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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; 36:421-434. [PMID: 37471447 DOI: 10.1097/asw.0000000000000005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19-related variables and hospital-acquired pressure injury (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as "COVID-19," "hospital-acquired pressure injuries," "pressure ulcer," "pressure injury," "decubitus ulcer," and "hospitalization." STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. Articles were included in the review if they were peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously, and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS The authors carried out a narrative synthesis of the extracted data because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should use more robust methodology and focus on quantitative modeling to iteratively improve inpatient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD, MAPWCA, JM is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022; published ahead of print January 27, 2023. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website ( www.ASWCjournal.com )
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Tian J, Liang XL, Wang HY, Peng SH, Cao J, Liu S, Tao YM, Zhang XG. Nurses' and nursing students' knowledge and attitudes to pressure injury prevention: A meta-analysis based on APUP and PUKAT. NURSE EDUCATION TODAY 2023; 128:105885. [PMID: 37354659 DOI: 10.1016/j.nedt.2023.105885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/15/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Morbidity and mortality among patients due to pressure injuries continue to rise. Nurses play a critical role in preventing pressure injuries. However, published results on nurses' knowledge and attitudes for pressure injury prevention are often contradictory. OBJECTIVES To conduct a meta-analysis of nurses' and nursing students' knowledge and attitudes toward pressure injury prevention. DESIGN A meta-analysis of cross-sectional studies. DATA SOURCES Ten databases were queried for the meta-analysis. The search period was from the time of the databases' establishment to February 2023. REVIEW METHODS This review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The Agency for Healthcare Research and Quality (AHRQ) was used to assess the methodological quality of the included studies. Statistical analysis was conducted with the Stata 15.0 software, and the quantitative data of knowledge and attitude toward preventing PI in all studies were summarized. RESULTS Thirteen studies from 9 countries were included. The meta-analysis showed that nurses and nursing students had low knowledge but positive attitudes toward pressure injury prevention. Subgroup analysis showed that the pooled proportion of both knowledge and attitudes was higher in Asia than in Europe. Nurses had higher knowledge than nursing students, however, the former had a more negative attitude than the latter. Sensitivity analyses were robust. Egger's test showed no significant publication bias. CONCLUSION The knowledge of nurses and nursing students about pressure injury prevention is not promising and there is an urgent need for continuous learning. Attitudes are more positive but there is room for improvement. The relevant departments should strengthen nurses' and nursing students' knowledge of pressure injury prevention and further improve their attitudes toward pressure injury prevention.
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Affiliation(s)
- Jing Tian
- College of Nursing, Chengdu University of Traditional Chinese Medicine, shierqiao campus, Jinniu District, Chengdu City, Sichuan province, 610075, China
| | - Xiao Li Liang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu City, Sichuan province 610100, China
| | - Hong Yan Wang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu City, Sichuan province 610100, China
| | - Si Han Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu City, Sichuan province 610032, China
| | - Jun Cao
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu City, Sichuan province 610100, China
| | - Shan Liu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, shierqiao campus, Jinniu District, Chengdu City, Sichuan province, 610075, China
| | - Yan Min Tao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, shierqiao campus, Jinniu District, Chengdu City, Sichuan province, 610075, China
| | - Xian Geng Zhang
- Sichuan Nursing Vocational College, No.173 Longdu South Road, Longquanyi District, Chengdu City, Sichuan province 610100, China.
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Nan X, Xu Z, Cao X, Hao J, Wang X, Duan Q, Wu G, Hu L, Zhao Y, Yang Z, Gao L. A Review of Epidermal Flexible Pressure Sensing Arrays. BIOSENSORS 2023; 13:656. [PMID: 37367021 DOI: 10.3390/bios13060656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
In recent years, flexible pressure sensing arrays applied in medical monitoring, human-machine interaction, and the Internet of Things have received a lot of attention for their excellent performance. Epidermal sensing arrays can enable the sensing of physiological information, pressure, and other information such as haptics, providing new avenues for the development of wearable devices. This paper reviews the recent research progress on epidermal flexible pressure sensing arrays. Firstly, the fantastic performance materials currently used to prepare flexible pressure sensing arrays are outlined in terms of substrate layer, electrode layer, and sensitive layer. In addition, the general fabrication processes of the materials are summarized, including three-dimensional (3D) printing, screen printing, and laser engraving. Subsequently, the electrode layer structures and sensitive layer microstructures used to further improve the performance design of sensing arrays are discussed based on the limitations of the materials. Furthermore, we present recent advances in the application of fantastic-performance epidermal flexible pressure sensing arrays and their integration with back-end circuits. Finally, the potential challenges and development prospects of flexible pressure sensing arrays are discussed in a comprehensive manner.
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Affiliation(s)
- Xueli Nan
- School of Automation and Software Engineering, Shanxi University, Taiyuan 030006, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhikuan Xu
- School of Automation and Software Engineering, Shanxi University, Taiyuan 030006, China
| | - Xinxin Cao
- School of Automation and Software Engineering, Shanxi University, Taiyuan 030006, China
| | - Jinjin Hao
- School of Automation and Software Engineering, Shanxi University, Taiyuan 030006, China
| | - Xin Wang
- School of Automation and Software Engineering, Shanxi University, Taiyuan 030006, China
| | - Qikai Duan
- School of Automation and Software Engineering, Shanxi University, Taiyuan 030006, China
| | - Guirong Wu
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen 361102, China
| | - Liangwei Hu
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen 361102, China
| | - Yunlong Zhao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen 361102, China
- Discipline of Intelligent Instrument and Equipment, Xiamen University, Xiamen 361102, China
| | - Zekun Yang
- Key Laboratory of Instrumentation Science and Dynamic Measurement Ministry of Education, North University of China, Taiyuan 030051, China
| | - Libo Gao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen 361102, China
- Innovation Laboratory for Sciences and Technologies of Energy Materials of Fujian Province (IKKEM), Xiamen 361005, China
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Tervo-Heikkinen T, Heikkilä A, Koivunen M, Kortteisto T, Peltokoski J, Salmela S, Sankelo M, Ylitörmänen T, Junttila K. Nursing interventions in preventing pressure injuries in acute inpatient care: a cross-sectional national study. BMC Nurs 2023; 22:198. [PMID: 37303039 DOI: 10.1186/s12912-023-01369-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/06/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Several nursing interventions for pressure injury prevention have been identified, including risk and skin status assessment. The aim of this study was to explore prevention of pressure injuries in Finnish acute inpatient care. The data were collected on pressure injury risk and skin status assessments, repositioning, the use of support surfaces, preventive skin care, malnutrition risk assessment, and nutritional care. METHODS This multicentre, cross-sectional study was conducted in 16 acute care hospitals, excluding psychiatric care. Adult patients from inpatient care were recruited on the annual international Stop Pressure Ulcers Day in 2018 and 2019. Enrolment covered 6,160 participants in 503 units. Descriptive statistics were used to describe pressure injuries, risk assessments, and preventive nursing interventions. Cross tabulation, Pearson's chi-square and Fisher's exact tests were also used. Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS In all, 30% of the participants had their pressure injury risk assessed during the care, and for 19% within 8 h after admission. The same time limit in risk assessment was fulfilled for 16% of the participants with a pressure injury, and 22% of the participants using a wheelchair or being bedridden. A skin status assessment within 8 h after admission was conducted for 30% of all participants, and for 29% of the participants with a pre-existing pressure injury, and for 38% of the participants using a wheelchair or being bedridden. The risk of malnutrition was screened in 20% of the participants. Preventive interventions were targeted to participants with a pressure injury instead of patients with a high-pressure injury risk. CONCLUSION This study adds evidence about pressure injury risk assessments and the implementation of preventive nursing interventions in Finnish acute care. Skin status and pressure injury risk assessments were irregularly conducted, and the outcome was not used by nurses to guide the implementation of preventive interventions. The results reveal the gaps in evidence-based nursing practice, which require further efforts to prevent pressure injuries. Improving the national focus on pressure injury prevention practice is critical for improving healthcare for our patients.
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Affiliation(s)
- Tarja Tervo-Heikkinen
- Wellbeing Services County of North Savo, Kuopio University Hospital, PO Box 1711, Kuopio, FI70211, Finland.
| | - Anniina Heikkilä
- Helsinki University Hospital and University of Helsinki. Group Administration, FI00029 HUS. Helsinki, PO Box 705, Helsinki, Finland
| | - Marita Koivunen
- Wellbeing Services County of Satakunta, Department of Nursing Science, Pori, Finland, and University of Turku, Sairaalantie 3, Turku, FI28500, Finland
| | - Tiina Kortteisto
- Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Elämänaukio 2, PO Box 2000, Tampere, FI33521, Finland
| | - Jaana Peltokoski
- Wellbeing Services County of Central Finland, Hoitajantie 3, Jyväskylä, FI40620, Finland
| | - Susanne Salmela
- Wellbeing Services County of Ostrobothnia, Korsholmanpuistikko 44, Vaasa, FI65100, Finland
| | - Merja Sankelo
- Wellbeing Services County of South Ostrobothnia, Hanneksenrinne 7, Seinäjoki, FI60220, Finland
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Tuija Ylitörmänen
- Finnish Institute for Health and Welfare, PO Box 30, Helsinki, FI00271, Finland
| | - Kristiina Junttila
- Helsinki University Hospital and University of Helsinki, HUS Nursing Research Center, PO Box 442, Helsinki, FI00029 HUS, Finland
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Chegini Z, Kolawole IO, Behforoz A. The effects of educational intervention on patient participation in pressure injury prevention: a pilot study. J Wound Care 2023; 32:S10-S17. [PMID: 37300865 DOI: 10.12968/jowc.2023.32.sup6.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patients' roles in reducing pressure injuries (PIs) are emphasised in clinical guidelines, although patients' preferences are undetermined. This study evaluated the effects of a pilot six-month educational intervention on patient participation in PI prevention. METHOD A convenience sampling method was used to select patients admitted to medical-surgical wards at one of the teaching hospitals in Tabriz, Iran. This is a one-group pre-test and post-test interventional study, conducted via quasi-experimental design. Using a pamphlet, patients received education in preventing PIs. Data collected before and after intervention through a questionnaire were analysed using descriptive and inferential statistics (McNemar and paired t-tests) in SPSS software (IBM Corp., US). RESULTS The study cohort consisted of 153 patients. Findings revealed that the knowledge of the patients about PIs, patients' ability to talk with the nurses, information received about PIs, and patients' ability to participate in decisions related to PI prevention had significantly increased following the intervention (p<0.001). CONCLUSION Educating patients can improve their knowledge to enable them to participate in PI prevention. The findings of this study suggests further research is necessary on factors influencing patients' participation in such self-care behaviours.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Ali Behforoz
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Yeo H, Hwang J, Lee M, No D, Jang I. Effect of a prophylactic dressing for sacral pressure injuries in non-critically ill patients after general surgery: A randomized controlled trial. Worldviews Evid Based Nurs 2023. [PMID: 37183386 DOI: 10.1111/wvn.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries are strongly associated with surgeries performed under general anesthesia. AIMS The aim of this study was to evaluate the effects of using a prophylactic multi-layer soft silicone foam dressing in non-critically ill patients with a Braden Scale score of ≤18 after undergoing routine surgery without sacral pressure injuries. METHODS This randomized controlled trial included 156 patients who were admitted for surgery under general anesthesia in a tertiary general hospital. The patients were divided into a control group and an intervention group. A 5-layer soft silicone foam dressing was applied to the sacrum of patients in the intervention group immediately after surgery. For the control group, standard pressure injury prevention activities were performed alongside standard care without preventive dressings. RESULTS There were no significant differences in general and clinical characteristics between the two groups; however, the incidence of pressure injury and blanching erythema was higher in the control group, showing a significant difference from the experimental group. Factors influencing the development of pressure injuries and blanching erythema through multivariate regression analysis were prophylactic dressing application and Braden Scale score at the time of admission. A statistically significant difference was noted in survival time from pressure injury between both groups. LINKING EVIDENCE TO ACTION The incidence of pressure injuries and blanching erythema was lower when the prophylactic dressing was applied with standard protocol for general ward patients after surgery. Accurate evaluation of the patient's skin condition and pressure injury risk assessment before surgery are important. Progressive prophylactic dressings to prevent pressure injuries are effective, and tailored nursing interventions based on accurate assessment of patient's skin condition and risk factors are essential for maintaining skin integrity.
