Journal of tissue viability最新文献_第5页

ADVERTISEMENT - JTV - CONFERENCE 2026 210X280MM 广告- JTV -会议2026 210x280mm

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-07-21 DOI: 10.1016/S0965-206X(25)00089-0

引用次数: 0

Surgical reconstruction (SR) to treat severe pressure ulcers (SPU) in the UK: a mixed-methods analysis of surveys of healthcare professionals 外科重建（SR）治疗严重压疮（SPU）在英国：混合方法分析调查的医疗保健专业人员

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-07-14 DOI: 10.1016/j.jtv.2025.100938

Maria Pufulete , Matthew Hackney , Christalla Pithara-McKeown , Abby O'Connell , Una Adderley , Nicky Cullum , Matthew J. Ridd , Jeremy Rodrigues , Jason KF. Wong , Barnaby C. Reeves , Jo C. Dumville

Background

We surveyed primary and secondary care health professionals to describe the care and referral pathways for treatment, including surgical reconstruction (SR), for patients with a severe pressure ulcer (SPU).

Methods

We administered three online surveys comprising closed and open-ended questions (free text comment boxes) to healthcare professionals working in primary care, nurses who look after patients with severe PUs in any setting and surgeons (11, 30 and 22 questions, respectively). Participants were recruited through professional organisations, contacts of study team members and through social media. We calculated descriptive statistics for the closed questions and used principles of thematic analysis to analyse the free text comments.

Results

There were 59 primary care (76 % GPs), 146 nurse and 45 surgeon respondents. Most nurses worked in hospitals (60 %) or the community (55 %) and almost all (93 %) were trained in wound care. Most surgeons were plastic surgeons (79 %) in consultant roles (81 %). Over half of primary care respondents did not know SR is a treatment option to close SPUs and had never referred patients with SPUs to secondary care for a surgical opinion. Nearly three quarters of nurses (72 %) considered SR for a SPU and over half (54 %) believed that SR to close a SPU should be more widely available. Surgeons reported that SR was not performed for most referred SPU patients; but two thirds (68 %) believed that SR should be more widely available. There was good agreement about which patients are suitable for SR. The free-text analysis identified both system-level (e.g. lack of care pathways, dedicated multidisciplinary teams, resources) and patient-level (e.g. patient lifestyle, behaviour and preferences) factors influencing patients’ access to SR.

Conclusions

Our surveys highlighted that nurses and surgeons agree about which SPU patients are suitable for SR but lack of awareness, the absence of an established referral pathway and lack of multidisciplinary teams are barriers to access to SR.

背景：我们调查了初级和二级保健卫生专业人员，以描述严重压疮（SPU）患者的护理和转诊治疗途径，包括手术重建（SR）。方法我们对从事初级保健工作的卫生保健专业人员、在任何环境中照顾严重脓毒症患者的护士和外科医生进行了三次在线调查，包括封闭式和开放式问题（免费文本评论框）（分别为11、30和22个问题）。参与者是通过专业组织、研究小组成员的联系以及社交媒体招募的。对封闭问题进行描述性统计，并运用专题分析原理对自由文本评论进行分析。结果接受调查的初级保健人员59人（76%为全科医生），护士146人，外科医生45人。大多数护士在医院（60%）或社区（55%）工作，几乎所有护士（93%）都接受过伤口护理培训。大多数外科医生是整形外科医生（79%），担任顾问（81%）。超过一半的初级保健受访者不知道SR是关闭spu的一种治疗选择，也从未将spu患者转介到二级保健以获得手术意见。近四分之三的护士（72%）考虑为SPU提供SR，超过一半（54%）认为应该更广泛地提供关闭SPU的SR。外科医生报告说，大多数转诊的SPU患者没有进行SR；但三分之二（68%）的人认为应该更广泛地提供SR。自由文本分析确定了系统层面（如缺乏护理途径、专门的多学科团队、资源）和患者层面（如患者的生活方式、行为和偏好）影响患者获得SR的因素。结论sour调查强调，护士和外科医生对哪些SPU患者适合SR有共识，但缺乏认识。缺乏既定的转诊途径和缺乏多学科团队是获得SR的障碍。

