1
|
Konya I, Shishido I, Nemoto M, Yano R. Risk factors of skin barrier dysfunction in older adults: A systematic review. Jpn J Nurs Sci 2024; 21:e12597. [PMID: 38516948 DOI: 10.1111/jjns.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
AIM Skin barrier dysfunction can trigger various skin disorders in older adults. Skin barrier assessment is essential for nurses and caregivers to prevent skin disorders; however, the evidence available for clinical assessment is limited. This systematic review aimed to clarify the risk factors of skin barrier dysfunction in older adults. METHODS This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The four databases were searched using multiple terms related to "aged" and "skin barrier." The search was initially run on April 19, 2023, and rerun on October 12, 2023. Peer-reviewed quantitative studies in English were included, with no publication time limit being set. Two reviewers assessed the risk of bias in a blinded and independent manner using JBI tools. Owing to the heterogeneity of the results, a narrative synthesis was performed. RESULTS Among the database-identified 4833 studies, 20 studies were included. The extracted factors were categorized as demographic characteristics, functional characteristics, chronic diseases, nutritional status, skin condition, and environmental factors. However, owing to high risk of bias and inconsistent results across studies, only chronic kidney disease and dry skin were considered risk factors for skin barrier dysfunction in older adults. CONCLUSIONS Assessment of chronic kidney disease and dry skin in daily skin care may guide the development of personalized skincare programs to maintain skin integrity in older adults. Furthermore, cohort studies that consider confounding factors and the reliability of measurements are needed for an in-depth investigation into skin barrier dysfunction and more risk factors.
Collapse
Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Inaho Shishido
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Moe Nemoto
- Medical Sciences Group, Research Support Division, Hokkaido University Library, Sapporo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| |
Collapse
|
2
|
Sufiyan M, Kushwaha P, Ahmad M, Mandal P, Vishwakarma KK. Scaffold-Mediated Drug Delivery for Enhanced Wound Healing: A Review. AAPS PharmSciTech 2024; 25:137. [PMID: 38877197 DOI: 10.1208/s12249-024-02855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024] Open
Abstract
Wound healing is a complex physiological process involving coordinated cellular and molecular events aimed at restoring tissue integrity. Acute wounds typically progress through the sequential phases of hemostasis, inflammation, proliferation, and remodeling, while chronic wounds, such as venous leg ulcers and diabetic foot ulcers, often exhibit prolonged inflammation and impaired healing. Traditional wound dressings, while widely used, have limitations such poor moisture retention and biocompatibility. To address these challenges and improve patient outcomes, scaffold-mediated delivery systems have emerged as innovative approaches. They offer advantages in creating a conducive environment for wound healing by facilitating controlled and localized drug delivery. The manuscript explores scaffold-mediated delivery systems for wound healing applications, detailing the use of natural and synthetic polymers in scaffold fabrication. Additionally, various fabrication techniques are discussed for their potential in creating scaffolds with controlled drug release kinetics. Through a synthesis of experimental findings and current literature, this manuscript elucidates the promising potential of scaffold-mediated drug delivery in improving therapeutic outcomes and advancing wound care practices.
Collapse
Affiliation(s)
- Mohd Sufiyan
- Faculty of Pharmacy, Integral University, Dasauli-Kursi Road, Lucknow, India
| | - Poonam Kushwaha
- Faculty of Pharmacy, Integral University, Dasauli-Kursi Road, Lucknow, India.
| | - Mohammad Ahmad
- Faculty of Pharmacy, Integral University, Dasauli-Kursi Road, Lucknow, India
| | - Purba Mandal
- Faculty of Pharmacy, Integral University, Dasauli-Kursi Road, Lucknow, India
| | | |
Collapse
|
3
|
Hara K, Uemura T, Tachibana R, Kumashiro R, Yamaguchi M, Kawahara I, Fujioka M. Prevention of Postoperative Skin Disorders and Pressure Injuries in the Neurosurgical Park Bench Position Surgery: A Prospective Cohort Study. Cureus 2024; 16:e58552. [PMID: 38765353 PMCID: PMC11102086 DOI: 10.7759/cureus.58552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Background In neurosurgical procedures where the park bench position is employed, the risk of perioperative pressure injuries is elevated due to the limited contact surface area, with the head and part of the upper torso extending beyond the surgical table. This study aimed to examine the effects of preventative measures against such injuries, proposing a potential standard for postural fixation in these surgeries. Methods Conducted at a medical center, from January 2017 to March 2023, this prospective cohort study involved participants aged 20 and above who underwent neurosurgical procedures in the park bench position under general anesthesia. The focus was on comparing the incidence of pressure injuries between intervention and control groups. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results Out of 65 patients enrolled, 28 were assigned to each of the intervention and control groups. The control group experienced 17 instances of postoperative pressure injuries and skin disorders in areas prone to pressure, such as the axillary and greater trochanter regions. Conversely, the intervention group reported no such incidents, underscoring the efficacy of meticulous surgical positioning and management of bodily pressure, temperature, humidity, and microclimate. Conclusion Implementing preventive measures in neurosurgical park bench procedures significantly reduces the incidence of postoperative pressure injuries and skin disorders. These findings advocate for the adoption of standardized postural fixation protocols in such surgeries, potentially influencing global clinical practices in neurosurgery.
