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Healthcare (Basel, Switzerland) Apr 2024Pressure ulcers carry a significant risk in clinical practice. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers...
Pressure ulcers carry a significant risk in clinical practice. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve the data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity, and skin moisture. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. Thus, the primary aim of this approach is to provide nursing professionals with valuable insights for assessing the potential risk levels of pressure ulcers, which could support their decision-making and allow, for example, the application of suitable preventive measures tailored to each patient's requirements. The interpretability of the models proposed and their performance, evaluated through stratified cross-validation, make them a helpful tool for nursing care in estimating the pressure ulcer risk level.
PubMed: 38727470
DOI: 10.3390/healthcare12090913 -
SAGE Open Nursing 2024Nursing students in internship programs can play a role in preventing pressure injuries as they engage in real clinical situations and are assigned to conduct clinical...
INTRODUCTION
Nursing students in internship programs can play a role in preventing pressure injuries as they engage in real clinical situations and are assigned to conduct clinical tasks. Thus, nursing students in internship programs should be adequately prepared in terms of their knowledge and attitudes to contribute to pressure injury prevention.
OBJECTIVE
To explore and understand the knowledge and attitudes of nursing interns toward pressure injury prevention in Saudi Arabia.
METHODS
This cross-sectional study included 161 nursing interns from various public hospitals across three provinces in Saudi Arabia and used an online questionnaire. The Pressure Ulcer Knowledge Assessment Tool and Attitude toward Pressure Ulcer Prevention instrument were used to collect data from nursing students in the internship program. The Statistical Package of the Social Sciences Program version 28 was used for the data analysis.
RESULTS
Participants reported inadequate knowledge regarding the prevention of pressure injuries, with a mean knowledge score of 48.15%. Additionally, the participants showed unsatisfactory attitudes toward the prevention of pressure injuries, with a mean score of 61.36%. Significant differences were observed in knowledge (= 0.008) and attitude (< 0.001) levels between sexes, with female participants scoring higher than male participants. Additionally, students who completed longer internships had better knowledge levels than those who completed shorter internships (= 0.007). In the open-response question, participants reported a lack of preparation and support during the internship and suggested recommendations to address these deficiencies in preparation and support.
CONCLUSION
Nursing interns need pre-internship preparation and continuous learning and support during the internship to manage and prevent pressure injuries.
PubMed: 38715770
DOI: 10.1177/23779608241251631 -
Clinical Interventions in Aging 2024Extracorporeal shock wave therapy (ESWT) is a beneficial adjunct modality for chronic wounds. Limited research has been conducted on pressure ulcers (PUs), while the... (Clinical Trial)
Clinical Trial
PURPOSE
Extracorporeal shock wave therapy (ESWT) is a beneficial adjunct modality for chronic wounds. Limited research has been conducted on pressure ulcers (PUs), while the majority of studies have focused on diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). This study aimed to evaluate the short-term effects of radial ESWT in older adults with chronic wounds.
PATIENTS AND METHODS
This study involved a total of 31 wounds: PUs (n=22), VLUs (n=7), and DFUs (n=2). A single radial ESWT was performed with 300 + 100 shocks per cm, pressure of 2.5 bar, energy of 0.15 mJ/mm, and frequency of 5 Hz. Assessments using digital planimetry and clinical methods, utilizing the Wound Bed Score (WBS) and the Bates-Jansen Wound Assessment Tool (BWAT) were performed before the radial ESWT application (M0) and one week after (M1).
RESULTS
A significant wound decrease in planimetry was noted (pre-ESWT vs post-ESWT), with wound area from 9.4 cm to 6.2 cm, length from 6.4 cm to 3.9 cm, and width from 2.8 cm to 2.1 cm (p<0.001). Additionally, a substantial clinical improvement was noted in both the WBS with a 31.25% increase and the BWAT with a 20.00% increase (p<0.001). It was also found a significant correlation between the planimetric and clinical outcomes for both tools: WBS (r=-0.446, p=0.012) and BWAT (r=0.327, p=0.073).
CONCLUSION
The ESWT application yields substantial immediate clinical effects that support the healing of chronic wounds in older adults. Even a single ESWT session can prove to be clinically effective and beneficial in the management of chronic wounds.
