Review of the Current Management of Pressure Ulcers

Collagen-Based Wound Dressings: Innovations, Mechanisms, and Clinical Applications

Collagen-based wound dressings have developed as an essential component of contemporary wound care, utilizing collagen's inherent properties to promote healing. This review thoroughly analyzes collagen dressing advances, examining different formulations such as hydrogels, films, and foams that enhance wound care. The important processes by which collagen promotes healing (e.g., promoting angiogenesis, encouraging cell proliferation, and offering structural support) are discussed to clarify its function in tissue regeneration. The effectiveness and adaptability of collagen dressings are demonstrated via clinical applications investigated in acute and chronic wounds. Additionally, commercially accessible collagen-based skin healing treatments are discussed, demonstrating their practical use in healthcare settings. Despite the progress, the study discusses the obstacles and restrictions encountered in producing and adopting collagen-based dressings, such as the difficulties of manufacturing and financial concerns. Finally, the current landscape's insights indicate future research possibilities for collagen dressing optimization, bioactive agent integration, and overcoming existing constraints. This analysis highlights the potential of collagen-based innovations to improve wound treatment methods and patient care.

A murine pressure ulcer model for evaluating persistence and treatment of Staphylococcus aureus infection

Chronic wounds, particularly pressure ulcers, pose significant healthcare challenges, especially in the elderly population. This study presents an experimental murine model of chronically infected pressure ulcers using a single cycle of magnet-induced ischemic injury combined with infection by bioluminescent Staphylococcus aureus. The model addresses previous limitations in studying pressure ulcer infection pathogenesis and evaluating treatment efficacy. By combining this model with in vivo imaging system (IVIS) technology, we achieved real-time, non-invasive monitoring of infection dynamics. This approach demonstrated persistent pressure ulcer wound infection and provided temporal and spatial data on infection status. To validate the model's utility, we evaluated the antimicrobial efficacy of TCP-25, a synthetic host defense peptide, delivered in a topical gel formulation. Our findings highlight the potential of this model for investigating wound infection mechanisms, bacterial persistence, and therapeutic interventions. This innovative approach represents a significant advancement in pressure ulcer research, offering new opportunities for developing effective treatment strategies and improving patient outcomes.

Sub-Micrometer Polycaprolactone and Polyethylene Glycol-Based Fiber Mats With Iodine and Its Potential for Wound Healing

This study introduces an innovative approach to developing advanced antimicrobial wound dressings by engineering fiber mats of polycaprolactone (PCL) and polycaprolactone/polyethylene glycol (PCL/PEG) loaded with iodine using solution blow spinning (SBS). The mats exhibited a unique morphology, combining fibers and beads, with average fiber diameters of 570 nm for 12% (w/v) PCL and 470 nm for 1% (w/v) PEG in 12% (w/v) PCL, and bead diameters of 11.34 μm and 10.43 μm, respectively. PEG incorporation rendered the mats hydrophilic and significantly enhanced their swelling capacity, which is essential for wound exudate management. Remarkably, iodine was incorporated at a concentration specifically optimized to achieve its minimum inhibitory concentration (MIC) against a range of microorganisms while preserving the structural integrity and release profile of the mats. While PEG facilitated a higher initial iodine release rate, equilibrium was achieved after 5 days. UV-Vis spectroscopy unveiled the formation of transient iodine complexes with both PCL and PEG, underscoring their functional synergy. Biological assays revealed that PCL/PEG mats loaded with 4.26 mg/mL of iodine (PCL/PEG 3MIC) exhibited potent antimicrobial efficacy against gram-positive and gram-negative bacteria, as well as fungi, alongside significant in vitro wound healing potential. These findings underscore the promise of PCL/PEG iodine-loaded mats as an innovative platform for next-generation antimicrobial wound care, combining effective infection control with enhanced wound healing capabilities.

Understanding recurrent pressure injuries: A scoping review of current research and risk factors

AIM

To describe published studies on the current status of recurrent pressure injuries.

BACKGROUND

Pressure injuries burden patients and the health care system, so it is essential to prevent their recurrence and prevent patients from experiencing secondary injury. However, most current studies focus on primary pressure injury and less on its recurrence.

DESIGN AND METHODS

We employed a scoping review methodology. From the database construction until December 9, 2024, we searched PubMed, Embase, Web of Science, CINAHL, and the Cochrane Library. Two researchers independently screened and extracted data.

RESULTS

Twenty-eight articles met our criteria, most published after 2000. The included studies showed that 13 articles dealt with the definition of recurrent pressure injuries, but no uniform standard has been formed yet. The incidence of recurrent pressure injuries is 5.4 %-73.6 %. The most commonly reported site of recurrence is the ischium. The high-risk population for recurrence is the patient with spinal cord injury. Eleven studies described 26 risk factors for recurrent pressure injuries, of which albumin was the most commonly reported risk factor, followed by spinal cord injuries, age, hospital stay, and ulcer size. The 26 risk factors were summarised into five aspects: personal factors, social-environmental factors, disease-related factors, physiological and biochemical parameters, and Initial ulcer characteristics.

CONCLUSIONS

The incidence of recurrent pressure injuries varies widely, and specific definitions and standardised staging criteria must be further determined to improve clinical judgment and reporting accuracy. The risk factors for recurrent pressure injuries involve many aspects. Some studies have described local flaps and overall recurrence risk factors separately, and further verification is needed to determine whether there is a difference between the two.

The successful healing effect of local Taurolidine irrigation for treating deep pressure ulcers: a case report

BACKGROUND

Pressure ulcers, particularly stage III and IV lesions, pose a significant healthcare challenge owing to their high morbidity, economic burden, and recalcitrance to conventional therapies. Current management often includes systemic antibiotics, debridement, and advanced wound dressings, yet outcomes remain suboptimal in many cases. Innovative approaches to wound care are needed to address this gap.

CASE PRESENTATION

We report a case of a 17-year-old Iranian paraplegic male with a stage III sacral pressure ulcer complicated by an underlying abscess and exposed bone. Despite systemic antibiotics, regular debridement, and dressing changes, the ulcer failed to heal. The introduction of serial Taurolidine irrigation, combined with limited application of cryopreserved human amniotic membrane, resulted in progressive wound granulation and complete reepithelialization within 2 months. The patient experienced no adverse effects and maintained complete healing at follow-ups up to 1 year.

CONCLUSION

This case highlights the potential of Taurolidine as a novel antiseptic and wound-healing agent for recalcitrant pressure ulcers. Taurolidine irrigation demonstrated efficacy in achieving complete ulcer healing, suggesting its role as a promising therapeutic option for challenging wound infections.

Advanced biomaterials in pressure ulcer prevention and care: from basic research to clinical practice

Pressure ulcers are a common and serious medical condition. Conventional treatment methods often fall short in addressing the complexities of prevention and care. This paper provides a comprehensive review of recent advancements in advanced biomaterials for pressure ulcer management, emphasizing their potential to overcome these limitations. The study highlights the roles of biomaterials in enhancing wound healing, preventing infections, and accelerating recovery. Specific focus is placed on the innovation and application of multi-functional composite materials, intelligent systems, and personalized solutions. Future research should prioritize interdisciplinary collaboration to facilitate the clinical translation of these materials, providing more effective and tailored treatment approaches. These advancements aim to improve the quality of life and health outcomes for patients by offering more reliable, efficient, and patient-specific therapeutic options.

