Journal of wound care最新文献

Objective: This study aimed to investigate whether application of autologous platelet-rich plasma (PRP) at split-thickness skin grafting (STSG) donor sites in patients with burns can promote wound healing.

Method: A randomised crossover clinical trial was conducted involving participants, each with a donor site divided into two equal-sized areas for application of PRP and Vaseline gauze (VG) or with VG alone. Wound healing progress was evaluated at days 14, 21 and 30 postoperatively by measuring the healed area and comparing it between the PRP and VG groups.

Results: The study included 20 participants, equally divided into the two groups. Both groups demonstrated significant improvement throughout the study period. The PRP group demonstrated a statistically significant acceleration in wound healing compared to the control group, at days 14 and 21 postoperatively. However, at 30 days' postoperatively, there was no statistically significant difference in healed area between the two groups.

Conclusion: The findings of this study suggest that PRP has the potential to expedite the healing process and may help reduce hospital stay and wound infection rates, even though it did not result in a significantly larger overall healed area. The decision to use PRP should take into account various factors including resources, costs and desired clinical outcomes. Future research is needed to elucidate the role of PRP in the treatment of donor wounds.

Objective: To evaluate the effectiveness of telemedicine in home healthcare for patients with diabetic foot ulcers (DFUs) on wound healing time, wound score and patient self-management.

Method: Participants with DFUs were randomly assigned to either the study group (telemedicine in home healthcare) or to the control group (outpatient face-to-face care). Time to wound healing was identified as the primary outcome.

Results: Overall, 74 patients were randomised, and 64 patients were included in the study in the per-protocol analysis (32 patients in the study group and 32 patients in the control group). No significant difference was found in wound healing time between the two groups. Following eight weeks of treatment, there was also no difference in wound score between the two groups. However, the study group showed improved self-management of DFUs compared to the control group.

Conclusion: In this study, the use of telemedicine in home healthcare for patients with DFUs showed promising results in promoting wound healing, which was comparable to the effects of outpatient face-to-face care. Additionally, it was found to enhance self-management behaviour among patients with DFUs, indicating positive development prospects for this approach. In the future, it would be beneficial to explore the potential of developing a smartphone app specifically designed for wound care to enhance the effectiveness of telemedicine-based hard-to-heal (chronic) wound care services.

Objective: While the assessment of scientific research output is common, pressure ulcer (PU) research lacks a comprehensive global survey. This study aimed to evaluate the volume and impact of worldwide PU publications from 2015-2024, as well as delineate global scientific production characteristics.

Method: Original articles and reviews concerning PUs published between 2015-2024 were retrieved from the Web of Science database. Data extracted for each contributing nation included total publication count, publications per capita and per gross domestic product (GDP), total citations and mean number of citations per article. Countries were categorised by income level and geographical region.

Results: The survey identified 7461 publications, with a significant upward trajectory in annual output (p<0.001). East Asia, North America and Western Europe were the most productive regions. High-income economies contributed the substantial majority (72.36%) of articles. The US led in absolute publication volume (1816 articles, 24.34%) and total citations (39,870). When normalised, Turkey ranked highest for number of publications per $100 billion USD GDP (24.41), while Australia led on number of publications per 10 million population (140.29). Canada achieved the highest mean number of citations per paper (27.33). A significant positive correlation was observed between numbers of publications and national GDP (r=0.574; p=0.010), but not with population size (r=0.366; p=0.132).

Conclusion: Global research output on PUs has markedly increased over the past decade, predominantly driven by high-income nations. The US is the leading contributor in absolute terms, whereas countries such as Australia and Turkey exhibit strong relative productivity. National economic status significantly correlated with research contributions in this domain.

Objective: Despite the global shift in delegating greater responsibilities, including pressure ulcer (PU) prevention, to healthcare support workers (HCSWs), their experiences and perspectives are often under-represented in research. The aim of this study was to explore HCSWs' experiences and perspectives in PU prevention when delivering patient care.

Method: A generic qualitative research was used. Between March and June 2021, four focus groups were conducted via Zoom (Zoom Corp., US) with HCSWs working in different clinical settings. The focus groups explored HCSWs' experiences and perspectives into PU prevention, including their roles, challenges and areas requiring improvement. Data were analysed using thematic analysis.

Results: The research included 14 participants: three trainee nursing associates (acute n=2, community n=1) and one nursing associate from acute settings; and 10 healthcare assistants from acute (n=4), community (n=2), domiciliary care (n=3) and mental health (n=1). Participants demonstrated strong commitment to PU prevention, driven by their compassion and a genuine desire to alleviate patient suffering. Participants discussed challenges to effective PU prevention, including: lack of knowledge; skills; staff shortages; excessive workloads; and inconsistent practices. They stressed the critical role of teamwork and communication with patients and families for successful PU prevention. There was a strong call for structured training to enhance their knowledge and skills, advocating for mandatory, comprehensive and recurrent training for all involved in patient care.

