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Oztas P, Demirci EK, Aksakal FNB, Yildiz M. Hospital-acquired pressure injury: our seven years of experience. J Wound Care 2024; 33:S14-S21. [PMID: 38573951 DOI: 10.12968/jowc.2024.33.sup4.s14] [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: 04/06/2024]
Abstract
OBJECTIVE A pressure injury (PI) happens on the skin and in deeper tissues. Generally, it occurs due to prolonged compression over bony structures. A PI, when occurring during a hospital stay, is regarded as a hospital-acquired pressure injury (HAPI), and is considered as a marker for patient care quality. It might cause medical, legal or economic problems, and could be a burden on health systems. In this study we evaluate the factors contributing to HAPI formation. METHOD Between June 2014-June 2021, we retrospectively investigated the files of patients who were hospitalised with different medical conditions in Bayindir Sögütözü Hospital, Ankara, Turkey, for patients' age, sex, Waterlow scale score, mobilisation status, application of zinc-containing and/or barrier creams (ZnBC), airbed usage, hospitalisation period, and the day of wound opening. RESULTS The study cohort comprised 2327 hospitalised patients: 303 (13%) developed Stage 2 and deeper PIs; 2024 patients were hospitalised and discharged without wound opening. We found an increased risk in male patients and a lack of efficacy of ZnBC in protection from HAPI in our study population. However, we observed that ZnBC helped to delay wound opening and that the most protective treatment was the use of airbeds. CONCLUSION Health professionals should be more aware of HAPI formation with prolonged hospitalisation periods. Only the use of an airbed for a patient hospitalised for a long period appears to be protective against PI formation. On the other hand, use of ZnBC delays wound opening. However, further research is needed to demonstrate the protective effect of ZnBC, due to the lack of randomisation in our study and the lack of some nursing records.
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Affiliation(s)
- Pinar Oztas
- Lokman Hekim University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | | | - F Nur Baran Aksakal
- Gazi University Faculty of Medicine Department of Public Health, Ankara, Turkey
| | - Mucahit Yildiz
- Gazi University Faculty of Medicine Department of Public Health, Ankara, Turkey
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2
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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3
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Melotto G, Tunprasert T, Forss JR. The effects of electrical stimulation on diabetic ulcers of foot and lower limb: A systematic review. Int Wound J 2022; 19:1911-1933. [PMID: 35112496 DOI: 10.1111/iwj.13762] [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: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 01/04/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a life-threatening condition affecting a third of diabetic patients. Many adjuvant therapies aimed at improving the healing rate (HR) and accelerating healing time are currently under investigation. Electrical stimulation (ES) is a physical-based therapy able to increase cells activity and migration into wound bed as well as inhibiting bacterial activity. The aim of this paper was to collect and analyse findings on the effects of ES used in combination with standard wound care (SWC) in the treatment of diabetic foot ulceration compared with SWC alone. A systematic review was performed to synthesise data from quantitative studies from eight databases. Article quality was assessed using the Crowe critical appraisal tool. Seven articles out of 560 publications met the inclusion criteria. A meta-analysis was not performed due to the heterogeneity of the studies and the results were narratively synthetised. Findings showed that HR appears to be higher among diabetic ulcers treated with ES; however, the reliability of these findings is affected by the small sample sizes of the studies. Furthermore, four studies are considered as moderate or high risk of bias. The evidence to suggest the systematic usage of ES in the treatment of DFUs is still insufficient.
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Affiliation(s)
- Gianluca Melotto
- School of Health Sciences, University of Brighton, Eastbourne, UK
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4
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Song YP, Wang L, Yuan BF, Shen HW, Du L, Cai JY, Chen HL. Negative-pressure wound therapy for III/IV pressure injuries: A meta-analysis. Wound Repair Regen 2020; 29:20-33. [PMID: 32989919 DOI: 10.1111/wrr.12863] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
This meta-analysis was conducted to identify the potential benefits and the efficacy of negative-pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32-1.70). There were significant differences in wound healing time (WMD = -16.47 days, 95% [CI (-22.36, - 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = -2.39, 95% CI [-3.47, -1.30], P ≤ .001); (SMD = -2.55, 95% CI [-4.07, -1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = -3.61, 95% [CI (-4.57, - 2.66) times, P ≤ .001]). Our meta-analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high-quality multicenter RCTs.
