Ginger Salvadalena - Academia.edu (original) (raw)
Papers by Ginger Salvadalena
PubMed, Sep 1, 1992
Pressure ulcers in hospitalized patients represent a significant challenge to the health professi... more Pressure ulcers in hospitalized patients represent a significant challenge to the health professionals who care for these patients. This challenge extends to the health care system as a whole because of the staggering costs associated with pressure ulcer resolution. Although the relative benefits of various treatment methods have long been debated, intervention before ulcer formation clearly stands as the most efficacious approach to this problem. The Braden Scale for Predicting Pressure Sore Risk, a recently developed paper tool, was evaluated in our acute care medical unit for its ability to predict pressure ulcer occurrence. The sensitivity of the Braden Scale in this evaluation was much lower than that reported in other published studies. The Braden Scale was less effective than the nurse judgment prediction method, the current prevailing prediction method at this institution. The gravity of these results, however, is unclear because of the questionable incidence of ulcers in this study, which may be artificially high due to permissive criteria used in the identification of stage 1 ulcers. We determined that the lack of unequivocally defined criteria for the identification of stage 1 ulcers may contribute to variance between studies. We also found that intervention measures were used only 27% of the time after the identification of patients at risk.
Wound management & prevention, Feb 1, 2022
BACKGROUND Longitudinal patient-reported data are limited for people living with an ostomy. PURPO... more BACKGROUND Longitudinal patient-reported data are limited for people living with an ostomy. PURPOSE The Observational Study of Ostomy Consumers (OSO) registry collects data from individuals living with an ostomy. METHODS Self-reported data were collected via repeated electronic surveys completed by adults living with an ostomy in the United States (US) and United Kingdom (UK). RESULTS Baseline data, collected between October 2018 and February 2021, were available for 299 individuals from the US (77.9%) and UK (22.1%). Most participants reported using a 2-piece pouching system (55.5%) rather than a 1-piece system (44.4%), and using a convex barrier (54.4%) or flat barrier (44.3%). The most commonly reported barrier wear times were ≥ 3 to < 4 days for 36.6% of participants in the US and ≥ 1 to < 2 days for 42.4% of participants in the UK. Despite self-reports of leakage and peristomal skin conditions, quality of life remained positive. A majority of participants (92.0%) reported being very satisfied or somewhat satisfied with their ostomy product. CONCLUSION The Observational Study of Ostomy Consumers registry allows for a continuous data stream that can be mined to help understand the patient experience over time. Understanding patient experiences will help to inform clinical practice and research, health care utilization, and product innovation.
Journal of Wound, Ostomy and Continence Nursing, 2008
Journal of Wound, Ostomy and Continence Nursing, 2007
Journal of Wound, Ostomy and Continence Nursing, 2006
Reported complications include ureteral obstruction, ascending urinary tract infections, metaboli... more Reported complications include ureteral obstruction, ascending urinary tract infections, metabolic complications, increased risk of malignancy, and limited endoscopic access to the upper tracts. 2,4-8
Journal of ET nursing : official publication, International Association for Enterostomal Therapy
The Data base is a tool for use by experienced and new ET nurses to document information gleaned ... more The Data base is a tool for use by experienced and new ET nurses to document information gleaned during the initial contact with a new patient with an ostomy. The Data base may be used to structure the interview or simply to record the data. The summary section at the bottom of the form facilitates prioritization and listing of goals for care of the patient. The Data base documents data used by the ET nurse as she formulates her plan of care for the patient with an ostomy. By demonstrating the scope of the assessment and organizing its content, the Data base is one way of ensuring comprehensive data collection, an issue paramount to quality care.
Journal of Wound, Ostomy & Continence Nursing, 2015
Journal of Wound, Ostomy and Continence Nursing, 2013
The purpose of this document was to defi ne the correct technique for obtaining a urine sample fr... more The purpose of this document was to defi ne the correct technique for obtaining a urine sample from a urostomy, ileal, or colon conduit. While healthcare providers do not commonly encounter patients with a urostomy, knowledge of the correct procedure to obtain a urine specimen is essential. Urine samples obtained incorrectly from a urostomy can lead to inaccurate cultures, resulting in an improper diagnosis and treatment, which can endanger the life of a patient. This column presents patient preparation, the procedure to obtain a specimen with and without a catheter, and aftercare of the patient and specimen. This best practice guideline has been developed by a panel of certifi ed ostomy nurses serving on the Wound, Ostomy and Continence Nurses (WOCN) Society's Clinical Practice Ostomy Committee. The guideline has undergone content validation through a consensus-building process by the WOCN Society, which was managed by the Center for Clinical Investigation.
