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Kudelka J, Ollenschläger M, Dodel R, Eskofier BM, Hobert MA, Jahn K, Klucken J, Labeit B, Polidori MC, Prell T, Warnecke T, von Arnim CAF, Maetzler W, Jacobs AH. Which Comprehensive Geriatric Assessment (CGA) instruments are currently used in Germany: a survey. BMC Geriatr 2024; 24:347. [PMID: 38627620 PMCID: PMC11022468 DOI: 10.1186/s12877-024-04913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Comprehensive Geriatric Assessment (CGA) records geriatric syndromes in a standardized manner, allowing individualized treatment tailored to the patient's needs and resources. Its use has shown a beneficial effect on the functional outcome and survival of geriatric patients. A recently published German S1 guideline for level 2 CGA provides recommendations for the use of a broad variety of different assessment instruments for each geriatric syndrome. However, the actual use of assessment instruments in routine geriatric clinical practice and its consistency with the guideline and the current state of literature has not been investigated to date. METHODS An online survey was developed by an expert group of geriatricians and sent to all licenced geriatricians (n = 569) within Germany. The survey included the following geriatric syndromes: motor function and self-help capability, cognition, depression, pain, dysphagia and nutrition, social status and comorbidity, pressure ulcers, language and speech, delirium, and frailty. Respondents were asked to report which geriatric assessment instruments are used to assess the respective syndromes. RESULTS A total of 122 clinicians participated in the survey (response rate: 21%); after data cleaning, 76 data sets remained for analysis. All participants regularly used assessment instruments in the following categories: motor function, self-help capability, cognition, depression, and pain. The most frequently used instruments in these categories were the Timed Up and Go (TUG), the Barthel Index (BI), the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Visual Analogue Scale (VAS). Limited or heterogenous assessments are used in the following categories: delirium, frailty and social status. CONCLUSIONS Our results show that the assessment of motor function, self-help capability, cognition, depression, pain, and dysphagia and nutrition is consistent with the recommendations of the S1 guideline for level 2 CGA. Instruments recommended for more frequent use include the Short Physical Performance Battery (SPPB), the Montreal Cognitive Assessment (MoCA), and the WHO-5 (depression). There is a particular need for standardized assessment of delirium, frailty and social status. The harmonization of assessment instruments throughout geriatric departments shall enable more effective treatment and prevention of age-related diseases and syndromes.
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Affiliation(s)
- Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany
| | - Malte Ollenschläger
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Richard Dodel
- Chair of Geriatric Medicine, University Duisburg-Essen, Essen, Germany
| | - Bjoern M Eskofier
- Department of Artificial Intelligence in Biomedical Engineering (AIBE), Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany
| | - Klaus Jahn
- Schön Klinik Bad Aibling, Neurology and Geriatrics, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University (LMU) of Munich, Munich, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg
- Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Bendix Labeit
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the University of Muenster, Osnabrueck, Germany
| | | | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany.
| | - Andreas H Jacobs
- Department of Geriatrics & Neurology, Johanniter Hospital Bonn, Johanniter Strasse 1-3, Bonn, 53113, Germany.
- Centre for Integrated Oncology (CIO) of the University of Bonn, Bonn, Germany.
- European Institute for Molecular Imaging (EIMI) of the Westfälische Wilhelms University (WWU), Münster, Germany.
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Zuniga J, Mungai M, Chism L, Frost L, Kakkar R, Kyololo O. Pressure ulcer prevention and treatment interventions in Sub-Saharan Africa: A systematic review. Nurs Outlook 2024; 72:102151. [PMID: 38490058 DOI: 10.1016/j.outlook.2024.102151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The high burden of pressure ulcers (PUs) in Sub-Saharan Africa (SSA), coupled with the limited resources, underscores the need for preventive and context-specific treatment strategies. PURPOSE Therefore, the purpose of this systematic review was to establish and elucidate PU prevention and treatment interventions tested in SSA. METHODS This systematic review of the literature used, PRISMA to guide the search. FINDINGS The review identified nine studies on PU prevention (three) and treatment (six). Low-cost interventions assembled from locally available materials and multifaceted policies significantly prevented and treated PUs. The interventions included wound dressing agents, simple negative pressure suction devices that significantly treated PUs, and water-based bed surfaces. DISCUSSION There were gaps in the interventions that have been proven successful in other global settings. CONCLUSION In SSA, there is a need for nurses to tailor, test, and disseminate findings from evidence-based projects for PU prevention that have been successful in similar settings.
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Affiliation(s)
- Julie Zuniga
- School of Nursing, The University of Texas at Austin, Austin, TX
| | | | - Lucy Chism
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Livia Frost
- School of Medicine, Baylor College of Medicine, Houston, TX
| | - Reha Kakkar
- College of Natural Sciences, The University of Texas at Austin, Austin, TX
| | - O'Brien Kyololo
- School of Nursing and Midwifery, Moi University, Eldoret, Kenya
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sepahvand E, Daryabor A, Hosseini RS, Neyseh F. Design and Development of Kardex and Nursing Reports in the Rehabilitation Hospital. SAGE Open Nurs 2023; 9:23779608231153472. [PMID: 36761365 PMCID: PMC9903012 DOI: 10.1177/23779608231153472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 01/08/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction A nursing rehabilitation Kardex and reports could act as a framework to facilitate and organize rehabilitation programs. Objectives This study aimed to design a special Kardex and a structure to rehabilitation nursing reports. Methods This study was carried out in two phases consisting of literature review and Delphi method in Rofideh Rehabilitation Hospital, Tehran, Iran. In the first phase, a diverse literature review was done. PubMed, Elsevier, Web of Science, and Google Scholar as a search engine were searched using the keywords of Kardex, "nursing report," "nursing note," "nursing rehabilitation," "nursing Kardex" from 2010 to 2020. After a literature review, the first draft of the Kardex was made. In the next step, using the Delphi method, the initial Kardex was sent to rehabilitation nursing experts in four rounds, and their comments were applied on that. Results The rehabilitation nursing Kardex was prepared after four rounds. The Kardex content included "Evaluation of nutritional needs," "Requirements for daily living," "Patients' education," "Examination of bedsores," "Fall prevention," and "communication with rehabilitation departments (physiotherapy, occupational therapy, and speech therapy)." Conclusion Rehabilitation Kardex and nursing report sample can be used as a suitable tool to promote patients' independence in rehabilitation centers.
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Affiliation(s)
- Elham Sepahvand
- Department of Nursing, School of Nursing and Midwifery, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran,Elham Sepahvand, Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Neyseh
- Department of Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yakupu A, Aimaier R, Yuan B, Chen B, Cheng J, Zhao Y, Peng Y, Dong J, Lu S. The burden of skin and subcutaneous diseases: findings from the global burden of disease study 2019. Front Public Health 2023; 11:1145513. [PMID: 37139398 PMCID: PMC10149786 DOI: 10.3389/fpubh.2023.1145513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background The small number of existing integrative studies on the global distribution and burden of all types of skin and subcutaneous diseases hinders relevant comparisons. Objective This study aimed to determine the latest distribution, epidemiological differences, and factors potentially influencing each skin and subcutaneous disease and the policy implications. Methods Data on the skin and subcutaneous diseases were obtained from the Global Burden of Disease Study 2019. The incidence, disability-adjusted life years (DALYs), and deaths due to skin and subcutaneous diseases in 204 countries and regions from 1990 to 2019 were analyzed and stratified by sex, age, geographical location, and sociodemographic index (SDI). The annual age-standardized rate of change in the incidence was obtained to evaluate temporal trends. Results Of 4,859,267,654 (95% uncertainty interval [UI], 4,680,693,440-5,060,498,767) new skin and subcutaneous disease cases that were identified, most were fungal (34.0%) and bacterial (23.0%) skin diseases, which accounted for 98,522 (95% UI 75,116-123,949) deaths. The burden of skin and subcutaneous diseases measured in DALYs was 42,883,695.48 (95%UI, 28,626,691.71-63,438,210.22) in 2019, 5.26% of which were years of life lost, and 94.74% of which were years lived with disability. The highest number of new cases and deaths from skin and subcutaneous diseases was in South Asia. Globally, most new cases were in the 0-4-year age group, with skin and subcutaneous disease incidence slightly higher in men than in women. Conclusion Fungal infections are major contributors to skin and subcutaneous diseases worldwide. Low-middle SDI states had the highest burden of skin and subcutaneous diseases, and this burden has increased globally. Targeted and effective management strategies based on the distribution characteristics of each country are, thus, required to reduce the burden of skin and subcutaneous diseases.
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Affiliation(s)
- Aobuliaximu Yakupu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rehanguli Aimaier
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Yuan
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Chen
- Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jia Cheng
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yaohua Zhao
- Department of Burn and Plastic Surgery, Jiangyin Hospital Affiliated to Medical College of Southeast University, Jiangyin, China
| | - Yinbo Peng
- Department of Burns and Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Traumatic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaoyun Dong
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiaoyun Dong
| | - Shuliang Lu
- Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shuliang Lu
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Aquino GA, Sousa CNS, Medeiros IS, Almeida JC, Cysne Filho FMS, Santos Júnior MA, Vasconcelos SMM. Behavioral alterations, brain oxidative stress, and elevated levels of corticosterone associated with a pressure injury model in male mice. J Basic Clin Physiol Pharmacol 2022; 33:789-801. [PMID: 34390639 DOI: 10.1515/jbcpp-2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Sustained stress can cause physiological disruption in crucial systems like the endocrine, autonomic, and central nervous system. In general, skin damages are physical stress present in hospitalized patients. Also, these pressure injuries lead to pathophysiological mechanisms involved in the neurobiology of mood disorders. Here, we aimed to investigate the behavioral alterations, oxidative stress, and corticosterone levels in the brain areas of mice submitted to the model of pressure injury (PI). METHODS The male mice behaviors were assessed in the open field test (OFT), elevated plus maze test (EPM), tail suspension test (TST), and sucrose preference test (SPT). Then, we isolated the prefrontal cortex (PFC), hippocampus (HP), and striatum (ST) by brain dissection. The nonprotein sulfhydryl groups (NP-SH) and malondialdehyde (MDA) were measured in the brain, and also the plasma corticosterone levels were verified. RESULTS PI model decreased the locomotor activity of animals (p<0.05). Considering the EPM test, the PI group showed a decrease in the open arm activity (p<0.01), and an increase in the closed arm activity (p<0.05). PI group showed an increment in the immobility time (p<0.001), and reduced sucrose consumption (p<0.0001) compared to the control groups. Regarding the oxidative/nitrosative profile, all brain areas from the PI group exhibited a reduction in the NP-SH levels (p<0.0001-p<0.01), and an increase in the MDA level (p<0.001-p<0.01). Moreover, the PI male mice presented increased levels of plasma corticosterone (p<0.05). CONCLUSIONS Our findings suggest that the PI model induces depressive and anxiety-like behaviors. Furthermore, it induces pathophysiological mechanisms like the neurobiology of depression.
