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Journal of Yeungnam Medical Science Oct 2023Growing evidence suggests that beta-hydroxy-beta-methylbutyrate (HMB), arginine (Arg), and glutamine (Gln) positively affect wound recovery. This study investigated the...
Long-term supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine for pressure ulcer in sedentary older adults: a retrospective matched case-control study.
BACKGROUND
Growing evidence suggests that beta-hydroxy-beta-methylbutyrate (HMB), arginine (Arg), and glutamine (Gln) positively affect wound recovery. This study investigated the effects of long-term administration of HMB/Arg/Gln on pressure ulcer (PU) healing in sedentary older adults admitted to geriatric and rehabilitation care facilities.
METHODS
This was a pilot retrospective case (standard of care and HMB/Arg/Gln)-control (standard of care alone) clinical study. Outcome measures were relative healing rates and Pressure Ulcer Scale for Healing (PUSH) scores (calculated after 4, 8, 12, 16, and 20 weeks) and time to healing.
RESULTS
The study subpopulation was comprised of 14 participants (four males, 28.6%) with the median age of 85.5 years (interquartile range [IQR], 82.0-90.2 years). The control subpopulation was comprised of 31 participants (18 males, 58.1%) with the median age of 84.0 years (IQR, 78.0-90.0 years). At the beginning of follow-up, there were no statistically significant demographic (sex and age) and clinical (main diagnosis, baseline area, and PU perimeter) differences between the groups. During the study period, there were no significant differences in the relative healing rates and PUSH scores between the subpopulations. The median time to complete healing in the study and control populations was 170.0 days (95% confidence interval [CI], 85.7-254.3) and 218.0 days (95% CI, 149.2-286.7) (log-rank, chi-square=3.99; p<0.046), respectively.
CONCLUSION
More than 20 weeks of HMB/Arg/Gln supplementation had a positive effect on difficult PU healing in older adults with multiple comorbidities.
PubMed: 36796413
DOI: 10.12701/jyms.2022.00899 -
Journal of Clinical Nursing Oct 2023The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive...
AIM AND OBJECTIVE
The aim of this cross-sectional study was to determine the point prevalence and associated risk factors of medical device-related pressure injuries (MDRPI) in intensive care patients in Turkey.
BACKGROUND
MDRPI remain a clinical problem that has garnered the attention of healthcare professionals.
DESIGN
This study used a cross-sectional design and was conducted over a single day in all intensive care units.
METHOD
Data were collected through face-to-face interviews, observation, skin examination and detailed diagnosis of MDRPI development and influencing factors. Presence of pressure injuries on the skin in the areas where the patient's medical device was placed was defined. The study was reported according to the STROBE declaration.
RESULTS
MDRPI developed in 65 out of 200 patients included in the study (32.5%). The most frequent locations were on the face (71%). The MDRPIs were commonly associated with nasogastric tube (29.2%), endotracheal tube (18.5%) and CPAP mask (15.4%). A significant proportion of these injuries were mucosal (53.8%, n = 35). The majority of the skin pressure injuries were classified as Stage II (18.5%, n = 12). The risk increased 14 times in patients who were hospitalised for 9-16 days and 13 times in those who received mechanical ventilator support.
CONCLUSION
The study findings suggest that MDRPI developed in approximately one of three patients hospitalised in the intensive care unit, and the length of hospital stay and mechanical ventilator support were important determining risk factors. The high prevalence of MDRPI may indicate inadequate nursing care quality. Therefore, it is recommended that nurses be aware of risk factors and evaluate the suitability and safety of medical devices.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution was involved in this study.
Topics: Humans; Cross-Sectional Studies; Prevalence; Pressure Ulcer; Awareness; Critical Care
PubMed: 37726592
DOI: 10.1111/jocn.16831 -
International Wound Journal Aug 2023This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and... (Observational Study)
Observational Study
This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. A quantitative quasi-experimental observational approach was used. A total of 149 at risk acute hospital patients took part, 78 treatment, and 71 control. SEM deltas were recorded daily for a maximum of 5 days using the SEM Scanner (Bruin Biometrics LLC, Los Angeles, California), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted PU prevention interventions occurring in those with an elevated SEM delta scores in the treatment group. Intention to treat analysis was used to guide the final composition of results. SEM PU represents PU development as identified by 2 days of sustained abnormal SEM delta scores, ≥0.5, after day one. The mean number of days completed by participants was just under 4 days, participants had many different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. Results showed that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD: 0.49; 95% CI: 0.59, 0.39; P < .0001), and in the odds of developing a SEM PU (OR: 0.59, 95% CI: 0.24 to 1.00; P = .05). In the treatment group, none of the participants developed a visual PU, whereas, in the control group, 1.41% (n = 1/71) developed a visual PU. Based on all the results, the following is concluded, (1). There was a greater reduction in mean SEM delta scores among those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta scores was statistically significantly lower at the study end for those who received targeted treatments based on abnormal SEM scores. More research is now needed in other and larger at-risk groups to further validate what was found in this study.