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace ... more Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes.
Journal of Wound, Ostomy and Continence Nursing, 2015
Journal of Wound, Ostomy & Continence Nursing
The Journal of Stomal Therapy Australia
Journal of Wound, Ostomy and Continence Nursing
Journal of Wound, Ostomy and Continence Nursing
To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramid... more To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramide-infused ostomy skin barriers and control skin barriers. DESIGN: The ADVOCATE trial is a multi-centered randomized controlled trial, and double-blinded international study with an adaptive design. SUBJECTS AND SETTING: The sample comprised 153 adults from 25 sites from the United States, Canada, and Europe. Participants were seen in hospital and outpatient care settings. METHODS: Data were collected by investigators at each site during face-to-face visits and during telephone check-in calls between visits. Cost of care data were collected using a questionnaire developed specifi cally for the study. The peristomal skin was assessed using the Ostomy Skin Tool. Health-related quality of life was measured using the SF-12v2. Patient-reported outcomes were collected using a patient-centered study-specifi c questionnaire. Cost of care was analyzed via analysis of covariance comparing total cost of care for 12 weeks between the 2 groups. The incidence of PSC was analyzed via Barnard's exact test comparing the incidence of PSCs between the control and treatment groups. Tertiary outcomes were exploratory in nature and not statistically powered. RESULTS: Use of the ceramide-infused barrier signifi cantly reduced stoma-related cost of care over a 12-week period, resulting in a 36.46decreaseincost(1436.46 decrease in cost (14% relative decrease). The adjusted average costs were 36.46decreaseincost(14223.73 in the treatment group and $260.19 in the control group (P = .017). The overall incidence of PSCs in the study was 47.7%; PSC incidence was 40.5% for the treatment group versus 55.4% for controls (P = .069, 95% confi dence interval of the difference: − 1.2 to 30.4). Signifi cantly more participants using the ceramide-infused skin barrier were "very satisfi ed" with barrier performance (75% vs 55%; P = .033), prevention of leakage (63% vs 38%; P < .01), and prevention of itching (53% vs 31%; P = .016). General postoperative improvement in health-related quality of life was noted in both groups. CONCLUSIONS: The use of a ceramide-infused barrier signifi cantly decreased cost and increased satisfaction with patientreported outcomes.
Skin Research and Technology
Peristomal skin complications (PSCs) are common occurrences among individuals with a colostomy, i... more Peristomal skin complications (PSCs) are common occurrences among individuals with a colostomy, ileostomy or urostomy. 1 The most common cause of PSCs is leakage of stoma effluent onto the skin resulting in peristomal moisture associated dermatitis. 2 Optimizing ostomy product fit helps to prevent leakage, yet other factors (such as medical adhesive-related skin injury, sensitivity reactions, and skin infections) can also contribute to irritation in the peristomal area. Removal of adhesive medical devices is one of the factors known to remove some of the outermost layers of the stratum corneum and lead to elevated transepidermal water loss (TEWL) rates. Computerized evaporimetry is considered the "gold standard" for assessing the extent of stratum corneum barrier disruption. 3 Since the method was established, there have been numerous reports
The purpose of this study was to examine stoma and peristomal complications and related variables... more The purpose of this study was to examine stoma and peristomal complications and related variables among adults with ostomies. The primary study aim was to determine the incidence of peristomal and stoma complications during the first 3 months after stoma creation. Data were collected using a prospective, repeated-measures descriptive study design. Data were collected at 2 university-based hospitals with outpatient ostomy clinics in the Midwestern United States. The sample included 43 adults with newly created colostomy, ileostomy, or urostomy stomas. Participants were examined for the presence of complications up to 4 times during a 3-month period: within 7 days of surgery. Patients were also evaluated at 2, 6, and 12 weeks after stoma creation. Data were collected using a validated instrument with acceptable interrater reliability. Peristomal skin complications developed in 27 participants, comprising 63% of the sample. The onset of peristomal skin complications occurred most frequently during the 21- to 40-day time period. The most common skin conditions at nearly all time intervals were irritation (peristomal moisture-associated skin damage) and infection. Of the 18 participants observed 70 days or longer, just 7 (38%) remained free of peristomal skin complications throughout the study. Six participants developed 1 or more stoma complications, all of which occurred 20 or more days after surgery. No demographic or clinical factors were found to be associated with the development of complications. Although the participants were evaluated at regular intervals by a specialized nurse, the majority experienced peristomal skin complications. These results underscore the importance of further work in interventions to prevent and treat peristomal skin complications and to provide ongoing outpatient follow-up to individuals with stomas.