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Affiliation(s)
- Yi-Ping Song
- School of Medicine, Nantong University, Nantong, Jiangsu, P.R. China
| | - Lei Wang
- Information Department, The Third People's Hospital of Nantong, Nantong, Jiangsu, P.R. China
| | - Bao-Fang Yuan
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P. R. China
| | - Hong-Wu Shen
- Nursing Department, Affiliated Hospital of Nantong University, Nantong, Jiangsu, P. R. China
| | - Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, P.R. China
| | - Ji-Yu Cai
- School of Medicine, Nantong University, Nantong, Jiangsu, P.R. China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, P.R. China
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5
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Geng J, Zhao Y, Wang Z, Wang M, Wei Z. Dressing interventions to heal pressure ulcers: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2020; 99:e22699. [PMID: 33031342 PMCID: PMC7544375 DOI: 10.1097/md.0000000000022699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pressure ulcer (PU) is defined as a lesion or trauma to the skin and underlying tissue resulting from unrelieved pressure, shear, friction, moisture, or a combination of all these, usually appearing over a bony prominence. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness, safety, and economy of the dressing treatments for PU through an overview. METHODS We searched the following electronic bibliographic databases: PubMed, Embase, Cochrane Library, CINAHL Complete, PsycARTICLES, PsycINFO, DynaMed Plus, as well as the Chinese databases without any language restriction. We will include meta-analyses that dressings treatments in the management of PUs. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane's Q and I statistics) and small-study effect (Egger's test); we will also estimate the evidence of excess significance bias. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. RESULTS This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. ETHICS AND DISSEMINATION Ethical approval is not applicable, since this is an overview based on published articles. PROTOCOL REGISTRATION NUMBER The protocol has been registered on PROSPERO under the number CRD42020161232.
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6
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Reyes BJ, Mendelson DA, Mujahid N, Mears SC, Gleason L, Mangione KK, Nana A, Mijares M, Ouslander JG. Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society. Geriatr Orthop Surg Rehabil 2020; 11:2151459320935100. [PMID: 32728485 PMCID: PMC7366407 DOI: 10.1177/2151459320935100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The majority of patients require postacute care (PAC) after a hip fracture. Despite its importance, there is no established consensus regarding the standards of care provided to hip fracture patients in PAC facilities. METHODOLOGY A writing group was created by professionals from the International Geriatric Fracture Society (IGFS) with representation from other organizations. The focus of the statements included in this article is toward PAC providers located in nursing facilities. Contributions were integrated in a single document that underwent several reviews by each author and then underwent a final review by the lead and senior authors. After this process was completed, the document was appraised by reviewers from IGFS. RESULTS/CONCLUSION A total of 15 statements were crafted. These statements summarize the best available evidence and is intended to help PAC facilities managing older adults with hip fractures more efficiently, aiming toward overall better outcomes in the areas of function, quality of life, and with less complications that could interfere with their optimal recovery.
