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Chaboyer W, Latimer S, Priyadarshani U, Harbeck E, Patton D, Sim J, Moore Z, Deakin J, Carlini J, Lovegrove J, Jahandideh S, Gillespie BM. The effect of pressure injury prevention care bundles on pressure injuries in hospital patients: A complex intervention systematic review and meta-analysis. Int J Nurs Stud 2024; 155:104768. [PMID: 38642429 DOI: 10.1016/j.ijnurstu.2024.104768] [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: 11/15/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Numerous interventions for pressure injury prevention have been developed, including care bundles. OBJECTIVE To systematically review the effectiveness of pressure injury prevention care bundles on pressure injury prevalence, incidence, and hospital-acquired pressure injury rate in hospitalised patients. DATA SOURCES The Medical Literature Analysis and Retrieval System Online (via PubMed), the Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus, the Cochrane Library and two registries were searched (from 2009 to September 2023). STUDY ELIGIBILITY CRITERIA Randomised controlled trials and non-randomised studies with a comparison group published in English after 2008 were included. Studies reporting on the frequency of pressure injuries where the number of patients was not the numerator or denominator, or where the denominator was not reported, and single subgroups of hospitalised patients were excluded. Educational programmes targeting healthcare professionals and bundles targeting specific types of pressure injuries were excluded. PARTICIPANTS AND INTERVENTIONS Bundles with ≥3 components directed towards patients and implemented in ≥2 hospital services were included. STUDY APPRAISAL AND SYNTHESIS METHODS Screening, data extraction and risk of bias assessments were undertaken independently by two researchers. Random effects meta-analyses were conducted. The certainty of the body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Nine studies (seven non-randomised with historical controls; two randomised) conducted in eight countries were included. There were four to eight bundle components; most were core, and only a few were discretionary. Various strategies were used prior to (six studies), during (five studies) and after (two studies) implementation to embed the bundles. The pooled risk ratio for pressure injury prevalence (five non-randomised studies) was 0.55 (95 % confidence intervals 0.29-1.03), and for hospital-acquired pressure injury rate (five non-randomised studies) it was 0.31 (95 % confidence intervals 0.12-0.83). All non-randomised studies were at high risk of bias, with very low certainty of evidence. In the two randomised studies, the care bundles had non-significant effects on hospital-acquired pressure injury incidence density, but data could not be pooled. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Whilst some studies showed decreases in pressure injuries, this evidence was very low certainty. The potential benefits of adding emerging evidence-based components to bundles should be considered. Future effectiveness studies should include contemporaneous controls and the development of a comprehensive, theory and evidence-informed implementation plan. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42023423058. TWEETABLE ABSTRACT Pressure injury prevention care bundles decrease hospital-acquired pressure injuries, but the certainty of this evidence is very low.
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/SharonLLatimer
| | - Udeshika Priyadarshani
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka
| | - Emma Harbeck
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jenny Sim
- Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney Australia
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons Ireland, University of Medicine and Health Sciences, 123 St Stephens's Green, Dublin, 2, Ireland
| | - Jodie Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia. https://twitter.com/jodie_deakin3
| | - Joan Carlini
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Health Consumer and Department of Marketing, Griffith Business School, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Josephine Lovegrove
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Sepideh Jahandideh
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, Griffith University, Gold Coast Campus, Queensland 4222, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia. https://twitter.com/bgillespie6
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Navarro JS, Brody R. Nutrition Support for Older Adults With Pressure Injuries Receiving Maintenance Hemodialysis: A Case Study. J Ren Nutr 2024; 34:260-265. [PMID: 38000521 DOI: 10.1053/j.jrn.2023.11.006] [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: 05/19/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Hemodialysis (HD) and pressure injuries (PI) are both hypercatabolic states that may contribute to protein-energy wasting development. These conditions require increased energy and protein to prevent losses from HD and support wound healing. Nutrition support therapy using intradialytic parenteral nutrition (IDPN) with or without a combination of oral nutrition supplements has yielded positive outcomes among patients receiving HD with protein-energy wasting. However, IDPN is not a standard of care for patients with PI and receiving HD. No existing guidelines support its use with these combined complex medical conditions. We present a case of an older adult with PI receiving HD who required supplemental IDPN. This case demonstrated that IDPN helps wound healing, reduces the hospital length of stay, and enhances quality of life.
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Affiliation(s)
- Julius S Navarro
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey; Clinical Dietitian, Department of Nutrition and Food Services, University of California San Francisco Medical Center, San Francisco, California
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey; Professor, Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, Newark, New Jersey.
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Kiyat I, Ozbas A. Comparison of the Predictive Validity of Norton and Braden Scales in Determining the Risk of Pressure Injury in Elderly Patients. CLIN NURSE SPEC 2024; 38:141-146. [PMID: 38625804 DOI: 10.1097/nur.0000000000000815] [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: 04/18/2024]
Abstract
AIM To compare the reliability and predictive validity of Norton and Braden scales in determining the risk of pressure injury in elderly patients. DESIGN This research used a comparative design. One hundred thirty elderly patients participated in the study. METHODS The daily pressure injury risk of participants was evaluated by a researcher using both the Norton and Braden scales in a consecutive manner. RESULTS The mean age of patients was 75.1 ± 8.5 years, and that for those without and with pressure injury development was 75.0 ± 8.3 years and 76.1 ± 9.7 years (P < .001), respectively. The reliability coefficients of the Norton and Braden scales were .82 and .89, respectively. The sensitivity, specificity, and positive and negative predictive values of the Norton Scale were 100%, 40.7%, 20.2%, and 100%, and those of the Braden Scale were 100%, 32.7%, 18.3%, and 100%, respectively. CONCLUSIONS The reliability of both scales for elderly patients was found to be high, and their ability to differentiate patients at risk was comparable. However, both scales had low specificity. Further research is needed to develop scales that have higher predictive validity for the elderly population, taking into account other risk factors that influence total scale scores.