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Affiliation(s)
- Gabriel A Aquino
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Caren N S Sousa
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Ingridy S Medeiros
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Jamily C Almeida
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Francisco M S Cysne Filho
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Manuel A Santos Júnior
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Silvânia M M Vasconcelos
- Laboratório de Neuropsicofarmacologia, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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Veiga TP, Rêgo AS, Montenegro WS, Ferreira PR, Rocha DS, Felipe IMA, Santos-de-Araújo AD, Mendes RG, Tavarez RRDJ, Bassi-Dibai D. Braden scale has low reliability in different patients under care in intensive care unit. Rev Assoc Med Bras (1992) 2022; 68:1221-1227. [PMID: 36134772 PMCID: PMC9575023 DOI: 10.1590/1806-9282.20220249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the inter-reliability of the Braden scale and its subscales for different patients assisted in the intensive care unit. We hypothesized that the Braden scale has low reliability in different populations. METHODS This reliability study involved the Braden scale in intensive care unit of a hospital. A total of 200 patients were admitted to the intensive care unit in four different groups: neurological patients, sepsis, elderly, and adults affected by trauma. The Braden scale is a tool composed of six subscales for patient assessment: sensory perception, humidity, activity, mobility, nutrition, and friction. The total score was also calculated. The Braden scale was applied by two different nurses with an interval of 20-30 min between applications. RESULTS For all populations, kappa values considered unsuitable were observed for most categories of the Braden scale, ranging from 0.06-0.25. Only for the total Braden scale score was moderate reliability identified in all groups evaluated, with intraclass correlation coefficient values ranging from 0.48-0.75. CONCLUSIONS Braden scale is not a reliable tool to be used in the intensive care unit, and we do not recommend the use of this scale to assess the risk of developing pressure injury.
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Affiliation(s)
- Thalita Pereira Veiga
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil
| | - Adriana Sousa Rêgo
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil
| | | | | | | | | | | | - Renata Gonçalves Mendes
- Universidade Federal de São Carlos, Department of Physical Therapy – São Carlos (SP), Brazil
| | | | - Daniela Bassi-Dibai
- Universidade Ceuma, Postgraduate Program in Management and Health Services – São Luís (MA), Brazil.,Corresponding author:
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Yakupu A, Wang H, Huang L, Zhou J, Wu F, Lu Y, Lu S. Global, Regional, and National Levels and Trends in the Burden of Pressure Ulcer from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease 2019. INT J LOW EXTR WOUND 2022:15347346221092265. [PMID: 35379022 DOI: 10.1177/15347346221092265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients' families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729-2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75-90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries' healthcare system performances improved.
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Affiliation(s)
- Aobuliaximu Yakupu
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Hanqi Wang
- Department of Radiology, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Lifang Huang
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Jingqi Zhou
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Fangyi Wu
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
| | - Shuliang Lu
- Wound Healing Center, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
- Department of Burn, Ruijin Hospital, 66281Shanghai Jiao Tong University School of Medicine, China
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Li Y, Zeng X, Wang J, Wang C. What is the better choice for nurses? Alternating air pressure mattresses versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29084. [PMID: 35421062 PMCID: PMC9276249 DOI: 10.1097/md.0000000000029084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/26/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Evidence on the comparative effectiveness between commercially available support surfaces in preventing pressure ulcer development is lacking. The purpose of this study was to compare the efficacy and safety of alternating air pressure mattresses (AAPMs) versus static air mattresses to prevent pressure ulcers in elderly hospitalized patients and to provide evidence for clinical practice. METHODS The electronic databases of Cochrane Library, EMBASE, PubMed, and Web of Science will be searched in April 2022 using the following key terms: "pressure ulcers," "support surface," and "pressure mattresses," for all relevant studies. Only English publications are included. The primary outcome is the incidence of pressure ulcers; secondary outcomes include patient satisfaction, cost, and other bedridden complications. The Cochrane risk of bias tool will be independently used to evaluate the risk of bias of included randomized cohort studies by 2 reviewers. A modified version of the Downs and Black tool is adopted to evaluate the quality of nonrandomized cohort studies. All outcomes are pooled on random-effect model. RESULTS We hypothesized that group with AAPMs will provide better therapeutic benefits compared with control group. CONCLUSIONS It is worthy to critically review the evidence of the assessment of AAPMs and static air mattresses to inform clinical practice. OSF REGISTRATION NUMBER 10.17605/OSF.IO/MYPZ2.
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Affiliation(s)
- Yinxi Li
- Dermatological Department, Wuhan Xinzhou District People's Hospital, Wuhan, China
| | - Xuemei Zeng
- Nursing Department, Wuhan Xinzhou District People's Hospital, Wuhan, China
| | - Jianyuan Wang
- Orthopedics Department, Wuhan Xinzhou District People's Hospital, Wuhan, China
| | - Chunlei Wang
- Dermatological Department, Wuhan Xinzhou District People's Hospital, Wuhan, China
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10
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Abstract
Pressure ulcer (PU) is one of the most common occurrences in bedridden subjects. Despite the standard of care, there is a huge challenge in monitoring immobile subjects in all the bodily pressure points. This increases the chance of onset of PU which in turn increases the expenditure for treating and managing the PU. Hence, we made a study on the biological and physiological factors that are responsible for the formation of PU and also on various techniques used for diagnosis. Thus, we have summarised the efficacy of various advanced diagnostic procedures with their limitations. Though there are advanced imaging techniques, risk assessment tools based on the visual inspection are widely followed in hospitals. Based on our observation, we here have identified three major areas; one being the development of mathematical modeling, the second is towards the development of non-invasive devices and finally to automate cot facility. We have also provided possible suggestions as to solutions that could be useful to researchers and for society. Thus, this review covers the present difficulty faced by bedridden subjects and respective care-takers along with the knowledge gap and a few suggestions as to future scope.
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Affiliation(s)
- G Annie Nancy
- 382205Loyola-ICAM college of Engineering and Technology, Chennai, India
| | - R Kalpana
- 29862Rajalakshmi Engineering College, Thandalam, Chennai, India
| | - S Nandhini
- 29862Rajalakshmi Engineering College, Thandalam, Chennai, India
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11
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Gurkan A, Kirtil I, Aydin YD, Kutuk G. Pressure injuries in surgical patients: a comparison of Norton, Braden and Waterlow risk assessment scales. J Wound Care 2022; 31:170-177. [PMID: 35148625 DOI: 10.12968/jowc.2022.31.2.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to determine the predictive power of the Norton, Braden and Waterlow scales in determining risk of pressure injury (PI) in surgical patients. METHOD This prospective study was carried out in the surgery clinic of a training and research hospital in Istanbul, Turkey between January and April 2017. The study sample consisted of adult patients aged ≥18 years and who did not have PI on admission to the clinic, had abdominal surgery under general anaesthesia and who stayed in the clinic for at least 48 hours. The data were collected using the Turkish versions of the Norton, Braden and Waterlow risk assessment scales. The predictive validity of PI risk assessment tools was assessed based on their sensitivity, specificity, positive and negative predictive values and the area under the receiver operating characteristic (ROC) curve. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals (CI). RESULTS The study sample included 250 patients, and the incidence of PI was 12%. The sensitivity, specificity, positive predictive value and negative predictive value were: 83.3%, 45.4%, 17.2% and 95.2%, respectively, for the Norton scale (a cut-off point of 14); 100%, 40.4%, 18.6% and 100%, respectively, for the Braden scale (a cut-off point of 16); and 100%, 48.1%, 20.8% and 100%, respectively, for the Waterlow scale (a cut-off point of 10). The areas under the ROC curve were 0.749 for the Norton, 0.771 for the Braden and 0.971 for the Waterlow scales. This study's findings produced the following predictive capacity indicators: Norton (RR=3.62; 95%CI=1.43-9.14), Braden (RR=33.88; 95%CI=2.09-547.66); and Waterlow (RR=45.01; 95%CI=2.78-727.97). CONCLUSION In this study, the Waterlow scale demonstrated the best values of predictive validity among the three scales in the assessment of PI risk. However, all three scales had low specificity despite high sensitivity in terms of a good risk prediction. No definitive decision could be reached on the predictive capacities of the scales because of wide CIs.
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Affiliation(s)
- Aysel Gurkan
- Department of Nursing, Marmara University Faculty of Health Sciences, Istanbul, Turkey
| | - Inci Kirtil
- Department of Nursing, Marmara University Faculty of Health Sciences, Istanbul, Turkey
| | - Yesim Dikmen Aydin
- Department of Nursing, Marmara University Faculty of Health Sciences, Istanbul, Turkey
| | - Gamzegul Kutuk
- Okmeydanı Training and Research Hospital, Surgery Clinic, University of Health Sciences, Istanbul, Turkey
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12
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Yap J, Holloway S. Evidence-based review of the effects of nutritional supplementation for pressure ulcer prevention. Int Wound J 2021; 18:805-821. [PMID: 34528752 PMCID: PMC8613380 DOI: 10.1111/iwj.13584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 03/04/2021] [Indexed: 11/28/2022] Open
Abstract
The objective of this evidence-based review was to explore whether the evidence supports the use of nutritional supplements in pressure ulcer (PU) prevention strategies. Several electronic databases, including Ovid MEDLINE (1946 to May week 32 019), Ovid EMBASE (1947 to May 28, 2019), EBSCO CINAHL (until June 13, 2019), Scopus (until July 9, 2019), and the Web of Science (until June 13, 2019) were searched. No limitation was placed on the year of publication. Studies considered for inclusion were those with adult populations, and only English language texts with available full text were reviewed. AMSTAR (a measurement tool to assess systematic reviews) was used to evaluate the quality of the studies included in the systematic review. The Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence was used to assess the level of evidence. Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) was used to assess guideline article, and Appraisal tool for Cross-Sectional Studies (AXIS) was also used for cross-sectional studies. The search identified 1761 studies. After the application of inclusion and exclusion criteria, 24 studies were retained of various designs, including 10 systematic reviews, five clinical reviews, three randomised controlled trials, two observational studies, one quasi-experimental study, one cross-sectional study, one cohort study, and one Clinical Guideline. Two were rated as high-quality reviews, 14 were rated as moderate-quality reviews, five were rated as low-quality reviews, and three were rated as critically low-quality reviews. The majority of the reviewed studies were of low-to-moderate quality because of biases in the study design and incomplete data reporting, which did not fulfil the reporting criteria of the appraisal tools. However, the majority of the studies showed a reduction in PU incidence after nutritional supplement though not significant. Whether the use of pharmacological appraisal tools to assess non-pharmacological studies is appropriate is unclear. Regardless of the low-to-moderate quality of the studies in this review, nutritional supplements appear to play a role in PU prevention.
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Affiliation(s)
- JiannWen Yap
- Wound Healing & Tissue RepairCardiff University School of MedicineCardiffUK
- Wound & Stoma Care Unit, General Surgical DepartmentQueen Elizabeth HospitalKota KinabaluMalaysia
| | - Samantha Holloway
- Centre for Medical Education, School of MedicineCollege of Biomedical & Lifesciences, Cardiff UniversityCardiffUK
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13
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Cho KS, Lee JH. Incidence and prevalence of pressure ulcers in hospitals: 10-year cohort study. J Wound Care 2021; 30:S38-S45. [PMID: 34882008 DOI: 10.12968/jowc.2021.30.sup12.s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pressure ulcers (PUs) are a serious problem in patients with multiple comorbidities and are associated with a longer duration of hospital stay and higher medical costs. The aetiology and rate of PU occurrence in South Korea remains unclear. Therefore, we aimed to determine the incidence, prevalence, mortality and common comorbidities of hospitalised patients with PUs in the South Korean healthcare system. METHOD A 10-year cohort study using the healthcare insurance reimbursement claims from the South Korean National Health Insurance System database. Patients diagnosed with a PU on admission to hospital [ICD-10: L89 + procedure code] between January 2002 and December 2016 were included and their comorbidities evaluated. Patients <20 years of age and recurrent PU cases were excluded. RESULTS Incidence, prevalence, survival rate and risk factors related to survival rate of patients with PUs were determined. The study population in 2006 was 36,195,121 (all patients admitted to hospital that year), which changed yearly because of the inclusion of additional patients who met the study inclusion criteria, and removal of patients who had died during the year. Standardised PU incidence rate decreased from 17.1 in 2006 to 14.9 in 2015 per 10,000 people. Standardised PU prevalence also showed a slightly decreasing trend from 20.2 in 2006 to 18.9 in 2015 per 10,000 people. CONCLUSION This findings of this 10-year study showed that incidence and prevalence of PUs markedly increased with age after the seventh decade. Incidence of PUs increased in patients with pneumonia, cerebral infarction, sepsis, femoral neck fracture and malignant neoplasm of the bronchus. Patients with femoral neck fracture and cerebral infarction showed a higher rate of survival than those with other high-risk comorbidities.
