Appendix 6 Assessment Of Risk Of Bias
1. Was the allocation sequence randomly generated?
Low risk of bias
The investigators describe a random component in the sequence generation process such as: referring to a random number table using a computer randomnumber generator coin tossing shuffling cards or envelopes throwing dice drawing of lots.
High risk of bias
The investigators describe a nonrandom component in the sequence generation process. Usually, the description would involve some systematic, nonrandom approach, for example: sequence generated by odd or even date of birth sequence generated by some rule based on date of admission sequence generated by some rule based on hospital or clinic record number.
Unclear
Insufficient information about the sequence generation process provided to permit a judgement of low or high risk of bias.
2. Was the treatment allocation adequately concealed?
Low risk of bias
Participants and investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation: central allocation sequentiallynumbered drug containers of identical appearance sequentiallynumbered, opaque, sealed envelopes.
High risk of bias
Unclear
3. Blinding was knowledge of the allocated interventions adequately prevented during the study?
Low risk of bias
Any one of the following.
High risk of bias
Any one of the following.
Unclear
4. Were incomplete outcome data adequately addressed?
Low risk of bias
Unclear
How The Intervention Might Work
The principle of moist wound healing directs contemporary wound care. This is optimised through the application of occlusive or semiocclusive dressings and preparation of the wound bed . Animal experiments performed 50 years ago suggested that acute wounds healed more quickly when their surface was kept moist, rather than being left to dry and scab . A moist environment is thought to provide optimal conditions for the cells involved in the healing process, as well as allowing autolytic debridement , which is thought to be an important component of the healing pathway . The desire to maintain a moist wound environment is an important factor in the choice of wound dressing. Wound dressings vary in their level of absorbency so that a dry wound may be treated with an occlusive dressing to maintain a moist environment to promote healing. Alternatively a wet wound may be treated with a more absorbant dressing to draw excess moisture away from the area of injury and avoid skin damage.
Causes Of Itchy Bumps On Buttocks
What causes water blisters on buttocks? There is an array of causes that might be causing you the bumps or the painful blister on buttocks. The symptoms in terms of how severe itching or pain is will depend on what the underlying cause of the blisters is.
Some causes might be mild and clear on their own without any medical treatment. For some causes, due to their infectious nature, urgent treatment to limit its spread is highly recommended. Some of the common cause of blister on buttocks might include the following.
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Symptoms Of Pressure Sores
Pressure sores go through 4 stages.
- Stage 1. During this stage, the area of the sore looks red. It may feel warm to the touch. It may burn, hurt, or itch. The pressure sore may look blue or purple in people who have dark skin.
- Stage 2. During this stage, the area is more damaged. The sore may be open. It may look like a cut or blister. The skin around the sore may be discolored. The sore is painful.
- Stage 3. During this stage, the sore will have a crater-like look. This is due to increased damage below the surface. This makes the wound deeper.
- Stage 4. This is the most serious stage. Skin and tissue are severely damaged. The sore becomes a large wound. Infection is possible. Youre likely able to see muscle, bones, tendons, and joints.
Infected pressure sores take a long time to heal. Also, the infection can spread to the rest of your body. Signs of infection at the site include:
- Thick, yellow, or green pus
- A bad smell coming from the sore
- Redness or skin that is warm to the touch
- Swelling around the sore
Signs that the infection has spread include:
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Appendix 1 Pressure Ulcer Grading
One of the most widely recognised systems for categorising pressure ulcers is that of the National Pressure Ulcer Advisory Panel . Their international classification recognises four categories or stages of pressure ulcer and two categories of unclassifiable pressure injury, in which wound depth and/or extent, or both, cannot be accurately determined unclassifiable pressure ulcers are generally severe and would be grouped clinically with Stage 3 or Stage 4 ulcers :
The two additional categories of unclassifiable wounds are:
- Unstageable/unclassified Obscured fullthickness skin and tissue loss: Fullthickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. If slough or eschar is removed, a Stage 3 or Stage 4 pressure injury will be revealed. Stable eschar on the heel or ischemic limb should not be softened or removed.
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Make Sure You Eat And Drink The Right Things
It is important that you are eating a balanced diet and drinking plenty of fluids to help prevent pressure sores. Your healthcare professional may discuss your diet with you to see if it is likely that you are lacking in any nutrients. They may refer you to a dietician and/or you may be advised to take some supplements.
