Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale.

INTRODUCTION: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. METHODS: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. RESULTS: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. CONCLUSION: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.

Complications Associated with Peripherally Inserted Central Catheters (PICC) in People Undergoing Autologous Hematopoietic Stem Cell Transplantation (HSCT) in Home Hospitalization.

INTRODUCTION: The SARS-CoV-2 pandemic generated the need to keep immunosuppressed patients away from hospital institutions for as long as possible. This in turn stimulated the implementation of a home hospitalization model for autologous hematopoietic stem-cell transplantation (HSCT). PURPOSE: To analyze whether there are significant differences in post-transplantation complications related to catheters observed in patients treated in the home-transplant care modality compared to patients treated in the hospital. METHODOLOGY: Observational, analytical, longitudinal, and retrospective study of cases and controls. A convenience sample was chosen, in which the cases comprised 20 patients included in the home HSCT care model. For each patient, it was considered suitable to propose two controls among those who received autologous transplantation in the last five years with a baseline demographic and pathological profile similar to the case for whom they were control. RESULTS: The home patients achieved an average of 22.4 ± 2.6 days of evolution with an average of 16.4 ± 2.08 days post-transplant, compared to the hospital process with an average of 21.21 ± 4.18 days of evolution and 15.51 ± 3.96 days post-transplant (evolution days p = 0.022; post-transplant days p = 0.002). A higher percentage of use of parenteral nutrition (p = 0.036) and transfusions (p = 0.003) was observed during the post-transplant phase in the hospital. The rest of the therapeutic measures did not show significant differences. When analyzing the frequency of adverse effects in the post-transplant phase, a significant increase in neutropenic fever (OR = 8.55) and positive blood cultures (OR = 6.65) was observed in hospital patients. Any other significant differences in other variables related to PICC were found (presence and days of neutropenic fever, catheter infection, complications, pathogens, admission to the ICU, or death). Concerning local complications (pain, DVT, Medical adhesive-related Skin Injury, and erythema), there was more erythema in the hospital (p = 0.056). CONCLUSIONS: The results obtained indicate that regarding the appearance of complications associated with PICCs in home hospitalization HSCT patients, there are no significant differences compared to hospitalization, so that home care can be a safe context for people with these lines.

Post-Transplant Complications in Patients Undergoing Autologous Hematopoietic Cell Transplantation (HCT)-A Comparative Analysis of Home Care versus Hospitalized Patients.

Background and Objectives: The increase in indications for hematopoietic cell transplants (HCTs) has led to the development of new care options after said transplant, such as home care after transplantation, which improves the patients' quality of life. The main purpose of this research is to analyze the differences in the appearance of post-transplant complications between patients having underwent autologous HCT with at-home post-transplant modalities and those under in-hospital post-transplant care. Materials and Methods: An observational, analytical, longitudinal, and retrospective study of cases and controls. All transplanted people in the domiciliary model since 2020 are included as cases (20 subjects). For each case, two controls (40 subjects) are proposed among patients who received an autologous transplant in a hospital in the last five years with a similar demographic and pathological base profile in each case. Results: No significant differences were found between cases and controls, except for the Karnofsky value, which was higher in people receiving home treatment (91.7% vs. 87.74%; p = 0.05). The average number of days of the process post-transplantation was more significant at home (processing days 22.4 ± 2.6; post-transplantation days of 16.4 ± 2.08 versus 21.21 ± 4.18, with a mean of 15.51 ± 3.96 days post-transplant (days of the process p = 0.022; days post-transplant p = 0.002)). There is a more significant presence of neutropenic fever, mucositis, and positive blood cultures in the post-transplant patients who remain in the hospital. In contrast, the patients receiving home care post-transplantation undergo significantly more weight loss. Regarding the odds ratio of the appearance of adverse events, in the hospital setting, it is up to 8.5 times more likely to encounter neutropenic fever, 4.63 times more likely for mucositis, and 6.65 times more likely for the presence of pathogens in blood cultures. Conclusions: The home care modality in the post-transplant phase does not show an inferiority in conditions in the management and safety of the patient concerning the appearance of adverse events. However, more significant weight loss is detected in patients at home, and an increased risk of episodes of neutropenic fever, mucositis, and positive blood cultures for patients in hospital settings.

