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Li X, Tang Y, Deng X, Zhou F, Huang X, Bai Z, Liang X, Wang Y, Lyu J. Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit. Intensive Crit Care Nurs 2024; 84:103749. [PMID: 38896964 DOI: 10.1016/j.iccn.2024.103749] [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: 01/22/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population. METHOD This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients' International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0-2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury. RESULT Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24-2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts. CONCLUSIONS Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis. IMPLICATION FOR CLINICAL PRACTICE The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.
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Affiliation(s)
- Xinya Li
- School of Nursing, Jinan University, Guangzhou, China
| | - Yonglan Tang
- School of Nursing, Jinan University, Guangzhou, China
| | - Xingwen Deng
- Department of Medical Information, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaxuan Huang
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zihong Bai
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xin Liang
- School of Nursing, Jinan University, Guangzhou, China
| | - Yu Wang
- School of Nursing, Jinan University, Guangzhou, China; Community Health Service Center of Jinan University, Guangzhou, China; Department of School Clinic, the First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Jun Lyu
- Department of Clinical Research, the First Affiliated Hospital of Jinan University, Guangzhou, China.
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Liu Q, Wang F, Tan L, Liu L, Hu X. Art therapies and cognitive function in elderly with subjective cognitive decline: a protocol for a network meta-analysis. BMJ Open 2024; 14:e079146. [PMID: 38643016 PMCID: PMC11033635 DOI: 10.1136/bmjopen-2023-079146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/18/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Subjective cognitive decline means a decline in the subjective perception of self-cognitive function, which is likely to evolve into mild cognitive impairment and dementia. The number of elderly with subjective cognitive decline has increased, bringing huge burdens and challenges to caregivers and society. With the increase in research on art therapies, some of them have gradually been proven to be effective for cognitive function. Therefore, this study aims to summarise the evidence and identify the best art therapy for elderly with subjective cognitive decline. METHODS AND ANALYSIS We will include published randomised controlled trials written in English and Chinese if the intervention is one of the art therapies and applied in people aged 60 and above with subjective cognitive decline. Eight electronic databases, including the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Elsevier, China BioMedical Literature Database, China National Knowledge Infrastructure, VIP Database and Wanfang Database, will be searched from January 2013 to December 2023. Art therapies will mainly include music therapy, reminiscence therapy, painting therapy, dance therapy, reading therapy, horticultural therapy, museum therapy, calligraphy therapy and so on. The outcome will be cognitive function. Study selection, data extraction and quality assessment will be performed by two reviewers. The risk of bias will be evaluated according to the Cochrane Collaboration's risk-of-bias tool, and the evidence quality will be assessed with the Grading of Recommendations Assessment, Development and Evaluation. Standard pairwise meta-analysis and Bayesian network meta-analysis will be conducted. The probabilities of each art therapy will be ranked based on the surface under the cumulative ranking curve. ETHICS AND DISSEMINATION Ethical approval is not required for reviewing published studies. To provide important evidence for clinicians and guideline developers, the findings of this study will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023443773.
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Affiliation(s)
- Qian Liu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Fang Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Lixia Tan
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Li Liu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Itakura DA, Nakato AM, Hembecker PK, Neves EB, Nohama P. Thermal changes in the sacral region with different mattresses used in the prevention of pressure injuries. J Therm Biol 2022; 110:103366. [PMID: 36462883 DOI: 10.1016/j.jtherbio.2022.103366] [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: 06/15/2021] [Revised: 08/01/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pressure Injury (PI) is a severe health problem that affects millions of people. As a preventive strategy for high-risk ICU patients, the appropriate selection of a support surface is essential for preventing PI, along with risk assessment and repositioning. Increasing skin temperature has been associated with a higher susceptibility to PI development. OBJECTIVE This study aimed to evaluate thermal variations related to skin pressure in the sacral area of healthy individuals lying on three different mattresses models (standard, inflatable air, and egg crate). DESIGN Experimental study. MAIN OUTCOMES Initially, a survey was performed to identify the mattresses models most used in four public university hospitals and preventive strategies adopted. And then, an experimental study was conducted with a non-probabilistic sample involving 28 individuals of both sexes, aged 18-35 years old. The volunteers were immobilized for 2 h, and temperature variations in the sacral region were obtained by acquiring thermal images. RESULTS A significant difference was not found in the temperature recorded on the three mattresses models before the experiment. However, there were significant differences at the 1st and 31st minute (p < 0.001). The lowest temperature values were identified in the air inflatable mattress. Post-hoc comparisons revealed a significant difference between standard or egg crate mattresses and the inflatable air model. CONCLUSION The inflatable air mattress should be considered for preventing pressure injury in ICU patients since the temperature had returned to the initial value (pre-test) after the 31st min. In addition to the appropriate selection surface, risk assessment and positioning are essential to PI prevention strategies.
