INTRODUCCIÓN Las úlceras por presión (UPP), aún en el si-glo XXI, siguen constituyendo una epide-mia viva, alarmante para nuestros servicios sanitarios, sociales y para toda nuestra so-ciedad del bienestar (1) y, por tanto, debe-rían considerarse como un problema de sa-lud de primer orden y que afecta a todo tipo de pacientes sin distinción social (2) y a to-dos los niveles asistenciales (3). Especial relevancia tienen en el contex-to de los cuidados críticos (UCI) donde la incidencia es muy elevada. Los primeros datos sobre incidencia en las UCI fueron publicados por Nancy Bergstrom en 1987 (4), donde puso de manifiesto la realidad del problema con una incidencia del 40%. Desde entonces, quizás el estudio más im-portante sobre la epidemiología en los Es-tados Unidos de América fue el desarrolla-do por Janet Cuddigan en 2001, y forma parte del documento Pressure ulcers in Ame-rica: prevalence, incidence and implications for the future, en el que se presentan datos epidemiológicos de las UPP en UCI. Las cifras de incidencia varian entre el 5,2% y RESUMEN Objetivos: identificar las escalas de valoración del riesgo de desarrollar úlceras por presión que han sido utilizadas en el contexto de los cuidados críticos. Determinar cuáles de ellas han sido validadas en función de los criterios de validez predictiva, capacidad predictiva y fiabilidad, elaborando, cuando sea posible, indicadores agregados. Métodos: revisión sistemática de la literatura científica. Se realizo una búsqueda en las 14 principales bases de datos bibliográficas internacionales de ciencias de la salud. Se incluyeron los estudios publicados entre 1962 y 2009, sin restricción idiomática, que fueran prospectivos, con pérdidas < 25%, con seguimiento sistemático y que aportaran datos de validez y/o capacidad predictiva y/o fiabilidad. Se ha excluido la literatura gris, los estudios de revisión, retrospectivos y transversales. La valoración de la calidad metodológica de los estudios se ha realizado mediante el Critical Appraisae Skills Programme (CASP). Los indicadores analizados han sido validez, magnitud de efecto (RR) y fiabilidad. Resultados: se han identificado un total de 255 artículos que identifican 16 escalas de valoración del riesgo diseñadas específicamente para las UCI. Existen 26 estudios que miden la validez de las mismas. Solo tres escalas tienen más de un estudio de validación (NM Bienstein, Cubbin-Jackson, Jackson-Cubbin). Cuatro escalas generalistas también han sido validadas en UCI (Braden, Norton, BM Song-Choi y Waterlow). NM Bienstein y Waterlow no son válidas por baja sensibilidad. Cubbin-Jackson, Jackson-Cubbin y Norton presentan datos muy similares de validez y capacidad predictiva, pero con muestra muy pequeña. Braden es la escala mejor testada en las UCI, con adecuados parámetros de validez y capacidad predictiva. Conclusiones: recomendamos el uso de la escala de Braden para valorar el riesgo de desarrollar úlceras por presión en las unidades de cuidados críticos. Otras escalas como 6. SUPLEMENTO HELCOS_GEROKOMOS 30/05/13 11:56 ...

Although most of the recommendations on pressure ulcer care found in guidelines are well known by nurses, there is a group of interventions about which they have insufficient knowledge and low implementation rates.

Enteral nutrition through a nasogastric tube is a technique often used with hospitalized patients when they present problems with oral nutrition. Patients receiving enteral nutrition show several kinds of complications such as diarrhoea, vomiting, constipation, lung aspiration, tube dislodgement, tube clogging, hyperglycaemia and electrolytic alterations. We present a prospective and observational study carried out in an Internal Medicine Unit with 64 patients who were fed by a nasogastric tube. From the results it can be seen that older people represented a majority (the average age was 76.2 years), and difficulty in swallowing was the main reason for beginning enteral nutrition. The complications which appeared were: tube dislodgement (48.5%); electrolytic alterations (45.5%); hyperglycaemia (34.5%); diarrhoea (32.8%); constipation (29.7%); vomiting (20.4%); tube clogging (12.5%); and lung aspiration (3.1%). We discuss the possible relationship between the different factors associated with the enteral nutrition procedure and the occurrence of these complications. Finally, some nursing interventions are suggested, such as: checking the gastric residue periodically; attempting to place the tube in the duodenum in unconscious patients; and the use of protective mittens in disturbed patients.

(1) Background: Reactive oxygen species (ROS) play a crucial role in the preparation of the normal wound healing response. Therefore, a correct balance between low or high levels of ROS is essential. Antioxidant dressings that regulate this balance are a target for new therapies. The purpose of this review is to identify the compounds with antioxidant properties that have been tested for wound healing and to summarize the available evidence on their effects. (2) Methods: A literature search was conducted and included any study that evaluated the effects or mechanisms of antioxidants in the healing process (in vitro, animal models or human studies). (3) Results: Seven compounds with antioxidant activity were identified (Curcumin, N-acetyl cysteine, Chitosan, Gallic Acid, Edaravone, Crocin, Safranal and Quercetin) and 46 studies reporting the effects on the healing process of these antioxidants compounds were included. (4) Conclusions: this review offers a map of the research on some of the antioxidant compounds with potential for use as wound therapies and basic research on redox balance and oxidative stress in the healing process. Curcumin, NAC, quercetin and chitosan are the antioxidant compounds that shown some initial evidence of efficacy, but more research in human is needed.

A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.