Effects of scar massage on burn scars: A systematic review and meta-analysis.

AIMS AND OBJECTIVES: This study explored the physical and psychological effects of scar massage on burn patients. BACKGROUND: Hypertrophic scar development is highly prevalent following burn injuries. Scar massage may have physical and psychological effects, although evidence of its effectiveness for burn scar improvement remains inconsistent. DESIGN: A systematic review and meta-analysis of randomised controlled trials and quasi-experimental trials. METHODS: This study was conducted following the Centre of Reviews and Dissemination guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PubMed, EMBASE, and Chinese Electronic Periodical Services were searched for studies published between January 1990 and February 2022. Quality was assessed using the Joanna Briggs Institute (JBI) Appraisal Checklist. The final recommendation strength was assessed according to the JBI recommendation rating. A meta-analysis was performed using Review Manager Version 5.4 software with a random-effect model. RESULTS: Seven studies (420 participants) investigating scar massage for burn patients were included. The scar massage sessions lasted 5-30 min and were delivered by massage therapists 1-3 times a week for 12 weeks. Overall, scar massage decreased pain levels (standardised mean difference [SMD]: -2.39; 95% confidence interval [CI]: -3.96 to -0.83), improved scar thickness (mean difference: -0.05; 95% CI: -0.1 to -0.0), reduced pruritus (SMD: -1.89; 95% CI: -2.95 to -0.82) and reduced anxiety (SMD: -1.52; 95% CI: -2.73 to -0.32), but no significant effect on depression(SMD: -0.92; 95% CI:-2.28 to 0.44). CONCLUSIONS: The meta-effects of scar massage among burn patients are significantly improved scar formation and reduced pruritus and anxiety. Providing scar massage is feasible and effective for burn patients. Future research should evaluate its long-term effects. RELEVANCE TO CLINICAL PRACTICE: Scar massage is relatively convenient and effective in preventing and alleviating hypertrophic burn scarring. Further research can provide detailed suggestions for effective scar massage implementation.

[Hand Allotransplantation: Care and Challenges].

Hand allotransplantation, a composite tissue allograft, is a time-consuming surgical procedure. This procedure has been shown to significantly improve quality of life in patients with upper extremity loss. The suitability of this procedure must be rigorously evaluated before surgery, and long term antirejection drugs and rehabilitation exercises must be carried out after hand transplantation. Moreover, its success requires close collaboration within the multidisciplinary team. Several related issues are addressed in this article, including the history of hand transplantation surgery, the pros and cons of this procedure, rejection response and immunotherapy, rehabilitation and hand function recovery after hand transplantation, and pre- and post-procedure psychological reactions and evaluations. Response suggestions at the patient and environmental level that reflect the multiple challenges involved in hand transplantation are provided as a reference for clinical decision-makers.

[Reducing the Incidence of Medical Adhesive-Related Skin Injuries in Surgical Intensive Care Unit].

BACKGROUND & PROBLEMS: Patients with critical illnesses face an elevated risk of medical adhesive relation skin injuries (MARSI), which have negative, subsequent impacts on recovery and quality of healthcare. PURPOSE: The aim of this project was to decrease the incidence of MARSI in the surgical intensive care unit and to improve the accuracy of MARSI preventive care implementation. RESOLUTIONS: The intervention included the implementation of product-use cards, high-risk warning slogans, education programs, experience workshops, and a standard prevention-care protocol for MARSI. RESULTS: After project implementation, the incidence rate of MARSI decreased from 18.2% to 0%-9.3%, and the accuracy rate of preventive care increased from 38.6% to 95.5%. CONCLUSIONS: This project effectively reduced the incidence of skin injury and improved the quality of critical care. The skills related to the care and prevention of MARSI have been implemented throughout the hospital.

[A Systematic Review and Meta-Analysis of the Pros and Cons of Consuming Liquids Preoperatively].

