-
Scientific Reports Apr 2024Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated...
Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease. We aimed to determine whether toe pressures differed in smokers with a foot ulcer, when compared to non-smokers and ex-smokers, as well as ulcer outcomes at 12 months, among patients attending Blacktown Hospital High Risk Foot Service (HRFS). This study is a retrospective analysis of our prospectively collected clinic database. Eligible participants were adults attending the HRFS between June 2020 and April 2022. Participants were included if they had an ulcer, at least one systolic toe pressure reading completed at their initial visit and attended at least one follow-up visit. Participants were followed until healing, loss to follow-up or a minimum of 12 months. A total of 195 participants were included; 36 smokers, 82 ex-smokers, and 77 controls who had never smoked. Smoking status was by self-report. Current smokers were significantly younger at initial presentation (p = .002) and tended towards lower socioeconomic status (p = .067). Current smokers were significantly more likely to have ischaemic grade 3 toe pressures (< 30 mmHg) of their left foot (p = .027), suggestive of reduced perfusion. At the end of follow up period, smokers had the numerically highest rates of minor amputations. In conclusion, smokers ulcerate younger and are more likely to have grade 3 ischaemia. Collecting information about the brachial artery pressures and the time since the last cigarette may clarify any relationship between smoking and toe pressures.Trial registration: WSLHD HREC ethics approval 2111-02 and ANZCTR registration 382470. Registered on 15/09/2021.
Topics: Adult; Humans; Ulcer; Retrospective Studies; Tobacco Smoking; Smokers; Foot Diseases; Toes
PubMed: 38609449
DOI: 10.1038/s41598-024-59158-5 -
Wound Management & Prevention Mar 2024Pressure injuries result from prolonged pressure and lead to tissue damage, infections, extended recovery times, and an economic burden.
BACKGROUND
Pressure injuries result from prolonged pressure and lead to tissue damage, infections, extended recovery times, and an economic burden.
PURPOSE
To explore risk factors for pressure injuries in patients who underwent surgery under general anesthesia.
METHODS
This retrospective study included patients who underwent surgery at a regional educational hospital in southern Taiwan from January 1, 2018, through December 31, 2018.
RESULTS
A comprehensive multivariate analysis was used to identify the prominent risk factors for pressure injury among the 11 231 patients enrolled in this study. These risk factors were an age of ≥65 years; surgery duration of >120 minutes; diastolic blood pressure of <60 mm Hg for >30 minutes during surgery; intraoperative use of dopamine, norepinephrine, or epinephrine as vasopressors; American Society of Anesthesiologists physical classification of III or higher; minimum intraoperative body temperature of ≤35°C; blood loss of >500 mL; and a supine or prone surgical position.
CONCLUSIONS
This study identified several pressure injury risk factors related to surgical conditions and patient characteristics. Surgical teams must monitor, control, and manage these factors, prioritize staff education, and adopt preventive protocols.
Topics: Humans; Aged; Pressure Ulcer; Retrospective Studies; Anesthesia, General; Body Temperature; Crush Injuries; Hospitals, Teaching; Multiple Trauma
PubMed: 38608164
DOI: 10.25270/wmp.23025 -
Wound Management & Prevention Mar 2024As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment.
BACKGROUND
As COVID-19 has emerged as a pandemic virus, multiple reports have surfaced to describe skin lesions that occur either associated with the virus or due to treatment.
OBJECTIVE
To compare patient demographics, treatments, and outcomes in COVID-19 symptomatic patients who developed skin lesions (COVID-19 or hospital-acquired pressure ulcer/injury [HAPU/I]) during the first year of the pandemic.
METHODS
A retrospective chart review was conducted on COVID-positive symptomatic patients admitted from March 1, 2020, through March 1, 2021. The authors analyzed the difference in patient demographics, patient skin tones, treatments, hospital length of stay (LOS), intensive care unit (ICU) LOS, death, and discharge disposition for those with COVID-19 lesions compared to those who developed HAPU/Is.
RESULTS
Of those who developed lesions, 2.3% developed COVID-19 lesions and 7.2% developed HAPU/Is. Patients with COVID-19 lesions were more likely to be male (64%), younger (median age 60), and had a higher BMI (30) than patients with no wounds and patients with HAPU/I.
CONCLUSION
This study advances the knowledge of the patient demographics and treatments that may contribute to identifying the new phenomenon of COVID lesions and how they differ from HAPU/Is.
Topics: Humans; Male; Middle Aged; Female; Pressure Ulcer; Retrospective Studies; COVID-19; Demography; Hospitals
PubMed: 38608162
DOI: 10.25270/wmp.23018 -
Wound Management & Prevention Mar 2024To evaluate the efficacy of recombinant human epidermal growth factor (rhEGF) in healing pressure injuries (PIs). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the efficacy of recombinant human epidermal growth factor (rhEGF) in healing pressure injuries (PIs).
