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International Wound Journal Oct 2023This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the... (Review)
Review
This systematic review aimed to examine the knowledge of caregivers regarding pressure ulcer (PU) prevention. A thorough, methodical search was conducted from the earliest date to February 1, 2023 using keywords extracted from Medical Subject Headings such as "Caregivers", "Knowledge", and "Pressure ulcer" in various international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and Scientific Information Database. The quality of the studies included in this systematic review was evaluated using an appraisal tool for cross-sectional studies (AXIS tool). In total, 927 caregivers participated in the eight studies. The average age of the participants was 40.50 (SD = 12.67). Among the participants, 61.87% were women. The average caregiver's knowledge of PU prevention was 53.70 (SD = 14.09) out of 100, which suggests a moderate level of knowledge. Factors such as level of education, age, occupation, information about PUs, attitude, and practice had a significant positive relationship with caregivers' knowledge related to the prevention of PUs. Knowledge had a significantly negative relationship with age. In addition, marital status, type of relationship, age, gender, occupation, level of education, and inpatient wards had a significant relationship with caregivers' knowledge regarding PUs prevention. Therefore, managers and policymakers in the medical field can help increase caregivers' knowledge by providing an online or in-person educational platform relevant to PU prevention.
Topics: Humans; Female; Male; Caregivers; Cross-Sectional Studies; Ulcer; Pressure Ulcer; Suppuration
PubMed: 36960763
DOI: 10.1111/iwj.14168 -
Inquiry : a Journal of Medical Care... 2023Turning and repositioning is considered one of the strategies to reduce the incidence of pressure injuries (PIs) among hospitalized patients, as it helps to redistribute... (Review)
Review
Turning and repositioning is considered one of the strategies to reduce the incidence of pressure injuries (PIs) among hospitalized patients, as it helps to redistribute and minimize direct pressure on the targeted skin and enhance blood perfusion in the affected areas. The frequency of turning and repositioning is generally uniform across clinical settings, with most clinical guidelines recommending a substantial change in a patient's position according to their health status. Notably, the optimal time interval between the position changes has not yet been established. Therefore, this study aimed to review the current literature in relation to the frequency of turning and repositioning adult patients to prevent PIs. The author used a systematic review following Whittemore and Knafl's review strategy. The author used the following databases: CINAHL, Scopus, PubMed, ProQuest, Ovid, MedLine, Web of Science, and Google Scholar. During the search, Boolean logic operators, MeSH terms, and keywords were utilized. The researcher followed the Johns Hopkins Nursing Evidence-based Practice Grading Scale to evaluate the quality of selected studies. The search yielded 723 articles, of which 10 were included in this review. These 10 articles revealed several frequency intervals for comparison purposes: 2-hourly, 3-hourly, 4-hourly, and 6-hourly depending on the healthcare setting, with a combination of supine, 30° tilt, or 90° tilt. This review shows that the optimal frequency of turning and repositioning to prevent PIs remains unclear and further investigation is necessary. Considering the varying nature of clinical settings, there is a lack of clarity regarding a golden standard for the same. Therefore, patients' health conditions should be considered when choosing the proper frequency to prevent PIs.
Topics: Humans; Adult; Pressure Ulcer; Health Facilities; Incidence; Health Status; Hospitals
PubMed: 38050921
DOI: 10.1177/00469580231215209 -
Journal of Tissue Viability May 2023To develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services. (Review)
Review
AIM
To develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services.
MATERIALS AND METHODS
Systematic review of prevalence and incidence studies developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols and the Joanna Briggs Institute methodology. The inclusion criteria were based on the CoCoPop mnemonic. The main variables of interest were the "prevalence" and/or the "incidence" of "pressure ulcers/injuries" (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The Systematic Review Protocol was registered in PROSPERO (CDR42021252906).
RESULTS
The pressure ulcer/injury (point) prevalence ranged from 5.2% (at admission) to 12.3% (at discharge) and the pressure ulcer/injury incidence ranged from 4.5% to 78.4%. Most of the pressure ulcers/injuries documented were category/stage I. The most problematic anatomical locations were the sacrococcygeal region and the heels. The preventive measures should be implemented as soon as possible and are important in patients older than 75 years, with multiple comorbidities, high C-Reative Protein levels, cervical spine immobilization, presented to hospital emergency service by ambulance or with hypotension at the time of admission.
