• Journal of Korean Academy of Nursing
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• v.45 no.3
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• pp.357-366
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• 2015

Purpose: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. Methods: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. Results: The experimental group had significantly less severe IAD (t=6.69, p <.001), lower occurrence of pressure ulcers (${\chi}^2=7.35$, p =.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p =.009) than the control group. Conclusion: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.

• Archives of Plastic Surgery
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• v.49 no.2
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• pp.275-284
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• 2022

Background Population aging has led to an increased incidence of pressure ulcers, resulting in a social burden and economic costs. We developed a three-dimensional knitted fabric (3-DKF) with a pressure-reducing function that can be applied topically in the early stages of pressure ulcers to prevent progression. Methods We evaluated the effects of the 3-DKF in a streptozotocin-induced diabetes mellitus pressure ulcer mouse model, and the fabric was preliminarily applied to patients. Twelve-week-old male C57BL/6 mice were used for the animal experiments. In the pressure ulcer mouse model, an ischemia-reperfusion injury was created using a magnet on the dorsa of the mice. Pressure was measured with BodiTrak before and after applying the 3-DKF to 14 patients at risk of sacral pressure ulcers. Results In the 3-DKF-applied mice group, the ulcers were shallower and smaller than those in the control group. Compared with the mice in the control group, the 3-DKF group had lower platelet-derived growth factor-α and neutrophil elastase expression, as parameters related to inflammation, and increased levels of transforming growth factor (TGF)-β1, TGF-β3, proliferating cell nuclear antigen, and α-smooth muscle actin, which are related to growth factors and proliferation. Additionally, typical normal tissue staining patterns were observed in the 3-DKF group. In the preliminary clinical analysis, the average skin pressure was 26.2 mm Hg before applying the 3-DKF, but it decreased to an average of 23.4 mm Hg after 3-DKF application. Conclusion This study demonstrated that the newly developed 3-DKF was effective in preventing pressure ulcers through testing in a pressure ulcer animal model and preliminary clinical application.

• Journal of the Ergonomics Society of Korea
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• v.29 no.4
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• pp.639-646
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• 2010

The APAM's quantitative effectiveness and comparative study in preventing and treating pressure ulcer has not been sufficiently evaluated mainly because of uncertainty of pressure load input and lack of interpretation of dynamic perfusion recovery characteristics of soft tissue. The purpose of this paper was to quantify and analyze the alternating pressure characteristics of APAM as a preventive measure for pressure ulcers. To quantify the alternating load to human body, we introduced alternating pressure profile concept and developed parametric model of the profile. Regarding pressure level and cycle time, 3 global and 7 local periodic parameters were used to define the profile such as light, standard, typical and heavy duty profile shape. Pressure impulse ratio of light duty is the lowest but pressure fluctuation is significantly high. For the same duty shape, contact conditions are changed with alternating cycle time and more dramatically in shorter alternating cycle time conditions. We can conclude that if we use shorter alternating cycle time on APAM's operation we can get more positive effects regarding to inflated contact time condition. We proposed the quantitative methods on tissue viability study of external loading by simultaneous measurement of interface pressure and tissue perfusion with proper alternating pressure profile conditions.

• Korean Journal of Adult Nursing
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• v.27 no.3
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• pp.347-357
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• 2015