Collapse
Affiliation(s)
- Kentaro Hara
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
- Healthcare Management Research Center, Chiba University Hospital, Chiba, JPN
| | - Takahiro Uemura
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Reika Tachibana
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Ryosuke Kumashiro
- Operation Center Division, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Michiko Yamaguchi
- Department of Anesthesiology, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| | - Ichiro Kawahara
- Department of Neurosurgery, Japan Community Health Care Organization Isahaya General Hospital, Nagasaki, JPN
| | - Masaki Fujioka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, JPN
| |
Collapse
|
4
|
Marché C, Creehan S, Gefen A. The frictional energy absorber effectiveness and its impact on the pressure ulcer prevention performance of multilayer dressings. Int Wound J 2024; 21:e14871. [PMID: 38591160 PMCID: PMC11002638 DOI: 10.1111/iwj.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Cécile Marché
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
| | | | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv UniversityTel AvivIsrael
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary CareGhent UniversityGhentBelgium
- Department of Mathematics and Statistics, Faculty of SciencesHasselt UniversityHasseltBelgium
| |
Collapse
|
5
|
Lin P, Tang X, Zhong J, Tang F, Liu H, Peng L, Wan B, Wang M, Ye Y, Guo R, Liu X, Deng L. Antibacterial, ROS scavenging and angiogenesis promoting ϵ-Polylysine/gelatin based hydrogel containing CTLP to regulate macrophages for pressure ulcer healing. Biofabrication 2024; 16:025025. [PMID: 38408382 DOI: 10.1088/1758-5090/ad2d2e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/26/2024] [Indexed: 02/28/2024]
Abstract
Pressure ulcers (PUs) have emerged as a substantial burden on individuals and society. The introduction of innovative dressings that facilitate the healing of pressure ulcer wounds represents a cost-effective alternative for treatment. In this study, the emphasis is on the preparation of Carthamus tinctorius L. polysaccharide (CTLP) as hydrogel microspheres (MPs), which are then encapsulated within a hydrogel matrix crosslinked with phenylboronic acid gelatin (Gelatin-PBA) andϵ-polylysine-grafted catechol (ϵ-PL-Cat) to enable sustained release for promoting pressure ulcer healing. The presented Gelatin-PBA/ϵ-PL-Cat (GPL)/CTLP-MPs hydrogel demonstrated outstanding self-healing properties. In addition,in vitroexperiments revealed that the hydrogel exhibited remarkable antibacterial activity, excellent biocompatibility. And it showed the capacity to promote vascular formation, effectively scavenge reactive oxygen species, and facilitate macrophage polarization from the M1 to M2 phenotype.In vivowound healing of mice PUs indicated that the prepared GPL/CTLP-MPs hydrogel effectively accelerated the formation of granulation tissue and facilitated the healing of the wounds. In summary,in vivoandin vitroexperiments consistently highlight the therapeutic potential of GPL/CTLP-MPs hydrogel in facilitating the healing process of PUs.
Collapse
Affiliation(s)
- PinLi Lin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Xiaona Tang
- Shenzhen Bao'an Traditional Chinese Medicine Hospital Group, Shenzhen, People's Republic of China
| | - Jintao Zhong
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Fang Tang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Hanjiao Liu
- Shenzhen Hospital of Integrative Medicine, Shenzhen, People's Republic of China
| | - Lu Peng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Biyu Wan
- School of Nursing Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Mengya Wang
- School of Nursing Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Yuling Ye
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
| | - Rui Guo
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Guangdong Provincial Engineering and Technological Research Centre for Drug Carrier Development, Department of Biomedical Engineering, Jinan University, Guangzhou, People's Republic of China
| | - Xusheng Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Traditional Chinese Medicine), Guangzhou, People's Republic of China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Lili Deng
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, 51000, People's Republic of China
| |
Collapse
|
6
|
Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2024; 2:CD003216. [PMID: 38345088 PMCID: PMC10860148 DOI: 10.1002/14651858.cd003216.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pressure ulcers are localized injuries to the skin or the underlying tissue, or both, and are common in older and immobile people, people with diabetes, vascular disease, or malnutrition, as well as those who require intensive or palliative care. People with pressure ulcers often suffer from severe pain and exhibit social avoidance behaviours. The prevention and treatment of pressure ulcers involves strategies to optimize hydration, circulation, and nutrition. Adequate nutrient intake can reduce the risk factor of malnutrition and promote wound healing in existing pressure ulcers. However, it is unclear which nutrients help prevent and treat pressure ulcers. This is an update of an earlier Cochrane Review. OBJECTIVES To evaluate the benefits and harms of nutritional interventions (special diets, supplements) for preventing and treating pressure ulcers in people with or without existing pressure ulcers compared to standard diet or other nutritional interventions. SEARCH METHODS We used extensive Cochrane search methods. The latest search was in May 2022. SELECTION CRITERIA We included randomized controlled trials (RCTs) in people with or without existing pressure ulcers, that compared nutritional interventions aimed at preventing or treating pressure ulcers with standard diet or other types of nutritional interventions. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcome for prevention studies was the proportion of participants who developed new (incident) pressure ulcers. For treatment studies, our primary outcomes were time to complete pressure ulcer healing, number of people with healed pressure ulcers, size and depth of pressure ulcers, and rate of pressure ulcer healing. Secondary outcomes were side effects, costs, health-related quality of life and acceptability. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 33 RCTs with 7920 participants. Data for meta-analysis were available from 6993 participants. Pressure ulcer prevention Eleven studies (with 12 arms) compared six types of nutritional interventions for the prevention of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may result in little to no difference in the proportion of participants developing a pressure ulcer (energy, protein and micronutrient supplements 248 per 1000, standard diet 269 per 1000; RR 0.92, 95% CI 0.71 to 1.19; 3 studies, 1634 participants; low-certainty evidence). Compared to standard diet, protein supplements may result in little to no difference in pressure ulcer incidence (protein 21 per 1000, standard diet 28 per 1000; RR 0.75, 95% CI 0.49 to 1.14; 4 studies, 4264 participants; low-certainty evidence). The evidence is very uncertain about the gastrointestinal side effects of these supplements (protein 109 per 1000, standard diet 155 per 1000; RR 0.70, 95% CI 0.06 to 7.96; 2 studies, 140 participants, very low-certainty evidence). The evidence is very uncertain about the effects of protein, arginine, zinc and antioxidants; L-carnitine, L-leucine, calcium, magnesium and vitamin D; EPA, GLA and antioxidants; disease-specific supplements on pressure ulcer incidence when compared to standard diet (1 study each; very low-certainty evidence for all comparisons). Pressure ulcer treatment Twenty-four studies (with 27 arms) compared 10 types of nutritional interventions or supplements for treatment of pressure ulcers. Compared to standard diet, energy, protein and micronutrient supplements may slightly increase the number of healed pressure ulcers (energy, protein and micronutrients 366 per 1000, standard diet 253 per 1000; RR 1.45, 95% CI 1.14 to 1.85; 3 studies, 577 participants, low-certainty evidence). The evidence is very uncertain about the effect of these supplements on gastrointestinal side effects. Compared to standard diet, the evidence is very uncertain about the effect of protein, arginine, zinc and antioxidant supplements on pressure ulcer healing (pressure ulcer area: mean difference (MD) 2 cm² smaller, 95% CI 4.54 smaller to 0.53 larger; 2 studies, 71 participants, very low-certainty evidence). The evidence on side effects of these supplements is very uncertain. Compared to standard diet, supplements with arginine and micronutrients may not increase the number of healed pressure ulcers, but the evidence suggests a slight reduction in pressure ulcer area (MD 15.8% lower, 95% CI 25.11 lower to 6.48 lower; 2 studies, 231 participants, low-certainty evidence). The evidence is very uncertain about changes in pressure ulcer scores, acceptability, and side effects of these supplements. Compared to placebo, collagen supplements probably improve the mean change in pressure ulcer area (MD 1.81 cm² smaller, 95% CI 3.36 smaller to 0.26 smaller; 1 study, 74 participants, moderate-certainty evidence). The evidence is very uncertain about the effect of these supplements on side effects. The evidence is very uncertain about the effects of vitamin C, different doses of arginine; EPA, GLA (special dietary fatty acids) and antioxidants; protein; a specialized amino acid mixture; ornithine alpha-ketoglutarate and zinc supplements on pressure ulcer healing (1 or 2 studies each; very low-certainty evidence). AUTHORS' CONCLUSIONS The benefits of nutritional interventions with various compositions for pressure ulcer prevention and treatment are uncertain. There may be little or no difference compared to standard nutrition or placebo. Nutritional supplements may not increase gastrointestinal side effects, but the evidence is very uncertain. Larger studies with similar nutrient compositions would reduce these uncertainties. No study investigated the effects of special diets (e.g. protein-enriched diet, vegetarian diet) on pressure ulcer incidence and healing.