CONCLUSIONS
The prevalence and incidence of pressure ulcers/injuries in hospital emergency services remains an understudied topic which could limit the generalization of our data. This systematic review highlighted that the management of pressure ulcers/injuries is a real and current challenge in hospital emergency services. It is important to identify the patients at (higher) risk to establish an (earlier) preventive care plan according to patients and emergency services' characteristics.
Topics: Adult; Humans; Cohort Studies; Crush Injuries; Emergency Service, Hospital; Hospitalization; Pressure Ulcer
PubMed: 36792441
DOI: 10.1016/j.jtv.2023.02.001 -
Heliyon Mar 2024Many clinical management strategies have been proposed to deal with diabetic foot ulcers. However, the occurrence and recurrence of foot ulcers remain the major problems...
Many clinical management strategies have been proposed to deal with diabetic foot ulcers. However, the occurrence and recurrence of foot ulcers remain the major problems for diabetics. This study aims to identify, visualize, and characterize the meta-analyses on diabetic foot ulcer research. Articles published online were retrieved from the Web of Science core collection database using a search query incorporating MeSH terms and topics related to diabetic foot ulcers and meta-analysis. The publications were then analyzed for basic characteristics, including publication year, countries, topics covered, references, and keywords discussed in the articles. Data visualization was performed using CiteSpace. 334 meta-analyses and systematic reviews on diabetic foot ulcers were identified. The number of publications has experienced rapid growth in recent years (nearly 6-fold since 2016). The United States, China, Netherlands, England, and Australia had a strong collaboration in the contribution of publication. 7 primary topics were summarized from the top 100 highly cited publications: #1 Interventions (proportion: 59%), #2 Risk factors and Prevention (22%), #3 Epidemiology analysis (6%), #4 Cost-effectiveness of interventions (5%), #5 Long-term prognosis (3%), #6 Quality of life analysis (3%), and #7 Economic burden analysis (2%). Footwear and offloading interventions, multidisciplinary care, hyperbaric oxygen, platelet-rich plasma, and negative pressure wound therapies are highly regarded in terms of intervention. Diabetic foot osteomyelitis, peripheral diabetic neuropathy, chronic limb-threatening ischemia, and infections are the main comorbidities. In recent years, offloading interventions, debridement, telemedicine, long-term prognosis, and economic burden analyses have gradually received attention. Individualized treatment, multidisciplinary collaboration, quality of life considerations, and economic burden analyses are the long-term concerns.
PubMed: 38496839
DOI: 10.1016/j.heliyon.2024.e27534 -
The Cochrane Database of Systematic... Feb 2022Sitting can be viewed as a therapeutic intervention and an important part of a person's recovery process; but the risk of ulceration must be mitigated. Interventions for... (Review)
Review
BACKGROUND
Sitting can be viewed as a therapeutic intervention and an important part of a person's recovery process; but the risk of ulceration must be mitigated. Interventions for ulcer prevention in those at risk from prolonged sitting include the use of specialist cushions and surfaces, especially for wheelchair users. Whilst there is interest in the effects of different pressure redistributing cushions for wheelchairs, the benefits of pressure redistributing static chairs, compared with standard chairs, for pressure ulcer development in at-risk people are not clear.
OBJECTIVES
To assess the effects of pressure redistributing static chairs on the prevention of pressure ulcers in health, rehabilitation and social care settings, and places of residence in which people may spend their day.
SEARCH METHODS
In June 2021 we searched the following electronic databases to identify reports of relevant randomised clinical trials: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature). We also searched clinical trials registers for ongoing and unpublished studies, and reference lists of relevant systematic reviews, meta-analyses and health technology reports. There were no restrictions by language, date of publication or study setting.
SELECTION CRITERIA
We sought to include published or unpublished randomised controlled trials that assessed pressure redistributing static chairs in the prevention or management of pressure ulcers.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection. We planned that two review authors would also assess the risk of bias, extract study data and assess the certainty of evidence according to GRADE methodology.
MAIN RESULTS
We did not identify any studies that met the review eligibility criteria, nor any registered studies investigating the role of pressure redistributing static chairs in the prevention or management of pressure ulcers.
AUTHORS' CONCLUSIONS
Currently, there is no randomised evidence that supports or refutes the role of pressure redistributing static chairs in the prevention or management of pressure ulcers. This is a priority area and there is a need to explore this intervention with rigorous and robust research.
