New feature: weekly search challenge
We've had feedback from readers of the case study column that are interested in getting more "in-depth" into the process of designing a search strategy for patron questions - what terms are useful for a topic, what terms aren't, what databases and other resources are necessary to make sure you've identified as much as possible, etc.
To this end, we're going to start posting a "search challenge" question each Monday. We encourage you to post your ideas and questions in the comments or to us by email (using our profile links above). You can also feel free to "reference interview" us by posting questions for clarification or more detail as needed.
Then, each Friday we'll post a search strategy and other thoughts on that question. We hope this will add to the usefulness of the cases by giving another outlet for developing searching skills and discussing strategies with colleagues.
So, this week's question is:
Does the use of a pressure-reducing bed or mattress lead to a reduction in the incidence of pressure sores or other complications in an adult hospital in-patient population?
To this end, we're going to start posting a "search challenge" question each Monday. We encourage you to post your ideas and questions in the comments or to us by email (using our profile links above). You can also feel free to "reference interview" us by posting questions for clarification or more detail as needed.
Then, each Friday we'll post a search strategy and other thoughts on that question. We hope this will add to the usefulness of the cases by giving another outlet for developing searching skills and discussing strategies with colleagues.
So, this week's question is:
Does the use of a pressure-reducing bed or mattress lead to a reduction in the incidence of pressure sores or other complications in an adult hospital in-patient population?
posted by Becky at 2:33 PM
4 Comments:
Cavicchioli A. Carella G. Clinical effectiveness of a low-tech versus high-tech pressure-redistributing mattress. [Journal Article, Clinical Trial, Research, Tables/Charts] Journal of Wound Care. 2007 Jul; 16(7): 285-9. (19 ref)
N. McInnes E. Bell-Syer SEM. Legood R. Support surfaces for pressure ulcer prevention. [Journal Article, Research, Systematic Review] Cochrane Database of Systematic Reviews. 2007;(4): (CD001735)
Dealey C. Review: support surfaces, nutritional supplements, and topical agents help prevent pressure ulcers. [Journal Article, Abstract, Commentary, Tables/Charts] Evidence-Based Nursing. 2007 Apr; 10(2): 54. (2 ref)
Nixon J. Cranny G. Iglesias C. Nelson EA. Hawkins K. Phillips A. Torgerson D. Mason S. Cullum N. Randomised, controlled trial of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers: PRESSURE (pressure relieving support surfaces) trial [corrected] [published erratum appears in BMJ 2006 Jul 1;333(7557):30]. [Journal Article, Clinical Trial, Research, Tables/Charts] BMJ. 2006 Jun 17; 332(7555): 1413-5. (11 ref)
Eachempati SR. Eliminating pressure ulcers: do specialty beds or specialty nurses matter more? [Journal Article, Commentary, Editorial] Critical Care Medicine. 2007 Mar; 35(3): 966-7. (14 ref)
The Cochrane Wounds group search is quite thorough:
The Cochrane Central Register of Controlled Trials (CENTRAL) was searched, Issue 4 2003 using the following strategy:
1. BEDS single term (MeSH)
2. (bed or beds or bedding)
3. mattress*
4. cushion*
5. foam or transfoam
6. overlay*
7. (pad or pads)
8. gel
9. (pressure near relie*)
10. (pressure near device*)
11. (pressure near reduction)
12. (pressure near reducing)
13. (positioning* or repositioning*)
14. ((low next pressure) and support*)
15. ((low next pressure) and device*)
16. (constant near pressure)
17. (alternat* near pressure)
18. (air near suspension*)
19. (water near suspension*)
20. clinifloat
21. vaperm
22. therarest
23. maxifloat
24. sheepskin*
25. hammock*
26. (foot next waffle)
27. silicore
28. pegasus
29. (cairwave near therapy)
30. (turning near table*)
31. (kinetic near table*)
32. (kinetic near therapy)
33. (air next bag*)
34. (elevation near device*)
35. (static next air)
36. (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10)
37. (#11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20)
38. (#21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30)
39. (#31 or #32 or #33 or #34 or #35)
40. (#36 or #37 or #38 or #39)
41. DECUBITUS ULCER single term (MeSH)
42. (decubitus next ulcer*)
43. (bed near ulcer*)
44. (bed near sore*)
45. (pressure near sore*)
46. (pressure near ulcer*)
47. (#41 or #42 or #43 or #44 or #45 or #46)
48. (#40 and #47)
Search Results
Ovid MEDLINE(R) 1950 to Present with Daily Update
# Searches Results
1 Beds/ 2962
2 *Beds/ 1849
3 pressure-reducing.mp. or pressure.ti. or pressure.ab. or pressure/ 426548
4 pressure ulcer/ 7370
5 Incidence/ or incidence.ab. 364653
6 critical illness/ or Intensive Care Units/ or Intensive Care/ or Critical Care/ 52738
7 2 and 3 and 4 and 5 61
8 Hospitalization/ 50645
9 Inpatients/ 6788
10 Hospitals/ 42644
11 6 or 8 or 9 or 10 150247
12 limit 7 to ("all adult (19 plus years)" and english and (female or male)) 33
13 11 and 12 5
14 from 13 keep 1-5 5
15 from 13 keep 1-5 5
Results of your search: from 13 [11 and 12] keep 1-5
Results Available: 5
Results Displayed: 1-5
Result 1.