Collapse
Affiliation(s)
- Gero Langer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, Australia
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Astrid Fink
- Department of Health, District administration Groß-Gerau, Groß-Gerau, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University Graz, Graz, Austria
| |
Collapse
|
7
|
ALFadhalah T, Lari M, Al Salem G, Ali S, Al Kharji H, Elamir H. Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study. BMC Health Serv Res 2024; 24:173. [PMID: 38326902 PMCID: PMC10851550 DOI: 10.1186/s12913-024-10615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals. METHODS A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis. RESULTS The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied. CONCLUSIONS The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.
Collapse
Affiliation(s)
- Talal ALFadhalah
- Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Marjan Lari
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Gheed Al Salem
- Accreditation Affairs Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Shaimaa Ali
- Nursing Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hamad Al Kharji
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Hossam Elamir
- Research and Technical Support Department, Quality and Accreditation Directorate, Ministry of Health, Kuwait City, Kuwait.
| |
Collapse
|
8
|
Kwek MSY, Thangaveloo M, Madden LE, Phillips ARJ, Becker DL. Targeting Cx43 to Reduce the Severity of Pressure Ulcer Progression. Cells 2023; 12:2856. [PMID: 38132176 PMCID: PMC10741864 DOI: 10.3390/cells12242856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
In the skin, repeated incidents of ischemia followed by reperfusion can result in the breakdown of the skin and the formation of a pressure ulcer. Here we gently applied paired magnets to the backs of mice to cause ischemia for 1.5 h and then removed them to allow reperfusion. The sterile inflammatory response generated within 4 h causes a stage 1 pressure ulcer with an elevation of the gap junction protein Cx43 in the epidermis. If this process is repeated the insult will result in a more severe stage 2 pressure ulcer with a breakdown of the epidermis 2-3 days later. After a single pinch, the elevation of Cx43 in the epidermis is associated with the inflammatory response with an increased number of neutrophils, HMGB1 (marker of necrosis) and RIP3 (responsible for necroptosis). Delivering Cx43 specific antisense oligonucleotides sub-dermally after a single insult, was able to significantly reduce the elevation of epidermal Cx43 protein expression and reduce the number of neutrophils and prevent the elevation of HMGB1 and RIP3. In a double pinch model, the Cx43 antisense treatment was able to reduce the level of inflammation, necroptosis, and the extent of tissue damage and progression to an open wound. This approach may be useful in reducing the progression of stage 1 pressure ulcers to stage 2.
Collapse
Affiliation(s)
- Milton Sheng Yi Kwek
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| | - Leigh E. Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| | | | - David L. Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore (M.T.); (L.E.M.)
- Skin Research Institute Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore 308232, Singapore
| |
Collapse
|
9
|
Cortés OL, Herrera VM, Salazar LD, Rojas YA, Esparza M, Taborda A, Dennis RJ. Impact of hydrocolloid dressings in the prevention of pressure ulcers in high-risk patients: a randomized controlled trial (PENFUP). Sci Rep 2023; 13:21639. [PMID: 38062132 PMCID: PMC10703794 DOI: 10.1038/s41598-023-47483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
It is uncertain whether hydrocolloid dressings, a more costly intervention than offering standard care with petrolatum, is superior to prevent pressure ulcers among hospitalized high-risk adults. Randomized, parallel-group, open-label, superiority trial with an active control group, blinded for investigators, event validators, and analysts (December 1, 2015 to December 12, 2017). Eligible patients were ≥ 18 years of age with intact skin judged as high-risk for skin ulcers (Braden scale), admitted to surgical or medical wards of two tertiary-level hospitals. Participants were randomized (1:1) to protection with hydrocolloid dressings or petrolatum. The primary outcome was the first occurrence of pressure ulcers (with post-injury photographs adjudicated by three judges) under intention-to-treat analysis. Based on prior cost analysis, and the available resources (assumed incidence of 6 ulcers/1000 patient-days in controls), inclusion of up to 1500 participants allowed to surpass a one-sided superiority threshold > 5% based on a target efficacy > 40% for dressings. We planned an economic analysis using a decision tree model based on the effectiveness of the study results from a perspective of the third payer of health care. After inclusion of 689 patients (69 events), the trial was stopped for futility after a planned interim analysis (conditional power < 0.1 for all scenarios if the trial was completed). Pressure ulcers had occurred in 34 (10.2%) patients in the intervention group [9.6 per 1000 patient-days] and 35 (9.9%) participants in the control group [7.9 per 1000 patient-days], HR = 1.07 [95% CI 0.67 to 1.71]. The estimated incremental cost for dressings (a dominated strategy) was USD 52.11 per patient. Using hydrocolloid dressings was found similar to petrolatum for preventing pressure ulcers among hospitalized high-risk patients. As it conveys additional costs, and in this study was unlikely to demonstrate enough superiority, this strategy did not overcome conventional skin care.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT02565745 registered on December 1, 2015.
