Takehiko Ohura

Hokkaido University, Sapporo, Hokkaidō, Japan

Are you Takehiko Ohura?

Claim your profile

Publications (9)16.53 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Unlabelled: Aim. To evaluate the governmental regulation system introduced in October 2002 by investigating the prevalence of pressure ulcers (PUs) and to investigate the relationship between the change in prevalence and the structure and system within hospitals. Methods: This retrospective cohort study used 2582 randomly sampled hospitals in Japan. Questionnaires were mailed to each type of hospital, including university hospitals, acute hospitals, acute and long-term (mixed care) hospitals, long-term care hospitals, and psychiatric hospitals. Prevalence and severity of pressure ulcers over 4 consecutive periods (1 month before the introduction of regulation, immediately after the introduction, 6 months later, and 1 year later) and related factors for the improved prevalence were assessed. Results: The overall prevalence before the regulation was 4.26%, which decreased to 4.18% immediately after regulation, and to 3.95% and 3.64% 6 months and 1 year later, respectively. The overall proportion of Stage III and IV pressure ulcers acquired after admission was 23.9% and 10.9%, respectively, before introduction of regulation, and gradually decreased to 18.8% and 8.1%, respectively, after 1 year. The related factor for improved PU prevalence was sufficient distribution of alternating air mattresses (odds ratio = 2.259, 95% CI; 1.091-4.679, P = 0.028). Conclusion: The governmental regulation had a clinically important effect on the decrease in PU prevalence. The regulation focused on the structure of hospitals was confirmed to influence the outcome of hospital care quality.
    Wounds: a compendium of clinical research and practice 05/2015; 20(6):176-82. · 0.54 Impact Factor
  • Takehiko Ohura · Norihiko Ohura · Hiroaki Oka ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Unlabelled: Measuring pressure ulcer outcomes for deep tissue injury (DTI) in pressure ulcers has improved the authors' understanding of DTI. The authors' multidisciplinary team has also identified previously unexplored patterns of tissue necrosis. Objective: Illustrate these new patterns of tissue necrosis and report their incidence in a hospital setting. Methods: Progressive tissue deterioration was explored using CT scans and ultrasonography of 326 Stage IV pressure ulcers with deep tissue injuries (DTI) managed by a multidisciplinary wound care team using standardized protocols of care in a Japanese hospital from June 2002 to June 2006. Results: Two new patterns of pressure ulcer necrosis were found and are illustrated. All patients were checked consecutively and treated by the multidisciplinary team every 2 weeks. Among the consecutive sample of 326 patients, 194 (60%) were common DTI with column-shaped necrosis, including 7 with relatively healthy tissue sandwiched between shallow and deep necrosis. The remaining 132 (40%) had hourglass-shaped area of necrosis, including 20 with sandwiched-shaped necrosis. Hourglass shaped necrosis was associated with a combination of shear forces and pressure over a bony prominence. Sandwich-shaped hourglass necrosis often appeared to heal the superficial tissue but was reopened with deep necrosis that liquified and sloughed. Conclusion: Understanding the morphology and course of deterioration and healing of these different types of necrosis has helped the team recognize and manage previously unpredictable DTI, improving staff, patient, and family expectations, and reducing misunderstandings about pressure ulcer development.
    Wounds: a compendium of clinical research and practice 05/2015; 19(11):310-9. · 0.54 Impact Factor
  • Takehiko Ohura · Norihiko Ohura · Suguru Matsui · Eisuke Uchiyama ·