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Affiliation(s)
- Bernardo J. Reyes
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | | | - Nadia Mujahid
- Warren Alpert School of Brown University, Rhode Island, USA
| | | | - Lauren Gleason
- The University of Chicago Medical and Biological Science, IL,
USA
| | | | - Arvind Nana
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | - Maria Mijares
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
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7
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Arora M, Harvey LA, Glinsky JV, Nier L, Lavrencic L, Kifley A, Cameron ID. Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev 2020; 1:CD012196. [PMID: 31962369 PMCID: PMC6984413 DOI: 10.1002/14651858.cd012196.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pressure ulcers (also known as pressure sores, decubitus ulcers or bedsores) are localised injuries to the skin or underlying tissue, or both. Pressure ulcers are a disabling consequence of immobility. Electrical stimulation (ES) is widely used for the treatment of pressure ulcers. However, it is not clear whether ES is effective. OBJECTIVES To determine the effects (benefits and harms) of electrical stimulation (ES) for treating pressure ulcers. SEARCH METHODS In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. We did not impose any restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included published and unpublished randomised controlled trials (RCTs) comparing ES (plus standard care) with sham/no ES (plus standard care) for treating pressure ulcers. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 20 studies with 913 participants. The mean age of participants ranged from 26 to 83 years; 50% were male. ES was administered for a median (interquartile range (IQR)) duration of five (4 to 8) hours per week. The chronicity of the pressure ulcers was variable, ranging from a mean of four days to more than 12 months. Most of the pressure ulcers were on the sacral and coccygeal region (30%), and most were stage III (45%). Half the studies were at risk of performance and detection bias, and 25% were at risk of attrition and selective reporting bias. Overall, the GRADE assessment of the certainty of evidence for outcomes was moderate to very low. Nineteen studies were conducted in four different settings, including rehabilitation and geriatric hospitals, medical centres, a residential care centre, and a community-based centre. ES probably increases the proportion of pressure ulcers healed compared with no ES (risk ratio (RR) 1.99, 95% confidence interval (CI) 1.39 to 2.85; I2 = 0%; 11 studies, 501 participants (512 pressure ulcers)). We downgraded the evidence to moderate certainty due to risk of bias. It is uncertain whether ES decreases pressure ulcer severity on a composite measure compared with no ES (mean difference (MD) -2.43, 95% CI -6.14 to 1.28; 1 study, 15 participants (15 pressure ulcers) and whether ES decreases the surface area of pressure ulcers when compared with no ES (12 studies; 494 participants (505 pressure ulcers)). Data for the surface area of pressure ulcers were not pooled because there was considerable statistical heterogeneity between studies (I2 = 96%) but the point estimates for the MD of each study ranged from -0.90 cm2 to 10.37 cm2. We downgraded the evidence to very low certainty due to risk of bias, inconsistency and imprecision. It is uncertain whether ES decreases the time to complete healing of pressure ulcers compared with no ES (hazard ratio (HR) 1.06, 95% CI 0.47 to 2.41; I2 = 0%; 2 studies, 55 participants (55 pressure ulcers)). We downgraded the evidence to very low certainty due to risk of bias, indirectness and imprecision. ES may be associated with an excess of, or difference in, adverse events (13 studies; 586 participants (602 pressure ulcers)). Data for adverse events were not pooled but the types of reported adverse events included skin redness, itchy skin, dizziness and delusions, deterioration of the pressure ulcer, limb amputation, and occasionally death. We downgraded the evidence to low certainty due to risk of selection and attrition bias and imprecision. ES probably increases the rate of pressure ulcer healing compared with no ES (MD 4.59% per week, 95% CI 3.49 to 5.69; I2 = 25%; 12 studies, 561 participants (613 pressure ulcers)). We downgraded the evidence to moderate certainty due to risk of bias. We did not find any studies that looked at quality of life, depression, or consumers' perception of treatment effectiveness. AUTHORS' CONCLUSIONS ES probably increases the proportion of pressure ulcers healed and the rate of pressure ulcer healing (moderate certainty evidence), but its effect on time to complete healing is uncertain compared with no ES (very low certainty evidence). It is also uncertain whether ES decreases the surface area of pressure ulcers. The evidence to date is insufficient to support the widespread use of ES for pressure ulcers outside of research. Future research needs to focus on large-scale trials to determine the effect of ES on all key outcomes.
