The Braden Scale for Predicting the Outcome and Prognosis of Pressure Injuries in Older Inpatients: A Multicenter, Retrospective Cohort Study.

INTRODUCTION: The Braden scale is used to assess the risk of patients with pressure injuries (PIs), but there are limitations to the prediction of PI healing. There is a lack of tools for evaluating PI healing and outcome in clinical practice. OBJECTIVE: The purpose of this study was to examine the ability of the Braden scale to predict the outcome and prognosis of PIs in older patients. MATERIALS AND METHODS: Outcome indicator was the wound healing rate of patients with PIs at discharge. The receiver operating characteristic (ROC) and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination and calibration. RESULTS: Completed data were available for 309 patients, 181 of whom (58.6%) were male. The Braden scale had poor discrimination to predict the outcome and prognosis of PIs with an area under the curve (AUC) of 0.63 (95% CI, 0.56-0.70; P = .01). Subgroup analyses showed the Braden scale had low diagnostic value for patients aged over 90 years (AUCROC = 0.56; 95% CI, 0.17-0.96; P = .738), patients with respiratory diseases (AUCROC = 0.51; 95% CI, 0.37-0.65; P = .908), and digestive system diseases (AUCROC = 0.59; 95% CI, 0.42-0.75; P = .342). The level of calibration ability by Hosmer-Lemeshow goodness-of-fit test was acceptable, defined as P >.200 (χ2 = 6.59; P = .473). In patients aged more than 90 years (χ2 = 4.88; P = .431) and female patients (χ2 = 7.03; P = .425), the Braden scale was also fitting. It was not suitable for patients with respiratory diseases (χ2 = 11.35; P = .078). CONCLUSIONS: The Braden scale had low discrimination for predicting the outcome and prognosis of PIs in older inpatients. The development of a new tool is needed to predict healing in patients with preexisting PIs.

Negative-pressure wound therapy for III/IV pressure injuries: A meta-analysis.

This meta-analysis was conducted to identify the potential benefits and the efficacy of negative-pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32-1.70). There were significant differences in wound healing time (WMD = -16.47 days, 95% [CI (-22.36, - 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = -2.39, 95% CI [-3.47, -1.30], P ≤ .001); (SMD = -2.55, 95% CI [-4.07, -1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = -3.61, 95% [CI (-4.57, - 2.66) times, P ≤ .001]). Our meta-analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high-quality multicenter RCTs.

Predicting the Development of Surgery-Related Pressure Injury Using a Machine Learning Algorithm Model.

BACKGROUND: Surgery-related pressure injury (SRPI) is a serious problem in patients who undergo cardiovascular surgery. Identifying patients at a high risk of SRPI is important for clinicians to recognize and prevent it expeditiously. Machine learning (ML) has been widely used in the field of healthcare and is well suited to predictive analysis. PURPOSE: The aim of this study was to develop an ML-based predictive model for SRPI in patients undergoing cardiovascular surgery. METHODS: This secondary analysis of data was based on a single-center, prospective cohort analysis of 149 patients who underwent cardiovascular surgery. Data were collected from a 1,000-bed university-affiliated hospital. We developed the ML model using the XGBoost algorithm for SRPI prediction in patients undergoing cardiovascular surgery based on major potential risk factors. Model performance was tested using a receiver operating characteristic curve and the C-index. RESULTS: Of the sample of 149 patients, SRPI developed in 37, an incidence rate of 24.8%. The five most important predictors included duration of surgery, patient weight, duration of the cardiopulmonary bypass procedure, patient age, and disease category. The ML model had an area under the receiver operating characteristic curve of 0.806, which indicates that the ML model has a moderate prediction value for SRPI. CONCLUSIONS: Applying ML to clinical data may be a reliable approach to the assessment of the risk of SRPI in patients undergoing cardiovascular surgical procedures. Future studies may deploy the ML model in the clinic and focus on applying targeted interventions for SRPI and related diseases.

Incidence of suicide death in patients with cancer: A systematic review and meta-analysis.