Adaptación transcultural al español y validez de contenido de 3 escalas de riesgo nutricional / Cross-cultural adaptation to Spanish and content validity of three nutritional risk scales

Introducción: Existen diversas escalas diseñadas para determinar el riesgo de desnutrición al ingreso hospitalario en población infantil, sin embargo, la mayor parte de estos instrumentos se desarrollan y publican en lengua inglesa, siendo preceptiva su adaptación transcultural y validación para poder ser utilizados en nuestro país.Objetivos: Adaptar transculturalmente 3 escalas diseñadas para determinar el riesgo de desnutrición ligada a la enfermedad y determinar la validez de su contenido.Material y métodos: Adaptación transcultural mediante el método de traducción-retrotraducción de acuerdo con las recomendaciones de la International Test Commission Guidelines for Translating and Adapting Tests. Se midió la validez de contenido a través de un panel de expertos (bajo 7 criterios básicos de selección adaptados del modelo Fehring) que evaluaron cada ítem de las escalas midiendo 4 criterios: ambigüedad, sencillez, claridad y relevancia. Con la puntuación extraída se obtuvo el estadístico V de Aiken para cada ítem y para las escalas completas.Resultados: Partiendo de 3 traducciones independientes por escala se obtuvieron 3 versiones definitivas en castellano de las escalas PNRS, STRONGkids y STAMP semánticamente equivalentes a sus versiones originales. Las escalas PNRS y STRONGkids presentaron una V de Aiken superior a 0,75 en todos sus ítems, mientras que escala STAMP presentó un valor inferior a 0,75 para el ítem «peso y altura».Conclusión: Este estudio aporta las versiones en castellano adaptadas transculturalmente de las escalas PNRS, STRONGkids y STAMP. Las escalas PNRS y STRONGkids presentan un contenido válido para ser aplicadas en el contexto hospitalario estatal. STAMP requiere la adaptación de su ítem «peso y altura» para considerar adecuado su uso en población infantil española. (AU)

Introduction: There are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country.Objectives: Cross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content.Material and methods: Cross-cultural adaptation using the translation-back-translation method in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken's V statistic was obtained for each item and for the complete scales.Results: Starting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken's V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item “weight and height”.Conclusion: This study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item “weight and height” to consider its use in a Spanish child population adequate. (AU)

Cross-cultural adaptation to Spanish and content validity of three nutritional risk scales.

INTRODUCTION: There are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country. OBJECTIVES: Cross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content. MATERIAL AND METHODS: Cross-cultural adaptation using the translation-back-translation method in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken's V statistic was obtained for each item and for the complete scales. RESULTS: Starting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken's V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item "weight and height". CONCLUSION: This study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item "weight and height" to consider its use in a Spanish child population adequate.

Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction.

BACKGROUND: Factors such as the manufacturing materials, shape or even the mechanical and thermal response of sitting Pressure Redistribution Support Surfaces (PRSS) can be potential contributors to pressure ulcers. However, few studies have compared a number of characteristics of the most frequently used devices. OBJECTIVE: To compare three potential contributors to pressure ulcers in five commercial PRSS: pressure redistribution, temperature and perceived comfort. METHOD: Study with a cross-over randomized design in healthy volunteer participants. Data was collected in a temperature and relative humidity controlled environment. To assess thermal response, the temperature (Flir-E60) of the region of interest was captured before and after use of each PRSS for further analysis. The region of interest was the gluteal zone. To assess the pressure redistribution a pressure mat (XSensor®) was used between the 5 cushion and each study participant using a standardized method. Finally, a subjective perception questionnaire recorded comfort, adaptability and thermal sensation parameters. Data analysis levels of significance were set at 0.05. RESULTS: A total of 22 participants completed the assessments. There were no statistically significant differences in baseline temperatures between PRSS (>0.05). Pressure redistribution analysis showed significant differences between all PRSS in all variables evaluated except in the maximum and peak pressure index al sacrum. The subjective assessment suggested no major user-perceived differences between PRSS. CONCLUSION: Seat cushions made of open cell polyurethane foam blocks of variable hardness and the horseshoe cushion (also open cell polyurethane foam) seem to provide a more effective pressure relief characteristic than those injected with polyurethane foam and gel in most of the studied pressure variables. However, the cushions provide similar thermal response and perceived comfort.

