Advances in Skin & Wound Care最新文献

Abstract:

Objective: To identify markers associated with pressure injury (PrI) history in individuals with spinal cord injury (SCI) using two approaches: skin blood flow (SBF) response toward localized heating, and serum marker for insulin resistance.

Methods: For this cross-sectional, observational study of adults with chronic traumatic SCI at T12 and above, researchers recruited two groups of participants: with history of PrI (group 1), and without history of PrI (group 2). The study protocol included obtaining fasting blood samples and measurement of SBF at bilateral heels with localized heating of 42 °C for 30 minutes from all participants. Primary SBF outcomes were initial peak and plateau SBF normalized to baseline SBF. The primary outcome for insulin resistance was Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), calculated from fasting plasma glucose and insulin. Secondary outcomes included demographic and SCI information. Researchers used the Fisher exact test and Wilcoxon-Mann-Whitney test to compare the intergroup difference of categorical and continuous variables, respectively.

Results: Sixteen adults completed this study (group 1, n = 7; group 2, n = 9). In comparison with group 2, group 1 had significantly higher HOMA-IR (3.90 ± 0.71 vs 1.45 ± 0.71), suggesting higher insulin resistance, and longer duration of injury (22.54 ± 7.24 vs 7.98 ± 6.58 years). There were no between-group differences in SBF or other secondary outcomes.

Conclusions: HOMA-IR is a novel serum index associated with PrI history in persons with chronic SCI. Future longitudinal study is warranted to examine the role of insulin resistance in increasing PrI risk for the SCI population.

Abstract:

Objective: To evaluate the feasibility and effectiveness of the Scott-Munro (S-M) model in the dynamic assessment of intraoperatively acquired pressure injuries (IAPIs) in adults.

Methods: This study included 8,254 patients who underwent surgery between October 2022 and September 2023. The S-M model was applied for the dynamic risk assessment of IAPIs. The first cycle was set as the baseline from October 1, 2022, to December 31, 2022, and cycles were set every 3 months thereafter. Each cycle was compared with the first cycle and the previous cycle, in terms of IAPI incidence, actual assessment rate of IAPIs in high-risk patients, and accuracy of IAPI assessment in high-risk patients.

Results: The incidences of IAPIs in the four cycles were 0.52%, 0.27%, 0.09%, and 0.13%, respectively. The third and fourth cycles both differed significantly from the first cycle (P < .05). The actual assessment rates of IAPIs in high-risk patients in the four cycles were 13.01%, 47.20%, 90.96%, and 95.67%, respectively (P < .05). Similarly, the accuracy of the assessment of IAPIs in high-risk patients was 38.04%, 67.37%, 89.93%, and 86.58%, respectively, in the four cycles (P < .05).

Conclusions: The S-M model can reduce the incidence of IAPIs, dynamically and effectively evaluate IAPIs, and provide a basis for the management and prevention of IAPIs.

Abstract:

Background: Altered localized microclimate conditions are known to increase the risk of pressure injuries in immobile patients. Limited in vivo studies have examined how skin properties change over time and under different skin microclimate conditions.

Objective: To examine changes in erythema, stratum corneum hydration, and skin temperature in response to an altered microclimate, simulated by the introduction of heat, at the skin-support surface interface of semirecumbent healthy adults.

Methods: In this quasi-experimental study, researchers obtained noninvasive biophysical skin measures at the elbows, heels, and sacrum of healthy adults positioned semirecumbently. Participants advanced through a controlled condition and heat intervention. Repeated measures were gathered at the anatomic sites every 10 minutes for 60 minutes per condition. Linear mixed models were used to compare skin measures over time and between conditions.

Results: Large regional variation in skin measures emerged by condition and among participants. The introduction of heat increased skin temperature at the heels (P < .001), elbows (P = .005), and sacrum (P < .001). Erythema increased at the sacrum (P = .012) but at no other anatomic testing site. There was no impact on stratum corneum hydration as a result of increased heat at any anatomic testing site.

Conclusions: More frequent monitoring cycles for erythematous skin discoloration and thermal changes may be required at the sacral skin in immobile patients. Distinctive protocols in relation to skin-care regimens may be warranted for individual patients. Skin cooling, enabled by intermittent off-loading of pressure-prone areas, may assist optimization of the skin microclimate.

Abstract:

Background: Although most pressure injuries (PIs) are healable with appropriate assessment, preventive intervention, and treatment, nursing professionals recognize that some PIs are unavoidable. Research investigating unavoidable PIs is limited because there are few clear means of determining whether these injuries are unavoidable.

Objective: To clarify the reality of unavoidable PIs by analyzing the state of PIs and blood test results in patients who were actively dying.

Methods: From 2018 to 2023, 904 hospitalized patients at the author's medical center developed PIs. Of these patients, 710 survived and were discharged (survival group). Of the 194 patients who died after developing a PI, 111 died more than 8 days after onset (end-of-life group), and 83 patients died within 7 days of onset (actively dying group). The researcher analyzed patients' age, weight, and height, as well as various blood work parameters at the time of PI occurrence in the survival, end-of-life, and actively dying patient groups.

Results: Approximately half of patients with PIs in the actively dying stage had cancer. Total protein, albumin, and blood urea nitrogen were significantly lower among the actively dying patients compared with those who survived. Aspartate transferase, alanine aminotransferase, white blood cell count, and C-reactive protein were all significantly higher among patients in the actively dying versus the surviving group.

Conclusions: It is difficult to determine whether a PI is unavoidable. However, the author believes that clinical symptoms and blood test data can help make that decision.

