Education of healthcare professionals for preventing pressure ulcers.

BACKGROUND: Pressure ulcers, also known as bed sores or pressure sores, are localised areas of tissue damage arising due to excess pressure and shearing forces. Education of healthcare staff has been recognised as an integral component of pressure ulcer prevention. These educational programmes are directed towards influencing behaviour change on the part of the healthcare professional, to encourage preventative practices with the aim of reducing the incidence of pressure ulcer development. OBJECTIVES: To assess the effects of educational interventions for healthcare professionals on pressure ulcer prevention. SEARCH METHODS: In June 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs, that evaluated the effect of any educational intervention delivered to healthcare staff in any setting to prevent pressure ulceration. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts of the studies identified by the search strategy for eligibility. We obtained full versions of potentially relevant studies and two authors independently screened these against the inclusion criteria. MAIN RESULTS: We identified five studies that met the inclusion criteria for this review: four RCTs and one cluster-RCT. The study characteristics differed in terms of healthcare settings, the nature of the interventions studied and outcome measures reported. The cluster-RCT, and two of the RCTs, explored the effectiveness of education delivered to healthcare staff within residential or nursing home settings, or nursing home and hospital wards, compared to no intervention, or usual practices. Educational intervention in one of these studies was embedded within a broader, quality improvement bundle. The other two individually randomised controlled trials explored the effectiveness of educational intervention, delivered in two formats, to nursing staff cohorts.Due to the heterogeneity of the studies identified, pooling was not appropriate and we have presented a narrative overview. We explored a number of comparisons (1) education versus no education (2) components of educational intervention in a number of combinations and (3) education delivered in different formats. There were three primary outcomes: change in healthcare professionals' knowledge, change in healthcare professionals' clinical behaviour and incidence of new pressure ulcers.We are uncertain whether there is a difference in health professionals' knowledge depending on whether they receive education or no education on pressure ulcer prevention (hospital group: mean difference (MD) 0.30, 95% confidence interval (CI) -1.00 to 1.60; 10 participants; nursing home group: MD 0.30, 95% CI -0.77 to 1.37; 10 participants). This was based on very low-certainty evidence from one study, which we downgraded for serious study limitations, indirectness and imprecision.We are uncertain whether there is a difference in pressure ulcer incidence with the following comparisons: training, monitoring and observation, versus monitoring and observation (risk ratio (RR) 0.63, 95% CI 0.37 to 1.05; 345 participants); training, monitoring and observation, versus observation alone (RR 1.21, 95% CI 0.60 to 2.43; 325 participants) or, monitoring and observation versus observation alone (RR 1.93, 95% CI 0.96 to 3.88; 232 participants). This was based on very low-certainty evidence from one study, which we downgraded for very serious study limitations and imprecision. We are uncertain whether multilevel intervention versus attention control makes any difference to pressure ulcer incidence. The report presented insufficient data to enable further interrogation of this outcome.We are uncertain whether education delivered in different formats such as didactic education versus video-based education (MD 4.60, 95% CI 3.08 to 6.12; 102 participants) or e-learning versus classroom education (RR 0.92, 95% CI 0.80 to 1.07; 18 participants), makes any difference to health professionals' knowledge of pressure ulcer prevention. This was based on very low-certainty evidence from two studies, which we downgraded for serious study limitations and study imprecision.None of the included studies explored our other primary outcome: change in health professionals' clinical behaviour. Only one study explored the secondary outcomes of interest, namely, pressure ulcer severity and patient and carer reported outcomes (self-assessed quality of life and functional dependency level respectively). However, this study provided insufficient information to enable our independent assessment of these outcomes within the review. AUTHORS' CONCLUSIONS: We are uncertain whether educating healthcare professionals about pressure ulcer prevention makes any difference to pressure ulcer incidence, or to nurses' knowledge of pressure ulcer prevention. This is because the included studies provided very low-certainty evidence. Therefore, further information is required to clarify the impact of education of healthcare professionals on the prevention of pressure ulcers.

