More than a passing interest.
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Biomedical subjects
Publications and source records attributed to Joyce M Black.
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Several categories of patients may be receiving anticoagulation therapy and require surgery. Many patients take cardioprotective aspirin or warfarin for atrial fibrillation, the presence of a mechanical heart valve, prior thromboembolism, a documented left ventricular thrombus, or a history of venous thromboembolism with or without a pulmonary embolism. Inpatients may be receiving injectable forms of anticoagulation to reduce risk of deep venous thrombosis or for other conditions, such as atrial fibrillation. Patients receiving any type of anticoagulation present a problem when they require surgery because the interruption of anticoagulant therapy increases their risk of thromboembolism and stroke (Schanbacher & Bennett, 2000). Rational decisions regarding the appropriateness of perioperative anticoagulation depend on individual patient factors and can only be made when the risk of perioperative thromboembolism is balanced against the risk of perioperative bleeding.
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OBJECTIVE: To identify how current pressure ulcer staging systems and experts describe pressure-related deep tissue injury under intact skin in the published research literature. DESIGN: A systematic review of published English-language literature as of November 2002 with the words decubitus or pressure ulcer(s) in the title. Additional relevant articles were identified by National Pressure Ulcer Advisory Panel members and were included in the analysis. An expert commentary was developed by iterative review by the National Pressure Ulcer Advisory Panel members. MAIN OUTCOME MEASURES: Manuscripts were reviewed for staging systems cited or described, definitions of Stage I pressure ulcers, and descriptions or definitions of pressure-related deep tissue injury under intact skin. MAIN RESULTS: Ninety-four relevant articles were identified. Seventy-three articles (78%) described a staging system, and 55 of 73 (75%) cited the staging definitions from Shea, the National Pressure Ulcer Advisory Panel, or the Agency for Health Care Policy and Research. The National Pressure Ulcer Advisory Panel's staging definitions were the most frequently cited overall. Twenty-three articles (25%) included some discussion that could be interpreted as relevant to the topic of pressure-related deep tissue injury under intact skin; however, no consistency in definitions of Stage I pressure ulcers or terminology for pressure-related deep tissue injury under intact skin was found. CONCLUSIONS: Several pressure ulcer staging systems are frequently cited, but none define pressure-related deep tissue injury under intact skin. The National Pressure Ulcer Advisory Panel recommends using the terms "pressure-related deep tissue injury under intact skin" or "deep tissue injury under intact skin" for describing these lesions and encourages investigators to establish the epidemiology and natural history of these lesions.