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Sibbald RG, Dalgarno N, Hastings-Truelove A, Soleas E, Jaimangal R, Elliott J, Coderre-Ball AM, Hill S, van Wylick R, Smith K. COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp. Adv Skin Wound Care 2024; 37:76-84. [PMID: 38241450 DOI: 10.1097/asw.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. METHODS An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. RESULTS Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. CONCLUSIONS This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.
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Affiliation(s)
- R Gary Sibbald
- R. Gary Sibbald, MD, MEd, FRCPC (Med, Derm), FAAD, MAPWCA, JM, is Professor of Public Health and Medicine, University of Toronto, Dalla Lana School of Public Health and Dept. of Medicine, Faculty of Medicine, University of Toronto, Canada. Nancy Dalgarno, HBOR, BEd, MEd, PhD, OCT, is Director of Education Scholarship, Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, Canada. Also at Queen's University, Amber Hastings-Truelove, MA, PhD, is Health Education Researcher and Consultant, Office of Professional Development and Educational Scholarship; and Eleftherios Soleas, MEd, PhD, OCT, is Director of Continuing Professional Development, Office of Professional Development and Educational Scholarship, Faculty of Health Sciences. Reneeka Jaimangal, MD, MScCH, is Project Manager, WoundPedia Project ECHO Ontario, Ontario Skin and Wound, Mississauga, Canada. James Elliott, MSc, is Director of Operations, Woundpedia, Mississauga. Also at Queen's University, Angela M. Coderre-Ball, MSc, PhD, is Research Associate, Department of Family Medicine; Shannon Hill, MEd, OCT, is PhD Candidate, School of Rehabilitation Therapy; Richard van Wylick, MD, FRCPC, is Associate Dean, Professional Development, Faculty of Health Sciences; and Karen Smith, MD, FRCPC, FAAPMR, FABEM, is Professor, Department of Physical Medicine and Rehabilitation
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Moattari M, King EC, Ruco A. Whole versus hole: enabling community nurses to implement holistic wound care. J Wound Care 2023; 32:748-757. [PMID: 37907360 DOI: 10.12968/jowc.2023.32.11.748] [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] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To improve wound-related quality of life (QoL) in clients with hard-to-heal wounds in their lower limbs and to increase referrals to multidisciplinary teams in the management of care for these clients. METHOD This was a quality improvement project with a two-group pretest-posttest interventional evaluation design. We implemented a package of interventions including the WounDS app, education related to wound care, and client engagement through a QoL self-assessment. Wound-related QoL was measured using the Cardiff Wound Impact Schedule and referrals to the multidisciplinary team were tracked through chart audits. We explored nurses' experiences with the interventions through semi-structured interviews. RESULTS Clients' average ratings for 'wellbeing', 'physical symptoms and daily living', and 'overall QoL' improved by 27%, 38% and 54%, respectively. The number of referrals increased by 78% post intervention. Nurses described the interventions as effective strategies that motivated them to implement a holistic approach to care. CONCLUSION The project was successful in creating a culture shift to practice holistic wound care. This package of interventions (WounDS app, education and client self-assessment of QoL) led to improvements in the QoL of clients with hard-to-heal wounds. Further studies are needed to generalise the findings. Strategies for sustainability include forming a champion group and providing the education and decision supports based on nurses' educational needs assessment.
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Affiliation(s)
- Marzieh Moattari
- VHA Home HealthCare, Toronto, Canada
- Humber River Health, Toronto, Canada
| | - Emily C King
- VHA Home HealthCare, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Arlinda Ruco
- VHA Home HealthCare, Toronto, Canada
- St. Francis Xavier University, Antigonish, Canada
- Women's College Hospital, Toronto, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, Canada
- Nova Scotia Health, Nova Scotia, Canada
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Beitz JM, Kennedy-Evans KL. Good Things Don't Always Come in Small Packages: Comprehensive Care of Patients With Class 3 Obesity: An Integrative Review. J Wound Ostomy Continence Nurs 2023; 50:365-374. [PMID: 37713346 DOI: 10.1097/won.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The epidemic of obesity and morbid obesity is straining the American health care system's ability to provide quality patient care. Patients with Class 3 (also referred to as morbid or severe) obesity require specialized equipment, unique approaches in the delivery of care, and understanding of the biopsychosocial pathophysiologic mechanisms underlying their condition. This article defines Class 3 obesity, its pathophysiology, and discusses issues that arise when providing quality care of these individuals including safe patient handling, right-sized equipment, and empathetic interpersonal care. We also discuss skin and wound care issues associated with Class 3 obesity.