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Affiliation(s)
- Kyu Sang Cho
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
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14
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Zhang Z, Yang H, Luo M. Association Between Charlson Comorbidity Index and Community-Acquired Pressure Injury in Older Acute Inpatients in a Chinese Tertiary Hospital. Clin Interv Aging 2021; 16:1987-1995. [PMID: 34880605 PMCID: PMC8645800 DOI: 10.2147/cia.s338967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/19/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To explore the correlation between community-acquired pressure injury (CAPI) and comorbidities in elderly patients with emergency admission. PATIENTS AND METHODS Patients aged 65 years or above were enrolled from multiple departments, such as Internal Medicine, Surgery, Geriatrics, and Intensive Care Unit of Wuhan Third Hospital, which is affiliated to Wuhan University, from January to December 2020. Comorbidity data were extracted using the 10th edition of the International Classification of Diseases (ICD-10) from the hospital electronic medical record system, and the Charlson Comorbidity Index (CCI) was calculated using these data. Participants were divided into two groups according to whether pressure injury was present at admission. The baseline characteristics of the two groups were compared using Student's t-tests, Mann-Whitney U-tests, and chi-square tests. Univariate and multivariate logistic regression models were constructed to explore the relationship between CAPI and the CCI. Smooth curve fitting was used to show the relationship between the CCI and CAPI. By drawing the receiver operating characteristic curve, the CCI was used to predict CAPI. RESULTS A total of 5759 participants with an average age of 75.1 ± 7.6 were included in this population-based study. The prevalence of CAPI was 4.3%. In logistic regression analysis, there was a positive relationship between the CCI and CAPI after adjustment for sex, age, hypoproteinemia, and anemia (OR = 1.37, 95% CI = 1.29-1.45, p < 0.001, trend test p < 0.001). The area under the receiver operating characteristic curve was 0.75, and the maximum value of the Youden index was 0.35, with a critical value of 5.5. CONCLUSION The development of CAPI was positively correlated with the CCI. The risk of developing pressure injury increases with the number and severity of comorbidities. This study shows that the CCI has certain reference value in predicting CAPI.
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Affiliation(s)
- Zhili Zhang
- Department of Surgical, Wuhan Third Hospital Affiliated to Wuhan University, Wuhan, 430070, People's Republic of China
| | - Hongli Yang
- Department of Public Health, The First Community Health Service Center of Guanshan, Wuhan, 430073, People's Republic of China
| | - Man Luo
- Department of Nursing, Wuhan Third Hospital Affiliated to Wuhan University, Wuhan, 430070, People's Republic of China
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15
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Öğülmüş Demircan F, Yücedağ İ, Toz M. A novel mathematical model including the wetness parameter as a variable for prevention of pressure ulcers. Proc Inst Mech Eng H 2021; 236:427-437. [PMID: 34696655 DOI: 10.1177/09544119211048557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pressure ulcers are injuries caused by external conditions such as pressure, friction, shear, and humidity resulting from staying in the same position for a long time in bedridden patients. It is a serious problem worldwide when assessed in terms of hospital capacity, nursing staff employment and treatment costs. In this study, we developed a novel mathematical model based on one of our previous models to prevent pressure ulcers or delay injuries. The proposed model uses a human thermal model that includes skin temperature, hypothalamus temperature, regional perspiration coefficient, and unconsciously loss of water amount. Moreover, in our model, we defined a variable wetness parameter in addition to the parameters, pressure, temperature, and humidity. The proposed model is mathematically defined in detail and tested for a wide range of parameters to show the model's effectiveness in determining the pressure ulcer formation risk. The model is also compared with a model from the literature that based on only the general parameters, pressure, temperature, and humidity. The obtained results showed that the model determines the risk of the occurrence of the pressure ulcer more precisely than the compared one.
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Affiliation(s)
| | - İbrahim Yücedağ
- Department of Computer Engineering, Faculty of Engineering, Duzce University, Duzce, Turkey
| | - Metin Toz
- Department of Computer Engineering, Faculty of Engineering, Karamanoglu Mehmetbey University, Karaman, Turkey
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16
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Saikali M, Tanios A, Saab A. Evaluation of a Broad-Spectrum Partially Automated Adverse Event Surveillance System: A Potential Tool for Patient Safety Improvement in Hospitals With Limited Resources. J Patient Saf 2021; 17:e653-e664. [PMID: 29166298 DOI: 10.1097/pts.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the sensitivity and resource efficiency of a partially automated adverse event (AE) surveillance system for routine patient safety efforts in hospitals with limited resources. METHODS Twenty-eight automated triggers from the hospital information system's clinical and administrative databases identified cases that were then filtered by exclusion criteria per trigger and then reviewed by an interdisciplinary team. The system, developed and implemented using in-house resources, was applied for 45 days of surveillance, for all hospital inpatient admissions (N = 1107). Each trigger was evaluated for its positive predictive value (PPV). Furthermore, the sensitivity of the surveillance system (overall and by AE category) was estimated relative to incidence ranges in the literature. RESULTS The surveillance system identified a total of 123 AEs among 283 reviewed medical records, yielding an overall PPV of 52%. The tool showed variable levels of sensitivity across and within AE categories when compared with the literature, with a relatively low overall sensitivity estimated between 21% and 44%. Adverse events were detected in 23 of the 36 AE categories defined by an established harm classification system. Furthermore, none of the detected AEs were voluntarily reported. CONCLUSIONS The surveillance system showed variable sensitivity levels across a broad range of AE categories with an acceptable PPV, overcoming certain limitations associated with other harm detection methods. The number of cases captured was substantial, and none had been previously detected or voluntarily reported. For hospitals with limited resources, this methodology provides valuable safety information from which interventions for quality improvement can be formulated.
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Affiliation(s)
| | - Alain Tanios
- Emergency Department, Lebanese Hospital Geitaoui-University Medical Center, Beirut, Lebanon
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17
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Alanazi FK, Sim J, Lapkin S. Systematic review: Nurses' safety attitudes and their impact on patient outcomes in acute-care hospitals. Nurs Open 2021; 9:30-43. [PMID: 34538027 PMCID: PMC8685891 DOI: 10.1002/nop2.1063] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/02/2021] [Accepted: 09/02/2021] [Indexed: 11/11/2022] Open
Abstract
AIMS The aim of this review was to synthesize the best available evidence on the impact of nurses' safety attitudes on patient outcomes in acute-care hospitals. DESIGN Systematic review with a narrative synthesis of the available data. DATA SOURCES Data sources included MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Scopus and Web of Science Core Collection. Studies published up to March 2021 were included. REVIEW METHODS This review was conducted using guidance from the Joanna Briggs Institute for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS A total of 3,452 studies were identified, and nine studies met the inclusion criteria. Nurses with positive safety attitudes reported fewer patient falls, medication errors, pressure injuries, healthcare-associated infections, mortality, physical restraints, vascular access device reactions and higher patient satisfaction. Effective teamwork led to a reduction in adverse patient outcomes. Most included studies (N = 6) used variants of the Hospital Survey on Patient Safety Culture to assess nurses' safety attitudes. Patient outcomes data were collected from four sources: coded medical records data, incident management systems, nurse perceptions of adverse events and patient perceptions of safety. CONCLUSION A positive safety culture in nursing units and across hospitals resulted in fewer reported adverse patient outcomes. Nurse managers can improve nurses' safety attitudes by promoting a non-punitive response to error reporting and promoting effective teamwork and good communication.
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Affiliation(s)
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,School of Nursing & Midwifery, University of Newcastle, Callaghan, NSW, Australia.,Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Samuel Lapkin
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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18
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Faucher N, Barateau M, Hentz F, Michel P, Meaume S, Rousseaux C, Marty M, Le Fort M, Nicolas B. Use of multilayer silicone foam dressings as adjuvant therapy to prevent pressure injuries. J Wound Care 2021; 30:712-721. [PMID: 34554838 DOI: 10.12968/jowc.2021.30.9.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public health problem because of their frequency and morbidity. Protection of the skin by multilayer silicone foam dressings may be an adjuvant measure to prevent PIs in high-risk patients. Despite the available clinical data and published recommendations on this measure, caregivers face difficulties in identifying patients who would benefit from this adjuvant measure. The objective of this work was to define the profiles of high-risk patients who would benefit optimally from this measure in combination with basic preventive procedures. This consensual expert opinion was drawn up using two methods: the Nominal Group Technique with eight medical and paramedical experts, and the Delphi process with 16 experts. The bases for this expert consensual opinion were a formal search and analysis of the published literature regarding evidence on the prevention of PIs using multilayer silicone foam dressings. The consensual expert opinion reported here addresses five proposals mostly intended to define patients who would benefit from the use of a multilayer silicone foam dressing (≥4 layers) to prevent PIs (sacrum and heels).
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Affiliation(s)
- Nathalie Faucher
- Service de Gériatrie Hôpital Bichat Claude Bernard, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | - Martine Barateau
- Consultation Plaies, Service de Gériatrie, CHU, Bordeaux, France.,Société Française de l'Escarre
| | - Franck Hentz
- Direction des soins CHU, Clermont Ferrand, France
| | - Philippe Michel
- Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France.,Société Française de l'Escarre
| | - Sylvie Meaume
- Service Plaie et Cicatrisation, Hôpital Rothschild, Paris, France.,Société Française et Francophone des Plaies et Cicatrisations
| | | | - Marc Marty
- Nukléus, Research department, Paris, France
| | - Marc Le Fort
- Service de MPR neurologique, Hôpital Saint Jacques, CHU Nantes, France
| | - Benoit Nicolas
- Pôle MPR St Hélier, Rennes, France.,Société Française de l'Escarre
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19
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Borzou SR, Amiri S, Azizi A, Tapak L, Rahimi Bashar F, Moradkhani S. Topical Almond Oil for Prevention of Pressure Injuries: A Single-Blinded Comparison Study. J Wound Ostomy Continence Nurs 2020; 47:336-42. [PMID: 32379165 DOI: 10.1097/WON.0000000000000648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of our study was to determine the effect of topical almond oil for prevention of pressure injuries. DESIGN Single-blind randomized clinical trial. SAMPLE AND SETTING Patients admitted to an intensive care unit in Besat Hospital, Hamadan, Iran, were invited to participate in the trial. Data were collected over an 8-month period. METHODS A convenience sample of 108 patients, using a permuted block randomization method was assigned to 3 equal groups that received the intervention almond oil, placebo (liquid paraffin), or control (standard of care). Data included demographic information, Braden Scale score, and National Pressure Ulcer Advisory Panel-European Pressure Ulcer Advisory Panel (NPUAP-EPUAP) pressure injury staging system classification score. The intervention and placebo groups received daily application of 6.5 cc of topical almond oil or paraffin to the sacrum, heels, and shoulders for 7 consecutive days. The skin was evaluated for pressure injuries by an expert nurse who was blinded to groups. Chi-square test, analysis of variance, and regression analyses were used to evaluate relationships within and between groups for study variables, incidence of pressure injuries, and duration of time of onset of pressure injuries. P values less than .05 were deemed statistically significant. RESULTS The incidence of pressure injury in the almond oil group (n = 2; 5.6%) was lower than that in the placebo (n = 5; 13.9%, P = .189) or control groups (n = 9; 25.1%, P = .024). The incidence of pressure injuries in the control group was 6.8 and 2.12 (P = .227) times higher than that in the almond and placebo groups, respectively. The onset day of a pressure injury occurred 5.4 days after initiation of the protocol in the almond oil group compared to 4.22 days in the control group (P = .023) and 5 days in the placebo group (P = .196). CONCLUSION The topical application of almond oil was associated with a lower incidence of pressure injuries and that developed later during the study compared to participants who received paraffin or standard of care only. Further study is recommended to advance this work in populations at risk for pressure injury.
