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Murata E, Yoshida T, Tomaru U, Yamamoto S, Fukui-Miyazaki A, Ishizu A, Kasahara M. Decreased proteasome function increases oxidative stress in the early stage of pressure ulcer development. Exp Mol Pathol 2024; 137:104891. [PMID: 38462206 DOI: 10.1016/j.yexmp.2024.104891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
The aging process in the elderly results in heightened skin fragility associated with various disorders, including pressure ulcers (PUs). Despite the high incidence of PUs in the elderly population, there is a limited body of research specifically examining the impact of aging on the development of pressure ulcers. Therefore, investigating age-related physiological abnormalities is essential to elucidate the pathogenesis of PUs. Ischemia-reperfusion (I/R) injury and the subsequent oxidative stress caused by reactive oxygen species (ROS) play essential roles in the early stage of PUs. In this study, we used a mouse model of proteasomal dysfunction with an age-related phenotype to examine the role of proteasome activity in cutaneous I/R injury in vivo. Decreased proteasome function did not affect the expression of inflammatory cytokines and adhesion molecules in the I/R area in transgenic mice; however, proteasome inhibition increased oxidative stress that was not attenuated by activation of the oxidative stress response mediated by NF-E2-related factor 2 (Nrf2). In dermal fibroblasts (FCs) subjected to hypoxia-reoxygenation (H/R), proteasome inhibition induced oxidative stress and ROS production, and Nrf2 activation did not adequately upregulate antioxidant enzyme expression, possibly leading to antioxidant/oxidant imbalance. The free radical scavenger edaravone had protective effects against I/R injury in vivo and decreased oxidative stress in FCs treated with a proteasome inhibitor and subjected to H/R in vitro. The results suggest that the age-related decline in proteasome activity promotes cutaneous I/R injury-induced oxidative stress, and free radical scavengers may exert protective effects by preventing oxidative stress in the early stage of PUs.
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Affiliation(s)
- Eri Murata
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan; Department of Fundamental Nursing, Yamagata University Graduate School of Nursing, Yamagata, Yamagata, Japan
| | - Takuma Yoshida
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Utano Tomaru
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan; Department of Surgical Pathology, Hokkaido University Hospital, Sapporo 060-8648, Japan.
| | - Saaki Yamamoto
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Aya Fukui-Miyazaki
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Masanori Kasahara
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, Japan
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2
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Hibbert PD, Molloy CJ, Cameron ID, Gray LC, Reed RL, Wiles LK, Westbrook J, Arnolda G, Bilton R, Ash R, Georgiou A, Kitson A, Hughes CF, Gordon SJ, Mitchell RJ, Rapport F, Estabrooks C, Alexander GL, Vincent C, Edwards A, Carson-Stevens A, Wagner C, McCormack B, Braithwaite J. The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study). BMC Med 2024; 22:22. [PMID: 38254113 PMCID: PMC10804560 DOI: 10.1186/s12916-023-03224-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. METHODS Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. RESULTS Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. CONCLUSIONS This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia.
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia.
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA, 5000, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Faculty of Medicine and Health, University of Sydney, Kolling Institute, Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital Campus, Woolloongabba, QLD, 4102, Australia
| | - Richard L Reed
- Discipline of General Practice, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Rebecca Bilton
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Ruby Ash
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Clifford F Hughes
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Susan J Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | | | - Charles Vincent
- Department of Experimental Psychology, Radcliffe Observatory, University of Oxford, Woodstock Road, Oxford, OX2 6GG, England, UK
| | - Adrian Edwards
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, 8Th Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, 8Th Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK
| | - Cordula Wagner
- Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513 CR, The Netherlands
- Amsterdam University Medical Center/VU University, Van Der Boechorststraat 7, 1081 HV, Amsterdam, The Netherlands
| | - Brendan McCormack
- The Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, City Road, Sydney, NSW, 2006, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, Sydney, NSW, 2109, Australia
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3
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Badino G, Veronese N, Cella A. Effectiveness of a kinesio-taping-based treatment in stage IV sacral pressure ulcers in older patients: a pilot study. J Wound Care 2024; 33:60-65. [PMID: 38197280 DOI: 10.12968/jowc.2024.33.1.60] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE As reduced tissue vascularity is one of the mechanisms that prevent skin ulcers from healing, treatments that can improve local circulation could accelerate their clinical resolution. Given that kinesio-taping (KT) can improve tissue blood circulation and lymphatic drainage, we aimed to determine whether applying KT close to stage IV pressure ulcers (PUs) could improve their healing. METHOD Older patients with stage IV sacral PUs, and impaired mobility and functional dependency who were consecutively admitted in a six-month period to the Home Care service of Galliera Hospital (Genoa, Italy) were screened for participation in this pilot clinical trial. Patients' PUs were divided into two treatment areas-in the experimental intervention, KT was applied close to a portion of the PU, while the contralateral portion of the same lesion was treated according to the standard protocol ('control'). The surface reduction of both portions was measured every four days, for a total of five examinations (timepoints (T2-T6) after the baseline evaluation (T1). RESULTS A total of 12 patients (male=5, female=7; mean age 78.83±8.94 years) fulfilled the inclusion criteria and were enrolled in the study. At all timepoints (T2-T6), the mean percentage reduction was significantly greater in KT-treated areas than in control areas: T2=20.66% versus 6.17%, respectively; p<0.001; T3=37.33% versus 17.31%, respectively; p<0.001; T4=57.01% versus 30.06%, respectively; p<0.001; T5=69.04% versus 40.55%, respectively; p<0.001; and T6=80.34% versus 51.91%, respectively; p<0.001. Furthermore, from T3 onwards, a significantly higher number of KT-treated areas than control areas had halved in size, the maximum difference being recorded at T5 (10 versus two, respectively; p=0.002). CONCLUSION From the findings of this pilot study, KT would seem to be an effective, rapid, low-cost therapy for advanced sacral PUs in older patients with impaired mobility and functional dependency. Declaration of interest: The authors have no conflicts of interest to declare.
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Affiliation(s)
- Giorgio Badino
- Difficult Wound Healing Unit, Local Health Agency 'ASL3 Genovese', Genoa, Italy
| | - Nicola Veronese
- Department of Internal Medicine, Geriatric Unit, University of Palermo, Italy
| | - Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Primary Care Department, Local Health Agency 'ASL2 Savonese', Savona, Italy
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4
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Zhang YB, Tang QL, Wang SY, Zhao YH, Wu TR, Wang JX. Evidence mapping of clinical practice guidelines on nutritional management for pressure injuries and their quality. Nutr Rev 2023:nuad146. [PMID: 38156738 DOI: 10.1093/nutrit/nuad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
CONTEXT The safety and efficacy of nutritional management for pressure injuries (PIs) have been the subjects of ongoing interest. Some evidence demonstrated that nutrition is essential for skin and tissue viability, supporting tissue repair for healing the pressure injury. OBJECTIVE This investigation aimed to systematically review clinical practice guidelines (CPGs) for the nutritional management of PIs and furnish an evidence map to assess research trends and CPG gaps. METHODS The PubMed, Embase, and guidelines databases, and society websites were searched for CPGs for the nutritional management of PIs. The basic recommendations for the nutritional management of PIs, method quality, and reporting CPGs quality were identified and imported into Excel. Four researchers independently elucidated each CPG's quality via the Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. All bubble charts were generated using Excel software. RESULTS This review included 12 CPGs with a combined 23 recommendations. The nutrition screening and assessment were summarized on the basis of the PI recommendations for 6 major items, 12 items on nutrition management, and 3 on PI education. The assessed CPGs had mixed quality, and the highest score ± standard deviation based on the clarity of presentation was 83.46 ± 7.62, whereas the lowest mean score based on AGREE II applicability was 53.31 ± 16.90. Field 1 (basic information) in the RIGHT checklist had the greatest reporting rate (68.06%), whereas field 5 (review and quality assurance) had the lowest CPGs quality (41.67%). CONCLUSION This investigation furnishes an evidence map and provides new perspectives on the CPGs for the nutritional management of PIs. However, the CPGs included still need improvement, especially in the applicability and editorial independence domains.
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Affiliation(s)
- Ya-Bin Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qi-Lan Tang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shui-Yu Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yu-Hua Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Tian-Rui Wu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jun-Xia Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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5
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Meaume S, Marty M. Prevention of pressure injuries using a non-motorised decompression air mattress: a non-interventional study. J Wound Care 2023; 32:538-543. [PMID: 37682790 DOI: 10.12968/jowc.2023.32.9.538] [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] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Prevention of pressure injuries (PI) is a public health issue. Among the preventive measures, the use of support surfaces adapted to the risk of PI occurrence is recommended. This study aimed to report the incidence of PIs in patients at medium-to-high risk of occurrence of PIs and using a new non-motorised automated decompression air mattress combined with other recommended PI prevention measures. METHOD An observational, national, multicentre, prospective, non-comparative study, with a follow-up period of 35 days was conducted. Patients at medium-to-high risk of PIs and without PIs at baseline were included if they were lying on a specific non-powered automated decompression air mattress. The primary outcome was the percentage of patients who developed at least one category 2 or more severe PI of the sacrum, backbone or heel between day 0 and day 35. RESULTS In total, 81 patients were included from four participating centres. There was one report of a patient with a PI that fitted within the definition of the primary outcome, meaning an incidence of 1.2% (95% confidence interval (CI) 0-6.7%). More than 80% of patients rated the overall comfort and the stability of the non-motorised automated decompression air mattress as satisfactory or very satisfactory. In more than 80% of cases, the healthcare teams found the use of the mattress to be easy or very easy. CONCLUSION This study has shown that in combination with other preventive measures, the use of a specific non-motorised air mattress with automated decompression is associated with a low incidence of PIs in patients with medium-to-high risk of occurrence of PIs.