Efectividad de las medidas y estrategias de prevención de úlceras por presión en neonatos / Effectiveness of measures and strategies for the prevention of pressure ulcers in neonates

OBJETIVOS: Analizar la efectividad, en términos de disminución de la incidencia de úlceras por presión (UPP), de las medidas y estrategias preventivas de UPP en neonatos hospitalizados. MÉTODO: La recuperación de estudios se realizó a través de tres bases de datos (Medline a través de PubMed, Scopus y Science Direct) y a partir de un experto. Solamente se incluyeron en esta revisión los estudios publicados del 2007 al 2017 en español o inglés, que de forma directa o indirecta valoraran la efectividad de una medida o estrategia preventiva de UPP en neonatos hospitalizados y que en cuanto al diseño fueran o estudios clínicos controlados o cuasiexperimentales. RESULTADOS: De 100 estudios recuperados se realizó el análisis de cinco; los demás fueron excluidos por no cumplir los criterios de elegibilidad. La mayoría de los estudios analizan la efectividad de una medida preventiva de UPP secundaria al tratamiento con ventilación mecánica no invasiva en neonatos prematuros. Todos ellos tienen limitaciones en la metodología que emplean, lo que hace que la evidencia de sus recomendaciones sea baja-moderada. CONCLUSIONES: Es necesaria la realización de estudios controlados aleatorios de mayor potencia para poder recomendar alguna medida o estrategia preventiva

Objetives: The main objective of this review was to examine the effectiveness, in terms of reducing the incidence of pressure ulcers (PU), of measures and preventive strategies of PU in hospitalized infants. METHOD: The recovery of studies was carried out through three databases (Medline through Pubmed, Scopus and Science Direct), and from an expert. Only studies published from 2007-2017 in Spanish or English were included in this review, which directly or indirectly appreciate the effectiveness of a measure or preventive strategy of PU in hospitalized neonates and that in terms of design were controlled or quasi-experimental trials. RESULTS: From 100 retrieved studies was conducted analysis of 5 studies, others were excluded for failing to meet the eligibility criteria. Most studies analyze the effectiveness of a preventive measure of secondary PU to treatment with Noninvasive mechanical ventilation in preterm infants. All of the studies have limitations in the methodology used, which makes the evidence of its recommendations to be low-moderate. CONCLUSIONS: Is necessary the realization of randomized controlled studies of higher power to be able to recommend any measure or preventive strategy

Estudio EDIPO: heridas en las extremidades inferiores. ¿Cómo abordan su manejo las enfermeras? / EDIPO study: wounds in the lower extremities. How do nurses approach their management?

Objetivo: Describir las prácticas habituales en la atención de personas con úlceras en extremidad inferior y su relación con las características profesionales y sociodemográficas de los profesionales de enfermería que trabajan en instituciones sanitarias y sociosanitarias en España. Métodos: Estudio observacional descriptivo, mediante encuesta transversal de ámbito nacional dirigida a profesionales de enfermería que atienden en su práctica habitual a personas con úlceras en extremidades inferiores (EE. II.) distribuidos por toda la geografía española. El cuestionario se distribuyó a través de grupos en redes sociales y a través de correos electrónicos. Resultados: Se recopiló información de un total de 646 encuestas realizadas a profesionales de enfermería. El 36,5% (235) ocupaba un puesto como enfermera referente de heridas. El 55,6% (358) señaló que las úlceras venosas eran las que trataban con más frecuencia. El 92,7% (599) de los participantes afirmó haber recibido formación sobre manejo de úlceras de EE. II. Conclusión: La práctica clínica habitual se basaba en recomendaciones con evidencia científica; cuanto mayor experiencia, mayor nivel de formación y cursos relacionados con el manejo de las heridas realizaban las enfermeras

