Advances in Skin & Wound Care最新文献

Objective: This study aimed to design an artificial intelligence (AI) tool that can more accurately and objectively identify different stages of pressure injuries (PIs).

Methods: In this study, the authors proposed using AI and computer vision to classify PI images by stage. To this end, the authors implemented a classification network and trained it on a set of PIs images labeled with their stages. This dataset included images from 2 different sources, namely the publicly available Pressure Injury Image Dataset (1091 images), and a private dataset from Koç University Wound Research Laboratory (AY-Lab) (572 images). All images were resized to 224×224 and normalized according to the ImageNet-1K dataset before model input. Various deep learning architectures, including ResNet18, ResNet18-Transformer Encoder Hybrid Model, and DenseNet-121, were used for training and testing. Three-fold cross-validation was used to ensure more robust training and testing. Multiple configurations were tested for each model, and the best-performing configuration was identified. Grad-CAM was applied to visualize attention areas for further evaluation of the model results.

Results: After 3-fold cross-validation, ResNet18 outperformed all tested models, achieving an average accuracy of 76.92 ± 0.92% on the 4-class classification task. The model demonstrated the highest precision of 87.35 ± 5.54% for Stage 1 and the lowest precision of 64.72 ± 2.66% for Stage 3.

Conclusions: The results of using the proposed computational approach for PI staging are promising. The AI model can automate PI stage classification, making it a valuable tool for clinic experts.

Objective: To map, in the literature and mobile app stores, mobile applications for health care support for individuals with fecal intestinal stomas.

Data sources: The search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), Brazilian Digital Library of Theses and Dissertations (Capes), Scientific Open Access Repository of Portugal (RCAAP), The National Library of Australia's Trove, and Academic Archive Online (DIVA).

Study selection: Studies were initially selected based on titles and abstracts. Full-text studies were included if they addressed applications with content and functionalities aimed at the care of individuals with intestinal ostomies. The app store selection followed the same procedure: review of title and description, followed by download and analysis.

Data extraction: From the selected studies, information was extracted regarding study objectives, app names, content, functionalities, and main conclusions. From the app stores, data were extracted on app names, developers, app size, latest update, content, and functionalities.

Data synthesis: The final sample comprised 12 studies and 13 applications. Most aimed to provide self-care information for individuals with intestinal ostomies after hospital discharge. Others facilitated communication with health care professionals, with the primary function of enabling patient monitoring.

Conclusions: There is a promising landscape for the development of new mobile technologies to support individuals with intestinal ostomies. However, there is a lack of studies on this topic, particularly on the impact of these technologies on the target population.

Objective: This case series emphasizes the role of dermoscopic evaluation and the multidisciplinary approach for the correct diagnosis and treatment of atypical ulcers.

Methods: The authors documented the clinical and dermoscopic features of 5 cases of atypical, previously misdiagnosed ulcers to emphasize the dermatologist's role in approaching these difficult lesions.

Results: This report will present 5 clinical cases of skin ulcers treated as typical ulcers on which, following worsening of the manifestations, a skin biopsy was performed and the histologic examination revealed neoplastic and autoimmune lesions. The clinical and dermoscopic evaluation by the dermatologist was decisive in achieving the diagnosis of the cases described.

Conclusions: The prevalence of skin ulcers of the lower limbs is around 1% of the general population, of which a large part consists of the typical ulcers, with vascular, neuropathic or mixed etiology. Atypical ulcers include ulcers from inflammatory, neoplastic, autoimmune diseases, infections and vasculopathies. This case series encourages the dermoscopic evaluation of atypical ulcers and the multidisciplinary approach to achieve their healing.

Objective: To investigate and compare the effectiveness and safety of pulsed dye laser (PDL), topical brimonidine tartrate, and their combined use in post-acne erythema (PAE) treatment.

Methods: In this randomized clinical comparative trial, 60 patients who had PAE on both sides of the face were equally divided into 2 groups. According to a split-face design, the PAE lesions in each participant of group A were randomly treated with PDL followed by brimonidine tartrate on one side and PDL alone on the other one. Alternatively, PAE lesions on each face side in group B were treated with a single-treatment modality, either brimonidine or PDL. The efficiency of treatments was assessed by the Global Assessment of Improvement scores, by the clinical assessment of PAE lesion count, and patient satisfaction, as well as objective morphometric analysis of the patient photographs.

