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Year Number of Results
1954 1
1958 1
1964 1
1965 1
1969 1
1971 3
1972 1
1973 1
1974 2
1975 1
1976 1
1977 4
1980 2
1981 1
1983 4
1987 2
1989 2
1990 1
1991 1
1992 1
1993 3
1994 2
1995 2
1996 1
1997 6
1999 2
2000 9
2001 7
2002 5
2003 1
2004 6
2005 6
2006 2
2007 4
2008 12
2009 4
2010 15
2011 14
2012 15
2013 15
2014 19
2015 26
2016 25
2017 23
2018 31
2019 27
2020 25
2021 24
2022 31
2023 38
2024 19

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Page 1
Randomized Controlled Trial
. 2024 Jun 1;33(Sup6):S13-S18.
doi: 10.12968/jowc.2021.0124.

Comparing the effectiveness of active and reactive mattresses in pressure injury healing: a pilot study

Affiliations
Randomized Controlled Trial

Comparing the effectiveness of active and reactive mattresses in pressure injury healing: a pilot study

Katherine E Rae et al. J Wound Care. .

Abstract

Objective: A feasibility study to test the proposed methodology for a larger randomised control trial was conducted, investigating the comparative effectiveness of the two types of pressure management support surfaces with regards to healing pressure injuries (PI). A secondary objective was to provide insights into the user acceptability of the two types of pressure management support surfaces.

Method: A randomised control feasibility study was conducted in a community health setting in Canberra, Australia. Patients aged ≥65 years with an existing Stage 2 PI who slept in a bed were eligible. Participants were randomised to either the active mattress group or the reactive mattress group for use on their bed. All participants received standard wound care by community nursing staff and were provided an air-flotation cushion for use when not in bed. Photographs were taken and used for blind assessment of wound healing. Secondary information was gathered through a survey regarding user acceptability of the support surfaces and changes in habits regarding PI prevention strategies.

Results: In total, five patients were recruited, with one passing away prior to mattress allocation. Results were inconclusive with regards to comparative effectiveness and user acceptability due to the small sample size; however, secondary data indicated an increasing implementation of PI prevention strategies.

Conclusion: This study confirmed the need for further high quality research comparing reactive and active pressure mattresses. Trends indicate the importance of including education on PI prevention strategies to promote changes in behaviour. Changes to the proposed methodology will be made to increase recruitment in the primary study.

Keywords: community nursing; pressure injury; pressure mattress; treatment; wound; wound care; wound dressing; wound healing.

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. 2024 May 21.
doi: 10.1111/ajag.13317. Online ahead of print.

Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes

Affiliations

Introduction of enhanced weekend physiotherapy for patients with hip fracture is associated with improved early mobility outcomes

Danielle Ní Chróinín et al. Australas J Ageing. .

Abstract

Objective: To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated with improved clinical outcomes.

Methods: We retrospectively analysed all previously ambulatory adults admitted with hip fracture to our tertiary hospital, comparing 'usual' ('control') care (09/19-03/20) to EWP (09/20-03/21). Outcomes included Day-7 mobility ≥20 m (primary), additional mobility measures, specified postoperative complications, new residential facility placement, acute length-of-stay (LOS) and 30-day death.

Results: Amongst 235 eligible patients (128 control, 107 EWP), 66% were female, mean age was 80.4 years (SD 10.5), 20% from residential care and 49% (114/235) were mobilising without aid at baseline (no between-group differences; all p ≥ .20). Median acute LOS was 10 days (IQR 6-15), total hospital LOS was 21 days (IQR 12-37) and 3% (n = 6) died by Day 30. Median Day-7 distance mobilised was 25 m (IQR 7-50) with EWP versus 10 m (3-40) (p = .06). No EWP patients developed pressure injury (0 vs. 6, p = .02); other outcomes were similar between groups. Adjusting for age, residence, baseline cognitive impairment, American Society of Anesthesiologist score and preadmission mobilisation without aids, EWP was independently associated with increased likelihood of mobilising ≥20 m at Day 7 (aOR 1.83, 95% CI 1.04-3.23, p = .03).

Conclusions: Enhanced daily weekend physiotherapy was associated with improvement in early mobility, but not other outcomes assessed. These data would be strengthened by randomised controlled trial data exploring more intense physiotherapy, cost-benefit analysis and patient experience measures.

Keywords: aged; hip fractures; hospitalisation; physical therapy modalities; treatment outcome.

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. 2024 May 17:S0882-5963(24)00200-8.
doi: 10.1016/j.pedn.2024.05.018. Online ahead of print.

Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study

Affiliations
Free article

Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study

Maleea D Holbert et al. J Pediatr Nurs. .
Free article

Abstract

Purpose: Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.

