Bedsore

褥疮
  • 文章类型: Journal Article
    压力性溃疡是长期就寝时间患者的严重问题,并在手术后出现常见并发症。它是为患者提供护理质量的关键绩效指标之一。几项研究报道了埃塞俄比亚压疮的患病率,但目前的研究领域尚未得到充分解决。因此,该研究旨在评估进入手术室的成年患者的压疮及其相关因素。以机构为基础,横断面研究于2023年4月15日至5月15日进行.采用系统随机抽样技术选择480例患者。一个标准化的,预先测试,并采用结构化问卷。结果使用表格和数字描述性地呈现。使用二元逻辑回归来评估相关因素。在总共480名患者中,所有患者均以100%的反应率参加。压疮患病率为10.2%。吸烟者[95%CIAOR7.46(2.64,21.06)],卧床不起[95%CIAOR3.92(1.28,11.66)],住院时间超过20天[95%CIAOR3.01(1.13,8.02)],经历疼痛[95%CIAOR3.20(1.06,7.51)],或具有摩擦和剪切[95%CIAOR5.71(1.91,17.08)],与压疮显著相关。这项研究表明,相当比例的患者患有压疮。吸烟,有疼痛,卧床不起,暴露于摩擦和剪切问题,住院时间与压疮显著相关.医疗保健提供者应该教育患者吸烟风险,疼痛管理,床垫安装,和亚麻护理。
    Pressure ulcers are a serious concern in patients with prolonged bedtime and present with common complications following surgery. It is one of the key performance indicators of the quality of nursing care provided to patients. Several studies have reported the prevalence of pressure ulcers in Ethiopia, but the current study area has not yet been fully addressed. Hence, the study aims to assess pressure ulcers and their associated factors among adult patients admitted to the surgical ward. An institution-based, cross-sectional study was conducted from April 15 to May 15, 2023. A systematic random sampling technique was used to select 480 patients. A standardized, pre-tested, and structured questionnaire was used. The results were presented descriptively using tables and figures. A binary logistic regression was used to assess associated factors. From a total of 480, all patients have participated with a 100% response rate. The prevalence rate of pressure ulcers was 10.2%. Being smoker [95% CI AOR 7.46 (2.64, 21.06)], bedridden [95% CI AOR 3.92 (1.28, 11.66)], having a length of hospital stay of greater than 20 days [95% CI AOR 3.01 (1.13, 8.02)], experiencing pain [95% CI AOR 3.20 (1.06, 7.51)], or having friction and shear [95% CI AOR 5.71 (1.91, 17.08)], were significantly associated with pressure ulcers. This study showed that a considerable proportion of patients had pressure ulcers. Smoking, having pain, being bedridden, being exposed to friction and shear problems, and length of hospital stay were significantly associated with pressure ulcers. Healthcare providers should educate patients about smoking risks, pain management, mattress installation, and linen care.
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  • 文章类型: Journal Article
    压疮,或者褥疮,由长期压力下的皮肤区域产生,并可能导致皮肤和下面的组织损伤。本研究评估了含有多西环素(DOX)的羧甲基纤维素/海藻酸钠/明胶(CMC/Alg/Gel)水凝胶在改善压疮愈合过程中的作用。用磁铁对大鼠背部皮肤施加压力,诱导压疮模型。然后是无菌纱布,CMC/Alg/Gel,和CMC/Alg/Gel/1%w/vDOX水凝胶用于覆盖伤口。血液相容性,减肥,细胞相容性,药物释放率,细胞活力,伤口闭合,并在治疗后第14天评估所有动物的上皮再形成。体内结果和组织病理学评估显示,在CMC/Alg/Gel/1%w/vDOX水凝胶组中(治疗后14天),56.66%的伤口闭合和最高的再上皮化。此外,real-timePCR结果表明,含有DOX的水凝胶显着降低了由MMP2和MMP9mRNA组成的MMP家族的表达,并增加了血管内皮生长因子VEGFmRNA的表达。这项研究表明,添加DOX,抗生素和MMP抑制剂,水凝胶在压疮的愈合过程中可能是有效的。
    Pressure ulcers, or bedsores, are created by areas of the skin under prolonged pressure and can lead to skin and underlying tissue damage. The present study evaluated the effects of carboxymethyl cellulose/sodium alginate/gelatin (CMC/Alg/Gel) hydrogel containing doxycycline (DOX) on improving the healing process of pressure ulcers. The magnet was used to apply pressure on the dorsum skin rat to induce a pressure ulcer model. Then sterile gauze, CMC/Alg/Gel, and CMC/Alg/Gel/1% w/v DOX hydrogels were used to cover the wounds. Blood compatibility, weight loss, cytocompatibility, drug release rate, cell viability, wound closure, and re-epithelialization were evaluated in all animals on the 14th day after treatment. In vivo results and histopathological evaluation showed 56.66% wound closure and the highest re-epithelialization in the CMC/Alg/Gel/1% w/v DOX hydrogel group (14 days after treatment). Furthermore, real-time PCR results indicated that the hydrogel containing DOX significantly decreased the expression of the MMP family consisting of MMP2 and MMP9 mRNA and also increased the expression of vascular endothelial growth factor VEGF mRNA. This study suggested that the addition of DOX, an antibiotic and MMP inhibitor, to hydrogels may be effective in the healing process of pressure ulcers.
