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Postepy Dermatologii I Alergologii Apr 2024As a catastrophic complication of bedridden and elderly patients, pressure ulcer usually continuously affects patients' health and quality of life, so the daily care of...
Clinical evaluation of continuous irrigation with Bikerui combined with negative pressure closed drainage and platelet-rich plasma technique for treatment of stage III-IV pressure ulcer.
INTRODUCTION
As a catastrophic complication of bedridden and elderly patients, pressure ulcer usually continuously affects patients' health and quality of life, so the daily care of wounds is attached great importance in clinic.
AIM
This work investigated the effect of Bikerui disinfectant + vacuum sealing drainage (VSD) + platelet-rich plasma (PRP) therapy on patients with stage III ~ IV pressure sore.
MATERIAL AND METHODS
In this work, 110 patients with pressure ulcer (PU) treated in our hospital were enrolled and were randomly divided into an experimental group (Exp group) and a control group (Ctrl group) by a blind selection method, with 55 cases in each group. Patients in the Ctrl group received surgical debridement + VSD for treatment, while those in the Exp group were treated with Bikerui disinfectant + VSD + PRP. Inflammatory response (IR) score, PU healing (PUH) score, healing time, dressing change frequency (DCF), dressing interval time (DIT), and scar recovery (SR) score of patients in different groups were compared.
RESULTS
The results revealed that the positive rate of bacterial culture in wound secretions in the Exp group was greatly lower than that in the Ctrl group 1 or 2 weeks after treatment ( < 0.05). The IR score in the Exp group was much lower at week 1 and 2 after treatment ( < 0.05). The total effective rate (TER) in the Exp group was obviously higher than that in the Ctrl group (94.55% vs. 76.36%).
CONCLUSIONS
The results suggested that Bikerui disinfectant + VSD + PRP therapy could effectively improve the inflammatory degree of PU patients, promote the wound repair and scar recovery of patients, and greatly improve the clinical efficacy of PU patients.
PubMed: 38784931
DOI: 10.5114/ada.2024.138675 -
Pressure Injury Prevention in Adult Critically Ill Patients: A Best Practice Implementation Project.The American Journal of Nursing Jun 2024Implementation science is the process of integrating an intervention into practice within an organization or health system and is a useful strategy to improve practice,...
Implementation science is the process of integrating an intervention into practice within an organization or health system and is a useful strategy to improve practice, affect patient outcomes, and promote practice sustainability. In this series, AJN and the journal JBI Evidence Implementation have partnered to deliver examples of how health care facilities from around the world have worked to solve common patient care problems. Through this partnership, we strive to create awareness and share knowledge and experiences by publishing summaries of studies that have appeared in JBI Evidence Implementation. These summaries are designed to provide nursing teams with an overview of the barriers faced and the strategies and resources needed to improve practice and drive change at the unit level. Our goal is to ensure that AJN readers have access to important evidence-based information designed to influence patient outcomes and nursing practice.-Carl A. Kirton, DNP, MBA, RN, ANP, FAAN.
Topics: Humans; Critical Illness; Pressure Ulcer; Adult; Evidence-Based Nursing; Implementation Science; Practice Guidelines as Topic
PubMed: 38780338
DOI: 10.1097/01.NAJ.0001023964.06635.13 -
Biological Trace Element Research May 2024Bedsores impose an important challenge to the healthcare system. Se-baring probiotics are considered effective agents in wound healing and inflammation reduction via...
Bedsores impose an important challenge to the healthcare system. Se-baring probiotics are considered effective agents in wound healing and inflammation reduction via several pathways. The present study focused on the administration of a Se-enriched probiotic, originally obtained from a traditional dairy product for bedsore healing. Daily doses of the probiotic were administered to 20 ICU patients for 14 days and the wound healing criteria were compared with those of the same group of ICU patients as control, both groups suffering from stages I and II bedsore (a randomized, double-blind, controlled clinical trial). The administered Se-enriched probiotic decreased the bedsore healing period significantly (on average by 2.4 days, P-value: 0.039), as well as bedsore size (on average by 7 mm, nonsignificant) and bedsore grade (10%, nonsignificant) in the treatment group more efficiently than the control group. Some key laboratory parameters associated with inflammation were also improved in patients receiving the Se-supplemented probiotic. The limitations of this study include the low number of patients meeting inclusion criteria within the timeframe of the study, and the impossibility of following up patients after discharge from the ICU. In summary, this study revealed the effectiveness of the Se-enriched probiotic in bedsore improvement, suggesting consideration of the enriched probiotic as an auxiliary agent in bedsore management.
