Advances in Skin & Wound Care最新文献

Objective: To evaluate the predictive validity of the Cubbin & Jackson scale and the COMHON index in intensive care units in China.

Methods: This study was conducted in the intensive care unit of a tertiary grade A hospital in Shenzhen, China, from February 2022 to December 2023. Two senior nurses independently performed each assessment using both the Cubbin & Jackson scale and the COMHON index simultaneously. Baseline characteristics were collected at the first evaluation. Sensitivity, specificity, positive and negative predictive value, Youden Index, and the area under the curve of the receiver operating characteristic were used to compare the predictive performance.

Results: A total of 253 patients were included in the evaluation, out of which 25 patients developed pressure injuries. The cut-off score of 32 for the Cubbin & Jackson scale and 9 for the COMHON index demonstrated the highest predictive validity. The sensitivity, specificity, positive and negative predictive value, Youden Index, and area under the curve of the receiver operating characteristic were determined to be 100%, 63.89%, 21.21%, 100%, 0.64, and 0.88, respectively, for the Cubbin & Jackson scale. Similarly, the COMHON index exhibited values of 100%, 64.58%, 21.54%, 100%, 0.65, and 0.80 for the same parameters.

Conclusions: The Cubbin & Jackson scale and the COMHON index demonstrated comparable moderate predictive efficacy in assessing pressure injury risk among patients in the intensive care unit.

Objective: To develop a three-dimensional (3D) spacer mattress for pressure relief and to evaluate its effectiveness during cardiac surgery.

Methods: This study consisted of 3 phases: development, initial assessment, and randomized controlled trial (ClinicalTrials.gov, NCT06071039). Sixty patients underwent cardiac surgery divided into 2 groups, 30 patients each. The data were collected in a public hospital in Istanbul Provincial Health Directorate Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital between February and September 2023. A 3D spacer mattress was used for the intervention group, and a standard operating theatre mattress (foam) was used for the control group. Pressures on the sacrum, left heel, and right heel were measured throughout surgery using a continuous pressure measurement system.

Results: The mean pressure values were 49.73 ± 17.40, 15.65 ± 5.19, and 18.01 ± 9.34 mm Hg for sacrum, left heel, and right heel, respectively, in the control group, whereas the mean pressure values were 28.21 ± 11.70, 5.88 ± 1.88, and 6.56 ± 2.81 mm Hg for the sacrum, left heel, and right heel, respectively, in the intervention group. The means of the maximum pressure values were 90.36 ± 8.63, 62.51 ± 13.77, and 54.19 ± 16.71 mm Hg for sacrum, left heel, and right heel, respectively, in the control group, whereas the means of the maximum pressure values were 49.31 ± 12.61, 28.82 ± 13.56, and 31.17 ± 16.65 mm Hg for the sacrum, left heel, and right heel, respectively, in the intervention group. There were statistically significant differences between the groups for mean and maximum pressure on the sacrum, left heel, and right heel ( P < .05).

Conclusions: The use of a 3D spacer mattress is an effective method to relieve pressure during cardiac surgery.

Abstract:

Objective: This study aimed to analyze the effectiveness of health education interventions related to self-care in patients at risk of developing complications associated with peripheral diabetic neuropathy.

Data sources: A quantitative systematic literature review was conducted using the Joanna Briggs Institute methodology. The guiding question was, "Is health education effective for self-care in patients at risk for peripheral neuropathy?" The databases used included MEDLINE (via Ovid), BVS, CINAHL, PubMed (PMC), Cochrane Library, EMBASE, OasisBR, SCIELO, and Google Scholar as of May 22, 2023. Studies were identified using Health Sciences Descriptors (DeCS) from the Virtual Health Library (BVS in Portuguese), and Medical Subject Headings (MeSH) from the National Library of Medicine, United States (US NLM).

Study selection: The search results were imported into the reference manager, Rayyan, and then duplicate documents were removed. Studies that met the selection criteria based on abstract reading proceeded to the second stage, which included full-text article analysis.

Data extraction: Data on health education and care of patients with diabetic neuropathy were extracted from the studies.