Methods: A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.

Results: Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.

Conclusion: Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.

Trial registration: Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.

Keywords: Implementation barriers; Implementation science; Negative pressure wound therapy; Pediatric burn; Re-epithelialization.

Conflict of interest statement

Declaration of competing interest This project has been awarded funding from the National Health and Medical Research Council (NHMRC) Partnership Projects PRC2 Funding ID: 2006970. The authors declare that they have no competing interests.

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. 2024 May 15.
doi: 10.1111/vsu.14101. Online ahead of print.

In vitro evaluation of a hybrid negative pressure system for wound therapy

Affiliations

In vitro evaluation of a hybrid negative pressure system for wound therapy

Jack S Davey et al. Vet Surg. .

Abstract

Objective: The objective of this study was to assess whether negative pressure could be maintained accurately and repeatably with a wall-suction-based hybrid negative pressure wound therapy (h-NPWT) system by comparing it with a commercial negative pressure wound therapy (NPWT) device.

Study design: In vitro experimental study.

Methods: A commercial NPWT device (control) and three h-NPWT devices, with 0, 3, and 6 meters of additional tubing using the hospital-wall suction (groups 1, 2, and 3 respectively), were applied sequentially to a commercial NPWT dressing on a silicone skin substrate and set to run at a continuous pressure of -125 mmHg. The pressure within the wound space was monitored at 10 second intervals for 24 h. The process was repeated five times for each group.

Results: The commercial NPWT device produced an average pressure variance of 3.02 mmHg, and the h-NPWT produced average variances of 4.38, 4.24 and 4.20 mmHg for groups 1, 2 and 3, respectively. All groups produced an average pressure within 0.15 mmHg of -125 mmHg over the 24-hour period, and the h-NPWT systems produced the smallest range with all values remaining within a ±5% variation from -125 mmHg.

Conclusion: The h-NPWT system achieved negative pressures that were comparable to those of a commercial control NPWT device. The addition of tubing between the skin substrate and the canister did not affect the pressure applied at the wound site.

Clinical significance: The h-NPWT device tested in this study can be considered as an alternative for negative wound therapy when a commercial device cannot be used.

Proceed to details
. 2023 Dec;31(4):174-181.
doi: 10.33235/wpr.31.4.174-181.

Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity

Affiliations

Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity

Holly C Felix et al. Wound Pract Res. 2023 Dec.

Abstract

Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring.

Keywords: nursing homes; obesity; pressure injuries.

Conflict of interest statement

Conflict of interest The authors declare no conflicts of interest.

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Review
. 2024 May 8.
doi: 10.1111/inr.12984. Online ahead of print.

Structured interactions between nurses and patients through intentional rounding: A scoping review

Affiliations
Review

Structured interactions between nurses and patients through intentional rounding: A scoping review

Abdelrahman Al-Anati et al. Int Nurs Rev. .

Abstract

Aim: To synthesize existing literature describing the impact of intentional rounding on patient outcomes among hospitalized adults.

Background: Intentional rounding has been described as purposeful therapeutic communication between nurses and patients during regular checks with patients using standardized protocols. Despite the widespread adoption of intentional rounding, the current understanding of the benefits of these structured interactions between nurses and patients is limited.

Introduction: The critical role of nurses in ensuring high-quality and safe care in acute hospitals is often noted only when things go wrong. This was highlighted by investigations into the reasons for the failures in patient care at the Mid Staffordshire National Health Services.

Methods: A scoping review was performed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review guidelines.

Findings: Sixteen studies were included in the final review. Various rounding models were noted among different clinical settings; four studies reported a significant reduction in falls, and a further three reported a decrease in pressure injuries. Two studies reported a reduction in call bell usage. Significant improvements in patients' satisfaction with intentional rounding were reported in three studies.

Discussion: Promoting intentional rounding without solid evidence of its acceptability, feasibility, and suitability in different clinical settings could compromise nurses' ability to provide safe care.

Conclusion and implications for nursing: There is weak evidence of the effectiveness of intentional rounding on patient outcomes because of the diversity of methods employed and methodological limitations in many studies. Our findings identify the need for robust studies to explore the acceptability and feasibility of a rounding protocol that can be implemented in different clinical settings.

Keywords: Clinical outcome; communication in health care; hourly round; intentional round; patient safety indicators; proactive round.

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. 2024 May 6:10:23779608241251631.
doi: 10.1177/23779608241251631. eCollection 2024 Jan-Dec.

