Foam dressings for treating pressure injuries in patients of any age in any care setting: An abridged Cochrane Systematic Review

Background: Pressure injuries are localised areas of injury to the skin and/or underlying tissues. Objectives: To assess foam dressings compared to other dressings in healing pressure injuries. Design: Systematic review and meta-analysis Data sources: The review team searched: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Ovid Embase; EBSCO CINAHL Plus and the NHS Economic Evaluation Database. Authors also searched clinical trials registries and scanned reference lists for reviews, meta-analyses and health technology reports. No restrictions were applied to language, publication date or study setting. Study eligibility criteria: Published or unpublished randomised controlled trials and cluster- randomised controlled trials that examined the clinical or cost effectiveness of foam dressings for healing pressure injuries. Participants: Patients of any age with a pressure injury of Stage II or above in any care setting. Interventions: Use of any foam wound dressing for treating Stage II pressure injuries or above. Study appraisal and synthesis methods: Full-text were assessed for eligibility using a priori criteria by two authors. Risk of bias was assessed using the Grading of Recommendations, Assessment, Development and Evaluation criteria, and Consolidated Health Economic Evaluation Reporting Standards. Risk ratio and mean difference with 95% confidence intervals were used to measure the effect. The review team used Review Manager 5 to enter narrative and qualitative data of included studies. Results: Authors found nine studies published between 1994 and 2016 involving 483 participants with pressure injuries at Stage II or above. Included studies compared foam dressings with other types of dressings. However, it was unclear if the foam dressing affected healing (RR 1.00, 95% CI 0.78 to 1.28), time to complete healing (MD 5.67 days 95% CI-4.03 to 15.37), adverse events (RR 0.33, 95% CI 0.01 to 7.65), or reduction in pressure injury size (MD 0.30 cm2 per day, 95% CI -0.15 to 0.75), as the certainty of the evidence was very low. Limitations: Using the Grading of Recommendations, Assessment, Development and Evaluation criteria, the certainty and completeness of evidence was low to very low, making it difficult to draw comparisons between foam and other dressings. Conclusions and implications: It is uncertain whether foam dressings are more clinically effective, more acceptable to users, or more cost effective compared to alternative dressings in treating pressure injuries

Design Mobile App to Help Prevent Pressure Ulcers in Wheelchair Bound Patients

UROP paper, 2016, Computer ScienceUndergraduate Research Opportunities Program, University of Minnesota Dulut

Evaluating the Trezzo range of static foam surfaces: results of a comparative study

This paper presents analysis from a 6-week prospective product evaluation of the Trezzo range of mattresses, compared to standard foam mattresses, in use on two clinical areas within Pennine Acute NHS Trust. Data were collected via distribution of three questionnaires. A patient experience questionnaire was completed by patients after using their mattress. This questionnaire elicited responses relating to patient comfort, temperature and sleep quality while using the mattress (and cushion if appropriate). The Trezzo mattress was found to be comparable to the standard NHS mattress in these domains. A staff clinical evaluation (patient) questionnaire was completed by nursing staff on behalf of patients in their care at patient admission and discharge. This questionnaire elicited responses relating to patient skin condition, and incidences of pressure ulceration. The Trezzo mattress was found to be comparable to the standard NHS mattress with respect to changes in patient skin condition during hospital stay. A second staff clinical evaluation (mattress) questionnaire was completed by nursing staff, in which the Trezzo mattress was compared against standard mattresses in the domains of aesthetics, ease of use, ergonomics and temperature control; patient moving and handling and mattress stability; and cleaning and sodium hypochlorite use. The Trezzo mattress scored substantively higher than the standard mattress on all of these domains; with differences being statistically significant in all cases

