***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the impact of in-hospital pressure ulcer development on mortality among older , high-risk , hospitalized patients up to 1 year post-hospital discharge , after adjusting for baseline patient characteristics , disease severity , hospital complications , and discharge activity level . DESIGN A prospect i ve , inception , cohort study . SETTING An urban , tertiary , acute care , university teaching hospital . PATIENTS A total of 286 patients aged 55 or older , expected to be confined to bed or chair for at least 5 days , who were admitted to the hospital without a Stage 2 or greater pressure ulcer . MEASUREMENTS The primary outcome measurement was time to death from admission to 1-year post-hospital discharge . Baseline information included demographic , medical , functional , and nutritional variables known to be associated with increased mortality . Measures of global disease severity and co-morbidity included the admitting physician 's estimate of illness severity and life expectancy , the acute physiology score of APACHE II , the Co-morbidity Damage Index , and the Medicus Nursing Classification Score . Baseline infections , incident infections , and noninfectious hospital complications were determined . Functional activity level was determined at hospital discharge . Post-discharge vital status was determined by telephone interviews at 3,6,9 , and 12 months after discharge and confirmed by death certificate review . MAIN RESULTS Development of an in-hospital pressure ulcer was associated with greater risk of death at 1 year ( 59.5 % vs 38.2 % , P = .02 ) . However , pressure ulcer development did not remain independently associated with decreased survival after adjusting for other predictors of mortality . Predictors of mortality at hospital admission by multivariate Cox regression analysis included weight loss in the 6 months before admission ( RR 2.4 , CI 1.6 , 3.6 ) , physician estimate of life expectancy ( RR 2.1 , CI 1.7 , 2.6 ) , and the Co-morbidity Damage Index ( RR 1.1 , CI 1.0 , 1.2 ) . Multivariate predictors of 1-year mortality at discharge included physician estimate of life expectancy ( RR 2.2 , CI 1.8,2.6 ) , weight loss in the 6 months before admission ( RR 2.2 , CI 1.5,3.2 ) , remaining confined to bed or chair ( RR 1.9 , CI 1.2,3.1 ) , and the total number of hospital complications ( RR 1.3 , CI 1.2,1.5 ) . CONCLUSIONS Pressure ulcers that develop during acute hospitalization are not associated with reduced 1-year survival among high risk older persons after adjusting for nutritional and functional status , global measures of disease severity and co-morbidity , and noninfectious hospital complications 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 prospect i ve 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 cutoff 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 BACKGROUND Although guidelines advise against massage , it is one of the methods widely regarded and used by nurses to prevent pressure ulcers ( PU ) . OBJECTIVES The purpose of this study was to examine the effectiveness of different variations of massage in preventing pressure ulcers . METHODS A r and omized , double-blind cross-over design , in which patients of nursing homes who are prone to PU underwent two of the three possible interventions ; ' position changes only ' , ' massaging with an indifferent cream ' and ' massaging with a dimethyl sulfoxide ( DMSO ) cream ' . RESULTS The results of three interventions did not differ significantly . DMSO did not fulfil the expectations raised by literature and a previous pilot- study OBJECTIVE To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay . Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not . DESIGN Cross-sectional , observational study . SETTING Tertiary-care referral and teaching hospital in Australia . PATIENTS Two thous and hospitalized patients 18 years and older who had a minimum stay in the hospital of 1 night and admission to selected clinical units . METHODS Two thous and participants were r and omly selected from 4,500 patients enrolled in a prospect i ve survey conducted between October 2002 and January 2003 .  Quantile median robust regression was used to assess risk factors for excess length of hospital stay . RESULTS Having a pressure ulcer result ed in a median excess length of stay of 4.31 days . Twenty other variables were statistically significant at the 5 % level in the final model . CONCLUSIONS Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis . However , our estimates were substantially lower than those currently used to make predictions of the economic costs of pressure ulcers ; existing estimates may overstate the true economic cost UNLABELLED BACKGROUND L : Pressure ulcers are common , costly and impact negatively on individuals . Pressure is the prime cause , and immobility is the factor that exposes individuals to pressure . International guidelines advocate repositioning ; however , there is confusion surrounding the best method and frequency required . DESIGN A pragmatic , multi-centre , open label , prospect i ve , cluster-r and omised controlled trial was conducted to compare the incidence of  pressure ulcers among older persons nursed using two different repositioning regimens . METHOD Ethical approval was received . Study sites ( n=12 ) were allocated to study arm using cluster r and omisation . The experimental group ( n=99 ) were repositioned three hourly at night , using the 30 ° tilt ; the control group ( n=114 ) received routine prevention ( six-hourly repositioning , using 90 ° lateral rotation ) . Data analysis was by intention to treat ; follow-up was for four weeks . RESULTS All participants ( n=213 ) were Irish and white , among them 77 % were women and 65 % aged 80 years or older . Three patients ( 3 % ) in the experimental group and 13 patients ( 11 % ) in the control group developed a pressure ulcer ( p=0·035 ; 95 % CI 0·031 - 0·038 ; ICC=0·001 ) . All pressure ulcers were grade 1 ( 