Knowledge and Attitude of Nursing Interns Toward Pressure Injury Prevention in Saudi Arabia: A Multiregional Cross-Sectional Study

Affiliations

Knowledge and Attitude of Nursing Interns Toward Pressure Injury Prevention in Saudi Arabia: A Multiregional Cross-Sectional Study

Hassan Al Gharash et al. SAGE Open Nurs. .

Abstract

Introduction: Nursing students in internship programs can play a role in preventing pressure injuries as they engage in real clinical situations and are assigned to conduct clinical tasks. Thus, nursing students in internship programs should be adequately prepared in terms of their knowledge and attitudes to contribute to pressure injury prevention.

Objective: To explore and understand the knowledge and attitudes of nursing interns toward pressure injury prevention in Saudi Arabia.

Methods: This cross-sectional study included 161 nursing interns from various public hospitals across three provinces in Saudi Arabia and used an online questionnaire. The Pressure Ulcer Knowledge Assessment Tool and Attitude toward Pressure Ulcer Prevention instrument were used to collect data from nursing students in the internship program. The Statistical Package of the Social Sciences Program version 28 was used for the data analysis.

Results: Participants reported inadequate knowledge regarding the prevention of pressure injuries, with a mean knowledge score of 48.15%. Additionally, the participants showed unsatisfactory attitudes toward the prevention of pressure injuries, with a mean score of 61.36%. Significant differences were observed in knowledge (P = 0.008) and attitude (P < 0.001) levels between sexes, with female participants scoring higher than male participants. Additionally, students who completed longer internships had better knowledge levels than those who completed shorter internships (P = 0.007). In the open-response question, participants reported a lack of preparation and support during the internship and suggested recommendations to address these deficiencies in preparation and support.

Conclusion: Nursing interns need pre-internship preparation and continuous learning and support during the internship to manage and prevent pressure injuries.

Keywords: attitude; knowledge; nursing students; pressure injury.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Proceed to details
. 2024 May 2:S2468-0451(24)00023-3.
doi: 10.1016/j.idh.2024.04.001. Online ahead of print.

N-95/P2 respirator compliance with fit testing recommendations and respirator satisfaction amongst hospital staff

Affiliations
Free article

N-95/P2 respirator compliance with fit testing recommendations and respirator satisfaction amongst hospital staff

Liam Hackett et al. Infect Dis Health. .
Free article

Abstract

Background: Filtering Facepiece Respirators (FFRs) are an important and readily scalable infection control measure; however their effectiveness is ultimately determined by compliance. We aimed to examine staff compliance and satisfaction with wearing the N95/P2 FFRs assigned to them via the standardised fit testing protocol implemented in a single large healthcare network in Victoria, Australia.

Methods: In this cross-sectional survey, employees from five hospital campuses who participated in the health networks N95/P2 FFR fit testing process were invited in person to participate in the study. Data were analysed descriptively, after which chi-squared analysis was performed to determine differences between respirator types, gender, and age groups.

Results: Amongst the 258 staff members surveyed, 28% had either never or only sometimes worn an FFR to which they had been successfully fit tested, and 11% had experienced facial changes that potentially rendered their most recent fit test invalid. More than half (53%) of those surveyed had experienced side effects, the most common being skin irritation and pressure sores. A majority (87%) of staff felt that wearing an FFR had some impact on their ability to perform their duties. Pooled mean self-reported satisfaction ratings were highest for three-panel flat-fold and duckbill models.

Conclusion: 28% of HCWs surveyed described not wearing N-95/P2 FFRs for which they had successfully been fit tested. Reasons for non-compliance remain unclear, but rates of side effects and interference with duties were high. Further research is required to determine and address potential causative factors and ascertain ongoing optimal organisation-level fit test strategies.

Keywords: Covid-19; Infection control; N95 respirators; Personal protective equipment; Respiratory protective devices.

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. 2024 Dec 1;19(12):2773-2784.
doi: 10.4103/NRR.NRR-D-23-01198. Epub 2024 Jan 31.

Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury: a randomized controlled study

Affiliations

Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury: a randomized controlled study

Hui Zhu et al. Neural Regen Res. .

Abstract

JOURNAL/nrgr/04.03/01300535-202412000-00032/figure1/v/2024-04-08T165401Z/r/image-tiff For patients with chronic spinal cord injury, the conventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection, pressure sores, osteoporosis, and deep vein thrombosis. Surgery is rarely performed on spinal cord injury in the chronic phase, and few treatments have been proven effective in chronic spinal cord injury patients. Development of effective therapies for chronic spinal cord injury patients is needed. We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal cord injury to compare intensive rehabilitation (weight-bearing walking training) alone with surgical intervention plus intensive rehabilitation. This clinical trial was registered at ClinicalTrials.gov (NCT02663310). The goal of surgical intervention was spinal cord detethering, restoration of cerebrospinal fluid flow, and elimination of residual spinal cord compression. We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement, reduced spasticity, and more rapid bowel and bladder functional recovery than weight-bearing walking training alone. Overall, the surgical procedures and intensive rehabilitation were safe. American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries. Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Conflict of interest statement

Conflicts of interest: The authors declare that they have no conflicts of interest.