BACKGROUND: Preoperative anesthesia long time fasting, may increase patient hemodynamic instability during surgery and may affect the patient's post-surgery electrolyte balance. No meta-analysis has been conducted to explore the effects of preoperative liquid intake amount on gastric fluid PH, gastric fluid volume, surgery inhalation of pulmonary complications, and patient self-perceptions quality of care systematic review and meta-analysis of the literature. PURPOSE: To assess the pros and cons of preoperative liquid intake using a systematic review of the literature. METHODS: The authors searched ten databases including NRC (Nursing Reference Center), CINAHL (Cumulative Index to Nursing and Allied Health Literature), WOS (Web of Science), PubMed, The Cochrane Library, UpToDate, DynaMed, NGC (National Guideline Clearinghouse), Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan, to identify relevant articles that were published from 2003 to January 2017. Nine qualified articles were included in the analysis from the 30 articles that were selected using an initial keyword search. The Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence was used as the evidence grade and the CASP (Critical Appraisal Skills Program) was used to evaluate the quality of the selected articles. The quantitative results were analyzed using Review Manager, Version 5.1. RESULTS: The quality of the literature was medium to high. A small to moderate dose of fluid consumed at 2 hours prior to surgery did not significantly increase gastric fluid volume during anesthesia, with a combined effect of 2.37 (95% CI [-5.12, 9.85], p = .54), and had no effect on gastric fluid PH, with a combined effect of 0.10 (95% CI [0.00, 0.20], p = .05). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results indicate that consuming a small to moderate dose of liquid at 2 hours prior to the provision of anesthesia does not significantly increase the gastric fluid volume or gastric fluid PH of patients during anesthesia. Moreover, the positive benefits of consuming this dose of liquid include reduced risks of aspiration pneumonia, gastroesophageal reflux disease, and postoperative complications as well as reduced perceptions of thirst and hunger during the immediate preoperative period. Thus, this analysis supports that the advantages of allowing patients to consume a moderate or smaller dose of liquid prior to surgery outweigh the disadvantages.

[Reducing the Incidence of Incontinence Associated Dermatitis in Intensive Care Unit Diarrhea Patients].

BACKGROUND & PROBLEMS: Incontinence associated dermatitis (IAD) is a common skin disorder in critical patients who suffer from fecal incontinence. Symptoms of IAD include pain, redness, swelling, and, in some cases, secondary infections. IAD is thus a major problem faced in critical nursing care. The incidence of incontinence associated dermatitis averaged 34.72% at the intensive care unit in our hospital from October to December 2013. The factors that we identified as associated with IAD included: (1) Nurses: incorrect nursing care and insufficient IAD-related knowledge among nurses; (2) DEVICES: lack of skin barrier products and the use of diapers with poor air ventilation; (3) Regulations: lack of IAD care standards and lack of auditing oversight; (4) Patient problems: skin edema, incontinence, and medication use. PURPOSE: To decrease the incidence of IAD from 34.72% to 22%. METHODS: The authors searched the Cochrane, PubMed, CINAHI, and Nursing Reference Center databases for relevant articles that were published from 2000 to 2014. Fifty studies were identified and four evidence-based references were selected for follow-up assessment. Levels of evidence were at levels 2 and 3. We designed an intervention that: (1) set a high-risk notice to increase awareness; (2) held six in-service training programs; (3) developed nursing standards and designed e-learning education lessons that specifically targeted reducing the incidence of IAD; (4) established a regular audit system. RESULT: The incidence of IAD decreased from 34.72% pretest to 19.8% posttest (posttest period: April - October 2014). CONCLUSION: This project effectively reduced the incidence of IAD in high-risk patients in our intensive care unit. The authors established evidence-based interventions that significantly improved patient outcomes.

[Project to improve the free flap survival rate in oral cancer microreconstruction free flap surgery].

