Wound management & prevention最新文献

Background: Persons with diabetes often face significant foot problems due to inadequate foot care, and foot care training programs could be beneficial for these patients.

Purpose: To examine the effects of diabetic foot care training on self-efficacy and adaptation based on Social Cognitive Theory and the Roy Adaptation Model.

Methods: In this randomized controlled study, 80 patients treated in the endocrine polyclinic of an education and research hospital in İzmir, Turkey, were randomized to intervention (n = 40) or control (n = 40). The intervention group received diabetic foot care training at 1 month, 3 months, and 6 months. Using a diabetic foot model, foot care training was given on diabetic foot care practices; in addition, a foot care training booklet prepared by the researchers was provided. Foot care behaviors, self-efficacy, and adaptation were reevaluated after the training and education. Data were collected at baseline, 1 month, 3 months, and 6 months in both groups.

Results: Diabetic foot care training and telephone follow-up were effective in improving foot care behaviors and facilitating the coping and adaptation process of individuals with diabetes, as well as in increasing their self-efficacy regarding foot care.

Conclusions: When providing theory-based diabetic foot education, the use of visual materials along with verbal instruction as well as telephone follow-ups to evaluate training effectiveness increases patients' self-efficacy and adaptation.

Objective: To evaluate the efficacy of recombinant human epidermal growth factor (rhEGF) in healing pressure injuries (PIs).

Methods: A meta-analysis was conducted of randomized controlled trials (RCTs) involving rhEGF in the treatment of PIs that were identified in PubMed, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure (CNKI). The population, intervention, comparison, outcomes, study design (PICOS) strategy was applied to determine analysis eligibility. The Cochrane risk of bias tool was used, and statistical analysis, including sensitivity analysis, was performed of 3 outcomes indicators: the primary outcome was total efficacy of rhEGF in treating PIs, and the secondary outcomes were the proportion of complete healing and the time to complete healing. Total efficacy refers to the proportion of cases that have been cured, obviously effective, or effective. Complete healing refers to cases where the wound has healed, scabbed, and the scab has sloughed off.

Results: Sixteen RCTs were included, comprising a total of 1,206 patients. Study and control group size varied by outcomes. The total effective healing rate in rhEGF group was 97.18%, which was significantly higher than 83.38% in control group (OR: 5.69, [95% CI: 3.61, 8.97], z=7.49, P < .001). The proportion of complete healing in the rhEGF group was 73.30%, which was higher than 39.52% in control group (OR: 3.88, [95% CI: 3.01, 5.01], z=10.39, P < .001). Furthermore, the healing time using rhEGF was shorter (SMD: -2.14 days, [95% CI: -2.60, -1.67], z=9.07, P < .001). Sensitivity analyses indicated that the results were robust.

Conclusions: The meta-analysis indicated that rhEGF was effective in healing PIs with few negative effects. Further research beyond Chinese populations involving larger studies and studies that distinguish between results found in using rhEGF alone or in combination are recommended.

Background: Incontinence-associated dermatitis (IAD) is one of the most common complications of incontinence. Improved diaper designs can minimize the occurrence of IAD.

Purpose: To develop a novel diaper design to minimize the damaging effects of incontinence on the epidermal barrier.

Methods: An optimized diaper design was tested for surface dryness (ie, rewet), maintenance of a skin-adapted surface pH of 5.5, and ability to protect epidermal barrier function from an alkaline pH 10.7 challenge.

Results: The diapers released a mean (standard deviation [SD]) of 1.2 (0.2) mg/cm2 of solution under pressure after the first loading and a mean of 2.9 (1.7) mg/cm2 after the second loading. The surface pH remained between 4.5 and 5.5 over 5 hours. In healthy skin, transepidermal water loss (TEWL) increased by a mean of 3.43 (4.67) g/m2/h after the alkaline urine solution challenge with the new diaper design versus a mean of 8.38 (5.67) g/m2/h with a cellulose patch (P < .001) as a control. The mean erythema readings were 1.18 (1.30) g/m2/h for the new design and 2.56 (1.25) g/m2/h for the cellulose patches (P < .001).

