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Wound Care at the Intersection of Race, Ethnicity, and Malnutrition. 种族、民族和营养不良交织的伤口护理。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1097/ASW.0000000000000211
Nancy Munoz, Mary Litchford

Abstract: Ensuring adequate nutrition is vital for maintaining skin health and promoting successful wound healing. Globally, the rise in malnutrition and diet-related diseases is contributing to increased rates of illness and disability. Populations in food deserts and those experiencing food insecurity are particularly at risk. Being at risk for or having malnutrition associated with chronic conditions such as diabetes and cardiovascular disease can increase the incidence of wounds. Healthcare disparities and varied clinical outcomes among ethnic minorities further contribute to these challenges. Research indicates that racial and ethnic minorities experience a higher prevalence and severity of wounds, including pressure injuries. Detecting early-stage wounds in individuals with darker skin tones can be difficult, adding to the disparities.Culturally appropriate nutrition interventions are essential in addressing these health inequities because tailored approaches tend to be more effective than uniform strategies. Understanding diverse dietary patterns and incorporating cultural food preferences into care plans can improve patient adherence and outcomes. Promoting equity in wound care through culturally sensitive practices helps to foster respect, dignity, and trust within healthcare settings, particularly for minority populations.In this review, the authors highlight the need for inclusive interventions that provide culturally aligned nutrition, supporting patients' clinical and holistic well-being.

摘要:确保充足的营养对于保持皮肤健康和促进伤口成功愈合至关重要。在全球范围内,营养不良和与饮食相关疾病的增加导致患病率和残疾率上升。食物荒漠中的人群和食物无保障的人群面临的风险尤其大。糖尿病和心血管疾病等慢性病的高危人群或营养不良人群会增加伤口的发病率。少数族裔在医疗保健方面的差异和不同的临床结果进一步加剧了这些挑战。研究表明,少数种族和族裔的伤口(包括压力伤)发生率和严重程度更高。要解决这些健康不平等问题,文化上适当的营养干预措施至关重要,因为量身定制的方法往往比统一的策略更有效。了解不同的饮食模式并将文化饮食偏好纳入护理计划可提高患者的依从性和治疗效果。在这篇综述中,作者强调需要采取包容性干预措施,提供与文化相适应的营养,为患者的临床和整体健康提供支持。
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引用次数: 0
High-Quality Dietary Protein: The Key to Healthy Granulation Tissue. 优质膳食蛋白质:健康肉芽组织的关键。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1097/ASW.0000000000000210
Andy S Chu, Barbara Delmore, Ernest S Chiu

General purpose: To review the role of nutrition and high-quality dietary protein intake in creating healthy granulation tissue and optimize wound healing in patients with chronic wounds.

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:1. Summarize the structure and composition of proteins. 2. Specify the role of proteins in generating healthy granulation tissue and wound healing. 3. Explain the physiologic pathways involved in the wound healing process. 4. Describe evidence-based interventions to support nutrition in wound healing.

一般目的:回顾营养和优质膳食蛋白质摄入在创建健康肉芽组织和优化慢性伤口患者伤口愈合方面的作用:本继续教育活动面向对皮肤和伤口护理感兴趣的医生、医生助理、执业护士和注册护士:参加本教育活动后,学员将: 1. 总结蛋白质的结构和组成。2.2. 明确蛋白质在生成健康肉芽组织和伤口愈合中的作用。3.3. 解释伤口愈合过程中涉及的生理途径。4.描述在伤口愈合过程中支持营养的循证干预措施。
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引用次数: 0
Opportunities and Solutions: Unintentional Weight Loss. 机遇与解决方案:无意减肥。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1097/ASW.0000000000000208
Rebecca Guterman, Andy S Chu, Rebecca Hirsch, Judy Singer, Sarah Johnston, Katy Fung

Abstract: In this narrative review, the authors provide a concise overview of current information on the identification and management of unintentional weight loss (UWL) in clinical care settings. Unintended weight loss can occur widely and is often multifactorial. Clinicians should use screening tools to identify those experiencing UWL. Management includes nutrition assessments and diagnosing malnutrition when present. Nutrition counseling by a registered dietitian nutritionist should address the causes and manifestations of UWL. Individualized dietary plans with supplementation and/or nutrition support and medications for appetite stimulation may be considered. The presence of UWL at the end of life should be addressed in line with the patient's care plan. Managing UWL is part of the multidisciplinary care teams' responsibilities.