Collapse
Affiliation(s)
- Olga L Cortés
- Research Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
- Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
| | | | - Luz D Salazar
- Hospitalization Services, Fundación Cardioinfantil-Instituto Cardiología, Bogotá, Colombia
| | - Yudy A Rojas
- Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Maribel Esparza
- Nursing Department, Clínica Carlos Ardila Lulle, FOSCAL, Bucaramanga, Colombia
| | - Alejandra Taborda
- Department of Public Health and Health Economics, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Rodolfo José Dennis
- Research Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| |
Collapse
|
10
|
Tatarusanu SM, Lupascu FG, Profire BS, Szilagyi A, Gardikiotis I, Iacob AT, Caluian I, Herciu L, Giscă TC, Baican MC, Crivoi F, Profire L. Modern Approaches in Wounds Management. Polymers (Basel) 2023; 15:3648. [PMID: 37688274 PMCID: PMC10489962 DOI: 10.3390/polym15173648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Wound management represents a well-known continuous challenge and concern of the global healthcare systems worldwide. The challenge is on the one hand related to the accurate diagnosis, and on the other hand to establishing an effective treatment plan and choosing appropriate wound care products in order to maximize the healing outcome and minimize the financial cost. The market of wound dressings is a dynamic field which grows and evolves continuously as a result of extensive research on developing versatile formulations with innovative properties. Hydrogels are one of the most attractive wound care products which, in many aspects, are considered ideal for wound treatment and are widely exploited for extension of their advantages in healing process. Smart hydrogels (SHs) offer the opportunities of the modulation physico-chemical properties of hydrogels in response to external stimuli (light, pressure, pH variations, magnetic/electric field, etc.) in order to achieve innovative behavior of their three-dimensional matrix (gel-sol transitions, self-healing and self-adapting abilities, controlled release of drugs). The SHs response to different triggers depends on their composition, cross-linking method, and manufacturing process approach. Both native or functionalized natural and synthetic polymers may be used to develop stimuli-responsive matrices, while the mandatory characteristics of hydrogels (biocompatibility, water permeability, bioadhesion) are preserved. In this review, we briefly present the physiopathology and healing mechanisms of chronic wounds, as well as current therapeutic approaches. The rational of using traditional hydrogels and SHs in wound healing, as well as the current research directions for developing SHs with innovative features, are addressed and discussed along with their limitations and perspectives in industrial-scale manufacturing.
Collapse
Affiliation(s)
- Simona-Maria Tatarusanu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
- Research & Development Department, Antibiotice Company, 1 Valea Lupului Street, 707410 Iasi, Romania
| | - Florentina-Geanina Lupascu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Bianca-Stefania Profire
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania;
| | - Andrei Szilagyi
- Advanced Research and Development Center for Experimental Medicine (CEMEX), University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania; (A.S.); (I.G.)
| | - Ioannis Gardikiotis
- Advanced Research and Development Center for Experimental Medicine (CEMEX), University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania; (A.S.); (I.G.)
| | - Andreea-Teodora Iacob
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Iulian Caluian
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Lorena Herciu
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| | - Tudor-Catalin Giscă
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street 700115 Iasi, Romania;
| | - Mihaela-Cristina Baican
- Department of Pharmaceutical Physics, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania;
| | - Florina Crivoi
- Department of Pharmaceutical Physics, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 University Street, 700115 Iasi, Romania;
| | - Lenuta Profire
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy “Grigore T. Popa” of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (S.-M.T.); (F.-G.L.); (A.-T.I.); (I.C.); (L.H.)
| |
Collapse
|
11
|
Speth J. Guidelines in Practice: Prevention of Perioperative Pressure Injury. AORN J 2023; 118:37-44. [PMID: 37368530 DOI: 10.1002/aorn.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/29/2023]
Abstract
Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand-over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient-specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population.
Collapse
|
12
|
Walker RM, Chaboyer W, Cooke M, Whitty JA, Thalib L, Lockwood I, Latimer S, Campbell J, Probert R, Gillespie BM. EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial. Trials 2023; 24:70. [PMID: 36721259 PMCID: PMC9887548 DOI: 10.1186/s13063-022-06999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. METHODS This is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. DISCUSSION This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. TRIAL REGISTRATION ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019.
Collapse
Affiliation(s)
- R. M. Walker
- grid.412744.00000 0004 0380 2017NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia , Brisbane, Australia
| | - W. Chaboyer
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - M. Cooke
- grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - J. A. Whitty
- grid.8273.e0000 0001 1092 7967Health Economics Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - L. Thalib
- grid.449300.a0000 0004 0403 6369Department of Biostatistics, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - I. Lockwood
- grid.1022.10000 0004 0437 5432Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - S. Latimer
- grid.1022.10000 0004 0437 5432School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University & Gold Coast University Hospital, Gold Coast Health, Gold Coast, Australia
| | - J. Campbell
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - R. Probert
- grid.412744.00000 0004 0380 2017Stomal Therapy and Wound Management Department in the Division of Surgery, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - B. M. Gillespie
- grid.1022.10000 0004 0437 5432NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| |
Collapse
|
13
|
Gomes JT, Wanzeler AMV, Júnior SM, Soares RHFC, de Oliveira CP, Rodrigues EDM, Soares BM, Alcantara DD, Burbano RM, Tuji FM. The chromatographic constitution of andiroba oil and his healing effects, compared to the LLLT outcomes, in oral mucositis induced in golden Syrian hamsters: a new treatment option. Oncotarget 2023; 14:23-39. [PMID: 36634224 PMCID: PMC9836383 DOI: 10.18632/oncotarget.28338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The oral mucositis is a mucosal alteration that usually arises from oncological treatments, such as chemotherapy, and it is characterized as an inflammatory process. The aim of this study is to demonstrate the chromatographic constitution of Andiroba oil, comparing and evaluating Andiroba oil and laser scarring efficiency in treatments of oral mucositis in hamsters. These animals were submitted to 5-Fluorouracil. A total of 122 animals were used, randomized and divided into the following groups: (a) positive control; (b) laser associated to andiroba oil; (c) laser; (d) andiroba oil; (e) negative control; (f) cyclophosphamide (genotoxicity control). The induction of oral mucositis occurred by the administration of intraperitoneal Fluorouracila (60 mg/kg) and trauma to the mucosa. The laser protocol was performed once a day and the andiroba oil applied 3 times a day (1,5 ml/day). The mucosae were photographed and removed for clinical and histopathological analysis on day 4, 8, 12 and 15. The analysis was based in OM severity, in specific scoring for the clinical and histopathological aspect. Toxicity was evaluated on day 15 using comet assay and it was performed by variant DNA damage parameters. The data were analysed using analysis of variance (ANOVA) Tukey post-test and Kruskal-Wallis Dunn post-test. The "andiroba oil" and "laser" groups presented better results when compared to the control groups and the treatment associations. The andiroba oil presented the best scarring results, even considering its efficiency proximity to the laser treatment. Andiroba and laser, separately, did not present genotoxicity, however their association evidences damage to DNA.
