hiroe koyanagi

BACKGROUND: The use of mobile apps to promote knowledge level, practice, and behavioral change potential has become increasingly common. However, studies on apps targeting social welfare employees working in the home-care setting to prevent pressure injury (PI) are lacking. The care manager (CM) plays a key role in connecting the demand and supply of home-care services. PI is more prevalent in the home-care setting, where resources are limited, than in acute settings. OBJECTIVE: The research hypothesis was that CMs who use a mobile app will have improved general knowledge and heightened practice for PI prevention, compared to that before using the app. This study aimed to assess the effectiveness of a PI prevention support mobile app prototyping model (Pips-Map) in improving the knowledge level, practice, and behavioral change potential of CMs in PI prevention in the home-care setting. METHODS: This was conducted between December 2021 and December 2023 as a single-arm, pre-post pilot study including 27 CMs who worked in a Japanese city. Pips-Map was used for 6 months in daily practice, and a self-administered test questionnaire was used to assess participants' knowledge and practice in PI prevention before or after using Pips-Map. At the end of the posttest, a validated App Behavior Change Scale was used to analyze behavioral change potential. This study followed the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. RESULTS: In total, 19 participants were analyzed. Out of 55 points, the total mean knowledge score significantly increased from 30.9 (SD 5.9) in the pretest group to 36.1 (SD 5.9) in the posttest group (P=.0003). The number of participants with a total score of >70% (adequate knowledge level) increased from 2 (11%) to 7 (36.8%), but the difference was not statistically significant (P=.07). For the level of practice, out of 21 points, the total score increased from 15.2 (SD 3.1) in the pretest group to 16.2 (SD 3.0) in the posttest group, but no statistically significant differences were observed (P=.16). The behavior change scale revealed that participants positively evaluated the Pips-Map to provide information on PI prevention guidelines but had concerns regarding inadequate usability and financial incentives of Pips-Map. CONCLUSIONS: The use of Pips-Map for 6 months in actual practice increased the knowledge level of Japanese CMs in PI prevention, but it did not change the level of practice. Considering the need for updating apps that aim to promote behavioral change, this study identified some limitations of Pips-Map. Thus, revisions must be made to adapt Pips-Map to home-based care needs.

OBJECTIVES: We aimed to determine (1) the prevalence of constipation among inpatients, (2) the prevalence and symptoms of difficult defecation among constipated inpatients, and (3) the factors associated with constipation. METHODS: We performed a retrospective cohort study over a single day at one university hospital. We analyzed the nursing records for inpatients who had been hospitalized for at least 3 days. The survey items included the symptoms associated with defecation difficulty and nutritional intake. The symptoms of difficult defecation were defined as (1) fewer than three spontaneous bowel movements per week; (2) lumpy or hard stools (Bristol stool form scale types 1-2); (3) straining during defecation; and (4) the sensation of incomplete evacuation during defecation, based on the Roma-IV diagnostic criteria. Constipation was defined as the presence of two or more symptoms of defecation difficulty. Univariate and multivariate analyses were performed to determine the constipation status of the patients. RESULTS: The prevalence of constipation in the university hospital was 12.2%, and the department with the highest prevalence of difficulty with defecation was the Psychiatry Department (64.1%). Of the patients with constipation, 36.8% exhibited symptoms of defecation difficulty other than low frequency of defecation. The factor that was significantly associated with constipation after admission was pre-admission constipation (odds ratio=8.92, p<0.01). CONCLUSIONS: Subjective assessment has limitations for the accurate determination of constipation status. In addition, patients with a history of constipation before admission require early interventions to aid defecation following their admission.