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. 2024 Mar 25.
doi: 10.1111/ans.18941. Online ahead of print.

Prophylactic negative pressure wound therapy to improve wound healing rates following ileostomy closure: a randomized controlled trial

Affiliations

Prophylactic negative pressure wound therapy to improve wound healing rates following ileostomy closure: a randomized controlled trial

Thomas Tiang et al. ANZ J Surg. .

Abstract

Background: Reversal of ileostomy is associated with morbidity including wound infection and prolonged wound healing. Negative pressure wound therapy (NPWT) has been shown to reduce time to wound healing by secondary intention. The aim of this study was to determine whether NPWT improved wound healing rates, compared with simple wound dressings, in patients undergoing reversal of ileostomy where the skin wound is closed with a purse-string suture.

Methods: This was a dual-centre, open-label, randomized controlled trial with two parallel intervention arms. Patients undergoing elective loop ileostomy reversal were randomized 1:1 to receive NPWT or simple wound dressings. The primary endpoint of the study was assessment of complete wound healing at day 42 post reversal of ileostomy and the secondary endpoints were patient-reported wound cosmesis using a visual analogue scale and rates of surgical site infection (SSI).

Results: The study was conducted from June 2018 to December 2021. The trial was approved by the local ethics committee. We enrolled 40 patients, 20 in each arm. One patient in each arm was lost to follow up. Nine patients (9/19, 47.36%) in the simple dressing group had wound healing vs. 13 patients (13/19, 68.42%) in the NPWT group (P = 0.188). There was no significant difference in patient- reported wound cosmesis or SSI.

Conclusion: There was no difference in wound healing rates when comparing NPWT to simple wound dressings at early and late time points post reversal of ileostomy, where the skin wound was closed with a purse-string suture.

Keywords: ileostomy reversal; negative pressure wound therapy; stoma closure.

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. 2024 Mar 8;10(6):e27534.
doi: 10.1016/j.heliyon.2024.e27534. eCollection 2024 Mar 30.

Bibliometric analysis of systematic review and meta-analysis on diabetic foot ulcer

Affiliations

Bibliometric analysis of systematic review and meta-analysis on diabetic foot ulcer

Yanyan Wang et al. Heliyon. .

Abstract

Many clinical management strategies have been proposed to deal with diabetic foot ulcers. However, the occurrence and recurrence of foot ulcers remain the major problems for diabetics. This study aims to identify, visualize, and characterize the meta-analyses on diabetic foot ulcer research. Articles published online were retrieved from the Web of Science core collection database using a search query incorporating MeSH terms and topics related to diabetic foot ulcers and meta-analysis. The publications were then analyzed for basic characteristics, including publication year, countries, topics covered, references, and keywords discussed in the articles. Data visualization was performed using CiteSpace. 334 meta-analyses and systematic reviews on diabetic foot ulcers were identified. The number of publications has experienced rapid growth in recent years (nearly 6-fold since 2016). The United States, China, Netherlands, England, and Australia had a strong collaboration in the contribution of publication. 7 primary topics were summarized from the top 100 highly cited publications: #1 Interventions (proportion: 59%), #2 Risk factors and Prevention (22%), #3 Epidemiology analysis (6%), #4 Cost-effectiveness of interventions (5%), #5 Long-term prognosis (3%), #6 Quality of life analysis (3%), and #7 Economic burden analysis (2%). Footwear and offloading interventions, multidisciplinary care, hyperbaric oxygen, platelet-rich plasma, and negative pressure wound therapies are highly regarded in terms of intervention. Diabetic foot osteomyelitis, peripheral diabetic neuropathy, chronic limb-threatening ischemia, and infections are the main comorbidities. In recent years, offloading interventions, debridement, telemedicine, long-term prognosis, and economic burden analyses have gradually received attention. Individualized treatment, multidisciplinary collaboration, quality of life considerations, and economic burden analyses are the long-term concerns.

Keywords: Bibliometric analysis; Diabetic foot ulcer; Intervention; Meta-analysis; Prevention; Prognosis.

Conflict of interest statement

The authors and their immediate family have no relevant financial or non-financial interests to disclose.

Proceed to details
. 2024 Feb 27:4:1352363.
doi: 10.3389/fneph.2024.1352363. eCollection 2024.