Collapse
Affiliation(s)
- Jessica T. Gomes
- 1Department of Dentistry, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil
| | - Ana Márcia V. Wanzeler
- 1Department of Dentistry, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil
| | - Sergio M.A. Júnior
- 1Department of Dentistry, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil
| | | | | | | | - Bruno M. Soares
- 3Department of Genetics, Laboratory of Human Cytogenetics, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil
| | - Diego D.F.A. Alcantara
- 3Department of Genetics, Laboratory of Human Cytogenetics, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil,Correspondence to:Diego D.F.A. Alcantara, email:
| | - Rommel M.R. Burbano
- 3Department of Genetics, Laboratory of Human Cytogenetics, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil
| | - Fabrício M. Tuji
- 1Department of Dentistry, Federal University of Pará, Guamá, Belém, Pará 66075-970, Brazil
| |
Collapse
|
14
|
Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:4-13. [PMID: 35680115 DOI: 10.1016/j.enfcle.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/01/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings. METHODS A literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. Evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model. RESULTS Of the 1056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95% CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95% CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95% CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95% CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95% CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27). CONCLUSION The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.
Collapse
|
15
|
Hernández-Vásquez A, Visconti-Lopez FJ, Cabanillas-Ramirez C, Díaz-Seijas D, Meléndez-Escalante J, Comandé D, Santero M. Efficacy and Safety of Topical Application of Olive Oil for Preventing Pressure Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14921. [PMID: 36429639 PMCID: PMC9690722 DOI: 10.3390/ijerph192214921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
The purpose was to identify and summarize the existing evidence on the efficacy and safety of the topical application of olive oil for preventing pressure ulcers (PUs). We included only randomized controlled trials (RCTs) involving patients at risk of developing PUs, testing the topical application of olive oil versus other products for PU prevention. We assessed the risk of bias using the RoB 2 tool, and the certainty of the evidence with GRADE. Four RCTs met the eligibility criteria. All studies were judged at a low risk of bias overall. The meta-analysis showed that the clinical efficacy of olive oil for prevention occurs by reducing the incidence of PUs (RR = 0.56, 95% CI = 0.30 to 0.79, I2 = 0%); with no differences in adverse effects, it may be associated with a shorter development time of PUs and shorter hospital stays. The certainty of the evidence assessed by the GRADE approach was moderate and low. The topical application of olive oil is effective and safe in reducing the incidence of PUs compared to other treatments. These findings could provide new insights into olive oil as a preventive and alternative treatment for PUs as it is accessible and inexpensive compared to other products.
Collapse
Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | | | | | | | | | - Daniel Comandé
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires C1414CPV, Argentina
| | - Marilina Santero
- Iberoamerican Cochrane Centre, IIB Sant Pau—Servei d’Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| |
Collapse
|
16
|
Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Qazi M, Khattak AF, Barki MT. Pressure Ulcers in Admitted Patients at a Tertiary Care Hospital. Cureus 2022; 14:e24298. [PMID: 35607569 PMCID: PMC9123348 DOI: 10.7759/cureus.24298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pressure ulcers (PUs) occur when the skin covering a weight-bearing part of the body is compressed for a long time between bone, any other part of the body, bed, chair, or any other hard surface. This study aimed to determine the prevalence of pressure ulcers at a tertiary care hospital in all specialty departments including COVID-19. Methods A retrospective study was conducted at North West General Hospital and Research Center, Peshawar, Pakistan. After obtaining ethical approval, data were obtained from the hospital database from July 2020 to June 2021. The keywords "bed sore," "pressure sore," and "pressure ulcer" were used to search for relevant cases, and patient demographics, including age and gender, site of pressure ulcer, stage of pressure ulcer, whether the pressure ulcer was single or multiple, length of stay at the hospital, and specialty department, were collected. Results In total, 99 patients met the inclusion criteria, of which 65 (65.7%) were males, while 34 (34.3%) were females. The age of the patients ranged from 15 to 92 years, with a mean age of 59.93 years. Of the patients, 87 (87.9%) had acquired only a single pressure ulcer. Stage 2 pressure ulcers were the most documented, making up 43.1% of the total cases reported, while stage 4 cases were only 3.3%. The sites most frequently affected by pressure ulcers were the gluteal and sacral regions, accounting for 34.4% and 30.3%, respectively. The incidence of pressure ulcers was the highest in the COVID-19 ward, i.e., 25.3%, followed by the neurosurgery ward with a 20.2% incidence. Conclusion Pressure ulcers occur frequently in almost all the specialty departments of a healthcare setting, especially in COVID-19 and neurosurgery wards, and impose significant physical, psychological, and financial burdens. The prevention of pressure ulcers is the best approach to avert patients and their families from all the burdens associated with pressure ulcers.