BACKGROUND: Growing evidence indicated the higher risk of suicide in cancer survivors compared with general population. Our aim is to systematically quantify the extent of suicide death and identify risk factors associated with the incidence of suicide in cancer patients. METHODS: We conducted a meta-analysis of relevant studies published in English or Chinese before May 20, 2020. Suicide rate and the number of suicide death were extracted. Our main outcome was suicide rate per 100,000 person-years with 95% CIs using random-effects model. RESULTS: The pooled incidence of suicide death was 39.72 per 100,000 person-years (95%CI, 33.91-46.52, I 2= 99.6%, P <0 .001). The suicide rate for cancer patients was higher in men (57.78, 95%CI, 47.31-70.56) than in women (14.47, 95%CI, 11.27-18.57). For both sexes combined, esophagus cancer had the highest rate of suicide (87.71, 95%CI, 27.42-280.54). By sex, suicide rates ranked first in males and females were pancreas cancer (195.70, 95%CI, 129.55-295.61) and esophagus cancer (18.34, 95%CI, 5.92-56.84), respectively. The highest suicide rate was 61.02(95%CI, 53.66-69.40) in Asia, and Oceania (24.07, 95%CI, 20.78-27.88) had lowest suicide rate. Suicide rate had a downward trend by years after diagnosis, with the first six months after cancer diagnosis clearly standing out (89.33, 95%CI, 50.64-157.58). LIMITATIONS: Included studies came from high-income countries and our results might not represent the suicide rate among cancer patients in low- and middle-income countries. CONCLUSIONS: The incidence of suicide among cancer patients was high despite the declined trend recent years, which emphasized psychological health aspects of interventions and perfecting suicide prevention programs.

Incidence of Pressure Injury in Individuals With Spinal Cord Injury: A Systematic Review and Meta-analysis.

PURPOSE: The purpose of this systematic review and quantitative analysis of pooled data was to assess the global incidence of pressure injury (PI), across time frames and countries, in individuals with spinal cord injury (SCI). DESIGN: Systematic review and meta-analysis. SEARCH STRATEGY: PubMed, Web of Science, and EMBASE databases were systematically searched for studies published from database inception to January 2019, with only English language studies that reported the incidence of PIs in individuals with SCI were included. Study quality was assessed by a 14-item standardized checklist. We calculated the incidence of PIs as the number of new PIs in individuals with SCI and the total number of individuals with SCI during the study period. Findings are presented as incidence rate with 95% confidence intervals (CIs). RESULTS: The search yielded 1652 studies; after studies were reviewed for inclusion criteria, 29 studies representing N = 82,722 patients were retained for data extraction. The global incidence of PIs was 0.23 (95% CI, 0.20-0.26). Data for regional distribution by country showed a pooled incidence of 0.43 (95% CI, 0.28-0.57) in individuals with SCI in South American countries, 0.36 (95% CI, 0.16-0.56) in African countries, 0.25 (95% CI, 0.14-0.37) in European countries, 0.23 (95% CI, 0.19-0.27) in North American countries, and 0.16 (95% CI, 0.06-0.25) in Asian countries. The incidence was 0.22 (95% CI, 0.19-0.26) in developing countries versus 0.27 (95% CI, 0.17-0.37) in developed countries. From 2000 to 2009, the incidence of PIs in individuals with SCI was 0.28 (95% CI, 0.09-0.47). The incidence rate of PIs before 2000 and after 2009 was 0.23. The hospital- and community-acquired PI incidence was 0.22 (95% CI, 0.19-0.26) and 0.26 (95% CI, 0.20-0.32), respectively. CONCLUSIONS: Study findings indicate that more than 1 in 5 individuals with SCI will develop a PI. Individuals with SCI are at high risk of developing PI, especially in community settings or low- and middle-income developing countries. The findings highlight the importance of further investigation of risk factors and prevention and management strategies for PIs in individuals with SCI.

Zinc Therapy Is a Reasonable Choice for Patients With Pressure Injuries: A Systematic Review and Meta-Analysis.

