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Annals of Internal Medicine Jul 2013Pressure ulcers are associated with substantial health burdens but may be preventable. (Review)
Review
BACKGROUND
Pressure ulcers are associated with substantial health burdens but may be preventable.
PURPOSE
To review the clinical utility of pressure ulcer risk assessment instruments and the comparative effectiveness of preventive interventions in persons at higher risk.
DATA SOURCES
MEDLINE (1946 through November 2012), CINAHL, the Cochrane Library, grant databases, clinical trial registries, and reference lists.
STUDY SELECTION
Randomized trials and observational studies on effects of using risk assessment on clinical outcomes and randomized trials of preventive interventions on clinical outcomes.
DATA EXTRACTION
Multiple investigators abstracted and checked study details and quality using predefined criteria.
DATA SYNTHESIS
One good-quality trial found no evidence that use of a pressure ulcer risk assessment instrument, with or without a protocolized intervention strategy based on assessed risk, reduces risk for incident pressure ulcers compared with less standardized risk assessment based on nurses' clinical judgment. In higher-risk populations, 1 good-quality and 4 fair-quality randomized trials found that more advanced static support surfaces were associated with lower risk for pressure ulcers compared with standard mattresses (relative risk range, 0.20 to 0.60). Evidence on the effectiveness of low-air-loss and alternating-air mattresses was limited, with some trials showing no clear differences from advanced static support surfaces. Evidence on the effectiveness of nutritional supplementation, repositioning, and skin care interventions versus usual care was limited and had methodological shortcomings, precluding strong conclusions.
LIMITATION
Only English-language articles were included, publication bias could not be formally assessed, and most studies had methodological shortcomings.
CONCLUSION
More advanced static support surfaces are more effective than standard mattresses for preventing ulcers in higher-risk populations. The effectiveness of formal risk assessment instruments and associated intervention protocols compared with less standardized assessment methods and the effectiveness of other preventive interventions compared with usual care have not been clearly established.
Topics: Bandages; Bedding and Linens; Beds; Comparative Effectiveness Research; Dietary Supplements; Humans; Nursing Diagnosis; Patient Positioning; Pressure Ulcer; Risk Assessment; Skin Cream
PubMed: 23817702
DOI: 10.7326/0003-4819-159-1-201307020-00006 -
International Wound Journal Aug 2023In most health care centres, pressure ulcers (PUs) are a common concern. This systematic review aimed to summarise nurses' practice and related factors toward PU... (Review)
Review
In most health care centres, pressure ulcers (PUs) are a common concern. This systematic review aimed to summarise nurses' practice and related factors toward PU prevention. An extensive search was conducted on electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database via keywords extracted from Medical Subject Headings such as "Pressure ulcer", "Pressure sore", "Bedsore", "Practice", and "Nurses" from the earliest to 9 March 2022. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Data extraction and quality assessment of included studies were performed by two researchers independently. A total of 6501 nurses were enrolled in twenty-nine studies. Of the participants, 75.15% were female and 55.64% were single, and 94.57% had a bachelor of science in nursing degree. Mean age and work experience of nurses was 30.69 (SD = 4.73) and 8.61 (SD = 5.44) years, respectively. The mean score of nurses' practices toward the prevention of PUs was 57.58 (SD = 14.62) out of 100. Also, 48.95% of nurses had a desirable practice toward the prevention of PUs. Factors such as knowledge (n = 6), attitude (n = 4), level of education (n = 4), a history of participating in workshops related to the prevention of PUs (n = 3), work experience (n = 2), area of practice (n = 2), self-adequacy (n = 1), follow the literature (n = 1), age (n = 1), and involvement in research (n = 1) had a significant positive relationship with nurses' practice toward PUs prevention. However, the nurses practice of PUs prevention had a significant negative relationship with lack of job satisfaction (n = 1), disproportionate nurse-to-patient ratio (n = 1), and lack of policies and guidelines (n = 1). The level of nurses' practice toward the prevention of PUs was relatively desirable. The result of this study can help improve the practice of nurses toward PUs prevention. Increasing nurses' knowledge and attitude toward PUs prevention can improve their practice. Therefore, it is suggested that policymakers and nursing managers implement PUs prevention education for nurses based on the factors associated with nurses' practice.