Collapse
Affiliation(s)
- Mustafa Qazi
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | - Muhammad T Barki
- Neurological Surgery, North West General Hospital and Research Center, Peshawar, PAK
| |
Collapse
|
18
|
Moore Z, Moore D, McEvoy NL, Avsar P, O'Connor T, Budri A, Curley G, Walsh S, Burke F, Porter‐Armstrong A, Chaboyer W, Rice J, Patton D. Preventing facial pressure injuries among health care staff working in diverse COVID-19 care environments. Int Wound J 2022; 19:1677-1685. [PMID: 35146927 PMCID: PMC9111615 DOI: 10.1111/iwj.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries among frontline health care workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. This was a mixed methods study. First, a pre-posttest observational design was employed to evaluate the impact of the pre-piloted intervention, a care bundle including skin cleansing and hydration, protective material use, facemask selection and skin inspection, developed in line with international best practice guidelines. Data were collected using survey methodology. Frontline COVID-19 staff working in acute, community and ambulance services were invited to participate. Then, judgemental and volunteer sampling was used to select participants to undertake semi-structured interviews to elicit feedback on their perceptions of the care bundle. The sample included 120 acute hospital staff, 60 Ambulance staff, 24 Community Hub staff and 20 COVID-19 testing centre staff. A survey response rate of 61% was realised (n = 135/224). Of the participants, 32% (n = 43) had a facial pressure ulcer (FPI) pre-intervention and 13% (n = 18) developed an FPI while using the care bundle. The odds ratio (OR) was 0.33 (95% CI: 0.18 to 0.61; P = .0004), indicating a 77% reduction in the odds of FPI development with use of the care bundle. Analysis of the qualitative data from 22 interviews identified three key themes, the context for the care bundle, the ease of use of the care bundle and the care bundle as a solution to FPI development. The care bundle reduced the incidence of FPI among the participants and was found to be easy to use. Implementation of skin protection for frontline staff continues to be important given the persistently high incidence of COVID-19 and the ongoing need to wear PPE for protracted durations.
Collapse
Affiliation(s)
- Zena Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityMonashAustralia,Department of Public HealthFaculty of Medicine and Health Sciences, Ghent UniversityGhentBelgium,Lida InstituteShanghaiChina,University of WalesCardiffUK,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandQueenslandAustralia
| | | | - Natalie L. McEvoy
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Beaumont HospitalDublinIreland
| | - Pinar Avsar
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Lida InstituteShanghaiChina
| | - Aglecia Budri
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Gerard Curley
- Beaumont HospitalDublinIreland,RCSI University of Medicine and Health SciencesDublinIreland
| | - Simone Walsh
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Frank Burke
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | | | - Wendy Chaboyer
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandQueenslandAustralia
| | | | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland,School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland,Fakeeh College of Health SciencesJeddahSaudi Arabia,School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia,Faculty of Science, Medicine and HealthUniversity of WollongongAustralia
| |
Collapse
|
19
|
Li Z, Marshall AP, Lin F, Ding Y, Chaboyer W. Pressure injury prevention practices among medical surgical nurses in a tertiary hospital: An observational and chart audit study. Int Wound J 2021; 19:1165-1179. [PMID: 34729917 PMCID: PMC9284631 DOI: 10.1111/iwj.13712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Pressure injuries are frequently occurring adverse events in hospitals, negatively impacting patient safety and quality of care. Most pressure injuries are avoidable if effective prevention strategies are used. However, the extent to which various settings influence their use of prevention strategies is unknown. The aim of this study was to describe and compare pressure injury prevention strategies used by medical and surgical nurses in the Chinese context. In this observational study, we used semi-structured observations with chart audits to collect data in two medical and two surgical wards in a tertiary hospital from June to December 2020. Observations were patient-focused; any prevention practices the patient received were recorded, and a chart audit was used to identify documented prevention strategies. The frequency of each prevention strategy was reported, and differences between medical and surgical wards were analysed using independent t-test or χ2 test. A total of 577 patients (n = 294, 50.9% medical; n = 283, 49.1% surgical) were observed and their charts audited. Risk assessment was completed on admission for all patients. Repositioning was the most frequently used strategy, with about 84% (n = 486) patients being repositioned regularly. However, skin care, nutritional risk screening and the use of support surfaces were suboptimal. Patient education was not commonly observed but was documented in 75% (n = 433) of audited charts. More medical patients' skin was kept clean and hydrated, but more surgical patients received barrier creams, had a support surface and received more nutrition support and if a prone position was used, they were more likely to be turned after 2 hr and to be repositioned after sitting in a chair for an hour. Prevention strategies were more likely to be documented in surgical patients' charts. Despite pressure injury prevention guideline recommendations provided various prevention strategies for nurses to apply, the observed use of some strategies such as nutrition, skin care and support surfaces was not ideal. Nurses relied heavily on repositioning for pressure injury prevention. Most pressure injury prevention practices need improvement although surgical patients generally received better preventative care. These findings can facilitate clinicians and nurse managers when tailoring future pressure injury prevention work.
Collapse
Affiliation(s)
- Zhaoyu Li
- School of Nursing and Midwifery, Griffith University, Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast Health, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Frances Lin
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Yanming Ding
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| |
Collapse
|
20
|
Jobanputra RD, Hayes J, Royyuru S, Masen MA. A numerical analysis of skin-PPE interaction to prevent facial tissue injury. Sci Rep 2021; 11:16248. [PMID: 34376802 PMCID: PMC8355255 DOI: 10.1038/s41598-021-95861-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
The use of close-fitting PPE is essential to prevent exposure to dispersed airborne matter, including the COVID-19 virus. The current pandemic has increased pressure on healthcare systems around the world, leading to medical professionals using high-grade PPE for prolonged durations, resulting in device-induced skin injuries. This study focuses on computationally improving the interaction between skin and PPE to reduce the likelihood of discomfort and tissue damage. A finite element model is developed to simulate the movement of PPE against the face during day-to-day tasks. Due to limited available data on skin characteristics and how these vary interpersonally between sexes, races and ages, the main objective of this study was to establish the effects and trends that mask modifications have on the resulting subsurface strain energy density distribution in the skin. These modifications include the material, geometric and interfacial properties. Overall, the results show that skin injury can be reduced by using softer mask materials, whilst friction against the skin should be minimised, e.g. through use of micro-textures, humidity control and topical creams. Furthermore, the contact area between the mask and skin should be maximised, whilst the use of soft materials with incompressible behaviour (e.g. many elastomers) should be avoided.