Prospective evaluation of a closed-incision negative pressure wound therapy system in kidney transplantation and its association with wound complications

Affiliations

Prospective evaluation of a closed-incision negative pressure wound therapy system in kidney transplantation and its association with wound complications

Susanna Lam et al. Front Nephrol. .

Abstract

Introduction: Wound complications can cause considerable morbidity in kidney transplantation. Closed-incision negative pressure wound therapy (ciNPWT) systems have been efficacious in reducing wound complications across surgical specialties. The aims of this study were to evaluate the use of ciNPWT, Prevena™, in kidney transplant recipients and to determine any association with wound complications.

Material and methods: A single-center, prospective observational cohort study was performed in 2018. A total of 30 consecutive kidney transplant recipients deemed at high risk for wound complications received ciNPWT, and the results were compared to those of a historical cohort of subjects who received conventional dressings. Analysis for recipients with obesity and propensity score matching were performed.

Results: In total, 127 subjects were included in the analysis. Of these, 30 received a ciNPWT dressing and were compared with 97 subjects from a non-study historical control group who had conventional dressing. The overall wound complication rate was 21.3% (27/127). There was no reduction in the rate of wound complications with ciNPWT when compared with conventional dressing [23.3% (7/30) and 20.6% (20/97), respectively, p = 0.75]. In the obese subset (BMI ≥30 kg/m2), there was no significant reduction in wound complications [31.1% (5/16) and 36.8% (7/19), respectively, p = 0.73]. Propensity score matching yielded 26 matched pairs with equivalent rates of wound complications (23.1%, 6/26).

Conclusion: This is the first reported cohort study evaluating the use of ciNPWT in kidney transplantation. While ciNPWT is safe and well tolerated, it is not associated with a statistically significant reduction in wound complications when compared to conventional dressing. The findings from this study will be used to inform future studies associated with ciNPWT in kidney transplantation.

Keywords: closed incision management; closed incision negative pressure; closed incision negative pressure wound therapy; kidney transplant; wound complication.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Supplementary material templates can be found in the Frontiers Word Templates file.

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. 2024 Mar 11.
doi: 10.1111/jan.16140. Online ahead of print.

Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital

Affiliations

Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital

Tanesha Dimanopoulos et al. J Adv Nurs. .

Abstract

Background: Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital.

Methods: This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies.

Results: The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk.

Conclusion: HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations.

Implications for the profession and patient care: This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies.

Impact: The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care.

Reporting method: STROBE guidelines.

No patient or public contribution: There was no patient or public contribution to the conduct of this study.

Keywords: hospital-acquired; incidence; multidisciplinary; nursing; paediatric; pressure injury; tertiary hospital.

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. 2024 Mar 7.
doi: 10.1111/jan.16142. Online ahead of print.

Pressure injury risk assessment and prescription of preventative interventions using a structured tool versus clinical judgement: An interrater agreement study

Affiliations

Pressure injury risk assessment and prescription of preventative interventions using a structured tool versus clinical judgement: An interrater agreement study

Paul Fulbrook et al. J Adv Nurs. .

Abstract

Aim: To assess agreement of pressure injury risk level and differences in preventative intervention prescription between nurses using a structured risk assessment tool compared with clinical judgement.

Design: Interrater agreement study.

Methods: Data were collected from November 2019 to December 2022. Paired nurse-assessors were allocated randomly to independently assess pressure injury risk using a structured tool (incorporating the Waterlow Score), or clinical judgement; then prescribe preventative interventions. Assessments were conducted on 150 acute patient participants in a general tertiary hospital. Agreement of risk level was analysed using absolute agreement proportions, weighted kappa and prevalence-adjusted and bias-adjusted kappa.

Results: Ninety-four nurse assessors participated. Absolute agreement of not-at-risk versus at-risk-any-level was substantial, but absolute agreement of risk-level was only fair. Clinical judgement assessors tended to underestimate risk. Where risk level was agreed, prescribed intervention frequencies were similar, although structured tool assessors prescribed more interventions mandated by standard care, while clinical judgement assessors prescribed more additional/optional interventions. Structured tool assessors prescribed more interventions targeted at lower-risk patients, whereas assessors using clinical judgement prescribed more interventions targeted at higher-risk patients.

Conclusion: There were clear differences in pressure injury risk-level assessment between nurses using the two methods, with important differences in intervention prescription frequencies found. Further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk, with emphasis on the impact of risk assessments on subsequent preventative intervention implementation.

