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Haesler E, Cuddigan J, Carville K, Moore Z, Kottner J, Ayello EA, Berlowitz D, Carruth A, Yee CY, Cox J, Creehan S, Nixon J, Ngan HL, Balzer K. Protocol for the Development of the Fourth Edition of the Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline Using GRADE Methods. Adv Skin Wound Care 2024; 37:136-146. [PMID: 37929973 DOI: 10.1097/asw.0000000000000079] [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: 11/07/2023]
Abstract
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.
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Affiliation(s)
- Emily Haesler
- Emily Haesler, PhD, BN, PGDip Adv Nurs (Gerontics), is Adjunct Professor, Curtin University, Perth, Australia, and Adjunct Associate Professor, La Trobe University, Melbourne, Victoria. Janet Cuddigan, PhD, RN, FAAN, is Professor, University of Nebraska Medical Center, Omaha, Nebraska, United States. Also at Curtin University, Keryln Carville, PhD, RN, STN (Cred), is Professor, Primary Health Care and Community. Zena Moore, PhD, is Chair in Nursing, Head of the School of Nursing & Midwifery, and Director of the Skin Wounds and Trauma Research Centre, Research College of Surgeons in Ireland, Dublin, Ireland. Jan Kottner, PhD, is Professor of Nursing Science, Charité-Universitäts Medizin Berlin, Germany. Elizabeth A. Ayello, PhD, RN, CWON, FAAN, is Faculty Emeritus, Excelsior University School of Nursing, Albany, New York and President, Ayello Harris & Associates, Inc, Copake, New York. Dan Berlowitz, MD, MPH, is Professor, University of Massachusetts Lowell. Althea Carruth, PhD, MBA, BSc (Hons), DPM, is Principle Podiatrist, Lake Dunstan Podiatry, Cromwell, Otago, New Zealand. Chang Yee Yee, WOCN, is Nurse Clinician, Dover Park Hospice, Singapore. Jill Cox, PhD, RN, APN-c, CWOCN, FAAN, is Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey, and Wound, Ostomy, and Continence Advanced Practice Nurse, Englewood Health, Englewood, New Jersey. Sue Creehan, MSN, RN, CWON, is Independent Wound Nurse Consultant, Midlothian, Virginia. Jane Nixon, MBE, PhD, MA, RGN, is Professor of Tissue Viability and Clinical Trials Research, University of Leeds, West Yorkshire, England. Hau Lan Ngan, MN, RN, ET, CLT, is Nurse Consultant, Stoma and Wound Care, Kowloon East Cluster, Hospital Authority, Hong Kong. Katrin Balzer, PhD, is Full Professor, Evidence-based Nursing, and Head of Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Germany. Acknowledgments: Development of this protocol and the guideline work are supported by the National Pressure Injury Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance. The authors have disclosed no other financial relationships related to this article. Submitted July 31, 2023; accepted in revised form October 6, 2023
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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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Coleman S, Wray F, Hudson K, Forster A, Conroy S, Tremyl J, Shenkin SD, Nixon J, Fader M, Goodwin VA, Woods D, Crossland S, Holt R, Mcgregor L, Maud R, Wyrko Z, Lamb S, Teale E. Using consensus methods to prioritize modifiable risk factors for development of manifestations of frailty in hospitalized older adults. Nurs Open 2022; 10:1016-1028. [PMID: 36161707 PMCID: PMC9834546 DOI: 10.1002/nop2.1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/30/2022] [Accepted: 08/30/2022] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
- Susanne Coleman
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK,Academic Unit for Ageing and Stroke Research, Bradford Institute for Health ResearchBradford Teaching Hospitals NHS Foundation TrustBradfordUK
| | - Kristian Hudson
- The Improvement AcademyBradford Institute for Health ResearchBradfordUK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health ResearchBradford Teaching Hospitals NHS Foundation TrustBradfordUK,Department of Stroke Rehabilitation, Academic Unit for Ageing and Stroke Research, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Simon Conroy
- Central and North West London NHS Foundation TrustLondonUK
| | | | - Susan D. Shenkin
- Geriatric Medicine, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jane Nixon
- Tissue Viability and Clinical Trials ResearchLeeds Institute Health SciencesLeedsUK
| | - Mandy Fader
- Department of Continence TechnologyUniversity of SouthamptonSouthamptonUK
| | | | | | | | - Rachel Holt
- Mid Yorkshire Hospitals NHS TrustWakefieldUK
| | - Louise Mcgregor
- St Georges University Hospitals NHS Foundation TrustLondonUK
| | | | | | - Sarah E. Lamb
