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Iizaka S, Koitabashi E, Negishi T, Kawamura A, Iizuka Y. Distance from the nearest grocery stores and frequency of store-specific shopping are associated with dietary intake frequency among the community-dwelling independent elderly population. Nutr Health 2020; 26:197-207. [PMID: 32400265 DOI: 10.1177/0260106020923806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Low accessibility to grocery stores may change dietary habits and increase health problems for elderly people living in communities. AIM This study investigated whether the distance from the nearest grocery stores, including supermarkets, convenience stores, and drugstores, and the frequency of store-specific shopping were associated with dietary intake frequency among elderly people. METHODS A cross-sectional study was conducted in two towns of suburban cities. A total of 177 people aged ≥65 years were recruited (M age=76.7 years). The frequency of intake of 10 food groups and dietary variety scores (DVS) were evaluated. Distances from the districts to the nearest grocery stores and the frequency of shopping during a week at each store were evaluated using a geographic information system. RESULTS For supermarkets, people living <300 metres from the nearest supermarket showed a higher intake frequency of fruit (p=0.024) and oil/fat (p=0.045), and those shopping three or more times a week showed a higher intake frequency of meat (p=0.025). In the case of drugstores, people shopping one or more times a week showed a higher intake frequency of eggs (p=0.006) and oil/fat (p=0.048). People living <300 m from the nearest supermarkets (p=0.048) and drugstores (p=0.047) showed higher DVS than those living ≥500 m from the nearest supermarkets and drugstores. CONCLUSIONS Our findings suggest that shopping at supermarkets and drugstores is associated with dietary intake frequency and dietary quality for elderly people living in suburban cities.
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Affiliation(s)
- Shinji Iizaka
- School of Nutrition, College of Nursing and Nutrition, Shukutoku University, Japan
| | - Emiko Koitabashi
- Department of Nursing, Faculty of Health Science, Toho University, Japan
| | - Takako Negishi
- Department of Nursing, Faculty of Health Sciences, Tokyo Kasei University, Japan
| | - Aki Kawamura
- Department of Nursing, Faculty of Nursing, Wayo Women's University, Japan
| | - Yuzuru Iizuka
- School of Nutrition, College of Nursing and Nutrition, Shukutoku University, Japan
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Ibuki A, Minematsu T, Yoshida M, Iizaka S, Matsumoto M, Sugama J, Sanada H. Microsatellite polymorphism in the Heme oxygenase-1 gene promoter is associated with dermal collagen density in Japanese obese male subjects. PLoS One 2018; 13:e0199994. [PMID: 30024897 PMCID: PMC6053161 DOI: 10.1371/journal.pone.0199994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
We previously reported elevated oxidative stress-related mechanical vulnerabilities of the skin as sparse distributions of hyperechoic areas. Although this helped establish a personalized skin care system to prevent skin disorders related to mechanical stress, obesity-related skin vulnerability involves individual differences. Here, we hypothesized that individual differences are caused by polymorphisms of GT repetitive sequences in the heme oxygenase1 (HMOX1) promoter region, which encodes an antioxidant enzyme. This cross-sectional study enrolled healthy male volunteers in a walking classroom aimed at weight control. Subjects with a body mass index <25 kg/m2 were classified as non-obese and those with body mass index ≥25 kg/m2 were classified as obese. Subject skin was categorized into sparse dermis or normal groups according to the distribution of hyperechoic areas by high-resolution skin ultrasonography (20 MHz). Genomic DNA and mRNA extracted from three body hairs with attached follicle cells were used to analyze GT repetitive sequences of the HMOX1 promoter, HMOX1 mRNA expression levels, and oxidative stress levels (8-hydroxy-2’-deoxyguanosine). Classifications of GT repetitive sequence of HMOX1 promoter were Short (<27 times) and Long (≥27 times). Higher numbers of subjects with sparse dermis were in the obese group compared with the non-obese group. In obese subjects, the number of subjects that had the Long allele of the HMOX1 promoter with sparse dermis was significantly higher compared with the normal group, whereas no association was observed between the polymorphism and ultrasonographic features in non-obese subjects. Thus, HMOX1 polymorphisms detected a risk of low collagen density in Japanese obese male subjects.
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Affiliation(s)
- Ai Ibuki
- Department of Biological Science and Nursing, School of Medicine, Yokohama City University, Kanagawa, Japan
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mikako Yoshida
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- School of Nutrition, College of Nursing and Nutrition, Shukutoku University, Chiba, Japan
| | - Masaru Matsumoto
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Advanced Health Care Science Research Unit Innovative Integrated Bio-Research Core Institute for Frontier Science Initiative, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
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Sakurai S, Hanafusa N, Kato H, Iizaka S, Murayama R, Nangaku M. Questionnaire survey on nutritional supplement therapy and exercise training at hemodialysis facilities in Japan. Ren Replace Ther 2017. [DOI: 10.1186/s41100-017-0137-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
OBJECTIVE This study aimed to investigate skin hydration status of the lower legs by comparing several methods and examining lifestyle-related factors in community-dwelling older people. METHODS A cross-sectional study was conducted in three community settings in Japan from autumn to winter. Participants were older people aged ≥65 years (n=118). Skin hydration status of the lower legs was evaluated by stratum corneum hydration using an electrical device, clinical symptoms by an expert's observation and the visual analogue scale. Lifestyle factors of skin care were evaluated by a self-administered questionnaire. RESULTS The mean age of participants was 74.4 years and 83.9% were women. Stratum corneum hydration was significantly correlated with clinical scores by an expert's observation (rho=-0.46, P<0.001), but it was not correlated with the visual analogue scale (rho=-0.08, P=0.435). Among participants who did not perceive dry skin, 57.5% showed low stratum corneum hydration. Hospitalization in the past year (b=-9.4, P=0.008), excessive bathing habits (b=-4.6, P=0.014), and having an outdoor hobby (b=-5.7, P=0.007) were negatively associated, and diuretics (b=11.5, P=0.002) and lotion-type moisturizer use (b=4.6, P=0.022) were positively associated with stratum corneum hydration. CONCLUSION Stratum corneum hydration measurements show an adequate association with observation-based evaluation by an expert, but poor agreement with subjective evaluation in community-dwelling older people. Hospitalization experience and lifestyle factors are associated with skin hydration.
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Affiliation(s)
- Shinji Iizaka
- School of Nutrition, College of Nursing and Nutrition, Shukutoku University, 673 Nitonacho, Chuo-ku, Chiba-shi, Chiba, 260-8703, Japan.
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Iizaka S, Nagata S, Sanada H. Nutritional Status and Habitual Dietary Intake Are Associated with Frail Skin Conditions in Community-Dwelling Older People. J Nutr Health Aging 2017; 21:137-146. [PMID: 28112767 DOI: 10.1007/s12603-016-0736-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Prevention of frail skin is important in older people because frail skin is associated with a risk of injury in this population. In this study, we investigated the association of nutritional status and habitual dietary intake with skin conditions in community-dwelling older people. DESIGN Cross-sectional study. SETTING Three community settings in Japan from autumn to winter. PARTICIPANTS Older people aged ≥65 years without care-need certification (n=118). MEASUREMENTS Malnutrition and obesity were evaluated to assess the nutritional status. Nutrient and food group intakes per 1000 kcal were evaluated using a brief self-administered diet history questionnaire. Dietary patterns based on food groups were evaluated by principal component analysis. Skin condition parameters, including stratum corneum hydration, appearance of xerosis (specific symptom sum score [SRRC score]), and dermal intensity by high-frequency ultrasonography, were measured on a lower leg. Multiple linear regression analysis was performed with adjustment for confounders. RESULTS The mean (standard deviation) age was 74.1 (4.8) years, and 83.1% of participants were female. A higher intake of plant fat (p=0.018) was associated with a lower SRRC score. Higher intakes of α-tocopherol (p=0.050) and vitamin C (p=0.017) were associated with increased dermal intensity. A body mass index ≥25 (p=0.016) was associated with decreased dermal intensity. A dietary pattern characterized by higher vegetable and fruit intake was associated with a better skin condition. CONCLUSION Plant fat, antioxidant vitamins, and a dietary pattern characterized by vegetables and fruits showed positive and obesity showed negative associations for frail skin in community-dwelling older people.