Impact: The results of this study are important for clinical practice as they demonstrate the influence of using a structured pressure injury risk assessment tool compared to clinical judgement. Whilst further research is required into the use of both structured tools and clinical judgement to assess pressure injury risk and prescribe interventions, our findings do not support a change in practice that would exclude the use of a structured pressure injury risk assessment tool.

Reporting method: This study adhered to the GRRAS reporting guideline.

Patient/public contribution: No patient or public involvement in this study.

Implications for the profession and/or patient care: Educators and researchers can use the findings to guide teaching about pressure injury risk assessment and preventative intervention and to direct future studies. For clinical nurses and patients, a change in clinical practice that would exclude the use of a structured risk assessment tool is not recommended and further work is needed to validate the role of clinical judgement to assess risk and its impact on preventative intervention.

Keywords: acute care; clinical judgement; clinical reasoning; hospitals; intervention; nursing; pressure injury; pressure ulcer; prevention; risk assessment; skin integrity.

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. 2024 Jan 31;13(1):42-52.
doi: 10.21037/tau-23-445. Epub 2024 Jan 23.

Catheter-associated meatal pressure injuries (CAMPI) in patients with long-term urethral catheters-a cross-sectional study of 200 patients

Affiliations

Catheter-associated meatal pressure injuries (CAMPI) in patients with long-term urethral catheters-a cross-sectional study of 200 patients

Kale Munien et al. Transl Androl Urol. .

Abstract

Background: Indwelling urethral catheters (IDC) are ubiquitous to healthcare settings, and are associated with many familiar risks like haematuria, infections, bladder spasms and stones. However, a less known complication is catheter-associated meatal pressure injury (CAMPI), especially in those with long-term IDCs. The objective of this study was to explore the prevalence, associated features and management of CAMPI in adults with a long-term IDC.

Methods: A cross-sectional multi-centre study was undertaken of 200 adults with a long-term IDC across regional south-west Queensland, Australia between June 2019 to June 2021. The prevalence of CAMPI was determined by clinical examination, voluntary surveys completed by participants and documentation in medical records. Key IDC statistics included total duration of IDC, location of IDC changes, IDC size, type and fixation.

Results: Out of 200 adults with a long-term IDC, 9% (18/200) had a CAMPI. There was a higher prevalence of male CAMPI (17/169, 10%) compared to female CAMPI (1/31, 3%). The median time to identification of a CAMPI after initial IDC insertion was 12 weeks (2-136 weeks), but occurred as soon as 2 weeks. CAMPI formation was associated with IDC changes in the community, impaired mobility and congestive cardiac failure (CCF). CAMPI were mostly treated by conservative means given the frailty of the population.

Conclusions: Poor mobility, community-managed IDCs, and CCF were all found to have statistically significant associations with the development of CAMPI. CAMPI represents an important and underserved iatrogenic complication within urology practice, and greater awareness is needed to prevent it in vulnerable patients with long-term IDCs.

Keywords: Urology; community health services; complications; urinary catheter; urological surgical procedures.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-23-445/coif). The authors have no conflicts of interest to declare.

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. 2024 Feb 19:10:23779608241229507.
doi: 10.1177/23779608241229507. eCollection 2024 Jan-Dec.

Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases

Affiliations

Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases

Raban Heller et al. SAGE Open Nurs. .

Abstract

Introduction: Pressure injuries (PIs) arise from sustained pressure on tissue, leading to reduced blood flow to the affected area. In patients with spinal cord injuries (SCIs), these PIs can significantly diminish their independence and overall quality of life. This research sought to assess the frequency of surgical complications in treatment regimens for large sacral PIs involving the anus. Specifically, the study focused on the incorporation of stoma formation in patients with SCIs.

Methods: A retrospective review identified 25 SCI patients who had extensive sacral PIs. These patients underwent intestinal stoma formation as a preparatory step before plastic reconstructive surgery to address the wounds between 2015 and 2020.

Results: Successful wound closure was achieved in all instances. Notably, each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before this intervention. The observed rate of surgical complications aligned with findings from previous analogous studies.

Conclusion: While often viewed as a treatment of last resort, an intestinal stoma might serve as a valuable strategy, particularly for SCI patients with extensive PIs near the anal region, to promote the healing of such injuries. Tailored decision-making is essential to ensure the best possible patient outcomes.

Keywords: pressure injuries; quality of life; spinal cord injury; stoma formation.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Review
. 2024 Jan 31.
doi: 10.1111/1440-1630.12932. Online ahead of print.

The effect of wheelchair cushion properties on the microclimate at the cushion-user interface: A systematic review and meta-analysis

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Review

The effect of wheelchair cushion properties on the microclimate at the cushion-user interface: A systematic review and meta-analysis

Lisa Couzens et al. Aust Occup Ther J. .

