-
Journal of Tissue Viability Feb 2022The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.
AIMS
The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.
BACKGROUND
Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum.
DESIGN
Quantitative systematic review.
METHODS
Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms.
STUDY ELIGIBILITY CRITERIA
Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication.
PARTICIPANTS
patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion.
RESULTS
Thirteen studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies.
CONCLUSIONS
There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation.
PROSPERO ID
PROSPERO International prospective register of systematic reviews: CRD42017071459.
Topics: Adolescent; Adult; Cross-Sectional Studies; Heel; Humans; Pressure Ulcer; Risk Factors
PubMed: 34742635
DOI: 10.1016/j.jtv.2021.10.007 -
International Journal of Radiation... Nov 2020To identify and define the incidence, risk factors, clinical characteristics, and treatment approaches to pelvic insufficiency fractures (PIFs) that develop as a...
PURPOSE
To identify and define the incidence, risk factors, clinical characteristics, and treatment approaches to pelvic insufficiency fractures (PIFs) that develop as a consequence of pelvic radiation therapy for gynecologic malignancies.
MATERIALS AND METHODS
A systematic literature review (PubMed and Embase indexed from January 1, 1980, to May 1, 2020) of studies describing PIFs that result from radiation therapy for gynecologic malignancies. A random-effects model weighted by the inverse variance was used to calculate the pooled crude incidence, actuarial incidence, and proportion of symptomatic PIFs, and to evaluate the relationship between PIF incidence and various risk factors.
RESULTS
Thirty-eight studies describing PIFs following radiation therapy for gynecologic malignancies were reviewed. A meta-analysis of 6488 patients (37 studies) identified the crude incidence of PIF as 9.4% (95% confidence interval [CI] 6.8%-12.4%), and a meta-analysis of 2131 patients (9 studies) identified the 5-year actuarial incidence of PIF as 15.3% (95% CI 7.5%-25.0%). Factors that significantly correlated with increased risk of PIF development included evidence of osteoporosis (P < .001), postmenopausal state (P < .001), and history of diabetes mellitus (P = .005). Median time to PIF development ranged from 8 to 39 months after radiation therapy with the sacrum being the most frequent location for fracture development (60%). From 18 studies, 58.5% (95% CI 50.6%-66.2%) of PIFs were symptomatic, with pain as the most common presenting symptom of PIFs. Conservative management was used more than bone-directed therapies for treatment of PIFs (85% and 6% of patients, respectively).
CONCLUSIONS
PIFs cause significant morbidity in gynecologic cancer patients after radiation therapy. In this systematic review, we discuss the incidence and risk factors associated with PIF development as it relates to the different detection methods, radiation techniques, doses, and gynecologic cancers treated. Additional studies are needed to further define prevention and treatment approaches for insufficiency fractures.
Topics: Adult; Aged; Aged, 80 and over; Bone Density; Conservative Treatment; Diabetes Mellitus; Female; Fractures, Stress; Genital Neoplasms, Female; Hormone Replacement Therapy; Humans; Incidence; Middle Aged; Osteoporosis; Pelvic Bones; Postmenopause; Risk Factors; Sacrum; Young Adult
PubMed: 32442476
DOI: 10.1016/j.ijrobp.2020.05.013 -
Frontiers in Surgery 2024Unstable fractures of the sacrum often occur in patients with pelvic fractures and represent a real challenge for the orthopedic surgeon. Triangular osteosynthesis (TOS)... (Review)
Review
OBJECTIVE
Unstable fractures of the sacrum often occur in patients with pelvic fractures and represent a real challenge for the orthopedic surgeon. Triangular osteosynthesis (TOS) and lumbopelvic fixation (LP) may represent a valid management option for the treatment of this condition. We present a systematic literature review about lumbopelvic fixation and triangular fixation as treatment option for unstable sacral fractures, to assess clinical and radiological outcomes after surgery and to evaluate appropriate indications and impact on the natural history of sacral fractures.
METHODS
The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 50 articles out of 108 titles, were considered eligible for the full-text analysis. Finally, 16 studies that met inclusion criteria were included in this review.
RESULTS
Overall, 212 patients (87 males, 58 females) with sacral fractures treated with TOS triangular fixation or LP lumbopelvic fixation were collected. The mean age was 37.6 years. Mean follow-up reported in all studies was 24.14 months.
CONCLUSION
The results presented by the different authors, highlight the effectiveness of TOS triangular fixation and LP lumbopelvic fixation for the treatment of unstable sacral fractures associated with other pelvic fractures, in terms of function, stability, cost-effectiveness, and quality of life postoperatively.