METHODS
A meta-analysis was conducted of randomized controlled trials (RCTs) involving rhEGF in the treatment of PIs that were identified in PubMed, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure (CNKI). The population, intervention, comparison, outcomes, study design (PICOS) strategy was applied to determine analysis eligibility. The Cochrane risk of bias tool was used, and statistical analysis, including sensitivity analysis, was performed of 3 outcomes indicators: the primary outcome was total efficacy of rhEGF in treating PIs, and the secondary outcomes were the proportion of complete healing and the time to complete healing. Total efficacy refers to the proportion of cases that have been cured, obviously effective, or effective. Complete healing refers to cases where the wound has healed, scabbed, and the scab has sloughed off.
RESULTS
Sixteen RCTs were included, comprising a total of 1,206 patients. Study and control group size varied by outcomes. The total effective healing rate in rhEGF group was 97.18%, which was significantly higher than 83.38% in control group (OR: 5.69, [95% CI: 3.61, 8.97], z=7.49, P < .001). The proportion of complete healing in the rhEGF group was 73.30%, which was higher than 39.52% in control group (OR: 3.88, [95% CI: 3.01, 5.01], z=10.39, P < .001). Furthermore, the healing time using rhEGF was shorter (SMD: -2.14 days, [95% CI: -2.60, -1.67], z=9.07, P < .001). Sensitivity analyses indicated that the results were robust.
CONCLUSIONS
The meta-analysis indicated that rhEGF was effective in healing PIs with few negative effects. Further research beyond Chinese populations involving larger studies and studies that distinguish between results found in using rhEGF alone or in combination are recommended.
Topics: Humans; China; Epidermal Growth Factor; Pressure Ulcer; Randomized Controlled Trials as Topic
PubMed: 38608161
DOI: 10.25270/wmp.22092 -
Asian Journal of Surgery Jul 2024
Topics: Humans; Pressure Ulcer; Prevalence; Incidence; Iatrogenic Disease; Male; Female
PubMed: 38604845
DOI: 10.1016/j.asjsur.2024.03.156 -
BMJ Open Apr 2024To predict the risk of hospital-acquired pressure injury using machine learning compared with standard care.
OBJECTIVE
To predict the risk of hospital-acquired pressure injury using machine learning compared with standard care.
DESIGN
We obtained electronic health records (EHRs) to structure a multilevel cohort of hospitalised patients at risk for pressure injury and then calibrate a machine learning model to predict future pressure injury risk. Optimisation methods combined with multilevel logistic regression were used to develop a predictive algorithm of patient-specific shifts in risk over time. Machine learning methods were tested, including random forests, to identify predictive features for the algorithm. We reported the results of the regression approach as well as the area under the receiver operating characteristics (ROC) curve for predictive models.
SETTING
Hospitalised inpatients.
PARTICIPANTS
EHRs of 35 001 hospitalisations over 5 years across 2 academic hospitals.
MAIN OUTCOME MEASURE
Longitudinal shifts in pressure injury risk.
RESULTS
The predictive algorithm with features generated by machine learning achieved significantly improved prediction of pressure injury risk (p<0.001) with an area under the ROC curve of 0.72; whereas standard care only achieved an area under the ROC curve of 0.52. At a specificity of 0.50, the predictive algorithm achieved a sensitivity of 0.75.
CONCLUSIONS
These data could help hospitals conserve resources within a critical period of patient vulnerability of hospital-acquired pressure injury which is not reimbursed by US Medicare; thus, conserving between 30 000 and 90 000 labour-hours per year in an average 500-bed hospital. Hospitals can use this predictive algorithm to initiate a quality improvement programme for pressure injury prevention and further customise the algorithm to patient-specific variation by facility.
Topics: Humans; Aged; United States; Cohort Studies; Pressure Ulcer; Electronic Health Records; Medicare; Machine Learning; Retrospective Studies; ROC Curve
PubMed: 38594078
DOI: 10.1136/bmjopen-2023-082540 -
International Wound Journal Apr 2024Pressure ulcers including heel ulcers remain a global healthcare concern. This study comprehensively evaluates the biomechanical effectiveness of the market-popular... (Review)
Review
Pressure ulcers including heel ulcers remain a global healthcare concern. This study comprehensively evaluates the biomechanical effectiveness of the market-popular ALLEVYN® LIFE multilayer dressing in preventing heel ulcers. It focuses on the contribution of the frictional sliding occurring between the non-bonded, fully independent layers of this dressing type when the dressing is protecting the body from friction and shear. The layer-on-layer sliding phenomenon, which this dressing design enables, named here the frictional energy absorber effectiveness (FEAE), absorbs approximately 30%-45% of the mechanical energy resulting from the foot weight, friction and shear acting to distort soft tissues in a supine position, thereby reducing the risk of heel ulcers. Introducing the novel theoretical FEAE formulation, new laboratory methods to quantify the FEAE and a review of relevant clinical studies, this research underlines the importance of the FEAE in protecting the heels of at-risk patients. The work builds on a decade of research published by our group in analysing and evaluating dressing designs for pressure ulcer prevention and will be useful for clinicians, manufacturers, regulators and reimbursing bodies in assessing the effectiveness of dressings indicated or considered for prophylactic use.
