-
International Wound Journal Jul 2024This study aimed to evaluate assistant nurses' knowledge of and attitudes towards pressure injuries in a clinical setting. It employed a cross-sectional design, using...
This study aimed to evaluate assistant nurses' knowledge of and attitudes towards pressure injuries in a clinical setting. It employed a cross-sectional design, using two validated surveys: PUKAT 2.0 and APUP, alongside open-ended questions. A convenience sample of 88 assistant nurses from five wards across two departments at a 600-bed university hospital in Sweden participated. Participants answered the questionnaire and open-ended questions, followed by a learning seminar led by the study leader covering PUKAT 2.0 knowledge questions. The seminar ended with an evaluation of this training approach. Results revealed a significant knowledge gap in pressure injury prevention among assistant nurses, with a mean PUKAT 2.0 knowledge score of 33.8 and a standard deviation of ±11.7 (a score of 60 is deemed satisfactory). Only 3.4% (n = 3) of participants achieved a satisfactory knowledge score. However, attitudes towards pressure injury prevention, assessed by the APUP tool, were generally positive among the majority of the participants. Open-ended questions and evaluations of the seminar showed assistant nurses' desire for pressure injury prevention training and their appreciation for the seminar format. Further studies need to evaluate recurrent training procedures and departmental strategies aimed at reducing the knowledge gap among healthcare staff.
Topics: Humans; Pressure Ulcer; Cross-Sectional Studies; Male; Female; Adult; Sweden; Health Knowledge, Attitudes, Practice; Surveys and Questionnaires; Middle Aged; Nursing Assistants; Attitude of Health Personnel; Nursing Staff, Hospital; Clinical Competence
PubMed: 38923719
DOI: 10.1111/iwj.14950 -
Revista Gaucha de Enfermagem 2024To analyze the associations between the clinical characteristics of patients hospitalized with pressure injuries (PI) during the COVID-19 pandemic.
OBJECTIVE
To analyze the associations between the clinical characteristics of patients hospitalized with pressure injuries (PI) during the COVID-19 pandemic.
METHOD
Cross-sectional study of 237 PI notifications in a hospital in southern Brazil. Collection took place in 2021 in an institutional management program, with interlocution to the patient's medical record. Analysis using descriptive statistics, Student's t-test, Pearson's chi-square and Wilcoxon.
RESULTS
The mean age was 59.4±14.4 years, with 59.7% male, 74.7% diagnosed with COVID-19. High risk (57.8%), stage 2 (80.2%), sacral region, intergluteal/gluteal region (73.0%) were predominant and death was the prevalent outcome (51.1%), with a median of 9.5 (0-217) days after notification. There was no association of death with diabetes, systemic arterial hypertension, smoking and reason for hospitalization.
CONCLUSION
The association between the clinical characteristics of hospitalized patients with pressure injuries reflects the systemic inflammation of patients affected by COVID-19.
Topics: Humans; Pressure Ulcer; COVID-19; Male; Female; Middle Aged; Cross-Sectional Studies; Brazil; Aged; Pandemics; Adult; Hospitalization; Risk Factors; Aged, 80 and over
PubMed: 38922229
DOI: 10.1590/1983-1447.2024.20230086.en -
International Journal of Palliative... Jun 2024Pressure injuries (PIs) are prevalent in palliative care. Lack of knowledge and skills among informal caregivers on PI prevention and management contributes...
BACKGROUND
Pressure injuries (PIs) are prevalent in palliative care. Lack of knowledge and skills among informal caregivers on PI prevention and management contributes significantly to the occurance or deterioration of PIs.
AIM
The aims of this study were to: (1) determine the level of knowledge and practices of informal caregivers on PI prevention and treatment; (2) explore the socio-demographic characteristics of informal caregivers that influence PI prevention and treatment among patients who need palliative care.
METHODS
The quantitative cross-sectional descriptive design was used to collect data from 146 informal caregivers, and a valid and reliable questionnaire was used.
RESULTS
A total of 146 informal caregivers of patients with PI completed the study. Most participants had a relatively low level of PI prevention, treatment knowledge and practice. Participants who were older than 28 years, working for the government and married had significantly better knowledge and practice of PI prevention and treatment than other participants.
CONCLUSION
Information for informal caregivers in different settings about PI prevention and treatment is needed. Informal caregivers need to acquire more professional practices and knowledge to improve the quality of patient care.
Topics: Humans; Caregivers; Male; Female; Cross-Sectional Studies; Adult; Middle Aged; Palliative Care; Pressure Ulcer; Health Knowledge, Attitudes, Practice; Surveys and Questionnaires; Aged
PubMed: 38913643
DOI: 10.12968/ijpn.2024.30.6.274 -
JMIR Serious Games Jun 2024Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of...
BACKGROUND
Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations.
OBJECTIVE
We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences.
METHODS
PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim.
RESULTS
The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management.
CONCLUSIONS
The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.
PubMed: 38913417
DOI: 10.2196/53165 -
Journal of Orthopaedic Case Reports Jun 2024Charcot arthropathy consists of a rapid and destructive complication of the joints following the loss of innervation caused by many complicated etiologies. Diabetic...