New Perspectives of Hydrogels in Chronic Wound Management

Chronic wounds pose a substantial healthcare concern due to their prevalence and cost burden. This paper presents a detailed overview of chronic wounds and emphasizes the critical need for novel therapeutic solutions. The pathophysiology of wound healing is discussed, including the healing stages and the factors contributing to chronicity. The focus is on diverse types of chronic wounds, such as diabetic foot necrosis, pressure ulcers, and venous leg ulcers, highlighting their etiology, consequences, and the therapeutic issues they provide. Further, modern wound care solutions, particularly hydrogels, are highlighted for tackling the challenges of chronic wound management. Hydrogels are characterized as multipurpose materials that possess vital characteristics like the capacity to retain moisture, biocompatibility, and the incorporation of active drugs. Hydrogels' effectiveness in therapeutic applications is demonstrated by how they support healing, including preserving ideal moisture levels, promoting cellular migration, and possessing antibacterial properties. Thus, this paper presents hydrogel technology's latest developments, emphasizing drug-loaded and stimuli-responsive types and underscoring how these advanced formulations greatly improve therapy outcomes by enabling dynamic and focused reactions to the wound environment. Future directions for hydrogel research promote the development of customized hydrogel treatments and the incorporation of digital health tools to improve the treatment of chronic wounds.

Assessing 3D printable density-graded lattice structures to minimize risk of tissue damage from compression-release stabilized sockets

BACKGROUND

Pressure, shear stress, and friction can contribute to soft tissue damage experienced by a residual limb. Current compression/release stabilized (CRS) socket designs may pose a risk to soft tissue from abrupt compression differences within the socket.Objectives:Density-graded lattice structures are investigated for their potential to mitigate risk of tissue damage by assessing their ability to produce more gradual transitions between high-compression and low-compression areas.Study Design:A full factorial experimental design was used to reveal the effects of changes among three variables: lattice geometry, density alteration, and displacement magnitude. A total of 144 experimental conditions were examined.

METHODS

Lattice samples representing areas of compression and release based on a novel cushioned transhumeral level CRS style socket design were 3D printed. Compression testing was performed on 2 types of lattice structures which incorporated 1 of 8 design elements to alter density and axial stiffness. The effect on stiffness of the sample as a function of lattice type and density alteration was recorded under 3 loading conditions.

RESULTS

The offset diamond lattice type with blend radius density alterations produced the only samples meeting criteria set for compression areas of the socket. No samples satisfied criteria for release areas. Transitional density lattices that gradually tapered between the best performing compression and release values were successfully produced.

CONCLUSIONS

Transitional density lattices offer promise for mitigation of soft tissue damage through minimization of compression differentials throughout the socket. Wider implications for this research include use in sockets for other levels of amputation and in orthotics. Future work will focus on lattice optimization to improve release behavior within a modified CRS socket.

Application of novel strategies in chronic wound management with focusing on pressure ulcers: new perspective

Invading blood cells, extracellular tissue, and soluble mediators all play important roles in the wound-healing process. There is a substantial global burden of disease and mortality attributable to skin defects that do not heal. About 1% to 2% of the population in industrialized nations suffers from chronic wounds that don't heal, despite healthcare breakthroughs; this condition is very costly, costing about $25 billion each year in the US alone. Amputation, infection (affecting as many as 25% of chronic wounds), sepsis, and dermal replacements are all consequences of conventional therapeutic approaches like growth factor therapy and diabetic foot ulcers account for 85% of lower limb amputations. Despite these obstacles, scientists are constantly looking for new ways to speed healing and close wounds. The unique immunomodulatory capabilities and multipotency of mesenchymal stem cells (MSCs) have made them a potential therapeutic choice in tissue engineering and regenerative medicine. Animal models of wound healing have shown that MSCs can speed up the process by as much as 40% through enhancing angiogenesis, modulating inflammation, and promoting fibroblast migration. Clinical trials provide more evidence of their effectiveness; for instance, one RCT found that, after 12 weeks, patients treated with MSCs had a 72% smaller wound size than those in the control group. This review offers a thorough examination of MSCs by combining the latest research with preclinical evidence. Highlighting their potential to transform treatment paradigms, it delves into their biological properties, how they work during regeneration and healing, and therapeutic usefulness in controlling chronic wounds.

Evaluation of surgical nurses' knowledge and attitudes towards pressure ulcer prevention

BACKGROUND

Pressure ulcers are an indicator of healthcare quality. The knowledge and attitudes of nurses are important in the prevention of pressure ulcers.

OBJECTIVE

This study aimed to evaluate the knowledge and attitudes of surgical nurses regarding the prevention of pressure ulcers.

DESIGN

The research is descriptive and cross-sectional in nature.

SETTING

The study was conducted at a university hospital in Turkey between May and November 2022.

PARTICIPANTS

The research population consisted of 310 nurses working in the surgical clinic and intensive care units of a university hospital.

METHODS

The study included 203 nurses. Data were collected between May 2022 and November 2022 using the "Descriptive Information Form", the "Knowledge Towards Pressure Ulcers Prevention Scale", and the "Attitude Towards Pressure Ulcers Prevention Scale". The data analysis utilized frequency, percentage, mean, independent groups t-test, one-way ANOVA, Pearson correlation, and linear regression analysis.

RESULTS

The knowledge levels of surgical nurses regarding pressure ulcer prevention were inadequate. Nurses had a positive attitude towards preventing pressure ulcers; however, this positive attitude was not at a satisfactory level. The nurses' knowledge level was a predictor of their positive attitude.

CONCLUSIONS

This study revealed that surgical nurses had insufficient knowledge about preventing pressure ulcers and exhibited a positive attitude that was not at the desired level.

Pressure injuries and biofilms: Microbiome, model systems and therapies

Chronic wounds have emerged as significant clinical problems owing to their increasing incidence and greater recognition of associated morbidity and socio-economic burden. They are defined as wounds that do not progress normally through the stages of healing in a timely and/or orderly manner. Pressure injuries, in particular, represent a serious problem for patients who are elderly or have limited mobility, such as wheelchair users or those who spend most of the day in bed. These injuries often result from prolonged pressure exerted on the skin over the bone. Treatment of pressure injuries is complex and costly. Emerging evidence suggests that the pressure injury microbiome plays a vital role in chronic wound formation and delaying wound healing. Additionally, antibiotics often fail due to the formation of resistant biofilms and the emergence of antimicrobial-resistant bacteria. In this review, we will summarise the current knowledge on: (a) biofilms and microbiomes in pressure injuries; (b) in vitro and in vivo model systems to study pressure injuries, and (c) current therapies and novel treatment approaches. Understanding the complex interactions between microbes and the host immune system in pressure injuries will provide valuable insights to improve patient outcomes.