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Affiliation(s)
- Ibrahim Kiyat
- Author Affiliations: Research Assistant, Kırklareli University, Faculty of Health Sciences, Department Nursing, Kırklareli/Turkey (Kiyat); and Professor, Istanbul University-Cerrahpasa, Faculty of Nursing, Department of Surgical Nursing, Istanbul, Turkey (Ozbas)
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Giovannoni L, Longobucco Y, Iovino P, Barbetti C, Becattini S, Bonanni D, Cordelli F, Cosci M, Del Perugia C, Flego R, Giannuzzi D, Guasti B, Iannone SR, Latini R, Macchitella C, Piccardi F, Prisco E, Pucci T, Tricca M, Rasero L. Complementing Braden scale for pressure ulcer risk with clinical and demographic-related factors in a large cohort of hospitalized Italian patients. J Tissue Viability 2024:S0965-206X(24)00030-5. [PMID: 38458956 DOI: 10.1016/j.jtv.2024.03.005] [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: 04/20/2023] [Revised: 01/23/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
AIMS To determine the prevalence, risk, and determinants of pressure ulcer risk in a large cohort of hospitalized patients. DESIGN A prospective cross-sectional study with data collection in January 2023. METHODS Registered nurses collected data from 798 patients admitted to 27 health care units of an Italian hospital. The pressure ulcer risk was assessed using the Braden scale. The presence of comorbidities was collected from clinical reports. Obesity was assessed according to international indicators (Body Mass Index). The receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of different Braden scores for identifying participants with pressure ulcers. RESULTS The prevalence of pressure ulcers was 9.5%, and 57.4% of the sample were at risk of developing pressure ulcers. The area under the ROC curve was 0.88. The best sensitivity and specificity were found for a Braden cutoff score of 15.5 (sensibility = 0.76; specificity = 0.85). The determinants of lower Braden scores were older age (p < 0.001), comorbidities (p < 0.001), wounds of other nature (p = 0.001), urinary incontinence (p < 0.001), fecal incontinence (p < 0.001), and urinary catheterization (p < 0.001). CONCLUSION Several demographic factors and specific clinical indicators have been identified as determinants of the risk of developing pressure ulcers, which are easily ascertainable by healthcare providers; thus, they may routinely complement the Braden Scale in the assessment of pressure ulcer risk in order to reinforce and accelerate clinical judgment.
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Affiliation(s)
- Lorenzo Giovannoni
- Research and Development of Clinical Practice Unit, Careggi University Hospital, Florence, Italy; Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Yari Longobucco
- Research and Development of Clinical Practice Unit, Careggi University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Iovino
- Department of Health Sciences, University of Florence, Florence, Italy.
| | - Chiara Barbetti
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Silvia Becattini
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Daniela Bonanni
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Francesco Cordelli
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Matteo Cosci
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | | | - Rachele Flego
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Domenica Giannuzzi
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Barbara Guasti
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | | | - Riccardo Latini
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | | | - Francesca Piccardi
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Elia Prisco
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Tiziana Pucci
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Manola Tricca
- Nursing and Midwifery Department, Careggi University Hospital, Florence, Italy
| | - Laura Rasero
- Research and Development of Clinical Practice Unit, Careggi University Hospital, Florence, Italy; Department of Health Sciences, University of Florence, Florence, Italy
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Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2024; 2:CD003216. [PMID: 38345088 PMCID: PMC10860148 DOI: 10.1002/14651858.cd003216.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance behaviours. The prevention and treatment of pressure ulcers involves strategies to optimize hydration, circulation, and nutrition. Adequate nutrient intake can reduce the risk factor of malnutrition and promote wound healing in existing pressure ulcers. However, it is unclear which nutrients help prevent and treat pressure ulcers. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of nutritional interventions (special diets, supplements) for preventing and treating pressure ulcers in people with or without existing pressure ulcers compared to standard diet or other nutritional interventions. SEARCH METHODS We used extensive Cochrane search methods. The latest search was in May 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with or without existing pressure ulcers, that compared nutritional interventions aimed at preventing or treating pressure ulcers with standard diet or other types of nutritional interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome for prevention studies was the proportion of participants who developed new (incident) pressure ulcers. For treatment studies, our primary outcomes were time to complete pressure ulcer healing, number of people with healed pressure ulcers, size and depth of pressure ulcers, and rate of pressure ulcer healing. Secondary outcomes were side effects, costs, health-related quality of life and acceptability. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 33 RCTs with 7920 participants. Data for meta-analysis were available from 6993 participants. Pressure ulcer prevention Eleven studies (with 12 arms) compared six types of nutritional interventions for the prevention of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may result in little to no difference in the proportion of participants developing a pressure ulcer (energy, protein and micronutrient supplements 248 per 1000, standard diet 269 per 1000; RR 0.92, 95% CI 0.71 to 1.19; 3 studies, 1634 participants; low-certainty evidence). Compared to standard diet, protein supplements may result in little to no difference in pressure ulcer incidence (protein 21 per 1000, standard diet 28 per 1000; RR 0.75, 95% CI 0.49 to 1.14; 4 studies, 4264 participants; low-certainty evidence). The evidence is very uncertain about the gastrointestinal side effects of these supplements (protein 109 per 1000, standard diet 155 per 1000; RR 0.70, 95% CI 0.06 to 7.96; 2 studies, 140 participants, very low-certainty evidence). The evidence is very uncertain about the effects of protein, arginine, zinc and antioxidants; L-carnitine, L-leucine, calcium, magnesium and vitamin D; EPA, GLA and antioxidants; disease-specific supplements on pressure ulcer incidence when compared to standard diet (1 study each; very low-certainty evidence for all comparisons). Pressure ulcer treatment Twenty-four studies (with 27 arms) compared 10 types of nutritional interventions or supplements for treatment of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may slightly increase the number of healed pressure ulcers (energy, protein and micronutrients 366 per 1000, standard diet 253 per 1000; RR 1.45, 95% CI 1.14 to 1.85; 3 studies, 577 participants, low-certainty evidence). The evidence is very uncertain about the effect of these supplements on gastrointestinal side effects. Compared to standard diet, the evidence is very uncertain about the effect of protein, arginine, zinc and antioxidant supplements on pressure ulcer healing (pressure ulcer area: mean difference (MD) 2 cm² smaller, 95% CI 4.54 smaller to 0.53 larger; 2 studies, 71 participants, very low-certainty evidence). The evidence on side effects of these supplements is very uncertain. Compared to standard diet, supplements with arginine and micronutrients may not increase the number of healed pressure ulcers, but the evidence suggests a slight reduction in pressure ulcer area (MD 15.8% lower, 95% CI 25.11 lower to 6.48 lower; 2 studies, 231 participants, low-certainty evidence). The evidence is very uncertain about changes in pressure ulcer scores, acceptability, and side effects of these supplements. Compared to placebo, collagen supplements probably improve the mean change in pressure ulcer area (MD 1.81 cm² smaller, 95% CI 3.36 smaller to 0.26 smaller; 1 study, 74 participants, moderate-certainty evidence). The evidence is very uncertain about the effect of these supplements on side effects. The evidence is very uncertain about the effects of vitamin C, different doses of arginine; EPA, GLA (special dietary fatty acids) and antioxidants; protein; a specialized amino acid mixture; ornithine alpha-ketoglutarate and zinc supplements on pressure ulcer healing (1 or 2 studies each; very low-certainty evidence). AUTHORS' CONCLUSIONS The benefits of nutritional interventions with various compositions for pressure ulcer prevention and treatment are uncertain. There may be little or no difference compared to standard nutrition or placebo. Nutritional supplements may not increase gastrointestinal side effects, but the evidence is very uncertain. Larger studies with similar nutrient compositions would reduce these uncertainties. No study investigated the effects of special diets (e.g. protein-enriched diet, vegetarian diet) on pressure ulcer incidence and healing.
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Affiliation(s)
- Gero Langer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Astrid Fink
- Department of Health, District administration Groß-Gerau, Groß-Gerau, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University Graz, Graz, Austria
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Uslu Y, Adıgüzel Akbaba M. Evaluation of perioperative pressure injury in adults 65 years and older: A prospective cohort study. J Tissue Viability 2024; 33:43-49. [PMID: 38000967 DOI: 10.1016/j.jtv.2023.11.005] [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: 06/03/2023] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Old age is an important risk factor for the formation of pressure injury (PI). The aim of this study was to investigate the incidence, risk factors, characteristics of PI and suitability of risk assessment tools for patients aged 65 years and older. METHOD This prospective monocentric cohort study was conducted in Turkey between September 2022 and March 2023. Data were collected from a total of 240 surgical patients aged 65 years and older using a skin assessment form and the Braden and Munro scales for PI risk assessment. RESULTS The patients had a mean age of 72.90 ± 5.53 years, 123 (51 %) were male, 203 (85 %) had chronic diseases, and the mean operative time was 194.83 ± 99.45 min. PI occurred in 45 patients (18.8 %). PIs were most commonly stage I and located in the coccyx region. Postoperative Munro score, postoperative Braden score, and operative time were significant in univariate analyses (p < 0.001). According to the multiple logistic regression model, a postoperative Munro score ≥26 and postoperative Braden score ≤20 were independent factors associated with increased risk of PI. CONCLUSION Measures to prevent PI in surgical patients should begin in the preoperative period. Age alone may not be a risk factor in geriatric surgical patients. The Munro and Braden PI risk assessment scales can be used in geriatric surgical patients, but changes in cut-off score calculations may be required and additional age-related risk factors should be evaluated.
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Affiliation(s)
- Yasemin Uslu
- Faculty of Nursing, Istanbul University, Fatih, Istanbul, Turkey.