- Medical School Building (F.02), St Lukes CampusExeterUK
| | - Elizabeth Teale
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health ResearchBradford Teaching Hospitals NHS Foundation TrustBradfordUK,Geriatric Medicine, Academic Unit for Ageing and Stroke Research, Leeds Institute of Health SciencesUniversity of LeedLeedsUK
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Lechner A, Coleman S, Balzer K, Kirkham JJ, Muir D, Nixon J, Kottner J. Core outcomes for pressure ulcer prevention trials: results of an international consensus study. Br J Dermatol 2022; 187:743-752. [PMID: 35789479 DOI: 10.1111/bjd.21741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Anna Lechner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Berlin, Germany
| | - Susanne Coleman
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Katrin Balzer
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK.,Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Jamie J Kirkham
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Delia Muir
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Jane Nixon
- Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Jan Kottner
- Institute of Clinical Nursing Science, Berlin, Germany
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Lechner A, Rancan F, Hadam S, Vogt A, Blume‐Peytavi U, Kottner J. Comparing the effects of three different multilayer dressings for pressure ulcer prevention on sacral skin after prolonged loading: An exploratory crossover trial. Wound Repair Regen 2020; 29:270-279. [DOI: 10.1111/wrr.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Anna Lechner
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Fiorenza Rancan
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Sabrina Hadam
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Annika Vogt
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology, Venereology and Allergy, Clinical Research Center for Hair and Skin Science Charité – Universitätsmedizin Berlin Berlin Germany
| | - Jan Kottner
- Charité Center Health and Human Sciences Charité – Universitätsmedizin Berlin Berlin Germany
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Lechner A, Kottner J, Coleman S, Muir D, Beeckman D, Chaboyer W, Cuddigan J, Moore Z, Rutherford C, Schmitt J, Nixon J, Balzer K. Outcomes for Pressure Ulcer Trials (OUTPUTs) project: review and classification of outcomes reported in pressure ulcer prevention research. Br J Dermatol 2020; 184:617-626. [DOI: 10.1111/bjd.19304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- A. Lechner
- Charité – Universitätsmedizin Berlin Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Berlin Germany
| | - J. Kottner
- Charité – Universitätsmedizin Berlin Department of Dermatology and Allergy Clinical Research Center for Hair and Skin Science Berlin Germany
- University Centre for Nursing and Midwifery Ghent University Ghent Belgium
| | - S. Coleman
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
| | - D. Muir
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
| | - D. Beeckman
- University Centre for Nursing and Midwifery Ghent University Ghent Belgium
- School of Health Sciences, Nursing and Midwifery University of Surrey Guildford UK
- School of Nursing and Midwifery Royal College of Surgeons in Ireland Faculty of Medicine and Health Sciences Dublin Ireland
- School of Health Sciences Örebro University Örebro Sweden
| | - W. Chaboyer
- School of Nursing and Midwifery Menzies Health Institute Queensland Griffith University and Gold Coast Hospital and Health Service Southport QLD Australia
| | - J. Cuddigan
- University of Nebraska Medical Center College of Nursing Omaha NE USA
| | - Z. Moore
- Royal College of Surgeons in Ireland Dublin Ireland
- Monash University Melbourne VIC Australia
- Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
- Lida Institute Shanghai China
- Cardiff University Cardiff UK
| | - C. Rutherford
- Faculty of Science Quality of Life Office School of Psychology University of Sydney Sydney NSW Australia
- Faculty of Medicine and Health Susan Wakil School of Nursing and Midwifery Cancer Nursing Research Unit (CNRU) University of Sydney Sydney NSW Australia
| | - J. Schmitt
- Centre for Evidence‐based Healthcare Medical Faculty Carl Gustav Carus Technical University Dresden Dresden Germany
| | - J. Nixon
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
| | - K. Balzer
- Institute of Clinical Trials Research Clinical Trials Research Unit University of Leeds Leeds UK
- Institute for Social Medicine and Epidemiology Nursing Research Unit University of Lübeck Lübeck Germany
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