Nurse-led family-based approach in primary health care for patients with type 2 diabetes mellitus: a qualitative study.

PURPOSE: The prevalence of Type 2 diabetes is rapidly increasing, with 537 million people estimated to have diabetes in 2021. The literature suggests that nurses can deliver effective person-centred diabetes care and that families can be essential in supporting patients. Thus, a Nurse-led Family-based (NLFB) approach may be particularly effective. This study aims to explore the perceptions of nurses, adults with type 2 diabetes, and family members regarding the NLFB intervention. METHODS: Guided by the UK Medical Research Council Framework, this seminal study adopted a qualitative, descriptive approach with content analysis. Data were obtained through 16 semi-structured, in-depth interviews. Themes emerged based on an inductive process using constant comparison (Graneheim and Lundman 2004). The COREQ checklist was used in ensuring rigour. RESULTS: Three main themes emerged includes: (1) nurses' experiences with current diabetes care practices, (2) stakeholders' views on the development of a NLFB approach, and (3) merging the nurse-led family aspects into the diabetes care. The key challenges are the dominant medical model, lack of specialist nurses, and time. The key facilitators are knowledge and social support. CONCLUSION: The study recommends stakeholders embrace nursing empowerment strategies and involve families to enhance the nurses' advanced roles and family inclusion in healthcare.

Knowledge and Attitudes of Men in Bahrain Toward Prostate Cancer.

OBJECTIVES: Bahrain has one of the highest rates of prostate cancer in the Middle East, when compared to neighboring countries. Therefore, a seminal study was undertaken, investigating the knowledge and attitudes of Arabic men over 50 years and older, who are in the highest risk group for prostate cancer. A secondary objective was to apply inter-professional student learning of research though the inclusion of medical and nursing students in the research team. DATA SOURCES: A descriptive research design with data collection through a researcher-administered questionnaire. Study participants included 74 men, predominantly of Arabic origin. CONCLUSION: Whereas the results of this study are generally reflective of the international literature, the study also provides some new and interesting insights into the perspectives of Arabic men. The findings highlight the importance of a culturally sensitive, health awareness programme for men's health and prostate cancer in Bahrain. IMPLICATIONS FOR NURSING PRACTICE: The study supports the important role of nurses in men's health promotion and disease prevention. An expansion in community nursing roles could facilitate the development of nursing specialist roles in the area of prostate disease prevention. An enhancement of undergraduate nursing student research learning occurs through active engagement with researchers in research projects, where students participate in preparing for research ethics approval, data collection, data analysis and writing for publication. Inter-professional learning is a very valuable experience in lowering traditional barriers between medicine and nursing.

The impact of introducing nurse-led analgesia and sedation guidelines in ventilated infants following cardiac surgery.

INTRODUCTION: Enhanced clinical outcomes in the Paediatric Intensive Care Unit following standardisation of analgesia and sedation practice are reported. Little is known about the impact of standardisation of analgesia and sedation practice including incorporation of a validated distress assessment instrument on infants post cardiac surgery, a subset of whom have Trisomy 21. This study investigated whether the parallel introduction of nurse-led analgesia and sedation guidelines including regular distress assessment would impact on morphine administered to infants post cardiac surgery, and whether any differences observed would be amplified within the Trisomy 21 population. METHODOLOGY: A retrospective single centre before/after study design was used. Patients aged between 44 weeks postconceptual age and one year old who had open cardiothoracic surgery were included. RESULTS: 61 patients before and 64 patients after the intervention were included. After the intervention, a reduction in the amount of morphine administered was not evident, while greater use of adjuvant sedatives and analgesics was observed. Patients with Trisomy 21 had a shorter duration of mechanical ventilation after the change in practice. CONCLUSION: The findings from this study affirm the importance of the nurses' role in managing prescribed analgesia and sedation supported by best available evidence. A continued education and awareness focus on analgesia and sedation management in the pursuit of best patient care is imperative.

A Population Study of Safety and Security in Admission Psychiatric Wards in the Kingdom of Bahrain.

