Advances in Skin & Wound Care最新文献

Objective: To identify the incidence and perioperative risk factors of postoperative pressure injuries (PIs) in patients with intracranial hemorrhage who had surgical evacuation of hematoma.

Methods: This retrospective cohort study was conducted at a tertiary care university hospital. Researchers collected medical record data from April 2010 to March 2020 and conducted backward selection in multiple logistic regression.

Results: Of the 386 patients identified, 103 (26.7%) developed postoperative PIs. The most common site of PI was the coccyx (n = 56; 38.9%). More than half of the patients had stage 2 PIs, and 43 (41.7%) developed PIs 14 or more days after surgery. Three variables were associated with an increased risk of postoperative PI: older age ( P = .025), receiving a packed red blood cell transfusion while in the ICU ( P = .004), and staying in the ICU for more than 7 days ( P < .001).

Conclusions: The present findings indicate that risk factors for postoperative PIs include older age, requiring a blood transfusion, and longer ICU stays, which may increase nursing workload regardless of surgery type. Future research on postoperative PIs in patients undergoing neurosurgery should consider additional ICU work environment factors, including nurse-to-patient ratio and immobility-related factors such as duration of medical device use. Further, international comparisons of risk factors for postoperative PIs among patients undergoing neurosurgery are needed.

Objective: To report on the current state of outpatient nursing care for patients with an intestinal fistula in a stoma clinic in China.

Methods: This retrospective study included 41 patients with an intestinal fistula who visited the stoma clinic in a tertiary hospital in Shanghai, China, between January 2019 and December 2023. Electronic medical records were selected for analysis of patients' clinical data, fistula diagnosis and treatment process, and outcome regression.

Results: Few patients with an intestinal fistula are referred to the stoma clinic for nursing care (1.29%). At patients' first visit to the stoma clinic, the majority of those with an intestinal fistula (87.80%) had perifistular moisture-associated skin damage (MASD). The mean discolor, erosion, and tissue score was 6.73 ± 4.35, the mean healing time for MASD was 8.77 ± 8.51 days, and the mean number of follow-ups was 3.41 ± 1.92. The majority of patients (87.80%) complained of accompanying pain of different degrees. The mean self-healing time for nonoperative treatment was 301.96 ± 193.95 days. Enterostomal therapists applied the dressings to care for the skin around the fistula and formulated and guided a personalized management method to effectively contain output.

Conclusions: The quality of outpatient nursing care for patients with an intestinal fistula needs to be optimized. Standardized assessment and individualized precise intervention can reduce the incidence of complications such as MASD and improve the quality of care and prognosis of patients.

General purpose: To review the clinical presentation, diagnostic evaluation, and management approaches for pemphigus vulgaris (PV).

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 learner will: 1. Summarize the clinical manifestations associated with PV. 2. Evaluate risk factors associated with PV. 3. Explain evidence-based diagnostic and treatment options for PV.

Objective: To investigate the performance of the Braden QD Scale in predicting hospital-acquired pressure injuries (HAPIs) in critically ill adult patients and the incidence and factors associated with HAPIs within such patients.

Methods: A prospective observational study was conducted in a dual-center comprehensive ICU from June to September 2023. The nurse on duty examined all patients for skin integrity upon admission to the ICU and also scored patients using both the Braden and Braden QD scales. A patient's skin was then checked daily by 14 course-trained nurses until the patient was discharged or transferred out of the ICU. If a suspected HAPI was found, photographs were taken and sent to specialist nurses for confirmation and documentation.

Results: A total of 316 critically ill patients were enrolled in the study, and 79 HAPIs occurred. Fifty-five patients (17.4%) had pressure injuries (PIs), 35 patients (11.1%) had medical device-related PIs, and 14 patients (4.4%) had both medical device-related PIs and PIs. Essential predictors of HAPIs were detected. Further, the Braden QD Scale performed better than the Braden Scale in predicting HAPI development in critically ill adults, with the area under the curve being 0.77 (CI, 0.75-0.84) on admission.

Conclusions: The incidence of HAPIs in critically ill adult patients is high, with several influencing factors. The Braden QD Scale emerges as a validated predictive tool for HAPIs in critically ill adult patients, demonstrating clinical utility that warrants additional investigation to optimize prevention strategies.

Objective: To perform a service evaluation of neuromuscular electrostimulation (NMES) as an adjunct to compression therapy, comparing the rate of wound margin advance and time to closure with a matched retrospective control group.

Methods: Fifteen patients with venous leg ulcers were prescribed NMES for 6 hours per day for 56 days or until wound closure (whichever occurred first), in addition to multilayer compression. Wounds were selected for size, with an inclusion criterion of a maximum of 12 cm 2 . Wound progress was compared with 15 retrospective control patients who were matched for ulcer size and duration.