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Affiliation(s)
- Janice M Beitz
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, MAPWCA, ANEF, WOCNF, FNAP, FAAN, School of Nursing-Camden, Rutgers University, Camden, New Jersey
- Karen Lou Kennedy-Evans, RN, APRN-BC, FNP, University of Arizona College of Nursing, Tucson, and K.L. Kennedy LLC, Tucson, Arizona
| | - Karen Lou Kennedy-Evans
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, MAPWCA, ANEF, WOCNF, FNAP, FAAN, School of Nursing-Camden, Rutgers University, Camden, New Jersey
- Karen Lou Kennedy-Evans, RN, APRN-BC, FNP, University of Arizona College of Nursing, Tucson, and K.L. Kennedy LLC, Tucson, Arizona
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Derwin R, Patton D, Strapp H, Moore Z. Wound pH and temperature as predictors of healing: an observational study. J Wound Care 2023; 32:302-310. [PMID: 37094930 DOI: 10.12968/jowc.2023.32.5.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The aim of this study was to measure wound pH, wound temperature and wound size together to gain further understanding of their impact as predictors of wound healing outcomes. METHOD This study employed a quantitative non-comparative, prospective, descriptive observational design. Participants with both acute and hard-to-heal (chronic) wounds were observed weekly for four weeks. Wound pH was measured using pH indicator strips, wound temperature was measured using an infrared camera and wound size was measured using the ruler method. RESULTS Most of the 97 participants (65%, n=63) were male; participant's ages ranged between 18 and 77 years (mean: 42±17.10. Most of the wounds observed were surgical 60%, (n=58) and 72% (n=70) of the wounds were classified as acute, with 28% (n=27) classified as hard-to-heal wounds. At baseline, there was no significant difference in pH between acute and hard-to-heal wounds; overall the mean pH was 8.34±0.32, mean temperature was 32.86±1.78°C) and mean wound area was 910.50±1132.30mm2. In week 4, mean pH was 7.71±1.11, mean temperature was 31.90±1.76°C and mean wound area was 339.90±511.70mm2. Over the study follow-up period, wound pH ranged from 5-9, from week 1 to week 4, mean pH reduced by 0.63 units from 8.34 to 7.71. Furthermore, there was a mean 3% reduction in wound temperature and a mean 62% reduction in wound size. CONCLUSION The study demonstrated that a reduction in pH and temperature was associated with increased wound healing as evidenced by a corresponding reduction in wound size. Thus, measuring pH and temperature in clinical practice may provide clinically meaningful data pertaining to wound status.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | | | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland
- Cardiff University, Cardiff, Wales
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, KSA
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Lida Institute, Shanghai, China
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Derwin R, Patton D, Strapp H, Moore Z. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J 2023; 20:1118-1129. [PMID: 36251505 PMCID: PMC10031221 DOI: 10.1111/iwj.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n = 19) were male, and most wounds were acute (70%; n = 19) and included surgical and trauma wounds, the remaining (30%; n = 8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Coleraine, UK
- School of Nursing and Midwifery, Cardiff University, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Departmnet of Nursing, Lida Institute, Shanghai, China
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Poradzka AA, Czupryniak L. The use of the artificial neural network for three-month prognosis in diabetic foot syndrome. J Diabetes Complications 2023; 37:108392. [PMID: 36623424 DOI: 10.1016/j.jdiacomp.2022.108392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Anna A Poradzka
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland.
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
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Chemello G, Salvatori B, Morettini M, Tura A. Artificial Intelligence Methodologies Applied to Technologies for Screening, Diagnosis and Care of the Diabetic Foot: A Narrative Review. BIOSENSORS 2022; 12:985. [PMID: 36354494 PMCID: PMC9688674 DOI: 10.3390/bios12110985] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Diabetic foot syndrome is a multifactorial pathology with at least three main etiological factors, i.e., peripheral neuropathy, peripheral arterial disease, and infection. In addition to complexity, another distinctive trait of diabetic foot syndrome is its insidiousness, due to a frequent lack of early symptoms. In recent years, it has become clear that the prevalence of diabetic foot syndrome is increasing, and it is among the diabetes complications with a stronger impact on patient's quality of life. Considering the complex nature of this syndrome, artificial intelligence (AI) methodologies appear adequate to address aspects such as timely screening for the identification of the risk for foot ulcers (or, even worse, for amputation), based on appropriate sensor technologies. In this review, we summarize the main findings of the pertinent studies in the field, paying attention to both the AI-based methodological aspects and the main physiological/clinical study outcomes. The analyzed studies show that AI application to data derived by different technologies provides promising results, but in our opinion future studies may benefit from inclusion of quantitative measures based on simple sensors, which are still scarcely exploited.