Topics: Bedding and Linens; Beds; Bias; Humans; Pressure Ulcer
PubMed: 35174477
DOI: 10.1002/14651858.CD013644.pub2 -
Journal of Tissue Viability Nov 2022To systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs.
METHODS
A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched to collect cross-sectional studies and cohort studies related to PIs among hospitalized fracture patients. All electronic literature sources were searched from inception to March 2022, and a hand-search through references was also conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. All data analysis used Stata14.0. The I statistic and random-effects model were used to determine the heterogeneity.
RESULTS
A total of 7906 articles were screened, and 18 studies with 8956 patients were ultimately involved in this review. The pooled incidence of PIs in the fracture patients was 20.4% (95%CI: 14.9 to 25.8), and the incidence of PIs only in spinal and hip fracture patients was 23.9% (95%CI: 19.6 to 28.2). The incidence of PIs in 65 years old or over was significantly high (23.3% [95%CI: 15.3 to 31.2]). The most affected body sites were sacrococcygeal regions (56.7%) and heels (19.9%). The most common stages were stage 2 (62.2%) and stage 1 (17.4%).
CONCLUSION
The overall incidence of PIs in fracture patients was as high as 20.4%, significantly higher than the average incidence of adults. We found that the potential for PIs in fracture patients increases with age. Hence, our discoveries recommended that healthcare givers should consider reducing the occurrence of PIs. Additionally, more research may be conducted to improve the understanding of characteristics of PIs among fracture patients and to identify PIs risk factors to prevent and treat them effectively.
Topics: Adult; Aged; Humans; China; Cross-Sectional Studies; Crush Injuries; Incidence; Risk Factors; Pressure Ulcer
PubMed: 36109261
DOI: 10.1016/j.jtv.2022.08.006 -
International Wound Journal Sep 2023The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and meta-analysis is to provide an overview of the prevalence of pressure ulcers (PU) in orthopaedic wards. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database (SID) using keywords extracted from Medical Subject Headings such as "Prevalence", "Pressure ulcer", "Pressure sore", and "Orthopaedics" from the earliest to February 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. Finally, 11 studies were included in the final analysis. The results indicated that the prevalence of PU in orthopaedic departments was 18% (ES: 0.18, 95% CI: 0.10-0.26, Z = 4.53, I : 99.09%). Although the odds ratio of PU was lower in men than women, it was not statistically significant (OR: 0.91, 95% CI: 0.74-1.11, Z = 0.95, I : 17.4%, P = .34). Also, results showed the prevalence of PU was higher among studies with a sample size of more than 200 (ES: 0.19, 95% CI: 0.10-0.28, Z = 4.07, I : 99.1%), Europe region (ES: 0.20, 95% CI: 0.14-0.26, Z = 6.7, I : 93.0%) and prospective design (ES: 0.23, 95% CI: 0.18-0.27, Z = 9.47, I : 83.3%) when compared with other sub-groups. In sum, considering the 18% prevalence of PU in the orthopaedic department, it is recommended to focus on detecting risk factors and design interventions to reduce PU in the patients admitted orthopaedic department.
Topics: Male; Humans; Female; Ulcer; Cross-Sectional Studies; Risk Factors; Hospitals; Europe; Pressure Ulcer
PubMed: 36960790
DOI: 10.1111/iwj.14156 -
International Wound Journal Mar 2024This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science, and Cochrane Library were... (Meta-Analysis)
Meta-Analysis Review
This review aims to systematically evaluate the association between hypertension and pressure ulcer (PU). PubMed, Embase, Web of Science, and Cochrane Library were searched for studies from their inception until September 12, 2023. Literature search, data extraction, and quality assessment were conducted independently by two researchers. The random-effects model was used to calculate the combined odds ratio (OR) and corresponding 95% confidence interval (CI) of hypertension in patients with PU; subgroup analyses were performed to explore the source of between-study heterogeneity; sensitivity analysis was used to test the robust of the combined result; and funnel plot and Egger's test were used to assess the publication bias. Finally, a total of 19 studies with 564 716 subjects were included; the overall pooled result showed no significant association between hypertension and risk of developing PU (OR = 1.15, 95% CI = 0.90-1.47, p = 0.27); and the sensitivity analysis and publication bias analysis showed robust of the combined result. Subgroup analysis indicated a significant association between hypertension and PU when the primary disease was COVID-19 (OR = 1.73, 95% CI = 1.35-2.22, p < 0.0001). No association between hypertension and PU was seen in subgroup analysis on the patient source and study design. In sum, there is no significantly statistical association between hypertension and the occurrence of PU in most cases, while the risk of PU significantly elevates among COVID-19 patients combined with hypertension regardless of patient source and study design.