We aimed to investigate the association between the presence of cutaneous urease-producing bacteria and the development of incontinence-associated dermatitis (IAD) using an original urea agar medium as a step toward developing advanced preventive measures. In previous clinical assessments, we developed an original urea agar medium to detect urease-producing bacteria via the medium's colour changes. In a cross-sectional study, specimens were collected via the swabbing technique at genital skin sites in 52 stroke patients hospitalised in a university hospital. The primary objective was to compare the presence of urease-producing bacteria between the IAD and no-IAD groups. Determining the bacterial count was the secondary objective. The prevalence of IAD was 48%. A significantly higher detection rate of urease-producing bacteria was observed in the IAD group than in the no-IAD group (P = .002) despite the total number of bacteria being equivalent between them. In conclusion, we discovered that there was a significant association between the presence of urease-producing bacteria and IAD development in hospitalised stroke patients.

AIM: To compare the isolated and identified bacterial species colonizing on the genital skin between patients with and without incontinence-associated dermatitis. METHODS: This cross-sectional study included 102 patients with stroke admitted to an acute hospital in Japan. Swabs were collected, and bacterial species found in swabs were isolated and identified using a selective agar medium and simple identification kits. In addition to demographic information, severity of incontinence-associated dermatitis and the total bacterial counts were measured. RESULTS: Incontinence-associated dermatitis was present in 53.9% of the participants. Staphylococcus aureus was found in 50% of the participants with incontinence-associated dermatitis and only 17.9% of those without incontinence-associated dermatitis (P = 0.0029). Bacterial species distribution by erythema and skin erosion, which denote severity of incontinence-associated dermatitis, was different, but not significant; additionally, the total number of bacterial colonies was equivalent. CONCLUSIONS: Bacterial species distribution differed between patients with and without incontinence-associated dermatitis, whereas the total number of bacterial colonies was equivalent. A high detection rate of S. aureus on genital skin sites potentially affects the presence of incontinence-associated dermatitis and its severity. Geriatr Gerontol Int 2023; 23: 537-542.

皮膚・排泄ケア認定看護師(WOCN)の資格をもちWOC領域の専門外来に従事している11名にアンケートとインタビューを行い、以下の項目について調査した結果を報告した。1)実施している特定行為の内容。2)従事している専門外来の概要。3)同行訪問の状況。4)専門外来における診療報酬の算定。5)専門外来におけるアウトカム評価。6)主治医との連携。7)病棟との連携。8)訪問看護師との連携。9)在宅医療との連携。10)高齢者施設との連携。11)施設管理職との関係性。12)所属する施設の組織体制。13)所属施設での環境調整。14)施設の医師との関係性。15)施設の職員との関係性。16)複数のWOCN間の連携。17)WOCNの業務の調整。18)物品の調達。19)専門外来におけるWOCNの存在意義。20)専門外来におけるWOCNの役割。

AIM: Temporary lodging facilities which were non-medical facilities were established to secure beds for severely and moderately ill patients with COVID-19, as well as for isolation, non-contact observation, and care of mildly ill and asymptomatic patients in Japan. This study aims to understand nursing management practices adopted in these facilities by examining cases of their establishment and operation. METHODS: A multiple-case study design was used. Interviews for qualitative data collection were conducted from August to October 2020. After analyzing the nursing management practices in four temporary lodging facilities, common points were collated and integrated. RESULTS: For the establishment and operation of temporary lodging facilities, a three-layer structure based on disaster management methods was adopted: headquarters at the helm as overseers, field supervisors in the middle, and frontline nursing staff at the base. The structure had clear roles, facilitated information exchange, and provided efficient and effective nursing care. Field supervisors mainly provided psychological and clinical support for staff and served as information and interprofessional hubs. CONCLUSION: It is recommended that temporary lodging facilities should be organized based on principles of the division of labor. The workforce should comprise nursing staff, and experienced nursing professionals should be recruited to the higher echelons.