Collapse
Affiliation(s)
- Rikeen D Jobanputra
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - Jack Hayes
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Sravani Royyuru
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Marc A Masen
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| |
Collapse
|
21
|
Role of microRNAs in Pressure Ulcer Immune Response, Pathogenesis, and Treatment. Int J Mol Sci 2020; 22:ijms22010064. [PMID: 33374656 PMCID: PMC7793489 DOI: 10.3390/ijms22010064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.
Collapse
|
22
|
Beeckman D, Fourie A, Raepsaet C, Van Damme N, Manderlier B, De Meyer D, Beele H, Smet S, Demarré L, Vossaert R, de Graaf A, Verhaeghe L, Vandergheynst N, Hendrickx B, Hanssens V, Keymeulen H, Vanderwee K, Van De Woestijne J, Verhaeghe S, Van Hecke A, Savoye I, Harrison J, Vrijens F, Hulstaert F. Silicone adhesive multilayer foam dressings as adjuvant prophylactic therapy to prevent hospital-acquired pressure ulcers: a pragmatic noncommercial multicentre randomized open-label parallel-group medical device trial. Br J Dermatol 2020; 185:52-61. [PMID: 33216969 PMCID: PMC8359283 DOI: 10.1111/bjd.19689] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Background Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital‐acquired pressure ulcers (PUs). Objectives To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. Methods This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At‐risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) – pooled as the treatment group – and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. Results In the intention‐to‐treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41–0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35–0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34–1·68, P = 0·49). Conclusions Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at‐risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas. What is already known about this topic?The incidence of hospital‐acquired pressure ulcers (PUs) remains high despite the implementation of best‐practice recommendations. The concept of using silicone foam dressings as an additional prophylactic strategy in PU prevention has been investigated in previous studies but with some limitations. Most RCTs were monocentric studies, restricted to either critically ill or acute care patients and did not observe more than two anatomical at‐risk skin sites, which limited the generalizability of the findings.
What does this study add?This large pragmatic RCT suggests that it is beneficial to use silicone adhesive multilayer foam dressings on the sacrum, in addition to standard of care, to help prevent hospital‐acquired PUs. Clinical decision making for heel dressings should be based on the clinical effectiveness of the intervention weighed against the potential risk of falling.
Linked Comment: F. Coyer. Br J Dermatol 2021; 185:4–5.
Collapse
Affiliation(s)
- D Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - A Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - C Raepsaet
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - N Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - B Manderlier
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - D De Meyer
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - H Beele
- Wound Care Centre, Ghent University, Ghent, Belgium
| | - S Smet
- Wound Care Centre, Ghent University, Ghent, Belgium
| | - L Demarré
- AZ Sint-Elisabeth, Zottegem, Oost-Vlaanderan, Belgium
| | - R Vossaert
- AZ Sint-Elisabeth, Zottegem, Oost-Vlaanderan, Belgium
| | - A de Graaf
- Wound Care Support Team, Nursing Centre of Excellence, University Hospitals of Leuven, Leuven, Belgium
| | | | | | - B Hendrickx
- University Hospital of Brussels (UZB), Department of Plastic Surgery, Brussels, Belgium
| | - V Hanssens
- University Hospital of Brussels (UZB), Department of Plastic Surgery, Brussels, Belgium
| | - H Keymeulen
- OLV Ziekenhuis Aalst, Aalst, Oost-Vlaanderan, Belgium
| | - K Vanderwee
- OLV van Lourdes Ziekenhuis Waregem, Waregem, West-Vlaanderan, Belgium
| | | | - S Verhaeghe
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - A Van Hecke
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - I Savoye
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - J Harrison
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - F Vrijens
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - F Hulstaert
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| |
Collapse
|
23
|
Prevention and treatment of pressure injuries: A meta-synthesis of Cochrane Reviews. J Tissue Viability 2020; 29:227-243. [DOI: 10.1016/j.jtv.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/13/2020] [Accepted: 05/29/2020] [Indexed: 12/21/2022]
|
24
|
Zheng KI, Rios RS, Zeng QQ, Zheng MH. COVID-19 Cross-Infection and Pressured Ulceration Among Healthcare Workers: Are We Really Protected by Respirators? Front Med (Lausanne) 2020; 7:571493. [PMID: 33015112 PMCID: PMC7511704 DOI: 10.3389/fmed.2020.571493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kenneth I Zheng
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rafael S Rios
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qi-Qiang Zeng
- Clinical Research Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming-Hua Zheng
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.,Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China
| |
Collapse
|
25
|
Abstract
Hydrogels, swellable hydrophilic polymer networks fabricated through chemical cross-linking or physical entanglement are increasingly utilized in various biomedical applications over the past few decades. Hydrogel-based microparticles, dressings and microneedle patches have been explored to achieve safe, sustained and on-demand therapeutic purposes toward numerous skin pathologies, through incorporation of stimuli-responsive moieties and therapeutic agents. More recently, these platforms are expanded to fulfill the diagnostic and monitoring role. Herein, the development of hydrogel technology to achieve diagnosis and monitoring of pathological skin conditions are highlighted, with proteins, nucleic acids, metabolites, and reactive species employed as target biomarkers, among others. The scope of this review includes the characteristics of hydrogel materials, its fabrication procedures, examples of diagnostic studies, as well as discussion pertaining clinical translation of hydrogel systems.
Collapse
|
26
|
Sönmez M, Yapucu Güneş Ü. Preventive effect of extra virgin olive oil on pressure injury development: A randomized controlled trial in Turkey. Complement Ther Clin Pract 2020; 40:101208. [PMID: 32891284 DOI: 10.1016/j.ctcp.2020.101208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Different moisturizing products are used in the prevention of pressure injuries, but there is a limited number of studies on the effectiveness of extra virgin olive oil, which is an herbal and natural product. The aim of this study was to examine the effect of topically applied extra virgin olive oil on the prevention of pressure injuries. METHODS AND MATERIALS This was a randomized controlled experimental study conducted between February and October 2015 with a total of 129 patients, of whom 64 were in the control group and 65 in the extra virgin olive oil group. RESULTS 16.9% of patients in the extra virgin olive oil group (n = 11) and 32.8% of patients in the control group (n = 21) developed pressure injuries, and the difference was found to be statistically significant. CONCLUSION This study showed that the application of extra virgin olive oil is effective in preventing pressure injuries.
