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PloS One 2018Pressure ulcers are a prevalent and global issue and support surfaces are widely used for preventing ulceration. However, the diversity of available support surfaces and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pressure ulcers are a prevalent and global issue and support surfaces are widely used for preventing ulceration. However, the diversity of available support surfaces and the lack of direct comparisons in RCTs make decision-making difficult.
OBJECTIVES
To determine, using network meta-analysis, the relative effects of different support surfaces in reducing pressure ulcer incidence and comfort and to rank these support surfaces in order of their effectiveness.
METHODS
We conducted a systematic review, using a literature search up to November 2016, to identify randomised trials comparing support surfaces for pressure ulcer prevention. Two reviewers independently performed study selection, risk of bias assessment and data extraction. We grouped the support surfaces according to their characteristics and formed evidence networks using these groups. We used network meta-analysis to estimate the relative effects and effectiveness ranking of the groups for the outcomes of pressure ulcer incidence and participant comfort. GRADE was used to assess the certainty of evidence.
MAIN RESULTS
We included 65 studies in the review. The network for assessing pressure ulcer incidence comprised evidence of low or very low certainty for most network contrasts. There was moderate-certainty evidence that powered active air surfaces and powered hybrid air surfaces probably reduce pressure ulcer incidence compared with standard hospital surfaces (risk ratios (RR) 0.42, 95% confidence intervals (CI) 0.29 to 0.63; 0.22, 0.07 to 0.66, respectively). The network for comfort suggested that powered active air-surfaces are probably slightly less comfortable than standard hospital mattresses (RR 0.80, 95% CI 0.69 to 0.94; moderate-certainty evidence).
CONCLUSIONS
This is the first network meta-analysis of the effects of support surfaces for pressure ulcer prevention. Powered active air-surfaces probably reduce pressure ulcer incidence, but are probably less comfortable than standard hospital surfaces. Most prevention evidence was of low or very low certainty, and more research is required to reduce these uncertainties.
Topics: Beds; Humans; Incidence; Network Meta-Analysis; Patient Comfort; Pressure Ulcer; Randomized Controlled Trials as Topic; Surface Properties; Treatment Outcome
PubMed: 29474359
DOI: 10.1371/journal.pone.0192707 -
Tidsskrift For Den Norske Laegeforening... Mar 2011Pressure sores are common and affect 10-20% of all institutionalized patients. Health personnel should have sufficient knowledge of prevention, evaluation and treatment.
BACKGROUND
Pressure sores are common and affect 10-20% of all institutionalized patients. Health personnel should have sufficient knowledge of prevention, evaluation and treatment.
MATERIAL AND METHODS
This article is based on a non-systematic search in Medline and EMBASE, and the authors' own clinical experience.
RESULTS
The causes of pressure sores are mechanical pressure, shear and frictional forces on the skin and underlying tissue. Neuropathy, nutrition deficiency, moist skin, and infection are risk factors for development and persistence of the wound. Preventive measures and treatment must to be directed towards both causes and risk factors. Pressure sores are graded on a scale from 0 to 4, based on depth of wound penetration into underlying tissue. Superficial wounds are treated conservatively while deeper pressure sores, which affect muscle and bone, must be evaluated for surgical treatment.
INTERPRETATION
Alleviation of pressure and reduction of risk factors are important for prevention and treatment of pressure sores. Depending on the depth of wound penetration into underlying tissue, additional treatment may be conservative wound treatment or surgery.
Topics: Humans; Pressure Ulcer; Risk Factors; Wound Healing
PubMed: 21383799
DOI: 10.4045/tidsskr.09.1472 -
Journal of Advanced Nursing Oct 2014To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.
AIM
To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework.
BACKGROUND
A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study.
DESIGN
Consensus study.
METHOD
A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011.
FINDINGS
The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways.
CONCLUSION
The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework.
Topics: Humans; Los Angeles; Pressure Ulcer; Risk Assessment
PubMed: 24845398
DOI: 10.1111/jan.12444 -
Inquiry : a Journal of Medical Care... 2021We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four... (Review)
Review
We developed and tested the effectiveness of an algorithm to prevent medical device-related pressure injuries in intensive care unit patients. It was developed in four stages: literature review and analysis of medical records; preliminary algorithm development; validation of the preliminary algorithm by experts in two rounds; and practical feasibility verification of the revised algorithm by 109 intensive care unit nurses. To verify the algorithm's effectiveness, we compared the incidence of medical device-related pressure injuries between 324 patients without algorithm application (control group) and 312 patients with algorithm application (experimental group). The outcomes were skin inspection of the medical device attachment, pressure injury evaluation, and implementation of pressure injury-preventive nursing care, based on the medical device type. The incidence rates were 1.46 per 100 devices (control group) and 1.19 per 100 devices (experimental group). Since there was no homogeneity in the previous score of the Braden scale in the experimental and control groups, the results regarding the incidence of pressure damage after applying the algorithm should be interpreted with care. Applying this algorithm was a safe intervention that helped prevent medical device-related pressure injuries in this population.