AIM: We aim to identify measures implemented by hospital nursing directors early in the COVID-19 pandemic and enabling factors. BACKGROUND: Managerial factors affect nurses' physical and mental health and willingness to work, especially early in a pandemic. METHOD: We used multiple-case study of 15 hospitals, comparing management approaches by interviewing 28 nursing directors and their assistants from August to December 2020. RESULTS: Hospitals that accepted COVID-19 patients and hospitals that unexpectedly experienced clusters underwent a nursing provision system organization phase, followed by an adjustment phase to maintain nursing organization function. Two factors aided measure implementation: an emergency system and staff protection policies. CONCLUSION: Early epidemic management strategies apply across contexts. The hospital's basic attitude is key to effective implementation of the strategies. IMPLICATIONS FOR NURSING MANAGEMENT: The results suggest that hospitals, nursing directors and nurses can each prepare for future emerging infectious disease epidemics.

AIM: This study investigates which work-related communication mediates the relationship between diversity climate and psychological empowerment among part-time nurses. BACKGROUND: Part-time nurses' high psychological empowerment is desirable because it may lead to high quality nursing practice. METHODS: Anonymous self-report questionnaires or web-based surveys were used to measure diversity climate (Climate for Inclusion Scale), psychological empowerment (Japanese version of the Psychological Empowerment Scale) and work-related communication (scale developed in this study). The respondents were part-time nurses from departments with shift work in six Japanese hospitals having over 200 beds. The surveys were conducted from September to October 2020. Multiple regression analyses and a significance test of indirect effects were then conducted. RESULTS: Among the work-related communication components, 'expressing thoughts about their work' fully mediated the relationship between diversity climate and psychological empowerment. CONCLUSIONS: It is important for part-time nurses to be actively 'expressing thoughts about their work' to enhance their psychological empowerment. Positive diversity climate is also important because it allows part-time nurses to express their thoughts regarding work. IMPLICATIONS FOR NURSING MANAGEMENT: Managers can enhance part-time nurses' psychological empowerment by encouraging them to express their work-related opinions based on the diversity climate.

AIMS: The study aimed to identify the aspects and items of nurse turnover impact on organizations as perceived by nursing management. BACKGROUND: Turnover rate does not capture the extent to which an organization is affected by turnover. Another indicator is required to assess the control status of turnover impact. METHODS: A Delphi study was conducted in 2021, where 2670 managers of nursing at 712 hospitals were asked to complete the survey three times. Factor analysis was conducted on these items for which a consensus was reached. RESULTS: Overall, 232 managers who responded multiple times, including the third survey, were included in the analysis. Consensus was reached for 36 items affected by turnover and considered important for nursing management. Using exploratory factor analysis, the following six factors were extracted: quality of nursing care, physical and mental health of nursing staff, workload and working conditions of nursing staff, relationships among nursing staff members, sense of responsibility among nursing staff, and cost and benefit of hiring replacement personnel. CONCLUSIONS: Six factors consisting of 36 items were extracted that can be used to assess the impact of nurse turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can assess the status of the organization more appropriately by understanding the factors that impact nurse turnover in vaious facilitites and look at strategies to overcome the impact on nurse staffing.

Background: Cellulitis is frequently encountered in patients with lymphedema despite existing prevention protocols. To resolve this issue, social aspects surrounding patients, such as communication with patients and professionals, are necessary to consider new approaches. This study aimed to clarify the association between the history of cellulitis in patients with lymphedema and access to specialists after adjustment for relevant confounding factors. Methods and Results: This study was a secondary analysis of the Lymphoedema IMpact and PRevalence-INTernational (LIMPRINT) study using a national Japanese database of adult lymphedema compiled between 2014 and 2015 (n = 113). Descriptive data were collected for patient characteristics. Multivariate logistic regression analysis was conducted to explore possible risk factors for patients having experienced cellulitis. The duration of edema ranged from <6 months (16.2%) to 10 years or longer (25.2%), with varying severity. History of cellulitis was observed in 31.9% of patients. The prevalent treatment techniques within the context of complex decongestive therapy included skin care advice (52.2%), compression garments (55.8%), exercise advice (41.6%), multilayer bandages (38.1%), cellulitis advice (49.6%), and massage (61.1%). Overall, 57.1% of patients had access to lymphedema specialists. Longer duration of lymphedema (adjusted odds ratio [AOR] = 4.10, p = 0.005) and access to lymphedema specialists (AOR = 0.28, p = 0.009) were significantly associated with a history of cellulitis. Conclusions: A history of cellulitis in patients with lymphedema is associated with limited access to specialists. To support self-care in this patient population, reasonable consideration systems, including telehealth, should be developed to facilitate communication between specialists and patients and decrease the occurrence of cellulitis in lymphedema.

