POSTER
WINNERS' ABSTRACTS
 |
Poster
Presentations, Berlin:
First Prize awarded to Alexander Heyneman, Gent, Belgium (centre),
Second Prize awarded to Anne Ballard-Wilson, Dunfermiline,
Scotland (left),
Third Prize awarded to Anna-Karin Westerlund, Uppsala, Sweden
(right). |
Pressure
ulcer treatment with dressings: a systematic review of published
randomized controlled trials
A. Heyneman, RN, MA; H. Beele, MD, PhD; T. Defloor, RN, PhD
Nursing Science, Department of Public Health, Ghent University,
UZ 2 Blok A, De Pintelaan 185, B 9000 Gent, Belgium (Contact:
alexander.heyneman@ugent.be)
Introduction:
Pressure ulcers are a common problem in nursing practice and entail
great expenses for the patients as well as for the Health Care
Services. Financial resources are limited, an optimal use is thus
recommended. The aim of the study is to identify and review the
published literature on the use of dressings as treatment of pressure
ulcers.
Methods:
A Cochrane based search strategy was used in three databases (PubMed,
Embase and CENTRAL), manuals, reference lists and conference proceedings.
Used keywords were ‘randomized controlled trial’,
‘random allocation’, ‘decubitus ulcer’,
‘therapeutics’ and ‘therapy’. Studies
in which pressure ulcers were treated with dressings, as defined
by The British National Formulary, were systematically included
and analysed. An additional search was performed to identify validated
instruments for assessment of the quality and cost-effectiveness
analysis. No sufficiently validated instrument could be identified.
Results:
54 publications, dealing with 52 different studies, met the inclusion
criteria. Grouping, based on The British National Formulary, resulted
in 31 different categories. Based on the available evidence, none
of the dressing categories was proven to be more effective than
others. There was marginal evidence that dressings which needed
to be changed less frequently were better rated by patients and
caregivers. The same was true for pain during wearing and changing.
Summary:
A clear recommendation about the most effective dressing category
could not be made. Identification and analysis of additional studies
is recommended. Additionally, the development of an instrument
to validate the quality and the cost-effectiveness is needed.
Pressure Ulcer Prevalence in a District
General Division: What are the benefits of doing it?
Anne Ballard Wilson, Tissue Viability Nurse Specialist
Fife Acute Operational Division, Queen Margaret Hospital,
Whitefield Road, Dunfermline, KY12 0SU
Introduction:
Pressure ulcers continue to pose serious clinical and economic
challenges within the National Health Service. Point Prevalence
Studies assist our decision-making by giving valuable information,
which can help with identification of the type of care and equipment
required within an organisation.
Methodology:
A Point Prevalence Survey was carried out in February 2006 in
a 600-bedded Hospital. The Tissue Viability (TV) Service in conjunction
with Pegasus Ltd, who compiled the data, conducted it. The audit
itself was carried out by the TVN with a team of tissue viability
link nurses, working to a predetermined protocol. The survey included
age, sex, number of established pressure ulcers, the likelihood
of developing a pressure ulcer, and current provision of pressure
distributing surfaces. In addition, the ability of patients’
to turn unassisted in bed, and care planning provision.
Results:
Data was collected for 591 patients, 15% having established pressure
ulcers. The age, sex and severity of pressure ulcers will be discussed,
with particular emphasis on the type of surface patients were
nursed on. A comparison will also be made with two studies carried
out two and five years ago.
Summary:
This study showed that although the age of patients is steadily
increasing, there is no significant change in the overall number
or severity of pressure damage. Within this Trust there has been
a shift away from nursing patients on the more ‘high tech’
dynamic surfaces, with no apparent detriment to the patient.
Do
nutritional supplements for patients with hip fracture reduce
postoperative complications?
Anna-Karin Westerlund, RN1,2, Katarina Lönn, MD2, Lena
Gunningberg, RN, PhD3,4
1. Department of Public Health and Caring Sciences, Section of
Caring Science, Uppsala University, Uppsala, Sweden.
2. Department of Orthopaedics, University Hospital, Uppsala, Sweden.
3. Department of Surgical Sciences, Uppsala University, Uppsala
Sweden.
4. Department of Surgery, University Hospital, Uppsala, Sweden.
Introduction:
Malnutrition is common in Swedish hospitals; the incidence of
malnutrition in 25 Swedish studies (n = 5120) was 28%. Patients
with hip fracture constitute a group at particular risk for malnutrition.
British research has shown that these patients do not receive
all the energy and calories they need after surgery, which can
lead to postoperative complications. Previous research at the
University Hospital in Uppsala has showed that 29% of patients
with hip fracture developed pressure ulcers during their hospital
stay. Pressure ulcers increase the overall cost of care to society
and can cause both physical and psychological suffering for patients.
Nutritional supplements can delay both the onset and progression
of pressure ulcers. However, as 57% of patients develop pressure
ulcers within two days after surgery and 76% within four days
after, it is important that the supplements be given as early
as possible postoperatively.
Aim:
The aim of the present study is to investigate whether nutritional
supplements reduce postoperative complications – specifically,
pressure ulcers – in patients with hip fracture.
Methods:
The design was quasi-experimental, with both intervention and
control groups; 100 patients with hip fracture admitted to the
University Hospital in Uppsala are included consecutively (50
patients in each group). Data collection started in September
2005 and will continue until June 2006. The intervention group
received a glucose infusion starting the night before surgery
and ending the morning the day after surgery, complemented with
a carbohydrate-supplement drink. For five days postoperatively,
patients also receive nutritional supplements, three times a day.
The need of energy was calculated for each patient, nutritional
and liquid intake was assessed daily, and interventions according
to clinical guidelines were implemented if needed. Outcome measures
used were the Modified Norton Scale, pressure ulcer classification
according to EPUAP recommendations, weight, Insulin-like Growth
Factor-1, Short Portable Mental Square Questionnaire and the Katz
index. All of the assessments were collected preoperatively and
five days postoperatively. Every patient’s nutrient and
liquid intake was assessed daily for five days.
Results:
Data will be analysed in July 2006.
