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Biomedical subjects

B J Braden

Publications and source records attributed to B J Braden.

9 recordsLinked to original sources
PubMed1999

Pressure ulcer patient and wound assessment: an AHCPR clinical practice guideline update.

The Agency for Health Care Policy and Research (AHCPR) clinical practice guidelines on the treatment of pressure ulcers are based on the literature published before 1994. For the patient and wound assessment recommendations, a review of the literature from 1993 to 1998 was conducted in an effort to update this section of the guideline. In addition, the strength-of-evidence rating system used was critiqued for its narrow definitions, particularly as it pertains to recommendations related to assessment practices. Studies to determine the prospective validity of the entire guideline, as well as further research to assess the validity of individual recommendations, is needed.

Humans↗
PubMed1998

The relationship between stress and pressure sore formation.

The purpose of this study was to explore the relationship between serum cortisol and pressure sore formation among persons over age 65 who recently relocated to a nursing home. Twenty-six subjects who exhibited risk for pressure sore formation and were free of pressure sores and diagnoses or medications known to affect cortisol were recruited from consecutive admissions to a nursing home. Morning and evening cortisol levels were assayed the first and second weeks following admission, and subject's skin and risk status were assessed twice weekly for five weeks. Subjects who developed pressure sores had significantly higher cortisol levels than those who did not (p < 0.02), with the greatest differences occurring in the second week (p < 0.002). The cortisol levels observed in subjects who developed pressure sores may be due to the stress of relocation, but other explanations are also possible. Furthermore, a causal relationship between cortisol and pressure sore development cannot be inferred.

Adaptation, Psychological↗
PubMed1997

Computerized decision support systems: implications for practice.

The informatics literature variously defines Computerized Decision Support (CDS) systems. These definitions are sometimes narrow and sometime broad, leading to occasional confusion in terminology. For purposes of this paper, a broad definition that enjoys some professional consensus has been adapted from Langston and colleagues: CDS systems encompass any computer software employing a knowledge base (facts and/or rules) designed for use by a clinician involved in patient care, as a direct aid to clinical decision-making.

Decision Making, Computer-Assisted↗
PubMed1994

Predictive validity of the Braden Scale for pressure sore risk in a nursing home population.

The predictive validity of the Braden Scale and the timing of assessment for optimal prediction of pressure sore development (PS) were studied in a nursing home population. Subjects (N = 102) over age 19, free of PS and admitted within the previous 72 hr, were randomly selected from consecutive admissions to a skilled nursing facility. Subjects were assessed for risk and skin condition every 48 to 72 hr for 4 weeks. Twenty-eight subjects (27.5%) developed a PS. A cut score of 18 used at the observation prior to the first recorded PS maximized prediction, producing a sensitivity of 79%, a specificity of 74%, a 54% predictive value of a positive test, 90% predictive value of a negative test, and 75% correct classification rate.

Aged↗
PubMed1987

A clinical trial of the Braden Scale for Predicting Pressure Sore Risk.

The purpose of this article was to describe the protocol by which predictive instruments can be tested for validity and to evaluate the usefulness of an instrument for predicting pressure sore risk in an AICU. The Braden Scale for Predicting Pressure Sore Risk was described. Methods for measuring predictive validity and for calculating sensitivity, specificity, and per cent predictive value of positive and negative tests were discussed. Sixty consecutively admitted AICU patients who were pressure sore free were rated for pressure sore risk within 24 to 72 hours after admission. The skin condition of each patient was systematically assessed every 2 days. Twenty-four subjects developed pressure sores during the study period. The critical cut-off point at which the patient could be judged to be at risk for pressure sore formation was a Braden Scale score equal to or less than 16. The sensitivity and specificity of the scale at this score were 83 to 64 per cent, respectively. The per cent predictive value of a positive and negative test were 61 and 85 per cent, respectively. The Braden Scale compared favorably with the Norton Scale in respect to sensitivity. The specificity, or the tendency of a scale to overpredict, was greater for the Norton than for the Braden Scale. The Norton Scale overpredicted by 64 per cent, whereas the Braden Scale overpredicted by 36 per cent. This difference may be important clinically if all patients who were judged to be at risk received additional nursing care or protective devices. A greater number of patients may receive unnecessary and expensive treatments using the Norton Scale.

Adult↗
PubMedDate not supplied

The Braden Scale for Predicting Pressure Sore Risk.

The Braden Scale for Predicting Pressure Sore Risk was developed to foster early identification of patients at risk for forming pressure sores. The scale is composed of six subscales that reflect sensory perception, skin moisture, activity, mobility, friction and shear, and nutritional status. Content and construct validity were established by expert opinion and empirical testing. Three studies of reliability are reported here, using raters who varied in level of educational preparation and geographic region. Two prospective studies of predictive validity were completed to determine the scale's sensitivity and specificity. Reliability ranged from r = .83 to r = .94 for nurses' aides and licensed practical nurses; when used by registered nurses, the reliability increased to r = .99. Predictive validity was calculated for each cut-off point of the scale. Using a cut-off point of 16, sensitivity was 100% in both studies. Specificity ranged from 64% to 90%. This instrument has highly satisfactory reliability when used by RNs, and greater sensitivity and specificity than instruments previously reported.

Adolescent↗
PubMedDate not supplied

Risk assessment and risk-based programs of prevention in various settings.

An assortment of screening tools exist to estimate risk for pressure ulcer development. The Braden Scale has undergone testing in several settings which guide users in answering the following questions: Who should assess risk? Does cut-off score differ by setting? Does timing of assessment vary by setting? Is formal risk assessment necessary? How does risk assessment fit into a program of prevention? Based on these studies, RNs are able to use the Braden Scale more reliably than Nurse Aides and LPNs. While the Braden Scale does not replace clinical judgement, its use will help caregivers of all levels to identify at risk patients and intervene for specific risk factors. Generally, all patients should be assessed upon admission and 24 to 48 hours later, followed by ongoing assessment. A formal risk-based program is effective in both reducing the incidence of pressure ulcers and the costs associated with prevention. Protocols can be developed to address each level of risk, with each level requiring more aggressive preventive modalities. Some investigators have also tied interventions to specific subscale scores. It is important that risk assessment and risk-based protocols such as the Braden Scale become a standard of practice in all healthcare settings.

Education, Nursing, Continuing↗