{"title":"Surgical reconstruction (SR) to treat severe pressure ulcers (SPU) in the UK: a mixed-methods analysis of surveys of healthcare professionals","authors":"Maria Pufulete , Matthew Hackney , Christalla Pithara-McKeown , Abby O'Connell , Una Adderley , Nicky Cullum , Matthew J. Ridd , Jeremy Rodrigues , Jason KF. Wong , Barnaby C. Reeves , Jo C. Dumville","doi":"10.1016/j.jtv.2025.100938","DOIUrl":"10.1016/j.jtv.2025.100938","url":null,"abstract":"<div><h3>Background</h3><div>We surveyed primary and secondary care health professionals to describe the care and referral pathways for treatment, including surgical reconstruction (SR), for patients with a severe pressure ulcer (SPU).</div></div><div><h3>Methods</h3><div>We administered three online surveys comprising closed and open-ended questions (free text comment boxes) to healthcare professionals working in primary care, nurses who look after patients with severe PUs in any setting and surgeons (11, 30 and 22 questions, respectively). Participants were recruited through professional organisations, contacts of study team members and through social media. We calculated descriptive statistics for the closed questions and used principles of thematic analysis to analyse the free text comments.</div></div><div><h3>Results</h3><div>There were 59 primary care (76 % GPs), 146 nurse and 45 surgeon respondents. Most nurses worked in hospitals (60 %) or the community (55 %) and almost all (93 %) were trained in wound care. Most surgeons were plastic surgeons (79 %) in consultant roles (81 %). Over half of primary care respondents did not know SR is a treatment option to close SPUs and had never referred patients with SPUs to secondary care for a surgical opinion. Nearly three quarters of nurses (72 %) considered SR for a SPU and over half (54 %) believed that SR to close a SPU should be more widely available. Surgeons reported that SR was not performed for most referred SPU patients; but two thirds (68 %) believed that SR should be more widely available. There was good agreement about which patients are suitable for SR. The free-text analysis identified both system-level (e.g. lack of care pathways, dedicated multidisciplinary teams, resources) and patient-level (e.g. patient lifestyle, behaviour and preferences) factors influencing patients’ access to SR.</div></div><div><h3>Conclusions</h3><div>Our surveys highlighted that nurses and surgeons agree about which SPU patients are suitable for SR but lack of awareness, the absence of an established referral pathway and lack of multidisciplinary teams are barriers to access to SR.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100938"},"PeriodicalIF":2.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Role understanding of the interprofessional team in promoting movement for pressure ulcer prevention: An ethnographic study 跨专业团队在促进压疮预防运动中的角色理解：一项民族志研究

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-07-05 DOI: 10.1016/j.jtv.2025.100936

Johanna Dreier , Sandra Staudacher-Preite , Hannah Bosshart , Sabine Hübsch , Peter Suter , Eva-Maria Panfil

Background

Interprofessional movement promotion is a key measure for preventing pressure ulcers. Although international guidelines emphasize the importance of interprofessional collaboration, it remains unclear what specific roles different professional groups assume in movement promotion and how they collaborate in clinical practice. Therefore, this study aimed to investigate the implementation of interprofessional movement promotion as well as the understanding, roles, and expectations of the involved healthcare professionals.

Methods

As part of qualitative rapid ethnography, we observed the clinical practice of pressure ulcer prevention in an acute care hospital by using an observation guide, informal interviews, field notes, and memos. Using purposive sampling, we included patients at risk of pressure ulcers and the health professionals caring for them, including nurses, physiotherapists, and physicians. The data analysis was based on interpretive description.

Results

We observed 8 patients at risk of decubitus ulcers with relatives and 52 professionals from nursing, physiotherapy, and the medical profession during 30 observation sequences and a total of 80 h. We found uncertainties in the understanding of roles, responsibility for managing and controlling the process of movement promotion, and the involvement of patients and relatives. The involved professionals are convinced of the importance of interprofessional collaboration, but we did not observe corresponding implementation in practice.

Conclusion

The implementation of interprofessional movement promotion for pressure ulcer prevention in acute-care hospitals requires a binding, cross-hospital concept that defines the team composition, roles, and suitable communication channels to promote exchange.

背景跨专业运动促进是预防压疮的关键措施。尽管国际指南强调跨专业合作的重要性，但不同专业团体在运动促进中扮演的具体角色以及他们如何在临床实践中合作仍不清楚。因此，本研究旨在探讨跨专业运动促进的实施情况，以及相关医护人员对跨专业运动促进的理解、角色和期望。方法作为定性快速人种志的一部分，采用观察指南、非正式访谈、现场记录和备忘录等方法，对某急症护理医院预防压疮的临床实践进行观察。采用有目的的抽样，我们纳入了有压疮风险的患者和照顾他们的卫生专业人员，包括护士、物理治疗师和医生。数据分析基于解释性描述。结果我们观察了8例有可能发生褥疮的患者及其亲属和52名护理、理疗和医疗专业人员，共30个观察序列，共80小时。我们发现在运动促进过程的角色认识、管理和控制责任以及患者和亲属的参与方面存在不确定性。相关专业人士都相信跨专业合作的重要性，但我们并没有在实践中观察到相应的实施。结论急诊医院开展压疮预防跨专业运动推广，需要有一个具有约束力的跨医院理念，明确团队组成、角色和合适的沟通渠道，促进交流。

