I have a colostomy, about 1" opening, and for 8 years I had no problem with my pouches. Then for 3 or 4 months I can't seem to have a bag on for more than a day, and there is leakage. What is deep convexity and should I have different kind of pouches that have a deep convexity? Would that help? Thank you.
Pediatric Pressure Ulcer Prevalence: A Multicenter, Cross-Sectional, Point Prevalence Study in Switzerland
- 6/30/2012
- 1 Comments
- 4062 reads
PU prevalence and patient characteristics. Of the 412 patients taking part in this study, a total of 142 had one or more PUs on the day of the study, a PU prevalence rate of 35%. Of these 142 patients, 77 (54%) had one, 35 (25%) had two, 17 (12%) had three, six had four (4%), two had five (2%), three had six (1%), one had nine, and one patient had 10 PUs. This yields a total number of 269 PUs (see Table 3).
The most frequent type of PU was a category 1 PU (121, 94%). Sixteen patients (16, 3%) had category 2 and higher, three had category 3, and two had category 4 where assessed. The three children with a category 3 PU were all 16 years of age with multiple diagnoses and treatment for orthopedic surgery. One category 3 PU had occurred within the last 2 weeks on the ward where the patient was hospitalized, while the two other category 3 PUs had existed for a longer time. These two category 3 PUs had existed for 3 to 6 months and had developed in another hospital before these patients were transferred to the clinic where they were assessed. The two children with a category 4 PU were 9 and 16 years of age. The younger child was being treated in the surgery department after a multiple trauma incident and had developed the category 4 PU within the previous 2 weeks, while the other patient was being treated for an orthopedic surgery indication. The PU in this patient had already existed for more than 1 year and had developed in another care setting.
The PU prevalence differed between the departments (X2: 13.8, df: 5, P = 0.002), with the highest PU prevalence (44%) seen among patients in PICU (see Table 3).
The prevalence of PUs for patients with an external device was 40% (see Table 3). By age category, the PU prevalence for patients <1 year of age was 43%, followed by 31% for patients >12 years of age. In terms of length of stay before measurement, patients with a PU had been in the hospital slightly longer than patients without a PU (P = 0.036) (see Table 3).
Within the group found to be at risk for PUs (ie, patients with a Braden Scale score ≤20), 93 patients presented with a PU (49%), whereas among patients not at risk 46 (24%) had a PU (X2: 26.4; df: 1; P <0.001). Classified by departments, the PU prevalence for patients at risk was 50% for a patient after a surgical intervention as well as for neonates, 46% for pediatric medical patients, 25% for patients in a rehabilitation setting, and 60% for patients in the PICU. Of all patients with at least one PU, 76% were assessed as being at risk (sensitivity 67%). The number of patients assessed as being at risk who did not have a PU (specificity) was 95 (40%).
PU influencing factors. The risk factors age, gender, surgery (ie, the patient had at least one surgical intervention during the present hospitalization), BMI, preventive intervention, Braden scale score, institution, and department were examined with a multiple logistic regression analysis. The factors department, age, Braden score, and institution contributed significantly to fit in the model. The Hosmer Lemeshow test showed an adequate goodness of fit for this model (Nagelkerke R2 = 0.248) (see Table 4). This means that those remaining four variables explain 25% of the variance when PUs are the dependent variable.
_sm.jpg)
Chronic cerebrospinal venous insufficiency (CCSVI), or the pathological restriction of venous vessel discharge from the CNS has been proposed by Zamboni, et al, as having a correlative relationship to Multiple Sclerosis. From a clinical perspective, it has been demonstrated that the narrowed jugular veins in an MS patient, once widened, do affect the presenting symptoms of MS and the overall health of the patient. It has also been noted that these same veins once treated, restenose after a time in the majority of cases. Why the veins restenose is speculative. One insight, developed through practical observation, suggests that there are gaps in the therapy protocol as it is currently practiced. In general, CCSVI therapy has focused on directly treating the venous system and the stenosed veins. Several other factors that would naturally affect vein recovery have received much less consideration. As to treatment for CCSVI, it should be noted that no meaningful aftercare protocol based on evidence has been considered by the main proponents of the ‘liberation’ therapy (neck venoplasty). In fact, in all of the clinics or hospitals examined for this study, patients weren’t required to stay in the clinical setting any longer than a few hours post-procedure in most cases. Even though it has been observed to be therapeutically useful by some of the main early practitioners of the ‘liberation’ therapy, follow-up, supportive care for recovering patients post-operatively has not seriously been considered to be part of the treatment protocol. To date, follow-up care has primarily centered on when vein re-imaging should be done post-venoplasty. The fact is, by that time, most patients have restenosed (or partially restenosed) and the follow-up Doppler testing is simply detecting restenosis and retrograde flow in veins that are very much deteriorated due to scarring left by the initial procedure. This article discusses a variable approach as to a combination of safe and effective interventional therapies that have been observed to result in enduring venous drainage of the CNS to offset the destructive effects of inflammation and neurodegeneration, and to regenerate disease damaged tissue.
Reply to this comment »As stated, it has been observed that a number of presenting symptoms of MS almost completely vanish as soon as the jugulars are widened and the flows equalize in most MS patients. Where a small number of MS patients have received no immediate benefit from the ‘liberation’ procedure, flows in subject samples have been shown not to have equalized post-procedure in these patients and therefore even a very small retrograde blood flow back to the CNS can offset the therapeutic benefits. Furthermore once the obstructed veins are further examined for hemodynamic obstruction and widened at the point of occlusion in those patients to allow full drainage, the presenting symptoms of MS retreat. This noted observation along with the large number of MS patients who have CCSVI establish a clear association of vein disease with MS, although it is clearly not the disease ‘trigger’.For more information please visit http://www.ccsviclinic.ca/?p=978
Post new comment