Topics: Humans; Pressure Ulcer; Hypertension; Research Design; COVID-19
PubMed: 38494175
DOI: 10.1111/iwj.14829 -
International Wound Journal Oct 2023The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1,... (Review)
Review
The purpose of this review study is to investigate the attitude of nursing students toward the prevention of pressure ulcers (PUs) and related factors. From February 1, 2023, a comprehensive search was conducted in international and Persian electronic databases such as Web of Science, PubMed, Scopus, Iranmedex, and Scientific information database (SID). The keywords obtained from Medical Subject Headings, including "Attitude", "Nursing students", and "Pressure ulcer" were used in this search. The quality assessment of the present studies in this systematic review was based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 6454 nursing students participated in ten cross-sectional studies. All students were studying at the undergraduate level and 81.20% of them were female. Nursing students were in the first (39.27%), second (28.19%), and third and fourth (32.54%) academic years. Among the participants, 49.86% have completed at least 2 clinical units. The mean scores of attitudes toward PU prevention in nursing students based on attitude toward PU prevention (APuP) and researcher-made questionnaires were 75.01% and 68.82%, respectively. The attitude of nursing students was influenced by various factors, including age, sex, academic year, clinical experience, number of clinical units, experience in caring for PU patients, previous courses on PU in the curriculum, and contribution of training to knowledge. Also, in the present study, the positive relationship between the attitude and knowledge of nursing students was shown as the only significant correlation. In sum, the attitude of the majority of nursing students toward the prevention of PUs was at a satisfactory level. Therefore, it is expected to transfer the necessary knowledge to them with proper planning so that preventive actions can be carried out by following the guidelines.
Topics: Humans; Female; Male; Ulcer; Students, Nursing; Cross-Sectional Studies; Surveys and Questionnaires; Pressure Ulcer; Health Knowledge, Attitudes, Practice; Suppuration; Attitude of Health Personnel
PubMed: 37434034
DOI: 10.1111/iwj.14191 -
Journal of Foot and Ankle Research Nov 2023Plantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Plantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy and its risk factors are scant impeding the development of targeted interventions to prevent and promote healing of ulcers. The aim of this review is to generate evidence on the prevalence of plantar ulcer and its risk factors in leprosy.
METHODS
Databases (Medline, Embase, Web of Science, CINAHL, BVS), conference abstracts and reference lists were searched for eligible studies. Studies were included that reported a point prevalence of plantar ulcer and/or its "risk factors" associated with development of ulcers (either causatively or predictively), including individual level, disease related and bio-mechanical factors. We followed PRISMA guidelines for this review. Random-effects meta-analysis was undertaken to estimate the pooled point prevalence of ulcers. Reported risk factors in included studies were narratively synthesised. This review is registered in PROSPERO: CRD42022316726.
RESULTS
Overall, 15 studies (8 for prevalence of ulcer and 7 for risk factors) met the inclusion criteria. The pooled point prevalence of ulcer was 34% (95% CIs: 21%, 46%) and 7% (95% CIs: 4%, 11%) among those with foot anaesthesia and among all people affected by leprosy, respectively. Risk factors for developing ulcers included: unable to feel 10 g of monofilament on sensory testing, pronated/hyper-pronated foot, foot with peak plantar pressure, foot with severe deformities, and those with lower education and the unemployed.
CONCLUSIONS
The prevalence of plantar ulceration in leprosy is as high as 34% among those with loss of sensation in the feet. However, the incidence and recurrence rates of ulceration are least reported. The inability to feel 10 g of monofilament appears to be a strong predictor of those at risk of developing ulcers. However, there is a paucity of evidence on identifying those at risk of developing plantar ulcers in leprosy. Prospective studies are needed to estimate the incidence of ulcers. Identifying individuals at risk of ulcers will help design targeted interventions to minimize risk factors, prevent ulcers and promote ulcer healing.
Topics: Humans; Foot Ulcer; Ulcer; Prevalence; Risk Factors; Leprosy
PubMed: 37953361
DOI: 10.1186/s13047-023-00674-4