Wound management & prevention最新文献

"OBJECTIVE: The aim of the study was to comparatively evaluate the in vivo interphase pressure (IP) and statis stiffness index (SSI), upon initial application, of 7, 2-layer cohesive bandage kits when applied on healthy volunteers.

Method: Bandages were applied in random order, on non-consecutive days by a single experienced clinician. The IP at the time of application was measured on the right lower limb of 10 healthy volunteers at 2 different points (B1, C). Measurements were made in 2 positions, supine and standing. There were 2 consecutive applications and measurements made for each compression bandage set. Statistical analysis of the outcome data was performed, utilizing a repeated measures analysis of variance (ANOVA) to determine: the effects of the bandage type on IP and SSI for each of the measurement points and according to the subject's position. Post hoc analyses were performed by Tukey and Bonferroni test to identify significant differences. The dispersion of the recorded pressures within the study population (dispersion between subjects) was assessed by the coefficient of variations.

Results: The in vivo IP measured at B1 in the supine position varied from 50.1 mmHg (±5.3) to 73.7 mmHg (±13.4). The in vivo IP measured at C in the supine position varied from 53.2 mmHg (±7.6) to 69.3 mmHg (±10.6). Bonferroni post hoc analyses demonstrated with a 95% confidence interval, there was a significant difference between wraps and placed them into 5 groups for the IP measured at B1, and 3 groups for measurements taken at C. A regression model including the main effects of the wrap and the subject with their interaction were similar for the IP observed at B1 and C in the supine position (r2 = 0.881). The in vivo SSI measured at B1 varied from 11.95 (±5.4) to 6.65 (±4.4). Post hoc analyses similarly demonstrated significant differences placing the wraps into 3 different groups. Statistical analysis of the variability of the IP observed at B1 and C showed there was a significant difference at B1 (P = .001), which was not observed at C (P = .347).

Conclusion: Sub-bandage pressure measurements produced by the 7, '2-layer cohesive' compression box sets were not equivocal. IP and SSI varied by textile composition, clinically supporting the trial of alternative '2-layer cohesive' compression box set if the desired outcome (ie, wound healing, edema reduction) is not achieved. Additional study in patients with edema is warranted to allow an evidenced-based approached to the selection of a compression bandage set.

Background: Use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) can assist with wound bed preparation for successful closure. The authors present their experience using NPWTi-d to manage lower extremity wounds in 4 patients and discuss the feasibility of improving cost efficiency.

Methods: NPWTi-d involved instillation of normal saline with an 8-to 10 minute dwell time, followed by 3 to 3.5 hours of -125 mm Hg. Therapy continued for 6 to 7 days with dressing changes every 2 to 3 days.

Results: Patients were all male, between the ages of 24 and 83 years old. Wound etiologies included chemical burn, deep tissue laceration, compartment syndrome with hematoma, and diabetic foot osteomyelitis. All wounds required cleansing. Prior to NPWTi-d, surgical debridement and antibiotics were administered as necessary. After NPWTi-d, the wounds exhibited healthy granulation and reduced in size, allowing for discharge to outpatient care. Upon follow-up 2 to 6 months later, no patients experienced wound complications or required readmission to the operating room, potentially saving on time and cost.

Conclusion: In these patients, use of NPWTi-d assisted in cleansing the wound surface and producing a positive healing outcome. Despite higher initial costs of NPWTi-d over standard dressings, a wound management protocol including NPWTi-d may help mitigate expenses incurred by delayed healing.

Background: Pressure injury (PI) due to medical devices is one of the most common PIs, especially in patients treated in intensive care. Medical device-related pressure injuries (MDRPIs), as part of their treatment, require extra care and prevention interventions than injuries caused by immobilization. Standardized nursing models are needed to care for PIs caused by medical devices on mucous membranes.

Purpose: To provide information about the evaluation and care of the MDRPIs in the mucosal membrane due to the endotracheal tube (ET).

Case report: A 35-year-old male with chronic obstructive pulmonary disease (COPD) and coronavirus disease has MDRPIs on the lower lip edge due to the ET on the fifteenth day after intubation. North American Nursing Diagnosis Association (NANDA) diagnoses were determined by systematically analyzing the data using the Gordon's Functional Health Patterns (GFHP) model in the patient. Nursing care was planned and applied in line with the determined NANDA diagnoses, Nursing Outcomes Classification (NOC) interventions, and using the recommendations of current PI guides for treatment of MDRPIs.

Conclusion: This case report illustrates MDRPIs resulting from ET and provides information about the formation of MDRPIs and appropriate maintenance therapy. Future research is recommended to examine and evaluate the nursing care and outcome of MDRPIs in different mucosal membranes.

Background: PechaKucha (PK) is a presentation technique that uses visual and narrative presentations consisting of 20 slides, each shown for 20 seconds.

Purpose: The aim of this study was to evaluate the effects of the PK presentation on elderly care department students' knowledge about pressure injury prevention.

Methods: This study used a single-blinded randomized control trial. Elderly care department students were randomized to the PK presentation technique (intervention group) and traditional PowerPoint presentations only (control group). The sample of the study consisted of 54 (intervention group = 28, control group = 26) elderly care department students. Data was collected using the Sociodemographic Form and the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI). PUPKAI was administered before the presentations (pre-test), after the presentations (post-test 1), and 4 weeks after the presentations (post-test 2).

Results: Following the presentations, the intervention group's PUPKAI mean score (47.23 ± 11.62) was significantly higher than the control group's mean score (36.64 ± 12.41) (P < .05). Four weeks after completing the education, the intervention group's mean PUPKAI score (43.11 ± 13.72) was significantly higher than the control group's mean score (36.46 ± 12.76) (P < .05).

Conclusion: The knowledge level of the elderly care department students was found to be below the satisfactory level. It was determined that the PK presentation increased the knowledge level of the students regarding pressure injury prevention.

Background: In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss.

Purpose: To understand the impact of COVID-19 on amputation rates.

Methods: A retrospective review of lower limb institution-wide amputations was conducted at Northwell Health from January 2020 to January 2021. The amputation rates during the COVID-19 shutdown period were compared to the pre-pandemic, post-shutdown, and reopening period.

Results: The pre-pandemic period had 179 amputations, of which 8.38 % were proximal. 86 amputations were performed during shutdown, with a greater proportion being proximal (25.58 %, p=0.0009). Following the shutdown period, amputations returned to baseline. The proportion of proximal amputations during post-shutdown was 18.5 % and during reopening was 12.06 %. Patients had 4.89 times higher odds of undergoing a proximal amputation during the shutdown period.

Conclusions: The effect of COVID-19 on amputation rates demonstrates an increase in proximal amputation during the initial shutdown. This study suggests an indirect negative effect of COVID-19 hospital restrictions on surgeries during the initial shutdown period.