    01/2015; 7(3):173-184. DOI:10.7792/jlspm.7.173
  • [Show abstract] [Hide abstract]
    ABSTRACT: Unlabelled: The objective of this multicenter open-label randomized study was for evaluating nutrition intervention on pressure ulcer healing. Tube-fed patients with Stages III to IV pressure ulcers were enrolled. Target energy levels to be given were the same value as at the time of enrollment or BEE×1.1 (activity factor)×1.1-1.3 (stress factor) in the control group, and BEE×1.1×1.3-1.5 in the intervention group. Both groups received the feeding formula Racol(®) for 12 weeks, and were prescribed to have pressure relief mattresses, and to unify the repositioning method, treatment drugs, and wound dressing materials. Ulcer sizes (length×width), nutritional state, and adverse events were evaluated. Results of the study: Energy levels administered to the control (n=29) and intervention (n=21) groups were 29.1±4.9 (mean±SD) and 37.9±6.5 kcal/kg/day, respectively. Regarding pressure ulcer size, the interaction between the nutrition intervention and the courses during observational weeks was significant (P<0.001). Similarly, significant differences were observed with weight, waist circumference, Cu (P<0.001), suprailiac skinfold thickness (P<0.01), thigh circumference, and prealbumin (P<0.05), but not with the incidence of adverse events (P=0.360). Principal component analysis indicated remarkable decreases in ulcer size and improvement rates of waist circumference and suprailiac skinfold thickness in the intervention group. Covariance structure analysis showed that nutrition intervention has a direct effect on reduction in ulcer size. The results suggested that aggressive nutrient intervention accelerated the pressure ulcer of wound healing process and had a direct effect on reduction in ulcer size.
    Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 08/2013; 50(3):377-83. DOI:10.3143/geriatrics.50.377
  • Source
    Akinori Hisashige · Takehiko Ohura ·
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND & AIMS: Pressure ulcers not only affect quality of life among the elderly, but also bring a large economic burden. There is limited evidence available for the effectiveness of nutritional interventions for treatment of pressure ulcers. In Japan, recently, a 60-patient randomized controlled trial of nutritional intervention on pressure ulcers demonstrated improvement in healing of pressure ulcers, compared with conventional management. To evaluate value for money of nutritional intervention on healing of pressure ulcers, cost-effective analysis was carried out using these trial results. METHODS: The analysis was carried out from a societal perspective. As effectiveness measures, pressure ulcer days (PUDs) and quality-adjusted life years (QALYs) were estimated. Prevalence of pressure ulcers was estimated by the Kaplan-Meier method. Utility score for pressure ulcers is derived from a cross-sectional survey among health professionals related to pressure ulcers. Costs (e.g., nutritional interventions and management of pressure ulcers) were estimated from trial data during observation and follow-up. Stochastic and qualitative sensitivity analyses were performed to examine the robustness of results. RESULTS: For observation (12 weeks) and follow-up (12-week observation plus 4-week follow-up), nutritional intervention reduced PUDs by 9.6 and 16.2 per person, and gained 0.226 × 10(-2) QALYs and 0.382 × 10(-2) QALYs per person, respectively. In addition, costs were reduced by $542 and $881 per person, respectively. This means nutritional intervention is dominant (cost savings and greater effectiveness). The sensitivity analyses showed the robustness of these results. CONCLUSION: Economic evaluation of nutritional intervention on healing pressure ulcers from a small randomized controlled trial showed that this intervention is cost saving with health improvement. Further studies are required to determine whether this is a cost-effective intervention for widespread use.
    Clinical nutrition (Edinburgh, Scotland) 05/2012; 31(6). DOI:10.1016/j.clnu.2012.04.013 · 4.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A basic fibroblast growth factor (bFGF) case and a control case whose total scores of Pressure Ulcer Healing Process-Ohura (PUHP-Ohura) and risk factors for pressure ulcers, and level of care for pressure ulcers were equivalent were paired. Twenty-three such eligible pairs were enrolled in this study. Both cases in each pair were treated under conditions in which extrinsic factors such as the use of a pressure-relief mattress and the frequency of postural change were equivalent. The efficacy of bFGF was assessed by analyzing the data obtained over time as the scores of PUHP-Ohura for nine observation items using the SAS MIXED procedure. Treatment of pressure ulcers with bFGF accelerated wound healing over time more significantly than the control in six observation items (exudate volume, ulcer depth, granulation formation, wound edge, epithelialization, total score of the PUHP-Ohura). These data suggest that it may be possible to evaluate drugs for the treatment of pressure ulcers using the PUHP-Ohura wound-assessment tool.