Polymer- and Lipid-Based Nanostructures Serving Wound Healing Applications: A Review

Management of hard-to-heal wounds often requires specialized care that surpasses the capabilities of conventional treatments. Even the most advanced commercial products lack the functionality to meet the needs of hard-to-heal wounds, especially those complicated by active infection, extreme bleeding, and chronic inflammation. The review explores how supramolecular nanovesicles and nanoparticles-such as dendrimers, micelles, polymersomes, and lipid-based nanocarriers-can be key to introducing advanced wound healing and monitoring properties to address the complex needs of hard-to-heal wounds. Their potential to enable advanced functions essential for next-generation wound healing products-such as hemostatic functions, transdermal penetration, macrophage polarization, targeted delivery, and controlled release of active pharmaceutical ingredients (antibiotics, gaseous products, anti-inflammatory drugs, growth factors)-is discussed via an extensive overview of the recent reports. These studies highlight that the integration of supramolecular systems in wound care is crucial for advancing toward a new generation of wound healing products and addressing significant gaps in current wound management practices. Current strategies and potential improvements regarding personalized therapies, transdermal delivery, and the promising critically evaluated but underexplored polymer-based nanovesicles, including polymersomes and proteinosomes, for wound healing.

Clinical Presentation and Integrated Management of Pressure Injuries in the Emergency Hospital Setting: A Plastic Surgeon's Perspective

Background: Pressure injuries are localized areas of tissue damage or necrosis that occur when pressure is applied to the skin for prolonged periods, often over bony prominences, often the sacrum, heels, ischial tuberosities, and greater trochanters. The pathophysiology is complex, involving a combination of mechanical forces, ischemia, and tissue hypoxia. Methods: We conducted a 2-year retrospective study aiming to assess the clinical characteristics, risk factors, and management of pressure injuries in patients admitted to an emergency hospital who underwent a plastic surgery examination. Results: This study included 176 patients with clinically diagnosed pressure ulcers, with findings showing 28.52% of cases as stage III and 35.57% as stage IV. Common sites included the sacrum (40.94%), ischium (15.1%), and heel (14.43%). The median patient age was 76 years, with 47.15% between 60 and 80 years and 36.93% ≥ 80 years, often presenting with comorbidities increasing the risk of pressure injuries, such as cardiovascular disease (71.59%), diabetes (18.18%) and obesity (9.66%). Important risk factors included neurological diseases (46.02%), spinal cord injuries (14.7%), and nutritional deficiencies, as indicated by anemia (10.43g/dL; 95% CI [10.04; 10.82]), low serum albumin (2.56 g/dL; 95% CI [2.43; 2.69]) and proteins (5.54 g/dL; 95% CI [5.34; 5.73]). Mortality was significant, at 36.93%, with 23.3% occurring within the first 7 days of hospitalization due to the patients' critical condition. Decision-making for surgical intervention considered the patient's general status, comorbidities, and ulcer severity. Surgical treatment consisted of seriate debridement, negative pressure vacuum therapy, and/or coverage using skin grafting, local advancement, or rotation flaps. Conclusions: The key question for a plastic surgeon to consider is how pressure ulcers should be managed. Various debridement and covering techniques should be tailored to the wound's characteristics, considering patient comorbidities and general health condition.

Povidone-iodine-induced scalp lesions in pediatric neurosurgery patients: a case series

PURPOSE

Povidone-iodine, or Betadine® (Atlantis Consumer Healthcare Inc., Bridgewater, NJ), is a commonly used agent for surgical site preparation. Although commonly used, it carries the risk of skin reactions, and multiple cases of intra-operative contact dermatitis and chemical burns have been reported. However, to our knowledge, there are currently no published cases of povidone-iodine-induced skin lesions in neurosurgical patients.

METHODS

A single-center retrospective chart review was performed to identify patients who developed scalp lesions secondary to chemical toxicity following neurosurgical procedures between October 1, 2021, and June 30, 2024.

RESULTS

Three patients were identified, ranging from 2.5 months to 14 years old. Two were positioned prone and the third in lateral decubitus. All patients' heads were supported by a horseshoe headrest covered with a gel pad and wrapped in a cotton roll. For two patients, Reston™ foam (3M©, St. Paul, MN) was added on the horseshoe. Surgical sites were prepped with isopropyl alcohol, Betadine®, and chlorohexidine. Two patients had their heads intermittently lifted throughout the procedure. Lesions were identified immediately after returning the patient to the supine position in the operating room and steadily improved over the course of one to five months with local wound care.

CONCLUSIONS

Careful preparation of the surgical site is an essential step in the prevention of surgical site infections. However, caution should be exercised during skin preparation to avoid pooling of povidone-iodine around dependent regions. Additional steps, such as scheduled head elevations and pressure dispersion, should be taken to mitigate factors contributing to these lesions.

Management of Xylazine-Induced Soft-Tissue Necrosis: A Review of 20 Cases

PURPOSE

The illicit injection of xylazine has recently been designated as an emerging public health threat. The use of this drug is associated with devastating soft-tissue necrosis that may lead to limb amputation. This study aimed to (1) report cases of soft-tissue injury from xylazine and (2) describe a staging and management algorithm for wounds related to xylazine use.

METHODS

A retrospective review was conducted to identify patients treated for xylazine-related soft-tissue necrosis at a trauma center. Clinical cases, treatment strategy, and available outcomes were presented. In addition, a comprehensive literature search was conducted using the keywords "xylazine" and "soft tissue."

RESULTS

The management of seven patients with xylazine-related upper extremity soft-tissue necrosis was included, in addition to summarizing findings of five studies reporting on 13 additional cases. These cases were managed with local wound care (2 patients), soft-tissue reconstruction (4 patient), osseous reconstruction (1 patient), and limb amputation (10 patients).

DISCUSSION

Acute treatment of xylazine-related soft-tissue necrosis is ideal to minimize morbidity and prevent limb loss. Management strategies of these wounds should be based on the depth of tissue involvement. Superficial ulceration involving the skin and subcutaneous tissue (Stage 1) should be managed with local wound care. Deeper ulceration involving tendons and/or muscle (Stage 2) requires surgical débridement and soft-tissue reconstruction. Deeper ulceration involving bone (Stage 3) requires osseous débridement and reconstruction. Finally, when all tissues in the extremity are involved (Stage 4), amputation is often necessary.

Evaluation of Nurses' attitudes, behaviors, and barriers toward pressure ulcer prevention in neonatal and pediatric intensive care units

Introduction

Pressure ulcers are a significant concern in pediatric intensive care units, with prevalence rates ranging from 0.8% to 27%. They pose serious physical and psychological challenges, particularly in neonatal and pediatric intensive care units (NICU and PICU). This study explores nursing strategies, attitudes, and barriers toward pressure ulcer prevention in NICU and PICU settings.

Methods

Using a descriptive study design, data were collected from 80 nurses working in NICU and PICU through validated questionnaires, including a demographic profile and a pressure ulcer survey. Descriptive statistics were employed to calculate mean scores and percentages, while inferential statistics assessed associations between variables.

Results

The study revealed specific nursing strategies, along with significant barriers and attitudes toward pressure ulcer prevention in NICU and PICU. The total attitude mean score was 3.57, with the highest positive response (mean = 4.29) for "most pressure sores can be avoided", and the highest negative response (mean = 3.86) for "pressure sore prevention is a low priority for me". Among participants, 72.5% conducted risk assessments on all patients, 60% had written prevention care plans, and 76.3% implemented preventive strategies. Barriers such as staff shortages and time constraints were reported by 76.2% of nurses. Multivariate analysis indicated that nurses with more than 10 years of qualification (OR = 3.67) and permanent staff with over 10 years of employment (OR = 4.31) were significantly more likely to engage in preventive practices. The use of a pressure ulcer grading tool (OR = 2.49, P < 0.05) and participation in formal training (OR = 3.14, P < 0.05) were also positively associated with preventive practices.

