Advances in Skin & Wound Care最新文献

Abstract:

Objective: To develop and validate a nomogram model for pressure injury (PI) risk assessment in hospitalized patients, and provide a visual tool for hospital-acquired pressure injury (HAPI) risk assessment.

Methods: This retrospective case-control study included 973 patients between January 2021 and December 2022 from 2 hospitals: the First Hospital of Lanzhou University and the Gansu Provincial Hospital. Patients were randomly divided into the development cohort (n=682) and validation cohort (n=291) according to a ratio of 7:3. In the development cohort, univariate and multivariate logistic regression analyses were used to identify PI risk factors of the nomogram. The nomogram model was validated by the concordance index (C-index), receiver operating characteristic curve analysis (ROC curve), and calibration curves with the Hosmer-Lemeshow goodness-of-fit test. The clinical utility of the model was assessed through decision curve analysis (DCA).

Results: The nomogram model comprised 9 variables: age, length of hospital stay, alcohol consumption, self-care ability, changes in bowel status, Braden score, indwelling nasogastric tube, taking sedative analgesics, and taking diuretic drugs. The area under the ROC curve (AUC) was 0.862. In the validation cohort, the nomogram still had good discrimination (AUC: 0.871). The calibration curve and DCA showed that the risk assessment nomogram had good consistency and clinical utility.

Conclusions: A high-performance nomogram model was established, which can accurately assess the risk of PI among hospitalized patients. Notably, this nomogram provides an accurate visual tool to nursing staff and caregivers for risk assessment, early intervention, and risk management of HAPI.

Objective: The aims of this pilot study were to determine whether (1) a modified version of the Robinson-Ho Skin Type Color Bar would identify early, subtle skin tone variations in patients with dark skin tones because of injury, and (2) if the tool was reliable between clinicians.

Methods: This was a prospective, observational cohort study in a surgical intensive care/acute care unit located in an urban, academic hospital. Patients who were ≥18 years old without a skin injury, but with a confirmed dark skin tone based on the modified Robinson-Ho Skin Type Color Bar, were included in the pilot study.

Results: The first aim could not be supported because of the lack of patients who developed subtle skin tone changes indicative of a skin injury. Two patients developed a skin injury (deep tissue pressure injury, trauma). These wounds did not manifest as subtle changes, therefore rendering the tool ineffective for these cases. The second aim was supported as inter-rater reliability of the Robinson-Ho Skin Type Color Bar showed moderate agreement between multiple raters. It was also noted that race/ethnicity was not an objective marker for determining skin tone per the tool.

Conclusions: Although the modified Robinson-Ho Skin Type Color Bar was not an effective method to detect subtle skin tone changes indicative of injury because of the 2 wounds that did occur, it was reliable to use between multiple users. The tool also served as an objective marker for determining baseline skin tone.

Abstract:

Objective: Respiratory therapists (RTs) commonly use medical devices to assist breathing, which increases the risk for hospital-acquired pressure injuries. Prophylactic skin measures can help reduce these device-related skin injuries. The primary aim of this study was to determine how many hospitals within the United States utilize RT-driven protocols to prevent respiratory device-related skin injuries.

Methods: This was a descriptive, cross-sectional survey of US hospitals, conducted between March 2023 and May 2023 through an online survey. Information related to the hospital setting, RT involvement with hospital skin committees, and RT departmental initiatives related to preventing respiratory device skin breakdown was collected.

Results: A total of 100 participants fully completed the survey: 50 directors/managers, 27 direct care staff, 22 clinical educators, and 1 quality improvement specialist. Among the respondents, 60% worked in academic hospitals with >300 beds. At the institution level, 77% of respondents collaborated with the hospital-wide skin committee, and 80% were involved in respiratory device-related skin breakdown initiatives. In terms of RT departments, 63% respondents had RT-driven protocols to prevent respiratory device-related skin breakdown, and 47% had RT departmental committees to review these skin breakdowns. For education, 84% of the respondents received education on skin breakdown prevention, and 40% of the respondents received training annually. In the past year, 41% of the respondents reported 5 or fewer incidences of respiratory device-related skin breakdown.

Conclusions: This survey study found that approximately two-thirds of the respondents utilize RT-driven protocols and approximately half employ an internal RT committee to review skin breakdown.

Nicolau syndrome (NS) is a rare but serious iatrogenic complication characterized by cutaneous necrosis following intramuscular injections. Hyperbaric oxygen therapy (HBOT) has shown promise in enhancing tissue oxygenation and promoting wound healing in NS cases. The authors report the case of a 51-year-old female who developed a painful necrotic ulcer on her left gluteal region, diagnosed as NS following an intramuscular injection of etofenamate administered for knee osteoarthritis. The patient was treated with a combination of local wound care and a series of 30 HBOT sessions. This treatment regimen led to complete ulcer healing with residual hypopigmented scarring. Hyperbaric oxygen therapy can be an effective treatment for NS induced by intramuscular etofenamate injection, facilitating complete ulcer healing and minimizing sequelae. This case underscores the importance of early recognition and comprehensive management of NS, including the potential benefits of HBOT.

