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The Cochrane Database of Systematic... May 2015Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type.
OBJECTIVES
To assess the effects of alginate dressings for treating pressure ulcers in any care setting.
SEARCH METHODS
For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.
SELECTION CRITERIA
Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above).
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, risk of bias assessment and data extraction.
MAIN RESULTS
We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. Where data were available there was no evidence of a difference between alginate dressings and alternative treatments in terms of complete wound healing or adverse events.
AUTHORS' CONCLUSIONS
The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.
Topics: Alginates; Bandages; Bandages, Hydrocolloid; Dextrans; Glucuronic Acid; Hexuronic Acids; Humans; Hyperthermia, Induced; Pressure Ulcer; Randomized Controlled Trials as Topic; Silver Compounds; Silver Sulfadiazine; Sulfadiazine
PubMed: 25994366
DOI: 10.1002/14651858.CD011277.pub2 -
The Cochrane Database of Systematic... Dec 2016The management of pressure ulcers involves several interventions ranging from pressure-relieving measures such as repositioning, to treatments that can include... (Review)
Review
BACKGROUND
The management of pressure ulcers involves several interventions ranging from pressure-relieving measures such as repositioning, to treatments that can include reconstructive surgery. Such surgery may be considered for recalcitrant wounds when full thickness skin loss arises and deeper structures such as muscle fascia and even bone are exposed. The surgery commonly involves wound debridement followed by the addition of new tissue into the wound. Whilst reconstructive surgery is an accepted means of ulcer management, the benefits and harms of surgery compared with non-surgical treatments, or alternative surgical approaches are not clear.
OBJECTIVES
To assess the effects of reconstructive surgery for healing pressure ulcers (stage II or above), comparing surgery with no surgery or comparing alternative forms of surgery in any care setting.
SEARCH METHODS
We searched the following electronic databases to identify reports of relevant randomised clinical trials (searched 26 September 2016): the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL. We also searched three clinical trials registers and reference lists of relevant systematic reviews, meta-analyses and health technology assessment reports.
SELECTION CRITERIA
Published or unpublished randomised controlled trials that assessed reconstructive surgery in the treatment 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 and extract study data.
MAIN RESULTS
We did not identify any studies that met the review eligibility criteria nor any registered studies investigating the role of reconstructive surgery in the management of pressure ulcers.
AUTHORS' CONCLUSIONS
Currently there is no randomised evidence that supports or refutes the role of reconstructive surgery in pressure ulcer management. This is a priority area and there is a need to explore this intervention with more rigorous and robust research.
Topics: Humans; Patient Positioning; Pressure Ulcer; Plastic Surgery Procedures; Wound Healing
PubMed: 27919120
DOI: 10.1002/14651858.CD012032.pub2 -
The Cochrane Database of Systematic... Feb 2015Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many different dressing options including hydrogel dressings. A clear and current overview of the current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers.
OBJECTIVES
To assess the effects of hydrogel dressings on the healing of pressure ulcers in any care setting.
SEARCH METHODS
We searched the following databases: the Cochrane Wounds Group Specialised Register (searched 19 June 2014); The Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 5); Ovid MEDLINE (1946 to June Week 2 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 23 June 2014); Ovid EMBASE (1974 to 20 June 2014); and EBSCO CINAHL (1982 to 18 June 2014). There were no restrictions based on language or date of publication.
SELECTION CRITERIA
Published or unpublished randomised controlled trials (RCTs) comparing the effects of hydrogel dressings with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above).
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, risk of bias assessment and data extraction.
MAIN RESULTS
We included eleven studies (523 participants) in this review. Ten studies had two arms and one had three arms that were all relevant to this review. Three studies compared a hydrogel dressing with a basic wound contact dressing; three studies compared a hydrogel dressing with a hydrocolloid dressing; three studies compared a hydrogel dressing with another hydrogel dressing; one study compared a hydrogel dressing with a foam dressing; one study compared a hydrogel dressing with a dextranomer paste dressing and one study compared a hydrogel dressing with a topical treatment (collagenase). Limited data were available for analyses in this review: we conducted no meta-analyses. Where data were available there was no evidence of a difference between hydrogel and alternative treatments in terms of complete wound healing or adverse events. One small study reported that using hydrogel dressings was, on average, less costly than hydrocolloid dressings, but this estimate was imprecise and its methodology was not clear. All included studies were small, had short follow-up times and were at unclear risk of bias.
AUTHORS' CONCLUSIONS
It is not clear if hydrogel dressings are more or less effective than other treatments in healing pressure ulcers or if different hydrogels have different effects, Most trials in this field are very small and poorly reported so that risk of bias is unclear.