Discussion

These findings underscore the importance of structured assessment tools, ongoing education, and the need to foster positive attitudes among nurses to effectively reduce pressure ulcer prevalence and enhance patient outcomes in NICU and PICU settings.

Lumbosacral rotation flap: a simple method for covering sacral pressure injuries

BACKGROUND

Pressure injuries (PIs) are among the most common skin and soft tissue wounds occurring in patients who are bedbound and/or immobile. PI management hinges on their prevention; however, reoccurrence poses a challenge to their management and requires a multidisciplinary approach. Here, the authors describe a lumbosacral rotation flap (LSRF) for the coverage of sacral PIs.

METHOD

A single-centre, retrospective analysis of prospectively collected data was carried out. All patients undergoing LSRF for sacral PIs were included. Patients with active systemic sepsis, immune compromise, hepatic or renal dysfunction were excluded. All patients underwent preoperative optimisation and wound cultures to direct antibiotic therapy after surgery.

RESULTS

A total of nine patients underwent the procedure (seven male and two female). Mean age was 47.6 years with a mean ulcer size of 92.9 cm2. Bone biopsy indicated the presence of osteomyelitis in three patients. Of the LSRFs, two flaps showed minimal local complications in the form of marginal flap necrosis which was managed conservatively. All flaps healed well with no cases of flap loss or the need for secondary procedures.

CONCLUSION

The results of this analysis showed that LSRF can be considered a first line of treatment of sacral PIs. They can be used to cover large defects. Due to their large base and flap size, readvancement in cases of recurrence is also possible.

Dermatologic Conditions Following Limb Loss

The use of prostheses in individuals with limb loss increases the risk of maceration, friction, and pressure-induced skin injuries due to the vulnerability of the residual limb and the close contact with the socket. Poorly fitting prostheses exacerbate these issues, especially for those with immunosuppression or vascular conditions. Skin pathologies disrupt daily prosthetic limb use and impact the independence of those with limb loss. Preventive measures, including proper prosthesis socket fitting and meticulous skin care, are crucial. This review explores residual limb-site skin pathologies and details current mitigation and management strategies.

Effect of the "aSSKINg" Model in Reducing Pressure Ulcer Risk: A Comparative Study Using the Braden Risk Assessment Score

Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.

Critical care nurses' knowledge and perceived barriers regarding pressure injury prevention among critically ill patients at Baghdad teaching hospitals: A cross-sectional survey

Background

One of the most vital forms of the affected patient safety is pressure ulcers (PUs), which can be a critical health problem that every day impacts sufferers and healthcare structures. This study aimed to explore the level of nurse's knowledge and perceived barriers regarding PUs prevention among critically ill patients.

Methods

This cross-sectional study was conducted among 100 nurses who working in the critical care units (CCUs) at tertiary teaching hospitals in Baghdad City, the study extended from April to June 2024 to assess the nurses' knowledge level using the knowledge perceived barriers on the prevention of PUs questionnaire. The data were analyzed using descriptive and inferential statistics (SPSS version 26).

Results

The age of the participants included in this study ranged between 18 and 27 years with a mean age of (28.61 ± 6.603) years and females accounted 55% of total study participants. The highest group of the study population has finished their bachelor's degree (74%). Moreover, less than half of the study population (43%) had <5 years of experience in CCU.

Conclusions

Nurses' knowledge on the prevention of PU in CCUs is satisfactory in this study and moderately has a high level of perceived barriers toward PU prevention. Several barriers perceived to affect patients' quality of care regarding proper prevention of PUs were identified by Iraqi CCUs. The findings of this study suggest that several barriers need to be resolved if proper prevention of PUs is to be guaranteed in CCUs.

Evaluation and Management of Pelvic Osteomyelitis in Stage IV Pressure Injuries: A Multidisciplinary Collaborative Approach

Managing pelvic osteomyelitis (POM) in the setting of stage IV pressure injuries requires multidisciplinary evaluation as well as patient and caregiver engagement and is complicated by the lack of high-evidence data to guide best practices. In this review, we describe our approach to pressure injury and POM evaluation and management through multidisciplinary collaboration and highlight areas of future research that are necessary to enhance patient outcomes, reduce healthcare costs, and improve the quality of life of those affected by POM.

Cognitive status, psychological state and needs of caregivers for elderly patients with home-induced pressure injuries: a qualitative study

Aims/Background Pressure injury stands as a global healthcare concern, primarily affecting elderly individuals. As the ageing of the global population shows no signs of slowing down, both society and the families of the affected individuals continue to bear the brunt of the consequences of pressure injuries. The majority of pressure injury cases are managed at home, and the occurrence and progression of pressure injuries in the elderly are closely associated with informal caregivers. This study aims to qualitatively explore the cognitive status of caregivers for elderly patients with home-induced pressure injuries, as well as their psychological state and needs during the caregiving process. Methods This research is qualitative, descriptive, and phenomenological in nature. A purposive sampling method was used. Eighteen caregivers of elderly patients with pressure injuries were selected from Jiangnan University Medical Centre as interviewees from June 2023 to August 2023. Semi-structured interviews were utilised to collect data regarding the caregivers' cognition, psychological state, and care-related needs while caring for elderly patients with home-induced pressure injuries. The data were then organised and analysed using Colaizzi's phenomenological analysis method and NVivo 11.0. Results Through the analysis of interview data from caregivers of elderly patients with home-induced pressure injuries, three main themes and nine subthemes were identified. The data analysis also revealed that the caregivers surveyed lacked the crucial awareness of preventing pressure injuries and that their caregiving practices were not up to standards. During the caregiving process, they were challenged with substantial stress while also experiencing negative emotions such as anxiety or depression. They had a strong desire for persistent medical support to alleviate the psychological and emotional challenges. Conclusion The findings of this study establish a collaborative relationship network among the hospitals, family, medical staff, and caregivers in the management of pressure injuries, but with a special attention to the caregivers' needs for disease-related knowledge and psychophysical support. Such relationships streamline communication between medical staff, patients, and their caregivers, facilitating the adoption of active and correct methods by caregivers to prevent and care for pressure injuries. This can positively impact the quality of care for pressure injuries, further improving the life quality of patients and their caregivers, controlling the incidence of pressure injuries, and reducing readmission rates.

Cannabinoids in Integumentary Wound Care: A Systematic Review of Emerging Preclinical and Clinical Evidence

This systematic review critically evaluates preclinical and clinical data on the antibacterial and wound healing properties of cannabinoids in integument wounds. Comprehensive searches were conducted across multiple databases, including CINAHL, Cochrane library, Medline, Embase, PubMed, Web of Science, and LILACS, encompassing records up to May 22, 2024. Eighteen studies met the inclusion criteria. Eleven were animal studies, predominantly utilizing murine models (n = 10) and one equine model, involving 437 animals. The seven human studies ranged from case reports to randomized controlled trials, encompassing 92 participants aged six months to ninety years, with sample sizes varying from 1 to 69 patients. The studies examined the effects of various cannabinoid formulations, including combinations with other plant extracts, crude extracts, and purified and synthetic cannabis-based medications administered topically, intraperitoneally, orally, or sublingually. Four animal and three human studies reported complete wound closure. Hemp fruit oil extract, cannabidiol (CBD), and GP1a resulted in complete wound closure in twenty-three (range: 5-84) days with a healing rate of 66-86% within ten days in animal studies. One human study documented a wound healing rate of 3.3 cm2 over 30 days, while three studies on chronic, non-healing wounds reported an average healing time of 54 (21-150) days for 17 patients by oral oils with tetrahydrocannabinol (THC) and CBD and topical gels with THC, CBD, and terpenes. CBD and tetrahydrocannabidiol demonstrated significant potential in reducing bacterial loads in murine models. However, further high-quality research is imperative to fully elucidate the therapeutic potential of cannabinoids in the treatment of bacterial skin infections and wounds. Additionally, it is crucial to delineate the impact of medicinal cannabis on the various phases of wound healing. This study was registered in PROSPERO (CRD42021255413).