Topics: Humans; Pressure Ulcer; Friction; Ulcer; Bandages; Skin Care; Heel
PubMed: 38591160
DOI: 10.1111/iwj.14871 -
Photodiagnosis and Photodynamic Therapy Jun 2024Neuroimmunomodulation is the capacity of the nervous system to regulate immune processes. The existence of neurotransmitter receptors in immune cells enables this... (Review)
Review
Neuroimmunomodulation is the capacity of the nervous system to regulate immune processes. The existence of neurotransmitter receptors in immune cells enables this phenomenon to take place. Neuronal mediators possess the capacity to direct and control several occurrences during the wound healing process. Nitric oxide (NO) functions as a neuromodulator, playing a crucial role in the regulation of vascular tone and blood pressure with antimicrobial properties. Photodynamic therapy has been shown to augment the function of immune cells involved in the healing process of venous leg ulcers. Nitric oxide can be secreted into the extracellular environment by these cells. In lesions treated with PDT, the synthesis of iNOs (the enzyme that releases NO) increased, as demonstrated by the experimental results. Therefore the significance of PDT in enhancing the clinical condition of the lesion is thus highlighted.
Topics: Wound Healing; Photochemotherapy; Humans; Nitric Oxide; Photosensitizing Agents; Neuroimmunomodulation; Varicose Ulcer; Animals
PubMed: 38588874
DOI: 10.1016/j.pdpdt.2024.104078 -
International Wound Journal Apr 2024Pressure injuries are a significant concern for patients undergoing neurosurgical procedures due to prolonged immobility and the complexity of care. This study evaluates...
Pressure injuries are a significant concern for patients undergoing neurosurgical procedures due to prolonged immobility and the complexity of care. This study evaluates the efficacy of standardized pressure ulcer management protocols in preventing pressure injuries and enhancing patient care in a neurosurgical context. A comprehensive retrospective analysis was conducted at a single institution from December 2020 to December 2023, comparing 50 patients who received standardized pressure ulcer management (intervention group) with 50 patients who received conventional care (control group). The study assessed the incidence of pressure ulcers, patient comfort levels using the Kolcaba Comfort Scale and sleep quality using the Richards-Campbell Sleep Questionnaire (RCSQ). Statistical analysis was performed using SPSS software, version 27.0, applying t-tests and chi-square tests as appropriate. The intervention group exhibited a significantly lower incidence of pressure ulcers at all measured time points post-surgery compared to the control group. Patient comfort levels in the intervention group were consistently higher across psychological, environmental, physiological and socio-cultural domains. Sleep quality metrics, including sleep depth, latency to sleep onset and overall sleep quality, were significantly improved in the intervention group. The implementation of standardized pressure ulcer management protocols in neurosurgical care significantly reduces the incidence of pressure injuries, enhances patient comfort and improves sleep quality. These findings highlight the importance of adopting structured care protocols to improve postoperative outcomes and patient well-being in neurosurgical settings.
Topics: Humans; Pressure Ulcer; Retrospective Studies; Intensive Care Units; Research Design; Neurosurgical Procedures
PubMed: 38581264
DOI: 10.1111/iwj.14879 -
BMC Geriatrics Apr 2024Pressure injuries are a common and serious issue for bedridden residents in long-term-care facilities. Areas of bony prominences, such as the scapula, sacrum, and heels,...
BACKGROUND
Pressure injuries are a common and serious issue for bedridden residents in long-term-care facilities. Areas of bony prominences, such as the scapula, sacrum, and heels, are more likely to develop pressure injuries. The management of pressure injury wounds include dressing changes, repositioning, away from moisture, decreasing the occurrence of friction and shear, and more. Some supportive surfaces are also used for pressure injury cases such as gel pads, alternating pressure air mattresses, and air-fluidized beds. The aim of this case study was to determine whether the use of an artificial intelligent mattress can improve a nursing home resident with prolonged pressure injury.
CASE PRESENTATION
A retrospective study design was conducted for this case study. A 79-year-old male developed a pressure injury in the sacrum. His pressure injury was initially at stage 4, with a score of 12 by the Braden scale. The PUSH score was 16. During 5.5 months of routine care plus the use of the traditional alternative air mattress, in the nursing home, the wound stayed in stage 3 but the PUSH score increased up to 11. An artificial intelligence mattress utilizing 3D InterSoft was used to detect the bony prominences and redistribute the external pressure of the skin. It implements a color guided schematic of 26 colors to indicate the amount of pressure of the skin.
RESULTS
The wound size was decreased and all eczema on the resident's back diminished. The PUSH score was down to 6, as the artificial intelligent mattress was added into the routine care. The staff also reported that the resident's quality of sleep improved and moaning decreased. The hemiplegic side is at greater risk of developing pressure injury.
CONCLUSIONS
This novice device appeared to accelerate wound healing in this case. In the future, more cases should be tested, and different care models or mattress can be explored.
Topics: Male; Humans; Aged; Pressure Ulcer; Retrospective Studies; Artificial Intelligence; Wound Healing; Beds
PubMed: 38566023
DOI: 10.1186/s12877-024-04900-x