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
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Discussion
The current study reveals a very high PU prevalence rate (35%) in the 14 pediatric hospitals. However, the prevalence rate of category 2 and higher PUs is only 3%. In particular, the age of the patients, the Braden risk score for PU development, and the institution in which the patients were hospitalized appear to be related to the development of PU.
In this study, the patients were assessed by a trained rater pair. From the good interrater reliability and data consistency in the pretest, one can assume the results presented are of sufficiently good quality. The prevalence rate of 35% is higher than previously found prevalence rates in worldwide pediatric care settings, which varied from 3% to 28%.8
The high prevalence rate demands critical appraisal. First, an already well-known problem is the diagnosis of category 1 pressure ulcers. This problem was first described in a study by Halfens et al.24 In a cross-sectional mail survey of coordinators of the Dutch National Pressure Ulcer Prevalence Survey in 1998, the authors distinguished several factors that have an impact on the assessment of PUs in institutions. One of these factors is the difficulty in diagnosing category 1 PUs. It should be noted that a category 1 PU can be misidentified because nurses might diagnose a blanchable erythema as a category 1 PU. This may lead to an overdiagnosis of PUs.26,27 Furthermore, according to the study by Halfens et al,24 most category 1 PUs are reversible. Therefore, several authors have recommended defining PU prevalence by starting the category system at category 2.26,27 The raters for this study were prepared and especially trained in diagnosing category 1 PUs. In the current study interrater pretest, 95% agreement was achieved, suggesting that findings are reliable. Also, even if category 1 PU is not defined as a PU, the presence of a category 1 PU can at least be considered the most important risk factor for PU,27 which subsequently can be interpreted for this study as meaning that a high percentage of pediatric patients are at high risk of developing PUs.
The prevalence of category 2 PUs and above accounts for 3% of the total. This is lower than the prevalence of PUs in the studies by Suddaby et al6 and Groene-veld et al16 (both 5.1%) and also lower than the PU prevalence in an earlier study by Schlüer et al8 (4.5%). In Groene-veld et al’s 2004 study,16 prevalence was assessed in 97 inpatients; prevalence among children was found to be 13.1% (including category 1). On the basis of Groene-veld et al’s16 and Schlüer et al’s8 results, one can conclude that while many patients are vulnerable to PU, the progression to a higher category occurs rather infrequently. Nevertheless, this implies that the diagnosis of a category 1 PU requires a related preventive intervention.
The data collection in all participating clinics took place on 1 day within the same time span from the morning (7:30 am) up to 3:00 pm in the afternoon. This is important insofar as it is known from adult patient populations that approximately 50% of all category 1 PUs disappear during the day, whereas approximately 22% of all category 1 PUs worsen during the day.24 No study related to this particular phenomenon has been undertaken so far for the pediatric setting.
The most widely affected patient group in this study involved very young patients in the PICU setting, who presented with mostly category 1 PUs. This is in line with results of Curley et al.13 The PU prevalence of nearly 45% in this patient group with 60% at risk is disconcerting and needs urgent attention. Patients in the NICU care setting had an overall prevalence of 43%.
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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
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