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Yu G, Sun C, Hao S, Wu H. Comparative analysis of pressure ulcer development in stroke patients within and outside healthcare facilities: A systematic review and meta-analysis. Int Wound J 2024; 21:e14840. [PMID: 38556516 PMCID: PMC10982073 DOI: 10.1111/iwj.14840] [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: 02/05/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
The risk of pressure ulcers in stroke patients is a significant concern, impacting their recovery and quality of life. This systematic review and meta-analysis investigate the prevalence and risk factors of pressure ulcers in stroke patients, comparing those in healthcare facilities with those in home-based or non-clinical environments. The study aims to elucidate how different care settings affect the development of pressure ulcers, serving as a crucial indicator of patient care quality and management across diverse healthcare contexts. Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Embase, Web of Science and the Cochrane Library. Inclusion criteria encompassed studies on stroke patients in various settings, reporting on the incidence or prevalence of pressure ulcers. Exclusion criteria included non-stroke patients, non-original research and studies with incomplete data. The Newcastle-Ottawa scale was used for quality assessment, and statistical analyses involved both fixed-effect and random-effects models, depending on the heterogeneity observed. A total of 1542 articles were initially identified, with 11 studies meeting the inclusion criteria. The studies exhibited significant heterogeneity, necessitating the use of a random-effects model. The pooled prevalence of pressure injuries was 9.53% in patients without family medical services and 2.64% in patients with medical services. Sensitivity analysis confirmed the stability of these results, and no significant publication bias was detected through funnel plot analysis and Egger's linear regression test. The meta-analysis underscores the heightened risk of pressure injuries in stroke patients, especially post-discharge. It calls for concerted efforts among healthcare providers, policymakers and caregivers to implement targeted strategies tailored to the specific needs of different care environments. Future research should focus on developing and evaluating interventions to effectively integrate into routine care and reduce the incidence of pressure injuries in stroke patients.
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Affiliation(s)
- Guifen Yu
- Department of NeurologyThe Second People's Hospital of LinhaiLinhaiChina
| | - Changqing Sun
- Department of NeurosurgeryBaodi Hospital Affiliated To Tianjin Medical UniversityTianjinChina
| | - Sha Hao
- Department of OncologyJingmen Hospital of Traditional Chinese MedicineJingmenChina
| | - Hui Wu
- Department of NeurologyThe Second People's Hospital of YuhuanYuhuanChina
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L Cortés O, M Vásquez S. Patient Repositioning during Hospitalization and Prevention of Pressure Ulcers: a Narrative Review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e07. [PMID: 39083819 PMCID: PMC11290892 DOI: 10.17533/udea.iee.v42n1e07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/14/2024] [Indexed: 08/02/2024]
Abstract
Objective This article presents a literature review to explore and analyze the current situation of pressure ulcers or lesions or decubitus ulcers, pathophysiological, epidemiological aspects, and risk factors. The progress in evidence of the effectiveness of preventive repositioning in the appearance of these lesions in vulnerable hospitalized patients is also evaluated. Methods Databases were reviewed in non-systematic manner, including the Cochrane Wounds Specialized Register; Medline, Scopus, PubMed, the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); EMBASE (Ovid), Web of Science, SciELO, and Lilacs. The general search terms included [pressure ulcers or pressure lesions or decubitus ulcers] and [prevention or preventive] and [repositioning or positioning or position changes or postural change] and [patient at risk or vulnerable] and [hospitalized or ICU or intensive care]. Systematic literature reviews, randomized clinical trials, observational studies, cost-effectiveness and qualitative studies in English or Spanish were included. Results Although globally, the incidence, prevalence, and years of disability associated to these lesions has diminished between 1990 and 2019, the high impact on health persists. Evidence found on the effectiveness of repositioning in preventing pressure ulcers and health associated costs has been evaluated with certainty between low and very low, as a result of conducting research with serious methodological limitations that report results with high inaccuracy. Conclusion The findings reported present that these lesions persist at hospital level and continue being a global social and health problem with high impact on health budgets. Likewise, there is a need to develop greater quality research on prevention strategies, such as repositioning, which validate their effectiveness, and justify their use.