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Affiliation(s)
- Gaetano Chemello
- CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127 Padova, Italy
| | | | - Micaela Morettini
- Department of Information Engineering, Università Politecnica delle Marche, Via Brecce Bianche, 12, 60131 Ancona, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, Corso Stati Uniti 4, 35127 Padova, Italy
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Araújo ALD, Negreiros FDDS, Florêncio RS, Oliveira SKPD, Silva ARVD, Moreira TMM. Effect of thermometry on the prevention of diabetic foot ulcers: a systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3567. [PMID: 35584410 DOI: 10.1590/1518-8345.5663.3567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. METHOD a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. CONCLUSION thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.
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Affiliation(s)
- Açucena Leal de Araújo
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | | | - Thereza Maria Magalhães Moreira
- Universidade Estadual do Ceará, Fortaleza, CE, Brasil.,Bolsista do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
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Araújo ALD, Negreiros FDDS, Florêncio RS, Oliveira SKPD, Silva ARVD, Moreira TMM. Efecto de la termometría en la prevención de las úlceras del pie diabético: revisión sistemática con metaanálisis. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5663.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumen Objetivo: analizar el efecto de la termometría cutánea del pie en personas con diabetes mellitus, en comparación con la prevención estándar de las úlceras del pie adoptada en estos pacientes. Método: revisión sistemática con metaanálisis. Protocolo registrado en PROSPERO (CRD42020202686). Se siguieron las recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se realizó en las fuentes de datos: SCOPUS, Web of Science, MEDLINE a través de PubMed, MEDLINE a través de EBSCO, MEDLINE a través de la Biblioteca Virtual en Salud, Embase, CINAHL, Cochrane Library, LILACS a través de la Biblioteca Virtual en Salud, Google Scholar, Biblioteca Digital Brasileña de Tesis y Disertaciones, Catálogo de Tesis y Disertaciones-Capes, Open Grey y ProQuest Dissertations and Theses. El riesgo de sesgo se evaluó mediante la Cochrane Collaboration Risk of Bias Tool (RoB 2), el metaanálisis se realizó con el software Review Manager 5.4 y la certeza de la evidencia se evaluó mediante el sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: de los 670 registros, cinco artículos fueron elegibles. El metaanálisis se calculó para el resultado prevención de la incidencia de úlceras del pie diabético, con sumarización del efecto (RR 0,53; IC95% 0,29, 0,96; p=0,02), con certeza de evidencia moderada. Conclusión: la termometría mostró un efecto protector sobre la incidencia de úlceras del pie diabético en comparación con el cuidado estándar del pie.
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Affiliation(s)
- Açucena Leal de Araújo
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
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10
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Araújo ALD, Negreiros FDDS, Florêncio RS, Oliveira SKPD, Silva ARVD, Moreira TMM. Effect of thermometry on the prevention of diabetic foot ulcers: a systematic review with meta-analysis*. Rev Lat Am Enfermagem 2022. [PMID: 35584410 PMCID: PMC9109465 DOI: 10.1590/1518-8345.5663.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the effect of cutaneous foot thermometry in people with Diabetes Mellitus, compared with the standard prevention of foot ulcers adopted in these patients. Method: a systematic review with meta-analysis. Protocol registered with PROSPERO (CRD42020202686). The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. The search was performed in the following data sources: SCOPUS, Web of Science, MEDLINE via PubMed, MEDLINE via EBSCO, MEDLINE via Biblioteca Virtual em Saúde, Embase, CINAHL, Cochrane Library, LILACS via Biblioteca Virtual em Saúde, Google Scholar, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses & Dissertações-Capes, Open Grey and ProQuest Dissertations and Theses. The risk of bias was assessed by the Cochrane Collaboration Risk of Bias Tool (RoB 2), the meta-analysis was performed in the Review Manager 5.4 software and the Certainty of evidence in the Grading of Recommendations Assessment, Development and Evaluation system. Results: of the 670 records, five articles were eligible. The meta-analysis was calculated for the prevention of the incidence of diabetic foot ulcers outcome, with effect summarization (RR 0.53; 95%CI 0.29-0.96; p=0.02), with certainty of moderate evidence. Conclusion: thermometry showed a protective effect on the incidence of diabetic foot ulcers when compared to standard foot care.