The aim of this systematic review was to summarize the evidence on the efficacy of zinc supplementation in patients with pressure injuries (PIs). Electronic data bases (Embase, MEDLINE, and Web of Science) were searched from inception to 2019 for randomized controlled trials (RCTs) and non-RCTs addressing the efficacy of zinc supplementation compared with a control nutrition invention on PI outcomes. The primary study outcome was the healing rate of PIs during treatment; the secondary outcomes were the improvement of PI area and pressure ulcer scale for healing (PUSH) score. A total of 7 studies were included in this systematic review and meta-analysis. The intervention group significantly had improved healing vs that of the control group (relative risk, 1.44; 95% CI, 1.01-2.06; P = 0.043, I2 = 19.3%). There was no obvious asymmetry in the funnel plot and no strong evidence of publication bias. Sensitivity analysis showed that meta-analysis has good stability. Studies showed a greater mean reduction in PI area. All the studies we included had a significant improvement in the PUSH score of PIs. Our systematic review and meta-analysis from clinical research confirmed that zinc therapy can promote wound healing and suggest that medical staff should consider providing patients with zinc during PI treatment.

The relationship between pressure injury complication and mortality risk of older patients in follow-up: A systematic review and meta-analysis.

Pressure injuries (PIs) have now become a common complication of the elderly patients. Some studies have observed that pressure injuries may increase mortality, but this area of evidence has not been evaluated and summarised. The aim of this study was to compare the mortality of patients with pressure injuries and those without pressure injuries. A meta-analysis of observational studies was performed. PubMed, Cochrane Library, Embase, and Web of Science were searched up to April 2019. Studies about mortality among the elderly patients with and without pressure injuries were included. Methodological quality was assessed by the Newcastle-Ottawa Scale (NOS). The fixed effect or random effect model was determined by the test of heterogeneity. The subgroup analysis was performed based on the pressure injuries stages, the region, and the type of study design. The meta-regression analysis was performed to investigate the relationship between the mortality and patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio. The sensitivity analysis was used to explore the impact of an individual study by excluding one at a time. The hazard ratio (HR) and 95% confidence intervals (CIs) in terms of the comparison of two groups were extracted for meta-analysis. A survival curve between two groups by individual patient-level was drew. Eight studies with 5523 elderly patients were included in the analysis. Follow-up periods for the included studies ranged from about 0.5 to 3 years. The elderly patients who complicated with pressure injuries had a higher risk of death. The pooled HR was 1.78 (95% CI 1.46-2.16). A funnel plot showed no publication bias. Further subgroup analysis showed that HR values for the patient stage 3 to 4 pressure injuries (HR:2.41; 95% CI:1.08-5.37) were higher than stage 1-4 and 2-4 pressure injuries (HR: 1.66; 95% CI: 1.35-2.05; HR: 1.74; 95% CI: 1.16-2.60). The meta-regression analysis found that patients' enrolled year, average age, the incidence of pressure injuries, and gender ratio were not the sources of heterogeneity. Sensitivity analyses showed that the outcomes of the study did not change after removing the Onder's article. The survival curve at the individual patient-level also indicated that patients complicated with pressure injuries significantly increased the risk of death (HR: 1.958; 95% CI: 1.79-2.14) in elderly patients. Our meta-analysis indicated that patients complicated with pressure injuries are estimated to have a two times higher risk on mortality compared with patients without pressure injuries during the 3 years follow-up period. Particular attention should be given to the elderly patients who are at higher risk for mortality.

The Risk Factors of Postoperative Pressure Ulcer After Liver Resection With Long Surgical Duration: A Retrospective Study.

OBJECTIVE: The aim of this study is to investigate the risk factors of postoperative pressure ulcer (PU) development after liver resection with a long surgical duration. MATERIALS AND METHODS: A retrospective analysis was performed of patients who underwent a liver resection with a surgical duration greater than 2 hours between January 2015 and December 2016 at a tertiary referral hospital in eastern China. Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors for postoperative PUs. RESULTS: Of the 128 patients included in the study, 11 (8.6%; 95% confidence interval [CI], 4.4%-14.9%) developed a stage 1 PU. Univariate analysis showed albumin on admission, diabetes mellitus complication, length of surgery, and intraoperative blood loss were all significantly different between the developed PU group (n = 11) and no PU group (n = 117; P ⟨ .05). However, multivariate logistic regression showed length of surgery (odds ratio [OR] = 1.026; 95% CI, 1.008-1.146) and intraoperative blood loss (OR = 1.014; 95% CI, 1.009-1.124) as only the independent risk factors for PU development after liver resection with a long surgical duration. CONCLUSIONS: These results showed length of surgery and intraoperative blood loss were independent risk factors for PU after liver resection with a long surgical duration. Use of PU prevention strategies are recommended for patients who undergo liver resection with massive intraoperative blood loss and long surgical duration.

