The document discusses the epidemiology of chronic cutaneous ulcers, specifically leg ulcers and pressure ulcers in the United States. It finds that leg ulcers and pressure ulcers are common, but accurate data on their prevalence and costs within the US is lacking. While pressure ulcer rates in healthcare settings have been studied, national surveys are needed to obtain more precise figures. Risk factors for both types of ulcers are also discussed, such as immobility and age. Improved data collection is important for understanding the true impact of chronic ulcers.
ALE Presentation: A Multiple Cause Analysis of Massachusetts Trends in HIV an...David Meyers
In this presentation that I created for my Applied Learning Experience for my Master's education, I outline trends over the past ten years in HIV and Hepatitis C Mortality from across the state of Massachusetts.
ALE Presentation: A Multiple Cause Analysis of Massachusetts Trends in HIV an...David Meyers
In this presentation that I created for my Applied Learning Experience for my Master's education, I outline trends over the past ten years in HIV and Hepatitis C Mortality from across the state of Massachusetts.
Objective: Diabetic nephropathy is one of the most serious complications of diabetes mellitus. It develops in approximately one-third of diabetic patients, years after the onset of metabolic abnormalities.
Study Design: The biopsy specimens were evaluated with the focus on light microscopy. The aim of our study was to reveal differences in the details and the frequency of occurrence of individual histomorphological changes in diabetic nephropathy and other glomerulonephritides.
Results: Diabetic nephropathy accounted for 14 out of 82 analyzed biopsies. Isolated thickening of the glomerular basement membrane was not present in any case, but along with some degree of mesangial expansion, hypercellularity or glomerulosclerosis was seen in 12 out of 14 findings of diabetic nephropathy. In other glomerular diseases, mesangial changes, but without glomerular basement membrane thickening, were the most frequent findings. In addition to glomerular lesions, some of the tubular, interstitial, and vascular changes were seen in 13 out of 14 patients with diabetic nephropathy. In other glomerulonephritides the combination of all these changes was a rare finding.
Conclusion: There are cases where immunofluorescence and electron microscopy cannot be performed or their results are not helpful. In such cases we must rely on light microscopic histomorphological changes.
Awareness regarding the systemic effects- PERIO SYSTEMIC RELATIONSHIPNagarajan Srini
For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal disease as a means of ameliorating systemic diseases.
Ascaris lumbricoides and other Gastrointestinal Helminthic Parasites among Qe...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract—Epidemiological study of Rivers State University of Science and Technology Port Harcourt, Nigeria was carried out to identify the morbidity pattern in the University community in order to establish the current health status and trends. This study utilized secondary morbidity data sourced from Health Services Department. Data on staff mortality were obtained from the Personnel/Establishment Division. Methods employed for data collection were health records survey and data collection sheets. Morbidity information required were date, sex, age, department, card number and diagnosis of each case. Information required for each mortality case was date, sex, age, department, salary level and the cause of death. Of all cases of morbidity, communicable diseases comprised 17.5%; non-communicable diseases 24.1%, generalized disease symptoms 55.2% and others 3.2%. The study revealed that the leading causes of morbidity in the University were fever/headache/cold (36.9%), hypertension (13.6%), generalized body pain (7.5%), abdominal pain/vomiting (6.7%) and diabetes (4.9%). Hypertension emerged the second major cause of morbidity among the staff and males had higher rate of morbidity compared to females. It was also concluded that although mortality was increasing with time but there was no sex wise significant difference in mortality trend. It was recommended among others that Diabetes Mellitus and Hypertension being silent killers should be monitored regularly within the University community. Also the current practice of manual data entry should be replaced with computerized data system for better health records management.
15m people worldwide suffer a stroke every day. What can be done to combat the disease? This report, sponsored by AstraZeneca, assesses current developments and the economic burden of stroke across the regions of the world.
Sexually transmitted diseases in the elderly in South FloridaArete-Zoe, LLC
Florida is attractive for retired Americans, and their population continues to grow. In primary care, sexual health is often overlooked in elderly patients, since they rarely open the topic themselves, and physicians often assume their patients are no longer sexually active. Drugs for erectile dysfunction, as well as attractions of life on the beach, create opportunities that may no longer be out of reach. Mature adults do indeed have girlfriends and friends with benefits, along with their regular partners and spouses.