Topics: Humans; Female; Male; Ulcer; Cross-Sectional Studies; Clinical Competence; Pressure Ulcer; Nurses; Suppuration; Surveys and Questionnaires
PubMed: 36543328
DOI: 10.1111/iwj.14062 -
Frontiers in Public Health 2022Pressure ulcers (PUs) are an indicator of the quality of nursing care and nurses can prevent PUs well if they have sufficient knowledge. Numerous studies in this field... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure ulcers (PUs) are an indicator of the quality of nursing care and nurses can prevent PUs well if they have sufficient knowledge. Numerous studies in this field have reported different results. The aim of this study was to estimate the pooled score of nurses' knowledge about PU prevention based on the Pressure Ulcer Knowledge Assessment Tool (PUKAT).
METHODS
In this systematic review and meta-analysis, databases including Web of Science, ScienceDirect, PubMed, and Scopus were searched. All studies published in English between 2011 and 2022 that reported the status of nurses' knowledge of PU prevention based on PUKAT were included in the analysis. Based on heterogeneity between the studies, the data were analyzed using a random effects model.
RESULTS
The pooled scores of PU prevention knowledge in nurses and nursing students were (51.5%; 95% CI: 45.8-57.2%) and (48.9%; 95% CI: 42.5-55.2%), respectively. As the age of the participants increased, the pooled score of pressure ulcer prevention knowledge increased significantly ( = 0.028). The publication bias was not significant. The highest and lowest knowledge scores in nurses and nursing students were related to the fourth dimension (nutrition) and the fifth dimension (preventive measures to reduce the amount of pressure/shear), respectively.
CONCLUSION
Knowledge of nurses and nursing students about PU prevention is insufficient. Providing regular training to nurses and including the principles of PU prevention in the curriculum of nursing students to improve their knowledge seems necessary.
Topics: Clinical Competence; Curriculum; Humans; Pressure Ulcer; Students, Nursing; Suppuration
PubMed: 36159260
DOI: 10.3389/fpubh.2022.964680 -
Annals of Palliative Medicine Oct 2021Negative pressure wound therapy (NPWT) is one of the new modality for the treatment of diabetic foot ulcers. In this article we will investigate the efficacy and safety... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Negative pressure wound therapy (NPWT) is one of the new modality for the treatment of diabetic foot ulcers. In this article we will investigate the efficacy and safety of it by literature search and meta-analysis.
METHODS
The databases of PubMed, Embase, Ovid, and Cochrane library were selected as search platforms. Randomized controlled trials (RCTs) published after 2010 were searched with the keyword "vacuum-assisted closure therapy" OR "negative pressure wound therapy" OR "diabetic foot". The Cochrane Review Handbook was used to assess the bias of the literatures. The software RevMan 5.4 was used for analysis to obtain a forest plot and funnel plot.
RESULTS
In this study, 363 articles were initially screened, and 9 literatures were finally included, involving a total of 943 patients. Combined analysis using the fixed effects model showed that the healing rate of the NPWT group was significantly lower than the standard group [odds ratio (OR) =3.60, 95% confidence interval (CI): 2.38 to 5.45, P<0.001]. The granulation tissue formation time of the NPWT group was significantly less than the standard group [mean difference (MD) =-8.95, 95% CI: -10.26 to -7.64, P<0.001]. The rate of adverse events of both groups showed no significant difference (OR =0.49, 95% CI: 0.10 to 2.42, P=0.38). The amputation rate of both groups showed no statistically significant (OR =0.33, 95% CI: 0.09 to 1.26, P=0.10) too.
DISCUSSION
Negative pressure wound therapy can effectively accelerate wound healing, it is equally safe with general routine treatment. However, the negative pressure value should be appropriately maintained and adjusted to avoid bleeding tendency of the wound when applying this new modality.
Topics: Diabetes Mellitus; Diabetic Foot; Humans; Negative-Pressure Wound Therapy; Wound Healing
PubMed: 34763444
DOI: 10.21037/apm-21-2476 -
Journal of Wound Care Sep 2020The aim of this systematic review was to assess the effects of different repositioning regimens on pressure ulcer (PU) incidence in at-risk adult individuals without... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this systematic review was to assess the effects of different repositioning regimens on pressure ulcer (PU) incidence in at-risk adult individuals without existing PUs.
METHOD
Using systematic review methodology, randomised controlled trials (RCTs), including cluster-RCTs, prospective non-RCTs, pre-post-studies and interrupted-time-series studies were considered. Specifically explored was the impact of the frequency of repositioning, use of repositioning systems and use of turning teams. The search was conducted in January 2019, using PubMed, CINAHL, SCOPUS, Cochrane and EMBASE databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan.