Data synthesis: A total of 426 articles were identified after completion of the searches. After selection, 3 articles were included in the review. Two had a low risk of bias and 1 had a high risk of bias. Health education was found to be effective in controlling various signs and symptoms associated with diabetic neuropathy.

Conclusions: Key findings in the literature support the effectiveness of health education in managing the signs, symptoms, and complications of diabetic neuropathy.

The optimal treatment modality for diabetic foot osteomyelitis (DFO) remains unclear. The current guidelines from Diabetes Canada recommend the use of oral antibiotics and/or intravenous antibiotics with no preferred agent or route of administration. This report aimed to evaluate the current evidence surrounding oral antibiotic therapy for DFO. Embase and MEDLINE databases were searched for original articles written in English that reported efficacy and safety data on oral antibiotic use for this indication. Twenty-six unique studies were included, encompassing 972 patients treated with oral antibiotics. The mean age was 64.6 years (range: 30 to 90 y). When used as monotherapy, the complete resolution and partial resolution rate for oral antibiotic therapy were 75.2% (539/717) and 3.2% (23/717), respectively. When used as a step-down therapy after intravenous antibiotics, the complete and partial resolution rate for oral antibiotics were 56.5% (155/255) and 20.4% (52/255), respectively. No resolution of DFO resulting in refractory infection or amputation was observed in 155 (21.6%) cases of oral antibiotics monotherapy and 59 (23.1%) of step-down therapy. Recurrence rates for oral antibiotics monotherapy and step-down therapy were 5.4% (39/717) and 3.9% (10/255), respectively. Oral antibiotic therapy demonstrates favorable outcomes in DFO comparable to intravenous treatment. Oral antibiotic therapy may be especially useful in low-resource settings where hospital beds are limited and in situations where patients require ambulation. Nonetheless, patients should be counselled on the vital importance of adherence, and resource stewardship should be practiced by health care providers to avoid antibiotic resistance. GENERAL PURPOSE: To present a systematic review article evaluating the utility of oral antibiotics for the treatment of diabetic foot osteomyelitis. JOURNAL/aswca/04.03/00129334-202511000-00004/figure1/v/2025-11-11T122732Z/r/image-jpeg TARGET AUDIENCE: This continuing education activity is intended for physicians; physician assistants; nurse practitioners; podiatrists/other foot specialists; and registered nurses with an interest in skin, wound, and diabetic foot care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, the participant should be better able to: Summarize the evidence the authors considered when evaluating the utility of oral antibiotics for diabetic foot osteomyelitis.Select the characteristics of the participants and settings in which oral antibiotic therapy was utilized.Identify the results of the authors' study assessing the use of oral antibiotics.Discuss potential situations in which oral antibiotic therapy may provide favorable outcomes as monotherapy or in conjunction with intravenous antibiotics for diabetic foot osteomyelitis.

Objective: The aim of this study was to retrieve, evaluate, and summarize the best available evidence on skin-mucosal care for patients with Stevens-Johnson syndrome (SJS) / toxic epidermal necrolysis (TEN).

Data sources: The data were gathered from national and international databases and reputable websites. A top-down approach was applied following the 6S Evidence Search Model, with a search time frame from the time of database construction to December 25, 2023. Multiple sources, including clinical decisions, guidelines, and expert consensus, were reviewed.

Study selection: Studies that addressed skin-mucosal care in patients with SJS/TEN were eligible for inclusion. The literature was rigorously screened to ensure its relevance and methodological quality. A total of 11 documents were included in this review, which consisted of 1 clinical decision, 5 clinical practice guidelines, and 5 expert consensus documents.

Data extraction: Two researchers independently assessed the quality of the included studies, extracted evidence, and summarized the findings. A total of 34 pieces of evidence spanning 6 dimensions of skin-mucosal care were identified and categorized.

Data synthesis: The extracted evidence was synthesized and summarized to provide actionable insights for clinical practice. The evidence focused on wound care, infection prevention, pain management, hydration, and specific recommendations for skin-mucosal care tailored to the unique needs of patients with SJS/TEN.