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Affiliation(s)
- Olga L Cortés
- Nurse, PhD. Associate researcher, Department of Research and Nursing. Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
| | - Skarlet M Vásquez
- Nurse, Master's. Associate professor, Nursing Program, Universidad Autónoma de Bucaramanga, Floridablanca, Colombia.
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Xiao Y, Liu T, Meng C, Jiao ZA, Meng F, Guo S. [Modeling and comfort analysis of arrayed air cushion mattress for pressure ulcer prevention and assisted repositioning]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2024; 41:160-167. [PMID: 38403617 PMCID: PMC10894743 DOI: 10.7507/1001-5515.202305016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Assisting immobile individuals with regular repositioning to adjust pressure distribution on key prominences such as the back and buttocks is the most effective measure for preventing pressure ulcers. However, compared to active self-repositioning, passive assisted repositioning results in distinct variations in force distribution on different body parts. This incongruity can affect the comfort of repositioning and potentially lead to a risk of secondary injury, for certain trauma or critically ill patients. Therefore, it is of considerable practical importance to study the passive turning comfort and the optimal turning strategy. Initially, in this study, the load-bearing characteristics of various joints during passive repositioning were examined, and a wedge-shaped airbag configuration was proposed. The airbags coupled layout on the mattress was equivalently represented as a spring-damping system, with essential model parameters determined using experimental techniques. Subsequently, different assisted repositioning strategies were devised by adjusting force application positions and sequences. A human-mattress force-coupled simulation model was developed based on rigid human body structure and equivalent flexible springs. This model provided the force distribution across the primary pressure points on the human body. Finally, assisted repositioning experiments were conducted with 15 participants. The passive repositioning effectiveness and pressure redistribution was validated based on the simulation results, experimental data, and questionnaire responses. Furthermore, the mechanical factors influencing comfort during passive assisted repositioning were elucidated, providing a theoretical foundation for subsequent mattress design and optimization of repositioning strategies.
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Affiliation(s)
- Yunxuan Xiao
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Hebei University of Technology, Tianjin 300401, P. R. China
- State Key Lab of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300401, P. R. China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, P. R. China
| | - Teng Liu
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Hebei University of Technology, Tianjin 300401, P. R. China
- State Key Lab of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300401, P. R. China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, P. R. China
| | - Chuizhou Meng
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Hebei University of Technology, Tianjin 300401, P. R. China
- State Key Lab of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300401, P. R. China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, P. R. China
| | - Zi' Ang Jiao
- School of Electrical Engineering, Hebei University of Technology, Tianjin 300130, P. R. China
| | - Fanchao Meng
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Hebei University of Technology, Tianjin 300401, P. R. China
- State Key Lab of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300401, P. R. China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, P. R. China
| | - Shijie Guo
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Hebei University of Technology, Tianjin 300401, P. R. China
- State Key Lab of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300401, P. R. China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, P. R. China
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Ramalho ADO, Santiago LM, Meira L, Marin A, de Oliveira LB, Püschel VADA. Pressure injury prevention in adult critically ill patients: best practice implementation project. JBI Evid Implement 2023; 21:218-228. [PMID: 36374975 DOI: 10.1097/xeb.0000000000000352] [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: 11/15/2022]
Abstract
OBJECTIVE This study assessed compliance with the best practices for pressure injury prevention among ICU patients at a tertiary hospital in São Paulo, Brazil. INTRODUCTION Intensive care patients are at high risk of developing a pressure injury; preventing this requires a best practice protocol. METHOD This best practice implementation project was conducted in a Brazilian tertiary hospital in three phases following the JBI Model of Evidence-based Healthcare. Ten criteria derived from the best available evidence were audited and monitored before and after best practice implementation. RESULTS The baseline and follow-up audits evaluated 28 patients at each step. A total of 448 h of care were analyzed using a monitoring camera and medical records. Compliance with all 10 audited criteria increased, with a 50% reduction in the prevalence of pressure injuries in intensive care. Of the 223 employees, 71% claimed to have some knowledge of pressure injury prevention, and 66% reported adequate adherence to prevention protocols. CONCLUSION The audit and feedback strategy improved compliance with the criteria. Future audits are needed to promote the sustainability of evidence-based practice.