Enhancing Healthcare Team Outcomes
The primary goal is to prevent pressure ulcers through various means including the use of air-fluidized or foam mattresses, improving the nutritional status of the patients, proper placing of patients in bed, changing position frequently, and treatment of the underlying diseases. A treatment plan involves the removal of all devitalized tissue that may serve as a reservoir for bacterial contamination . Also, it involves dressing by utilizing hydrogels, hydrocolloids, or saline-moistened gauze to enable granulation tissue to grow and the wound to heal. Treatment of underlying infection by topical or systemic antibiotic medications might be needed to help in the healing process, but tissue culture should be obtained before selecting the accurate drug. Pain and discomfort can be controlled by analgesics. A dietary consult should be made to ensure that the patient is receiving adequate calories. When possible, the patient should be out of bed to chair, and physical therapy should be consulted for ambulation and/or exercise. Wound care specialty trained nurses should assist in dressing changes, debridement of wounds, and provide close followup care. The nurses should also assist the clinician in the education of the patient and family. Pressure ulcers are very difficult to treat, it is crucial that the nurses and clinicians work together as an interprofessional team to provide the very best care including treatment, monitoring, and followup care.
Outcomes
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How To Treat Pressure Ulcer
When Pressure ulcers are in the early stages, people may be able to treat them at home. Frequently changing positions can help the ulcers heal and keep new ones from forming.
Pressure ulcers can be prevented by periodically repositioning yourself to avoid stress on the skin. Other strategies include taking good care of the skin, maintaining good nutrition and fluid intake, quitting smoking, managing stress, and exercising daily.
MaxioCel, an advanced wound dressing product, provides faster healing to patients suffering from chronic wounds, such as pressure ulcers, diabetic foot ulcers, venous leg ulcers, cavity wounds, and skin abrasions to name some.
MaxioCel range of advanced chitosan dressings has the potential to address this gap and be a real game-changer. With a range of MaxioCel products, millions of patients who need advanced wound care products are being treated every year. MaxioCel with its 360-degree care combined hemostatic, pain management, and scar improvement properties, fulfills a large gap in the market.
Juwariah Khan
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What Is Mepilex Safetac Technology
The unique proprietary Safetac technology of Molnlycke resides closest to the skin. It has been proven to minimize pain to patients during dressing changes and does not cause skin reactions.
- Molnlycke dressing drastically reduces both the pain and tissue damage in wound management
- Without the trauma of maceration and skin-stripping, the healing process is accelerated
- Mepilex medicated wound dressing does not adhere to the moist wound bed, but only to dry skin
- Adheres gently to the surrounding skin for easy application of secondary fixation
- Seals the wound margins and reduces the risk of maceration
- For pressure ulcer prevention, its elasticity dissipates shear forces and provides assistance with the dressing after skin assessment
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Designed With Patients At Heart
Optimise your wound treatment and prevention with Mepilex® dressings. The Mepilex range is supported by more than 300 pieces of evidence of strong clinical and health economic outcomes.
Depending on the challenge youre facing, Mepilex dressings are available in many shapes and for many uses. Innovation is in our DNA. So were always improving and developing new solutions to deliver even better ouctomes for patients.
Mepilex will continue to drive the future of treatment and prevention.
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Quality Of The Evidence
We have explored the application of a new approach to GRADE analysis, alongside NMA in STATA . We applied the GRADE approach separately to effect estimates for different contrasts and to the ranking of interventions, but the two aspects are closely interrelated and, in this review, are a consequence of the sparse network and the high risk of bias through much of the network. The effect estimates were exemplified by contrasts of interventions versus saline gauze.
Across the network as a whole, the evidence was of very low certainty. There was overall high risk of bias and overlap of the ranking probability distributions, and no clearcut results. The evidence was of such poor quality that we consider it inappropriate to focus on which treatments had the highest probabilities of healing .
