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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 -
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 -
Revista Latino-americana de Enfermagem 2021to evaluate evidence on effectiveness support surfaces for pressure injury prevention in the intraoperative period. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
to evaluate evidence on effectiveness support surfaces for pressure injury prevention in the intraoperative period.
METHOD
systematic review. The search for primary studies was conducted in seven databases. The sample consisted of 10 studies. The synthesis of the results was carried out descriptively and through meta-analysis.
RESULTS
when comparing low-tech support surfaces with regular care (standard surgical table mattress), the meta-analysis showed that there is no statistically significant difference between the investigated interventions (Relative Risk = 0.88; 95%CI: 0.30-2.39). The Higgins inconsistency test indicated considerable heterogeneity between studies (I2 = 83%). The assessment of the certainty of the evidence was very low. When comparing high-tech and low-tech support surfaces, the meta-analysis showed that there is a statistically significant difference between the interventions studied, with high-tech being the most effective (Relative Risk = 0.17; 95%CI: 0.05-0.53). Heterogeneity can be classified as not important (I2 = 0%). The assessment of certainty of evidence was moderate.
CONCLUSION
the use of high-tech support surfaces is an effective measure to prevent pressure injuries in the intraoperative period.
Topics: Humans; Beds; Intraoperative Complications; Wounds and Injuries; Pressure Ulcer
PubMed: 34755774
DOI: 10.1590/1518-8345.5279.3493 -
Journal of Tissue Viability Feb 2022The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.
AIMS
The main aim of this systematic literature review was to identify risk factors for development of heel pressure ulcers and quantify their effect.
BACKGROUND
Pressure ulcers remain one of the key patient safety challenges across all health care settings and heels are the second most common site for developing pressure ulcers after the sacrum.
DESIGN
Quantitative systematic review.
METHODS
Data sources: Electronic databases were searched for studies published between 1809 to March 2020 using keywords, Medical Subject Headings, and other index terms, as well as combinations of these terms and appropriate synonyms.
STUDY ELIGIBILITY CRITERIA
Previous systematic literature reviews, cohort, case control and cross-sectional studies investigating risk factors for developing heel pressure ulcers. Only articles published in English were reviewed with no restrictions on date of publication.
PARTICIPANTS
patients aged 18 years and above in any care setting. Study selection, data extraction, risk of bias and quality assessment were completed by two independent reviewers. Disagreements were resolved by discussion.
RESULTS
Thirteen studies met the eligibility criteria and several potential risk factors were identified. However, eligible studies were mainly moderate to low quality except for three high quality studies.
CONCLUSIONS
There is a paucity of high quality evidence to identify risk factors associated with heel pressure ulcer development. Immobility, diabetes, vascular disease, impaired nutrition, perfusion issues, mechanical ventilation, surgery, and Braden subscales were identified as potential risk factors for developing heel pressure ulcers however, further well-designed studies are required to elucidate these factors. Other risk factors may also exist and require further investigation.
PROSPERO ID
PROSPERO International prospective register of systematic reviews: CRD42017071459.
Topics: Adolescent; Adult; Cross-Sectional Studies; Heel; Humans; Pressure Ulcer; Risk Factors
PubMed: 34742635
DOI: 10.1016/j.jtv.2021.10.007 -
Journal of Diabetes Science and... Jan 2023Areas of the foot with diabetic ulcers have been observed to have greater plantar pressures compared to non-ulcerated. Pressures play an essential role in the mechanism... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Areas of the foot with diabetic ulcers have been observed to have greater plantar pressures compared to non-ulcerated. Pressures play an essential role in the mechanism of lesion, and their reduction is effective in prevention. We conducted a systematic review to evaluate pedobarography as a predictive tool for ulcer development, since there is still no consensus on this aspect.
METHODS
We searched PUBMED (MedLine), EMBASE, Scopus, Web of Science, CINAHL and Scielo for cohort studies that measured plantar pressure at baseline and verified ulcer development on follow-up. Pooled effects of accuracy, sensitivity, specificity and relative risk were calculated using the inverse variance method. Risk of bias was assessed using the QUADAS-2 tool.
RESULTS
Three studies ( = 2000) had enough information on accuracy to be included into a meta-analysis, and 4 ( = 2651) were analyzed using qualitative methods. Pooled sensitivity and specificity were found to be 0.63 (Confidence Interval (CI) 0.58-0.68) and 0.42 (CI 0.27-0.58), respectively. Pooled relative risk was 1.95 (CI 1.09-3.51). Risk of bias was low to uncertain.
