A Critical Appraisal of Pressure Ulcer Prevention in ICU Patients

This assignment is a critical appraisal of a systematic review and meta-analysis investigating the effectiveness of pressure ulcer (PU) prevention strategies for adult patients in intensive care units (ICUs). The appraisal assesses the review's methodology, including the clarity of the research question, comprehensiveness of the literature search, appropriateness of the study design, and methods for assessing the risk of bias. It evaluates the characteristics of included and excluded studies, the use of appraisal checklists like JBI-MAStARI, and the synthesis of data. The appraisal also examines the overall results, addressing publication bias, precision, and the applicability of the findings to patient care, highlighting both the advantages and disadvantages of the reviewed study and its implications for future research and clinical practice. The document is available on Desklib, a platform offering a range of study resources for students.

Running head: CRITICAL APPRAISAL OF LITERATURE REVIEW
Critical Appraisal Of Literature Review
Effectiveness of Pressure Ulcer Prevention
Strategies for Adult Patients in Intensive
Care Units: A Systematic Review
Name of the Student:
Name of the University:
Author Note:

1CRITICAL APPRAISAL OF LITERATURE REVIEW
Table of Contents
Introduction......................................................................................................................................3
Review question...............................................................................................................................3
Systematic review or meta-analysis.............................................................................................3
Clearly focused question..............................................................................................................4
Population studied.......................................................................................................................4
Intervention given........................................................................................................................4
Outcome considered....................................................................................................................4
Literature search..............................................................................................................................4
Comprehensive literature search..................................................................................................4
Study design and its appropriateness...........................................................................................4
Usage of appropriate database and outside resources..................................................................5
Methods of assessing risk of bias................................................................................................5
Quality of the review.......................................................................................................................6
Characteristics of the included & excluded criteria.....................................................................6
Reviewers....................................................................................................................................6
Appraisal checklist.......................................................................................................................6
Data synthesized..........................................................................................................................7
Results..............................................................................................................................................7
Overall results..............................................................................................................................7

2CRITICAL APPRAISAL OF LITERATURE REVIEW
Publication bias............................................................................................................................7
Precision of the results.................................................................................................................8
Result analysis.................................................................................................................................8
Conclusion.......................................................................................................................................9
References......................................................................................................................................10

3CRITICAL APPRAISAL OF LITERATURE REVIEW
Introduction
The paper aims to provide a critical appraisal of the chosen health related systematic
literature review that discusses about the effectiveness of the Pressure Ulcer (PU) prevention
strategies for adult patients. To control the building of Hospital-Acquired Pressure Ulcers
(HAPUs), the healthcare industry is emphasizing on scientific and innovative strategies for the
advancement of the medical inventions. The reduction of the occurrences of HAPUs is
prioritized due to the frequent occurrence and high risk factor associated with it among adult
patients (McInnes et al., 2015). This article systematically and analytically judges the
effectiveness of the prescribed clinical research paper to evaluate whether the requirements and
proposed deliverables are met or not at the end of the research (LoBiondo-Wood et al., 2013).
Usually, the prevention of PU is easier by adopting multiple prevention strategies. Thus, the
purpose of the literature study is to research and analyse whether a single prevention strategy is
impactful for preventing PU or not.
Review question
Systematic review or meta-analysis
A systematic review can be described as a variation of literature review where the
purpose is to address the identification, analytical evaluation, and accumulation of the
discoveries from the result. The author utilises systematic methodologies for systematic review.
On the other hand, the meta-analysis can be defined as the statistical processes that use statistical
tools for drawing conclusion on the collected data (Athappan et al., 2013). It uses specific
quantitative measures, like evaluating effect size, for identifying association among variables.
The result of the research study calculates the effect size as result (Wacker et al., 2013). The
chosen report is therefore a representative of both systematic review and meta-analysis.

