Cath Lab Digest

Index: Ostomy Wound Manage 2001;47(11):36–43

  Pressure ulcers constitute a pervasive problem in healthcare. They cause a great deal of suffering and frustration to patients, their relatives, and their caregivers. Furthermore, pressure ulcers increase the workload of healthcare clinicians and, as a consequence, increase healthcare costs dramatically.^1-4 High prevalence rates have been documented. In the Netherlands, for instance, a prevalence rate of 23% has been found for hospitals and 32% for nursing homes.^5-7 The Dutch Health Council has calculated that at least 1.3% of the national healthcare budget is used for the prevention and treatment of pressure ulcers.⁸ This means that pressure ulcers are one of the biggest and most expensive problems within healthcare and demand considerable attention from clinicians and scientists. This article examines the attention pressure ulcers have been getting in the clinical, and especially, scientific literature, and the topics this attention has targeted.

  In general, clinicians rely on several sources of knowledge: tradition; authority; experience and trial and error; logical reasoning; and scientific methods.⁹ Pressure ulcer knowledge is mostly based on the first four sources. For example, the frequent use of "massages" as a preventive method¹⁰ is being perpetuated by tradition or custom, and ultimately by authority – ie, that of the physician.¹¹ Furthermore, many methods are developed by experience or trial and error, as in the choice of support surfaces.¹² Although these sources of knowledge are very useful, they have one common problem: The conclusions they elicit can be affected by personal experience, emotions, and other sources of bias. The scientific method uses a range of checks to minimize these biases. As the guidelines of the Panel for the Prediction and Prevention of Pressure Ulcers in Adults¹³ and the European Pressure Ulcer Advisory Panel (EPUAP) guidelines¹⁴ show, most knowledge is still not based on scientific research; therefore, building a scientific knowledge base is important in order to temper personal experience and other forms of bias from affecting clinical decisions.

Research Questions

  The present article tries to answer the following research questions:
    1. What proportion of the articles published from 1965 to 1999 relate to pressure ulcers?

    2. In what proportion of the clinical and research articles published from 1965 to 1999 was pressure ulcers the main topic?

    3. What topics are examined and what designs are used in the research articles published from 1965 to 1999?

    4. What (if any) are the differences between publications of authors from the United States and Europe?

Method

  A Medline search was performed, using the terms "pressure ulcers," "pressure sore," and "decubitus." No other sources (such as Cumulative Index to Nursing and Allied Health Literature® [CINAHL]) were used, because many clinicians agree that Medline provides a good representation of what has been written about pressure ulcers. Medline includes articles of medical and nursing journals. Between 1965 and 1999, a total of 6,056 articles regarding pressure ulcers were found. All editorials, comments, and letters (n = 330) then were excluded. To further reduce the number of articles, the search terms offered by Medline were used. These were not sufficiently reliable to select the research articles. Hence, all articles would have to be classified manually by the first author.