CONCLUSIONS
Pedobarography in itself appears to have low accuracy in evaluating risk of ulceration. Several methodological heterogeneities were found, and the most optimal cut-off value is yet to be determined.
Topics: Humans; Diabetic Foot; Foot; Foot Ulcer; Sensitivity and Specificity; Pressure; Diabetes Mellitus
PubMed: 34590893
DOI: 10.1177/19322968211043550 -
Wound Management & Prevention Sep 2021Smoking is a risk factor for many diseases. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Smoking is a risk factor for many diseases.
PURPOSE
This study explored the relationship between current or past smoking and pressure injury (PI) risk through a systematic review and meta-analysis.
METHODS
The databases PubMed, Web of Science, and China National Knowledge Infrastructure were searched for the years between 2001 and 2020. Quality of evidence was estimated by the Newcastle-Ottawa Scale. The random effects model was applied to assess the odds ratios (OR) and 95% confidence intervals (CI); pooled adjusted OR and 95% CI, subgroup analysis, publication bias, sensitivity analyses, and meta-regression analysis were performed.
RESULTS
Fifteen (15) studies (12 retrospective and 3 prospective) comprising data on 11 304 patients were eligible for inclusion in the review. The meta-analysis demonstrated that smoking increased the risk of PI (OR = 1.498; 95% CI, 1.058-2.122), and the pooled adjusted OR (1.969) and 95% CI (1.406-2.757) confirmed this finding. Publication bias was not detected by funnel plot, Begg's test (P = .322), or Egger's test (P = .666). Subgroup analyses yielded the same observations in both retrospective (OR = 1.607; 95% CI, 1.043-2.475) and prospective (OR = 1.218; 95% CI, 0.735-2.017) studies. The results were consistent across sensitivity analyses (OR = 1.07; 95% CI, 1.043- 2.475). Relevant heterogeneity moderators were not identified by meta-regression analysis with PI incidence (P = .466), years of patient data included (P = .637), mean patient age (P = .650), and diabetes mellitus diagnosis (P = .509).
CONCLUSION
This study found that individuals who are current or formers smokers have an almost 1.5 times higher risk of PI development than do those who do not smoke.
Topics: Humans; Odds Ratio; Prospective Studies; Retrospective Studies; Risk Factors; Smoking; Pressure Ulcer
PubMed: 34473642
DOI: No ID Found -
The Cochrane Database of Systematic... Aug 2021Pressure ulcers (also known as pressure injuries, pressure sores and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by... (Review)
Review
BACKGROUND
Pressure ulcers (also known as pressure injuries, pressure sores and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Specific kinds of beds, overlays and mattresses are widely used with the aim of preventing and treating pressure ulcers.
OBJECTIVES
To summarise evidence from Cochrane Reviews that assess the effects of beds, overlays and mattresses on reducing the incidence of pressure ulcers and on increasing pressure ulcer healing in any setting and population. To assess the relative effects of different types of beds, overlays and mattresses for reducing the incidence of pressure ulcers and increasing pressure ulcer healing in any setting and population. To cumulatively rank the different treatment options of beds, overlays and mattresses in order of their effectiveness in pressure ulcer prevention and treatment.
METHODS
In July 2020, we searched the Cochrane Library. Cochrane Reviews reporting the effectiveness of beds, mattresses or overlays for preventing or treating pressure ulcers were eligible for inclusion in this overview. Two review authors independently screened search results and undertook data extraction and risk of bias assessment using the ROBIS tool. We summarised the reported evidence in an overview of reviews. Where possible, we included the randomised controlled trials from each included review in network meta-analyses. We assessed the relative effectiveness of beds, overlays and mattresses for preventing or treating pressure ulcers and their probabilities of being, comparably, the most effective treatment. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
We include six Cochrane Reviews in this overview of reviews, all at low or unclear risk of bias. Pressure ulcer prevention: four reviews (of 68 studies with 18,174 participants) report direct evidence for 27 pairwise comparisons between 12 types of support surface on the following outcomes: pressure ulcer incidence, time to pressure ulcer incidence, patient comfort response, adverse event rates, health-related quality of life, and cost-effectiveness. Here we focus on outcomes with some evidence at a minimum of low certainty. (1) Pressure ulcer incidence: our overview includes direct evidence for 27 comparisons that mostly (19/27) have very low-certainty evidence concerning reduction of pressure ulcer risk. We included 40 studies (12,517 participants; 1298 participants with new ulcers) in a network meta-analysis involving 13 types of intervention. Data informing the network are sparse and this, together with the high risk of bias in most studies informing the network, means most network contrasts (64/78) yield evidence of very low certainty. There is low-certainty evidence