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Zhetmekova Z, Kassym L, Kussainova A, Akhmetova A, Everink I, Orazalina A, Zhanaspayeva G, Botabayeva A, Kozhakhmetova D, Olzhayeva R, Semenova Y. The prevalence and risk factors of pressure ulcers among residents of long-term care institutions: a case study of Kazakhstan. Sci Rep 2024; 14:7105. [PMID: 38531944 DOI: 10.1038/s41598-024-57721-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Limited information is available regarding the prevalence of pressure ulcers (PUs) in residential homes in Central Asia. Therefore, the aim of this study was to identify the prevalence rates and risk factors associated with PUs among residents of long-term care medical institutions in the Republic of Kazakhstan. This cross-sectional study was conducted in four long-term care institutions in Kazakhstan. The study sample consisted of 640 patients who were assessed for the presence of PUs and associated risk factors. The evaluation was performed using the International Prevalence Measurement of Care Quality (Landelijke Prevalentiemeting Zorgkwaliteit, LPZ), the Braden scale, and the Care Dependency Score (CDS). The overall prevalence of PUs, classified as categories I-IV, was found to be 37%. When excluding category I PUs, the prevalence decreased to 35.6%. The odds ratios (ORs) for presenting with PUs were as follows: history of stroke (OR 5.22), diseases of the digestive system (OR 10.01), presence of spinal cord lesions/paraplegia (OR 20.50), recent reported confusion within the last 7 days (OR 184.00), and limited extent dependency according to the CDS (OR 4.44; 95%CI 1.31-16.1). It is imperative to establish specialized training programs aimed at equipping medical personnel, relatives, and patients themselves with the necessary skills to provide optimal care for individuals affected by PUs.
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Affiliation(s)
| | - Laura Kassym
- Department of General Medical Practice with a Course of Evidence-Based Medicine, Astana Medical University, Astana, Kazakhstan.
| | - Assiya Kussainova
- Department of Infectious Diseases, Dermatovenereology and Immunology, Semey Medical University, Semey, Kazakhstan
| | - Almira Akhmetova
- Department of Infectious Diseases, Dermatovenereology and Immunology, Semey Medical University, Semey, Kazakhstan
| | - Irma Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Ainash Orazalina
- Department of Molecular Biology and Medical Genetics Named After the Academician of National Academy of Sciences Republic of Kazakhstan Raissov T. K., Semey Medical University, Semey, Kazakhstan
| | - Galiya Zhanaspayeva
- National Scientific Center of Traumatology and Orthopedics Named After Academician Batpenov N.D., Astana, Kazakhstan
| | - Ainur Botabayeva
- Department of Internal Diseases and Rheumatology, Semey Medical University, Semey, Kazakhstan
| | - Dana Kozhakhmetova
- Department of Internal Diseases and Rheumatology, Semey Medical University, Semey, Kazakhstan
| | - Rauza Olzhayeva
- Department of Biochemistry and Chemical Disciplines Named D.M.S., Professor Tapbergenov S.O., Semey Medical University, Semey, Kazakhstan
| | - Yuliya Semenova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
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Soegaard K, Sig JR, Nielsen C, Verhaeghe S, Beeckman D, Biering-Sørensen F, Sørensen JA. "I am just trying to live a life!" -a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries. J Tissue Viability 2024; 33:50-59. [PMID: 38044163 DOI: 10.1016/j.jtv.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. OBJECTIVE This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. DESIGN and method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. PARTICIPANTS and setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49-81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. RESULTS The analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. CONCLUSIONS People with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.
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Affiliation(s)
- Knaerke Soegaard
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.
| | | | - Charlotte Nielsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Fin Biering-Sørensen
- University of Copenhagen, Denmark; Department for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
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Heywood-Everett S, Henderson R, Webb C, Bland AR. Psychosocial factors impacting community-based pressure ulcer prevention: A systematic review. Int J Nurs Stud 2023; 146:104561. [PMID: 37542960 DOI: 10.1016/j.ijnurstu.2023.104561] [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] [Received: 11/07/2022] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Pressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership. OBJECTIVE To synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour. DESIGN Mixed methods systematic review and narrative synthesis. METHOD Systematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model. RESULTS Thirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport. CONCLUSIONS Several psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.
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Affiliation(s)
- Suzanne Heywood-Everett
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK.