4CRITICAL APPRAISAL OF LITERATURE REVIEW
Clearly focused question
If a study addresses a specified topic and maps to identify solution for that particular
topic only, then it can be said that the study labels a clearly focused question. The chosen
research literature attempts to find out single strategy to reduce the problem of PU and ends up
finding a full proof solution of PU. Thus, the study addresses a clearly focused question.
Population studied
The research study has considered the population of intensive care severely ill patients
for the study and the conclusion has been drawn based on the heterogeneity of the population.
Intervention given
The intervention in this research study is to prevent the development of PU and to devise
treatment process.
Outcome considered
All the primary outcomes have been considered along with statistical results.
Literature search
Comprehensive literature search
The literature research has considered all the electronic databases from 2000 to 2015.
Besides, the data from s4everal health care agencies have been used. Thus, the study has used
comprehensive literature search.
Study design and its appropriateness
There are three types of research design which are
a. Descriptive or analytical design
b. Explanatory design and
c. Exploratory design.

5CRITICAL APPRAISAL OF LITERATURE REVIEW
Out of all these research designs, the analytical research design uses all the available information
to analyse the data and make critical evaluation from the available data to draw conclusions
(Nassaji, 2015). The analytical design provides a deep-rooted analysis too. Therefore, the given
study has used analytical research design. This research design is appropriate as the research
study aims to provide a deep analysis of the single strategy for the treatment of PU.
Usage of appropriate database and outside resources
The information from database and other resources have been used and have been utilized
for further calculations to obtain the systematic review. The data from CINAHL, NICE, and
other significant medical institutions have been collected for the purpose of this study. In
addition to this, how the outside resources have been manipulated, has been represented through
a flow-diagram. Therefore, the study has utilized all the databases and resources properly.
Methods of assessing risk of bias
The risk of bias in any systematic review can be explained as a systematic deviation from
the originality of the statement at the time of inference. The systematic review of any medical
literature frequently gets affected by the risk of bias for several reasons. The risks of bias are
primarily of two types – High risk of bias and Low risk of bias. Assessing the risk of bias
indicates the assessment of the strength of the evidence that has been evaluated (Sterne et al.,
2016). The selected systematic review has been assessed by the standardized tool JBI-MAStARI
for identifying any sort of risk of bias in study selection (Feng et al., 2013). It is a critical
appraisal tool that stands for Joanna Briggs Institute Meta-Analysis of Statistics Assessment and
Review Instrument (Tarandeep et al., 2018). It works by extracting the data using an extraction
tool and it is reviewed then to check any bias and significant error. If the risk of bias is found

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then the bias is minimized by the reviewer. The criteria for allowing the data in the systematic
review is to meeting 50% criteria of JBI-MAStARI checklist tool.
Quality of the review
Characteristics of the included & excluded criteria
The included criteria can be defined as the factor that a study must have to be mentioned
in the systematic review. On the other hand, the exclusion criteria is the factor that must not be
included the review of the study. There is a protocol in every systematic review that handles the
inclusion and exclusion criteria for t6hje assessment of the research study. The characteristics of
the criterion are-
i. The studies which are published other than English languages are excluded from
the study.
ii. The previous studies published from the year 2000 to 2015 are included for the
research.
iii. The studies that have satisfied the criterion of the methodological validity by two
independent reviewers, are included in the study.
Reviewers
There are two reviewers for reviewing the methodological validity of the secondary data
resources that is the previous research studies.
Appraisal checklist
An appraisal checklist is a list of that checks a list criterion for assessing the authenticity
of the city. Appraisal checklist of the given systematic review consists of e JBI-MAStARI tool
that will check presence of bias, review the collected studies, and assess the inclusion and
exclusion criterion.