RESULTS
A total of 530 records were returned, of which 16 met the inclusion criteria. Half of studies were conducted in intensive care units (50%). The mean sample size was 629±604 participants. Frequency of repositioning was explored in nine studies. PU incidence was 8% (n=221/2834) for repositioning every 2-3 hours, versus 13% (n=398/3050) for repositioning every 4-6 hours. The odds ratio (OR) was 0.75 (95% confidence interval (CI): 0.61-0.90, p=0.03), suggesting that there is a 25% reduction in the odds of PU development in favour of more frequent repositioning. Use of a repositioning system was explored in three studies. PU incidence was 2% (17/865) for the repositioning system, versus 5.5% (51/926) for care without using the repositioning system. The OR was 0.26 (95% CI: 0.05-1.29, p=0.10); this finding was not statistically significant. Use of a turning team was explored in two studies. PU incidence was 11% (n=22/200) with use of a turning team versus 20% (n=40/200) for usual care. The OR was 0.49 (95% CI: 0.27-0.86, p=0.01) suggesting that there is a 51% reduction in the odds of PU development in favour of use of a turning team. Using GRADE appraisal, the certainty of the evidence was assessed as low.
CONCLUSION
The results of this systematic review indicate that more frequent repositioning and use of a turning team reduce PU incidence. However, given the low certainty of evidence, results should be interpreted with caution.
Topics: Adult; Humans; Intensive Care Units; Moving and Lifting Patients; Pressure Ulcer
PubMed: 32924821
DOI: 10.12968/jowc.2020.29.9.496 -
Journal of Clinical Nursing Aug 2021To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients. (Review)
Review
AIM
To systemically synthesise the evidence on the most effective nursing interventions to prevent pressure injuries among critical care patients.
BACKGROUND
Although pressure injury (PI) prevention is a focus of nursing care in critical care units, hospital-acquired pressure injuries continue to occur in these settings.
DESIGN
A systematic review of literature guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Synthesis without meta-analysis (SWiM) guidelines.
METHODS
Four electronic databases were searched for relevant studies. Included studies were screened and then critically appraised using the appropriate Joanna Briggs Institute appraisal tool. Data were analysed and reported using a narrative synthesis.
RESULTS
The review included 14 studies. Randomised controlled trials, quasi-experimental, case series and cross-sectional studies were included. The review identified four broad categories of interventions that are the most effective for preventing pressure injuries: (a) PI prevention bundles, (b) repositioning and the use of surface support, (c) prevention of medical device-related pressure injuries and (d) access to expertise. All the included studies reported a reduction in pressure injuries following the interventions; however, the strength of the evidence was rated from moderate to very low.
CONCLUSIONS
Nurses are well qualified to lead in the prevention of pressure injuries in critical care units. Every critically ill patient requires interventions to prevent pressure injuries, and the prevention of PIs should be considered a complex intervention. Nurses must plan and implement evidence-based care to prevent all types of pressure injuries, including medical device-related pressure injuries. Education and training programmes for nurses on PI prevention are important for prevention of pressure injuries.
RELEVANCE TO CLINICAL PRACTICE
Nursing interventions should consist of evidence-based 'bundles' and be adapted to patients' needs. To prevent pressure injuries among critically ill patients, nurses must be competent and highly educated and ensure fundamental strategies are routinely implemented to improve mobility and offload pressure.
Topics: Humans; Critical Care; Critical Illness; Cross-Sectional Studies; Delivery of Health Care; Intensive Care Units; Pressure Ulcer
PubMed: 33590917
DOI: 10.1111/jocn.15709 -
International Journal of Nursing Studies May 2020Pressure injuries are frequently occurred adverse events in hospitals, affecting the well-being of patients and causing considerable financial burden to healthcare... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure injuries are frequently occurred adverse events in hospitals, affecting the well-being of patients and causing considerable financial burden to healthcare systems. However, the estimates of prevalence, incidence and hospital-acquired rate of pressure injury in hospitalised patients vary considerably in relevant published studies.
OBJECTIVES
To systematically quantify the prevalence and incidence of pressure injuries and the hospital-acquired pressure injuries rate in hospitalised adult patients and identify the most frequently occurring pressure injury stage(s) and affected anatomical location(s).
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest databases from January 2008 to December 2018.
REVIEW METHODS
We included studies with observational, cross-sectional or longitudinal designs, reporting pressure injury among hospitalised adults (≥16 years) and published in English. Outcomes were point prevalence, incidence of pressure injuries and the hospital-acquired pressure injuries rate reported as percentages. Two reviewers independently appraised the methodological quality of included studies. Heterogeneity was assessed by using the I² statistic and random effects models were employed. Sources of heterogeneity were investigated by subgroup analysis and meta-regression.
