Advances in wound care最新文献

Objective: Having a wound decreases patients' quality of life and brings uncertainty, especially if the wound does not show a healing tendency. The objective of this study was to develop and validate a model to dynamically predict time to wound healing at subsequent routine wound care visits. Approach: A dynamic prediction model was developed in a cohort of wounds treated by nurse practitioners between 2017 and 2022. Potential predictors were selected based on literature, expert opinion, and availability in the routine care setting. To assess performance for future wound care visits, the model was validated in a new cohort of wounds visited in early 2023. Reporting followed TRIPOD guidelines. Results: We analyzed data from 92,098 visits, corresponding to 14,248 wounds and 7,221 patients. At external validation, discriminative performance of our developed model was comparable with internal validation (concordance statistic = 0.70 [95% confidence interval 0.69, 0.71]), and the model remained well calibrated. Strong predictors were wound-level characteristics and indicators of the healing process so far (e.g., wound surface area). Innovation: Going beyond previous prediction studies in the field, the developed model dynamically predicts the remaining time to wound healing for many wound types at subsequent wound care visits, in line with the dynamic nature of wound care. In addition, the model was externally validated and showed stable performance. Conclusion: The developed model can potentially contribute to patient satisfaction and reduce uncertainty around wound healing times when implemented in practice. When the predicted time of wound healing remains high, practitioners can consider adapting their wound management.

Objective: To identify how cellular and/or tissue-based products (CTPs) relate to value in terms of cost per quality-adjusted life years (QALYs) in wound care in comparison with treatments in other medical fields. Approach: This is a cross-sectional study and a cost-effectiveness analysis. Payment limits for each CTP were obtained via the Healthcare Common Procedure Coding System Q codes and formulated as cost inputs into a cost-utility model published for treatment of Wagner 1 diabetic foot ulcers using dehydrated human amnion and chorion allograft versus standard of care (SOC). Additional changes to cap the number of CTP applications and adjustments for recent inflation were made. The literature was searched for other cost-utility models in other diabetes-related diseases as a comparison. Results: When the payment limit was ≤$140 per square centimeter, interventions were dominant (less costly, better outcomes) compared with SOC. When the limit exceeded $430 per square centimeter, the cost-effectiveness threshold of $100,000/QALY was exceeded. Newer Q codes are generally much more expensive and likely to not be cost-effective, similar to the results for many other chronic diabetes-related diseases . Innovation: This study presents decision makers with tools, by which they can determine as to whether a given CTP is likely to be cost-effective for patients. Conclusion: Over a third of all CTPs will very likely result in noncost-effective interventions. This number is likely to be higher when wounds are larger or used in other wound types where they are less efficacious. The recent trend in much higher costs for CTPs is worrisome.

Significance: Burn wound injuries are a global health challenge, affecting millions annually and resulting in significant morbidity, mortality, and economic burden. The urgent need for accessible and cost-effective therapeutic alternatives, especially for underserved populations, has driven interest in novel approaches such as noninvasive splenic stimulation using pulsed-focused ultrasound (pFUS). This technique targets systemic inflammation, a key factor in delayed wound healing, offering a potential shift in burn care management. Recent Advances: Preclinical studies have shown that pFUS applied to the spleen can accelerate wound healing by activating the cholinergic anti-inflammatory pathway, promoting pro-angiogenic and anti-inflammatory responses. While current treatments-including biologics, antioxidants, and growth factors-have limitations, pFUS presents a noninvasive alternative. One interventional study and ongoing clinical trials are now investigating its application in burn wound care, marking an important step toward clinical translation. Critical Issues: Despite encouraging results, research on splenic stimulation for wound healing remains limited. The small number of studies highlights the need for further investigation into the underlying mechanisms, optimal treatment parameters, and potential risks. Additionally, the scalability and cost-effectiveness of pFUS in diverse clinical settings require thorough evaluation. Future Directions: Ongoing clinical trials will provide critical data on the efficacy and safety of splenic pFUS in burn patients. Future research should focus on expanding clinical studies, refining stimulation protocols, and exploring its broader application in tissue repair. If validated, this approach could offer a cost-effective, noninvasive treatment, particularly valuable in socioeconomically challenged regions.

