Pressure Ulcer Treatment Strategies Comparative Effectiveness
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Pressure Ulcer Treatment Strategies
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Author : Somnath Saha
language : en
Publisher:
Release Date : 2013
Pressure Ulcer Treatment Strategies written by Somnath Saha and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.
OBJECTIVES: Pressure ulcers affect up to 3 million Americans and are a major source of morbidity, mortality, and health care cost. This review summarizes evidence comparing the effectiveness and safety of pressure ulcer treatment strategies. DATA SOURCES: Articles published between January 1, 1985, and October 17, 2012, were identified from searches of MEDLINE(r) (Ovid), Embase (Elsevier), CINAHL (EBSCOhost), EBM Reviews (Ovid), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Health Technology Assessment. Additional studies were identified by searching reference lists from included studies and systematic reviews of pressure ulcer treatments. Gray literature, including unpublished data, abstracts, dissertations, and individual product packets from manufacturers, was also reviewed. REVIEW METHODS: The literature, quality of included studies, and extracted data were dual-reviewed using predefined criteria. Results were summarized in evidence tables. Summary results were derived primarily from qualitative analysis and synthesis. RESULTS: We reviewed 7,274 titles and abstracts and 1,836 full-length articles. We included 174 studies (trials and observational studies) addressing the effectiveness and/or harms of different treatments for pressure ulcers. These studies examined a wide range of interventions, but sample sizes often were small. We found moderate-strength evidence that some interventions were associated with wound improvement, including the use of air-fluidized beds (compared with other support surfaces), protein-containing nutritional supplements (compared with placebos or other routine measures of nutritional support), radiant heat dressings (compared with other dressings), and electrical stimulation (compared with a sham treatment). Several other interventions had limited evidence of effectiveness (strength of evidence rated as low). Only a minority of studies examined complete wound healing as an outcome. In general, the evidence about the harms of any of these treatments was limited. LIMITATIONS: Most studies were of poor quality and had followup periods inadequate to assess complete wound healing. Studies often measured healing outcomes using heterogeneous methods, making it difficult to compare results across studies. CONCLUSIONS: There was limited evidence to draw firm conclusions about the best approaches for treating pressure ulcers, a finding consistent with other recent reviews on this topic. Future research with larger sample sizes, more rigorous adherence to methodological standards for clinical trials, longer followup periods, and more standardized and clinically meaningful outcome measures is needed to inform clinical practice and policy.
Pressure Ulcer Treatment Strategies Comparative Effectiveness
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Author : U. S. Department of Health and Human Services
language : en
Publisher: CreateSpace
Release Date : 2013-06-29
Pressure Ulcer Treatment Strategies Comparative Effectiveness written by U. S. Department of Health and Human Services and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-06-29 with Medical categories.
Uninterrupted pressure exerted on the skin, soft tissue, muscle, and bone can lead to the development of localized ischemia, tissue inflammation, shearing, anoxia, and necrosis. Pressure ulcers affect up to three million adults in the U.S. Pressure ulcer healing rates—which depend on comorbidities, clinical interventions, and ulcer severity—vary considerably. Ulcer severity is assessed using a variety of different staging or grading systems, but the National Pressure Ulcer Advisory Panel (NPUAP) staging system is the most commonly used. Comorbidities predisposing toward pressure ulcer development and affecting ulcer healing include those affecting patient mobility (e.g., spinal cord injury), wound environments (e.g., incontinence), and wound healing (e.g., diabetes and vascular disease). Delayed healing can add to the length of hospitalization and impede return to full functioning. Prevalence of pressure ulcers is used as an indicator of quality for long-term care facilities, and progression of pressure ulcers in hospitalized patients is often considered an avoidable complication representing failure of inpatient management. Given the negative impact pressure ulcers have on health status and patient quality of life, as well as health care costs, treatments are needed that promote healing, shorten healing time, and minimize the risk of complications. Pressure ulcer treatment involves a variety of different approaches, including interventions to treat the conditions that give rise to pressure ulcers (support surfaces and nutritional support); interventions to protect and promote healing of the ulcer (wound dressings, topical applications, and various adjunctive therapies, including vacuum-assisted closure, ultrasound therapy, electrical stimulation, and hyperbaric oxygen therapy); and surgical repair of the ulcer. Most ulcers are treated using a combination of these approaches. The following Key Questions are the focus of our report. KQ1. In adults with pressure ulcers, what is the comparative effectiveness of treatment strategies for improved health outcomes, including but not limited to: complete wound healing, healing time, reduced wound surface area, pain, and prevention of serious complications of infection? KQ1a. Does the comparative effectiveness of treatment strategies differ according to features of the pressure ulcers, such as anatomic site or severity at baseline? KQ1b. Does the comparative effectiveness of treatment strategies differ according