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Affiliation(s)
- Sylvie Meaume
- Rothschild Hospital, Geriatric Department and Wound Care Unit, Assistance Publique Hôpitaux de Paris, 75000 Paris, France
| | - Marc Marty
- Independent Methodologist in Clinical Research, 94000 Créteil, France
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6
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Katahira Y, Murakami F, Inoue S, Miyakawa S, Sakamoto E, Furusaka Y, Watanabe A, Sekine A, Kuroda M, Hasegawa H, Mizoguchi I, Yoshimoto T. Protective effects of conditioned media of immortalized stem cells from human exfoliated deciduous teeth on pressure ulcer formation. Front Immunol 2023; 13:1010700. [PMID: 36713359 PMCID: PMC9881429 DOI: 10.3389/fimmu.2022.1010700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
Pressure ulcers (PUs) are increasing with aging worldwide, but there is no effective causal therapy. Although mesenchymal stem cells (MSCs) promote cutaneous wound healing, the effects of the conditioned medium (CM) of MSCs on cutaneous PU formation induced by ischemia-reperfusion injury have been poorly investigated. To address this issue, herein, we first established an immortalized stem cell line from human exfoliated deciduous teeth (SHED). This cell line was revealed to have superior characteristics in that it grows infinitely and vigorously, and stably and consistently secretes a variety of cytokines. Using the CM obtained from the immortalized SHED cell line, we investigated the therapeutic potential on a cutaneous ischemia-reperfusion mouse model for PU formation using two magnetic plates. This is the first study to show that CM from immortalized SHEDs exerts therapeutic effects on PU formation by promoting angiogenesis and oxidative stress resistance through vascular endothelial growth factor and hepatocyte growth factor. Thus, the CM of MSCs has potent therapeutic effects, whereas these therapies have not been implemented in human medicine. To try to meet the regulatory requirements for manufacturing and quality control as much as possible, it is necessary to produce CM that is consistently safe and effective. The immortalization of stem cells could be one of the breakthroughs to meet the regulatory requirements and consequently open up a novel avenue to create a novel type of cell-free regenerative medicine, although further investigation into the quality control is warranted.
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Affiliation(s)
- Yasuhiro Katahira
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Fumihiro Murakami
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Shinya Inoue
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Satomi Miyakawa
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Eri Sakamoto
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Yuma Furusaka
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Aruma Watanabe
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Ami Sekine
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Hasegawa
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Izuru Mizoguchi
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Takayuki Yoshimoto
- Department of Immunoregulation, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan,*Correspondence: Takayuki Yoshimoto,
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7
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Zhang M, Sun J, Zhu M, Sun T, Shi Z, Zhang L, Wang X, Song Y, Ye X, Deng Y, Chu W, Shen C. Within-patient randomised clinical trial exploring the development of microskin implantation in the treatment of pressure ulcers. Int Wound J 2022. [PMID: 36575064 DOI: 10.1111/iwj.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022] Open
Abstract
Pressure injury often seriously affects the life quality of aged patients, especially the long-term bedridden casualties. Widely adopted by different disciplines, negative pressure suction has its role in pressure injury. Microskin implantation has been demonstrated powerful in increasing the expansion ratio of donor area-derived skin and accelerating wound healing by forming "skin islands". The study was designed to evaluate the efficacy and safety of additional use of bedside microskin implantation in the palliative care of pressure injury of aged patients who cannot tolerate surgical treatment as a supplement for standard negative pressure suction. An open-label within-patient RCT was conducted in aged patients with pressure injury. Sixteen patients were enrolled. After granulation tissues formed, half of a pressure injury was randomised to receive the negative pressure suction as the control group, and the other half exposed to additional bedside microskin implantation as the experimental group. Efficacy was evaluated within 1 month after treatment, and the primary endpoints included the wound healing rate and pressure ulcer scale for healing (PUSH) scores. The secondary outcomes included survival rate of implanted microskin, pain intensity assessment, satisfaction surveys from patients or their family, and pressure ulcer healing complications. Sixteen patients completed the study. After 14 days of operation, 5.63 ± 1.78 out of 10 pieces of implanted microskin survived and formed neonatal epithelium. The wound healing rates of the control group and the experimental group at 1 month were (26.17 ± 9.03%) and (35.95 ± 16.02%), respectively (P < .01). The mean PUSH score before the surgery was 12.38 ± 2.23. At 1 month after surgery, the mean difference of PUSH score from baseline was 2.13 ± 0.96 in the control group and 2.81 ± 0.83 in the experimental group (P < .01). The treatment of microskin implantation did not cause additional pain or complications to the patients. Accompanied by a better ulcer status, the majority of patients or their guardians have a high degree of acceptance towards the microskin implantation. Bedside microskin implantation could accelerate wound healing with lower PUSH scores. As a complementary palliative treatment, supplementary microskin implantation is effective and well tolerated.
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Affiliation(s)
- Ming Zhang
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiachen Sun
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Minhui Zhu
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tianjun Sun
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhiyuan Shi
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Lu Zhang
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xingtong Wang
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yaoyao Song
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiangbo Ye
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yuanxin Deng
- Department of Critical Care Medicine, Peking University Cancer Hospital, Beijing, People's Republic of China
| | - Wanli Chu
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chuanan Shen
- Department of Burns and Plastic Surgery, Fourth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
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8
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Vieceli AS, Martins JC, Hendler KG, Santos APT, das Neves LMS, Barbosa RI, Kuriki HU, Marcolino AM. Effectiveness of electrophysical agents for treating pressure injuries: a systematic review. Lasers Med Sci 2022; 37:3363-3377. [PMID: 36201144 DOI: 10.1007/s10103-022-03648-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
Tissue injuries that affect the skin and/or adjacent tissues and are usually over a bony prominence are called pressure injuries. The prevalence of these dysfunctions remains high, and despite technological advances, there is no consensus on the most appropriate treatment. The objective of this review was to evaluate the efficacy of photobiomodulation (PBM), ultrasound, and high-frequency electrophysical agents in the healing of pressure injuries in adults and the elderly. The search was conducted in the PubMed, Embase, Cochrane Library, Web of Science, and PEDro databases; in clinical trial records, a list of references of the selected articles, as well as through manual search (Google), of the last 5 years in humans in English and Portuguese. Nine thousand and sixty-seven studies were identified, 13 pre-selected, and 6 were included in this systematic review. PBM showed similar efficacy to other technologies indicated in other studies in healing pressure injuries. PBM with red wavelength (660 nm) in stages 2 and 3 pressure injuries effectively promoted healing compared to standard care. It was observed that the use of PBM accelerates tissue repair in pressure injuries; therapeutic ultrasound showed similar efficacy to other electrophysical agents but was effective in reducing the area of pressure injuries when comparing pre- and post-intervention. No clinical studies using the high-frequency electrophysical agent have been described in the last 5 years.
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Affiliation(s)
- Aline Santos Vieceli
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil.,Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Juruciara Cristiano Martins
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil.,Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Ketlyn Germann Hendler
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil.,Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Ana Paula Tavares Santos
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Lais Mara Siqueira das Neves
- Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Rafael Inacio Barbosa
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil.,Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Heloyse Uliam Kuriki
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil.,Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil
| | - Alexandre Marcio Marcolino
- Postgraduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil. .,Laboratory of Assessment and Rehabilitation of Locomotor System (LARAL), Federal University of Santa Catarina, Rua Pedro João Pereira, 150, CEP 88.905-120, Araranguá, SC, Brazil.
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Avendaño-Coy J, Martín-Espinosa NM, Ladriñán-Maestro A, Gómez-Soriano J, Suárez-Miranda MI, López-Muñoz P. Effectiveness of Microcurrent Therapy for Treating Pressure Ulcers in Older People: A Double-Blind, Controlled, Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10045. [PMID: 36011679 PMCID: PMC9408011 DOI: 10.3390/ijerph191610045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the effectiveness of microcurrent therapy for healing pressure ulcers in aged people. A multicentric, randomized clinical trial was designed with a sham stimulation control. The experimental group received an intervention following a standardized protocol for curing ulcers combined with 10 h of microcurrent therapy daily for 25 days. The sham group received the same curing protocol plus a sham microcurrent stimulation. The studied healing-related variables were the Pressure Ulcer Scale for Healing (PUSH) and the surface, depth, grade, and number of ulcers that healed completely. Three evaluations were conducted: pre-intervention (T1), 14 days following the start of the intervention (T2), and 1 day after the intervention was completed (T3). In total, 30 participants met the inclusion criteria (n = 15 in each group). The improvement in the PUSH at T2 and T3 was 16.8% (CI95% 0.5-33.1) and 25.3% (CI95% 7.6-43.0) greater in the experimental group versus the sham control, respectively. The reduction in the wound area at T2 and T3 was 20.1% (CI95% 5.2-35.0) and 28.6% (CI95% 11.9-45.3) greater in the experimental group versus the control, respectively. Microcurrent therapy improves the healing of pressure ulcers in older adults, both quantitatively and qualitatively.
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Affiliation(s)
- Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Noelia M. Martín-Espinosa
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
| | | | - Julio Gómez-Soriano
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
| | | | - Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain
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10
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Siotos C, Bonett AM, Damoulakis G, Becerra AZ, Kokosis G, Hood K, Dorafshar AH, Shenaq DS. Burden of Pressure Injuries: Findings From the Global Burden of Disease Study. EPLASTY 2022; 22:e19. [PMID: 35873067 PMCID: PMC9275412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pressure injuries remain among the most common problems faced by plastic surgeons and comprise a large portion of wound clinic practice. However, little is known about the overall morbidity related to the disease. This research sought to identify the burden related to the diagnosis of pressure injuries. METHODS We used the Global Burden of Disease Study 2017 to extract information about incidence and disability-adjusted life years (DALYs) related to pressure injuries from 1990 to 2017. Descriptive statistics were used to identify changes in the outcomes of interest. RESULTS A relative though not statistically significantly decrease in the incidence and burden of pressure injuries was observed between 1990 and 2017. Rates of incidence in the US appear higher than other higher socio-demographic index countries. No clinically and statistically significant changes were observed based on age or sex. CONCLUSIONS Pressure injury incidence and burden have remained relatively stable between 1990 and 2017 with no significant improvement noted. There is room for improvement on a national performance level, and further research is needed regarding inconsistencies in regional outcomes.