| | - Rebecca Henderson
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Claire Webb
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Amy R Bland
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
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An W, Tang X, Xiao X, Aku W, Wang H. Status and factors associated with patient activation and its relationship with HIV clinic outcomes among Yi minority people living with HIV in Liangshan, China: a cross-sectional study. Front Public Health 2023; 11:1114561. [PMID: 37397752 PMCID: PMC10309002 DOI: 10.3389/fpubh.2023.1114561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Patient activation is determined by an individual's knowledge, skills and confidence in managing his/her health. It is vital for people living with HIV (PLWH) to enhance their self-management skills and health outcomes, especially those from low- and middle-income regions, since they are at higher risk of worse health outcomes. However, literature from those regions is limited, especially in China. OBJECTIVES This study aimed to explore the status and factors associated with patient activation among Yi minority PLWH in Liangshan, China and to determine whether patient activation is associated with HIV clinic outcomes. METHODS This cross-sectional study included 403 Yi minority people living with HIV in Liangshan between September and October 2021. All participants completed an anonymous survey measuring sociodemographic characteristics, HIV-related information, patient activation and illness perception. Multivariate linear regression and multivariate binary logistic regression were used to explore factors associated with patient activation and the association between patient activation and HIV outcomes, respectively. RESULTS The Patient Activation Measure (PAM) score was low (mean = 29.8, standard deviation = 4.1). Participants with negative illness perception, low income, and self-rated antiretroviral therapy (ART) effect based on self-perception were most likely to have a lower PAM score (β = -0.3, -0.2, -0.1, respectively; all p < 0.05); those with having disease knowledge learning experiences and an HIV-positive spouse were more likely to have a higher PAM score (β = 0.2, 0.2, respectively; both p < 0.001). A higher PAM score (AOR=1.08, 95% CI: 1.02, 1.14) was associated with viral suppression, mediated by gender (AOR=2.25, 95% CI: 1.38, 3.69). CONCLUSION Low patient activation level among Yi minority PLWH impacts HIV care. Our findings indicate patient activation is associated with viral suppression for minority PLWH in low- and middle-income settings, suggesting that tailored interventions enhancing patient activation may improve viral suppression.
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Affiliation(s)
- Wenhong An
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xuefeng Tang
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Xueling Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Waha Aku
- Red Ribbon Antiviral Care Center, Zhaojue County People's Hospital, Liangshan, China
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, China
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Wang T, Luo C, Xie S, Tang J, He Z, Li K. Skin self-management of community-dwelling patients with spinal cord injury: A cross-sectional study. J Tissue Viability 2023:S0965-206X(23)00060-8. [PMID: 37246018 DOI: 10.1016/j.jtv.2023.05.003] [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: 12/07/2022] [Revised: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND community-acquired pressure injury is one of the most common and troublesome complications of discharged patients with spinal cord injury. Previous studies have shown that pressure injury can not only increase the financial burden and care burden of patients, but also seriously affect their quality of life. AIM To evaluate the skin self-management of community-dwelling patients with spinal cord injury and to explore the related independent influencing factors. METHODS This was a cross-sectional survey study. A convenience sample of 110 community-dwelling patients with spinal cord injury recruited from three rehabilitation centers in Guangzhou and Chengdu in China completed the survey from September 2020 to June 2021. They were asked about their demographic data, skin self-management, knowledge about skin self-management, attitude to skin self-management, self-efficacy, and functional independence. Univariate analysis and multiple linear regression were performed to isolate the most important relationships. RESULTS The skin self-management of community-dwelling patients with spinal cord injury was relatively low, and they also performed poorly in the three categories of: skin check, preventing pressure ulcer, and preventing wounds. Skin self-management was found to be most often associated with level of knowledge about skin self-management, higher reimbursement and self-efficacy. CONCLUSION Community-dwelling patients with spinal cord injury with lower level of knowledge about skin self-management, with lower self-efficacy, and those with higher reimbursement have worse skin self-management.
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Affiliation(s)
- Tong Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, China; Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Luo
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sumei Xie
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Jie Tang
- Sichuan Provincial Rehabilitation Hospital, Chengdu, China
| | - Zheng He
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
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Soegaard K, Sollie M, Beeckman D, Biering-Sørensen F, Ahm-Sørensen J. Interventions, stakeholders, and organization related to pressure ulcer prevention for individuals with spinal cord injuries in transition from hospital to home - A scoping review. J Tissue Viability 2023; 32:194-205. [PMID: 36997467 DOI: 10.1016/j.jtv.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/03/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
STUDY DESIGN Scoping review. AIM OF THE STUDY To obtain an overview of initiatives, organisational components, and stakeholders' perspectives on PU prevention in transitional care. METHODS Scoping review searching the databases: MEDLINE, EMBASE), CINAHL, Cochrane Library, Web of Science, and SCOPUS in May 2022. Inclusion of English-written research on pressure ulcer prevention in adult people with spinal cord injury in transition from hospital or rehabilitation centre to the home care environment. RESULTS Fifteen studies of different types are included in this study: six qualitative studies, four randomized controlled trials, three cohort studies, one cross-sectional study and an interventional study. The included studies are relatively low-level evidence but of acceptable quality. CONCLUSION Continuous tailored education and information about PU prevention and follow-up services are essential components in preventing PUs and rehabilitating people with SCI. The complexity of SCI requires adaptations, equipment and access to specialist care and treatment after discharge. However, there is a discrepancy between the international recommendations, the perceived needs, and the delivered healthcare services. The consequences are a lower quality of life and a higher risk of PUs for people with SCI.