PubMed: 38456170
DOI: 10.3389/fsurg.2024.1266393 -
International Journal of Nursing Studies Dec 2019Pressure injury can cause significant patient physical pain, impact quality of life for individuals and their families, and increase hospital length of stay and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure injury can cause significant patient physical pain, impact quality of life for individuals and their families, and increase hospital length of stay and healthcare costs. Within the hospital setting, it is considered to be largely preventable and regarded as an adverse event. In this context, prophylactic use of a protective sacral dressing to prevent pressure injury has been investigated by various researchers.
OBJECTIVES
Analyse the effectiveness of prophylactic sacral protective dressings to prevent pressure injury.
DESIGN
Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES
Electronic database searches were undertaken in 2018 and 2019. Initial searches identified 557 articles. Following duplicate removal and screening, 49 full text articles were reviewed. Most were excluded, leaving six studies that met the criteria for full review.
REVIEW METHODS
Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted using sample sizes based on intention-to-treat analysis. Sub-group meta-analyses were conducted of three studies in the intensive care setting and four studies that used the same dressing.
RESULTS
Overall, the six randomised controlled trials were judged to be of moderate quality. Due to visibility of the intervention, blinding was rare. Five studies were described as intention-to-treat; however two of these presented per-protocol analyses. All studies compared the intervention plus standard care to standard care. Five studies demonstrated statistically significant reduced pressure injury incidence in the intervention group. All studies were included in the meta-analysis (total n = 1872) and demonstrated homogeneity (I = 10%). Meta-analysis revealed an overall effect in favour of the intervention [risk ratio (RR) = 0.30, 95% CI 0.17-0.51] with a 95% prediction interval of 0.11-0.80. Sub-group analyses of intensive care studies and those using the same dressing demonstrated positive effects (RR = 0.17, 95% CI 0.06-0.49, I = 0%, and RR = 0.32, 95% CI 0.13-0.764, I = 31%; respectively).
CONCLUSIONS
The meta-analysis provides moderate evidence of the effectiveness of a prophylactic sacral dressing to prevent pressure injury, with an overall relative risk indicating that the intervention decreases pressure injury risk by 70%. Sub-group analysis of intensive care studies demonstrated a large relative risk reduction of 83% suggesting the dressing may be more effective in this high-risk group. The lower relative risk reduction of 68% found in four studies using the same dressing, in which there was moderate heterogeneity, indicates that further research is needed to clarify dressing choice.
Topics: Bandages; Humans; Length of Stay; Pressure Ulcer; Quality of Life; Sacrum
PubMed: 31629209
DOI: 10.1016/j.ijnurstu.2019.103400 -
Expert Review of Medical Devices Feb 2022Sacral Neuromodulation (SNM) is a minimally invasive treatment for OAB patients following failure of conventional interventions. Patient selection, lead placement, and...
INTRODUCTION
Sacral Neuromodulation (SNM) is a minimally invasive treatment for OAB patients following failure of conventional interventions. Patient selection, lead placement, and testing technique are important pillars in optimizing success rates.
AREAS COVERED
A comprehensive literature search was conducted on 'sacral neuromodulation' and 'overactive bladder.' There was no date restriction, with the last search dated 31 May 2021. Patient selection, lead placement, test phases, safety, efficacy, and available devices are thoroughly discussedLastly, future perspectives will be presented with the anticipated trajectory of sacral neuromodulation over the next five years.
EXPERT OPINION/COMMENTARY
SNM has proved to be a safe and effective therapy on the short-, medium- and long-term without precluding any other treatment options. In all studies reviewed, no life threatening or major irreversible complications were presented. However, surgical re-intervention rates were high with a median of 33.2% (range: 8-34%) in studies with at least 24 months follow-up. No true consensus could be made regarding prognostic factors. However, optimized lead placement, consequent ideal motor thresholds, and the use of a curved stylet theoretically facilitates reaching maximal success with SNM. Test phase success rates increased to such a level that from a cost-effective point of view, single-stage implants could be considered. OAB: overactive bladder; SNM: sacral neuromodulation; BoNT-A: Botulinum toxin A; PFM EMG: pelvic floor muscle electromyography; IPG: implantable pulse generator; PNE: percutaneous nerve evaluation; FSTLP: first-stage tined lead procedure; NLUTD: neurogenic lower urinary tract dysfunction; ITT: intention to threat; PPMC: per protocol modified completers; PPC: per protocol completers; AE: adverse event; MRI: magnetic resonance imaging; RCT: randomized controlled trial.
Topics: Electric Stimulation Therapy; Electromyography; Humans; Sacrum; Treatment Outcome; Urinary Bladder, Overactive
PubMed: 35061951
DOI: 10.1080/17434440.2022.2032655 -
Neuro-Chirurgie Mar 2023To determine the incidence of sacroiliac joint (SIJ) pain after lumbosacral spinal fusion.