Abstract

Introduction: Pressure injuries are a preventable yet highly prevalent health concern. Wheelchair cushion prescription can have significant implications for wheelchair users' risk of pressure injury development, which can impact functional abilities and quality of life. The efficacy of a wheelchair cushion to redistribute pressure has been well-researched, but the efficacy to manage the microclimate is less clear, particularly in warm-hot environments. The aim of this study was to systematically review studies examining the effect of wheelchair cushions on temperature, moisture and thermal perception to determine which cushions are superior to improve these responses.

Method: A systematic review with meta-analyses of randomised cross-over and randomised control trials of wheelchair cushion interventions on measures of temperature, moisture, and thermal perception was conducted.

Results: Eight studies were identified that met the eligibility criteria and six meta-analyses were conducted. Pooled analyses identified a significantly lower temperature on foam-gel cushions compared to air cushions (MD = 0.80, 95% CI: 0.31, 1.29; p = 0.002) and a significantly lower temperature on foam-gel cushions compared to foam cushions (SMD = 0.76, 95%CI; 0.45, 1.06; p < 0.00001). Pooled analyses also demonstrated significantly lower relative humidity (i.e., moisture) on foam cushions compared to foam-gel cushions (p = 0.02). Differences in thermal perception were inconclusive due to limited data found.

Conclusion: It is clear that not one cushion is ideal in managing all aspects of microclimate, as foam-gel cushions were the superior cushion to manage temperature and foam cushions were the superior cushion to manage moisture. This article provides occupational therapists and other health professionals with evidence-based information to assist with wheelchair cushion prescription that minimises the temperature and moisture accumulation, and associated risk of pressure injury for wheelchair users.

Keywords: microclimate; pressure injury; relative humidity; systematic review; temperature; wheelchair cushions.

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Review
. 2024 Jan 23.
doi: 10.1111/jan.16073. Online ahead of print.

Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis

Affiliations
Review

Invasive device-associated skin complications and mechanical dysfunctions in paediatric healthcare: A systematic review and meta-analysis

Mari Takashima et al. J Adv Nurs. .

Abstract

Aim: This study aimed to estimate the proportion and rate of skin complications and mechanical dysfunction associated with indwelling invasive devices in paediatric healthcare.

Design: This systematic review is reported in accordance with Cochrane standards for randomized controlled trials and the Meta-analysis of Observation Studies in Epidemiology for cohort studies.

Data sources: MEDLINE, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched.

Review methods: Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) paediatric participants admitted to a hospital, (3) reporting post-insertion device-associated skin complication and/or mechanical dysfunction, and (4) published in English, were included. Device-associated skin complication and mechanical dysfunction (infiltration, leakage, occlusion/blockage, dislodgement/malposition, breakage and others). Pooled proportion and incidence rate per 1000 device days are reported.

Results: This review synthesized 114 studies (30,782 devices; 1,635,649 device-days). Skin complications were reported in 40 studies, but none exclusively reported individual device-related pressure injuries. Mechanical dysfunctions were well-reported for central venous access devices, peripheral intravenous catheters, nasogastric/gastric tubes and peritoneal dialysis catheters but less for arterial catheters, extracorporeal membrane oxygenation and ventricular assist devices.

Conclusions: This systematic review highlights the need for standardized definitions and reporting methods to better surveil and benchmark device-related complications, particularly for understudied device types. Device-related pressure injuries were not reported in any of the included studies, and all devices except for vascular access devices require standardized reporting of complications.

Impact: Despite the widespread use of invasive devices, comprehensive data on their prevalence, utility, and associated paediatric complications is limited. This review identified prevalent skin complications, occlusions and dislodgments in children with devices, underscoring the need for standardized reporting to enhance surveillance and understanding of paediatric device-related complications.

Reporting method: MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist.

Patient or public contribution: No Patient or Public Contribution.

Keywords: device-related complications; device-related skin complications; indwelling invasive device; paediatric device dysfunctions.

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Observational Study
. 2024 Apr:81:103604.
doi: 10.1016/j.iccn.2023.103604. Epub 2023 Dec 27.

Exploring body morphology, sacral skin microclimate and pressure injury development and risk among patients admitted to an intensive care unit: A prospective, observational study

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Free article
Observational Study

Exploring body morphology, sacral skin microclimate and pressure injury development and risk among patients admitted to an intensive care unit: A prospective, observational study

Jessica Ingleman et al. Intensive Crit Care Nurs. 2024 Apr.
Free article

Abstract

Objective: To determine the association between body morphology, sacral skin microclimate and their impact on the development and risk of pressure injuries among patients in an intensive care unit.

