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      Medida de la cicatrización en úlceras por presión: ¿Con qué contamos? Translated title: Measure healing in pressure ulcers: What do we have?

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          Abstract

          El presente artículo corresponde a una puesta al día de los métodos e instrumentos de medida de las heridas hacia la cicatrización. La forma en que las heridas son medidas a menudo es subjetiva, lo que hace que evaluar la eficacia de los tratamientos se haga de manera errónea y se llegue a la parcialidad. En el mismo escrito, se exponen los métodos de medida más usados en el ámbito clínico y de investigación, para valorar el progreso o retroceso de las heridas crónicas hacia la cicatrización. Aunque, en su mayoría, los instrumentos y herramientas que se mencionan hacen referencia sólo a las úlceras por presión y sólo algunos han sido utilizados en otro tipo de heridas, lo que genera un vacío al tratar de valorar los demás tipos de heridas que se encuentran en este mismo proceso. El aumento de la demanda en la práctica basada en la evidencia hace que lograr resultados óptimos en la valoración, el tratamiento y coste-efectividad se haya vuelto una prioridad. Esto, sumado a la poca validez de los instrumentos existentes, hace necesaria la adopción de un enfoque común en el que se estandarice un método fiable, que posea sensibilidad al cambio y que sea válido, de manera que permita a los clínicos tomar decisiones rápidas y concretas en la herida que están tratando.

          Translated abstract

          This paper is an update of the methods and instruments to measure wound healing. The way in which wounds are measured, often seems subjective, which makes assessing the effectiveness of treatments biased. In that article, we present the most widely used measurement methods in clinical and research fields to assess progress or regression of chronic wounds healing. While most of the instruments and tools listed refer only to pressure ulcers and only some have been used in other types of wounds, creating a void when trying to evaluate other wound types. Increased demand in the evidence-based practice makes optimal results in the assessment, treatment and cost effectiveness has become a priority. This coupled with the lack of validity for existing instruments, makes necessary to adopt a common approach to standardize a reliable method, with sensitivity to change and valid, in a way that allows clinicians to make quick and concrete decisions on the wound treated.

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          Most cited references66

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          Risk assessment scales for pressure ulcer prevention: a systematic review.

          This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk.
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            Pressure sores: classification and management.

            Four grades of pressure can be recognized on the basis of pathophysiology of soft tissue breakdown overlying bony prominences. Management is correlated with the extent of the lesion and ranges from local wound care, turning and systemic support for Grade I and II, to local and radical excision with soft tissue flap closure for the more extensive Grades III and IV.
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              Wound measurement: can it help us to monitor progression to healing?

              Wound measurement can help practitioners to monitor the progression to healing. The most effective way of doing this is to calculate the percentage reduction of wound area over time, particularly within the first four weeks.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                geroko
                Gerokomos
                Gerokomos
                Idemm Farma, S.L. (Barcelona, Barcelona, Spain )
                1134-928X
                March 2011
                : 22
                : 1
                : 35-42
                Affiliations
                [01] Antioquía orgnameUniversidad de Antioquía
                [02] Alicante orgnameUniversidad de Alicante orgdiv1Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e História de la Ciencia
                [06] orgnameConferencia Nacional de Consenso sobre las Úlceras de la Extremidad Inferior (CONUEI)
                [05] orgnameEuropean Wound Management Association (EWMA)
                [03] orgnameGrupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas (GNEAUPP)
                [04] orgnameEuropean Pressure Ulcer Advisory Panel (EPUAP)
                Article
                S1134-928X2011000100006
                10.4321/s1134-928x2011000100006
                8a0c8465-e461-477a-b2dc-328dba3d8c89

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 51, Pages: 8
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                SciELO Spain


                Instrumentos de medida,cicatrización,úlceras por presión,Instruments to measure,wounds healing,pressure ulcers

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