Topics: Algorithms; Humans; Incidence; Intensive Care Units; Pressure Ulcer; Risk Factors
PubMed: 34672226
DOI: 10.1177/00469580211050219 -
The Pan African Medical Journal 2018
Topics: Aged, 80 and over; Humans; Male; Oral Ulcer; Pressure Ulcer; Tongue Diseases
PubMed: 30167058
DOI: 10.11604/pamj.2018.30.31.15007 -
Journal of Nursing Management Jul 2022To analyse patient factors and nurse staffing-related issues involving hospital-acquired pressure ulcers in patients at two types of hospital.
AIM
To analyse patient factors and nurse staffing-related issues involving hospital-acquired pressure ulcers in patients at two types of hospital.
BACKGROUND
Hospital-acquired pressure ulcers are important for the safety of hospitalized patients. Hospital-acquired pressure ulcers not only cause health problems, but also pose an economic burden to patients. In addition to patient factors such as mobility and skin integrity, hospital factors such as nurse staffing can also affect the management of such patients.
METHODS
This study is a retrospective review of patient data and analysis of factors related to hospital-acquired pressure ulcers using stratified Cox proportional hazards regression.
RESULTS
A total of 53,923 patients were included. The incidence of hospital-acquired pressure ulcers was 0.98 per 1,000 days. Hospital-acquired pressure ulcers were affected by gender, age, previous falls, low oxygen levels, positioning and toilet use. When the levels of nurse staffing were determined as one of the hospital factors, the daily hours of patient care was increased thereby contributing to the reduced incidents of hospital-acquired pressure ulcers.
CONCLUSION
Strategies for preventing hospital-acquired pressure ulcers should be based on the analysis of risk factors.
IMPLICATIONS FOR NURSING MANAGEMENT
Most individual risk factors for hospital-acquired pressure ulcers identified cannot be modified easily in a short time. Nurse staffing should be set at adequate levels to prevent hospital-acquired pressure ulcers.
Topics: Humans; Incidence; Nursing Staff, Hospital; Personnel Staffing and Scheduling; Pressure Ulcer; Risk Factors; Workforce
PubMed: 31811735
DOI: 10.1111/jonm.12928 -
International Journal of Nursing Studies Jan 2024Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Older nursing home residents are prone to develop different skin conditions at the same time, including xerosis cutis, skin tears, pressure ulcers, incontinence-associated dermatitis or intertrigo. Guidelines and recommendations mainly address these skin conditions separately. The overall aim of this study was to measure the effects of the implementation of a skincare and prevention package.
TRIAL DESIGN
A two-arm cluster-randomised controlled trial was conducted.
METHODS
In nursing homes being assigned to the intervention group, an evidence-based and structured skincare and prevention programme was implemented for six months. Nursing home residents in the control group received standard care as usual. Blinded dermatologists conducted head-to-toe skin assessments, and the researchers assessed skin barrier parameters including stratum corneum hydration and transepidermal water loss at the upper and lower extremities after three and six months. Outcomes included the cumulative incidence of incontinence-associated dermatitis, skin tears, pressure ulcers and intertrigo, and were presented as intention-to-treat and per protocol analysis. Skin dryness and resident-reported outcomes (pain, itch, quality of life) were assessed.
RESULTS
A random sample of 17 nursing homes in the federal state of Berlin, Germany, was drawn and randomised in intervention (n = 9) and control groups (n = 8). In total, 165 participants were allocated to the intervention, and 149 participants were allocated to the control group. The cumulative incidence of skin tears (19.2 %, 95 % CI 12.8-27.8), pressure ulcers (13.6 %, 95 % CI 8.1-21.9) and intertrigo (27.0 %, 95 % CI 18.4-37.7) was lower in the intervention compared to the control group, with cumulative incidences of 27.2 % (95 % CI 19.3-36.9) for skin tears, 16.9 % (95 % CI 10.6-25.9) for pressure ulcer, and 37.8 % (95 % CI 27.5-49.4) for intertrigo. The incidence of incontinence-associated dermatitis was higher in the intervention group (26.3 %, 95 % CI 17.9-36.8) compared to the control group (23.1 %; 95 % CI 14.6-34.5). Mean skin dryness was lower in the intervention group but showed variation. The impact on pain, itch, and quality of life was trivial.
