Advances in Skin & Wound Care最新文献

Objective: To investigate the clinical efficacy of stamp skin grafting in promoting wound healing for patients with chronic wounds.

Methods: This study enrolled 86 patients with chronic wounds from a wound care clinic between November 2022 and December 2023. The participants were randomly allocated into the control (n = 44) and skin-grafting (n = 42) groups using a preset random number table. The control group received conventional wet dressing care, whereas the skin-grafting group underwent additional stamp skin-grafting care.

Results: The skin-grafting group demonstrated significantly reduced wound healing time, improved healing efficacy, decreased dressing change frequency, and lowered dressing change costs compared with the control group (all P s < .05). During the nursing process, the skin-grafting group exhibited significantly lower pretreatment Numeric Rating Scale scores when the fourth and fifth dressings were changed and during-treatment Visual Analog Scale scores from the third to fifth dressing changes compared with the control group (all P s < .05). After adjusting for confounding factors, wound area served as an independent risk factor for both healing time ( rpartial  = 0.457, P  < .05) and healing efficacy ( β  = -0.559, P  < .05) in the skin-grafting group, whereas patient adherence to wound care served as an independent risk factor for both healing time ( rpartial  = 0.333, P  < .05) and healing efficacy ( β  = 1.194, P  < .05) in the control group, as well as for healing efficacy ( β  = 1.318, P  < .05) in the skin-grafting group.

Conclusions: Stamp skin grafting effectively promotes the rapid recovery of chronic wounds with reduced medical burden and patient pain. The effectiveness primarily depends on the wound area and patient adherence.

Considering the increase in cesarean surgeries in recent years and, therefore, the complications related to this type of surgical wound, attention has been drawn to treatment methods such as biological wound dressings. In this case series, the authors describe the treatment of infected cesarean wounds with impaired healing in 4 women. For this aim, human placentas were collected under sterile conditions and amniotic membranes were separated from the placenta. To decrease immunogenic response, the membrane was decellularized using 1% Triton-x-100, 1 mmol/L EDTA, and Trypsin 0.05. Then, using glycerol and Dulbecco Modified Eagle Medium, the decellularized amniotic membrane (dAM) was frozen for 3 months at -80 °C. After this period, the dAM was used to dress the wounds of the 4 patients. All patients treated with dAM achieved complete wound healing, indicating that dAM may be an effective treatment method for cesarean section wounds, especially those prone to complications.

Objective: To evaluate the effects of extra-virgin olive and almond oils on maintaining skin integrity in neonates admitted to the neonatal intensive care unit.

Methods: This was a semiexperimental study. The sample comprised 120 term (37-42 weeks) neonates treated in a state hospital in Istanbul, Turkey (May-August 2023), who met the sample criteria (olive oil: 60, almond oil: 60). The data were collected using a newborn identification form, the Neonatal Skin Condition Score, and the DMM Skin Moisture Meter.

Results: The neonates' sex, gestational age, postnatal age, birth weight, length, and head circumference measurements were similar, suggesting no significant differences between the groups ( P s > .05). A statistically significant difference was found between the mean skin hydration levels of neonates treated with almond oil and extra-virgin olive oil on the first, second, and third days of the application, where a higher skin hydration was determined in the extra-virgin olive oil group ( P  = .024, P  = .004, P  = .020). However, no statistically significant difference was found between the Neonatal Skin Condition Score scores of neonates treated with almond oil and extra-virgin olive oil before and on all days of the application (1-5 days, P  > .05).

Conclusions: Both extra-virgin olive oil and almond oil increased the stratum corneum hydration in term neonates. The application of extra-virgin olive oil and almond oil did not result in any adverse effects on neonatal skin conditions of neonates admitted to the neonatal intensive care unit.

Background: Diabetic foot ulcers and diabetic foot infections (DFIs) are serious complications that can lead to premature death. Although most DFIs are located in the forefoot, rates of bone involvement and the need for amputation in each toe are not reported in the literature.

Objective: To report early epidemiologic data on the frequency of initial osteomyelitis (OM) and amputation in severe DFIs.

Methods: This retrospective comparative study included 91 DFI episodes treated with surgery. All patients had severely infected toe ulcers (University of Texas grade 3/stage B). Cases were classified as conservative surgery group versus amputation surgery group. Outcomes were defined as initial rate of OM and amputation surgery. Analysis was conducted to search for significant differences in outcomes between toes.

Results: Diabetic foot infection frequencies from hallux to the fifth toe were as follows: 37 (44%), 15 (16.5%), 10 (11%), 12 (13.2%), and 17 (18.7%). For the OM and amputation outcomes, no significant differences were found between hallux and second toe, whereas significance was recorded between the two medial toes compared with the three lateral toes, where both outcomes were highly prevalent in the three lateral toes.

Conclusions: This epidemiological report highlights for the first time significant differences in the outcomes of severe toe infection with respect to toe location. The authors propose a new prognostic grouping to better reflect outcome prediction of diabetic toe infection: a medial toe group comprising the hallux and second toe versus a lateral toe group including the third, fourth, and fifth toes.

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.

Background: Several prior studies have investigated determinants linked to the insufficient delivery of diabetic foot self-care education (DFSE), with some specifically concentrating on rural environments. Individuals with diabetes, especially those at risk of foot ulcers, should acquire the skills necessary for daily foot inspection, proper toenail-trimming techniques, consistent use of appropriate footwear, and a thorough understanding of preventive measures against ulcers.

Objective: To explore the challenges associated with delivering DFSE among nurses in rural areas.

Methods: The authors used a qualitative descriptive design. Fourteen participants were purposively selected from two township health centers. Data were collected through focus group discussions. All interviews were analyzed using thematic analysis.

Results: The primary challenges to delivering DFSE in rural areas were identified and categorized into four key themes: limited human resources, excessive patient visits, high patient turnover rate, and understanding gaps in collaborative medical care.

Conclusions: Limited diabetic nursing resources hinder patient education, affecting those with high admissions and extensive care needs. Excessive patient visits pose a challenge, overshadowing education efforts, especially during peak times after festival celebrations. Swift patient turnover and communication gaps among healthcare providers are significant barriers to timely health education. Nurses must enhance interdisciplinary communication for quality teaching and patient care. Integrating technology into nursing education can improve flexibility and accessibility. For the reform of China's national primary healthcare system, attracting and retaining skilled healthcare professionals in primary care should involve incentives and professional development.

Objective: To evaluate the effect of a situated simulation teaching strategy for negative-pressure wound therapy (NPWT) on surgical nurses' knowledge of care for patients who receive NPWT.

Methods: This quasi-experimental study used a one-group pretest/posttest design. Thirty-one female surgical nurses from a central Taiwan district hospital participated. They received situational simulation training and completed self-administered preintervention and postintervention scale assessing their knowledge of NPWT-related care and a demographic questionnaire.

Results: Participants' mean score on the knowledge of NPWT-related care scale was 19.90 preintervention and increased to 27.84 postintervention, a significant improvement ( z = -4.45, P < .001). All aspects of NPWT knowledge, including indications and effects ( z = -3.84, P < .001), device operation ( z = -3.71, P < .001), assessment ( z = -3.89, P < .001), and anomaly response ( z = -3.93, P < .001), significantly improved following the intervention.

Conclusions: The study indicates that simulation and cues and a debriefing session in situational simulation teaching significantly enhance surgical nurses' knowledge of NPWT-related care and facilitates the acquisition of problem-solving methods, suggesting its potential application in NPWT-related continuing education courses for surgical nurses.