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The Efficacy Of Duoderm
A study by Michel Hermans treating small partial-thickness burns found that HydroColloid Dressings provide an optimum wound environment for more rapid re-epithelialization than either allografts or SSD. The cosmetic and functional results were also excellent.1 A meta-analysis of pressure ulcers performed by Matthew Bradley comparing a hydrocolloid dressing with a traditional treatment suggested that treatment with the hydrocolloid resulted in a statistically significant improvement in the rate of healing compared to wet-to-dry dressings.2
How To Apply Hydrocolloid Dressings
Applying a hydrocolloid dressing is similar to the best practices for most wound care. Follow these steps:
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Who Is At Risk For A Decubitus Ulcer
Individuals with limited mobility and who remain for long periods of time sitting or lying in the same position are vulnerable to developing pressure ulcers. Older individuals with more fragile skin are also at risk. Other risk factors include:
- Poor diet with insufficient nutrients for skin health.
- Not drinking enough water to hydrate skin.
- Medical conditions such as diabetes which causes poor blood circulation to skin tissue.
Foam Dressings For Treating Pressure Ulcers
What is the aim of this review?
The aim of this review was to find out whether foam dressings have any advantages or disadvantages in healing pressure ulcers compared with other dressings . Researchers from Cochrane collected and analysed all relevant studies to answer this question and found nine relevant studies.
Key messages
There is no clear evidence from any of the studies included in this review that foam dressings are more effective at healing pressure ulcers than other types of dressings or that foam dressings are more cost effective than other dressings. This is due in part to the low quality of the studies, many of which had small numbers of participants and did not provide accurate details of their methods.
What was studied in the review?
Pressure ulcers are wounds that develop on bony parts of the body such as the heels, hips and lower back. Sitting or lying in the same position for long periods can cause damage to the skin and underlying tissue. People at risk of developing pressure ulcers include those with limited physical mobility such as people with spinal cord injuries, older people, or those ill in hospital.
What are the main results of the review?
Generally, the studies we found did not have many participants and the results were often inconclusive. Overall the evidence that exists is of very low quality.
How up to date is this review?
We searched for studies that had been published up to February 2017.
We present data for four comparisons.
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Setting And Eligibility Criteria
This study will recruit patients who receive primary health assistance, including patients able to attend the primary health center or receive health assistance in homes, nursing-homes and non-acute long term hospitalization centers. Each patient must present with at least one PrU-II.
Inclusion criteria
-
Age18 years.
-
Confirmed diagnosis of PrU-II. If a patient has more than one PrU-II, only the largest diameter ulcer will be assessed. Other PrU-II will receive the best treatment elected by the study nurse.
Exclusion criteria
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How Are Pressure Injuries Treated
Pressure injuries can be treated in many ways depending on the stage. Once the stage and severity of the wound is determined, it must be cleaned, usually with a saline solution. After the wound is cleaned, it needs to be kept clean, moist, and covered with an appropriate bandage. There are several different types of bandages your doctor may use to dress the wound. These include:
- Water-based gel with a dry dressing
- Foam dressing
- Hydrocolloid dressing
- Alginate dressing
Sometimes debridement is needed. This is a process of ridding the wound of dead tissue. Debridement is an important part of the healing process. It changes the wound from a long-lasting one to a short-term wound. There are several types of debridement. These methods include:
- Ultrasound: Using sound waves to remove the dead tissue.
- Irrigation: Using fluid to wash away dead tissue.
- Laser: Using focused light beams to remove the dead tissue.
- Biosurgery: Using maggots to eliminate bacteria from the wound.
- Surgery: Using surgery to remove the dead tissue and close the wound.
- Topical: Medical-grade honey or enzyme ointments.
If a loved one has been severely injured or is extremely ill, they may need to spend a significant amount of time in bed. Prolonged immobility, while beneficial to recovery, can become problematic if it places persistent pressure on vulnerable skin. Unless preventive steps are taken, pressure ulcers, also known as decubitus ulcers or bedsores, can develop.
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Keep Skin Clean And Dry
- Bathe daily with mild soap and warm water and rinse and dry thoroughly. Pay particular attention to keeping the genital area and skin folds clean and dry.
- Immediately wash and dry skin and change clothing after any leakage of stool or urine.
- Avoid harsh soaps, skin agents with alcohol, and antibacterial or antimicrobial soaps. Do not use powders. Use a moisturizer that has been approved by your health care provider.
Foam Dressings For Treating Pressure Ulcers 4×4 Foam Dressing
Foam dressings are used to provide a moist wound environment, most commonly in wounds with moderate-to-heavy exudate.
Foam dressing:
Mechanisms:
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