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Affiliation(s)
- Charalampos Siotos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Andrew M Bonett
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | | | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - George Kokosis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Keith Hood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Amir H Dorafshar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Deana S Shenaq
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL
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11
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Joshi CJ, Carabano M, Perez LC, Ullrich P, Hassan AM, Wan R, Liu J, Soriano R, Galiano RD. Effectiveness of a fluid immersion simulation system in the acute postoperative management of pressure ulcers: A prospective, randomized controlled trial. Wound Repair Regen 2022; 30:526-535. [PMID: 35641440 PMCID: PMC9542107 DOI: 10.1111/wrr.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/08/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
The Fluid Immersion Simulation system (FIS) has demonstrated good clinical applicability. This is the first study to compare surgical flap closure outcomes of FIS with an Air-Fluidized Bed (AFB), considered as standard of care. The success of closure after 14 days post-op was the primary endpoint. Secondary endpoints were incidences of complications in the first two weeks after surgery and the rate of acceptability of the device. 38 subjects were in the FIS group while 42 subjects were placed in the AFB group. Flap failure rate was similar between groups (14% vs 12%; P= 0.84). Complications, notably dehiscence and maceration, were significantly higher in the FIS group (40% vs 17%; P=0.0296). The addition of a microclimate regulation device (ClimateCare®) to FIS for the last 43 patients showed a significant decrease in the rate of flap failure (71% vs 16%; P=0.001) and incidence of complications (33% vs 0%; P= 0.011). There was no statistically significant difference between the FIS and AFB in the rate of acceptability (nurse acceptance: 1.49 vs 1.72; P = 0.8; patient acceptance: 2.08 vs 2.06; P = 0.17), which further illustrates the potential implementation of this tool in a patient-care setting. Our results show that the use of ClimateCare® in combination with FIS can be a better alternative to the AFB in surgical closure of pressure ulcers.
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Affiliation(s)
- Chitang J Joshi
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Miguel Carabano
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Laura C Perez
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Peter Ullrich
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Abbas M Hassan
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Rou Wan
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Jing Liu
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Rachna Soriano
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine
| | - Robert D Galiano
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine
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12
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Chen L, Ruan Y, Ma Y, Ge L, Han L. Effectiveness and safety of electrical stimulation for treating pressure ulcers: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13041. [PMID: 35244315 DOI: 10.1111/ijn.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/26/2021] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aims to synthesize qualitative evidence on the effectiveness and safety of electrical stimulation for treating pressure ulcers. BACKGROUND Electrical stimulation is often used clinically to treat pressure ulcers, but its effectiveness and safety and some potential problems are not clear. DESIGN This is a qualitative systematic review. DATA SOURCES The data sources are four English databases (PubMed, EMBASE, The Cochrane Library and Web of Science) and four Chinese databases (CNKI, SinoMed, VIP and WANFANG). METHODS Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study. We used the Review Manager 5.3 software to perform data analysis. RESULTS Seventeen randomized controlled trials including 740 patients were included in this study. Meta-analysis of eight randomized controlled trials demonstrated that electrical stimulation significantly reduced the ulcer surface in contrast with standard wound care alone or pulsed sham electrical stimulation. Nine studies showed that electrical stimulation increased the risk of pressure ulcers being completely healed than the controlled group. Three studies reported that adverse reactions were rare. CONCLUSIONS This study demonstrated that electrical stimulation was a relatively effective and safe adjunctive therapy for pressure ulcers treatment.
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Affiliation(s)
- Lian Chen
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China.,Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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13
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Abstract
Chronic wounds originate from venous hypertension, arterial insufficiency, or pressure-induced ischemia. Determination of the type and associated causes and contributory conditions is essential for the diagnosis and management of these common conditions.
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14
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Avendaño-Coy J, López-Muñoz P, Serrano-Muñoz D, Comino-Suárez N, Avendaño-López C, Martin-Espinosa N. Electrical microcurrent stimulation therapy for wound healing: A meta-analysis of randomized clinical trials. J Tissue Viability 2021; 31:268-277. [PMID: 34903470 DOI: 10.1016/j.jtv.2021.12.002] [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: 01/27/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Electrical microcurrent therapy (EMT) consists of the application of low intensity (μA) currents that are similar to endogenous electric fields generated during wound healing. AIMS To examine the effectiveness and safety of EMT for improving wound healing and pain in people with acute or chronic wounds. METHOD Randomized clinical trials (RCTs) assessing the effectiveness of EMT in wound healing published up to August 1st, 2020 were included. The main outcomes were wound surface area, healing time, and number of wounds healed. Secondary outcomes were pain perception and adverse events. A quantitative analysis was conducted using the inverse variance and Mantel-Haenszel methods. RESULTS Eight RCTs were included in the qualitative summary and seven in the quantitative analysis (n = 337 participants). EMT plus standard wound care (SWC) produced a greater decrease in wound surface [mean difference (MD) = -8.3 cm2; CI 95%: -10.5 to -6.0] and healing time (MD = -7.0 days; CI 95%: -11.9 to -2.1) that SWC alone, showing moderate and low certainty in the evidence, respectively. However, no differences were observed in the number of healed wounds [risk ratio = 2.0; CI 95%: 0.5 to 9.1], with very low quality of evidence. EMT decreased perceived pain (MD = -1.4; CI 95%: -2.7 to -0.2), but no differences in adverse effects were noted between groups (risk difference = 0.05; CI 95%: -0.06 to 0.17). CONCLUSIONS EMT is an effective, safe treatment for improving wound area, healing time, and pain. Further clinical trials that include detailed intervention parameters and protocols should be designed to lower the risk of bias.
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Affiliation(s)
- Juan Avendaño-Coy
- Faculty of Physiotherapy and Nursing. Group for Physiotherapy Research in Toledo (GIFTO), University of Castilla-La Mancha, Avda. Carlos III, S/n, 45071, Toledo, Spain.
| | - Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing. Group for Physiotherapy Research in Toledo (GIFTO), University of Castilla-La Mancha, Avda. Carlos III, S/n, 45071, Toledo, Spain.
| | - Diego Serrano-Muñoz
- Faculty of Physiotherapy and Nursing. Group for Physiotherapy Research in Toledo (GIFTO), University of Castilla-La Mancha, Avda. Carlos III, S/n, 45071, Toledo, Spain.
| | - Natalia Comino-Suárez
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, 28002, Spain.
| | - Carlos Avendaño-López
- Faculty of Physiotherapy and Nursing. Group for Physiotherapy Research in Toledo (GIFTO), University of Castilla-La Mancha, Avda. Carlos III, S/n, 45071, Toledo, Spain.
| | - Noelia Martin-Espinosa
- Faculty of Physiotherapy and Nursing. Group for Physiotherapy Research in Toledo (GIFTO), University of Castilla-La Mancha, Avda. Carlos III, S/n, 45071, Toledo, Spain.
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15
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Rosa LP, Silva FCD, Luz SCL, Vieira RL, Tanajura BR, Silva Gusmão AGD, de Oliveira JM, Jesus Nascimento FD, Dos Santos NAC, Inada NM, Blanco KC, Carbinatto FM, Bagnato VS. Follow-up of pressure ulcer treatment with photodynamic therapy, low level laser therapy and cellulose membrane. J Wound Care 2021; 30:304-310. [PMID: 33856908 DOI: 10.12968/jowc.2021.30.4.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A pressure ulcer (PU) is an area of tissue trauma caused by continuous and prolonged pressure, often associated with hospitalised patients immobilised due to neurological problems, negatively affecting their quality of life, and burdening the public budget. The aim of this study was to report the follow-up, for 45 weeks, of three patients with neurological lesions due to trauma who subsequently developed PUs, and who were treated with a combination of photodynamic therapy (PDT), low level laser therapy (LLLT) and cellulose membrane (CM). METHOD PDT was mediated by the photosensitiser curcumin on a 1.5% emulsion base. Blue LED light at 450 nm was delivered continuously for 12 minutes at an irradiance of 30mW/cm2 and total energy delivered to the tissue was 22J/cm2. LLLT was performed with 660 nm laser, punctuated and continuous, twice a week with parameters: spot size 0.04cm2, power of 40mW, 10 seconds per point, fluence of 10J/cm2 and irradiance of 1000mW/cm2. RESULTS All PUs had a significant reduction (range: 95.2-100%) of their area after 45 weeks of follow-up and two PUs had complete healing at 20 weeks and 30 weeks. All of the PUs showed a reduction in contamination with the PDT treatments in different proportions. CONCLUSION From the results obtained, we conclude that the combination of PDT, LLLT and CM is a promising treatment for PU healing.