Prevalence of pressure injury among Chinese community-dwelling older people and its risk factors: A national survey based on Chinese Longitudinal Healthy Longevity Survey.

AIM: To investigate the distribution of pressure injuries among older adults in China and to identify the associated risk factors. DESIGN: Cross-sectional study. METHODS: The identified subjects were collected from 2012 wave of a national Chinese Longitudinal Healthy Longevity Survey. Older people were defined as being 65 years of age or older. We used chi-square test and binary logistic regression to investigate the risk factors of pressure injury development. RESULTS: A total of 55 older people were documented as suffering from pressure injuries among 6,961 older Chinese adults, with a prevalence of 0.8%. In the group of disability, the prevalence of pressure injuries from high to low was 3.6% in the highly limited group, 0.4% in the moderately limited group, and 0.3% in the not limited group. The prevalence of pressure injury among older people with stroke, cancer, and dementia were 2%, 4.2%, and 6.6%, respectively. According to the final binary logistic regression analysis, age, disability, incontinence, cancer, and dementia emerged as important risk factors for pressure injury development. CONCLUSION: Pressure injury among Chinese community-dwelling aged people was shown to be associated with age, disability, incontinence, cancer, and dementia. As the development of pressure injury may distinctly increase the burden on individuals and healthcare systems, the social and related institutions should actively prevent and control the disease. IMPACT: The results of this study will improve the identification of pressure injury among older Chinese people and contribute to the development of effective pressure injury risk management interventions.

Vaginal delivery and HBV mother to child transmission risk after immunoprophylaxis: A systematic review and a meta-analysis.

OBJECTIVE: HBV mother to child transmission (MTCT) can be prevented by passive and active immunoprophylaxis. In this study, we aim to assess whether vaginal delivery is safe for HBV MTCT after immunoprophylaxis. MATERIAL AND METHODS: PubMed and Web of Science were systematically searched. We compared the MTCT incidence of infants at 6 months or older between vaginal delivery and caesarean section. Serological HBV positive incidences for newborns at birth were also compared. RESULTS: Eighteen studies with 11,446 mother-child pairs were included in the meta-analysis. The average incidence of serological HBV positive for newborns at birth was 7.2% in the cesarean section group, and 16.6% in the vaginal delivery group. The summary odds ratio (OR) was 0.499 (95% CI 0.364-0.684; Z = 4.33, P < 0.00001) between two groups. However, the average incidences of MTCT were 3.3% and 4.1% for the cesarean section group and the vaginal delivery group, respectively. The summary OR compared between two groups was 0.790 (95% CI 0.614 to 1.016; Z = 1.83, P = 0.067). The funnel plot, Begg's Test (z = -0.55, P = 0.583) and Egger's test (t = -0.29, P = 0.777) suggested there was no publication bias among the included studies. Sensitive analyze showed the ORs were 0.764 (95% CI 0.490 to 1.192; Z = 1.19, P = 0.236), and 0.386 (95% CI 0.132 to 1.125; Z = 1.74, P = 0.0081), respectively. CONCLUSION: The vaginal delivery did not increase the HBV MTCT incidence after immunoprophylaxis at 6 months old or more. The existing evidence does not support the conclusion that caesarean section can prevent MTCT in HBsAg-positive mother after immunoprophylaxis. However, this conclusion should be cautious in the HBV mother with high viral load.

Use of a Hydrocolloid Dressing in the Prevention of Device-related Pressure Ulcers During Noninvasive Ventilation: A Meta-analysis of Randomized Controlled Trials.