AIMS: Critical colonization in pressure ulcers delays healing and has been studied. However, local wound management includes no clear strategy for preventing the development of biofilms. Therefore, this multicenter, prospective, observational study was conducted to examine the effect of local management on the biofilm area of pressure ulcers with critical colonization. METHODS: Participants were 34 patients with a pressure ulcer deeper than the dermis and in a state of critical colonization. The primary outcome was the change over a week in the proportion of the biofilm area in relation to that of the pressure ulcer area. We investigated the relationship between primary outcome and local wound management. The wound-blotting method was used for determining the biofilm area. To calculate the change in the biofilm area, baseline proportion was subtracted from proportion 1 week later. RESULTS: Six types of topical treatment were used in three facilities. The proportion of the biofilm area at 1 week follow-up was significantly smaller with iodine ointment than that without iodine ointment (p = .02). The standardized partial regression coefficient of iodine ointment adjusted by the type of medical facility was -0.26 (p = .003). CONCLUSION: This study revealed that the use of iodine ointment reduced the proportion of the biofilm area in the pressure ulcer surface. To manage pressure ulcers in a state of critical colonization, these results suggest that local management include the use of iodine ointment.

AimsCritical colonization has attracted attention as a cause of delayed healing of pressure ulcers. However, there is no clear strategy for local wound management in such cases. Here, we prospectively investigated exudate, infection, and pressure ulcer status in a critical colonization state to determine the optimal strategy for local wound management of such pressure ulcers.MethodsThis prospective cohort study was conducted in three facilities: a university hospital, a general hospital, and a long-term care hospital. Subjects were patients with pressure ulcers at a depth deeper than the dermis with a diagnosis of critical colonization by a dermatologist or wound ostomy continence nurse. Patients were divided into three groups according to local wound management: Group A, hydrating ointment with infection control or low exudate-absorption dressing material; Group B, high exudate-absorption dressing material; and Group C, hydrating ointment with exudate-absorption and infection control. Exudate, the moisture of the surrounding wound skin, stratum corneum hydration, area of biofilm, bacterial count, and wound severity assessed by DESIGN-R, were measured at baseline and at 1 week. The relative changes in these variables at 1 week were calculated for the analysis. ResultsOverall, 16 patients were classified into Group A (n = 7), Group B (n = 5), and Group C (n = 4). The patients in all three groups ranged in age from 78 to 86 years old and ≥ 50% were male. At baseline, the median proportion of wound area covered by the biofilm was similar between the three groups (0.50, 0.59, and 0.30, respectively). The median total DESIGN-R score in Group A was lower than those in the other groups (12, 24, and 21.5, respectively). With regard to the changes after 1 week, the proportion of wound area covered by the biofilm in Group C was larger than those in the other groups (-0.18, -0.27, and -0.87, respectively). However, the change in total DESIGN-R score in Group C was smaller than those in the other groups (-0.12, -0.11, and -0.01, respectively).ConclusionChanges in infection and pressure ulcer status in cases of critical colonization were described according to local wound management. However, due to the small number of patients, it was not possible to determine the most appropriate local wound management for pressure ulcers in a critical colonization state.【目的】クリティカルコロナイゼーションは、褥瘡の治癒遅延の原因として、最近注目を受けている。しかし、クリティカルコロナイゼーション状態への局所管理に関する対策は明らかでない。この研究において、私たちは、クリティカルコロナイゼーション状態の褥瘡の局所管理の最適な方法を検討するために、滲出液、感染と褥瘡状態を前向きに調査した。【方法】本研究は、前向きコホート研究であり、大学病院、総合病院、長期ケア病院の 3施設で実施した。対象者は、皮膚科医師または皮膚・排泄ケア認定看護師によって真皮より深い褥瘡で、かつクリティカルコロナイゼーション状態であると判断された褥瘡を有する入院患者である。患者は、局所管理方法によって 3 つの群に分けられた：A 群（補水と感染制御作用がある外用薬または滲出液吸収作用の低いドレッシング材）;B 群（滲出液吸収作用が高いドレッシング材）;C 群（滲出液吸収作用と感染制御作用がある外用薬）。滲出液、褥瘡周囲皮膚と健常皮膚の角質水分量、バイオフィルム面積、褥瘡表面の細菌数と DESIGN-R による褥瘡状態得点を、ベースラインと 1 週間後に測定した。これらの変数の 1 週間後の変化量の相対値により分析した。【結果】全 16 例の患者は、A 群（n = 7 ）、B 群（n = 5 ）、C 群（n = 4 ）に分類された。3 群の年齢の中央値は 78 〜 86 歳であった。また患者の 50% 以上は男性だった。ベースライン時に、バイオフィフムの面積が創面の面積に占める割合の中央値は同程度であった(0.50 vs. 0.59 vs. 0.30)。さらに、A 群のDESIGN-R 総点の中央値は、他の群より低かった（12 vs. 24 vs. 21.5）。一方、 1 週間後の変化量の相対値は、バイオフィフムの面積が創面の面積に占める割合は C 群が他の群より大きかった（-0.18 vs. -0.27 vs. -0.87）。DESIGN-R の合計点は C 群が他の群より低かった（-0.12 vs. -0.11 vs. -0.01）。【結論】本研究では、褥瘡の局所管理方法別に、バイオフィルムの面積、バイオフィルムの面積が創面の面積に占める割合、褥瘡表面の細菌数、DESIGN-R による創傷治癒過程を記述した。しかし、症例数が少なく、クリティカルコロナイゼーションの褥瘡の管理方法を明らかにすることはできなかった。