Assaultive behavior is a feature of mental health services. Psychiatric staff may experience significant psychological effects in relation to assaultive behavior and aggression. The international literature highlights a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. There are no published studies from the Kingdom of Bahrain on safety and security in mental health services. The aim of the study is to describe the safety and security measures currently applied in the 18 psychiatric admission wards of the one and only psychiatric hospital in the Kingdom of Bahrain. A descriptive cross-sectional survey research design was used. Questionnaires were completed by the charge nurse in each psychiatric admission ward in the Kingdom of Bahrain. The instrument has previously been validated and used in Ireland and the UK. There was a response rate of 100%. The results identified deficiencies when compared to established international practice. There was a lack of security features related to the use of a swipe card system, personal panic alarms for staff, metal detectors, and rapid response team always on call. A wide range of differing practices were noted concerning the banning of items including searching of patients on admission and return from leave. The results provide important data and the impetus to guide the development of policy for best practice in safety and security in psychiatric services. Mental health managers must audit and regularly review work safety and security practices and ensure up to date policies and procedures.

The NURSING-Positive Recruitment Arabic Model (NURS-P.R.A.M.): A mixed methods study.

AIM: To identify factors influencing high school students' choice of nursing and explore strategic interventions to promote nursing as a career in the Arab region. BACKGROUND: This study forms part of a PhD thesis, conducted in Bahrain, in a healthcare environment with a high dependence on expatriate nurses to maintain nursing services. However, in attracting local candidates to study nursing, the public image of nursing in the Middle East must be improved by implementing strategies that are sensitive to the Arabic culture. DESIGN: A mixed methods approach incorporating quantitative and qualitative dimensions. METHODS: Data were collected between 2012 - 2015 using self-administered questionnaires, semi-structured interviews, focus groups, and written narratives. The study sample included high school students, parents, career guidance counsellors, and nursing students. A one-group pre-test posttest design was used to introduce a nursing recruitment intervention to high school students. spss was used to analyse quantitative data. Colaizzi's () and Krueger's () frameworks were applied to analyse the qualitative data. FINDINGS: It is proposed that the public perceptions of Arab people about nursing may be grounded in strong cultural influences and any efforts to improve the enrolment and retention of local nurses should consider enhancing the social values of the nursing profession. The NURSING-Positive Recruitment Arabic Model incorporates essential elements which will guide nursing recruitment in the Arabic cultures. CONCLUSION: The study findings reflect certain issues similar to the core international literature on nursing recruitment, however there are fundamental issues particular to the Arab region, which must be included in the development of a nursing recruitment strategy for Arabic nursing.

A descriptive survey study of violence management and priorities among psychiatric staff in mental health services, across seventeen european countries.

BACKGROUND: In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach. METHODS: The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an eDelphi survey approach was selected for the study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG. RESULTS: The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2 eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression. CONCLUSION: In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice.

Debridement for venous leg ulcers.