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20
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Zubkoff L, Neily J, McCoy-Jones S, Soncrant C, Young-Xu Y, Boar S, Mills P. Implementing Evidence-Based Pressure Injury Prevention Interventions: Veterans Health Administration Quality Improvement Collaborative. J Nurs Care Qual 2021; 36:249-56. [PMID: 32868734 DOI: 10.1097/NCQ.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injury prevention is a persistent concern in nursing. The Veterans Health Administration implemented a creative approach with successful outcomes across the United States. PROBLEM Pressure injury prevention is a measure of nursing quality of care and a high priority in the Veterans Health Administration. METHODS A 12-month Virtual Breakthrough Series Collaborative utilizing coaching and group calls was conducted to assist long-term and acute care teams with preventing pressure injuries. INTERVENTIONS Interventions from the Veterans Health Administration Skin Bundle were implemented, including pressure-relieving surfaces, novel turning techniques, specialized dressings, and emollients to prevent skin breakdown. RESULTS The aggregated pressure injury rate for all teams decreased from Prework to the Action phase from 1.0 to 0.8 per 1000 bed days of care (P = .01). The aggregated pressure injury rates for long-term care units decreased from Prework to Continuous Improvement from 0.8 to 0.4 per 1000 bed days of care (P = .021). CONCLUSION The Virtual Breakthrough Series helped reduce pressure injuries.
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21
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Abstract
BACKGROUND Pressure ulcers (also known as pressure injuries, pressure sores, decubitus ulcers and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Alternating pressure (active) air surfaces are widely used with the aim of preventing pressure ulcers. OBJECTIVES To assess the effects of alternating pressure (active) air surfaces (beds, mattresses or overlays) compared with any support surface on the incidence of pressure ulcers in any population in any setting. SEARCH METHODS In November 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials that allocated participants of any age to alternating pressure (active) air beds, overlays or mattresses. Comparators were any beds, overlays or mattresses. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. MAIN RESULTS We included 32 studies (9058 participants) in the review. Most studies were small (median study sample size: 83 participants). The average age of participants ranged from 37.2 to 87.0 years (median: 69.1 years). Participants were largely from acute care settings (including accident and emergency departments). We synthesised data for six comparisons in the review: alternating pressure (active) air surfaces versus: foam surfaces, reactive air surfaces, reactive water surfaces, reactive fibre surfaces, reactive gel surfaces used in the operating room followed by foam surfaces used on the ward bed, and another type of alternating pressure air surface. Of the 32 included studies, 25 (78.1%) presented findings which were considered at high overall risk of bias. PRIMARY OUTCOME pressure ulcer incidence Alternating pressure (active) air surfaces may reduce the proportion of participants developing a new pressure ulcer compared with foam surfaces (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.34 to 1.17; I2 = 63%; 4 studies, 2247 participants; low-certainty evidence). Alternating pressure (active) air surfaces applied on both operating tables and hospital beds may reduce the proportion of people developing a new pressure ulcer compared with reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds (RR 0.22, 95% CI 0.06 to 0.76; I2 = 0%; 2 studies, 415 participants; low-certainty evidence). It is uncertain whether there is a difference in the proportion of people developing new pressure ulcers between alternating pressure (active) air surfaces and the following surfaces, as all these comparisons have very low-certainty evidence: (1) reactive water surfaces; (2) reactive fibre surfaces; and (3) reactive air surfaces. The comparisons between different types of alternating pressure air surfaces are presented narratively. Overall, all comparisons suggest little to no difference between these surfaces in pressure ulcer incidence (7 studies, 2833 participants; low-certainty evidence). Included studies have data on time to pressure ulcer incidence for three comparisons. When time to pressure ulcer development is considered using a hazard ratio (HR), it is uncertain whether there is a difference in the risk of developing new pressure ulcers, over 90 days' follow-up, between alternating pressure (active) air surfaces and foam surfaces (HR 0.41, 95% CI 0.10 to 1.64; I2 = 86%; 2 studies, 2105 participants; very low-certainty evidence). For the comparison with reactive air surfaces, there is low-certainty evidence that people treated with alternating pressure (active) air surfaces may have a higher risk of developing an incident pressure ulcer than those treated with reactive air surfaces over 14 days' follow-up (HR 2.25, 95% CI 1.05 to 4.83; 1 study, 308 participants). Neither of the two studies with time to ulcer incidence data suggested a difference in the risk of developing an incident pressure ulcer over 60 days' follow-up between different types of alternating pressure air surfaces. Secondary outcomes The included studies have data on (1) support-surface-associated patient comfort for comparisons involving foam surfaces, reactive air surfaces, reactive fibre surfaces and alternating pressure (active) air surfaces; (2) adverse events for comparisons involving foam surfaces, reactive gel surfaces and alternating pressure (active) air surfaces; and (3) health-related quality of life outcomes for the comparison involving foam surfaces. However, all these outcomes and comparisons have low or very low-certainty evidence and it is uncertain whether there are any differences in these outcomes. Included studies have data on cost effectiveness for two comparisons. Moderate-certainty evidence suggests that alternating pressure (active) air surfaces are probably more cost-effective than foam surfaces (1 study, 2029 participants) and that alternating pressure (active) air mattresses are probably more cost-effective than overlay versions of this technology for people in acute care settings (1 study, 1971 participants). AUTHORS' CONCLUSIONS Current evidence is uncertain about the difference in pressure ulcer incidence between using alternating pressure (active) air surfaces and other surfaces (reactive water surfaces, reactive fibre surfaces and reactive air surfaces). Alternating pressure (active) air surfaces may reduce pressure ulcer risk compared with foam surfaces and reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds. People using alternating pressure (active) air surfaces may be more likely to develop new pressure ulcers over 14 days' follow-up than those treated with reactive air surfaces in the nursing home setting; but as the result is sensitive to the choice of outcome measure it should be interpreted cautiously. Alternating pressure (active) air surfaces are probably more cost-effective than reactive foam surfaces in preventing new pressure ulcers. Future studies should include time-to-event outcomes and assessment of adverse events and trial-level cost-effectiveness. Further review using network meta-analysis will add to the findings reported here.
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Affiliation(s)
- Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Asmara Jammali-Blasi
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (ACU), School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Darlinghurst, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
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22
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Abstract
BACKGROUND Pressure ulcers (also known as pressure injuries, pressure sores, decubitus ulcers and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Beds, overlays or mattresses are widely used with the aim of treating pressure ulcers. OBJECTIVES To assess the effects of beds, overlays and mattresses on pressure ulcer healing in people with pressure ulcers of any stage, in any setting. SEARCH METHODS In November 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials that allocated participants of any age to pressure-redistributing beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for treating pressure ulcers. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. MAIN RESULTS We included 13 studies (972 participants) in the review. Most studies were small (median study sample size: 72 participants). The average age of participants ranged from 64.0 to 86.5 years (median: 82.7 years) and all studies recruited people with existing pressure ulcers (the baseline ulcer area size ranging from 4.2 to 18.6 cm2,median 6.6 cm2). Participants were recruited from acute care settings (six studies) and community and long-term care settings (seven studies). Of the 13 studies, three (224 participants) involved surfaces that were not well described and therefore could not be classified. Additionally, six (46.2%) of the 13 studies presented findings which were considered at high overall risk of bias. We synthesised data for four comparisons in the review: alternating pressure (active) air surfaces versus foam surfaces; reactive air surfaces versus foam surfaces; reactive water surfaces versus foam surfaces, and a comparison between two types of alternating pressure (active) air surfaces. We summarise key findings for these four comparisons below. (1) Alternating pressure (active) air surfaces versus foam surfaces: we are uncertain if there is a difference between alternating pressure (active) air surfaces and foam surfaces in the proportion of participants whose pressure ulcers completely healed (two studies with 132 participants; the reported risk ratio (RR) in one study was 0.97, 95% confidence interval (CI) 0.26 to 3.58). There is also uncertainty for the outcomes of patient comfort (one study with 83 participants) and adverse events (one study with 49 participants). These outcomes have very low-certainty evidence. Included studies did not report time to complete ulcer healing, health-related quality of life, or cost effectiveness. (2) Reactive air surfaces versus foam surfaces: it is uncertain if there is a difference in the proportion of participants with completely healed pressure ulcers between reactive air surfaces and foam surfaces (RR 1.32, 95% CI 0.96 to 1.80; I2 = 0%; 2 studies, 156 participants; low-certainty evidence). When time to complete pressure ulcer healing is considered using a hazard ratio, data from one small study (84 participants) suggests a greater hazard for complete ulcer healing on reactive air surfaces (hazard ratio 2.66, 95% CI 1.34 to 5.17; low-certainty evidence). These results are sensitive to the choice of outcome measure so should be interpreted as uncertain. We are also uncertain whether there is any difference between these surfaces in patient comfort responses (1 study, 72 participants; very low-certainty evidence) and in adverse events (2 studies, 156 participants; low-certainty evidence). There is low-certainty evidence that reactive air surfaces may cost an extra 26 US dollars for every ulcer-free day in the first year of use (1 study, 87 participants). Included studies did not report health-related quality of life. (3) Reactive water surfaces versus foam surfaces: it is uncertain if there is a difference between reactive water surfaces and foam surfaces in the proportion of participants with healed pressure ulcers (RR 1.07, 95% CI 0.70 to 1.63; 1 study, 101 participants) and in adverse events (1 study, 120 participants). All these have very low-certainty evidence. Included studies did not report time to complete ulcer healing, patient comfort, health-related quality of life, or cost effectiveness. (4) Comparison between two types of alternating pressure (active) air surfaces: it is uncertain if there is a difference between Nimbus and Pegasus alternating pressure (active) air surfaces in the proportion of participants with healed pressure ulcers, in patient comfort responses and in adverse events: each of these outcomes had four studies (256 participants) but very low-certainty evidence. Included studies did not report time to complete ulcer healing, health-related quality of life, or cost effectiveness. AUTHORS' CONCLUSIONS We are uncertain about the relative effects of most different pressure-redistributing surfaces for pressure ulcer healing (types directly compared are alternating pressure air surfaces versus foam surfaces, reactive air surfaces versus foam surfaces, reactive water surfaces versus foam surfaces, and Nimbus versus Pegasus alternating pressure (active) air surfaces). There is also uncertainty regarding the effects of these different surfaces on the outcomes of comfort and adverse events. However, people using reactive air surfaces may be more likely to have pressure ulcers completely healed than those using foam surfaces over 37.5 days' follow-up, and reactive air surfaces may cost more for each ulcer-free day than foam surfaces. Future research in this area could consider the evaluation of alternating pressure air surfaces versus foam surfaces as a high priority. Time-to-event outcomes, careful assessment of adverse events and trial-level cost-effectiveness evaluation should be considered in future studies. Further review using network meta-analysis will add to the findings reported here.
