Incidence of wound dehiscence in patients undergoing laparoscopy or laparotomy: a systematic review and meta-analysis.

Surgical wound dehiscence (SWD) is a serious complication-with a 40% estimated mortality rate-that occurs after surgical intervention. Since the implementation of advanced recovery protocols, the current global incidence of SWD is unknown. This systematic review and meta-analysis estimated the worldwide incidence of SWD and explored its associated factors in general surgical patients. Eligible full-text cross-sectional, cohort and observational studies in English, between 1 January 2010 to 23 April 2021, were retrieved from MEDLINE, CINAHL, EMBASE and the Cochrane Library. Data extraction and quality appraisal were undertaken independently by three reviewers. Random effects meta-analytic models were used in the presence of substantial inconsistency. Subgroup, meta-regression and sensitivity analyses were used to explore inconsistency. Publication bias was assessed using Hunter's plots and Egger's regression test. Of 2862 publications retrieved, 27 studies were included in the final analyses. Pooled data from 741,118 patients across 24 studies were meta-analysed. The 30-day cumulative incidence of SWD was 1% (95% Confidence Interval (CI): 1-1%). SWD incidence was highest in hepatobiliary surgery, at 3% (95% CI: 0-8%). Multivariable meta-regression showed SWD was significantly associated with duration of operation and reoperation (F=7.93 (2-10); p=0.009), explaining 58.2% of the variance. Most studies were retrospective, predated the agreed global definition for SWD and measured as a secondary outcome; thus, our results likely underestimate the scope of the problem. Wider uptake of the global definition will inform the SWD surveillance and improve the accuracy of reporting.

Variations in sacral sub-epidermal moisture measurements in hospitalized medical and surgical patients: A longitudinal observational sub-study.

BACKGROUND: Pressure injury risk assessment tools have several well-known limitations. As a result, new methods of assessing risk are emerging, including the use of sub-epidermal moisture measurement to detect localized edema. AIMS: To assess the daily variation in sacral sub-epidermal moisture measurement over five days and establish if age and prophylactic sacral dressing use influenced these measurements. METHODS: As part of a larger randomized controlled trial of the use of prophylactic sacral dressings, a longitudinal observational substudy was undertaken in hospitalized medical and surgical adult patients at risk of pressure injury. The substudy was conducted in consecutively recruited patients from 20 May 2021 to 9 November 2022. Using the SEM 200 (Bruin Biometrics LLC), daily sacral sub-epidermal measurements for up to five days were completed. Two measurements were generated, the most recent sub-epidermal moisture measurement and, after at least three measurements, a delta value, the difference between the highest and lowest values. The delta measurement was the outcome, with a delta of ≥0.60 considered abnormal, increasing the risk of pressure injury development. A mixed analysis of covariance was undertaken to determine if there was any change in delta measurements over the five days and to determine if age and sacral prophylactic dressing use influenced sub-epidermal moisture delta measurement. RESULTS: A total of 392 participants were included in this study; 160 (40.8%) patients had completed five consecutive days of sacral sub-epidermal moisture delta measurements. In total, 1324 delta measurements were undertaken across the five study days. In total, 325 of 392 patients (82.9%) had experienced one or more abnormal delta. Furthermore, 191 (48.7%) and 96 (24.5%) of patients experienced abnormal deltas for two or more and three or more consecutive days. There was no statistically significant variation in sacral sub-epidermal moisture delta measurements over time; increasing age and prophylactic dressing use did not influence sub-epidermal moisture deltas over the five days. CONCLUSION: If only one abnormal delta was used as a trigger, about 83% of patients would have received additional pressure injury prevention strategies. But, if a more nuanced approach to responding to abnormal deltas is taken, between 25 and 50% of patients may receive additional pressure injury prevention, representing a more time and resource efficient approach. TWEETABLE ABSTRACT: Sub-epidermal moisture delta measurements did not vary over 5 days; increasing age and prophylactic dressing use did not influence these measurements.

Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews.

BACKGROUND: There are many high-quality systematic reviews to inform practice around pressure injury (PI) prevention and treatment. However, they are often unable to provide recommendations for practice and research due to low quality trials. OBJECTIVES: To evaluate current systematic review evidence on the prevention and treatment of PI. METHODS: This meta-synthesis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only Cochrane Reviews were included. Evidence from reviews was independently screened and assessed for risk of bias and certainty using Grading of Recommendations, Assessment, Development and Evaluations by two authors, with a third resolving discrepancies. Methodological quality of included reviews was assessed using the second version of A Measurement Tool to Assess Systematic Reviews, and a narrative synthesis undertaken. RESULTS: Twenty-five Cochrane Reviews were included; eight for PI prevention and 19 for PI treatment. Prevention reviews included 102 studies (27,933 participants). Treatment reviews included 154 studies (over 16,936 participants). Three prevention reviews and nine treatment reviews reported risk of bias, judging the included trials as having low or very low certainty evidence. Two reviews reported moderate certainty evidence. Methodological quality of the systematic reviews was rated as high for eight reviews (7/19 for treatment and 1/6 for prevention). Recommendations for prevention included repositioning, nutrition and support surfaces. Recommendations for treatment focused on nutrition and repositioning. CONCLUSIONS: This meta-synthesis confirms the low-certainty of PI prevention and treatment trials, resulting in few recommendations to inform clinical practice. Generation of high-quality evidence on PI prevention and treatment is imperative.

