Advances in Skin & Wound Care最新文献

Objective: To assess the diagnostic potential of procalcitonin in identifying osteomyelitis in patients with pressure injuries (PIs).

Methods: The authors conducted a retrospective study of 21 patients with PIs from 2017 to 2022. Inflammatory markers (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, procalcitonin) and radiologic images were analyzed to determine osteomyelitis presence. Patients were divided into osteomyelitis-positive and osteomyelitis-negative groups, with marker levels compared statistically.

Results: Both C-reactive protein and procacitonin levels were significantly higher in the osteomyelitis group ( P s = .05). Elevated procalcitonin (>0.5) indicated a 10.67 times higher likelihood of osteomyelitis.

Conclusions: Procalcitonin may serve as a valuable marker for diagnosing osteomyelitis in patients with PIs, aiding in early detection and treatment planning. Further research with larger cohorts is needed to confirm its diagnostic and monitoring potential.

Background: Maintenance of skin integrity in the neonatal period is crucial to avoid morbidity and mortality associated with skin problems in infants admitted to the neonatal ICUs (NICUs). Neonatal ICU nurses play a key role in the assessment of newborn skin for the early detection and management of skin injury. Consequently, there is a need to foster positive attitudes toward newborn skin assessment among nurses through training to reduce the incidence of skin injury.

Objective: To examine the effect of virtual reality simulator (VRS)-based training on the attitude toward newborn skin assessment among NICU nurses.

Methods: The study had a quasi-experimental design, involving pretest/posttest comparisons. A total of 73 NICU nurses (training group, n = 33; control group, n = 40) working in public and private hospitals in Gaziantep, Turkey, were included in the study, which was conducted from March to May 2022. Data were collected using the Sociodemographic and Occupational Data Form and the Newborn Skin Assessment Attitude Scale (NSAAS). The nurses in the training group received a VRS training program that was developed based on the theory of attitude change known as the Message-Learning Approach. The control group did not receive any training.

Results: Intragroup and between-group comparisons of the pretest and posttest scores of the NSAAS subdimensions (awareness, practice, and avoidance) and total scores after training showed that all subdimension scores and total NSAAS scores improved significantly in the training group.

Conclusions: The VRS training was effective in enhancing or reinforcing positive attitudes toward newborn skin assessment among NICU nurses.

General purpose: To review the risk factors and clinical features of bullous pemphigoid (BP) and discuss available treatment options.

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: 1. Summarize the clinical features and manifestations associated with BP. 2. Identify evidence-based methods to diagnose BP. 3. Explain evidence-based pharmacologic management strategies for the effective treatment of BP.

Abstract: This report describes the clinical course of a patient who underwent radical excision of a basal cell carcinoma and subsequent reconstruction using a Zitelli modification of the bilobed flap, which resulted in a nasal tip defect. The patient did not wish to undergo another surgical nose reconstruction; thus, the author used a two-stage application method with deep-frozen amniotic membrane to treat the nasal tip defect. The first application-the graft version-was applied to exposed cartilaginous structures, initiating tissue restoration. Seven days later, the author observed complete absorption of the amniotic membrane, wound bed granulation with overlapping cartilaginous structures, and peripheral epithelialization. The second application-the patch version-supported tissue restoration and acted as a biological cover. This method provides a better aesthetic outcome and shorter healing time compared with secondary intention wound healing. It may be indicated for patients with skin defects on the nasal tip who do not want to or who cannot undergo surgical intervention.

Objective: To synthesize the literature on skin failure and pressure injuries (PIs) among hospitalized patients with COVID-19.

Data sources: An electronic literature search using relevant keywords and controlled vocabulary was conducted in March 2023 on MEDLINE/PubMed, EMBASE, and CINAHL. Manual citation searches of included articles and gray literature, including the Wound, Ostomy, and Continence Nurses Society website were performed. Articles published in English between 2020 and April 2023 were considered.

Study selection: Articles were included if they reported on hospitalized adults who were COVID-19 positive with wounds that were not present upon admission. A total of 31 articles met these criteria.

Data extraction: Covidence was used to extract article data, including publication information; study aims and design; participant characteristics; wound characteristics, location, and diagnosis; care setting; clinical outcomes; and clinical and research implications.

Data synthesis: Of the 31 studies, 27 reported new onset skin lesions during hospitalization. Wounds were classified as PIs, skin failure, livedo racemosea, and/or, retiform purpura, and were associated with microvascular thrombosisthrombotic vasculopathy. Most PIs were associated with prone positioning, and affected patients often had multiple comorbidities including hypertension, diabetes mellitus, end-stage renal disease, heart disease, and chronic obstructive pulmonary disorder. Four articles highlighted an increased risk of new onset wounds, and three emphasized the importance of distinguishing deep tissue PIs from ischemic-related lesions in patients with COVID-19.

Conclusions: The evidence suggests an increased risk of ischemic lesions and PIs in patients with COVID-19 infection. This phenomenon may have inflated the numbers of PIs reported during the pandemic and adversely affected nursing quality measures in acute care environments.

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.