摘要:在这篇叙述性综述中,作者简明扼要地概述了目前在临床护理环境中识别和管理意外体重减轻(UWL)的相关信息。意外体重减轻的发生范围很广,而且往往是多因素造成的。临床医生应使用筛查工具来识别意外减重者。管理包括营养评估和诊断营养不良。注册营养师提供的营养咨询应针对体重减轻的原因和表现。可考虑制定个性化的饮食计划,提供营养补充和/或营养支持,以及刺激食欲的药物。应根据患者的护理计划处理生命末期出现的尿失禁问题。处理 UWL 是多学科护理团队职责的一部分。
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引用次数: 0
Omega Fatty Acid-Based Therapy for Healing of Recalcitrant Wounds in Patients with Complex Comorbidities. 基于欧米茄脂肪酸的疗法可帮助患有复杂并发症的患者愈合顽固伤口。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1097/ASW.0000000000000207
Jacob Reinkraut, Adeen Khokhar, Sarah Abdou, Sonya Wali, Desmond Bell

Abstract: The human body possesses the unique ability to repair itself after injury through complex, sequential phases. Current development of advanced wound care therapies generally focuses on addressing a single aspect of this biological process that can result in delayed or ineffective wound healing. When patients present with further systemic and local confounding pathologies, it can result in painful, chronic wounds that are especially challenging to treat.In this case report, the authors demonstrate how treatment with a novel multimodal wound matrix expedited healing and decreased pain in two patients who had each been unresponsive to treatment with advanced modalities for more than 7 months. The first patient had factor V Leiden, and the second patient had sickle cell disease. Use of a once-weekly treatment protocol with the multimodal wound matrix, combined with sharp debridement when deemed clinically necessary, resulted in elimination of pain and expedited wound healing to closure. The wound matrix's omega fatty acid-based formulation is designed to target multiple factors common among hard-to-heal wounds that when not addressed can adversely inhibit the wound-healing cascade.

摘要:人体具有在受伤后通过复杂、连续的阶段进行自我修复的独特能力。目前开发的先进伤口护理疗法通常侧重于解决这一生物过程中的一个方面,这可能导致伤口愈合延迟或无效。在本病例报告中,作者展示了使用新型多模式伤口基质治疗如何加快两名患者的伤口愈合并减轻疼痛,这两名患者均在使用先进疗法超过 7 个月后仍无反应。第一位患者患有因子 V 莱顿,第二位患者患有镰状细胞病。采用每周一次的多模式伤口基质治疗方案,并在临床需要时结合锐性清创术,可消除疼痛,加快伤口愈合直至闭合。伤口基质的欧米茄脂肪酸配方是针对难以愈合的伤口中常见的多种因素设计的,这些因素如果得不到解决,就会对伤口愈合级联产生不利的抑制作用。
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引用次数: 0
High-Quality Dietary Protein: The Key to Healthy Granulation Tissue. 优质膳食蛋白质:健康肉芽组织的关键。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1097/ASW.0000000000000214
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引用次数: 0
A Catheter Securement Strategy for Patients with Epidermolysis Bullosa. 牛皮癣患者的导管固定策略
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1097/ASW.0000000000000216
Kim M Strupp, Amy J Lee, Melissa Brooks Peterson, Norah Janosy
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引用次数: 0
Use of Commercial Bacon to Extract Maggots from an Infested Chronic Wound. 使用商业培根从慢性伤口中提取蛆虫
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-10-01 DOI: 10.1097/ASW.0000000000000209
Gregory Fenati, Santana Youssoffi, Shriya Vejendla, Cameron C Neeki, Vinh T Nguyen, Fanglong Dong, Michael M Neeki

