ORCID Profile
0000-0002-8287-2560
Current Organisation
Singapore General Hospital
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Publisher: Wiley
Date: 13-03-2023
DOI: 10.1002/HCS2.30
Abstract: Little is known about stage 1 and 2 pressure injuries that are health care‐acquired. We report incidence rates of health care‐acquired stage 1 and stage 2 pressure injuries, and, estimate the excess length of stay using four competing analytic methods. We discuss the merits of the different approaches. We calculated monthly incidence rates for stage 1 and 2 health care‐acquired pressure injuries occurring in a large Singapore acute care hospital. To estimate excess stay, we conducted unadjusted comparisons with a control cohort, performed linear regression and then generalized linear regression with a gamma distribution. Finally, we fitted a simple state‐based model. The design for the cost attribution work was a retrospective matched cohort study. Incidence rates in 2016 were 0.553% (95% confidence interval [CI] 0.55, 0.557) and 0.469% (95% CI 0.466, 0.472) in 2017. For data censored at 60 days’ maximum stay, the unadjusted comparisons showed the highest excess stay at 17.68 (16.43‐18.93) days and multi‐state models showed the lowest at 1.22 (0.19, 2.23) days. Poor‐quality methods for attribution of excess length of stay to pressure injury generate inflated estimates that could mislead decision makers. The findings from the multi‐state model, which is an appropriate method, are plausible and illustrate the likely bed‐days saved from lowering the risk of these events. Stage 1 and 2 pressure injuries are common and increase costs by prolonging the length of stay. There will be economic value investing in prevention. Using biased estimates of excess length of stay will overstate the potential value of prevention.
Publisher: BMJ
Date: 09-2023
Publisher: Wiley
Date: 13-03-2023
DOI: 10.1111/IWJ.14132
Abstract: Venous leg ulceration results in significant morbidity. However, the majority of studies conducted are on Western populations. This study aims to evaluate the wound healing and quality of life for patients with venous leg ulcers (VLUs) in a Southeast Asian population. This is a multi‐centre prospective cohort study from Nov 2019 to Nov 2021. All patients were started on 2‐ or 4‐layer compression bandage and were reviewed weekly or fortnightly. Our outcomes were wound healing, factors predictive of wound healing and the EuroQol 5‐dimensional 5‐level (EQ‐5D‐5L) health states. Within our cohort, there were 255 patients with VLU. Mean age was 65.2 ± 11.6 years. Incidence of diabetes mellitus was 42.0%. Median duration of ulcer at baseline was 0.30 years (interquartile range 0.136–0.834). Overall, the median time to wound healing was 4.5 months (95% confidence interval [CI]: 3.77–5.43). The incidence of complete wound healing at 3‐ and 6‐month was 47.0% and 60.9%, respectively. The duration of the wound at baseline was independently associated with worse wound healing (Hazard ratio 0.94, 95% CI: 0.89–0.99, P = .014). Patients with healed VLU had a significantly higher incidence of perfect EQ‐5D‐5L health states at 6 months (57.8% vs 13.8%, P .001). We intend to present longer term results in subsequent publications.
Location: Ireland
No related grants have been discovered for David Carmody.