CONCLUSIONS
The present study results indicate that the implementation of tailored and evidence-based nursing routines improves skin health and safety in residential long-term care. Evidence suggests that multiple adverse skin conditions can be prevented by regular skin assessments and individually tailored skincare routines. Positive effects on skin dryness were observed, but skin physiology parameters did not indicate changes of the skin barrier function.
TRIAL REGISTRATION
This study is registered at the German Clinical Trials Register (registration number: DRKS00015680; date of registration: January 29, 2019) and ClinicalTrials.gov (NCT03824886; date of registration: January 31, 2019).
Topics: Humans; Aged; Pressure Ulcer; Quality of Life; Skin; Intertrigo; Pain
PubMed: 37956524
DOI: 10.1016/j.ijnurstu.2023.104627 -
The Israel Medical Association Journal... Sep 2013The issue of professional responsibility for the treatment and care of the patient with pressure ulcers (PU) is crucial as it impacts on mortality, financial costs and... (Review)
Review
The issue of professional responsibility for the treatment and care of the patient with pressure ulcers (PU) is crucial as it impacts on mortality, financial costs and the patient's quality of life. Pressure ulcers in the elderly present a complicated health problem with multifactorial etiologies. Since the pressure ulcer is the final common pathway of multiple underlying factors and medical conditions, the approach when dealing with the elderly is not only local wound management but systemic--i.e., it relates to the patient's overall condition, comorbidities, nutritional status, and disabilities. With the increase in longevity and disability, the prevalence of PU is higher and has concomitant severity and complications. For treatment to be effective it must be comprehensive and multidisciplinary. The traditional, and pivotal, role of the nurse in coordinating treatment has expanded and now includes more active collaboration with the physician and the multidisciplinary team regarding the development and course of the wound. Physicians are required to be knowledgeable, actively involved, and alert to reversible multifactorial etiologies, in order to determine the goal and level of aggressive treatment during the course of PU.
Topics: Aged; Cooperative Behavior; Health Knowledge, Attitudes, Practice; Humans; Nurse's Role; Patient Care Team; Practice Patterns, Physicians'; Pressure Ulcer; Quality of Health Care; Severity of Illness Index
PubMed: 24340845
DOI: No ID Found -
Ostomy/wound Management May 2008Although wound pain often is described as an important clinical factor by both patients and providers, pain associated with pressure ulcers is poorly understood. To... (Review)
Review
Although wound pain often is described as an important clinical factor by both patients and providers, pain associated with pressure ulcers is poorly understood. To assess the state of knowledge of pain with pressure ulcers, a systematic, integrative review of the literature was conducted to determine: 1) how pain is measured, 2) pain prevalence/incidence, and 3) factors associated with pressure ulcer pain. Bibliographic databases including MEDLINE (1966-2005), HealthSTAR (1975-2005), CINAHL (1982-2005), and seven others were searched using the terms decubitus ulcers, pressure ulcer, pressure sore, bed sore, and pain and then culled to English-language, clinical publications. Of the 417 articles recovered, 26 met the study inclusion criteria, six specifically identified pain prevalence (ranging from 37% and 100%), and none documented the incidence of pain in patients with pressure ulcers. Measurement tools used to assess pain included the Visual Analogue Scale, the Verbal Rating Scale, the Wong-Baker Facial Recognition Scale, the McGill Pain Questionnaire-Short Form, the Numerical Rating Scale, and the Present Pain Intensity scale. Pressure ulcer pain was described as a burning sensation and reported as both constant and transient. Contrary to often-held clinical opinion, the studies reviewed suggest that pain increases with pressure ulcer stage. Although a number of intrinsic and extrinsic factors were studied (eg, age, ulcer stage, and bed surfaces), no conclusions could be drawn from the available research. Because pain is an issue for individuals with pressure ulcers and may present a different profile than other sources of pain, pain assessment should become an integral part of pressure ulcer care and documented to guide pressure ulcer management.
Topics: Humans; Pain; Pain Measurement; Pressure Ulcer; Prevalence
PubMed: 18493092
DOI: No ID Found -
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