BACKGROUND&PROBLEMS: Free-flap thrombosis risk factors affect the success of microreconstruction surgery that involves the use of a free flap. The free flap survival rate in our unit was 92.65%. Relevant risk factors identified included: (1) poor nursing assessment cognizance and low accuracy rates; (2) lack of standardized of postoperative monitoring protocols; (3) lack of assessment tools; (4) inadequate inter-team communication; and (5) lack of a free flap care monitoring audit. PURPOSE: The purpose of this project was to improve the free flap survival rate from 92.65% to at least 97%. RESOLUTIONS: The authors: (1) held relevant educational training programs; (2) evaluated nurse skills in clinical settings; (3) established a standardized nursing monitoring protocol; (4) provided sufficient assessment equipment; (5) improved inter-team communication mechanisms; and (6) formulated a monitoring audit protocol. RESULTS: The free flap survival rate rose from 92.65% to 100%, with no failed flaps during the assessment period December 2011 to May 2012. CONCLUSIONS: The resolutions proposed by this project may significantly improve the free flap survival rate.

[Compassion fatigue and coping strategies for hospital nurses].

Over-involvement in patient trauma and loss in clinical settings negatively affects nurses and may cause compassion fatigue. Compassion fatigue is associated with prolonged exposure to trauma cases, over-involvement in patient situations and over-extending caring energies. Nurses unable to adapt and cope may suffer physically and psychologically, reduce their quality of care, cause medical care costs to increase, and ultimately become frustrated and decide to leave the nursing profession. While current approaches to addressing compassion fatigue focus on evaluating individual nurse situations, adjusting attitudes, holding education programs, and bolstering support systems, little research attention has been directed toward the consequences of such on patient care or the origins of compassion fatigue in Taiwan nurses. This paper defines compassion fatigue, examines its importance and consequences, and delineates common nursing coping strategies in Taiwan. Findings expand domestic research on this phenomenon and suggest relevant theories and effective interventions to achieve remediation.

[The decision making process of ESRD families during the dialysis withdrawal period].

Hemodialysis is a financial burden to the state and families and the cause of much suffering in patients. It is a life prolonging therapy and death-delaying treatment. When the burdens of therapy substantially outweigh its benefits, withdrawal from dialysis is an appropriate option. However, considering the ethical and legal concerns of doing such is something families must face. There has been little research and little understanding of the process of decision-making within families in Taiwan. The process is full of conflicts, worries, guilt, shame, and lack of consensus. Effective communication with the medical team to resolve the conflict and describe the prognosis is necessary in order to reach a consensus and move toward palliative care. The article uses a case report and discusses the process. Finally, the author suggests an approach to making the situation better in the future.

[Self-regulation effect in dietary control of obesity].

Problems associated with excess bodyweight and obesity are increasing worldwide. These problems increase risks of metabolic syndrome, cardiovascular disorders and hypertension. Improving diet and exercise control and self-monitoring, self-evaluating and self-adjusting are critical to modify risky lifestyles. In this paper, the author's designed a diet control protocol and then applied it to an obese adult. The project ran from Feb 2nd to July 30th, 2009, and used the principles and concepts of self-regulation theory, a daily diet plan, and body weight chart to guide the patient to consider and appreciate the gaps between his behavior and the standard in order to encourage improvement. The processes related to the goal and effect are significant. By learning self-regulation skills the patient's weight declined from 106.1kg to 84.4kg. Self-efficacy also improved. The author predict the efficacy of the approach in helping prevent chronic disease. The author wishes to share their experience with nursing colleagues and propose this protocol as an effective diet control approach for obese patients.

[Nursing experience using motivational interview techniques in caring for an obese patient with type 2 diabetes].

Global prevalence and incidence of diabetes for all age groups are increasing. Research evidence reveals that lifestyle modification can both significantly improve glycemic control and delay complications. Obese patients suffering from type 2 Diabetes Mellitus in particular require food therapy and weight reduction through behavior modification in order to regain a healthy quality of life. This article used motivational interviews and the transtheoretical model to develop a behavioral change strategy to set health behavior as well as to assist the patient to attain weight reduction and glycemic control goals. Over the study period (April 30, 2009 to June 10, 2009), the patient's weight declined from 93.4kg to 90kg. Also, her blood sugar is gradually stable. Because of the effectiveness of behavior modification, the patient exhibited sustained motivation to continue maintaining diet control, which reflects motivation is an important component for behavior modification. The authors would like to share this case report to provide nursing professionals with a reference for using motivational interview techniques and transtheoretical model.