Unique Identifier 11299575
Status MEDLINE
Authors Phillips L.
Authors Full Name Phillips, L.
Institution Pegasus Egerton Ltd, Pegasus House, Waterberry Drive, Waterlooville, Hampshire, PO7 7XX.
Title Cost-effective strategy for managing pressure ulcers in critical care: a prospective, non-randomised, cohort study.
Source Journal of Tissue Viability. 10(3 su):2-6, 2000 Jul.
Abstract A prospective, clinical outcome study was undertaken in a critical care environment to provide evidence of the effectiveness of a unique pressure-relieving (PR) alternating mattress system in both the prevention and treatment of pressure ulcers in an extremely vulnerable population. In total, 160 critical care patients were recruited across five facilities within the United Kingdom. Despite the severity of the patients' condition (mean stay 8 days, mortality rate 24.7%) the incidence of new tissue damage was low (n = 6, 3.75%), predominantly superficial and occurring near to death, while 80% (n = 16/20) of pre-existing superficial ulcers healed. The study highlights the complexity of assessing differing levels of risk in this vulnerable population, where 87.5% of patients were ventilated and 93.1% were totally immobile. No correlation was found between the occurrence of pressure damage and Waterlow score, serum albumin, hypotension and the use of inotropic agents. Cost-effective patient management includes the allocation of effective resources to those patients who will benefit most. However, if complex risk assessment precludes the accurate assignment of resources, an alternative approach may be to provide a minimum, yet effective, standard of care to all patients. This strategy also avoids recourse to more costly interventions especially where there is little evidence of improved patient outcome.
Publication Type Clinical Trial. Journal Article.
Result 2.
Unique Identifier 9095813
Status MEDLINE
Authors Jesurum J. Joseph K. Davis JM. Suki R.
Authors Full Name Jesurum, J. Joseph, K. Davis, J M. Suki, R.
Institution St. Luke's Episcopal Hospital, Texas Heart Institute, Houston, USA.
Title Balloons, beds, and breakdown. Effects of low-air loss therapy on the development of pressure ulcers in cardiovascular surgical patients with intra-aortic balloon pump support.
Source Critical Care Nursing Clinics of North America. 8(4):423-40, 1996 Dec.
Local Messages Himmelfarb Library electronic access (see E-Journals page for details)
Abstract There is limited research related to pressure ulcers in the ICU patient population and even less has focused on patients who have undergone cardiovascular surgery and IABP support. The objective of this article was to determine the incidence of pressure ulcers in the postoperative CVS patient with IABP support and to determine if LAL therapy was more effective in the prevention of pressure ulcers in this patient population. In a quasiexperimental design, a convenience sample of 36 adults was used. Patients who were placed on IABP support the day of surgery were enrolled into the study within 24 hours of admission to the cardiovascular recovery room. Data collection was daily for 4 days and continued if the patient developed a pressure ulcer. Final measurements were obtained on the day of hospital discharge. Instruments used were demographic data form, APACHE II, Patient Identification for Rotation Therapy, and the Braden Scale. The most common surgical patient in this pilot underwent aortocoronary bypass with IABP support. Pressure ulcers developed in 9 of 36 (25%) patients for a total of 17 ulcers. Patients who developed pressure ulcers were generally older, had a history of cerebrovascular disease, renal insufficiency, a higher APACHE II score, and Braden score of 9 on POD 1. In addition, these patients generally had a lower hemoglobin level, higher serum creatinine level, and an altered level of consciousness on POD 1. The results suggest that LAL therapy does make a difference in the prevention of pressure ulcers in the aortocoronary bypass patient with IABP support.
