Abstract Background Incontinence- Associated Dermatitis (IAD) is one of the clinical manifestations of Moisture- Associated Skin Damage (MASD). IAD is a common problem in aged patients with faecal ...and/or urinary incontinence. Aim Update about IAD terminology, aetiology, epidemiology, observation, prevention, and treatment. Methods Integrative review. Results The lack of an ICD-10 codes and an internationally validated and standardized method for IAD data collection contribute to a variation in epidemiological data. Frequent episodes of incontinence (especially fecal), occlusive containment products, poor skin condition, reduced mobility, diminished cognitive awareness, inability to perform personal hygiene, pain, pyrexia, certain medications (antibiotics, immunosuppressant), poor nutritional status, and critical illness are associated with IAD. Correctly diagnosing IAD and distinguish it from pressure ulcers is difficult. Even though the clinical presentation of partial thickness pressure ulcers and IAD is similar, the underlying etiologic factors differ. However, incontinence and IAD were found to be risk factors for pressure ulcer development. IAD management should essentially focus on skin cleansing to remove dirt, debris and microorganisms; skin moisturization to repair or augment the skin's barrier; and the application of a skin barrier product to prevent skin breakdown by providing an impermeable or semi-permeable barrier on the skin. The body of evidence is still limited, buy growing since the last decade. Conclusion Incontinence causes disruptions of the skin barrier function and leads to superficial skin damage. Macerated skin and superficial skin changes due to incontinence are associated with pressure ulcer development. Skin maceration, chemical irritation, and physical irritation should be targeted to effectively prevent and treat IAD.
Abstract Context Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from ...diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. Objectives The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. Methods A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. Results Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. Conclusion There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.
ABSTRACT
OBJECTIVE
To systematically review recommendations for promoting and maintaining skin integrity in end-of-life care and their level of evidence.
DATA SOURCES
MEDLINE (PubMed interface), ...CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and The Cochrane Library were systematically searched using a combination of key terms including
end-of-life care
,
skin care
,
skin hygiene
, and
skin cleansing
.
STUDY SELECTION
Articles were included if they (1) described skin care recommendations, including but not limited to the use of skin care products and interventions such as cleansing procedures; and (2) included adult patients who were expected to die within 12 months. There were no restrictions on study design, study setting, or language. Articles with a publication date before 2000 were excluded.
DATA EXTRACTION
Two data extraction forms were developed. The first included information about the author, publication year, type of evidence, study topic, sample, sample size, setting, limitations of the study, level of evidence, and quality of the study. The second included recommendations for promoting and maintaining skin integrity in patients at the end of life.
DATA SYNTHESIS
Because of methodological heterogeneity, results were synthesized narratively, and no meta-analysis was performed.
CONCLUSIONS
The information contained in the recommendations will assist nurses in promoting and maintaining skin integrity in patients at the end of life. More research is needed on end-of-life skin care, with an emphasis on patient-centered, holistic strategies that improve patient well-being and quality of life. In most current research, recommendations are limited to literature reviews and level V evidence. Skin care must balance the promotion and maintenance of skin integrity, wound prevention, and management while promoting patient dignity and quality of life.
Aim
To study the effectiveness of tailored repositioning and a turning and repositioning system on: (a) nurses’ compliance to repositioning frequencies; (b) body posture of patients after ...repositioning; (c) incidence of pressure ulcers and incontinence‐associated dermatitis; (d) nurses’ and patients’ preferences, comfort and acceptability; and (e) budget impact.
Background
Patient‐tailored systematic repositioning is key in pressure ulcer prevention. To date, a clinical decision‐making tool is lacking and compliance to pressure ulcer prevention guidelines is low. Research concerning commercially available turning and repositioning systems is lacking.
Design
Multicentre, cluster, three‐arm, randomized, controlled pragmatic trial.
Methods
Two hundred and twenty‐seven patients at risk of pressure ulcer development were recruited at 29 wards in 16 hospitals between February 2016 and December 2017. Wards were randomly assigned to two experimental groups and one control group.