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Affiliation(s)
- Açucena Leal de Araújo
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
| | | | - Raquel Sampaio Florêncio
- Universidade Estadual do Ceará, Brazil; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
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11
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Gomes F, Furtado GE, Henriques M, Sousa LB, Santos-Costa P, Bernardes R, Apóstolo J, Parreira P, Salgueiro-Oliveira A. The skin microbiome of infected pressure ulcers: A review and implications for health professionals. Eur J Clin Invest 2022; 52:e13688. [PMID: 34601718 DOI: 10.1111/eci.13688] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pressure ulcers (PUs) are injuries resulting from ischaemia caused by prolonged compression or shear forces on the skin, adjacent tissues and bones. Advanced stages of PUs are associated with infectious complications and constitute a major clinical challenge, with high social and economic impacts in health care. GOALS This study aims to identify and describe the relationship between PU risk factors, stages and anatomical locations, and the relevance of microbial cohabitation and biofilm growth. METHODS The narrative review method to advocating a critical and objective analysis of the current knowledge on the topic was performed. Indexed databases and direct consultation to specialized and high-impact journals on the subject were used to extract relevant information, guided by co-authors. The Medical Subject Headings of pressure ulcer (or injury), biofilms, infection and other analogues terms were used. RESULTS Development of PUs and consequent infection depends on several direct and indirect risk factors, including cutaneous/PU microbiome, microclimate and behavioural factors. Infected PUs are polymicrobial and characterized by biofilm-associated infection, phenotypic hypervariability of species and inherent resistance to antimicrobials. The different stages and anatomical locations also play an important role in their colonization. The prevention and monitoring of PUs remain crucial for avoiding the emergence of systemic infections and reducing health care-associated costs, improve the quality of life of patients and reduce the mortality-associated infected PUs.
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Affiliation(s)
- Fernanda Gomes
- LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, CEB, Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Guilherme Eustáquio Furtado
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,Polytechnic Institute of Guarda, Research Unit for Inland Development (UDI), Guarda, Portugal
| | - Mariana Henriques
- LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, CEB, Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Liliana Baptista Sousa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rafael Bernardes
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - João Apóstolo
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Pedro Parreira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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Sibbald RG, Mufti A, Armstrong DG, Smart H. Nontouch Infrared Skin Thermometry: An Underutilized Tool. Adv Skin Wound Care 2021; 34:614-615. [PMID: 34669665 DOI: 10.1097/01.asw.0000795248.80980.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- R Gary Sibbald
- R. Gary Sibbald, MD, MEd, BSc, FRCPC (Med Derm), MACP, FAAD, MAPWCA, DSc (Hons), is Professor of Public Health and Medicine, University of Toronto, Ontario, Canada; Director, International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care), Dalla Lana School of Public Health, University of Toronto; Past President, Chair Education Committee, World Union of Wound Healing Societies; and Editor-in-Chief, Advances in Skin & Wound Care . Asfandyar Mufti, MD, BMSc, is Dermatology Resident, Faculty of Medicine, University of Toronto. David G. Armstrong, MD, PhD, DPM, is Professor of Surgery, University of Arizona College of Medicine, Tucson; and Director, Southern Arizona Limb Salvage Alliance. Hiske Smart, MA (Nur), RN, PGDipWHTR (UK), IIWCC, is Manager, Wound Care & Hyperbaric Oxygen Therapy Unit, King Hamad University Hospital, Kingdom of Bahrain
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Proios I, Kusenda M, Seiler C, Siewert C, Seifert H, Kaske M. Postoperative wound assessment in cattle: How reliable is the back hand palpation? Ir Vet J 2021; 74:16. [PMID: 34134768 PMCID: PMC8207616 DOI: 10.1186/s13620-021-00195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/01/2021] [Indexed: 11/27/2022] Open
Abstract
Background As part of clinical wound assessment in bovine surgery, discrepancies in skin temperature are evaluated by placing the back of the hand on the area to be examined. Generally, an increased skin temperature at the wound site for a prolonged period is considered as an indicator of impaired wound healing. The aim of this study was to verify the reliability of palpation under bovine practice conditions using laparotomy as an example. Fourteen cows (German Holstein) with a left displacement of the abomasum (LDA) without other severe concurrent diseases were examined preoperatively and once daily for ten days after surgery. The skin temperature of the wound site in the right flank was assessed by palpation, followed by thermographic evaluation using an infrared camera after a 45-min acclimatisation period, under standardised conditions in a closed examination room daily for 10 days. Results All the incisions healed without clinical detectable perturbances. The ambient temperature range during the study period was 7.8 − 24.1 °C. Two groups were retrospectively defined according to the ambient temperature: high ambient temperature (HT group; median: 20.2 °C 25/75 quartile: 18.5 °C / 21.7 °C; n = 6) and low ambient temperature (LT group; 10.8 °C; 9.4 °C / 12.8 °C; n = 8). The temperature differences (Δϑ) between the mean skin temperature of the wound site and a defined reference area cranial to the wound were assessed. A significant negative correlation was found between the ambient temperature (ϑAmb) and Δϑ (r=-0.51; P < 0.001). The Δϑ was postoperatively higher in the cows in the LT group (median of the individual animals 0.8–2.5 °C) than in the HT group (0.1–0.5 °C; P < 0.05). In contrast to the thermographic findings, manual palpation rarely detected local hyperthermia (> 1 °C) at the wound site (sensitivity 0.20; specificity 0.96). Conclusions The infrared thermography provides a more reliable assessment of temperature changes at the wound site in comparison to manual palpation. The ambient temperature markedly affects the extent of local hyperthermia at the wound site.