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Affiliation(s)
- Mohit Arora
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Lisa A Harvey
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Joanne V Glinsky
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Lianne Nier
- Royal North Shore HospitalSpinal Cord Injury UnitWard 7E, Royal North Shore Hospital, Reserve Road, St LeonardsSydneyNSWAustralia2065
| | - Lucija Lavrencic
- Royal North Shore HospitalSpinal Cord Injury UnitWard 7E, Royal North Shore Hospital, Reserve Road, St LeonardsSydneyNSWAustralia2065
| | - Annette Kifley
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Ian D Cameron
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
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8
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Stolt M, Hjerppe A, Hietanen H, Puukka P, Haavisto E. Local treatment of pressure ulcers in long-term care: a correlational cross-sectional study. J Wound Care 2019; 28:409-415. [PMID: 31166863 DOI: 10.12968/jowc.2019.28.6.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To analyse the treatment of pressure ulcers (PU) in long-term care. METHOD In this correlational cross-sectional study, data was collected between November 2015 and January 2016 from older people with PUs in private and public long-term care facilities in Finland. Data collection was conducted by trained nurses using the Pressure Ulcer Patient Instrument (PUP-Ins). Outcomes measured were: prevalence and localisation of PU, local PU treatment, frequency (how often/week/day) and duration (minutes/week or day) of PU treatment. RESULTS In total, 112 patients with 158 PUs were identified (a prevalence rate of 5%). PUs were located most often on the heel (38%), hip (13%), buttocks (10%) and lateral malleolus (9.5%). The most frequently used PU treatment was skin protecting agents and local wound care products. The most typical treatment in category I, II and III PUs were foam dressings. In category III PUs, ribbon gauze dressings were also used. The most typical products for category IV PUs were complex dressings. Category I PUs received more treatment per day or week than other categories of PUs. CONCLUSION PU treatment is inconsistent and often conducted with varying methods and products. Holistic patient care must be the focus. Nurses in long-term care settings might benefit from in-depth in-service education focusing on the treatment of PUs. More research is needed about nurses' competence in PU treatment.
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Affiliation(s)
- Minna Stolt
- Docent, University Lecturer, Podiatrist, Department of Nursing Science, University of Turku, Finland.,Turku University Hospital, Finland
| | - Anna Hjerppe
- Chief Physician, Clinical Teacher, Clinic of Dermatology, Satakunta Hospital District, Finland.,Department of Medicine, University of Turku, Finland.,Finnish Medial Association, Finland
| | - Helvi Hietanen
- Wound Care Expert, Finnish Wound Care Association, Finland
| | - Pauli Puukka
- Senior Research Statistician, National Institute for Health and Welfare, Turku, Finland
| | - Elina Haavisto
- Docent, University Lecturer, Podiatrist, Department of Nursing Science, University of Turku, Finland.,Professor, Satakunta Hospital District, Finland
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9
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High Voltage Monophasic Pulsed Current (HVMPC) for stage II-IV pressure ulcer healing. A systematic review and meta-analysis. J Tissue Viability 2018; 27:274-284. [DOI: 10.1016/j.jtv.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/07/2018] [Accepted: 08/10/2018] [Indexed: 01/02/2023]
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10
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Rae KE, Isbel S, Upton D. Support surfaces for the treatment and prevention of pressure ulcers: a systematic literature review. J Wound Care 2018; 27:467-474. [PMID: 30086254 DOI: 10.12968/jowc.2018.27.8.467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Changes in technology have resulted in a lack of clarity regarding the comparative effectiveness between active and reactive support surfaces in the prevention and treatment of pressure ulcers (PUs). The purpose of this literature review was to evaluate the comparative effectiveness of active and reactive mattresses for prevention and treatment of PUs. METHOD A literature search was completed using CINAHL, Medline Plus, Scopus, Cochrane Library and PubMed databases, as well as reference lists. A temporal limiter was placed excluding studies published before 2000 due to changes in care standards and support surface technology. RESULTS Of the 33 articles included, nine were systematic/literature reviews and 24 were randomised controlled trials (RCTs). There was a consensus that pressure mattresses are an effective prevention and treatment strategy, however comparisons of the two types were often inconclusive or conflicting. Studies were conducted in acute, sub-acute or residential facilities, with no studies in a domiciliary setting. The majority of studies were rated as moderate quality with significant methodological limitations. CONCLUSION Further research is needed to investigate the use of support surfaces in a domiciliary setting with an appropriate methodology aimed at minimising the limitations described in the existing literature.