Conclusion: The new diaper design minimizes rewetting, maintains an acidic surface, and protects the epidermal barrier against an alkaline pH challenge. This design may help prevent IAD.

Background: As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment.

Objective: To compare patient demographics, treatments, and outcomes in COVID-19 symptomatic patients who developed skin lesions (COVID-19 or hospital-acquired pressure ulcer/injury [HAPU/I]) during the first year of the pandemic.

Methods: A retrospective chart review was conducted on COVID-positive symptomatic patients admitted from March 1, 2020, through March 1, 2021. The authors analyzed the difference in patient demographics, patient skin tones, treatments, hospital length of stay (LOS), intensive care unit (ICU) LOS, death, and discharge disposition for those with COVID-19 lesions compared to those who developed HAPU/Is.

Results: Of those who developed lesions, 2.3% developed COVID-19 lesions and 7.2% developed HAPU/Is. Patients with COVID-19 lesions were more likely to be male (64%), younger (median age 60), and had a higher BMI (30) than patients with no wounds and patients with HAPU/I.

Conclusion: This study advances the knowledge of the patient demographics and treatments that may contribute to identifying the new phenomenon of COVID lesions and how they differ from HAPU/Is.

Background: Hyperbaric oxygen therapy (HBOT), in which patients receive high concentrations of oxygen in a pressurized chamber, has been used in clinical practice to improve wound healing. More recent applications of HBOT have resulted in successful management of a wide range of conditions; however, the psychosomatic factors associated with these conditions remain understudied and require clarification.

Purpose: To investigate the effects of HBOT in a female patient without diabetes who presented with an atypical wound of 9 years' duration with no sign of healing as well as with psychosomatic factors.

Case report: The patient underwent 20 once-daily sessions of HBOT for 120 minutes per session every Monday through Friday for 4 weeks at 2.4 ATA (atmosphere absolute pressure) and received daily dressing changes with a nonadherent dressing containing silver, alginate, and carboxymethylcellulose. The 36-Item Short Form Health Survey and the Hospital Anxiety and Depression Scale quality-of-life questionnaires were administered before treatment and after 1 year of treatment. HBOT resulted in complete lasting wound remission as well as subjective improvement in quality of life and in levels of anxiety and depression.

Conclusion: HBOT has known therapeutic effects on wound healing, and it may also have a substantial effect on psychosomatic mechanisms.

Background: Pressure injuries result from prolonged pressure and lead to tissue damage, infections, extended recovery times, and an economic burden.

Purpose: To explore risk factors for pressure injuries in patients who underwent surgery under general anesthesia.

Methods: This retrospective study included patients who underwent surgery at a regional educational hospital in southern Taiwan from January 1, 2018, through December 31, 2018.

Results: A comprehensive multivariate analysis was used to identify the prominent risk factors for pressure injury among the 11 231 patients enrolled in this study. These risk factors were an age of ≥65 years; surgery duration of >120 minutes; diastolic blood pressure of <60 mm Hg for >30 minutes during surgery; intraoperative use of dopamine, norepinephrine, or epinephrine as vasopressors; American Society of Anesthesiologists physical classification of III or higher; minimum intraoperative body temperature of ≤35°C; blood loss of >500 mL; and a supine or prone surgical position.

Conclusions: This study identified several pressure injury risk factors related to surgical conditions and patient characteristics. Surgical teams must monitor, control, and manage these factors, prioritize staff education, and adopt preventive protocols.

Background: Older patients with diabetes have behaviors and practices in foot care that differ from those of younger patients. There is a need for a tool to assess the foot care of patients with diabetes who are over the age of 65 years.

Purpose: This study aimed to assess the validity and reliability of the long and short versions of the Foot Care Scale for Older Diabetics (FCS-OD) in Turkish society.

Methods: A total of 172 older patients with diabetes participated in the study. Language validity, content validity, construct validity, Cronbach's alpha coefficient value, item-scale correlations, parallel form reliability, and test-retest correlations were used to assess the Turkish version of FCS-OD. A patient identification form, FCS-OD, Diabetic Foot Care Self-Efficacy Scale, and Foot Self-Care Behavior Scale were used for data collection.