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Affiliation(s)
- Daniela Akemi Itakura
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
| | - Adriane Muller Nakato
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
| | - Paula Karina Hembecker
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Universidade Tecnológica Federal do Paraná (UTFPR), Brazil.
| | - Percy Nohama
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná (PUCPR), Brazil.
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Ding L, Ding S, He C, Zhang Q, An J. The efficacy of continuing nursing interventions on intraoperative pressure ulcer-related complications in breast cancer patients: systematic review and meta-analysis. Gland Surg 2022; 11:1078-1085. [PMID: 35800736 PMCID: PMC9253194 DOI: 10.21037/gs-22-258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/27/2022] [Indexed: 06/19/2024]
Abstract
BACKGROUND This study systematically reviewed the effects of continuous nursing intervention on intraoperative pressure ulcers (PUs) and related complications in breast cancer patients. The effectiveness of continuous nursing intervention for intraoperative pressure ulcers related complications in breast cancer patients is highly controversial. Therefore, it is necessary to systematically review and address this issue by means of meta-analysis. METHODS By searching the Cochrane Library, PubMed, Web of Science, Embase, and Chinese Biomedical Literature Database (CBM) were screened. Quality evaluation and data extraction were performed for the included studies, and meta-analysis was performed for the included RCTs using Review Manager 5.2 software. Literature was included in strict compliance with the PICOS principle, and bias risk was analyzed by t-test and funnel plot. RESULTS A total of 1,431 patients were enrolled in 9 studies, and meta-analysis showed that there was a significant statistical difference between the experimental group and the control group in the incidence of PUs [odds ratio (OR) =0.18, 95% confidence interval (95% CI): 0.13-0.24, P<0.00001], the Braden pressure ulcer risk score after nursing [mean difference (MD) =2.64, 95% CI: 1.47-3.81, P<0.0001], and the quality of life after nursing (MD =9.76, 95% CI: 6.82-12.69, P<0.00001). DISCUSSION Continuous care can reduce the incidence of PUs in patients with advanced breast cancer, reduce the severity of wounds in the healing process of PUs, and improve the knowledge of PUs in patients with advanced breast cancer risk.
