Acta Medica Croatica最新文献

Posttraumatic and postoperative infective wounds that progress to chronic wounds can pose serious problem for the traumatizedpatient with reduced biological potential for healing. Also, due to the need for specific and individual approach tosuch a patient, they represent a challenge for physicians. The use of topical hemoglobin spray (Granulox®) with protectiveand supportive local action ensures and improves physiological conditions for healing, thus providing additional possibilitiesfor adequate and safe healing of complicated infected wounds.

Patients with pressure ulcers usually arrive to the Unified Emergency Admission Department (UEAD) due to other illnesses,from the family or social care institutions. After triage and treatment at UEAD, the patient is hospitalized or discharged fromthe hospital. The objective of this study was to examine the incidence, reasons for presenting to UEAD and further procedurethat patients with pressure ulcers admitted to UEAD were subjected to. Data in the Hospital Information System on patientswith pressure ulcers admitted to UEAD, Dr Tomislav Bardek General Hospital in Koprivnica in the period between January 1,2016 and May 31, 2016 were retrospectively analyzed. The analysis included demographic data, location from which thepatient arrived, triage category and further procedure the patient was subjected to. Data were analyzed by using the methodsof descriptive statistics. A total of 18 patients with pressure ulcers were admitted to UEAD, 13 (72%) women and five (28%)men. Five (28%) patients were referred from social care institutions and 13 (72%) from the family. Triage category 2 included7 (38.8%) patients, four (22%) patients were included in triage categories 3 and 4, while three (16%) patients were includedin triage category 5. Ten (55.5%) patients were hospitalized, while eight (44.4%) patients were discharged from the hospital.Only one patient was admitted primarily due to pressure ulcer complications. Contrary to our assumptions, a lower numberof patients were referred from social care institutions, i.e. more patients were referred from the family. These data resultedfrom a long lasting active training of nurses and implementation of the nurse’s discharge letter.

Negative pressure therapy is gradually taking an increasingly important role in the treatment of chronic wound healing becauseof its simple application in hospital or outpatient setting and good comfort with no pain for the patient. Chronic woundhealing is accelerated in comparison with other conservative treatments. The level of negative pressure is between 40 and125 mm Hg below ambient. Direct and indirect effect of the negative pressure therapy helps in wound healing and providesgood preparation for definitive surgical management of wounds.

The ever improving health standards in terms of quality and more efficient health care result in an increase in life expectancy,thus increasing the number of elderly people in the population. A higher level of activity in elderly population leads to greaterincidence of injuries, and on the other hand, there is an increasing number of comorbidities. Circulatory disorders, diabetesmellitus, metabolic imbalances, etc. and a reduced biological potential of tissue regeneration result in an increased numberof chronic wounds that pose a significant health, social and economic burden on the society. These conditions require significantinvolvement of medical and non-medical staff in pre-hospital institutions. Significant material and other health careresources are allocated for the treatment of chronic wounds. These conditions result in a lower quality of life of patients andtheir families and caregivers. Debridement is a crucial medical procedure for the treatment of acute and chronic wounds.The result of debridement is removal of all barriers within and around the wound that obstruct physiological processes ofwound healing. Debridement is a repeating process when indicated. There are several types of debridement, each with itsadvantages and disadvantages. The method of debridement should be determined by the physician or other professionaltrained person on the basis of wound characteristics and in accordance with their expertise and capabilities. In the samewound, we can combine different types of debridement, all with the goal of faster and better wound healing.

Practical experience and numerous studies have shown that, after finishing their studies nursing graduates are not surein their independent assessment and treatment of wounds. It appears that nursing education lacks narrowly specializededucational content in this area, practical skills and connection between graduates and experts who follow the standardsand guidelines in the area of wound healing. The aim of this study was to assess the knowledge through tests and attitudesof nurses/nursing graduates on the condition of the skin and damage treatment. In addition, the study was also aimed atlearning about possible guidelines for the future content of the nursing curriculum studies in Croatia. The study was conductedon a sample of 71 students (six (8.5%) male and 65 (91.5%) female of Nursing Studies at University North. Thesubjects voluntarily and anonymously completed the survey electronically. A semi-structured standardized questionnaire wasused, “Knowledge test about the basis of pressure ulcers in geriatric patients”, designed by Dr Andrija Štampar Departmentof Health Gerontology, Reference Center for Health Care of the Elderly of the Ministry of Health of the Republic of Croatia.The test administered to the sample of students of nursing, mostly aged 18-25 (64.8%) showed correct answers to 12questions asked, in a range of 17.9% to 100% (median 60.6%, SD 24.1, Q1 53.8%, Q3 81%). Answers to question 13(daily work with patients) revealed that 39.4% of students knew and often used modern approach to the prevention andtreatment of pressure ulcers; the same percentage of students rarely used modern method of prevention and treatment ofpressure ulcers, 26.8% were not familiar with the issue, while 2.8% were not interested in it. As for question 14 (given theexisting contents on the treatment of pressure ulcers in the educational program for students of nursing), 47.9% of studysubjects believed they needed more practical skills in treating pressure ulcers, 45.1% considered it necessary to introducemore contents on the treatment of pressure ulcers in regular courses, while 8.5% believed it was not necessary to introduceadditional contents because there was enough knowledge on wound treatment. The results indicated that there was arelatively satisfactory partial knowledge to assess skin condition, prevention measures and treatment of pressure ulcers inthe elderly, but also that more practical skills were needed in the treatment and modern dressing application, which can beconsidered as guidelines for future educational contents in the nursing studies. Based on the simple and standardized surveyin a relatively broad sample of students of Nursing Studies at University North, student knowledge on the prevention andtreatment of pressure ulcers with modern methods can be well assessed. Scarce practical knowledge in the field of modernpressure ulcer treatment, the lack of professional literature revision in terms of modern guideli