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Affiliation(s)
- S Iizaka
- Shinji Iizaka, RN, PhD, School of Nutrition, College of Nursing and Nutrition, Shukutoku University. 673 Nitonacho, Chuo-ku, Chiba-shi, Chiba, Japan Phone:81-43-305-1881 E-mail:
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Koyano Y, Nakagami G, Iizaka S, Sugama J, Sanada H. Skin property can predict the development of skin tears among elderly patients: a prospective cohort study. Int Wound J 2016; 14:691-697. [PMID: 27758078 DOI: 10.1111/iwj.12675] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/19/2016] [Accepted: 08/26/2016] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to identify skin properties that may be used to predict the development of a skin tear (ST) among elderly patients. A prospective cohort study was conducted among elderly patients aged 65 and older (N = 149) at a long-term medical facility in Japan over an 8-month period. Skin properties at baseline were measured on the forearm using a 20-MHz ultrasound scanner, which measured the thickness of the dermis layer and low-echogenic pixels, and skin blotting method, which evaluated the levels of collagen type IV, matrix metalloproteinase-2 and tumour necrosis factor-alpha. Adjusted hazard ratios (HRs) for the main confounders were obtained using the Cox proportional hazard model. A total of 52 STs were recorded among the 21 patients, resulting in an incidence rate of 1·13/1000 person-days. The predictor of STs was dermis thickness (HR = 0·52; 95% confidence interval = 0·33-0·81; P-value = 0·004). The cut-off point for dermis thickness was 0·80 mm (area under the curve = 0·77; 95% confidence interval = 0·66-0·88; P-value = 0·006). Our results suggest that measuring the dermis thickness at baseline is an easy and accurate way to identify a high-risk patient.
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Affiliation(s)
- Yuiko Koyano
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Koyano Y, Nakagami G, Iizaka S, Minematsu T, Noguchi H, Tamai N, Mugita Y, Kitamura A, Tabata K, Abe M, Murayama R, Sugama J, Sanada H. Exploring the prevalence of skin tears and skin properties related to skin tears in elderly patients at a long-term medical facility in Japan. Int Wound J 2016; 13:189-97. [PMID: 24674027 PMCID: PMC7949576 DOI: 10.1111/iwj.12251] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/10/2014] [Accepted: 02/18/2014] [Indexed: 11/28/2022] Open
Abstract
The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross-sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long-term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20-MHz ultrasonography, skin blotting and also Corneometer CM-825, Skin-pH-meterPH905, VapoMeter, Moisture Meter-D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low-echogenic pixels (LEP) by 20-MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase-2, and increased tumour necrosis factor-α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.
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Affiliation(s)
- Yuiko Koyano
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Noguchi
- Department of Life Support Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Tamai
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Masatoshi Abe
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Sapporo Skin Clinic, Hokkaido, Japan
| | - Ryoko Murayama
- Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Yoshimura M, Nakagami G, Iizaka S, Yoshida M, Uehata Y, Kohno M, Kasuya Y, Mae T, Yamasaki T, Sanada H. Microclimate is an independent risk factor for the development of intraoperatively acquired pressure ulcers in the park-bench position: A prospective observational study. Wound Repair Regen 2015; 23:939-47. [DOI: 10.1111/wrr.12340] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mine Yoshimura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Mikako Yoshida
- Department of Life Support Technology (Molten), Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yoko Uehata
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Michihiro Kohno
- Department of Neurosurgery; Tokyo Medical University; Tokyo Japan
| | - Yusuke Kasuya
- Department of Anesthesiology; Tokyo Women's Medical University; Tokyo Japan
| | - Tomoko Mae
- Department of Anesthesiology; Tokyo Metropolitan Police Hospital; Tokyo Japan
| | - Takashi Yamasaki
- Department of Anesthesiology; Tokyo Metropolitan Police Hospital; Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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9
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Kaitani T, Nakagami G, Iizaka S, Fukuda T, Oe M, Igarashi A, Mori T, Takemura Y, Mizokami Y, Sugama J, Sanada H. Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses. Wound Repair Regen 2015; 23:915-21. [PMID: 26284460 DOI: 10.1111/wrr.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Abstract
The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care.
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Affiliation(s)
- Toshiko Kaitani
- Department of Nursing, Sapporo City University, Sapporo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Fukuda
- Department of Health and Welfare Services, National Institute of Public Health, Saitama, Japan
| | - Makoto Oe
- Department of Advanced Nursing Technology, Social Cooperation Program Graduate School of Medicine The University of Tokyo, Tokyo, Japan
| | - Ataru Igarashi
- Department of Drug Policy & Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mori
- Department of Life Support Technology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukie Takemura
- Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yuko Mizokami
- Department of Courses for Certified Nurses Institute for Graduate Nurses, Japanese Nursing Association, Tokyo, Japan
| | - Junko Sugama
- Department of Clinical Nursing, Institute of Medical, and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract
We report the case of a 46-year-old female who presented with a category IV pressure ulcer (PU) in the sacral region. Undermining of the PU was assessed with the aid of two-dimensional and three-dimensional ultrasound (3D-US).3D-US clearly visualized the wound in three directions and allowed determination of its volume. Our results show that volumetric analysis carried out with 3D-US enables the evaluation of wound morphology and thus better treatment of patients with PUs. The technique is simple and can be used routinely in daily wound management to assess the volume of the undermined wound.
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Affiliation(s)
- Koichi Yabunaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Japan
| | | | - Masayuki Fujioka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Japan.
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11
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Kanazawa T, Kitamura A, Nakagami G, Goto T, Miyagaki T, Hayashi A, Sasaki S, Mugita Y, Iizaka S, Sanada H. Lower temperature at the wound edge detected by thermography predicts undermining development in pressure ulcers: a pilot study. Int Wound J 2015. [PMID: 26212623 DOI: 10.1111/iwj.12454] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Undermined pressure ulcers (PUs) are troublesome complications that are likely to delay wound healing. Early skin incision and debridement can prevent the deterioration of undermined PUs, thus it is necessary to identify devitalised tissue areas to determine the appropriate timing for such interventions. This retrospective cohort study evaluated whether a lower temperature at the wound edge than the wound bed and periwound skin, detected by thermography, can predict undermining development in PUs 1 week after the assessment. Twenty-two participants with category III, IV, or unstageable PUs who were examined by interdisciplinary PU team and were followed up for at least two consecutive weeks were analysed. We found 9/11 PUs without a lower temperature at the wound edge did not develop undermining development, whereas 8/11 PUs with the lower temperature did develop undermining. The relative risk of undermining development after 1 week in PUs with the lower temperature was 4·00 (95% confidence intervals: 1·08-14·7). The sensitivity, specificity, positive predictive value and negative predictive value were 0·80, 0·75, 0·73 and 0·81, respectively. A thermal imaging assessment focusing on a lower temperature pattern at the wound edge may provide sufficient information to predict undermining development.