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Affiliation(s)
- Lin Ding
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Shuang Ding
- Department of Nuclear Medicine, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Chunmei He
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Qifa Zhang
- Comprehensive Neurological Ward, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jingjing An
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Abstract
The objective of this educational article is to explain in non-technical terms how the engineering considerations in the design of prophylactic dressings for pressure ulcer (PU, also known as pressure injury) prevention eventually determine the associated clinical and cost-benefit outcomes. The article specifically describes a bioengineering algorithm for quantitative evaluation of the biomechanical efficacy of different prophylactic dressing designs, which is exemplified for two fundamentally different dressing technologies, one based on superabsorbent cellulose core versus the conventional silicone-foam dressing design. A set of three biomechanical indices is described and employed for the above comparative evaluation, namely, the protective efficacy index, the protective endurance and the prophylactic trade-off design parameter. It is demonstrated that the dressing with the superabsorbent cellulose core is at least as good as silicone-foams but, importantly, provides a good balance between its protective performance in its ‘new’ condition, as opposed to its ‘used’ condition, i.e., after being exposed to moisture. Most notably, we show that preventative dressings are never equal in their performances; the underlying structure and the dressing ingredients together determine the extent of the delivered tissue protection and its durability.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University Tel Aviv 6997801, Israel
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Baracho VDS, Chaves MEDA, Lucas TC. Application of the educational method of realistic simulation in the treatment of pressure injuries. Rev Lat Am Enfermagem 2020; 28:e3357. [PMID: 32901770 PMCID: PMC7478887 DOI: 10.1590/1518-8345.3946.3357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/04/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate the use of realistic simulation as a strategy to promote teaching about pressure injuries. METHOD This is a quasi-experimental study. A modified and translated version of the Pieper Pressure Ulcer knowledge test was applied. Kappa statistical analysis was used to assess the professionals' knowledge in the realistic simulation using the SPSS software. A p-value <0.05 was considered significant. RESULTS Seventy-seven nursing professionals participated in the realistic simulation, the majority (72.7%) being nursing technicians. Regarding the knowledge of primary and secondary coverage techniques, the Kappa index went from 0.56 (p=0.002) in the pre-test to 0.87 (p=0.001) in the post-test. As for the sterile dressing technique, there was a variation from 0.55 (p=0.002) in the pre-test to 0.91 (p=0.001) in the post-test. Regarding the cleaning of pressure injuries, there was a variation from 0.81 (CI: 0.62-0.84) in the pre-test to 0.91 (0.85-0.97) in the post-test. The knowledge about the use of a sterile spatula to distribute the dressing in the wound increased from an agreement index from regular to good. CONCLUSION The introduction of the realistic simulation in the clinical practice has created quality assessment indicators for the prevention and treatment of pressure injuries.
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Affiliation(s)
- Valéria da Silva Baracho
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Diamantina, MG, Brazil
| | | | - Thabata Coaglio Lucas
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Diamantina, MG, Brazil
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El Genedy M, Hahnel E, Tomova-Simitchieva T, Padula WV, Hauß A, Löber N, Blume-Peytavi U, Kottner J. Cost-effectiveness of multi-layered silicone foam dressings for prevention of sacral and heel pressure ulcers in high-risk intensive care unit patients: An economic analysis of a randomised controlled trial. Int Wound J 2020; 17:1291-1299. [PMID: 32391627 PMCID: PMC7948587 DOI: 10.1111/iwj.13390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Pressure ulcer incidence is high in intensive care units. This causes a serious financial burden to healthcare systems. We evaluated the cost‐effectiveness of multi‐layered silicone foam dressings for prevention of sacral and heel pressure ulcers in addition to standard prevention in high‐risk intensive care units patients. A randomised controlled trial to assess the efficacy of multi‐layered silicone foam dressings to prevent the development of pressure ulcers on heels and sacrum among 422 intensive care unit patients was conducted. Direct costs for preventive dressings in the intervention group and costs for treatment of incident pressure ulcers in both groups were measured using a bottom‐up approach. A cost‐effectiveness analysis by calculating the incremental cost‐effectiveness ratio using different assumptions was performed. Additional dressing and labour costs of €150.81 (€116.45 heels; €34.36 sacrum) per patient occurred in the intervention group. Treatment costs were €569.49 in the control group and €134.88 in the intervention group. The incremental cost‐effectiveness ratio was €1945.30 per PU avoided (€8144.72 on heels; €701.54 sacrum) in the intervention group. We conclude that application of preventive dressings is cost‐effective for the sacral area, but only marginal on heels for critically ill patients.
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Affiliation(s)
- Monira El Genedy
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Hahnel
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tsenka Tomova-Simitchieva
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, California, USA.,The Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Armin Hauß
- Nursing Science, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nils Löber
- Department of Clinical Quality and Risk Management, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Kottner
- Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Public Health and Primary Care, Skin Integrity Research Group (SKINT), Ghent University, University Centre for Nursing and Midwifery, Ghent, Belgium
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