Topics: Humans; Aged; Female; Male; Wound Healing; Aged, 80 and over; Extracorporeal Shockwave Therapy; Pressure Ulcer; Chronic Disease; Varicose Ulcer; Diabetic Foot; Treatment Outcome
PubMed: 38706636
DOI: 10.2147/CIA.S448298 -
Annals of Clinical Microbiology and... May 2024Non-surgical chronic wounds, including diabetes-related foot diseases (DRFD), pressure injuries (PIs) and venous leg ulcers (VLU), are common hard-to-heal wounds. Wound... (Review)
Review
BACKGROUND
Non-surgical chronic wounds, including diabetes-related foot diseases (DRFD), pressure injuries (PIs) and venous leg ulcers (VLU), are common hard-to-heal wounds. Wound evolution partly depends on microbial colonisation or infection, which is often confused by clinicians, thereby hampering proper management. Current routine microbiology investigation of these wounds is based on in vitro culture, focusing only on a limited panel of the most frequently isolated bacteria, leaving a large part of the wound microbiome undocumented.
METHODS
A literature search was conducted on original studies published through October 2022 reporting metagenomic next generation sequencing (mNGS) of chronic wound samples. Studies were eligible for inclusion if they applied 16 S rRNA metagenomics or shotgun metagenomics for microbiome analysis or diagnosis. Case reports, prospective, or retrospective studies were included. However, review articles, animal studies, in vitro model optimisation, benchmarking, treatment optimisation studies, and non-clinical studies were excluded. Articles were identified in PubMed, Google Scholar, Web of Science, Microsoft Academic, Crossref and Semantic Scholar databases.
RESULTS
Of the 3,202 articles found in the initial search, 2,336 articles were removed after deduplication and 834 articles following title and abstract screening. A further 14 were removed after full text reading, with 18 articles finally included. Data were provided for 3,628 patients, including 1,535 DRFDs, 956 VLUs, and 791 PIs, with 164 microbial genera and 116 species identified using mNGS approaches. A high microbial diversity was observed depending on the geographical location and wound evolution. Clinically infected wounds were the most diverse, possibly due to a widespread colonisation by pathogenic bacteria from body and environmental microbiota. mNGS data identified the presence of virus (EBV) and fungi (Candida and Aspergillus species), as well as Staphylococcus and Pseudomonas bacteriophages.
CONCLUSION
This study highlighted the benefit of mNGS for time-effective pathogen genome detection. Despite the majority of the included studies investigating only 16 S rDNA, ignoring a part of viral, fungal and parasite colonisation, mNGS detected a large number of bacteria through the included studies. Such technology could be implemented in routine microbiology for hard-to-heal wound microbiota investigation and post-treatment wound colonisation surveillance.
Topics: Humans; Metagenomics; Bacteria; High-Throughput Nucleotide Sequencing; Wound Healing; Microbiota; Pressure Ulcer; Diabetic Foot; Wound Infection; Varicose Ulcer
PubMed: 38702796
DOI: 10.1186/s12941-024-00698-z -
Cureus Apr 2024Venous ulcers are open wounds commonly associated with chronic venous insufficiency. Each patient's healing process is unique, and factors like nutrition and compression... (Review)
Review
Venous ulcers are open wounds commonly associated with chronic venous insufficiency. Each patient's healing process is unique, and factors like nutrition and compression therapy can affect it. Compression therapy and optimal nutritional status can assist in improving venous blood circulation, decreasing swelling, and promoting wound healing. This in-depth review looks at all the recent research on how nutrition and compression therapy can help heal venous ulcers, aiming to develop evidence-based guidelines for improving treatment outcomes. The systematic review, registered in the International Prospective Register of Systematic Reviews (PROSPERO) and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles, conducted an extensive electronic search in databases such as PubMed, MEDLINE, Cochrane, Web of Science, and Scopus. Using Medical Subject Headings (MeSH) terms and different types of studies, the search method focused on studies that directly looked at how nutrition and compression therapy affected the healing of venous ulcers. After deduplicating and screening publications, a collaborative full-text review was conducted to determine their inclusion. As a result, several research studies were chosen for the qualitative synthesis. The authors created a data extraction form to document important variables such as demographics, therapy specifics, and wound features. Several studies on patients with venous ulcers have shown that consuming basic nutrients can improve wound healing. Treatment results differed depending on the types of compression and pressure intensity. Although minimal data indicates the possible benefits of two-layer therapy, a definitive comparison is still uncertain. Further clinical studies are necessary to investigate a wider range of dietary factors and to evaluate different treatments in similar situations.