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Malek Hosseini A, Rostam Khani M, Abdi S, Abdi S, Sharifi N. Comparison of aloe vera gel dressing with conventional dressing on pressure ulcer pain reduction: a clinical trial. BMC Res Notes 2024; 17:25. [PMID: 38229162 DOI: 10.1186/s13104-023-06682-8] [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: 08/11/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Aloe Vera has a strong analgesic and anti-inflammatory effect, and its use effectively controls pain. This study aimed to determine the effect of Aloe Vera gel versus saline on pain relief of pressure ulcers. METHODS This study is a double-blind, randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran from May 2020 to April 2022. Using the available sampling method, 95 patients with pressure ulcers were assessed for eligibility, 64 patients were selected, 33 patients were placed in the experimental and 34 patients in control. For the experimental group, the ulcers were first cleaned with normal saline to remove the slough and then the already prepared Aloe Vera gel was evenly applied. For control groups, the ulcers were first washed with normal saline to remove off the slough and then covered with a sterile cotton gage, and the wound was tightly bandaged with a cotton roll to keep the "daily dressing" in place. A visual pain scale was used to assess the patient's pain level. Data analysis was done using SPSS 17. Descriptive statistics, ANOVA, and greenhouse tests were used. The significance level was 0.05. RESULTS The results showed that the average pain score in both groups had a downward trend; that is, both dressings effectively reduced pressure ulcer pain (P < 0.001). The greenhouse test results showed that the difference between the two groups was significant (P < 0.001). CONCLUSION The results showed the effect of Aloe Vera gel in reducing pressure ulcer pain. Dressing with Aloe Vera gel is preferable to reducing pain during dressing changes in patients with pressure ulcers. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT20180715040478N2, 2021-08-17.
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Affiliation(s)
- Azam Malek Hosseini
- Department of Nursing, Khomein University of Medical Sciences, Khomein, Iran
| | | | - Sina Abdi
- Department of Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Siavash Abdi
- Department of Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Nader Sharifi
- Department of Public Health, Khomein University of Medical Sciences, Khomein, Iran.
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Sugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud 2023; 148:104605. [PMID: 37801939 DOI: 10.1016/j.ijnurstu.2023.104605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN Systematic review and meta-analysis. SETTING(S) Nursing homes, aged care, or long-term care facilities. PARTICIPANTS Older people, 60 years and older. METHODS Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER PROSPERO CRD42022328367. TWEETABLE ABSTRACT Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.
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Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
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McCranie AS, Constantine RS, Lee N, Le ELH, Gehring M, Iorio ML. Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database. Wound Repair Regen 2023; 31:641-646. [PMID: 37583305 DOI: 10.1111/wrr.13110] [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: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023]
Abstract
In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.
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Affiliation(s)
- Alec S McCranie
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ryan S Constantine
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nayun Lee
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elliot L H Le
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Gehring
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew L Iorio
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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10
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Aldughayfiq B, Ashfaq F, Jhanjhi NZ, Humayun M. YOLO-Based Deep Learning Model for Pressure Ulcer Detection and Classification. Healthcare (Basel) 2023; 11:healthcare11091222. [PMID: 37174764 PMCID: PMC10178524 DOI: 10.3390/healthcare11091222] [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: 03/12/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Pressure ulcers are significant healthcare concerns affecting millions of people worldwide, particularly those with limited mobility. Early detection and classification of pressure ulcers are crucial in preventing their progression and reducing associated morbidity and mortality. In this work, we present a novel approach that uses YOLOv5, an advanced and robust object detection model, to detect and classify pressure ulcers into four stages and non-pressure ulcers. We also utilize data augmentation techniques to expand our dataset and strengthen the resilience of our model. Our approach shows promising results, achieving an overall mean average precision of 76.9% and class-specific mAP50 values ranging from 66% to 99.5%. Compared to previous studies that primarily utilize CNN-based algorithms, our approach provides a more efficient and accurate solution for the detection and classification of pressure ulcers. The successful implementation of our approach has the potential to improve the early detection and treatment of pressure ulcers, resulting in better patient outcomes and reduced healthcare costs.
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Affiliation(s)
- Bader Aldughayfiq
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Farzeen Ashfaq
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - N Z Jhanjhi
- School of Computer Science, SCS, Taylor's University, Subang Jaya 47500, Malaysia
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Saudi Arabia
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11
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Öğüt Düzen K, Güneş Z. The effect of pH-compatible cleansing cloths on skin pH and the development of pressure ulcers. J Tissue Viability 2022; 31:673-677. [PMID: 36180377 DOI: 10.1016/j.jtv.2022.09.003] [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: 04/27/2022] [Revised: 09/03/2022] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
AIM Skin care plays an important role in the prevention of the development of pressure ulcers. The aim of this study was to determine the effect of skincare with a body pH-compatible cleansing cloth on the development time of pressure ulcers and on skin pH. METHODS This experimental research was conducted with 156 patients hospitalized in intensive care clinics of a state hospital between September 2019 and 2020. The sample was calculated with a power of 80% and a significance level of 0.05 (α error) and as a result, 78 elderly patients formed the intervention group and another 78 elderly patients made up the control group. Data were collected using the Elderly Information Form, Braden Risk Assessment Scale, Pressure Ulcer Staging Tool and Skin pH Measurement Form. The pre- and post-care skin pH of both groups was measured with a skin pH meter. P < 0.05 was considered statistically significant. RESULTS The average development time for pressure ulcers was 14.9 days in the control group, 18.9 days in the intervention group and the difference was not statistically significant (p > 0.05). Skin pH decreased in the intervention group after the skin care routine was applied, whereas it increased in the control group. CONCLUSION It can be said that care of one's skin with a body pH-compatible cleansing cloth has a positive effect on the development time of pressure ulcers and also positively changes the skin pH to acidic.