Purpose: This study was conducted to assess the prevalence rate of, and the risk factors for pressure ulcers in critical patients at the time of intensive care unit (ICU) admission. Methods: We reviewed the electronic medical records of 2,107 patients who were admitted to the intensive care units in D university hospital between January 1 and December 31, 2012. The collected date were analyzed by ${\chi}^2$-test, t-test, and multi-variate logistic regression with forward stepwise selection using the SPSS program version 21. Results: The prevalence rate of pressure ulcers at the ICU admission was 23.7%. Risk factors significantly affecting pressure ulcers carrying were the age of 80 years or older (OR=3.70, 95% CI: 1.80~7.60), body weight less than 50 kg (OR=2.82, 95% CI: 1.74~4.56), sedated consciousness (OR=6.10, 95% CI: 3.57~10.40), use of ventilator (OR=1.60, 95% CI: 1.02~2.49), use of vasopressors (OR=1.53, 95% CI: 1.09~2.14), ICU admission via operation room (OR=0.49, 95% CI: 0.29~0.85), and hospital admission from nursing homes (OR=13.65, 95% CI: 3.02~61.72). Conclusion: The findings of this study suggested that the prevention efforts for pressure ulcers should be given in prior to ICU admission. Further research is necessary for developing nursing interventions for preventing pressure ulcers in the pre-ICU stage.

• Korean Journal of Adult Nursing
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• v.22 no.4
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• pp.353-364
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• 2010

Purpose: The purpose of this study was to develop an algorithm for preventing and managing of pressure ulcer and to verify the its appropriateness. Methods: The first step was development of a pre-algorithm through a literature review and expert opinion. The second step was to establish content validity by submitting the algorithm questionnaires about the content to 12 experts. The third step was the revision of the algorithm. The fourth and last step was to establish the clinical validity of the algorithm with 25 experienced nurses. Results: For the ease of the practitioner the algorithm for prevention and the management of pressure ulcers was confined to one page depicting the main algorithm pathway and seven stepwise guidelines. The guidelines included skin care of pressure ulcer prevention, mechanical loading care, support surface care, reposition care of pressure ulcer, and Stages II, III and IV explanations along with debridement/wound irrigation and infection control. Most of all algorithm courses chosen more than 80% of agreement by expert index of content validity. The usefulness, appropriateness, and convenience of the algorithm were demonstrated through clinical validity with intensive care unit and ward nurses. Conclusion: The algorithm will improve the quality of pressure ulcer nursing care as it provides a model for decision making for clinical nurses as well as providing consistent and integrated nursing care for patients with pressure ulcer throughout an institution.

• The Journal of the Convergence on Culture Technology
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• v.6 no.3
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• pp.353-359
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• 2020

In this study, the controller structure and control algorithm of medical robot bed developed for pressure ulcer prevention and healing are described. The existing pressure ulcer prevention mattress is operated manually and the remaining maximum body pressure exceeds the pressure of ulcer generation, so there is always room for pressure ulcers. However, the system developed in this study does not generate the pressure ulcers because the body pressure drops to zero when the keyboard of the bed descends using the active electric driving keyboard. In addition, even if the bed is raised and the pressure above the critical body ulcer pressure is abnormal, the device and the control algorithm are designed so that the lasting time is within the pressure ulcer generation critical time and the pressure ulcer itself is not generated. The bed key board motor is a motor designed with the BLDC servos suitable for medical use and these can communicate each other easily through CAN(Car Area Network). The system is new medical robot bed that is effective in preventing pressure ulcers and will be distributed to many patients suffering from pressure ulcers.

• The Journal of the Institute of Internet, Broadcasting and Communication
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• v.18 no.5
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• pp.215-222
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• 2018

Recently, various motion beds have been actively developed and popularized. The motion bed has the functions of height adjustment, back plate rising, knee lifting, tilt function and left / right rotation, and the remote control can conveniently be used by the patient himself or the caregiver to move the patient. However, since the medical bed for use does not have a function of preventing pressure ulcers, exchanging sheets, and transferring patients, it is necessary to disperse body pressure by using a pressure ulcer prevention matrix to prevent pressure ulcers. However, it is accompanied by muscle strength and hard work, and nurses are avoiding difficult nursing care. In this study, we developed the first prototype in the world and confirmed that the system works normally with the goal of developing multifunctional beds that automatically perform the prevention of bed sores, the exchange of sheets and the transfer of patients in order to facilitate such nursing work. It is anticipated that the proposed multifunctional motorized bed in the future will be a model of a medical robot for smart healthcare.