BACKGROUND: Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice documents and expert opinion suggests that the removal of devitalised tissue from venous ulcers (debridement) by any one of six methods helps to promote healing. However, to date there has been no review of the evidence from randomised controlled trials (RCTs) to support this. OBJECTIVES: To determine the effects of different debriding methods or debridement versus no debridement, on the rate of debridement and wound healing in venous leg ulcers. SEARCH METHODS: In February 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. In addition we handsearched conference proceedings, journals not cited in MEDLINE, and the bibliographies of all retrieved publications to identify potential studies. We made contact with the pharmaceutical industry to enquire about any completed studies. SELECTION CRITERIA: We included RCTs, either published or unpublished, which compared two methods of debridement or compared debridement with no debridement. We presented study results in a narrative form, as meta-analysis was not possible. DATA COLLECTION AND ANALYSIS: Independently, two review authors completed all study selection, data extraction and assessment of trial quality; resolution of disagreements was completed by a third review author. MAIN RESULTS: We identified 10 RCTs involving 715 participants. Eight RCTs evaluated autolytic debridement and included the following agents or dressings: biocellulose wound dressing (BWD), non-adherent dressing, honey gel, hydrogel (gel formula), hydrofibre dressing, hydrocolloid dressings, dextranomer beads, Edinburgh University Solution of Lime (EUSOL) and paraffin gauze. Two RCTs evaluated enzymatic preparations and one evaluated biosurgical debridement. No RCTs evaluated surgical, sharp or mechanical methods of debridement, or debridement versus no debridement. Most trials were at a high risk of bias.Three RCTs assessed the number of wounds completely debrided. All three of these trials compared two different methods of autolytic debridement (234 participants), with two studies reporting statistically significant results: one study (100 participants) reported that 40/50 (80%) ulcers treated with dextranomer beads and 7/50 (14%) treated with EUSOL achieved complete debridement (RR 5.71, 95% CI 2.84 to 11.52); while the other trial (86 participants) reported the number of ulcers completely debrided as 31/46 (76%) for hydrogel versus 18/40 (45%) for paraffin gauze (RR 0.67, 95% CI 0.45 to 0.99). One study (48 participants) reported that by 12 weeks, 15/18 (84%) ulcers treated with BWD had achieved a 75% to 100% clean, granulating wound bed versus 4/15 (26%) treated with non-adherent petrolatum emulsion-impregnated gauze.Four trials assessed the mean time to achieve debridement: one (86 participants) compared two autolytic debridement methods, two compared autolytic methods with enzymatic debridement (71 participants), and the last (12 participants) compared autolytic with biosurgical debridement; none of the results achieved statistical significance.Two trials that assessed autolytic debridement methods reported the number of wounds healed at 12 weeks. One trial (108 participants) reported that 24/54 (44%) ulcers treated with honey healed versus 18/54 (33%) treated with hydrogel (RR (adjusted for baseline wound diameter) 1.38, 95% CI 1.02 to 1.88; P value 0.037). The second trial (48 participants) reported that 7/25 (28%) ulcers treated with BWD healed versus 7/23 (30%) treated with non-adherent dressing.Reduction in wound size was assessed in five trials (444 participants) in which two autolytic methods were compared. Results were statistically significant in one three-armed trial (153 participants) when cadexomer iodine was compared to paraffin gauze (mean difference 24.9 cm², 95% CI 7.27 to 42.53, P value 0.006) and hydrocolloid compared to paraffin gauze (mean difference 23.8 cm², 95% CI 5.48 to 42.12, P value 0.01). A second trial that assessed reduction in wound size based its results on median differences and, at four weeks, produced a statistically significantly result that favoured honey over hydrogel (P value < 0.001). The other three trials reported no statistically significant results for reduction in wound size, although one trial reported that the mean percentage reduction in wound area was greater at six and 12 weeks for BWD versus a non-adherent dressing (44% versus 24% week 6; 74% versus 54% week 12).Pain was assessed in six trials (544 participants) that compared two autolytic debridement methods, but the results were not statistically significant. No serious adverse events were reported in any trial. AUTHORS' CONCLUSIONS: There is limited evidence to suggest that actively debriding a venous leg ulcer has a clinically significant impact on healing. The overall small number of participants, low number of studies and lack of meta-analysis in this review precludes any strong conclusions of benefit. Comparisons of different autolytic agents (hydrogel versus paraffin gauze; Dextranomer beads versus EUSOL and BWD versus non-adherent dressings) and Larvae versus hydrogel all showed statistically significant results for numbers of wounds debrided. Larger trials with follow up to healing are required.

Repositioning for treating pressure ulcers.

BACKGROUND: Pressure, from lying or sitting on a particular part of the body results in reduced oxygen and nutrient supply, impaired drainage of waste products and damage to cells. If a patient with an existing pressure ulcer continues to lie or bear weight on the affected area, the tissues become depleted of blood flow and there is no oxygen or nutrient supply to the wound, and no removal of waste products from the wound, all of which are necessary for healing. Patients who cannot reposition themselves require assistance. International best practice advocates the use of repositioning as an integral component of a pressure ulcer management strategy. This review has been conducted to clarify the role of repositioning in the management of patients with pressure ulcers. OBJECTIVES: To assess the effects of repositioning patients on the healing rates of pressure ulcers. SEARCH METHODS: For this third update we searched the Cochrane Wounds Group Specialised Register (searched 28 August 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 7); Ovid MEDLINE (2013 to August Week 3 2014); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 29 August, 2014); Ovid EMBASE (2012 to 29 August, 2014); and EBSCO CINAHL (2012 to 27 August 2014). SELECTION CRITERIA: We considered randomised controlled trials (RCTs) comparing repositioning with no repositioning, or RCTs comparing different repositioning techniques, or RCTs comparing different repositioning frequencies for the review. Controlled clinical trials (CCTs) were only to be considered in the absence of RCTs. DATA COLLECTION AND ANALYSIS: Two authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two authors independently screened these against the inclusion criteria. MAIN RESULTS: We identified no studies that met the inclusion criteria. AUTHORS' CONCLUSIONS: Despite the widespread use of repositioning as a component of the management plan for individuals with existing pressure ulcers, no randomised trials exist that assess the effects of repositioning patients on the healing rates of pressure ulcers. Therefore, we cannot conclude whether repositioning patients improves the healing rates of pressure ulcers. The effect of repositioning on pressure ulcer healing needs to be evaluated.

