Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness: Comparative Effectiveness

Author by : U. S. Department of Health and Human Services
Languange Used : en
Release Date : 2013-06-29
Publisher by : CreateSpace

ISBN :

Description : 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?...

Author by :
Languange Used : en
Release Date : 2013
Publisher by :

ISBN :

Description : ...

Author by : Roger Chou
Languange Used : en
Release Date : 2013
Publisher by :

ISBN :

Description : OBJECTIVES: While pressure ulcers commonly occur and are associated with significant health burdens, they are potentially preventable. This report systematically reviews the evidence on (1) risk-assessment scales for identifying people at higher risk of pressure ulcers and (2) preventive interventions to decrease incidence or severity of pressure ulcers. The Agency for Healthcare Research and Quality also commissioned a separate report on effectiveness of interventions to treat pressure ulcers. DATA SOURCES: Articles were identified from searches of MEDLINE(r) (1946 to July 2012), CINAHL (1988 to July 2012), the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (through July 2012), clinical trials registries, and reference lists. Review methods. We used predefined criteria to determine study eligibility. We selected randomized trials and cohort studies on the effects of use of risk-assessment tools and preventive interventions on clinical outcomes. We also selected prospective studies on the diagnostic accuracy of risk-assessment tools for predicting incidence of pressure ulcers. The quality of included studies was assessed, data were extracted, and results were summarized. RESULTS: Of the 4,733 citations identified at the title and abstract level, we screened and reviewed 747 full-text articles. A total of 120 studies (in 122 publications) were included. One good- and two poor-quality studies evaluated effects of using a risk-assessment tool on clinical outcomes, with the good-quality randomized trial showing no difference between use of the Waterlow scale or the Ramstadius tool compared with clinical judgment in subsequent risk of pressure ulcers. Studies of diagnostic accuracy found that commonly used risk-assessment instruments (such as the Braden, Norton, and Waterlow scales) can help identify patients at increased risk for ulcers, but appear to be relatively weak predictors, with no clear difference among instruments in diagnostic accuracy. Fair-quality randomized trials consistently found that more advanced static support surfaces were associated with lower risk of pressure ulcers compared with standard mattresses in higher risk patients (relative risk range, 0.20 to 0.60), with no clear differences among different advanced static support surfaces. Evidence on the effectiveness and comparative effectiveness of other support surfaces, including more advanced dynamic support surfaces, was limited, with some trials showing no clear differences between dynamic and static support surfaces. One fair-quality trial found that stepped care with dynamic support surfaces was associated with substantially decreased risk of ulcers compared with stepped care beginning with static support surfaces. In lower risk populations of patients undergoing surgery, two trials found use of a foam overlay associated with an increased risk of pressure ulcers compared with a standard operating room mattress. Evidence on effectiveness of other preventive interventions (nutritional supplementation; repositioning; pads and dressings; lotions, creams, and cleansers; corticotropin injections; polarized light therapy; and intraoperative warming therapy for patients undergoing surgery) compared with standard care was sparse and insufficient to reach reliable conclusions. CONCLUSIONS: Although risk-assessment instruments can identify patients at higher risk for pressure ulcers, more research is needed to understand how the use of risk-assessment instruments impacts pressure ulcer incidence compared with clinical judgment. More advanced static support surfaces are more effective than standard mattresses for preventing ulcers in higher risk populations. More research is needed to understand the effectiveness of other preventive interventions over usual care and the comparative effectiveness of preventive interventions....

Author by : Theris A. Touhy
Languange Used : en
Release Date : 2015-08-06
Publisher by : Elsevier Health Sciences

ISBN :

Description : Get all the knowledge you need to provide effective care for adults as they age. Grounded in the core competencies recommended by the AACN in collaboration with the Hartford Institute for Geriatric Nursing, Ebersole & Hess’ Toward Healthy Aging, 9th Edition is the only comprehensive text to address all aspects of gerontological nursing care. The new ninth edition has been extensively revised and updated and now includes shorter, more streamlined chapters and pedagogical features to facilitate learning, covering the areas of safety and ethical considerations, genetics, communication with the patient and caregiver, promoting health in persons with conditions commonly occurring in later-life world-wide addressing loss and palliative care and much more. This new edition considers the experience of aging as a universal experience and the nurse’s role in the reduction of health disparities and inequities as a member of the global community. Plus, it contains a variety of new learning features that focus the readers’ attention on applying research and thinking critically in providing care to aging adults across the care continuum....

