Evaluating the impact of an interdisciplinary integrated limb preservation service operating concurrently with a single-specialty service

BACKGROUND

This study examined the efficacy of an interdisciplinary limb preservation service (LPS) in improving surgical outcomes for diabetic foot ulcer (DFU) patients compared to traditional care.

METHODS

Data from January 1, 2017 to September 30, 2020 were retrospectively reviewed. An interdisciplinary LPS clinic began on August 1, 2018, coexisting with a preexisting single specialty service. Primary outcomes were major/minor amputation rates and ratios and hospital length of stay. Surgical endpoints pre- and post-LPS launch were compared.

RESULTS

Among 976 procedures for 731 unique DFU patients, most were male (80.4%) and Hispanic (89.3%). Patient demographics were consistent before and after LPS initiation. Major amputation rates decreased by 45.5% (15.4%-8.4%, p = 0.001), with outpatient procedures increasing over 5-fold (3.3% pre-LPS to 18.7% post-LPS, p < 0.001). Hospital stay reduced from 10.1 to 8.5 days post-LPS (p < 0.001). The major to minor amputation ratio declined from 22.4% to 12.7%.

CONCLUSIONS

The interdisciplinary LPS improved patient outcomes, marked by fewer major amputations and reduced hospital stays, suggesting the model's potential for broader application.

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.

The clinical and cost effectiveness of remote expert wound nurse consultation for healing of pressure injuries among residential aged care patients: A protocol for a prospective pilot parallel cluster randomised controlled trial

Pressure injuries affect 1 to 46% of residents in aged care (long term) facilities and cause a substantial economic burden on health care systems. Remote expert wound nurse consultation has the potential to improve pressure injury outcomes; however, the clinical and cost effectiveness of this intervention for healing of pressure injuries in residential aged care require further investigation. We describe the remote expert wound nurse consultation intervention and the method of a prospective, pilot, cluster randomised controlled trial. The primary outcome is number of wounds healed. Secondary outcomes are wound healing rate, time to healing, wound infection, satisfaction, quality of life, cost of treatment and care, hospitalisations, and deaths. Intervention group participants receive the intervention over a 12-week period and all participants are monitored for 24 weeks. A wound imaging and measurement system is used to analyse pressure injury images. A feasibility and fidelity evaluation will be concurrently conducted. The results of the trial will inform the merit of and justification for a future definitive trial to evaluate the clinical and cost effectiveness of remote expert wound nurse consultation for the healing of pressure injuries in residential aged care.

The Effect of Padded Adhesive Dressing and Static Body Position on Sacral Interface Pressure

OBJECTIVES

Padded adhesive bandages are frequently used in the inpatient setting for sacral pressure injury prevention, but it is unclear whether they truly decrease interface pressure. We hypothesized such devices reduce sacral peak interface pressure in the supine position, which would be further reduced in 30-degree reclined and upright seated positions.

METHODS

Study participants rested with their sacrum on a pressure-sensing mat, in 3 positions, for 30 seconds each: (1) sitting upright; (2) supine; and (3) supine against 30-degree wedge. Measurements were made with and without a padded adhesive bandage overlying the sacrum. Age, sex, and body mass index (BMI) were collected. These variables were entered sequentially, in an a priori order to construct a linear mixed-effects model.

RESULTS

Forty healthy adults participated. After controlling for by-subject variation, age, and sex, BMI did not influence peak sacral pressure (P = 0.22), although the effect of body position was significant (P < 0.01). Subsequent addition of padded adhesive dressing was nonsignificant (P = 0.17); sacral peak pressure was similar with a padded adhesive dressing (247.8 ± 147.3 mm Hg) or without (mean ± standard deviation = 229.8 ± 127.7 mm Hg). Lastly, there was no significant interaction between BMI and body position (P = 0.11).

CONCLUSIONS

Padded adhesive bandages did not reduce interface pressure in any position. Sacral pressure was highest in the supine position and was not specifically affected by BMI. If padded bandages provide clinically significant reduction in pressure injury incidence, it is not simply through the reduction of interface pressure.

A Multi-Site Thailand Heart Failure Snapshot Study

BACKGROUND

The prevalence of heart failure (HF) is increasing in many low-income and middle-income countries, but the limited availability of data on patient profiles and clinical outcomes, particularly at a community level, challenges health service planning.

METHODS

The Thai HF Snapshot Study was a multi-site, observational study conducted in Thailand between June 2017 to June 2019. It aimed to document demographic, clinical and sociodemographic characteristics, and to compare clinical outcomes by the level of the hospital.

RESULTS

A total of 512 participants were recruited across Thailand: mean age was 64.9±15.3 years and 286 were female (55.9%). The most frequently identified admitting diagnosis was ischaemic heart disease (45.1%). Most patients (70.3%) were classified as New York Heart Association class II at discharge. Patients in university hospitals were frailer (3.2 vs 2.9; p=0.015), had more depressive symptoms (8.1 vs 5.7; p<0.001), and had lower functional status (66.2 vs 73.3; p<0.001) than those in tertiary care.

CONCLUSION

Although HF patients admitted to university hospitals had access to advanced technology and health care specialists, clinical outcomes likely affected patient acuity. Interventions are urgently needed to ensure improved HF management considering the social determinants of health in Thailand.

Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction

BACKGROUND

Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments.

METHODS AND RESULTS

The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants.

CONCLUSIONS

This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.

Visual rehabilitation in low vision patients with aging macular degeneration

Using optical visual aids, visual rehabilitation was performed in 14 cases (25 eyes) for low-vision patients with aging macular degeneration (AMD). With distance aids, visual acuity improvements were recorded for 24 eyes (95 percent) out of 25 eyes. Twelve eyes (48 percent) achieved vision equal to or better than 0.4. Utilizing near visual aids, the near visual acuity for all eyes (100 percent) were improved. Thirteen eyes (52 percent) received near vision equal to or better than 0.5. Ten patients were able to read No. 5 equal to or better than 0.5. Ten patients were able to read No. 5 Chinese print (corresponding visual angle is 0.67 at 30 cm of reading distance). The reading success rate was 71.4 percent. The results suggest that the application of visual aids is an effective method to improve the distance and near visual acuity of low vision patients with AMD.