Abstract: Maggot therapy, also known as larval therapy or biosurgery, is the use of live, sterilized maggots to debride necrotic tissue. Alternatively, wound infestation by maggots, known as myiasis, can occur in patients with poor wound management, particularly in those living in poor socioeconomic conditions. In the case of myiasis, various maggot extraction solutions are used to encourage the live larvae to emerge from the wound on their own. Current recommendations include the use of hypochlorous acid, sodium hypochlorite solutions, isopropyl alcohol, betadine, and hydrogen peroxide for wound cleansing. This case report focuses on a unique utilization of commercial bacon strips for the extraction of maggots in an infested necrotic wound. The use of commercial bacon strips in selective patients as a noninvasive technique for the removal of maggots from necrotic wounds can be an additional tool for medical providers.

摘要:蛆虫疗法,又称幼虫疗法或生物手术,是指使用经过消毒的活蛆来清除坏死组织。另外,伤口管理不善的患者,尤其是社会经济条件较差的患者,也会出现蛆虫侵袭伤口的情况,即蝇蛆病。在蝇蛆病的情况下,可使用各种蛆虫提取液来促使活幼虫自行从伤口中钻出。目前的建议包括使用次氯酸、次氯酸钠溶液、异丙醇、倍他定和双氧水清洗伤口。本病例报告重点介绍了利用商用培根条在受侵染的坏死伤口中提取蛆虫的独特方法。在选择性患者中使用商用培根条作为一种非侵入性技术来清除坏死伤口中的蛆虫,可以为医疗服务提供者提供额外的工具。
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引用次数: 0
Risk Factors Related to the Development of Full-thickness Pressure Injuries in Hospitalized Pediatric Patients. 住院儿科患者发生全厚压伤的相关风险因素。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-09-01 DOI: 10.1097/ASW.0000000000000194
Ann Marie Nie, Elizabeth Hawkins-Walsh, Barbara Delmore

Background: Current pediatric pressure injury (PI) prevention measures are based on risk factors related to PI development in adults. Children offer a unique concern for PI development because their bodies are still developing, and their skin responds differently to external pressure.

Objective: To explore risk factors for the development of full-thickness PIs in children aged 21 weeks' gestation to 21 years.

Methods: This retrospective, observational, correlational study included 799 hospitalized children who developed a PI. The pediatric and adult PI risk factors used in the study were identified from the International Pressure Ulcer Prevention and Treatment Guideline. A stepwise multivariate logistic regression model was used.

Results: Multivariate analyses revealed that risk factors for predicting a full-thickness PI varied by age. For children aged 38 weeks to 12 months, risk factors included tissue perfusion and oxygenation: generalized edema, conditions of the OR, and nutrition deficits. For children aged 1 to 7 years, fragile skin status was a risk factor. For youth aged 8 to 21 years, the two risk factors were tissue perfusion and oxygenation: decreased oxygenation and extracorporeal membrane oxygenation. Across the total sample, extracorporeal membrane oxygenation, tissue perfusion and oxygenation: decreased oxygenation and malnutrition were risk factors for predicting a full-thickness PI.

Conclusions: Full-thickness PI risk factors differ among the ages of pediatric patients.