{"title":"Role understanding of the interprofessional team in promoting movement for pressure ulcer prevention: An ethnographic study","authors":"Johanna Dreier , Sandra Staudacher-Preite , Hannah Bosshart , Sabine Hübsch , Peter Suter , Eva-Maria Panfil","doi":"10.1016/j.jtv.2025.100936","DOIUrl":"10.1016/j.jtv.2025.100936","url":null,"abstract":"<div><h3>Background</h3><div>Interprofessional movement promotion is a key measure for preventing pressure ulcers. Although international guidelines emphasize the importance of interprofessional collaboration, it remains unclear what specific roles different professional groups assume in movement promotion and how they collaborate in clinical practice. Therefore, this study aimed to investigate the implementation of interprofessional movement promotion as well as the understanding, roles, and expectations of the involved healthcare professionals.</div></div><div><h3>Methods</h3><div>As part of qualitative rapid ethnography, we observed the clinical practice of pressure ulcer prevention in an acute care hospital by using an observation guide, informal interviews, field notes, and memos. Using purposive sampling, we included patients at risk of pressure ulcers and the health professionals caring for them, including nurses, physiotherapists, and physicians. The data analysis was based on interpretive description.</div></div><div><h3>Results</h3><div>We observed 8 patients at risk of decubitus ulcers with relatives and 52 professionals from nursing, physiotherapy, and the medical profession during 30 observation sequences and a total of 80 h. We found uncertainties in the understanding of roles, responsibility for managing and controlling the process of movement promotion, and the involvement of patients and relatives. The involved professionals are convinced of the importance of interprofessional collaboration, but we did not observe corresponding implementation in practice.</div></div><div><h3>Conclusion</h3><div>The implementation of interprofessional movement promotion for pressure ulcer prevention in acute-care hospitals requires a binding, cross-hospital concept that defines the team composition, roles, and suitable communication channels to promote exchange.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100936"},"PeriodicalIF":2.4,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effect of core exercises on shoulder rotator strength, core endurance and suprasipinatus structure in tennis players with rotator cuff injuries 核心训练对肩袖损伤的网球运动员肩旋转肌力量、核心耐力和斜上肌结构的影响

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-07-04 DOI: 10.1016/j.jtv.2025.100934

Emine Merve Ersever , Bayram Goktas

Objective

— Tennis is a demanding sport that requires proper physical conditioning to prevent injuries in players with rotator cuff issues. This study aims to evaluate the effects of an eight-week core exercise training program on pain, core endurance, rotator strength, and muscle architecture in rotator cuff tennis players.

Materials and methods

— The study group consisted of 41 subjects (22 women, 19 men) with a mean age of 42.06 ± 8.17. The core exercise group trained with core exercises in addition to routine training 3 times a week for 8 weeks; The control group only performed routine training 3 times a week for the same duration. Assessments of pain, muscle endurance, strength, and architecture were conducted before and after the 8-week intervention.

Results

— Data analysis revealed a significant improvement in the experimental group compared to the control group. This indicates a large effect size (p < 0.05) in pain, muscle strength, endurance, and muscle architecture length (excluding pennation angle).

Conclusions

—The results of this study demonstrate that core exercise training is an effective method for reducing pain and improving functional outcomes in tennis players with rotator cuff lesions. Furthermore, the findings highlight the importance of targeted and comprehensive core stability training in minimizing the risk of re-injury.

目的：网球是一项要求很高的运动，需要适当的身体调节，以防止运动员因肩袖问题受伤。本研究旨在评估为期八周的核心运动训练计划对网球运动员的疼痛、核心耐力、旋转体力量和肌肉结构的影响。材料与方法：研究组共41例，其中女性22例，男性19例，平均年龄42.06±8.17岁。核心训练组在常规训练的基础上进行核心训练，每周3次，持续8周；对照组每周只进行3次常规训练，持续时间相同。在8周干预前后对疼痛、肌肉耐力、力量和结构进行评估。结果-数据分析显示实验组与对照组相比有显著改善。这表明效应量很大(p <；0.05)疼痛，肌肉力量，耐力和肌肉结构长度（不包括笔角）。结论：本研究的结果表明，核心运动训练是减轻肩袖损伤网球运动员疼痛和改善功能结果的有效方法。此外，研究结果强调了有针对性和全面的核心稳定性训练在减少再损伤风险方面的重要性。

{"title":"The effect of core exercises on shoulder rotator strength, core endurance and suprasipinatus structure in tennis players with rotator cuff injuries","authors":"Emine Merve Ersever , Bayram Goktas","doi":"10.1016/j.jtv.2025.100934","DOIUrl":"10.1016/j.jtv.2025.100934","url":null,"abstract":"<div><h3>Objective</h3><div>— Tennis is a demanding sport that requires proper physical conditioning to prevent injuries in players with rotator cuff issues. This study aims to evaluate the effects of an eight-week core exercise training program on pain, core endurance, rotator strength, and muscle architecture in rotator cuff tennis players.</div></div><div><h3>Materials and methods</h3><div>— The study group consisted of 41 subjects (22 women, 19 men) with a mean age of 42.06 ± 8.17. The core exercise group trained with core exercises in addition to routine training 3 times a week for 8 weeks; The control group only performed routine training 3 times a week for the same duration. Assessments of pain, muscle endurance, strength, and architecture were conducted before and after the 8-week intervention.</div></div><div><h3>Results</h3><div>— Data analysis revealed a significant improvement in the experimental group compared to the control group. This indicates a large effect size (p < 0.05) in pain, muscle strength, endurance, and muscle architecture length (excluding pennation angle).</div></div><div><h3>Conclusions</h3><div>—The results of this study demonstrate that core exercise training is an effective method for reducing pain and improving functional outcomes in tennis players with rotator cuff lesions. Furthermore, the findings highlight the importance of targeted and comprehensive core stability training in minimizing the risk of re-injury.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 3","pages":"Article 100934"},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review 绘制证据以确定压力、焦虑和抑郁对糖尿病相关足溃疡患者伤口愈合的影响：一项范围综述

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-07-03 DOI: 10.1016/j.jtv.2025.100935

Lujain Alasfour , Ali Alboloushi , Ellen Kirwan , Caroline McIntosh , Claire MacGilchrist , Joanne E. Hurst

Introduction

Diabetes-related foot ulcers (DFUs) are a severe complication of diabetes, affecting an estimated 6.3 % of individuals globally and significantly increasing healthcare burdens. Psychological factors such as stress, anxiety, and depression are common in DFU patients and are believed to impact wound healing through immune system disruptions and decreased self-care.

