% at the heel and 1.8% at the sacrum. Multivariate analysis showed that the variables actually correlated to the outcome were age (p=0.074; odds ratio (OR)=1.08), body mass index (BMI, p=0.037; OR=1.13) and Braden scale (p=0.029; OR=0.72). A combination of these three parameters showed better predictivity of PUs (area under the curve (AUC) 84%). Conclusion: Age, BMI and preoperative Braden score were shown to be independent predictive factors of the onset of PUs in patients with knee replacements. The combined use of all three variables increased the ability to identify the patients at most risk of developing a PU. Declaration of interest: The study was financed by the Professional Nurse Register of Bologna as winner of a competition for research projects in the province of Bologna. The authors declare no conflicts of interest.

Risk Factors Associated With Pressure Ulcers in Patients With Traumatic Brain Injury Admitted to the Intensive Care Unit

Pressure injuries (PIs) are one of the most important and frequent complications in patients admitted to the intensive care unit (ICU) or those with traumatic brain injury (TBI). The purpose of this study was to determine the incidence and risk factors of PIs in patients with TBI admitted to the ICU. In this retrospective study, the medical records of 237 patients with TBI admitted to the trauma ICU of a university hospital were examined. Demographic, trauma-related, and treatment-related characteristics of all the patients were evaluated from their records. The incidence of PIs was 13.9%, while the main risk factors were a higher injury severity score, use of mechanical ventilation, vasopressor infusion, lower Braden Scale score, fever, and period of enteral feeding. This study advances the nursing practice in the ICU by predicting the development of PIs and their characteristics in patients with TBI.

A recurrent neural network-based predictive model for pressure ulcers based on an intensive care unit dataset (MIMIC-III) (Preprint)

BACKGROUND A pressure ulcer (PU) is a localized cutaneous injury caused by pressure or shear, which usually occurs in the region of a bony prominence. PUs are common in hospitalized patients and cause complications including infection. OBJECTIVE This study aimed to build a recurrent neural network-based algorithm to predict PUs 24 hours before their occurrence. METHODS This study analyzed a freely accessible intensive care unit (ICU) dataset, MIMIC- III. Deep learning and machine learning algorithms including long short-term memory (LSTM), multilayer perceptron (MLP), and XGBoost were applied to 37 dynamic features (including the Braden scale, vital signs and laboratory results, and interventions to reduce the risk of PUs) and 35 static features (including the length of time spent in the ICU, demographics, and comorbidities). Their outcomes were compared in terms of the area under the receiver operating characteristic (AUROC) and the area under the precision-recall curve (AUPRC). RESULTS A total of 1,048 cases of PUs (10.0%) and 9,402 controls (90.0%) without PUs satisfied the inclusion criteria for analysis. The LSTM + MLP model (AUROC: 0.7929 ± 0.0095, AUPRC: 0.4819 ± 0.0109) outperformed the other models, namely: MLP model (AUROC: 0.7777 ± 0.0083, AUPRC: 0.4527 ± 0.0195) and XGBoost (AUROC: 0.7465 ± 0.0087, AUPRC: 0.4052 ± 0.0087). Various features, including the length of time spent in the ICU, Glasgow coma scale, and the Braden scale, contributed to the prediction model. CONCLUSIONS This study suggests that recurrent neural network-based algorithms such as LSTM can be applied to evaluate the risk of PUs in ICU patients.

ASSESSMENT OF THE RISK OF DECUBITUS ULCERS USING BRADEN SCALE

Purpose: Within the behavioral guidelines of hospitalized patients who need compensatory nursing care, an assessment of the risk of decubitus ulcers is recommended to be done at regular intervals, in schedule, and after each altered state. The goal of this research is to apply the BRADEN SCALE for assessment of the risk of decubitus ulcers occurring during a hygienic toilet in sick people who need compensatory nursing care. Material/Methods: An assessment of the risk of decubitus ulcers via using the Braden scale is applied in 120 hospitalized patients during a hygienic toilet. Treatment of decubitus ulcers I and II degree is being performed when the state of the skin and wounds that have already occurred are being established. For processing, analysis and graphic presentation of the results and data, the statistic program SPSS 20.0 is being used. Results: It's reported that 50, 83% of the respondents have got quite a risk of decubitus wounds occurring, 26,67% are at great risk, and 14,17% are at moderate risk. Only 8, 33% of all patients tested are at light risk. Conclusions: In all patients tested, a various degree of decubitus wounds occurrence, is reported. This defines the importance of the nurses' hygienic care and activities for the prevention of decubitus ulcers to occur. If the prevention measures of patients who have gotten in a risk group are not observed, every decubitus wound leads to a continuous stay in the hospital and also additional treatment and tests, which automatically prolong and raise the cost of hospital treatment.

The Prevalence and Characters of Pressure Injuries in Hospital: A Hospital Study in Southeast China

Background and objective: Hospital-acquired pressure injuries (HAPIs) carry many adverse consequences (such as pain, wound odors, long lengths of hospital stay), and are a concern internationally. The aim of this study was to describe the incidence, clinical and epidemiological features of HAPI in a tertiary hospital. Methods A retrospective, qualitative study was conducted from 2017 to 2018. A questionnaire was designed around the existing literature about HAPI, including general information, Braden Scale scores (on admission, the moment that patients developed HAPI, and discharge), and the assessment of HAPI. Results 419 patients had HAPI, representing an incidence of 0.12%. On average, patients developed HAPI after 12 days. The intensive care unit (ICU; 79,18.9%) saw the largest number of patients with HAPI. HAPIs were most commonly at Stage 2 (71.4%) and of a sacral location (42.3%). Braden Scale scores at first development of HAPI were lower than those on admission or discharge (with a low score signifying high risk). Conclusion The incidence of HAPI in a tertiary hospital was lower than at other hospitals. Braden Scale scores predicted the highest HAPI risk occurring at the point where HAPI were first developed.