In order to use a clinical instrument in a research study, the issues of validity and reliability... more In order to use a clinical instrument in a research study, the issues of validity and reliability must be addressed. In this poster presentation, we will share the methods used to establish interrater and test-retest reliability on the Ostomy Forum Observation Index®, which is being used in a longitudinal study of stoma and peristomal skin complications. This instrument was developed by a group of experienced Enterostomal Therapy nurses from the United Kingdom, The Netherlands, Poland, Denmark, Norway, Sweden and Japan, and used in one prior study1. Page one of the instrument consists of observations about the stoma, peristomal skin, and output, while page 2 consists of psychological, social, and sexuality evaluations. Only the 13 items pertaining to stoma condition and 11 items pertaining to the peristomal skin are used in the current study. The WOC Nurses participating in this study were provided with education about the purpose and use of the instrument, and then they practiced u...
Journal of ET nursing : official publication, International Association for Enterostomal Therapy
Pressure ulcers in hospitalized patients represent a significant challenge to the health professi... more Pressure ulcers in hospitalized patients represent a significant challenge to the health professionals who care for these patients. This challenge extends to the health care system as a whole because of the staggering costs associated with pressure ulcer resolution. Although the relative benefits of various treatment methods have long been debated, intervention before ulcer formation clearly stands as the most efficacious approach to this problem. The Braden Scale for Predicting Pressure Sore Risk, a recently developed paper tool, was evaluated in our acute care medical unit for its ability to predict pressure ulcer occurrence. The sensitivity of the Braden Scale in this evaluation was much lower than that reported in other published studies. The Braden Scale was less effective than the nurse judgment prediction method, the current prevailing prediction method at this institution. The gravity of these results, however, is unclear because of the questionable incidence of ulcers in th...
Materials management in health care, 1995
PubMed, Sep 1, 1992
Pressure ulcers in hospitalized patients represent a significant challenge to the health professi... more Pressure ulcers in hospitalized patients represent a significant challenge to the health professionals who care for these patients. This challenge extends to the health care system as a whole because of the staggering costs associated with pressure ulcer resolution. Although the relative benefits of various treatment methods have long been debated, intervention before ulcer formation clearly stands as the most efficacious approach to this problem. The Braden Scale for Predicting Pressure Sore Risk, a recently developed paper tool, was evaluated in our acute care medical unit for its ability to predict pressure ulcer occurrence. The sensitivity of the Braden Scale in this evaluation was much lower than that reported in other published studies. The Braden Scale was less effective than the nurse judgment prediction method, the current prevailing prediction method at this institution. The gravity of these results, however, is unclear because of the questionable incidence of ulcers in this study, which may be artificially high due to permissive criteria used in the identification of stage 1 ulcers. We determined that the lack of unequivocally defined criteria for the identification of stage 1 ulcers may contribute to variance between studies. We also found that intervention measures were used only 27% of the time after the identification of patients at risk.
Wound management & prevention, Feb 1, 2022
BACKGROUND Longitudinal patient-reported data are limited for people living with an ostomy. PURPO... more BACKGROUND Longitudinal patient-reported data are limited for people living with an ostomy. PURPOSE The Observational Study of Ostomy Consumers (OSO) registry collects data from individuals living with an ostomy. METHODS Self-reported data were collected via repeated electronic surveys completed by adults living with an ostomy in the United States (US) and United Kingdom (UK). RESULTS Baseline data, collected between October 2018 and February 2021, were available for 299 individuals from the US (77.9%) and UK (22.1%). Most participants reported using a 2-piece pouching system (55.5%) rather than a 1-piece system (44.4%), and using a convex barrier (54.4%) or flat barrier (44.3%). The most commonly reported barrier wear times were ≥ 3 to < 4 days for 36.6% of participants in the US and ≥ 1 to < 2 days for 42.4% of participants in the UK. Despite self-reports of leakage and peristomal skin conditions, quality of life remained positive. A majority of participants (92.0%) reported being very satisfied or somewhat satisfied with their ostomy product. CONCLUSION The Observational Study of Ostomy Consumers registry allows for a continuous data stream that can be mined to help understand the patient experience over time. Understanding patient experiences will help to inform clinical practice and research, health care utilization, and product innovation.