Objective

This scoping review evaluates current evidence on the influence of psychological distress on DFU healing, identifies research gaps, and underscores the importance of integrating mental health support in DFU management.

Methods

Following Joanna Briggs Institute guidelines and PRISMA-ScR reporting standards, a comprehensive literature search was conducted in MEDLINE, CINAHL, and PubMed. Studies with adult DFU patients reporting stress, anxiety, or depression and measurable wound outcomes were included.

Results

Ten studies were included, consistently demonstrating that psychological distress impairs DFU healing. Chronic stress was found to extend inflammation and weaken immune function, while anxiety and depression were associated with reduced self-care and directly impaired wound healing, further hindering recovery. These findings highlight the significant impact of psychological factors on the DFU healing process.

Conclusion

psychological distress, including stress, anxiety, and depression, may impair the healing process of diabetes-related foot ulcers (DFUs). However, the evidence is very low quality, making it difficult to draw definitive conclusions. This highlights the need for further high-quality research to clarify the role of mental health in DFU management.

糖尿病相关性足部溃疡（DFUs）是糖尿病的一种严重并发症，全球约有6.3%的人受到影响，并显著增加了医疗负担。压力、焦虑和抑郁等心理因素在DFU患者中很常见，并被认为通过免疫系统破坏和自我保健能力下降影响伤口愈合。目的：本综述评估了目前关于心理困扰对DFU治疗影响的证据，确定了研究空白，并强调了在DFU治疗中整合心理健康支持的重要性。方法按照Joanna Briggs研究所的指南和PRISMA-ScR报告标准，在MEDLINE、CINAHL和PubMed进行全面的文献检索。研究纳入了报告压力、焦虑或抑郁的成人DFU患者和可测量的伤口结局。结果包括10项研究，一致表明心理困扰损害DFU的愈合。研究发现，慢性压力会延长炎症，削弱免疫功能，而焦虑和抑郁会导致自我护理能力下降，直接损害伤口愈合，进一步阻碍康复。这些发现强调了心理因素对DFU愈合过程的重要影响。结论应激、焦虑、抑郁等心理困扰可能影响糖尿病相关性足溃疡的愈合过程。然而，证据质量很低，因此很难得出明确的结论。这突出表明需要进一步进行高质量的研究，以阐明精神健康在DFU管理中的作用。

{"title":"Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review","authors":"Lujain Alasfour , Ali Alboloushi , Ellen Kirwan , Caroline McIntosh , Claire MacGilchrist , Joanne E. Hurst","doi":"10.1016/j.jtv.2025.100935","DOIUrl":"10.1016/j.jtv.2025.100935","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetes-related foot ulcers (DFUs) are a severe complication of diabetes, affecting an estimated 6.3 % of individuals globally and significantly increasing healthcare burdens. Psychological factors such as stress, anxiety, and depression are common in DFU patients and are believed to impact wound healing through immune system disruptions and decreased self-care.</div></div><div><h3>Objective</h3><div>This scoping review evaluates current evidence on the influence of psychological distress on DFU healing, identifies research gaps, and underscores the importance of integrating mental health support in DFU management.</div></div><div><h3>Methods</h3><div>Following Joanna Briggs Institute guidelines and PRISMA-ScR reporting standards, a comprehensive literature search was conducted in MEDLINE, CINAHL, and PubMed. Studies with adult DFU patients reporting stress, anxiety, or depression and measurable wound outcomes were included.</div></div><div><h3>Results</h3><div>Ten studies were included, consistently demonstrating that psychological distress impairs DFU healing. Chronic stress was found to extend inflammation and weaken immune function, while anxiety and depression were associated with reduced self-care and directly impaired wound healing, further hindering recovery. These findings highlight the significant impact of psychological factors on the DFU healing process.</div></div><div><h3>Conclusion</h3><div>psychological distress, including stress, anxiety, and depression, may impair the healing process of diabetes-related foot ulcers (DFUs). However, the evidence is very low quality, making it difficult to draw definitive conclusions. This highlights the need for further high-quality research to clarify the role of mental health in DFU management.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 3","pages":"Article 100935"},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dynamic microcirculation characteristics of plantar skin in response to life-like pressure in diabetes patients 糖尿病患者足部皮肤动态微循环特征对生活压力的响应

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-06-26 DOI: 10.1016/j.jtv.2025.100933