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Affiliation(s)
- Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Asmara Jammali-Blasi
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University (ACU), School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Darlinghurst, Australia
| | - Victoria Ramsden
- School of Nursing, Faculty of Medicine, University of Notre Dame, Darlinghurst, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
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23
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Abstract
BACKGROUND Pressure ulcers (also known as pressure injuries, pressure sores, decubitus ulcers and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Reactive air surfaces (beds, mattresses or overlays) can be used for preventing pressure ulcers. OBJECTIVES To assess the effects of reactive air beds, mattresses or overlays compared with any support surface on the incidence of pressure ulcers in any population in any setting. SEARCH METHODS In November 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials that allocated participants of any age to reactive air beds, overlays or mattresses. Comparators were any beds, overlays or mattresses that were applied for preventing pressure ulcers. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. If a reactive air surface was compared with surfaces that were not clearly specified, then we recorded and described the concerned study but did not included it in further data analyses. MAIN RESULTS We included 17 studies (2604 participants) in this review. Most studies were small (median study sample size: 83 participants). The average participant age ranged from 56 to 87 years (median: 72 years). Participants were recruited from a wide range of care settings with the majority being acute care settings. Almost all studies were conducted in the regions of Europe and America. Of the 17 included studies, two (223 participants) compared reactive air surfaces with surfaces that were not well described and therefore could not be classified. We analysed data for five comparisons: reactive air surfaces compared with (1) alternating pressure (active) air surfaces (seven studies with 1728 participants), (2) foam surfaces (four studies with 229 participants), (3) reactive water surfaces (one study with 37 participants), (4) reactive gel surfaces (one study with 66 participants), and (5) another type of reactive air surface (two studies with 223 participants). Of the 17 studies, seven (41.2%) presented findings which were considered at high overall risk of bias. PRIMARY OUTCOME Pressure ulcer incidence Reactive air surfaces may reduce the proportion of participants developing a new pressure ulcer compared with foam surfaces (risk ratio (RR) 0.42; 95% confidence interval (CI) 0.18 to 0.96; I2 = 25%; 4 studies, 229 participants; low-certainty evidence). It is uncertain if there is a difference in the proportions of participants developing a new pressure ulcer on reactive air surfaces compared with: alternating pressure (active) air surfaces (6 studies, 1648 participants); reactive water surfaces (1 study, 37 participants); reactive gel surfaces (1 study, 66 participants), or another type of reactive air surface (2 studies, 223 participants). Evidence for all these comparisons is of very low certainty. Included studies have data on time to pressure ulcer incidence for two comparisons. When time to pressure ulcer incidence is considered using a hazard ratio (HR), low-certainty evidence suggests that in the nursing home setting, people on reactive air surfaces may be less likely to develop a new pressure ulcer over 14 days' of follow-up than people on alternating pressure (active) air surfaces (HR 0.44; 95% CI 0.21 to 0.96; 1 study, 308 participants). It is uncertain if there is a difference in the hazard of developing new pressure ulcers between two types of reactive air surfaces (1 study, 123 participants; very low-certainty evidence). Secondary outcomes Support-surface-associated patient comfort: the included studies have data on this outcome for three comparisons. We could not pool any data as comfort outcome measures differed between included studies; therefore a narrative summary is provided. It is uncertain if there is a difference in patient comfort responses between reactive air surfaces and foam surfaces over the top of an alternating pressure (active) air surfaces (1 study, 72 participants), and between those using reactive air surfaces and those using alternating pressure (active) air surfaces (4 studies, 1364 participants). Evidence for these two comparisons is of very low certainty. It is also uncertain if there is a difference in patient comfort responses between two types of reactive air surfaces (1 study, 84 participants; low-certainty evidence). All reported adverse events: there were data on this outcome for one comparison: it is uncertain if there is a difference in adverse events between reactive air surfaces and foam surfaces (1 study, 72 participants; very low-certainty evidence). The included studies have no data for health-related quality of life and cost-effectiveness for all five comparisons. AUTHORS' CONCLUSIONS Current evidence is uncertain regarding any differences in the relative effects of reactive air surfaces on ulcer incidence and patient comfort, when compared with reactive water surfaces, reactive gel surfaces, or another type of reactive air surface. Using reactive air surfaces may reduce the risk of developing new pressure ulcers compared with using foam surfaces. Also, using reactive air surfaces may reduce the risk of developing new pressure ulcers within 14 days compared with alternating pressure (active) air surfaces in people in a nursing home setting. Future research in this area should consider evaluation of the most important support surfaces from the perspective of decision-makers. Time-to-event outcomes, careful assessment of adverse events and trial-level cost-effectiveness evaluation should be considered in future studies. Trials should be designed to minimise the risk of detection bias; for example, by using digital photography and adjudicators of the photographs being blinded to group allocation. Further review using network meta-analysis will add to the findings reported here.
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Affiliation(s)
- Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vannessa Leung
- Sydney Eye Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
- School of Medicine, University of Sydney, Camperdown, Sydney, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
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24
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Abstract
BACKGROUND Pressure ulcers (also known as injuries, pressure sores, decubitus ulcers and bed sores) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Reactive surfaces that are not made of foam or air cells can be used for preventing pressure ulcers. OBJECTIVES To assess the effects of non-foam and non-air-filled reactive beds, mattresses or overlays compared with any other support surface on the incidence of pressure ulcers in any population in any setting. SEARCH METHODS In November 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials that allocated participants of any age to non-foam or non-air-filled reactive beds, overlays or mattresses. Comparators were any beds, overlays or mattresses used. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. If a non-foam or non-air-filled surface was compared with surfaces that were not clearly specified, then the included study was recorded and described but not considered further in any data analyses. MAIN RESULTS We included 20 studies (4653 participants) in this review. Most studies were small (median study sample size: 198 participants). The average participant age ranged from 37.2 to 85.4 years (median: 72.5 years). Participants were recruited from a wide range of care settings but were mainly from acute care settings. Almost all studies were conducted in Europe and America. Of the 20 studies, 11 (2826 participants) included surfaces that were not well described and therefore could not be fully classified. We synthesised data for the following 12 comparisons: (1) reactive water surfaces versus alternating pressure (active) air surfaces (three studies with 414 participants), (2) reactive water surfaces versus foam surfaces (one study with 117 participants), (3) reactive water surfaces versus reactive air surfaces (one study with 37 participants), (4) reactive water surfaces versus reactive fibre surfaces (one study with 87 participants), (5) reactive fibre surfaces versus alternating pressure (active) air surfaces (four studies with 384 participants), (6) reactive fibre surfaces versus foam surfaces (two studies with 228 participants), (7) reactive gel surfaces on operating tables followed by foam surfaces on ward beds versus alternating pressure (active) air surfaces on operating tables and subsequently on ward beds (two studies with 415 participants), (8) reactive gel surfaces versus reactive air surfaces (one study with 74 participants), (9) reactive gel surfaces versus foam surfaces (one study with 135 participants), (10) reactive gel surfaces versus reactive gel surfaces (one study with 113 participants), (11) reactive foam and gel surfaces versus reactive gel surfaces (one study with 166 participants) and (12) reactive foam and gel surfaces versus foam surfaces (one study with 91 participants). Of the 20 studies, 16 (80%) presented findings which were considered to be at high overall risk of bias. PRIMARY OUTCOME Pressure ulcer incidence We did not find analysable data for two comparisons: reactive water surfaces versus foam surfaces, and reactive water surfaces versus reactive fibre surfaces. Reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds (14/205 (6.8%)) may increase the proportion of people developing a new pressure ulcer compared with alternating pressure (active) air surfaces applied on both operating tables and hospital beds (3/210 (1.4%) (risk ratio 4.53, 95% confidence interval 1.31 to 15.65; 2 studies, 415 participants; I2 = 0%; low-certainty evidence). For all other comparisons, it is uncertain whether there is a difference in the proportion of participants developing new pressure ulcers as all data were of very low certainty. Included studies did not report time to pressure ulcer incidence for any comparison in this review. Secondary outcomes Support-surface-associated patient comfort: the included studies provide data on this outcome for one comparison. It is uncertain if there is a difference in patient comfort between alternating pressure (active) air surfaces and reactive fibre surfaces (one study with 187 participants; very low-certainty evidence). All reported adverse events: there is evidence on this outcome for one comparison. It is uncertain if there is a difference in adverse events between reactive gel surfaces followed by foam surfaces and alternating pressure (active) air surfaces applied on both operating tables and hospital beds (one study with 198 participants; very low-certainty evidence). We did not find any health-related quality of life or cost-effectiveness evidence for any comparison in this review. AUTHORS' CONCLUSIONS Current evidence is generally uncertain about the differences between non-foam and non-air-filled reactive surfaces and other surfaces in terms of pressure ulcer incidence, patient comfort, adverse effects, health-related quality of life and cost-effectiveness. Reactive gel surfaces used on operating tables followed by foam surfaces applied on hospital beds may increase the risk of having new pressure ulcers compared with alternating pressure (active) air surfaces applied on both operating tables and hospital beds. Future research in this area should consider evaluation of the most important support surfaces from the perspective of decision-makers. Time-to-event outcomes, careful assessment of adverse events and trial-level cost-effectiveness evaluation should be considered in future studies. Trials should be designed to minimise the risk of detection bias; for example, by using digital photography and adjudicators of the photographs being blinded to group allocation. Further review using network meta-analysis will add to the findings reported here.