Collapse
Affiliation(s)
- Münevver Sönmez
- Zonguldak Bülent Ecevit University, Faculty of Health Science, Fundamentals of Nursing Department, 67000, Zonguldak, Turkey.
| | - Ülkü Yapucu Güneş
- Ege University, Nursing Faculty, Fundamentals of Nursing Department, İzmir, Turkey
| |
Collapse
|
27
|
Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 2020; 8:182. [PMID: 32266224 PMCID: PMC7096556 DOI: 10.3389/fbioe.2020.00182] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.
Collapse
Affiliation(s)
- Chenyu Shi
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qiuju Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ronghang Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Shao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.,Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| |
Collapse
|
28
|
Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front Pharmacol 2020; 11:155. [PMID: 32180720 PMCID: PMC7059819 DOI: 10.3389/fphar.2020.00155] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/05/2020] [Indexed: 01/20/2023] Open
Abstract
Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians’ knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.
Collapse
Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Sussman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
29
|
Chou PR, Wu SH, Hsieh MC, Huang SH. Retrospective Study on the Clinical Superiority of the Vacuum-Assisted Closure System with a Silicon-based Dressing over the Conventional Tie-over Bolster Technique in Skin Graft Fixation. ACTA ACUST UNITED AC 2019; 55:medicina55120781. [PMID: 31842472 PMCID: PMC6956263 DOI: 10.3390/medicina55120781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/25/2023]
Abstract
Background and Objectives: The tie-over bolster technique has been conventionally used for skin graft fixation; however, long operative times and postoperative pain are the main disadvantages of this method. In this study, we introduce a new method using vacuum-assisted closure (VAC) with a silicon-based dressing as an alternative for skin graft fixation. This retrospective study aimed to evaluate the clinical effect of the VAC plus silicon-based dressing method and the conventional tie-over bolster technique for skin graft fixation in terms of pain, operative time, and skin graft take rate. Materials and Methods: Sixty patients who underwent skin graft surgery performed by a single surgeon from January 2017 to October 2018 were included in this clinical study. They were divided into two groups based on the type of treatment: tie-over bolster technique and vacuum-assisted closure (VAC), or silicon-based dressing groups. The operative times were recorded twice (during suturing or stapling of the graft and during removal of the dressing) in the two groups; similarly, pain was assessed using a numeric rating scale (NRS) after surgery and during dressing removal. Skin graft take rate was evaluated two weeks after dressing removal. Results: Twenty-six patients who met the eligibility criteria were enrolled into the study and assigned to one of the two groups (n = 13 each). No significant differences in age, gender, and graft area were noted between the two groups of patients. The VAC plus silicon-based dressing group demonstrated higher skin graft take rates (p < 0.05), shorter operation times (p < 0.05), and lower levels of pain (postoperative pain and pain during dressing removal) compared with the tie-over bolster technique group (p < 0.05). Conclusions: These findings indicate that VAC with silicon-based dressing can be used for skin graft fixation due to its superior properties when compared with the conventional method, and can improve the quality of life of patients undergoing skin graft fixation.
Collapse
Affiliation(s)
- Ping-Ruey Chou
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Sheng-Hua Wu
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 807, Taiwan
| | - Meng-Chien Hsieh
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 7676)
| |
Collapse
|
30
|
Gaspar S, Peralta M, Marques A, Budri A, Gaspar de Matos M. Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review. Int Wound J 2019; 16:1087-1102. [PMID: 31264345 DOI: 10.1111/iwj.13147] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/11/2019] [Indexed: 12/12/2022] Open
Abstract
The effective approach on pressure ulcer (PU) prevention regarding patient safety in the hospital context was evaluated. Studies were identified from searches in EBSCO host, PubMed, and WebofScience databases from 2009 up to December 2018. Studies were selected if they were published in English, French, Portuguese, or Spanish; incidence of PUs was the primary outcome; participants were adults (≥18 years) admitted in hospital wards and/or units. The review included 26 studies. Studies related to prophylactic dressings applied in the sacrum, trochanters, and/or heels, education for health care professionals, and preventive skin care and system reminders on-screen inpatient care plan were effective in decreasing PUs. Most of the studies related to multiple intervention programmes were effective in decreasing PU occurrence. Single interventions, namely support surfaces and repositioning, were not always effective in preventing PUs. Repositioning only was effective when supported by technological pressure-mapping feedback or by a patient positioning system. Risk-assessment tools are not effective in preventing PUs. PUs in the hospital context are still a worldwide issue related to patient safety. Multiple intervention programmes were more effective in decreasing PU occurrence than single interventions in isolation. Single interventions (prophylactic dressings, support surfaces, repositioning, preventive skin care, system reminders, and education for health care professionals) were effective in decreasing PUs, which was always in compliance with other preventive measures. These results provide an overview of effective approaches that should be considered when establishing evidence-based guidelines to hospital health care professionals and administrators for clinical practice effective in preventing PUs.
Collapse
Affiliation(s)
- Susana Gaspar
- Faculty of Human Kinetics, Aventura Social, University of Lisbon, Lisbon, Portugal.,Faculty of Medicine, Environmental Health Institute (ISAMB), University of Lisbon, Lisbon, Portugal
| | - Miguel Peralta
- Faculty of Human Kinetics, Aventura Social, University of Lisbon, Lisbon, Portugal.,Faculty of Medicine, Environmental Health Institute (ISAMB), University of Lisbon, Lisbon, Portugal.,Faculty of Human Kinetics, Interdisciplinary Center for the Study of Human Performance (CIPER), University of Lisbon, Lisbon, Portugal
| | - Adilson Marques
- Faculty of Human Kinetics, Aventura Social, University of Lisbon, Lisbon, Portugal.,Faculty of Medicine, Environmental Health Institute (ISAMB), University of Lisbon, Lisbon, Portugal.,Faculty of Human Kinetics, Interdisciplinary Center for the Study of Human Performance (CIPER), University of Lisbon, Lisbon, Portugal
| | - Aglécia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Margarida Gaspar de Matos
- Faculty of Human Kinetics, Aventura Social, University of Lisbon, Lisbon, Portugal.,Faculty of Medicine, Environmental Health Institute (ISAMB), University of Lisbon, Lisbon, Portugal
| |
Collapse
|