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Affiliation(s)
- Katherine E Rae
- Occupational Therapist, PhD Candidate, ACT Health Directorate, Canberra, Australia, University of Canberra, Canberra, Australia
| | - Stephen Isbel
- Associate Professor, Course Convenor, ACT Health Directorate, Canberra, Australia
| | - Dominic Upton
- Professor, Dean, College of Health and Human Sciences, Charles Darwin University
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11
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 638] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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12
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Zhang L, Fu XB, Chen S, Zhao ZB, Schmitz C, Weng CS. Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta-analysis. Int Wound J 2018; 15:590-599. [PMID: 29675986 DOI: 10.1111/iwj.12902] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/17/2018] [Indexed: 12/18/2022] Open
Abstract
This study aimed to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and conventional wound therapy (CWT) for acute and chronic soft tissue wounds. All English-language articles on ESWT for acute and chronic soft tissue wounds indexed in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, Physiotherapy Evidence Database, and HealthSTAR published prior to June 2017 were included, as well as corresponding articles cited in reference lists of related review articles. The methodological quality of the selected studies was assessed with the Cochrane Collaboration's "risk of bias" tool. Study design, subject demographics, wound aetiology, treatment protocols, assessment indexes, and follow-up duration were extracted. The fixed or random-effects model was used to calculate the pooled effect sizes according to studies' heterogeneity. Ten randomised controlled trials (RCTs) involving 473 patients were included in this systematic review and meta-analysis. The meta-analysis showed that ESWT statistically significantly increased the healing rate of acute and chronic soft tissue wounds 2.73-fold (odds ratio, OR = 3.73, 95% confidence interval, CI: 2.30-6.04, P < .001) and improved wound-healing area percentage by 30.45% (Standardized Mean Difference (SMD) = 30.45; 95% CI: 23.79-37.12; P < .001). ESWT reduced wound-healing time by 3 days (SMD = -2.86, 95% CI:-3.78 to -1.95, P < .001) for acute soft tissue wounds and 19 days (SMD = -19.11, 95% CI: -23.74 to -14.47, P < .001) for chronic soft tissue wounds and the risk of wound infection by 53% (OR = 0.47, 95% CI: 0.24-0.92, P = .03) when compared with CWT alone. Serious adverse effects were not reported. ESWT showed better therapeutic effects on acute and chronic soft tissue wounds compared with CWT alone. However, higher-quality and well-controlled RCTs are needed to further assess the role of ESWT for acute and chronic soft tissue wounds.
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Affiliation(s)
- Li Zhang
- Department of Rehabilitation Medicine, Nan Lou of Chinese PLA General Hospital, Beijing, China.,Key Laboratory of Wound Repair and Regeneration of PLA, College of Life Sciences, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Bing Fu
- Key Laboratory of Wound Repair and Regeneration of PLA, College of Life Sciences, Chinese PLA General Hospital, Beijing, China
| | - Shuo Chen
- Department of Medical Information, Chinese PLA General Hospital, Beijing, China
| | - Zhan-Bo Zhao
- School of Software and Microelectronics, Peking University, Beijing, China
| | - Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Chang-Shui Weng
- Department of Rehabilitation Medicine, Nan Lou of Chinese PLA General Hospital, Beijing, China
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13
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Relevant outcomes for nutrition interventions to treat and prevent malnutrition in older people: a collaborative senator-ontop and manuel delphi study. Eur Geriatr Med 2018; 9:243-248. [DOI: 10.1007/s41999-018-0024-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
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14
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Non-pharmacological interventions to prevent falls in older patients: Clinical practice recommendations – the SENATOR ONTOP Series. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Affiliation(s)
- CJ Deutsch
- Clinical Fellow in Plastic Surgery, Department of Plastic Surgery, Royal London Hospital, London E1 1BB
| | - DM Edwards
- Clinical Nurse Specialist, Department of Plastic Surgery, Royal London Hospital, London
| | - S Myers
- Consultant Plastic Surgeon and Senior Clinical Lecturer in Plastic Surgery, Department of Plastic Surgery, Royal London Hospital, London
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16
