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International Wound Journal Mar 2023To systematically assess the prevalence of facial pressure injuries related to adult non-invasive ventilation equipment, and risk factors of facial pressure injuries.... (Meta-Analysis)
Meta-Analysis
To systematically assess the prevalence of facial pressure injuries related to adult non-invasive ventilation equipment, and risk factors of facial pressure injuries. PubMed, Cochrane Library, Web of Science, Embase, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Database and Weipu Database were comprehensively searched for observational studies investigating the prevalence and risk factors of facial pressure injuries related to adult non-invasive ventilation equipment from inception to May 16th, 2022. Filter articles based on inclusion and exclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 16.0 software package. In total, 2835 articles were screened and data from 12 studies were used in meta-analysis. The prevalence of facial pressure injuries related to adult non-invasive ventilation equipment was 25% (95% confidence interval, CI:15% to 37%, I = 97.34%, P < 0.0001). After controlling for confounding variables, the following risk factors of facial pressure injuries: use equipment form, with diabetes, fever, cumulative time of using equipment, facial skin oedema and Glasgow score. Understanding the risk factors of facial pressure injuries can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.
Topics: Humans; Adult; Noninvasive Ventilation; Pressure Ulcer; Prevalence; Risk Factors; Facial Injuries
PubMed: 35899399
DOI: 10.1111/iwj.13903 -
Gland Surgery Jun 2022This study systematically reviewed the effects of continuous nursing intervention on intraoperative pressure ulcers (PUs) and related complications in breast cancer...
BACKGROUND
This study systematically reviewed the effects of continuous nursing intervention on intraoperative pressure ulcers (PUs) and related complications in breast cancer patients. The effectiveness of continuous nursing intervention for intraoperative pressure ulcers related complications in breast cancer patients is highly controversial. Therefore, it is necessary to systematically review and address this issue by means of meta-analysis.
METHODS
By searching the Cochrane Library, PubMed, Web of Science, Embase, and Chinese Biomedical Literature Database (CBM) were screened. Quality evaluation and data extraction were performed for the included studies, and meta-analysis was performed for the included RCTs using Review Manager 5.2 software. Literature was included in strict compliance with the PICOS principle, and bias risk was analyzed by -test and funnel plot.
RESULTS
A total of 1,431 patients were enrolled in 9 studies, and meta-analysis showed that there was a significant statistical difference between the experimental group and the control group in the incidence of PUs [odds ratio (OR) =0.18, 95% confidence interval (95% CI): 0.13-0.24, P<0.00001], the Braden pressure ulcer risk score after nursing [mean difference (MD) =2.64, 95% CI: 1.47-3.81, P<0.0001], and the quality of life after nursing (MD =9.76, 95% CI: 6.82-12.69, P<0.00001).
DISCUSSION
Continuous care can reduce the incidence of PUs in patients with advanced breast cancer, reduce the severity of wounds in the healing process of PUs, and improve the knowledge of PUs in patients with advanced breast cancer risk.
PubMed: 35800736
DOI: 10.21037/gs-22-258 -
Frontiers in Endocrinology 2022[This corrects the article DOI: 10.3389/fendo.2022.848695.].
Corrigendum: Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
[This corrects the article DOI: 10.3389/fendo.2022.848695.].
PubMed: 35615715
DOI: 10.3389/fendo.2022.916377 -
Spinal Cord May 2022Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To systematically review the evidence for the effectiveness of telerehabilitation as an intervention for people with spinal cord injury (SCI) in low-and middle-income countries (LMICs).
SETTING
Not applicable.