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  • 文章类型: Journal Article
    褥疮对医疗保健系统构成了重要挑战。硒化益生菌被认为是通过几种途径在伤口愈合和炎症减少中的有效试剂。本研究集中在富含硒的益生菌的管理,最初是从传统乳制品中获得的,用于治疗褥疮。每天给20名ICU患者服用益生菌14天,并将伤口愈合标准与对照组的ICU患者进行比较。两组都患有Ⅰ期和Ⅱ期褥疮(随机,双盲,对照临床试验)。施用的富硒益生菌显着降低了褥疮愈合期(平均2.4天,P值:0.039),以及褥疮大小(平均7平方毫米,不显著)和褥疮等级(10%,无显著性)治疗组比对照组更有效。在接受硒补充益生菌的患者中,与炎症相关的一些关键实验室参数也得到改善。这项研究的局限性包括在研究的时间范围内符合纳入标准的患者数量少,以及从ICU出院后无法对患者进行随访。总之,这项研究揭示了富硒益生菌在改善褥疮方面的有效性,建议考虑将富含益生菌作为褥疮管理的辅助药物。
    Bedsores impose an important challenge to the healthcare system. Se-baring probiotics are considered effective agents in wound healing and inflammation reduction via several pathways. The present study focused on the administration of a Se-enriched probiotic, originally obtained from a traditional dairy product for bedsore healing. Daily doses of the probiotic were administered to 20 ICU patients for 14 days and the wound healing criteria were compared with those of the same group of ICU patients as control, both groups suffering from stages I and II bedsore (a randomized, double-blind, controlled clinical trial). The administered Se-enriched probiotic decreased the bedsore healing period significantly (on average by 2.4 days, P-value: 0.039), as well as bedsore size (on average by 7 mm2, nonsignificant) and bedsore grade (10%, nonsignificant) in the treatment group more efficiently than the control group. Some key laboratory parameters associated with inflammation were also improved in patients receiving the Se-supplemented probiotic. The limitations of this study include the low number of patients meeting inclusion criteria within the timeframe of the study, and the impossibility of following up patients after discharge from the ICU. In summary, this study revealed the effectiveness of the Se-enriched probiotic in bedsore improvement, suggesting consideration of the enriched probiotic as an auxiliary agent in bedsore management.
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  • 文章类型: Journal Article
    背景:伤口的适当护理和治疗是小时的需要,无论是感染的还是未感染的伤口。如果伤口愈合由于某种原因而延迟,它会导致严重的并发症,并进一步增加住院时间和治疗费用。在这里,我们描述了一种新型抗菌伤口敷料配方(VG111),目的是产生显示不同类型伤口的独特优势的初步数据。
    方法:本病例系列涉及不同病因患者对VG111常规伤口愈合治疗反应不佳的急性伤口或慢性伤口的治疗。13例患者包括糖尿病患者,压疮,烧伤,创伤,在所有情况下,用VG111治疗的其他患者均显示出快速的伤口愈合,甚至在发生完全皮肤再生时无需移植。
    结果:通过清除伤口感染来说明,渗出物的减少/消失,强烈造粒的外观,上皮化,和抗生物膜活性,然后完全闭合伤口。这种VG111排除了局部感染对全身抗菌药物的需要,这种单一的代理是试图解决现有产品的局限性和缺点。
    结论:尽管患者属于老年组,有糖尿病等合并症,VG111仍然显示出有效的快速伤口愈合,而且在难以治愈的情况下也没有任何疤痕形成,感染,和未感染的伤口。

    Introduction: Appropriate care and treatment of a wound is the need of the hour whether it is an infected or a non-infected wound. If wound healing is delayed for some reason, it leads to serious complications and further increases the hospital stay and cost of treatment. Herein, we describe a novel antimicrobial wound dressing formulation (VG111), with an objective to generate the preliminary data showing the distinct advantages in various types of wounds.