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Affiliation(s)
- Hyunjung Yeo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Jihyeon Hwang
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Miju Lee
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Dayeong No
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Insil Jang
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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107
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Wu Z, Song B, Liu Y, Zhai Y, Chen S, Lin F. Barriers and facilitators to pressure injury prevention in hospitals: A mixed methods systematic review. J Tissue Viability 2023:S0965-206X(23)00055-4. [PMID: 37150650 DOI: 10.1016/j.jtv.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/28/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To systematically synthesize research evidence on barriers and facilitators to pressure injury prevention in hospital settings. METHODS A systematic literature review of quantitative, qualitative, and mixed methods research was undertaken using PubMed, MEDLINE, Embase, CINAHL, and Cochrane Library. Studies that reported barriers or/and facilitators to pressure injury prevention in the acute care settings and published in English from 2008 to 2022 were included. Studies were excluded if they were conducted in residential care facilities and nursing homes, or other long-term community care settings. Two authors independently screened articles against the inclusion and exclusion criteria. Quality appraisal was conducted by two authors by using the Mixed Methods Appraisal Tool. Reported results were mapped to the Theoretical Domains Framework to identify the barriers and facilitators to pressure injury prevention. RESULTS A total of 78 studies were included. There were 65 quantitative studies, 11 qualitative studies, and two mix-methods studies. The most salient Theoretical Domains Framework domains identified in this review were "Knowledge", "Skills", "Environmental Context and Resources", "Optimism", "Social/Professional Role and Identity", and "Social influences". CONCLUSION The barriers and facilitators to pressure injury prevention in hospital settings identified in this systematic review were diverse, and included issues at both individual and organizational level. Healthcare organizations can address the barriers and facilitators from the influential Theoretical Domains Framework domains. Future research is required to investigate the effectiveness of behaviour change interventions that specifically target these barriers and facilitators to pressure injury prevention.
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Affiliation(s)
- Zijing Wu
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.
| | - Bing Song
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.
| | - Yu Liu
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, China.
| | - Yongzhen Zhai
- Department of Infectious Disease, Shengjing Hospital of China Medical University, No.39 Huaxiang Road, Tiexi District, Shenyang, Liaoning Province, China.
| | - Si Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, No.4 Chongshan East Road, Huanggu District, Shenyang, Liaoning Province, China.
| | - Frances Lin
- School of Health, University of the Sunshine Coast, Queensland, Australia.
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108
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Chen B, Yang Y, Cai F, Zhu C, Lin S, Huang P, Zhang L. Nutritional status as a predictor of the incidence of pressure injury in adults: A systematic review and meta-analysis. J Tissue Viability 2023:S0965-206X(23)00043-8. [PMID: 37117126 DOI: 10.1016/j.jtv.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/12/2023] [Accepted: 04/15/2023] [Indexed: 04/30/2023]
Abstract
AIM Pressure injuries are a significant health care problem worldwide, and many factors influence their occurrence and development. The purpose of this systematic review and meta-analysis was to investigate the role of nutritional status in the development rate of pressure injuries as a potentially modifiable risk factor. METHODS Study designs included cohort (prospective and retrospective), case-control, and RCTs if the association between nutrition status and pressure injuries was reported. Databases searched included: PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Library on April 20th, 2022. The data were analyzed using OR and random effect model in Revman5.3 and STATA 15 Software. Report this systematic review and meta-analysis according to the PRISMA 2020 statement. RESULTS A total of 22 separate studies were retained in this systematic review. Of these, 16 articles were included in the meta-analysis. Three studies were assessed as low risk and sixteen as a moderate risk of bias. All RCTs were B quality. The odds ratio of the incidence of pressure injuries in malnourished and non-malnourished patients was 3.66(95% CI: 2.77-4.83). In the three RCTs studies(n = 870), the odds ratio of the incidence of pressure ulcers in patients with standard nutrition to those with specific nutritional interventions was 1.35(95%CI:1.02-1.78). CONCLUSIONS This systematic review and meta-analysis showed that nutritional status is significantly associated with pressure injuries. Malnutrition can increase the incidence of pressure injuries, and specific nutritional interventions can reduce the incidence of pressure injuries compared to standard nutrition.
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Affiliation(s)
- Bei Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
| | - Yufan Yang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Fuman Cai
- College of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Chunjing Zhu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shaoqin Lin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pan Huang
- College of Nursing, Wenzhou Medical University, Wenzhou, China.
| | - Liping Zhang
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
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Graves N, Maiti R, Aloweni FAB, Yi Zhen N, Yuh AS, Bishnoi P, Chong TT, Carmody D, Harding K. Retrospective matched cohort study of incidence rates and excess length of hospital stay owing to pressure injuries in an Asian setting. HEALTH CARE SCIENCE 2023; 2:82-93. [PMID: 38938768 PMCID: PMC11080845 DOI: 10.1002/hcs2.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 06/29/2024]
Abstract
Background Little is known about stage 1 and 2 pressure injuries that are health care-acquired. We report incidence rates of health care-acquired stage 1 and stage 2 pressure injuries, and, estimate the excess length of stay using four competing analytic methods. We discuss the merits of the different approaches. Methods We calculated monthly incidence rates for stage 1 and 2 health care-acquired pressure injuries occurring in a large Singapore acute care hospital. To estimate excess stay, we conducted unadjusted comparisons with a control cohort, performed linear regression and then generalized linear regression with a gamma distribution. Finally, we fitted a simple state-based model. The design for the cost attribution work was a retrospective matched cohort study. Results Incidence rates in 2016 were 0.553% (95% confidence interval [CI] 0.55, 0.557) and 0.469% (95% CI 0.466, 0.472) in 2017. For data censored at 60 days' maximum stay, the unadjusted comparisons showed the highest excess stay at 17.68 (16.43-18.93) days and multi-state models showed the lowest at 1.22 (0.19, 2.23) days. Conclusions Poor-quality methods for attribution of excess length of stay to pressure injury generate inflated estimates that could mislead decision makers. The findings from the multi-state model, which is an appropriate method, are plausible and illustrate the likely bed-days saved from lowering the risk of these events. Stage 1 and 2 pressure injuries are common and increase costs by prolonging the length of stay. There will be economic value investing in prevention. Using biased estimates of excess length of stay will overstate the potential value of prevention.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems ResearchDuke‐NUS Medical SchoolSingaporeSingapore
| | - Raju Maiti
- Centre for Quantitative MedicineDuke‐NUS Medical SchoolSingaporeSingapore
| | | | - Ng Yi Zhen
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | | | - Priya Bishnoi
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
| | | | | | - Keith Harding
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
- Wound Care Innovation for the Tropics ProgrammeSingaporeSingapore
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Takizawa C, Minematsu T, Nakagami G, Kitamura A, Koudounas S, Kunimitsu M, Sanada H. Expression levels of NPPB, ITGB6, CPNE4, EML5, and ITSN1 in fresh exudates swabbed from critically colonised and infected full-thickness wounds in rats. Int Wound J 2023; 20:1088-1097. [PMID: 36307995 PMCID: PMC10031246 DOI: 10.1111/iwj.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/30/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Pressure injury management requires reliable identification of critical colonisation due to lack of infection signs. Our research group previously proposed the mRNAs natriuretic peptide B (Nppb), integrin subunit beta 6 (Itgb6), copine 4 (Cpne4), echinoderm microtubule-associated protein like 5, and intersectin 1 as candidate markers in pooled exudates of critically colonised wounds. However, it is unclear whether mRNAs or proteins of the candidate genes would be suitable as biomarkers in fresh exudate. Therefore, this study aimed to evaluate the validity of the mRNAs and proteins as fresh exudate markers for critical colonisation. Three wound models of normal healing, critical colonisation, and infection were created in rats. Fresh swab-collected exudates were collected, and mRNA and protein expression levels were measured. In the fresh wound exudates, the detection frequency of Itgb6 tended to decrease in the critically colonised and infected wounds (P = .067), and those of Cpne4 and Nppb tended to be lower in the infected wounds than in the normal healing and critically colonised wounds (P = .006 and .067, respectively). In contrast, there was no difference in protein expression in the exudates. This study suggests that Itgb6 mRNA in fresh exudates is a promising biomarker for critical colonisation.
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Affiliation(s)
- Chihiro Takizawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sofoklis Koudounas
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mao Kunimitsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Oliveira-Cortez A, Rodrigues Ferreira I, Luíza Nunes Abreu C, de Oliveira Bosco Y, Kümmel Duarte C, Nogueira Cortez D. Incidence of the first diabetic foot ulcer: A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 198:110594. [PMID: 36842478 DOI: 10.1016/j.diabres.2023.110594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
AIM Investigate the incidence of the first diabetic foot ulcer. METHOD This is a systematic review with meta-analysis of cohort studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. A systematic search of Medline databases via PubMed, Embase, Lilacs, Scopus databases, and Web of Science was performed until July 2021. In addition to investigating the incidence of the first diabetic foot ulcer, the influence of the variables of the Human Development Index (HDI), glycated hemoglobin, and follow-up time of the participants on the incidence of the first diabetic foot ulcer (DFU) was analyzed through meta-regression. For the meta-analysis of cumulative incidence and possible variable associations, RevMan software was used in the Metaprop data package with 95% confidence interval (CI). RESULTS A total of 9,772 articles were identified out of which 87 were selected and 12 studies ultimately included in the systematic review and meta-analysis. The meta-analysis of cumulative incidence was 5.65% (95% CI: 4.20; 7.57). By meta-regression, a significant inverse association was identified between DFU incidence and HDI (estimate - 2.38; 95% CI - 4.10--0.67; p = 0.01). CONCLUSION The study presents the cumulative incidence for the first DFU, an inexistent datum in the national and international literature, and the HDI was inversely associated with the incidence of DFU.