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Affiliation(s)
- Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
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25
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Abstract
BACKGROUND Pressure ulcers (also known as pressure injuries) are localised injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction. Foam surfaces (beds, mattresses or overlays) are widely used with the aim of preventing pressure ulcers. OBJECTIVES To assess the effects of foam beds, mattresses or overlays compared with any support surface on the incidence of pressure ulcers in any population in any setting. SEARCH METHODS In November 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials that allocated participants of any age to foam beds, mattresses or overlays. Comparators were any beds, mattresses or overlays. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed studies using predetermined inclusion criteria. We carried out data extraction, 'Risk of bias' assessment using the Cochrane 'Risk of bias' tool, and the certainty of the evidence assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. If a foam surface was compared with surfaces that were not clearly specified, then the included study was recorded and described but not considered further in any data analyses. MAIN RESULTS We included 29 studies (9566 participants) in the review. Most studies were small (median study sample size: 101 participants). The average age of participants ranged from 47.0 to 85.3 years (median: 76.0 years). Participants were mainly from acute care settings. We analysed data for seven comparisons in the review: foam surfaces compared with: (1) alternating pressure air surfaces, (2) reactive air surfaces, (3) reactive fibre surfaces, (4) reactive gel surfaces, (5) reactive foam and gel surfaces, (6) reactive water surfaces, and (7) another type of foam surface. Of the 29 included studies, 17 (58.6%) presented findings which were considered at high overall risk of bias. PRIMARY OUTCOME pressure ulcer incidence Low-certainty evidence suggests that foam surfaces may increase the risk of developing new pressure ulcers compared with (1) alternating pressure (active) air surfaces (risk ratio (RR) 1.59, 95% confidence interval (CI) 0.86 to 2.95; I2 = 63%; 4 studies, 2247 participants), and (2) reactive air surfaces (RR 2.40, 95% CI 1.04 to 5.54; I2 = 25%; 4 studies, 229 participants). We are uncertain regarding the difference in pressure ulcer incidence in people treated with foam surfaces and the following surfaces: (1) reactive fibre surfaces (1 study, 68 participants); (2) reactive gel surfaces (1 study, 135 participants); (3) reactive gel and foam surfaces (1 study, 91 participants); and (4) another type of foam surface (6 studies, 733 participants). These had very low-certainty evidence. Included studies have data on time to pressure ulcer development for two comparisons. When time to ulcer development is considered using hazard ratios, the difference in the risk of having new pressure ulcers, over 90 days' follow-up, between foam surfaces and alternating pressure air surfaces is uncertain (2 studies, 2105 participants; very low-certainty evidence). Two further studies comparing different types of foam surfaces also reported time-to-event data, suggesting that viscoelastic foam surfaces with a density of 40 to 60 kg/m3 may decrease the risk of having new pressure ulcers over 11.5 days' follow-up compared with foam surfaces with a density of 33 kg/m3 (1 study, 62 participants); and solid foam surfaces may decrease the risk of having new pressure ulcers over one month's follow-up compared with convoluted foam surfaces (1 study, 84 participants). Both had low-certainty evidence. There was no analysable data for the comparison of foam surfaces with reactive water surfaces (one study with 117 participants). Secondary outcomes Support-surface-associated patient comfort: the review contains data for three comparisons for this outcome. It is uncertain if there is a difference in patient comfort measure between foam surfaces and alternating pressure air surfaces (1 study, 76 participants; very low-certainty evidence); foam surfaces and reactive air surfaces (1 study, 72 participants; very low-certainty evidence); and different types of foam surfaces (4 studies, 669 participants; very low-certainty evidence). All reported adverse events: the review contains data for two comparisons for this outcome. We are uncertain about differences in adverse effects between foam surfaces and alternating pressure (active) air surfaces (3 studies, 2181 participants; very low-certainty evidence), and between foam surfaces and reactive air surfaces (1 study, 72 participants; very low-certainty evidence). Health-related quality of life: only one study reported data on this outcome. It is uncertain if there is a difference (low-certainty evidence) between foam surfaces and alternating pressure (active) air surfaces in health-related quality of life measured with two different questionnaires, the EQ-5D-5L (267 participants) and the PU-QoL-UI (233 participants). Cost-effectiveness: one study reported trial-based cost-effectiveness evaluations. Alternating pressure (active) air surfaces are probably more cost-effective than foam surfaces in preventing pressure ulcer incidence (2029 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS Current evidence suggests uncertainty about the differences in pressure ulcer incidence, patient comfort, adverse events and health-related quality of life between using foam surfaces and other surfaces (reactive fibre surfaces, reactive gel surfaces, reactive foam and gel surfaces, or reactive water surfaces). Foam surfaces may increase pressure ulcer incidence compared with alternating pressure (active) air surfaces and reactive air surfaces. Alternating pressure (active) air surfaces are probably more cost-effective than foam surfaces in preventing new pressure ulcers. Future research in this area should consider evaluation of the most important support surfaces from the perspective of decision-makers. Time-to-event outcomes, careful assessment of adverse events and trial-level cost-effectiveness evaluation should be considered in future studies. Trials should be designed to minimise the risk of detection bias; for example, by using digital photography and by blinding adjudicators of the photographs to group allocation. Further review using network meta-analysis will add to the findings reported here.
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Affiliation(s)
- Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Rhodes
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Fitzroy, Melbourne, Australia
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Lin X, Mao Y, Li P, Bai Y, Chen T, Wu K, Chen D, Yang H, Yang L. Ultra-Conformable Ionic Skin with Multi-Modal Sensing, Broad-Spectrum Antimicrobial and Regenerative Capabilities for Smart and Expedited Wound Care. Adv Sci (Weinh) 2021; 8:2004627. [PMID: 33977071 PMCID: PMC8097371 DOI: 10.1002/advs.202004627] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/29/2020] [Indexed: 05/18/2023]
Abstract
While rapid wound healing is essential yet challenging, there is also an unmet need for functional restoration of sensation. Inspired by natural skin, an ultra-conformable, adhesive multi-functional ionic skin (MiS) with multi-modal sensing capability is devised for smart and expedited wound care. The base of MiS is a unique skin-like, conductive and self-adaptive adhesive polyacrylamide/starch double-network hydrogel (PSH) and self-powered, flexible, triboelectric sensor(s) is integrated on top of PSH for multi-tactile sensing. MiS could enhance wound contraction, collagen deposition, angiogenesis, and epidermis formation in a full-thickness skin defect wound model in vivo, while significantly inhibiting the biofilm formation of a wide range of microorganisms. MiS also exhibits multi-modal sensing capability for smart and instant therapeutics and diagnostics, including skin displacement or joint motion, temperature, pressure and tissue exudate changes of wound bed, and locally releasing drugs in a pH-responsive manner. More importantly, MiS could restore the skin-mimicking tactile sensing function of both touch location and intensity, and thus could be used as a human-machine interface for accurate external robotic control. MiS demonstrates a new comprehensive paradigm of combining wound diagnosis and healing, broad-spectrum anti-microbial capability and restoration of multi-tactile sensing for the reparation of severe wound.
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Affiliation(s)
- Xiao Lin
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Yuxuan Mao
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Peng Li
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Yanjie Bai
- School of Public HealthSoochow UniversitySuzhou215123P. R. China
| | - Tao Chen
- Jiangsu Provincial Key Laboratory of Advanced Robotics, School of Mechanical and Electric EngineeringSoochow UniversitySuzhou215123P. R. China
| | - Kang Wu
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Dandan Chen
- National Institute for Food and Drug ControlBeijing102629P. R. China
| | - Huilin Yang
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
| | - Lei Yang
- Orthopedic Institute and Department of OrthopedicsThe First Affiliated Hospital, Soochow UniversitySuzhouJiangsu215006P. R. China
- Center for Health Science and Engineering (CHSE), School of Materials Science and EngineeringHebei University of TechnologyTianjin300130P. R. China
- Tianjin Key Laboratory of Spine and Spinal CordTianjin Medical University General HospitalTianjin300130P. R. China
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Floyd NA, Dominguez-Cancino KA, Butler LG, Rivera-Lozada O, Leyva-Moral JM, Palmieri PA. The Effectiveness of Care Bundles Including the Braden Scale for Preventing Hospital Acquired Pressure Ulcers in Older Adults Hospitalized in ICUs: A Systematic Review. Open Nurs J 2021. [DOI: 10.2174/1874434602115010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background:
Despite technological and scientific advances, Hospital Acquired Pressure Ulcers (HAPUs) remain a common, expensive, but preventable adverse event. The global prevalence ranges from 9% to 53% while three million people develop HAPUs in the United States and 60,000 people die from associated complications. HAPU prevalence is reported as high as 42% in ICUs (ICU) costing on average $48,000 to clinically manage.
Objective:
The purpose of this systematic review was to evaluate the effectiveness of multi-component interventions (care bundles), incorporating the Braden scale for assessment, in reducing the prevalence of HAPUs in older adults hospitalized in ICUs.
Methods:
This was a systematic review of the literature using the Cochrane method. A systematic search was performed in six databases (CINAHL, Cochrane Library, Google Scholar, JBI Evidence-Based Practice Database, PubMed, and ProQuest) from January 2012 until December 2018. Bias was assessed with the Critical Appraisal Skills Programme Checklist, and the quality of evidence was evaluated with the American Association of Critical-Care Nurses Levels of Evidence.
Results:
The search identified 453 studies for evaluation; 9 studies were reviewed. From the analysis, pressure ulcer prevention programs incorporated three strategies: 1) Evidence-based care bundles with risk assessments upon admission to the ICU; 2) Unit-based skincare expertise; and 3) Staff education with auditing feedback. Common clinical management processes included in the care bundles were frequent risk reassessments, daily skin inspections, moisture removal treatments, nutritional and hydration support, offloading pressure techniques, and protective surface protocols. The Braden scale was an effective risk assessment for the ICU. Through early risk identification and preventative strategies, HAPU programs resulted in prevalence reduction, less severe ulcers, and reduced care costs.
Conclusion:
Older adults hospitalized in the ICU are most vulnerable to developing HAPUs. Early and accurate identification of risk factors for pressure is essential for prevention. Care bundles with three to five evidence-based interventions, and risk assessment with the Braden scale, were effective in preventing HAPUs in older adults hospitalized in intensive care settings. Higher quality evidence is essential to better understanding the impact of HAPU prevention programs using care bundles with risk assessments on patient outcomes and financial results.
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Huang C, Ma Y, Wang C, Jiang M, Yuet Foon L, Lv L, Han L. Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis. Nurs Open 2021; 8:2194-2207. [PMID: 33630407 PMCID: PMC8363405 DOI: 10.1002/nop2.792] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
AIM Pressure injuries are common adverse events in clinical practice, affecting the well-being of patients and causing considerable financial burden to healthcare systems. It is therefore essential to use reliable assessment tools to identify pressure injuries for early prevention. The Braden Scale is a widely used tool to assess pressure injury risk, but the literature is currently lacking in determining its accuracy. This study aimed to evaluate the accuracy of the Braden Scale in assessing pressure injury risk. DESIGN Systematic review and meta-analysis. METHODS Articles published between 1973-2020 from periodicals indexed in the PubMed, EMBASE, CINAHL, Web of Science and the Cochrane Library were selected. Two reviewers independently selected the relevant studies for inclusion. Data were analysed by the STATA 15.0 and the RevMan 5.3 software. RESULTS In total, 60 studies involving 49,326 individuals were eligible for this meta-analysis. The pooled SEN, SPE, PLR, NLR, DOR and AUC were 0.78 (95% CI: 0.74 to 0.82), 0.72 (95% CI: 0.66 to 0.78), 2.80 (95% CI: 2.30 to 3.50), 0.30 (95% CI: 0.26 to 0.35), 9.00 (95% CI: 7.00 to 13.00) and 0.82 (95% CI: 0.79 to 0.85), respectively. Subgroup analyses indicated that the AUC was higher for prospective design (0.84, 95% CI: 0.81 to 0.87), mean age <60 years (0.87, 95% CI: 0.84 to 0.90), hospital (0.82, 95% CI: 0.79 to 0.86) and Caucasian population (0.86, 95% CI: 0.82 to 0.88). In addition, 18 was found to be the optimal cut-off value. CONCLUSION The evidence indicated that the Braden Scale had a moderate predictive validity. It was more suitable for mean age <60 years, hospitalized patients and the Caucasian population, and the cut-off value of 18 might be used for the risk assessment of pressure injuries in clinical practice. However, due to the different cut-off values used among included studies, the results had a significant heterogeneity. Future studies should explore the optimal cut-off value in the same clinical environment.