    Method: This case series involved the treatment of acute cases of wounds or chronic wounds that did not respond well to conventional wound healing treatments with VG111 in patients with different etiologies. Thirteen cases of patients that included patients with diabetes, pressure ulcers, burns, trauma, and others treated with VG111 showed rapid wound healing in all the cases, even obviating the need for a graft when complete skin regeneration occurred.

    Result: This was illustrated by clearing of the wound infections, reduction/disappearance of the exudate, appearance of intense granulation, epithelialization, and anti-biofilm activity followed by complete wound closure. This VG111 precludes the need for systemic antimicrobial agents in localized infections and therefore, this single agent is an attempt to address the limitations and the drawbacks of the available products.

    Conclusion: Despite patients belonging to the old age group and having comorbidities like diabetes, still VG111 showed effective rapid wound healing, and that too without any scar formation in hardto- heal, infected, and non-infected wounds.

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  • 文章类型: Journal Article
    随着当今社会的老龄化,与年龄有关的疾病变得更加频繁。一种非常常见但仍可预防的疾病是压力性溃疡(PU)的发展。如果组织暴露于持久的压力负荷,则可能会发生PU,例如,躺在组织上没有转动。治疗PU需要重症监护,特别是对于老年人或具有先前存在的疾病的人,其组织需要更长的愈合时间。后果是患者遭受沉重的痛苦,医疗保健系统的成本极高。为了避免这些后果,我们的目标是开发一种压疮预防装置。为此,我们建立了一个新的传感器系统,能够监测压力负荷和组织的生命体征在病人的好发部位的局部附近。在临床研究中,我们发现了几个指标显示组织灌注与PU发展风险之间的相关性,包括在诊断PU之前,身体组织中的SpO2水平大大降低。最后,我们提出了一种预防系统,可以在早期阶段预测PU的发展。这项工作是建立一个有效的系统来警告患者或护理人员关于开发PU并采取适当预防措施的第一步。广泛的应用可以减少患者的痛苦并导致大量的成本节约。
    As today\'s society ages, age-related diseases become more frequent. One very common but yet preventable disease is the development of pressure ulcers (PUs). PUs can occur if tissue is exposed to a long-lasting pressure load, e.g., lying on tissue without turning. The cure of PUs requires intensive care, especially for the elderly or people with preexisting conditions whose tissue needs longer healing times. The consequences are heavy suffering for the patient and extreme costs for the health care system. To avoid these consequences, our objective is to develop a pressure ulcer prophylaxis device. For that, we built a new sensor system able to monitor the pressure load and tissue vital signs in immediate local proximity at patient\'s predilection sites. In the clinical study, we found several indicators showing correlations between tissue perfusion and the risk of PU development, including strongly reduced SpO2 levels in body tissue prior to a diagnosed PU. Finally, we propose a prophylaxis system that allows for the prediction of PU developments in early stages before they become visible. This work is the first step in generating an effective system to warn patients or caregivers about developing PUs and taking appropriate preventative measures. Widespread application could reduce patient suffering and lead to substantial cost savings.