The number of reported STDs in older adults has been steadily increasing since 2000. The most frequently reported infections are chlamydia, gonorrhea, and HIV. The population of adults over 50 years of age now reached 99 million (32%) and should not be ignored in regards to screening for STDs and related research. Clinical trials rarely study the sexual behavior of people over 50 or even 65 years of age. In the age group between 57 and 85 years of age, nearly 75% were still sexually active at 64, 53% at 74, and 25% at 85 years of age. The sexual life of mature adults is often neglected during preventative screenings. This omission may lead to late diagnosis of HIV or undetected relapse of STDs contracted earlier in life. AIDS-related dementia or neurosyphilis can be easily misdiagnosed as Alzheimer’s disease. Failure to detect STDs in mature adults can result in unnecessary early death and unmitigated exposure of relatives to the disease (Purpora & Claire, 2012).
Many STDs are notifiable diseases that require regular screening of patients who are sexually active or engage in potentially risky sexual behavior. Clinicians need to keep track of relevant federal and state legislation and comply with the reporting requirements as applicable.
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
Our project, our experience and our results at December 31 st 2013
Il nostro progetto, la nostra esperienza ed i nostri risultati aggiornati al 31.12.2013
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
Objective: Diabetic nephropathy is one of the most serious complications of diabetes mellitus. It develops in approximately one-third of diabetic patients, years after the onset of metabolic abnormalities.
Study Design: The biopsy specimens were evaluated with the focus on light microscopy. The aim of our study was to reveal differences in the details and the frequency of occurrence of individual histomorphological changes in diabetic nephropathy and other glomerulonephritides.
Results: Diabetic nephropathy accounted for 14 out of 82 analyzed biopsies. Isolated thickening of the glomerular basement membrane was not present in any case, but along with some degree of mesangial expansion, hypercellularity or glomerulosclerosis was seen in 12 out of 14 findings of diabetic nephropathy. In other glomerular diseases, mesangial changes, but without glomerular basement membrane thickening, were the most frequent findings. In addition to glomerular lesions, some of the tubular, interstitial, and vascular changes were seen in 13 out of 14 patients with diabetic nephropathy. In other glomerulonephritides the combination of all these changes was a rare finding.
Conclusion: There are cases where immunofluorescence and electron microscopy cannot be performed or their results are not helpful. In such cases we must rely on light microscopic histomorphological changes.
Awareness regarding the systemic effects- PERIO SYSTEMIC RELATIONSHIPNagarajan Srini
For decades, physicians and dentists have paid close attention to their own respective fields, specializing in medicine pertaining to the body and the oral cavity, respectively. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between allopathic medicine and dental medicine is quickly closing, due to significant findings supporting the association between periodontal disease and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, and osteoporosis. Significant effort has brought numerous advances in revealing the etiological and pathological links between this chronic inflammatory dental disease and these other conditions. Therefore, there is reason to hope that the strong evidence from these studies may guide researchers towards greatly improved treatment of periodontal infection that would also ameliorate these systemic illnesses. Hence, researchers must continue not only to uncover more information about the correlations between periodontal and systemic diseases but also to focus on positive associations that may result from treating periodontal disease as a means of ameliorating systemic diseases.
Ascaris lumbricoides and other Gastrointestinal Helminthic Parasites among Qe...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract—Epidemiological study of Rivers State University of Science and Technology Port Harcourt, Nigeria was carried out to identify the morbidity pattern in the University community in order to establish the current health status and trends. This study utilized secondary morbidity data sourced from Health Services Department. Data on staff mortality were obtained from the Personnel/Establishment Division. Methods employed for data collection were health records survey and data collection sheets. Morbidity information required were date, sex, age, department, card number and diagnosis of each case. Information required for each mortality case was date, sex, age, department, salary level and the cause of death. Of all cases of morbidity, communicable diseases comprised 17.5%; non-communicable diseases 24.1%, generalized disease symptoms 55.2% and others 3.2%. The study revealed that the leading causes of morbidity in the University were fever/headache/cold (36.9%), hypertension (13.6%), generalized body pain (7.5%), abdominal pain/vomiting (6.7%) and diabetes (4.9%). Hypertension emerged the second major cause of morbidity among the staff and males had higher rate of morbidity compared to females. It was also concluded that although mortality was increasing with time but there was no sex wise significant difference in mortality trend. It was recommended among others that Diabetes Mellitus and Hypertension being silent killers should be monitored regularly within the University community. Also the current practice of manual data entry should be replaced with computerized data system for better health records management.
15m people worldwide suffer a stroke every day. What can be done to combat the disease? This report, sponsored by AstraZeneca, assesses current developments and the economic burden of stroke across the regions of the world.