Use of a hydrocolloid dressing (HCD) is generally recommended to help prevent pressure ulcers (PUs) in high-risk patients, including ulcers caused by noninvasive ventilation (NIV). PURPOSE: The study was conducted to compare the effect of preventive use of HCD to other methods in the rate of facial PUs caused by NIV. METHODS: PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data were searched from date of index inception to August 2018 without language restrictions to identify randomized controlled trials (RCTs) that compared HCD use to other NIV-related PU prevention measures. Publications were systematically reviewed, data were extracted, and study quality was assessed using the Jadad scale. Odds ratio (OR) with 95% confidence intervals (CIs) for PU incidence in patients using HCD versus patients managed with gauze or standard skin care procedures (control) were calculated using a fixed-effects model. RESULTS: The search yielded 80 publications; 40 met the study criteria for full-text and 22 met the meta-analysis inclusion criteria (total study participants = 2519). Patients who used a HCD (n = 1260) had a significantly decreased incidence of PU (OR = 0.15; 95% CI: 0.11-0.20) compared with control group patients (n = 1259). Subgroup analysis by age showed a lower incidence in children (OR = 0.09; 95% CI: 0.01-0.81) and adults (OR = 0.16; 95% CI: 0.12-0.22) in the HCD group than in the control group. PU incidence using HCD was lower compared to gauze (OR = 0.17; 95% CI: 0.10-0.28) and regular skin care (OR = 0.13; 95% CI: 0.09-0.19). Funnel plot diagrams suggested a risk of bias. Sensitivity analysis using a random-effects model did not change the result of the main meta-analysis. CONCLUSION: Using a HCD significantly decreased the incidence of facial PUs caused by NIV. Additional high-quality, prospective research to confirm the effectiveness of HCD in preventing NIV-related PUs is warranted.

A Bibliometric Analysis of Global Research Production Pertaining to Diabetic Foot Ulcers in the Past Ten Years.

The aim of this study was to demonstrate the state of diabetic foot ulcer (DFU) research in the past 10 years by bibliometric analysis, especially by performing document co-citation and co-word visualization analysis to reveal the research hotspots, frontiers, and core literature. The literature in connection with DFUs from 2007 to 2018 was retrieved from the Web of Science Core Collection database (WoSCC). We used the WoSCC and CiteSpace to analyze publication outcomes, journals, research direction, research hotspots, and frontiers. Overall, 4580 publications on DFUs were retrieved until March 22, 2018. The number of publications from the United States accounts for approximately one third of all publications from the top 10 countries. Surgery accounted for the largest proportion of the publications we retrieved from the WoSCC in terms of research areas. Results of this analysis indicated that DFU research has been in a stable, mature stage. Developed countries pay more attention to DFU research field than do developing countries, especially the United States. The complications of DFUs, such as lower extremity amputation and diabetic foot infection, are the hotspots. Diabetic foot infection, wound management, prediction studies on DFU, and diseases related to DFU are the research frontiers that should be observed closely in the future.

Prenatal smoking and postpartum depression: a meta-analysis.

Objectives: Postpartum depression (PPD) is a common emotional distress among many women in diversified cultures. The aim of this study was to examine the relationship between prenatal smoking and PPD. Methods: We systematically searched PubMed, ISI Web of Science, EMBASE, Elsevier ScienceDirect, OVID and Springer databases up to 15 March 2017. The pooled odds ratio (OR) of PPD was compared between prenatal smoking women and the ones who did not smoke during pregnancy. The fixed effect model or random effect models were chosen according to heterogeneity between studies. Results: A total of 13 studies with 1,476,922 women were included in the meta-analysis. The average incidence of PPD was 3.0% (1717/57,997) in women with smoke exposure and 1.3% (6571/488,225) in women without smoke exposure. The pooled OR was 2.325 (95% CI 1.925-2.808; Z = 8.76, p < .0001) by random-effect model. The funnel plot was symmetrical, and either the Begg's test (Z = 0.92, p=.360) or the Egger's test (t = 0.04, p = .9700) suggested no publication bias among included studies. Sensitivity analysis indicated that the result was robust. Conclusion: Our meta-analysis indicated that prenatal smoking was associated with postpartum depression.