Zhenming Zhang , Xiaoyu Tang , Xiaoming Zhu , Zhaolin Teng , Wen-Ming Chen , Jian Yu , Xin Sun , Qiaoli Cui , Xiang Geng , Xin Ma

Diabetic foot ulcer (DFU) is a severe complication of diabetes associated with high mortality. Elevated plantar pressure and impaired microcirculation are considered as primary contributions to DFU. The International Working Group of Diabetic Foot (IWGDF) has recommended an increase in the level of walking‐related weight‐bearing daily activity by an extra 1000 steps/day, but has not provided specific exercise prescription due to limited data on the relationship between pressure and plantar microcirculation. In this study, we aimed to figure out the influence of cyclic life-like pressure on plantar DFU formation from microcirculation perspective. 20 healthy young subjects, 20 healthy middle-aged and elderly subjects, and 20 diabetes patients were recruited. A novel technique was developed to measure real-time skin blood flow (SBF) under cyclic life-like plantar pressure stimulus at plantar 1st metatarsal head. The exerted plantar force was adjusted from 10N (127.3 kPa) to 40N (509.3 kPa), increasing in an increment of 5N (63.7 kPa). Post-load SBF was measured for comparison after each level of pressure. We found all levels of cyclic pressure significantly increased plantar immediate-load and post-load SBF. Furthermore, a pressure threshold emerged at which the increasing magnitude of immediate-load SBF began to diminish. This altered microcirculatory response may serve as a valuable marker for identifying DFU risk and inform precise exercise prescriptions for patients with diabetes.

糖尿病足溃疡（DFU）是糖尿病的严重并发症，死亡率高。足底压力升高和微循环受损被认为是DFU的主要原因。国际糖尿病足工作组（IWGDF）建议将步行相关的日常负重活动水平增加1000步/天，但由于压力和足底微循环之间关系的数据有限，尚未提供具体的运动处方。本研究旨在从微循环角度探讨类生命循环压力对足底DFU形成的影响。健康青年受试者20名，健康中老年受试者20名，糖尿病患者20名。研究了一种实时测量足底第一跖头在模拟生命压力刺激下皮肤血流量的新技术。施加的足底力由10N （127.3 kPa）调整为40N (509.3 kPa)，增加5N （63.7 kPa）。在每个压力级别后测量加载后的SBF进行比较。我们发现所有水平的循环压力都显著增加了足底立即加载和加载后的SBF。此外，出现了一个压力阈值，在这个压力阈值上，立即荷载SBF的增加幅度开始减小。这种改变的微循环反应可以作为识别DFU风险的有价值的标志，并为糖尿病患者提供精确的运动处方。

{"title":"Dynamic microcirculation characteristics of plantar skin in response to life-like pressure in diabetes patients","authors":"Zhenming Zhang , Xiaoyu Tang , Xiaoming Zhu , Zhaolin Teng , Wen-Ming Chen , Jian Yu , Xin Sun , Qiaoli Cui , Xiang Geng , Xin Ma","doi":"10.1016/j.jtv.2025.100933","DOIUrl":"10.1016/j.jtv.2025.100933","url":null,"abstract":"<div><div>Diabetic foot ulcer (DFU) is a severe complication of diabetes associated with high mortality. Elevated plantar pressure and impaired microcirculation are considered as primary contributions to DFU. The International Working Group of Diabetic Foot (IWGDF) has recommended an increase in the level of walking‐related weight‐bearing daily activity by an extra 1000 steps/day, but has not provided specific exercise prescription due to limited data on the relationship between pressure and plantar microcirculation. In this study, we aimed to figure out the influence of cyclic life-like pressure on plantar DFU formation from microcirculation perspective. 20 healthy young subjects, 20 healthy middle-aged and elderly subjects, and 20 diabetes patients were recruited. A novel technique was developed to measure real-time skin blood flow (SBF) under cyclic life-like plantar pressure stimulus at plantar 1st metatarsal head. The exerted plantar force was adjusted from 10N (127.3 kPa) to 40N (509.3 kPa), increasing in an increment of 5N (63.7 kPa). Post-load SBF was measured for comparison after each level of pressure. We found all levels of cyclic pressure significantly increased plantar immediate-load and post-load SBF. Furthermore, a pressure threshold emerged at which the increasing magnitude of immediate-load SBF began to diminish. This altered microcirculatory response may serve as a valuable marker for identifying DFU risk and inform precise exercise prescriptions for patients with diabetes.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 4","pages":"Article 100933"},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The effect of topical insulin therapy on diabetic foot ulcers: A systematic review and meta-analysis 局部胰岛素治疗对糖尿病足溃疡的影响：系统回顾和荟萃分析

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-06-14 DOI: 10.1016/j.jtv.2025.100932

Shibei Hu , Yan Gong , Huiqi Zhang , Xiujing Guo , Peiyan Li

Aims

To systematically analyze the effect of topical insulin therapy on diabetic foot ulcers and to offer guidance for clinical practice.

Methods

We conducted a quantitative systematic review of the study in 9 representative databases for the effect of topical insulin therapy on diabetic foot ulcers. Meta-analysis was performed with Review-Manager. 5.4. This study has been registered on the official Prospero website, and the registration code is CRD42024581466.