Sexually transmitted diseases in the elderly in South FloridaArete-Zoe, LLC
Florida is attractive for retired Americans, and their population continues to grow. In primary care, sexual health is often overlooked in elderly patients, since they rarely open the topic themselves, and physicians often assume their patients are no longer sexually active. Drugs for erectile dysfunction, as well as attractions of life on the beach, create opportunities that may no longer be out of reach. Mature adults do indeed have girlfriends and friends with benefits, along with their regular partners and spouses.
The number of reported STDs in older adults has been steadily increasing since 2000. The most frequently reported infections are chlamydia, gonorrhea, and HIV. The population of adults over 50 years of age now reached 99 million (32%) and should not be ignored in regards to screening for STDs and related research. Clinical trials rarely study the sexual behavior of people over 50 or even 65 years of age. In the age group between 57 and 85 years of age, nearly 75% were still sexually active at 64, 53% at 74, and 25% at 85 years of age. The sexual life of mature adults is often neglected during preventative screenings. This omission may lead to late diagnosis of HIV or undetected relapse of STDs contracted earlier in life. AIDS-related dementia or neurosyphilis can be easily misdiagnosed as Alzheimer’s disease. Failure to detect STDs in mature adults can result in unnecessary early death and unmitigated exposure of relatives to the disease (Purpora & Claire, 2012).
Many STDs are notifiable diseases that require regular screening of patients who are sexually active or engage in potentially risky sexual behavior. Clinicians need to keep track of relevant federal and state legislation and comply with the reporting requirements as applicable.
Clinical and epidemiological profile of patients undergoing total hip arthro...David Sadigursky
Clinical and epidemiological profile of patients undergoing total hip arthroplasty.
Rheumatology and Orthopedic Medicine
Rheumatol Orthop Med, 2017 doi: 10.15761/ROM.1000120
Our project, our experience and our results at December 31 st 2013
Il nostro progetto, la nostra esperienza ed i nostri risultati aggiornati al 31.12.2013
(Angiologia-Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Angiology- Vascular Surgery -ULSS 15 Alta Padovana)
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Do African-Americans Prone to Suffer Osteoarthritis?schurmanjessica
A new study suggests that African-Americans are more prone to develop osteoarthritis (OA) in the knee and in multiple large joints than with Caucasians, although, not as much with the hands as opposed to Caucasians.
Read more of Stryker hip replacement recall at Stryker-hip-replacement-recall.com
One year mortality rate after hip fracture in the western region of saudi ara...Prof. Hesham N. Mustafa
Background:
The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies.
Methods:
The mortality rate (within 1 yr or less) in 177 patients over the age of 60 yr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention.
Results:
The overall mortality rate 1 yr after hip fracture was 12.43%, and the mean age was 77.77 yr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90 yr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw.
Conclusions:
The mortality rate of patients with hip fractures within 1 yr has a high-risk potential, especially for male patients over 71 yr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options.
Level of Evidence:
Level IV.
Should C2 Disease Classification Be Broken Down Further? Who Progresses to C4?Vein Global
By: Nick Morrison, MD, FACS, FACPh, RPhS
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
Is routine thromboprophylaxis warranted in all patients of tibial fracture ma...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This paper reviews the evolution of the definition of sepsis and the controversy surrounding the sepsis-3 definition and the sepsis screening tool, qSOFA.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
2. V O L . 102, NO. 6, SUPPLEMENT, JUNE 1994 CHRONIC CUTANEOUS ULCERS 39S
iridex of 0.9 or less in 185 (40%) of ulcerated legs. Arterial insuffi-
ciency wasjudged to be the possible dominating factor in 12%, with
an additional 6% showing clearly as ischemic ulcers. Mixed ulcers
w i t h combined arterial and venous insufficiency occurred in 22%,
1 3 % occurred in diabetics, and in 10% no venous or arterial impair-
irient was detectable. Approximately 40% of all ulcerated legs
showed potentially surgically curable circulatory disturbances.
From more recent reports, it appears that there has been a change
in the etiologic spectrum of leg ulcer towards arterial and mixed
ulcers. In the middle of this century leg ulcers were generally
thought to be associated with venous insufficiency. It is probable
that arterial disease has increased because of changes in age distribu-
tion of the population and also due to improved diagnostic tech-
niques resulting in better detection of arterial disease. There are no
data available on the etiology of leg ulcers in the United States,
although, presumably, it would be similar to that in other countries
of the Western world.