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Affiliation(s)
- Luciano Pereira Rosa
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
| | - Francine Cristina da Silva
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
| | - Suzete Carvalho Landulfo Luz
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
| | | | - Beatriz Rocha Tanajura
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
| | - Alana Gonçalves da Silva Gusmão
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
| | - Janeide Muritiba de Oliveira
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
| | - Fabiana de Jesus Nascimento
- Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58. Candeias. Vitória da Conquista, Bahia, Brazil
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16
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Serena TE, Jalodi O, Serena L, Patel K, Mynti M. Evaluation of the combination of a biofilm-disrupting agent and negative pressure wound therapy: a case series. J Wound Care 2021; 30:9-14. [PMID: 33439086 DOI: 10.12968/jowc.2021.30.1.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Approximately three million people in the US have hard-to-heal pressure ulcers (PUs), including 10% of hospitalised patients. Healing depends on ulcer stage and patient comorbidities. Despite advances in nutrition and wound care, PUs can take months or years to reach complete closure. To date, clinical studies have focused on single modality therapy. However, there is no one therapy that can address all of the deficits in these complex, hard-to-heal wounds. A commonly used treatment for PUs, negative pressure wound therapy (NPWT), has demonstrated improved healing in Stage 3 and 4 PUs. NPWT entails applying suction to a porous sponge fitted into the wound cavity and sealed with an occlusive dressing. Negative pressure facilitates wound healing by removing wound fluid containing harmful proteases, stimulating the formation of granulation tissue and promoting wound contracture. However, it does not affect biofilm formation. We hypothesised that adding an antibiofilm agent might increase the effectiveness of NPWT in recalcitrant PUs. METHOD A prospective case series was conducted in outpatient wound care centres and a skilled nursing facility to examine the combination of a biofilm-disrupting antimicrobial agent (Blast-X, Next Science, US) in combination with NPWT (VAC, 3M, US) in healing and reducing bacterial burden in treatment-resistant pressure ulcers. Patients consented to application of the antibiofilm agent and NPWT three times per week for four weeks. The wounds were measured, imaged for bacteria and tested for host and bacterial protease activity weekly. RESULTS Of the 10 patients, four dropped out of the study before the end of the four weeks. Of the remaining six, four patients experienced a reduction in wound surface area and volume, reduced protease activity and lower bacterial levels. CONCLUSION The results of this study showed that multimodal therapy, including NPWT and biofilm disruption, may restart the healing of stagnant treatment-resistant PUs.
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Affiliation(s)
| | - Omar Jalodi
- SerenaGroup Research Foundation, Cambridge, MA US
| | - Laura Serena
- SerenaGroup Research Foundation, Cambridge, MA US
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17
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Rajendran SB, Challen K, Wright KL, Hardy JG. Electrical Stimulation to Enhance Wound Healing. J Funct Biomater 2021; 12:40. [PMID: 34205317 PMCID: PMC8293212 DOI: 10.3390/jfb12020040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Electrical stimulation (ES) can serve as a therapeutic modality accelerating the healing of wounds, particularly chronic wounds which have impaired healing due to complications from underlying pathology. This review explores how ES affects the cellular mechanisms of wound healing, and its effectiveness in treating acute and chronic wounds. Literature searches with no publication date restrictions were conducted using the Cochrane Library, Medline, Web of Science, Google Scholar and PubMed databases, and 30 full-text articles met the inclusion criteria. In vitro and in vivo experiments investigating the effect of ES on the general mechanisms of healing demonstrated increased epithelialization, fibroblast migration, and vascularity around wounds. Six in vitro studies demonstrated bactericidal effects upon exposure to alternating and pulsed current. Twelve randomized controlled trials (RCTs) investigated the effect of pulsed current on chronic wound healing. All reviewed RCTs demonstrated a larger reduction in wound size and increased healing rate when compared to control groups. In conclusion, ES therapy can contribute to improved chronic wound healing and potentially reduce the financial burden associated with wound management. However, the variations in the wound characteristics, patient demographics, and ES parameters used across studies present opportunities for systematic RCT studies in the future.
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Affiliation(s)
- Saranya B. Rajendran
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire LA1 4AT, UK;
| | - Kirsty Challen
- Emergency Department, Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire PR2 9HT, UK;
| | - Karen L. Wright
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire LA1 4YG, UK
| | - John G. Hardy
- Department of Chemistry, Faculty of Science and Technology, Lancaster University, Lancaster, Lancashire LA1 4YB, UK
- Materials Science Institute, Lancaster University, Lancaster, Lancashire LA1 4YB, UK
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18
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Kuffler DP. Eliminating non-healing wounds: a review. Regen Med 2021; 16:391-404. [PMID: 33876695 DOI: 10.2217/rme-2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Non-healing cutaneous wounds, including pressure, diabetic and venous ulcers, are wounds where the skin and underlying tissues die due to ischemia, infection, metabolic conditions, immunosuppression or radiation. Some can be eliminated with relatively straightforward techniques, although they may continue to grow in diameter and depth, becoming increasingly painful and never heal. Others respond more slowly or poorly to treatment, while others are recalcitrant to treatments. This review examines the etiology of non-healing wounds and different wound management treatments. In addition, it examines the efficacy of platelet-rich plasma in promoting wound healing and its potential mechanisms of action. It is concluded that platelet-rich plasma alone, but more effectively when combined with another technique(s), has the greatest potential for promoting complete wound healing. However, further studies are required to determine whether the efficacy of wound healing induced by each of these techniques is enhanced by applying the techniques simultaneously.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico 00901, USA
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19
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Vander Horst MA, Raeman CH, Dalecki D, Hocking DC. Time- and Dose-Dependent Effects of Pulsed Ultrasound on Dermal Repair in Diabetic Mice. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1054-1066. [PMID: 33454160 PMCID: PMC7897308 DOI: 10.1016/j.ultrasmedbio.2020.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 05/15/2023]
Abstract
Chronic wounds, including diabetic, leg and pressure ulcers, impose a significant health care burden worldwide. Some evidence indicates that ultrasound can enhance soft tissue repair. However, therapeutic responses vary among individuals, thereby limiting clinical translation. Here, effects of pulsed ultrasound on dermal wound healing were assessed using a murine model of chronic, diabetic wounds. An ultrasound exposure system was developed to provide daily ultrasound exposures to full-thickness, excisional wounds in genetically diabetic mice. Wounds were exposed to 1 MHz ultrasound (2 ms pulse, 100 Hz pulse repetition frequency, 0-0.4 MPa) for 2 or 3 wk. Granulation tissue thickness and wound re-epithelialization increased as a function of increasing ultrasound pressure amplitude. At 2 wk after injury, significant increases in granulation tissue thickness and epithelial ingrowth were observed in response to 1 MHz pulsed ultrasound at 0.4 MPa. Wounds exposed to 0.4 MPa ultrasound for 3 wk were characterized by collagen-dense, revascularized granulation tissue with a fully restored, mature epithelium. Of note, only half of wounds exposed to 0.4 MPa ultrasound showed significant granulation tissue deposition after 2 wk of treatment. Thus, the db+/db+ mouse model may help to identify biological variables that influence individual responses to pulsed ultrasound and accelerate clinical translation.
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Affiliation(s)
| | - Carol H Raeman
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Diane Dalecki
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Denise C Hocking
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA; Department of Pharmacology and Physiology, University of Rochester, Rochester, New York, USA.
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20
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Gillespie BM, Latimer S, Walker RM, McInnes E, Moore Z, Eskes AM, Li Z, Schoonhoven L, Boorman RJ, Chaboyer W. The quality and clinical applicability of recommendations in pressure injury guidelines: A systematic review of clinical practice guidelines. Int J Nurs Stud 2021; 115:103857. [PMID: 33508730 DOI: 10.1016/j.ijnurstu.2020.103857] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/10/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injuries are one of the most frequently occurring, yet preventable hospital-acquired adverse events. Given there are many clinical practice guidelines available on the prevention and treatment of pressure injuries, it is useful to understand the quality of these guidelines and the clinical application of their recommendations. OBJECTIVE To critically evaluate the quality and applicability of the recommendations in pressure injury prevention and treatment clinical practice guidelines. DESIGN Systematic review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES We systematically searched the literature published from 2005 to 2020 using MEDLINE, EMBASE, CINAHL, the Cochrane Library, ProQuest and PubMed electronic databases, and nine guideline repositories. REVIEW METHODS We assessed overall quality using the validated Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE Recommendation Excellence (AGREE-REX) tools. Overall % mean scores across AGREE II and AGREE-REX domains were calculated for each guideline. Clinical practice guidelines were then ranked in tertiles based on "high", "moderate" or "low" quality. The review protocol was registered in the International Prospective Register of Systematic Reviews. RESULTS Initial combined database and repository searches yielded 3247 documents. Of these,73 full text documents were reviewed. The final analysis included 12 complete guidelines and 14 related documents. Overall AGREE II scores ranged from 32% to 96% while AGREE-REX scores were generally lower ranging from 10% to 75%. Combined % mean scores across AGREE II and AGREE-REX criteria suggest that four guidelines were ranked as "high" (range 69% to 85%) and are recommended without modification. These included; the 2019 International Guideline, the 2016 Canadian Guideline, the 2014 NICE Guideline, and the 2013 Belgian Guideline. CONCLUSIONS There is disparity in the quality of the included guidelines, however four high quality guidelines are available. These guidelines could ideally be implemented in daily practice and adapted to local policies.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
| | - Sharon Latimer
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Rachel M Walker
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Elizabeth McInnes
- St Vincent's Health Australia, Sydney, NSW, Australia; St Vincent's Hospital, Melbourne, VIC, Australia; Australian Catholic University, Melbourne, VIC, Australia.
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Anne M Eskes
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Zhaoyu Li
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Ultrecht University, Ultrecht, The Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom.
| | - Rhonda J Boorman
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Wendy Chaboyer
- School of Nursing & Midwifery, Griffith University, Brisbane, QLD, Australia; Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
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Toita R, Shimizu E, Murata M, Kang JH. Protective and healing effects of apoptotic mimic-induced M2-like macrophage polarization on pressure ulcers in young and middle-aged mice. J Control Release 2021; 330:705-714. [DOI: 10.1016/j.jconrel.2020.12.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/16/2020] [Accepted: 12/28/2020] [Indexed: 12/29/2022]
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Zwolińska J. The I/T curve coefficient for evaluating changes in neuromuscular excitability after polarized light irradiation - a placebo-controlled randomized trial. REHABILITACJA MEDYCZNA 2020. [DOI: 10.5604/01.3001.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: PILER light affects the sensory and motor excitability of the tissue, and these changes may depend on the color of the filter used in the irradiations.
Objective: To evaluate changes in neuromuscular excitability after PILER irradiation with different filters. To evaluate the usefulness of the I/T curve coefficient in neuromuscular excitability test.