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Affiliation(s)
- Aline de Oliveira Ramalho
- Sociedade Beneficente de Senhoras Hospital Sírio-Libanês
- School of Nursing, University of São Paulo (EEUSP)
| | | | - Luciana Meira
- Sociedade Beneficente de Senhoras Hospital Sírio-Libanês
| | | | | | - Vilanice Alves de Araújo Püschel
- School of Nursing, University of São Paulo (EEUSP)
- Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence (JBI Brazil), São Paulo, Brazil
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Xiao Y, Liu T, Meng C, Jiao Z, Meng F, Guo S. Numerical simulation modeling and kinematic analysis onto double wedge-shaped airbag of nursing appliance. Sci Rep 2023; 13:14261. [PMID: 37653334 PMCID: PMC10471570 DOI: 10.1038/s41598-023-41619-y] [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: 05/13/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
In previous studies, the numerical modeling and analyzing methods onto industrial or vehicle airbags dynamics were revealed to have high accuracy regarding their actual dynamic properties, but there are scarcely airbag stiffness modeling and comfortableness investigations of nursing cushion or mattress airbags. This study constructs a numerical model illustrating the association between the stiffness property and the internal gas mass of the wedge-shaped airbag of nursing appliance, and then the airbag stiffness variation discipline is described based on various inflation volumes. To start with, based on an averaged pressure prerequisite, a dynamic simulation model of the wedge-shaped airbag is established by the fluid cavity approach. For this modeling, the elastic mechanical behaviors of airbag material are determined according to a material constitutive model built by the quasi-static uniaxial tensile test. Besides, verification experiments clarify that the presented modeling method is accurate for airbag stiffness behavior prediction, and then can be effectively applied into design and optimization phases of wedge-shaped airbags. Ultimately, based on the simulation and experimental results, it is found that the wedge-shaped airbag stiffness exhibits a three stages characteristic evolution with the gas mass increase. Then the mathematical relationship between the airbag stiffness and gas mass is obtained by numerical fitting, which provides a vital basis for structural optimization and differentiated control of nursing equipment airbags.
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Affiliation(s)
- Yunxuan Xiao
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Tianjin, 300401, China
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Jointly Established By Hebei University of Technology and the Provincial Ministry, Tianjin, 300401, China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300401, China
| | - Teng Liu
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Tianjin, 300401, China.
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Jointly Established By Hebei University of Technology and the Provincial Ministry, Tianjin, 300401, China.
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300401, China.