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Affiliation(s)
- Toshiki Kanazawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taichi Goto
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akitatsu Hayashi
- Department of Plastic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sanae Sasaki
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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12
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Yoshimura M, Iizaka S, Kohno M, Nagata O, Yamasaki T, Mae T, Haruyama N, Sanada H. Risk factors associated with intraoperatively acquired pressure ulcers in the park-bench position: a retrospective study. Int Wound J 2015; 13:1206-1213. [PMID: 26043765 DOI: 10.1111/iwj.12445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/22/2015] [Indexed: 11/28/2022] Open
Abstract
Patients undergoing surgery in the park-bench position are at high risk of developing intraoperatively acquired pressure ulcers (IAPUs). The purpose was to examine retrospectively risk factors associated with IAPUs in the park-bench position. This study was conducted at a general hospital during the period of September 2010 to September 2012. Twenty-one potential risk factors were evaluated using data obtained from the hospital database. IAPUs developed in 30 of 277 patients (11%). Perspiration was statistically found to be independently associated with IAPUs [OR 3·09, 95% confidence interval (Cl) 1.07-8·58, P = 0·037]. A length of surgery of more than 6 hours was identified to be likely associated with IAPUs (OR 2·64, 95% Cl 0·84-9·08, P = 0·095) compared with less than 6 hours. Furthermore, there was an interaction between the length of surgery and the core temperature; that is, when the length of surgery was more than 6 hours, a core temperature of more than 38·1°C at the end of surgery had a higher odds ratio (8·45, 95% Cl 3·04-27·46, P < 0·001) than that at a lower core temperature (3·20, 95% Cl 1·23-8·78, P = 0·017). These results suggest that perspiration and core temperature are preventable causative factors of pressure ulcers, even under conditions of prolonged surgery in the park-bench position.
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Affiliation(s)
- Mine Yoshimura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Nursing, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michihiro Kohno
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Osamu Nagata
- Department of Anesthesiology, Cancer Institute Hospital, Tokyo, Japan
| | - Takashi Yamasaki
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Tomoko Mae
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Naoko Haruyama
- Department of Anesthesiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kitamura A, Yoshida M, Minematsu T, Nakagami G, Iizaka S, Fujita H, Naito A, Takahashi K, Mori T, Sanada H. Prediction of healing progress of pressure ulcers by distribution analysis of protein markers on necrotic tissue: A retrospective cohort study. Wound Repair Regen 2015; 23:772-7. [PMID: 25976913 DOI: 10.1111/wrr.12316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 02/10/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
Abstract
Predicting the short-term healing progress of pressure ulcers is important for providing timely and appropriate intervention. Although there are some prediction methods available, these are unsuitable for ulcers with abundant necrotic tissue. We aimed to elucidate the relationship between necrotic tissue alteration and protein distributions on ulcers to establish a new prediction method. Thirty-eight pressure ulcers were retrospectively analyzed. Protein distributions on necrotic tissue were evaluated by the wound blotting at three levels: marker protein positivity, signal patterns (speckled, heterogeneous, or homogeneous), and the occupation of heterogeneous pattern. Peroxidase, alkaline phosphatase, tumor necrosis factor α, and matrix metalloproteinase-2 were used as marker proteins. One-week necrotic tissue alteration was classified as liquefaction or nonliquefaction, and associations with protein distributions were analyzed. The peroxidase positivity was significantly higher in the liquefaction than in the nonliquefaction (p = 0.031). In peroxidase-positive samples, the proportion of nonliquefaction samples was significantly higher in the heterogeneous pattern (p = 0.029). In the heterogeneous-patterned samples, the proportion of samples with an occupation values greater than the median value tended to be higher in the nonliquefaction (p = 0.087). There was no significant relationship between liquefaction and other markers. Peroxidase positivity predicts 1-week liquefaction of necrotic tissue, while a heterogeneous pattern indicates nonliquefaction.
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Affiliation(s)
- Aya Kitamura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Research Fellow of Japan Society for the Promotion of Science
| | - Mikako Yoshida
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Fujita
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Ayumi Naito
- WOC Consultation room, Fujisawa City Hospital, Kanagawa, Japan
| | - Kazuo Takahashi
- Department of Dermatology, Fujisawa City Hospital, Kanagawa, Japan
| | - Taketoshi Mori
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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14
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Iizaka S, Kaitani T, Nakagami G, Sugama J, Sanada H. Clinical validity of the estimated energy requirement and the average protein requirement for nutritional status change and wound healing in older patients with pressure ulcers: A multicenter prospective cohort study. Geriatr Gerontol Int 2014; 15:1201-9. [DOI: 10.1111/ggi.12420] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Junko Sugama
- Division of Health Sciences; Graduate School of Medical Science, Kanazawa University; Ishikawa Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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15
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Sanada H, Nakagami G, Koyano Y, Iizaka S, Sugama J. Incidence of skin tears in the extremities among elderly patients at a long-term medical facility in Japan: A prospective cohort study. Geriatr Gerontol Int 2014; 15:1058-63. [DOI: 10.1111/ggi.12405] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yuiko Koyano
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Junko Sugama
- Wellness Promotion Science Center; Institute of Medical Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
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16
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Iizaka S, Koyanagi H, Sasaki S, Sekine R, Konya C, Sugama J, Sanada H. Nutrition-related status and granulation tissue colour of pressure ulcers evaluated by digital image analysis in older patients. J Wound Care 2014; 23:198-200, 202-6. [PMID: 24762383 DOI: 10.12968/jowc.2014.23.4.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting. METHOD The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) was calculated. RESULTS Haemoglobin levels were positively associated with %GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with %GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower %GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, %GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher %GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127). CONCLUSION Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.
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Affiliation(s)
- S Iizaka
- RN, PHN, PhD, Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Tokyo, Japan
| | - H Koyanagi
- RN, MHS, University of Tokyo Hospital, Tokyo, Japan
| | - S Sasaki
- RN, University of Tokyo Hospital, Tokyo, Japan
| | - R Sekine
- RD, University of Tokyo Hospital, Tokyo, Japan
| | - C Konya
- RN, PhD, School of Nursing, Kanazawa Medical University, Ishikawa, Japan
| | - J Sugama
- RN, PhD, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - H Sanada
- RN, PhD, Department of Gerontological Nursing/Wound Care Management, University of Tokyo, Tokyo, Japan
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17
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Iizaka S, Asada M, Koyanagi H, Sasaki S, Naito A, Konya C, Sanada H. The reliability and validity of color indicators using digital image analysis of peristomal skin photographs: results of a preliminary prospective clinical study. Ostomy Wound Manage 2014; 60:12-29. [PMID: 24610557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Accurate assessment is necessary to evaluate peristomal skin condition, but objective methods are lacking. The purpose of this prospective, repeated-measures study was to evaluate the reliability and validity of color indicators using digital image analysis of peristomal skin photographs. The 6-month study was conducted among 21 patients (mean age 65.1 years old, 15 men) with ostomies (14 colostomies, six ileostomies, and one urostomy) at four outpatient clinics. Photographs taken by nurses of the peristomal area using point-and-shoot cameras were processed using digital image analysis, which involved color calibration, image processing, and indicator calculation. An erythema index (EI), melanin index (MI), and hypopigmentation index were created to represent increased degrees of red, black, and white color, respectively, and their average values in the peristomal region of an image were calculated relative to values for intact skin. Reproducibility was evaluated using the interclass correlation coefficient (ICC). ICCs of color indicators for intact skin were >0.7 between baseline and the end of follow-up for the 16 participants with two or more clinic visits. Differences in these indices between peristomal and intact regions were evaluated using a linear mixed model. The EI and MI of peristomal skin were significantly higher than those of intact skin (n=42, P<0.001). All color indicators in adjacent regions and areas where adhesive was applied were associated with the discoloration severity score and visual analogue pain score (all P<0.05). This objective and simple method had adequate reproducibility and criterion-related validity and may be useful for peristomal skin assessment. Further research is warranted.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayumi Asada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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18
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Kato H, Nakagami G, Iwahira Y, Otani R, Nagase T, Iizaka S, Tamai N, Matsuyama Y, Sanada H. Risk Factors and Risk Scoring Tool for Infection during Tissue Expansion in Tissue Expander and Implant Breast Reconstruction. Breast J 2013; 19:618-26. [DOI: 10.1111/tbj.12175] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Hirofumi Kato
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | | | - Takashi Nagase
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Nao Tamai
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yutaka Matsuyama
- Department of Biostatistics; School of Public Health; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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19
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Nagase T, Iizaka S, Kato H, Nakagami G, Kaitani T, Machida M, Oshima H, Ochiai H, Bito S, Sanada H. Undermining incision and healing of deep pressure ulcers: a prospective cohort study of pressure ulcers by the Japanese national hospital organization. Wound Repair Regen 2013; 21:512-9. [PMID: 23755915 DOI: 10.1111/wrr.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 03/18/2013] [Indexed: 01/22/2023]
Abstract
Undermining is one of the most challenging complications of deep pressure ulcers. Recommendations in most guidelines are based only on expert opinions. Here, we examined the relationship between surgical incision of the undermined space and pressure ulcer healing through a Japanese multicenter prospective cohort study. A total of 162 patients with undermining in 40 national hospitals in Japan were enrolled from July 2007 to June 2009. The incision group included 39 patients (24.1%) whose undermining was surgically incised during the observational period. Their 4-week follow-up data on pressure ulcer severity and areas of healthy granulation tissue were recorded as outcome variables using the DESIGN-R pressure ulcer assessment tool. The 4-week follow-up was restarted after the incision in the incision group. The outcome variables over time were compared between the two groups using a linear mixed model with or without adjustment for demographic and other variables. The incision group showed more rapid improvement in the total and granulation DESIGN-R scores compared with the nonincision group (p < 0.001 and p = 0.007, respectively, in the crude models). This study may provide the first considerable evidence to support that surgical incision of undermining may promote healing of deep pressure ulcers.