Journal of Wound, Ostomy and Continence Nursing, 2008
Journal of Wound, Ostomy and Continence Nursing, 2007
Journal of Wound, Ostomy and Continence Nursing, 2006
Reported complications include ureteral obstruction, ascending urinary tract infections, metaboli... more Reported complications include ureteral obstruction, ascending urinary tract infections, metabolic complications, increased risk of malignancy, and limited endoscopic access to the upper tracts. 2,4-8
Journal of ET nursing : official publication, International Association for Enterostomal Therapy
The Data base is a tool for use by experienced and new ET nurses to document information gleaned ... more The Data base is a tool for use by experienced and new ET nurses to document information gleaned during the initial contact with a new patient with an ostomy. The Data base may be used to structure the interview or simply to record the data. The summary section at the bottom of the form facilitates prioritization and listing of goals for care of the patient. The Data base documents data used by the ET nurse as she formulates her plan of care for the patient with an ostomy. By demonstrating the scope of the assessment and organizing its content, the Data base is one way of ensuring comprehensive data collection, an issue paramount to quality care.
Journal of Wound, Ostomy & Continence Nursing, 2015
Journal of Wound, Ostomy and Continence Nursing, 2013
The purpose of this document was to defi ne the correct technique for obtaining a urine sample fr... more The purpose of this document was to defi ne the correct technique for obtaining a urine sample from a urostomy, ileal, or colon conduit. While healthcare providers do not commonly encounter patients with a urostomy, knowledge of the correct procedure to obtain a urine specimen is essential. Urine samples obtained incorrectly from a urostomy can lead to inaccurate cultures, resulting in an improper diagnosis and treatment, which can endanger the life of a patient. This column presents patient preparation, the procedure to obtain a specimen with and without a catheter, and aftercare of the patient and specimen. This best practice guideline has been developed by a panel of certifi ed ostomy nurses serving on the Wound, Ostomy and Continence Nurses (WOCN) Society's Clinical Practice Ostomy Committee. The guideline has undergone content validation through a consensus-building process by the WOCN Society, which was managed by the Center for Clinical Investigation.
Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society
Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace ... more Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes.
Journal of Wound, Ostomy and Continence Nursing, 2015
Journal of Wound, Ostomy & Continence Nursing
The Journal of Stomal Therapy Australia
Journal of Wound, Ostomy and Continence Nursing
Journal of Wound, Ostomy and Continence Nursing
To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramid... more To compare ostomy-related costs and incidence of peristomal skin complications (PSCs) for ceramide-infused ostomy skin barriers and control skin barriers. DESIGN: The ADVOCATE trial is a multi-centered randomized controlled trial, and double-blinded international study with an adaptive design. SUBJECTS AND SETTING: The sample comprised 153 adults from 25 sites from the United States, Canada, and Europe. Participants were seen in hospital and outpatient care settings. METHODS: Data were collected by investigators at each site during face-to-face visits and during telephone check-in calls between visits. Cost of care data were collected using a questionnaire developed specifi cally for the study. The peristomal skin was assessed using the Ostomy Skin Tool. Health-related quality of life was measured using the SF-12v2. Patient-reported outcomes were collected using a patient-centered study-specifi c questionnaire. Cost of care was analyzed via analysis of covariance comparing total cost of care for 12 weeks between the 2 groups. The incidence of PSC was analyzed via Barnard's exact test comparing the incidence of PSCs between the control and treatment groups. Tertiary outcomes were exploratory in nature and not statistically powered. RESULTS: Use of the ceramide-infused barrier signifi cantly reduced stoma-related cost of care over a 12-week period, resulting in a 36.46decreaseincost(1436.46 decrease in cost (14% relative decrease). The adjusted average costs were 36.46decreaseincost(14223.73 in the treatment group and $260.19 in the control group (P = .017). The overall incidence of PSCs in the study was 47.7%; PSC incidence was 40.5% for the treatment group versus 55.4% for controls (P = .069, 95% confi dence interval of the difference: − 1.2 to 30.4). Signifi cantly more participants using the ceramide-infused skin barrier were "very satisfi ed" with barrier performance (75% vs 55%; P = .033), prevention of leakage (63% vs 38%; P < .01), and prevention of itching (53% vs 31%; P = .016). General postoperative improvement in health-related quality of life was noted in both groups. CONCLUSIONS: The use of a ceramide-infused barrier signifi cantly decreased cost and increased satisfaction with patientreported outcomes.