Water-powered, electronics-free dressings that electrically stimulate wounds for rapid wound closure

Chronic wounds affect ~2% of the U.S. population and increase risks of amputation and mortality. Unfortunately, treatments for such wounds are often expensive, complex, and only moderately effective. Electrotherapy represents a cost-effective treatment; however, its reliance on bulky equipment limits its clinical use. Here, we introduce water-powered, electronics-free dressings (WPEDs) that offer a unique solution to this issue. The WPED performs even under harsh conditions-situations wherein many present treatments fail. It uses a flexible, biocompatible magnesium-silver/silver chloride battery and a pair of stimulation electrodes; upon the addition of water, the battery creates a radial electric field. Experiments in diabetic mice confirm the WPED's ability to accelerate wound closure and promote healing by increasing epidermal thickness, modulating inflammation, and promoting angiogenesis. Across preclinical wound models, the WPED-treated group heals faster than the control with wound closure rates comparable to treatments requiring expensive biologics and/or complex electronics. The results demonstrate the WPED's potential as an effective and more practical wound treatment dressing.

Nanotechnological Antibacterial and Conductive Wound Dressings for Pressure Ulcer Prevention

The development of pressure ulcers, associated with increased temperature and moisture in specific areas of the body, and the risk of microbial infections in patients lying in a static position for prolonged periods of time represents a serious issue in medicine. In order to prevent the formation of pressure ulcers, this work aims to present advanced nanostructured coatings developed by three research groups. Nanometric silver, ash and functionalized torrefied biomass were the basis for the treatment of wound dressings to improve thermal conductivity and antimicrobial properties of the conventional cotton gauzes. Each treatment was performed according to its own optimized method. The treated fabrics were characterized in terms of antimicrobial properties, heat transfer, morphology and hydrophobic behavior. The results demonstrated the effectiveness of the deposition treatments also in synergistic actions. In particular, the antibacterial efficacy was improved in all the samples by the addition of silver treatment, and the thermal conductivity was enhanced by around 58% with nanometric ashes. A further step of the study involved the designing of two multilayer systems evaluated using circuit models for determining the total thermal conductivity. In this way, both systems were designed with the aim to guarantee simultaneous efficacy: high antibacterial and hydrophilic properties at the skin level and more hydrophobic and conductive behaviors toward the external environment.

The muscle pump activator device: From evidence to lived experiences

A chronic wound is one that fails to progress through a normal timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after 3 months. The most common chronic wounds include venous, ischaemic and mixed leg ulcers, diabetic foot ulcers and pressure injuries. Chronic wounds place immense physical and psychosocial burden on patients and exact heavy costs for healthcare systems, with many patients continuing to live with chronic wounds even after all management options have been exhausted. The muscle pump activator (MPA) device can be used to bridge this therapeutic gap. By stimulating the common peroneal nerve to activate venous muscle pump of the leg and foot, the MPA device increases blood flow to the lower leg and foot to improve conditions for healing. Currently, evidence in the literature exist to show that the MPA device improves wound outcomes over standard compression therapy, decreases edema and increases wound healing rates. In this review, we also present a series of chronic wound patients treated with the MPA device in multicentre clinics to demonstrate the ability of the MPA device to improve wound outcomes, reduce pain and edema and improve patient quality of life.

Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes

Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

A Wireless Power Transfer Mattress Based System for Perpetually Operating Physiological Monitoring Wearables

This article presents a novel wireless power mattress-based system architecture tailored to guarantee continuous energy for in-home environment healthcare wearables intended to be used in the context of patients who would benefit from long-term monitoring of specific physiological biomarkers. The design demonstrates that it is possible to transfer over 20 mW at a primary-secondary distance of 20.7 cm, whilst still keeping within all FCC/ICNIRP safety regulations, using the proposed simplified beamforming-controlled power transfer multi-input single-output system. Compared with other beamforming-controlled based works, the proposed design used non-coupling coil arrays, significantly reducing the algorithmic complexity. An on-chip wireless power charger system was also designed to provide high-efficiency power storage (89.3% power conversion efficiency and 83.9% power charge efficiency), guaranteeing wearables can continuously maintain their functionality. In contrast with conventional NiMh chargers, this work proposes a trimming function that makes it compatible with batteries of varying capacities. It also employs a four-stage charge loop to ensure safety and sustainability during the charging process. Overall, this work shows that by relying on wireless power transfer, it is, in principle, possible to create a safe wearable that could enable continuous monitoring of certain healthcare biomarkers with little or zero maintenance burden for the patients or carers.

Complications and psychological impact of pressure ulcers on patients and caregivers

Pressure ulcers are persistent skin lesions that have substantial detrimental effects on the physical well-being of patients. Moreover, their psychological ramifications for both patients and their caregivers are becoming more widely acknowledged. This research was conducted to examine the psychological ramifications of pressure ulcers and ascertain efficacious approaches to mitigate these effects and improve overall well-being. A cross-sectional study was conducted from March 2022 to December 2023 across tertiary care centres located in Beijing. The cohort consisted of 431 participants, which included primary caregivers and patients who were diagnosed with pressure ulcers. The data were gathered through the utilization of structured questionnaires and semi-structured interviews. These methods encompassed demographic details, clinical characteristics and validated scales that assessed psychological parameters, including quality of life, anxiety, stress and depression. The research exposed substantial psychological toll on both individuals receiving care and those providing care, with caregivers enduring diminished quality of life and elevated levels of anxiety, depression and stress (p < 0.05). A significant positive correlation was identified between the degree of psychological distress and severity of pressure ulcers (p < 0.05). Both location of the ulcer and duration of care were substantial contributors to the psychological burden (p < 0.05). In spite of the apparent necessity, a significant proportion of the participants refrained from obtaining psychological counselling. The results underscored the significant psychological ramifications of pressure ulcers for both individuals receiving care and the caregivers. As a result, comprehensive care strategies that incorporate psychological assistance into the prescribed treatment plan are imperative. This research highlighted the criticality of implementing all-encompassing, interdisciplinary approaches to tackle the complex issues presented by pressure ulcers in an effort to enhance the general welfare of those influences.

Implementation of an Evidence-Based, Content-Validated, Standardized Support Surface Algorithm Tool in Home Health Care: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement project was to provide a standardized, repeatable, and easy-to-use process for selecting a support surface for prevention or treatment of pressure injuries (PIs).