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Affiliation(s)
- Takashi Nagase
- Department of Gerontological Nursing/Wound Care Management, Division of Health Science and Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
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20
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Zhong X, Nagase T, Huang L, Kaitani T, Iizaka S, Yamamoto Y, Kanazawa T, Sanada H. Reliability and validity of the Chinese version of DESIGN-R, an assessment instrument for pressure ulcers . Ostomy Wound Manage 2013; 59:36-43. [PMID: 23388396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lack of a valid and reliable assessment instrument may have contributed to a lack of wound healing research in China. The DESIGN-R tool scores the severity of pressure ulcers (PUs) and monitors healing using the observable state assessment; it was developed by the Scientific Education Committee of the Japanese Society of Pressure Ulcers (JSPU) and tested for reliability and validity. A Chinese version of DESIGN-R was developed based on Brislin's model of translationand tested for validity and reliability. Using a purposive sampling method, 44 practicing registered nurses (RNs) and 11 physicians (MDs) were recruited from 52 departments of Nanfang Hospital, Guangdong, China. Based on their experience, they were classified as general medical staff (gMS) or experienced medical staff (eMS). All used the Chinese version of DESIGN-R to assess eight photographs of PUs and descriptors. In addition, eight eMS also used the Bates- Jensen Wound Assessment Tool (BWAT) to assess the same wounds. Inter-rater reliability was high (total ICC score = 0.960). ICC inflammation/infection scores were 0.530 and 0.759 for gMS and eMS, respectively; granulation ICC scores were 0.532 and 0.794 in gMS and eMS, respectively. The correlation coefficients between the BWAT and DESIGN-R tool were >0.80 for all eight raters. The results suggest the Chinese version of DESIGN-R is valid and reliable and may be a useful scoring tool for RNs and MDs to monitor PU status in daily clinical practice. Additional research is warranted, and clinical instruments for inflammation/infection and granulation assessment must be developed for gMS.
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Affiliation(s)
- Xiaohong Zhong
- Department of Nursing, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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21
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Higashino T, Nakagami G, Kadono T, Ogawa Y, Iizaka S, Koyanagi H, Sasaki S, Haga N, Sanada H. Combination of thermographic and ultrasonographic assessments for early detection of deep tissue injury. Int Wound J 2012; 11:509-16. [PMID: 23174023 DOI: 10.1111/j.1742-481x.2012.01117.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 09/30/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022] Open
Abstract
Early detection and intervention of deep tissue injury are important to lead good outcome. Although the efficiency of ultrasonographic assessment of deep tissue injury has been reported previously, it requires a certain level of skill for accurate assessment. In this study, we present an investigation of the combination of thermographic and ultrasonographic assessments for early detection of deep tissue injury. We retrospectively reviewed 28 early-stage pressure ulcers (21 patients) presenting at the University of Tokyo Hospital between April 2009 and February 2010, surveying the associated thermographic and ultrasonographic findings. The wound temperature patterns were divided into low, even and high compared with the surrounding skin. Ultrasonographic findings were classified into unclear layer structure, hypoechoic lesion, discontinuous fascia and heterogeneous hypoechoic area. All 13 ulcers that were associated with low temperature showed good outcome; three ulcers had even temperatures and 12 ulcers showed high temperature on thermographic assessment. The two deep tissue injuries were rated high on thermographic assessment and showed heterogeneous hypoechoic area findings on ultrasonographic assessment. No non-deep tissue injury lesion was associated with these two findings simultaneously. The combination of thermographic and ultrasonographic assessments is expected to increase the accuracy of the early detection of deep tissue injuries.
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Affiliation(s)
- Takuya Higashino
- Department of Plastic Surgery, Asahi General Hospital, Chiba, Japan
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22
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Iizaka S, Matsuo J, Konya C, Sekine R, Sugama J, Sanada H. Estimation of Protein Requirements According to Nitrogen Balance for Older Hospitalized Adults with Pressure Ulcers According to Wound Severity in Japan. J Am Geriatr Soc 2012; 60:2027-34. [DOI: 10.1111/j.1532-5415.2012.04202.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing and Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; University of Tokyo; Tokyo Japan
| | - Junko Matsuo
- Faculty of Nursing; Osaka Medical College; Osaka Japan
| | - Chizuko Konya
- School of Nursing; Kanazawa Medical University; Ishikawa Japan
| | - Rie Sekine
- Department of Nutritional Management; University of Tokyo Hospital; Tokyo Japan
| | - Junko Sugama
- Division of Health Sciences; Graduate School of Medical Science; Kanazawa University; Ishikawa Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing and Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; University of Tokyo; Tokyo Japan
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23
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Iizaka S, Kaitani T, Sugama J, Nakagami G, Naito A, Koyanagi H, Konya C, Sanada H. Predictive validity of granulation tissue color measured by digital image analysis for deep pressure ulcer healing: a multicenter prospective cohort study. Wound Repair Regen 2012; 21:25-34. [DOI: 10.1111/j.1524-475x.2012.00841.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 07/23/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Toshiko Kaitani
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Junko Sugama
- Division of Health Sciences, Graduate School of Medical Science; Kanazawa University; Ishikawa Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | | | - Chizuko Konya
- School of Nursing; Kanazawa Medical University; Ishikawa Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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24
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Okajima S, Hirota A, Kimura E, Inagaki M, Tamai N, Iizaka S, Nakagami G, Mori T, Sugama J, Sanada H. Health-related quality of life and associated factors in patients with primary lymphedema. Jpn J Nurs Sci 2012; 10:202-11. [PMID: 24373443 DOI: 10.1111/j.1742-7924.2012.00220.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM Primary lymphedema requires continuous conservative treatment during the patient's life, which may affect their health-related quality of life (HRQOL). Physical and psychosocial characteristics related to lymphedema are associated with their HRQOL. This study aimed to assess HRQOL in those patients undergoing conservative treatment and to determine the factors associated with their HRQOL. METHODS This was a cross-sectional, observational study that included 83 patients with primary lymphedema at an outpatient clinic for lymphedema. HRQOL was assessed with the Medical Outcomes Study 36-Item Short Form Survey (SF-36) and EuroQol 5-Dimension (EQ-5D). Lymphedema status/complications and psychosocial status were evaluated by medical records, physical assessment, and self-administrative questionnaires. RESULTS The general health perception score in the SF-36 was lower than the age- and sex-stratified national norms (P = 0.001). In the EQ-5D, the proportions of patients with some/moderate or severe problems were 42.2% for pain/discomfort, 21.7% for usual activities, and 20.5% for anxiety/depression. By multiple regression analyses, a lower physical component summary score in the SF-36 was associated with a higher lymphedema stage (P = 0.021), cellulitis within 30 days (P = 0.003), exercise (P = 0.010), and more substance use coping (P = 0.012). A lower mental component summary score was associated with skin lesions over edematous limbs (P = 0.008), less humor coping (P = 0.005), and more self-blame coping (P = 0.014). CONCLUSION Patients with primary lymphedema have problems in health perception, discomfort, usual activities, and anxiety/depression. Preventing cellulitis and skin lesions and humor coping may be able to improve HRQOL.