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  • 文章类型: Journal Article
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  • 文章类型: Meta-Analysis
    进行了荟萃分析研究,以评估各种重新定位方案(RR)对没有现有PWU的高危成年人的压力伤口溃疡(PWU)发生的影响。直到2023年4月的包容性文献研究已经完成,并修订了1197项相互关联的研究。精选的15项研究,封闭的8510名没有现有PWU的有风险的成年人处于利用研究人员的起点,其中1002人正在利用重新定位,1069被控制,3443使用2-<4小时的重新定位,2994使用4-6小时的重新定位。通过二分方法和固定或随机模型,利用赔率比(OR)和95%置信区间(CI)评估了各种RR对没有现有PWU的高危成年人PWU发生的影响。重新定位显著降低了PWU(或,0.49;95%CI,0.32-0.73,p<0.001)与没有现有PWU人员的高危成年人的对照相比。2-<4小时重新定位的PWU显著降低(OR,0.62;95%CI,0.42-0.90,p=0.01),与没有现有PWU人员的高危成年人的4-6小时重新定位相比。与没有现有PWU人员的高危成年人相比,重新定位的PWU明显较低。与没有现有PWU的高危成年人的4-6小时重新定位相比,2-<4小时重新定位的PWU显着降低。然而,与其值相互作用时需要谨慎,因为在荟萃分析中发现的一些选定研究的样本量较低。
    Meta-analysis research was implemented to appraise the effect of various repositioning regimens (RRs) on pressure wound ulcer (PWU) occurrence in at-risk adult persons without existing PWUs. Inclusive literature research till April 2023 was done and 1197 interconnected researches were revised. The 15 picked researches, enclosed 8510 at-risk adult persons without existing PWUs persons were in the utilised researchers\' starting point, 1002 of them were utilising repositioning, 1069 were control, 3443 were utilising 2-<4 h repositioning and 2994 were utilising 4-6 h repositioning. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the consequence of various RRs on PWU occurrence in at-risk adult persons without existing PWUs by the dichotomous approach and a fixed or random model. Repositioning had significantly lower PWU (OR, 0.49; 95% CI, 0.32-0.73, p < 0.001) compared to control in at-risk adult persons without existing PWUs persons. 2-<4 h repositioning had significantly lower PWU (OR, 0.62; 95% CI, 0.42-0.90, p = 0.01) compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. Repositioning had significantly lower PWU compared to control in at-risk adult persons without existing PWU persons. 2-<4 h repositioning had significantly lower PWU compared to 4-6 h repositioning in at-risk adult persons without existing PWUs persons. However, caution needs to be taken when interacting with its values since there was a low sample size of some of the chosen research found for the comparisons in the meta-analysis.
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  • 文章类型: Journal Article
    背景:患者由于行动不便而在医院中获得压力伤害(PI),暴露于局部压力,循环条件,和其他诱发因素。每年有超过250万美国人遭受压力伤害。医疗保险和医疗补助中心认为医院获得性压力伤(HAPI)是最常见的可预防事件。它们是诉讼中第二常见的索赔。随着医院对电子健康记录(EHR)的利用越来越多,存在建立机器学习模型来识别和预测HAPI的机会,而不是依靠人类专家偶尔的人工评估。然而,准确的计算模型依赖于高质量的数据HAPI标签。不幸的是,EHR中的不同数据源可能会提供同一患者HAPI发生的相互矛盾的信息.此外,HAPI的现有定义彼此不一致,即使在同一患者群体中。不一致的标准使得无法对机器学习方法进行基准测试来预测HAPI。
    目的:该项目的目标有三个方面:1)确定EHR中HAPI来源的差异;2)使用所有EHR来源的数据制定HAPI分类的综合定义;3)说明改进HAPI定义的重要性。
    方法:我们评估了临床记录中记录的HAPI事件之间的一致性,诊断代码,程序代码,和图表事件从医疗信息集市重症监护III(MIMIC-III)数据库。我们分析了三种现有HAPI定义的标准及其对监管指南的遵守情况。我们提出了埃默里HAPI(EHAPI),改进和更全面的HAPI定义。然后,我们使用基于树的和顺序的神经网络分类器来评估标签在训练HAPI分类模型中的重要性。
    结果:我们说明了定义HAPI的复杂性,在4个数据源中,少于13%的住院时间至少记录了3个PI适应症。虽然图表事件是最常见的指标,这是超过49%的住宿的唯一PI文档。我们证明了现有HAPI定义和EHAPI之间缺乏一致性,只有219个停留在有共识积极标签的地方。我们的分析强调了我们改进的HAPI定义的重要性,使用我们的标签训练的分类器在来自护士注释器的小的手动标记集上以及在标签上所有定义都同意的共识集上表现优于其他人。
    结论:标准化的HAPI定义对于准确的HAPI护理质量度量评估和确定预防措施的HAPI发生率很重要。我们证明了在存在冲突和不完整的EHR数据的情况下定义HAPI事件的复杂性。我们的EHAPI定义具有良好的特性,使其成为HAPI分类任务的合适候选者。