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Affiliation(s)
- Ioannis Proios
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany.
| | - Marian Kusenda
- Nord-Ostsee Tierärzte, Veterinary Practice, Schafflund, Germany
| | - Christian Seiler
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Carsten Siewert
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Hermann Seifert
- Institute for General Radiology and Medical Physics, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Martin Kaske
- Department for Farm Animals, Vetsuisse Faculty, Zurich, Switzerland
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Abstract
GENERAL PURPOSE To present a cross-sectional cohort study conducted to assess the association between wound pH, local infection, and deep/surrounding infection. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Synthesize the background information associated with the study assessing the association between wound pH, local infection, and deep/surrounding infection.2. Summarize the results of the study presented here. ABSTRACT BACKGROUNDWounds with a higher pH often demonstrate lower rates of healing. Local and deep/surrounding infection can be diagnosed with the validated NERDS and STONEES clinical signs, respectively. This study assessed the association between wound pH, local infection, and deep/surrounding infection. METHODS A 100-patient prospective cross-sectional cohort study was conducted with leg and foot wounds. Wound pH was measured using pH indicator strips. The wounds were assessed for clinical signs of local or deep/surrounding infection with the NERDS and STONEES criteria, respectively. Temperature measurements were documented with a handheld infrared skin thermometry device at the wound/periwound site, the equivalent site on the opposite side of the same leg/foot, and the wound mirror image site on the opposite leg/foot. RESULTS There was no significant difference in the mean wound bed pH in patients with superficial critical colonization and those without (P = .837). The wound and periwound maximum temperature measurements were compared with an equivalent temperature on the mirror image on the opposite leg. There was a statistically significant difference in the mean temperature (ΔT) value between patients with deep/surrounding wound infection and three or more positive STONEES criteria (P = .002). CONCLUSIONS Nontouch infrared thermometry comparing maximum mirror image wound temperatures versus the opposite extremities when combined with two or more other STONEES criteria is a significant indicator of deep and surrounding infection. Surface wound bed pH indicator strip measurements do not correlate with local wound infection using the NERDS criteria.
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Ena J, Carretero-Gomez J, Arevalo-Lorido JC, Sanchez-Ardila C, Zapatero-Gaviria A, Gómez-Huelgas R. The Association Between Elevated Foot Skin Temperature and the Incidence of Diabetic Foot Ulcers: A Meta-Analysis. INT J LOW EXTR WOUND 2020; 20:111-118. [PMID: 32106729 DOI: 10.1177/1534734619897501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prior to the appearance of any foot ulcer, there is an increase in the local temperature due to the presence of an underlying inflammatory process. The use of thermometry to identify inflammation could make patients increase preventive measures until the inflammation disappears. We carried out a meta-analysis to determine the effectiveness of the daily measurement of the foot temperature in 6 points to prevent the occurrence of foot ulcers in patients with diabetes. Patients with temperature differences >4°F (2.2°C) between left and right corresponding sites should reduce activity and increase preventive measures until temperature is normalized. We searched the literature in MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, and clinicaltrials.gov. We have only included randomized clinical trials where individuals were assigned to receive enhanced care (temperature measurement and standard care) versus standard care (education, self-care practices, and periodic clinical visits). We found 4 trials comprising 462 patients from the United States and Norway that met our inclusion criteria. The duration of follow-up varied from 4.5 to 15 months. Overall, 18 (7.9%) subjects in the enhanced foot care group and 53 (22.6%) in the standard foot care group developed foot ulcers (pooled risk ratio = 0.37; 95% confidence interval = 0.21-0.66; P = .0008; percentage of heterogeneity [ I2], 25%; P = .26). The number needed to treat was 7 (95% confidence interval = 5-11). The results were robust after analysis by subgroups according to the potential risk of bias in the studies and the duration of follow-up.
