Pressure Injury Mitigation in Prolonged Care: A Randomized Noninferiority and Superiority Trial.

Introduction: Combat casualties are at increased risk for pressure injuries (PIs) during prolonged casualty care. There is limited research on operational PI risk mitigation strategies. The purpose of this study was to (1) compare a prototype mattress (AirSupport) designed for operational conditions versus the foldable Talon litter and Warrior Evacuation Litter Pad (WELP) on PI risk factors and (2) determine whether the Talon + AirSupport pad was noninferior and superior to the Talon + WELP on skin interface pressure.

Satisfaction and Barriers of Surgical Safety Checklist Implementation in a Nonmandatory Adoption Resource-Limited Country.

Objectives: A surgical safety checklist has been a globally implemented and mandated adoption in several countries. However, its use is not mandatory in Thailand. This study aimed to evaluate the perceptions of surgical personnel on surgical complications and safety and to examine the satisfaction and barriers of surgical safety checklist implementation.

Predicting Pressure Injury in Critical Care Patients: A Machine-Learning Model.

Background: Hospital-acquired pressure injuries are a serious problem among critical care patients. Some can be prevented by using measures such as specialty beds, which are not feasible for every patient because of costs. However, decisions about which patient would benefit most from a specialty bed are difficult because results of existing tools to determine risk for pressure injury indicate that most critical care patients are at high risk.

Noninvasive Blood Pressure Monitoring and Prediction of Fluid Responsiveness to Passive Leg Raising.

Background: Intravenous fluid boluses are administered to patients in shock to improve tissue hypoperfusion. However, fluid boluses result in clinically significant stroke volume increases in only about 50% of patients. Hemodynamic responses to passive leg raising measured with invasive and minimally invasive methods are accurate predictors of fluid responsiveness.

Reducing the Risk for Pressure Injury During Combat Evacuation.

Background: Combat casualties undergoing aeromedical evacuation are at increased risk for pressure injuries. The risk factors pressure and shear are potentially modifiable via solutions appropriate for en route care.

Objectives: To compare transcutaneous oxygen levels and skin temperatures in healthy participants under offloaded (side lying) and loaded (supine or supine with 30° backrest elevation) under 4 conditions: control (no intervention), Mepilex sacral and heel dressings, LiquiCell pad, and Mepilex plus LiquiCell.

An exploration of surgical team perceptions toward implementation of surgical safety checklists in a non-native English-speaking country.

Background: In-depth information on the success and failure of implementing the World Health Organization surgical safety checklist (SSC) has been questioned in non-native English-speaking countries. This study explored the experiences of SSC implementation and documented barriers and strategies to improve SSC implementation.

Methods: A qualitative study was performed in 33 Thai hospitals.

Patterns of Hand Grip Strength and Detection of Strength Loss in Patients Undergoing Bone Marrow Transplantation: A Feasibility Study.

Purpose/objectives: To determine the feasibility of measuring hand grip strength (HGS) daily in a population of recipients of bone marrow transplantation (BMT), to describe changes in strength measured by HGS, and to describe relationships between laboratory values (hematocrit, hemoglobin, and absolute neutrophil count) and HGS.
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Design: Prospective, longitudinal, repeated measures, within subject.

Midrange Braden Subscale Scores Are Associated With Increased Risk for Pressure Injury Development Among Critical Care Patients.

Purpose: The purpose of the current study was to examine the relationship between pressure injury development and the Braden Scale for Pressure Sore Risk subscale scores in a surgical intensive care unit (ICU) population and to ascertain whether the risk represented by the subscale scores is different between older and younger patients.

Design: Retrospective review of electronic medical records.

Subjects And Setting: The sample comprised patients admitted to the ICU at an academic medical center in the Western United States (Utah) and Level 1 trauma center between January 1, 2008 and May 1, 2013.

Effectiveness of Probiotic, Prebiotic, and Synbiotic Therapies in Reducing Postoperative Complications: A Systematic Review and Network Meta-analysis.

Background: Microbiome-directed therapies are increasingly used preoperatively and postoperatively to improve postoperative outcomes. Recently, the effectiveness of probiotics, prebiotics, and synbiotics in reducing postoperative complications (POCs) has been questioned. This systematic review aimed to examine and rank the effectiveness of these therapies on POCs in adult surgical patients.

Passive Leg-Raising and Prediction of Fluid Responsiveness: Systematic Review.

Fluid boluses are often administered with the aim of improving tissue hypoperfusion in shock. However, only approximately 50% of patients respond to fluid administration with a clinically significant increase in stroke volume. Fluid overload can exacerbate pulmonary edema, precipitate respiratory failure, and prolong mechanical ventilation.

Feasibility of Combining Common Data Elements Across Studies to Test a Hypothesis.