    BACKGROUND: Patients develop pressure injuries (PIs) in the hospital owing to low mobility, exposure to localized pressure, circulatory conditions, and other predisposing factors. Over 2.5 million Americans develop PIs annually. The Center for Medicare and Medicaid considers hospital-acquired PIs (HAPIs) as the most frequent preventable event, and they are the second most common claim in lawsuits. With the growing use of electronic health records (EHRs) in hospitals, an opportunity exists to build machine learning models to identify and predict HAPI rather than relying on occasional manual assessments by human experts. However, accurate computational models rely on high-quality HAPI data labels. Unfortunately, the different data sources within EHRs can provide conflicting information on HAPI occurrence in the same patient. Furthermore, the existing definitions of HAPI disagree with each other, even within the same patient population. The inconsistent criteria make it impossible to benchmark machine learning methods to predict HAPI.
    OBJECTIVE: The objective of this project was threefold. We aimed to identify discrepancies in HAPI sources within EHRs, to develop a comprehensive definition for HAPI classification using data from all EHR sources, and to illustrate the importance of an improved HAPI definition.
    METHODS: We assessed the congruence among HAPI occurrences documented in clinical notes, diagnosis codes, procedure codes, and chart events from the Medical Information Mart for Intensive Care III database. We analyzed the criteria used for the 3 existing HAPI definitions and their adherence to the regulatory guidelines. We proposed the Emory HAPI (EHAPI), which is an improved and more comprehensive HAPI definition. We then evaluated the importance of the labels in training a HAPI classification model using tree-based and sequential neural network classifiers.
    RESULTS: We illustrate the complexity of defining HAPI, with <13% of hospital stays having at least 3 PI indications documented across 4 data sources. Although chart events were the most common indicator, it was the only PI documentation for >49% of the stays. We demonstrate a lack of congruence across existing HAPI definitions and EHAPI, with only 219 stays having a consensus positive label. Our analysis highlights the importance of our improved HAPI definition, with classifiers trained using our labels outperforming others on a small manually labeled set from nurse annotators and a consensus set in which all definitions agreed on the label.
    CONCLUSIONS: Standardized HAPI definitions are important for accurately assessing HAPI nursing quality metric and determining HAPI incidence for preventive measures. We demonstrate the complexity of defining an occurrence of HAPI, given the conflicting and incomplete EHR data. Our EHAPI definition has favorable properties, making it a suitable candidate for HAPI classification tasks.
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  • 文章类型: Systematic Review
    在大多数医疗保健中心,压疮(PU)是一个常见的问题。本系统评价旨在总结护士预防PU的做法和相关因素。对Scopus等电子数据库进行了广泛的搜索,PubMed,WebofScience,Iranmedex,和科学信息数据库,通过从医学主题词中提取的关键词,如“压疮”,“压疮”,“褥疮”,\"练习\",和“护士”最早至2022年3月9日。使用横断面研究评估工具(AXIS工具)评估纳入研究的质量。纳入研究的数据提取和质量评估由两名研究人员独立进行。共有6501名护士参加了29项研究。在参与者中,75.15%为女性,55.64%为单身,94.57%拥有护理学学士学位。护士的平均年龄和工作经验分别为30.69(SD=4.73)和8.61(SD=5.44)岁,分别。护士预防PU的平均得分为100分中的57.58分(SD=14.62)。此外,48.95%的护士对预防PU有理想的做法。知识等因素(n=6),态度(n=4),教育水平(n=4),参加与预防PU相关的研讨会的历史(n=3),工作经验(n=2),实践领域(n=2),自我充分性(n=1),遵循文献(n=1),年龄(n=1),和参与研究(n=1)与护士预防PU的实践有显着的正相关。然而,护士预防PU的实践与缺乏工作满意度有显著的负相关(n=1),不成比例的护士与病人的比例(n=1),缺乏政策和指导方针(n=1)。护士对预防PU的实践水平相对理想。这项研究的结果可以帮助改善护士对PU预防的做法。增加护士对PUS预防的知识和态度可以改善他们的实践。因此,建议决策者和护理管理者根据与护士实践相关的因素,对护士实施PUS预防教育。
