Outcomes for Pressure Ulcer Trials (OUTPUTs): protocol for the development of a core domain set for trials evaluating the clinical efficacy or effectiveness of pressure ulcer prevention interventions

Protocol for the Development of the Fourth Edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline Using GRADE Methods

ABSTRACT

The National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and the Pan Pacific Pressure Injury Alliance are commencing a new (fourth) edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline . The fourth edition of the International Pressure Injury (PI) Guideline will be developed using GRADE methods to ensure a rigorous process consistent with evolving international standards. Clinical questions will address prevention and treatment of PIs, identification of individuals at risk of PIs, assessment of skin and tissues, and PI assessment. Implementation considerations supporting application of the guidance in clinical practice will be developed. The guideline development process will be overseen by a guideline governance group and methodologist; the guideline development team will include health professionals, educators, researchers, individuals with or at risk of PIs, and informal carers.This article presents the project structure and processes to be used to undertake a systematic literature search, appraise risk of bias of the evidence, and aggregate research findings. The methods detail how certainty of evidence will be evaluated; presentation of relative benefits, risks, feasibility, acceptability, and resource requirements; and how recommendations will be made and graded. The methods outline transparent processes of development that combine scientific research with best clinical practice. Strong involvement from health professionals, educators, individuals with PIs, and informal carers will enhance the guideline's relevance and facilitate uptake. This update builds on previous editions to ensure consistency and comparability, with methodology changes improving the guideline's quality and clarity.

Thermal changes in the sacral region with different mattresses used in the prevention of pressure injuries

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.

Using consensus methods to prioritize modifiable risk factors for development of manifestations of frailty in hospitalized older adults

AIM

The aim of the study was to reach consensus on modifiable risk factors for a novel system of care to address Manifestations of Frailty in hospitalized older adults.

DESIGN

Consensus study.

METHOD

A modified nominal group technique, incorporating expert group face-to-face interaction, review of existing evidence and pre/post-meeting questionnaire completion was undertaken November 2019-February 2020.

RESULTS

Seventy-one risk factors, within seven risk factor domains (pain, medication, fluid and nutrition intake, mobility, elimination, infection, additional patient factors) were considered. It was agreed that 44 risk factors incorporating patient, organizational and environmental risk factors were modifiable and should be included in a novel system of care.

Core outcomes for pressure ulcer prevention trials: results of an international consensus study

BACKGROUND

There is substantial heterogeneity between trial outcomes in pressure ulcer prevention research. The development of core outcome sets (COS) is one strategy to improve comparability between trial results and thus increase the quality of evidence.

OBJECTIVES

The aim of this study was to identify core outcomes for pressure ulcer prevention trials.

METHODS

A workshop was held with service users to discuss their views and understanding of the outcomes identified by a scoping review and to identify any missing outcomes. In a next step a Delphi survey comprising three rounds was conducted to evaluate a compiled list of outcomes by their importance. Afterwards the preselection from the Delphi survey was discussed in a virtual consensus meeting with the aim of agreeing on a final set of core outcomes. Individuals who had completed all three rounds of the Delphi survey were eligible to participate in this meeting. Participants included practitioners, service users, researchers and industry representatives.

RESULTS

The workshop did not reveal any missing outcomes, but the need for further efforts to make lay people understand what an outcome is in a study setting. The Delphi survey took place between December 2020 and June 2021. After the three rounds, 18 out of 37 presented outcomes were rated to be critically important. In the following consensus meeting six outcomes were prioritized to be included in the COS for pressure ulcer prevention trials: (1) pressure ulcer occurrence, (2) pressure ulcer precursor signs and symptoms, (3) mobility, (4) acceptability and comfort of intervention, (5) adherence/compliance and (6) adverse events/safety.

CONCLUSION

Based on a comprehensive list of outcomes in pressure ulcer prevention research, there was clear agreement on the six identified core outcomes in three international Delphi rounds and in the consensus meeting. Although outcome measurement instruments need to be identified next, the six identified core outcomes should already be considered in future trials, as service users, practitioners, researchers and industry representatives have agreed that they are critically important.

WUWHS 2020 Global Healing Changing Lives, Abu Dhabi, UAE March 8-12

The abstract book contains the abstracts of keynote lectures, global gelebration, focus sessions, symposia, regional view, workshops, sponsored symposia, oral presentations, posters and the index.