Material and methods: 60 healthy volunteers assigned to four groups: group v - without filter (n=15), group x - red filter (n=15), group y - blue filter (n=15), group z - placebo (n=15) had biceps brachii irradiated with PILER light. Outcome Measures: I/T curve coefficient for rectangular (■I/T coeff) and triangular (▲I/T coeff) pulses for sensory and motor excitability and the pressure pain threshold (PPT).
Results: ■I/T coeff (p=0.0013) and ▲I/T coeff (p=0.0011) for sensory excitability increased significantly in the irradiated group. ■I/T coeff (p=0.0356) and ▲I/T coeff (p=0.0022) increased significantly after blue light irradiation. A significant increase in the▲I/T coeff (p=0.0439) in motor excitability was observed in the irradiated group. ■I/T coeff (p=0.0309) and ▲I/T coeff (p=0.0064) increased significantly after blue light irradiation.
Conclusion: PILER light may reduce muscle excitability. Using a blue filter may increase the sensory threshold, and myorelaxation. Further experiments are necessary to confirm the usefulness of the I/T curve coefficient.
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Affiliation(s)
- Jolanta Zwolińska
- Institute of Health Sciences, Medical College, University of Rzeszow, Rzeszów, Poland St. Hedvig Clinical Provincial Hospital No. 2, Rzeszów, Poland; Centre for Innovative Research in Medical and Natural Sciences, University of Rzeszow, Rzeszów, Poland
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Zhang W, Liu X, Wang S, Cai J, Niu Y, Shen C. Mechanism and prevention of facial pressure injuries: A novel emergent strategy supported by a multicenter controlled study in frontline healthcare professionals fighting COVID-19. Wound Repair Regen 2020; 29:45-52. [PMID: 32909336 DOI: 10.1111/wrr.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/23/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
Numerous healthcare professionals fighting COVID-19 worldwide are suffering from the protective respirators related facial pressure injuries. This study explored the mechanism and prevention of such injuries and devised a novel emergent strategy, which was supported by a multicenter self-controlled study in 1161 frontline healthcare professionals. In this study, according to the anatomy of the face and the characteristics of facial pressure injuries, a respirator liner was designed using a polyurethane foam to redistribute the pressure across the face. A preclinical crossover trial was performed on eight participants to evaluate its efficacy. The strategy was then widely applied among 11 100 healthcare workers in seven frontline hospitals, and 1161 of them were sampled for a questionnaire investigation. The preclinical crossover trial showed that the novel strategy was very effective in preventing facial pressure injuries. The questionnaire investigation showed that pain score, wearing disturbance, and the incidence of pressure injury in the healthcare professionals were significantly correlated with wearing time (all ρ = 0.986). The new strategy significantly reduced the incidence of pressure injury from 84.7% to 11.1%, pain score IQR from 5 (2) to 1 (2), and wearing disturbance rate from 91.6% to 6.3%, and the results analyzed according to individual hospitals or different wearing time showed similar trends (all P < .0005). The protective respirators related facial pressure injuries can be effectively mitigated with this emergent strategy, which has also been applied in some European hospitals and can be popularized to help more healthcare professionals who are combating COVID-19 on the frontlines.
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Affiliation(s)
- Wen Zhang
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinzhu Liu
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shujun Wang
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianhua Cai
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuezeng Niu
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chuan'an Shen
- Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
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Hoversten KP, Kiemele LJ, Stolp AM, Takahashi PY, Verdoorn BP. Prevention, Diagnosis, and Management of Chronic Wounds in Older Adults. Mayo Clin Proc 2020; 95:2021-2034. [PMID: 32276784 DOI: 10.1016/j.mayocp.2019.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 11/18/2022]
Abstract
Chronic wounds are common, disproportionately affect older adults, and are likely to be encountered by providers across all specialties and care settings. All providers should be familiar with basic wound prevention, identification, classification, and treatment approach, all of which are outlined in this article.
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Affiliation(s)
| | | | - Anne M Stolp
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Department of Medicine, Divisions of Community Internal Medicine and Geriatric Medicine/Gerontology, Mayo Clinic, Rochester, MN
| | - Brandon P Verdoorn
- Department of Medicine, Divisions of Community Internal Medicine and Geriatric Medicine/Gerontology, Mayo Clinic, Rochester, MN.
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Wu M, Wang J, Panayi AC. Plastic Surgery During the COVID-19 Pandemic: The Space, Equipment, Expertise Approach. Aesthet Surg J 2020; 40:NP574-NP577. [PMID: 32530030 PMCID: PMC7314169 DOI: 10.1093/asj/sjaa136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mengfan Wu
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Jing Wang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Tchuenkam LW, Titcheu F, Mbonda A, Kamto T, Nwaha AM, Kamla IJ, Tochie JN. The gluteus maximus V-Y advancement flap for reconstruction of extensive soft tissue loss following an advanced sacral pressure ulcer. A case report and mini review. Int J Surg Case Rep 2020; 73:15-21. [PMID: 32623328 PMCID: PMC7334543 DOI: 10.1016/j.ijscr.2020.06.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The occurrence of pressure injuries (PIs) in an inpatient is a serious medical condition that requires a rigorous clinical evaluation. Management of these lesions should be comprehensive, including general measures and local care. Wound care occupies a large part of the treatment. For large skin loss, the treatment requires plastic surgery techniques for reconstruction. Myocutaneous advancement flaps are a good therapeutic option due to the provision of vascularized tissue within the skin defect. To ensure the success of the surgery, a good surgical technique preceeded by careful preparation of the patient in conjunction with the anesthesia team is imperative. CASE PRESENTATION We report the case of a 60-year-old bed ridden man for more than two months following an ischemic stroke with left spastic hemiplegia and loss of sensitivity. He was transferred to our surgical unit for the management of a chronic stage 4 PIs in the sacral area complicated with cellulitis, subcutaneous abscess and severe sepsis. Initial management consisted of resuscitation measures combining fluid therapy, antibiotic therapy, analgesics, blood transfusion, nutritional support, physioteherapy, wound care as well as preventive measures and psychological support. Once the granulation tissues were fully developed, the patient underwent reconstruction surgery with a V-Y myocutaneous advancement flap. The graft was successful with complete wound healing thereafter. CONCLUSION PIs are a multifactorial, complex and disabling pathology that requires multidisciplinary care. Surgeons, anesthetists, nutritionists, physiotherapists, nurses must act in agreement in order to provide optimal treatment. Prevention is the rule.
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Affiliation(s)
- Landry W Tchuenkam
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
| | | | - Aimé Mbonda
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
| | - Trevor Kamto
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
| | - Axel M Nwaha
- Urology Unit, Department of Surgery, Douala Laquintinie Hospital, Cameroon.
| | - Igor J Kamla
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
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Pressure ulcers after traumatic spinal injury in East Africa: risk factors, illustrative case, and low-cost protocol for prevention and treatment. Spinal Cord Ser Cases 2020; 6:48. [PMID: 32541848 DOI: 10.1038/s41394-020-0294-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective, case-control study. OBJECTIVES In a traumatic spinal injury (TSI) cohort from Tanzania, we sought to: (1) describe potential risk factors for pressure ulcer development, (2) present an illustrative case, and (3) propose a low-cost outpatient protocol for prevention and treatment. SETTING Tertiary referral hospital. METHODS All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, time to hospital, injury characteristics, operative management, length of hospitalization, and mortality. Pressure ulcer development was the primary outcome. Regressions were used to report potential predictors, and international guidelines were referenced to construct a low-cost outpatient protocol. RESULTS Of 267 patients that met the inclusion criteria, 51 developed a pressure ulcer. Length of stay was greater for patients with pressure ulcers compared with those without (45 vs. 30 days, p < 0.001). Potential predictors for developing pressure ulcers were: increased days from injury to hospital admission (p = 0.036), American Spinal Injury Association Impairment Scale grade A upon admission (p < 0.001), and thoracic spine injury (p = 0.037). The illustrative case described a young male presenting ~2 months after complete thoracic spinal cord injury with a grade IV sacral pressure ulcer that lead to septic shock and death. Considering the dramatic consequences of pressure ulcers in lower- and middle-income countries (LMICs), we proposed a low-cost protocol for prevention and treatment targeting support surfaces, repositioning, skin care, nutrition, follow-up, and dressing. CONCLUSIONS Pressure ulcers after TSI in LMICs can lead to increased hospital stays and major adverse events. High-risk patients were those with delayed presentation, complete neurologic injuries, and thoracic injuries. We recommended aggressive prevention and treatment strategies suitable for resource-constrained settings.
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Gutman JBL, Kongshavn PAL. Cysteine/cystine-rich undenatured whey protein supplement in patients' pressure ulcers outcomes: an open label study. J Wound Care 2020; 28:S16-S23. [PMID: 31295075 DOI: 10.12968/jowc.2019.28.sup7.s16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The prevalence and costs associated with treating pressure ulcers (PU) are at high levels. Frequently, PUs heal slowly or not at all, which may be due to the patient's catabolic state which may include protein energy malnutrition. The objective of this open label clinical trial was to improve healing rates by providing patients with a patented, high-quality protein containing all essential amino acids to ensure positive nitrogen balance. An additional benefit of this protein is the delivery of bioavailable cysteine (cystine) to promote glutathione (GSH) synthesis which supports immune function and heightens antioxidant defences. METHODS Patients with category II, III and IV PUs were fed 20g BID whey protein dietary supplement for 16-120 days, without change in ongoing 'best practice' PU management and their progress recorded. RESULTS A total of 10 patients were recruited, with an average age of 77 years. Most had shown no improvement in healing for ≥2 months before treatment and usually had other complications including chronic obstructive pulmonary disease (COPD), diabetes and various cardiovascular diseases. There were a total of 23 PUs, with some patients having more than one. Of these, 44% (n=10) showed complete resolution 83% (n=19) had better than 75% resolution over the observation period. Healing rates ranged from 16.9-0.2cm2/month (healed PUs) and 60.0-1.6cm2/month for resolving PUs. CONCLUSION By providing the necessary amino acids to rebuild tissues and bioactive cysteine (cystine) to promote synthesis of intracellular GSH and positive nitrogen balance, improvement in PUs healing was achieved.