Results

Twelve studies involving 731 patients were included. The meta-analysis results showed that compared with conventional treatment, topical insulin therapy can reduce wound healing time (P < 0.001), and wound area (P < 0.001), inflammatory factors (serum interleukin-1, interleukin-6, tumor necrosis factor-α(P < 0.001), advanced glycation end products (P < 0.001). Additionally, it improved the degree of granulation tissue regeneration (P < 0.001), microvascular density (P < 0.001), vascular endothelial growth factor (P < 0.001), and the expression of β-catenin in wound tissue (P < 0.001). However, there was no statistically significant difference in fasting plasma glucose (P > 0.05).

Conclusion

Topical insulin therapy is effective in promoting wound healing and reducing inflammation in DFU patients, but its impact on blood glucose control remains uncertain. Further, high-quality RCTs are needed to confirm these findings.

目的系统分析外用胰岛素治疗糖尿病足溃疡的效果，为临床提供指导。方法对9个代表性数据库的研究进行定量系统评价，探讨局部胰岛素治疗对糖尿病足溃疡的影响。meta分析采用Review-Manager进行。5.4. 本次研究已在普洛斯彼罗官网注册，注册码为CRD42024581466。结果纳入12项研究，731例患者。meta分析结果显示，与常规治疗相比，外用胰岛素治疗可缩短创面愈合时间(P <；0.001)，伤口面积(P <；0.001)、炎症因子(血清白细胞介素-1、白细胞介素-6、肿瘤坏死因子-α(P <；0.001)，晚期糖基化终产物(P <；0.001)。提高肉芽组织再生程度(P <；0.001)，微血管密度(P <；0.001)，血管内皮生长因子(P <；0.001)，伤口组织中β-catenin的表达(P <；0.001)。但两组空腹血糖差异无统计学意义(P >；0.05)。结论局部胰岛素治疗对DFU患者具有促进创面愈合、减轻炎症的作用，但对血糖控制的影响尚不明确。此外，需要高质量的随机对照试验来证实这些发现。

{"title":"The effect of topical insulin therapy on diabetic foot ulcers: A systematic review and meta-analysis","authors":"Shibei Hu , Yan Gong , Huiqi Zhang , Xiujing Guo , Peiyan Li","doi":"10.1016/j.jtv.2025.100932","DOIUrl":"10.1016/j.jtv.2025.100932","url":null,"abstract":"<div><h3>Aims</h3><div>To systematically analyze the effect of topical insulin therapy on diabetic foot ulcers and to offer guidance for clinical practice.</div></div><div><h3>Methods</h3><div>We conducted a quantitative systematic review of the study in 9 representative databases for the effect of topical insulin therapy on diabetic foot ulcers. Meta-analysis was performed with Review-Manager. 5.4. This study has been registered on the official Prospero website, and the registration code is CRD42024581466.</div></div><div><h3>Results</h3><div>Twelve studies involving 731 patients were included. The meta-analysis results showed that compared with conventional treatment, topical insulin therapy can reduce wound healing time (<em>P</em> < 0.001), and wound area (<em>P</em> < 0.001), inflammatory factors (serum interleukin-1, interleukin-6, tumor necrosis factor-α(<em>P</em> < 0.001), advanced glycation end products (<em>P</em> < 0.001). Additionally, it improved the degree of granulation tissue regeneration (<em>P</em> < 0.001), microvascular density (<em>P</em> < 0.001), vascular endothelial growth factor (<em>P</em> < 0.001), and the expression of β-catenin in wound tissue (<em>P</em> < 0.001). However, there was no statistically significant difference in fasting plasma glucose (<em>P</em> > 0.05).</div></div><div><h3>Conclusion</h3><div>Topical insulin therapy is effective in promoting wound healing and reducing inflammation in DFU patients, but its impact on blood glucose control remains uncertain. Further, high-quality RCTs are needed to confirm these findings.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 3","pages":"Article 100932"},"PeriodicalIF":2.4,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of cuff pressure and protective padding material selection on the prevention of skin complications associated with pneumatic tourniquet application in upper extremity surgery: A randomized controlled clinical trial 一项随机对照临床试验：袖带压力和保护性填充物选择对预防上肢手术中气动止血带应用相关皮肤并发症的影响

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-06-14 DOI: 10.1016/j.jtv.2025.100931

Sevgi Vermisli Ciftci , Zeki Gunsoy , Fatma Demir Korkmaz

Purpose

This study investigated the effect of cuff pressure and the selection of protective padding material (PPM) on the prevention of skin complications associated with pneumatic tourniquet (PT) application in upper extremity surgery.

Methods

This randomized controlled trial was conducted between October 2022 and September 2023 at the Hand Surgery Clinic of Bursa City Hospital. Standard tourniquet pressure (STP) or limb occlusion pressure (LOP) was applied as PT cuff pressure. Cotton pad (CP) or elastic stockinette (ES) was used for PPM under the cuff. Patients were categorized into four groups; (i) STP with a CP; (ii) STP with an ES; (iii) LOP with a CP; and (iv) LOP with an ES. Total of 200 patients were included in the study, with 50 patients in each group. Skin complications were evaluated postoperatively at 0, 30, and 180 min.