C o s t of Leg Ulcers The cost of chronic non-healing wounds is
enormous. However, the cost of leg ulcers is almost impossible to
estimate, because the prevalence of the condition is not known and
estimates of the cost of treating leg ulcers vary widely. A study in
England analyzing the cost of dressing material using venous leg
ulcers estimated that the cost of 4 months of outpatient treatment
varied between $250 and $2500 [19]. Estimated annual costs of
ulcer treatment in Sweden are $25 million. Projecting these figures
to the U.S. population, costs would vary betweeti $775 million and
$ 1 billion [20]. O'Donnell et al in 1977 calculated that traditional
treatment of venous ulcers, including visits by a visiting nurse,
amounted to almost $40,000 per year per patient [21]. There is an
estimated loss of 2,000,000 work days annually in the United States
because of leg ulcers [22]. In a survey conducted in Boston (Phillips
et al, unpublished data), 42% of patients with leg ulcers who were
not working at the time of interview stated that their ulcer was a
factor in their decision to stop work. Patients who were working all
stated that the ulcer limited what they could do on the Job. The
rnorbidity and mortality from venous and arterial ulcers is not
known. With regard to diabetic patients, there is considerable mor-
bidity and mortality associated with ulceration of the lower limbs.
Patients with diabetes have been estimated to account for 45-70%
of all lower-extremity amputations performed [23-27]. The mor-
tality rate of diabetic amputees is high. Between 41% and 70% of
diabetics who experience leg amputation do not survive more than 5
years after the surgery [27-29].
Olcer Recurrence In several studies, the incidence of ulcer re-
currence is noted to be high, particularly in patients with venous
insufficiency [17,30,31].
In conclusion, chronic leg ulcers are frequently encountered in
clinical practice but the extent of the problem is largely unknown.
In particular, epidemiologic information within the United States is
sadly lacking. One problem is in choosing which population to
screen and how to adequately do so. Potential sources would include
hospitals, nursing homes, health maintenance organizations, visit-
ing nurse associations, dermatologists, vascular surgeons, and family
practitioners. However, this would still leave a pool of patients who
are caring for their own wounds. Some surveys have used advertis-
ing to facilitate self-referral, but this also has limitations. Once the
population can he identified, patients with leg ulcers would need to
be seen and have vascular studies performed to more precisely deter-
mine etiology. Most of the patients, or at least a very highly repre-
sentative sample, would need to be screened to give good estimates.
Most surveys to date seem to have relied on postal screening in
smaller metropolitan populations. This might be a good starting
point.
PRESSURE ULCERS
O n e problem when looking at the epidemiology of pressure ulcers
is differences in definitions as to what a pressure ulcer is. It is agreed
that pressure ulcers are localized areas of tissue necrosis that tend to
develop when soft tissue is compressed between a bony prominence
and an external surface for a prolonged period of time [32].
Some authors define blanchable and nonblanchable erythema as
early-stage pressure ulcers. However, such lesions are often not
reliably identifiable, especially in dark-skinned individuals. In addi-
tion, they have less clear-cut clinical implications [33]. A commonly
used classification scheme for pressure ulcers was described by Shea
[34]. Within this scheme grade I includes both erythema and an
epithelial defect; stage II, full-thickness skin ulcer extending to
underlying subcutaneous fat; stage III, full-thickness skin ulcer ex-
tending into subcutaneous fat but limited by deep fascia; stage IV,
penetration of deep fascia with extensive soft tissue spread, includ-
ing bone and Joint involvement. However, several other classifica-
tion schemes exist. In some of these, the earliest pressure sore that
might be defined as erythema developing over a pressure point
might be classified as blanchable or nonblanchable, or even further
defined as a mild persistent, moderate persistent, or severe persistent
erythema [35-43].
The types of data available on pressure ulcers are variable. As well
as variations in the definition of pressure ulcers, the composition of
study populations seems to vary. Some studies include all hospital
admissions, whereas others exclude certain groups such as pediatric,
maternity, and ambulatory surgical patients [32].