Objective: To describe the usual practices in the care of people with ulcers in the lower limb and its relationship with the professional and sociodemographic characteristics of the nursing professionals working in health and socio-health institutions in Spain. Method: Descriptive observational study, through a cross-sectional survey of national scope directed to nurses who attend in their usual practice to people with lower-extremity ulcers distributed throughout the Spanish geography. The questionnaire was distributed through groups in social networks and through emails. Results: Information was collected from a total of 646 surveys carried out by nursing professionals. 36.5% (235) occupied a position as a nurse referring to injuries. 55.6% (358) indicated that venous ulcers were the most frequently treated. 92.7% (599) of the participants claimed to have received training in ulcerative ulcer management. Conclusion: The usual clinical practice was based on recommendations with scientific evidence as more experience, higher level of training and courses related to the management of wounds performed by nurses

Prevalence of pressure ulcers in the paediatric population and in primary health care: An epidemiological study conducted in Spain.

AIM: The primary goal of this study was to estimate the prevalence of pressure ulcers in the paediatric population cared for in primary health care. MATERIALS: The data of this epidemiological study were extracted from the records of the 24 departments that attended to an approximate population of 1 million inhabitants between 0 and 18 years old from 2012 to 2015. The study included children requiring assistance to reduce pressure ulcer incidence. The paediatric population was categorised into neonates and infants (0-2 years), young child (3-6 years), child (7-12 years) and adolescents (13-18 years). The primary outcome was information on the prevalence of pressure ulcers. Secondary outcomes were classification of ulcers in terms of location and category. Other outcomes included the total number of consultations owing to pressure ulcers. RESULTS: The sample included 65,359 children who attended 813 centres of primary health care. The prevalence of pressure ulcers was 1.72%. A higher prevalence was observed in children younger than 3 years (2.89%), with children at age 1 year showing the most prevalence (4.77%). The highest number of diagnosed ulcers was located in the lower back and heels, regardless of the age range. CONCLUSION: Overall, the prevalence of pressure ulcers in the paediatric population attended to in primary health care is low when compared to that of hospitalised and acutely ill children. The figures advise that special attention should be paid to the care of the population younger than 3 years, because this population shows the highest prevalence.

Pressure ulcers' incidence, preventive measures, and risk factors in neonatal intensive care and intermediate care units.

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.

Cross-cultural adaptation, reliability and validity of the Spanish version of the Neonatal Skin Risk Assessment Scale.

AIM: To adapt the Neonatal Skin Risk Assessment Scale to the Spanish context and to test its validity and reliability. BACKGROUND: Currently, in Spain there are no validated scales to evaluate the risk of pressure ulcers in infants. METHOD: The research was performed in 10 neonatal units. Overall, we use an observational study design, but divided it in to three stages. In the first stage, the transcultural adaptation of the scale and its content validation was performed. For the second stage, the inter-rater/intra-rater agreement and construct validity were evaluated using a cross-sectional design. Finally, in the third stage, a cohort study to analyse pressure ulcers' incidence, diagnostic tests and the cut-off points of the scale was performed. RESULTS: In the first phase, the content validity index was 0.93. In the second phase (336 neonates), the intra-rater reliability was 0.93 and the inter-rater reliability was 0.97. The construct validity has shown a two-dimensional model that fits better, representing "pressure duration and intensity" and "skin immaturity." In the third phase (268 neonates) the best values were those presented by the score 17: receiver operating characteristic curve was 0.84, showing a sensitivity of 91.18%, specificity of 76.50%, positive predictive value of 36.05% and negative predictive value of 98.35%. CONCLUSION: The scale has shown evidence of validity and reliability to measure the neonatal risk of pressure ulcers in the Spanish context. IMPLICATIONS FOR NURSING MANAGEMENT: Pressure ulcers are an adverse event recognised in paediatric units and specifically in neonatal units. The intent of the Spanish Neonatal Skin Risk Assessment Scale is to identify hospitalised neonates requiring prevention measures and their specific risk factors, to provide useful diagnostic information to improve the neonatal skin care into Spanish speaking countries. The Neonatal Skin Risk Assessment Scale could ensure the efficient and effective allocation of limited preventive resources, support clinical and management decisions, allow risk-adjusted cases in epidemiological studies, facilitate the development of risk assessment protocols and serve as evidence in litigation cases. All these features could facilitate developing best practice in nursing management and improve the quality and safety of neonatal care.

