摘要：Objective The present study aims to explore the individualized treatment options for multisite pressure ulcer (PU) at various stages in elderly patients with multiple medical conditions. Methods Stages 1 and 2 PU at 146 sites were treated with closed negative pressure suction combined with continuous micro-oxygen perfusion and the local application of foam dressings, silver ion dressings, and moist burn cream. Stages 3 and 4 PU in the sacrococcygeal region were treated with skin or myocutaneous flap transplantation. Results Stages 1 and 2 PU healed after treatment with closed negative pressure suction combined with continuous micro-oxygen perfusion and dressing changes. One case died during hospitalization due to an illness. Skin or myocutaneous flap repair was conducted in 34 cases of stage 3 or 4 PU in the sacrococcygeal area. Of these cases, 28 achieved primary healing, and 6 required two or three surgeries, 5 of which received micro-skin implantation. In addition, 10 small deep PU at other sites were repaired by direct excision and suturing or local flap repair. Seven cases were transferred to other departments or hospitals due to concomitant diseases or were discharged automatically without surgical treatment. Conclusion Home care for geriatric patients is difficult. PU often occur at multiple sites because of the duration of various pressures, and different sites may demonstrate different stages because of varying degrees of pressure. When actively treating stages 3 and 4 PU, the trauma management of stages 1 and 2 PU should not be neglected.

摘要：CONTEXT: Moist exposed burn ointment (MEBO), from China, has been said to revolutionize burn management. OBJECTIVE: Our study was conducted to compare MEBO with conventional management (C) with respect to the rate of wound healing, antibacterial and analgesic effect, and hospital costs. DESIGN: This is a prospective, randomized, controlled clinical trial conducted between 1 March 1997 and 24 October 1998. SETTING: The trial was conducted in a specialized burn facility located in a tertiary referral hospital in a developed and industrialized island-state in Southeast Asia. PATIENTS: We randomly assigned 115 consecutive patients between the ages of 12 and 80 who had partial-thickness thermal burns covering less than 40% of body surface area (BSA) to receive either MEBO or C. Fifty-seven patients were assigned to MEBO and 58 patients to C. The latter group received twice-daily dressing changes; MEBO patients received MEBO every 4 hours. MAIN OUTCOME MEASURES: Patients were hospitalized until 75% BSA had healed. BSA was determined by visual inspection and charted on Lund and Browder charts regularly. Wound healing rate, bacterial infection rate, pain score, and hospitalization costs were recorded. RESULTS: The median time to 75% healing was 17.0 and 20.0 days with MEBO and C, respectively (HR = 0.67, 95% CI = 0.41-1.11, P =.11), suggesting similar efficacy between the 2 modalities. Bacterial infection rates were similar between the 2 groups (HR = 1.10, 95% CI = 0.59-2.03, P =.76). MEBO imparted a greater analgesic effect in the first 5 days of therapy and reduced hospital costs by 8%. CONCLUSIONS: MEBO is as effective as conventional management but is not the panacea for all burn wounds. The use of MEBO eases the management of face and neck burns and facilitates early institution of occupational therapy in hand burns. It confers better pain relief such that fewer opiates are used during the first 5 days after burn injury.

摘要：Objective:The objective is to outline the overall health scene as it is in New Zealand and to demonstrate that there is tremendous potential for the increased use of Moist Exposed Burn Therapy(MEBT)across a wide variety of health care facilities within New Zealand.Method:The presentation allows me to share with you evidence from clini- cal based practice and examples of how and where MEBT and the product Moist Exposed Burn Ointment(MEBO)has been used within New Zealand' s health services.This will include evidence from other nursing colleagues who work in the Aged Care sector or in the New Zealand community.Result:My experiences in the clinical field have enabled me to see that there is much that can be done through education for nurses by professional nurse educators. Currently there is little or no funding available to Nurse Educators for them to be able to provide the required education and training,or to be able to introduce the correct clini- cal techniques of MEBT into our heahhcare profession. Patients who require wound management and have been treated using the MEBT method are provided with sustained wound healing,improved outcomes and consequently an improved quality of life. New Zealand health providers are beginning to realize that use of MEBT and MEBO is a cost effective form of treatment.Not only in monetary terms but in ethical and physiolog- ical terms as well.At this point in time however,there is evidence that nurses will experi- ment with products such as MEBO but revert back to techniques and products they know and are comfortable with in day to day nursing situations. It can therefore be concluded that New Zealand nurses do not have adequate knowl- edge or understanding of the clinical application of MEBT/MEBO to achieve the optimum results for their patients. Ongoing education is essential to ensure that nurses,who are using MEBT,under- stand the principals of MEBT and follow the correct clinical application. There has been evidence,during my clinical practice,of New Zealand nurses using MEBT alongside the current New Zealand wound management techniques and this combi- nation has often led to a misunderstanding about MEBT and the incorrect use of MEBO. As a result the patient outcomes are often substandard compared with the recommen- ded MEBT practice and the resulting potential for the increased quality of life is not fully realized by patient or practitioner. With the acceptance of a changing methodology and its education within the New Zea- land nursing culture,there is significant potential for this wound management concept to be widely used,particularly within the Aged Care and Disabilities sectors within New Zea- land prior to registration of MEBO being granted. With the full registration of the MEBO product,we will be able to use this treatment to its full potential to provide improved patient outcomes and an increase in quality of life for patients within New Zealand. My clinical knowledge of MEBT has helped me to initiate a starting point of MEBT education in New Zealand-currently focused on regional nurse education and community awareness.This will help facilitate the understanding,enthusiasm and commitment for this treatment across New Zealand and enable nurses to gain the necessary support to bring a- bout this change in wound management.