ARA0103 Aðferðafræði Rannsókna

1. bed sore/legusár I have lots of bed sores. ARA0103 Aðferðafræði Rannsókna Fyrirlestur 12Case Study/Dæmisaga Literature search on bed sores Dr Andy Brooks

2. 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 Dr Andy Brooks

3. 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). Dr Andy Brooks

4. 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 Dr Andy Brooks

5. Literature Searching, Research Critiquing, and MetaAnalysisGoogle Scholar; hvar.is; biomedcentralfreemedicaljournals; highwireRegistry of Nursing ResearchThe Cochrane Collaboration(list of reviews, review manager, learning, reviewer´s handbook)controlled-trails.com; ClinicalTrials.govHow to Read a Medical Journal ArticlePEDro Physiotherapy Evidence DatabasePEDro scaleOccupational Therapy Evidence-Based Practice Research GroupCASP Appraisal ToolsCentre for Reviews and Dissemination (UK)Methods of Accumulating Results Across Research DomainsLinks of Links: (Critiquing Research)The CONSORT Statement Dr Andy Brooks

6. 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 ? Dr Andy Brooks

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8. 514 Dr Andy Brooks

9. Useful ? Useful ? Dr Andy Brooks

10. 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. Dr Andy Brooks

11. Useful ? Useful ? Useful ? 200/514 Dr Andy Brooks

12. Cochrane reviews CINAHL MEDLINE Dr Andy Brooks www.unak.is - Bókasafn

13. Cochrane Database of Systematic Reviews Dr Andy Brooks

14. 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 pressureulcers, 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 pressureulcers 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. Dr Andy Brooks

15. 41 RCTs were included in the review.Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressureulcers 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 pressureulcers. 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. Dr Andy Brooks

16. 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 pressureulcers. 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.” Dr Andy Brooks