Abstract: Pyoderma gangrenosum is a rare ulcerative condition that poses diagnostic and therapeutic challenges. Diagnosis and appropriate management are often delayed due to its rarity and the presence of numerous clinical variants. In this case report, the authors present the case of a 36-year-old man who had long-standing and nonhealing ulcers that did not respond to multiple antibiotics and serial wound debridement. The patient was promptly initiated on oral corticosteroids and dapsone as an adjunctive steroid agent. After 6 months, the patient reported complete resolution of the lesions. This rare case underscores the potential value of combining prednisone and dapsone as a treatment option for pyoderma gangrenosum, particularly in resource-limited settings.

Background: Infective and noninfective dermatoses of the lower leg and foot can be attributed to factors such as infections, blood stagnation, chemical contact, and abnormal mechanics. These factors make the lower leg and foot more susceptible to microbial infections, contact dermatitis, stasis eczema, ulcers, corns, and calluses.

Objective: To identify the patterns of infective and noninfective dermatoses on the lower leg and foot.

Methods: This study took place between September 2020 and August 2021 at an outpatient dermatology clinic. All patients with lower leg and foot dermatoses were included in the study, irrespective of age, sex, or occupation. Patients with generalized lesions all over the body were excluded.

Results: Of the 42,527 patients who presented to the outpatient dermatology clinic during the study period, 424 patients (1%) had lower leg and foot dermatoses. The ratio of male to female patients was 2.3:1. Patients ranged in age from 4 to 76 (mean, 44.8 ± 15) years. A total of 152 patients had infective dermatoses, and 272 patients had noninfective dermatoses. Fungal infection (21.7%) was most common among patients with infective dermatoses, followed by bacterial infections (8.25%) and viral infections (7.07%). Lichen simplex chronicus (29.3%) and dermatoses due to venous stasis (19%) were most common among patients with noninfective dermatoses. The most commonly involved site was the shin, followed by the dorsum and sole of the foot.

Conclusions: The identification of high-risk patients is key in taking preventive measures to avoid complications.

Objective: To analyze the risk factors for peristomal skin complications (PSCs) in patients with colorectal cancer and an ostomy, construct a prediction model, and verify its effectiveness.

Methods: In this cross-sectional study, researchers recruited 265 patients with an ostomy at the stoma clinic of a tertiary hospital, from May 2022 to August 2023. Patients were divided into two groups: complications group (n = 81) and no complications group (n = 184). Researchers constructed a logistic regression prediction model using univariate and multivariate analyses. From May 2023 to August 2023, a validation group of 135 patients with an ostomy was selected for external validation of the model.

Results: The incidence of PSCs was 30.57% in the modeling group and 30.37% in the validation group. The predictor variables were preoperative and postoperative health education, tumor therapy within 3 months, preoperative stoma positioning, stoma height, stoma type, and excrement state. The Hosmer-Lemeshow test yielded a P value of .513, the area under the ROC curve was 0.872, the Youden index was 0.561, and the sensitivity and specificity were 0.827 and 0.734. For external validation, the Hosmer-Lemeshow test yielded a P value of .835, the area under the ROC curve was 0.887, and the sensitivity and specificity were 0.905 and 0.720, respectively.

Conclusions: The prediction model demonstrates good predictive efficacy and can serve as a reference for clinical caregivers in identifying patients at high risk of PSCs.

Objective: To present a full scope of detailed and engaging laboratory activities recommended by physical therapist clinicians and educators from across the US to assist health professions faculty to develop new or improve current integumentary/wound management (IWM) instruction.

Methods: A three-round Delphi survey was conducted to update IWM curriculum recommendations for entry-level doctor of physical therapy education. First-round participants provided ideas for laboratory activities. Activity responses were discussed, edited for redundancy, and clarified. Missing information (eg, estimated cost and time required) was added to increase usability.

Results: A total of 139 laboratory activities were recommended by survey participants. Many of the suggestions included inexpensive and readily available, do-it-yourself wound models requiring food or other moulage techniques. These simulations are elucidated to facilitate translation of ideas into classroom and community laboratory activities to promote student learning.

Conclusions: The literature supports that most entry-level healthcare profession programs report limited IWM education, emphasizing the need for effective and efficient use of IWM contact hours. Developing engaging and meaningful hands-on laboratory activities is vital to increasing student knowledge and skill in this area of clinical practice.

Objective: To investigate the incidence of skin changes at life's end (SCALE) among hospice patients and identify associated factors.

Methods: The authors conducted a retrospective chart review of demographic data, medical history, Braden Scale assessment scores, Charlson Comorbidity Index, symptom records, and medical treatments of patients admitted to a local teaching hospital's hospice unit between May 2019 and April 2021.

Results: Most (79%) of the 300 hospice patients included in the study had cancer. Of the 181 patients who died, 49 (60.3%) had SCALE. Logistic regression analysis revealed that greater variations in Braden Scale scores from admission to predeath (odds ratio, 1.188; 95% CI, 1.014-1.392; P = .033), higher Eastern Cooperative Oncology Group grades (odds ratio, 1.965; 95% CI, 1.241-3.109; P = .004), and elevated Charlson Comorbidity Index scores (odds ratio, 1.514; 95% CI, 1.237-1.854; P < .001) significantly increased the likelihood of developing SCALE.

Conclusions: The findings suggest that the occurrence of SCALE may serve as a valuable clinical indicator for healthcare professionals to recognize that a patient is approaching the end of life. Consequently, the care approach should prioritize pain relief and promote comfort rather than wound healing in this patient population. These results provide evidence to support the integration of SCALE-related training programs for hospice care, which can increase healthcare professionals' awareness and understanding of SCALE. Ultimately, the implementation of such training programs may lead to more appropriate care for hospice patients with SCALE, enhancing their quality of life at the end of life.