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VAN Gaal BGI, Engelen MM, Adriaansen MJM, Vermeulen H, Laat EDE, VAN Dulmen S. Lessons learned from patients with spinal cord injury in managing pressure ulcers: A qualitative study. J Tissue Viability 2022; 31:794-799. [PMID: 35868969 DOI: 10.1016/j.jtv.2022.07.002] [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: 12/24/2021] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To explore how individuals with spinal cord injury self-manage the prevention and treatment of pressure ulcers and to provide insight into experiences with self-management support. DESIGN Qualitative study using semi-structured interview and a deductive thematic analysis. SETTING Community. PARTICIPANTS Twelve of the 14 participating adults with a spinal cord injury had experience with pressure ulcers, and eight of these had a current pressure ulcer. RESULTS Respondents suggested to tailor treatment of pressure ulcers to patients' individual wishes and capabilities of patients. Patients and caregivers need to be aware of the importance of determining the cause of pressure ulcers to prevent deterioration. Patients often depend on informal caregivers for follow-up and prevention, and healthcare professionals in non-SCI specialties often lack the knowledge needed to manage pressure ulcers in this specific patient group. Tailored education and peer support are important for patients to set boundaries, be assertive, and cultivate a positive attitude when dealing with pressure ulcers. It is difficult to combine treatment of severe pressure ulcers and preventive measures with work roles. Managing the social impact of pressure ulcers requires more coordination with caregivers. CONCLUSIONS To support self-management of pressure ulcers in patients with a spinal cord injury, they must find out which preventive measures and treatments suit them best. Healthcare professionals play an important role in the self-management of pressure ulcers and can help patients deal with the emotional and social impact of pressure ulcers. To know patient's needs and tailor their education, healthcare professionals of non SCI organizations need to have knowledge of pressure ulcers management of this specific patient group.
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Affiliation(s)
- Betsie G I VAN Gaal
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Marscha M Engelen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Marian J M Adriaansen
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands
| | - Hester Vermeulen
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Erik DE Laat
- Radboud university medical center, Department of Plastic Surgery, Nijmegen, the Netherlands
| | - Sandra VAN Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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Farid J, Amin R, Sheikh MA, Irfan M, AlRuwaili R, Alruwaili M, Ali NH, Albarrak AM, Rahman S. Prevalence and prediction of pressure ulcers in admitted stroke patients in a tertiary care hospital. J Tissue Viability 2022; 31:768-775. [DOI: 10.1016/j.jtv.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
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Engelen M, van Dulmen S, Vermeulen H, de Laat E, van Gaal B. The content and effectiveness of self-management support interventions for people at risk of pressure ulcers: A systematic review. Int J Nurs Stud 2021; 122:104014. [PMID: 34274772 DOI: 10.1016/j.ijnurstu.2021.104014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pressure ulcers are a common complication with a high impact on well-being and quality of life in people with impaired mobility and/or dysfunctional pain sensations. Prevention is therefore crucial. However, persons at risk seem to experience difficulties in adhering to self-management regimens that can help to prevent or diminish the development of pressure ulcers. Self-management support interventions might help to improve their self-management skills. OBJECTIVES To review the content, components and effectiveness of self-management support interventions on clinical and behavioral outcomes for people at risk of pressure ulcers. METHODS A systematic literature search for the period of January 2000 to February 2020 was conducted in five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Science). Inclusion criteria were: (1) studies including persons at a high risk of pressure ulcers; (2) studies investigating interventions focused on self-management support; (3) studies describing clinical and behavioral outcomes related to prevention and care of pressure ulcers. All studies were independently screened on title, abstracts and full text by two researchers. The PRISMS taxonomy of 14 components was used to code intervention content. RESULTS The search yielded 5297 papers, which resulted in the inclusion of 16 papers on self-management support interventions for persons at risk of pressure ulcers. Interventions focused mostly on 'Information about condition and/or management' (13 interventions), 'Training in practical self-management activities' (7 interventions), and 'Training in psychological strategies' (6 interventions). 'Provision of equipment' was not investigated. The intensity of the interventions varied in delivery mode, frequency and duration. Improvements were found in clinical outcomes in four studies and in behavioral outcomes in ten studies. Four studies showed improvements in clinical outcomes and ten studies in behavioral outcomes. Knowledge was positively influenced in eight studies. CONCLUSION Self-management support interventions show potential. The extensiveness and intensity of the interventions seem to be predictive for the effectiveness, but specific content components cannot be recommended. This review revealed recommendations for future research and international consensus should be reached about patient-relevant outcomes.
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Affiliation(s)
- Marscha Engelen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.
| | - Hester Vermeulen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.
| | - Erik de Laat
- Radboud university medical center, Department of Plastic Surgery, The Netherlands.
| | - Betsie van Gaal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands.
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Braafhart M, de Laat HEW, Wagner T, van de Burgt EWT, Hummelink S, Ulrich DJO. Surgical reconstruction of pressure ulcers in spinal cord injury individuals: A single- or two-stage approach? J Tissue Viability 2020; 29:319-323. [PMID: 32883591 DOI: 10.1016/j.jtv.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/27/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. OBJECTIVE The aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. METHOD A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. RESULTS The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total. We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. CONCLUSIONS There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery. The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.
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Affiliation(s)
- Marieke Braafhart
- Skin Therapy, Hogeschool Utrecht, Universities of Applied Science, the Netherlands
| | - Henricus E W de Laat
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Till Wagner
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Stefan Hummelink
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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