Advances in Skin & Wound Care最新文献

Objective: To investigate associations among demographic data, gene expression, and psychosocial variables and characterize a biomarker panel of 18 proinflammatory gene transcripts for lonely individuals with chronic lower extremity wounds.

Methods: For this observational study, data and blood samples were collected from 38 individuals at baseline and week 4 follow-up while receiving wound care. Comparisons were made between individuals who identified as higher lonely (L+) ≥40 on UCLA Loneliness Scale or less lonely (L-) ≤39. Validated measures were used for self-reported wound pain, pain interference, sleep disturbance, physical health, depression, and wound healing, and RNA sequencing was used for whole blood samples.

Results: Individuals in the L+ group showed significantly elevated expression of proinflammatory genes over the 2 study visits (P=.010), with significant differences observed at both baseline and follow-up. Several wound characteristics were independently associated with elevated inflammatory gene expression, including wound healing (P=.025) and self-reported wound pain (P=.018). The L+ group elevation in inflammatory gene expression was robust to control for depressive symptoms and variations in leukocyte subset prevalence. More individuals in the L+ group lived alone, were single, had a lower socioeconomic status, larger wounds, were mildly depressed, and experienced pain interference with physical mobility.

Conclusions: Understanding differences in the biomarker profile of lonely individuals with chronic wounds, along with assessment of covariates such as living alone, low socioeconomic status, depression, poor social support, reduced mobility, and pain that impairs daily functioning, could lead to targeted interventions to improve patient outcomes.

Background: Lipodermatosclerosis (LDS) is a type of sclerosing panniculitis that predominantly involves the lower extremities and is characterized by erythema, hemosiderin pigmentation, and sclerotic skin lesions. LDS is a common reason for specialty consultations across clinical settings, including dermatology, vascular medicine, and occasionally the emergency department or internal medicine services.

Methods: To further evaluate the prevalence of venous hypertension in patients with LDS at the authors' institution, they retrospectively reviewed the findings of lower extremity Doppler ultrasonography with or without segmental pressure (ie, venous ultrasonography) performed for adult patients with biopsy-confirmed LDS who were treated at the Clinic from January 1, 2000, through September 30, 2022.

Results: A total of 430 patients were included in the study. Venous ultrasonography findings were abnormal for 327 (76.0%) patients, whereas the other 103 (23.9%) patients had normal findings. Venous hemodynamics studies, including air plethysmography and continuous-wave Doppler ultrasonography, were performed for 33 patients with normal venous ultrasonography findings. Of these patients, 7 had mild valvular incompetence, 12 had abnormal calf muscle pump function, and 2 had pulsatility (backflow in the peripheral vein with elevated right atrial pressure) evident on continuous-wave Doppler ultrasonography.

Conclusions: Overall, the findings extend previous observations that venous abnormalities are commonly present in patients with LDS and may contribute to its pathogenesis. However, a few patients with LDS have normal venous hemodynamics, which suggests that other factors also contribute to LDS pathogenesis.

Objective: The study aimed to assess the knowledge, attitude, and practice (KAP) of informal caregivers toward patients with pressure injury (PI) at Tier-3 Grade A hospitals and their community and nursing homes.

Methods: Data for this single-center cross-sectional study were collected from informal caregivers of patients with PIs who visited the outpatient department within 6 months of the patient's hospital discharge. A convenience sampling technique was used to recruit 239 subjects from April 2022 to April 2023. In the final analysis, 213 informal caregivers completed the questionnaire.

Results: The total score, knowledge score, attitude score, and behavior score were 36.17±3.49, 0.04±0.25, 26.07±3.63, and 10.05±3.27, respectively. There was a positive and significant relationship between the 3 variables. Relationship between caregivers and family members and their practices (P<.05). Findings revealed that the caregiver's job status can significantly positively affect knowledge scores (β=0.032 >0, P<.05). The caregiver's job status can significantly negatively affect knowledge scores (β=-0.581 <0, P<.05). The health of the caregiver can significantly positively affect knowledge scores (β=0.912 >0, P<.05); the caregiver's job status can significantly positively affect practice scores (β=0.386 >0, P<.05). Whether to assist or not can significantly positively affect practice scores (β=1.141 >0, P<.05). The caregiver's health can significantly positively affect practice scores (β=0.633 >0, P<.05).

Conclusions: The study found that informal caregivers had suboptimal knowledge and that most caregivers showed inadequate practices in preventing PI. Given the threat to patient safety, health care center managers must develop comprehensive plans with input from the health care team. Educational initiatives for PI prevention and coordinated nursing services for at-risk patients are essential.

Objective: To identify patient-centered approaches to pressure injury (PI) prevention and management for adults in acute care settings, including the strategies used and their effectiveness.

