Nursing Techniques to Prepare a Favorable Local Environment of a Pressure Ulcer ; Computer-developed Decision-making Care Algorithm

前言：本研究的目的是建立压疮评估工具和压疮决策护理算法，确认其有效性，并提供快速易用的CD-ROM。方法：(1)对478名难治性压疮护理专家进行问卷调查，了解难治性压疮现状及影响因素。(2)为了创建决策关怀算法，我们基于文献综述中EBN使用的方法设计了决策树。(3)将受试者分为实验组（评估工具/算法组）和对照组。通过将评估工具和算法（以下简称“系统”）的结果与压疮愈合的实际过程（采用DESIGN和创面面积）进行比较，评估整合评估工具和算法的有效性，并计算两组的成本-效果。为了使“系统”更容易使用，我们把它转成CD-ROM。结果：(1)该评估工具（采用DESIGN和照片）判断伤口是否处于难治状态。(2)“系统”由43棵决策树组成，这些决策树与评估工具相关联。(3)在压疮愈合过程中，实验组的设计评分显著低于对照组，创面面积显著小于对照组。实验组的伤口护理费用明显低于对照组。实验组的增量成本-效果比优于对照组。讨论与总结：我们是第一个为专业护理人员开发一个系统，可以为压疮提供治疗指导，以提供最合适的护理。通过实施该系统，我们的结果也显示出更快的愈合速度，这证明了在治疗压疮方面更具成本效益。

Introduction : The purpose of this study was to create a pressure ulcer assessment tool and a decision-making care algorithm for pressure ulcers, confirm its validity, and to provide it on a quick and easy-to-use CD-ROM. Method : (1)We handed out a questionnaire to examine the status and factors causing refractory pressure ulcers to 478 experts of the pressure ulcer care. An assessment tool was made from their results (2)To create the decision-making care algorithm we devised a decision tree based on the approach used by the EBN in the literature reviews. (3)The subjects were divided into an experimental group(assessment tool/algorithm group) and a control group. The effectiveness of integrating the assessment tool and the algorithm(hereafter referred to as "system") was evaluated by comparing their results with the actual process of pressure ulcer healing(using DESIGN and wound area) The cost-effectiveness was also calculated for both groups. To make the "system" more easy tu use, we transferred it to CD-ROM. Results : (1)This assessment tool(using DESIGN and photographs) determines whether the wound is in a refractory state or not. (2)The "system" consists of 43 decision trees that are linked to the assessment tool. (3)Concerning the pressure ulcer healing process, the DESIGN scores were significantly lower and wound area was significantly smaller in the experimental group than in the control group. The cost of wound care was significantly lower in the experimental group than in the control group. The incremental cost-effectiveness ratio was better in the experimental group than in the control group. Discussion and Summary : We are the first to develop a system for professional caregivers that can provide treatment guidance of a pressure ulcer to provide the most suitable care. By implementing this system, our results also showed a faster healing rate, which proved to be more cost-effective in the treatment of pressure ulcers.