are not currently included in the predictors. Since it is a prediction model that uses
only basic nursing information data that is always input to the electronic medical
record, it can be operated without requiring an additional burden on the clinical site
when implementing the automatic judgment function on the electronic medical
record. Prediction performance may be improved by adding more variables, and
the implementation and operation on electronic medical records are the future goals.
Thus, similar to the fall prediction study described above, it is possible for nurses
to predict the occurrence of pressure ulcers based on data collected by nurses in their
daily work, and that this information is updated daily. By using real-world data, it is
possible to perform clinically-based patient assessments that are not bound by
existing frameworks. This will improve the quality of nursing care.
3.2.3 Development of an Image-Based Innovative Assessment
of Pressure Ulcers Using Real-World Data
In order to properly manage pressure ulcers, it is necessary to understand whether
wound healing is progressing normally or being stalled. In the case of stalled wound
healing, clarifying the cause for proper management is needed. For this purpose, the
DESIGN-R
® evaluation scale, a gross pressure ulcer evaluation method, is used. On
the other hand, since this evaluation scale is a tool mainly based on gross findings, it
is not suitable for the evaluation of damage to deep tissues or invisible inflammation,
which is difficult to find from the outside. Therefore, focusing on deep tissue injury
and critical colonization, which are the two major problems in the management of
pressure ulcers, the authors will introduce emerging methods for evaluating pressure
ulcers using ultrasonography, thermography, and a rapid biofilm detection tool
developed through translational real-world data analyses.
3.2.4 Detecting Deep Tissue Injury by Ultrasonography
Pressure ulcers can be broadly divided into two types: where the damage progresses
from the surface to the deep part, and where the deep damage occurs first and the
tissue damage comes to the surface. The latter is called a deep tissue injury (DTI).
Although DTI is deeply damaged, it cannot be sufficiently judged by visual inspection or palpation from the surface, and thus treatment such as the sufficient distribution of body pressure is delayed, and a few days later, a deep pressure ulcer
becomes apparent. As shown in Fig. 6, even if it appears to be a slight injury to the
naked eye, it rapidly worsens, and so early intervention for preventing the progression to deep pressure ulcers is important. Therefore, an ultrasonic imaging device is
used as a means of visualizing the state of the deep tissue.
Many pressure ulcer patients are bedridden and are often not easy to move to the
examination room, and therefore it is desirable to use a portable ultrasound device if
possible. In recent years, the use of ultrasonography in chronic wounds such as
pressure ulcers has dramatically increased due to the extremely high image quality
Real-World Data-Based Care Innovation: Lessons Learned from Nursing Science
91
only basic nursing information data that is always input to the electronic medical
record, it can be operated without requiring an additional burden on the clinical site
when implementing the automatic judgment function on the electronic medical
record. Prediction performance may be improved by adding more variables, and
the implementation and operation on electronic medical records are the future goals.
Thus, similar to the fall prediction study described above, it is possible for nurses
to predict the occurrence of pressure ulcers based on data collected by nurses in their
daily work, and that this information is updated daily. By using real-world data, it is
possible to perform clinically-based patient assessments that are not bound by
existing frameworks. This will improve the quality of nursing care.
3.2.3 Development of an Image-Based Innovative Assessment
of Pressure Ulcers Using Real-World Data
In order to properly manage pressure ulcers, it is necessary to understand whether
wound healing is progressing normally or being stalled. In the case of stalled wound
healing, clarifying the cause for proper management is needed. For this purpose, the
DESIGN-R
® evaluation scale, a gross pressure ulcer evaluation method, is used. On
the other hand, since this evaluation scale is a tool mainly based on gross findings, it
is not suitable for the evaluation of damage to deep tissues or invisible inflammation,
which is difficult to find from the outside. Therefore, focusing on deep tissue injury
and critical colonization, which are the two major problems in the management of
pressure ulcers, the authors will introduce emerging methods for evaluating pressure
ulcers using ultrasonography, thermography, and a rapid biofilm detection tool
developed through translational real-world data analyses.
3.2.4 Detecting Deep Tissue Injury by Ultrasonography
Pressure ulcers can be broadly divided into two types: where the damage progresses
from the surface to the deep part, and where the deep damage occurs first and the
tissue damage comes to the surface. The latter is called a deep tissue injury (DTI).
Although DTI is deeply damaged, it cannot be sufficiently judged by visual inspection or palpation from the surface, and thus treatment such as the sufficient distribution of body pressure is delayed, and a few days later, a deep pressure ulcer
becomes apparent. As shown in Fig. 6, even if it appears to be a slight injury to the
naked eye, it rapidly worsens, and so early intervention for preventing the progression to deep pressure ulcers is important. Therefore, an ultrasonic imaging device is
used as a means of visualizing the state of the deep tissue.
Many pressure ulcer patients are bedridden and are often not easy to move to the
examination room, and therefore it is desirable to use a portable ultrasound device if
possible. In recent years, the use of ultrasonography in chronic wounds such as
pressure ulcers has dramatically increased due to the extremely high image quality
Real-World Data-Based Care Innovation: Lessons Learned from Nursing Science
91