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International Wound Journal Aug 2023This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for... (Randomized Controlled Trial)
Randomized Controlled Trial
This study evaluates the effect of nursing staff's renewed consistent pressure ulcer (PU) prevention practice on PU prevalence and the PU prevention implemented for residents. A quasi-experimental intervention study was conducted. The data were collected from 232 residents (n = 115 in intervention and 117 in comparison group) in two public long-term older people care (LOPC) facilities in Finland using the Pressure Ulcer Patient instrument (PUP-Instrument). The facilities were chosen with convenience sampling, after which they were randomly allocated as either intervention or comparison facility. Based on international guidelines for PU prevention, the renewed, consistent PU prevention practice with six areas was developed and implemented using the operational model for evidence-based practices (OMEBP). After the intervention, a significant difference between the intervention and the comparison facility was seen in the prevalence of PUs and in the residents' highest stage of PUs in the sacrum, buttock and hip areas, and heels. Between the facilities, a significant difference was seen in the use of PU and nutrition risk assessment instruments and nutritional supplements, time used for repositioning in the daytime and at night-time, lifting belt use, and avoiding shearing or stretching residents' skin. The successful intervention improved skin integrity in LOPC facilities.
Topics: Aged; Humans; Long-Term Care; Pressure Ulcer; Prevalence; Skin Care; Suppuration
PubMed: 36584884
DOI: 10.1111/iwj.14067 -
Revista Da Escola de Enfermagem Da U S P 2023Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries. (Review)
Review
OBJECTIVE
Summarizing the evidence from systematic reviews regarding the comparison the effectiveness of interventions to prevent pressure injuries.
METHOD
Overview of systematic reviews conducted in accordance with Cochrane guidelines. A search was performed in databases, repositories and systematic review registration sites.
RESULTS
15 reviews were included in this overview. The sensitivity analysis showed a reduction in the incidence of pressure injuries with nutritional supplementation compared to the standard hospital diet (Relative Risk (RR) = 0.83; 95% Confidence Interval (CI): 0.72-0.95). There was evidence of the superiority of constant low-pressure surfaces (RR = 0.38; 95% CI;0.24-0.61), alternating pressure devices (RR = 0.31; 95% CI:0.17-0.58) and alternative foams (RR = 0.40; 95% CI:0.21-0.74) when compared to the standard hospital mattress or standard foam. The use of a silicone cover reduced the incidence of pressure injuries by 75% (RR = 0.25; 95%CI:0.16-0.41) when compared to no cover.
CONCLUSION
Although some interventions have been shown to be effective in reducing the incidence of pressure injury, the evidence is limited or very limited and subject to change. Registration CRD42017064586.
Topics: Humans; Pressure Ulcer; Systematic Reviews as Topic
PubMed: 38133528
DOI: 10.1590/1980-220X-REEUSP-2023-0039en -
Ugeskrift For Laeger Oct 2019This review summarises the knowledge of hospital-acquired pressure injuries (PI), which are underestimated and very painful adverse events giving an increased risk of... (Review)
Review
This review summarises the knowledge of hospital-acquired pressure injuries (PI), which are underestimated and very painful adverse events giving an increased risk of infections and scarring and may lead to the need for reconstructive surgery. The majority of PI in the paediatric population are medical device-related, and according to international studies it is possible to reduce the extent through a systematic intervention. The staff must have knowledge and focus on principles for the prevention of PI, and a systematic risk assessment supplemented with the implementation of "bundles" is recommended to reduce PI among children.
Topics: Child; Humans; Iatrogenic Disease; Pressure; Risk Assessment; Wounds and Injuries; Pressure Ulcer
PubMed: 31610834
DOI: No ID Found -
Intensive & Critical Care Nursing Dec 2023To explore nurses' knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention.
OBJECTIVE
To explore nurses' knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention.
DESIGN/METHOD
A pre-and post-intervention study. Pre-intervention data collection involved administering an instrument, including demographic information, the Pressure Ulcer Knowledge Assessment Tool version 2, and the Attitudes towards Pressure Ulcer Prevention instruments. Following the analysis of pre-intervention data, an educational intervention was implemented. Post-intervention data were collected using the same instrument.
SETTING
Intensive care units at three Saudi Arabian hospitals.
MAIN OUTCOME MEASURES
Nurses' knowledge and attitudes towards pressure injury prevention.
RESULTS
The pre-intervention phase included 190 participants, and the post-intervention phase included 195 participants. Participants completed a paper-based survey at two different time points between June 2021 and March 2022. The mean pre-intervention scores for nurses' knowledge and attitudes towards pressure injury prevention were 43.22% and 74.77%, respectively. Following the educational intervention, the knowledge and attitude scores increased significantly to 51.22% and 79.02%, respectively. Higher knowledge of pressure injury prevention was positively associated with positive attitudes towards prevention practices. Age, clinical nursing experience, and experience in intensive care units were identified as factors correlated with knowledge of pressure injury prevention. A Bachelor's qualification or higher predicted better knowledge and attitudes towards pressure injury prevention.