Conclusions: This article offers a comprehensive evidence-based basis for effective skin-mucosal care to SJS/TEN patients. These best practices can improve patient outcomes and contribute to better clinical management.

Objective: The incidence of skin cancer is increasing worldwide every day. This study was conducted to evaluate body image perception and self-esteem in patients with skin cancer.

Methods: This prospective, cross-sectional, relationship-seeking, and descriptive research design study was carried out with 320 patients diagnosed with skin cancer to assess their body image perception and self-esteem levels. Data were collected between December 2023 and September 2024 at a city hospital. The data collection tools used in the study included the Patient Information Form, Body Image Scale, and Rosenberg Self-Esteem Scale (RSES).

Results: The average age of the patients participating in the study was found to be 63.9 ± 18.4 years. The average scores of the patients on the Body Image Scale and the RSES were 129.6 ± 26.1. It was found that the patients had a low body image perception. The average score on the RSES was 2.6 ± 1.5, indicating that the self-esteem level of the patients was at a moderate level. A statistically significant relationship was found between the scores on the Body Image Scale and the RSES ( P <.01). As the patients' positive body image perception increased, their self-esteem also improved.

Conclusions: It was determined that patients with skin cancer had a low body image perception and moderate self-esteem levels.

Objective: To explore the efficacy of a double-pocket fecal catheter system combined with camellia oil application in the prevention and treatment of irritant contact dermatitis (ICD) due to incontinence among patients in the intensive care unit (ICU).

Methods: A total of 248 patients admitted to the integrated ICU of the authors' hospital between January 1, 2022, and December 31, 2023, were selected. Among them, 204 high-risk patients with ICD due to incontinence were identified using the perineal assessment tool. The high-risk patients were divided into research group 1 (camellia oil application), research group 2 (double-pocket fecal catheter system combined with zinc oxide ointment application), research group 3 (double-pocket fecal catheter system combined with camellia oil application), and the control group (zinc oxide ointment application). The incidence, time of onset, severity, daily treatment cost, nursing efficiency, and healing time of ICD due to incontinence were compared among different groups.

Results: Different treatment methods had varying effects on the incidence (χ 2 =14.211, P <.001), time of onset ( F =5.521, P =.013), severity ( P =.023), daily treatment cost ( F =9.607, P <.001), nursing efficiency ( P =.037), and healing time of ICD due to incontinence ( F =3.907, P =.028). The performance of research group 3 in terms of ICD due to incontinence onset and healing times was superior to that of the other groups, with statistically significant differences ( P <.001).

Conclusions: Camellia oil combined with a double-pocket fecal catheter system exhibits high efficacy in the prevention and treatment of ICD due to incontinence among patients in the ICU.

Objective: To review currently available devices on pressure injury (PI) early detection, summarize challenges and opportunities to clinical implementation, and propose evaluation standards for device categories.

Data sources: PubMed and US Food and Drug Administration (FDA) databases.

Study selection: Published in English from peer-reviewed journals with full text available. Excluded if opinion statements, lack of empirical data, or unrelated to project's objective.

Data extraction: For both clinical device and research equipment: measurement mechanisms, measurement types, outcome/output, FDA classification, and indications for use. Addition data were extracted for clinical devices: instruction for use, end user, order requirement, and billable code.

Data synthesis: The 4 clinical devices are ultrasound, long-wave infrared thermography, subepidermal moisture assessment, and nearinfrared spectroscopy. The 3 research devices are laser Doppler flowmetry, laser speckle contrast imaging, and colorimetry.

Conclusions: The measurement mechanisms of all devices are unique and different from each other. One commonality is that they could measure the nonvisual signs of PI (eg, inflammation, edema, ischemia, and hypoxia) except colorimeter. Some clinical devices are promising to assist with early identification of PIs, especially in individuals with dark skin tones. Currently, there is no reimbursement available for early detection of PI. Current evidence did not support replacing the standard skin assessment of visual inspection and palpation with the devices reviewed, rather using validated devices to augment the current practice standard. This is especially recommended for individuals identified as high risk for a PI on admission to a facility.