NSG 527-ADVANCED LEVELS OF CLINICAL INQUIRY HW
NSG 527-ADVANCED LEVELS OF CLINICAL INQUIRY HW
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Pressure ulcers also known as pressure injuries, pressure sores, decubitus ulcers and bed sores are localized injuries to the skin or underlying soft tissue, or both, caused by unrelieved pressure, shear or friction (Shi et al., 2021)
Risk factors of pressure ulcer include limited mobility, poor nutrition, comorbidities, weak, dry, thin skin due to aging, pressure, friction, shear, and moisture.
70% of cases involving pressure ulcers are among individuals over 65 years of age
Injuries to the skin and underlying tissue, known as pressure ulcers (also known as pressure sores or bedsores), are most commonly caused by sustained pressure applied to the skin’s surface. Those who are confined to bed or who spend extended periods of time in a chair or wheelchair are more susceptible to developing these conditions than others. Pressure ulcers affect around 70% of adults over the age of 65, and they are seen in 9-22 percent of nursing home residents and 5-32 percent of hospitalized patients. Pressure ulcers are frequently caused by sitting or laying in the same posture for an extended period of time. Pressure ulcers are more prone to occur if the skin becomes thin, dry, or weak as a result of ageing or disease, among other factors. Pressure ulcers are more common in older persons in general, and they are particularly common in people who have trouble moving.
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Clinical issue of interest Continue
Negative pressure wound therapy (NPWT) uses suction, tubing, and wound dressing to promotes wound healing through optimization of blood flow, decreasing local tissue edema and remove excess exudate and any infectious material that may be present in the wound (Dumville, et al., 2015)
Standard moist wound therapy is the practice of keeping a wound in an optimally moist environment to promote faster healing and prevent the development of scab, promote keratinocytes cell function, facilitate autolytic debridement and stimulate collagen synthesis (Shi et al., 2021)
PICOT
P- Patient with immobility and elderly patients 60 years and above
I- Negative pressure wound therapy
C- Standard moist wound therapy
O- Improve the therapeutic process of pressure ulcer
T- two months
For elderly patients above 60 years with pressure ulcers (P), will negative pressure wound therapy (I) as opposed to standard moist wound therapy (C) improve the therapeutic process of the pressure ulcer (O) during their two-week stay at the hospital (T)?
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Description of the PICOT Question
Population/ Patient Problem: Identifies the people or patients with the clinical issue (pressure ulcer) which are patients with immobility and elderly 65 years and above.
Intervention: Represents the treatment plans to resolve the clinical issue which is the use of negative pressure wound therapy.
Comparison: Represents the alternatives to my plan, eg. different type of treatment like standard moist wound therapy ADVANCED LEVELS OF CLINICAL INQUIRY HW
Outcome: Represents the desired/expected result of the treatment that improve the therapeutic process of pressure ulcer
Time: The period that the treatment is expected to last which is within two month
Description of the PICOT Question Continue
My PICOT questions correspond to the question type “Intervention or Therapy,” which can be used to assess which
treatment will produce the best outcomes.
the comparison illustrates the difference between negative pressure wound therapy and standard moist wound therapy.
These questions can assist me in educating and advising my patients about their ulcer injuries, treatment options, and
success rates.
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Research database
Pubmed
Scopus
Google scholar
Medline
Level of evidence
Article- “Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review”
Level of evidence- level I
Systemic evidence is still lacking from randomized trials conducted on interventions for preventing pressure ulcers
No single effective way identified for preventing pressure ulcers
Only a 1/3 of the preventive interventions used were effective (Mäki-Turja-Rostedt et al., 2019)
Article- “Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers”
Level of evidence- level IV
The case study involved 5 patents
The evidence from the study is weak due to small sample size used, lack of control group and selection bias (Fernandez et al., 2017)
Patients suffer from pressure ulcers, which also place a significant financial strain on their families. Despite the fact that most PUs could be avoided, the number of PUs has remained high. Effective PU prevention is essential in order to avoid undue suffering and expenditures. There are numerous approaches of preventing PUs in LOPC facilities; however, there is no single approach that is effective in all situations. Prevention measures in LOPC facilities were shown to be beneficial in one-third of the cases. Systematic evidence from randomized trials on preventative interventions for PUs in LOPC settings, on the other hand, is currently missing in this area. The findings can be applied in practice for the selection of PUs in LOPC facilities, and in research for the development of efficient preventive treatments for PUs in LOPC settings.
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Level of evidence cont…
Article- “Negative pressure wound therapy for treating pressure ulcers”
Level of evidence- level I
There are no strong RCT evidence regrading negative wound therapy when compared to standard moist therapy among other alternatives for treating pressure ulcers (Dumville et al., 2015)
Article- “The clinical effectiveness of negative pressure wound therapy: a systematic review”
Level of evidence- I
The systemic review presents sufficient evidence showing that negative wound therapy is safe and accelerates healing hence justifying the use of this intervention in treating pressure ulcers (Xie et al., 2010) ADVANCED LEVELS OF CLINICAL INQUIRY HW
In order to make informed decisions about the use of negative pressure wound therapy (NPWT), it is necessary to have a comprehensive and current assessment of the available evidence. The evaluation includes four research with a total of 149 participants in the total. A total of three studies evaluated NPWT in comparison to dressings; one study evaluated NPWT in comparison to a series of gel treatments; and one study evaluated NPWT in comparison to “wet wound healing.” One study had a follow-up length of 24 weeks, two studies had a follow-up period of six weeks, and the follow-up period for one study was not known. Three of the four included studies were found to be at a high risk of bias from one or more of the ‘Risk of bias’ areas, and the overall quality of the evidence was deemed to be of very low significance. Although only one research provided adequate primary outcome data (complete wound healing), the sample size was small (12 participants), and there were only a few incidents (only one participant healed in the study). From the studies that were included, there was no further valuable information on either favorable results, such as wound healing, or negative ones, such as adverse reactions.
Moving on to the next article discovered 17 randomized controlled trials (RCTs), five of which had not previously been included in reviews or health technology assessments. In seven randomized controlled trials (RCTs) involving diabetic foot ulcers, there was consistent evidence of the effectiveness of NPWT when compared to control treatments. The outcomes of three randomized controlled trials on pressure ulcers were inconclusive.
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Evidence from five randomized controlled trials (RCTs) involving mixed wounds was encouraging, although of poor quality. Significant difficulties did not arise as a result of this. Now that there is adequate evidence to prove that NPWT is safe and will speed up the healing process, its use in the treatment of diabetes-associated chronic leg wounds can be considered justified. Evidence also suggests that healing of other wounds may be expedited, albeit the quality of the evidence is of questionable reliability.