Objective: Fat grafting is widely applied for various purposes, including volume restoration, improving tissue quality, and promoting wound healing, but it has poor long-term graft survival predictability. Alpha-1-antitrypsin (AAT) administration is hypothesized to improve fat graft outcomes by expediting inflammatory resolution and graft vascularity and reducing necrosis. Approach: Mice heterozygote to human AAT was grafted fat under the scalp alongside 400 µg/graft AAT or albumin (ALB) on days 0 and 3. Graft volume was determined by micro-magnetic resonance imaging, and explants were assessed for viability, histology, immunohistochemistry, and expression of selected genes. AAT expression was examined in hypoxia-exposed adipose-derived stem cells (ADSCs). Results: After 90 days, AAT-treated grafts maintained higher volumes (70.06% vs. 34.54%, n = 8, p = 0.02) and displayed improved tissue quality. On day 10 after grafting, grafts exhibited more blood vessels (mean 1.94/mm² vs. 0.33/mm²) and 6.25-fold more adiponectin transcript levels (n = 12, p = 0.02). Although day-3 interleukin (IL)-1β expression was 5-fold greater in AAT-treated grafts (n = 6, p = 0.4), day-10 IL-1β expression was 2-fold lower compared to ALB-treated grafts (n = 22, p = 0.01). In the Methoxynitrosulfophenyl-tetrazolium carboxanilide (XTT) assay, day-3 AAT-treated grafts were 1.56-fold more metabolically functional (n = 6, p = 0.04) and exhibited greater perilipin-positive regions (18.5% versus 3.1%). Hypoxia-exposed ADSC expressed 9-fold higher AAT transcript levels (p = 0.04). Innovation: Fat grafting outcomes improved by early AAT treatment, probably by accelerating inflammatory resolution. Due to its marked safety profile, the study's findings are for adjunct clinical-grade AAT therapy. Conclusion: AAT has a promising potential to be utilized as a fat graft outcome enhancer in terms of volume retention predictability and tissue quality.

Significance: Diabetic foot ulcer (DFU) is a common complication of diabetes, characterized by chronic, hard-to-heal wounds that can lead to serious infections and amputations. Effective self-management is crucial for treatment and prevention. Recent Advances: A comprehensive literature search was conducted across academic databases, clinical practice guideline (CPG) databases, and the websites of diabetes societies. The characteristics, recommendations, and evaluation criteria of the CPGs were extracted and organized using Excel. Four researchers independently assessed the methodological and reporting quality of the CPGs using the Appraisal of Guidelines Research and Evaluation II instrument and the Reporting Items for practice Guidelines in HealThcare checklist. Data were synthesized and visualized through evidence mapping to provide an overview of current guideline coverage and key recommendations. Critical Issues: This study included 13 CPGs and synthesized 46 recommendations. Self-management strategies for patients with DFU mainly involve health education, foot self-care, lifestyle change, comorbidity/symptom management, as well as follow-up and medical help-seeking. The identified CPGs were of mixed quality, with four classified as high quality. With respect to methodology, the CPGs performed well in scope and purpose (82.6%±10.9%) and clarity (80.77%±9.19%), but showed deficiencies in stakeholder involvement (52.8%; interquartile range [IQR]: 17.3%) and editorial independence (58.3%; IQR: 82.3%). For reporting quality, limitations were noted in transparency regarding review and quality assurance (18.75%; IQR: 100%), as well as funding and declaration of interests (12.5%; IQR: 32.82%). Future Directions: The evidence provided by CPGs for DFU self-management varied in strength, and some recommendations were inconsistent. The results adds to our knowledge and promotes the development of trustworthy CPGs on DFU. Further research is necessary to propose more evidence-based and high-quality recommendations.

Objective: The risk of pressure injuries (PIs) is increasing in Japan, where an aging population imposes substantial health care burdens. Approach: This retrospective cohort study utilizing the Shizuoka Kokuho Database evaluated factors associated with PI development in hospitalized patients. Results: An analysis of over 546,000 patients aged ≥65 years from 2012 to 2022 identified 6,372 PI cases. Cox regression analyses revealed that male sex (hazard ratio [HR] 1.32, 95% confidence interval [CI]: 1.25-1.39), advanced age (HR 8.54, 95% CI: 7.40-9.87 for ≥95 years vs. 65-69 years) and comorbidities such as neurological disorders (HR 1.87, 95% CI: 1.72-2.04), dementia (HR 1.69, 95% CI: 1.59-1.80), and congestive heart failure (HR 1.19, 95% CI: 1.12-1.27) were associated with increased PI risks. Conversely, antihyperlipidemic drugs may be associated with a lower PI risk (HR 0.69, 95% CI: 0.65-0.74). Due to data limitations, factors such as nutritional status, mobility, and caregiver support could not be evaluated. Innovation: This study is the first in Japan to leverage big data to identify high-risk groups for PIs, particularly among elderly individuals with specific comorbidities. This approach offers actionable insights into PI management, potentially enhancing care strategies and preventive guidelines. Conclusion: Male sex, advanced age, and comorbidities, including neurological disorders, dementia, psychosis, and congestive heart failure, were identified as primary PI risk factors. Conversely, antihyperlipidemic drug use may be associated with a lower PI risk. These findings highlight the need for comprehensive, targeted prevention strategies to reduce the risk of PI in elderly hospitalized patients.