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Affiliation(s)
- Jimmy B L Gutman
- Senior Medical Adviser, Immunotec Inc., 300 Joseph Carrier, Vaudreuil-Dorion, QC Canada
| | - Patricia A L Kongshavn
- Scientific Advisory Board Member, Immunotec Inc., 24-520 Marsett Place, Victoria, BC, Canada
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Bukowska J, Alarcon Uquillas A, Wu X, Frazier T, Walendzik K, Vanek M, Gaupp D, Bunnell BA, Kosnik P, Mehrara B, Katz AJ, Gawronska-Kozak B, Gimble JM. Safety of Human Adipose Stromal Vascular Fraction Cells Isolated with a Closed System Device in an Immunocompetent Murine Pressure Ulcer Model. Stem Cells Dev 2020; 29:452-461. [PMID: 31992147 DOI: 10.1089/scd.2019.0245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pressure ulcers (PUs) result in part due to ischemia-reperfusion injury to the skin and present frequently in elderly or quadriplegic patients with reduced mobility. Despite the high economic and societal cost of this condition, PU therapy relies primarily on preventive strategies and invasive surgical intervention. A growing body of clinical literature suggests that localized injection of adipose-derived cells can accelerate and enhance the closure of PUs. The current study systematically evaluated the safety of human adipose stromal vascular fraction (SVF) cells isolated using a closed system device when injected into a murine PU injury model. The human SVF cells were characterized by colony-forming unit-fibroblast and differentiation assays before use. Young (2 months) immunocompetent C57BL/6 mice subjected to a magnet-induced ischemia-reperfusion injury were injected subcutaneously with human SVF cells at increasing doses (0.25-2 million cells). The size of the PU was monitored over a 20-day period. Both female and male mice tolerated the concentration-dependent injection of the SVF cells without complications. While male mice trended toward more rapid wound closure rates in response to lower SVF cell concentrations (0.25-0.5 million cells), female mice responded favorably to higher SVF cell concentrations (1-2 million cells); however, outcomes did not reach statistical significance in either sex. Overall, the study demonstrates that human SVF cells prepared with a closed system device designed for use at point of care can be safely administered for PU therapy in an immunocompetent host animal model.
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Affiliation(s)
- Joanna Bukowska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | | | - Xiying Wu
- LaCell LLC, New Orleans, Louisiana.,Obatala Sciences, Inc., New Orleans, Louisiana
| | - Trivia Frazier
- LaCell LLC, New Orleans, Louisiana.,Obatala Sciences, Inc., New Orleans, Louisiana
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | | | - Dina Gaupp
- Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Bruce A Bunnell
- Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Babak Mehrara
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam J Katz
- Department of Plastic and Reconstructive Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- LaCell LLC, New Orleans, Louisiana.,Obatala Sciences, Inc., New Orleans, Louisiana.,Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Bukowska J, Alarcon Uquillas A, Wu X, Frazier T, Walendzik K, Vanek M, Gaupp D, Bunnell BA, Kosnik P, Mehrara B, Katz AJ, Gawronska-Kozak B, Gimble JM. Safety and Efficacy of Human Adipose-Derived Stromal/Stem Cell Therapy in an Immunocompetent Murine Pressure Ulcer Model. Stem Cells Dev 2020; 29:440-451. [PMID: 31950878 DOI: 10.1089/scd.2019.0244] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Pressure injuries/ulcers are frequent complications in elderly, paraplegic, and quadriplegic patients, which account for considerable cost to the international health care economy and remain refractory to current treatment options. Autologous or allogeneic adult stromal/stem cells represent an alternative therapeutic approach. The current study extends prior findings by exploring the safety and efficacy of human adipose-derived stromal/stem cell (ASC) therapy in an established immunocompetent murine skin pressure ulcer model where dermal fibroblast cells (DFCs) served as a control. Human adipose tissue was processed using a closed system device designed for point-of-care use in the operating room and on file with the Food and Drug Administration. Cell characterization was performed using colony-forming unit-fibroblast, differentiation, and immunophenotypic assays in vitro. Wound healing was assessed over a 20-day period based on photomicrographs, histology, and immunohistochemistry. The isolated human ASCs displayed significantly greater colony formation relative to DFCs while both populations exhibited comparable immunophenotype and differentiation potential. Both fresh and cryopreserved human ASCs significantly accelerated and enhanced wound healing in young (2 month) mice of both sexes relative to DFC controls based on tissue architecture and CD68+ cell infiltration. In contrast, while injection of either fresh or cryopreserved human ASCs was safe in older mice, the fresh ASCs significantly enhanced wound closure relative to the cryopreserved ASCs. Overall, these findings support the safety and efficacy of human ASCs isolated using a closed system device designed for clinical procedures in the future treatment of pressure injuries.
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Affiliation(s)
- Joanna Bukowska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | | | - Xiying Wu
- LaCell LLC, New Orleans, Louisiana
- Obatala Sciences, Inc., New Orleans, Louisiana
| | - Trivia Frazier
- LaCell LLC, New Orleans, Louisiana
- Obatala Sciences, Inc., New Orleans, Louisiana
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Mikaela Vanek
- Department of Biological Sciences, Loyola University New Orleans, New Orleans, Louisiana
| | - Dina Gaupp
- Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana
| | - Bruce A Bunnell
- Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana
| | | | - Babak Mehrara
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adam J Katz
- Department of Plastic and Reconstructive Surgery, Wake Forest University, Winston Salem, North Carolina
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- LaCell LLC, New Orleans, Louisiana
- Obatala Sciences, Inc., New Orleans, Louisiana
- Center for Stem Cell Research and Regenerative Medicine, Tulane University, New Orleans, Louisiana
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Bejinariu CG, Marinescu SA. The Role of Myocutaneous Flaps in the Treatment of Patients with Multiple Decubitus Ulcers. J Med Life 2020; 12:453-456. [PMID: 32025266 PMCID: PMC6993285 DOI: 10.25122/jml-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current research aims to present the therapeutic approach in the case of a paraplegic patient hospitalized in the Plastic Surgery Department at the “Bagdasar-Arseni” Emergency Clinical Hospital for the treatment of decubitus ulcers located at the level of the sacral, left trochanteric and posterior thoracic regions. The particularity of the case is given by the complexity of the surgical interventions necessary for the reconstruction of the above-mentioned anatomical regions. In order to cover the sacral region, two gluteal myocutaneous flaps were used, followed by a tensor fascia lata flap for the trochanteric lesion. For the thoracic defect, the surgical team has chosen the technique of excision and direct suture. Following reconstructive surgery, the patient had a favorable local evolution, being included in an intensive medical recovery program within the same health unit.
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Affiliation(s)
- Catalin Gheorghe Bejinariu
- Department of Plastic and Reconstructive Surgery, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania
| | - Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania
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Abstract
Pressure injuries (previously called pressure ulcers) are a common finding among patients in acute, long-term, or home settings. Numerous pathophysiologic and risk mechanisms factor into the development of pressure injuries. The timely recognition of these injuries is imperative. Many treatments exist for pressure injuries but the focus of patient management should be on preventing injury-related complications.
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Mendoza RA, Lorusso GA, Ferrer DA, Helenowski IB, Liu J, Soriano RH, Galiano RD. A prospective, randomised controlled trial evaluating the effectiveness of the fluid immersion simulation system vs an air-fluidised bed system in the acute postoperative management of pressure ulcers: A midpoint study analysis. Int Wound J 2019; 16:989-999. [PMID: 31063659 DOI: 10.1111/iwj.13133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 12/17/2022] Open
Abstract
The use of pressure-offloading support surfaces is considered the standard of care for pressure ulcers (PUs) by most surgeons. The fluid immersion simulation system (FIS) has shown significant results in previous studies. We compared it, for the first time, with a representative air-fluidised bed (AFB) for outcomes related to post-surgical flap closures. This trial was performed over 25 months, in which 40 subjects between 18 and 85 years of age with ≤2 PUs and history of <3 surgical closures underwent reconstruction by one surgeon. Subjects were randomly assigned to either treatment group for 2 weeks after closure. The primary endpoint was success of closure after the study period. Secondary endpoints included incidence of complications and nursing and patient acceptability of the device. The FIS group included 19 subjects, and the AFB group included 21. Flap failure rate was similar between groups (15% vs 17%; P = .99). The Minor complications rate, particularly dehiscence, was higher in the FIS group (66.7% vs 15%; P = .02). Nurse and patient self-reported acceptability had better mean numeric scores in the FIS compared with AFB (nurse: 1.5 vs 1.9; P = .12; patient: 1.9 vs 2.2; P = .14). Further analysis will be conducted to gain better insight on the FIS as an alternative treatment for PUs.