Publication Type Clinical Trial. Journal Article. Randomized Controlled Trial.
Result 3.
Unique Identifier 8826270
Status MEDLINE
Authors Gebhardt KS. Bliss MR. Winwright PL. Thomas J.
Authors Full Name Gebhardt, K S. Bliss, M R. Winwright, P L. Thomas, J.
Title Pressure-relieving supports in an ICU.
Source Journal of Wound Care. 5(3):116-21, 1996 Mar.
Abstract Intensive care wards have a high incidence of pressure sores. This trial, in an eight-bed unit, aimed to compare the cost-effectiveness of constant-low-pressure and alternating-pressure support systems for preventing pressure sores. Patients without sores with a Norton risk score of < 13 were allocated to either alternating- or constant-low-pressure supports according to their hospital number. The cheapest supports were used initially, and changed for more sophisticated types if the patient's pressure areas deteriorated. None of the 23 patients using low-cost alternating-pressure supports developed open sores and only one had to be transferred to a more sophisticated mattress because of persistent erythema. Eleven out of 20 patients on constant-low-pressure mattresses or overlays developed either persistent erythema (three) or sores (eight). Ten were transferred to more expensive support systems. The mean cost of supports per patient in the alternating-pressure group was 44.50 pounds and in the constant-low-pressure group 86.20 pounds.
Publication Type Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Result 4.
Unique Identifier 7919441
Status MEDLINE
Authors Sideranko S. Yeston NS.
Authors Full Name Sideranko, S. Yeston, N S.
Institution Hartford Hospital, CT.
Title Pressure sores no more: a quality improvement project.
Source Journal of Nursing Care Quality. 8(4):33-7, 1994 Jul.
Local Messages Himmelfarb Library print subscription (see Library Catalog for details), Himmelfarb Library electronic access (see E-Journals page for details)
Abstract Review of staff performance in the area of pressure sore prevention revealed that nursing practice was adequate. But the staff's belief that it could do a better job provided the impetus for a quality improvement project. Based on research data a planned change was implemented, and follow-up study reflected positive outcome results. This successful project integrated the concepts of research, cost effectiveness, and patient outcome.
Publication Type Journal Article.
Result 5.
Unique Identifier 1496149
Status MEDLINE
Authors Sideranko S. Quinn A. Burns K. Froman RD.
Authors Full Name Sideranko, S. Quinn, A. Burns, K. Froman, R D.
Institution Hartford Hospital, CT.
Title Effects of position and mattress overlay on sacral and heel pressures in a clinical population.
Source Research in Nursing & Health. 15(4):245-51, 1992 Aug.
Abstract A comparison of pressure reducing properties of alternating air, static air, and water mattress overlays was conducted with 57 patients in a surgical intensive care unit. Sacral and heel pressures in both recumbent and semi-Fowler's positions were tested for each surface using a repeated measures design. Mean pressures for the alternating air mattress were significantly higher than pressures with other surfaces, regardless of position or site. There were significant main effects for position and site, with higher pressures in the semi-Fowler's position and at the sacral site. A significant interaction between surface, site, and position was found. Pressure sores developed in eight patients, but the incidence was not significantly different across groups. A pressure measuring device constructed from available clinical materials proved to be both sensitive and reliable. The findings suggest alternating air overlays should be avoided, and that positioning and periodic position change to reduce sacral pressures for patients requiring prolonged upper body elevation is important.
Publication Type Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial.
PubMed Search:
Best result:
Option 1: ((beds[MESH] OR MATTRESS) AND (pressure AND reducing) AND (risk OR random* OR meta-analysis OR systematic REVIEW)) AND ADULT = 44
Option 2:(beds[MESH] OR MATTRESS) AND (pressure AND reducing) + LIMITS Clinical Trial , Meta-Analysis, Randomized Controlled Trial, Adult = the PubMed strategy was:
("beds"[MeSH Terms] OR (("beds"[TIAB] NOT Medline[SB]) OR "beds"[MeSH Terms] OR MATTRESS[Text Word])) AND (("pressure"[MeSH Terms] OR pressure[Text Word]) AND reducing[All Fields]) AND (Clinical Trial[ptyp] OR Meta-Analysis[ptyp] OR Randomized Controlled Trial[ptyp]) = 35 + Adult: 19-44 years = 11
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