Skin Research and Technology
Peristomal skin complications (PSCs) are common occurrences among individuals with a colostomy, i... more Peristomal skin complications (PSCs) are common occurrences among individuals with a colostomy, ileostomy or urostomy. 1 The most common cause of PSCs is leakage of stoma effluent onto the skin resulting in peristomal moisture associated dermatitis. 2 Optimizing ostomy product fit helps to prevent leakage, yet other factors (such as medical adhesive-related skin injury, sensitivity reactions, and skin infections) can also contribute to irritation in the peristomal area. Removal of adhesive medical devices is one of the factors known to remove some of the outermost layers of the stratum corneum and lead to elevated transepidermal water loss (TEWL) rates. Computerized evaporimetry is considered the "gold standard" for assessing the extent of stratum corneum barrier disruption. 3 Since the method was established, there have been numerous reports
The purpose of this study was to examine stoma and peristomal complications and related variables... more The purpose of this study was to examine stoma and peristomal complications and related variables among adults with ostomies. The primary study aim was to determine the incidence of peristomal and stoma complications during the first 3 months after stoma creation. Data were collected using a prospective, repeated-measures descriptive study design. Data were collected at 2 university-based hospitals with outpatient ostomy clinics in the Midwestern United States. The sample included 43 adults with newly created colostomy, ileostomy, or urostomy stomas. Participants were examined for the presence of complications up to 4 times during a 3-month period: within 7 days of surgery. Patients were also evaluated at 2, 6, and 12 weeks after stoma creation. Data were collected using a validated instrument with acceptable interrater reliability. Peristomal skin complications developed in 27 participants, comprising 63% of the sample. The onset of peristomal skin complications occurred most frequently during the 21- to 40-day time period. The most common skin conditions at nearly all time intervals were irritation (peristomal moisture-associated skin damage) and infection. Of the 18 participants observed 70 days or longer, just 7 (38%) remained free of peristomal skin complications throughout the study. Six participants developed 1 or more stoma complications, all of which occurred 20 or more days after surgery. No demographic or clinical factors were found to be associated with the development of complications. Although the participants were evaluated at regular intervals by a specialized nurse, the majority experienced peristomal skin complications. These results underscore the importance of further work in interventions to prevent and treat peristomal skin complications and to provide ongoing outpatient follow-up to individuals with stomas.
In order to use a clinical instrument in a research study, the issues of validity and reliability... more In order to use a clinical instrument in a research study, the issues of validity and reliability must be addressed. In this poster presentation, we will share the methods used to establish interrater and test-retest reliability on the Ostomy Forum Observation Index®, which is being used in a longitudinal study of stoma and peristomal skin complications. This instrument was developed by a group of experienced Enterostomal Therapy nurses from the United Kingdom, The Netherlands, Poland, Denmark, Norway, Sweden and Japan, and used in one prior study1. Page one of the instrument consists of observations about the stoma, peristomal skin, and output, while page 2 consists of psychological, social, and sexuality evaluations. Only the 13 items pertaining to stoma condition and 11 items pertaining to the peristomal skin are used in the current study. The WOC Nurses participating in this study were provided with education about the purpose and use of the instrument, and then they practiced u...
Journal of ET nursing : official publication, International Association for Enterostomal Therapy
Pressure ulcers in hospitalized patients represent a significant challenge to the health professi... more Pressure ulcers in hospitalized patients represent a significant challenge to the health professionals who care for these patients. This challenge extends to the health care system as a whole because of the staggering costs associated with pressure ulcer resolution. Although the relative benefits of various treatment methods have long been debated, intervention before ulcer formation clearly stands as the most efficacious approach to this problem. The Braden Scale for Predicting Pressure Sore Risk, a recently developed paper tool, was evaluated in our acute care medical unit for its ability to predict pressure ulcer occurrence. The sensitivity of the Braden Scale in this evaluation was much lower than that reported in other published studies. The Braden Scale was less effective than the nurse judgment prediction method, the current prevailing prediction method at this institution. The gravity of these results, however, is unclear because of the questionable incidence of ulcers in th...
Materials management in health care, 1995