Incidence and Prevalence of Pressure Injuries in Adult Intensive Care Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES: To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites. DATA SOURCES: MEDLINE, Embase, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature. STUDY SELECTION: Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries. DATA EXTRACTION: Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury. DATA SYNTHESIS: Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0-25.9% and 16.9-23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4-27.5%; all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6-36.8% and 12.2-24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0-23.8% and 12.4-15.5%. Five studies totalling 406 patients reported usable data on location; 95% CI of frequencies of PIs were as follows: sacrum 26.9-48.0%, buttocks 4.1-46.4%, heel 18.5-38.9%, hips 10.9-15.7%, ears 4.3-19.7%, and shoulders 0.0-40.2%. CONCLUSIONS: Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.

Driver prototypes and behavioral willingness: Young driver risk perception and reported engagement in risky driving.

INTRODUCTION: This study aimed to explore perceived risk and reported willingness to engage in risky driving in a sample of young Australian drivers. The study also considered the influence of gender, driving experience, and risky driver prototypes on willingness to engage in risky driving. Within this context, a prototype is a social image of the type of person who engages in specific risk behaviors. In the prototype willingness model (PWM), willingness accounts for motivations that do not directly rely on planning or goal formation. METHODS: The PWM was applied to a sample of 554 drivers (aged 17-25 years) to explore how risky driver prototypes: similarity (extent of identification with the prototype), favorability (how positive is the image), and behavioral willingness, may influence their perceived risk and reported engagement in risky driving behaviors. Drivers holding an Australian driver's license (Provisional 1, Provisional 2, or Open) anonymously completed an online survey measuring: 1) driver prototypes and behavioral willingness to engage in risky driving behaviors, 2) perceived risk of driving-related behaviors, and 3) the Behavior of Young Novice Drivers Scale transient and fixed violations subscales. RESULTS: Path analysis explored relationships between prototypes and willingness variables, perceived risk, and reported driving engagement. Goodness-of-fit statistics supported the conceptual model. Behavioral willingness showed the strongest relationship with perceived risk (negative) and reported driving violation engagement (positive). CONCLUSIONS: Risky driver prototypes and behavioral willingness, as well as driver's sex and driving experience, may help to explain individual differences in perceived risk, and young driver reported risky driving engagement. PRACTICAL APPLICATIONS: Identifying relevant factors that could be amenable to change, such as driver prototype and willingness variables, may contribute to improved road safety initiatives, and provide information and support to counter factors that might otherwise facilitate young drivers' risk perceptions and risky driving engagement.

Evaluation of a patient safety programme on Surgical Safety Checklist Compliance: a prospective longitudinal study.

BACKGROUND: Surgical Safety Checklists (SSC) have been implemented widely across 132 countries since 2008. Yet, despite associated reductions in postoperative complications and death rates, implementation of checklists in surgery remains a challenge. The aim of this study was to assess the impact of a patient safety programme over time on SSC use and incidence of clinical errors. DESIGN: A prospective longitudinal design over three time points and a retrospective secondary analysis of clinical incident data was undertaken. METHODS: We implemented a patient safety programme over 4 weeks to improve surgical teams' use of the SSC. We undertook structured observations to assess surgical teams' checklist use before and after programme implementation and conducted a retrospective audit of clinical incident data 12 months before and 12 months following implementation of the programme. RESULTS: There were significant improvements in the observed use of the SSC across all phases, particularly in sign-out where completion rates ranged from 79.3% to 94.5% (p<0.0001) following programme implementation. Across clinical incident audit periods, 33 019 surgical procedures were performed. Based on a subsample of 64 cases, clinical incidents occurred in 22/16 264 (0.13%) before implementation and 42/16 755 (0.25%) cases after implementation. The most predominant incident after programme implementation was inadequate tissue specimen labelling (23/42, 54.8%). Clinical incidents resulted in minimal or no harm to the patient. CONCLUSIONS: The benefit in using a surgical checklist lies in the potential to enhance team communications and the promotion of a team culture in which safety is the priority.

How reinforcement sensitivity and perceived risk influence young drivers' reported engagement in risky driving behaviors.

Gray's reinforcement sensitivity theory (RST), implementing Carver and White's behavior inhibition system (BIS) and behavior approach system (BAS) scales, was used to predict reported engagement in 10 risky driving behaviors: speeding (2 levels), driving under the influence of alcohol, racing other vehicles, cell phone use (hand-held and hands free), tailgating, unsafe overtaking, driving while fatigued, and not wearing a seatbelt. Participants were 165 young male and female (n=101) drivers aged 17-25 years who held a valid Australian driver's license. Effects of the explanatory variables and specific risk perceptions upon engagement in the reported risky driving behaviors were examined using SEM analyses. Also of interest was whether perceived risk mediated the relationship between the personality variables and reported engagement in risky driving behaviors. RST variables, negative reactivity, reward responsiveness and fun seeking, accounted for unique variance in young drivers' perceived risk. Reward responsiveness and perceived risk accounted for unique variance in young drivers' reported engagement in risky driving behaviors. Negative reactivity was completely mediated by perceived risk in its negative relationship with reported engagement. To better understand driving related risk decision making, future research could usefully incorporate drivers' motivation systems. This has the potential to lead to more tailored approaches to identifying risk-prone drivers and provide information for the development and implementation of media campaigns and educational programs.