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Affiliation(s)
- Kerime Öğüt Düzen
- Mehmet Akif Ersoy Unıversity Health Science Faculty, Nursing Department, Burdur, Turkey.
| | - Zeynep Güneş
- Aydın Adnan Menderes University Faculty of Nursing, Aydın, Turkey.
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12
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Abstract
Supplemental Digital Content is available in the text. Accurately measuring the risk of pressure injury remains the most important step for effective prevention and intervention. Time-dependent risk factors for pressure injury development in the adult intensive care unit setting are not well understood.
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13
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Graves N, Phillips CJ, Harding K. A narrative review of the epidemiology and economics of chronic wounds. Br J Dermatol 2021; 187:141-148. [PMID: 34549421 DOI: 10.1111/bjd.20692] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 12/11/2022]
Abstract
Chronic wounds have a debilitating effect on the quality of life of many individuals, and the large economic impact on health system budgets warrants greater attention in policy making and condition management than is currently evident. The aim of this narrative review is to summarize the nature and extent of the chronic wound problem that confronts health systems across the world. The first section is used to highlight the underlying epidemiology relating to chronic wounds, while the second explores the economic costs associated with them and the relative efficiency of measures designed to manage them.
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Affiliation(s)
- N Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - C J Phillips
- Department of Public Health and Policy Studies, Swansea University, Swansea, UK
| | - K Harding
- Clinical Innovation Hub, Cardiff University, Cardiff, UK
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14
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Tuz MA, Mitchell A. The influence of anaemia on pressure ulcer healing in elderly patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S32-S38. [PMID: 34379458 DOI: 10.12968/bjon.2021.30.15.s32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Anaemia is a common and multifactorial blood disorder in elderly individuals. This condition may be a significant barrier to pressure ulcers healing as it is associated with a decreased level of oxygen being supplied to body tissues. Some nutritional deficiencies such as iron, vitamin B12 and folate may also cause anaemia and have a negative impact on pressure ulcer healing. An increased iron demand in hard-to-heal pressure ulcers is a significant factor associated with the risk of anaemia of chronic disease in elderly patients. Anaemia screening and correction may need to be considered as well as iron supplementation if required in pressure ulcer prevention and management.
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Affiliation(s)
| | - Aby Mitchell
- Senior Lecturer, Adult Nursing, University of West London
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15
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Pérez-López C, López-Franco MD, Comino-Sanz IM, Pancorbo-Hidalgo PL. Validation of the Pressure Injury Prevention Knowledge questionnaire in nursing students: Rasch analysis. ENFERMERIA CLINICA 2021; 31:12-20. [PMID: 32962908 DOI: 10.1016/j.enfcli.2020.07.001] [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: 04/13/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of our study is to measure the knowledge of nursing students at the University of Jaén about evidence-based recommendation for the prevention of pressure injuries. METHOD A cross-sectional observational and validation study was carried in 2019, using an online survey. All the students registered on the Nursing Degree programme of the University of Jaén were invited to participate. The psychometric properties of the Pressure Injury Prevention Knowledge questionnaire (PIPK) were tested by a Rasch analysis. With the analysis, the percentage of correct and wrong answers was calculated, the global score and the association with some educational variables. RESULTS The PIPK questionnaire showed adequate psychometric characteristics (alpha=.89) and good fit to the Rasch model. The average knowledge score on pressure injury prevention obtained was 21.0 (this is 67.7% of the maximum). Higher scores were obtained by the students that had finished some clinical placements; those with more placements; had attended a meeting about pressure injuries and those in a higher year of the programme. CONCLUSIONS The PIPK questionnaire is a valid and reliable instrument for measuring the knowledge of nursing students about pressure injuries prevention. The nursing students of the University of Jaén obtained a score in the questionnaire higher than 50%.
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Affiliation(s)
- Cristina Pérez-López
- Grupo de Investigación Enfermería e Innovación en Cuidados de Salud, Universidad de Jaén, Jaén, España
| | - María Dolores López-Franco
- Grupo de Investigación Enfermería e Innovación en Cuidados de Salud, Universidad de Jaén, Jaén, España; Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Jaén, España.