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Affiliation(s)
- Andreza Oliveira-Cortez
- Nursing Department, Federal University of São João del-Rei/Centro Oeste Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour district. Zip Code: 35501-296. Divinópolis, Brazil
| | - Isabela Rodrigues Ferreira
- Nursing Department, Postgraduate Nursing Program, Federal University of São João del-Rei/Centro Oeste Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour district. Zip Code: 35501-296. Divinópolis, Brazil
| | - Carolina Luíza Nunes Abreu
- Nursing Department, Federal University of São João del-Rei/Centro Oeste Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour district. Zip Code: 35501-296. Divinópolis, Brazil
| | - Yvina de Oliveira Bosco
- Nursing Department, Federal University of São João del-Rei/Centro Oeste Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour district. Zip Code: 35501-296. Divinópolis, Brazil
| | - Camila Kümmel Duarte
- Nutrition Department, Postgraduate Nutrition and Health Program, Federal University of Minas Gerais, Belo Horizonte, Brazil Prof. Alfredo Balena Street, 190, Santa Efigênia district. Zip Code: 30130-100. Belo Horizonte, Brazil
| | - Daniel Nogueira Cortez
- Nursing Department, Postgraduate Nursing Program, Federal University of São João del-Rei/Centro Oeste Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour district. Zip Code: 35501-296. Divinópolis, Brazil.
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112
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Huang C, Chang C, Lee S, Chen C, Chen J, Wang H, Chiu W. The change of clinical features and surgical outcomes in patients with pressure injury during the COVID-19 pandemic. Int Wound J 2023; 20:971-980. [PMID: 36054743 PMCID: PMC9539383 DOI: 10.1111/iwj.13944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 01/19/2023] Open
Abstract
This retrospective study aims to explore whether the COVID-19 pandemic altered patient conditions and surgery outcomes by studying 213 pressure injury (PI) patients who underwent surgery during 2016 to 2019 (pre-COVID) and 2020 to 2021 (COVID) in Taiwan. We extracted patient demographics, surgical and blood test records, preoperative vital signs, and flap surgery outcomes. In total, 464 surgeries were performed, including 308 pre-COVID and 156 COVID. During the COVID period, there were more patients presenting with dementia, and it had significantly more patients with >12 000 white blood cells/μL (24.03% vs 15.59%, P = 0.029), higher C-reactive protein levels (7.13 ± 6.36 vs 5.58 ± 5.09 mg/dL, P = 0.014), pulse rates (86.67 ± 14.76 vs 81.26 ± 13.66 beats/min, P < 0.001), and respiratory rates (17.87 ± 1.98 vs 17.31 ± 2.39 breaths/min, P = 0.009) but lower haemoglobin levels (9.75 ± 2.02 vs 10.43 ± 1.67 mg/dL, P < 0.001) preoperatively. There were no between-group differences in flap surgery outcomes but had fewer flap surgeries during COVID-19. Thus, PI patient condition was generally poor during the COVID-19 pandemic because of reduced access to medical treatment; this problem may be resolved through holistic care during a future pandemic or pandemic-like situation.
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Affiliation(s)
- Ching‐Ya Huang
- School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan
| | - Chiung‐Wen Chang
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Sheng‐Lian Lee
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Public Health, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan
- Evidence‐Based Medicine Center, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Jin‐Hua Chen
- Biostatistics Center, College of ManagementTaipei Medical UniversityTaipeiTaiwan
- Graduate Institute of Data Science, College of ManagementTaipei Medical UniversityTaipeiTaiwan
| | - Hsian‐Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
| | - Wen‐Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipei CityTaiwan
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113
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Nakai A, Minematsu T, Nitta S, Hsu WJ, Tobe H, Sanada H. Development of a method to identify persistent and blanchable redness by skin blotting in mice. Int Wound J 2023; 20:1168-1182. [PMID: 36367160 PMCID: PMC10031224 DOI: 10.1111/iwj.13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/13/2022] Open
Abstract
Persistent and blanchable redness (PBR) is not currently included in category I pressure injury (PI), which is defined as non-blanchable redness (NBR). However, PBR progresses to PI in a clinical setting. Therefore, it should be clinically managed as category I PI, and a method to distinctly identify PBR is needed. This study aimed to examine whether PI-related biomarkers can distinguish PRB from transient redness (TR) and NBR using skin blotting. TR, PBR, and NBR models were established by the different conditions of dorsal skin compression. Redness observation and skin blotting were performed, and the skin tissue samples were subjected to histological and molecular biological analyses. The vascular endothelial growth factor (Vegf) b, heat shock protein (Hsp) 90aa1, tumour necrosis factor, interleukin (Il) 1b, and Il6 messenger ribonucleic acid levels were significantly different between the three models. The VEGF-A, VEGF-B, IL-1β, and IL-6 protein levels were different between the three models. Although the results of skin blot examinations were inconsistent with those of the expression analysis of tissue, HSP90α and IL-1β are suggested to be potential markers to distinguish PBR from TR and NBR.
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Affiliation(s)
- Ayano Nakai
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Nursing, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Takeo Minematsu
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Nitta
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wei-Jhen Hsu
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Tobe
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ryu JM, Kim MS, Kim JY. Psychometric validation of the Korean Pressure Ulcer Knowledge Assessment Tool. J Wound Care 2023; 32:172-181. [PMID: 36930188 DOI: 10.12968/jowc.2023.32.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the psychometric properties, including content validity, validity of multiple choice items, and the reliability of the Korean version of the Pressure Ulcer Knowledge Assessment Tool (K-PUKAT 2.0), using classical test theory (CTT) and item response theory (IRT). METHOD Linguistic validation process and factor analysis were conducted among wound care nurses, staff nurses and nursing students. Items were analysed according to the CTT and IRT using a two-parameter logistic model. Intraclass correlation coefficients were used to examine reliability. RESULTS A total of 378 wound care nurses, staff nurses and nursing students participated in this study. While most items showed moderate difficulty based on the CTT, difficulty index values based on the IRT were more broadly distributed (low: 5 items; moderate: 9 items; high: 1 item). The intraclass correlation coefficient for K-PUKAT 2.0 was 0.72. CONCLUSION The K-PUKAT 2.0 demonstrated concise and good psychometric properties. Based on the results of this study, repetitive use of K-PUKAT 2.0 will not only help in distinguishing whether an individual has sufficient clinical knowledge, but will also play a key role in supporting learning.
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Affiliation(s)
- Jung Mi Ryu
- Assistant Professor, Department of Nursing, Busan Institute of Science and Technology, Busan, South Korea
| | - Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, South Korea
| | - Jung Yoon Kim
- Wound, Ostomy and Continence Nurse, Nursing Headquarters, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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115
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Canfor J, Michailidis L, Williams C. Incidence and Characteristics of Suspected Deep Tissue Pressure Injuries on the Foot and Ankle: A Retrospective Study. J Wound Ostomy Continence Nurs 2023; 50:162-166. [PMID: 36867040 DOI: 10.1097/won.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE The purpose of this study was to measure the incidence of suspected deep tissue pressure injuries (DTPIs) in patients admitted to the hospital, describe their location, identify the related hospital length of stay, and explore any associations between intrinsic or extrinsic factors relevant to DTPI development. DESIGN Retrospective review/audit of clinical data. SUBJECTS AND SETTING We reviewed pertinent medical data from patients reported as developing a suspected deep tissue injury during hospital admission from January 2018 to March 2020. The study setting was a large tertiary public health service in Victoria, Australia. METHODS Patients who developed a suspected deep tissue injury during hospital admission between January 2018 and March 2020 were identified through the hospital online risk recording system. Data were extracted from the relevant health records, including demographics, admission data, and pressure injury data. The incidence rate was expressed per 1000 patient admissions. Multiple regression analyses were used to determine associations between the time (days) to develop a suspected deep tissue injury and intrinsic (patient level) or extrinsic (hospital level) factors. RESULTS Six hundred fifty-one pressure injuries were recorded during the audit period. A minority (9.5%; n = 62) of patients developed a suspected deep tissue injury; all were located on the foot and ankle. The incidence of suspected deep tissue injuries was 0.18 per 1000 patient admissions. The mean length of stay among patients who developed a DTPI was 59.0 (SD = 51.9) days as compared to a mean of 4.2 (SD = 11.8) days for all patients admitted to the hospital during this period. Multivariate regression analysis determined that the longer time (in days) to develop a pressure injury was associated with having a higher body weight (Coef = 0.02; 95% CI = 0.00 to 0.04; P = .043), not having off-loading (Coef =-3.63; 95% CI =-6.99 to -0.27; P = .034), and an increasing number of ward transfers (Coef = 0.46; 95% CI = 0.20 to 0.72; P = .001). CONCLUSIONS Findings identified factors that may play a role in the development of suspected deep tissue injuries. A review of risk stratification in health services may be beneficial, with consideration to adjustments of procedural assessments of patients at risk.
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Affiliation(s)
- James Canfor
- James Canfor, Masters of Podiatric Practice, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Lucia Michailidis, PhD, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Cylie Williams, PhD, Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia; and School of Primary and Allied Health, Monash University, Frankston, Victoria, Australia
| | - Lucia Michailidis
- James Canfor, Masters of Podiatric Practice, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Lucia Michailidis, PhD, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Cylie Williams, PhD, Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia; and School of Primary and Allied Health, Monash University, Frankston, Victoria, Australia
| | - Cylie Williams
- James Canfor, Masters of Podiatric Practice, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Lucia Michailidis, PhD, Podiatry Department, Peninsula Health, Frankston, Victoria, Australia
- Cylie Williams, PhD, Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia; and School of Primary and Allied Health, Monash University, Frankston, Victoria, Australia
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Liao N, Wang F, He X, Li L, Fei J. Predictive application of foam dressing on preventing of auricle pressure injury caused by ear dressing. Heliyon 2023; 9:e14883. [PMID: 37064460 PMCID: PMC10102193 DOI: 10.1016/j.heliyon.2023.e14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Objective The use of foam dressings has been regarded as part of the individualized care plan in clinical practice. Our study aimed to compare the predictive application of foam dressing and conventional nursing method in the prevention of auricle pressure injury (PI) caused by ear dressing. Methods Two hundred and four patients undergoing ear dressing after the operation in the Affiliated Hospital of Southwest Medical University in Sichuan, China from January 2021 to September 2021 were recruited as research objects. Patients were randomized into intervention group (n = 102) and control group (n = 102) using double-blind method. Result Results showed that patients in the intervention group showed significantly lower incidence of auricle PI and higher comfort and satisfaction levels than those in the control group (P < 0.05). Conclusion Our study reflected effective predictive application of foam dressing in reducing the incidence of auricle PI in ear dressing, which was suitable for clinical application.
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Andersson J, Imberg S, Rosengren K. Documentation of pressure ulcers in medical records at an internal medicine ward in university hospital in western Sweden. Nurs Open 2023; 10:1794-1802. [PMID: 36303218 PMCID: PMC9912387 DOI: 10.1002/nop2.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/10/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Pressure ulcers cause suffering, prolong care periods, and increase mortality. The aim was to describe and analyze the documentation of pressure ulcers and focused on the medical records from an internal medicine ward in a university hospital in western Sweden. METHODS A quantitative, retrospective review of medical records was conducted for all care events (n = 1,458) with descriptive statistics. RESULTS Documentation of the pressure ulcers in care plans was 2.1% (n = 31) compared to 6.7 % (n = 46) within final notes written by registered nurses (RN), a lower result compared to PPM (n = 3/14, 21.4%). Risk assessments were carried out in 68 (4.7%) care events, and 31 care plans included pressure ulcers. Moreover, 198 cases of tissue damage were documented, 43 (21.7%) defined as pressure ulcers, the other 147 (74.2%) lacked definition. CONCLUSIONS Differences (2.1%-21.4%) highlight improvements; knowledge and communication of pressure ulcers ensure reliable documentation in medical records.
