Carmen Domínguez-Nogueira

Pressure ulcers carry a significant risk in clinical practice. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve the data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity, and skin moisture. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. Thus, the primary aim of this approach is to provide nursing professionals with valuable insights for assessing the potential risk levels of pressure ulcers, which could support their decision-making and allow, for example, the application of suitable preventive measures tailored to each patient’s requirements. The interpretability of the models proposed and their performance, evaluated through stratified cross-validation, make them a helpful tool for nursing care in estimating the pressure ulcer risk level.

Pressure ulcers carry a significant risk in clinical practice and require effective preventive measures. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity and skin moisture. Their analysis allows nursing professionals to predict the risk levels of pressure ulcer and make informed decisions about patient care. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. The approach proposed aims to support nursing professionals in making timely decisions regarding the appropriate preventive interventions according to the risk levels of pressure ulcers, thus improving patient outcomes and healthcare costs. The usefulness and effectiveness of the models presented make them a valuable resource for nursing care in the prevention of pressure ulcers.

Applications where data mining tools are used in the fields of medicine and nursing are becoming more and more frequent. Among them, decision trees have been applied to different health data, such as those associated with pressure ulcers. Pressure ulcers represent a health problem with a significant impact on the morbidity and mortality of immobilized patients and on the quality of life of affected people and their families. Nurses provide comprehensive care to immobilized patients. This fact results in an increased workload that can be a risk factor for the development of serious health problems. Healthcare work with evidence-based practice with an objective criterion for a nursing professional is an essential addition for the application of preventive measures. In this work, two ways for conducting a pressure ulcer risk assessment based on a decision tree approach are provided. The first way is based on the activity and mobility characteristics of the Braden scale, whilst the second way is based on the activity, mobility and skin moisture characteristics. The results provided in this study endow nursing professionals with a foundation in relation to the use of their experience and objective criteria for quick decision making regarding the risk of a patient to develop a pressure ulcer.

Pressure ulcers (PU) represent a health problem with a significant impact on the morbidity and mortality of immobilized patients, and on the quality of life of affected people and their families. Risk assessment of pressure ulcers incidence must be carried out in a structured and comprehensive manner. The Braden Scale is the result of an analysis of risk factors that includes subscales that define exactly what should be interpreted in each one. The healthcare work with evidence-based practice with an objective criterion by the nursing professional is an essential addition for the application of preventive measures. Explanatory models based on the different subscales of Braden Scale purvey an estimation to level changes in the risk of suffering PU. A binary-response logistic regression model, supported by a study with an analytical, observational, longitudinal, and prospective design in the Granada-Metropolitan Primary Healthcare District (DSGM) in Andalusia (Southern Spain), with a sample of 16,215 immobilized status patients, using a Braden Scale log, is performed. A model that includes the mobility and activity scales achieves a correct classification rate of 86% (sensitivity (S) = 87.57%, specificity (SP) = 81.69%, positive predictive value (PPV) = 91.78%, and negative preventive value (NPV) = 73.78%), while if we add the skin moisture subscale to this model, the correct classification rate is 96% (S = 90.74%, SP = 88.83%, PPV = 95.00%, and NPV = 80.42%). The six subscales provide a model with a 99.5% correct classification rate (S = 99.93%, SP = 98.50%, PPV = 99.36%, and NPV = 99.83%). This analysis provides useful information to help predict this risk in this group of patients through objective nursing criteria.

Background: Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients’ own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment. Objective: This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers–associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients. Methods: The DSGM runs SIRUPP, which is linked to patients’ electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version. Results: The project commenced in June 2017 and is expected to conclude in April 2020. Conclusions: This study addresses two main health outcomes—the time needed for wound healing and the mortality associated with pressure ulcers—both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers. International Registered Report Identifier (IRRID): DERR1-10.2196/13701

BACKGROUND Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients’ own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment. OBJECTIVE This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers–associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients. METHODS The DSGM runs SIRUPP, which is linked to patients’ electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version. RESULTS The project commenced in June 2017 and is expected to conclude in April 2020. CONCLUSIONS This study addresses two main health outcomes—the time needed for wound healing and the mortality associated with pressure ulcers—both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13701

Clinical scenarios associated with low therapeutic effectiveness (LTE) are especially complex and highly relevant in oncology. The objective was to test a methodological framework for creating consensual clinical recommendations for routine practice. The study was in three phases from Mars 2006 to January 2008: 1) Definition of LTE situations; 2) Preparation by 10 experts of a panel of LTE situations in cancers of breast, lung, head and neck, colon and rectum and brain; and 3) Development of a consensus on each situation and its optimal treatment by gathering agreement and disagreements (two-round Delphi method) from 68 practicing oncologists in Andalusian Community. Three major and three minor criteria were established for an LTE situation, defined when at least one major or two minor criteria were met. The expert group proposed 48 possible LTE clinical scenarios for breast (n = 7), lung (10), brain (11), head and neck (11) and colorectal cancers (9). Sixty-eight oncologists agreed to participate in the study; the response rate was 79% (from 34 medical and 17 radiation oncologists) In the first round (definition), maximum agreement was obtained with the LTE definition of 10 of the 48 scenarios; in the second round (treatment options), maximum agreement was obtained on the treatment of 3 of these 10 scenarios. Oncologists reached low levels of agreement on the definition of an LTE situation and on its treatment recommendations. This study proposes an approach to the improvement of cancer management in situations of high uncertainty.