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International Journal of Nursing Studies Mar 2020In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care...
BACKGROUND
In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population.
OBJECTIVES
The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field.
DESIGN
An update of a previous systematic review published in 2013 was conducted.
DATA SOURCES
Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted.
METHODS
A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies.
RESULTS
Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments.
CONCLUSION
Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.
Topics: Aged; Humans; Skin; Skin Care
PubMed: 31945604
DOI: 10.1016/j.ijnurstu.2019.103509 -
Journal of Cardiology Nov 2022Randomized clinical trials (RCTs) investigating the impact of omega-3-fatty acid supplementation on cardiovascular events have largely shown no benefit. However, there... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Randomized clinical trials (RCTs) investigating the impact of omega-3-fatty acid supplementation on cardiovascular events have largely shown no benefit. However, there is debate about the benign nature of the placebo in these trials. We aimed to conduct a network meta-analysis of RCTs to compare the outcomes of omega-3 fatty acid supplementation to various placebo oils.
METHODS
MEDLINE and EMBASE were searched through May, 2021 to identify RCTs investigating cardiovascular outcomes with omega-3-fatty acid formulations [eicosapentaenoic acid (EPA), decosahexanoic acid (DHA), or the combination] versus placebo or standard of care controls.
RESULTS
Our analysis included 17 RCTs that enrolled a total of 141,009 patients randomized to EPA (n=13,655), EPA+DHA (n=56,908), mineral oil placebo (n=5,338), corn oil placebo (n =8,876), olive oil placebo (n=41,009), and controls (no placebo oil; n=15,223). Rates of cardiovascular death [hazard ratio (HR) (95% confidence interval, CI) =0.80 (0.65-0.98); p =0.033], myocardial infarction [HR (95% CI) =0.73 (0.55-0.97); p=0.029] and stroke [HR (95% CI) =0.74 (0.58-0.94); p=0.014] were significantly lower in those receiving EPA compared to those receiving mineral oil, but were not different from rates in those receiving other oils or controls. Rates of coronary revascularization were significantly lower in those receiving EPA than in those receiving either EPA+DHA, mineral oil, corn oil, or olive oil placebo, but not controls. All-cause death was similar among all groups, but combined EPA+DHA was associated with reduced risk of cardiovascular death compared to controls [HR (95%CI): 0.83 (0.71-0.98)].
CONCLUSIONS
Our analyses demonstrate that although EPA supplementation lowers risk of coronary revascularization more than other oils, there may not be a benefit relative to standard of care. Further, EPA reduces the risk of cardiovascular events only in comparison to mineral oil and not when compared with other placebo oils or controls. In contrast, combined EPA+DHA was associated with reduced risk of cardiovascular death compared to controls.
Topics: Corn Oil; Dietary Supplements; Docosahexaenoic Acids; Eicosapentaenoic Acid; Fatty Acids, Omega-3; Humans; Mineral Oil; Myocardial Infarction; Network Meta-Analysis; Olive Oil; Randomized Controlled Trials as Topic
PubMed: 35914996
DOI: 10.1016/j.jjcc.2022.07.008 -
Journal of Clinical Nursing Sep 2023This study systematically compared the efficacy of various dressings that may prevent facial medical device-related pressure injury (MRDPI) in medical staff during the... (Meta-Analysis)
Meta-Analysis Review
Evaluation of dressings preventing facial medical device-related pressure injury in medical staff during the COVID-19 pandemic: A systematic review and network meta-analysis.
AIM
This study systematically compared the efficacy of various dressings that may prevent facial medical device-related pressure injury (MRDPI) in medical staff during the COVID-19 pandemic.
BACKGROUND
During the COVID-19 pandemic, medical staff who are required to wear masks, goggles and other personal protective equipment (PPE) are susceptible to facial MRDPI, which exacerbates working conditions. Dressings can effectively prevent or alleviate MRDPI, but it is unclear which dressings are most effective.
DESIGN
A systematic review and network meta-analysis, in accordance with PRISMA.
METHODS
A comprehensive literature search was conducted in four English and four Chinese databases to identify relevant studies published up to 8 September 2022. The selected studies were randomised controlled trials, with populations comprising medical staff who wore PPE during the COVID-19 pandemic and included an observation and control group.
RESULTS
The network meta-analysis of the 12 selected articles showed that foam dressing, hydrocolloid dressing and petrolatum gauze were better than conventional protection for preventing MRDPI. The surface under the cumulative ranking curve indicated that foam dressing was the best preventative.
CONCLUSION
Foam dressing is more effective than other dressings in preventing facial MRDPI in medical staff. When PPE must be worn for many hours, such as during the COVID-19 pandemic, medical staff can use foam dressings to prevent MRDPI.
RELEVANCE TO CLINICAL PRACTICE
The results support the use of dressings, especially foam dressings, to prevent MRDPI in healthcare workers. The appropriate dressings are recommended to prevent MRDPI associated with wearing PPE.
Topics: Humans; COVID-19; Pressure Ulcer; Network Meta-Analysis; Pandemics; Bandages; Medical Staff
PubMed: 37082837
DOI: 10.1111/jocn.16721 -
Pediatric Dermatology Jan 2020Topical occlusive agents, such as petroleum jelly and silicone oils, kill head lice by coating and blocking its excretory system and are unlikely to induce treatment... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Topical occlusive agents, such as petroleum jelly and silicone oils, kill head lice by coating and blocking its excretory system and are unlikely to induce treatment resistance. Although a popular alternative to neurotoxic pediculicides, their efficacy and safety remain unclear.
METHODS
We searched CENTRAL, MEDLINE, HERDIN (from inception to October 31, 2017), and other relevant sources for randomized controlled trials that compared topical occlusive agents with neurotoxic pediculicides to treat patients with head lice infestation. Using Cochrane collaboration methods, we selected studies, assessed risk of bias, and pooled similar studies. We assessed certainty of evidence using GRADEPro.
RESULTS
Seventeen trials (N = 2005) testing occlusive agents met inclusion criteria. Risk of bias was moderate across trials, mainly from lack of blinding of participants and personnel. As a class, occlusive agents may be more pediculicidal than neurotoxic agents (final cure rate, RR 1.20, 95% CI 1.02, 1.41; 16 RCTs, N = 1779; I = 88%; low certainty of evidence). Post hoc subgroup analysis suggests that this benefit may be limited to synthetic combination occlusive products. Adverse effects, such as skin and eye irritation, are similar between groups (RR 0.65, 95% CI 0.36, 1.17; 15 RCTs, N = 1790; I = 28%; low certainty of evidence).
CONCLUSIONS
In treating head louse infestation, evidence suggests occlusive agents may be superior to or equally efficacious as neurotoxic pediculicides. Adverse effects are few and minor. Future trials should use appropriate comparators and consider effects of confounders such as neurotoxin resistance. Additionally, optimal occlusive formulation and dosing regimen need to be determined.
Topics: Administration, Topical; Animals; Antiparasitic Agents; Head; Humans; Lice Infestations; Pediculus; Petrolatum; Silicone Oils
PubMed: 31642120
DOI: 10.1111/pde.14016