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Affiliation(s)
- Shizuko Okajima
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing Department of Life Support Technology (Molten), Graduate School of Medicine, University of Tokyo Hirota Internal Medicine Clinic, Tokyo Aomori University of Health and Welfare, Aomori Department of Clinical Nursing, Division of Nursing Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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25
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Iizaka S, Sanada H, Matsui Y, Furue M, Tachibana T, Nakayama T, Sugama J, Furuta K, Tachi M, Tokunaga K, Miyachi Y. Predictive validity of weekly monitoring of wound status using DESIGN-R score change for pressure ulcer healing: A multicenter prospective cohort study. Wound Repair Regen 2012; 20:473-81. [DOI: 10.1111/j.1524-475x.2012.00778.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine, The University of Tokyo; Tokyo Japan
| | - Yuko Matsui
- Department of Nursing; School of Health Sciences; Kanazawa University; Ishikawa Japan
| | - Masutaka Furue
- Department of Dermatology; Faculty of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takao Tachibana
- Department of Dermatology; Shiga University of Medical Science; Otsu Japan
| | - Takeo Nakayama
- Department of Public Health; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Junko Sugama
- Department of Nursing; School of Health Sciences; Kanazawa University; Ishikawa Japan
| | - Katsunori Furuta
- Department of Pharmacology; National Center for Geriatrics and Gerontology; Aichi Japan
| | - Masahiro Tachi
- Department of Plastic Surgery; Tohoku University Graduate School of Medicine; Miyagi Japan
| | | | - Yoshiki Miyachi
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto Japan
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26
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Iizaka S, Jiao L, Sugama J, Minematsu T, Oba M, Matsuo J, Tabata K, Sugiyama T, Sanada H. Evaluation of nutritional status and skin condition among elderly residents in a long-term care hospital. J Nutr Health Aging 2012; 16:107-11. [PMID: 22238009 DOI: 10.1007/s12603-010-0292-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The availability of nutritional screening tools for older adults is limited, depending on their physical characteristics or the setting. We investigated the relationships between various nutritional indicators and skin conditions as possible screening indicators. DESIGN Cross-sectional study. SETTING A long-term care hospital in Japan. PARTICIPANTS 90 elderly residents who were aged ≥65 years old. MEASUREMENTS The nutritional status of the residents was assessed by body mass index (BMI), involuntary weight loss, arm muscle area, and serum albumin and prealbumin levels. Leg skin condition was evaluated by: 1) functional factors including pH, hydration and transepidermal water loss; 2) skin color including L*, a*, b* and individual typology angle (ITA°) using a tristimulus colorimetric instrument; and 3) skin morphology. Repeated measures analysis of variance was employed, adjusted for demographic characteristics and room temperature, with measurement site as the repeated variable. RESULTS Among the skin indicators, b* was significantly correlated with BMI (p=0.018), and weight loss over the previous month (p=0.042) and 6 months (p=0.002). Additionally, ITA° was associated with weight loss over 1 month (p=0.013). Both b* and ITA° showed the area under the receiver operating characteristic curve of 0.64 to 0.80 for weight loss >2% over 1 month. CONCLUSIONS Residents with poorer nutritional status had yellower and darker skin color.
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Affiliation(s)
- S Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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Affiliation(s)
- S. Iizaka
- Department of Gerontological Nursing/ Wound Care Management, University of Tokyo, Japan
| | - H. Sanada
- Department of Gerontological Nursing/ Wound Care Management, University of Tokyo, Japan
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28
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Iizaka S, Sanada H, Nakagami G, Koyanagi H, Konya C, Sugama J. Quantitative estimation of exudate volume for full-thickness pressure ulcers: the ESTimation method. J Wound Care 2011; 20:453-4, 458-63. [DOI: 10.12968/jowc.2011.20.10.453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Iizaka
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan
| | - H. Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan
| | - G. Nakagami
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan
| | | | - C. Konya
- School of Nursing, Kanazawa Medical University, Ishikawa, Japan
| | - J. Sugama
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
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Sanada H, Iizaka S, Matsui Y, Furue M, Tachibana T, Nakayama T, Sugama J, Furuta K, Tachi M, Tokunaga K, Miyachi Y. Clinical wound assessment using DESIGN-R total score can predict pressure ulcer healing: Pooled analysis from two multicenter cohort studies. Wound Repair Regen 2011; 19:559-67. [DOI: 10.1111/j.1524-475x.2011.00719.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management; Division of Health Sciences and Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Yuko Matsui
- Department of Nursing; School of Health Sciences; Kanazawa University; Ishikawa; Japan
| | - Masutaka Furue
- Department of Dermatology; Faculty of Medical Sciences; Kyushu University; Fukuoka; Japan
| | - Takao Tachibana
- Department of Dermatology; Shiga University of Medical Science; Otsu; Japan
| | - Takeo Nakayama
- Department of Public Health; Kyoto University Graduate School of Medicine; Kyoto; Japan
| | - Junko Sugama
- Department of Nursing; School of Health Sciences; Kanazawa University; Ishikawa; Japan
| | - Katsunori Furuta
- Department of Pharmacology; National Center for Geriatrics and Gerontology; Aichi; Japan
| | - Masahiro Tachi
- Department of Plastic Surgery; Tohoku University Graduate School of Medicine; Miyagi; Japan
| | | | - Yoshiki Miyachi
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto; Japan
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Nakagami G, Sanada H, Higashino T, Kadono T, Uchida G, Fujita H, Ogawa Y, Yamamoto Y, Iizaka S, Koyanagi H, Sasaki S, Haga N. Combination of Ultrasonographic and Thermographic Assessments for Predicting Partial-thickness Pressure Ulcer Healing . Wounds 2011; 23:285-292. [PMID: 25879269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED The ability to predict the prognosis of a pressure ulcer is re- quired to establish appropriate management in the early phase. The present study reports the usefulness of a combined assessment tech- nique using ultrasonography and thermography for predicting delayed wound healing. METHODS This retrospective cohort study included 37 patients with Stage I or II pressure ulcers. The patients were followed up for at least 3 weeks. The ultrasonographic and thermographic as- sessments were conducted at the initial multidisciplinary team round. The presence of four ultrasonographic features (unclear layered struc- ture, hypoechoic lesion, discontinuous fascia, and heterogeneous hy- poechoic area) and one thermographic feature (increased temperature) were determined from within the wound bed. Wound healing was re- assessed after 2 weeks and the rate of area reduction was calculated to determine whether the pressure ulcer was healing properly. A mul- tivariate logistic analysis was used to assess the predictive values of the possible assessment features. RESULTS A comprehensive review of the ultrasonographic and thermographic assessments of the pressure ulcers found that the combination of unclear layered structure and increased temperature was beneficial for predicting wound healing. When a pressure ulcer presented with an unclear layered structure and increased temperature in the wound bed, the risk of delayed wound healing or wound deterioration was 6.85 times higher compared with a pressure ulcer that did not have these manifestations. CONCLUSION The combination of ultrasonographic and thermographic assessments facilitates precise prediction of pressure ulcer outcomes.
