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Objectives: To determine the profile of diabetes patients with neuropathic and neuro-ischaemic lesions who are referred to the advanced practice nurse (APN) in complex chronic wounds; to determine whether a training strategy aimed at primary care nurses and nursing homes that care for patients with diabetic foot disease influences the performance of professionals; and to assess the extent, follow-up and evaluation of diabetic foot disease in patients with neuropathic ulcers and neuro-ischaemic ulcers referred to the specialist APN before and after the training. Methods: The characteristics of patients referred to the APN over a period of 6.5 years were analysed, as well as the numbers of amputations and deaths pre- and post-training. Results: of the total of 103 patients, 78 were men; across both sexes the average age was 69 years. Fifty patients had neuropathic ulcers and 53 had neuro-ischaemic ulcers, with healing rates of 59%. There were 50 amputations and 37 deaths over the study period. Conclusion: Prevention of diabetic foot ulcers depends on having in place a fast, agile, practical clinical pathway between primary care and hospital, with the role of the APN, including the co-ordination of care between primary and secondary settings, being key. [ABSTRACT FROM AUTHOR]

Purpose: To create a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time. To name and classify these types of skin injuries. To describe the clinical features of the different types of skin injuries that may occur in terminally ill and/or dying patients. Design: A sequential design with several different phases (a literature review, a nominal group, and a consensus conference) was used. Methods: Six experts with extensive knowledge of these types of injuries were selected for the nominal group. The traditional eight‐phase nominal group technique was followed. The consensus conference consisted of participants voting on different options based on the statements elaborated with the expert panel summarizing the best scientific evidence available. Findings: Using all these elements, a conceptual framework was constructed to identify skin injuries associated with severe life‐threatening situations (SI‐SLTSs), defined as unpredictable and therefore unpreventable injuries indicating a serious threat to life or even imminent death. These injuries can occur in two forms: (a) as skin injuries associated with multiple organ dysfunction syndrome (SI‐MODSs) or (b) as skin injuries associated with severe vasoconstriction (SI‐ESVs). SI‐MODSs develop very quickly and suddenly. They progress from superficial to deep stages abruptly, even within hours. The severity of the injuries does not reflect the care provided to the patient. Individuals suffering from these injuries have an irreversible clinical condition. SI‐ESVs also appear in individuals who are in a very critical, even terminal, clinical condition. They are frequently treated in the ICU and may exhibit severe vasoconstriction due to their disease process (e.g., shock), sometimes exacerbated by vasoconstriction caused by various drugs (e.g., noradrenaline). Conclusions: We have developed a conceptual framework for skin injuries developing in patients whose lives are severely compromised or who are expected to die within a short period of time and have named them SI‐SLTSs, distinguishing between SI‐MODSs and SI‐ESVs. Clinical relevance: This new conceptual framework may help clinicians understand the mechanisms and the pathophysiology of skin injuries that develop in terminally ill and/or dying patients associated with multi‐organ failure. Through this new framework these injuries can be identified and differentiated from pressure injuries or other dependence‐related skin lesions. [ABSTRACT FROM AUTHOR]

Epidemiological studies on pressure ulcers (PUs) in hospitalised infants are scarce. Spain lacks comprehensive research studies providing data on the prevalence or incidence in this population. This work was developed to determine the incidence of PUs in hospitalised infants admitted to intensive and intermediate care units, along with relevant risk factors and preventive measures. A prospective study appraising the incidence of PUs in infants was performed. The risk factors and preventive measures were evaluated using a multivariate logistic regression model. A sample of 268 infants was included. The cumulative incidence of PUs was 12.70% (95% confidence interval, CI95% = [8.95%‐17.28%]). The cumulative incidence in the intermediate care units was 1.90% (CI95% = [0.39%‐5.45%]), while it was 28.18% (CI95% = [20.02%‐37.56%]) in the intensive care units. The PUs were categorised as stage I, 57.10%; stage II, 31.70%; and stage III, 11.10%. The multivariate analysis found the following to be risk factors: low scores in the Spanish version of the Neonatal Skin Risk Assessment Scale (e‐NSRAS) (Relative Risk (RR) 0.80; CI95% = [0.66‐0.97]), the use of non‐invasive mechanical ventilation (RR 12.24; CI95% = [4.02‐37.32]), and the length of stay (RR 1.08; CI95% = [1.02‐1.15]), suggesting a direct impact of these factors on PU development in infants. Kangaroo care influenced the prevention of PUs (RR 0.26; CI95% = [0.09‐0.71]). The infants admitted in intermediate care units suffered PUs. In the case of intensive care units, the incidence is even higher. The risk increases with the length of stay, while the presence of medical devices, particularly non‐invasive mechanical ventilation, is the main causal relationship. Kangaroo care has been shown to be an important preventive measure. [ABSTRACT FROM AUTHOR]

Aims: To identify risk assessment scales for pressure ulcers that have been used in critical care units. Determine which of them have been validated according to validity, predictive capacity and reliability criteria, developing, where possible, aggregate indicators. Methods: Systematic review of the clinical literature with meta-analysis. The main international health science databases were searched for prospective studies on the validity and/or predictive capacity of pressure ulcers risk assessment scales published between 1962 and 2009 in any language and with a loss to follow-up of less than 25%. We excluded grey literature, reviews, and retrospective and crosssectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Programme. The indicators analysed were validity, effect size (RR - relative risk) and reliability. When two or more valid original studies were found, a meta-analysis was conducted using the random effect model followed by a sensitivity analysis. Results: A total of 255 articles were found. These articles identified 16 risk assessment scales designed specifically for ICUs. Twenty-six (26) studies measure the validity of these scales. Only three scales have been validated by more than one study (NM Bienstein, Cubbin-Jackson, Jackson- Cubbin). Four general scales have also been validated in ICUs (Braden, Norton, BM Choi Song-and Waterlow). Waterlow and NM Bienstein are not valid due to their low sensitivity. The Cubbin- Jackson, Jackson-Cubbin and Norton scales present very similar predictive validity data, but have only been tested with very small samples. The Braden scale presents the best test results in ICUs, with adequate parameters and predictive validity. Conclusions: We recommend the use of the Braden Scale for the pressure ulcer risk assessment in critical care units. Other scales, such as the Cubbin- Jackson, Jackson-Cubbin, Norton or BM Choi-Song scales, may be useful but need to be tested in larger numbers of patients. [ABSTRACT FROM AUTHOR]