***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 purpose of this study was to identify  pressure ulcer ( PU ) incidence and risk factors that are associated with PU development in patients in two adult intensive care units ( ICU ) in Saudi Arabia . A prospect i ve cohort study design was used . A total of 84 participants were screened second daily basis until discharge or death , over a consecutive 30-day period , out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3 % ( 33/84 participants ) . The incidence of medical devices-related PUs was 8·3 % ( 7/84 ) . Age , length of stay in the ICU , history of cardiovascular disease and kidney disease , infrequent repositioning , time of operation , emergency admission , mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU . According to binary logistic regression analyses , age , longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs , while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs . In conclusion , PU incidence rate was higher than that reported in other international studies . This indicates that urgent attention is required for PU prevention strategies in this setting AIM This study identified risk factors for pressure ulcer development early in the admission stage to determine what appropriate interventions might be conducted early in the admission stage to decrease the risk of pressure ulcer development . BACKGROUND Among patients who develop pressure ulcers , 8 - 40 % of them occur in a critical care setting . Therefore , the development of pressure ulcers is a common problem . DESIGN Prospect i ve cohort study . METHODS The study facility was a 606-bed tertiary care hospital . Ninety eight patients admitted to the intensive care unit ( ICU ) or the high care unit ( HCU ) from 16 April 2003 - 15 July 2003 were evaluated in the final analysis . RESULTS The mean patient age was 62.3 ( SD 16.1 ) years , and the incidence of pressure ulcers in this study was 11.2 % during the observation period . Multivariate analysis showed that ' emergency ICU/HCU patients ' and ' infrequent turning ' were related to pressure ulcer development .  Patients with pressure ulcers experienced significantly fewer turns and repositionings ( OR = 0.452 , 95 % CI : 0.212 - 0.966 ] , p < 0.05 . Fewer pressure ulcers developed in scheduled ICU/HCU patients than in emergency ICU/HCU patients ( OR = 0.041 [ 95 % CI : 0.004 - 0.470 ] , p < 0.01 ) . CONCLUSION There was no relationship between pressure ulcer development and APACHE II score , or any medication that affected skin integrity . The frequency of turning and repositioning and patients with an emergency admission to the ICU/HCU can be the prognostic indicators for developing scoring system in critical care setting s. RELEVANCE TO CLINICAL PRACTICE These patients admitted directly to ICU or HCU were in a high risk group , further preventive strategies will be required AIMS To determine the incidence of  pressure ulcers occurring at least 48 hours after admission and risk factors for  pressure ulcers grade 2 - 4 in a long-stay surgical Intensive Care Unit ( ICU ) population . BACKGROUND The incidence of  pressure ulcers  in intensive care units is larger than in non-intensive environments . DESIGN Prospect i ve descriptive research design . METHODS Using pressure ulcers grade 2 - 4 as an outcome measure , a multivariate logistic regression analysis was used to identify the risk factors . Data were obtained on a daily basis in a surgical intensive care unit of the University Hospital Leuven between November 2003-March 2004 . A total of 520 long-stay ( > or= 24 hours ) intensive care patients were included . RESULTS Cumulative incidence of pressure ulcers grade 2 - 4 was 20.1 % . The following variables were positively associated with pressure ulcers grade 2 - 4 : history of vascular disease , treatment with Dopamine or Dobutamine , intermittent haemodialysis ( IHD ) or continuous veno-venous haemofiltration ( CVVH ) , mechanical ventilation .  Also preventive measures were statistically positively associated with pressure ulcers grade 2 - 4 : turning , floating heels , alternating mattresses , adequate prevention . The use of sedatives , body temperature above 38.5 degrees C and sitting in chair where negatively associated with pressure ulcers . Pressure ulcers are statistically associated with different risk factors and preventive measures . CONCLUSION The identified risk factors are eligible to be included in a new risk assessment scale for patients admitted to intensive care units . RELEVANCE TO CLINICAL PRACTICE The novel insights have implication s for risk assessment for patients in intensive care units . Patients admitted to intensive care units have other risk factors for pressure ulcers which are eligible to be included in a new risk assessment scale The analytical effect of the number of events per variable ( EPV ) in a proportional hazards regression analysis was evaluated using Monte Carlo simulation techniques for data from a r and omized trial containing 673 patients and 252 deaths , in which seven predictor variables had an original significance level of p < 0.10 . The 252 deaths and 7 variables correspond to 36 events per variable analyzed in the full data set . Five hundred simulated analyses were conducted for these seven variables at EPVs of 2 , 5 , 10 , 15 , 20 , and 25 . For each simulation , a r and om exponential survival time was generated for each of the 673 patients , and the simulated results were compared with their original counterparts . As EPV decreased , the regression coefficients became more biased relative to the true value ; the 90 % confidence limits about the simulated values did not have a coverage