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Affiliation(s)
- Julia Andersson
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sara Imberg
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kristina Rosengren
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐centred Care (GPCC), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Internal MedicineSahlgrenska University HospitalMölndalSweden
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118
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Perrenoud B, Maravic P, Delpy P. Pressure injury prevention in the operating unit of a Swiss university hospital: a best practice implementation project. JBI Evid Implement 2023; 21:46-57. [PMID: 36374987 PMCID: PMC10010690 DOI: 10.1097/xeb.0000000000000341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this project was to promote best practice in pressure injury prevention for patients during the intraoperative period in the main operating unit of a Swiss tertiary hospital, through improving risk assessment, safe positioning and documentation. INTRODUCTION Pressure injury is a common and serious complication of surgery patients. Despite pressure injuries being mostly preventable, they are not a top priority of operating room professionals. METHODS A baseline audit was conducted using the JBI Practical Application of Clinical Evidence System, applying nine evidence-based criteria. The audit was followed by the implementation of multiple strategies to promote best practice in pressure injury prevention. A follow-up audit was conducted to determine the compliance with best practice recommendations. RESULTS The baseline audit indicated poor compliance with evidence-based practice in most audited criteria. The project team identified barriers to best practice and strategies implemented to improve practice, including tailored education, direct support in each surgery specialty, assignment of responsibilities regarding pressure injury prevention measures among the multidisciplinary team members and multiple channels of communication. Improvements in practice were observed in eight of nine criteria in the follow-up audit. CONCLUSION The project demonstrated important positive changes in pressure injury prevention during the intraoperative period, despite a sharp slowdown in its implementation process. Continuing education for nursing and nonnursing practitioners has been systematized. Follow-up audits will need to be conducted in the future to maintain pressure injury prevention processes, and contribute to safety of care in adult patients during the perioperative period.
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Affiliation(s)
- Beatrice Perrenoud
- Interdisciplinary Department, Lausanne University Hospital (CHUV)
- BEST JBI Centre of Excellence, Lausanne, Switzerland
| | - Philippe Maravic
- Interdisciplinary Department, Lausanne University Hospital (CHUV)
| | - Pierre Delpy
- Interdisciplinary Department, Lausanne University Hospital (CHUV)
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119
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Sandhu J, Miller C, Kapp S. Characteristics of COVID-19 patients who developed pressure injuries: a scoping review. J Wound Care 2023; 32:S9-S16. [PMID: 36930283 DOI: 10.12968/jowc.2023.32.sup3.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with COVID-19 who developed pressure injuries (PIs), the characteristics of PIs experienced, and the incidence and prevalence of PIs among the patients with COVID-19. PIs are associated with increased morbidity, mortality and healthcare expense. PIs have been reported among patients who have contracted COVID-19. Understanding the characteristics of COVID-19 patients, and how PIs are prevented and managed, may inform care and optimise the outcomes for COVID-19-positive patients. METHOD A scoping review was conducted. All study designs, including grey literature, published in the English language from December 2019 to March 2021, reporting on patients with COVID-19 and PIs, were included. RESULTS In total, 27 publications (n=4820 patients) were included in the review. The reported incidence rate of PIs was 7.3-77.0%. The causative factors noted were: prone positioning (28.5%); medical devices (21.4%); and medical devices used during prone positioning (14.2%). The most common PI sites were the cheeks (18.7%). PIs occurred on average at 14.7 days post-acute care admission. Of the PIs where staging information was specified (67.7%), the most common was Stage 2/II (45.2%). PI risk may intensify on account of the intrinsic mechanism of COVID-19-associated intensive care treatment. CONCLUSION PI prevention and management should be prioritised for patients with COVID-19, given the reported high prevalence of PIs and exacerbated risk arising from the use of prone position and medical devices. Further research is required to understand the association between COVID-19 and PIs, and to guide effective prevention and treatment approaches.
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Affiliation(s)
- Julie Sandhu
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
| | - Charne Miller
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
- School of Nursing & Midwifery, La Trobe University, Melbourne, Australia
| | - Suzanne Kapp
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, University of Melbourne, Australia
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Accuracy of Thermographic Imaging in the Early Detection of Pressure Injury: A Systematic Review. Adv Skin Wound Care 2023; 36:158-167. [PMID: 36812081 DOI: 10.1097/01.asw.0000912000.25892.3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To verify the accuracy of thermographic images in the early detection of pressure injury (PI) in adult patients. DATA SOURCES Between March 2021 and May 2022, researchers searched 18 databases for relevant articles using nine keywords. In total, 755 studies were evaluated. STUDY SELECTION Eight studies were included in the review. Studies were included if they evaluated individuals older than 18 years who were admitted to any healthcare setting; were published in English, Spanish, or Portuguese; examined the accuracy of thermal imaging in the early detection of PI, including suspected stage 1 PI or deep tissue injury; and they compared the region of interest to another area or control group, or to the Braden Scale or Norton Scale. Animal studies and reviews, studies with contact infrared thermography, and those including stages 2, 3, 4, and unstageable PIs were excluded. DATA EXTRACTION Researchers examined sample characteristics and assessment measures related to image capture, including environmental, individual, and technical factors. DATA SYNTHESIS Across the included studies, sample sizes ranged from 67 to 349 participants, and patients were followed up for periods ranging from a single assessment up to 14 days, or until the appearance of a PI, discharge, or death. Evaluation with the infrared thermography identified temperature differentials between regions of interest and/or in comparison with risk assessment scales. CONCLUSIONS Evidence on the accuracy of thermographic imaging in the early detection of PI is limited.
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121
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Han H, Oh YS, Cho S, Park H, Lee SU, Ko K, Park JM, Choi J, Ha JH, Han C, Zhao Z, Liu Z, Xie Z, Lee JS, Min WG, Lee BJ, Koo J, Choi DY, Je M, Sun JY, Park I. Battery-Free, Wireless, Ionic Liquid Sensor Arrays to Monitor Pressure and Temperature of Patients in Bed and Wheelchair. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2205048. [PMID: 36534830 DOI: 10.1002/smll.202205048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/20/2022] [Indexed: 06/17/2023]
Abstract
Repositioning is a common guideline for the prevention of pressure injuries of bedridden or wheelchair patients. However, frequent repositioning could deteriorate the quality of patient's life and induce secondary injuries. This paper introduces a method for continuous multi-site monitoring of pressure and temperature distribution from strategically deployed sensor arrays at skin interfaces via battery-free, wireless ionic liquid pressure sensors. The wirelessly delivered power enables stable operation of the ionic liquid pressure sensor, which shows enhanced sensitivity, negligible hysteresis, high linearity and cyclic stability over relevant pressure range. The experimental investigations of the wireless devices, verified by numerical simulation of the key responses, support capabilities for real-time, continuous, long-term monitoring of the pressure and temperature distribution from multiple sensor arrays. Clinical trials on two hemiplegic patients confined on bed or wheelchair integrated with the system demonstrate the feasibility of sensor arrays for a decrease in pressure and temperature distribution under minimal repositioning.
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Affiliation(s)
- Hyeonseok Han
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Yong Suk Oh
- Department of Mechanical Engineering, Changwon National University, Changwon, 51140, Republic of Korea
| | - Seokjoo Cho
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Hyunwoo Park
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Sung-Uk Lee
- Advanced 3D Printing Technology Development Division, Korea Atomic Energy Research Institute, Daejeon, 34057, Republic of Korea
| | - Kabseok Ko
- Department of Electronics Engineering, Kangwon National University, Chuncheon, 24341, Republic of Korea
| | - Jae-Man Park
- Department of Materials Science & Engineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Jungrak Choi
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Ji-Hwan Ha
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Chankyu Han
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Zichen Zhao
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian, 116024, P. R. China
| | - Zhuangjian Liu
- Institute of High-Performance Computing, Agency for Science, Technology and Research, Singapore, 138632, Singapore
| | - Zhaoqian Xie
- State Key Laboratory of Structural Analysis for Industrial Equipment, Dalian University of Technology, Dalian, 116024, P. R. China
| | - Je-Sang Lee
- Department of Rehabilitation Medicine, Gimhae Hansol Rehabilitation & Convalescent Hospital, Gimhae, 50924, Republic of Korea
| | - Weon Gi Min
- Department of Planning and Development, Gimhae Hansol Rehabilitation & Convalescent Hospital, Gimhae, 50924, Republic of Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Jahyun Koo
- School of Biomedical Engineering, Korea University, Seoul, 02841, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Republic of Korea
| | - Dong Yun Choi
- Biomedical Manufacturing Technology Center, Korea Institute of Industrial Technology (KITECH), Yeongcheon, 38822, Republic of Korea
| | - Minkyu Je
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
| | - Jeong-Yun Sun
- Department of Materials Science & Engineering, Seoul National University, Seoul, 08826, Republic of Korea
- Research Institute of Advanced Materials (RIAM), Seoul National University, Seoul, 08826, Republic of Korea
| | - Inkyu Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 34141, Republic of Korea
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Alanazi FK, Lapkin S, Molloy L, Sim J. Safety culture, quality of care, missed care, nurse staffing and their impact on pressure injuries: A cross-sectional multi-source study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Chami L, Boussaid O, Boussaid H, Serhani Y, Zerhane R, Janati-Idrissi R. Nursing students' knowledge towards pressure injury prevention: A cross-sectional study in the north of Morocco. J Tissue Viability 2023; 32:248-254. [PMID: 36803881 DOI: 10.1016/j.jtv.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/10/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
AIM This study aimed to assess nursing students' knowledge towards pressure injury prevention. The intent is to improve the undegraduate nursing curricula. MATERIAL AND METHODS The study adopted a cross-sectional descriptive research design. The study population consisted of 285 nursing students enrolled during the second semester of the 2022 year. The response rate was 84.9%. The authors translated and validated the English version of PUKAT 2.0 into French to collect data. PUKAT-Fr is a French version of PUKAT 2.0. The authors used an information form to gather data about participants' descriptive characteristics and specific educational behaviors. Data analysis was performed through descriptive statistics and non-parametric tests. Ethical procedures were accomplished. RESULTS The total mean score of the participants was low (5.88/25). « Prevention of pressure ulcers » and « Specific patient groups » were the most critical themes. Most participants did not use the risk assessment tool in the lab or clinical settings (66.5%) nor the pressure-redistribution mattresses or cushions (43.3%). Education specialization and the number of departments frequented were significantly associated with the participants' total mean score (p < 0.001). CONCLUSION The nursing students' knowledge level was low (5.88/25). Curricular and organizational issues were involved. Efforts from faculty and nursing managers could be introduced to ensure evidence-based education and practice.
