-
Nursing Open Jan 2024The aim of this review was to determine the effectiveness of the e-learning programs for improving the knowledge and professional practices of nursing personnel in... (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of this review was to determine the effectiveness of the e-learning programs for improving the knowledge and professional practices of nursing personnel in managing pressure injuries patients.
DESIGN
Systematic review and meta-analysis.
METHODS
Systematic search was done in EMBASE, SCOPUS, Cochrane library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov databases until August 2022. Meta-analysis was carried out using random-effects model, and the results were reported as pooled standardized mean differences (SMD), or odds ratios (OR) with 95% confidence intervals (CIs).
RESULTS
Eight studies were included in the analysis. Most of the studies had higher risk of bias. The pooled SMD for knowledge score and for the classification skill were 1.40 (95%CI: 0.45-2.35; I = 93.1%) and 1.75 (95%CI: 0.94-3.24; I = 78.3%) respectively. The pooled OR for the classification skills was 1.75 (95%CI: 0.94-3.24; I = 78.3%).
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Humans; Clinical Competence; Computer-Assisted Instruction; Nurses; Pressure Ulcer
PubMed: 38268243
DOI: 10.1002/nop2.2039 -
Patient Safety in Surgery Jan 2024Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to...
BACKGROUND
Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region.
METHODS
This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064).
RESULTS
A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05).
CONCLUSION
This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.
PubMed: 38263177
DOI: 10.1186/s13037-023-00384-7 -
The International Journal of Lower... Jan 2024Pressure ulcers are common chronic wounds in clinical practice, severely affecting patients' quality of life and causing substantial economic burdens. Platelet-rich... (Review)
Review
Pressure ulcers are common chronic wounds in clinical practice, severely affecting patients' quality of life and causing substantial economic burdens. Platelet-rich plasma (PRP) has been explored for its potential in treating pressure ulcers. Herein, a study was carried out to evaluate the efficacy and safety of PRP in comparison to conventional treatments for pressure ulcers. A comprehensive search was conducted in databases including PubMed, Embase, Web of Science, and Cochrane Library, covering studies published from the inception to May 20, 2023, with only randomized controlled trials (RCTs) assessing the effect of PRP on the healing of pressure ulcers included. The outcomes of interest included healing rates, ulcer area, ulcer volume, Pressure Ulcer Scale for Healing (PUSH) score, healing time, and complications. Finally, 9 RCTs, involving 511 patients with 523 pressure ulcers, met the inclusion criteria. Our meta-analysis revealed a significant improvement in the healing rate, as evidenced by a weighted odds ratio (OR) of 3.40 (95% CI = 1.87 to 6.21, = 32%, < 0.0001). Additionally, the standard mean difference (SMD) for healed ulcer area favored the PRP group, reflecting an improvement of 1.38 cm ( = 0.02). Furthermore, the reduction in PUSH scores within the PRP group outperformed that observed in the control group, demonstrating a SMD of 1.69 ( = 0.01). Nevertheless, complications and the SMD for ulcer volume reduction revealed no statistically significant differences between the groups. From these findings, PRP stands out as a promising and safe therapeutic approach for pressure ulcers. For a deeper understanding of PRP's role in pressure ulcer healing, it is crucial to conduct more well-structured, high-quality RCTs in upcoming studies.
PubMed: 38239009
DOI: 10.1177/15347346241227001 -
Patient Safety in Surgery Jan 2024Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to...
BACKGROUND
Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region.
METHODS
This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064).
RESULTS
A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05).
CONCLUSION
This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs.
PubMed: 38167487
DOI: 10.1186/s13037-023-00383-8 -
Advances in Wound Care May 2024This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of stem cell therapy for... (Meta-Analysis)
Meta-Analysis Review
This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of stem cell therapy for diabetic foot (DF). We conducted a comprehensive search in four databases for SRs/MAs that included randomized controlled trials (RCTs) on stem cell therapy for DF. Two separate researchers independently evaluated the methodological quality and evidence quality of the SRs/MAs that were included in the study. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Egger's test and sensitivity analysis are used to examine the reliability of the results. This umbrella review includes eight SRs/MAs, and their methodological quality and evidence quality were all deemed unsatisfactory. Out of the 8 SRs/MAs, 26 RCTs were included, with a total corrected covered area of 21.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that DF patients can benefit from stem cell therapy, as indicated by effectiveness in measures, including healing rate, amputation rate, ankle-brachial index, transcutaneous oxygen pressure, ulcer size reduction, complete healing time, pain-free walking distance, rest pain score, and new angiogenesis rate. This study conducted a comprehensive evaluation and reanalysis of the current evidence regarding the effectiveness and safety of stem cell therapy for DF, which is the first of its kind. Based on the existing evidence, stem cell therapy is effective and safe for patients with DF.
