Surgical wound care preferences and priorities from the perspectives of patients: a qualitative analysis.

OBJECTIVE: To explore patients' priorities and preferences for optimal care of their acute or hard-to-heal surgical wound(s). METHOD: This qualitative study involved semi-structured individual interviews with patients receiving wound care in Queensland, Australia. Convenience and snowball sampling were used to recruit patients from inpatient and outpatient settings between November 2019 and January 2020. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Emergent themes were discussed by all investigators to ensure consensus. RESULTS: A total of eight patients were interviewed, five of whom were male (average median age: 70.5 years; interquartile range (IQR): 45-80 years). Four interrelated themes emerged from the data that describe the patients' surgical wound journey: experiencing psychological and psychosocial challenges; taking back control by actively engaging in care; seeking out essential clinician attributes; and collaborating with clinicians to enable an individualised approach to their wound care. CONCLUSION: Findings from this study indicate that patients want to actively collaborate with clinicians who have caring qualities, professional skills and knowledge, and be involved in decision-making to ensure care meets their individual needs.

Oedema as a predictor of the incidence of new pressure injuries in adults in any care setting: A systematic review and meta-analysis.

BACKGROUND: Oedema measurement, also termed sub-epidermal moisture measurement is recommended as an adjunct pressure injury prevention intervention in international guidelines because it indicates early tissue damage. OBJECTIVE: To determine the prognostic value of oedema measurement in predicting future pressure injury in adults in any care setting. DESIGN: Systematic review and meta-analysis. SETTING: Participants were recruited from nursing homes or aged care facilities, hospitals, or post-acute facilities. PARTICIPANTS: Adults. METHODS: A modified 2-week systematic review was undertaken. Study designs included cohort (prospective and retrospective), case-control, case series if relevant comparisons were reported, randomised controlled trials if the association between oedema measurement and pressure injury was reported, and registry data. Databases searched included: Medical Literature Analysis and Retrieval System Online, The Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica and the Cochrane Library from inception to 13 July 2021 with no language restrictions. Screening, data extraction using Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies - Prognostic Factors (CHARMS-PF) and quality assessment using Quality in Prognostic Factor Studies (QUIPS) were undertaken independently by ≥2 authors and adjudicated by another if required. Meta-analyses and meta-regression were undertaken. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Six studies (n = 483 total) were included. Two studies were set in nursing homes and four in either hospitals or post-acute facilities. Fives studies were prospective cohorts, and one was a randomised control trial. Two studies were assessed as low risk and four studies as moderate risk of bias. The pooled risk ratio in four studies (n = 388) for the relationship between oedema and pressure injury cumulative incidence was 18.87 (95% CI 2.13-38.29) and for time to pressure injury was 4.08 days (95% CI 1.64-6.52). Using GRADE, the certainty of the body of evidence was low for all outcomes. Meta-regression indicated that age, gender, and sample size were poor predictors for the association between oedema and pressure injury. CONCLUSIONS: Measuring oedema as a predictor for pressure injury development is showing promise but a stronger body of evidence that takes into consideration other prognostic factors is needed to better understand its benefit. REGISTRATION: PROSPERO CRD42021267834. TWEETABLE ABSTRACT: Measuring oedema is a promising strategy to prevent pressure injuries but the certainty of evidence for this claim is low.

Process evaluation of an intervention to test the effectiveness of foam border dressings in preventing hospital-acquired sacral pressure injuries (the EEPOC trial): A protocol.

BACKGROUND: Prophylactic foam border dressings are recommended for high-risk patients in addition to standard pressure injury prevention protocols despite limited high-quality evidence regarding their effectiveness. This protocol describes the process evaluation that will be undertaken alongside a multisite randomised controlled trial investigating the clinical and cost-effectiveness of these dressings in reducing hospital-acquired sacral pressure injury incidence. METHODS: This theory informed parallel process evaluation using qualitative and quantitative methods will be undertaken in medical and surgical units. To evaluate fidelity, recruitment, reach, dose delivered and received, and context, process data will include: research nurses' self-reported adherence to intervention protocols; semi-structured interviews with participants and research nurses and focus groups with nursing staff; participants' satisfaction and comfort with the dressings and perceived level of participation in pressure injury prevention; and nurses' attitudes toward pressure injury prevention. The proportion of the target population recruited, participant characteristics, and adherence to intervention protocols will be reported using descriptive statistics. Chi square or t-tests will compare differences in demographic characteristics between groups, and non-participants, and multivariate modelling will investigate potential moderators on the trial outcomes. Analysis of qualitative data will be guided by the Framework Method, which provides a clear, systematic process for developing themes. DISCUSSION: This process evaluation will provide valuable insights into mechanisms of impact and contextual and moderating factors influencing trial outcomes. Process data will enhance reproducibility of the intervention and trustworthiness of findings, and inform clinicians, researchers, and policy makers about the extent to which foam border dressings can be feasibly implemented in clinical practice. TRIAL REGISTRATION: ACTRN12619000763145p.