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Lozano-Montoya I, Correa-Pérez A, Abraha I, Soiza RL, Cherubini A, O'Mahony D, Cruz-Jentoft AJ. Nonpharmacological interventions to treat physical frailty and sarcopenia in older patients: a systematic overview - the SENATOR Project ONTOP Series. Clin Interv Aging 2017; 12:721-740. [PMID: 28490866 PMCID: PMC5413484 DOI: 10.2147/cia.s132496] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Physical frailty (PF) and sarcopenia are predictors of negative health outcomes such as falls, disability, hospitalization, and death. Some systematic reviews (SRs) have been published on different nonpharmacological treatments of frailty and sarcopenia using heterogeneous definitions of them. Objective To critically appraise the evidence from SRs of the primary studies on nonpharmacological interventions to treat PF (defined by Fried’s frailty phenotype) and sarcopenia (defined by the EWGSOP) in older patients. Design Overview of SRs and meta-analysis of comparative studies. Data sources PubMed, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched in October 2015. Eligibility criteria for selecting studies SRs that included at least one comparative study evaluating any nonpharmacological intervention to treat PF or sarcopenia in older patients in any health care setting. Any primary study described in these SRs with experimental design was included. Data extraction and management Two reviewers independently screened titles, abstracts, and full-texts of articles. Quality assessment was carried out by using criteria from the Cochrane Collaboration and the GRADE working group. Results Ten SRs with 5 primary studies satisfied the inclusion criteria. The most frequent interventions in the included studies were physical exercise (4) and nutritional supplementation (2). Muscle strength (MS; except for one study in a frail population) and physical performance (PP; except for another study in a frail population) improved with exercise and amino acid supplementation in frail and sarcopenic old adults. Falls and activities of daily living were assessed in two studies with opposite results. The overall quality of the evidence was low. Conclusion This overview of SRs highlights the importance of exercise interventions with or without nutritional supplementation to improve the PP in community-dwelling patients aged >65 years with PF and sarcopenia. MS improved with multidisciplinary treatment and exercise interventions in this population.
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Affiliation(s)
| | - Andrea Correa-Pérez
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Roy L Soiza
- Department of Medicine for the Elderly, National Health Service Grampian, Aberdeen, UK
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
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Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, Gudmundsson A, Soiza R, O'Mahony D, Guaita A, Cherubini A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017; 7:e012759. [PMID: 28302633 PMCID: PMC5372076 DOI: 10.1136/bmjopen-2016-012759] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/05/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). DESIGN Systematic overview of reviews. DATA SOURCES PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015). ELIGIBILITY CRITERIA Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. DATA EXTRACTION Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs. DATA ANALYSIS Extracted data were synthesised using a narrative approach. RESULTS 38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. CONCLUSIONS A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.
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Affiliation(s)
- Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Fabiana Mirella Trotta
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Giuseppina Dell'Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | | | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University,Ghent, Belgium
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | | | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
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Soiza RL, Subbarayan S, Antonio C, Cruz-Jentoft AJ, Petrovic M, Gudmundsson A, O'Mahony D. The SENATOR project: developing and trialling a novel software engine to optimize medications and nonpharmacological therapy in older people with multimorbidity and polypharmacy. Ther Adv Drug Saf 2016; 8:81-85. [PMID: 28382196 DOI: 10.1177/2042098616675851] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roy L Soiza
- Department of Medicine for the Elderly, NHS Grampian, Wards 303/4, Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen AB25 2ZN, UK
| | | | - Cherubini Antonio
- Italian National Research Centre on Aging, (IRCCS-INRCA), Ancona, Italy
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Rimland JM, Abraha I, Dell’Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, Petrovic M, O’Mahony D, Todd C, Cherubini A. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series. PLoS One 2016; 11:e0161579. [PMID: 27559744 PMCID: PMC4999091 DOI: 10.1371/journal.pone.0161579] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Falls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making. OBJECTIVES To systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals. METHODS We searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions. RESULTS Fifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis. CONCLUSIONS The aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.