Topics: Humans; Epidermis; Inpatients; Physical Examination; Pressure Ulcer; Skin Care
PubMed: 36575149
DOI: 10.1111/iwj.14061 -
International Journal of Nursing Studies Jul 2024Numerous interventions for pressure injury prevention have been developed, including care bundles. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Numerous interventions for pressure injury prevention have been developed, including care bundles.
OBJECTIVE
To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients.
DATA SOURCES
The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023).
STUDY ELIGIBILITY CRITERIA
Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded.
PARTICIPANTS AND INTERVENTIONS
Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included.
STUDY APPRAISAL AND SYNTHESIS METHODS
Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation.
RESULTS
Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO CRD42023423058.
TWEETABLE ABSTRACT
Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.
Topics: Pressure Ulcer; Humans; Patient Care Bundles; Hospitalization
PubMed: 38642429
DOI: 10.1016/j.ijnurstu.2024.104768 -
International Wound Journal Jun 2024To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal... (Review)
Review
To assess all published studies which describe what happens to the delivery of pressure ulcer/injury (PI/PU) care pathways as a result of detecting raised sub-epidermal moisture (SEM) delta (∆ ≥ 0.6). We undertook a systematic review of the literature, and included original research studies using either a prospective or retrospective study design that report the impact that assessment using SEM assessments have on healthcare practitioners' delivery of PI/PU care pathways in adults at risk of developing PI/PUs. The review protocol was registered on PROSPERO (CRD42023416975). A literature search was conducted in May 2023, using PubMed, CINAHL, Scopus, Cochrane, EMBASE, Web of Science and Science Direct databases. Data were extracted using a data extraction tool including elements such as country, setting, sample size, intervention, control and quality appraisal was undertaken using the Evidence-based Librarianship. We identified nine papers published between 2017 and 2022. The majority of these studies were conducted in England (n = 6; 67%). The systematic review included studies conducted across multiple care settings including acute care, medical-surgical units, and palliative care, highlighting the importance of PI/PU prevention and management across diverse patient populations. The PI/PU care pathways implemented in the studies varied, but commonly included elements such as the application or increased use of pressure-redistributing mattresses/cushions, implementation of repositioning plans, management of incontinence and moisture, regular skin inspection, and assessment of patient mobility. Out of the nine studies identified, seven reported PI/PU incidence. A meta-analysis of seven studies (N = 18 451) demonstrated a statistically significant reduction in visual PI/PU development in favour of SEM-guided care pathways compared to usual care (the odds ratio = 0.36 [95% confidence interval: 0.24-0.53, p < 0.00001]). This systematic review provides evidence that implementing SEM assessments in patients at risk of developing PI/PUs prompts anatomy-specific clinical actions. The subsequent implementation of enhanced and targeted skin care interventions leads to consistent and sustained reductions in hospital-acquired PU incidence. The findings emphasise the importance of incorporating SEM assessments as part of comprehensive PI/PU prevention strategies in all care settings and patient populations. This systematic review is limited by the predominance of observational studies and variable study quality. Future research should focus on randomised trials in different care settings that monitor the efficacy of preventive interventions and their impact in reducing PI/PU incidence when implemented based on SEM assessments.
Topics: Pressure Ulcer; Humans; Male; Female; Middle Aged; Aged; Adult; Aged, 80 and over; Critical Pathways; Delivery of Health Care
PubMed: 38832363
DOI: 10.1111/iwj.14928 -
Nutrition in Clinical Practice :... Oct 2023Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the... (Review)
Review
BACKGROUND
Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of providing nutrition therapy.
METHODS
We conducted a narrative literature review with three main thematic concepts to drive our literature search: the association of nutrition therapy with (1) skin integrity; (2) injury, wounds, and wound healing; and (3) differences of skin color. Using pertinent search and subject terms, PubMed, CINAHL, EMBASE, and SCOPUS databases were searched, yielding 316 articles. After removal of duplicates, articles were reviewed based on inclusion and exclusion criteria defined by the authors; only eight articles met the defined criteria to inform this review.