PARTICIPANTS AND SETTING

The Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm was chosen to guide clinicians in selection of an appropriate support surface. These clinicians provide services to approximately 465,000 patients across the nation annually.

APPROACH

This quality improvement project aimed to establish clinician knowledge and comfort levels when recommending a support surface and providing a standardized way to identify the appropriate support surface once a patient had been identified as at risk. The support surface algorithm was incorporated into our agency's electronic medical record (EMR); we chose this interactive algorithm to facilitate support surface selection among clinicians with no specialized expertise in PI treatment or prevention.

OUTCOMES

Clinicians reported an increase in knowledge and comfort levels in the ability to select an appropriate support surface following implementation of the clinical decision support tool. Benchmarking data illustrated a decrease in the year over year aggregate (September 2018 to September 2021) trending for the Centers for Medicare & Medicaid Services quality outcome measures surrounding potentially avoidable events related to PIs.

IMPLICATIONS FOR PRACTICE

Implementing the support surface algorithm assisted clinicians with support surface selection, elevated and standardized clinician practice, and reduced potentially avoidable events. As a result of this project, the Wound, Ostomy, and Continence Nurses Society Support Surface Algorithm Tool has been fully integrated into our EMR and is a standardized part of our clinical assessment.

Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study

BACKGROUND

Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals.

METHODS

A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis.

RESULTS

The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied.

CONCLUSIONS

The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.

Scalp wound management: a narrative review from a neurosurgical perspective

OBJECTIVE

This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice.

METHOD

We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant.

RESULTS

We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review.

CONCLUSION

There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.

Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors

PURPOSE

Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals.

METHOD

We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle.

RESULTS

Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers.

CONCLUSION

Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].

Physiological and nutrition-related challenges as perceived by spinal cord-injured endurance hand cyclists

This study explored the perceptions of spinal cord-injured (SCI) endurance hand cyclists regarding their physiological and nutrition-related challenges and the perceived impact of these challenges on nutritional intake and exercise capacity. This was an interpretive qualitative descriptive study in which semi-structured interviews were conducted with 12 adult South African national-level SCI endurance hand cyclists. Thematic analysis was used to explore perceptions regarding physiological and nutrition-related challenges and the impact thereof on nutritional practices and exercise capacity. Four themes emerged from the interviews: (i) physiological challenges experienced, (ii) nutrition-related challenges experienced, (iii) changes in nutritional practices, and (iv) compromised exercise capacity. The SCI endurance hand cyclists reported a number of physiological and nutrition-related challenges. Bowel and bladder challenges, limited hand function, muscle spasms, thermoregulatory challenges, pressure sores, menstrual periods, and low iron levels/anaemia were perceived to predominantly impact food and fluid intake (restrict intake) and compromise exercise capacity. This information can assist to devise tailored guidelines aimed to optimise fluid intake, overcome bladder challenges and ensure adequate nutritional intake in light of limited hand function.

Current Advances in Wound Healing and Regenerative Medicine

Treating chronic wounds is a common and costly challenge worldwide. More advanced treatments are needed to improve wound healing and prevent severe complications such as infection and amputation. Like other medical fields, there have been advances in new technologies promoting wound healing potential. Regenerative medicine as a new method has aroused hope in treating chronic wounds. The technology improving wound healing includes using customizable matrices based on synthetic and natural polymers, different types of autologous and allogeneic cells at different differentiation phases, small molecules, peptides, and proteins as a growth factor, RNA interference, and gene therapy. In the last decade, various types of wound dressings have been designed. Emerging dressings include a variety of interactive/ bioactive dressings and tissue-engineering skin options. However, there is still no suitable and effective dressing to treat all chronic wounds. This article reviews different wounds and common treatments, advanced technologies and wound dressings, the advanced wound care market, and some interactive/bioactive wound dressings in the market.

Effect evaluation of new dressing URGOTULRANGE in the treatment of pressure injury

BACKGROUND

Pressure injury (PI) is a local injury of the skin and/or soft tissue located at the bone caused by medical or other equipment and is common in long-term bedridden patients.

OBJECTIVE

To investigate the clinical effect of Urgotul foam dressing in the treatment of stage 3 ∼ 4 PI and deep tissue PI.

METHODS

A total of 38 patients with stage 3 ∼ 4 PI and deep tissue PI admitted to Jinan Central Hospital from January 2016 to December 2018 were selected and randomly divided into a control group (dressing change plus silver ion cream dressing) and an observation group (dressing change plus Urgotul Absorb non-border foam dressing), with 19 cases in each group. After 4 weeks of treatment, the pain intensity during dressing change and the treatment efficacy for PI wounds were compared between the two groups.

RESULTS

There were no differences in gender (P= 0.740), age (P= 0.130), single wound area (P= 0.673), consultation department (P= 0.972), stage (P= 0.740), presence of undermining (P= 0.721), deep tissue PI (P= 0.721), and systemic antibiotic therapy (P= 1.000) between the two groups, which were comparable. The treatment effect of the observation group was better than that of the control group (P= 0.003), and the pain score of the observation group was lower than that of the control group (P< 0.001).

CONCLUSION

Urgotul Absorb non-border foam dressing has a good effect in the treatment of stage 3 ∼ 4 PI and deep tissue PI and can relieve patients' pain, and is thus worth promoting.

Nurses' barriers to the pressure ulcer risk assessment scales implementation: A phenomenological study

AIM

The aim of the study was to explore nurses' barriers to the pressure ulcer risk assessment scales implementation.

DESIGN

A qualitative descriptive phenomenological study.

METHODS

The research participants comprised of 10 nurses at various medical and surgical departments in a teaching hospital northeast of Namibia. Data were collected between August and September 2022 through in-depth, semi-structured face-to-face individual interviews and analysed using Colaizzi's 7-step method.

RESULTS

The interviews with nurses, led to two major themes being discovered: (1) factors hindering the effective prevention of pressure ulcers; (2) suggestions for improvements in the utilization of risk assessment scales. The participants noted that they had inadequate knowledge of the formal risk assessment scales; there were inadequate resources and insufficient staff; there were no policies or guidelines regarding the management of pressure ulcers, all of which influenced their utilization of pressure risk assessment scales. Education and training, the provision of equipment, the hiring of new staff and the formulation of policies/guidelines would thus improve the nurses' utilization of the scales.

CONCLUSION

The findings of this study have uncovered three primary factors that have a detrimental impact on the utilization of risk assessment scales by nurses, that is their lack knowledge on pressure ulcer risk assessment scales; a shortage of staff and equipment; and an absence of policies/guidelines. The findings from this study provide valuable implications for guiding quality improvement initiatives aimed at enhancing the standard of care in Namibia and other resource-limited settings.

Prediction Model for Postoperative Pressure Injury in Patients with Acute Type A Aortic Dissection

OBJECTIVE

To establish a risk assessment model to predict postoperative National Pressure Injury Advisory Panel stage 2 or higher pressure injury (PI) risk in patients undergoing acute type A aortic dissection surgery.

METHODS

This retrospective assessment included consecutive patients undergoing acute type A aortic dissection surgery in the authors' hospital from September 2017 to June 2021. The authors used LASSO (logistic least absolute shrinkage and selection operator) regression analysis to identify the most relevant variables associated with PI by running cyclic coordinate descent with 10-times cross-validation. The variables selected by LASSO regression analysis were subjected to multivariate logistic analysis. A calibration plot, receiver operating characteristic curve, and decision curve analysis were used to validate the model.