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Affiliation(s)
- Rafael A Mendoza
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gabriella A Lorusso
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniela A Ferrer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Irene B Helenowski
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jing Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachna H Soriano
- Division of Physical and Rehabilitation Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert D Galiano
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. J Tissue Viability 2019; 28:51-58. [DOI: 10.1016/j.jtv.2019.01.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/13/2018] [Accepted: 01/02/2019] [Indexed: 12/28/2022]
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Computer-Assisted Wound Assessment and Care Education Program in Registered Nurses: Use of an Interactive Online Program by 418 Registered Nurses. J Wound Ostomy Continence Nurs 2019; 46:90-97. [PMID: 30844865 DOI: 10.1097/won.0000000000000515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this descriptive study was to evaluate use of a previously validated, online, interactive wound assessment and wound care clinical pathway in a group of RNs. Specific aims were to (a) evaluate the proportions of correct, partially correct, and incorrect algorithmic decisions and dressing selections, (b) compare response rates between nurses who are and who are not wound care certified, and (c) evaluate its ease of use, educational value, and applicability in clinical practice. DESIGN Descriptive study. SUBJECTS AND SETTING Participants were recruited using convenience and snowball sampling methods. Four hundred eighteen nurses completed all 15 assessments; nearly half held a bachelors' degree in nursing (189, 45%), more than two-thirds worked in an inpatient acute care settings (277, 68%), and 293 (70%) were not certified in wound care. METHODS After providing written informed consent and completing the participant demographics form, participants assessed 15 photographs of wounds with accompanying moisture descriptions and completed an algorithm and dressing selection for each. All responses were anonymously collected by the program. Existing, retrospective, program data were also downloaded and data from nurses who completed all assessments were extracted and analyzed. Descriptive statistics were used to analyze all variables. Selection outcomes and survey responses between nurses who were and who were not wound care certified were compared using a 2-sample Student t test assuming unequal variances. Individual responses for the first 6 wounds were compared to the last 6 wounds using a paired t test. RESULTS The mean (M) proportions of fully or partially correct (operationally defined as safe but not fully correct) algorithm and dressing choice were 81% (SE: 0.88, 95% confidence level: 1.73) and 78.1% (SE: 0.70, 95% confidence level: 1.39), respectively. Wound care-certified nurses had higher mean algorithm scores than those who were not certified (M: 89.2%, SE: 1.27 vs M: 77.8%, SE: 1.10, P < .001). Most incorrect/partially correct choices were attributable to incorrect necrotic tissue assessment (n = 845, 58%). The difference between fully correct first 6 and last 6 algorithm choices was statistically significant (M: 310, SE: 0.02 vs M: 337, SE: 9.32, P = .04). On a Likert scale of 1 (not at all) to 5 (very), average scores for ease of program and algorithm use, educational value, and usefulness for clinicians ranged from M: 4.14, SE: 0.08 to M: 4.22, SE: 0.08. CONCLUSIONS Results suggest that the algorithm is valid and has potential educational value. Initial evaluation also suggests that program refinements are needed. Evaluation of participant responses indicated potential problems with the definitions used for necrotic tissue or assessment knowledge deficits. Results also substantiate the importance of instructional design and testing online education programs. More research is needed to uncover potential gaps in nurses' wound care knowledge that may hamper evidence-based practices adoption and the need to develop effective, evidence-based education-delivery techniques.
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Shakibamehr J, Rad M, Akrami R, Rad M. Effectiveness of Tragacanth Gel Cushions in Prevention of Pressure Ulcer in Traumatic Patients: a Randomized Controlled Trial. J Caring Sci 2019; 8:45-49. [PMID: 30915313 PMCID: PMC6428161 DOI: 10.15171/jcs.2019.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/22/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction: Introduction: Pressure ulcer is one of the most common and painful complications in patients admitted to intensive care units (ICUs). This study aimed to compare the effects of tragacanth gel cushions and foam-filled ones on the prevention of pressure ulcers. Methods: This triple-blind, randomized, clinical trial was performed on 94 patients admitted to the ICU of Taleqhani Hospital of Mashhad, Iran. The participants were divided into two groups of tragacanth gel pad and foam (n=47 for each group). Both groups received all the routine care. The participants were examined on a daily basis during a ten-day period. We considered sacral region as the most affected site, and the patients with erythema were excluded from the study. To analyze the data, Chi-squared test, Fisher’s exact test, and t-test were run, using Stata version 12. Results: The data showed significant differences in terms of the incidence of skin redness in the tragacanth gel cushions group and foam cushion group, respectively, 6.84 (1.58) and 5.67 (1.26) days after admission. In addition, in the tragacanth gel cushions group 14 patients (29.7%) did not have skin redness compared with the foam cushion group (8.51%), which indicated a significant difference. Conclusion: This study showed that the use of tragacanth gel cushion is effective in the prevention of pressure ulcers in ICU patients. Cushions filled with tragacanth gel also delayed the onset of erythema. Considering their cost-effectiveness and naturalness, the use of tragacanth gel cushions is recommended to improve the sacral skin health and prevent pressure ulcers.
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Affiliation(s)
- Javad Shakibamehr
- Department of Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mojtaba Rad
- Department of Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Rahim Akrami
- Department of Epidemiology & Biostatistics, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mostafa Rad
- Department of Nursing, Nursing and Midwifery School, Iranian Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Brown-Etris M, Milne CT, Hodde JP. An extracellular matrix graft (Oasis ® wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial. J Tissue Viability 2018; 28:21-26. [PMID: 30509850 DOI: 10.1016/j.jtv.2018.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 01/29/2023]
Abstract
AIM The purpose of the study was to evaluate clinical safety and effectiveness of Oasis® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care. METHODS A total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures. RESULTS The proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037). CONCLUSIONS The results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone.
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Affiliation(s)
- Marie Brown-Etris
- Etris Associates, Inc, 14450 Bustleton Avenue, Philadephia, PA, 19116, USA.
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, LLC, 204 Keegan Rd, Plymouth, CT, 06782, USA.
| | - Jason P Hodde
- Cook Biotech Incorporated, 1425 Innovation Place, West Lafayette, IN, 47906, USA.
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Prosthetic Knee Selection for Individuals with Unilateral Transfemoral Amputation: A Clinical Practice Guideline. ACTA ACUST UNITED AC 2018; 31:2-8. [PMID: 30662248 PMCID: PMC6314512 DOI: 10.1097/jpo.0000000000000214] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction This guideline was developed to present the evidence and provide clinical recommendations on prosthetic knee selection for unilateral amputation at the knee disarticulation or transfemoral level. Methods The guideline is based upon the best available evidence as it relates to prosthetic knee selection after unilateral knee disarticulation or transfemoral amputation. Recommendations are drawn from systematic review, meta-analysis, and additional published practice guidelines. Results Recommendation 1. Fluid knee benefits and indications: Knees with hydraulic or pneumatic swing resistance are indicated for active walkers, permitting increased walking comfort, speed, and symmetry.Recommendation 2. Microprocessor knee benefits: Compared with nonmicroprocessor knees:a) With respect to self-report indices and measures, microprocessor knees are indicated to reduce stumbles, falls, and associated frustrations as well as the cognitive demands of ambulation.b) With respect to self-report indices and measures, microprocessor knees are indicated to increase confidence while walking, self-reported mobility, satisfaction, well-being, and quality of life.c) With respect to physical performance indices and measures, microprocessor knees are indicated to increase self-selected walking speed, walking speed on uneven terrain, and metabolic efficiency during gait.Recommendation 3. Microprocessor knee equivalence: Given the comparable values observed with the use of microprocessor and nonmicroprocessor knees with regard to daily step counts, temporal and spatial gait symmetry, self-reported general health, and total costs of prosthetic rehabilitation, these parameters may not be primary indications in prosthetic knee joint selection.Recommendation 4. Microprocessor knees for limited community ambulators: Among limited community ambulators, microprocessor knees are indicated to enable increases in level ground walking speed and walking speed on uneven terrain while substantially reducing uncontrolled falls and increasing both measured and perceived balance. Conclusions These clinical practice guidelines summarize the available evidence related to prosthetic knee selection for individuals with unilateral knee disarticulation or transfemoral amputation. The noted clinical practice guidelines are meant to serve on as "guides." They may not apply to all patients and clinical situations.
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A Framework to Assist Providers in the Management of Patients with Chronic, Nonhealing Wounds. Adv Skin Wound Care 2018; 31:491-501. [DOI: 10.1097/01.asw.0000546117.86938.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stevens PM, Rheinstein J, Wurdeman SR. Prosthetic Foot Selection for Individuals with Lower-Limb Amputation: A Clinical Practice Guideline. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2018; 30:175-180. [PMID: 30473606 PMCID: PMC6221375 DOI: 10.1097/jpo.0000000000000181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This guideline was developed to present current evidence and to provide associated clinical recommendations on prosthetic foot selection for individuals with lower-limb amputation. MATERIALS NA. METHODS The guideline is based upon the best available evidence as it relates prosthetic foot selection during the provision of definitive lower-limb prostheses. Where possible, recommendations are drawn from Cochrane Review, meta-analysis, systematic and narrative literature reviews, and published evidence-based guidelines. Where this standard is unavailable, alternate academic literature has been used to support individual recommendations. RESULTS Recommendation 1: For patients ambulating at a single speed who require greater stability during weight acceptance because of weak knee extensors or poor balance, a single-axis foot should be considered. Recommendation 2: Patients at elevated risks for overuse injury (i.e., osteoarthritis) to the sound-side lower limb and lower back are indicated for an energy-storage-and-return (ESAR) foot to reduce the magnitude of the cyclical vertical impacts experienced during weight acceptance. Recommendation 3: Neither patient age nor amputation etiology should be viewed as primary considerations in prosthetic foot type. Recommendation 4: Patients capable of variable speed and/or community ambulation are indicated for ESAR feet. CONCLUSIONS These clinical practice guidelines summarize the available evidence related to prosthetic foot selection for individuals with lower limb amputation. The noted clinical practice guidelines are meant to serve only as "guides." They may not apply to all patients and clinical situations.