    In most health care centres, pressure ulcers (PUs) are a common concern. This systematic review aimed to summarise nurses\' practice and related factors toward PU prevention. An extensive search was conducted on electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database via keywords extracted from Medical Subject Headings such as \"Pressure ulcer\", \"Pressure sore\", \"Bedsore\", \"Practice\", and \"Nurses\" from the earliest to 9 March 2022. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Data extraction and quality assessment of included studies were performed by two researchers independently. A total of 6501 nurses were enrolled in twenty-nine studies. Of the participants, 75.15% were female and 55.64% were single, and 94.57% had a bachelor of science in nursing degree. Mean age and work experience of nurses was 30.69 (SD = 4.73) and 8.61 (SD = 5.44) years, respectively. The mean score of nurses\' practices toward the prevention of PUs was 57.58 (SD = 14.62) out of 100. Also, 48.95% of nurses had a desirable practice toward the prevention of PUs. Factors such as knowledge (n = 6), attitude (n = 4), level of education (n = 4), a history of participating in workshops related to the prevention of PUs (n = 3), work experience (n = 2), area of practice (n = 2), self-adequacy (n = 1), follow the literature (n = 1), age (n = 1), and involvement in research (n = 1) had a significant positive relationship with nurses\' practice toward PUs prevention. However, the nurses practice of PUs prevention had a significant negative relationship with lack of job satisfaction (n = 1), disproportionate nurse-to-patient ratio (n = 1), and lack of policies and guidelines (n = 1). The level of nurses\' practice toward the prevention of PUs was relatively desirable. The result of this study can help improve the practice of nurses toward PUs prevention. Increasing nurses\' knowledge and attitude toward PUs prevention can improve their practice. Therefore, it is suggested that policymakers and nursing managers implement PUs prevention education for nurses based on the factors associated with nurses\' practice.
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  • 文章类型: Meta-Analysis
    目的是确定和总结有关局部使用橄榄油预防压疮(PU)的有效性和安全性的现有证据。我们只纳入了随机对照试验(RCT),涉及有患PU风险的患者,测试橄榄油与其他产品的局部应用以预防PU。我们使用RoB2工具评估了偏倚的风险,以及等级证据的确定性。四个RCT符合资格标准。所有研究的总体偏倚风险较低。荟萃分析显示,橄榄油预防的临床疗效是通过降低PU的发生率(RR=0.56,95%CI=0.30至0.79,I2=0%);不良反应无差异,它可能与较短的PU发展时间和较短的住院时间有关.通过GRADE方法评估的证据的确定性是中等和较低的。与其他治疗方法相比,局部使用橄榄油可有效且安全地降低PU的发生率。这些发现可以为橄榄油作为PU的预防和替代疗法提供新的见解,因为与其他产品相比,它是可获得且便宜的。
    The purpose was to identify and summarize the existing evidence on the efficacy and safety of the topical application of olive oil for preventing pressure ulcers (PUs). We included only randomized controlled trials (RCTs) involving patients at risk of developing PUs, testing the topical application of olive oil versus other products for PU prevention. We assessed the risk of bias using the RoB 2 tool, and the certainty of the evidence with GRADE. Four RCTs met the eligibility criteria. All studies were judged at a low risk of bias overall. The meta-analysis showed that the clinical efficacy of olive oil for prevention occurs by reducing the incidence of PUs (RR = 0.56, 95% CI = 0.30 to 0.79, I2 = 0%); with no differences in adverse effects, it may be associated with a shorter development time of PUs and shorter hospital stays. The certainty of the evidence assessed by the GRADE approach was moderate and low. The topical application of olive oil is effective and safe in reducing the incidence of PUs compared to other treatments. These findings could provide new insights into olive oil as a preventive and alternative treatment for PUs as it is accessible and inexpensive compared to other products.
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