INTRODUCTION
Charcot arthropathy consists of a rapid and destructive complication of the joints following the loss of innervation caused by many complicated etiologies. Diabetic neuropathy has become the most common etiological factor.
CASE REPORT
We present a case of a 64-year-old female patient with a history of chronic renal failure on hemodialysis, hypertension, hypothyroidism, and Type 2 diabetes, complicated with neuropathy and Charcot disease, who referred to our department. Initially, the patient was managed with a restraint orthotic device due to a bimalleolar ankle fracture. An unsuccessful treatment and the presence of a pressure ulcer with pus-like drainage on the lateral malleolus 2 months later led to the decision for a below-knee amputation.
CONCLUSION
High clinical suspicion by the attending physician may reduce the risk of complications and lead to proper treatment with better outcomes.
PubMed: 38910990
DOI: 10.13107/jocr.2024.v14.i06.4498 -
Zhongguo Gu Shang = China Journal of... Jun 2024To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by...
OBJECTIVE
To explore clinical effect of vancomycin calcium sulfate combined with internal fixation on calcaneal beak-like fracture secondary to calcaneal osteomyelitis caused by diabetic foot.
METHODS
From April 2018 to October 2021, a retrospective analysis was performed on 5 patients with calcaneal bone osteomyelitis secondary to diabetic foot, including 2 males and 3 females, aged from 48 to 60 years old;diabetes course ranged from 5 to 13 years;the courses of diabetic foot disease ranged from 18 to 52 days;5 patients were grade Ⅲ according to Wagner classification. All patients were treated with debridement, vancomycin bone cement implantation, negative pressure aspiration at stageⅠ, vancomycin calcium sulfate and internal fixation at stageⅡfor calcaneal beak-like fracture. Surgical incision and fracture healing time were recorded, and the recurrence of osteomyelitis was observed. American Orthopedic Foot Andankle Society (AOFAS) score and exudation at 12 months after operation were evaluated.
RESULTS
Five patients were successfully completed operation without lower extremity vascular occlusion, and were followed up for 16 to 36 months. The wound healing time after internal fixation ranged from 16 to 26 days, and healing time of fractures ranged from 16 to 27 weeks. AOFAS score ranged from 65 to 91 at 12 months after operation, and 2 patients got excellent result, 2 good and 1 fair. Among them, 1 patient with skin ulcer on the back of foot caused by scalding at 5 months after operation (non-complication), was recovered after treatment;the wound leakage complication occurred in 2 patients, and were recovered after dressing change. No osteomyelitis or fracture occurred in all patients.
CONCLUSION
Vancomycin calcium sulfate with internal fixation in treating calcaneal osteomyelitis secondary to calcaneal osteomyelitis caused by diabetic foot could not only control infection, but also promote fracture healing, and obtain good clinical results.
Topics: Humans; Male; Middle Aged; Female; Osteomyelitis; Diabetic Foot; Calcaneus; Retrospective Studies; Fracture Fixation, Internal; Fractures, Bone
PubMed: 38910385
DOI: 10.12200/j.issn.1003-0034.20230327 -
BMJ Open Jun 2024Diabetic foot ulcer is a major medical, social, and economic problem, and a leading cause of hospitalisations, increased morbidity, and mortality. Despite a rising...
BACKGROUND
Diabetic foot ulcer is a major medical, social, and economic problem, and a leading cause of hospitalisations, increased morbidity, and mortality. Despite a rising occurrence, there is a dearth of data on the incidence and its predictors.
OBJECTIVE
To assess the incidence and predictors of diabetic foot ulcers among patients with diabetes mellitus in a diabetic follow-up clinic in Central Ethiopia.
DESIGN
Retrospective follow-up study design.
PARTICIPANTS
A total of 418 newly diagnosed diabetes mellitus patients from 1 January 2012 to 31 December 2022. A computer-generated simple random sampling method was used to select the study participants. Data were collected using a structured data extraction checklist. The collected data were entered into Epi Info V.7.2 and exported to STATA V.14 for analysis. To estimate survival time, the Kaplan-Meier method was used, and the survival difference was tested using a log-rank test.
OUTCOME MEASURES
The Cox proportional hazard model was fitted to identify the predictors of diabetic foot ulcer development. The strength of the association was estimated using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI), and statistical significance was proclaimed at a p<0.05.
RESULT
The overall incidence of diabetic foot ulcer was 1.51 cases (95% CI 1.03 to 2.22) per 100 person-years of observation. The cumulative incidence was 6.2% (95% CI 4.1% to 8.6%) over 10 years. The median time of follow-up was 45 months (IQR 21-73). Diastolic blood pressure of 90 mm Hg or above (AHR 2.91, 95% CI 1.25 to 6.77), taking combined medication (AHR 3.24, 95% CI 1.14 to 9.19) and having a peripheral arterial disease (AHR 5.26, 95% CI 1.61 to 17.18) were statistically significant predictors of diabetic foot ulcer development.
CONCLUSION
The risk of occurrence of diabetic foot ulcer was relatively high. Diastolic blood pressure level, combined medication and peripheral arterial disease were independent predictors of diabetic foot ulcer development. Hence, close monitoring and proper interventions are essential.