RESULTS
Of 7,489 studies identified, 42 were included in the systematic review and 39 of them were eligible for meta-analysis, with a total sample of 2,579,049 patients. The pooled prevalence of 1,366,848 patients was 12.8% (95% CI 11.8-13.9%); pooled incidence rate of 681,885 patients was 5.4 per 10,000 patient-days (95% CI 3.4-7.8) and pooled hospital-acquired pressure injuries rate of 1,893,593 was 8.4% (95% CI 7.6-9.3%). Stages were reported in 16 studies (132,530 patients with 12,041 pressure injuries). The most frequently occurred stages were Stage I (43.5%) and Stage II (28.0%). The most affected body sites were sacrum, heels and hip. Significant heterogeneity was noted across some geographic regions. Meta-regression showed that the year of data collection, mean age and gender were independent predictors, explaining 67% variability in the prevalence of pressure injuries. The year of data collection and age alone explained 93% of variability in hospital-acquired pressure injuries rate.
CONCLUSION
This study suggested that the burden of pressure injuries remains substantial with over one in ten adult patients admitted to hospitals affected. Superficial pressure injuries, such as Stage I and II, are most common stages and are preventable. Our results highlight healthcare institutions' focus on pressure injuries globally and supports the need to dedicate resources to prevention and treatment on pressure injuries. Registration number: PROSPERO CRD42019118774.
Topics: Global Health; Hospitalization; Humans; Incidence; Pressure Ulcer; Prevalence
PubMed: 32113142
DOI: 10.1016/j.ijnurstu.2020.103546 -
Medicina Intensiva 2017Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their... (Review)
Review
INTRODUCTION
Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients.
METHODOLOGY
The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered.
RESULTS
From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning.
CONCLUSIONS
There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development.
Topics: Critical Illness; Humans; Intensive Care Units; Pressure Ulcer; Risk Factors
PubMed: 27780589
DOI: 10.1016/j.medin.2016.09.003 -
JMIR Medical Informatics Oct 2020The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific... (Review)
Review
BACKGROUND
The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice.
OBJECTIVE
The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management.
METHODS
The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies.
RESULTS
The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice.
CONCLUSIONS
The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42019127663; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127663.
PubMed: 33064099
DOI: 10.2196/21621 -
International Journal of Nursing Studies Jul 2013To identify risk factors independently predictive of pressure ulcer development in adult patient populations? (Review)
Review
OBJECTIVE
To identify risk factors independently predictive of pressure ulcer development in adult patient populations?
DESIGN
A systematic review of primary research was undertaken, based upon methods recommended for effectiveness questions but adapted to identify observational risk factor studies.
DATA SOURCES
Fourteen electronic databases were searched, each from inception until March 2010, with hand searching of specialist journals and conference proceedings; contact with experts and a citation search. There was no language restriction.
REVIEW METHODS
Abstracts were screened, reviewed against the eligibility criteria, data extracted and quality appraised by at least one reviewer and checked by a second. Where necessary, statistical review was undertaken. We developed an assessment framework and quality classification based upon guidelines for assessing quality and methodological considerations in the analysis, meta-analysis and publication of observational studies. Studies were classified as high, moderate, low and very low quality. Risk factors were categorised into risk factor domains and sub-domains. Evidence tables were generated and a summary narrative synthesis by sub-domain and domain was undertaken.
RESULTS
Of 5462 abstracts retrieved, 365 were identified as potentially eligible and 54 fulfilled the eligibility criteria. The 54 studies included 34,449 patients and acute and community patient populations. Seventeen studies were classified as high or moderate quality, whilst 37 studies (68.5%) had inadequate numbers of pressure ulcers and other methodological limitations. Risk factors emerging most frequently as independent predictors of pressure ulcer development included three primary domains of mobility/activity, perfusion (including diabetes) and skin/pressure ulcer status. Skin moisture, age, haematological measures, nutrition and general health status are also important, but did not emerge as frequently as the three main domains. Body temperature and immunity may be important but require further confirmatory research. There is limited evidence that either race or gender is important.
CONCLUSIONS
Overall there is no single factor which can explain pressure ulcer risk, rather a complex interplay of factors which increase the probability of pressure ulcer development. The review highlights the limitations of over-interpretation of results from individual studies and the benefits of reviewing results from a number of studies to develop a more reliable overall assessment of factors which are important in affecting patient susceptibility.
Topics: Adult; Female; Humans; Male; Pressure Ulcer; Risk Factors
PubMed: 23375662
DOI: 10.1016/j.ijnurstu.2012.11.019