***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: 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 r and omly 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 BACKGROUND There have been no studies that have tested the Braden Scale for predictive validity and established cutoff points for assessing risk specific to different setting s. OBJECTIVES To evaluate the predictive validity of the  Braden Scale  in a variety of setting s ( tertiary care hospitals , Veterans Administration Medical Centers [ VAMCs ] , and skilled nursing facilities [ SNFs ] ) . To determine the critical cutoff point for classifying risk in these setting s and whether this cutoff point differs between setting s. To determine the optimal timing for assessing risk across setting s. METHOD R and omly selected subjects ( N= 843 ) older than 19 years of age from a variety of care setting s who did not have pressure ulcers on admission were included . Subjects were 63 % men , 79 % Caucasian , and had a mean age of 63 ( + /-16 ) years . Subjects were assessed for  pressure ulcers  using the  Braden Scale  every 48 to 72 hours for 1 to 4 weeks . The  Braden Scale score and skin assessment  were independently rated , and the data collectors were blind to the findings of the other measures . RESULTS One hundred eight of 843 ( 12.8 % ) subjects developed pressure ulcers . The incidence was 8.5 % , 7.4 % , and 23.9 % in tertiary care hospitals , VAMCs , and SNFs , respectively . Subjects who developed pressure ulcers were older and more likely to be female than those who did not develop ulcers . Braden Scale scores were significantly ( p = .0001 ) lower in those who developed ulcers than in those who did not develop ulcers . Overall , the critical cutoff score for predicting risk was 18 . Risk assessment on admission is highly predictive of pressure ulcer development in all setting s but not as predictive as the assessment completed 48 to 72 hours after admission . CONCLUSIONS Risk assessment on admission is important for timely planning of preventive strategies . Ongoing assessment in SNFs and VAMCs improves prediction and permits fine-tuning of the risk-based prevention protocol s. In tertiary care the most accurate prediction occurs at 48 to 72 hours after admission and at this time the care plan can be refined The purpose of this study was to examine the predictive validity of the Braden scale in predicting pressure sore risk and to determine the physiological and nonphysiological variables associated with the prediction of  pressure ulcers in Black and Latino/Hispanic elders . A prospect i ve clinical design ws used to conduct the study . Among 74 patients aged 60 years or older , 24 patients ( 32 % ) developed either a stage 1 or stage 2 pressure ulcer .  Black elders had a higher incidence rate ( 21 % ) than Latino/Hispanic elders ( 11 % ) . A 2-tailed Fisher 's exact test revealed that the Braden scale  with a cutoff score of 18 was highly associated with predicting Black elders aged 75 years and older who were at risk of developing pressure ulcers ( p < or = .011 ) . Sensitivity was 81 % and specificity was 100 % . The female gender was also a highly significant factor in the development of pressure ulcers ( chi 2(1 , N = 49 ) = 6.4 , p < or = .011 ) . Overall , the Braden scale was found to be a valid tool in predicting pressure ulcer risk in Black elders aged 75 years or older when a cutoff score of 18 is used OBJECTIVE To identify specific demographic , medical , functional status , and nutritional characteristics that predict the development of stage 2 or greater pressure ulcers among patients whose activity is limited to bed or chair . DESIGN Prospect i ve inception cohort study . SETTING Tertiary care , urban , university teaching hospital . PATIENTS A total of 286 patients fulfilling the following criteria : admitted to the hospital within the previous 3 days , age 55 years or more , expected to be confined to bed or chair for at least 5 days or had a hip fracture , and without a stage 2 or greater pressure ulcer . MAIN OUTCOME MEASURE Time to in-hospital development of a stage 2 or greater pressure ulcer . RESULTS Total cumulative incidence of pressure ulcers was 12.9 % ( n = 37 ) after a median time of 9 days from admission to final skin examination . Age of 75 years or more ,  dry skin , nonblanchable erythema ( a stage 1 pressure ulcer ) , previous pressure ulcer history , immobility , fecal incontinence , depleted triceps skinfold , lymphopenia ( lymphocyte count < 1.50 x 10(9)/L ) , and decreased body weight ( < 58 kg ) were significantly associated with pressure ulcer development by univariate Kaplan-Meier survival analyses ( P < .05 by log-rank test ) . Risk ratios ( and 95 % confidence intervals ) for predictors ( P < or = .05 ) of pressure ulcer development after multivariable Cox regression analysis included the following : nonblanchable erythema , 7.52 ( 1.00 to 59.12 ) ; lymphopenia , 4.86 ( 1.70 to 13.89 ) ; immobility , 2.36 ( 1.14 to 4.85 ) ; dry skin , 2.31 ( 1.02 to 5.21 ) ; and decreased body weight , 2.18 ( 1.05 to 4.52 ) . The 3-week cumulative incidence of pressure ulcers with none , one , two , or three or more of these characteristics was 0 % , 11.4 % , 39.6 % , and 67.9 % , respectively ( P < .001 by log-rank test ) . CONCLUSIONS These results suggest that nonblanchable erythema , lymphopenia , immobility , dry skin , and decreased body weight are independent and significant risk factors for pressure ulcers in hospitalized patients whose activity is limited to bed or chair This article describes a method for estimating the  inter-rater reliability of pressure ulcer ( PU ) staging ( stages I-IV ) from raters in National Data base of Nursing Quality Indicators ( NDNQI ) participating hospitals . The method models ordinal spanning data utilizing an ordinal probit Bayesian hierarchical model ( BHM ) across several hospitals in which raters monitor patient 's PUs . An ulcer that can not be accurately assessed because the base of the wound can not be seen is defined as unstageable . Our novel approach allows for an unstageable PU rating to be included in the analysis . We compare the ordinal probit BHM to an approximate r and om-effects ( st and ard approach in the literature ) model that assumes that the raw ordinal