Risk assessment tools for the prevention of pressure ulcers.

BACKGROUND: Use of pressure ulcer risk assessment tools or scales is a component of the assessment process used to identify individuals at risk of developing a pressure ulcer. Indeed, use of a risk assessment tool is recommended by many international pressure ulcer prevention guidelines, however it is not known whether using a risk assessment tool makes a difference to patient outcomes. We conducted a review to provide a summary of the evidence pertaining to pressure ulcer risk assessment in clinical practice. OBJECTIVES: To determine whether using structured, systematic pressure ulcer risk assessment tools, in any health care setting, reduces the incidence of pressure ulcers. SEARCH METHODS: In December 2013, for this second update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid EMBASE; and EBSCO CINAHL. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the use of structured, systematic, pressure ulcer risk assessment tools with no structured pressure ulcer risk assessment, or with unaided clinical judgement, or RCTs comparing the use of different structured pressure ulcer risk assessment tools. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for eligibility, obtained full versions of potentially relevant studies and screened these against the inclusion criteria. MAIN RESULTS: We included two studies in this review. One small, cluster randomised study found no statistical difference in pressure ulcer incidence in patients who were assessed by nurses using the Braden risk assessment tool (n=74) compared with patients assessed by nurses who had receiving training and then used unstructured risk assessment (n=76) (RR 0.97, 95% CI 0.53 to 1.77) and those patients assessed by nurses using unstructured risk assessment alone (n=106) (RR 1.43, 95% CI 0.77 to 2.68). The second study was a large single blind randomised controlled study which compared the effect of risk assessment on pressure ulcer incidence using the Waterlow risk assessment tool (n=411), the Ramstadius risk screening tool (n=420) and no formal risk assessment (n=420). There was no statistical difference in pressure ulcer incidence between the three groups (Waterlow 7.5% (n=31); Ramstadius 5.4% (n=22); clinical judgement 6.8% (n=28) (RR 1.10, 95% CI 0.68 to 1.81; Waterlow vs no formal risk assessment), (RR 0.79, 95% CI 0.46 to 1.35; Ramstadius vs no formal risk assessment), (RR 1.44, 95% CI 0.85 to 2.44; Waterlow vs Ramstadius). AUTHORS' CONCLUSIONS: Two studies were identified which evaluated the effect of risk assessment on patient outcomes; In one study, there was no statistically significant difference in pressure ulcer incidence between people who were assessed using the Braden risk assessment tool compared with those receiving unstructured risk assessment. Methodological limitations of this study prevent firm conclusions being drawn. However, a further high quality RCT identified no statistical differences in pressure ulcer incidence when people were assessed using either the Waterlow risk assessment tool, the Ramstadius risk assessment tool, or using clinical judgement alone. There is no reliable evidence to suggest that the use of structured, systematic pressure ulcer risk assessment tools reduces the incidence of pressure ulcers.

Symptoms, clusters and quality of life prior to surgery for breast cancer.