| | - Inés María Comino-Sanz
- Grupo de Investigación Enfermería e Innovación en Cuidados de Salud, Universidad de Jaén, Jaén, España; Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Jaén, España
| | - Pedro Luis Pancorbo-Hidalgo
- Grupo de Investigación Enfermería e Innovación en Cuidados de Salud, Universidad de Jaén, Jaén, España; Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Jaén, España
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Artico M, Piredda M, D'Angelo D, Lusignani M, Giannarelli D, Marchetti A, De Chirico C, Mastroianni C, De Marinis MG. Prevalence, incidence and associated factors of pressure injuries in hospices: A multicentre prospective longitudinal study. Int J Nurs Stud 2020; 111:103760. [PMID: 32919359 DOI: 10.1016/j.ijnurstu.2020.103760] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/19/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients in palliative care are the population cohort that most frequently develop pressure injuries, severely impacting their quality of life. Data from prospective studies on the prevalence and incidence of pressure injuries in hospices are lacking. AIM To describe the point prevalence and cumulative incidence of pressure injuries in patients admitted to residential hospices, and to analyze their predictive factors over time. DESIGN Multicentre prospective longitudinal observational study. SETTING/PARTICIPANTS Adult patients (n = 992) enrolled in 13 Italian residential hospices, with a minimum sample of 280 for each macro-region (North, center, South/Islands). METHODS Assessments including the Karnofsky Performance Status, Braden, Edmonton Symptom Assessment System Revised scales and pressure injury staging according to National Pressure Ulcer Advisory Panel were conducted at least every four days, from admission to patients' death/discharge. RESULTS The 7,967 observations recorded provided prevalence and incidence rates of 34.1% and 26.5%, respectively. The logistic regression model showed non-cancer disease (OR = 2.39, 95%CI = 1.65-3.47), age >80 (OR = 2.01, 95%CI = 1.49-2.71), Braden score 'at risk' (OR = 1.92, 95%CI = 1.17-3.14), urinary catheter (OR = 1.96, 95%CI = 1.40-2.75), drowsiness (OR = 1.41, 95%CI = 1.02-1.95) and artificial nutrition (OR = 1.47, 95%CI = 1.01-2.14) as the variables associated with pressure injury at admission. The generalized estimating equations models, built on the timeframes for observation groups, revealed male gender (OR = 1.68, 95%CI = 1.01-2.79) and Braden score 'at risk' (OR = 4.45, 95%CI = 1.74-11.34) as predictive factors of a new pressure injury developed up to three weeks before a patient's death, while in the last ten days of life these predictors were replaced by diagnosis of cancer (OR = 1.80, 95%CI = 1.11-2.91), worsening pain (OR = 1.65, 95%CI = 1.10-2.49), drowsiness (OR = 1.79, 95%CI = 1.25-2.57) and dyspnea (OR = 1.48, 95%CI = 1.01-2.18). CONCLUSIONS The high incidence and prevalence of pressure injuries confirm the importance of palliative care nurses continuously focusing on prevention and management strategies. In the last three weeks of a patient's life, the predictive power of the Braden scale for a new pressure injury is not confirmed, throwing doubt on the effectiveness of aimed interventions at modifying risk factors. Along the different disease trajectories, pressure injuries developed during the instability/worsening phases of illness, occurring before hospice admission for non-cancer patients and in the end-of-life phase for cancer patients. Despite continuous provision of appropriate interventions, most of the new pressure injuries were detected during the last ten days of a patient's' life and assessed as 'unavoidable'. These results are crucial to guiding palliative care nursing plans during the different phases of illness, and to predicting care needs, possible management strategies ('wound management' vs. 'wound palliation'), and resource utilization.
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Affiliation(s)
- Marco Artico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Daniela D'Angelo
- Center for Clinical Excellence and Quality of Care (CNEC), Istituto Superiore di Sanità (ISS), Via Regina Elena, 299, Rome 00161, Italy.
| | - Maura Lusignani
- Associate Professor, Department of Biomedical Sciences for Health, University of Milan, Via Pascal, 35, Milan 20133, Italy.
| | - Diana Giannarelli
- Biostatistical Unit, National Cancer Institute "Regina Elena" - IRCCS, Via Chianesi, 53, Rome 00144, Italy.
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
| | - Cosimo De Chirico
- Palliative Care Unit, Azienda ULSS4 Veneto Orientale, Piazza De Gasperi, 5, San Donà di Piave, Venezia 30027, Italy.
| | - Chiara Mastroianni
- Centro ANTEA, Piazza Santa Maria della Pietà, 5 Pad. XXII, Rome 00135, Italy.
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21, Rome 00128, Italy.
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Rodríguez JEC, Gamboa SG. Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería. J Wound Care 2020; 29:6-15. [PMID: 33054619 DOI: 10.12968/jowc.2020.29.latam_sup_2.6] [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: 11/11/2022]
Abstract
OBJECTIVE Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.
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18
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Rodríguez JEC, Gamboa SG. Prevención de lesiones por presión: conocimientos y actitudes del personal de enfermería. J Wound Care 2020; 29:6-15. [PMID: 33048017 DOI: 10.12968/jowc.2020.29.sup10.6] [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: 11/11/2022]
Abstract
OBJECTIVE Identify, analyse and summarise the empirical evidence on nurses' knowledge and attitudes towards pressure ulcer (PU) prevention. METHOD A systematic literature review on articles published between 2008 y 2019 was performed following PRISMA guidelines. Databases were checked for the following terms in Spanish, English and Portuguese: attitude, knowledge, pressure ulcer, and nursing staff. RESULTS A total of 33 articles with a quantitative descriptive approach were included in this review. The authors found a lack of knowledge on PU prevention among nursing staff. The nurses' attitudes were considered positive. Few studies examined the correlation between knowledge, attitude and clinical practice. CONCLUSION There is a need for continued professional education in terms of PU prevention among nurses. Research on alternative ways to organise nursing staff's work is needed. Studying up-to-date guidelines on PU prevention on a regular basis and attending training in this subject might be beneficial to improve nurses' knowledge and attitudes towards PU prevention.