Results
Nurses’ compliance to repositioning frequencies increased significantly in the experimental groups when patients were cared for in bed (94.6% vs. 69% and 84.9% vs. 71.4%). Applying the turning and repositioning system was associated with significantly more correctly positioned patients (30–45° tilted side‐lying position) (69.6% vs. 34.6%). Few pressure ulcers and incontinence‐associated dermatitis incidents occurred. Both patients and nurses were positive about the intervention. Higher labour costs related to repositioning in bed were found in the control group.
Conclusion
This was the first study investigating the effect of tailored repositioning and the use of a repositioning aid to increase nurses’ compliance to repositioning. The results were in favour of the interventions yet demonstrating the importance of follow‐up and education.
Trial registration
This study is registered at https://clinicaltrials.gov/NCT02690753;NCT02690753.
目的
研究个性化换位和转弯换位系统的有效性:(1)护士对换位频率的依从性;(b)患者复位后的身体姿势;(c)压疮和尿失禁相关皮炎的发生率;(d)护士和病人的偏好、舒适度和接受度;(e)预算影响。
背景
患者个体化体位调整是预防压疮的关键。
迄今为止,缺乏临床决策工具,对压力性溃疡预防指南的依从性较低。关于商业上可用的转向的研究和重新定位系统还很缺乏。
设计
多中心、聚类、三步走、随机、对照、实用试验。
方法
2016年2月至2017年12月,在16家医院的29个病房招募了227名有压力溃疡发展风险的患者。病房随机分为两组实验组和一组对照组。
结果
实验组患者卧床治疗后,护士对复位频率的依从性显著提高(94.6% vs. 69%, 84.9% vs. 71.4%)。使用转弯和重新定位系统可以显著提高患者的定位正确率(30‐45°倾斜侧卧位)(69.6%对34.6%)。很少发生压疮和尿失禁相关的皮炎事件。患者和护士对干预均持积极态度。
在对照组中,与床上重新定位有关的劳动力成本较高。
结论
这是第一个研究量身定制的重新定位的效果和使用重新定位援助,以增加护士的依从性重新定位。调查结果支持这些干预措施,但也表明了跟进和教育的重要性。
临床试验注册
本研究注册于https://clinicaltrials.gov/NCT02690753.
Title. Prevention and treatment of incontinence‐associated dermatitis: literature review.
Aim. This paper is a report of a review conducted to describe the current evidence about the prevention and ...treatment of incontinence‐associated dermatitis and to formulate recommendations for clinical practice and research.
Background. Incontinence‐associated dermatitis is a common problem in patients with incontinence. It is a daily challenge for healthcare professionals to maintain a healthy skin in patients with incontinence.
Data sources. PubMed, Cochrane, Embase, the Cumulative Index to Nursing and Allied Health Literature, reference lists and conference proceedings were explored up to September 2008.
Review methods. Publications were included if they reported research on the prevention and treatment of incontinence‐associated dermatitis. As little consensus about terminology was found, a very sensitive filter was developed. Study design was not used as a selection criterion due to the explorative character of the review and the scarce literature.
Results. Thirty‐six publications, dealing with 25 different studies, were included. The implementation of a structured perineal skin care programme including skin cleansing and the use of a moisturizer is suggested. A skin protectant is recommended for patients considered at risk of incontinence‐associated dermatitis development. Perineal skin cleansers are preferable to using water and soap. Skin care is suggested after each incontinence episode, particularly if faeces are present. The quality of methods in the included studies was low.
Conclusions. Incontinence‐associated dermatitis can be prevented and healed with timely and appropriate skin cleansing and skin protection. Prevention and treatment should also focus on a proper use of incontinence containment materials. Further research is required to evaluate the efficacy and effectiveness of various interventions.
Descriptions of training intervention in healthcare include a lot of vagueness, leaving the reader in doubt about the intervention and the true value of the reported effects. A set of reporting ...criteria to improve the transparency and comprehensiveness in reporting training interventions in healthcare is recommended.