Results: The retrospective group had a healing rate of 0.31 mm per week (95% CI, 29-37 mm/week), whereas the prospective compression plus NMES group had a healing rate of 0.56 mm per week (95% CI, 50-62 mm/week; P = .004). All wounds in both groups healed completely during the service evaluation. Mean time to closure for the retrospective group was 77 days (95% CI, 66-88 days), whereas the NMES group had a mean time to closure of 40 days (95% CI, 37-43 days; P = .005).

Conclusions: Adding NMES of the common peroneal nerve to a care bundle including multicomponent compression resulted in significantly faster wound margin advance and significantly less time to heal in comparison with retrospective matched controls. Future randomized controlled trials or self-controlled studies of this approach would be of great interest to inform clinical practice.

Objective: To assess the skin tear knowledge of intensive care nurses who care for surgical patients.

Methods: This study was conducted among intensive care nurses working in a training and research hospital and caring for surgical patients. Data were collected face-to-face using the Demographic Data Collection Form and the Skin Tear Knowledge Assessment Instrument.

Results: Participants were primarily women (66.7%), and most (71.3%) had a bachelor's degree. The mean age of the participants was 30.01 ± 2.49 years, and the mean years of intensive care experience was 6.29 ± 2.76 years. No significant relationships were found between the scale scores of the participants and age, sex, and education status, or whether they had received training on skin tears. There was a statistically significant positive correlation between years of intensive care experience and experience caring for patients with skin tears and OASES (Skin Tear Knowledge Assessment Instrument) total scale score. The analysis revealed that years of intensive care experience had a significant positive effect on the scale total score.

Conclusions: This study revealed that nurses had a moderate level of knowledge about skin tears and that intensive care experience and status of caring for patients with skin tears were important factors influencing skin tear knowledge.

Abstract: Postoperative anastomotic leakage following surgery for colorectal cancer is a serious complication that is frequently associated with significant intra-abdominal infection and the formation of peristomal abscesses. Patients with this condition often present with complex medical comorbidities and face considerable challenges in achieving wound healing. In this case report, a 57-year-old man presented with colonic obstruction secondary to colon cancer and subsequently underwent curative surgery. Postoperatively, anastomotic leakage occurred, which necessitated resection of the anastomosis and the formation of a descending colostomy. The patient subsequently developed severe intra-abdominal infection and peristomal abscess, leading to impaired wound healing. Clinicians implemented a treatment regimen combining continuous negative-pressure wound therapy (NPWT) with intermittent NPWT with instillation and dwell time. This approach resulted in rapid wound healing. Ultimately, the patient successfully underwent colostomy closure, restoring gastrointestinal continuity. For abdominal wounds with severe fecal contamination and extensive separation of the dermis and subcutaneous tissues, the combination of continuous NPWT and intermittent NPWT with instillation and dwell time may be an efficacious therapeutic strategy.

Objective: To explore the application of telemedicine in patients with an ostomy and assess the current research status.

Data sources: The authors searched PubMed, EMBASE, Web of Science, Ovid, CINAHL (Cumulative Index to Nursing and Allied Health Literature), China Biology Medicine, China National Knowledge Infrastructure, WanFang, and VIP (Chinese Scientific Journals Database) databases from the inception of each database to March 2024.

Study selection: A total of 41 articles comparing telemedicine and standard care in ostomy patients were included.

Data extraction: Information was extracted from full-text articles, including author(s), year, country, study design, ostomy type, sample characteristics, intervention type, duration, and outcomes.

Data synthesis: In the 41 studies, telemedicine intervention tools encompass social and conference software, mobile healthcare apps, and remote devices. Intervention durations ranged from 4 weeks to 3 years. The intervention content can be categorized into seven key aspects: health guidance, health counseling, psychological care, peer support, medical appointment scheduling, information statistics, and remote visits. Evaluation of these interventions involves measuring outcomes in 10 areas, including quality of life, ostomy knowledge, self-efficacy, self-care ability, stoma complications, participant satisfaction, psychology, coping and adaptation, burden, and health condition.

Conclusions: The implementation of telemedicine for patients with an ostomy has had a profound impact. As internet technology evolves, optimization of platforms and longer interventions are needed. Healthcare professionals should enhance their training in online communication. In addition, researchers should design specific, specialized measurement scales based on the characteristics of patients with stomas.

Abstract: Hidradenitis suppurativa (HS) is a chronic skin condition that can lead to significant morbidity and, in some cases, transformation to squamous cell carcinoma (SCC). This report details the case of a 53-year-old man with a history of HS treatment with adalimumab and systemic antibiotics who developed well-differentiated SCC. For this malignant transformation, the patient required aggressive management, including radiation therapy, wide excision, and reconstructive surgery. Follow-up showed no disease progression. This case highlights the importance of early detection, routine screening, and a multidisciplinary approach in managing the risk of SCC in patients with HS.