• Journal of the Ergonomics Society of Korea
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• v.29 no.6
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• pp.875-887
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• 2010

The quantitative effectiveness of powered support surfaces such as APAM in preventing and treating pressure ulcers has not been sufficiently evaluated because of uncertainty of alternating pressure load input and lack of interpretation of dynamic perfusion characteristics of soft tissue. The aim was to verify the dynamic loading effects to sacral tissue perfusion characteristics from alternating set pressure changes. We developed integrated experiment system to supply alternating load to supinely positioned sacrum and concurrently measured $TcPO_2$, $TcPCO_2$ and air cell pressure. Ten aged subjects (5 female, 5 male) were tested with alternating set pressure 20, 30, 40, 50 and 60mmHg. From the dynamic perfusion response eight characteristic parameters were proposed such as average, minimum, maximum and perfusion range regarding to $TcPO_2$ and $TcPCO_2$. A one-way ANOVA was carried out to determine whether the manipulation of alternating set pressure had any effect on $TcPO_2$ and $TcPCO_2$. From the dynamic tissue perfusion response we found mean $TcPO_2$ decreased exponentially as alternating pressure load increased and perfusion range varied mainly because of minimum level change of $TcPO_2$. And perfusion range of $TcPCO_2$ affected by increase of maximum value of $TcPCO_2$. From the results we can get more strict insights about actual physiological dynamic tissue perfusion mechanism under alternating pressure load.

• Journal of Korean Critical Care Nursing
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• v.11 no.1
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• pp.79-88
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• 2018

Purpose : This study was performed to evaluate the effects of a prolonged a $30^{\circ}$ side-lying position on comfort and skin condition by applying the trunk maintenance repositioning method, which can keep the $30^{\circ}$ side-lying position effective for preventing pressure ulcers. Method : Fifty-four healthy nurses working at a general hospital in Seoul were randomly assigned to an experimental group (n=27) or a control group (n=27) and assumed a position of lying on their right or left side for two hours. The trunk maintenance repositioning method was applied to the experimental group using the pillow made by the researcher, while the original repositioning method was applied to the control group using the regular pillow from the subject hospital. Participants' posture angles, comfort, and skin condition were measured at the time of the intervention, as well as at one and two hours after the intervention. Results : There was no statistically significant difference in position angle, comfort, skin condition change, or sacrum and greater trochanter pressure change between the two groups over time. Conclusion : It is necessary to review the method and frequency of change of position in each hospital. In addition, a proper position changing pillow should be developed in consideration of patients' various body shapes.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.669-671
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• 2006

Purpose: Congenital insensitivity to pain with anhidrosis(CIPA) is a rare form of autosomal recessive peripheral sensory neuropathy. Patients with CIPA show loss of pain sensation, which leads to corneal ulcers and opacities, self-mutilation of the tongue and fingertips, as well as fractures with subsequent joint deformities and chronic osteomyelitis. The purpose of this report is to highlight the fact that pressure sores also are a potential complication of CIPA. Methods: This case report describes a patient presenting with pressure sores resulting from CIPA. A 5-year-old boy was referred to our department for the treatment of a $5{\times}5cm$ sacral pressure sore as a result of a hip spica cast applied for the treatment of a left hip joint dislocation. He had a history suggesting CIPA such as multiple bony fractures, mental retardation, recurrent hyperpyrexia, anhidrosis, and clubbing fingers due to oral mutilation. A microscopic examination of the sural nerve showed mainly large myelinated fibers, a few small myelinated fibers and an almost complete loss of unmyelinated fibers. After wound preparation for two weeks, the exposed bone was covered with two local advancement flaps. Results: Two weeks later, complete wound healing was achieved. A 16-month follow-up showed no recurrence. However, the patient presented with a new pressure sore on the left knee due to orthosis for the treatment of the left hip joint dislocation. Conclusion: The early diagnosis of CIPA and special care of pressure sores are important for preventing and treating pressure sores resulting from CIPA.