Results

Four different skin complications were observed: redness, tourniquet scar, petechiae, and bullae. Redness was higher at 0 min in the group with STP using a CP and at 30 min in the group with LOP using an ES. Tourniquet scar was less in the LOP using an ES at 0 and 30 min. Petechiae was more in the STP group with the CP than in the LOP group at 180 min. Bullae were more in the group with STP using a CP at 0, 30, and 180 min.

Conclusion

LOP for the purposes of cuff pressure and the use of an ES as a PPM are recommended to reduce skin complications associated with PT application.

The CTRN

2022–12/5(ClinicalTrials.gov).

目的探讨臂套压力和保护垫材料（PPM）的选择对预防上肢手术中使用气动止血带（PT）相关皮肤并发症的影响。方法本随机对照试验于2022年10月至2023年9月在布尔萨市医院手外科诊所进行。PT袖带压力采用标准止血带压力（STP）或肢体闭塞压力（LOP）。棉垫（CP）或弹性短袜（ES）用于袖带下的PPM。患者分为四组；(i)具有CP的STP；（ii）具有ES的STP；（iii）具有CP的LOP；（iv）带有ES的LOP。本研究共纳入200例患者，每组50例。结果观察到4种不同的皮肤并发症：红肿、止血带疤痕、瘀点、大疱。STP组在0分钟使用CP， LOP组在30分钟使用ES，红度更高。在0和30分钟时，使用ES的LOP组止血带疤痕较少。在180分钟时，使用CP的STP组比使用LOP组有更多的瘀点。在使用CP的STP组中，在0、30和180分钟时，使用CP的STP组中有更多的大疱。结论建议使用LOP用于袖带压力和使用ES作为PPM以减少与PT应用相关的皮肤并发症。CTRN2022-12/5 (ClinicalTrials.gov)。

{"title":"Effect of cuff pressure and protective padding material selection on the prevention of skin complications associated with pneumatic tourniquet application in upper extremity surgery: A randomized controlled clinical trial","authors":"Sevgi Vermisli Ciftci , Zeki Gunsoy , Fatma Demir Korkmaz","doi":"10.1016/j.jtv.2025.100931","DOIUrl":"10.1016/j.jtv.2025.100931","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated the effect of cuff pressure and the selection of protective padding material (PPM) on the prevention of skin complications associated with pneumatic tourniquet (PT) application in upper extremity surgery.</div></div><div><h3>Methods</h3><div>This randomized controlled trial was conducted between October 2022 and September 2023 at the Hand Surgery Clinic of Bursa City Hospital. Standard tourniquet pressure (STP) or limb occlusion pressure (LOP) was applied as PT cuff pressure. Cotton pad (CP) or elastic stockinette (ES) was used for PPM under the cuff. Patients were categorized into four groups; (i) STP with a CP; (ii) STP with an ES; (iii) LOP with a CP; and (iv) LOP with an ES. Total of 200 patients were included in the study, with 50 patients in each group. Skin complications were evaluated postoperatively at 0, 30, and 180 min.</div></div><div><h3>Results</h3><div>Four different skin complications were observed: redness, tourniquet scar, petechiae, and bullae. Redness was higher at 0 min in the group with STP using a CP and at 30 min in the group with LOP using an ES. Tourniquet scar was less in the LOP using an ES at 0 and 30 min. Petechiae was more in the STP group with the CP than in the LOP group at 180 min. Bullae were more in the group with STP using a CP at 0, 30, and 180 min.</div></div><div><h3>Conclusion</h3><div>LOP for the purposes of cuff pressure and the use of an ES as a PPM are recommended to reduce skin complications associated with PT application.</div></div><div><h3>The CTRN</h3><div>2022–12/5(ClinicalTrials.gov).</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 3","pages":"Article 100931"},"PeriodicalIF":2.4,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A health economic analysis of ‘A novel implementation of best evidence practice for incontinence-associated dermatitis’ (IMBED) “失禁相关性皮炎最佳证据实践的新实施”（IMBED）的卫生经济学分析

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-06-07 DOI: 10.1016/j.jtv.2025.100930

Michelle Cunich , Michelle Barakat-Johnson , Sheena Arora , Jody Church , Michelle Lai , John Stephenson , Shifa Basjarahil , Jayne L. Campbell , Gary Disher , Samara Geering , Natalie Ko , Catherine Leahy , Thomas Leong , Eve McClure , Melissa O'Grady , Joan Walsh , Kate White , Fiona Coyer

Aim

To assess resource usage and other outcomes of implementing a bundle of evidence-based, clinician-led incontinence-associated dermatitis interventions, ‘IMBED’ intervention.

Methods

Patients with incontinence recruited from 6 public hospitals in Australia in pre-intervention (1 February-31 March 2020) and post-intervention periods (1 May-30 June 2021). For the health economic study, nurses/research officers recorded resource usage for a random sample of incontinence care episodes each week.