Dressings can be categorized into groups according to their exudate absorbing capacity or the phase of wound healing whenthey are most efficient. Wound dressings are also classified as basic dressings, i.e. materials used in all types of wound (assecondary dressings), highly absorbent dressings, alginate dressings, dressings with antimicrobial action (with the additionof DACC, iodine, PHMB, silver), films, foams, dressings with honey, hydrocolloids, hydrogels, anti-odor dressings, dressingswith protease modulators, dressings applied on scars, skin protecting dressings, dressings protecting wound surface,bio-cellulose dressings, dressings with collagen, and dressings with polyurethane matrix.

Pressure ulcer is defined as a wound resulting from tissue ischemia due to prolonged continuous pressure on the protrudingparts of the body. Pressure ulcer is a significant health problem that more often affects the elderly and disabled. It can benoticed that a large number of patients who end up on prolonged and severe treatment are released from the hospital tohome care without or with mild degree pressure ulcers. Therefore, the conclusion is that patient care in hospital conditionsis satisfactory. It is important to emphasize the importance of maintaining the same level of care for patients at a high risk ofpressure ulcers, considering all recommendations and innovations in preventing development of pressure ulcers.

Pressure ulcer is an undesired event for patient, frequently used in quality monitoring as an indicator of healthcare qualityand patient safety. According to legal regulations in the Republic of Croatia, pressure ulcer is included in the group of indicatorsof other undesired events (patient safety) and healthcare institutions are obliged to monitor the applicable indicator andsubmit report to the Agency every six months. Annual reports on the patient safety indicators are available on the Agencywebsite. The article presents the descriptive list of indicators and descriptive list for the Pressure Ulcer indicator.

Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation betweenpsychiatric and dermatological disorders is a highly complex relation considering etiology, diagnostic procedures and treatment.There are three major groups of psychodermatological disorders: psychosomatic (psychophysiologic) disorders,primary psychiatric disorders and secondary psychiatric disorders. Psychosomatic disorders are dermatological diseaseswhich can be exacerbated or worsened by emotional stress, but are not caused directly by stress. Emotional stress canexacerbate many chronic dermatoses like urticaria, eczema, psoriasis, acne, seborrheic dermatitis, atopic dermatitis, alopeciaareata, psychogenic purpura, rosacea, atypical pain syndromes and hyperhidrosis. The treatment of patients with theresistant chronic dermatosis can be difficult when stress is not recognized as a provoking factor. Primary psychiatric disordersare psychiatric conditions which induce development of various skin changes, e.g trichotillomania, factitial dermatitis,neurotic excoriations, delusions of parasitosis and dysmorphophobia. They include psychiatric disorders with anxiety, compulsive-opsessive and depressive symptoms and pathologic delusional ideas or hallucinations regarding the skin. Secondarypsychiatric disorders appear as a result of a certain disfiguring skin disease that induces psychologic suffering such as lossof self-confidence, anxiety and social phobia. This category includes diseases like psoriasis, chronic eczema, various ichthyosiformsyndromes, rhinophyma, multiple neurofibromas, severe acne, and other cosmetically disfiguring cutaneous lesions.The therapeutic approach of psychodermatological disorders should be multidisciplinary including primary care physicians,dermatologist, psychiatrist and psychologist. It is very important to educate dermatologists in the diagnostic procedures andtherapy of psychiatric disorders which sometimes coexist with the skin disease. Majority of psychodermatological disorderscan be treated with cognitive-bihevioral psychotherapy, psychotherapeutic stress-and-anxiety-management techniques andpsychotropic drugs. Psychopharmacologic treatment includes anxiolytics, antidepressants, antipsychotics and mood stabilizer.

Pressure ulcer develops as a result of many factors, primarily pressure, tensile forces and ischemia with immobility andincontinence. Targeted and properly designed preventive measures reduce the incidence and complications of pressureulcers, among which the most common are infections. An important preventive measure is protection of the surroundingskin before the application of wound dressings. Skin changes dictate the use of emollients and topical therapy according todermatological status.