Process evaluations undertaken alongside randomised controlled trials in the hospital setting: A scoping review.

Background: There is increasing recognition of the importance of undertaking process evaluations alongside implementation of health interventions by examining mechanisms of impact and contextual factors. However, a comprehensive synthesis of process evaluations undertaken alongside clinical trials in hospital settings is lacking. We undertook a scoping review to address this gap. Methods: This review was guided by the methodological framework for scoping studies. Studies were identified using four databases; Ovid Medline, EBSCO CINAHL, EMBASE and Scopus. Two authors independently screened all titles and available abstracts, with a third author available to adjudicate. Studies were eligible for inclusion if they described a process evaluation undertaken alongside a randomised controlled trial in the hospital setting. Data were abstracted by one author and checked by two others and analysed both descriptively and using inductive content analysis. Results: Data were extracted from 30 articles reporting on 15 trials, most of which were cluster randomised trials (c-RTs) (n = 12). The most common data collection methods used in process evaluations were interviews, questionnaires or surveys, and records or logs. Data analysis revealed three themes relative to how authors: use process data to interpret, understand and explain trial outcomes; evaluate responses to the intervention; and consider the implementation context. Conclusions: Findings from this review demonstrate the complex nature of intervention implementation in the hospital setting. Overall, there is need for standardised reporting of process evaluations and more explicit descriptions of how authors use frameworks to guide their evaluation.

Repositioning for pressure injury prevention in adults: An abridged Cochrane systematic review and meta-analysis.

BACKGROUND: A pressure injury is an area of localised damage to the skin and underlying tissues. Patient repositioning is an important prevention strategy, as those with limited mobility are at increased risk of developing pressure injury. OBJECTIVES: To assess the clinical and cost-effectiveness of repositioning schedules on the prevention of pressure injury in adults. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials; MEDLINE (Ovid); Embase (Ovid) and Cumulative Index of Nursing and Allied Health Literature Plus (EBSCO) were searched in February 2019. No restrictions were applied to language or date of publication. REVIEW METHODS: Studies were eligible if they were randomised controlled trials including cluster trials, published or unpublished, and undertaken in any healthcare setting that assessed the clinical and/or cost effectiveness of repositioning schedules for prevention of pressure injury in adults. Methodological quality of the studies was independently assessed by three authors. Heterogeneity between studies was assessed using the I2 statistic, and the pooled risk ratios along with their 95% confidence intervals were estimated using either fixed and random effects models, as indicated. Grading of Recommendations Assessment, Development and Evaluation was used to appraise the certainty of evidence. RESULTS: Eight eligible trials involving 3,941 participants published between 2004 and 2018 were identified. Trials compared either different repositioning frequencies or positioning regimens. Three trials (1074 participants) compared 2-hourly with 4-hourly repositioning (risk ratio 1.06, 95% confidence interval 0.80 to 1.41; I2 = 45%). Two other trials (252 participants) compared a 30-degree tilt with a 90-degree tilt (risk ratio0.62, 95% confidence interval 0.10 to 3.97; I2 =69%). Only two trials included economic analyses, both amongst nursing home residents. One study estimated the costs of repositioning to be Canadian dollars $11.05 and Canadian dollars $16.74 less per resident per day for the 3-hourly or 4-hourly regimens, respectively, when compared to 2-hourly regimen. The second study reported 3-hourly repositioning using a 30-degree tilt to cost €46.50 (95% confidence interval €1.25 to €74.60) less per patient in nursing time compared with 6-hourly repositioning with a 90-degree lateral rotation. CONCLUSION: It remains unclear which repositioning frequencies or positions are most effective in preventing pressure injury in adults. There is limited evidence to support the cost effectiveness of repositioning frequencies and positions. Registration: Cochrane protocol published in 2012.