that, compared with foam surfaces (reference treatment), reactive air surfaces (e.g. static air overlays) (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.29 to 0.75), alternating pressure (active) air surfaces (e.g. alternating pressure air mattresses, large-celled ripple mattresses) (RR 0.63, 95% CI 0.42 to 0.93), and reactive gel surfaces (e.g. gel pads used on operating tables) (RR 0.47, 95% CI 0.22 to 1.01) may reduce pressure ulcer incidence. The ranking of treatments in terms of effectiveness is also of very low certainty for all interventions. It is unclear which treatment is best for preventing ulceration. (2) Time to pressure ulcer incidence: four reviews had direct evidence on this outcome for seven comparisons. We included 10 studies (7211 participants; 699 participants with new ulcers) evaluating six interventions in a network meta-analysis. Again, data from most network contrasts (13/15) are of very low certainty. There is low-certainty evidence that, compared with foam surfaces (reference treatment), reactive air surfaces may reduce the hazard of developing new pressure ulcers (hazard ratio (HR) 0.20, 95% CI 0.04 to 1.05). The ranking of all support surfaces for preventing pressure ulcers in terms of time to healing is uncertain. (3) Cost-effectiveness: this overview includes direct evidence for three comparisons. For preventing pressure ulcers, alternating pressure air surfaces are probably more cost-effective than foam surfaces (moderate-certainty evidence). Pressure ulcer treatment: two reviews (of 12 studies with 972 participants) report direct evidence for five comparisons on: complete pressure ulcer healing, time to complete pressure ulcer healing, patient comfort response, adverse event rates, and cost-effectiveness. Here we focus on outcomes with some evidence at a minimum of low certainty. (1) Complete pressure ulcer healing: our overview includes direct evidence for five comparisons. There is uncertainty about the relative effects of beds, overlays and mattresses on ulcer healing. The corresponding network meta-analysis (with four studies, 397 participants) had only three direct contrasts and a total of six network contrasts. Again, most network contrasts (5/6) have very low-certainty evidence. There was low-certainty evidence that more people with pressure ulcers may heal completely using reactive air surfaces than using foam surfaces (RR 1.32, 95% CI 0.96 to 1.80). We are uncertain which surfaces have the highest probability of being the most effective (all very low-certainty evidence). (2) Time to complete pressure ulcer healing: this overview includes direct evidence for one comparison: people using reactive air surfaces may be more likely to have healed pressure ulcers compared with those using foam surfaces in long-term care settings (HR 2.66, 95% CI 1.34 to 5.17; low-certainty evidence). (3) Cost-effectiveness: this overview includes direct evidence for one comparison: compared with foam surfaces, reactive air surfaces may cost an extra 26 US dollars for every ulcer-free day in the first year of use in long-term care settings (low-certainty evidence).
AUTHORS' CONCLUSIONS
Compared with foam surfaces, reactive air surfaces may reduce pressure ulcer risk and may increase complete ulcer healing. Compared with foam surfaces, alternating pressure air surfaces may reduce pressure ulcer risk and are probably more cost-effective in preventing pressure ulcers. Compared with foam surfaces, reactive gel surfaces may reduce pressure ulcer risk, particularly for people in operating rooms and long-term care settings. There are uncertainties for the relative effectiveness of other support surfaces for preventing and treating pressure ulcers, and their efficacy ranking. More high-quality research is required; for example, for the comparison of reactive air surfaces with alternating pressure air surfaces. Future studies should consider time-to-event outcomes and be designed to minimise any risk of bias.
Topics: Bedding and Linens; Beds; Humans; Incidence; Network Meta-Analysis; Pressure Ulcer; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 34398473
DOI: 10.1002/14651858.CD013761.pub2 -
Heliyon Jul 2021Pressure ulcers (PU) are injuries to the skin and underlying tissue because of prolonged pressure. It affects millions of people in the world. One of the major nursing...
OBJECTIVE
Pressure ulcers (PU) are injuries to the skin and underlying tissue because of prolonged pressure. It affects millions of people in the world. One of the major nursing roles is to prevent patients from developing PU. Inadequate knowledge of nurses' toward PU can have a significant effect on preventive care strategies. Therefore, the aim of this meta-analysis study was to assess the overall level of nurses' knowledge about the prevention of pressure ulcers.
METHODS
A systemic review of primary research was undertaken and nurses' knowledge on pressure ulcer prevention was evaluated. All original cross-sectional studies conducted only in Ethiopia in the English language were included in this meta-analysis. After extraction, the data analysis was done using STATA version 11 statistical software. Based on heterogeneity between the studies, the data were analyzed using a random effects model.