Heridas en Consultas de Enfermería de Atención Primaria ¿Qué lesión genera mayor carga de trabajo? / Wounds in primary nursing care: what injuries cause an increased workload in terms of nursing time?

Introducción. El cuidado de las personas con heridas supone un aumento de la carga de trabajo en las consultas de enfermería en Atención Primaria. Objetivo. Describir las características de las lesiones de la integridad cutánea y analizar la carga laboral medida en tiempo de enfermería. Metodología. Estudio analítico multicéntrico urbano y transversal realizado en el ámbito de la Atención Primaria en los centros de salud de Castellón de la Plana, Denia, Granada, Madrid y Logroño, durante los meses de enero y febrero de 2016. Resultados. La población incluida en los 6 centros de salud participantes era de 74 277 habitantes > 15 años. Se realizaron un total de 1105 observaciones. Un 56.2 % de estas se realizaron sobre lesiones de EEII y un 43 8 % sobre heridas quirúrgicas. En el 38.5 % se realizó el procedimiento clínico de cura (PCC) en menos de 15 minutos. El resto de PCC superaron este tiempo. Discusión. La ausencia de bibliografía sobre el tema nos impide realizar comparaciones entre estudios. Pese a tener el material disponible en más de la mitad de los centros de salud a estudio, solo un 1 % de las intervenciones terapéuticas sobre úlceras venosas se realizaron con vendas multicapas en kit. Conclusiones. Son las lesiones en las EEII las que generan mayor carga de trabajo efectiva en las consultas de enfermería a demanda (AU)

Introduction. Wound care represents a significant workload in primary health care nursing consultations. Objective. To analyze the characteristics of injuries causing deterioration of cutaneous integrity, which pose an increased workload in nursing consultations in terms of nursing time. Methodology. An urban and cross multicenter analytical study in primary health care centers of Castellon de la Plana, Denia, Granada, Madrid and Logroño, between January and February 2016. Results. The 6 participating health care centers had a population assignation of 74,277 inhabitants > 15 years old. A total of 1,105 observations were performed: 56.2 % were on lower extremity wounds and 43.8 % on surgical wounds. 38.5 % of treated wounds required a clinical cure procedure that was accomplished in less than 15 minutes. The remaining clinical cure procedures exceeded the aforementioned time. Discussion. The lack of literature on the subject prevents comparisons between studies. Despite material availability in more than half of the study’s health care centers, only 1 % of therapeutic interventions on venous ulcers were performed with multilayer bandage kits. CONCLUSIONS. Lower extremity wounds generate an increased workload in nursing consultations on demand. The administration should adjust appointments to real-time needs for treatment, or assign different time slots depending on whether patients have surgical or lower extremity injuries (AU)

A prospective, longitudinal study to assess use of continuous and reactive low-pressure mattresses to reduce pressure ulcer incidence in a pediatric intensive care unit.

Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009-2011) study was conducted among PICU patients. The two pediatric mattresses - one for children weighing between 500 g and 6 Kg and another for children weighing more than 6 Kg - were provided to patients at risk for PUs (Braden-Q ≤16, Neonatal Skin Risk Assessment Scale [NSRAS] ≤13, or per nurse assessment of clinical need). Between 2009 and 2011, 30 children (13 [43.3%] girls and 17 [56.7%] boys), ages 0 to 10 years, at risk of developing PUs (NSRAS risk: n = 14 [13.2 ± 3.03] and Braden-Q risk: n = 10 [10.4 ± 2.4]) were placed on the study mattresses for a median of 4 (range 1 to 25) days. Primary reasons for PICU admission included disorders of the respiratory system (40%), infectious and parasitic diseases (23.3%), and illnesses of the musculoskeletal system and connective tissue (10%). All other PU prevention strategies (eg, repositioning, specialty devices) used as part of standard care protocols also were implemented. Of the 30 participants, only one (3.3%) (confidence interval [CI] 95% = 0.08 -17.2%) developed a nondevice-related PU. No adverse events occurred. A 2008 incidence study in the same PICU, before use of these special surfaces, found a cumulative incidence of 20% nondevice-related PUs. The observed incidence rate of nonmedical device-related PUs in this high-risk population placed on these mattresses is encouraging and warrants future research.

[Special surfaces for managing pressure in pediatrics (II). Choice, assigned algorithm (Tarise) and management models]. / Superficie especial del manejo de la presión (SEMP) pediátrica (y II). Elección, algoritmo de asignación (Tarise) y modelos de gestión.

Bed sores among children are an adverse effect provoked by the application of new technology adapted to pediatrics. Special surfaces for managing pressure in pediatrics are a preventive measure effective to avoid the development of these lesions. So that children benefit from this preventive measure, it must be adapted to their specific circumstances. In order for this to occur, it is fundamental to know: the specific characteristics which differentiate children from adults, and the type of special surfaces for managing pressure in pediatrics which are available on the market and to evaluate their appropriateness and effectiveness. The Group of Nurses to Improve Quality in Pediatrics at the University Clinical Hospital in Valencia has developed some tools which make it possible to manage and assign different sizes and types of special surfaces for managing pressure in pediatrics by means of a scientific method (Tarise). These are based on anthropometric measurements (Pediatric Space table) for each age range, the risk to develop a bed sore or skin ulcer due to pressure, the presence of a bed sore, the pathological seriousness and the type of special surfaces for managing pressure in pediatrics.

[Special therapeutic surfaces for handling pressure in pediatrics (I). Characteristics and competency]. / Superficie especial del manejo de la presión (SEMP) pediátrica. (I). Características e idoneidad.

Bed sores among pediatric patients constitutes an all too common adverse effect provoked by the application of new technologies adapted to a pediatrics context. Special Therapeutic Surfaces for Handling Pressure has proven to be an effective measure among adults. But the use of Special Therapeutic Surfaces for Handling Pressure for adults on children constitutes a grave error which can even be prejudicial for a pediatric patient. This is deemed an error due to the differences in anthropometrical measures between children and adults plus the specific design of Special Therapeutic Surfaces for Handling Pressure for adults. So that pediatric patients are benefited by this preventive measure, this measure must be adapted to pediatrics own specific circumstances. Along this line, the use of static Special Therapeutic Surfaces for Handling Pressure on patients at risk has proven to have a better cost-benefit ratio, a greater degree of comfort, and a greater degree of security than dynamic ones. To apply the most adequate Special Therapeutic Surfaces for Handling Pressure, we need to their specific characteristics as well as those of a pediatric patient. The best complement to Special Therapeutic Surfaces for Handling Pressure Special Therapeutic Surfaces for Handling Pressure are local devices which provide relief to pressure, preferably those which comply with the national norms for health products.

Superficie especial del manejo de la presión (SEMP) pediátrica (y II). Elección, algoritmo de asignación (TARISE) y modelos de gestión / Special surfaces for managing pressure in pediatrics (II). Choice, assigned algorithm (TARISE) and management models