AIMS AND OBJECTIVES: To examine the pretreatment symptoms and symptom clusters that women awaiting breast cancer surgery are experiencing and the impact of these symptoms on their quality of life. BACKGROUND: Most women diagnosed with breast cancer will have surgery as a first-line treatment. The presence of presurgery symptoms may be significant in contributing to distress and impaired quality of life. While it seems that women with breast cancer may experience the symptoms of fatigue, pain, depression and sleep disturbance as a cluster, this has not yet been confirmed by empirical research in the presurgery time period. DESIGN: A multiple-point prospective longitudinal cohort panel design is used. METHODS: Presurgery symptoms and quality of life were assessed using the Hospital Anxiety and Depression Scale, Insomnia Severity Index, Functional Assessment of Cancer Therapy-Fatigue, Brief Pain Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(3). RESULTS: Participants (n = 94, age range 30-92) experienced symptoms prior to surgery, with pain being a more prevalent symptom (35%) than fatigue (32%), sleep disturbances (25·5%) or depression (11%). global quality of life was significantly impacted on by fatigue and showed a moderate correlation with emotional functioning and a weak correlation with physical and social functioning. Hierarchical cluster analysis identified the presence of five clusters with symptoms present in differing intensities in each cluster. CONCLUSION: In this cohort of women, healthy other than having a diagnosis of breast cancer, symptoms were impacting on quality of life. It is evident that clusters of symptoms are present presurgery that must be assessed and managed. RELEVANCE TO PRACTICE: Healthcare delivery systems must ensure that early symptoms are addressed effectively in the presurgery period to improve quality of life and reduce adverse outcomes postsurgery.

A nurse-led intervention study: Promoting compliance with Diskus Inhaler use in asthma patients.

AIM: To examine the impact of a nurse-led patient assessment and education programme in promoting compliance with inhaler use in asthma patients. DESIGN: A quasi-experimental pre-test and post-test design. METHODS: A sample of asthmatic patients (N = 21) were recruited from the population of patients attending an asthma clinic. An Inhaler Proficiency Schedule (IPS) was developed and validated. At each visit, participants were requested to demonstrate their inhaler technique. The participants were investigated as to their confidence level with self-administration of their inhaler and adherence to prescribed doses. This information was recorded on a Patient-Reported Behaviour (PRB) questionnaire. RESULTS: Technique, compliance and patient confidence levels improved with nurse-led education repeated over three visits; this was sustained on measurement at 6 months following completion of the education programme.

An economic analysis of repositioning for the prevention of pressure ulcers.

AIMS AND OBJECTIVES: To compare pressure ulcer incidence and costs associated with repositioning older individuals in long-term care using two different repositioning regimes. BACKGROUND: Repositioning has not always been integrated into pressure ulcer preventative methods, with arguments that it is an expensive procedure in terms of personnel and time. DESIGN: Participants were randomly allocated to the experimental group (n = 99; repositioned every 3 hours, using the 30° tilt) and the control group (n = 114 standard care, repositioned every 6 hours, using the 90° lateral rotation). The analysis explored the incidence of pressure ulcer development and the cost difference between the two repositioning schedules, over a 4-week period. RESULTS: The mean daily nurse time for repositioning was 18·5 minutes (experimental) and 24·5 minutes (control). Nurse time cost per patient over the study period was €206·6 (experimental) and €253·1 (control), 96·6% of participants (experimental) remained free of pressure ulcers, compared with 88·1% (control). The cost per patient free of ulcer was €213·9 (experimental) and €287·3 (control). Projected annual costs were estimated for the 588 (53·5%) residents in the 12 study sites requiring repositioning. The cost would be €1·59 m (experimental) and €2·10 m (control), a cost difference of €510,000. This represents a difference of 58·8 hours of nurse time, equivalent to approximately 12 full time nurses across the 12 sites. CONCLUSION: Repositioning every 3 hours, using 30° tilt, has been shown to be more effective in less costly in terms of nurse time compared with standard care. RELEVANCE TO CLINICAL PRACTICE: Repositioning individuals at risk of pressure ulcer development makes both economic and clinical sense, thereby supporting the EPUAP/NPUAP 2009 guidelines.

Nurses' knowledge of chest drain management in an Irish Children's Hospital.