Purpose: The purpose of this article is to describe the outcomes of a collaborative initiative to share data across five schools of nursing in order to evaluate the feasibility of collecting common data elements (CDEs) and developing a common data repository to test hypotheses of interest to nursing scientists. This initiative extended work already completed by the National Institute of Nursing Research CDE Working Group that successfully identified CDEs related to symptoms and self-management, with the goal of supporting more complex, reproducible, and patient-focused research.

Design: Two exemplars describing the group's efforts are presented.

Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

Background: Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk.

Full-Thickness and Unstageable Pressure Injuries That Develop in Nursing Home Residents Despite Consistently Good Quality Care.

Purpose: The purpose of this study was to determine whether stage 3, 4, and unstageable pressure injuries develop despite consistently good quality care (CGQC); ascertain whether these wounds occur without prior recognition of a lower-stage pressure injury; and to describe and analyze characteristics of nursing home residents and their higher-stage pressure injuries.

Design: Descriptive, nonexperimental, prospective analysis.

Subjects And Setting: A convenience sample of 20 residents from facilities participated in the study; research sites were located in 7 counties in Western Washington and Orange County, along with a single site in Wisconsin.

Practices and impacts post-exposure to blood and body fluid in operating room nurses: A cross-sectional study.

Background: Improper or inadequate actions taken after blood and body fluid exposures place individuals at risk for infection with bloodborne pathogens. This has potential, significant impact for health and well-being.

Objectives: To evaluate the practices and the personal impact experienced following blood and body fluid exposures among operating room nurses.

Defining Unstageable Pressure Ulcers as Full-Thickness Wounds: Are These Wounds Being Misclassified?

Purpose: The purpose of this study was to describe the evolution of unstageable pressure ulcers (PUs) over time to determine if their healing trajectory is consistent with full- or partial-thickness wounds.

Design: Retrospective review of electronic medical record and a clinical PU database.

Subjects And Settings: Patients with hospital-acquired, unstageable PUs were evaluated.

Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand.

Background: Operating room nurses are at high risk for occupational exposure to bloodborne pathogens. This study examined the prevalence of and risk factors for needlestick injuries (NSIs), sharps injuries (SIs), and blood and body fluid exposures (BBFEs) among operating room nurses in Thai hospitals.

Methods: A cross-sectional study was performed in 247 Thai hospitals.

The Effects of Local Warming on Surgical Site Infection.

Background: Surgical site infections (SSI) account for a major proportion of hospital-acquired infections. They are associated with longer hospital stay, readmissions, increased costs, mortality, and morbidity. Reducing SSI is a goal of the Surgical Care Improvement Project and identifying interventions that reduce SSI effectively is of interest.

Changes in classifications of chronic lower-limb wound codes in patients with diabetes: ICD-9-CM versus ICD-10-CM.

Purpose: To enhance the learner's competence with knowledge of changes in classifications of chronic lower limb wound codes from ICD-9-CM to ICD-10-CM in patients with diabetes.

Target Audience: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

Objectives: After participating in this educational activity, the participant should be better able to:1.

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

Purpose: The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention.

Methods: From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding.

The impact of inpatient point-of-care blood glucose quality control testing.

Analyze the effectiveness of mandated point-of-care (POC) blood glucose (BG) meter quality control (QC) testing. All POC BG QC tests were analyzed to evaluate operator and strip/meter error rates and institutional cost. POC BG QC test failure (17/103,580 over 24 months) was low and no meters failed subsequent linearity testing.

Retrospective review of the reduction of oral pressure ulcers in mechanically ventilated patients: a change in practice.

Hospital-acquired pressure ulcers (HAPU) are a growing concern in patient care. Mucosal pressure ulcers (PUs) on the lips, mouth, gums, and tongue caused by oral intubation and their securement devices can be difficult to identify and prevent. In an effort to address this problem and reduce mucosal PU, implementation of an alternative securement device, the Hollister ETAD endotracheal (ET) tube securing device, in conjunction with the B&B Medical Universal Bite Block, was introduced at our institution, a level 1 trauma and burn center, in July 2007.

Understanding pressure ulcer research and education needs: a comparison of the association for the advancement of wound care pressure ulcer guideline evidence levels and content validity scores.

 Although difficult to quantify due to methodological variations, the worldwide burden of pressure ulcers (PUs) is substantial. Recognizing the importance of providing evidence-based care to help reduce this burden, the North American Wound Care Council societies collaborated to identify PU research and education opportunities using the PU "Guideline of Guidelines" developed and tested by Association for the Advancement of Wound Care Guideline Department (AAWC GD). Volunteer AAWC GD members compiled recommendations from PU guidelines available in 2008, searched the lit- erature for additional research as needed, and developed evidence levels for all recommendations using an established level-of-evidence rating scheme.