RESULTS
Large and important gaps exist in the current literature regarding an association between nutrition therapy, skin injury, and wound healing. Little to no attention was found for associations with skin color. The resulting narrative review addresses these topics and subtopics with additional references included that are independent of the original search strategy.
CONCLUSIONS
A dearth of evidence exists describing associations between nutrition and disruption of skin integrity in pediatric critical illness. Children with dark skin are at increased risk, as manifestation and identification of disruption to skin integrity may not be recognized. Research is needed to describe these associations and the impact of nutrition on skin integrity, including differences of skin color.
Topics: Humans; Child; Critical Illness; Pressure Ulcer; Nutritional Status; Wound Healing; Enteral Nutrition
PubMed: 37721464
DOI: 10.1002/ncp.11063 -
Journal of Tissue Viability Aug 2023To determine attitudes and levels of knowledge related to pressure injury (PI) prevention among operating room nurses and identify associated factors.
AIM
To determine attitudes and levels of knowledge related to pressure injury (PI) prevention among operating room nurses and identify associated factors.
METHODS
This descriptive, cross-sectional study was conducted in Turkey with a sample of 112 operating room nurses recruited by the snowball method of convenience sampling. Data were collected online via Google Forms using a nurse data collection form, the Knowledge of Operating Room Nurses about Pressure Injuries Form, and the Attitude Towards Pressure Ulcer Prevention Instrument (APuP).
RESULTS
The operating room nurses' mean score for PI knowledge was 52.19 ± 17.01 out of 100, and their mean total APuP score was 42.28 ± 5.19 out of 52. Knowledge about PIs was negatively associated with being male (β = -0.287, p < 0.001) and positively associated with intervening to prevent PIs during surgery (β = 0.214, p = 0.008), using international PI guidelines as a reference in the operating room (β = -0.225, p = 0.005), and APuP score (β=.415, p < 0.001). Intervening to prevent PIs during surgery (β = 0.294, p = 0.003) was a significant predictor of attitude toward PI prevention.
CONCLUSION
Our results indicate that overall, operating room nurses have insufficient knowledge but positive attitudes about PI prevention. Female gender, using international PI reference guides in the operating room, and positive attitude toward PI prevention were identified as factors associated with higher PI knowledge level, while intervening to prevent PIs during surgery was positively associated with both knowledge level and attitude toward PI prevention.
Topics: Humans; Male; Female; Pressure Ulcer; Cross-Sectional Studies; Operating Rooms; Surveys and Questionnaires; Attitude of Health Personnel; Health Knowledge, Attitudes, Practice; Nurses
PubMed: 37258335
DOI: 10.1016/j.jtv.2023.05.005 -
Journal of Wound Care Sep 2023The aim of this systematic review was to critically appraise and synthesise the existing research literature pertaining to nurses' attitudes toward pressure ulcer (PU)...
OBJECTIVE
The aim of this systematic review was to critically appraise and synthesise the existing research literature pertaining to nurses' attitudes toward pressure ulcer (PU) prevention.
METHOD
The systematic review presented in our paper serves as an updated version of the definitive review conducted by Avsar et al. in 2019. Using systematic review methodology, we considered published quantitative studies focusing on nurses' attitudes toward PU prevention as measured using psychometric tests. The search was conducted in April 2022, using PubMed, CINAHL, Scopus, Cochrane and EMBASE databases, and returned 454 records, of which 35 met the inclusion criteria. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the evidence-based librarianship (EBL) appraisal checklist.
RESULTS
In most studies, distinct measurement instruments were used for measuring nurses' attitudes toward the prevention of PUs: the Moore and Price Attitude Scale and the Attitude towards Pressure Ulcer Prevention Instrument (APuP). In this first update, the mean attitude score was 69% (±14%, range: 33.6-89%). A separate analysis of the new studies alone included in this first update (n=14) indicated a mean attitude score of 62.25% (±17.9%; median: 14%), suggesting a 10.75% lower mean attitude score. In total, 46% (n=16) yielded a score ≥75%. Conversely, Avsar et al. in 2019, 86% (n=18) of studies yielded positive attitude results. Studies from the Middle East show the lowest mean attitude score (mean 55%; ±15%; median 53%; n=9), with studies from Europe displaying the highest mean attitude score (mean 79%; ±6%; median 79%; n=12).
