Advances in Skin & Wound Care最新文献

Abstract:

Objective: To investigate the impact of darker skin tones on skin tolerance to shear forces in the context of pressure injuries (PIs) and explore the mechanobiological hypothesis that people with darker skin may be at an increased PI risk due to altered biomechanical skin properties resulting from a lower water content (WC) as some literature suggests.

Methods: The authors developed a computational modeling framework simulating skin with varying Poisson ratios to represent different WC levels in the stratum corneum (SC), focusing on the effects of ethnicity and WC on mechanical stresses in superficial skin during weightbearing postures. Mechanical properties of the tissues were based on literature values. Pure compression and compression with shear were applied to the skin model.

Results: A lower Poisson ratio in the SC, indicating lower WC, is associated with higher tissue stresses and more intense stress concentrations, especially under combined compression and shear loading. The initial reduction in the Poisson ratio had the most significant impact on increased tissue loading. These results support the hypothesis that the lower WC in darker skin, associated with increased transepidermal water loss, may lead to altered biomechanical behavior and increased PI risk.

Conclusions: The modeling suggests that reduced WC and increased transepidermal water loss, notably present in darker skin tones, lead to higher stress concentrations within the SC, thus elevating the PI risk. Comprehensive clinical and biomechanical data across various skin tones are needed to improve the practice of PI prevention in individuals with darker skin.

Abstract:

Objective: To evaluate the experiences of caregivers (patients' companions and nurses) in managing pressure injuries (PIs) in patients in palliative care.

Methods: Included in this qualitative phenomenologic study were 10 caregivers (five patient companions and five nurses) involved in the care of five patients hospitalized in the palliative care unit of a single facility between January and March 2023. The research data were collected through face-to-face, in-depth interviews using semistructured interviews.

Results: Two main themes emerged from the interviews: "approach to care" and "factors affecting the care of PIs." Regarding "approach to care," subsidiary analytic themes included "management of PIs" and "feelings." For "factors affecting the care of PIs," analytic themes were "level of knowledge," "facilitators," "difficulty in caregiving," and "experience of care."

Conclusions: The interviewed nurses and patients' companions identified factors facilitating and complicating the effective management of PIs, knowledge of which may steer the development of strategies by healthcare providers and administrators that meet the needs of healthcare personnel. These findings may contribute to creating interventions and policies for managing PIs, potentially increasing the patients' quality of life.

Abstract:

Background: Few studies have investigated the application of massage to bony prominences, and international guidelines do not currently recommend additional massage in these areas.

Objective: To investigate the impact of the effleurage technique, a component of classical massage known for its clinical applicability and practicality, in preventing pressure injuries (PIs).

Methods: The study focused on bedridden patients in the ICU of a state hospital. The sample included patients admitted between July 1, 2021, and November 30, 2021, without preexisting PIs. Using a randomized controlled trial design with simple randomization, routine nursing care was provided to the control group of 30 patients, and the experimental group of 30 patients received classical massage (effleurage technique) in addition to routine care. Both groups were followed up for an average of 12 days using various assessment tools, including a patient information form, the Braden Risk Assessment Scale, the Pressure Wound Staging Form, and an experimental/control group follow-up form.

Results: The research results revealed a statistically significant impact of massage application on preventing PIs (P < .05). The average day of PI development was 10.93 ± 2.31 in the experimental group and 6.79 ± 4.42 in the control group.

Conclusions: The study findings suggest that the effleurage technique, as part of classical massage, can be integrated into nursing practices to effectively prevent PIs.

General purpose: To review risk factors for the development of medical device-related and immobility-related pressure injuries in hospitalized pediatric patients.

Target audience: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.

Learning objectives/outcomes: After participating in this educational activity, the participant will be better able to:1. Describe trends in pressure injuries (PIs) for hospitalized pediatric patients as summarized in current literature.2. Identify risk factors predictive of medical device-related and immobility-related PIs in hospitalized pediatric patients.3. Summarize the methodology used to understand risk factors for developing PIs in the hospitalized pediatric patient population.

Abstract:

Objective: To estimate the increase in length of stay and cost of illness of pressure injuries (PIs) in the inpatient area of a socio-health center.

Methods: This was a retrospective cohort study that included a consecutive sampling of patients admitted to the inpatient programs of a socio-healthcare center between January 1, 2016, and December 31, 2018. Data were retrospectively extracted from patients' electronic health records.

Results: During the study period 4,062 patients were admitted to the different hospitalization programs. The patients' mean age was 75.34 ± 13.69 years, and 51.2% of them were men. Of these, 1,421 patients had PIs, and 318 patients had to prolong their hospital stay due to PIs. These 318 patients were admitted 12,089 days longer (mean of 38.01 ± 41.49 days per patient) than patients without a PI, representing an expense of €1,381,006 (US $1,430,722). The cost of illness in the period under study was estimated at €1,922,049 (US $1,991,212). The average cost of PI treatment per patient was €1,352.60 ± €3,351.43 (US $1,401.29 ± $3,472.08), and the average cost of treatment until complete resolution of a PI was €2,064.65 ± €4,282.48 (US $1,470.79 ± $4,436.65). The cost of treatment ranged from €1,419.68 ± €3,100.47 (US $2,138.98 ± $3,212.09) for stage 1 PIs to €6,299.31 ± €10,000.57 (US $6,526.08 ± $10,360.59) for stage 4 PIs.

Conclusions: This study highlights the significant health and economic impacts of PIs in the inpatient area of a socio-health center. The findings emphasize the necessity of effective prevention strategies to mitigate the occurrence of PIs and their associated costs. By understanding the financial burden of PIs, healthcare providers and policymakers can make informed decisions to improve resource allocation, enhance patient care, and reduce financial strain on the healthcare system.