Advances in Skin & Wound Care最新文献

General purpose: To describe how wound care clinicians can improve treatment outcomes by promoting resilience in people with chronic wounds.JOURNAL/aswca/04.03/00129334-202510000-00004/figure1/v/2025-09-15T111045Z/r/image-jpeg 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:Explain the impact of psychological stressors on wound healing.Identify interventions to assess and promote resilience in individuals with chronic wounds.Describe the impact of chronic wounds on psychological health.The prevalence of chronic wounds and their impact on physical, psychological, and social well-being continues to escalate. Optimal outcomes rely on the ability of clinicians to work collaboratively with patients and care partners to plan and implement holistic, individualized treatments. Physical health is heavily impacted by wound status and the patients' capacity to engage in usual daily activities. Functional limitations carry a host of consequences, including adverse effects on patients' sense of meaning and purpose in life, self-esteem, and body image. Negative emotions, fear, and loss of autonomy can create challenges to mental well-being, with higher rates of depression and anxiety reported in people with chronic wounds as compared with the general population. These challenges are exacerbated by stigma, patients' reluctance to disclose psychological symptoms, and clinicians' lack of preparation in assessing and addressing mental, as well as physical health. Psychological stress carries physiological consequences that can contribute to healing delays. These consequences can be offset by cognitive behavioral interventions, a strong therapeutic alliance, and peer support. Integrative, individualized plans of care are improved by shared decision-making and the application of social and behavioral theory to provide insight regarding patients' abilities and willingness to actively engage in collaborative wound management. Resilience, or the ability to productively cope with adversity, mediates the psychological burden associated with chronic wounds. The purpose of this targeted, narrative review of the literature is to assist clinicians in assessing the physiological consequences of delayed healing and promoting resilience in people with chronic wounds.

Background: Smartphone photography may play a role in various aspects of clinical practice in wound surgery. Its accuracy as a tool for wound assessment and clinical decision-making is yet to be proven. Moreover, data regarding the magnitude of its use in practice are lacking.

Methods: Eleven board-certified plastic surgeons performed 79 wound observations and completed a questionnaire regarding wound properties and decisions regarding management. Wounds were photographed using smartphones at the time of initial wound observation. At least 3 months later, photographs of the wounds were anonymously presented to the same surgeons who completed the questionnaires again. Statistical analysis was used to compare the results. In addition, an online survey was used to assess the magnitude and manner of smartphone photography use among plastic surgeons.

Results: Comparison of bedside and photographic wound evaluation found no statistically significant differences in nearly all descriptive wound parameters and aspects of clinical decision-making. Statistically significant differences were found for periwound subcutaneous space assessment (P=.02) and recommendation for operative wound closure (P=.035). Seventy-four plastic surgeons replied to the online survey, and 93% of them stated that they use smartphone photography in their daily practice, with the majority using it equally for patient follow-up, consulting other physicians, and communication with patients.

Conclusions: Smartphone photography seems to play a major role in present-day clinical practice. According to the findings of this study, assessment of wounds via smartphone photography can be safely used as an adjunct for clinical decision-making when used as a consultation aid between wound surgeons.

Objective: This study explores nurses' acceptability and readiness to integrate patient-centered artificial intelligence (AI) technologies for pressure injury (PI) prevention, aiming to inform the design of clinically applicable technologies.

Methods: This qualitative descriptive study gathered insights from 202 international nurses in 2 countries through focus group discussions and written responses. Thematic analysis was conducted using MAXQDA.

Results: Three main concepts were identified. Under the use of manual tools in risk assessment, the theme was clinical challenges of the Braden Scale, with subthemes of accuracy and reliability, limitations in specific patient populations, and patient nonmodifiable related risk stratification. Within integration of AI-based technologies, themes included expectations from AI-based systems, with subthemes of advanced risk stratification prediction and real-time data, and concerns about AI integration in the system, with subthemes of acceptability level, education and awareness, data accuracy and reliability, and ethical issues and patient safety. For patient-centered monitoring systems, themes included development of automated documentation with subthemes of reducing workload, time management, integration of early warning systems with subthemes of automated monitoring, early intervention, and AI-supported decision support systems with subthemes of personalized interventions and proactive intervention.

Conclusions: Current nurse-led risk assessment systems require improvement for specific patient groups, affecting safety and care quality. Artificial intelligence-based systems can provide more accurate risk predictions and personalized interventions, enhancing decision-making and clinical outcomes. Although nurses are ready for AI adoption, further education is needed for full integration to optimize patient care.

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.