METHODS
MEDLINE (Ovid), Embase (Ovid), Pubmed and Global Health databases were used to identify studies published between 1946-2020 meeting the following criteria: (1) patients with SCI diagnosis; (2) in LMIC; (3) an outcome measuring clinical functional ability, quality of life or all-cause mortality reduction. The risk of bias in studies was graded using revised Cochrane risk-of-bias tool in randomised trials (RoB 2) and risk-of-bias tool in non-randomised trials (ROBINS-I). Evidence levels were graded with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
RESULTS
In total, 107 articles were identified from the initial search. After screening, five studies were included. Some significant improvements to quality of life and pressure ulcer management were observed, alongside some improvement in functional ability with suggested improvement to depression scores. Telerehabilitation alleviated participants' sense of social isolation, improved satisfaction scores and assisted them to remember techniques for SCI management. Telerehabilitation was valued by health professionals. There was no reduction in all-cause mortality.
CONCLUSION
There is insufficient evidence to recommend telerehabilitation as an intervention to treat and manage SCI in LMICs, although there is an indication of potential patient benefit. Further research is required to better understand the causal mechanisms underpinning the use of telerehabilitation and establish its efficacy, in the context of resource-limited settings.
Topics: Activities of Daily Living; Developing Countries; Humans; Quality of Life; Spinal Cord Injuries; Telerehabilitation
PubMed: 35411024
DOI: 10.1038/s41393-022-00797-8 -
Frontiers in Endocrinology 2022Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes. (Meta-Analysis)
Meta-Analysis
Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
BACKGROUND
Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes.
PURPOSE
To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids.
DATA SOURCES
PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20 June 2021.
STUDY SELECTION
Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention.
DATA EXTRACTION
Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI).
DATA SYNTHESIS
Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias.
LIMITATIONS
Heterogeneity and potential publication bias may limit applicability of findings.
CONCLUSIONS
Remote management significantly improves control of modifiable risk factors.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433], identifier PROSPERO (CRD42021258433).
Topics: Diabetes Mellitus; Dyslipidemias; Humans; Hyperglycemia; Hypertension; Randomized Controlled Trials as Topic
PubMed: 35370974
DOI: 10.3389/fendo.2022.848695 -
Global Spine Journal Oct 2022Systematic review and meta-analysis. (Review)
Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar.
METHODS
Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted. Two reviewers independently screened the search results according to pre-determined search criteria. Data was extracted and tabulated. Joanna Briggs Institute checklists were used for assessing the quality of included studies.
RESULTS
The search identified 773 articles. A total of 25 studies were selected for final inclusion. The results largely comprised a mixture of case reports/series, cohort studies and reviews. The most commonly reported complications were pressure ulcers, dysphagia and increased intracranial pressure. A pressure ulcer pooled prevalence of 7% was calculated. There was insufficient data for quantitative analysis of any other complication.
CONCLUSIONS
There is significant morbidity from prolonged hard collar immobilisation, even amongst younger patients. Whilst based upon limited and low-quality evidence, these findings, combined with the low-quality evidence for the efficacy of hard collars, highlights a knowledge gap for future research.
PubMed: 35333123
DOI: 10.1177/21925682221087194 -
Journal of Tissue Viability May 2022Pressure injury imposes a significant burden for patients and healthcare systems and the majority of pressure injuries are preventable. The early identification of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure injury imposes a significant burden for patients and healthcare systems and the majority of pressure injuries are preventable. The early identification of pressure injury is critical for its prevention. As an objective measure, biomarkers have preliminarily shown the potential to identify individuals at risk for developing pressure injury before it is visually observed to occur. However, these results have not been synthesized.
OBJECTIVE
To assess and synthesise the predictive effect of different biomarkers in the early detection of pressure injury formation.
DESIGN
A systematic review and meta-analysis.
DATA SOURCES
PubMed, EMBASE, CINAHL Complete and the Cochrane Library were comprehensively searched for articles up to June 2021. No restrictions were applied to study design type, language, country, race or date of publication.
REVIEW METHODS
Two reviewers independently extracted data from all original eligible studies using a specified data extraction form, resolved disagreements through discussion and the involvement of an additional reviewer. Methodological quality of all included studies was independently appraised by two authors with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Newcastle-Ottawa Quality Assessment Scale (NOS). Heterogeneity of each study was estimated using the I statistic, and the data was synthesized using StataSE15.