Patient-controlled Analgesia and Postoperative Pressure Ulcer: A Meta-analysis of Observational Studies.

BACKGROUND: Patient-controlled analgesia (PCA) has become a common practice after surgery, but research has shown that the use of PCA is also a significant risk factor for pressure ulcers. However, no meta-analysis or conclusive review has investigated whether patients using PCA have a significantly higher prevalence of pressure ulcers. OBJECTIVE: This study explores the association between the use of postoperative PCA and the prevalence of pressure ulcers. MATERIALS AND METHODS: PubMed, the Cochrane Controlled Register of Trials, Web of Science, China National Knowledge Infrastructure, Wanfang, and Vip databases were searched to identify studies, published up until November 2016, concerning the association between PCA and pressure ulcer prevalence. A manual search of the references of relevant studies also was performed. Odds ratio (OR) and corresponding 95% confidence interval (CI) were used to evaluate the strength of association between the use of PCA after surgery and pressure ulcer prevalence. The methodological quality of included case-control studies and cohort studies was assessed by the Newcastle-Ottawa Scale. The test of heterogeneity, subgroup analysis, meta-regression, Begg's funnel plot, and Egger's test also were used. RESULTS: Four cohort studies and 1 case-control study were included. In these 5 studies, 265 participants were identified. In pooled analysis, heterogeneity was 0 among the studies. In a fixed effects model, postoperative pressure ulcer was associated with PCA (pooled OR, 3.525; 95% CI, 1.655-7.509). Subgroup analysis of these 5 studies yielded an OR of 3.29 (95% CI, 1.47-7.40) for cesarean section, 5.10 (95% CI, 0.24-107.55) for general surgery, and 5.10 (95% CI, 0.24-107.55) for orthopedic surgery. There was no heterogeneity among the 5 studies. Additional meta-regression of year and incidence did not find significant outcomes. CONCLUSIONS: This meta-analysis shows PCA may be associated with an increased risk of postoperative pressure ulcer, especially after caesarean section. More evidence-based studies on this research field are needed to draw a firmer conclusion.

Maternal viral load and hepatitis B virus mother-to-child transmission risk: A systematic review and meta-analysis.

AIM: The aim of this study was to assess the relationship between maternal viral load and mother-to-child transmission (MTCT) risk in hepatitis B envelope antigen (HBeAg)-positive mothers. METHODS: PubMed and Web of Science were systematically searched. We compared MTCT incidence between maternal hepatitis B virus (HBV)-DNA-positive and HBV-DNA-negative groups. We also examined the dose-response effect of this relationship. RESULTS: Twenty-one studies with 10 142 mother-child pairs were included in the studies. The mean MTCT incidence was 13.1% in the maternal HBV-DNA-positive group, compared with 4.2% in the negative group. The summary MTCT odds ratio of maternal HBV-DNA positive compared with negative was 9.895 (95% confidence interval [CI], 5.333 to 18.359; Z = 7.27, P < 0.00001) by random-effects model. In maternal HBV-DNA <6 log10 copies/mL, 6-8 log10 copies/mL, and >8 log10 copies/mL level stratifications, the pooled MTCT incidences were 2.754% (95% CI, 1.198-4.310%; Z = 3.47, P = 0.001), 9.932% (95% CI, 6.349-13.516%; Z = 5.43, P < 0.00001), and 14.445% (95% CI, 8.317-20.572%; Z = 4.62, P < 0.00001), respectively. A significant linear dose-response association was found between maternal viral load and MTCT risk, with the points estimate of increased MTCT risk 2.705 (95% CI, 1.808-4.047) at 6 log10 copies/mL compared with reference (3 log10 copies/mL), and 7.316 (95% CI, 3.268-16.378) at 9 log10  copies/mL. A significant non-linear dose-response association was also found between maternal viral load and HBV MTCT risk (model χ2 = 23.43, P < 0.00001). CONCLUSION: Our meta-analysis indicated that maternal viral load was an important risk factor for MTCT in HBeAg-positive mothers, and maternal viral load was dose-dependent with HBV MTCT incidence.