Treating and Preventing Pressure Ulcers - Article Example

Treating and Preventing Pressure Ulcers Abstract The essay aims to address a two-fold objective to wit: (1) to summarize the articles; and (2) to identify the different research elements such as design, methods, population, strengths, and limitations. Rapid Appraisal Moore, Z.E.H. & Cowman, S. (2010). Risk assessment tools for the prevention of pressure ulcers (Review). The Cochrane Collaboration, 12: 1-25. Moore & Cowman (2010) stated that the risk assessment tool is a routine part of assessing individual risk for developing pressure ulcer (p. 1). The study aimed to determine whether using structured, systematic pressure risk assessment tools reduces the incidence of pressure ulcers in any health care setting. Two review authors assessed the eligibility of each study based on the inclusion criteria. The original review found no studies that would meet the inclusion criteria and that there was no statistically significant difference among groups in terms of pressure ulcer incidence. Further evaluation and studies need to be conducted regarding the effectiveness of risk assessment tools. Randomized controlled trial was utilized as the design of the study. Methods include were the Braden pressure ulcer risk assessment tool and training, unstructured risk assessment and training, and unstructured risk assessment alone. Population included 256 people randomised by ward into three groups. The strengths of the study included the focus made on resolving biases such as sequence generation, allocation concealment, blinding, incomplete outcome data, selective outcome reporting, and extreme baseline imbalance. Limitations of the study include methodological limitations that prevent firm conclusions and unavailability of high quality RCT evidence. Jaul, E. (2010). Assessment and Management of Pressure Ulcers in the Elderly: Current Strategies. Drug Aging, 27(4): 311-325. The article of Jaul (2010) discussed the pathogenesis of pressure ulcer development in the elderly (p. 311). Elderly were assessed in terms of comorbities, risk factor, and management of pressure ulcers.The review found out the pressure ulcers were common problems of elderly in all types of health care settings. Immobility, nutritional deficiency, chronic diseases, and multisystem dysfunction predispose the elderly to the development of pressure ulcers. Factors related to the overall health status of the patients and the management done by health care practitioners affect the development and treatment of pressure ulcers. The article is primarily a review; no research design stated. Methods employed were review of literatures and studies. There was no specific population stated but elderly in general. The vast majority of literatures and studies were the strengths of the article. Limitations focused only on review of risk factor, wound, pathogenesis, and management of pressure ulcers. McInnes E. et al. (2011). Support surfaces for pressure ulcer prevention (Review). The Cochrane Collaboration, 4: 1-125. McInnes et al. (2011) stated that pressure-relieving surfaces are used to help prevent pressure ulcer development (p. 1). The authors aimed to establish the extent to which pressure-relieving support surfaces reduce the incidence of pressure ulcers compared with standard support surfaces and to determine the comparative effectiveness in pressure ulcer prevention. Inclusion studies totaled to 53. Results found out that foam alternatives and Australian standard medical sheepskins prevent pressure ulcer development in people at risk. The study suggested that higher-specification foam mattresses should be used in at risk population rather than the standard hospital foam mattresses. The research design is a systematic review of RCTs and quasi-randomised studies. Methods employed were criteria for inclusion studies such as report of an objective, clinical, outcome measure, interventions such as low-tech CLP support surfaces, high-tech support surfaces, and others, and measures of primary and secondary outcomes.Population included people receiving health care and at risk to develop pressure ulcers. Strengths of the study included strong evidence that people lying on ordinary foam mattresses are more likely to get pressure ulcers than those lying on a higher specification foam mattress and that people who used sheepskin overlays on their mattress developed fewer pressure ulcers. The unclear merits of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure ulcers and the need for more comparative researches were the limitations of the review. Moore, Z. & Cowman, S. (2010). Systematic review of Repositioning for the Treatment of Pressure Ulcers. European Wound Management Association Journal, 10(1): 5-12. Moore & Cowman (2010) conducted a review to assess the effects and clarify the role of repositioning patients on the healing rates of pressure ulcers (p. 5). RCTs and CCTs about repositioning were included in the review. The results found no studies that would meet the inclusion criteria. Repositioning has been used routinely for management of pressure ulcers although the practice lacks randomised trials that would prove its efficacy. Further studies need to be conducted in order to determine and conclude the effect of repositioning on pressure ulcer healing. Systematic review of RCTs and CCTs were the research design used in the study. Methods included inclusion criteria, types of participants, types of interventions, and measures of outcomes. Population included people of any age from all types of health care settings and with existing pressure ulcers. Strengths of the study included the expert’s review and used of cluster randomization to increase efficiency, increase compliance with the study protocol, and avoid contamination. Limitations of the study included lack of RCTs as evidence and lack of clarity of repositioning schedules. Langer, G. et al. (2008). Nutritional interventions for preventing and treating pressure ulcers (Review). The Cochrane Collaboration, 3: 1-21. The study of Langer et al. (2008) stated that 10% of people in hospitals are affected by pressure ulcers; particularly at highest risk are older people (p. 1). The objective of the study was to evaluate the effectiveness of enteral and parenteral nutrition on the prevention and treatment of pressure ulcers. Most of the eight (8) randomised controlled trials included in the study were mostly small and of poor methodological quality. Due to heterogeneity of the trials to participants, interventions and outcomes, meta-analysis is inappropriate to perform. Thus, the authors cannot conclude that enteral and parenteral nutritionhas effect on the prevention and treatment of pressure ulcers. Review of RCTs was primarily the design of the study. Methods employed wereselection criteria that involve the evaluation of effectiveness of enteral or parenteral nutrition on the prevention and treatment of pressure ulcers, measuring incidence of pressure ulcers, and determining healing or changes in pressure ulcer severity. Population included people of any age and sex with or without existing pressure ulcers, in any care setting, irrespective of primary diagnosis. Strengths noted are availability of studies of nutritional supplementation in terms of interventions, outcome measurements and follow up. Limitations included are trials with small and poor methodological quality, few patients and high drop-out rate, short follow-up time, and low reliability of the interventions. References Jaul, E. (2010). Assessment and Management of Pressure Ulcers in the Elderly: Current Strategies. Drug Aging, 27(4): 311-325. Langer, G. et al. (2008). Nutritional interventions for preventing and treating pressure ulcers (Review). The Cochrane Collaboration, 3: 1-21. McInnes E. et al. (2011). Support surfaces for pressure ulcer prevention (Review). The Cochrane Collaboration, 4: 1-125. Moore, Z.E.H. & Cowman, S. (2010). Risk assessment tools for the prevention of pressure ulcers (Review). The Cochrane Collaboration, 12: 1-25. Moore, Z. & Cowman, S. (2010). Systematic review of Repositioning for the Treatment of Pressure Ulcers. European Wound Management Association Journal, 10(1): 5-12. Read More