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Affiliation(s)
- Laila Chami
- Higher Institute of Nursing Professions and Health Techniques (ISPITS), Tetouan, 93000, Morocco; Research Team in Pedagogical Engineering and Science Didactics (ERIPDS), Ecole Normale Supérieure (ENS), Abdelmalek Essaadi University, Tetouan, 93000, Morocco.
| | - Oumayma Boussaid
- Higher Institute of Nursing Professions and Health Techniques (ISPITS), Tetouan, 93000, Morocco
| | - Hamida Boussaid
- Higher Institute of Nursing Professions and Health Techniques (ISPITS), Tetouan, 93000, Morocco
| | - Youssra Serhani
- Higher Institute of Nursing Professions and Health Techniques (ISPITS), Tetouan, 93000, Morocco
| | - Rajae Zerhane
- Research Team in Pedagogical Engineering and Science Didactics (ERIPDS), Ecole Normale Supérieure (ENS), Abdelmalek Essaadi University, Tetouan, 93000, Morocco.
| | - Rachid Janati-Idrissi
- Research Team in Pedagogical Engineering and Science Didactics (ERIPDS), Ecole Normale Supérieure (ENS), Abdelmalek Essaadi University, Tetouan, 93000, Morocco.
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Su HH, Zhu FF, Zeng HL, Kong Y, Zhou HJ. Influencing factors of medical device-related pressure ulcers in medical personnel during the COVID-19 pandemic: A systematic review and meta-analysis. J Tissue Viability 2023; 32:206-212. [PMID: 36803882 PMCID: PMC9918436 DOI: 10.1016/j.jtv.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To determine the influencing factors of medical device related pressure injury (MDRPU) in medical staff by meta-analysis. METHODS A comprehensive literature search was conducted by PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, CBM, and WanFang Data (from inception to July 27, 2022). Two researchers independently performed literature screening, quality evaluation and data extraction, and meta-analysis was conducted with RevMan 5.4 and Stata12.0 software. RESULTS Total of 11215 medical staff were included in 9 articles. Meta analysis showed that gender, occupation, sweating, wearing time, single working time, department of COVID-19, preventive measures, and level 3 PPE were the risk factors for MDRPU in medical staff (P < 0.05). CONCLUSION The outbreak of COVID-19 led to the occurrence of MDRPU among medical staff, and the influencing factors should be focused on. The medical administrator can further improve and standardize the preventive measures of MDRPU according to the influencing factors. Medical staff should accurately identify high-risk factors in the clinical work process, implement intervention measures, and reduce the incidence of MDRPU.
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Affiliation(s)
- Hong-Hong Su
- School of Nursing, Fuzhou Institute of Technology, 8 Xijiangbin Avenue, Fuzhou, Fujian, China
| | - Fang-Fang Zhu
- School of Nursing, Fujian University of Traditional Chinese Medicine, 1 Qiu Yang Road, Fuzhou, Fujian, China
| | - Hui-Ling Zeng
- Department of General Surgery, Zhongshan Hospital, Xiamen University, 201 South Hubin Road, Siming District, Fujian Province, China
| | - Yue Kong
- Teaching and Research Department, Fuzong Clinical Medical College of Fujian Medical University, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China.
| | - Hong-Juan Zhou
- School of Nursing, Putian University, 1133 Xueyuan Middle Road, Putian, Fujian, China.
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125
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Sardo PMG, Teixeira JPF, Machado AMSF, Oliveira BF, Alves IM. A systematic review of prevalence and incidence of pressure ulcers/injuries in hospital emergency services. J Tissue Viability 2023; 32:179-187. [PMID: 36792441 DOI: 10.1016/j.jtv.2023.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
AIM To develop a systematic review on the prevalence and the incidence of pressure ulcers/injuries in adult patients in hospital emergency services. MATERIALS AND METHODS Systematic review of prevalence and incidence studies developed according to the Preferred Reporting Items Form Systematic Review and Meta-Analysis Protocols and the Joanna Briggs Institute methodology. The inclusion criteria were based on the CoCoPop mnemonic. The main variables of interest were the "prevalence" and/or the "incidence" of "pressure ulcers/injuries" (Condition) reported in studies developed in hospital emergency services (Context) with adult participants (Population). The Systematic Review Protocol was registered in PROSPERO (CDR42021252906). RESULTS The pressure ulcer/injury (point) prevalence ranged from 5.2% (at admission) to 12.3% (at discharge) and the pressure ulcer/injury incidence ranged from 4.5% to 78.4%. Most of the pressure ulcers/injuries documented were category/stage I. The most problematic anatomical locations were the sacrococcygeal region and the heels. The preventive measures should be implemented as soon as possible and are important in patients older than 75 years, with multiple comorbidities, high C-Reative Protein levels, cervical spine immobilization, presented to hospital emergency service by ambulance or with hypotension at the time of admission. CONCLUSIONS The prevalence and incidence of pressure ulcers/injuries in hospital emergency services remains an understudied topic which could limit the generalization of our data. This systematic review highlighted that the management of pressure ulcers/injuries is a real and current challenge in hospital emergency services. It is important to identify the patients at (higher) risk to establish an (earlier) preventive care plan according to patients and emergency services' characteristics.
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Affiliation(s)
- Pedro Miguel Garcez Sardo
- School of Health Sciences, University of Aveiro, Portugal; Institute of Biomedicine (iBiMED), University of Aveiro, Portugal.
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Swerdlow M, Guler O, Yaakov R, Armstrong DG. Simultaneous Segmentation and Classification of Pressure Injury Image Data Using Mask-R-CNN. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:3858997. [PMID: 36778787 PMCID: PMC9911250 DOI: 10.1155/2023/3858997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 02/05/2023]
Abstract
Background Pressure injuries (PIs) impose a substantial burden on patients, caregivers, and healthcare systems, affecting an estimated 3 million Americans and costing nearly $18 billion annually. Accurate pressure injury staging remains clinically challenging. Over the last decade, object detection and semantic segmentation have evolved quickly with new methods invented and new application areas emerging. Simultaneous object detection and segmentation paved the way to segment and classify anatomical structures. In this study, we utilize the Mask-R-CNN algorithm for segmentation and classification of stage 1-4 pressure injuries. Methods Images from the eKare Inc. pressure injury wound data repository were segmented and classified manually by two study authors with medical training. The Mask-R-CNN model was implemented using the Keras deep learning and TensorFlow libraries with Python. We split 969 pressure injury images into training (87.5%) and validation (12.5%) subsets for Mask-R-CNN training. Results We included 121 random pressure injury images in our test set. The Mask-R-CNN model showed overall classification accuracy of 92.6%, and the segmentation demonstrated 93.0% accuracy. Our F1 scores for stages 1-4 were 0.842, 0.947, 0.907, and 0.944, respectively. Our Dice coefficients for stages 1-4 were 0.92, 0.85, 0.93, and 0.91, respectively. Conclusions Our Mask-R-CNN model provides levels of accuracy considerably greater than the average healthcare professional who works with pressure injury patients. This tool can be easily incorporated into the clinician's workflow to aid in the hospital setting.
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Affiliation(s)
- Mark Swerdlow
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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127
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Xia H, Peng S, Huang S, Jiang J, Zeng X, Zhang H, Pu X, Zou K, Lü Y, Xu H, Peng Y, Lü M, Tang X. A systematic evaluation of methodological and reporting quality of meta-analysis published in the field of gastrointestinal endoscopy. Surg Endosc 2023; 37:807-816. [PMID: 36050611 DOI: 10.1007/s00464-022-09570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND To evaluate the methodological and reporting quality of published meta-analyses (MAs) in four major gastrointestinal endoscopic journals, and identify the predicted factors for high quality. METHODS A systematic search was performed in PubMed to identify MAs from 1, January, 2016 to 31, December, 2020 in four major gastrointestinal endoscopic journals (including Digestive Endoscopy, Gastrointestinal Endoscopy, Surgical Endoscopy, and Endoscopy). We collected the characteristics of MAs after filtering unqualified articles, and assessed methodological and reporting qualities for eligible articles by AMSTAR tool and PRISMA checklist, respectively. Logistic regression was used for identifying predictive factors for high quality. RESULTS A total of 289 MAs were identified after screening by predefined inclusion and exclusion criteria. The scores (mean ± SD) of AMSTAR and PRISMA were 7.73 ± 1.11 and 22.90 ± 1.85, respectively. In PRISMA checklist, some items had less than 50% complete adherence, including item 2 (structured summary), items 5 (protocol and registration), items 12 and 19 (risk of bias in studies), item 27 (funding support). Item 1 (a priori design), item 4 (gray literature research), item 5 (list of included and excluded) were inferior to 50% adherence in AMSTAR tool. We found the predictive factors for high quality through logistic regression analysis: a priori design and funding support were associated with methodological quality. Protocol and registration influenced the methodological and reporting quality closely. CONCLUSION In general, qualities on the methodology and the reporting of MAs published in the gastrointestinal endoscopic journals are good, but both of which still potentially need further improvement.
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Affiliation(s)
- Huifang Xia
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Shicheng Peng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Shu Huang
- Department of Gastroenterology, The People's Hospital of Lianshui, Huaian, China
| | - Jiao Jiang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Xinyi Zeng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Han Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Xinxin Pu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Kang Zou
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Yingqin Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Huan Xu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Yan Peng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Muhan Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China
| | - Xiaowei Tang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China.
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Walker RM, Chaboyer W, Cooke M, Whitty JA, Thalib L, Lockwood I, Latimer S, Campbell J, Probert R, Gillespie BM. EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial. Trials 2023; 24:70. [PMID: 36721259 PMCID: PMC9887548 DOI: 10.1186/s13063-022-06999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. METHODS This is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. DISCUSSION This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. TRIAL REGISTRATION ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019.
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Affiliation(s)
- R. M. Walker
- grid.412744.00000 0004 0380 2017NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia , Brisbane, Australia
| | - W. Chaboyer
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - M. Cooke
- grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - J. A. Whitty
- grid.8273.e0000 0001 1092 7967Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - L. Thalib
- grid.449300.a0000 0004 0403 6369Department of Biostatistics, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - I. Lockwood
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - S. Latimer
- grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University & Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
| | - J. Campbell
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - R. Probert
- grid.412744.00000 0004 0380 2017Stomal Therapy and Wound Management Department in the Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - B. M. Gillespie
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
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Bourkas AN, Zaman M, Sibbald RG. COVID-19 and Hospital-Acquired Pressure Injuries: A Systematic Review. Adv Skin Wound Care 2023; Publish Ahead of Print:00129334-990000000-00021. [PMID: 36705972 DOI: 10.1097/01.asw.0000919408.20614.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the relationship between COVID-19 related variables and hospital-acquired pressure injuries (HAPI) incidence. DATA SOURCES The authors searched four databases: Cochrane, MEDLINE, EMBASE, and CINAHL. The literature search contained key terms such as COVID-19, hospital-acquired pressure injuries, pressure ulcer, pressure injury, decubitus ulcer, and hospitalization. STUDY SELECTION The systematic search of the literature identified 489 publications that matched the inclusion criteria. This included peer-reviewed publications that reported HAPI incidence for patients who were hospitalized and COVID-19 positive. Two reviewers performed the screen simultaneously and 19 publications were included. DATA EXTRACTION Two reviewers followed a standardized extraction form that included study and patient characteristics, COVID-19 status, HAPI characteristics, prone positioning, length of hospitalization, and HAPI prevention and treatment strategies. DATA SYNTHESIS A narrative synthesis of the extracted data was carried out because the data obtained were too heterogeneous for meta-analysis. The primary outcome was HAPI incidence. CONCLUSIONS This review identified that HAPI incidence was high among men who were COVID-19 positive, had longer hospital stays, experienced prone positioning, and had care teams without a skin and wound care expert. Future research should employ more robust methodology and focus on quantitative modeling to iteratively improve in-patient HAPI guidelines.