PubMed: 38773035
DOI: 10.1007/s12011-024-04233-1 -
International Wound Journal May 2024Older adults are at increased risk of pressure injuries (PIs) due to age-related changes. Traditionally, PI knowledge and education have been delivered in hospitals and... (Review)
Review
Older adults are at increased risk of pressure injuries (PIs) due to age-related changes. Traditionally, PI knowledge and education have been delivered in hospitals and residential aged care facilities, however, there remains a critical gap in understanding how PI knowledge on prevention and management is shared with older adults and their carers living in the community. We aimed to describe the nature and characteristics of structured and unstructured PI education programs available to community-dwelling older adults and their carers. As coping review was undertaken. We searched five databases: CINAHL, Medline, Scopus, Cochrane Library and ProQuest from 2009 to August 2023. The review was guided by Arksey and O'Malley's six-step framework and adhered to the PRISMA-ScR guidelines. It included primary peer-reviewed papers published in English, which focus on PI education for older adults and/or their carers living in community settings. Data extraction was organised in a table, and findings presented as a narrative summary. One-hundred and thirty-six papers were screened and four included in the review. Results indicate that consideration was placed on literacy levels and cognitive status of older adults and their carers when designing PI education materials. Educational materials such as leaflets/brochures, in-person training sessions or a combination of both were used. However, duration of these interventions varied, lasting for 1-4 weeks while others were completed over 12 months. Some improvements in PI knowledge such as how to treat PI, dietary requirements and importance of mobility were noted. However, information retention and its translation into effective long-term behaviour change remained unclear. In conclusion, adopting a multifaceted educational approach increases the effectiveness of PI knowledge translation. Continuous education, support and reinforcement on PIs over time are necessary when interacting with older adults and caregivers to ensure long-term management and prevention success. Conversations on PIs should start at the primary care levels when older adults and carers are visiting their GP clinics and accessing support services for other healthcare needs. Understanding older adults' and carers' literacy levels, cognitive status and cultural background can assist clinicians in designing and delivering fit-for-purpose PI educational interventions that are accessible, relatable and effective in promoting knowledge transfer and behaviour change. Carers are vital conduits in the care continuum. These factors will lead to a more informed, collaborative and person-centred approaches to PI management and prevention.
Topics: Humans; Caregivers; Aged; Pressure Ulcer; Independent Living; Aged, 80 and over; Male; Patient Education as Topic; Female; Middle Aged
PubMed: 38772749
DOI: 10.1111/iwj.14894 -
Advances in Skin & Wound Care Jun 2024Urinary catheter-related meatal pressure injury (UCR-MPI) is a preventable and serious complication of indwelling urinary catheter use. This prospective study aimed to...
OBJECTIVE
Urinary catheter-related meatal pressure injury (UCR-MPI) is a preventable and serious complication of indwelling urinary catheter use. This prospective study aimed to determine the prevalence and risk factors of UCR-MPI in male critical care patients.
METHODS
A total of 138 male patients 18 years and older using an indwelling urinary catheter were included in the study. Participants' perineal areas were assessed daily for the development of MPI.
RESULTS
The UCR-MPI prevalence was 26.1% (n = 36/138). Most patients (61.1%) had a grade I UCR-MPI with intact skin and mucosa and nonblanchable erythema. Urinary catheter irrigation (P = .001), lower Braden Scale scores (P = .040), lower Glasgow Coma Scale score (P = .002), higher Itaki Fall Risk Scale score (P = .040), higher dependency level (P = .027), hypoalbuminemia (P = .002), and perineal edema (P = .001) were risk factors for UCR-MPI.
CONCLUSIONS
The prevalence of UCR-MPI was high in this sample. Providers should take preventive measures to prevent UCR-MPI in patients with a penis including early and frequent risk assessment.
Topics: Humans; Male; Prospective Studies; Pressure Ulcer; Middle Aged; Risk Factors; Urinary Catheterization; Aged; Adult; Critical Care; Urinary Catheters; Catheters, Indwelling; Prevalence; Risk Assessment
PubMed: 38767425
DOI: 10.1097/ASW.0000000000000157 -
World Journal of Diabetes May 2024Diabetes foot is one of the most serious complications of diabetes and an important cause of death and disability, traditional treatment has poor efficacy and there is... (Clinical Trial)
Clinical Trial
BACKGROUND
Diabetes foot is one of the most serious complications of diabetes and an important cause of death and disability, traditional treatment has poor efficacy and there is an urgent need to develop a practical treatment method.
AIM
To investigate whether Huangma Ding or autologous platelet-rich gel (APG) treatment would benefit diabetic lower extremity arterial disease (LEAD) patients with foot ulcers.
METHODS
A total of 155 diabetic LEAD patients with foot ulcers were enrolled and divided into three groups: Group A (62 patients; basal treatment), Group B (38 patients; basal treatment and APG), and Group C (55 patients; basal treatment and Huangma Ding). All patients underwent routine follow-up visits for six months. After follow-up, we calculated the changes in all variables from baseline and determined the differences between groups and the relationships between parameters.
RESULTS
The infection status of the three groups before treatment was the same. Procalcitonin (PCT) improved after APG and Huangma Ding treatment more than after traditional treatment and was significantly greater in Group C than in Group B. Logistic regression analysis revealed that PCT was positively correlated with total amputation, primary amputation, and minor amputation rates. The ankle-brachial pressure and the transcutaneous oxygen pressure in Groups B and C were greater than those in Group A. The major amputation rate, minor amputation rate, and total amputation times in Groups B and C were lower than those in Group A.