CONCLUSION
The findings suggest that, overall, nurses are relatively positively disposed toward PU prevention. However, there are differences across continents. It is important to highlight also that the nurses have difficulties reflecting this positive attitude into actual preventative strategies.
Topics: Humans; Pressure Ulcer; Databases, Factual; Europe; Attitude; Nurses
PubMed: 37682786
DOI: 10.12968/jowc.2023.32.9.544 -
International Wound Journal Jun 2024Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action... (Review)
Review
Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action when discussing noninvasive ventilation-induced pressure injuries. A systematic review was designed to summarize and analyse all published literature on strategies to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The protocol of the systematic review followed the PRISMA guideline. An extensive search from the beginning to May 16, 2023, using current articles in databases such as Web of Science (WOS), Scopus, PubMed, and Cochrane Library was conducted. Medical Subject Headings (MESH) were used as follows: "Pressure Injury," "Noninvasive Ventilation," "Prevention," and "Pressure Sore." Any language-published studies that met the inclusion criteria were included in this review. A risk of bias assessment was conducted using the Joanna Briggs Institute tool, including evaluation methodologies for all studies. Database searches yielded 2546 articles, which were reduced to 23 that met our criteria after reviewing full texts. A narrative synthesis was conducted. As a result, type of interface (14 studies), dressings (4 studies), adjustment of mask leakage (1 study), humidity (1 study), positioning (1 study), and design of personalized masks (2 studies) seem to be a practical approach to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The results of our study show the effectiveness of preventive methods in reducing the incidence of pressure injuries caused by masks. Given the significant occurrence of pressure injury related to noninvasive ventilation and the crucial role of prevention and treatment, it is imperative to conduct more rigorous studies to ascertain the efficacy of each strategy.
Topics: Humans; Pressure Ulcer; Masks; Noninvasive Ventilation; Female; Male; Aged; Middle Aged; Adult; Aged, 80 and over
PubMed: 38826030
DOI: 10.1111/iwj.14909 -
Intensive & Critical Care Nursing Oct 2023To explore the characteristics and risk factors of facial pressure injuries in patients using noninvasive positive pressure ventilation.
OBJECTIVE
To explore the characteristics and risk factors of facial pressure injuries in patients using noninvasive positive pressure ventilation.
SETTING AND SAMPLE
Patients who developed facial pressure injuries due to non-invasive positive pressure ventilation at a teaching hospital in Taiwan from January 2016 to December 2021 were selected, resulting in a total of 108 patients in our case group. A control group was formed by matching each case by age and gender to three acute inpatients who had used non-invasive ventilation but had not developed facial pressure injuries, resulting in 324 patients in the control group.
RESEARCH METHODOLOGY
This study was a retrospective case-control study. The characteristics of the patients who developed pressure injuries at different stages in the case group were compared, and the risk factors of non-invasive ventilation-related facial pressure injuries were then determined.
RESULTS
Higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale score, and lower albumin levels in the former group. The results of multivariate analysis from binary logistic regression involving the duration of non-invasive ventilation usage demonstrated that the patients who used this device for 4-9 days and 16 days were at greater risk of facial pressure injuries than those who used it for 3 days; in terms of the Braden scale score, higher Braden scale scores were correlated with a higher risk of facial pressure injuries. In addition, albumin levels lower than the normal range were correlated with a higher risk of facial pressure injuries.
CONCLUSION
Patients with pressure injuries at higher stages had a higher duration of non-invasive ventilation usage, higher length of hospital stay, lower Braden scale scores, and lower albumin levels. Thus, a longer duration of non-invasive ventilation use, lower Braden scale scores, and lower albumin levels were also risk factors for non-invasive ventilation-related facial pressure injuries.
IMPLICATIONS FOR CLINICAL PRACTICE
Our results serve as a useful reference for hospitals, both in creating training programs for their medical teams to prevent and treat facial pressure injuries and in drafting guidelines for assessing risk in order to prevent facial pressure injuries caused by non-invasive ventilation. The duration of device usage, Braden scale scores, and albumin levels in particular should be seriously monitored to reduce the occurrence of facial pressure injuries in acute inpatients treated with non-invasive ventilation.
Topics: Humans; Retrospective Studies; Case-Control Studies; Inpatients; Risk Assessment; Noninvasive Ventilation; Pressure Ulcer; Risk Factors; Positive-Pressure Respiration; Albumins
PubMed: 37172467
DOI: 10.1016/j.iccn.2023.103453