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Affiliation(s)
- Adrienn N Bourkas
- At Queen's University School of Medicine, Kingston, Ontario, Canada, Adrienn N. Bourkas, MSc, and Michele Zaman, MScPH, are Medical Students. R. Gary Sibbald, MD, MEd, FRCPC, FAAD is Professor, Dalla Lana School of Public Health and Division of Dermatology, Department of Medicine, University of Toronto, Ontario. Acknowledgment: The authors thank the project ECHO Ontario Skin and Wound Team members Andrew Mohan, Reneeka Jaimangal, and Laurie Goodman for their support throughout the project. They also specially thank Queen's University Health Sciences Medical Librarian Abdul K. Pullattayil for his hard work and support during the electronic search process. The authors have disclosed no financial relationships related to this article. Submitted August 3, 2022; accepted in revised form October 4, 2022
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Damioli L, Shepard Z, Wilson MP, Erlandson KM. Retrospective analysis of the management of pelvic decubitus ulcers and their outcomes. Ther Adv Infect Dis 2023; 10:20499361231196664. [PMID: 37693861 PMCID: PMC10483971 DOI: 10.1177/20499361231196664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Many patients with decubitus-related osteomyelitis are ineligible for myocutaneous flapping, and optimal management in this population is unknown. We describe treatments and outcomes of hospitalized patients with decubitus ulcer-related osteomyelitis who did not undergo surgical reconstruction or coverage. Methods We systematically identified hospitalized patients with diagnoses of pelvic, sacral, or femoral osteomyelitis due to decubitus ulceration between 1 January 2018 and 31 December 2018. Demographics, comorbidities, laboratory data, and outcomes were collected by manual chart review. T-tests or Chi-square tests were used for descriptive statistical comparisons; logistic regressions were used to explore the odds of readmission, osteomyelitis-related readmission, and death. Results Of 89 patients meeting inclusion criteria, 34 (38%) received surgical debridement and ⩾6 weeks of antibiotics; 55 (62%) received either antibiotics alone or debridement and <6 weeks of antibiotics. Mean age was 55 (standard deviation 18) years, 55% of patients were male, and 69% had spinal cord injury or other form of paralysis. Within 1 year, 56 (63%) patients were readmitted, 38 (44%) patients were readmitted due to complications from osteomyelitis, and 15 (17%) died. We found no significant differences in readmission (OR = 1.33, 95% CI: 0.54-3.21, p = 0.53), readmission related to osteomyelitis (OR = 1.64, 95% CI: 0.69-4.04, p = 0.27), subsequent sepsis (OR = 2.27, 95% CI: 0.83-6.93, p = 0.13), or death (OR = 2.88, 95% CI: 0.83-13.4, p = 0.12) by treatment group. Conclusions Among patients with decubitus-related osteomyelitis who did not undergo myocutaneous flapping, outcomes were generally poor regardless of treatment, and not significantly improved with prolonged antibiotics. Prospective studies are needed to assess best practice strategies for this challenging patient population.
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Affiliation(s)
- Laura Damioli
- Infectious Disease Division, University of Colorado Hospital, 12700 E. 19th Avenue B-168, Research Complex 2 Building, Aurora, CO 80045, USA
| | - Zachary Shepard
- Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa P. Wilson
- Department of Bioinformatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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131
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Mamom J, Rungroungdouyboon B, Daovisan H, Sri-Ngernyuang C. Electronic Alert Signal for Early Detection of Tissue Injuries in Patients: An Innovative Pressure Sensor Mattress. Diagnostics (Basel) 2023; 13:diagnostics13010145. [PMID: 36611437 PMCID: PMC9818190 DOI: 10.3390/diagnostics13010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Monitoring the early stage of developing tissue injuries requires intact skin for surface detection of cell damage. However, electronic alert signal for early detection is limited due to the lack of accurate pressure sensors for lightly pigmented skin injuries in patients. We developed an innovative pressure sensor mattress that produces an electronic alert signal for the early detection of tissue injuries. The electronic alert signal is developed using a web and mobile application for pressure sensor mattress reporting. The mattress is based on body distributions with reference points, temperature, and a humidity sensor to detect lightly pigmented skin injuries. Early detection of the pressure sensor is linked to an electronic alert signal at 32 mm Hg, a temperature of 37 °C, a relative humidity of 33.5%, a response time of 10 s, a loading time of 30 g, a density area of 1 mA, and a resistance of 7.05 MPa (54 N) at 0.87 m3/min. The development of the innovative pressure sensor mattress using an electronic alert signal is in line with its enhanced pressure detection, temperature, and humidity sensors.
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Affiliation(s)
- Jinpitcha Mamom
- Center of Excellence in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Pathum Thani 12121, Thailand
- Department of Adult Nursing and the Aged, Faculty of Nursing, Thammasat University, Pathum Thani 12121, Thailand
- Correspondence: (J.M.); (H.D.)
| | - Bunyong Rungroungdouyboon
- Center of Excellence in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Pathum Thani 12121, Thailand
| | - Hanvedes Daovisan
- Human Security and Equity Centre of Excellence, Social Research Institute, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: (J.M.); (H.D.)
| | - Chawakorn Sri-Ngernyuang
- Institute of Field Robotics, King Mongkut’s University of Technology Thonburi, Bangkok 10140, Thailand
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Elsorady KE, Nouh AH. Biomarkers and clinical features associated with pressure injury among geriatric patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
<b>Purpose:</b> The study aims to identify biomarkers and clinical features associated with pressure injury (PI) among geriatric patients.<br />
<b>Methods:</b> A cross-sectional study including 191 patients aged ≥60 years. Patients were classified into those with and without PI. Assessing the risk of PI was performed on admission by applying the Braden scale (BS) for predicting pressure sore risk. Clinical history, baseline hematology, and biochemistry results were obtained. C-reactive protein to albumin ratio (CAR) and Charlson comorbidity index (CCI) were calculated. Statistical analyses were performed.<br />
<b>Results: </b>43 (22.5%) patients had PI. PI was significantly associated with higher CCI, total leukocyte count, and CAR, besides lower BS scores, serum albumin, and total proteins. Significant comorbidities were diabetes mellitus, stroke/transient ischemic attack, dementia, incontinence, and chronic kidney disease. The optimal cut-offs for PI occurrence were ≤14, ≤3.1 g/dl and >1.27 for BS, albumin, and CAR, respectively.
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Affiliation(s)
- Khalid Elsayed Elsorady
- Department of Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, EGYPT
- Geriatrics Hospital, Ain Shams University Hospitals, Abbasia, Cairo, EGYPT
| | - Ahmed Hassan Nouh
- Department of Dermatology and Venereology, Al Azhar University, Cairo, EGYPT
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Asiri S. Turning and Repositioning Frequency to Prevent Hospital-Acquired Pressure Injuries Among Adult Patients: Systematic Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231215209. [PMID: 38050921 DOI: 10.1177/00469580231215209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
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.
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Su H, Zhou W, Kong Y, Zhu F, Xu B, Shen X, Zhang W, Zhou Q, Lv Q. Incidence of facial pressure injuries in health-care professionals during the COVID-19 pandemic: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13125. [PMID: 36535903 PMCID: PMC9877937 DOI: 10.1111/ijn.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the incidence of facial pressure injuries in health-care professionals during the COVID-19 pandemic in a meta-analysis. METHODS Related studies were obtained through electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) Chinese Scientific Journal (VIP) China Biomedical Literature service systems (CBM) and Wanfang Data (from inception to 27 November 2021). The pooled incidence and the 95% confidence interval of facial pressure injuries were calculated with Review Manager v5.4 software. RESULTS Overall, 16 studies with 14 430 health-care professionals were included. Pooled results showed that the pooled incidence of facial pressure injury in health-care professionals was 58.8% (95% CI: 49.0%-68.7%; p < 0.01). The results of the subgroup analysis showed that the incidence of facial pressure injury in these staff was high, and predominantly stage I pressure injury, in the following cases: in health-care professionals who wore personal protective equipment for longer than 4 h, in those without any training experience, and on the nose. CONCLUSION Administrators and researchers should pay attention to preventing facial pressure injury related to the wearing of personal protective equipment (PPE) by ensuring all health-care professionals receive training and by limiting prolonged periods of use.
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Affiliation(s)
- Honghong Su
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Wenguang Zhou
- Department of EquipmentChenggong Hospital of Xiamen University (the 73th Group Military Hospital of the People's Liberation Army)XiamenChina
| | - Yue Kong
- Teaching and Research DepartmentFuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of Joint Logistic Support Force, PLA)FuzhouChina
| | - Fangfang Zhu
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Baoling Xu
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
| | - Xianying Shen
- School of NursingFujian Medical UniversityFuzhouChina
| | - Weiqin Zhang
- School of NursingFujian Medical UniversityFuzhouChina
| | - Qijun Zhou
- Medical CollegeQiqihar Medical UniversityQiqiharChina
| | - Qian Lv
- Nursing CollegeFujian University of Traditional Chinese MedicineFuzhouChina
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Prevention and management of hospital-acquired pressure injury among patients with lung disease in a hospital: a best practice implementation project. JBI Evid Implement 2022; 20:301-312. [PMID: 36378109 DOI: 10.1097/xeb.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this project was to promote evidence-based practice in the prevention and management of pressure injury in lung disease patients. INTRODUCTION Pressure injury is a crucial quality indicator for hospital care of patients. The pressure injury incidence threshold in the chest wards has been exceeding that of the general ward (0.128%), which may extend patients' hospital stay. METHODS Clinical audits were performed using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice (GRiP) audit and feedback tool. Twelve audit criteria representing best practice recommendations for preventing and managing pressure injury among lung disease patients were used. A baseline audit was performed to measure the degree of consistency between existing practice and best practice. This project used the GRiP analysis and multiple strategies to develop care protocols for pressure injury prevention and management. A follow-up audit was conducted to measure changes in clinical practice and pressure injury incidence. RESULTS Postimplementation audit compliance rates improved for the following criteria: skin assessment for identifying pressure injury indications (from 31 to 81%), identification of pressure injury risk score/category (from 19 to 88%), employment of nutritional assessment tools (from 8 to 93%), and provision of information regarding oral nutritional supplements (from 23 to 84%). Furthermore, patients learning the pressure injury care protocols (from 48 to 93%), the receipt of additional skin protection measures, and repositioning of vulnerable areas to relieve pressure increased to 100 and 93%, respectively. After project implementation, the monthly pressure injury incidence decreased markedly from 0.075 to 0.021%. CONCLUSION The success factors of this project are attributable to leadership, open communication, multiple learning-by-doing strategies, regular audits, and the promotion of patient and family engagement.