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Affiliation(s)
- Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan;
| | - Takuya Higashino
- Department of Plastic Surgery, Asahi General Hospital, Chiba, Japan
| | - Takafumi Kadono
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Gentaro Uchida
- Department of Plastic Surgery, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hideki Fujita
- Department of Dermatology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuki Ogawa
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuko Yamamoto
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan
| | - Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroe Koyanagi
- Department of Nursing, The University of Tokyo Hospital, Japan
| | - Sanae Sasaki
- Department of Nursing, The University of Tokyo Hospital, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Japan
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Iizaka S, Sanada H, Matsui Y, Furue M, Tachibana T, Nakayama T, Sugama J, Furuta K, Tachi M, Tokunaga K, Miyachi Y. Serum albumin level is a limited nutritional marker for predicting wound healing in patients with pressure ulcer: two multicenter prospective cohort studies. Clin Nutr 2011; 30:738-45. [PMID: 21802178 DOI: 10.1016/j.clnu.2011.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/05/2011] [Accepted: 07/08/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS We aimed to investigate the predictive validity of serum albumin for pressure ulcer healing, according to patient condition and wound characteristics. METHODS This study was a secondary analysis of pooled data from two multicentre cohort studies undertaken in 2005 and 2007. All adult patients with pressure ulcer were included and were tracked until wound healing or discharge from care. Baseline serum albumin data were obtained from medical charts. RESULTS A total of 2530 patients were analyzed. By multivariate Cox proportional hazards analysis, higher serum albumin level was associated with wound healing of only superficial pressure ulcers for patients in acute/postoperative conditions (hazard ratio 1.29, 95% confidence interval 1.13-1.46) and the cutoff point was 24/25 g/L. However, the addition of serum albumin level to other factors resulted in little increase in the ability to predict wound healing as measured by the overall C-statistics. For patients in chronic/palliative conditions, serum albumin level as the continuous variable was not significantly associated with ulcer healing. CONCLUSIONS The addition of serum albumin marker may not have much advantage to predict pressure ulcer healing although its level can be associated with ulcer healing, depending on patient condition and wound depth.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Faculty of Medicine Bldg. No. 5-308, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Nagase T, Sanada H, Takehara K, Oe M, Iizaka S, Ohashi Y, Oba M, Kadowaki T, Nakagami G. Variations of plantar thermographic patterns in normal controls and non-ulcer diabetic patients: Novel classification using angiosome concept. J Plast Reconstr Aesthet Surg 2011; 64:860-6. [DOI: 10.1016/j.bjps.2010.12.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 10/25/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
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Akase T, Shimada T, Harasawa Y, Akase T, Ikeya Y, Nagai E, Iizuka S, Nakagami G, Iizaka S, Sanada H, Aburada M. Preventive Effects of Salacia reticulata on Obesity and Metabolic Disorders in TSOD Mice. Evid Based Complement Alternat Med 2011; 2011:484590. [PMID: 19505975 PMCID: PMC3136534 DOI: 10.1093/ecam/nep052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/23/2009] [Indexed: 12/22/2022]
Abstract
The extracts of Salacia reticulata (Salacia extract), a plant that has been used for the treatment of early diabetes, rheumatism and gonorrhea in Ayurveda, have been shown to have an anti-obesity effect and suppress hyperglycemia. In this study, the effects of Salacia extract on various symptoms of metabolic disorder were investigated and compared using these TSOD mice and non-obese TSNO mice. Body weight, food intake, plasma biochemistry, visceral and subcutaneous fat (X-ray and CT), glucose tolerance, blood pressure and pain tolerance were measured, and histopathological examination of the liver was carried out. A significant dose-dependent decline in the gain in body weight, accumulation of visceral and subcutaneous fat and an improvement of abnormal glucose tolerance, hypertension and peripheral neuropathy were noticed in TSOD mice. In addition, hepatocellular swelling, fatty degeneration of hepatocytes, inflammatory cell infiltration and single-cell necrosis were observed on histopathological examination of the liver in TSOD mice. Salacia extract markedly improved these symptoms upon treatment. Based on the above results, it is concluded that Salacia extract has remarkable potential to prevent obesity and associated metabolic disorders including the development of metabolic syndrome.
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Affiliation(s)
- Tomoko Akase
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Iizaka S, Sugama J, Nakagami G, Kaitani T, Naito A, Koyanagi H, Matsuo J, Kadono T, Konya C, Sanada H. Concurrent validation and reliability of digital image analysis of granulation tissue color for clinical pressure ulcers. Wound Repair Regen 2011; 19:455-63. [PMID: 21518090 DOI: 10.1111/j.1524-475x.2011.00686.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Granulation tissue color is one indicator for pressure ulcer (PU) assessment. However, it entails a subjective evaluation only, and quantitative methods have not been established. We developed color indicators from digital image analysis and investigated their concurrent validity and reliability for clinical PUs. A cross-sectional study was conducted on 47 patients with 55 full-thickness PUs. After color calibration, a wound photograph was converted into three images representing red color: erythema index (EI), modified erythema index with additional color calibration (granulation red index [GRI]), and , which represents the artificially created red-green axis of L(*) a(*) b(*) color space. The mean intensity of the granulation tissue region and the percentage of pixels exceeding the optimal cutoff intensity (% intensity) were calculated. Mean GRI (ρ=0.39, p=0.007) and (ρ=0.55, p<0.001), as well as their % intensity indicators, showed positive correlations with a(*) measured by tristimulus colorimeter, but erythema index did not. They were correlated with hydroxyproline concentration in wound fluid, healthy granulation tissue area, and blood hemoglobin level. Intra- and interrater reliability of the indicator calculation using both GRI and had an intraclass correlation coefficient >0.9. GRI and from digital image analysis can quantitatively evaluate granulation tissue color of clinical PUs.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan
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Minematsu T, Yamamoto Y, Nagase T, Naito A, Takehara K, Iizaka S, Komagata K, Huang L, Nakagami G, Akase T, Oe M, Yoshimura K, Ishizuka T, Sugama J, Sanada H. Aging enhances maceration-induced ultrastructural alteration of the epidermis and impairment of skin barrier function. J Dermatol Sci 2011; 62:160-8. [PMID: 21498052 DOI: 10.1016/j.jdermsci.2011.03.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/04/2011] [Accepted: 03/13/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin maceration is recognized as a risk factor for the development of certain skin lesions. In health care settings, incontinence-associated skin maceration is highly prevalent in the elderly. However, the effect of senescence on maceration has not been fully elucidated. OBJECTIVE To reveal the enhancement of the maceration-induced ultrastructural alteration and barrier function of the epidermis by aging. METHODS Skin maceration was reproduced by exposure to agarose gel in human and rat. The ultrastructural alterations in human and rat tissue were observed by transmission electron microscopy. The skin barrier function was evaluated by noninvasive methods in human, and by the transdermal penetration of small- and large-fluorescent molecules in rat. In order to reveal the effect of aging on the skin maceration, we compared these parameters between young and aged rats. RESULTS In macerated skin, we observed expansion of the interstices of the stratum corneum, spinosum, and basale of the epidermis; disruption of the intercellular lipid structure in the stratum corneum; a decreased number of cell processes in the stratum spinosum and basale. The transdermal penetration test in the rat using two types of fluorescein indicated that maceration disrupted skin barrier function. Furthermore, senescence-enhanced ultrastructural and functional alterations were revealed in the rodent studies. CONCLUSION This study demonstrates that aging enhances skin maceration. Considering that maceration is a risk factor for the skin damage, the development of technology to promote skin barrier recovery after maceration in the elderly is warranted.