AIMS AND OBJECTIVES: To explore contact with and knowledge regarding chest drain management among nurses. BACKGROUND: Chest drains are commonly used in both adult and paediatric settings, for example, for cardiothoracic patients or postspinal surgery, where they are inserted intra-operatively to drain excess fluid. Despite a large number of children requiring chest drain insertion annually, current literature suggests that many nurses have reduced contact with chest drains and a knowledge deficit regarding their management. Furthermore, the literature is limited in relation to chest drain management in the paediatric patient. Mismanagement of chest drains can have devastating consequences for patients. DESIGN: A standardised descriptive survey approach was employed. METHODS: The sample consisted of 121 critical care and ward nurses from a large urban paediatric hospital, who cared for chest drains on a regular basis. Data were collected using a 37-item questionnaire, adapted from a study in the adult setting. Statistical analysis was performed using spss V15. RESULTS: The findings demonstrate that increased exposure to caring for children with chest drains is synonymous with a greater perception of knowledge levels in this area of practice. While critical care nurses looked after children with chest drains more frequently than ward nurses, there was no difference in the knowledge assessment section of the questionnaire. This research identified where knowledge deficits exist. CONCLUSIONS: This study identified the key areas where overall uncertainties existed leading to a decreased knowledge perception. Nurses are engaging with methods of knowledge acquisition; however, those who have less contact with chest drains require regular updates. RELEVANCE TO CLINICAL PRACTICE: Addressing misconceptions about chest drain management is imperative. Providing up to date guidelines in clinical areas will improve chest drain management. Strategic educational initiatives are in place to ensure identified knowledge deficits are addressed and a complete revision of chest drain guidelines has been undertaken.

Wound cleansing for pressure ulcers.

BACKGROUND: Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the elderly, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care. OBJECTIVES: This systematic review seeks to answer the following question: what is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers? SEARCH METHODS: For this third update, we searched the Cochrane Wounds Group Specialised Register (searched 3 January 2013); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to November Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 31, 2012); Ovid EMBASE (2010 to 2012 Week 52); and EBSCO CINAHL (2010 to 21 December 2012). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and resolved disagreements through discussion. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, risk ratio (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, mean difference (MD), plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. Two review authors independently assessed each included study using the Cochrane Collaboration tool for assessing risk of bias. MAIN RESULTS: One additional eligible study was identified from the updated searches, one study was added to the table of excluded studies. A total of three studies (169 participants) met the inclusion criteria for the review. No studies compared cleansing with no cleansing. Two studies compared different wound cleansing solutions. A statistically significant improvement in Pressure Sore Status Tool scores occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline (P value = 0.025), but no statistically significant change in healing was seen when water was compared with saline (RR 3.00, 95% CI 0.21 to 41.89). One study compared cleansing techniques; for pressure ulcers cleansed with pulsatile lavage, compared with sham (the lavage flow was directed into a wash basin positioned adjacent to the wound and not visible to the participants), there was a statistically significant reduction in ulcer volume at the end of the three week study period in the lavage group compared with the sham group (MD -6.60, 95% CI-11.23, -1.97). AUTHORS' CONCLUSIONS: We identified three small studies addressing cleansing of pressure ulcers. One reported a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline solution, a further study reported no statistically significant change in healing was seen when wounds were cleaned with water was compared with saline. A final study compared pulsatile lavage with sham and found a significantly greater reduction in ulcer volume at the end of the study period in the lavage group compared with the sham group. The authors conclude that there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.

The future cost of stroke in Ireland: an analysis of the potential impact of demographic change and implementation of evidence-based therapies.

BACKGROUND AND PURPOSE: this paper examines the impact of demographic change from 2007 to 2021 on the total cost of stroke in Ireland and analyses potential impacts of expanded access to stroke unit care and thrombolytic therapy on stroke outcomes and costs. METHODS: total costs of stroke are estimated for the projected number of stroke cases in 2021 in Ireland. Analysis also estimates the potential number of deaths or institutionalised cases averted among incident stroke cases in Ireland in 2007 at different rates of access to stroke unit care and thrombolytic therapy. Drawing on these results, total stroke costs in Ireland in 2007 are recalculated on the basis of the revised numbers of incident stroke patients estimated to survive stroke, and of the numbers estimated to reside at home rather than in a nursing home in the context of expanded access to stroke units or thrombolytic therapy. RESULTS: future costs of stroke in Ireland are estimated to increase by 52-57% between 2007 and 2021 on the basis of demographic change. The projected increase in aggregate stroke costs for all incident cases in 1 year in Ireland due to the delivery of stroke unit care and thrombolytic therapy can be offset to some extent by reductions in nursing home and other post-acute costs.