Topics: Humans; Amputation, Surgical; Diabetic Foot; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Stem Cell Transplantation; Systematic Reviews as Topic; Treatment Outcome; Wound Healing
PubMed: 38149885
DOI: 10.1089/wound.2023.0136 -
Journal of Clinical Medicine Dec 2023Despite numerous measures used to prevent pressure ulcers, their growing prevalence in recent years is expected to continue as the population ages. This review aims to... (Review)
Review
BACKGROUND
Despite numerous measures used to prevent pressure ulcers, their growing prevalence in recent years is expected to continue as the population ages. This review aims to report the outcomes of the regenerative potential of MSCs in treating pressure ulcers, assessing the effectiveness of MSCs in treating pressure ulcers.
METHODS
A computerized search for articles on animal models that use MSCs as primary therapy to treat pressure ulcers, published from conception to present, was conducted using PubMed, MEDLINE, Embase, and CINAHL. Our search yielded 52 articles, narrowed to 44 after excluding duplicates.
RESULTS
Out of 52 articles collected from four databases, 11 met the inclusion criteria. A total of 11 articles published between 2008 and 2020 met the inclusion criteria. Eight studies were observational descriptive papers in animal models, and three were prospective. Six studies used autologous MSCs, while five used allogenic MSCs. Three studies were conducted in humans, and the remaining eight were conducted in animals. The most common method of cell delivery was an intradermal injection in the margins of the ulcer. All studies reported positive results, including improved wound healing, reduced inflammation, and improved tissue regeneration.
CONCLUSIONS
MSCs have shown promising results in treating pressure ulcers in animal and clinical trials. The combination of MSCs and scaffold materials has also been studied and found to be effective in wound healing. A standardized human wound model has been proposed further to investigate the efficacy of cell-based therapies for chronic wounds. However, more research is needed to determine the best quantity of cells to apply for pressure ulcers and to ensure the safety and efficacy of these treatments in clinical settings.
PubMed: 38137625
DOI: 10.3390/jcm12247545 -
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 -
Intensive & Critical Care Nursing Apr 2024To assess the effect of different noninvasive ventilation interfaces on preventing the facial pressure injury. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the effect of different noninvasive ventilation interfaces on preventing the facial pressure injury.
METHODS
This network meta-analysis was conducted following the PRISMA reporting guidelines. Seven electronic databases were systematically searched for randomised controlled trials about the comparative effectiveness of different interfaces in preventing facial pressure injury with noninvasive ventilation in adults and newborns from inception to June 2023. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. Study selection and data extraction were performed by two independent reviewers. The Cochrane risk of bias assessment tool was used to assess the methodological quality.
RESULTS
A total of 78 randomised controlled trials involving 7,291 patients were included. The results of network meta-analysis showed that the effectiveness of the eight noninvasive ventilation interfaces on the prevention of facial pressure injury was in the order of: nasal cannula > full-face mask > rotation of nasal mask with nasal prongs > helmet > nasal mask > oronasal mask > nasal prongs > face mask. The use of full-face mask in adults and nasal cannula in newborns had the best effect on preventing the incidence of facial pressure injury.
CONCLUSIONS
The use of full-face mask in adults and nasal cannula in newborns had the most clinical advantage in preventing the incidence of facial pressure injury and were worthy promoting in clinical practice.
IMPLICATIONS FOR CLINICAL PRACTICE
This study provides a certain theoretical basis for the selection of appropriate interface for patients with noninvasive ventilation. Clinical practitioners should choose the appropriate interfaces based on the patient's specific condition to reduce the incidence of facial pressure injury, enhance patient comfort, and improve the effectiveness of respiratory therapy.
Topics: Adult; Humans; Infant, Newborn; Noninvasive Ventilation; Pressure Ulcer; Network Meta-Analysis; Masks; Incidence; Randomized Controlled Trials as Topic
PubMed: 37977002
DOI: 10.1016/j.iccn.2023.103585 -
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 -
British Journal of Nursing (Mark Allen... Nov 2023Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and cardiovascular disease.
AIM
Nurses play a crucial role in the prevention and management of pressure injuries, however, published evidence on the effectiveness of educational interventions, directed specifically at nurses in the hospital environment, is scarce.
METHOD
The authors retrieved published studies on the subject from selected databases (Pubmed/Medline, Embase, Web of Science and the Cochrane Library) in a number of languages (Portuguese, English, French and Spanish). The search yielded randomised controlled trials, as well as quasi-experimental and comparative studies.
FINDINGS
In total, 11 studies were selected. The outcomes analysed, following some type of educational intervention, included the attitudes and knowledge of the nursing professionals, as well as the incidence of pressure injuries.
CONCLUSION
The present study demonstrated that different educational strategies can help prevent pressure injuries in the hospital environment.
Topics: Humans; Pressure Ulcer; Hospitals
PubMed: 37949494
DOI: 10.12968/bjon.2023.32.Sup20.S40