RESULTS
Eight observational studies involving 10595 participants were included. The overall pooled area under curve (AUC) and the 95% confidence intervals (CIs) of Serum albumin (Alb) was 0.66(0.62-0.70), and the Serum haemoglobin (Hb) was 0.67(0.60-0.74). The AUC and 95% CI of C-reactive protein (CRP) was 0.62(0.50-0.74), Braden score was 0.56 (0.429-0.691), Waterlow score was 0.729(0.654-0.803), Alb with Waterlow was 0.741(0.694-0.787), and the combination of Hb, CRP, Alb, Age and Gender was 0.79(0.682-0.898). Besides, the chemokine interferon-γ-induced protein of 10kd/CXCL10, cytokine interferon-α, tumor necrosis factor-alpha (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-15 (IL-15) and combination of creatine kinase (CK), myoglobin (Mb), heart-type fatty acid binding protein (H-FABP) and CRP may prove potential for detecting pressure injury.
CONCLUSION
The findings suggest the combination of Hb, CRP, Alb, Age and Gender is superior to other biomarkers. However, the predictive effect of biomarkers needs to be confirmed by more researches and patient-level data.
Topics: Humans; Biomarkers; Crush Injuries; Early Diagnosis; Research Design; Risk Assessment; Pressure Ulcer
PubMed: 35227559
DOI: 10.1016/j.jtv.2022.02.005 -
Journal of Tissue Viability May 2022This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions... (Review)
Review
AIM
This systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries.
METHOD
Relevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15-25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained.
RESULTS
17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%-82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8-88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region.
CONCLUSION
PPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.
Topics: COVID-19; Health Personnel; Humans; Pandemics; Personal Protective Equipment; Pressure Ulcer; Pruritus; Retrospective Studies
PubMed: 35210162
DOI: 10.1016/j.jtv.2022.02.004 -
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 -
Annals of Palliative Medicine Oct 2021A meta-analysis was conducted to investigate the effects of the 45° semi-recumbent position on the clinical outcomes of mechanically ventilated patients. (Meta-Analysis)
Meta-Analysis
BACKGROUND
A meta-analysis was conducted to investigate the effects of the 45° semi-recumbent position on the clinical outcomes of mechanically ventilated patients.
METHODS
The PubMed, Embase, and Cochrane medical databases were searched using the keywords "45°", "head-of-bed elevation", and "semi-recumbent". All relevant randomized controlled trials (RCTs) published between 2005 and 2021 were obtained. The Cochrane system for randomized intervention was adopted and the RevMan 5.3.5 software was used to construct forest plots and funnel plots to assess the risk of bias for the included studies.
RESULTS
A total of 128 literatures were initially screened for this meta-analysis, and 7 studies were finally included, with a total of 740 patients. Meta-analysis revealed that the incidence of ventilator-associated pneumonia (VAP) was significantly lower in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position [odds ratio (OR) =0.48; 95% confidence interval (CI): 0.28 to 0.84; Z=2.59; P=0.009]. Furthermore, the incidence of gastric reflux was significantly lower in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position (OR =0.50; 95% CI: 0.27 to 0.96; Z=2.09; P=0.04). Meta-analysis demonstrated that the incidence of pressure sores was significantly higher in patients in the 45° semi-recumbent position compared to patients in the 30° semi-recumbent position (OR =1.88; 95% CI: 1.05 to 3.36; Z=2.11; P=0.03).
DISCUSSION
The 45° semi-recumbent position can reduce the incidence of VAP and gastric reflux in patients undergoing mechanical ventilation (MV), but it may also increase the risk of pressure sores. Thus, consideration should be made based on a comprehensive understanding of the patient's condition and physical state.
Topics: Humans; Incidence; Pneumonia, Ventilator-Associated; Pressure Ulcer; Respiration, Artificial
PubMed: 34763512
DOI: 10.21037/apm-21-2359