Topics: Bandages, Hydrocolloid; Collagenases; Dextrans; Humans; Hydrogels; Ointments; Pressure Ulcer; Randomized Controlled Trials as Topic
PubMed: 25914909
DOI: 10.1002/14651858.CD011226.pub2 -
The Cochrane Database of Systematic... Oct 2016Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony... (Review)
Review
BACKGROUND
Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, and impact negatively on the individual's quality of life. International guidelines suggest bed rest as a component of the treatment strategy to manage pressure ulcers among wheelchair users. The potential benefits and risks need to be considered when assessing the effectiveness of bed rest as an intervention for treating pressure ulcers in this population. Therefore, it was important to search and appraise existing research evidence in order to determine the impact of bed rest on the healing of pressure ulcers in wheelchair users.
OBJECTIVES
To assess the impact of bed rest on pressure ulcer healing, in wheelchair users, of any age, who are living or being cared for in any setting.
SEARCH METHODS
In October 2016 we searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trials registries and conference proceedings and for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
We considered randomised controlled trials (RCTs) and cluster-RCTs that evaluated the impact of bed rest on healing pressure ulcers in wheelchair users.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for their eligibility.
MAIN RESULTS
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS
We set out to evaluate the research evidence, from randomised controlled trials, of the impact of bed rest on pressure ulcer healing in wheelchair users. No study met the inclusion criteria. It is uncertain whether bed rest makes a difference to the healing of pressure ulcers in wheelchair users. Well-designed trials addressing important clinical, quality of life and economic outcomes are required.
Topics: Bed Rest; Humans; Pressure Ulcer; Wheelchairs; Wound Healing
PubMed: 27748506
DOI: 10.1002/14651858.CD011999.pub2 -
Journal of Pain and Symptom Management Sep 2011Pressure ulcers (PUs) can cause patients considerable pain and discomfort; however, little is known about how PU pain affects patients' everyday lives. To improve... (Review)
Review
CONTEXT
Pressure ulcers (PUs) can cause patients considerable pain and discomfort; however, little is known about how PU pain affects patients' everyday lives. To improve outcomes for patients and to help clinicians manage PU pain, the existing qualitative and quantitative research bases were systematically reviewed.
OBJECTIVES
The aims were to identify and synthesize all research that obtained verbal patient reports of PU-associated pain, including descriptions of the pain experience, intensity, quality, and impact to interpret the complexities of the pain experienced from PUs; describe specific characteristics of PU pain; and determine how it affects patients' lives.
METHODS
We searched eight electronic databases (from inception to January 2010), hand searched and cross-referenced. Research studies that addressed the experience of PU-associated pain by direct patient reports were included. Two reviewers independently applied inclusion criteria and extracted findings, allocating findings to defined categories. Synthesis of findings and categories were reviewed by three reviewers until reaching consensus.
RESULTS
Ten studies were included: six qualitative and four quantitative. These included 108 adults with PUs. The PU pain experience was mapped, producing a conceptual framework of five domains: communicating the pain, feeling the pain, impact of pain, self-management, and professional management, and represented by 23 subdomains and five mediating factors (four psychological well-being plus comorbidity).
CONCLUSION
A biopsychosocial model of pain experienced from PUs is presented. Improved communication of pain experienced between the individual and health care professionals is needed to promote more effective PU pain management in the future.
Topics: Humans; Pain; Pain Management; Pressure Ulcer; Self Care; Self Report; Severity of Illness Index
PubMed: 21444182
DOI: 10.1016/j.jpainsymman.2010.11.016 -
BMJ Clinical Evidence Aug 2011Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades... (Review)
Review
INTRODUCTION
Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades it from 1 to 5. The annual incidence of ulcers among people with diabetes is 2.5% to 10.7% in resource-rich countries, and the annual incidence of amputation for any reason is 0.25% to 1.8%.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent foot ulcers and amputations in people with diabetes? What are the effects of treatments in people with diabetes with foot ulceration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 50 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: debridement, human cultured dermis, human skin equivalent, patient education, pressure off-loading with felted foam or pressure-relief half-shoe, pressure off-loading with total-contact or non-removable casts, screening and referral to foot-care clinics, systemic hyperbaric oxygen for non-infected ulcers, systemic hyperbaric oxygen in infected ulcers, therapeutic footwear, topical growth factors, and wound dressings.
