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Graves LY, Schwartz KR, Shiff J, Chan ER, Galea M, Henzel MK, Olney C, Bogie KM. Genomic Biomarkers Can Provide a Deeper Understanding of Recurrent Pressure Injuries. Adv Skin Wound Care 2023; 36:534-539. [PMID: 37729163 PMCID: PMC10545060 DOI: 10.1097/asw.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/12/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To identify genetic biomarkers predisposing individuals with spinal cord injury (SCI) to recurrent pressure injuries (PIs). METHODS Repeated measures of the transcriptome profile of veterans with SCI at three Veterans Spinal Cord Injuries and Disorders Centers. Exclusion criteria included having significant active systemic disease at time of enrollment. Researchers obtained comprehensive profiles of clinical and health factors and demographic information relevant to PI history at enrollment and at each follow-up visit by reviewing patients' medical charts. Whole blood samples were collected at 6- to 12-month intervals for 2 to 4 years. In addition to DNA profiling with whole genome sequencing of the patients, RNA sequencing was performed to assess pathways associated with PI risk. RESULTS Whole genome sequencing analysis identified 260 genes that showed increased prevalence of single-nucleotide variations in exonic regions with high (>20) combined annotation-dependent depletion scores between persons with high versus low intramuscular adipose tissue levels when cross-referenced with persons who had recurrent PIs. Gene set enrichment analysis using Hallmark and KEGG (Kyoto Encyclopedia of Genes and Genomes) gene sets of these candidate genes revealed enrichment in genes encoding proteins involved in fatty acid metabolism (P < .01). Further, RNA sequencing revealed upregulated activity in biological senescence pathways and downregulated activity in antimicrobial protection pathways. CONCLUSIONS Genomic biomarkers may complement electronic health records to support management of complex interactive health issues such as risk of recurrent PIs in people with SCI. These findings may also be leveraged for homogeneous phenotypic grouping of higher-risk individuals.
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Affiliation(s)
- Letitia Y Graves
- Letitia Y. Graves, PhD, RN, is Assistant Professor, School of Nursing, University of Texas Medical Branch, Galveston, Texas, and Research Health Scientist, Louis Stokes Cleveland Veterans Affairs Medical Center. Katelyn R. Schwartz, MPH, BSN, RN, is Research Nurse, Cleveland VA Medical Center, Cleveland, Ohio. Josie Shiff, MS, is Research Assistant, Cleveland VA Medical Research & Education Foundation. Ernest R. Chan, PhD, is Research Scientist, Case Western Reserve University, Cleveland. Marinella Galea, MD, is Chief, Spinal Cord Injuries and Disorders, James J. Peters VAMC, Bronx, New York, and Associate Professor, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York. Mary K. Henzel, MD, PhD, is Assistant Chief, Spinal Cord Injuries and Disorders, and Spinal Cord Injury Physiatrist, Louis Stokes Cleveland VA Medical Center. Christine Olney, PhD, RN, is Nurse Scientist, Minneapolis VA Health Care System, Minneapolis, Minnesota. Kath M. Bogie, DPhil, FAIMBE, is Research Career Scientist, Louis Stokes Cleveland Veterans Affairs Medical Center, and Professor, Department of Orthopedics, Case Western Reserve University
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Eren F, DeLuca R, Kirshblum S. Frequency of turning in bed at home in persons with chronic spinal cord injury. J Spinal Cord Med 2022; 45:390-394. [PMID: 32808913 PMCID: PMC9135412 DOI: 10.1080/10790268.2020.1800965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To determine the routine turning frequency of persons with chronic spinal cord injury (SCI) in bed at night in their home environment.Design: An online questionnaire consisting of 22 questions.Setting: Free standing SCI rehabilitation facility.Participants: Persons between ages 18-75 with a traumatic SCI for ≥3 months, and living at home.Interventions: None.Outcome measures: Questionnaire-based evaluation of turning frequency of persons with SCI.Results: 86 subjects (70 men) with traumatic SCI completed the survey; 66.3% with tetraplegia and 41.9% with a neurological complete SCI. Almost every participant (96%) recalled being counseled on the importance of turning in bed at night upon discharge from their rehabilitation facility with 48.4% recalling the frequency recommended as every 2 h. At present, 25.6% of subjects reported turning every 2 h, 15.1% every 3 h, 15.1% every 4 h, 3.5% every 6 h, and 40.7% of respondents stated that they do not turn regularly at night.Conclusion: Although frequently recommended for repositioning at night in bed every two hours for persons with chronic SCI, especially for those at risk for pressure injuries, only 25.6% of individuals report turning at this frequency and 40.7% report not turning at night time regularly. The reasons for limited turning may be multi-factorial, however, this finding may serve as a call to practitioners to best determine the most appropriate turning frequency that can meet compliance of the individual with SCI, as well as maintain skin protection in the chronic period after injury.
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Affiliation(s)
- Fatma Eren
- Kessler Foundation, West Orange, New Jersey, USA,Department of PM&R, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence to: Fatma Eren, 1199 Pleasant Valley Way, West Orange, New Jersey07052, USA; Ph: 973-243-6916. Supplemental data for this article can be accessed on the publisher’s website. https://doi.org/10.1080/10790268.2020.1800965
| | - Robert DeLuca
- Kessler Institution for Rehabilitation, West Orange, New Jersey, USA
| | - Steven Kirshblum
- Kessler Foundation, West Orange, New Jersey, USA,Department of PM&R, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Institution for Rehabilitation, West Orange, New Jersey, USA
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Burkhart L, Skemp L, Siddiqui S, Bates-Jensen B. Developing a decision support tool to prevent community-acquired pressure injuries in spinal cord injury in ambulatory care: A nurse-led protocol for mix methods research. Nurs Outlook 2021; 69:127-135. [PMID: 33583605 DOI: 10.1016/j.outlook.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of formal guidelines and decision support tools to prevent community-acquired pressure injuries (CAPrIs) in Veterans with spinal cord injury (SCI). PURPOSE In this article we present our research protocol that describes our plans to create and test a decision support tool to prevent CAPrIs in SCI. METHODS In Aim 1, we identified mental-models of CAPrI prevention from the perspectives of Veterans (using photovoice, guided tours), and Veterans Health Administration SCI providers (using interviews), and triangulation to compare the two mental-models. This led to a decision support tool developed and validated using Delphi approaches in Aim 2 and will be followed by tool automation and system redesign for pilot implementation in Aim 3. FINDINGS The nurse-led research protocol provides a map to systematically explore, address and translate research into evidence-based practice. DISCUSSION Refinement of the protocol will guide future research and implementation.
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Affiliation(s)
- Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Hospital, Hines, IL; Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL.
| | - Lisa Skemp
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Hospital, Hines, IL; Marcella Niehoff School of Nursing and Parkinson School of Health Sciences and Public Health, Maywood, IL
| | | | - Barbara Bates-Jensen
- School of Nursing and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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