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Affiliation(s)
| | | | | | | | | | - Ricardo Gómez-Huelgas
- Hospital Regional Universitario de Málaga, Malaga, Spain
- Universidad de Málaga, Málaga, Spain
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16
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Naik PP, Farrukh SN. Clinical Significance of Diabetic Dermatopathy. Diabetes Metab Syndr Obes 2020; 13:4823-4827. [PMID: 33324080 PMCID: PMC7733392 DOI: 10.2147/dmso.s286887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
Diabetic dermopathy is a cutaneous manifestation commonly seen in diabetes patients and was initially described by Melin in 1964. These lesions are well-demarcated, hyperpigmented macules or papules with atrophic depression and were commonly sighted on shins of the tibia with bilateral asymmetrical distribution and rarely seen on arms, thighs and abdomen. The incidence of DD ranges from 0.2 to 55%. It has been frequently associated with microangiopathic complications of diabetes such as nephropathy, retinopathy and polyneuropathy. Although the exact mechanism of occurrence is unknown, it may be related to impaired wound healing due to decreased blood flow, local thermal trauma or local subcutaneous nerve degeneration. Diagnosis is made by clinical examination and the differential diagnosis includes stasis dermatitis, early lesion of necrobiosis lipoidica and purpuric dermatitis. Prevention of dermopathy lesions includes optimized glucose control. No active treatment is recommended or proven effective and DD is known to resolve on its own as time passes. Modified collagen and high glycerine-based lotion have shown marked improvement in skin color changes due to diabetic dermopathy. Diabetic dermopathy is known to have a strong association with microangiopathic complications; the presence of such lesions must raise strong suspicion and prompt investigation for severe underlying pathology. Enhanced scrutinized glycemic control in diabetic dermatopathy patients can even lead to abatement in further progression to microvascular complications and improved long-term patient outcomes.
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Affiliation(s)
- Piyu Parth Naik
- Department of Dermatology, Saudi-German Hospitals & Clinics, Dubai, United Arab Emirates
- Correspondence: Piyu Parth Naik Department of Dermatology, Saudi-German Hospitals & Clinics, Hessa Street 331 West, Al Barsha 3, Exit 36 Sheikh Zayed Road, Opposite of American School, Dubai, United Arab EmiratesTel +971562173323 Email
| | - Syed Nadir Farrukh
- Department of Internal Medicine, Adam-Vital Hospital, Dubai, United Arab Emirates
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17
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Killeen AL, Brock KM, Dancho JF, Walters JL. Remote Temperature Monitoring in Patients With Visual Impairment Due to Diabetes Mellitus: A Proposed Improvement to Current Standard of Care for Prevention of Diabetic Foot Ulcers. J Diabetes Sci Technol 2020; 14:37-45. [PMID: 31122064 PMCID: PMC7189171 DOI: 10.1177/1932296819848769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Two debilitating sequelae of diabetes are foot ulcerations and vision impairing conditions including retinopathy, open-angle glaucoma, and cataracts. Current standard of care recommends daily visual screening of feet. Despite willingness, many patients are impeded by visual impairment. We investigate whether once-daily remote temperature monitoring can improve self-screening for patients at risk for diabetic foot complications. METHODS We followed four male veterans with diabetes mellitus, peripheral neuropathy, impaired visual acuity, and at least one other diabetes-related visual impairment in a high-risk podiatry clinic. Patients received a telemedicine remote temperature monitoring mat and instructed on proper daily use. Each patient developed a "hotspot," defined as a 1.75°C localized temperature difference between matched pedal locations, which resulted in telephone triage outreach. RESULTS In three cases, outreach resulted in a sooner appointment where patients were found to have a relevant outcome at the hotspot. Patients in cases 1-3 had University of Texas (UT) 1A ulcerations. The patient in case 4 had inflammation from trauma. All patients had refractive errors plus another vision impairing condition that potentially delayed identification of lesions. Patients in cases 1 and 2 have cataracts, patients in cases 2 and 3 have retinopathy, and patient in case 4 has glaucoma. CONCLUSIONS As an adjunct to daily preventative diabetic self-care, once-daily remote temperature monitoring technology can augment self-screening to prompt necessary outreach and treatment and potentially prevent costly and debilitating diabetic foot complications. This case series serves as a pilot study for real-world application of thermometry, where further large-scale research is needed.
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Affiliation(s)
- Amanda L. Killeen
- Department of Surgery, Podiatry Section,
Southern Arizona Veteran Affairs Health Care System, Tucson, AZ, USA
| | | | - James F. Dancho
- Department of Surgery, Podiatry Section,
Southern Arizona Veteran Affairs Health Care System, Tucson, AZ, USA
| | - Jodi L. Walters
- Department of Surgery, Podiatry Section,
Southern Arizona Veteran Affairs Health Care System, Tucson, AZ, USA
- Jodi L. Walters, DPM, Diplomate, ABFAS,
Southern Arizona VA Health Care System, 3601 S 6th Ave, Tucson, AZ 85723, USA.