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Cuddigan J, Haesler E, Moore Z, Carville K, Kottner J. Development, dissemination and evaluation of a smartphone-based app for pressure ulcer/injury prevention and treatment for use at the bedside. J Wound Care 2022; 31:S29-S39. [PMID: 36475841 DOI: 10.12968/jowc.2022.31.sup12.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE After launching the 2019 International Pressure Ulcer/Injury Guideline, the National Pressure Injury Advisory Panel (NPIAP), the European Pressure Ulcer Advisory Panel (EPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA) collaborated with Sensorydata Corp., US, to develop a guideline app (InterPIP App). The app was designed to: present evidence-based guideline recommendations; incorporate search capacities and functionality to facilitate easy access to clinical guidance; provide accessibility in multiple languages; and to be available worldwide at a reasonable price, including opportunities for free access in low-resource countries. This paper describes the development, dissemination and formative evaluation of a mobile app providing evidence-based recommendations for pressure injury prevention, assessment/classification, and treatment at the point of care. METHOD An evaluation tool was designed based on a framework developed by Nouri et al. and made available to all app subscribers. RESULTS The InterPIP App is currently available in 11 languages and had been downloaded 3616 times by February 2022 in 78 countries. A total of 62 individuals responded to the survey of end-users. In this formal evaluation of user experiences, the app was rated positively on criteria of: information/content; usability; design; functionality; ethics; and security/privacy (median=4 on a 1-5 Likert scale). Overall perceived value was ranked lower with a median of three. Users provided suggestions for ongoing app enhancement. CONCLUSION The InterPIP App offers a unique opportunity to bring evidence-based guidance to the point of care. Formal evaluation of end-user experiences identified opportunities for quality improvement, and informed plans for future development and evaluation.
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Affiliation(s)
- Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, US
| | - Emily Haesler
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,Australian Centre for Evidence Based Aged Care, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Canberra, Australian Capital Territory, Australia
| | - Zena Moore
- Royal College of Surgeon in Ireland University of Medicine and Health Sciences, Dublin, Ireland.,School of Nursing & Midwifery, Griffith University, Queensland, Australia.,School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland.,Cardiff University, Cardiff, Wales.,Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA.,Department of Public Health; Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai, China
| | - Keryln Carville
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,Silver Chain Group, Perth, Australia
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany
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Konya C, Takeuchi Y, Nakagami G, Kitamura A, Morita K, Ishizawa M, Abe Y, Higuchi H, Mizuki T, Motegi SI, Shoju S, Shimada K, Tanaka K, Kawakami S, Sanada H. Nationwide time-series surveys of pressure ulcer prevalence in Japan. J Wound Care 2022; 31:S40-S47. [PMID: 36475842 DOI: 10.12968/jowc.2022.31.sup12.s40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Japanese Society of Pressure Ulcers (JSPU) has two purposes: first, to improve knowledge and skills among health professionals related to preventing and managing pressure ulcers (PUs); and second, to represent those in the field managing PUs, including with government and health authorities. Since 2006, JSPU has conducted fact-finding surveys about every four years to identify PU prevalence in Japan (2006, 2010, 2013 and 2016). Based on the prevalence identified by these surveys, an attempt was made to validate the achievements of JSPU's activities. METHOD Information from one-day surveys of hospitals, long-term care health facilities, long-term care welfare facilities, and home visit nursing care stations was analysed. We used generalised estimating equations to estimate the proportions of PUs and their 95% confidence intervals (CIs) for each survey. RESULTS A total of 662,419 patients in 2631 facilities participated in the surveys. The estimated proportions for all facilities (95% CI) in chronological order, from the first to the fourth survey, were: 2.67% (2.52-2.83); 2.61% (2.43-2.80); 1.99% (1.83-2.17); and 1.79% (1.65-1.94), respectively. In all facility types, the proportion of PUs was lower in the fourth survey than the first survey. CONCLUSION The proportion of PUs showed a decreasing trend and was low according to global standards, demonstrating the efficacy of JSPU's activities.
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Affiliation(s)
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- Japanese Society of Pressure Ulcers, Tokyo, Japan
| | - Chizuko Konya
- School of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - Yoshinori Takeuchi
- Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Nursing Administration and Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koujiro Morita
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Ishizawa
- Faculty of Nursing, School of Medicine, Nara Medical University, Nara, Japan
| | - Yoshiro Abe
- Department of Plastic and Reconstructive Surgery, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirobumi Higuchi
- Department of Plastic and Reconstructive Surgery, Iwate Prefectural Chubu Hospital, Iwate, Japan
| | - Takeo Mizuki
- Department of Nursing, Hakodate Municipal Hospital, Hokkaido, Japan
| | | | - Sawako Shoju
- Department of Nursing, Morinomiya Hospital, Osaka, Japan
| | - Kenichi Shimada
- Department of Plastic and Reconstructive Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Hiromi Sanada
- School of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan.,Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Chuang ST, Liao PL, Lo SF, Chang YT, Hsu HT. Effectiveness of an E-Book App on the Knowledge, Attitudes and Confidence of Nurses to Prevent and Care for Pressure Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15826. [PMID: 36497905 PMCID: PMC9737897 DOI: 10.3390/ijerph192315826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
AIMS This study evaluates the effectiveness of an interactive E-book app training program in improving nurses' knowledge, attitudes, and confidence to prevent and care for pressure injury. DESIGN Randomized experimental study. METHODS Participants were recruited from a teaching hospital in Taiwan. The study was carried out between 20 March 2014 to 1 April 2016. In total, 164 participants were randomly assigned to a pressure injury E-book app training program (n = 86) or a conventional education program (n = 78) with a one-month follow-up. Outcome variables were levels of pressure injury knowledge, attitudes, and confidence of pressure injury care. RESULTS Participants answered 51.96% of the pressure injury knowledge questions correctly before the intervention and 75.5% after the intervention. The pressure injury attitude score was slightly positive, with moderate confidence in pressure injury care. The knowledge, attitudes, and confidence of pressure injury care of the two groups in the pretest and posttest groups increased significantly. Analysis of covariance indicated that nurses in the pressure injury E-book app group had significantly greater improvement in knowledge, attitudes, and pressure injury care confidence as compared with the control group. CONCLUSION The pressure injury E-book app interactive training program was effective in improving nurses' knowledge and attitudes toward pressure injury care and in enhancing their confidence in pressure injury care; therefore, this program has potential for nurses' in-service education in both Taiwan and worldwide. IMPACT E-book apps allow individuals to control the time and place of learning. Direct observation of procedural skills can provide feedback to trainees on techniques to ensure learning effectiveness and pressure injury care quality.
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Affiliation(s)
- Shu-Ting Chuang
- Taichung Tzu Chi Hospital, No. 88, Section 1, Fengxing Road, Taichung 427, Taiwan
- Department of Nursing, Tzu Chi University of Science and Technology, No. 880, Section 2, Jianguo Road, Hualien 970046, Taiwan
| | - Pei-Lin Liao
- Tzu Chi Fondation Tzu Chi Taichung Home-Based Long-Term Care Facilities, No. 88, Section 1, Fengxing Road, Tanzih District, Taichung 427, Taiwan
| | - Shu-Fen Lo
- Department of Nursing, Tzu Chi University, No. 701, Section 3, Zhongyang Road, Hualien 97004, Taiwan
| | - Ya-Ting Chang
- Taichung Tzu Chi Hospital, No. 88, Section 1, Fengxing Road, Taichung 427, Taiwan
| | - Hsiang-Tzu Hsu
- Tzu Chi Foundation Long-Term Care Promotion Center, No. 88, Section 1, Fengxing Road, Taichung 427, Taiwan
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Jiang M, Wang Q, Finch T, She D, Zhou Y, Chung YF, Chen J, Han L. Validity and reliability of the Chinese version of the Normalization MeAsure Development(NoMAD). BMC Health Serv Res 2022; 22:1338. [DOI: 10.1186/s12913-022-08737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Normalization MeAsure Development (NoMAD) is a brief quantitative tool based on the Normalization Process Theory (NPT), which can measure the implementation process of new technologies and complex interventions. The aim of our study was to translate and culturally adapt the NoMAD into Chinese, and to evaluate the psychometric properties of the Chinese version of NoMAD.
Methods
According to the NoMAD translation guideline, we undertook forward translation, backward translation, and compared these translations to get a satisfactory result, then we performed cognitive interviews to achieve cross-culture adaptation. And the psychometric properties of the final version were evaluated among clinical nurses who used the pressure injuries management system via WeChat mini-program at a tertiary hospital in northwestern China.
Results
A total of 258 nurses were enrolled in our study, and the response rate was 92.1%. The Cronbach’s alpha of four dimensions were as follow: Coherence (0.768), Cognitive Participation (0.904), Collective Action (0.820), and Reflexive Monitoring (0.808). The overall internal consistency was 0.941. The confirmatory factor analysis results showed a good fit for its theoretical structure (CFI = 0.924, TLI = 0.910, RMSEA = 0.0079, SRMSR = 0.046, χ2/df = 2.61). The item-level content validity index ranged from 0.857 to 1, and the scale-level content validity index was 0.95. There were positive correlations between four constructs scores and three general normalization scores.
Conclusions
The Chinese version of NoMAD is a reliable and valid tool to evaluate the implementation process of innovations.
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Falk‐Brynhildsen K, Raepsaet C, Wistrand C, Bååth C, Leo Swenne C, Gifford M, Gunningberg L, von Vogelsang A, Björn C, Beeckman D. Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room. Int Wound J 2022; 20:1534-1543. [PMID: 36318882 PMCID: PMC10088857 DOI: 10.1111/iwj.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument.
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Affiliation(s)
- Karin Falk‐Brynhildsen
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research Örebro University Sweden
| | - Charlotte Raepsaet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care Ghent University Belgium
| | - Camilla Wistrand
- University Health Care Research Centre, Faculty of Medicine and Health Örebro University Sweden
| | - Carina Bååth
- Department of Health Sciences, Faculty of Health, Science and Technology Karlstad University Karlstad Sweden
- Faculty of Health, Welfare and Organisation Östfold University College Fredrikstad Norway
| | | | - Mervyn Gifford
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research Örebro University Sweden
| | - Lena Gunningberg
- Department of Public Health and Caring Sciences Uppsala University Sweden
| | - Ann‐Christin von Vogelsang
- Department of Neurosurgery Karolinska University Hospital Stockholm Sweden
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - Catrine Björn
- Centre for Research & Development Uppsala University/Region Gävleborg Sweden
| | - Dimitri Beeckman
- Faculty of Medicine and Health, School of Health Sciences, Nursing Science Unit, Swedish Centre for Skin and Wound Research Örebro University Sweden
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care Ghent University Belgium
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Patton D, Latimer S, Avsar P, Walker RM, Moore Z, Gillespie BM, O'Connor T, Nugent L, Budri A, Brien NO, Chaboyer W. The effect of prone positioning on pressure injury incidence in adult intensive care unit patients: A meta-review of systematic reviews. Aust Crit Care 2022; 35:714-722. [PMID: 34916149 DOI: 10.1016/j.aucc.2021.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Numerous systematic reviews have examined the impact of prone positioning on outcomes, including pressure injury (PI). The objective of this meta-review was to synthesise the evidence on the effect of prone positioning on the incidence and location of PIs in adult intensive care unit patients. REVIEW METHOD This is a meta-review of published systematic reviews. Five databases were searched; data were extracted by three authors and adjudicated by a fourth. The AMSTAR-2 tool was used to quality appraise the selected articles, which was completed by three authors with a fourth adjudicating. RESULTS Ten systematic reviews were synthesised. The cumulative incidence of PI in 15,979 adult patients ranged from 25.7% to 48.5%. One study did not report adult numbers. Only one review reported the secondary outcome of PI location. PIs were identified in 13 locations such as the face, chest, iliac crest, and knees. Using the AMSTAR-2, three reviews were assessed as high quality, six as moderate quality, and one as low quality. CONCLUSION The high incidence of PI in the prone position highlights the need for targeted preventative strategies. Care bundles may be one approach, given their beneficial effects for the prevention of PI in other populations. This review highlights the need for proactive approaches to limit unintended consequences of the use of the prone position, especially notable in the current COVID-19 pandemic.