OBJECTIVES
To determine the incidence of sacroiliac joint (SIJ) pain after lumbosacral spinal fusion.
BACKGROUND
Persistent low back pain is a potential source of disability and poor outcomes following lumbar spine fusion. The SIJ has been described as a potential source. However, there is a paucity of data concerning its importance.
METHODS
This is a PROSPERO registered systematic review. A systematic search of the English literature was performed in Medline, Embase and Cochrane Library databases. MeSH terms such as Lumbar vertebrae, Sacrum, Spinal Fusion, Pain, Sacrum, Ligaments, Sacroiliac Joint were utilized for the search. Key words such as "sacroiliac dysfunction.mp." and "sacroiliac complex.mp." were utilized for the search. Two independent reviewers reviewed articles to determine eligibility for final review and analysis. The Newcastle-Ottawa Scale was used to appraise the quality of all nonrandomized observational studies. Inverse variance weighting with random effects was used to pool data. The GRADE approach, PRISMA workflow and checklists was performed.
RESULTS
Twelve studies were included. All studies were observational and of moderate to low quality. The pooled incidence of sacroiliac joint pain was 15.8%. The pooled incidence of SIJ pain for patients without fusion extending to the sacrum was 15.8%. The pooled incidence of SIJ pain for patients with fusion extending to the sacrum was 32.9%. There was high heterogeneity.
CONCLUSION
SIJ pain is a potential cause of persistent pain after lumbar spine surgery. The current literature of poor quality. Patients presenting with pain after lumbosacral spine fusion should be evaluated for SIJ related pain.
Topics: Humans; Spinal Fusion; Sacroiliac Joint; Incidence; Low Back Pain; Lumbar Vertebrae
PubMed: 36754146
DOI: 10.1016/j.neuchi.2023.101419 -
Spine Deformity May 2024Spinopelvic fixation (SPF) using traditional iliac screws has provided biomechanical advantages compared to previous constructs, but common complications include screw... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Spinopelvic fixation (SPF) using traditional iliac screws has provided biomechanical advantages compared to previous constructs, but common complications include screw prominence and wound complications. The newer S2 alar-iliac (S2AI) screw may provide a lower profile option with lower rates of complications and revisions for adult spinal deformity (ASD). The purpose of this study was to compare rates of complications and revision following SPF between S2AI and traditional iliac screws in patients with ASD.
METHODS
A PRISMA-compliant systematic literature review was conducted using Cochrane, Embase, and PubMed. Included studies reported primary data on adult patients undergoing S2AI screw fixation or traditional IS fixation for ASD. Primary outcomes of interest were rates of revision and complications, which included screw failure (fracture and loosening), symptomatic screw prominence, wound complications (dehiscence and infection), and L5-S1 pseudarthrosis.
RESULTS
Fifteen retrospective studies with a total of 1502 patients (iliac screws: 889 [59.2%]; S2AI screws: 613 [40.8%]) were included. Pooled analysis indicated that iliac screws had significantly higher odds of revision (17.1% vs 9.1%, OR = 2.45 [1.25-4.77]), symptomatic screw prominence (9.9% vs 2.2%, OR = 6.26 [2.75-14.27]), and wound complications (20.1% vs 4.4%, OR = 5.94 [1.55-22.79]). S2AI screws also led to a larger preoperative to postoperative decrease in pain (SMD = - 0.26, 95% CI = -0.50, - 0.011).
CONCLUSION
The findings from this review demonstrate higher rates of revision, symptomatic screw prominence, and wound complications with traditional iliac screws. Current data supports the use of S2AI screws specifically for ASD.
PROSPERO ID
CRD42022336515.
LEVEL OF EVIDENCE
III.
Topics: Humans; Bone Screws; Ilium; Sacrum; Spinal Curvatures; Spinal Fusion; Postoperative Complications; Reoperation; Adult
PubMed: 38427156
DOI: 10.1007/s43390-024-00834-x -
Pediatric Surgery International Sep 2019Sacral nerve stimulation (SNS) is frequently used for constipation and fecal incontinence in the adult literature. The purpose of this study is to perform a systemic...
BACKGROUND
Sacral nerve stimulation (SNS) is frequently used for constipation and fecal incontinence in the adult literature. The purpose of this study is to perform a systemic review of the literature for SNS for constipation and fecal incontinence in children with emphasis in anorectal malformations.
METHODS
Systematic literature review was conducted to include all SNS studies in patients < 19 years of age. Studies were separated into those for (1) constipation, (2) bowel and bladder dysfunction, and (3) anorectal malformations.