背景:当前的儿科压力性损伤(PI)预防措施是基于与成人压力性损伤发展相关的风险因素。由于儿童的身体仍处于发育阶段,其皮肤对外部压力的反应也不尽相同,因此儿童在压力性损伤的发生方面具有独特的优势:目的:探讨妊娠 21 周至 21 岁儿童发生全厚型脓疱疮的风险因素:这项回顾性、观察性、相关性研究纳入了 799 名患 PI 的住院儿童。研究中使用的儿童和成人褥疮风险因素是从《国际褥疮预防和治疗指南》中确定的。研究采用了逐步多变量逻辑回归模型:多变量分析表明,预测全厚性褥疮的风险因素因年龄而异。对于 38 周至 12 个月的儿童,风险因素包括组织灌注和氧合:全身水肿、手术室条件和营养不良。对于 1 到 7 岁的儿童,皮肤脆弱也是一个风险因素。对于 8 至 21 岁的青少年,两个风险因素是组织灌注和氧合:氧合减少和体外膜氧合。在所有样本中,体外膜氧合、组织灌注和氧合:氧合下降和营养不良是预测全厚皮肤感染的风险因素:结论:不同年龄段的儿科患者发生全厚型 PI 的风险因素各不相同。
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引用次数: 0
Improving Wound Healing and Infection Control in Long-term Care with Bacterial Fluorescence Imaging. 利用细菌荧光成像技术改善长期护理中的伤口愈合和感染控制。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-17 DOI: 10.1097/ASW.0000000000000177
Martha R Kelso, Mark Jaros

Background: High bacterial burden stalls wound healing and can quickly progress to infection and sepsis in complex, older-adult patients in long-term care (LTC) or skilled nursing facilities (SNFs).

Objective: To investigate the outcomes of point-of-care fluorescence (FL) imaging (MolecuLight i:X) of bacterial loads, which are frequently asymptomatic, to inform customized wound treatment plans for patients in LTC/SNFs.

Methods: In this retrospective pre/postinterventional cohort study, the authors compared the healing and infection-associated outcomes of 167 pressure injuries from 100 Medicare beneficiaries before and after implementation of FL imaging.

Results: Most patient demographics and wound characteristics did not differ significantly between the standard-of-care (SOC; n = 71 wounds) and FL (n = 96 wounds) cohorts. Significantly more wounds (+71.0%) healed by 12 weeks in the FL cohort (38.5%) versus the SoC cohort (22.5%). Wounds in the FL cohort also healed 27.7% faster (-4.8 weeks), on average, and were 1.4 times more likely to heal per Kaplan-Meier survival analysis (hazard ratio = 1.40; 95% CI, 0.90-2.12). Infection-related complications decreased by 75.3% in the FL cohort, and a significant shift from largely systemic to topical antibiotic prescribing was evidenced.

Conclusions: Fluorescence-imaging-guided management of wounds significantly improved healing and infection outcomes in highly complex and multimorbid patients in LTC/SNFs. Proactive bacterial infection management via local treatments was enabled by earlier, objective detection. These reported outcome improvements are comparable to randomized controlled trials and cohort studies from less compromised, selectively controlled outpatient populations. Fluorescence imaging supports proactive monitoring and management of planktonic and biofilm-encased bacteria, improving patient care in a complex, real-world setting.

