ARA0103 A�fer�afr��i by fbwbT101

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									bed sore/legusár
                                              I have lots of bed sores.




                    ARA0103
             Aðferðafræði Rannsókna
                            Fyrirlestur 12
                       Case Study/Dæmisaga
                   Literature search on bed sores




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scenario/framtíðarsýn


                         Scenario
  • You are a research nurse.
  • You work in a large hospital.
  • Many patients are bed-ridden.
  • Many patients suffer from bed sores.
  • You wish to do some research and find the best way of
    reducing bed sores.
  • You have found the following article and you want to find
    more articles.

      eMJA1 Preventing pressure ulcers with the Australian
      Medical Sheepskin: an open-label randomised controlled
      trial. Jolley et al, MJA Vol 180 5-April 2004 pp 324-327
   04/10/2012               Dr Andy Brooks                      2
  Fyrirlestur 9 Dæmisaga BMJ7 "Hospital at home...review of evidence"
  (pdf, ppt)


• Databases searched:
     – Cochrane controlled trial register, Science
       Citation Index, Embase, Medline, UK National
       Research Register, Web of Science,
       respiratory journal websites, proceedings
       (European Respiratory Society, American
       Thoracic Society, British Thoracic Society,
       Thoracic Society of Australia and New
       Zealand).

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 V9 (local copy) "Literature Review of Evidence Based Physiotherapy
 in Patients with Facial Nerve Paresis" Beurskens et al, Journal of The
 Japanese Physical Therapy Association, Volume 7, pp 35-39, 2004

                                                         CINAHL




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                        Resources/Auðlindir


      Literature Searching, Research Critiquing, and MetaAnalysis
                     Google Scholar; hvar.is; biomedcentral
                          freemedicaljournals; highwire
                          Registry of Nursing Research
                           The Cochrane Collaboration
      (list of reviews, review manager, learning, reviewer´s handbook)
                     controlled-trails.com; ClinicalTrials.gov
                     How to Read a Medical Journal Article
            PEDro Physiotherapy Evidence Database PEDro scale
      Occupational Therapy Evidence-Based Practice Research Group
                              CASP Appraisal Tools
                   Centre for Reviews and Dissemination (UK)
         Methods of Accumulating Results Across Research Domains
                      Links of Links: (Critiquing Research)
                            The CONSORT Statement
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              Key words/phrases
•   bed sore(s)
•   pressure ulcer(s)
•   intervention
•   treatment
•   review
                        Time frame
• eMJA1 5-April 2004
   – published in 2004
   – performed in 2003?
• Search from jan 1. 2003 ?
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                              514




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                              Useful ?




                              Useful ?


04/10/2012   Dr Andy Brooks              9
   Clin Nutr. 2003
   Aug;22(4):401-5.
A randomised, double-blind assessment of the effect of nutritional
supplementation on the prevention of pressure ulcers in hip-fracture patients.

BACKGROUND & AIMS: Malnutrition is a risk factor for development of pressure
ulcers (PU). Nutritional supplementation may thus reduce the incidence of PU. We
investigated the effect of nutritional supplementation on incidence of PU in hip-fracture
patients at risk of developing PU. METHODS: Hip-fracture patients (n=103) were
included in this double-blind, randomised, placebo-controlled trial. They received 400
ml daily of a supplement enriched with protein, arginine, zinc and antioxidants (n=51) or
a non-caloric, water-based placebo supplement (n=52). Presence and stage of PU
were assessed daily for 28 days or until discharge (median: 10 days during
supplementation). RESULTS: Incidence of PU was not different between supplement
(55%) and placebo (59%), but incidence of PU stage II showed a 9% difference
(difference: 0.091; 95% CI: 0.07-0.25) between supplement (18%) and placebo (28%).
Of patients developing PU 57% developed it by the second day. Time of onset (days)
showed a trend (P=0.090) towards later onset of PU with supplement (3.6+/-0.9) than
placebo (1.6+/-0.9). CONCLUSIONS: Hip-fracture patients develop PU at an early
stage. Nutritional supplementation may not prevent PU at this stage, but contributes
possibly to a delayed onset and progression of PU. Nutritional supplementation may be
more effective if initiated earlier.

  04/10/2012                          Dr Andy Brooks                                 10
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                              Useful ?


                                 200/514
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             Cochrane


                                             reviews


                                             CINAHL



                                             MEDLINE




04/10/2012     Dr Andy Brooks   www.unak.is - Bókasafn   12
             Cochrane Database of Systematic Reviews




04/10/2012                  Dr Andy Brooks             13
Selection criteria:

Randomised controlled trials (RCTs), published or unpublished, which
assessed the effectiveness of beds, mattresses, mattress overlays, and
seating cushions for the prevention of pressure ulcers, in any patient
group, in any setting. RCTs were eligible for inclusion if they reported an
objective, clinical outcome measure such as incidence and severity of
new of pressure ulcers developed. Studies which only reported proxy
outcome measures such as interface pressure were excluded.

Data collection and analysis:

Trial data were extracted by one researcher and checked by a second.
The results from each study are presented as relative risk for
dichotomous variables. Where deemed appropriate, similar studies were
pooled in a meta analysis.



 04/10/2012                     Dr Andy Brooks                            14
41 RCTs were included in the review.

Foam alternatives to the standard hospital foam mattress can reduce the
incidence of pressure ulcers in people at risk. The relative merits of
alternating and constant low pressure devices, and of the different
alternating pressure devices for pressure ulcer prevention are unclear.

Pressure-relieving overlays on the operating table have been shown to
reduce postoperative pressure ulcer incidence, although one study
indicated that an overlay resulted in adverse skin changes. One trial
indicated that Australian standard medical sheepskins prevented
pressure ulcers. There is insufficient evidence to draw conclusions on
the value of seat cushions, limb protectors and various constant low
pressure devices as pressure ulcer prevention strategies.

A study of Accident & Emergency trolley overlays did not identify a
reduction in pressure ulcer incidence. There are tentative indications
that foot waffle heel elevators, a particular low air loss hydrotherapy
mattress and an operating theatre overlay are harmful.
04/10/2012                     Dr Andy Brooks                             15
Conclusions:

In people at high risk of pressure ulcer development, consideration
should be given to the use of higher specification foam mattresses rather
than standard hospital foam mattresses. The relative merits of higher-
tech constant low pressure and alternating pressure for prevention are
unclear. Organisations might consider the use of pressure relief for high
risk patients in the operating theatre, as this is associated with a
reduction in post-operative incidence of pressure ulcers. Seat cushions
and overlays designed for use in Accident & Emergency settings have
not been adequately evaluated.


    Nurse researcher: “We do not use the higher specification foam
    matresses. I could set up a randomized control trial to convince
    senior management that these matresses really work in the context
    of our hospital and that the cost is justified. I will look over the
    abstracts of the 41 RCTs mentioned in the Cochrane review and
    replicate the trial which is most suitable.”
04/10/2012                     Dr Andy Brooks                          16

								
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