Impact of Multiplayer Online Role-Playing Games upon the Psychosocial Well-Being of Adolescents and Young Adults: Reviewing the Evidence.

Introduction. For many people, the online environment has become a significant arena for everyday living, and researchers are beginning to explore the multifaceted nature of human interaction with the Internet. The burgeoning global popularity and distinct design features of massively multiplayer online role-playing games (MMORPGs) have received particular attention, and discourses about the phenomenon suggest both positive and negative impact upon gamer health. Aim. The purpose of this paper was to critically appraise the research literature to determine if playing MMORPGs impacts upon the psychosocial well-being of adolescents and young adults. Method. Initial searches were conducted on nine databases spanning the years 2002 to 2012 using key words, such as online gaming, internet gaming, psychosocial, and well-being, which, in addition to hand searching, identified six studies meeting the inclusion and exclusion criteria for this review. Results. All six studies strongly associated MMORPG playing with helpful and harmful impact to the psychosocial well-being of the populations under study; however due to the methodologies employed, only tentative conclusions may be drawn. Conclusion. Since both helpful and harmful effects were reported, further multidisciplinary research is recommended to specifically explore the clinical implications and therapeutic potentialities of this modern, growing phenomenon.

Do high frequency ultrasound images support clinical skin assessment?

High frequency ultrasound imaging has been reported as a potential method of identifying the suspected tissue damage in patients "at risk" of pressure ulceration. The aim of this study was to explore whether ultrasound images supported the clinical skin assessment in an inpatient population through identification of subcutaneous tissue damage. Skin on the heels and/or sacral coccygeal area of fifty vascular surgery inpatients was assessed clinically by tissue viability nurses and with ultrasound pre operatively and at least every other day until discharge. Images were compared to routine clinical skin assessment outcomes. Qualitative classification of ultrasound images did not match outcomes yielded through the clinical skin assessment. Images corresponding to 16 participants were classified as subgroup 3 damage at the heels (equivalent to grade 2 pressure ulceration); clinical skin assessment rated no heels as greater than grade 1a (blanching erythema). Conversely, all images captured of the sacral coccygeal area were classified as normal; the clinical skin assessment rated two participants as grade 1b (non-blanching erythema). Ultrasound imaging is a potentially useful adjunct to the clinical skin assessment in providing information about the underlying tissue. However, further longitudinal clinical assessment is required to characterise images against actual and "staged" pressure ulceration.

Impact of sitting time on seat-interface pressure and on pressure mapping with multiple sclerosis patients.

OBJECTIVE: To examine changes in seat-interface pressure with multiple sclerosis (MS) patients. DESIGN: Case series. SETTING: Multiple Sclerosis Society's Resource Centre and community. PARTICIPANTS: Convenience sample of 15 MS wheelchair users and 12 MS non-wheelchair users. INTERVENTION: Interface pressure was measured for 8 minutes using the Force Sensing Array pressure mapping system. MAIN OUTCOME MEASURES: Number of activated sensors, standard deviation, average and maximum pressures. RESULTS: With the wheelchair users, significant decreases were found in the standard deviation and average and maximum pressures during 0 to 2 minutes of sitting ( P <.01). Average pressure was the only parameter to show a significant decrease in the non-wheelchair users ( P <.01) during 0 to 2 minutes. Significant increases were found in all output parameters during 2 to 4 minutes with both groups ( P <.05). Non-wheelchair users showed no significant changes in the output parameters after 4 minutes, but wheelchair users showed significant continued increases in the output parameters from 4 to 8 minutes ( P <.05). CONCLUSIONS: Because no significant changes in interface pressure occurred after 4 minutes of sitting with the non-wheelchair users, 4 minutes may be a reasonable sitting time before interface pressure is recorded with this group. Significant changes in interface pressure continued up to 8 minutes with the wheelchair users, therefore 8 minutes or beyond may be a reasonable sitting time before recording with this group.