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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]

We present the clinical case of an 87-year-old man who presents with chronic prurigo without skin treatment. The aim is to apply an individualized care plan that allows, based on the latest evidence, to achieve skin integrity, which is deteriorated, and improve its quality of life due to the current failure toad dress the pathology. Several NANDA International diagnostic labels were identified using the NNNConsult online tool and the expected outcomes were plan along with the planned nursing interventions. The care plan shows the intrinsic difficulty of a multifactorial pathology that is little known and rare but that entails a notable impact on the quality of life and skin integrity, especially when new treatment approaches are currently emerging that are un explored by patients and professionals. This situation makes it necessary to expose and train cases like the one presented, update treatment path ways, real involvement of professionals for adaptation, individualization and continuous search to meet the needs and problems suffered by the people we care for, as well as the need to know new skin approaches. This work outlines a line of skin care that respects skin integrity, following the latest evidence and points out the therapeutic medical approach without going into depth as it is not the aim of the work or nursing competence., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier España S.L.U.)

Aim: To determine the incidence of various types of dependence-related lesions (DRL) on a population of critically ill patients., Method: Descriptive, longitudinal and prospective study in an Intensive Care Unit from January 2014 to January 2015. Adult patients who did not present DRL at the moment of admission were included. Those with brain death and/or stay at the unit for more than two days were excluded. Patients were studied till they developed DRL, were exitus, discharged or stayed for more than 14 days. Each patient was evaluated daily till DRL did develop or was excluded from the study. If DRL did develop it was photographed and related data were recorded. The comparison between quantitative variables of normal distribution was done with the t de Student. The Mann-Whitney U was used to compare the other variables. Qualitative variables were compared through Pearson's chi square. In both cases p≤.05 was considered significant., Results: 295 patients were included, 27.45% of them developed DRL. The density of incidence was 41 DRL/1,000 days at risk. 50.62% of DRL were categorized as PU. 17.28% were moisture injuries, 13.58% were due to friction and the rest were combined injuries. The risk according to EMINA and Braden scale was significantly different in the group of patients with lesions compared to the group without them., Conclusions: Not all injuries were caused by pressure. Specific prevention strategies based on different causal mechanisms are required., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Throughout the course of human history many people have been affected by the presence of chronic wounds. Millions of anonymous people have suffered bed sores, varicose ulcers, arterial ulcers or neuropathic ulcers. But there have been some famous people who, from time to time, remove these lesions from their cloak of invisibility In our day and age, every time a famous person suffers from these wounds, we observe how the means of communication publicize this health problem. However famous people also suffered from these wounds in the past. In this article, the authors will review historical figures who died due to these feared sores. Kings or saints have been affected by this problem. Specifically the authors will focus on six historical figures: three kings, one composer and two saints,; the authors shall analyze the influence of chronic wounds as a cause of their deaths. This article was submitted at the VII National Symposium on Bed Sores and Chronic Wounds and at the First Latin American Congress on Ulcers and Wounds.

The aging process and environmental aggressions will leave their imprints on the state of a person's skin, possibly compromising some of its functions. Age is a risk factor for the development of bed sores, but not the only factor nor the most important one; therefore, we need to develop prevention programs directed to all patients who spend long periods of time sedentary or bedridden. Prevention programs for bed sores must be based on the best evidence available and include a risk evaluation on these factors: suffering a lesion due to pressure, specific skin treatment, incontinence control, excessive humidity posture changes and the use of special surfaces to manage pressure during an increase in mobility or activity by the patient, local pressure reducing devices as well as paying attention to special situations. All of these care measures have to be developed based on a continuity of treatment among the institutions and caretakers involved with treating each patient.