CONCLUSIONS
Nurses' knowledge and attitudes towards pressure injury prevention greatly improved following tailored, evidence-based education. The educational intervention featured multiple on-site bedside discussions, case studies, small-group presentations, and the provision of printed resources.
IMPLICATIONS FOR CLINICAL PRACTICE
Nurses' knowledge and attitudes towards pressure injury prevention should be examined, and education provided to ensure evidence-based prevention practices are implemented. Tailored small-group education sessions delivered conveniently could be an effective approach. Efforts should focus on attracting and retaining experienced, highly qualified nurses to ensure the adoption of evidence-based prevention practices.
Topics: Humans; Pressure Ulcer; Clinical Competence; Saudi Arabia; Nurses; Critical Care; Attitude
PubMed: 37603978
DOI: 10.1016/j.iccn.2023.103528 -
Assistive Technology : the Official... Sep 2022Wheelchair users often experience prolonged periods of stationary sitting. Such periods are accompanied with increased loading of the ischial tuberosities. This can lead...
Wheelchair users often experience prolonged periods of stationary sitting. Such periods are accompanied with increased loading of the ischial tuberosities. This can lead to the development of pressure ulcers which can cause complications such as sepsis. Periodic pressure offloading is recommended to reduce the onset of pressure ulcers. Experts recommend the periodic execution of different movements to provide the needed pressure offloading. Wheelchair users, however, might not remember to perform these recommended movements in terms of both quality and quantity. A system that can detect such movements could provide valuable feedback to both wheelchair users as well as clinicians. The objective of this study was to present and validate the WiSAT - a system for characterizing in-seat activity for wheelchair users. WiSAT is designed to detect two kinds of movements - weight shifts and in-seat movements. Weight shifts are movements that offload pressure on ischial tuberosities by 30% as compared to upright sitting and are maintained for 15 seconds. In-seat movements are shorter transient movements that involve either a change in the center of pressure on the sitting buttocks or a transient reduction in total load by 30%. This study validates the use of WiSAT in manual wheelchairs. WiSAT has a sensor mat which was inserted beneath a wheelchair cushion. Readings from these sensors were used by WiSAT algorithms to predict weight shifts and in-seat movements. These weight shifts and in-seat movements were validated against a high-resolution interface pressure mat in a dataset that resembles real-world usage. The proposed system achieved weight shift precision and recall scores of 81% and 80%, respectively, while in-seat movement scores were predicted with a mean absolute error of 22%. Results showed that WiSAT provides sufficient accuracy in characterizing in-seat activity in terms of weight shifts and in-seat movement.
Topics: Buttocks; Fitness Trackers; Humans; Pressure; Pressure Ulcer; Wheelchairs
PubMed: 33617402
DOI: 10.1080/10400435.2021.1893237 -
Journal of Wound Care Dec 2020The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure...
The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure ulcer (PU, also known as pressure injury) prevention eventually determine the associated clinical and cost-benefit outcomes. The article specifically describes a bioengineering algorithm for quantitative evaluation of the biomechanical efficacy of different prophylactic dressing designs, which is exemplified for two fundamentally different dressing technologies, one based on superabsorbent cellulose core versus the conventional silicone-foam dressing design. A set of three biomechanical indices is described and employed for the above comparative evaluation, namely, the protective efficacy index, the protective endurance and the prophylactic trade-off design parameter. It is demonstrated that the dressing with the superabsorbent cellulose core is at least as good as silicone-foams but, importantly, provides a good balance between its protective performance in its 'new' condition, as opposed to its 'used' condition, i.e., after being exposed to moisture. Most notably, we show that preventative dressings are never equal in their performances; the underlying structure and the dressing ingredients together determine the extent of the delivered tissue protection and its durability.
Topics: Bandages; Humans; Pressure Ulcer; Silicones; Skin Care
PubMed: 33320759
DOI: 10.12968/jowc.2020.29.Sup12.S6 -
Journal of Medical Internet Research Sep 2022Pressure injury is a common complication after a spinal cord injury. Long-term multidisciplinary follow-up is difficult after such patients have been discharged.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressure injury is a common complication after a spinal cord injury. Long-term multidisciplinary follow-up is difficult after such patients have been discharged. Telemedicine promises to provide convenient and effective support for the prevention and treatment of pressure injury, but previous attempts to demonstrate that have produced inconsistent results.
OBJECTIVE
The aim of this study is to evaluate the effectiveness of telemedicine in preventing and treating pressure injury among community-dwelling patients with spinal cord injury, and determine which telemedicine form is more effective.
