Home About us Contact
|
Home About us Contact | ||
|
|
||
Ulcer Incidence (ulcer + incidence)
Selected AbstractsRisk assessment scales for pressure ulcer prevention: a systematic reviewJOURNAL OF ADVANCED NURSING, Issue 1 2006Pedro L. Pancorbo-Hidalgo PhD RN Aim., This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Background., Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. Method., A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Findings., Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57·1%/67·5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4·08, CI 95% = 2·56,6·48). The Norton Scale has reasonable scores for sensitivity (46·8%), specificity (61·8%) and risk prediction (OR = 2·16, CI 95% = 1·03,4·54). The Waterlow Scale offers a high sensitivity score (82·4%), but low specificity (27·4%); with a good risk prediction score (OR = 2·05, CI 95% = 1·11,3·76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50·6%) and specificity (60·1%), but is not a good pressure ulcer risk predictor (OR = 1·69, CI 95% = 0·76,3·75). Conclusion., There is no evidence that the use of risk assessment scales decreases pressure ulcer incidence. The Braden Scale offers the best balance between sensitivity and specificity and the best risk estimate. Both the Braden and Norton Scales are more accurate than nurses' clinical judgement in predicting pressure ulcer risk. [source] Uncomplicated peptic ulcer in the UK: trends from 1997 to 2005ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009S. CAI Summary Background, Few studies have examined the incidence of uncomplicated peptic ulcer or the trends in factors affecting its incidence. Aim, To estimate the incidence rate of uncomplicated peptic ulcer in the UK from 1997 to 2005 and report temporal changes in the main known preventive and risk factors. Methods, Population-based cohort study of 1 049 689 patients enrolled in The Health Improvement Network in the UK. We estimated the incidence rate of uncomplicated peptic ulcer and evaluated temporal trends in demographic characteristics and prescription patterns for various anti-inflammatory and gastroprotective agents. Results, Overall uncomplicated peptic ulcer incidence was 0.75 cases per 1000 persons-years, declining from 1.1 to 0.52 cases per 1000 person-years between 1997 and 2005. Distributions of age, gender and alcohol habits were similar in 1997 and 2005. The proportion of documented Helicobacter pylori -negative cases increased from 5% to 12%. Monthly prevalence of subjects with prescriptions for traditional non-aspirin NSAIDs changed from 7.7% to 6.8%, Coxibs from 0% to 0.7%, and proton pump inhibitors (PPIs) from 2.4% to 7.4%. The proportion of subjects on prescription NSAIDs on PPIs increased continuously over time. Conclusion, A reduction in H. pylori -related peptic ulcers, changing patterns in NSAID use and increasing PPI use may have contributed to a decline in uncomplicated peptic ulcer incidence in the UK. [source] Meta-analysis: incidence of endoscopic gastric and duodenal ulcers in placebo arms of randomized placebo-controlled NSAID trialsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009Y.-H. YUAN Summary Background, The safety of NSAIDs is often evaluated by comparison with placebo in clinical trials. Aim, To investigate the incidence of gastric and duodenal ulcers (GDU) in placebo arms in NSAID trials over the last three decades. Methods, Randomized placebo-controlled trials of oral NSAIDs from 1975 to 2006 were systematically reviewed. The pooled incidence of GDU in placebo arms was calculated and compared. Meta-regression was used to identify risk factors related to the incidence of the placebo ulcer at the study level. Results, Thirty-six studies met inclusion criteria (duration of 6.5 days to 24 weeks). In total, 3.29% GDUs were reported in 36 placebo arms. The incidence of GDU in placebo arms was 0, 4.20% and 3.03% in the studies from 1975,1989, 1990,1999 and 2000,2006 respectively (P > 0.05). Eligible subjects with previous GI events and eligible subjects on co-therapy with low-lose aspirin/corticosteroids were associated with the increase in placebo ulcer incidence after adjusting for other factors. Conclusions, The incidence of GDU in placebo arms has not changed significantly over the last three decades, although has decreased in the past 10 years. Studies show that previous GI events and co-therapy with low-dose aspirin/corticosteroids were associated with increasing GDU in placebo arms. [source] Review article: gastrointestinal bleeding with low-dose aspirin , what's the risk?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2006L. LAINE Summary This review examines ulcers and gastrointestinal bleeding with low-dose aspirin, focusing on randomized placebo-controlled trials. The single endoscopic trial assessing ulcers showed no significant difference in 12-week ulcer incidence: 6% of 381 given placebo vs. 7% of 387 given 81 mg enteric-coated aspirin. The relative risk of major gastrointestinal bleeding with low-dose aspirin in a meta-analysis of placebo-controlled trials of vascular protection was 2.07 (95% CI: 1.61,2.66). The absolute rate increase with aspirin above placebo was 0.12% per year (95% CI: 0.07,0.19%) with a number-needed-to-harm of 833 patients (95% CI: 526,1429). A meta-analysis of aspirin 50,1500 mg daily reported an odds ratio for any gastrointestinal bleeding of 1.68 (95% CI: 1.51,1.88) with an number-needed-to-harm at 1 year of 247. The relative risk of hospitalization for upper gastrointestinal bleeding with low-dose aspirin in a large Danish cohort study was 2.6 (95% CI: 2.2,2.9) with an absolute annual incidence of 0.6%. Factors that may increase the risk of gastrointestinal bleeding include prior history of ulcers or gastrointestinal bleeding, corticosteroid use, anticoagulant therapy and addition of a non-aspirin non-steroidal anti-inflammatory drug. When determining whether low-dose aspirin is appropriate for an individual patient, the cardiovascular benefit must be weighed against the potential for clinical events such as gastrointestinal bleeding. [source] | ||||||||||