治癒遅延状態にある褥瘡に使用する創傷被覆材を変更し、創底滲出液量と創周囲皮膚に接触する滲出液をコントロールすることで不顕性感染に影響するのかについて検討した。褥瘡回診チームが介入している滲出液を伴うd2の褥瘡を有する患者2名(89歳男性、82歳女性)を対象とした。症例1、2ともに、感染コントロールと滲出液コントロールのために、スクロードパスタを選択していたが、キュティメドシルテックL(P/Sドレッシング)へ変更していた。P/Sドレッシングへ変更後、DESIGN-Rにおける滲出液量は変化しなかったが、褥瘡創面から褥瘡周囲に接触する滲出液量は1〜2週目までの間に減少していた。Bates-Jensen Wound Assessment Toolの滲出液量における評価では、P/Sドレッシングへ変更前の「湿潤状態」から、変更後1週目は「湿った状態」に変化していた。

<p>【はじめに】</p><p></p><p>平成28年度の診療報酬改定で排尿自立指導料が新設され，多職種で構成された排尿ケアチームと病棟看護師等が排尿自立に対して包括的ケアを実施するシステムが動き始めた。当院では，平成28年6月より排尿ケアチームによる活動が開始している。今回，当院での排尿ケアチームの活動経過を振り返り，対象者の特徴を調査した。これらを通しチーム内での理学療法士（以下PT）の役割と今後の課題について検討したので報告する。</p><p></p><p>【方法】</p><p></p><p>排尿自立指導料算定に向けた事務部門との連携，排尿ケアチームの結成，施設基準申請に必要な院内勉強会の開催など，当院における一連の活動を振り返った。さらに平成28年6月の算定開始から8月までに排尿自立指導料を算定した入院患者150名及びリハビリテーション（以下リハ）科医師の処方を経てPTが個別療法として介入した33名を対象としてその特徴を検討した。</p><p></p><p>【結果】</p><p></p><p>当院では平成28年4月から関係部署のスタッフが集まり，診療計画書の作成や対象病棟・対象患者の院内基準の決定，コンサルト手順などのシステム作りを開始した。その上で，排尿自立指導料に関わる説明会，勉強会を実施し院内スタッフへの周知を行い，6月から算定を開始した。これまでに排尿自立指導料の対象となった患者は実人数150名，診療科は泌尿器科113名，整形外科23名，その他の診療科14名であった。そのうち通常のリハ処方を経てPTが介入したのは33名（23.2％）で，平均年齢は61.1±20.3歳，整形外科23名，泌尿器科6名，その他の診療科4名，手術目的での入院が28名であった。また，PT介入時に移動を含めたセルフケアが自立していたのは29名であり，リハ依頼は主に術後の安静度拡大に応じた動作指導，機能回復などが目的であった。</p><p></p><p>【結論】</p><p></p><p>多職種からなる排尿ケアチームの中で，PTは専門性を生かして排泄動作の妨げとなっている機能障害を評価し，病棟看護師等に対して安全な動作の誘導方法や環境設定を提案する役割を持つ。今回の調査では，当院での指導料算定対象病棟が外科中心であったため，リハ医の処方を経たPT介入目的は主に術後の身体機能へのアプローチであったことがわかった。今後の排尿ケアチームにおけるPTの役割として，術後の身体機能へのアプローチ以外にも疾患特性や既往歴などから判断して，低体力や骨盤底機能低下，巧緻運動機能低下などの個別に対応が必要と考えられる患者をスクリーニングし，積極的に個別療法の対象として提案していくことも重要であると考える。</p>