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18
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Soares RSA, Lima SBS, Eberhardt TD, Rodrigues LR, Martins RS, Silveira LBTD, Alves PJP. Skin temperature as a clinical parameter for nursing care: a descriptive correlational study. J Wound Care 2019; 28:835-841. [DOI: 10.12968/jowc.2019.28.12.835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To identify the skin temperature in different body areas of hospitalised individuals in the surgical unit, without risk of developing a pressure ulcer (PU). Methods: A descriptive, correlational and cross-sectional study, carried out May–October 2017, in a surgical unit of a university hospital in southern Brazil. Temperature was measured at the bony prominences including scapula, elbow, trochanters and heels, on both sides of the body, as well as occipital and sacral regions. Results: A total of 230 patients took part in the study. All regions of the body measured presented differences in temperatures. The sacral region presented the highest mean temperature (34.2±0.1°C). Patients (aged 18–59 years) had higher skin temperatures in the sacral region than older patients (aged 60–88 years). There was a symmetry in temperatures on both sides of the body. There was a low degree of correlation between age, room temperature, room humidity and skin temperature in some body regions. Conclusion: The study established mean values for skin temperature in specific body regions in patients without risk of developing a PU, hospitalised in a surgical unit. It also demonstrates how skin temperature can be used as a clinical parameter in practice to support the prevention of PUs.
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Affiliation(s)
- Rhea SA Soares
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Suzinara BS Lima
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Thaís D Eberhardt
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Liane R Rodrigues
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Robson S Martins
- Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | | | - Paulo JP Alves
- Universidade Católica Portuguesa, Porto, Porto, Portugal
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19
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Peripheral Neuropathy and the Insensate Foot: More Than Diabetes. Adv Skin Wound Care 2019; 32:149. [DOI: 10.1097/01.asw.0000554390.18232.bd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al-Gharibi KA, Sharstha S, Al-Faras MA. Cost-Effectiveness of Wound Care: A concept analysis. Sultan Qaboos Univ Med J 2019; 18:e433-e439. [PMID: 30988960 DOI: 10.18295/squmj.2018.18.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/09/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
This review aimed to analyse the concept of cost-effectiveness within the context of chronic wound care using Walker and Avant's approach. The Cumulative Index to Nursing and Allied Health Literature® (EBSCO Information Services, Ipswich, Massachusetts, USA), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) and Nursing & Allied Health® (ProQuest LLC, Ann Arbor, Michigan, USA) databases were searched using a combination of keywords. A total of 18 peer-reviewed articles were identified. In wound care, defining attributes for the concept of cost-effectiveness encompassed treatments which were both effective and economical. Four antecedents were identified, including the type of wound, care setting, type of dressing and patient-related characteristics. The consequences of cost-effective wound care were patient prognosis, quality of life, the economic burden on the patient and healthcare system and cost-savings. These findings will hopefully help to standardise cost-effectiveness terminology among nursing professionals in various healthcare settings.
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Affiliation(s)
| | - Sajana Sharstha
- College of Nursing & Health Professions, Valparaiso University, Valparaiso, Indiana, USA
| | - Maria A Al-Faras
- College of Nursing & Health Professions, Valparaiso University, Valparaiso, Indiana, USA
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21
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Abstract
GENERAL PURPOSE To provide information on the use of topical antimicrobial agents for the treatment of chronic wounds. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Examine features of wounds and wound healing as well as the purpose of specific antimicrobial agents.2. Identify potential therapeutic and adverse effects of specific topical antimicrobial agents for the treatment of chronic wounds. ABSTRACT Bacteria can delay or prevent healing in the surface compartment of a chronic wound or invade the deep and surrounding structures. This article focuses on the superficial compartment and the appropriate use of topical antimicrobial therapies. The authors have reviewed the published evidence for the last 5 years (2012-2017) and extrapolated findings to clinical practice with critical appraisal and synthesis of the recent literature with expert opinion, patient-centered concerns, and healthcare systems perspectives. Summary evidence tables for commonly used topical antimicrobials are included.
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22
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Stevens K, Bruneau J, Moralejo D. Foot self-management for adults with diabetes in western countries: a scoping review protocol. ACTA ACUST UNITED AC 2018; 15:2249-2256. [PMID: 28902691 DOI: 10.11124/jbisrir-2016-003269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
SCOPING REVIEW OBJECTIVE/QUESTION The objective of this scoping review is to examine and map the range of issues related to self-management of feet in adults with diabetes with similar lifestyles, risks and health care in western countries.