Results: Significant improvement was noticed subjectively and objectively after treatment with PDL alone, brimonidine alone, and PDL+brimonidine compared with baseline. In group A, PDL+brimonidine achieved superior improvement with regard to global assessment of improvement, percentage of lesion count reduced, erythema index, and patient satisfaction.

Conclusions: Pulsed dye laser and topical brimonidine separately proved to be effective and safe in the treatment of PAE. Their combination can have an additively positive therapeutic outcome.

Objective: Pressure injuries (PIs) remain a significant challenge in healthcare, causing patient discomfort, prolonging hospital stays, and imposing substantial financial burdens on healthcare systems. Despite advancements in prevention strategies, determining the most cost-effective interventions remains paramount for healthcare providers and policymakers. The study authors aimed to assess the cost-effectiveness of various PI prevention strategies within a quasi-experimental design framework.

Methods: A quasi-experimental study with 2 arms was conducted between September 2022 and February 2023 in a hospital in Saudi Arabia: the routine care for the PI group, group 1, and the PI prevention bundle group, group 2. Data on PI incidence, severity, and associated costs were collected to compare outcomes between group 1 and group 2.

Results: A total of 368 patients were enrolled in the study: 218 patients in group 1 and 150 in group 2. Mortality was higher in the routine care group. The mean PI-free day in the prevention bundle group was 298.8 days compared with 19.7 days in the routine care group. Overall, the mean total cost for the bundle care group was ~$9600 lower than that of the routine care group.

Conclusions: This quasi-experimental study confirmed that PI prevention is cost-effective. Hospitals should invest in interdisciplinary teams and prevention bundles to improve patient outcomes and resource utilization.

Abstract: Despite advances in healing wounds, lower extremity amputations remain common. Typically, the most common cause of lower extremity amputations is peripheral arterial disease or diabetes mellitus. In addition, war-related wounds in recent years have led to an epidemic of lower extremity amputations in Europe and Asia. Postamputation wound complications are common, and these wounds have unique characteristics. Yet, currently, there are no treatment algorithms addressing postamputation wounds. The author presents 9 cases of postamputation wound complications that occurred between 2019 and 2023 and describes various approaches used to facilitate postamputation wound closure. Two stump wounds were related to above-the-knee amputations, and 7 were due to below-the-knee amputations. The average wound depth was 2.1 cm. Four wounds were tunneled. The case series demonstrates typical challenges and describes treatment modalities needed for wound closure, including 2 innovative techniques, a modified Unna boot and "soap scrap," which have proven to be helpful in healing postamputation wounds.

Objective: The caregiver burden is a stressor that affects caregivers' quality of life. However, the impact of mutuality and positive aspects of caregiving on caregiver burden and quality of life has not been studied in caregivers of patients with diabetic foot who have undergone amputation. This study aimed to explore the moderating effects of mutuality and positive aspects of caregiving on the relationship between caregiver burden and quality of life.

Methods: In this descriptive cross-sectional survey, the authors conducted a questionnaire survey of 150 caregivers of patients who underwent diabetic foot amputation from September 2021 to February 2022. The investigation was conducted with the Mutuality Scale, Zarit Caregiver Burden Interview, Positive Aspects of Caregiving, and Health Survey Short Form 12. Stratified regression analysis and the Johnson-Neyman technique were used to explore the moderating role of mutuality and positive aspects of the adverse effects of caregiver burden.

Results: A total of 150 caregivers participated in this study. The results of the study showed that the caregiver burden was negatively correlated with mental health ( r =-0.229, P <.01). Moreover, mutuality was positively correlated with mental health ( r =0.252, P <.01), and positive aspects of caregiving were positively correlated with mental health ( r =0.276, P <.01). Mutuality and positive aspects of caregiving played a moderate role in caregiver burden and mental health in patients who underwent diabetic foot amputation (β=0.278, t =3.221, P <.05; β =0.032, t =2.526, P <.05).

Conclusions: The authors found that mutuality and positive aspects of caregiving reduce caregiver burden and improve the mental health of patients with diabetic foot who have undergone amputation.