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Affiliation(s)
- Can Huang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Chenxia Wang
- Nursing Department, Gansu Provincial Hospital, Lanzhou, China
| | - Mengyao Jiang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Loretta Yuet Foon
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Lin Lv
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Nursing Department, Gansu Provincial Hospital, Lanzhou, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Nursing Department, Gansu Provincial Hospital, Lanzhou, China
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Dong Y, Liu JE, Song L. Risk Factors for Intraoperative Pressure Injury in Aortic Surgery: A Nested Case-Control Study. Cardiovascular Innovations and Applications 2021. [DOI: 10.15212/cvia.2019.1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims and Objectives: The aim of this study was to identify risk factors associated with an increased risk of intraoperative pressure injury in patients undergoing aortic surgery.Background: Intraoperative pressure injuries are some of the most significant health problems
in clinical practice. According to previous studies, patients undergoing aortic surgery are at high risk of developing an intraoperative pressure injury, with an incidence much higher than that associated with other types of cardiac surgery.Design: This was a nested case-control
study.Methods: Following the STROBE checklist, a nested case-control approach was adopted in this study. A patient cohort was selected on the basis of inclusion and exclusion criteria from patients undergoing aortic surgery. Data were collected from these patients by means of a
tailored questionnaire designed in-house. Patients with intraoperative pressure injury at the end of surgery were identified as the case group, while the control group consisted of patients without intraoperative pressure injury. Patients in the groups underwent 1:1 matching based on age and
sex. Initially, a single-factor analysis was conducted between the two groups. Subsequently, risk factors for intraoperative pressure injury were identified through conditional logistic regression analysis with use of the variables that exhibited statistically significant differences in the
single-factor analysis.Results: A total of 400 patients were selected. Among these, 167 patients experienced intraoperative pressure injury at an incidence rate of 41.8%. Strict preoperative bed confinement, deep hypothermic circulatory arrest during surgery, application of norepinephrine
or dopamine during surgery, and intraoperative skin wetting were associated with the occurrence of intraoperative pressure injury in patients undergoing aortic surgery.Conclusions: Nurses should thoroughly assess the risk of intraoperative pressure injury and implement appropriate
preventative interventions, particularly in high-risk patients undergoing aortic surgery.
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Affiliation(s)
- Yao Dong
- Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Jun-E Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ling Song
- Beijing Anzhen Hospital Affiliated with Capital Medical University, Beijing, China
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Grosemans J, Bergs J, Vlayen A, Schrooten W, Hellings J. Defining a set of potentially preventable complications relevant to nursing: A Delphi Study among head nurses. J Nurs Manag 2020. [DOI: 10.1111/jonm.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joep Grosemans
- Faculty of Medicine and Life Sciences Hasselt University Hasselt Belgium
- Healthcare Department PXL University of Applied Sciences and Arts Hasselt Belgium
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences Hasselt University Hasselt Belgium
- Healthcare Department PXL University of Applied Sciences and Arts Hasselt Belgium
| | - Annemie Vlayen
- Faculty of Medicine and Life Sciences Hasselt University Hasselt Belgium
| | - Ward Schrooten
- Faculty of Medicine and Life Sciences Hasselt University Hasselt Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences Hasselt University Hasselt Belgium
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Jiang Q, Liu Y, Yu H, Song S, Li G, Liu H, Zhou Y, Zhu Y, Jia J, Huang Y, Wang J. A Multicenter, Comparative Study of Two Pressure-Redistribution Mattresses with Repositioning Intervals for Critical Care Patients. Adv Skin Wound Care 2020; 33:1-9. [PMID: 32058444 DOI: 10.1097/01.ASW.0000653160.13611.5d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effectiveness of two protocols for preventing pressure injuries (PIs) in Chinese hospitals. DESIGN AND SETTING A multicenter, open-label, comparative study conducted in seven Chinese acute care hospitals. PATIENTS AND INTERVENTION In total, 1,654 eligible patients were identified, and 1,204 were enrolled in the study. Enrolled patients were randomly assigned into the trial group (4-hour repositioning combined with a viscoelastic foam mattress; n = 602) or the control group (2-hour repositioning combined with a powered air pressure redistribution mattress; n = 602). Participants received their respective protocols until they were discharged, died, or for at least 7 days. MAIN OUTCOME MEASURES The incidence of PIs, Braden Scale scores, and the time to development of PIs. MAIN RESULTS Ultimately, 596 trial group patients and 598 control group patients were analyzed. Thirteen patients had single new stage 2 or worse PIs. The total incidence of PIs was 1.1%. The difference between the two groups was significant (0.3% vs 1.8%). However, the difference between the groups' Braden Scale score median during the intervention was not significant (13 vs 13.5). CONCLUSIONS The 4-hour repositioning interval combined with a viscoelastic foam mattress did not increase PI incidence or risk. These findings could help providers select the right pressure redistribution mattresses and repositioning intervals for critical care patients.
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Prasad S, Hussain N, Sharma S, Chandy S, Kurien J. Impact of Pressure Injury Prevention Protocol in Home Care Services on the Prevalence of Pressure Injuries in the Dubai Community. Dubai Med J 2020. [DOI: 10.1159/000511226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Pressure injuries (PIs) in the community have emerged as a health care burden in the past few years, leading to high rates of morbidity and mortality among the elderly population. There is evidence that simple risk assessment tools and protocols have reduced the prevalence of PIs considerably by shifting the focus to timely prevention and adequate management. The prevalence of PIs is high in home care setting and utilizes a major share of the organizational resources for its treatment and prevention. <b><i>Aim:</i></b> This study aims to assess the impact of the newly developed PI prevention protocol for home care patients in Dubai. The objectives are to evaluate effective implementation of the proposed protocol and its impact on the prevalence of PIs in the community to identify the gaps for improvement in the future. <b><i>Methods:</i></b> This retrospective observational was conducted in 13 primary health care centers in Dubai, UAE. Data were collected from 249 patients’ records at an average age of 75.5 ± 14.5 years old with compromised mobility (bedbound/chairbound) from January to July 2019. The PI prevalence was assessed before and after 6 months of implementing the PI prevention protocol and comparison was done using a standardized skin assessment scale (Braden Scale). Internationally validated tools from the Agency for Healthcare Research and Quality and National Institute for Health and Care Excellence were used to ensure the reliable use of the Braden Scale and PI protocol compliance. The prevalence was calculated from the existing key performance indicators in the home care office and considering the significant improvement at <i>p</i> value of <0.05. <b><i>Results:</i></b> The findings in the first quarter revealed a significant drop in both prevalence (9.0%) and incidence rate (6.0%) to approximately 2.0%. Overall PIs prevalence declined significantly after implementing the protocol (<i>p</i> < 0.0001) among both genders. Also, a significant improvement was detected in the use of Braden Scale and multidisciplinary care plan (<i>p</i> < 0.0001). <b><i>Conclusion:</i></b> This study indicates that standardization of care delivery reduces the increased risk and incidence of PIs with a potentially positive outcome on PI prevalence.
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Araujo SM, Sousa P, Dutra I. Clinical Decision Support Systems for Pressure Ulcer Management: Systematic Review. JMIR Med Inform 2020; 8:e21621. [PMID: 33064099 PMCID: PMC7600011 DOI: 10.2196/21621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/27/2020] [Accepted: 09/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical decision-making process in pressure ulcer management is complex, and its quality depends on both the nurse's experience and the availability of scientific knowledge. This process should follow evidence-based practices incorporating health information technologies to assist health care professionals, such as the use of clinical decision support systems. These systems, in addition to increasing the quality of care provided, can reduce errors and costs in health care. However, the widespread use of clinical decision support systems still has limited evidence, indicating the need to identify and evaluate its effects on nursing clinical practice. OBJECTIVE The goal of the review was to identify the effects of nurses using clinical decision support systems on clinical decision making for pressure ulcer management. METHODS The systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. The search was conducted in April 2019 on 5 electronic databases: MEDLINE, SCOPUS, Web of Science, Cochrane, and CINAHL, without publication date or study design restrictions. Articles that addressed the use of computerized clinical decision support systems in pressure ulcer care applied in clinical practice were included. The reference lists of eligible articles were searched manually. The Mixed Methods Appraisal Tool was used to assess the methodological quality of the studies. RESULTS The search strategy resulted in 998 articles, 16 of which were included. The year of publication ranged from 1995 to 2017, with 45% of studies conducted in the United States. Most addressed the use of clinical decision support systems by nurses in pressure ulcers prevention in inpatient units. All studies described knowledge-based systems that assessed the effects on clinical decision making, clinical effects secondary to clinical decision support system use, or factors that influenced the use or intention to use clinical decision support systems by health professionals and the success of their implementation in nursing practice. CONCLUSIONS The evidence in the available literature about the effects of clinical decision support systems (used by nurses) on decision making for pressure ulcer prevention and treatment is still insufficient. No significant effects were found on nurses' knowledge following the integration of clinical decision support systems into the workflow, with assessments made for a brief period of up to 6 months. Clinical effects, such as outcomes in the incidence and prevalence of pressure ulcers, remain limited in the studies, and most found clinically but nonstatistically significant results in decreasing pressure ulcers. It is necessary to carry out studies that prioritize better adoption and interaction of nurses with clinical decision support systems, as well as studies with a representative sample of health care professionals, randomized study designs, and application of assessment instruments appropriate to the professional and institutional profile. In addition, long-term follow-up is necessary to assess the effects of clinical decision support systems that can demonstrate a more real, measurable, and significant effect on clinical decision making. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42019127663; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127663.
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Affiliation(s)
- Sabrina Magalhaes Araujo
- Medical Informatics, Faculty of Medicine and Faculty of Sciences, University of Porto, Porto, Portugal
| | - Paulino Sousa
- Nursing School of Porto, Porto, Portugal
- Health Information Systems & Electronic Health Records, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Inês Dutra
- Department of Computer Science, Faculty of Sciences, University of Porto, Porto, Portugal
- Artificial Intelligence for Health Care, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Abstract
Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.
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Abstract
Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper, we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. The change of Person Centred Care to Kin Centred Care introduces a broader concept of the person and ensures that Person Centred Care is included in every domain of quality rather than as a separate domain. The concentration on the technological aspects of quality is an example of the problem in the past. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
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Affiliation(s)
- Peter Lachman
- Royal College of Physicians Ireland (RCPI), Dublin, Ireland
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kris Vanhaecht
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, 3000, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, 3000, Belgium
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Lachman P, Batalden P, Vanhaecht K. A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health. F1000Res 2020; 9:1140. [PMID: 34158927 PMCID: PMC8191516 DOI: 10.12688/f1000research.26368.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 09/21/2023] Open
Abstract
Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
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Affiliation(s)
- Peter Lachman
- Royal College of Physicians Ireland (RCPI), Dublin, Ireland
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kris Vanhaecht
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, 3000, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, 3000, Belgium
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Lachman P, Batalden P, Vanhaecht K. A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals in the new COVID-19 period. F1000Res 2020; 9:1140. [PMID: 34158927 PMCID: PMC8191516 DOI: 10.12688/f1000research.26368.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/30/2022] Open
Abstract
Background: It is twenty years since the Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of "service-oriented" systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or "kin-centred care" to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what "person-centredness" began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.