ストーマ療法看護師(ET)、皮膚・排泄ケア認定看護師(WOCN)の会員が在職している施設を対象に、スキン・テア(皮膚裂傷)の実態を把握するための調査を実施した。診療計画書、看護記録等から情報を収集した。調査協力に同意したET/WOCNが所属する374施設に調査を依頼し、257施設から回答が得られた。全調査施設の患者総数は93820名、スキン・テア有病患者総数は720名、スキン・テア総部位は925部位であった。スキン・テアの有病率は、一般病院(療養病床あり)1.26%、その他1.00%、一般病院(療養病床なし)0.91%、国立病院0.88%、大学病院0.46%、小児専門病院0.29%、訪問看護ステーション0.00%であり、施設種間で有意差がみられた。また、統合分類による診療科の平均有病率の上位3位は、皮膚科1.65%、膠原病科1.54%、ICU・救急科1.41%であった。スキン・テア保有者の平均年齢は79.6歳、男性が448名、女性が272名であった。

Early detection and intervention of deep tissue injury are important to lead good outcome. Although the efficiency of ultrasonographic assessment of deep tissue injury has been reported previously, it requires a certain level of skill for accurate assessment. In this study, we present an investigation of the combination of thermographic and ultrasonographic assessments for early detection of deep tissue injury. We retrospectively reviewed 28 early-stage pressure ulcers (21 patients) presenting at the University of Tokyo Hospital between April 2009 and February 2010, surveying the associated thermographic and ultrasonographic findings. The wound temperature patterns were divided into low, even and high compared with the surrounding skin. Ultrasonographic findings were classified into unclear layer structure, hypoechoic lesion, discontinuous fascia and heterogeneous hypoechoic area. All 13 ulcers that were associated with low temperature showed good outcome; three ulcers had even temperatures and 12 ulcers showed high temperature on thermographic assessment. The two deep tissue injuries were rated high on thermographic assessment and showed heterogeneous hypoechoic area findings on ultrasonographic assessment. No non-deep tissue injury lesion was associated with these two findings simultaneously. The combination of thermographic and ultrasonographic assessments is expected to increase the accuracy of the early detection of deep tissue injuries.