of 90 % for the original value ; large sample properties did not hold for variance estimates from the proportional hazards model , and the Z statistics used to test the significance of the regression coefficients lost validity under the null hypothesis . Although a single boundary level for avoiding problems is not easy to choose , the value of EPV = 10 seems most prudent . Below this value for EPV , the results of proportional hazards regression analyses should be interpreted with caution because the statistical model may not be valid 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 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 care hospitals , 8.7 % of the stage 1 pressure ulcers deteriorated to a higher stage , vs. 22.1 % in acute care hospitals . No significant patient characteristics were found to affect the course of stage 1 , except that women in acute care hospitals more often had a stage 1 pressure ulcer at the first re assessment than men . In general , patients whose stage 1 ulcer deteriorated were undergoing more preventive interventions ; not all differences were significant . We conclude that , although stage 1 is reversible in most cases , it can be interpreted as an important warning sign for nurses and patients to act . If no adequate interventions are applied , the pressure ulcer may deteriorate BACKGROUND Implementation of the ruling on the Inpatient Prospect i ve Payment System by the Centers for Medicare and Medicaid has challenged nurses to focus on the prevention of pressure ulcers . Despite years of research , pressure ulcers are still one of the most common complications experienced by patients in health care facilities . OBJECTIVE To examine the relationship between patients ' characteristics ( age , sex , body mass index , history of diabetes , and Braden Scale score at admission ) and care characteristics ( total operating room time , multiple surgeries , and vasopressor use ) and the development of pressure ulcers . METHODS In a cohort study , data from the electronic medical records of 3225 surgical patients admitted to a Midwest hospital , from November 2008 to August 2009 were analyzed statistically to determine predictors of pressure ulcers . RESULTS A total of 12 % of patients ( n = 383 ) had at least 1 pressure ulcer develop during their hospitalization . According to logistic regression analysis , scores on the Braden Scale at admission ( P < .001 ) , low body mass index ( P < .001 ) , number of vasopressors ( P = .03 ) , multiple surgeries during the admission ( P < .001 ) , total surgery time ( P < .001 ) , and risk for mortality ( P < .001 ) were significant predictors of pressure ulcers . CONCLUSION Scores on the Braden Scale at admission can be used to identify patients at increased risk for pressure ulcers . For other high-risk factors , such as low body mass index and long operative procedures , appropriate clinical interventions to manage these conditions can help prevent pressure ulcers PURPOSE : We sought to describe the occurrence of pressure ulcers in patients managed in a surgical intensive care unit ( ICU ) and report preliminary work toward development of a pressure ulcer risk assessment tool for use in this population that incorporates comorbidities and other factors not addressed in previous instruments . SUBJECTS AND SETTING S : Three hundred sixty-nine patients managed in the surgical ICU at Yale-New Haven Hospital comprised the sample . METHODS : Demographic and clinical data , including Braden Scale scores , were collected in this prospect i ve , 2-phase study . The principal investigator ( G.C.S. ) performed skin assessment s on all patients . We used chi-square analysis and t tests to determine variables to include in a stepwise logistic regression analysis to determine factors independently associated with the development of pressure ulcers . INSTRUMENT : We collected data , using a form we developed that contained demographic and clinical factors found in previous research and in our clinical practice to be associated with pressure ulcers . RESULTS : Eighty-eight out of 369 patients ( 23.9 % ) experienced a hospital-acquired pressure ulcer . Braden Scale scores ranged from 6 to 21 , with a mean score of 11.9 ± 2.2 . A lower Braden Scale score , the presence of diabetes mellitus , and patient age 70 years or older independently predicted the development of a pressure ulcer . These factors have been incorporated into the preliminary Surgical ICU Pressure Ulcer Risk Assessment scale . CONCLUSIONS : Findings from this study suggest that , in addition to a low Braden Scale score , age > 70 years and a diagnosis of diabetes may represent clinical ly relevant pressure ulcer risk factors in the surgical intensive care population and that patients with these factors may benefit from more aggressive preventive care . In addition , the Surgical ICU Pressure Ulcer Risk Assessment scale requires additional psychometric testing before its use can be recommended for the research or practice setting AIMS AND OBJECTIVES The study aim ed to evaluate the predictive validity and accuracy of a new pressure ulcer risk assessment scale  in two Indonesia intensive care units ( ICUs ) . BACKGROUND Several risk assessment scales have been design ed to identify patients at risk of developing pressure ulcers in ICU . However , the relative weight of each variable that contributes to pressure ulcer development in these scales is not described to enable design ing of a risk 
    Output:
    
Maximal pressure injury prevention efforts are particularly important among critical-care patients who are older , have altered mobility , experience poor perfusion , or who are receiving a vasopressor infusion