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Affiliation(s)
- Peter Lachman
- Royal College of Physicians Ireland (RCPI), Dublin, Ireland
| | - Paul Batalden
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kris Vanhaecht
- KU Leuven Institute for Healthcare Policy, KU Leuven, Leuven, 3000, Belgium
- Department of Quality, University Hospitals Leuven, Leuven, 3000, Belgium
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Abstract
OBJECTIVE The primary objective was to assess the incidence of pressure ulcer (PU) in patients at high risk of PU and lying between 15-20 hours per day on an alternating-pressure mattress overlay (APMO). Secondary objectives were the patient's satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use and the moisture level. METHOD This prospective observational study was conducted in three rehabilitation centres and two nursing homes between June 2016 and March 2017. To be included, patients should not have PU at baseline and present a high risk of PU (Braden score between 10-15). The primary endpoint was the percentage of patients in whom a PU developed over a 35-day period. RESULTS A total of 83 patients were included in the study. Neurological disease was responsible for the reduced mobility of 44 (53.7%) patients, 10 patients (12.0%) dropped out (one patient for a serious adverse event (femoral neck fracture) considered not to be related to the APMO, four patients for adverse events, two of which were considered to be related to APMO and five for other reasons, including, in one case, discomfort with the APMO. These patients were considered in the analysis. Over the study period, 1.2% (1/83) (95% confidence interval (CI): 0.03 to 6.53) of patients developed a PU. Patient satisfaction with the comfort of the APMO, patient acceptance of its sound level, and the care team's assessment of its use were considered satisfying for most patients. CONCLUSION Based on the findings of this study of a low incidence of PU in participating patients, the use of an AMPO is recommended in high-risk patients lying for between 15-20 hours a day.
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Affiliation(s)
- Sylvie Meaume
- Rothschild Hospital, Geriatric Department and Wound Care Unit, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Marc Marty
- Nukleus, Clinical Research Department, Paris, France
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Wassel CL, Delhougne G, Gayle JA, Dreyfus J, Larson B. Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. Int Wound J 2020; 17:1924-1934. [PMID: 32830460 DOI: 10.1111/iwj.13482] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 01/26/2023] Open
Abstract
Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital-acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital-acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score-adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in-hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30-, 60-, and 90-day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital-acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Horup MB, Soegaard K, Kjølhede T, Fremmelevholm A, Kidholm K. Static overlays for pressure ulcer prevention: a hospital-based health technology assessment. Br J Nurs 2020; 29:S24-S28. [PMID: 32579463 DOI: 10.12968/bjon.2020.29.12.s24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION At Odense University Hospital (OUH) alternating-air mattresses (AAM) are used in the prevention of pressure ulcers (PU); however, static overlays might be more effective and have lower costs. To investigate the properties and consequences of using static overlays for prevention of PU at OUH, a hospital-based health technology assessment (HTA) was conducted. METHODS Two types of static overlays were tested in an observational study and compared with AAM for patients with a medium-high risk of PU in geriatric and orthopaedic wards at OUH. Incidence of PU was investigated 7 months before (n=720) and 6 months after implementation (n=837). Staff attitudes were examined in a questionnaire survey (n=55) and focus group interviews (n=13). Patients who had tried one of the overlays and the AAM were interviewed (n=12). RESULTS No statistical difference in PU incidence was found before and after the implementation of overlays (2.5% before, 2.7% after, P=0.874, n=1557) and no patients lying on overlays developed PU (n=123). Staff had mixed attitudes, but the majority preferred having overlays as an option for their patients. Interviewed patients preferred overlays due to less noise and improved mobility. CONCLUSION Both types of overlay are effective in PU prevention. However, overlays introduce challenges for staff and clear guidelines for the selection of support surfaces are needed. Overall, it is recommended that static overlays are considered as an alternative to AAM for PU prevention.
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Affiliation(s)
- Mette Boeg Horup
- Project Manager, Centre for Innovative Medical Technology, Odense University Hospital, Denmark
| | - Knaerke Soegaard
- PhD candidate, Nurse, Department of Plastic Surgery, Odense University Hospital, Denmark
| | - Tue Kjølhede
- Project Manager, Centre for Innovative Medical Technology, Odense University Hospital, Denmark
| | - Aase Fremmelevholm
- Pressure Ulcer Specialist Nurse, Department of Plastic Surgery, Odense University Hospital, Denmark
| | - Kristian Kidholm
- Professor, Centre for Innovative Medical Technology, Odense University Hospital, Denmark
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Yang LL, Xiao ZL, An PJ, Yan HJ, Li Q. Association between pressure ulcers and the risk of postoperative infections in male adults with spinal cord injury. Br J Neurosurg 2020:1-4. [PMID: 32476503 DOI: 10.1080/02688697.2020.1769552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Lei-luo Yang
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zheng-liang Xiao
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ping-jiang An
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hai-jian Yan
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qing Li
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Padula WV, Malaviya S, Hu E, Creehan S, Delmore B, Tierce JC. The cost-effectiveness of sub-epidermal moisture scanning to assess pressure injury risk in U.S. health systems. Journal of Patient Safety and Risk Management 2020. [DOI: 10.1177/2516043520914215] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectiveHospital-acquired pressure injuries harm over 2.5 million patients at a U.S. cost of $26.8 billion. Sub-epidermal moisture scanning technology supports clinicians to anatomically identify locations at-risk of developing hospital-acquired pressure injuries. Our objective was to evaluate the cost-effectiveness of adopting sub-epidermal moisture scanners in comparison to existing hospital-acquired pressure injury prevention guidelines structured around subjective risk assessments.MethodsA Markov cohort model was developed to analyze the cost-effectiveness of sub-epidermal moisture scanners in comparison to existing prevention guidelines, based on current clinical trial data from the U.S. health care sector perspective in the acute, acute rehabilitation and skilled nursing facility settings. A hypothetical cohort was simulated over a time horizon of one year. An incremental cost-effectiveness ratio was measured using U.S. dollars per quality-adjusted life year at a willingness-to-pay threshold of $100,000/quality-adjusted life year, and uncertainty was tested using probabilistic sensitivity analysis.ResultsIntegration of sub-epidermal moisture scanners yielded cost-savings of $4054 and 0.35 quality-adjusted life years gained per acute care admission, suggesting that sub-epidermal moisture scanners are a dominant strategy compared to standard care and producing a net monetary benefit of $39,335. For every 1000 admissions in high-risk acute care, sub-epidermal moisture scanners could avert around seven hospital-acquired pressure injury-related deaths and decrease hospital-acquired pressure injury-related re-hospitalization by approximately 206 bed-days.ConclusionsAcute care, acute rehabilitation and skilled nursing settings that adopt sub-epidermal moisture technology could achieve a return on investment in less than one year. Providers may want to consider these types of technology that aid clinical judgment with objective measures of risk in quality improvement bundles.
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Affiliation(s)
- William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
- Monument Analytics, Baltimore, MD, USA
| | | | - Ellen Hu
- Monument Analytics, Baltimore, MD, USA
| | - Sue Creehan
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Barbara Delmore
- Department of Plastic and Reconstructive Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Jonothan C Tierce
- Monument Analytics, Baltimore, MD, USA
- Center for Drug Safety and Effectiveness, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jones A, Pope J, Osei-boadi Anguah K, Erickson D. Mini Nutritional Assessment Score as a Potential Predictor of Pressure Ulcers in Elderly Nursing Home Patients With Dementia. TOP CLIN NUTR 2020; 35:42-9. [DOI: 10.1097/tin.0000000000000195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gómez‐González AJ, Morilla‐Herrera JC, Lupiáñez‐Pérez I, Morales‐Asencio JM, García‐Mayor S, León‐Campos Á, Marfil‐Gómez R, Aranda‐Gallardo M, Moya‐Suárez AB, Kaknani‐Uttumchandani S. Perfusion, tissue oxygenation and peripheral temperature in the skin of heels of healthy participants exposed to pressure: a quasi‐experimental study. J Adv Nurs 2019; 76:654-663. [DOI: 10.1111/jan.14250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/13/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - Juan Carlos Morilla‐Herrera
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
- Distrito Sanitario Málaga – Valle del Guadalhorce Servicio Andaluz de Salud (SAS) Málaga Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
| | - Inmaculada Lupiáñez‐Pérez
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
- Distrito Sanitario Málaga – Valle del Guadalhorce Servicio Andaluz de Salud (SAS) Málaga Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
| | - José Miguel Morales‐Asencio
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
| | - Silvia García‐Mayor
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
| | - Álvaro León‐Campos
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
| | - Raquel Marfil‐Gómez
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
| | - Marta Aranda‐Gallardo
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
- Agencia Sanitaria Costa del Sol Marbella Spain
| | - Ana Belén Moya‐Suárez
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
- Agencia Sanitaria Costa del Sol Marbella Spain
| | - Shakira Kaknani‐Uttumchandani
- Department of nursing University of Málaga, Faculty of Health Sciences Málaga Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA) Málaga Spain
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Chun X, Lin Y, Ma J, He J, Ye L, Yang H. Predictive efficacy of the Braden Q Scale for pediatric pressure ulcer risk assessment in the PICU: a meta-analysis. Pediatr Res 2019; 86:436-443. [PMID: 31216569 DOI: 10.1038/s41390-019-0465-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Risk assessment is recommended as the foremost step in the prevention of pressure ulcers. This study aimed to evaluate the predictive efficacy of the Braden Q Scale for the assessment of pediatric pressure ulcer risk in the pediatric intensive care unit (PICU). METHODS Six databases were searched. A meta-analysis was performed using Meta DiSc 1.4. RESULTS Seven studies were included, with a total of 1273 cases and 72 pressure ulcers. The meta-analysis showed that the pooled sensitivity and specificity of the Braden Q Scale for PICU patients were 0.72 and 0.60 (95% confidence interval (CI): 0.60-0.82; 0.57-0.63), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 1.69, 0.62, and 3.34 (95% CI: 1.18-2.42; 0.40-0.94; 1.47-7.61), respectively. The area under the curve of summary receiver operating characteristics was 69.18%, and the Q index was 0.6464. CONCLUSION The Braden Q Scale predicted pressure ulcer risk in the PICU with moderate accuracy. More testing for the Braden QD Scale's performance is needed, taking into account the impact of the interventions. In the future, it will be necessary to look for and improve pediatric pressure ulcer risk assessment tools.
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Affiliation(s)
- Xiao Chun
- Pediatric Intensive Care Unit (PICU), Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China
| | - Yan Lin
- Nursing Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China.
| | - Jingxiang Ma
- Pediatric Intensive Care Unit (PICU), Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China
| | - Jing He
- Operating Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China
| | - Liyan Ye
- Pediatric Intensive Care Unit (PICU), Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China
| | - Hongmei Yang
- Operating Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China
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Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol 2019; 81:881-890. [DOI: 10.1016/j.jaad.2018.12.069] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/15/2022]
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Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. J Am Acad Dermatol 2019; 81:893-902. [DOI: 10.1016/j.jaad.2018.12.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE: To quantify the prevalence and incidence of different skin injuries, pressure ulcers (PU), skin tears (ST) and incontinence-associated dermatitis (IAD) in China, and to identify their causes to aid prevention and control. METHOD: A cross-sectional observational study was conducted across nine tertiary hospitals. Registered nurses were trained on a standard approach to injury assessment and examination. The study was carried out at the same time on the same day across the participating centres. Participating patients were examined for PU, ST or IAD. RESULTS: A total of 13,176 inpatients were assessed and 233 PU were identified, of which 126 occurred in hospitals, 99 cases at home and eight cases within community hospitals. In addition, there were 141 skin tears and 97 IADs. CONCLUSION: This study involved the largest number of hospitals, to date (in China). Therefore, the prevalence and rate of incidence of skin injury obtained in this study may represent a regional baseline in China.
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Affiliation(s)
- Haixia Feng
- Director Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Yanping Wu
- Head Nurse; Geriatric Department, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Chang Su
- Professor; Statistical Department, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Guohong Li
- Chief Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Cuirong Xu
- Deputy Chief Nurse; Department of Nursing Management, Zhongda Hospital, School of Medicine, Southeast University, China
| | - Changping Ju
- Chief Nurse; Lishui Country People's Hospital, The Group Hospital, Zhongda Hospital, School of Medicine, Southeast University, China
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