Data sources: A comprehensive search strategy was developed using the JBI Participants, Concept, and Context framework. The authors searched EMBASE, CINAHL, MEDLINE, Scopus, Cochrane Library, ProQuest, the James Lind Alliance, Healthcare Excellence Canada, and PI-specific organizations for English-language publications from the past 10 years.

Study selection: The search identified 3055 articles, and 1422 duplicates were removed. Studies were excluded if they did not focus on patient-centered PI prevention and management, did not occur in acute care settings, or did not include data that could be extracted. Following abstract and full-text screening, 21 studies were included in this review.

Data extraction: Two independent reviewers extracted data on study design, interventions, and outcomes, and quality (using the Mixed Methods Appraisal Tool).

Data synthesis: The included studies reported 4 main PI prevention strategies: care bundles, educational interventions, technological interventions, or tools to assess or reduce PI risk. Quantitative findings consistently showed reduced PI incidence with patient-centered interventions. Qualitative studies emphasized the importance of knowledge, communication, and collaboration in enhancing patient involvement. Barriers to engagement included pain, cognitive impairment, and health care provider time constraints. The methodological quality of the included studies varied, with limitations due to a lack of blinding and incomplete outcome data.

Conclusions: Patient-centered approaches can effectively reduce PI incidence in acute care. Future interventions should incorporate consistent education, tailored care plans, and effective communication to enhance patient engagement and improve PI prevention and management.

Objective: This systematic review of randomized controlled trials (RCTs) sought to evaluate and summarize the impact of nutrition on healing and prevention of pressure injury (PI).

Data sources: Randomized controlled trials were identified by searching Medline, ULAKBİM, PubMed, ProQuest, and Web of Science between 2002 and 2024.

Study selection: This study was designed based on the systematic review of RCTs. Search terms included "pressure ulcers," "pressure wounds," "pressure injury" in combination with "nutrition" and "supplements."

Data extraction: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Of 1877 articles screened, 18 met the eligibility criteria. All studies were independently assessed by 2 researchers, and data were summarized using a standardized table.

Data synthesis: Nutritional supplementation showed beneficial effects for both prevention and treatment. Prevention trials mainly evaluated protein, arginine, zinc, and antioxidant-enriched formulas, whereas treatment trials examined a wider range of products including collagen, ornithine alpha-ketoglutarate, fish oil, amino acid mixtures, and micronutrients. Overall, nutritional interventions appeared to enhance wound healing and reduce the incidence of new PIs. However, the strength of evidence was limited by small sample sizes, variability in interventions, and moderate methodological quality.

Conclusions: Across 18 studies including 1231 participants (aged 38 to 83 y) with stage 2 to 4 PIs, nutritional interventions demonstrated positive effects on prevention and healing. Formulas enriched with protein, arginine, zinc, antioxidants, and other nutrients appear promising; nonetheless, further large-scale, high-quality RCTs are needed to confirm these findings.

Objective: To evaluate direct care clinicians' understanding of the role of full-body support surfaces in pressure injury prevention.

Methods: A questionnaire was developed and distributed to direct care clinicians through QR code (through flyers and online). A total of 333 surveys were included in the analysis. Survey data were analyzed using both descriptive statistics and a Fisher exact test to compare the answers of respondents who were certified in wound care with those who were not certified.

Results: The majority of respondents were nurses (81.68%), but several other disciplines were represented. Of the respondents, 41% had practiced for 21 or more years, and the acute hospital setting was the most common area of practice (70.57%). Of the respondents, 73.87% were certified in wound care through at least one organization. More direct care clinicians who are certified in wound care were aware that testing standards are available for support surfaces as compared with those not certified in wound care (73.17% vs 62.07%). For the knowledge-based questions, the wound care certified clinicians performed better on 7 of the questions than those not certified (questions 1, 2, 4, 5, 6, 7, and 9). Questions 3 and 7 demonstrated low proficiency within both groups.

Conclusions: Based on the survey results, there are several deficits in knowledge demonstrated by direct care clinicians regarding support surface standards and their clinical application for use in pressure injury prevention.

Objective: To evaluate the efficacy of a machine learning predictive model integrating the Braden Scale with patient demographic and care-related features, in aiding risk identification and guiding targeted interventions aimed at preventing hospital-acquired pressure injuries (HAPIs).

Methods: This clinical pilot study was conducted at a regional medical center in the midwestern United States and included admitted patients ages 18 and older. A gradient boosting trees algorithm was trained using historical patient data and deployed in the electronic health record. Following a validation period, a 6-month pilot study on 2 medical floors involving 3808 admissions evaluated the model's impact. Patients identified by the model as high-risk received supplemental rounding and preventive care. Patients on control floors received standard care.

Results: The primary outcome measures were HAPI events per 1000 census days and the distribution of injury severities. A statistically significant shift in the proportion of deep tissue injuries to full-thickness PIs was observed on pilot floors (odds ratio, 0.09; 95% CI, 0.01-0.88; P=.03). A reduction in the odds of census days with HAPI events to those without was also observed but was not significant in the span of the pilot (odds ratio: 0.69; 95% CI, 0.34-1.39; P=.38).