背景:在长期护理(LTC)或专业护理机构(SNF)中,高细菌负荷会阻碍伤口愈合,并迅速发展为感染和败血症:对于长期护理(LTC)或专业护理机构(SNF)中病情复杂的老年成人患者来说,高细菌负荷会阻碍伤口愈合,并可能迅速发展为感染和败血症:目的:研究护理点荧光 (FL) 成像(MolecuLight i:X)对经常无症状的细菌负荷的效果,为 LTC/SNFs 患者定制伤口治疗计划提供依据:在这项干预前后的回顾性队列研究中,作者比较了 100 名医疗保险受益人的 167 处压伤在使用 FL 成像前后的愈合情况和感染相关结果:大多数患者的人口统计学特征和伤口特征在标准护理组(SOC;n = 71 个伤口)和 FL 组(n = 96 个伤口)之间没有明显差异。与标准护理组(22.5%)相比,FL 组(38.5%)有更多伤口(+71.0%)在 12 周前愈合。根据卡普兰-米尔生存分析,FL 组的伤口愈合速度平均快 27.7%(-4.8 周),愈合几率是 SoC 组的 1.4 倍(危险比 = 1.40;95% CI,0.90-2.12)。荧光成像队列中与感染相关的并发症减少了75.3%,抗生素处方也从主要使用全身性抗生素显著转向使用局部抗生素:荧光成像指导下的伤口管理显著改善了 LTC/SNF 中高度复杂和多病患者的愈合和感染效果。通过早期的客观检测,可以通过局部治疗积极控制细菌感染。所报告的这些疗效改善情况与随机对照试验和来自病情较轻、选择性控制门诊患者的队列研究结果相当。荧光成像支持对浮游生物和生物膜包裹的细菌进行主动监测和管理,从而改善了复杂的实际环境中的患者护理。
{"title":"Improving Wound Healing and Infection Control in Long-term Care with Bacterial Fluorescence Imaging.","authors":"Martha R Kelso, Mark Jaros","doi":"10.1097/ASW.0000000000000177","DOIUrl":"10.1097/ASW.0000000000000177","url":null,"abstract":"<p><strong>Background: </strong>High bacterial burden stalls wound healing and can quickly progress to infection and sepsis in complex, older-adult patients in long-term care (LTC) or skilled nursing facilities (SNFs).</p><p><strong>Objective: </strong>To investigate the outcomes of point-of-care fluorescence (FL) imaging (MolecuLight i:X) of bacterial loads, which are frequently asymptomatic, to inform customized wound treatment plans for patients in LTC/SNFs.</p><p><strong>Methods: </strong>In this retrospective pre/postinterventional cohort study, the authors compared the healing and infection-associated outcomes of 167 pressure injuries from 100 Medicare beneficiaries before and after implementation of FL imaging.</p><p><strong>Results: </strong>Most patient demographics and wound characteristics did not differ significantly between the standard-of-care (SOC; n = 71 wounds) and FL (n = 96 wounds) cohorts. Significantly more wounds (+71.0%) healed by 12 weeks in the FL cohort (38.5%) versus the SoC cohort (22.5%). Wounds in the FL cohort also healed 27.7% faster (-4.8 weeks), on average, and were 1.4 times more likely to heal per Kaplan-Meier survival analysis (hazard ratio = 1.40; 95% CI, 0.90-2.12). Infection-related complications decreased by 75.3% in the FL cohort, and a significant shift from largely systemic to topical antibiotic prescribing was evidenced.</p><p><strong>Conclusions: </strong>Fluorescence-imaging-guided management of wounds significantly improved healing and infection outcomes in highly complex and multimorbid patients in LTC/SNFs. Proactive bacterial infection management via local treatments was enabled by earlier, objective detection. These reported outcome improvements are comparable to randomized controlled trials and cohort studies from less compromised, selectively controlled outpatient populations. Fluorescence imaging supports proactive monitoring and management of planktonic and biofilm-encased bacteria, improving patient care in a complex, real-world setting.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":" ","pages":"471-479"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141632413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Wound Itch: An Update. 伤口瘙痒:最新进展。
IF 1.7 4区 医学 Q3 DERMATOLOGY Pub Date : 2024-09-01 DOI: 10.1097/ASW.0000000000000200
Julia C Paul

General purpose: To present current evidence regarding the physiology, assessment, and management of wound itch.

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:1. Summarize current understanding of itch physiology.2. Apply current evidence to the management of wound itch.

一般目的:介绍有关伤口瘙痒的生理学、评估和管理的最新证据:本继续教育活动面向对皮肤和伤口护理感兴趣的医生、医生助理、执业护士和注册护士:参加本教育活动后,学员将: 1.总结当前对痒生理学的理解。 2.将当前证据应用于伤口痒的管理。
{"title":"Wound Itch: An Update.","authors":"Julia C Paul","doi":"10.1097/ASW.0000000000000200","DOIUrl":"10.1097/ASW.0000000000000200","url":null,"abstract":"<p><strong>General purpose: </strong>To present current evidence regarding the physiology, assessment, and management of wound itch.</p><p><strong>Target audience: </strong>This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.</p><p><strong>Learning objectives/outcomes: </strong>After participating in this educational activity, the participant will:1. Summarize current understanding of itch physiology.2. Apply current evidence to the management of wound itch.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":"37 9","pages":"463-469"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Advances in Skin & Wound Care
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