METHODS
This systematic review was performed according to the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analysis) standards. Ten databases were searched to identify randomized controlled trials and quasi-experimental studies related to the effectiveness of telemedicine intervention in patients with spinal cord injury. Two researchers worked independently and blindly selected studies, extracted data, and assessed the risk of bias. The results were described as relative risk (RR) and weighted mean difference and 95% CI.
RESULTS
The 35 studies comprised 25 randomized controlled trials and 10 quasi-experimental studies involving 3131 patients. The results showed that telemedicine can significantly (P<.05) reduce the incidence of pressure injury (RR 0.24, 95% CI 0.14-0.41; P<.05; I=0%), promote faster healing (RR 0.73, 95% CI 0.62-0.85; P<.05; I=0%), and yield lower scores on the pressure ulcer scale of healing (weighted mean difference=-1.98, 95% CI -3.51 to -0.46; P<.05; I=0%). Cumulative ranking estimates showed that combining telemedicine with conventional intervention (93.5%) was the most effective approach.
CONCLUSIONS
Telemedicine is a feasible way to prevent pressure injury among patients with spinal cord injuries. It can decrease the incidence and severity of pressure injury and accelerate patients' healing without imposing economic burden. It is best used in tandem with other, more conventional interventions. Due to the limited quality and quantity of included studies, large-scale and well-designed randomized controlled trials are warranted.
Topics: Humans; Incidence; Independent Living; Pressure Ulcer; Spinal Cord Injuries; Telemedicine
PubMed: 36069842
DOI: 10.2196/37618 -
Inquiry : a Journal of Medical Care... 2021We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four... (Review)
Review
We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four stages: literature review and analysis of medical records; preliminary algorithm development; validation of the preliminary algorithm by experts in two rounds; and practical feasibility verification of the revised algorithm by 109 intensive care unit nurses. To verify the algorithm's effectiveness, we compared the incidence of medical device-related pressure injuries between 324 patients without algorithm application (control group) and 312 patients with algorithm application (experimental group). The outcomes were skin inspection of the medical device attachment, pressure injury evaluation, and implementation of pressure injury-preventive nursing care, based on the medical device type. The incidence rates were 1.46 per 100 devices (control group) and 1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous score of the Braden scale in the experimental and control groups, the results regarding the incidence of pressure damage after applying the algorithm should be interpreted with care. Applying this algorithm was a safe intervention that helped prevent medical device-related pressure injuries in this population.
Topics: Algorithms; Humans; Incidence; Intensive Care Units; Pressure Ulcer; Risk Factors
PubMed: 34672226
DOI: 10.1177/00469580211050219 -
International Journal of Molecular... Dec 2020Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they... (Review)
Review
Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.
Topics: Animals; Apoptosis; Disease Management; Disease Susceptibility; Extracellular Matrix; Gene Expression Regulation; Gene Regulatory Networks; Humans; Immunity; MicroRNAs; Oxidative Stress; Pressure Ulcer; RNA Interference; Reperfusion Injury; Signal Transduction; Wound Healing
PubMed: 33374656
DOI: 10.3390/ijms22010064 -
Sensors (Basel, Switzerland) Feb 2023In-bed posture monitoring has become a prevalent area of research to help minimize the risk of pressure sore development and to increase sleep quality. This paper...
In-bed posture monitoring has become a prevalent area of research to help minimize the risk of pressure sore development and to increase sleep quality. This paper proposed 2D and 3D Convolutional Neural Networks, which are trained on images and videos of an open-access dataset consisting of 13 subjects' body heat maps captured from a pressure mat in 17 positions, respectively. The main goal of this paper is to detect the three main body positions: supine, left, and right. We compare the use of image and video data through 2D and 3D models in our classification. Since the dataset was imbalanced, three strategies were evaluated, i.e., down sampling, over sampling, and class weights. The best 3D model achieved accuracies of 98.90 ± 1.05% and 97.80 ± 2.14% for 5-fold and leave-one-subject-out (LOSO) cross validations, respectively. To compare the 3D model with 2D, four pre-trained 2D models were evaluated, where the best-performing model was the ResNet-18 with accuracies of 99.97 ± 0.03% for 5-fold and 99.62 ± 0.37% for LOSO. The proposed 2D and 3D models provided promising results for in-bed posture recognition and can be used in the future to further distinguish postures into more detailed subclasses. The outcome of this study can be used to remind caregivers at hospitals and long-term care facilitiesto reposition their patients if they do not reposition themselves naturally to prevent pressure ulcers. In addition, the evaluation of body postures and movements during sleep can help caregivers understand sleep quality.
Topics: Humans; Neural Networks, Computer; Posture; Movement; Sleep; Hospitals; Pressure Ulcer
PubMed: 36904634
DOI: 10.3390/s23052430