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Affiliation(s)
- Takeo Minematsu
- Department of Advanced Skin Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Takehara K, Oe M, Tsunemi Y, Nagase T, Ohashi Y, Iizaka S, Ueki K, Tsukamoto K, Kadowaki T, Sanada H. Factors associated with presence and severity of toenail onychomycosis in patients with diabetes: a cross-sectional study. Int J Nurs Stud 2011; 48:1101-8. [PMID: 21367414 DOI: 10.1016/j.ijnurstu.2011.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 02/02/2011] [Accepted: 02/05/2011] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify the factors associated with toenail onychomycosis in patients with diabetes. METHODS In this cross-sectional, observational study, the presence and severity (area of nail involvement and nail thickness) of toenail onychomycosis and related factors were examined. One hundred and thirteen patients with diabetes were surveyed at the Diabetic Foot Outpatient Clinic at the University hospital. Toenails of all patients enrolled in the survey were examined whether onychomycosis was present or absent by mycological examination. The severity of onychomycosis was assessed by clinical evaluation, using the area of nail involvement and the nail thickness. RESULTS Fifty eight (51.3%) patients had toenail onychomycosis. The presence of onychomycosis was significantly associated with not washing of feet every day (the unadjusted model, OR: 3.45, 95% CI: 1.24-9.65, P=0.018). The median area of nail involvement was 50.0% (range 5.0-100.0%). A larger area of involvement was significantly related to a lower toe brachial index (β=-67.46, P=0.040). The median nail thickness with onychomycosis was 1.14 mm (range 0.68-9.86 mm). Increasing thickness was significantly correlated with higher hemoglobin A(1)c levels (β=0.98, P=0.003). CONCLUSIONS This study suggested that daily washing of feet may reduce the risk of onychomycosis in patients with diabetes. This suggested that education regarding the importance of the washing of feet every day and support for continuous self-care might be effective in the prevention of onychomycosis in patients with diabetes. Furthermore, good control of blood glucose might prevent increasing nail thickness. This study may highlight importance of early nursing educational intervention to improve patients' daily life style for prevention of onychomycosis induced diabetic foot ulcers.
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Affiliation(s)
- Kimie Takehara
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Japan
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Nakagami G, Sanada H, Iizaka S, Kadono T, Higashino T, Koyanagi H, Haga N. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. J Wound Care 2011; 19:465-6, 468, 470 passim. [PMID: 21135794 DOI: 10.12968/jowc.2010.19.11.79695] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate whether thermography can be used to detect latent inflammation in pressure ulcers and predict pressure ulcer prognosis in a clinical setting. METHOD For this cohort study, we recruited 35 patients with stage II-IV pressure ulcers on the torso, who underwent thermographic assessment on discovery of their pressure ulcer. The patients were followed up for at least 3 weeks. Thermography was performed immediately after dressing removal. Pressure ulcers were classified into two groups depending on whether or not the wound site temperature was lower or higher than the periwound skin: the low temperature group and the high temperature group respectively. A generalised estimation equation was used to estimate the relative risk of delayed healing of pressure ulcers, comparing wounds with high temperatures and low temperatures. RESULTS Of the 35 patients, 21 had 'low temperature' wounds and 14 had 'high temperature' wounds at baseline. Two patients in the high temperature group presented with overt infection, and were excluded from further analysis. Twenty-two pressure ulcers were considered to heal 'normally' (that is, the wound area reduced by 30% or more within 3 weeks) and 16 did not heal. The baseline DESIGN score (a measure of gross wound status) did not differ in any subscales between the high and low temperature groups. The relative risk for delayed healing in high temperature cases was 2.25 (95% confidence intervals; 1.13-4.47, p=0.021). Sensitivity was 0.56, specificity was 0.82, positive predictive value was 0.75, and negative predictive value was 0.67. CONCLUSION Our results indicate that using thermography to classify pressure ulcers according to temperature could be a useful predictor of healing at 3 weeks, even though wound appearances may not differ at the point of thermographical assessment. The higher temperature in the wound site, when compared with periwound skin, may imply the presence of critical colonisation, or other factors which disturb the wound healing.
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Affiliation(s)
- G Nakagami
- Department of Gerontological Nursing / Wound Care, the University of Tokyo, Tokyo, Japan
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Iizaka S, Sanada H, Minematsu T, Oba M, Nakagami G, Koyanagi H, Nagase T, Konya C, Sugama J. Do nutritional markers in wound fluid reflect pressure ulcer status? Wound Repair Regen 2010; 18:31-7. [PMID: 20082679 DOI: 10.1111/j.1524-475x.2009.00564.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Evaluation of wound fluid characteristics for pressure ulcer (PU) assessment in clinical settings remains subjective, requiring considerable expertise. This cross-sectional study focused on nutritional markers in wound fluid as possible objective tools and investigated whether they reflect the PU status according to the healing phase, infection, and granulation, especially after adjusting for serum values. Twenty-eight patients with 32 full-thickness PUs were studied. The concentration of albumin, total protein, glucose, and zinc in wound fluid were measured. For PU status, the healing phases and infection were evaluated by clinical signs, and the degree of granulation tissue formation was determined as the hydroxyproline concentration. The wound fluid/serum ratio for albumin was significantly lower during the inflammatory phase than during the proliferative phase (p=0.020). Infected wound fluid contained less glucose (0.3-1.0 mmol/L) than noninfected ones did (5.0-7.6 mmol/L) in an intraindividual comparison of three cases. The wound fluid/serum ratio for glucose was negatively correlated with hydroxyproline level in the proliferative phase (rho=-0.73, p=0.007), while zinc level in wound fluid showed a positive correlation (rho=0.61, p=0.028). Our results suggest that these traditional nutritional markers in wound fluid, especially wound fluid/serum ratio may be useful to evaluate local PU status.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/ Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Iizaka S, Sanada H, Nakagami G, Sekine R, Koyanagi H, Konya C, Sugama J. Estimation of protein loss from wound fluid in older patients with severe pressure ulcers. Nutrition 2009; 26:890-5. [PMID: 20022467 DOI: 10.1016/j.nut.2009.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/13/2009] [Accepted: 09/13/2009] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Protein loss from wound fluid is usually recognized as one of the factors contributing to the deterioration of the nutritional status in older patients with severe pressure ulcers. We quantified the protein loss owing to pressure ulcers and investigated associations with wound-related factors and nutritional status. METHODS This cross-sectional study included 25 patients (>or=60 y) from 10 institutions, with full-thickness pressure ulcers. Wound fluid was collected once after accumulating beneath a film dressing. The amount of protein loss per day was estimated by the volume of wound fluid per hour and the total protein concentration in the wound fluid. Wound evaluations and nutritional assessments were performed. Correlations between variables were obtained using Spearman's rank correlation. RESULTS The median age of the patients was 79 y (range 61-100), and median body mass index was 19.6 kg/m(2) (12.2-24.9). The median amount of protein loss was 0.2g/d (0.04-2.1), which corresponded to 0.01 g x kg(-1) x d(-1) (<0.01-0.04) and 0.6% (0.1-13.8) of protein intake. Four wounds characterized as infected or surgically debrided lost 1.5-2.1g of protein per day, which was substantially higher than other wounds lost. Protein loss was correlated with wound severity including area, depth, the wound severity score, and infectious markers (all Ps<0.05), but not with body mass index or arm muscle circumference (P>0.05). CONCLUSION The amount of protein loss could be small and thus may not be related directly to nutritional status, although it increased as the wound became more severe.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Sanada H, Nakagami G, Mizokami Y, Minami Y, Yamamoto A, Oe M, Kaitani T, Iizaka S. Evaluating the effect of the new incentive system for high-risk pressure ulcer patients on wound healing and cost-effectiveness: a cohort study. Int J Nurs Stud 2009; 47:279-86. [PMID: 19748617 DOI: 10.1016/j.ijnurstu.2009.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 06/04/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and cost-effectiveness of new incentive system for pressure ulcer management, which focused on skilled nurse staffing in terms of rate of healing and medical costs. DESIGN, SETTING AND PARTICIPANTS A prospective cohort study included two types of groups: 39 institutions, which introduced the new incentive system, and 20 non-introduced groups (control). Sixty-seven patients suffering from severe pressure ulcers in the introduced group and 38 patients in the non-introduced group were included. Wound healing and medical costs were monitored weekly for three weeks by their skilled nurses in charge. MAIN OUTCOME MEASURES Healing status and related medical costs. RESULTS The introduced group showed significantly higher rate of healing compared with the control group at each weekly assessment. Multiple regression analysis revealed that the introduction of the new incentive system was independently associated with the faster healing rate (beta=3.44, P<.001). The budget impact analysis demonstrated that introducing this system could reduce cost of treating severe pressure ulcers by 1.776 billion yen per year. CONCLUSIONS The new incentive system for the management of pressure ulcers, which focused on staffing with skilled nurses can improve healing rate with reduced medical cost.