Las UPP en la población pediátrica son un efecto adverso provocado por la aplicación de las nuevas tecnologías adaptadas al contexto pediátrico. Las Superficies Especiales del Manejo de la Presión (SEMP) constituyen una medida preventiva eficaz para evitar el desarrollo de estas lesiones. Para que la población pediátrica se vea favorecida por dicha medida se ha de adaptar a sus circunstancias propias. Para ello es fundamental conocer las características diferenciales respecto a la población adulta, los tipos de SEMP pediátricas que nos ofrece el mercado y evaluar su idoneidad y efectividad. El Grupo de Enfermería para la Mejora de la Calidad en Pediatría (GEMCP) del Hospital Clínico Universitario de Valencia ha desarrollado unas herramientas que permiten gestionar y asignar diferentes tamaños y tipos mediante un método científico (Tarise). Se basa en las medidas antropométricas (Tabla Espacio Pediátrico) de cada rango de edad, el riesgo de desarrollar una UPP, la presencia de las mismas, la gravedad de la patología y el tipo de SEMP(AU)

Bed sores among children are an adverse effect provoked by the application of new technology adapted to pediatrics. Special surfaces for managing pressure in pediatrics are a preventive measure effective to avoid the development of these lesions. So that children benefit from this preventive measure, it must be adapted to their specific circumstances. In order for this to occur, it is fundamental to know: the specific characteristics which differentiate children from adults, and the type of special surfaces for managing pressure in pediatrics which are available on the market and to evaluate their appropriateness and effectiveness. The Group of Nurses to Improve Quality in Pediatrics at the University Clinical Hospital in Valencia has developed some tools which make it possible to manage and assign different sizes and types of special surfaces for managing pressure in pediatrics by means of a scientific method (Tarise). These are based on anthropometric measurements (Pediatric Space table) for each age range, the risk to develop a bed sore or skin ulcer due to pressure, the presence of a bed sore, the pathological seriousness and the type of special surfaces for managing pressure in pediatrics(AU)

Superficie especial del manejo de la presión (SEMP) pediátrica(I). Características e idoneidad / Special therapeutic surfaces for handling pressure in pediatrics (I). Characteristics and competency

Las UPP en la población pediátrica constituyen un efecto adverso demasiado común provocado por la aplicación de las nuevas tecnologías adaptadas al contexto pediátrico. Las Superficies Especiales del Manejo de la Presión (SEMP) suponen una medida preventiva efectiva en la población adulta. Pero el uso de SEMP de adultos en niños constituye un error grave que puede, incluso, perjudicar al paciente pediátrico. Se considera un error por las diferencias entre las medidas antropométricas de los niños y los adultos y el diseño particular de las SEMP de adultos. Para que la población pediátrica se vea favorecida por esta medida preventiva se han de adaptar a sus circunstancias propias. En esta línea, el uso de SEMP estáticas en pacientes de riesgo ha demostrado una mejor relación coste-beneficio, mayor grado de comodidad y mayor grado de seguridad que las dinámicas. Para asignar la más adecuada debemos conocer sus características propias, así como las del paciente pediátrico. El mejor complemento de las SEMP son los dispositivos locales de alivio de la presión, preferiblemente aquellos que cumplen la normativa nacional sobre productos sanitarios(AU)

Bed sores among pediatric patients constitutes an all too common adverse effect provoked by the application of new technologies adapted to a pediatrics context. Special Therapeutic Surfaces for Handling Pressure has proven to be an effective measure among adults. But the use of Special Therapeutic Surfaces for Handling Pressure for adults on children constitutes a grave error which can even be prejudicial for a pediatric patient. This is deemed an error due to the differences in anthropometrical measures between children and adults plus the specific design of Special Therapeutic Surfaces for Handling Pressure for adults. So that pediatric patients are benefited by this preventive measure, this measure must be adapted to pediatrics own specific circumstances. Along this line, the use of static Special Therapeutic Surfaces for Handling Pressure on patients at risk has proven to have a better cost-benefit ratio, a greater degree of comfort, and a greater degree of security than dynamic ones. To apply the most adequate Special Therapeutic Surfaces for Handling Pressure, we need to their specific characteristics as well as those of a pediatric patient. The best complement to Special Therapeutic Surfaces for Handling Pressure Special Therapeutic Surfaces for Handling Pressure are local devices which provide relief to pressure, preferably those which comply with the national norms for health products(AU)