CONCLUSION
Our research indicated that diabetic foot ulcers (DFUs) lead to major amputation, minor amputation, and total amputation through local infection and poor microcirculation and macrocirculation. Huangma Ding and APG were effective attreating DFUs. The clinical efficacy of Huangma Ding was better than that of autologous platelet gel, which may be related to the better control of local infection by Huangma Ding. This finding suggested that in patients with DFUs combined with coinfection, controlling infection is as important as improving circulation.
PubMed: 38766441
DOI: 10.4239/wjd.v15.i5.923 -
Cell Transplantation 2024Pressure injuries, or pressure ulcers, are a common problem that may lead to infections and major complications, besides being a social and economic burden due to the...
Pressure injuries, or pressure ulcers, are a common problem that may lead to infections and major complications, besides being a social and economic burden due to the costs of treatment and hospitalization. While surgery is sometimes necessary, this also has complications such as recurrence or wound dehiscence. Among the newer methods of pressure injury treatment, advanced therapies are an interesting option. This study examines the healing properties of bone marrow mononuclear cells (BM-MNCs) embedded in a plasma-based scaffold in a mouse model. Pressure ulcers were created on the backs of mice (2 per mouse) using magnets and assigned to a group of ulcers that were left untreated (Control, n = 15), treated with plasma scaffold (Plasma, n = 15), or treated with plasma scaffold containing BM-MNC (Plasma + BM-MNC, n = 15). Each group was examined at three time points (3, 7, and 14 days) after the onset of treatment. At each time point, animals were subjected to biometric assessment, bioluminescence imaging, and tomography. Once treatment had finished, skin biopsies were processed for histological and wound healing reverse transcription polymerase chain reaction (RT-PCR) array studies. While wound closure percentages were higher in the Plasma and Plasma + BM-MNC groups, differences were not significant, and thus descriptive data are provided. In all individuals, the presence of donor cells was revealed by immunohistochemistry on posttreatment onset Days 3, 7, and 14. In the Plasma + BM-MNC group, less inflammation was observed by positron emission tomography-computed tomography (PET/CT) imaging of the mice at 7 days, and a complete morphometabolic response was produced at 14 days, in accordance with histological results. A much more pronounced inflammatory process was observed in controls than in the other two groups, and this persisted until Day 14 after treatment onset. RT-PCR array gene expression patterns were also found to vary significantly, with the greatest difference noted between both treatments at 14 days when 11 genes were differentially expressed.
Topics: Animals; Wound Healing; Pressure Ulcer; Mice; Disease Models, Animal; Bone Marrow Cells; Male; Tissue Scaffolds; Mice, Inbred C57BL; Bone Marrow Transplantation; Leukocytes, Mononuclear
PubMed: 38761062
DOI: 10.1177/09636897241251619 -
JBJS Case Connector Apr 2024A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental...
CASE
A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely. At the 1-year follow-up visit, there were no further signs of pressure injury.
CONCLUSION
This case report describes transiliac-shortening osteotomy as a viable treatment option for non-healing ischial pressure injuries secondary to fixed pelvic obliquity.
Topics: Humans; Male; Adolescent; Osteotomy; Ischium; Pressure Ulcer; Spinal Fusion; Cerebral Palsy; Scoliosis; Ilium
PubMed: 38758928
DOI: 10.2106/JBJS.CC.23.00557 -
Wound Management & Prevention Mar 2024Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on...
BACKGROUND
Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on outpatient and inpatient care settings. This burden is expected to increase markedly in the United States as the population ages and with increased rates of diabetes, obesity, and COVID-19.
PURPOSE
To articulate the effect of chronic, hard-to-heal wounds on acute care facilities, and how a few days of inpatient care can have a significant effect on the healing trajectory.
METHODS
An expert panel of 7 members, all with extensive knowledge and experience in the assessment and treatment of chronic wounds in an acute care setting, was convened in March 2022. The panel discussed the role of hospitals as part of the longer-term healing pathway of chronic wounds.
RESULTS
Chronic wounds have a significant effect on hospitals that includes unseen costs, bed occupancy, demands on bedside nurses, and wound complications that lead to extended stays or readmissions. A successful inpatient wound program offers appropriate identification of previously undiagnosed wounds, elevation of bedside care through simplified protocols, quickly and easily understood education and easy dressing selection, and comprehensive discharge planning with a multidisciplinary team for continuity of care and reduced risk of readmission.
CONCLUSION
Hospitals can play a key role in the management of chronic wounds, thus reducing the effect on each facility and the wider care network.
Topics: Humans; Chronic Disease; Wound Healing; COVID-19; Wounds and Injuries; United States; Diabetic Foot; SARS-CoV-2; Pressure Ulcer
PubMed: 38754105
DOI: 10.25270/wmp.22085 -
Journal of the American College of... Jun 2024The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide...
2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
AIM
The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia).
METHODS
A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate.
STRUCTURE
Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
Topics: Humans; Peripheral Arterial Disease; Lower Extremity; American Heart Association; United States; Cardiology; Societies, Medical
PubMed: 38752899
DOI: 10.1016/j.jacc.2024.02.013