Acute Care Settings The prevalence of pressure ulcers reported
ranges between 3% and 14% among hospitalized patients in acute
care settings depending on the source of data, the inclusion of stage I
lesions, and the sample population [32]. Most studies report a range
of 3-11% [44-49]. The incidence of pressure ulcers among hospi-
talized patients in acute care settings appears to range between 1%
and 5% [32]. However, among hospitalized patients expecting to be
confined to bed or a chair for at least a week, the incidence is much
higher, at 7.7% within 3 weeks [45]. Most pressure ulcers develop
early during hospitalization [50,51]. Norton et al reported that 70%
of ulcers develop within thefirst2 weeks of hospitalization and that
patients on a geriatric unit in an acute care hospital develop a pres-
sure ulcer in 24% of cases. Similar findings have been reported by
others [51 -54]. If erythema is included in the definition of pressure
ulcers, then the incidence in acute-care hospital settings is higher
[33,49,55].
Long-Term Care Settings The prevalence of pressure ulcers in
nursing homes is not particularly higher than in acute care hospitals,
although they tend to have a large at-risk population [33]. There is a
high prevalence of pressure ulcers on admission ofpatients to skilled
nursing facilities (15-25%) [32]. The prevalence of pressure ulcers
tends to be higher among spinal injury patients than among patients
in nursing home or acute-care hospitals [33]. Young et al [56] re-
ported a 20-30% prevalence of pressure ulcers 1-5 years after
initial injury among patients followed in spinal cord injury' centers
in the United States.
Home-Care Settings Several studies [33,57] suggest that at least
60% of persons who have developed pressure ulcers develop them in
a hospital. About 18% develop them in the home and 18% develop
them in a nursing home. Within the home-care setting, the preva-
lence of pressure ulcers has been reported at between 7% and 12%
[32], with an incidence of at least 1.85% [57]. Approximately 70%
of pressure sores occur in patients over 70 years of age [58].
Risk Factors for Pressure Ulcers Immobility appears to be one
of the most important risk factors for the development of a pressure
ulcer [59,60]. Alhnan et al [45] performed a cross-sectional survey
that suggested that liypoalbuminenemia, fecal incontinence, and
the presence of a fracture may increase the risk of pressure ulcers
among immobilized patients in hospitals. Nutritional factors may
also be of importance [59]. A prospective study on pressure sore risk
among institutionalized elderly suggested that older age, low sys-
tolic and diastolic blood pressure, high body temperatures, and low
dietary protein intake were good predictors of pressure sore devel-
opment [61]. Other factors also play a role: in one prospective study
3. 4 0 S PHILLIPS THE JOURNAL OF INVESTIGATIVE DERMATOLOGY
incontinence caused a 5.5-times increase in the risk of a pressure
ulcer [62].
The available data confirm that pressure ulcers are primarily a
problem of older persons. A study of risk factors by Guralnik et al
[57] suggests that persons 70-75 years of age have a nearly twofold
higher incidence of pressure ulcers than persons 55 to 69 years of
age. Other risk factors found in this study were self-assessed poor
health, dry or scaling skin (on physical examination), cigarette
smoking, and inactivity.
Cost of Pressure Ulcers Without knowing the precise inci-
dence of prevalence of pressure ulcers, it is impossible to predict
their total national cost. Estimates of average per-case financial cost
of pressure ulcer treatment in acute care settings range widely, from
approximately $2,000 to $30,000. The lower estimates are typically
for cases in which pressure ulcer is not the primary diagnosis [32]. In
many cases, hospital costs reflect total patient care, including man-
agement of chronic illness, which is likely to predispose to ulcer
formation. Thus, the specific cost of ulcer treatment is difficult to
separate [32]. It has been estimated that within the United Kingdom
the cost of pressure sore treatment by the National Health Service is
£150,000,000 ($2-3,000,000) per year. A full-thickness sacral
pressure ulcer may extend hospital stay by over 25 weeks at an
estimated cost of $40,000 [58].
Morbidity and Mortality of Pressure Ulcers Pressure ulcers
are associated with a variety of complications including infection
and bacteremia [33,63,64]. Sugarman reported that osteomyelitis
occurs in 26% of non-healing pressure ulcers [65]. Pressure ulcers
are associated with increased risk of death and prolonged hospital-
ization.
In one study pressure ulcers were associated with a fourfold risk of
dying [33]. Pressure ulcer patients tend to be hospitalized for longer
than patients without pressure ulcers [45].
In summary, although there are some data available regarding the
incidence and prevalence of pressure ulcers in acute and chronic care
facilities, national surveys should be considered to obtain more ac-
curate information on their incidence and prevalence. Multicenter
studies are necessary to determine the epidemiology and cost of
treating pressure ulcers by stage, setting, and other factors. Particu-
lar attention should be paid to high-risk groups such as spinal cord
injury patients, the elderly, and those who are immobilized or
chronically debilitated [32].
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