PubMed: 38694674
DOI: 10.7759/cureus.57407 -
Avicenna Journal of Medicine Jan 2024The incidence of ulcer pressure in the high care unit (HCU) was relatively high and could be reliably predicted using tools such as the Norton and Jackson/Cubbin...
The incidence of ulcer pressure in the high care unit (HCU) was relatively high and could be reliably predicted using tools such as the Norton and Jackson/Cubbin scales. However, other risk factors, such as age, gender, consciousness, systemic condition, duration of treatment, and use of restraint, may contribute to the occurrence of ulcer pressure. This study was conducted to analyze the relationship of various risk factors for pressure ulcers and prediction of ulcer pressure, using Norton and Jackson/Cubbin scale, to incident pressure ulcers in HCU patient. This study utilized a prospective cross-sectional study design to analyze various risk factors for ulcer pressure development in a patient admitted to the HCU, including age, gender, blood profile, consciousness, duration of treatment, and use of restraint. The Norton and Jackson/Cubbin scale was employed to predict pressure ulcers. The relationship between the risk factors and the prediction of pressure ulcer incidents was evaluated using multiple logistic binary regression analysis. Both the Norton and Jackson/Cubbin scales predicted a lower risk of pressure ulcer development (60.98 and 99.02%, respectively). This prediction is consistent with the low incidence of pressure injuries found, which is only 4.39%. Furthermore, the relationship between the identified risk factor (gender, duration of treatment in HCU and use of restraint) and the prediction and incident of pressure ulcer was not significant ( > 0.05). Thus, it is suggested that these risk factors may not strong predictors of pressure ulcer development. This study's result indicated no significant relationship exists between possible identified risk factors and the development of pressure ulcers in HCU patients. However, the Norton and Jackson/Cubbin scales were reliable predictors of pressure ulcer occurrence, with both scales predicting a lower risk of pressure ulcer development.
PubMed: 38694142
DOI: 10.1055/s-0043-1777420 -
Wounds : a Compendium of Clinical... Mar 2024NPWTi-d of a topical wound solution has been shown to benefit healing in a variety of wound types. This therapy has traditionally been applied via a standard ROCF-V. In... (Observational Study)
Observational Study
BACKGROUND
NPWTi-d of a topical wound solution has been shown to benefit healing in a variety of wound types. This therapy has traditionally been applied via a standard ROCF-V. In 2017, a new ROCF-CC was introduced at the practice of the authors of the current manuscript for adjunctive management of patients with wounds with thick exudate and/or nonviable tissue and in cases in which surgical debridement is not available or not appropriate.
OBJECTIVE
To compare the efficacy of NPWTi-d with ROCF-CC dressing (treatment) vs NPWTi-d with ROCF-V dressing (control).
MATERIALS AND METHODS
An observational retrospective cohort study of hospital records of patients with VLUs treated with NPWTi-d who received ROCF-CC dressings (n = 11) vs standard ROCF-V dressings (n = 11) was conducted. NPWTi-d was chosen to promote wound healing in VLUs that were not fully responsive to advanced dressings and/or compression bandage. Solution dwell time was 10 minutes, followed by 2.5-hour NPWT cycles at -125 mm Hg. Dressings were changed every 72 hours.
RESULTS
Overall, mean ± SD duration of therapy and hospital length of stay were shorter in the treatment group vs the control group (duration of therapy, 8.63 days ± 7.05 vs 11.72 days ± 17.41, respectively; P = .05, and length of stay, 9.9 days ± 2.98 vs 12.81 days ± 4.26, respectively; P = .08), but these differences were not statistically significant. Mean wound area reduction was greater in the treatment group than in the control group (14.63 cm2 ± 13.24 and 10.72 cm2 ± 14.06, respectively; P = .51), but this was not significant.