RESULTS
28 articles were included in the review: (1) 12 constipation (269 patients) and (2) 16 bowel and bladder dysfunction (441 patients). Some studies overlapped groups, as they included some patients with anorectal malformations (4 articles and 29 patients). Constipation studies included slow transit and retention constipation and showed varying degrees of improvement. For bowel and bladder dysfunction, studies also reported varying degrees of improvement using different measures (number of bowel movements per day, transit times, and soiling improvement). There was no specific description of the results in anorectal malformation (ARM) cases and also information regarding specific ARM type, sacral ratio, or presence of tethered cord.
CONCLUSIONS
SNS for constipation and urinary problems seems to be promising. Data are limited and heterogeneous, and SNS cannot be definitively encouraged or discouraged in patients with ARM, based on current studies. Future studies should include more objective measurements of bowel outcomes and specify outcomes related to patients with anorectal malformations including information regarding their specific malformation, sacral ratio, and presence of tethered cord. Complications' rate is considerable high.
Topics: Anorectal Malformations; Child; Child, Preschool; Constipation; Electric Stimulation Therapy; Fecal Incontinence; Female; Humans; Male; Sacrum
PubMed: 31256299
DOI: 10.1007/s00383-019-04515-z -
Journal of Wound, Ostomy, and...To explore the effect of silicone dressings on the prevention of pressure injuries in patients cared for in the acute care setting. Three main comparisons were explored:... (Meta-Analysis)
Meta-Analysis
PURPOSE
To explore the effect of silicone dressings on the prevention of pressure injuries in patients cared for in the acute care setting. Three main comparisons were explored: silicone dressing versus no dressing, all anatomical areas; silicone dressing versus no dressing on the sacrum; and silicone dressing versus no dressing on the heels.
METHODS
Using a systematic review methodology, published randomized controlled trials and cluster randomized controlled trials were included. The search was conducted from December 2020 to January 2021 using CINAHL, full text on EBSCOhost, MEDLINE on EBSCOhost, and Cochrane databases. The search returned 130 studies; 10 met inclusion criteria. Data were extracted using a predesigned extraction tool. The Cochrane Collaboration tool was used to assess the risk of bias and the certainty of the evidence was appraised using a software program specifically designed for this purpose.
RESULTS
Silicone dressings probably reduce the incidence of pressure injuries compared to no dressings (relative risk [RR]: 0.40, 95% confidence interval [CI]: 0.31-0.53; moderate certainty evidence). Furthermore, silicone dressings probably reduce the incidence of pressure injuries on the sacrum compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence). Finally, silicone dressings probably reduce the incidence of pressure injuries on the heels compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence).
CONCLUSION
There is moderate certainty evidence of the effect of silicone dressings as a component of a pressure injury prevention strategy. The main limiting factor in the study designs was a high risk of performance and detection bias. Although this is a challenge to achieve in trials such as these, consideration should be given to how the effect of this could be minimized. A further issue is the lack of head-to-head trials that limits clinicians' abilities to determine whether any of the products in this category are more effective than others.
Topics: Humans; Incidence; Pressure Ulcer; Patients; Spine; Bandages
PubMed: 36867034
DOI: 10.1097/WON.0000000000000953 -
European Spine Journal : Official... Sep 2019The classical spinopelvic fixation includes 1 iliac screw on each side. The purpose of this study is to specify the indications of the "dual iliac screw" (DIS)...
PURPOSE
The classical spinopelvic fixation includes 1 iliac screw on each side. The purpose of this study is to specify the indications of the "dual iliac screw" (DIS) construct, i.e., when to put 2 iliac screws on each side, to describe its biomechanical advantages, and to define its related technical aspects.
METHODS
A primary search on Medline through PubMed distribution was performed, with the use of the terms "pelvic fixation" or "spinopelvic" or "lumbo-iliac" and the terms "dual iliac screw" or "double iliac screw." English papers corresponding to the inclusion criteria were analyzed regarding the specific indications of the DIS construct and its surgical technique and advantages.
RESULTS
Eleven papers were identified according to the research criteria and included in this review. Three main indications were identified for the DIS technique according to three types of pathologies: in adult deformities when a long construct is needed in an osteoporotic patient or when correction requires three-column osteotomy of the sacrum; in trauma when a U-shaped fracture-dislocation of the sacrum is involved; in sacral tumors when a sacrectomy is performed or when destructive metastatic lesions of the sacrum require palliative surgical treatment. Biomechanically, the DIS technique proved to have higher construct stiffness in terms of compression and torsion.
CONCLUSION
In specific cases, affecting different areas of spinal diseases, the DIS technique is more advantageous, when compared to the "single iliac screw" version, as it would provide a stronger and safer fixation at the base of the spinopelvic construct. These slides can be retrieved under Electronic Supplementary Material.
Topics: Biomechanical Phenomena; Bone Screws; Humans; Ilium; Lumbar Vertebrae; Osteotomy; Spinal Fusion
PubMed: 31300882
DOI: 10.1007/s00586-019-06065-3