    Wound Repair and Regeneration 09/2011; 19(5):542-51. DOI:10.1111/j.1524-475X.2011.00726.x · 2.75 Impact Factor
  • Takehiko Ohura · Toshio Nakajo · Shingo Okada · Kenji Omura · Kayoko Adachi ·
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to evaluate the effects of nutrition intervention on nutritional states and healing of pressure ulcers by standardizing or unified factors including nursing, care and treatment in a multicenter open randomized trial. Tube-fed patients with Stage III-IV pressure ulcers were selected. The control group (30 patients) received the same nutrition management as before participating in this trial, whereas the intervention group (30 patients) was given calories in the range of Basal Energy Expenditure (BEE) × 1.1 × 1.3 to 1.5. The intervention period was 12 weeks. The efficacy and safety were evaluated based on the nutritional states and the sizes of ulcers (length × width), and on the incidence of adverse events related to the study, respectively. The calories administered to the control and intervention groups were 29.1 ± 4.9 and 37.9 ± 6.5 kcal/kg/day, respectively. Significant interactions between the presence or absence of the intervention and the intervention period were noted for nutritional states (p<0.001 for body weight, p<0.05 for prealbumin). Similarly, the size of ulcers differed significantly between subjects in the intervention group and in the control group (p<0.001). The results suggest that nutrition intervention could directly enhance the healing process in pressure ulcer patients.
    Wound Repair and Regeneration 05/2011; 19(3):330-6. DOI:10.1111/j.1524-475X.2011.00691.x · 2.75 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Surface pressures and shear forces were measured in order to clarify the mechanism leading to the development of a pressure ulcer at five sites on the body during the operation of a bed (bed) using a device for simultaneously measuring pressure and shear force. Changes of shear force and pressure when three body types adopted different supine positions, with or without raising/bending the knees (raising the knees), were investigated and analyzed. The results are as follows: a slender body type tends to have the highest shear force at the coccygeal bone site and also has a higher surface pressure at the coccygeal and at the lateral sacral bone sites than an obese body type. On the other hand, an obese body type has a higher surface pressure at the other sites than the slender type. Shear forces at the sacrum and coccygeal bone sites can be reduced during a bed operation by raising the knees. Furthermore, shear forces can be reduced during a bed operation in a supine position by matching the body's bending points with those of the bed or by shifting the subjects 10 cm toward the head of the bed. These new findings are clinically useful in the treatment and the prevention of the onset of pressure ulcers.
    Wound Repair and Regeneration 10/2009; 17(6):789-96. DOI:10.1111/j.1524-475X.2009.00540.x · 2.75 Impact Factor
  • Takehiko Ohura · Makoto Takahashi · Norihiko Ohura ·
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to measure the impact of external shear force and pressure on a superficial layer of skin and subcutaneous layer with an underlying bony prominence, and also to verify how the influence of these external forces can be reduced after dressings are applied. For this purpose, an experimental model was prepared, consisting of porcine skin and a Predia sensor capable of measuring pressure and shear force simultaneously. External force was applied to the skin model using a 1 kg weight consisting of metal beads. As a result, the control of the shear force value in the subcutaneous layer became approximately 35% smaller than the control in the superficial layer. The shear forces present in the subcutaneous layer were significantly reduced to within 31-45% when compared with the control values, depending on the dressing applied. Regarding the maximum pressures in the subcutaneous layer, the pressure measured following movement was 2.4 times higher in the control than the static pressure and they were also 1.3-1.8 times higher than the static pressure in all instances with the dressing tested. All the dressing materials tested proved to be effective in reducing pressure in the subcutaneous layer compared with the control. Film dressings and hydrocolloid dressings were more effective than hydropolymer and hydrocellular dressings. From the above results, we conclude that efforts made to reduce shear force and pressure may be clinically important.
    Wound Repair and Regeneration 02/2008; 16(1):102-7. DOI:10.1111/j.1524-475X.2007.00325.x · 2.75 Impact Factor