Advances in Skin & Wound Care最新文献

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.

Objective: This study aimed to develop a valid and reliable measurement tool to assess the risk of medical device-related pressure injuries (MDRPIs) in patients. A methodological design was employed to evaluate the validity and reliability of the Medical Device-Related Pressure Injury Risk Assessment Scale (MDRPI Scale).

Methods: The study was conducted with 200 patients who were undergoing care and treatment involving the use of medical devices. Data were collected using the Patient Descriptive Characteristics Form, the MDRPI Scale, and the Braden Risk Assessment Scale. Analyses focused on evaluating the MDRPI Scale's validity and reliability.

Results: The content validity index of the MDRPI Scale was 0.87, and its Cronbach α coefficient was 0.73. The scale's items, which explained 47.063% of the total variance, were grouped under 2 factors: Factor 1-General Condition of the Patient, and Factor 2-Effect of the Medical Device on the Contact Area. The model fit indices obtained from the Confirmatory Factor Analysis (CFA) supported the 2-factor structure (χ 2 / df =2.091). No problematic items were identified within the final 8-item version of the scale.

Conclusions: This study presents the first comprehensive and systematic scale specifically developed to identify MDRPI risk and to evaluate the integrity of skin and mucosa in patients exposed to medical devices. The findings demonstrate that the MDRPI Scale, consisting of 8 items and 2 factors, is a valid and reliable tool for assessing the risk of MPRPIs in clinical settings.

Objective: A quality improvement project (QIP) was implemented in 2021 at Al Qassimi Hospital in Sharjah, United Arab Emirates, to decrease the incidence of hospital-acquired pressure injuries (HAPIs).

Methods: A FOCUS PDCA (Find, Organize, Clarify, Understand, Select, Plan, Do, Check, and Act) methodology was used to reduce the HAPI rate, understand the source of variation, and select improvement measures. A protocol for PI assessment and prevention was developed and implemented. A multidisciplinary team was involved, and several educational sessions were conducted. The PIs per 1000 patient days were monitored monthly.

Results: The HAPI rate dropped from an average of 3.4/1000 patient days during the 3 months preintervention period to an average of 1.7/1000 patient days in the first 9 months following the QIP. During 2022 and 2023, the HAPI rate decreased to an average of 0.9 and 0.8 patient days, respectively.

Conclusions: The QIP reduced the incidence of HAPIs by 75% in 2023. Staff involvement and a multidisciplinary team were essential to the success of the project. For patients, the reduction of PI risk resulted in a better quality of life and shorter hospitalizations.

Abstract: Basal cell carcinoma (BCC) is the most common form of skin cancer globally, appearing most often in the upper extremities. The authors present 2 unique clinical presentations of nodular BCC of the lower extremity. Although the nodular subtype is the most diagnosed type of BCC, the prevalence of this lesion in the lower leg and foot is not common, comprising <5% of cases.

Abstract:

Objective: This study was conducted to adapt the revised Skin Management Needs Assessment Checklist (SMnac) into Turkish and determine the reliability and validity by using the Rasch model.

Methods: Data were collected between February and July 2023 from a total of 201 patients using a demographics and clinical history form, Braden Scale, and the revised SMnac. This methodological study used forward translation, expert opinion, back translation, pilot test, and finalization for the language adaptation of the instrument. The feasibility of the questionnaire for the Turkish population with pressure injury was assessed through the Rasch measurement model. Internal consistency reliability with Rasch analysis was calculated with the Person Reliability Index and Item Reliability Index. For content validity, the first Turkish version was evaluated by seven experts.

Results: The Content Validity Index of the Turkish version of the revised SMnac was determined to be 0.87. In the Rasch analysis, the person reliability coefficient was detected as 0.87 and the item reliability coefficient as 0.94. In accordance with the results of the adaptation and reliability validity analyses of the original scale, three items were excluded from the scale.

Conclusions: According to the results of the study, the revised SMnac scale was determined to be valid and reliable in Turkish.

Objective: The aim of this study was to evaluate the effect of music therapy on dressing pain in unconscious intensive care patients with pressure injuries (PIs).

Methods: A one-group quasi-experimental study was conducted with 39 patients hospitalized in the intensive care unit of a hospital in Istanbul, Turkey. Intubated, hemodynamically stable patients with Stage 2 to 4 PI and Glasgow Coma Score of 8 or higher were included. All patients underwent 2 wound dressing applications, one with music therapy and the other using the conventional method. The patients' behavioral pain scores and vital signs were measured before, during, and after each dressing.

Results: The patients had a mean age of 73.23 ± 1.44 years, and 56% were females. Patients who underwent wound dressing with the conventional method had higher diastolic blood pressure ( P = .038) and mean arterial blood pressure ( P = .034) after dressing when compared with patients who received music therapy. There was no statistically significant difference in other vital signs ( P >.05). Music therapy resulted in significantly lower behavioral pain scores at all time points ( P <.01).

Conclusions: Music therapy is a low-cost, easy, and effective method to reduce dressing pain in unconscious patients. The use of music therapy during dressing can contribute to both the physical and mental comfort of patients. Personal preferences should be taken into consideration in music therapy interventions. Further studies on the utility of this method are needed.