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Affiliation(s)
- Declan Patton
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Faculty of Science, Medicine and Health, University of Wollongong, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Rachel M Walker
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Southport, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China.
| | - Linda Nugent
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.
| | - Aglecia Budri
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Niall O Brien
- Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, Griffith University, Queensland, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia.
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Kandi LA, Rangel IC, Movtchan NV, Van Spronsen NR, Kruger EA. Comprehensive Management of Pressure Injury. Phys Med Rehabil Clin N Am 2022; 33:773-787. [DOI: 10.1016/j.pmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The effect of sub-epidermal moisture on pressure injury prevention strategies and incidence of pressure injuries: A feasibility pilot randomised controlled trial. J Tissue Viability 2022; 31:776-782. [PMID: 35934637 DOI: 10.1016/j.jtv.2022.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022]
Abstract
AIM Sub-epidermal moisture scanning (SEMS) is a novel point-of-care technology that measures localised oedema and detects early tissue damage that may develop into a pressure injury (PI). It provides objective data that may assist PI prevention (PIP) decision making. This study aimed to determine the feasibility of undertaking a definitive randomised controlled trial (RCT) to test the effectiveness of SEMS. MATERIALS AND METHODS This pilot RCT recruited medical and surgical patients at risk of developing a PI in one Australian hospital. All participants received routine PIP care and daily visual skin assessment to determine the presence of a PI. The intervention group also received daily SEMS. Clinical staff were told if the sub-epidermal moisture (SEM) value was abnormal but were not given advice for PIP. Blinding of patients, care staff and outcome assessors was not practical. Feasibility outcomes included recruitment, retention, intervention fidelity, and patient outcomes. RESULTS Of 1185 patients screened prior to eligibility, 950 were excluded (80%); 235 were then assessed for eligibility and 160 met the inclusion criteria (68.1%); 100 were recruited (70.0%) and randomised and 99 completed the trial (intervention n = 50; control n = 49) with one person withdrawn due to inappropriate recruitment (100% retention). Of the 657 expected SEMS observations, 598 were completed (91% intervention fidelity). Only 34 of 454 (7.4%) patient outcome data points were missing. CONCLUSIONS Most feasibility criteria were met, indicating a definitive trial to assess the effectiveness of SEMS in a medical-surgical patient population is realistic. However, recruitment may be resource intensive and require specific strategies.
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Jiao Y, Yuan C, Wu T, Zhang H, Wei Y, Ma Y, Zhang X, Han L. Incidence of pressure injuries in fracture patients: A systematic review and meta-analysis. J Tissue Viability 2022; 31:726-734. [PMID: 36109261 DOI: 10.1016/j.jtv.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched to collect cross-sectional studies and cohort studies related to PIs among hospitalized fracture patients. All electronic literature sources were searched from inception to March 2022, and a hand-search through references was also 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 the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. All data analysis used Stata14.0. The I2 statistic and random-effects model were used to determine the heterogeneity. RESULTS A total of 7906 articles were screened, and 18 studies with 8956 patients were ultimately involved in this review. The pooled incidence of PIs in the fracture patients was 20.4% (95%CI: 14.9 to 25.8), and the incidence of PIs only in spinal and hip fracture patients was 23.9% (95%CI: 19.6 to 28.2). The incidence of PIs in 65 years old or over was significantly high (23.3% [95%CI: 15.3 to 31.2]). The most affected body sites were sacrococcygeal regions (56.7%) and heels (19.9%). The most common stages were stage 2 (62.2%) and stage 1 (17.4%). CONCLUSION The overall incidence of PIs in fracture patients was as high as 20.4%, significantly higher than the average incidence of adults. We found that the potential for PIs in fracture patients increases with age. Hence, our discoveries recommended that healthcare givers should consider reducing the occurrence of PIs. Additionally, more research may be conducted to improve the understanding of characteristics of PIs among fracture patients and to identify PIs risk factors to prevent and treat them effectively.
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Affiliation(s)
- Yanxia Jiao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Chenlu Yuan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Tong Wu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Xiujuan Zhang
- Department of Respiratory, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
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Li J, Zhu C, Liu Y, Song B, Jin J, Liu Y, Wen X, Cheng S, Wu X. Critical Care Nurses’ Knowledge, Attitudes, and Practices Regarding Pressure Injury Treatment: A Nationwide Cross-Sectional Survey. Healthc Policy 2022; 15:2125-2134. [PMID: 36415220 PMCID: PMC9675999 DOI: 10.2147/rmhp.s389706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pressure injury is a common problem in intensive care units. Critical care nurses play an important role in multidisciplinary teams performing pressure injury treatment. Identifying the clinical status of pressure injury treatment may contribute to improving care quality. Aim To identify the knowledge, attitudes, and practices regarding pressure injury treatment in critical care nurses. Design A cross-sectional survey. Methods Secondary data were extracted from a multicenter clinical trial. Knowledge and attitudes toward pressure injury treatment were assessed through a self-administered eight-item questionnaire. The observed practices were recorded using a case report form. The report was in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. Results A total of 950 critical care nurses in 15 hospitals from six provinces/municipalities of China were investigated. The mean knowledge score was 2.89 ± 1.16 (95% confidence interval: 2.82–2.97) out of a possible total of 5 points. The correct rates of selecting wound dressings and pain management were 34.4% and 45.6%, respectively. The mean attitude score was 9.07 ± 1.09 (95% confidence interval: 9.00–9.13) out of a possible total of 12 points. A total of 2092 patient days of pressure injury treatment practices were observed and recorded. Repositioning was the most commonly employed treatment measure (98.8%). Foam dressing was the common dressing for stage I (53.6%), stage II (47.5%), and more severe pressure injury (67.9%), including stage III, IV, unstageable, and suspected deep tissue injury. Conclusion Critical care nurses exhibited a generally low level of knowledge and moderate attitudes regarding pressure injury treatment. Practices of pressure injury treatment were generally acceptable.
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Affiliation(s)
- Jiamin Li
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Ying Liu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Jingfen Jin
- Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, People’s Republic of China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Jianghan District, Wuhan, People’s Republic of China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan People’s Hospital, Chengdu, People’s Republic of China
| | - Shouzhen Cheng
- Department of Nursing, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People’s Republic of China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Xinjuan Wu, Email
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146
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Almeida RMFD, Tura LFR, Silva RCD. Preventive Measures For pressure injuries: structure of social representations of nursing teams. Rev Esc Enferm USP 2022; 56:e20220012. [PMID: 36279565 PMCID: PMC10081604 DOI: 10.1590/1980-220x-reeusp-2022-0012en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To analyze the structure of social representations on the preventive measures to pressure injury of nursing teams. METHOD Qualitative research, based on the structural approach of Social Representations. It was conducted with 103 nursing professionals from a specialized hospital, using the Word Association Test. Data were submitted to prototypical analysis, using two analysis techniques of centrality, similarity and double negation. RESULTS The evocations "care" and "decubitus" made up the central core of the representation, which was structured based on the imagery dimension of changing position, from which a hierarchy of preventive measures occurs. The term "care" referred to the normative dimension of representation as a responsibility of nursing, and to the practical dimension, as preventive actions with the use of technologies. CONCLUSION The image, normative and practice dimensions are part of the representation structure and guide compliance with preventive measures.
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Affiliation(s)
| | - Luiz Fernando Rangel Tura
- Universidade Federal do Rio de Janeiro, Instituto de Estudos e Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | - Rafael Celestino da Silva
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Fundamental, Rio de Janeiro, RJ, Brazil
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147
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Gould LJ, White-Chu E. Can technology change the status quo for pressure injury prevention? Br J Dermatol 2022; 187:456. [PMID: 35882383 DOI: 10.1111/bjd.21714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Linked Article: Jiang et al. Br J Dermatol 2022; 187:571–579.
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Affiliation(s)
- Lisa J Gould
- Department of Surgery, South Shore Hospital, Weymouth, MA, USA
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148
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Lau CH, Yu KHO, Yip TF, Luk LY, Wai AKC, Sit TY, Wong JYH, Ho JWK. An artificial intelligence-enabled smartphone app for real-time pressure injury assessment. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:905074. [PMID: 36212608 PMCID: PMC9541137 DOI: 10.3389/fmedt.2022.905074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%–100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.
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Affiliation(s)
- Chun Hon Lau
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ken Hung-On Yu
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tsz Fung Yip
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Luke Yik Fung Luk
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tin-Yan Sit
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Janet Yuen-Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing / Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong SAR, China
- Correspondence: Janet Yuen-Ha Wong Joshua Wing Kei Ho
| | - Joshua Wing Kei Ho
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Correspondence: Janet Yuen-Ha Wong Joshua Wing Kei Ho
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149
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Veiga TP, Rêgo AS, Montenegro WS, Ferreira PR, Rocha DS, Felipe IMA, Santos-de-Araújo AD, Mendes RG, Tavarez RRDJ, Bassi-Dibai D. Braden scale has low reliability in different patients under care in intensive care unit. Rev Assoc Med Bras (1992) 2022; 68:1221-1227. [PMID: 36134772 PMCID: PMC9575023 DOI: 10.1590/1806-9282.20220249] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations. METHODS This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications. RESULTS For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75. CONCLUSIONS Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.
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Affiliation(s)
- Thalita Pereira Veiga
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil
| | - Adriana Sousa Rêgo
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil
| | | | | | | | | | | | - Renata Gonçalves Mendes
- Universidade Federal de São Carlos, Department of Physical Therapy – São Carlos (SP), Brazil
| | | | - Daniela Bassi-Dibai
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil.,Corresponding author:
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150
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Feng X, Wang M, Zhang Y, Liu Q, Guo M, Liang H. Development and validation of a nomogram for predicting the risk of pressure injury in adult patients undergoing abdominal surgery. Int J Nurs Sci 2022; 9:438-444. [PMID: 36285073 PMCID: PMC9587389 DOI: 10.1016/j.ijnss.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 10/28/2022] Open
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