Results

799 patients with incontinence (9645 incontinence care episodes). There were significant differences in the proportion of incontinence care episodes using specific product-types between the pre- and post-intervention groups, with the greatest increase for treatment/prevention products (55.2 % versus 82.8 %; p < 0.001) and decrease for underpads/bed pads (28.5 % versus 12.9 %; p < 0.001). There was a significant decrease in mean total product cost per incontinence care episode between these groups (AU$2.64 versus AU$2.35; p < 0.001). There was a significant increase in mean staff cost per incontinence care episode between these groups (AU$9.65 versus AU$10.09; p = 0.001), driven by increases in the mean number of staff and time spent per episode. There was an increase in mean total cost per incontinence care episode (AU$0.15) between these groups but not significant (p = 0.344).

Conclusion

There was a significant decrease in mean total product cost per incontinence care episode in the intervention group. There was no significant change in mean total incontinence care cost per episode associated with the intervention, suggesting hospitals adopted IMBED with minimal extra expenses. There was streamlined resource usage and reductions in products not supported by evidence-based guidelines.

目的评估实施一系列循证临床主导的尿失禁相关性皮炎干预措施（“IMBED”干预）的资源使用情况和其他结果。方法在干预前（2020年2月1日至3月31日）和干预后（2021年5月1日至6月30日）从澳大利亚6家公立医院招募尿失禁患者。在卫生经济研究中，护士/研究人员每周随机记录尿失禁护理事件的资源使用情况。结果799例尿失禁患者（尿失禁护理发作9645次）。在干预前和干预后两组中，使用特定产品类型的尿失禁护理事件的比例存在显著差异，治疗/预防产品的增幅最大(55.2%对82.8%；p & lt;0.001)，护垫/床垫减少(28.5%对12.9%；p & lt;0.001)。两组患者每次尿失禁护理的平均总产品成本显著降低(2.64澳元对2.35澳元；p & lt;0.001)。在这些组之间，每次尿失禁护理的平均员工成本显著增加(9.65澳元对10.09澳元；P = 0.001)，这是由于平均工作人员数量和每集花费的时间增加所致。这些组之间每次尿失禁护理的平均总费用（0.15澳元）有所增加，但不显著（p = 0.344）。结论干预组每次尿失禁护理的平均总产品成本显著降低。与干预相关的每次发作的平均尿失禁总护理费用没有显著变化，表明医院采用IMBED的额外费用最小。精简了资源使用并减少了未得到循证指南支持的产品。

{"title":"A health economic analysis of ‘A novel implementation of best evidence practice for incontinence-associated dermatitis’ (IMBED)","authors":"Michelle Cunich , Michelle Barakat-Johnson , Sheena Arora , Jody Church , Michelle Lai , John Stephenson , Shifa Basjarahil , Jayne L. Campbell , Gary Disher , Samara Geering , Natalie Ko , Catherine Leahy , Thomas Leong , Eve McClure , Melissa O'Grady , Joan Walsh , Kate White , Fiona Coyer","doi":"10.1016/j.jtv.2025.100930","DOIUrl":"10.1016/j.jtv.2025.100930","url":null,"abstract":"<div><h3>Aim</h3><div>To assess resource usage and other outcomes of implementing a bundle of evidence-based, clinician-led incontinence-associated dermatitis interventions, ‘IMBED’ intervention.</div></div><div><h3>Methods</h3><div>Patients with incontinence recruited from 6 public hospitals in Australia in pre-intervention (1 February-31 March 2020) and post-intervention periods (1 May-30 June 2021). For the health economic study, nurses/research officers recorded resource usage for a random sample of incontinence care episodes each week.</div></div><div><h3>Results</h3><div>799 patients with incontinence (9645 incontinence care episodes). There were significant differences in the proportion of incontinence care episodes using specific product-types between the pre- and post-intervention groups, with the greatest increase for treatment/prevention products (55.2 % versus 82.8 %; p < 0.001) and decrease for underpads/bed pads (28.5 % versus 12.9 %; p < 0.001). There was a significant decrease in mean total product cost per incontinence care episode between these groups (AU$2.64 versus AU$2.35; p < 0.001). There was a significant increase in mean staff cost per incontinence care episode between these groups (AU$9.65 versus AU$10.09; p = 0.001), driven by increases in the mean number of staff and time spent per episode. There was an increase in mean total cost per incontinence care episode (AU$0.15) between these groups but not significant (p = 0.344).</div></div><div><h3>Conclusion</h3><div>There was a significant decrease in mean total product cost per incontinence care episode in the intervention group. There was no significant change in mean total incontinence care cost per episode associated with the intervention, suggesting hospitals adopted IMBED with minimal extra expenses. There was streamlined resource usage and reductions in products not supported by evidence-based guidelines.</div></div>","PeriodicalId":17392,"journal":{"name":"Journal of tissue viability","volume":"34 3","pages":"Article 100930"},"PeriodicalIF":2.4,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The role of digital health interventions in chronic ulcer management: a systematic review 数字健康干预在慢性溃疡管理中的作用：系统综述

IF 2.4 3区医学 Q2 DERMATOLOGY

Journal of tissue viability

Pub Date : 2025-05-24 DOI: 10.1016/j.jtv.2025.100928

Elise Stevenson , Andrea Coda , Ginger Chu , Michael Bourke

引用次数: 0