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Affiliation(s)
- Phillip M Stevens
- PHILLIP STEVENS, MEd, CPO, JOHN RHEINSTEIN, CP, and SHANE WURDEMAN, PhD, MSPO, CP, are affiliated with Hanger Clinic, Austin, TX
| | - John Rheinstein
- PHILLIP STEVENS, MEd, CPO, JOHN RHEINSTEIN, CP, and SHANE WURDEMAN, PhD, MSPO, CP, are affiliated with Hanger Clinic, Austin, TX
| | - Shane R Wurdeman
- PHILLIP STEVENS, MEd, CPO, JOHN RHEINSTEIN, CP, and SHANE WURDEMAN, PhD, MSPO, CP, are affiliated with Hanger Clinic, Austin, TX
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Najafi E, Ahmadi M, Mohammadi M, Beigmohammadi MT, Heidary Z, Vatanara A, Khalili H. Topical pentoxifylline for pressure ulcer treatment: a randomised, double-blind, placebo-controlled clinical trial. J Wound Care 2018; 27:495-502. [DOI: 10.12968/jowc.2018.27.8.495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elham Najafi
- Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Motahareh Ahmadi
- Clinical Pharmacist, Department of Clinical Pharmacy, Homozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Mostafa Mohammadi
- Anesthesiologist, Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taghi Beigmohammadi
- Anesthesiologist, Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zinat Heidary
- Clinical Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Vatanara
- Faculty Member, Department of Pharmaceutical Sciences, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Clinical Pharmacist, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Gomes TF, Pedrosa MM, de Toledo ACL, Arnoni VW, dos Santos Monteiro M, Piai DC, Sylvestre SHZ, Ferreira B. Bactericide effect of methylene blue associated with low-level laser therapy in Escherichia coli bacteria isolated from pressure ulcers. Lasers Med Sci 2018; 33:1723-1731. [DOI: 10.1007/s10103-018-2528-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/25/2018] [Indexed: 01/09/2023]
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Milcheski DA, Mendes RRDS, Freitas FRD, Zaninetti G, Moneiro AA, Gemperli R. Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction. Rev Col Bras Cir 2017; 44:574-581. [PMID: 29267554 DOI: 10.1590/0100-69912017006005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/23/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. METHODS retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. RESULTS in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. CONCLUSION the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.
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Affiliation(s)
- Dimas André Milcheski
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | | | - Fernando Ramos de Freitas
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Guilherme Zaninetti
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Araldo Ayres Moneiro
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
| | - Rolf Gemperli
- - Faculty of Medicine, University of São Paulo, Plastic Surgery Division, Hospital das Clínicas, São Paulo, SP, Brasil
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Motegi SI, Sekiguchi A, Uchiyama A, Uehara A, Fujiwara C, Yamazaki S, Perera B, Nakamura H, Ogino S, Yokoyama Y, Akai R, Iwawaki T, Ishikawa O. Protective effect of mesenchymal stem cells on the pressure ulcer formation by the regulation of oxidative and endoplasmic reticulum stress. Sci Rep 2017; 7:17186. [PMID: 29215059 PMCID: PMC5719411 DOI: 10.1038/s41598-017-17630-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/28/2017] [Indexed: 01/08/2023] Open
Abstract
Cutaneous ischemia-reperfusion (I/R) injury is associated with the early pathogenesis of cutaneous pressure ulcers (PUs). The objective of this study was to investigate the effect of mesenchymal stem cells (MSCs) injection on the formation of PUs after I/R injury and determine the underlying mechanisms. We found that the subcutaneous injection of MSCs into areas of I/R injured skin significantly suppressed the formation of PUs. I/R-induced vascular damage, hypoxia, oxidative DNA damage, and apoptosis were decreased by MSCs injection. Oxidative stress signals detected after I/R in OKD48 (Keap1-dependent oxidative stress detector, No-48-luciferase) mice were decreased by the injection of MSCs. In cultured fibroblasts, MSCs-conditioned medium significantly inhibited oxidant-induced reactive oxygen species (ROS) generation and apoptosis. Furthermore, endoplasmic reticulum (ER) stress signals detected after I/R in ERAI (ER stress-activated indicator) mice were also decreased by the injection of MSCs. These results suggest that the injection of MSCs might protect against the development of PUs after cutaneous I/R injury by reducing vascular damage, oxidative cellular damage, oxidative stress, ER stress, and apoptosis.
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Affiliation(s)
- Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
| | - Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihito Uehara
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Chisako Fujiwara
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sahori Yamazaki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Buddhini Perera
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideharu Nakamura
- Division of Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sachiko Ogino
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoko Yokoyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryoko Akai
- Division of Cell Medicine, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Takao Iwawaki
- Division of Cell Medicine, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Lee HJ, Ju YJ, Park EC, Kim J, Lee SG. Effects of home-visit nursing services on hospitalization in the elderly with pressure ulcers: a longitudinal study. Eur J Public Health 2017; 27:822-826. [PMID: 28957484 DOI: 10.1093/eurpub/ckx110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The risk of pressure ulcers in beneficiaries of long-term care insurance is expected to increase in South Korea's aging society. However, those who stay at home may not be managed appropriately with regard to pressure ulcer development. Here, we examined the relationship between home-visit nursing services and hospitalization related to pressure ulcers among beneficiaries with pressure ulcers in home-care settings. Methods We analyzed National Aging Cohort data from 2008 to 2013. The study population was defined as those who required nursing care for pressure ulcers and received home-care services at least once under long-term care insurance. Logistic regression analysis using generalized estimating equation models was performed to examine the association between home-visit nursing services and hospitalization related to pressure ulcers. Results Among 4,807 beneficiaries with pressure ulcers, 859 (17.9%) were admitted to hospitals during the study period. The use of home-visit nursing services was associated significantly with a lower risk of hospitalization (odds ratio = 0.68, 95% confidence interval = 0.49-0.93; reference, no use). This association was especially strong in beneficiaries with mildly impaired mobility and cognitive function. Conclusions Given the protective role of home-visit nursing services in the management of long-term care insurance beneficiaries with pressure ulcers who stay at home, healthcare professionals need to consider effective strategies for the activation of home-visit nursing services in South Korea.
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Affiliation(s)
- Hyo Jung Lee
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yeong Jun Ju
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Juyeong Kim
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sang Gyu Lee
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.,Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Haesler E, Kottner J, Cuddigan J. The 2014 International Pressure Ulcer Guideline: methods and development. J Adv Nurs 2017; 73:1515-1530. [PMID: 27987246 DOI: 10.1111/jan.13241] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
Abstract
AIM A discussion of the methodology used to develop the Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. (2014). BACKGROUND International experts representing National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance developed the second edition of this clinical guideline. DESIGN Discussion paper - methodology. DATA SOURCES A comprehensive search for papers published up to July 2013 was conducted in 11 databases and identified 4286 studies. After critical appraisal, 356 studies were included and assigned a level of evidence. IMPLICATIONS FOR NURSING Guideline recommendations provide guidance on best practice in pressure ulcer prevention and treatment. Understanding the development process of a guideline increases the meaningfulness of recommendations to clinicians. FINDINGS Five hundred and seventy five recommendations arose from the research and its interpretation. The body of evidence supporting each recommendation was assigned a strength of evidence. A strength of recommendation was assigned to recommendation statements using the GRADE system. Recommendations are primarily supported by a body of evidence rated as C (87% of recommendations), representing low quality and/or indirect evidence (30%) and expert opinion (57%). Two hundred and forty seven recommendations (43%) received a strong recommendation ('Do it'). CONCLUSION Recommendations were developed with consideration to research of the highest methodological quality evidence and studies that add to clinical insight and provide guidance for areas of care where minimal research has been conducted. Recommendations in the guideline reflect best practice and should be implemented with consideration to local context and resources and the individual's preferences and needs.
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Affiliation(s)
- Emily Haesler
- Curtin University, School of Nursing, Midwifery and Paramedicine, Perth, Western Australia, Australia
| | - Jan Kottner
- Clinical Research Centre for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Janet Cuddigan
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska, USA
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Machado RS, Viana S, Sbruzzi G. Low-level laser therapy in the treatment of pressure ulcers: systematic review. Lasers Med Sci 2017; 32:937-944. [DOI: 10.1007/s10103-017-2150-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/10/2017] [Indexed: 11/29/2022]
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Cereda E, Neyens JCL, Caccialanza R, Rondanelli M, Schols JMGA. Efficacy of a Disease-Specific Nutritional Support for Pressure Ulcer Healing: A Systematic Review and Meta-Analysis. J Nutr Health Aging 2017; 21:655-661. [PMID: 28537329 DOI: 10.1007/s12603-016-0822-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this systematic review was to summarize the evidence on the efficacy of high-calorie, high-protein nutritional formula enriched with arginine, zinc, and antioxidants (disease-specific support) in patients with pressure ulcers (PUs). METHODS Randomized controlled trials in English published from January 1997 until October 2015 were searched for in electronic databases (EMBASE, Medline, PubMed, and CINAHL). Studies comparing a disease-specific nutritional support (oral supplements or tube feeding) to a control nutritional intervention enabling the satisfaction of energy requirements regardless of the use of high-calorie formula or placebo or no support for at least 4 weeks were considered eligible. Study outcomes were the percentage of change in PU area, complete healing and reduction in the PU area ≥40% at 8 weeks, and the percentage of change in area at 4 weeks. RESULTS A total of 3 studies could be included in the meta-analysis. Compared with control interventions, formulas enriched with arginine, zinc and antioxidants resulted in significantly higher reduction in ulcer area (-15.7% [95%CI, -29.9, -1.5]; P=0.030; I2=58.6%) and a higher proportion of participants having a 40% or greater reduction in PU size (OR=1.72 [95%CI, 1.04, 2.84]; P=0.033; I2=0.0%) at 8 weeks. A nearly significant difference in complete healing at 8 weeks (OR=1.72 [95%CI, 0.86, 3.45]; P=0.127; I2=0.0%) and the percentage of change in the area at 4 weeks (-7.1% [95%CI, -17.4, 3.3]; P=0.180; I2=0.0%) was also observed. CONCLUSIONS This systematic review shows that the use of formulas enriched with arginine, zinc and antioxidants as oral supplements and tube feeds for at least 8 weeks are associated with improved PU healing compared with standard formulas.
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Affiliation(s)
- E Cereda
- Emanuele Cereda MD, PhD, Servizio di Dietetica e Nutrizione Clinica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy, Tel.: +39 0382 501615 ; Fax: + 39 0382 502801, E-mail:
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