PURPOSE: The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers. METHODS: Analysis was done using a retrospective cohort, nursing records representing 21,114 hospital days, 3,348 patients at risk for ulcers, admitted to the intensive care unit of a tertiary teaching hospital between January 2004 and January 2007. A BN model and two logistic regression (LR) versions, model-I and -II, were compared, varying the nature, number and quality of input variables. Classification competence and case coverage of the models were tested and compared using a threefold cross validation method. RESULTS: Average incidence of ulcers was 6.12%. Of the two LR models, model-I demonstrated better indexes of statistical model fits. The BN model had a sensitivity of 81.95%, specificity of 75.63%, positive and negative predictive values of 35.62% and 96.22% respectively. The area under the receiver operating characteristic (AUROC) was 85.01% implying moderate to good overall performance, which was similar to LR model-I. However, regarding case coverage, the BN model was 100% compared to 15.88% of LR. CONCLUSION: Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.
Adult ; Aged ; Area Under Curve ; Bayes Theorem ; Cohort Studies ; Female ; Humans ; Logistic Models ; Male ; Medical Records ; Middle Aged ; *Predictive Value of Tests ; Pressure Ulcer/epidemiology/*prevention & control ; Retrospective Studies ; Risk Assessment

PURPOSE: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. METHODS: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. RESULTS: The experimental group had significantly less severe IAD (t=6.69, p<.001), lower occurrence of pressure ulcers (chi2=7.35, p=.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p=.009) than the control group. CONCLUSION: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.
Aged ; Aged, 80 and over ; Dermatitis/pathology ; Evidence-Based Nursing/*standards ; Fecal Incontinence/pathology/*prevention & control ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pressure Ulcer/epidemiology/pathology ; Program Development ; *Program Evaluation ; Severity of Illness Index ; Skin Care ; Urinary Incontinence/pathology/*prevention & control