Practice Problem of Pressure Ulcers


The systematic review 1 thoroughly answers only one research question out of two ones that were considered. In particular, the evidence available to indicate the efficiency of the use of dressings in hospital-acquired pressure ulcer prevention was critically appraised. However, the researchers could not find adequate evidence to determine which types of prophylactic dressings have a greater effect on the prevention of pressure ulcers. The reasons for that will be further discussed in the paper. Systematic review 2 had only one research question which was answered in detail. The relative effects of the use of different types of support surfaces on the reduction of hospital-acquired pressure ulcers were determined and compared. Also, all these types of support surfaces were then ranked depending on their effectiveness.

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It has to be stated that the search of systematic review 1 can be regarded as comprehensive only to a limited extent. This is because the search was performed only through four electronic bibliographic databases, and non-English publications were not considered (Clark et al., 2014). However, it is worth mentioning that the inclusion criteria provided for the wide scope of review. There were no limitations related to publication date, setting, or study design. Based on the systematic review 1 methodology, one could note that the search is quite reproducible. This is because all the steps were thoroughly described so that a person could verify the findings of the research. Also, references to all reviewed randomized control trials and cohort control trials were given, so it is possible to perform the synthesis of the data.

The search of the systematic review 2 can be regarded as comprehensive as it identified and included 59 randomized control trials and quasi-randomized trials with no restriction based on language or publication status. Nine databases were used for the search to ensure great variability of data. However, since the study investigated only the effects of support surfaces, studies of cushions, turning beds, and limb protectors were excluded (Shi, Dumville, & Cullum, 2018). Also, some of the studies from China were excluded due to serious concerns related to their validity. Given that the search procedure and the search results have been described in detail, one could state that the search of the systematic review 2 is reproducible. However, even though the researchers made a flow diagram of the included studies, a thorough description of inclusion criteria was not given.

Both systematic reviews included a section addressing the limitations of the search performed and how they were minimized. In particular, systematic review 1 analyzed the evidence from mixed design studies and excluded non-English publications, thus restricting the scope of review. To address this limitation, researchers re-ran the search strategy and considered two non-English publications, one in Spanish and one in Farsi. Another specific limitation was associated with multiple weaknesses of the reviewed studies though was not addressed.

To minimize limitations of the systematic review 2, Cochrane’s Risk of Bias tool was utilized, and domain-specific risk of bias was assessed for newly included studies. To avoid bias, two persons conducted independent screening of research results of eligible studies, data extraction, risk of bias assessment, and data checking. In case of any disagreements, the third reviewer was involved. Even though the majority of the studies had serious or very serious drawbacks from which evidence uncertainty stemmed, this limitation could not have been addressed.


Based on the evidence summary, both of these systematic reviews can be considered as support for the selected practice problem of pressure ulcers. The two studies answer the research question to the extent permitted by limitations. These systematic reviews are quite comprehensive and reproducible and have good quality. The expertise appears to be credible, and fairly definitive conclusions which may be further utilized are drawn. Finally, the limitations of both studies are logically tied to the limitations of the research studies reviewed.


  1. Clark, M., Black, J., Alves, P., Brindle, C., Call, E., Dealey, C., & Santamaria, N. (2014). Systematic review of the use of prophylactic dressings in the prevention of pressure ulcers. International Wound Journal, 11(5), 460-471.
  2. Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: A network meta-analysis. PLOS One, 13(2), 1-29.