Objective: The primary objective of this study is to enhance the detection and staging of pressure injuries using machine learning capabilities for precise image analysis. This study explores the application of the You Only Look Once version 8 (YOLOv8) deep learning model for pressure injury staging. Approach: We prepared a high-quality, publicly available dataset to evaluate different variants of YOLOv8 (YOLOv8n, YOLOv8s, YOLOv8m, YOLOv8l, and YOLOv8x) and five optimizers (Adam, AdamW, NAdam, RAdam, and stochastic gradient descent) to determine the most effective configuration. We followed a simulation-based research approach, which is an extension of the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for dataset preparation and algorithm evaluation. Results: YOLOv8s, with the AdamW optimizer and hyperparameter tuning, achieved the best performance metrics, including a mean average precision at intersection over union ≥0.5 of 84.16% and a recall of 82.31%, surpassing previous YOLO-based models in accuracy. The ensemble model incorporating all YOLOv8 variants showed strong performance when applied to unseen images. Innovation: Notably, the YOLOv8s model significantly improved detection for challenging stages such as Stage 2 and achieved accuracy rates of 0.90 for deep tissue injury, 0.91 for Unstageable, and 0.74, 0.76, 0.70, and 0.77 for Stages 1, 2, 3, and 4, respectively. Conclusion: These results demonstrate the effectiveness of YOLOv8s and ensemble models in improving the accuracy and robustness of pressure injury staging, offering a reliable tool for clinical decision-making.

Objective: Pressure garment therapy is a common strategy for controlling hypertrophic scars; however, insufficient pressure due to reduced elasticity or joint movement limits its effectiveness around joints. The FlexiForce B201 pressure sensor offers precise pressure measurements, thereby demonstrating a promising solution. Approach: This study used a Bama pig scar model with an untreated group, a pressure garment group, and a pressure monitoring group that was treated with FlexiForce B201 sensors and pressure garments. The therapeutic effects were recorded over 1 month. The clinical research followed the Consolidated Standards of Reporting Trials and was registered as ChiCTR2200064173. Eighty-two patients with peri-joint hypertrophic scars were enrolled. Forty-one patients were randomly assigned to the control group and received conventional pressure garment therapy, whereas the remaining 41 patients were included in the monitoring group. Treatment outcomes were tracked at 3 months and 6 months. Results: The Bama pig scar model demonstrated reduced scar hypertrophy in the monitoring group. In the clinical study, the scar thickness in the monitoring group was 47.76% of the initial thickness after 6 months, thereby representing an additional 11.33% reduction compared to the control group. The Vancouver Scar Scale score of the monitoring group (6.44 ± 1.62) was significantly better than that of the control group (7.33 ± 1.53). Innovation: The FlexiForce B201 pressure sensor is soft and flexible. It provides accurate pressure measurements within the pressure garment and guides physicians in adjusting the pressure distribution. Conclusion: This study revealed that pressure monitoring technology enhances the effectiveness of pressure garments.

Significance: The skin serves as the primary defense against external stimuli, making it vulnerable to damage. Injuries can cause a dysregulated environment, resulting in chronic inflammation and inhibition of cell proliferation and migration, which delays recovery. Innovative approaches, such as three-dimensional (3D) bioprinting, can foster a controlled healing environment by promoting synergy between the skin microbiome and cells. Recent Advances: Traditional approaches to wound healing have focused on fostering an environment conducive to the interplay between cells, extracellular proteins, and growth factors. 3D bioprinting, a manufacturing technology with applications in tissue engineering, deposits biomaterial-based bioink containing living cells to fabricate custom-designed tissue scaffolds in a layer-by-layer fashion. This process controls the architecture and composition of a construct, producing multilayered and complex structures such as skin. Critical Issues: The selection of biomaterials for scaffolds has been a challenge when 3D skin tissue engineering. While prioritizing mechanical properties, current biomaterials often lack the ability to interact with environmental stimuli such as pH, temperature, or oxygen levels. Employing smart biomaterials that integrate bioactive molecules and adapt to external conditions could overcome these limitations. This innovation would enable scaffolds to create a sustainable wound-healing environment, fostering microbiome balance, reducing inflammation, and facilitating cellular recovery and tissue restoration, addressing critical gaps in existing wound care solutions. Future Directions: Novel bioink formulations for skin injury recovery are focused on improving long-term cell viability, proliferation, vascularization, and immune integration. Efficient recovery of the skin microbiome using bioactive molecules has the potential to create microenriched environments that support the recovery of the skin microbiome and restore immune regulation. This promising direction for future research aims to improve patient outcomes in wound care.