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19
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Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud 2020; 105:103546. [DOI: 10.1016/j.ijnurstu.2020.103546] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
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20
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Olivo S, Canova C, Peghetti A, Rossi M, Zanotti R. Prevalence of pressure ulcers in hospitalised patients: a cross-sectional study. J Wound Care 2020; 29:S20-S28. [PMID: 32160127 DOI: 10.12968/jowc.2020.29.sup3.s20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The main aim of this study was to estimate the prevalence of pressure ulcers (PU) and related risk factors of PU development in hospitalised patients in Italy. Furthermore, the study investigated the association between risk factors for PU present on admission and the development during hospitalisation (hospital-acquired pressure ulcer, HAPU). METHODS A cross-sectional study, using two separate designs at two separate timepoints: 2010 and 2015. The methodology used to measure PU prevalence was that recommended by the European Pressure Ulcer Advisory Panel (EPUAP). RESULTS The total sample was 7681 hospitalised patients (3011 patients in 2010, 4670 in 2015). Prevalence of PU in hospital was 19.5% in 2010 and 17% in 2015. The number of patients with PU present on admission were 9.60% in 2010 and 9.42% in 2015. Patients with HAPU were 5.08% in 2010 and 5.87% in 2015. Older age and comorbidities, and a total Braden score of ≤16 were positively associated with PU present on admission and HAPU in hospitals (p<0.05). A longer length of stay appeared to correlate positively with a better clinical outcome for PU if there were already present on admission. Heterogeneous results emerged for length of stay of >30 days and being admitted to intensive care unit (ICU). CONCLUSION Our results are comparable with other European and Italian studies. Most of the risk factors associated with PU development have been confirmed. However, further studies are needed to examine the effects of context on PU present on arrival and HAPU, especially regarding hospital length of stay.
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Affiliation(s)
- Stella Olivo
- 1 Department of Maternity. Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Cristina Canova
- 2 Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, University of Padua, Padua, Italy
| | - Angela Peghetti
- 3 Azienda Ospedaliera Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Maurilio Rossi
- 4 Azienda Ospedaliero-Universitaria Careggi di Firenze, Florence, Italy
| | - Renzo Zanotti
- 5 Laboratory of Nursing Studies, Public Health Section, Department of Medicine, University of Padova, Padua, Italy
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21
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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: 7] [Impact Index Per Article: 1.4] [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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Cuccolo NG, Sparenberg S, Ibrahim AMS, Crystal DT, Blankensteijn LL, Lin SJ. Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases†. J Plast Surg Hand Surg 2019; 54:67-76. [DOI: 10.1080/2000656x.2019.1688166] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nicholas G. Cuccolo
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sebastian Sparenberg
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ahmed M. S. Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dustin T. Crystal
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Louise L. Blankensteijn
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J. Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Campeau-Vallerand C, Michaud F, Routhier F, Archambault PS, Létourneau D, Gélinas-Bronsard D, Auger C. Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation. JMIR Rehabil Assist Technol 2019; 6:e13560. [PMID: 31674918 PMCID: PMC6856862 DOI: 10.2196/13560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/14/2019] [Accepted: 09/02/2019] [Indexed: 01/26/2023] Open
Abstract
Background In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up. Objective This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians. Methods On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts. Results A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up. Conclusions On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.
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Affiliation(s)
- Charles Campeau-Vallerand
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - François Michaud
- Interdisciplinary Institute for Technological Innovation, Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Routhier
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Philippe S Archambault
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Dominic Létourneau
- Interdisciplinary Institute for Technological Innovation, Department of Electrical Engineering and Computer Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dominique Gélinas-Bronsard
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
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24
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De Meyer D, Van Hecke A, Verhaeghe S, Beeckman D. PROTECT - Trial: A cluster RCT to study the effectiveness of a repositioning aid and tailored repositioning to increase repositioning compliance. J Adv Nurs 2019; 75:1085-1098. [PMID: 30549321 DOI: 10.1111/jan.13932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/09/2018] [Accepted: 12/04/2018] [Indexed: 12/19/2022]
Abstract
AIM To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses' compliance to repositioning frequencies; (b) body posture of patients after repositioning; (c) incidence of pressure ulcers and incontinence-associated dermatitis; (d) nurses' and patients' preferences, comfort and acceptability; and (e) budget impact. BACKGROUND Patient-tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision-making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking. DESIGN Multicentre, cluster, three-arm, randomized, controlled pragmatic trial. METHODS Two hundred and twenty-seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group. RESULTS Nurses' compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30-45° tilted side-lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence-associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group. CONCLUSION This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses' compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow-up and education. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.
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Affiliation(s)
- Dorien De Meyer
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department Health Care, VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden
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Eglseer D, Hödl M, Lohrmann C. Nutritional management of older hospitalised patients with pressure injuries. Int Wound J 2018; 16:226-232. [PMID: 30440105 PMCID: PMC7379703 DOI: 10.1111/iwj.13016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 12/14/2022] Open
Abstract
This cross-sectional, multicentre study was conducted in hospitals to investigate nutritional interventions conducted in patients aged 70 years or older with (risk of) pressure injuries. A total of 1412 patients from 33 hospitals with 208 wards participated in the study. A standardised questionnaire was used to collect demographic data and data on care dependency, malnutrition risk, risk for/prevalence of pressure injuries, and nutritional interventions. Data analyses were conducted by using descriptive statistics, chi-square tests, or independent t-tests. According to the Braden Scale, 678 (48.0%) of the patients were at risk of developing pressure injuries, and 71 patients (5.0%) had at least one pressure injury (assessed by skin inspection). The most frequently conducted nutritional interventions in patients with pressure injuries were providing support during mealtimes (50.7%), food specifically desired by the patient (40.8%), and conducting a malnutrition screening (39.4%). One quarter of the patients with pressure injuries were referred to a dietitian. The provision of an energy-enriched/protein-enriched diet (18.3%), energy-enriched/protein-enriched snacks (12.7%), or oral nutritional supplements (8.5%) was rare. Nutritional care in older patients with risk of pressure injuries is suboptimal. Health care professionals need to raise awareness regarding the importance of nutrition in the management of patients with pressure injuries.