Conclusions: Predictive modeling shows promise for enhancing HAPI risk identification and guiding targeted prevention in a clinical setting. Further research is needed to confirm that the results are generalizable across diverse health care systems.

Abstract:

Objective: This study was conducted to investigate the development of urinary catheter-related pressure injury (UCPI) in patients hospitalized in the intensive care unit (ICU).

Methods: This descriptive study included 60 patients with urinary catheters who were hospitalized in the adult ICU of a training and research hospital in Istanbul between January and June 2024. Patient Information Form, Glasgow Coma Scale (GCS), Braden Risk Assessment Scale, Urinary Catheter-Related Pressure Injury Assessment Form, and Pressure Injury Staging and Follow-up Form were used to collect data.

Results: The majority of patients (53.3%) were female, their mean age was 74.42±16.17 years, the mean length of stay in the ICU was 19.25±26.73 days, 90% were immobile, and the mean duration of urinary catheterization was 19.25±26.73 days. Urinary catheter-related pressure injury developed in 78.3% of the patients, PI developed on the outer side of the left thigh in 46.7%, and the mean duration of UCPI development was 2.47±1.86 days. Urinary catheter-related PI did not occur in 83.3% of the patients on the first day, 80% on the second day, and 60% on the third day; Stage 1 UCPI developed in 60% on the fourth day, and Stage 1 UCPI developed in 73.3% on the fifth day. In addition, body mass index, duration of mechanical ventilation, and the time of urinary catheter application were effective variables in the development of UCPI.

Conclusions: The risk of UCPI increases as the duration of medical device use becomes longer, and urinary catheters are one of the most common devices associated with medical device-related PIs. Although the risk of PI associated with urinary catheters is high in the ICU, appropriate precautions, risk assessment, evidence-based practices, and early implementation of appropriate nursing interventions may allow the prevention of PI.

Objective: To identify distinct trajectories of Braden Scale scores in critically ill ventilated patients and evaluate their association with pressure injury (PI) development using Latent Growth Mixture Modeling (LGMM), while assessing the prognostic value of these trajectories for early risk identification.

Methods: This retrospective cohort study analyzed data from 7339 adult patients (18 years and above) from the Medical Information Mart for Intensive Care database who received mechanical ventilation for at least 24 hours. Patients required at least 3 Braden score assessments during intensive care unit (ICU) stay. Braden scores were collected from ICU admission up to 48 hours. Latent Growth Mixture Modeling identified distinct trajectories, and competing risk models evaluated the association between trajectories and 14-day PI development, with death as a competing event.

Results: Latent Growth Mixture Modeling identified 4 distinct trajectories: steadily improving group (n=1549, 21.1%), rapidly deteriorating group (n=912, 12.4%), stable-slight improvement group (n=3251, 44.3%), and persistently low group (n=1627, 22.2%). The persistently low group showed the highest mortality (42%) and PI incidence (37%). During the first 48 hours, compared with the steadily improving group, adjusted hazard ratios were significantly higher: rapidly deteriorating group (1.49, 95% CI: 1.05-2.12), stable-slight improvement group (2.40, 95% CI: 1.83-3.17), and persistently low group (4.07, 95% CI: 3.04-5.45). Risk remained elevated during 48 to 120 hours but attenuated by 120 to 336 hours.

Conclusions: Early trajectory patterns of Braden scores demonstrate distinct associations with PI risk. The identification of these patterns, particularly during the first 48 hours, may enable earlier risk stratification and more targeted preventive strategies. Dynamic monitoring of Braden scores could enhance PI risk assessment and prevention in ICU settings.

Objective: This study aimed to assess the incidence and risk factors of physical restraint-related skin injuries among patients in intensive care units (ICUs).

Methods: This prospective cohort study included 260 patients who were physically restrained from 5 ICUs in a hospital. Data were collected using the Physical Restraint Monitoring Form and the Skin Injury Assessment Guide.

Results: The most common physical restraint-related skin injuries were edema (71.9%), ecchymosis (52.3%), scaling (30.8%), and pressure injuries (20%). Pressure injuries were most frequently observed in the neurosurgery and anesthesia/reanimation ICUs. They were more common among patients who were 70 years old or younger, male, had a high body mass index, received antiepileptic therapy, were restrained for more than 46 hours, or were restrained using gauze or tight bonds (P < .001). Male sex, overweight/obesity, and a restraint duration of ≥46 hours were identified as independent risk factors for pressure injury.

Conclusions: Physical restraint-related skin injuries in patients who are critically ill are influenced by factors such as sex, body mass index, restraint duration, and restraint material. The implementation of evidence-based guidelines and regular monitoring can help mitigate these risks and improve patient safety.