Results: Turkish versions of the FCS-OD, both short and long versions, were at acceptable levels regarding their content (content validity index: 0.964, 0.975) and construct (factor loadings > 0.4). Both versions of the scale showed a high level of internal consistency as demonstrated by Cronbach's alpha values (short version, 0.802; long version, 0.905) and item-scale correlations (> 0.3). Both versions of the scale were stable over time and compared to the parallel forms.

Conclusions: Both versions of the scale were found to be valid and reliable for Turkish society with regard to psychometric properties.

Background: Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on outpatient and inpatient care settings. This burden is expected to increase markedly in the United States as the population ages and with increased rates of diabetes, obesity, and COVID-19.

Purpose: To articulate the effect of chronic, hard-to-heal wounds on acute care facilities, and how a few days of inpatient care can have a significant effect on the healing trajectory.

Methods: An expert panel of 7 members, all with extensive knowledge and experience in the assessment and treatment of chronic wounds in an acute care setting, was convened in March 2022. The panel discussed the role of hospitals as part of the longer-term healing pathway of chronic wounds.

Results: Chronic wounds have a significant effect on hospitals that includes unseen costs, bed occupancy, demands on bedside nurses, and wound complications that lead to extended stays or readmissions. A successful inpatient wound program offers appropriate identification of previously undiagnosed wounds, elevation of bedside care through simplified protocols, quickly and easily understood education and easy dressing selection, and comprehensive discharge planning with a multidisciplinary team for continuity of care and reduced risk of readmission.

Conclusion: Hospitals can play a key role in the management of chronic wounds, thus reducing the effect on each facility and the wider care network.

Background: The attitudes of nurses should be measured using valid and reliable tools to develop effective nursing care strategies for the prevention of medical device-related pressure injuries and to organize necessary training programs.

Purpose: This study was planned to conduct the Turkish validity and reliability study of the Attitude towards Medical Device-Related Pressure Ulcers/Injuries Questionnaire (MDRPU/I Questionnaire (the English-language version)) in nurses.

Methods: This methodological study included 134 nurses working in hospitals of different sizes and characteristics (public hospitals, training and research hospitals, and university hospitals) in Turkey. The validity and reliability of the Attitude Towards Medical Device-Related Pressure Injuries (MDRPI Questionnaire (the Turkish-language version)) Questionnaire were tested using language validity, content validity, face validity, construct validity, and reliability analyses.

Results: The final version of the questionnaire had a content validity index of 98.03%, sufficient construct validity, and a Cronbach α value of 0.92 for the total questionnaire.

Conclusions: The Turkish version of the MDRPI Questionnaire is valid, reliable, and suitable for measuring the attitudes of nurses in Turkey toward the prevention and care of medical device-related pressure injuries.

Background: Chronic ulcers represent a significant challenge for patients with compromised microcirculation. As a novel branch of research, catalytic nanomedicine has exhibited promising outcomes with the development of nanostructured composites designed to disinfect and improve the healing of chronic wounds through the incorporation of bionanocatalysts within gel matrices.

Purpose: This study aimed to assess the impact of bionanocatalysts on 4 patients suffering from chronic venous ulcers, which had previously been indicated for lower extremity amputation.

Methods: Bionanocatalysts were synthesized and incorporated into a gel matrix. Monthly debridement was conducted with the objective of completely removing nonviable tissue. The bionanocatalyst-embedded gel was applied every other day, covering the entire wound surface and secured with a secondary dressing.

Results: Encouragingly, all cases exhibited complete wound closure, and patients reported no adverse side effects.

Conclusion: These findings offer robust support for the utilization of this technology in wound healing and prompt a reevaluation of the hypothesis regarding the mechanism of action of bionanocatalysts in chronic wounds. Future research endeavors should aim to quantitatively assess the bionanocatalysts' influence on the trajectory of wound healing, as well as address the myriad challenges associated with managing chronic wounds.