44 % ) or grade 2 ( 56 % ) . Mobility and activity were the highest predictors of pressure ulcer development ( β=-0·246 , 95 % CI=-0·319 to -0·066 ; p=0·003 ) ; ( β=0·227 , 95 % CI=0·041 - 0·246 ; p = 0·006 ) . CONCLUSION Repositioning older persons at risk of pressure ulcers every three hours at night , using the 30 ° tilt , reduces the incidence of pressure ulcers compared with usual care . The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines . RELEVANCE TO CLINICAL PRACTICE An effective method of pressure ulcer prevention has been identified ; in the light of the problem of pressures ulcers , current prevention strategies should be review ed . It is important to implement appropriate prevention strategies , of which repositioning is one AIMS AND OBJECTIVE The objective of this study was to identify prognostic factors associated with the development of pressure ulcer lesions ( grade 2 - 4 ) in nursing home patients with non-blanchable erythema . BACKGROUND No studies could be found that identify risk factors for further development of pressure ulcer in patients with non-blanchable erythema . For some patients with non-blanchable erythema , st and ard preventive measures do not suffice to prevent pressure ulcers from deterioration . Identifying these patients beforeh and can considerably contribute to the efficiency of pressure ulcer prevention . DESIGN Secondary data analyses of a previously conducted r and omised controlled trial were performed . METHODS Eighty-four wards of 16 Belgian nursing homes participated in the study . In total , 235 nursing home residents with a grade 1 pressure ulcer ( non-blanchable erythema ) were included . All the residents received st and ard preventive care . Potential prognostic factors were collected using a st and ardised form . The incidence of pressure ulcers was recorded according to the European pressure ulcer classification system . RESULTS The cumulative pressure ulcer incidence was 18.7 % ( 44/235 ) . Hypotension ( relative risk = 3.42 , 95 % CI = 1.56 - 7.49 ) , a history of a cerebral vascular accident ( relative risk = 1.94 , 95 % CI = 1.10 - 3.70 ) and contractures ( relative risk = 2.02 , 95 % CI 1.03 - 3.95 ) were identified as independent predictive factors for developing pressure ulcers . Remarkably , being urinary incontinent decreased the risk of developing a pressure ulcer by 76 % . CONCLUSIONS In nursing home residents with non-blanchable erythema , hypotension , contractures , and a history of cerebral vascular accident were independent risk factors for the development of pressure ulcer lesions . RELEVANCE TO CLINICAL PRACTICE Patients with non-blanchable erythema who have hypotension , contractures or a history of cerebral vascular accident are in need of more intensive preventive measures . Identifying these patients can contribute considerably to a more efficient pressure ulcer prevention policy , result ing in a lower pressure ulcer lesion incidence and in lower costs PURPOSE Nasal-ala pressure sores induced by nasotracheal intubation are common complications of oral and maxillofacial surgery , but are easily ignored . To determine whether such sores could be prevented , we studied the effects of a combination of cushioning material in an animal model , and then analyzed the efficacy of this combination clinical ly . MATERIAL S AND METHODS Four pigs received nasotracheal intubation .  Each pig received intubation for 4 , 8 , 12 , or 16 hours . Outcomes from pigs undergoing 500-gram-weight compression on each nostril were compared : one nostril received an application of cushioning material s , and the contralateral nostril did not . After the required study period , clinical assessment and further evaluation were performed by measuring pressure-sore dimensions and performing incisional biopsies . Clinical applications of this protective technique were then undertaken . Eight patients who underwent intubation without Soft Liner ( GC Co , Tokyo , Japan ) and DuoDERM CGF ( ConvaTec , Inc , Princeton , NJ ) protection , and 10 patients with Soft Liner and DuoDERM protection , were evaluated . RESULTS The protective efficacy of the cushioning material s was significant in the animal model as well as in clinical practice . Pressure sores were avoided on the protected side , with severe tissue necrosis documented on the control side . CONCLUSION We found that the combined use of Soft Liner and DuoDERM reduced the size and severity of nasal-ala pressure sores attributable to nasotracheal intubation during oral and maxillofacial surgery AIM This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients . BACKGROUND Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development . To eliminate these risks , we developed a dressing to reduce shear forces and improve the water-holding capacity . However , the effects of this dressing in clinical setting s remain unknown . METHOD An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development . The dressing was r and omly applied to the right or left greater trochanter for 3 weeks . No dressing was applied to the opposite side as a control . The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development . Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal . FINDINGS The incidence of persistent erythema was significantly lower in the intervention area than the control area [ P = 0.007 , RR 0.18 ( 95 % CI : 0.05 - 0.73 ) and NNT 4.11 ( 2.50 - 11.63 ) ] . No pressure ulcers occurred in either the intervention or control area . Skin hydration increased significantly during dressing application and remained high after removal ( P < 0.001 ) relative to the control area . Skin pH decreased significantly during the application ( P < 0.001 ) but returned to control levels after removal ( P = 0.38 ) . CONCLUSION This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers OBJECT 
    Output:
    
There is insufficient evidence from RCTs to support or refute the use of topical agents applied over bony prominences to prevent pressure ulcers .