to patient characteristics, including but not limited to: age, race/ethnicity, body weight, specific medical comorbidities, and known risk factors for pressure ulcers, such as functional ability, nutritional status, or incontinence? KQ1c. Does the comparative effectiveness of treatment strategies differ according to patient care settings, such as home, nursing facility, or hospital, or according to features of patient care settings, including but not limited to nurse/patient staffing ratio, staff education and training in wound care, the use of wound care teams, and home caregiver support and training? KQ2. What are the harms of treatments for pressure ulcers? KQ2a. Do the harms of treatment strategies differ according to features of the pressure ulcers, such as anatomic site or severity at baseline? KQ2b. Do the harms of treatment strategies differ according to patient characteristics, including age, race/ethnicity, body weight, specific medical comorbidities, and known risk factors for pressure ulcers, such as functional ability, nutritional status, or incontinence? KQ2c. Do the harms of treatment strategies differ according to patient care settings, such as home, nursing facility, or hospital, or according to features of patient care settings, including but not limited to nurse/patient staffing ratio, staff education and training in wound care, the use of wound care teams, and home caregiver support and training?
Pressure Ulcer Treatment Strategies
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Author :
language : en
Publisher:
Release Date : 2013
Pressure Ulcer Treatment Strategies written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.
Pressure Ulcer Risk Assessment And Prevention Comparative Effectiveness
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Author : U. S. Department of Health and Human Services
language : en
Publisher: CreateSpace
Release Date : 2013-06-29
Pressure Ulcer Risk Assessment And Prevention Comparative Effectiveness written by U. S. Department of Health and Human Services and has been published by CreateSpace this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013-06-29 with Medical categories.
Pressure ulcers are defined by the National Pressure Ulcer Advisory Panel (NPUAP) as “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.” A number of risk factors are associated with increased risk of pressure ulcer development, including older age, black race, lower body weight, physical or cognitive impairment, poor nutritional status, incontinence, and specific medical comorbidities that affect circulation such as diabetes or peripheral vascular disease. Pressure ulcers are often associated with pain and can contribute to decreased function or lead to complications such as infection. In some cases, pressure ulcers may be difficult to successfully treat despite surgical and other invasive treatments. In the inpatient setting, pressure ulcers are associated with increased length of hospitalization and delayed return to function. In addition, the presence of pressure ulcers is associated with poorer general prognosis and may contribute to mortality risk. Recommended prevention strategies for pressure ulcers generally involve use of risk assessment tools to identify people at higher risk for developing ulcers in conjunction with interventions for preventing ulcers. A variety of diverse interventions are available for the prevention of pressure ulcers. Categories of preventive interventions include support surfaces (including mattresses, integrated bed systems, overlays, and cushions), repositioning, skin care (including lotions, dressings, and management of incontinence), and nutritional support. Each of these broad categories encompasses a variety of interventions. The purpose of this report is to review the comparative clinical utility and diagnostic accuracy of risk-assessment instruments for evaluating risk of pressure ulcers and to evaluate the benefits and harms of preventive interventions for pressure ulcers in different settings and patient populations. The following Key Questions are the focus of this report: KQ1. For adults in various settings, is the use of any risk-assessment tool effective in reducing the incidence or severity of pressure ulcers compared with other risk-assessment tools, clinical judgment alone, and/or usual care? KQ1a. Do the effectiveness and comparative effectiveness of risk-assessment tools differ according to setting? KeQ1b. Do the effectiveness and comparative effectiveness of risk-assessment tools differ according to patient characteristics and other known risk factors for pressure ulcers, such as nutritional status or incontinence? KQ2. How do various risk-assessment tools compare with one another in their ability to predict the incidence of pressure ulcers? KQ2a. Does the predictive validity of various risk-assessment tools differ according to setting? KQ2b. Does the predictive validity of various risk-assessment tools differ according to patient characteristics? KQ3. In patients at increased risk of developing pressure ulcers, what are the effectiveness and comparative effectiveness of preventive interventions in reducing the incidence or severity of pressure ulcers? KQ3a. Do the effectiveness and comparative effectiveness of preventive interventions differ according to risk level as determined by different risk-assessment methods and/or by particular risk factors? KQ3b. Do the effectiveness and comparative effectiveness of preventive interventions differ according to setting? KQ3c. Do the effectiveness and comparative effectiveness of preventive interventions differ according to patient characteristics? KQ4. What are the harms of interventions for the prevention of pressure ulcers? KQ4a. Do the harms of preventive interventions differ according to the type of intervention? KQ4b. Do the harms of preventive interventions differ according to setting? KQ4c. Do the harms of preventive interventions differ according to patient characteristics?