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Affiliation(s)
- Joseph M. Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | - Giuseppina Dell’Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, United Kingdom
| | | | | | - Denis O’Mahony
- Division of Geriatrics, Department of Medicine, University College Cork, Cork, Ireland
| | - Chris Todd
- School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging, Ancona, Italy
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Steinberg KE. Skin Failure: A Practical Concept when Properly Applied. J Am Med Dir Assoc 2016; 17:570. [PMID: 27233492 DOI: 10.1016/j.jamda.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
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Lozano-Montoya I, Vélez-Díaz-Pallarés M, Abraha I, Cherubini A, Soiza RL, O'Mahony D, Montero-Errasquín B, Correa-Pérez A, Cruz-Jentoft AJ. Nonpharmacologic Interventions to Prevent Pressure Ulcers in Older Patients: An Overview of Systematic Reviews (The Software ENgine for the Assessment and optimization of drug and non-drug Therapy in Older peRsons [SENATOR] Definition of Optimal Evidence-Based Non-drug Therapies in Older People [ONTOP] Series). J Am Med Dir Assoc 2016; 17:370.e1-10. [DOI: 10.1016/j.jamda.2015.12.091] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 11/16/2022]
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Vélez-Díaz-Pallarés M, Lozano-Montoya I, Correa-Pérez A, Abraha I, Cherubini A, Soiza R, O’Mahony D, Montero-Errasquín B, Cruz-Jentoft A. Non-pharmacological interventions to prevent or treat pressure ulcers in older patients: Clinical practice recommendations. The SENATOR-ONTOP series. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abraha I, Rimland JM, Trotta F, Pierini V, Cruz-Jentoft A, Soiza R, O'Mahony D, Cherubini A. Non-Pharmacological Interventions to Prevent or Treat Delirium in Older Patients: Clinical Practice Recommendations The SENATOR-ONTOP Series. J Nutr Health Aging 2016; 20:927-936. [PMID: 27791223 DOI: 10.1007/s12603-016-0719-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
DESCRIPTION The ONTOP project aims to undertake a literature search of systematic reviews concerning evidence-based non-pharmacological interventions of prevalent medical conditions affecting older people, including delirium. OBJECTIVES To develop explicit and transparent recommendations for non-pharmacological interventions in older subjects at risk of developing delirium, as well as in older subjects with delirium, based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to rating the quality of evidence and the strength of recommendations. METHODS A multidisciplinary panel was constituted comprising geriatricians, research nurse and a clinical epidemiologist. The panel developed a systematic overview of non-pharmacological interventions to prevent or treat delirium. The GRADE approach was used to rate the evidence and to formulate recommendations. RESULTS The critical outcomes were delirium incidence, for delirium prevention, and delirium improvement and functional status, for delirium treatment. The non-pharmacological interventions were identified and categorized as multicomponent and single component. Strong recommendations in favor of multicomponent interventions to prevent delirium, in surgical or medicals wards, were formulated. In the latter case the evidence applied to older patients at intermediate - high risk of developing delirium. Weak recommendations, to prevent delirium, were formulated for multicomponent interventions provided by family members (medical ward), staff education (medical ward), ear plugs (intensive care unit), reorientation protocol (intensive care unit), and the use of a software to perform drug review. Weak recommendations were provided for the use of multicomponent interventions to prevent delirium in medical wards in patients not selected according to the risk of delirium. Strong recommendations not to use bright light therapy to prevent delirium in intensive care unit settings were articulated. Weak recommendations not to use music therapy to prevent delirium for patients undergoing surgical interventions were specified. The ability to make strong recommendations was limited by the low quality of evidence and the presence of uncertainty. Moreover, weak recommendations were provided for the use of multicomponent interventions to treat delirium of older patients (medical wards). CONCLUSIONS Overall, the panel developed 12 recommendations for the delivery of non-pharmacological interventions to older patients at risk of developing or, with delirium.
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Affiliation(s)
- I Abraha
- Y Iosief Abraha, Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy, E-mail: (IA)
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