7CRITICAL APPRAISAL OF LITERATURE REVIEW
Data synthesized
A dataset is said to be synthesized if any statistical approach is used for evaluating the
results from the data (Biswas et al., 2015).
 The review has considered the results from 25 studies. Therefore the results are
combined.
 Individual study have been displayed in the course of this research as only one study has
examined the strategies related to nutrition for the treatment of PU.
 The similarities among the individual studies have been taken into account and they have
been described in this systematic review.
 The similar results from different studies have been considered.
 The variations in results are discussed and demonstrated well in the course of the study.
Results
Overall results
The entire result can be summed up into the evaluation of 25 studies and from the meta-
analysis, the statistical significance of the performance strategy of a silicone foam with an effect
size of 4.62. The evaluation of the effect size suggests that the effect size is large and it suggests
that the outcome is quite effective that can be seen with the naked eye. Moreover, the prevention
of the building of HAPU is controllable with the implication of the single strategy.
Publication bias
It is a type of bias that occurs during the publication of the research paper. It generates
due to influential decision regarding the publication of the paper and it leads the publication of
the research paper based on certain criterion like publication of those papers showing more
statistically significant results (Biswas et al., 2015). The chosen systematic review includes

8CRITICAL APPRAISAL OF LITERATURE REVIEW
publication bias, more specifically language bias as it excludes studies published in other
languages than English. Also, only the methodological valid studies have been considered. Thus,
the publication bias is available.
Precision of the results
The precision of a study can be defined as the imminence of two or more studies. It
shows the accuracy of the result evaluated from the study. The result has analysed all the
significant outcomes of the individual studies amd all the results have been combined to provide
the outcome of the clearly focused research question of the systematic review.
Result analysis
 The evaluated results can be applied on patient as they single strategy of the application
of silicone foam is statistically significant with the confidence interval of 0.05-0.29 at
99.99% level of significance having a large effect size of 4.62 (van Assen, van Aert &
Wicherts, 2015).
 The review has focused on all the vital outcomes as it includes the outcomes on nutrition,
skin-care, positioning schedule and HAPU prevention treatment.
 Advantage - This systematic review discusses the strategy for the prevention of PU
based for the well-being of the critically ill adult patients admitted in ICU. Moreover, the
study devises a single prevention strategy beside the existing multiple prevention strategy
which shows an advancement of the clinical treatment (Pickering & Byrne, 2014).
 Disadvantage – The presence of publication bias is the main disadvantage of this
systematic review. Therefore, in general systematic reviews have issue in providing good
results. The chosen systematic review is of no exception (Pickering & Byrne, 2014).

9CRITICAL APPRAISAL OF LITERATURE REVIEW
 The study offers an evidence based rules for the future clinical studies on the treatment
and prevention of the PU. The study literature devises an impactful medical strategy for
controlling the development of HAPU. Thus, it has bright scope for the future research
and study.
Conclusion
From the above discussion of the critical appraisal of the systematic review of the
medical literature study, it can be concluded that this paper critically analyses the chosen
systematic review and checks all the points that need to be checked in the course of a critical
appraisal. This paper has verified the advantages and disadvantages of the study with the
examination of the presence of publication bias and the consequences of the risk of bias. In
addition to this, this appraisal also addresses the inclusion and exclusion criterion of the review
and analyses the significance of the statistical results. The data under study has been synthesized.
The critical appraisal is valid and sufficient for the systematic review.

10CRITICAL APPRAISAL OF LITERATURE REVIEW
References
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Tamburino, C. (2013). Incidence, predictors, and outcomes of aortic regurgitation after
transcatheter aortic valve replacement: meta-analysis and systematic review of
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Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A.
(2015). Sedentary time and its association with risk for disease incidence, mortality, and
hospitalization in adults: a systematic review and meta-analysis. Annals of internal
medicine, 162(2), 123-132.
Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A.
(2015). Sedentary time and its association with risk for disease incidence, mortality, and
hospitalization in adults: a systematic review and meta-analysis. Annals of internal
medicine, 162(2), 123-132.
Feng, J. Y., Chang, Y. T., Chang, H. Y., Erdley, W. S., Lin, C. H., & Chang, Y. J. (2013).
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McInnes, E., Jammali‐Blasi, A., Bell‐Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N.
(2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic
Reviews, (9).
Nassaji, H. (2015). Qualitative and descriptive research: Data type versus data analysis.

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