This study aimed to develop and content validate a set of reporting criteria for the development and evaluation of training interventions for healthcare professionals.
The set of criteria was developed along three stages: (1) a literature review, (2) the design of the criteria, and (3) a Delphi and consensus meeting process with ten experts from different professional disciplines.
The Criteria for Reporting on Development and Evaluation of Professional Training interventions in Healthcare (CRe-DEPTH) set was systematically developed and consisted of 12 items representing four categories: (1) development of the training, (2) characteristics of the training, (3) characteristics of the providers, and (4) assessment of the training outcomes. Each item has a detailed description to support its unambiguous interpretation.
The developed CRe-DEPTH reporting criteria guide high quality development, evaluation and reporting for complex training interventions, while preserving the flexibility to incorporate various teaching content or teaching methods. The Cre-DEPTH criteria will allow for detailed reporting on the training, its developmental process, as well as on the rationale for underlying choices, and will avoid non-reporting of training details.
To evaluate the psychometric properties of the Dutch version of the London Measure of Unplanned Pregnancy in women with pregnancies ending in birth.
A two-phase psychometric evaluation design was ...set-up. Phase I comprised the translation from English into Dutch and pretesting with 6 women using cognitive interviews. In phase II, the reliability and validity of the Dutch version of the LMUP was assessed in 517 women giving birth recently. Reliability (internal consistency) was assessed using Cronbach's alpha, inter-item correlations, and corrected item-total correlations. Construct validity was assessed using principal components analysis and hypothesis testing. Exploratory Mokken scale analysis was carried out.
517 women aged 15-45 completed the Dutch version of the LMUP. Reliability testing showed acceptable internal consistency (alpha = 0.74, positive inter-item correlations between all items, all corrected item-total correlations >0.20). Validity testing confirmed the unidimensional structure of the scale and all hypotheses were confirmed. The overall Loevinger's H coefficient was 0.57, representing a 'strong' scale.
The Dutch version of the LMUP is a reliable and valid measure that can be used in the Dutch-speaking population in Belgium to assess pregnancy planning. Future research is necessary to assess the stability of the Dutch version of the LMUP, and to evaluate its psychometric properties in women with abortions.
Objectives
Chest X-ray imaging is frequently used for verifying the position of a blindly inserted nasogastric tube. A high-quality X-ray increases the likelihood of conclusive visibility of tube tip ...positioning, thus avoiding risks due to a misplaced tube (e.g., pulmonary intubation, pneumothorax, small bowel insertion). Therefore, this study aims to determine patient-related and environmental factors affecting the visibility of nasogastric tubes on X-ray in adults.
Methods
A retrospective descriptive analysis of routinely collected clinical data was performed on all included patients (
N
= 215) from a prospective randomized trial in a general hospital. A chest X-ray was taken of each patient needing a nasogastric feeding tube, after which visibility and positioning of the tube on X-ray was independently evaluated by 3 radiologists.
Results
In 14.9% (
n
= 32) of all patients, image quality was insufficient, so no conclusive visibility of nasogastric tube positioning could be found. A patient-related predictor regression model (sex, age, body mass index) explained 21% of variance for an insufficient visibility of the nasogastric tube (Nagelkerke
R
2
= 0.21). An environmental factor regression model demonstrates a guidewire being inside the tube or not during X-ray as a predictor for a conclusive visibility on X-ray.
Conclusions
High body mass index, male sex, and the absence of a guidewire inside the nasogastric tube at the time of chest X-ray are associated with a risk of insufficient visibility of the tube on X-ray. Patient profiles can be defined in which supplementary attention is needed when obtaining chest X-rays whose purpose is to confirm nasogastric tube positioning.
Key Points
•
The quality of chest X-rays to confirm the positioning of nasogastric tubes in adults can be improved considerably.
•
There are several factors influencing the confirmation of nasogastric tube positioning on X-ray.
•
Defining patient profiles at risk for an insufficient visibility of the tube on X-ray will indirectly contribute to an improvement of the chest X-ray quality.