data are continuous OBJECTIVE To determine the incidence of pressure ulcers in varied population s , and whether demographic characteristics ( age , gender , race ) and primary diagnosis are factors in pressure ulcer development when the level of risk for developing ulcers is considered . To determine if there is a difference in the type of preventive services prescribed for persons who do or do not develop pressure ulcers when risk is controlled and whether differences can be related to demographic characteristics . DESIGN Cohort study . SETTING Two skilled nursing homes , two university operated tertiary care hospitals , and two Veteran 's Administration Medical Centers ( VAMCs ) in Omaha , NE , Durham , NC , and Chicago , IL . PATIENTS A total of 843 r and omly selected patients more than 19 years of age who did not have pressure ulcers on admission to their place of care . Subjects were 63 % male , 79 % white , and had a mean age of 63 ( + /- 16 ) years . MEASURES A head-to-toe skin assessment for pressure ulcers recording site and stage of ulcers , scores for the Braden Scale for Predicting Pressure Sore Risk , demographic characteristics ( age , sex , race ) , and primary diagnosis and preventive interventions ( turning or repositioning orders and pressure reduction surface ) were documented on the patient record . Observations were made every 48 to 72 hours for a minimum of 1 to a maximum of 4 weeks . MAIN OUTCOME MEASURES Presence/absence and stage of pressure ulcers . MAIN RESULTS One hundred eight of 843 ( 12.8 % ) subjects developed pressure ulcers . The incidence was 8.5 % , 7.4 % , and 23.9 % in tertiary care , VAMCs , and nursing homes , respectively . Logistic regression demonstrated that lower Braden Scale scores , older age and white race predicted pressure ulcers ; gender was not predictive . Primary diagnoses were not significant predictors of pressure ulcer risk when the Braden Scale score was entered into the regression . Prescription of turning was predicted by Braden Scale scores and by white race , whereas prescription of pressure reduction was predicted by Braden Scale scores , white race , and female sex . CONCLUSIONS Risk assessment , rather than diagnoses or demographic characteristics , is recommended as the basis for prescriptive decisions . Risk assessment should cue health care providers to make more judicious use of turning and support surfaces to prevent pressure ulcers . Persons who are at risk for pressure ulcers should have turning and pressure reduction surfaces consistently prescribed and implemented . The costs and goals of preventive prescription for those not at risk for pressure ulcers should be considered AIMS AND OBJECTIVES In this experimental study , a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the st and ard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients . BACKGROUND Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5 % . The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population . Pressure-reducing devices on the operating room (OR)-table should reduce the patients ' interface pressure and thus the hazard of skin breakdown . METHODS A r and omized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table ( test OR-table ) compared with the st and ard OR-table ( a water-filled warming mattress , no pressure-reducing device ) on the postoperative pressure ulcer incidence in cardiac surgery patients . INSTRUMENTS The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel ( EPUAP ) was used for pressure ulcer grading . RESULTS The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer ( 17.6 % ) than patients on the st and ard OR-table without the foam overlay ( 11.1 % ) . Because of the clinical relevance of the results , the r and omized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients . CONCLUSIONS The combination of a 4-cm viscoelastic foam overlay and a warming source can not be recommended for pressure ulcer prevention on the operating room table . RELEVANCE TO CLINICAL PRACTICE Foam overlays are used to prevent pressure ulcers in patients . It is necessary to use such devices according to patient safety and use of re sources Stage 1 pressure ulcers are difficult to diagnose . Several prevalence studies have shown that almost half of the pressure ulcers identified are stage 1 . The present study investigated the importance of stage 1 . The following research questions were formulated : Is there a difference between the prevalence of stage 1 pressure ulcers identified in the institutions participating in the present study and that found in the other institutions participating in the Dutch National Prevalence Survey ? What percentage of stage 1 pressure ulcers are reversible within a few hours ? What is the clinical course of stage 1 pressure ulcers ? Which patient characteristics and preventive interventions are related to the clinical course of stage 1 ? The study used a prospect i ve , descriptive and comparative design . All patients of six long-term care hospitals and six acute care hospitals in whom stage 1 pressure ulcers were identified during the 1999 National Prevalence Survey in the Netherl and s were followed for 1 week ( acute care hospitals ; n = 68 patients ) or 2 weeks ( long-term care hospitals ; n = 115 patients ) . The patients were reassessed using the question naire developed for the National Prevalence Survey ( patient characteristics , assessment of risk of pressure ulcers , characteristics of the pressure ulcers and use of preventive methods ) on the same day as the national survey itself , and again after 3 days , after 7 days and after 14 days ( only long-term care hospitals ) . The results showed fewer stage 1 pressure ulcers in the institutions participating in the present study than in the National Prevalence Survey , the difference being almost 50 % . The first re assessment found the prevalence of stage 1 to be further reduced by an average of almost 50 % , a reduction which was greater for the long-term care hospitals than for the acute care hospitals . However , some of the ulcers that had disappeared reappeared in subsequent re assessment s. In the long-term 
    Output:
    
There is at present not enough evidence to recommend a specific pressure ulcer classification system for use in daily practice .