Topics: Amputation, Surgical; Debridement; Diabetic Foot; Foot; Foot Ulcer; Humans; Pressure Ulcer
PubMed: 21871137
DOI: No ID Found -
International Wound Journal Sep 2023The aim of this review study is to investigate the nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers (MDRPUs). An... (Review)
Review
The aim of this review study is to investigate the nurses' knowledge and related factors towards the prevention of medical device-related pressure ulcers (MDRPUs). An extensive search was conducted in international electronic databases such as PubMed, Web of Science, and Scopus, and Persian databases, such as Iranmedex and the Scientific Information Database from December 1, 2022. During this search, keywords extracted from Medical Subject Headings, such as "Prevention knowledge," "Nurse," "Pressure ulcer," "Equipment and Supplies," and "Intensive Care Units" were used. The quality of the present studies in this review was evaluated based on the appraisal tool for cross-sectional studies (AXIS tool). A total of 1847 nurses participated in this review from five studies, and the majority of them (82.94%) were female. The mean age of the participants was 31.40 (SD = 5.97). The mean score of MDRPUs prevention knowledge in nurses based on PU2014 scale and researcher-made questionnaires were 16.50 (SD = 3.74) out of 31 and 65.49 (SD = 6.33) out of 100, respectively. The knowledge of nurses is influenced by factors such as age, sex, level of education, work experience, technical titles, type of hospital, level of hospital, and type of ward. Various factors had a significant positive relationship with nurses' MDRPUs prevention knowledge, which includes level of education, work experience, previous training on MDRPU, having a wound care certificate, an online search about MDRPU, and attitude and practise towards MDRPU prevention. At the same time, nurses' knowledge about the prevention of MDRPUs had a significant negative relationship with the time interval since last participating in MDRPU training or workshop. Overall, the level of MDRPUs prevention knowledge among nurses was insufficient to moderate. Therefore, it is suggested to provide facilities for nurses to receive the necessary training.
Topics: Humans; Male; Female; Pressure Ulcer; Cross-Sectional Studies; Clinical Competence; Attitude of Health Personnel; Hospitals; Surveys and Questionnaires; Health Knowledge, Attitudes, Practice; Nurses
PubMed: 36792930
DOI: 10.1111/iwj.14122 -
Journal of Tissue Viability May 2023The aim of this network meta-analysis is to analyze the difference in therapeutic effects between moist dressings and traditional dressings in the treatment of pressure... (Meta-Analysis)
Meta-Analysis Review
AIMS
The aim of this network meta-analysis is to analyze the difference in therapeutic effects between moist dressings and traditional dressings in the treatment of pressure injury (PI), explore the healing, healing time, direct cost, and number of dressing changes of different moist dressings for the management of pressure injuries.
BACKGROUND
The incidence of pressure injury is high and the burden of disease is high, but there is no consensus on how to choose moist dressing treatment.
DESIGN
A systematic review with network meta-analysis was performed.
DATA SOURCES
We searched the Chinese Biomedicine Literature Database and China National Knowledge Infrastructure, Wanfang Database, VIP database, PubMed, Web of Science, EMBASE.com, CENTRAL (Cochrane Central Register of Controlled Trials) and CINAHL to obtain randomized controlled trials (RCTs) on the treatment of PI with moist dressings.
REVIEW METHODS
R studio software and Stata 16.0 software were used to compare different moist dressings and traditional dressings.
RESULTS
41 RCTs of moist dressings in the treatment of PI were included. A total of seven kinds of moist dressings, Vaseline gauze and traditional gauze dressing were involved. All RCTs were at a medium to high risk of bias. Overall, moist dressings had more advantages than traditional dressings in terms of various outcome indicators.
CONCLUSION
The effect of moist dressings in treating PI is more advantageous than traditional dressings. However, in terms of direct cost and the number of dressings changes, more research is needed to improve the credibility of the network meta-analysis. The results of the network meta-analysis show that the silver ion dressing and alginate dressing are the best choices in the treatment of PI.
NO PATIENT OR PUBLIC CONTRIBUTION
This study is a network meta-analysis, which does not require the participation of patients and the public.
Topics: Humans; Pressure Ulcer; Network Meta-Analysis; Bandages; Wound Healing; Surgical Wound Infection
PubMed: 37012120
DOI: 10.1016/j.jtv.2023.03.003 -
The Cochrane Database of Systematic... Sep 2015Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony... (Review)
Review
BACKGROUND
Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers.
OBJECTIVES
To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting.
SEARCH METHODS
In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting.
SELECTION CRITERIA
We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria.
MAIN RESULTS
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS
We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure ulcers. Well-designed trials addressing important clinical, quality of life and economic outcomes are justified, based on the incidence of the problem and the high costs associated with pressure ulcer management.
Topics: Humans; Patient Care Team; Pressure Ulcer
PubMed: 26373268
DOI: 10.1002/14651858.CD011011.pub2 -
Revista Latino-americana de Enfermagem 2023to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument,... (Review)
Review
OBJECTIVE
to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments' use/limitations.
METHOD
a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample.
RESULTS
we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments.
CONCLUSION
the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units. (1) The risk assessment instrument must be applied to the patient's specificities. (2) The instruments are divided into two groups: generalist and specific. (3) The EVARUCI and CALCULATE instruments presented better results. (4) The EVARACI presented better results in terms of performance indicators. (5) The CALCULATE highlights itself for being recent scale, appropriate, simple, and easy to use.
Topics: Humans; Adult; Pressure Ulcer; Risk Assessment; Intensive Care Units
PubMed: 37820213
DOI: 10.1590/1518-8345.6659.3983