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Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Manuela Hödl
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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Katoh N, Tennstedt D, Abellan van Kan G, Saint Aroman M, Loir A, Bacqueville D, Duprat L, Guiraud B, Bessou-Touya S, Duplan H. Gerontodermatology: the fragility of the epidermis in older adults. J Eur Acad Dermatol Venereol 2018; 32 Suppl 4:1-20. [DOI: 10.1111/jdv.15253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Affiliation(s)
- N. Katoh
- Department of Dermatology; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - D. Tennstedt
- Department of Dermatology; Saint-Luc University Clinics; Brussels Belgium
| | - G. Abellan van Kan
- Gérontopôle; Department of Internal Medicine and Geriatrics; Toulouse University Hospital; Toulouse France
| | | | - A. Loir
- Pierre Fabre Dermo-Cosmétique; Lavaur France
| | - D. Bacqueville
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - L. Duprat
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - B. Guiraud
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - S. Bessou-Touya
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
| | - H. Duplan
- Pharmacology Division; Pierre Fabre Dermo-Cosmétique; Toulouse France
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Cieslik-Bielecka A, Skowroński R, Jędrusik-Pawłowska M, Pierchała M. The application of L-PRP in AIDS patients with crural chronic ulcers: A pilot study. Adv Med Sci 2018; 63:140-146. [PMID: 29120855 DOI: 10.1016/j.advms.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/04/2017] [Accepted: 10/17/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Nonhealing wounds or skin ulcerations are the result of insufficient repair and destruction of a local healing potential. Opportunistic infections which cause a lot of ulcer complications influence the worsening general condition of patients with AIDS, ultimately leading to death. The chronicity of the condition and poor results of conventional therapy have prompted the search for new methods of treatment. MATERIALS AND METHODS We have examined venous or arteriovenous insufficiency-related extensive crural ulcers in AIDS patients. Crural ulcer healing processes were evaluated with clinical observations and histopathological, immunohistochemical and molecular examinations of tissue samples harvested from the wound edges before and on day 10 after L-PRP cover dressing. RESULTS Clinical observations showed positive effects of L-PRP in all patients. However, complete wound closure was noted in 60% of cases. Statistical analysis of histological examination showed increased epidermal processes between samples, but the difference was nonsignificant. However, immunohistochemical investigations showed an increased healing process with strong statistical significance. The mean VEGF level before L-PRP usage was 114.3 vessels/mm2 and on day 10 118.9 (p=0.001523). The mean FLK level was 103.2 and 109.9 respectively (p=0.008241). The biggest differences were observed for CD34, with values of 68.2 on day 0 and 100.8 on day 10 (p=0.006982). Molecular analysis generally showed decreased gene expression and confirmed vascular formation and reepithelialization processes. CONCLUSIONS In our opinion, L-PRP may be used to eradicate microorganisms from wounds, to induce neovascularization, and in unhealed cases prepare the base and edge of the ulcer for skin grafting and tissue expansion procedures.
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Barrois B, Colin D, Allaert FA. Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France. Hosp Pract (1995) 2018; 46:30-36. [PMID: 29241381 DOI: 10.1080/21548331.2018.1418139] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study conducted in 2014 was to describe the prevalence of pressure ulcers in different types of French hospital unit at the national level to compare them with data from the 1994 and 2004 study. METHODS This cross-sectional study was conducted over a single day. All care units were invited to participate by drawing lots stratified by region in successive waves until 1,200 agreements were obtained. Lots were drawn for towns with more than 10,000 inhabitants. All public- and private-sector hospital facilities in each town drawn by lot were invited to participate in the survey. RESULTS 776 hospital services throughout France took part and accommodated 21,538 patients: 12,752 women (59.2%) and 8,786 men (40.8%). Of these patients, 1,753 (8.1%; IC95% = 7.7; 8.5) had pressure ulcers. The pressure-ulcer rate was 7.8% (IC95% = [7.3; 8.3] (n = 997)) for hospitalized women and 8.6% (IC95% = [8.0; 9.2] (n = 756)) for men (p = 0.0381). The 8.1% level reported in 2014 therefore points to a reduction in pressure-ulcer prevalence; 8.6% in 1994 and 8.9% in 2004. CONCLUSIONS The actions performed daily by healthcare professionals to prevent pressure ulcers, supported by research and training programs, including those by PERSE, are having a real impact over time.
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Affiliation(s)
- Brigitte Barrois
- a Département Qualité , Centre Hospitalier de Gonesse , Gonesse , France
| | - Denis Colin
- b Médecine Physique , Centre de l'Arche , Saint-Saturnin , France
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Park JU, Song EH, Jeong SH, Song J, Kim HE, Kim S. Chitosan-Based Dressing Materials for Problematic Wound Management. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1077:527-537. [DOI: 10.1007/978-981-13-0947-2_28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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30
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Levine JM. Skin Failure: An Emerging Concept. J Am Med Dir Assoc 2016; 17:666-9. [DOI: 10.1016/j.jamda.2016.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/20/2016] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
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