Conclusion: The findings highlighted the critical role of HCSWs in PU prevention within the current healthcare workforce model. They identified challenges and emphasised the need for structured training and support to fortify the contributions to effective PU prevention made by HCSWs.

Objective: To evaluate the incremental cost-effectiveness and cost-utility ratios (ICER; ICUR) of a single-layer high compression bandage (SLHCB) compared with Unna's boot (UB) from the perspective of the Brazilian healthcare system, with a time horizon of 26 weeks.

Method: A health economic evaluation of data from a prospective, randomised, open blinded endpoint study was conducted in 22 primary healthcare services in Porto Alegre city, Brazil, with patients with venous leg ulcers (VLUs) who were randomly allocated to receive SLHCB or UB. Participants were followed until VLU healing or up to 26 weeks. Nurses performed dressings weekly and blinded examiners measured the VLU size by planimetry at baseline and every two weeks. The Short Form-6 Dimensions questionnaire was applied at baseline and on the last day of follow-up to measure quality-adjusted life years (QALYs). The ICER and ICUR were estimated, and probabilistic sensitivity analyses performed.

Results: A total of 61 participants were enrolled in the trial, corresponding to 110 VLUs. SLHCB incurred an average expenditure of R$1118.74 (I$442.19) per VLU, while UB incurred R$1078.74 (I$426.38) per VLU. SLHCB exhibited a mean VLU reduction of 64.82% compared with 27.56% for UB. The mean QALY for SLHCB was 0.187 and 0.164 for UB. The ICER was 1.07 (0.42) per percentage point of VLUs healed and the ICUR was 1739.13 (687.40) per QALY gained.

Conclusion: In this study, SLHCB was cost-effective when compared with UB. These findings may prompt decision-makers to weigh the prospect of allocating an additional R$1.07 (I$0.42) for each percentage point reduction in VLU area or R$1739.13 (I$687.40) per QALY gained. This financial consideration holds significant implications for guiding resource allocation.

Objective: To evaluate the performance and safety of Biatain Fiber Ag (Coloplast A/S, Denmark), a new gelling fibre wound dressing containing silver, in venous leg ulcers (VLUs) after four weeks of treatment.

Method: This non-comparative, one-armed, open-labelled study included patients from two sites (clinics or community nursing caseloads) in the UK between February and May 2024. The primary endpoint was relative wound area reduction (WAR) after four weeks of treatment. Adverse events (AEs) were also assessed.

Results: In total, 50 patients with VLUs either infected or at risk of infection, and with medium-to-high levels of exudate, were included in the intention-to-treat (ITT) population. Of these, 45 patients completed the investigation on treatment and five patients discontinued the treatment. In the primary analysis, the estimated mean relative WAR after four weeks was 46.3% (95% confidence interval (CI): 36.5, 56.2%) in the full analysis set (n=49). In the sensitivity analysis based on the ITT population, it was 43.9% (95% CI: 33.1, 54.7%). In total, three AEs were found to be related to the investigational device; all were non-serious.

Conclusion: In this study, treatment of VLUs with the investigational device showed that the mean relative WAR after four weeks of treatment was 46.3%. This reduction in wound area is comparable to the performance of other silver-containing wound dressings. In addition, the results of this clinical investigation revealed no safety concerns. Thus, the study demonstrated that the investigational device is both a safe dressing and one that performs as intended to facilitate VLU healing.

Approximately 1% of skin cancers occur secondary to chronic inflammation, and approximately 95% of these are squamous cell carcinomas (SCC) with a metastasis rate of 20-30%. This case report describes the treatment of a 38-year-old male patient with paraplegia and with a history of operated meningomyelocele and congenital hip dysplasia who was admitted to the emergency service of the Basaksehir Cam ve Sakura City Hospital (Istanbul, Turkey) with complaints of bleeding, discharge and pain from a hard-to-heal (chronic) pressure ulcer (PU) in the right gluteal region. The patient had a haemorrhagic and ulcero-vegetant mass/wound of approximately 20×20cm with vegetative satellite lesions located in the right gluteal region extending to the sacral region. Acinetobacter baumannii was growing in the wound culture and appropriate antibiotherapy was initiated followng the recommendation of the infectious diseases clinic. The patient was started on a protein-rich diet, with parenteral paracetamol and non-steroid anti-inflammatory drugs for wound care and pain relief. Pathological examination of the tissue biopsy detected SCCs. According to the pelvic magnetic resonance imaging and positron emission tomography-computed tomography results, the mass was considered inoperable and radiotherapy was administered for wound palliation with the help of the radiation oncology clinic. After 13 sessions of radiotherapy, haemorrhage of the ulcer ceased and the mass showed minor regression. This case report demonstrates that it is important to follow-up on patients with hard-to-heal PUs who are fully or partially bedbound. This can be performed by home health services or family physicians in primary care. If the treatment process is prolonged in palliative care patients with hard-to-heal wounds, requesting further examinations when malignant transformations are observed may create the opportunity for an early diagnosis, which can improve their quality of life. Declaration of interest: The authors have no conflict of interest.