CONCLUSION
ROCF-CC dressings were a useful tool in assisting wound bed preparation and reducing time to skin graft closure in this series of complex VLUs.
Topics: Humans; Negative-Pressure Wound Therapy; Retrospective Studies; Wound Healing; Male; Female; Bandages; Treatment Outcome; Middle Aged; Aged; Varicose Ulcer
PubMed: 38684120
DOI: 10.25270/wnds/23081 -
Journal of Wound Care May 2024To evaluate the impact of a four-step biofilm-based wound care strategy, Wound Hygiene Protocol (WHP: cleanse, debride, refashion, and dress), on hard-to-heal wounds.
OBJECTIVE
To evaluate the impact of a four-step biofilm-based wound care strategy, Wound Hygiene Protocol (WHP: cleanse, debride, refashion, and dress), on hard-to-heal wounds.
METHOD
This was a prospective, real-world analysis of hard-to-heal wounds managed with the WHP that incorporated Aquacel Ag+ (Convatec Ltd., UK) dressings. Data were captured electronically between April 2021 and December 2022. The primary endpoint was change in wound volume from baseline to final assessment.
RESULTS
A total of 693 wounds in 669 patients (median patient age: 74 years) were included in the analysis with a median treatment time of 31 days. Most health professionals were general nurses (50%) or nurse practitioners (38%). Patient homes (27%) and community clinics (27%) were the most common clinical settings. Venous leg ulcers (26%) and pressure ulcers/injuries (17%) were the most common wound type. Duration was >12 months in 21% of wounds. At baseline, the mean wound volume was 57.8cm. At the final assessment, mean wound volume was 17.2cm, corresponding to an 80% reduction from baseline; p<0.001). At baseline, 66% of wounds were static or deteriorating. At final assessment, this had decreased to 5%, and 94% had improved or healed. Exudate levels were moderate or high in 69% of wounds at baseline which decreased to 25% at final assessment (p<0.001). Suspected biofilm and local wound infection decreased from 79% and 43%, respectively, at baseline, to 18% and 3%, respectively, at final assessment (p<0.001 for both).
CONCLUSION
The WHP is a new proposed standard of care that successfully treated hard-to-heal wounds by addressing the key local barriers to wound healing.
Topics: Humans; Wound Healing; Female; Prospective Studies; Male; Aged; Aged, 80 and over; Biofilms; Middle Aged; Bandages; Debridement; Wounds and Injuries; Pressure Ulcer; Wound Infection
PubMed: 38683779
DOI: 10.12968/jowc.2024.33.5.304 -
International Wound Journal May 2024This study sought to evaluate the perceptions of pressure injury (PI) management staff regarding skin failure (SF). Additionally, an analysis of influencing factors...
This study sought to evaluate the perceptions of pressure injury (PI) management staff regarding skin failure (SF). Additionally, an analysis of influencing factors based on the collected data was conducted to establish a foundation for targeted SF training. A descriptive, cross-sectional survey was undertaken in October-November 2023, utilising a convenience sampling method involving selected management staff of PI from 16 provinces in China. A total of 501 nursing participants were included, exhibiting an overall perception level that was moderately low. Although the majority were aware of the possibility of SF (n = 417, 83.23%), only 60% reported an understanding of the fundamentals of SF, with the lowest level of comprehension observed in differentiating between SF and PI (n = 212, 42.31%). Overall attitudes were generally positive. Regarding behaviour, active learning was more prevalent (n = 340, 67.86%), but training is less (n = 287, 57.29%). Family education (n = 401, 80.04%) and nursing record monitoring (n = 426, 85.03%) demonstrated better behaviour. Further analysis revealed that training (t = 13.937, p < 0.001) and professional title (F = 4.681, p = 0.010) had a significant effect on participants' perceptions. These findings underscore that there remains a substantial lack of perception about SF amongst participants. Overall, participants exhibited a positive attitude towards SF, highlighting the need for future improvements in SF training.
Topics: Humans; Cross-Sectional Studies; Pressure Ulcer; China; Male; Female; Adult; Middle Aged; Surveys and Questionnaires; Attitude of Health Personnel; Health Knowledge, Attitudes, Practice; Young Adult
PubMed: 38682890
DOI: 10.1111/iwj.14890