Wound management & prevention最新文献

Background: Despite technological advances to minimize the damage caused by ostomy surgery, patients face many physical and emotional challenges that can severely impact their health-related quality of life.

Purpose: This survey monitored the wellness of patients with ostomies during their clinical follow-up through the 8-item Wellness Questionnaire, a simplified version of the validated Ostomy-Q.

Methods: The survey involved 1054 Italian novice and expert ostomy appliance users who had received a new device prescription (expert users changed to a new device due to problems with a previous device such as a change in weight or body profile and leakage). Patients were questioned at 2 time points: baseline (T0) and 4 weeks after stoma placement (T1).

Results: The overall Wellness Questionnaire score and the individual items generally improved from T0 to T1 for both types of users, suggesting that both novice and expert users face an adjustment phase for the ostomy device that impacts several aspects of their life. However, novice users were less concerned about social relations and skin irritation at both time points compared with expert users, whereas device visibility under clothes at T0 and social relationships at T1 were of lesser concern for experienced users than for novice ones.

Conclusion: The Wellness Questionnaire, carried out by stoma therapists during the clinical follow-up of patients with ostomies, highlighted an overall improving trend 1 month after the device prescription for both expert and novice users. Both types of patients faced daily challenges related to the new ostomy device but from different perspectives. Further studies are needed to confirm the outcomes of this survey.

Background: Nurses' perception of medical device-related pressure injuries (MDRPIs) may affect their performance, but there is a lack of studies in this area.

Purpose: The current study aimed to examine intensive care unit (ICU), cardiac care unit (CCU) and emergency department nurses' perception of proper prevention of MDRPIs and care for individuals with such injuries.

Methods: This descriptive study was conducted in 4 general hospitals in Iran in 2021. All nurses (N = 310) working in ICUs, CCUs and emergency departments of these facilities were invited to complete a researcher-made demographic checklist and an 11-item questionnaire to assess attitudes toward MDRPIs. The questionnaire item responses were scored from 1 (strongly agree) to 5 (strongly disagree) with the total score for the 11 items ranging from 11 to 55. A score of 11 to 25 was categorized as indicating a negative attitude toward proper prevention of MDRPIs and care for such patients; a score of 26 to 40 indicated a neutral attitude, and a score >40 indicated a positive attitude.

Results: A total of 260 nurses fulfilled the data collection tool. The response rate was 83.8%. The mean total score of attitude toward MDRPIs was 41.7. No significant relationship was observed between the total score of nurses' attitudes and their demographic variables. Of the 260 participants, 159 stated they had not received any trainings on MDRPIs at nursing schools during their education, 212 stated they had not participated in any scientific workshops on MDRPIs, and 167 described their knowledge about the prevention and care of MDRPIs as insufficient.

Conclusion: Among ICU, CCU, and emergency nurses in Iran, most had a positive attitude toward the prevention and care of MDRPIs, but steps should be taken to offer more opportunities for nurses to increase their knowledge in this area.

Background: Venous leg ulcers (VLU) require early identification and treatment to prevent further harm. Health care providers often fail to initiate evidenced-based VLU treatment promptly because of a lack of knowledge of VLU guidelines.

Purpose: To improve early treatment for patients with VLUs presenting to outpatient clinic settings.

Methods: Plan-Do-Study-Act cycles were used for this quality improvement project. Virtual education and a comprehensive clinical decision support (CDS) order set were implemented. Outcome metrics included the rate of ankle-brachial index (ABI) testing, mechanical compression therapy, and home health service referrals for patients with VLUs. The frequency with which the CDS order set was used was also measured.

Results: Forty health care providers attended the virtual education sessions among 3 outpatient clinics. There was an increase in ankle-brachial index testing from pre (n = 7; 15.9%) to post (n = 10; 18.2%) (P = .796), but there was a decline in mechanical compression therapy from pre (n = 15; 34.1%) to post (n = 4; 7.3%) (P = .002) and home health service referrals from pre (n = 11; 25%) to post (n = 9; 16.4%) (P = .322). The CDS order set was used 9 times over 13 weeks.

Conclusion: Future Plan-Do-Study-Act cycles will include completing in-person education and reducing the VLU CDS order set length. Future projects should consider these approaches when implementing evidence-based VLU guidelines.

Background: Cesarean delivery (CD) is the most frequently performed surgery. Surgical site infection (SSI) is a common complication after CD.

Purpose: To evaluate the role of complete blood count parameters in predicting the development of SSI after CD.

Methods: Patients who were hospitalized because of SSI after CD were included in the SSI group (n = 48). A control group (n = 45) was formed with healthy postpartum women who had also undergone CD. Preoperative and postoperative hemoglobin (Hb), white blood cell count (WBC), neutrophil count, lymphocyte count, platelet count (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were recorded.

Results: WBC, neutrophil count, and NLR levels increased while Hb, PLT, and lymphocyte count levels decreased after CD in both the SSI and control groups. PLR increased after CD in the SSI group but remained stable in the control group. However, the difference in PLR could not predict SSI after CD.

Conclusion: Complete blood count parameters were not useful to predict SSI after CD. Larger prospective studies are needed.