Author by : Ruth Bryant
Languange Used : en
Release Date : 2023-05-18
Publisher by : Elsevier Health Sciences

ISBN :

Description : Acute & Chronic Wounds, 6th Edition provides the latest diagnostic and treatment guidelines to help novice to expert clinicians provide evidence-based, high-quality care for patients with wounds. This textbook presents an interprofessional approach to maintaining skin integrity and managing the numerous types of skin damage, including topics that range from the physiology of wound healing, general principles of wound management, special patient populations, management of percutaneous tubes, and specific care instructions to program development. Written by respected wound experts Ruth Bryant and Denise Nix, this bestselling reference also provides excellent preparation for all wound certification exams. Comprehensive approach addresses the prevention and management of acute and chronic wounds, making it the preeminent resource for skin health and wound management across all disciplines involved in wound care, from novice to expert. Learning Objectives at the beginning of each chapter emphasize the most important content. Clinical Consult feature in each chapter provides a synthesis of the chapter content, illustrating how to assess, manage, and document a realistic clinical encounter using the ADPIE or SBAR framework. Checklists provide a concise list of actions necessary to achieve the best patient care outcomes or satisfy a particular objective. Practical tools and algorithms help in performing risk assessment, differential diagnosis, classification, treatment, and documentation. Coverage of practice development issues addresses outcomes and productivity in agencies and institutions, home care, acute care, long-term care, and long-term acute care settings. Self-assessment questions help you test your knowledge and prepare for certification exams. Helpful appendices provide answers to self-assessment questions, as well as various tools, policies and procedures, competencies, patient and family education guidance, and more. NEW! Chapters on Postacute Care Settings; Telehealth and Wound Management; Quality Tracking Across the Continuum; and Medications and Phytotherapy: Impact on Wounds provide evidence-based coverage of these important topics. UPDATED! Consolidated pressure injuries content puts everything you need to know into one chapter. Expanded full-color insert includes 50 new images — for a total of 95 color plates with more than 160 images — that visually reinforce key concepts. New information presents the latest developments in biofilm assessment and management, topical oxygen therapy, skin manifestations related to COVID-19, and strategies to enhance engagement, as well as updated product photos and more authors who are clinical experts and providers....

Author by : Fred F. Ferri
Languange Used : en
Release Date : 2019-06-01
Publisher by : Elsevier Health Sciences

ISBN :

Description : Significantly updated with the latest developments in diagnosis and treatment recommendations, Ferri’s Clinical Advisor 2020 features the popular "5 books in 1" format to organize vast amounts of information in a clinically relevant, user-friendly manner. This efficient, intuitive format provides quick access to answers on 1,000 common medical conditions, including diseases and disorders, differential diagnoses, and laboratory tests – all reviewed by experts in key clinical fields. Updated algorithms, along with hundreds of new figures, tables, and boxes, ensure that you stay current with today’s medical practice. Contains significant updates throughout, covering all aspects of current diagnosis and treatment. Features 27 all-new topics including chronic traumatic encephalopathy, medical marijuana, acute respiratory failure, gallbladder carcinoma, shift work disorder, radial tunnel syndrome, fertility preservation in women, fallopian tube cancer, primary chest wall cancer, large-bowel obstruction, inguinal hernia, and bundle branch block, among others. Includes a new appendix covering Physician Quality Reporting System (PQRS) Measures. Provides current ICD-10 insurance billing codes to help expedite insurance reimbursements. Patient Teaching Guides for many of the diseases and disorders are included, most available in both English and Spanish versions, which can be downloaded and printed for patients....

Author by : Amy J. Litterini
Languange Used : en
Release Date : 2021-05-04
Publisher by : Routledge

ISBN :

Description : This book is a comprehensive summary of the recommendations for best practice, and current evidence, for physical activity and rehabilitation of functional deficits in individuals with end-stage diseases. While advances in technology have afforded us the opportunity to live longer lives, it has also demanded an expansion of focus of medical interventions towards palliative care to enhance the quality of life. Exercise and healthcare professionals must strive to broaden their perspectives to provide for the unique needs of these individuals, and to successfully engage with them, to achieve the most positive outcomes throughout the entire continuum of care. Healthcare providers play a critical role in advocating for care to allow individuals to remain physically active for as long as possible, even in the face of declining health. Finally, due to the increasing and progressively emergent healthcare utilization required by these individuals, a significant cost burden is experienced by healthcare systems, patients, families, and payers. There is evidence of substantial protective effects of physical activity, prevention, safety, and rehabilitative procedures to reduce hospital readmissions, reduce length of stay, and assist in avoiding unwarranted or unnecessary diagnostic tests or procedures. Physical activity has been proven to have a substantial impact and protective effects on virtually all medical conditions. During curative management, but especially during transitional phases to palliative care, other strategies need enhanced consideration to complement the existing plan of care and help to improve patient’s quality of life. Ideally, physical medicine would be at the forefront of allowing individuals to live their best life until the very end. Physical Activity and Rehabilitation in Life-threatening Illness is key reading for academics and policy makers in physical activity, international exercise, wellness and rehabilitation, and related disciplines, as well as research-focused clinicians in settings where patients with advanced illness are frequently encountered....