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Affiliation(s)
- Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Nishide K, Nagase T, Oba M, Oe M, Ohashi Y, Iizaka S, Nakagami G, Kadowaki T, Sanada H. Ultrasonographic and thermographic screening for latent inflammation in diabetic foot callus. Diabetes Res Clin Pract 2009; 85:304-9. [PMID: 19586674 DOI: 10.1016/j.diabres.2009.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 05/21/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
Abstract
AIMS Inflammation within the diabetic foot callus may be an earliest, predicting symptom of foot ulcer developing later. The purpose of this study was to identify latent inflammation within the foot callus using thermography and ultrasonography, and to investigate relationship between the inflammatory findings in callus and presence or absence of diabetes. METHODS This was a cross-sectional study of 60 cases with asymptomatic foot callus; the 30 diabetic patients and the 30 non-diabetic matched volunteers. Inflammation was defined using physiological imaging techniques; as skin temperature elevation in thermography and low echoic lesion in ultrasonography. RESULTS Sixty-three and ninety-four calli were observed in the diabetic and non-diabetic groups, respectively. The inflammation signs were detected by both of the two techniques in 10% of the calli in the diabetic group. No inflammation was noted in the non-diabetic group (p=0.014). CONCLUSIONS The inflammation signs presented here were specifically observed in the diabetic group. We consider that the physiological imaging techniques may be valuable screening tools for potential risk of diabetic foot ulcers.
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Affiliation(s)
- Kaoru Nishide
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033 Tokyo, Japan
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Yabunaka K, Iizaka S, Nakagami G, Aoi N, Kadono T, Koyanagi H, Uno M, Ohue M, Sanada S, Sanada H. Can ultrasonographic evaluation of subcutaneous fat predict pressure ulceration? J Wound Care 2009; 18:192, 194, 196 passim. [DOI: 10.12968/jowc.2009.18.5.42173] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Yabunaka
- Department of Radiology, Katsuragi Hospital, Kishiwada City, Osaka, Japan
| | - S. Iizaka
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, University of Tokyo
| | - G. Nakagami
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, University of Tokyo
| | - N. Aoi
- University of Tokyo Hospital
| | | | | | - M. Uno
- University of Tokyo Hospital
| | - M. Ohue
- Department of Orthopedics, Katsuragi Hospital, Kishwada City, Osaka, Japan
| | - S. Sanada
- Graduate School of Health Sciences, Kanazawa University, Kanazawa City, Ishikawa, Japan
| | - H. Sanada
- Department of Gerontological Nursing/Wound Care Management, Division of Health Sciences and Nursing, University of Tokyo
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Sari Y, Nakagami G, Kinoshita A, Huang L, Ueda K, Iizaka S, Sanada H, Sugama J. Changes in serum and exudate creatine phosphokinase concentrations as an indicator of deep tissue injury: a pilot study. Int Wound J 2009; 5:674-80. [PMID: 19134069 DOI: 10.1111/j.1742-481x.2008.00543.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Deep tissue injury (DTI) is difficult to detect in the early phase. Creatine phosphokinase (CPK) as a muscle enzyme could represent a promising indicator of DTI. However, serum CPK levels reflect the systemic condition rather than the local wound environment. Wound exudates can be indicative of the local wound environment. This study aimed to investigate the usefulness of CPK levels in wound exudates as an indicator of DTI. Rats were divided into control, 6 hours 10-kg and 6 hours 20-kg loading groups. Serum samples were obtained before wounding, and at 8 and 12 hours, and 1, 2 and 3 days after wounding, while exudate samples were obtained on days 2 and 3. Serum CPK levels were markedly increased in the 10-kg and 20-kg groups at 8 and 12 hours after loading compared with the baseline value and control group, but decreased to the normal level on day 1. In both loading groups, exudate CPK levels were high on day 2 and decreased on day 3. Muscle necrosis was more severe in the 20-kg group than in the 10-kg group by histological examination. This is the first study to indicate the potential of CPK in wound exudates as an indicator of DTI.
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Affiliation(s)
- Yunita Sari
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Iizaka S, Nakagami G, Urasaki M, Sanada H. Influence of the "hammock effect" in wheelchair cushion cover on mechanical loading over the ischial tuberosity in an artificial buttocks model. J Tissue Viability 2008; 18:47-54. [PMID: 18926705 DOI: 10.1016/j.jtv.2008.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 08/03/2008] [Accepted: 08/22/2008] [Indexed: 11/19/2022]
Abstract
The purpose of this study is to quantify hammock effects over artificial bony prominence using a newly developed buttocks model similar to human buttocks, and examine differences between various cushions and covers. A repeated measures design was used where immersions were measured with diverse weights on each type of cushion with or without covers. Polyurethane foam and air-cell cushions were used. Elastic original covers (cover 1) were evaluated for each cushion, and another less elastic cover (cover 2) was also used for the foam cushion. "Immersion" was defined as the difference in gauge readings between no load and each loading phase. Hammock effect was estimated by calculating the difference in load with and without a cover at any immersion from the approximate regression equation on immersion. All intraclass correlations were more than 0.99. The absolute hammock effect for each cover for each cushion increased as the immersion deepened. For the air-cell cushion, the relative hammock effect also increased and was higher than that for foam cushion at deeper immersion. For the foam cushion, the relative hammock effect on the cushion with cover 2 (160.5-188.6%) was higher than that with cover 1 (107.3-123.7%) at any immersion. The hammock effect could be quantified by the validated and reliable model. The mechanical property of the covers, the pressure redistributing property of the cushions and the length of bony prominence all influenced the intensity of the hammock effect.
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Affiliation(s)
- Shinji Iizaka
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, the University of Tokyo, Faculty of Medicine Bldg. 5-308, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Iizaka S, Tadaka E, Sanada H. Comprehensive assessment of nutritional status and associated factors in the healthy, community-dwelling elderly. Geriatr Gerontol Int 2008; 8:24-31. [DOI: 10.1111/j.1447-0594.2008.00443.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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