Asentohoitoa asentohoitotyynyillä

Asentohoito on tärkeä osa sairaanhoitajan perustyötä. Hoitotyötä tehdessä henkilökunnalla tulee olla riittävästi tietoa ja taitoa asentohoidosta ja sen toteuttamisesta. Teimme opinnäytetyönämme DVD:n siitä, miten asentohoitotyynyjen avulla voi toteuttaa asentohoitoa. Työmme tarkoitus on antaa toiminnallinen esimerkki siitä, miten asentohoitoa toteutetaan vuodepotilaille. DVD oli toimeksianto MediMattress Oy:ltä, ja se soveltuu hyvin opetuskäyttöön. DVD sisältää esimerk-kejä asentohoidon toteuttamisesta tyynyjen avulla, teoriatietoa asentohoidosta ja ergonomiasta sekä still -kuvat asennoista. Toiminnallisen opinnäytetyön teoriaosuudessa käsittelemme asentohoidon mahdolli-suuksista helpottaa potilaan kipua ja hengitysvaikeuksia sekä siitä miten asentohoidolla voi ehkäistä painehaavoja. Asentohoidolla tuetaan myös potilaan toiminnallisuutta, estetään liikerajoituksia ja vir-heasentoja sekä edistetään verenkiertoa. Käymme työssämme läpi kuinka potilas voidaan tukea eri lepo-asentoihin tyynyjen avulla ja kiinnitämme huomiota myös oikeaoppiseen ergonomiseen työasentoon. Jatkossa voisi tutkia, voiko tekemämme DVD:n käyttö opetuksessa vuodeosastoilla lisätä asentohoito-tyynyjen käyttöä ja sitä kautta ehkäistä painehaavojen syntymistä. MediMattress Oy voisi tuottaa lisää opetusvideoita, koska heillä on useita muitakin asentohoitotyynyjä valikoimissaan. Näin he voisivat ke-hittää tätä tuotosta.Positioning is an important part of practical nursing. The nursing personnel should have adequate knowledge of positioning and skills to implement it. We made our thesis DVD about how positioning can be put on practise by using positioning pillows. The purpose of the thesis is to give a functional example of how to put positioning in practice with bed patients. The DVD was an assignment of MediMattress Oy and it suits well to be used in education. The DVD contains examples of the use of positioning pillows, theory of positioning and ergonomy as well as still pictures of those positions. In this thesis we handle the possibilities to relieve patient’s pain and breath-ning difficulties and prevent pressure ulcers by positioning. Positioning can also support patient’s func-tionality, prevent movement restriction and abnormality positions and advance blood circulation. We handle how to put patient in different positions using positioning pillows and pay attention to right er-gonomic working positions. In the future it might be worth researching if the use of the DVD in education could increase the use of positioning pillows and as a result prevent decubitus ulcers. Because MediMattress Oy has several other positioning pillows in production they might also produce more DVDs for educational purpose

Basic functionality of a prototype wearable assistive soft exoskeleton for people with gait impairments : a case study

XoSoft is a soft modular wearable assistive exoskeleton for peo- ple with mild to moderate gait impairments. It is currently being developed by a European Consortium (www.xosoft.eu) and aims to provide tailored and active lower limb support during ambu- lation. During development, user-centered design principles were followed in parallel with the aim of providing functional support during gait. A prototype was developed and was tested for practi- cability, usability, comfort and assistive function (summarized as basic functionality) with a potential end user. The prototype con- sisted of a garment, electromagnetic clutch-controlled elastic bands supporting knee- and hip flexion and a backpack containing the sensor and actuator control of the system. The participant had ex- perienced a stroke and presented with unilateral impairment of the lower and upper extremities. In testing, he donned and doffed the prototype independently as far as possible, and performed walk- ing trials with the system in both active (powered on) and pas- sive (powered off) modes. Afterwards, the participant rated the perceived pressure and various elements of usability. Results high- lighted aspects of the system for improvement during future phases of XoSoft development, and also identified useful aspects of proto- type design to be maintained. The basic functionality of XoSoft could be assumed as satisfactory given that it was the first version of a working prototype. The study highlights the benefits of this participatory evaluation design approach in assistive soft robotics development

How Do Health Care Providers Identify and Address Lifestyle Factors with Community Dwelling Adults Who Have Chronic Wounds?

Wound prevention and management best practice guidelines and literature contain recommendations that treatment plans need to consider the client’s lifestyle but offer little guidance about the specific lifestyle factors to be considered, nor how to address these. A post positivist constructivist grounded theory study was used to explore this gap Participants were health care providers with at least 5 years of experience working with community dwelling adults with chronic wounds. Data were transcripts of two semi structured individual interviews, a reflective journal, relevant documents identified by participants and transcripts of focus groups. A common understanding of lifestyle factors was not found; however, a substantive theory was co-constructed. This work builds on a concept described by Schon (1987, pg 3)where best practices and research studies are described as occupying a high ground overlooking a swamp, where complex clients are managed with limited resources. In this study, three major themes emerged – the high ground, the swamp and co-occupation. The high ground included how the health care provider entered wound prevention and management, and that their initial task was local wound care. Health care providers expected wounds to heal with specific treatments within specific time frames. Practice, however, happens in the “swamp”. Participants described the context of the swamp to include ideas such as; the practicality of treatment, client characteristics, the client’s vocation, etc. Co-occupation occurs when the clinician and client are both engaged, working together on the common goal of identifying and addressing lifestyle factors within the context of the swamp

Risk Factors for Intraoperative Pressure Injury in Aortic Surgery: A Nested Case-Control Study

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