Methodology: A prospective observational exploratory study was conducted over 30 weeks. Repeat study observations occurred multiple times a week for 28 days or until discharge. Participant inclusion criteria were ≥ 18 years of age, expected intensive care length of stay > 24 h and intact skin over the sacrum region.

Setting: The study was conducted in a 36-bed intensive care unit of a major metropolitan public hospital in Queensland, Australia.

Outcome measures: Pressure injuries were staged and independently verified according to the international pressure injury classification system. Pressure injury risk was determined by the Braden scale score and subepidermal oedema, using a subepidermal moisture scanner at the sacrum.

Results: Of the 93 participants recruited, an inverted triangle body shape (p =.049), a BMI > 25 kg/m2 (p =.008), a standard foam mattress type (p =.017) and increased length of stay (p <.001) were associated with an increased pressure injury risk according to subepidermal oedema. Participants with increased sacral skin temperature (p <.001), mechanical ventilation (p <.001), vasoactive drugs administered (p =.003), increased sequential organ failure assessment score (p =.047), neurovascular diagnosis (p =.031) and increased length of stay (p =.027) were associated with increased pressure injury risk according to the Braden scale score.

Conclusion: Body morphology and skin microclimate are associated with pressure injury risk during critical illness.

Implications for clinical practice: Subepidermal oedema was associated with a patient's shape, body mass index and mattress type, factors that directly influence the pressure loading and the skin, whereas the Braden scale was associated with sacral temperature and clinical measures of critical illness. Consideration of body morphology and skin microclimate in pressure injury risk assessment could lead to more specific prevention strategies targeting high risk patients.

Keywords: Body morphology; Body shape; Critical illness; Intensive care; Pressure injury; Risk assessment; Skin integrity; Skin microclimate; Subepidermal oedema.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Review
. 2023 Dec 14.
doi: 10.1111/jan.16025. Online ahead of print.

The impact of whole of patient nursing assessment frameworks on hospital inpatients: A scoping literature review

Affiliations
Review

The impact of whole of patient nursing assessment frameworks on hospital inpatients: A scoping literature review

Taneal Wiseman et al. J Adv Nurs. .

Abstract

Introduction: A comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence-based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration.

Aim: The aim of this review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes.

Methods: A scoping literature review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA-ScR Checklist Item was followed to ensure a methodologically sound checklist was used.

Results: Ten primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction.

Conclusion: Evidence-based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient.

Implications for the profession and patient care: A framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation.

Impact: What problem did the study address? This study addresses the lack of evidence-based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence-based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment. What were the main findings? This review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating. Where and on whom will the research have an impact? This review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence-based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration.

Patient and public contribution: This review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration.

Keywords: assessment framework; assessment tool; nursing assessment; patient assessment; patient deterioration; scoping review; ward nursing.

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Review
. 2023 Aug;46(2):29-35.
doi: 10.18773/austprescr.2023.006.

An update on wound management

Affiliations
Review

An update on wound management

Geoffrey Sussman. Aust Prescr. 2023 Aug.

Abstract

Wound management involves an understanding of the aetiology and pathophysiology of a wound, the healing process and how best to manage both. Acute wounds can occur suddenly, such as burns and skin tears. Chronic wounds fail to progress through the normal stages of healing and can include ulcers, pressure injuries and infected wounds. Dressings and bandages provide the optimal environment for the healing of all wound types. It is important for healthcare practitioners to understand the key differences in their properties, uses and precautions. Selecting the ideal dressing or bandage can minimise the healing duration, reduce the bioburden, and improve a patient's quality of life.

Keywords: bandages; dressings; wound care; wound pathophysiology.

Conflict of interest statement

Conflicts of interest: none declared

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. 2023 Nov 30.
doi: 10.1111/jan.16002. Online ahead of print.

Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis

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Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis

Tanesha A Dimanopoulos et al. J Adv Nurs. .

Abstract

Aim: This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI.

Design: A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023.

Methods: Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach.

Results: Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence.

Conclusion: These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings.

Impact: Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs.

Patient or public contribution: No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.

Keywords: Paediatric; adverse event; hospital-acquired; hospital-acquired complication; multidisciplinary; nursing; pressure injury; tertiary hospital; wound care.

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Comment
. 2023 Nov;36(6):931-932.
doi: 10.1016/j.aucc.2022.12.006. Epub 2023 Oct 1.

Is the CALCULATE scale useful for prediction of pressure injury in critically ill patients? We need more evidence

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Comment

Is the CALCULATE scale useful for prediction of pressure injury in critically ill patients? We need more evidence

Qifang Shi et al. Aust Crit Care. 2023 Nov.
No abstract available

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