Pressure Ulcer Risk Assessment And Prevention
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Author :
language : en
Publisher:
Release Date : 2013
Pressure Ulcer Risk Assessment And Prevention written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.
Patient Safety And Quality
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Author : Ronda Hughes
language : en
Publisher: Department of Health and Human Services
Release Date : 2008
Patient Safety And Quality written by Ronda Hughes and has been published by Department of Health and Human Services this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with Medical categories.
"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
Fragility Fracture Nursing
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Author : Karen Hertz
language : en
Publisher: Springer
Release Date : 2018-06-15
Fragility Fracture Nursing written by Karen Hertz and has been published by Springer this book supported file pdf, txt, epub, kindle and other format this book has been release on 2018-06-15 with Medical categories.
This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care.
Emerging Technologies For The Prevention Of Pressure Ulcers In Acute Care Settings
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Author :
language : en
Publisher:
Release Date :
Emerging Technologies For The Prevention Of Pressure Ulcers In Acute Care Settings written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on with categories.
The Cost Effectiveness Of Prevention Strategies For Pressure Ulcers In Long Term Care Homes In Ontario
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Author : THETA.
language : en
Publisher:
Release Date : 2008
The Cost Effectiveness Of Prevention Strategies For Pressure Ulcers In Long Term Care Homes In Ontario written by THETA. and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with categories.
Comparative Effectiveness Of Quality Improvement Interventions For Pressure Ulcer Prevention In U S Academic Hospitals
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Author : William Vincent Padula (III)
language : en
Publisher:
Release Date : 2013
Comparative Effectiveness Of Quality Improvement Interventions For Pressure Ulcer Prevention In U S Academic Hospitals written by William Vincent Padula (III) and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with categories.
OBJECTIVE: To compare the effectiveness of quality improvement (QI) interventions for hospital-acquired pressure ulcer (HAPU) prevention among U.S. academic medical centers of the University HealthSystem Consortium (UHC). METHODS: We surveyed UHC hospitals to longitudinally characterize adoption patterns of QI interventions for HAPU prevention between 2007-2008 in response to CMS nonpayment policy for HAPUs. Characterization was based on the QI best-practice framework for QI strategy which includes 25 QI interventions organized into four domains: Leadership; Staff; Information Technology; and Performance & Improvement. Survey data was merged to quarterly hospital-level HAPU incidence rates to measure the effect of each QI intervention at reducing HAPU incidence. Utilizing an effect size analysis, we calculated derivatives of overall HAPU reduction for each QI intervention. A t-test compared marginal effect size in the first three quarters following adoption to remaining periods of adoption for each hospital. An analysis of covariance (ANCOVA) tested the correlation between of QI interventions and HAPU incidence variability while controlling for Medicare policy, age, gender, length-of-stay, case-mix index, and intensive-care unit (ICU) admission. RESULTS: A representative sample of fifty-five UHC hospitals responded to the survey, of which 53 (96%) indicated use of QI interventions in HAPU prevention. All QI interventions fit within the QI best-practice framework, thereby validating its structure. The effect size analysis identified five QI interventions with clinically meaningful effectiveness by reducing HAPU incidence greater than 1 case per 1,000 patient admissions between 2007-2012, including: Leadership Initiatives; Visual Tools; HAPU Staging; Skin Care; and Patient Nutrition. The t-test returned that the greatest reductions in HAPU incidence occur earlier in the adoption process (p