RESULTS

There were 469 patients in the study, including 94 (27.5%) with postoperative PI. Ten variables were selected from LASSO regression: body mass index, diabetes, Marfan syndrome, stroke, preoperative skin moisture, hemoglobin, albumin, serum creatinine, platelet, and d-dimer. Four risk factors emerged after multivariate logistic regression: Marfan syndrome, preoperative skin moisture, albumin, and serum creatinine. The area under the receiver operating characteristic curve of the model was 0.765. The calibration plot and the decision curve analysis both suggested that the model was suitable for predicting postoperative PI.

CONCLUSIONS

This study built an efficient predictive model that could help identify high-risk patients.

Pressure Ulcers-A Longstanding Problem: A 7-Year Neurorehabilitation Unit Experience of Management, Care, and Clinical Outcomes

BACKGROUND

Neurological disease patients present an increased risk of developing pressure ulcers. The primary aim of this study is to evaluate the incidence and prevalence of pressure ulcers and their impact on length of stay and functional recovery.

METHODS

A retrospective study was conducted in a neurorehabilitation unit over a seven-year period. Data collected include demographic data, length of stay, functional evaluation, risk of pressure ulcers development, nutritional status, and skin. Pressure ulcers were classified according to the European Pressure Ulcer Advisory Panel System.

RESULTS

Data from 816 patients were analyzed. On admission, the authors found 236 pressure ulcers in 131 patients (about 16%), divided into stage I (25%), stage II (50%), and stage III-IV (25%). The most common sites were the heel (36%) and sacrum (29%). Among the risk factors for the development of pressure ulcers, malnutrition played a significant role, with approximately 76% of patients with pressure ulcers having mild to moderate malnutrition.

CONCLUSION

The presence of pressure ulcers seems to have a negative impact on the functional recovery of patients, as shown by the outcome scales and the average length of stay: 51 days versus 36 days (p < 0.01).

Trends and racial disparity in primary pressure ulcer hospitalizations outcomes in the US from 2005 to 2014

In the United States (US), pressure ulcers affect ≤3 million people and costs exceed 26.8 billion US dollars in spending. To examine trends in primary pressure ulcer (PPU) hospitalization mortality, length of hospital stay (LOS), and inflation-adjusted charges (IAC) in the US from 2005 to 2014 by race/ethnicity. We secondarily examined the relationship between race/ethnicity with PPU mortality, LOS, and IAC with race/ethnicity. This cross-sectional study used Nationwide Inpatient Sample (NIS) data from 2005 to 2014. The study sample included all hospitalizations with the designated ICD-9-CM code of 707.20-25 (pressure ulcer). There was a notable decline in PPU hospitalization from 11.5% to 7.77 % between 2005 and 2014. The mean mortality decreased from 2.32% to 1.12% (P < .001), the mean LOS declined from 9.39 days (P < .001), and the mean IAC per hospitalization decreased from $30,935 to $29,432 (P < .001). Positive changes observed in mortality, LOS, and IAC trends were consistent across different racial and ethnic groups. The results of multivariable logistic and linear regression analyses revealed that Black patients (β = 0.68, 95% CI 0.36-1.01, P < .001) and patients belonging to the Other race/ethnic category (β = 0.93, 95% CI 0.18-1.69) had longer hospital stays compared to their White counterparts. Regarding IAC, Black patients (β = 2846, 95% CI 1254-4439, P < .005), Hispanic patients (β = 6527, 95% CI 4925-8130), and patients from the Other race/ethnic category (β = 3473, 95% CI 1771-5174) had higher IAC for PPU treatment compared to their White counterparts. PPU hospitalization discharges, as well as hospitalization mortality, LOS, and IAC, decreased during the study period, however, our findings revealed disparities in PPU outcomes among different racial/ethnic groups. Implications of the findings are discussed.

Updates on Recent Clinical Assessment of Commercial Chronic Wound Care Products

Impaired wound healing after trauma, disorders, and surgeries impact millions of people globally every year. Dysregulation in orchestrated healing mechanisms and underlying medical complications make chronic wound management extremely challenging. Besides standard-of-care treatments including broad spectrum antibiotics and wound-debridement, novel adjuvant therapies are clinically tested and commercialized. These include topical agents, skin substitutes, growth factor delivery, and stem cell therapies. With a goal to overcome factors playing pivotal role in delayed wound healing, researchers are exploring novel approaches to elicit desirable healing outcomes in chronic wounds. Although recent innovations in wound care products, therapies, and devices are extensively reviewed in past, a comprehensive review summarizing their clinical outcomes is surprisingly lacking. Herein, this work reviews the commercially available wound care products and their performance in clinical trials to provide a statistically comprehensive understanding of their safety and efficacy. The performance and suitability of various commercial wound care platforms, including xenogeneic and allogenic products, wound care devices, and novel biomaterials, are discussed for chronic wounds. The current clinical evaluation will provide a comprehensive understanding of the benefits and drawbacks of the most-recent approaches and will enable researchers and healthcare providers to develop next-generation technologies for chronic wound management.

Design and Implementation of a Novel Double-Layered Wavy Mattress for the Prevention and Recovery of Pressure Ulcers: A Feasibility Study

Pressure ulcers are a significant concern in patient care, particularly for those with limited mobility and extended hospital stays. Wavy mattresses are shown an effective tool for preventing or promoting the healing of these wounds by preventing pressure localization in different body regions. The current study aimed to present a novel double-layered wavy mattress design for the prevention and recovery of pressure ulcers, addressing some of the limitations of existing mattresses. The novel mattress includes double-layered cells, with the upper and lower layers, filled with water and air, respectively. The temperature of water in the cells can be manually adjusted to meet patients' needs, prevent skin sweating, regulate body temperature, and promote blood flow in areas susceptible to pressure ulcers. Patients who used this novel mattress during their hospitalization experienced a significantly shorter recovery period for bedsores compared to those who used other mattresses, showing that the novel wavy mattress is an effective tool for preventing and recovering from pressure ulcers in long-term hospitalized patients with limited mobility.

Determinants of the success in flap reconstruction-Outcome analysis of 120 flaps in 484 procedures for pressure injury

Pressure injury (PI) mainly occurs in bedridden older adults or those with physical limitations. Here, we aimed to determine the appropriate timing to conduct flap reconstruction in patients with PIs and identify factors affecting surgical outcomes. We retrospectively reviewed the data of all patients who received debridement or flap reconstruction surgery for PIs in our hospital from January 2016 to December 2021. The extracted data included patient demographics, surgical records, blood test results, vital signs, and flap outcomes. In total, 484 surgical procedures (364 debridements and 120 flaps) were performed on 216 patients. Serum albumin level of ≥2.5 g/dL remarkably increased the likelihood of complete wound healing (odds ratio [OR] = 4.12, P = .032) and reduced the risk of postoperative complications (OR = 0.26, P = .040). In contrast, advanced age (OR = 1.04, P = .045) and serum creatinine level ≥2 mg/dL (OR = 5.07, P = .016) increased the risk of postoperative complications. Thus, patients with a favourable nutrition status have a higher likelihood of achieving complete wound healing. By contrast, patients who are older and have serum creatinine ≥2 mg/dL and serum albumin <2.5 g/dL tend to develop more postoperative complications. Overall, thorough correction for patient inflammation, infection, anaemia, and malnutrition status can provide optimal flap surgery outcomes.