| | - Chuizhou Meng
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Tianjin, 300401, China
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Jointly Established By Hebei University of Technology and the Provincial Ministry, Tianjin, 300401, China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300401, China
| | - Zi'ang Jiao
- School of Electrical Engineering, Hebei University of Technology, Tianjin, 300130, China
| | - Fanchao Meng
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Tianjin, 300401, China
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Jointly Established By Hebei University of Technology and the Provincial Ministry, Tianjin, 300401, China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300401, China
| | - Shijie Guo
- Engineering Research Centre of the Ministry of Education for Intelligent Rehabilitation Devices and Testing Technology, Tianjin, 300401, China
- State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Jointly Established By Hebei University of Technology and the Provincial Ministry, Tianjin, 300401, China
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, 300401, China
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Chegini Z, Kolawole IO, Behforoz A. The effects of educational intervention on patient participation in pressure injury prevention: a pilot study. J Wound Care 2023; 32:S10-S17. [PMID: 37300865 DOI: 10.12968/jowc.2023.32.sup6.s10] [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: 06/12/2023]
Abstract
OBJECTIVE Patients' roles in reducing pressure injuries (PIs) are emphasised in clinical guidelines, although patients' preferences are undetermined. This study evaluated the effects of a pilot six-month educational intervention on patient participation in PI prevention. METHOD A convenience sampling method was used to select patients admitted to medical-surgical wards at one of the teaching hospitals in Tabriz, Iran. This is a one-group pre-test and post-test interventional study, conducted via quasi-experimental design. Using a pamphlet, patients received education in preventing PIs. Data collected before and after intervention through a questionnaire were analysed using descriptive and inferential statistics (McNemar and paired t-tests) in SPSS software (IBM Corp., US). RESULTS The study cohort consisted of 153 patients. Findings revealed that the knowledge of the patients about PIs, patients' ability to talk with the nurses, information received about PIs, and patients' ability to participate in decisions related to PI prevention had significantly increased following the intervention (p<0.001). CONCLUSION Educating patients can improve their knowledge to enable them to participate in PI prevention. The findings of this study suggests further research is necessary on factors influencing patients' participation in such self-care behaviours.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Ali Behforoz
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Numerical simulation-based loaded inflation height modeling of nursing bed airbag. Med Biol Eng Comput 2022; 60:3231-3242. [DOI: 10.1007/s11517-022-02671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
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Zhang Z, Qu H, Gong W. Multifactor Logistic Analysis to Explore the Risk Factors of Safety Risks in the Transport of Critically Ill Patients with ICU and the Improvement of Nursing Strategies. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3330667. [PMID: 35607648 PMCID: PMC9124074 DOI: 10.1155/2022/3330667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022]
Abstract
Objective Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and the improvement of nursing strategies. Methods Two hundred critical transport patients with ICU treated in our hospital from January 2019 to April 2021 were enrolled. According to the occurrence of unsafe events in transit, the patients were assigned to the control group (165 cases without unsafe events, n = 165) and the study group (35 cases with safety incidents, n = 35). Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and to enhance nursing strategies. Results (1) General data of the subjects: among the 200 critically ill patients with ICU who needed in-hospital transport, the age ranged from 18 to 85 years with an average age of 52.48 ± 3.31, including 89 males and 111 females. There were 35 cases of gastrointestinal bleeding, 16 cases of respiratory failure, 23 cases of heart failure, 43 cases of myocardial infarction, 26 cases of cerebrovascular accident, 14 cases of ectopic pregnancy, 25 cases of severe injury, and 18 cases of mechanical ventilation. There were 35 cases in the study group with accidents and 45 cases in group B without accidents. (2) Among the 200 patients, 35 patients had complications during the transit process in the intermediate people's court, with an incidence rate of 17.5%. It included blood pressure fluctuation (n = 6), artificial airway obstruction (n = 6), decrease in blood oxygen saturation (n = 10), dyspnea (n = 5), fall pain (n = 3), elevated intracranial pressure (n = 2), and other factors (n = 3). There exhibited no significant difference in blood oxygen saturation at each time point during transport (P > 0.05). There exhibited no significant difference in SpO2 before transport. The comparison of 5 min and 10 min blood oxygen saturation during transit in the study group was lower compared to the control group (P < 0.05). (3) In a univariate analysis of safety risks for critically ill ICU patients, home escorts did not show significant differences in hospital transport for critically ill ICU patients (P > 0.05). There were significant differences in terms of age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline (P < 0.05). The results of multivariate logistic regression analysis indicated that age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline were the risk factors affecting the safe transport of critically ill patients (P < 0.05). Conclusion Age, patient's condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline are the independent risk factors that affect the safe transport of emergency or ICU critically ill patients. Therefore, in order to reduce the risk of transshipment, we must enhance the safety awareness of escorts, strengthen the management and training of escorts, promote rules and regulations, and formulate dangerous plans, so as to eliminate the occurrence of unsafe factors.
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Affiliation(s)
- Zhenyu Zhang
- Department of Intensive Care Unit (Eastern), Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Hui Qu
- Department of Intensive Care Unit (Western), Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
| | - Wei Gong
- Department of Cardiac Intensive Care Unit, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
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