Objective: To translate and validate the content of the Skin Tears Knowledge Assessment Instrument (OASES) into Chilean Spanish.

Methods: A cultural adaptation was carried out using a simplified methodology. The process began with a forward translation conducted by 2 bilingual translators. Review by an expert panel comprising 10 judges, 8 of whom were wound care specialists. The panel assessed the content validity of the consensually translated version using the content validity ratio (CVR). Subsequently, a back-translation into English was performed and reviewed by one of the original authors of the instrument.

Results: Out of 113 items in the consensually translated version, 7 items initially demonstrated low agreement, with CVR values between 0 and 0.4. Following a second round of evaluation by the expert panel, all items achieved a CVR of 1, except for 1 item, which received a CVR of 0.8, still within acceptable limits. The final translated and validated version was approved by one of the original OASES authors.

Conclusions: The Chilean Spanish version of the OASES instrument meets local linguistic and cultural requirements while offering a validated, standardized tool for assessing knowledge about skin tears. This adaptation enhances the quality of training and supports prevention efforts across various clinical settings. Future work may include adapting the instrument for use in other Spanish-speaking countries, thereby fostering a more unified and culturally sensitive approach to skin tear prevention and management across Latin America.

Abstract:

Objective: Ablative fractional carbon dioxide laser (CO 2 -AFL) and intense pulsed light (IPL) are noninvasive light-based therapies that have demonstrated efficacy for various dermatological conditions. However, their application in the treatment of hidradenitis suppurativa (HS) remains relatively unexplored.

Methods: This retrospective case series presents the patient-reported outcomes of 4 patients with HS who were treated with CO 2 -AFL-assisted triamcinolone delivery (n=2) or IPL+CO 2 -AFL-assisted triamcinolone delivery (n=2).

Results: Patients treated with CO 2 -AFL alone (n=2) experienced a mean reduction in POSAS of 9±1.4 and DLQI of 6.6±0.7. Patients treated with IPL+CO 2 -AFL (n=2) experienced a mean reduction in POSAS of 30 and DLQI of 9. All patients reported high levels of satisfaction, and no adverse effects were observed.

Conclusions: CO 2 -AFL, either alone or in combination with IPL, followed by topical and intralesional triamcinolone, may be an effective treatment modality for HS. Prospective studies with larger cohorts, standardized treatment protocols, and extended follow-up periods are needed to further validate these findings.

Objective: To evaluate the efficacy and safety of composite ovine forestomach matrix and hyaluronic acid (OFM-HA) graft in facilitating tissue regeneration in atypical wounds secondary to calciphylaxis.

Methods: This retrospective case series included 3 patients with a total of 4 wounds (n = 4) who were diagnosed with wounds secondary to calciphylaxis in an outpatient setting. All wounds were treated with surgical debridement and a composite OFM-HA graft. Healing progress was monitored, and the total time to wound closure was assessed.

Results: All 4 wounds in the study achieved 100% wound healing, with a 12-week incidence of closure of 75%. The mean wound area at the time of OFM-HA treatment was 28.6 ± 26.9 cm 2 , with a mean depth of 0.2 ± 0.1 cm. The mean time to wound closure was 43.5 ± 37.0 days and all patients experienced a marked reduction in pain. No adverse events were reported, and all wounds remained healed after achieving 100% closure at final follow-up.

Conclusions: Ovine forestomach matrix and hyaluronic acid, in combination with wound bed preparation, were found to be safe and effective treatments for wounds associated with calciphylaxis; they may reduce the time to wound closure compared with traditional wound care and reduce complications associated with calciphylaxis-related wounds.

Objective: The relationship between the knowledge levels of agriculture faculty students regarding skin cancer risk and their protective behaviors was examined.

Methods: This study is a descriptive and cross-sectional research conducted to evaluate the knowledge and behaviors of agriculture faculty students regarding skin cancer and sun protection. Research data were collected with the Personal Information Form, Skin Cancer and Sun Knowledge Scale, and Sun Protection Behavior Scale.

Results: The mean scores obtained on the Skin Cancer and Sun Knowledge Scale were 10.95 ± 3.02, and the mean scores of the Sun Protection Behavior Scale were 24.79 ± 6.95. A statistically significant relationship was found between sun protection behaviors and various factors such as sex, hair color, skin color, and mole-checking methods ( P < .05). More specifically, students who described their skin color as dark had lower scores in sun protection, which was a statistically significant difference ( P < .05). In addition, a weak negative relationship was discovered between the subscale of skin cancer risk factors and the subscale of sun avoidance ( P < .05).

Conclusions: The study indicates that agriculture faculty students possess insufficient knowledge about skin cancer and sun protection, and their preventive behaviors are inadequate. It is important to develop educational programs and implement strategies to provide students with the necessary behaviors regarding skin cancer and sun-related health.