Wound management & prevention最新文献

Background: Urethral erosion secondary to a medical device-related pressure injury (MDRPI) is preventable, understudied, not well understood, and often overlooked.

Purpose: This case report describes a patient who sustained an MDRPI secondary to indwelling urinary catheter placement for urinary retention.

Case study: A 93-year-old man with prostate cancer and pneumonia received an indwelling urinary catheter for retention during a 2-week hospitalization. Upon his transfer to a rehabilitation facility, the patient's daughter informed staff that she had observed a 1-cm urethral erosion on the urinary meatus. Within a week, the penile erosion worsened to encircle the urinary meatus to 1.5 cm, and clinical signs of infection were present. Eventually, the patient was transferred to a hospice facility where he died.

Conclusion: This case study demonstrates the need for increased training of health care professionals in identifying risk factors for MDRPI and managing such injuries to limit their devastating impact on the patient and family members.

Background: Coronavirus disease-2019 (COVID-19) led to a global pandemic in March 2020 that has involved tens of millions of people. To date, prophylactic vaccines have been found to be the most effective method to contain the pandemic. Bullous pemphigoid (BP) is an autoimmune skin disease that mainly affects older individuals.

Case reports: The authors report 2 confirmed cases of BP in patients with history of cerebral infarction who received the inactivated severe acute respiratory syndrome coronavirus 2 vaccine. A 67-year-old woman was hospitalized for a generalized rash that appeared 7 days after the first dose of inactivated COVID-19 vaccine. The rash was aggravated after the second dose. The second patient was a 66-year-old woman who was hospitalized for a generalized rash that appeared 10 days after the first dose of inactivated COVID-19 vaccine. There were no abnormalities in the baseline blood tests. Laboratory and histologic examinations confirmed the diagnosis of BP. The patients were treated with systemic glucocorticoids, antibiotics, topical corticosteroids, and emollients, which resulted in a significant reduction in pruritus and regression of lesions after 2 weeks.

Conclusion: Two patients with a genetic background of HLA-DQB1*0302 had BP after vaccination in China. However, there is not enough evidence to indicate a requirement for genetic screening before receiving inactivated severe acute respiratory syndrome coronavirus 2 vaccines.

Background: Exudate pooling is the collection of wound fluid in the wound bed. Wounds with irregular depth, pockets, or cavities can create a dead space between the dressing and the wound bed where exudate can accumulate. Exudate pooling could lead to increased risk of infection or biofilm formation, maceration of the periwound skin, and delayed wound healing.

Purpose: This article aims to offer a simplified yet practical summary for the prevention and management of exudate pooling by using advanced wound dressings.

Methods: Following a review of published literature, consensus statements, and best practice guidelines, the authors put their learnings into practice by translating the findings into a practical guide for the prevention and management of exudate pooling.

Results: Nearly half (49.6%) of all wounds have depth beyond the epidermis (0.22 cm), a characteristic that increases the risk of exudate pooling. In addition, approximately 12% of chronic wounds are undermined by tunneling or cavities underneath the skin where exudate could pool. Appropriate dressing selection can help manage exudate and prevent exudate pooling. In particular, dressings that provide a moist environment, manage the dead space, and maintain close contact with the wound bed may help reduce the risks associated with exudate pooling. A practical guide is presented that could be used by nurses at all levels to help select appropriate dressings.

Conclusion: This practical guide could help prevent and manage exudate pooling and associated risk factors.

Background: Quality of life for patients after ileocystoplasty or ureterostomy due to a urinary bladder neoplasm can be limited after discharge from the hospital.

Purpose: To add the real-time communication ability of an application (app) to the daily care of this patient population to enhance communication between doctors and patients and provide improved nursing interventions, thus improving patients' self-care abilities and quality of life while decreasing stoma complications.

Methods: A total of 67 patients who underwent urinary tract diversion after total cystectomy were randomly divided into 2 groups. Patients in the control group (n = 32) received regular telephone follow-ups when they were discharged from the hospital, once a week for the first 2 months and then once a month for the next 22 months; patients in the intervention group (n = 35) used an app in addition to receiving regular telephone follow-ups. After 24 months of the intervention, multivariate analyses were conducted regarding self-care ability, complication rate, and quality of life.

Results: Self-care ability and quality of life scores in the intervention group were significantly improved during the 24-month period, and the complication rate was significantly reduced.

Conclusion: Interaction via an app improved patients' self-care ability and quality of life. In addition, stoma complications were reduced. Future studies with larger sample sizes and patients of different ages are needed.

Background: Some authors claim that the clinical methods often employed to assess chronic venous leg ulcers (CVLU) are based on subjective interpretation. The treatments based on a subjective characterization could become a trial-and-error therapy, resulting in longer evolutions and high recurrence rates.

Purpose: The aim of this work was to compare numeric parameters from acute and chronic venous leg ulcers to identify potential objective nonhealing parameters.

Methods: The study was performed with hospital outpatients from 2016 to 2019. Cohorts were established according to the ulcer evolution time. Data collected related to ulcer characteristics included exudate pH, lactate and glucose concentrations, temperatures, microbiology findings, and imaging study results.

Results: Approximately 83% of the examined ulcers were chronic. Seventy-one percent of CVLUs and 59% of the acute ulcers had a pH ≥8. A high variability was found for the concentration of glucose and lactate in exudates of both acute and chronic ulcers. Variations of temperatures of normal skin (ΔT1) and periulcer zone (ΔT2) in reference to the wound bed temperature with values above 1 could indicate the presence of an inflammatory process and be used as a new potential marker of inflammation. All the acute ulcers and 88% of CVLUs showed <80% of granulation tissue in the imaging study. Finally, more than 105 organisms per gram of tissuewere found in 100% of the analyzed samples.

Conclusions: Whereas there were not significant differences among the clinical measured parameters between acute and chronic ulcers, further research on the use of objective measurable parameters is needed to establish cutoff points to differentiate the "chronic state" of an ulcer as a "nonhealing state" regardless of the evolution time. Also, the use of these easily obtainable and low-cost nonhealing parameters would be a new approach to accurately monitor this pathology.

Background: Ostomy surgery can negatively affect quality of life; however, the lived experiences of individuals with ostomies in Saudi Arabia are not well understood.

Purpose: To examine how sex, ostomy type, disease diagnosis, and health care provider shape health-related quality of life (HRQOL) in individuals with ostomies in Saudi Arabia.

Methods: A descriptive cross-sectional study was conducted based on self-reported data of a convenience sample of 421 patients (239 male, 182 female) with ostomies (206 temporary, 211 permanent, 4 unknown) from 5 hospitals in Riyadh, Saudi Arabia. Data were collected using the City of Hope-Quality of Life-Ostomy Questionnaire (Arabic version) and analyzed by univariate and multiple regression analyses to identify predictors of physical, psychological, social, spiritual, and overall HRQOL.

Results: HRQOL scores correlated significantly with ostomy type (temporary vs permanent), sex, and health care provider. There were no significant differences in HRQOL scores by disease diagnosis (cancer vs non-cancer).

Conclusion: Several potential predictors of HRQOL among patients with ostomies in Saudi Arabia were identified, which may assist in developing intervention strategies to improve patients' HRQOL. Additional studies are needed to understand the specific barriers in each group.