Lupeol: A Triterpenoid Isolated from the Stem Bark of Hymenocardia Acida (tul.) Exhibits a van der Waal Antagonism on the Alpha Subunit of Gastric H+K+Atpase - A Promising Antiulcer Principle

BACKGROUND

Hymenocardia acida (HA) is one of the numerous medicinal plants in Nigeria with ethnomedicinal history of usage in the treatment of ulcer. The study aimed at isolating antiulcer principle(s) from the stem bark of HA as well as the mechanism of action determination.

METHODS

Antiulcer screenings of the crude extract, aqueous fraction, and bulked VLC fractions were performed using in vivo and in vitro models. Docking was carried out by using PyRx.

RESULTS

Crude extract (HA; 1 mg/mL) and the aqueous fraction of H. acida (HAA; 1 mg/mL) showed an acid neutralizing capacity (MEq) of 0.3948 and 0.4035, respectively which is significantly different from 0.431 MEq showed by negative control (distilled water) at p<0.05. BVLC 3 (1 mg/mL) showed a significant value of 0.4049 MEq. However, HA showed a dose-dependent decrease in activity across doses examined, with 100 mg/kg showing an ulcer index of 10.00±2.89 (61.50%) and cimetidine (positive control; 100 mg/kg), also showed the highest ulcer index of 3.67±0.88 (85.9%), which is significantly different from ulcer index of 26.00±6.35 (0.00%) p<0.05 observed in the negative control (5% dimethylsulphoxide). The highest ulcer index of 8.00±1.32 (65.10%) was noted in BVLC 3. Bioactive BVLC 3, resulted in an isolated compound (BF3B2A). The compound was suggested to be lupeol, with a docking score of -7.7. It showed a van der Waal interaction with some key amino acid residues in the vonoprazan binding site.

CONCLUSION

The experimental studies justify the ethnomedicinal claim of usage among locals.

Wearable Prophylaxis Tool for AI-Driven Identification of Early Warning Patterns of Pressure Ulcers

As today's society ages, age-related diseases become more frequent. One very common but yet preventable disease is the development of pressure ulcers (PUs). PUs can occur if tissue is exposed to a long-lasting pressure load, e.g., lying on tissue without turning. The cure of PUs requires intensive care, especially for the elderly or people with preexisting conditions whose tissue needs longer healing times. The consequences are heavy suffering for the patient and extreme costs for the health care system. To avoid these consequences, our objective is to develop a pressure ulcer prophylaxis device. For that, we built a new sensor system able to monitor the pressure load and tissue vital signs in immediate local proximity at patient's predilection sites. In the clinical study, we found several indicators showing correlations between tissue perfusion and the risk of PU development, including strongly reduced SpO2 levels in body tissue prior to a diagnosed PU. Finally, we propose a prophylaxis system that allows for the prediction of PU developments in early stages before they become visible. This work is the first step in generating an effective system to warn patients or caregivers about developing PUs and taking appropriate preventative measures. Widespread application could reduce patient suffering and lead to substantial cost savings.

Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database

In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.

Efficacy of different types of dressings on pressure injuries: Systematic review and network meta-analysis

AIM

To investigate the effectiveness of different dressings on pressure injuries and screen the dressings for efficacy.

DESIGN

Systematic review and network meta-analysis.

METHODS

Articles published from several electronic databases and other resources were selected. Two reviewers independently selected studies, extracted data and assessed the quality of selected studies.

RESULTS

Twenty-five studies that contained data on moist dressings (hydrocolloidal dressing, foam dressing, silver ion dressing, biological wound dressing, hydrogel dressing, polymeric membrane dressing) and sterile gauze dressings (traditional gauze dressings) were included. All RCTs were at a medium to high risk of bias. Moist dressings were found to be more advantageous than the traditional dressings. Hydrocolloid dressings [RR = 1.38, 95% CI (1.18, 1.60)] showed a higher cure rate than sterile gauze dressing and foam dressings [RR = 1.37, 95% CI (1.16, 1.61)]. Silver ion dressings [RR = l.37, 95% CI (1.08, 1. 73)] showed a higher cure rate than sterile gauze dressings. Sterile gauze dressing dressings [RR = 0.51, 95% CI (0.44, 0.78)] showed a lower cure rate compared with polymeric membrane dressings; whereas Sterile gauze dressing dressings [RR = 0.80, 95% CI (0.47, 1.37)] had a lower cure rate compared to biological wound dressings. Foam and hydrocolloid dressings were associated with the least healing time. Few dressing changes were required for moist dressings.

Comprehensive Care of Lower-Extremity Wounds

There are 5 common types of chronic nonhealing lower-extremity wounds: arterial, venous, diabetic foot ulcer, pressure, and mixed or atypical. Each chronic wound type has distinct features, and understanding the underlying cause will dictate the wound treatment plan. Here, the authors review the distinguishing wound properties for these 5 common chronic nonhealing lower-extremity wounds and outline a comprehensive treatment plan that addresses wound perfusion, debridement, infection control, moisture balance, and use of complementary advanced wound care products.

The Topical Formulation of Whey Protein for the Prevention of Pressure Ulcers in Critically Ill Patients: A Novel Intervention in a Randomized-Controlled Clinical Trial

Background

High prevalence of pressure ulcers (PUs) and their complications are important dilemmas in the intensive care unit (ICU). Therefore this study was designed to evaluate the effectiveness of topical whey protein formulation in preventing PUs in patients admitted to the ICU.

Materials and Methods

In this randomized placebo-controlled clinical trial under registration number [IRCTdeted for blinded article], 80 eligible ICU patients were randomly allocated to receive topical ointment of whey protein or placebo on the sacrum with a diameter of 15 cm twice daily for seven days, in addition to the routine care. The mean risk score for developing PUs was calculated at baseline using the Braden tool, and the PUSH score was used to assess PUs on days 4, 7, and 14. Patients' related demographic and clinical variables were also collected using a medical record for more evaluation.

Results

Our results showed that demographic characteristics and the Braden scores' baseline mean were not significantly different between groups (P > 0.05). The repeated measures ANOVA test revealed that the mean scores of PUs at various times were markedly lower in the whey protein than in the placebo group (P < 0.001).

Conclusion

This intervention can be routinely added as effective, safe, inexpensive, and accessible care to reduce the incidence of PUs for patients at risk of developing this injury.

Advance in topical biomaterials and mechanisms for the intervention of pressure injury

Pressure injuries (PIs) are localized tissue damage resulting from prolonged compression or shear forces on the skin or underlying tissue, or both. Different stages of PIs share common features include intense oxidative stress, abnormal inflammatory response, cell death, and subdued tissue remodeling. Despite various clinical interventions, stage 1 or stage 2 PIs are hard to monitor for the changes of skin or identify from other disease, whereas stage 3 or stage 4 PIs are challenging to heal, painful, expensive to manage, and have a negative impact on quality of life. Here, we review the underlying pathogenesis and the current advances of biochemicals in PIs. We first discuss the crucial events involved in the pathogenesis of PIs and key biochemical pathways lead to wound delay. Then, we examine the recent progress of biomaterials-assisted wound prevention and healing and their prospects.