RESULTS
In this systematic review and meta-analysis, all the studies on nurses' knowledge on the prevention of PU were reviewed based on the PRISMA statement. The overall knowledge of nurses' on pressure ulcer prevention was 46.24 % (95 % CI: 26.63-65.85).
CONCLUSION
The overall knowledge of nurses' on pressure ulcer prevention was low in this meta-analysis study. Sustainable training about the prevention of PU is very important for all nurses.
PubMed: 34381901
DOI: 10.1016/j.heliyon.2021.e07648 -
Implementation Science Communications Aug 2021The champion model is increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC). Studies suggest that an on-site champion may improve... (Review)
Review
BACKGROUND
The champion model is increasingly being adopted to improve uptake of guideline-based care in long-term care (LTC). Studies suggest that an on-site champion may improve the quality of care residents' health outcomes. This review assessed the effectiveness of the champion on staff adherence to guidelines and subsequent resident outcomes in LTC homes.
METHOD
This was a systematic review and meta-analyses of randomised controlled trials. Eligible studies included residents aged 65 or over and nursing staff in LTC homes where there was a stand-alone or multi-component intervention that used a champion to improve staff adherence to guidelines and resident outcomes. The measured outcomes included staff adherence to guidelines, resident health outcomes, quality of life, adverse events, satisfaction with care, or resource use. Study quality was assessed with the Cochrane Risk of Bias tool; evidence certainty was assessed using the GRADE approach.
RESULTS
After screening 4367 citations, we identified 12 articles that included the results of 1 RCT and 11 cluster-RCTs. All included papers evaluated the effects of a champion as part of a multicomponent intervention. We found low certainty evidence that champions as part of multicomponent interventions may improve staff adherence to guidelines. Effect sizes varied in magnitude across studies including unadjusted risk differences (RD) of 4.1% [95% CI: - 3%, 9%] to 44.8% [95% CI: 32%, 61%] for improving pressure ulcer prevention in a bed and a chair, respectively, RD of 44% [95% CI: 17%, 71%] for improving depression identification and RD of 21% [95% CI: 12%, 30%] for improving function-focused care to residents.
CONCLUSION
Champions may improve staff adherence to evidence-based guidelines in LTC homes. However, methodological issues and poor reporting creates uncertainty around these findings. It is premature to recommend the widespread use of champions to improve uptake of guideline-based care in LTC without further study of the champion role and its impact on cost.
TRIAL REGISTRATION
PROSPERO CRD42019145579 . Registered on 20 August 2019.
PubMed: 34344486
DOI: 10.1186/s43058-021-00185-y -
Journal of Tissue Viability Feb 2022Pressure injuries presently has been a serious healthcare problem all over the world. Children were recognized as the high-risk population of pressure injuries in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure injuries presently has been a serious healthcare problem all over the world. Children were recognized as the high-risk population of pressure injuries in the latest prevention and treatment of pressure injuries clinical practice guideline. However, the estimates of incidence, and prevalence of pressure injuries in hospitalized children patients vary considerable in relevant published studies.
OBJECTIVE
To systematically quantify the incidence and prevalence of pressure injuries (PIs) in hospitalized children and the most affected PIs sites.
METHODS
A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases searches of the Cochrane Library, Pubmed, Web of Science, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP), and hand-search through references were 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 Hoy's tool. The I statistic and random-effects model were used to assess the heterogeneity. Meta-regression analysis and subgroup analysis were conducted to examine between-study heterogeneity.
RESULTS
A total of 6, 672 articles were screened, and 30 studies with 251, 501 participants were ultimately included in this review. The pooled incidence of PIs for 3, 205 children was 13.5% (95% CI: 10.5-16.5); and the pooled prevalence of PIs for 4, 639 children was 12.2% (95% CI: 8.0-16.3). The most affected body sites were occiput, ears, and nose. Meta-regression and subgroup analysis showed that the inpatient ward, and region were the sources of heterogeneity.
CONCLUSIONS
The incidence and prevalence of PIs was significantly higher than the adults. Our discoveries recommended that healthcare givers ought to pay more consideration to diminish the happens of PIs. Additionally, more research may be needed to improve our understanding of the characteristics of PIs among children and to identify PIs risk factors to prevent and treat it in children effectively.
Topics: Adult; Child; Humans; China; Incidence; Prevalence; Risk Factors; Pressure Ulcer
PubMed: 34312030
DOI: 10.1016/j.jtv.2021.07.003