Topics: Humans; Diabetic Foot; Ethiopia; Female; Male; Retrospective Studies; Incidence; Middle Aged; Follow-Up Studies; Risk Factors; Adult; Aged; Proportional Hazards Models; Kaplan-Meier Estimate
PubMed: 38908850
DOI: 10.1136/bmjopen-2024-085281 -
Plastic and Reconstructive Surgery.... Jun 2024Chronic ulcer treatments, such as those for diabetic foot ulcers and pressure sores, require prolonged treatment periods. Availability of effective objective indicators...
Chronic ulcer treatments, such as those for diabetic foot ulcers and pressure sores, require prolonged treatment periods. Availability of effective objective indicators to determine treatment method efficacy is limited. Ulcer area is the agreed-upon indicator for ulcer healing because it contracts and/or undergoes epithelialization as healing occurs. Ulcer surface properties such as healthy or infected granulation and slough or necrotic tissue are also used. This study aimed to develop a user-friendly application automating the ulcer area measurement process and included a graphical time-series display of ulcer components manually classified by users. Images of ulcers photographed with adjacent circular 1.5-cm diameter stickers were prepared. In the application, users manually categorized and color-coded each image into five component types based on different ulcer characteristics. The application calculated the area of each component in pixels and then estimated the actual area using the sticker area as a reference. It also collated color-coded images and presented graphical illustrations of changes in area over time. The results indicated the application successfully automated area measurements of each ulcer component and graphical displays of changes in ulcer component areas over time. It enabled users to visually track quality changes and the chronic ulcer healing process. Historically, ulcer assessments are subjectively conducted via visual examination by physicians, creating less reproducible, objective data. Although ulcer properties still required manual entry by users, our application streamlined ulcer area measurement and time-course visualization and sets the groundwork for a fully automated artificial-intelligence-driven ulcer diagnosis system.
PubMed: 38903132
DOI: 10.1097/GOX.0000000000005922 -
British Journal of Nursing (Mark Allen... Jun 2024The annual cost to the NHS of managing 3.8 million patients with a wound was estimated in 2020 to be £8.3 billion, of which £5.6 billion was spent on the 30% of wounds... (Observational Study)
Observational Study
The annual cost to the NHS of managing 3.8 million patients with a wound was estimated in 2020 to be £8.3 billion, of which £5.6 billion was spent on the 30% of wounds that did not heal and £2.7 billion on the 70% of wounds that healed (Guest, 2020). One of the main symptoms associated with chronic 'hard-to-heal' wounds is the production of excess exudate (Atkin et al, 2019). This is due to a prolonged chronic inflammatory response stimulated by a physiological cause. This article describes what exudate is and its importance in the wound healing process, highlighting the consequences of too little or excessive wound exudate associated with any wound. The article goes on to describe a case series observational study involving a range of patients (=47; 33 male/14 female), aged between 33 and 91 years (mean 67.4 years), with a variety of acute (=11) and chronic exuding wounds (=44). In total, 55 wounds of various aetiologies were managed with DryMax Super (a dressing whose design includes superabsorbent polymers) in order to evaluate and report on the absorption and fluid-handling properties of the product.
Topics: Humans; Aged; Exudates and Transudates; Male; Aged, 80 and over; Middle Aged; Female; Adult; Bandages; Wound Healing; Wounds and Injuries
PubMed: 38900666
DOI: 10.12968/bjon.2024.0180 -
British Journal of Nursing (Mark Allen... Jun 2024An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before...
BACKGROUND
An objective, physiological measurement taken using a medical device may reduce the incidence of pressure ulcers through earlier detection of problems signs before visual signs appear. Research in this field is hampered by variations in clinical practice and patient-level confounders.
AIM
The authors outline key considerations for designing a protocol for a study to assess the efficacy and safety of a prognostic medical device in reducing pressure ulcer incidence in a hospital, including comparators, randomisation, sample size, ethics and practical issues.
METHOD
Key issues relating to methodology and ethics are considered alongside a theoretical protocol, which could support future researchers in wound care trials.
RESULTS
A prospective, three-armed, multi-centre, stratified cluster-randomised controlled trial is proposed. The third arm is recommended as it is expected that patients will need to be moved for the medical device to be used and repositioning is a preventive strategy. A minimum of 16 200 patients in 33 wards would needed to be recruited to achieve statistical significance. Ethical considerations in terms of consent or assent need to be considered.
CONCLUSION
The hypothetical study designed to evaluate the effectiveness of a diagnostic or prognostic medical device in reducing pressure ulcer incidence in secondary care, while accounting for biases, would require large sample sizes and involves risks of inter-operator and inter-device reliability, heterogeneity of users and the vague clinical interpretation of device results. Robust research in this field has the potential to influence or change policy and practice relating to the prevention of pressure ulcers in secondary care.
Topics: Pressure Ulcer; Humans; Research Design; Prospective Studies; Prognosis; Early Diagnosis
PubMed: 38900657
DOI: 10.12968/bjon.2024.0158