Accurate assessment is necessary to evaluate peristomal skin condition, but objective methods are lacking. The purpose of this prospective, repeated-measures study was to evaluate the reliability and validity of color indicators using digital image analysis of peristomal skin photographs. The 6-month study was conducted among 21 patients (mean age 65.1 years old, 15 men) with ostomies (14 colostomies, six ileostomies, and one urostomy) at four outpatient clinics. Photographs taken by nurses of the peristomal area using point-and-shoot cameras were processed using digital image analysis, which involved color calibration, image processing, and indicator calculation. An erythema index (EI), melanin index (MI), and hypopigmentation index were created to represent increased degrees of red, black, and white color, respectively, and their average values in the peristomal region of an image were calculated relative to values for intact skin. Reproducibility was evaluated using the interclass correlation coefficient (ICC). ICCs of color indicators for intact skin were >0.7 between baseline and the end of follow-up for the 16 participants with two or more clinic visits. Differences in these indices between peristomal and intact regions were evaluated using a linear mixed model. The EI and MI of peristomal skin were significantly higher than those of intact skin (n=42, P<0.001). All color indicators in adjacent regions and areas where adhesive was applied were associated with the discoloration severity score and visual analogue pain score (all P<0.05). This objective and simple method had adequate reproducibility and criterion-related validity and may be useful for peristomal skin assessment. Further research is warranted.

UNLABELLED: The ability to predict the prognosis of a pressure ulcer is re- quired to establish appropriate management in the early phase. The present study reports the usefulness of a combined assessment tech- nique using ultrasonography and thermography for predicting delayed wound healing. METHODS: This retrospective cohort study included 37 patients with Stage I or II pressure ulcers. The patients were followed up for at least 3 weeks. The ultrasonographic and thermographic as- sessments were conducted at the initial multidisciplinary team round. The presence of four ultrasonographic features (unclear layered struc- ture, hypoechoic lesion, discontinuous fascia, and heterogeneous hy- poechoic area) and one thermographic feature (increased temperature) were determined from within the wound bed. Wound healing was re- assessed after 2 weeks and the rate of area reduction was calculated to determine whether the pressure ulcer was healing properly. A mul- tivariate logistic analysis was used to assess the predictive values of the possible assessment features. RESULTS: A comprehensive review of the ultrasonographic and thermographic assessments of the pressure ulcers found that the combination of unclear layered structure and increased temperature was beneficial for predicting wound healing. When a pressure ulcer presented with an unclear layered structure and increased temperature in the wound bed, the risk of delayed wound healing or wound deterioration was 6.85 times higher compared with a pressure ulcer that did not have these manifestations. CONCLUSION: The combination of ultrasonographic and thermographic assessments facilitates precise prediction of pressure ulcer outcomes.

OBJECTIVE: Protein loss from wound fluid is usually recognized as one of the factors contributing to the deterioration of the nutritional status in older patients with severe pressure ulcers. We quantified the protein loss owing to pressure ulcers and investigated associations with wound-related factors and nutritional status. METHODS: This cross-sectional study included 25 patients (>or=60 y) from 10 institutions, with full-thickness pressure ulcers. Wound fluid was collected once after accumulating beneath a film dressing. The amount of protein loss per day was estimated by the volume of wound fluid per hour and the total protein concentration in the wound fluid. Wound evaluations and nutritional assessments were performed. Correlations between variables were obtained using Spearman's rank correlation. RESULTS: The median age of the patients was 79 y (range 61-100), and median body mass index was 19.6 kg/m(2) (12.2-24.9). The median amount of protein loss was 0.2g/d (0.04-2.1), which corresponded to 0.01 g x kg(-1) x d(-1) (<0.01-0.04) and 0.6% (0.1-13.8) of protein intake. Four wounds characterized as infected or surgically debrided lost 1.5-2.1g of protein per day, which was substantially higher than other wounds lost. Protein loss was correlated with wound severity including area, depth, the wound severity score, and infectious markers (all Ps<0.05), but not with body mass index or arm muscle circumference (P>0.05). CONCLUSION: The amount of protein loss could be small and thus may not be related directly to nutritional status, although it increased as the wound became more severe.