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Affiliation(s)
- Kathleen Stevens
- Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: a Joanna Briggs Institute Affiliated Group, School of Nursing, Memorial University of Newfoundland, St. John's, Canada
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Effects of 3 Different Methods of Care on the Peristomal Skin Integrity of Children with Percutaneous Endoscopic Gastrostomy Tubes: A Prospective Randomized Controlled Trial. Adv Skin Wound Care 2018; 31:172-181. [DOI: 10.1097/01.asw.0000530683.93372.3a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Migdalis I, Czupryniak L, Lalic N, Leslie RD, Papanas N, Valensi P. Diabetic Microvascular Complications. Int J Endocrinol 2018; 2018:5683287. [PMID: 29997650 PMCID: PMC5994569 DOI: 10.1155/2018/5683287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- I. Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
| | - L. Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - N. Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Belgrade, Serbia
| | - R. D. Leslie
- Department of Diabetes, Saint Bartholomew's Hospital, University of London and Blizard Institute, EC1A 7BE London, UK
| | - N. Papanas
- Diabetic Foot Clinic-Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - P. Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, 93140 Bondy, France
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26
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Wang SC, Anderson JAE, Evans R, Woo K, Beland B, Sasseville D, Moreau L. Point-of-care wound visioning technology: Reproducibility and accuracy of a wound measurement app. PLoS One 2017; 12:e0183139. [PMID: 28817649 PMCID: PMC5560698 DOI: 10.1371/journal.pone.0183139] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/31/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Current wound assessment practices are lacking on several measures. For example, the most common method for measuring wound size is using a ruler, which has been demonstrated to be crude and inaccurate. An increase in periwound temperature is a classic sign of infection but skin temperature is not always measured during wound assessments. To address this, we have developed a smartphone application that enables non-contact wound surface area and temperature measurements. Here we evaluate the inter-rater reliability and accuracy of this novel point-of-care wound assessment tool. METHODS AND FINDINGS The wounds of 87 patients were measured using the Swift Wound app and a ruler. The skin surface temperature of 37 patients was also measured using an infrared FLIR™ camera integrated with the Swift Wound app and using the clinically accepted reference thermometer Exergen DermaTemp 1001. Accuracy measurements were determined by assessing differences in surface area measurements of 15 plastic wounds between a digital planimeter of known accuracy and the Swift Wound app. To evaluate the impact of training on the reproducibility of the Swift Wound app measurements, three novice raters with no wound care training, measured the length, width and area of 12 plastic model wounds using the app. High inter-rater reliabilities (ICC = 0.97-1.00) and high accuracies were obtained using the Swift Wound app across raters of different levels of training in wound care. The ruler method also yielded reliable wound measurements (ICC = 0.92-0.97), albeit lower than that of the Swift Wound app. Furthermore, there was no statistical difference between the temperature differences measured using the infrared camera and the clinically tested reference thermometer. CONCLUSIONS The Swift Wound app provides highly reliable and accurate wound measurements. The FLIR™ infrared camera integrated into the Swift Wound app provides skin temperature readings equivalent to the clinically tested reference thermometer. Thus, the Swift Wound app has the advantage of being a non-contact, easy-to-use wound measurement tool that allows clinicians to image, measure, and track wound size and temperature from one visit to the next. In addition, this tool may also be used by patients and their caregivers for home monitoring.
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Affiliation(s)
- Sheila C. Wang
- Department of Medicine, Division of Dermatology, McGill University, Montreal, Quebec, Canada
- * E-mail:
| | | | - Robyn Evans
- Wound Care Centre, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Benjamin Beland
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Denis Sasseville
- Department of Medicine, Division of Dermatology, McGill University, Montreal, Quebec, Canada
| | - Linda Moreau
- Department of Medicine, Division of Dermatology, McGill University, Montreal, Quebec, Canada
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Abstract
The abstract book contains the abstracts of keynote lectures, focus sessions, symposia, workshops, AIUC annual meeting, AISLEC annual meeting, EPUAP annual meeting, ETRS special session, sponsor symposia, oral presentations, poster presentations and the subject index.
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28
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Miller JD, Najafi B, Armstrong DG. Current Standards and Advances in Diabetic Ulcer Prevention and Elderly Fall Prevention Using Wearable Technology. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0136-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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29
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Kelechi TJ, Madisetti M, Mueller M, Dooley M, Prentice M. Self-monitoring of lower leg skin temperature: accuracy of self-reported data and adherence to a cooling protocol for the prevention of venous leg ulcers. Patient Prefer Adherence 2015; 9:1751-61. [PMID: 26719678 PMCID: PMC4689265 DOI: 10.2147/ppa.s91992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND For intervention studies that require the use of participant self-reports, the quality and accuracy of recorded data and variability in participant adherence rates to the treatment can cause significant outcome bias. PURPOSE To assess the quality and accuracy of participant documentation of daily self-monitoring of leg skin temperature, adherence to a graduated cooling treatment protocol to prevent venous leg ulcers, and the potential for bias in treatment effect in a randomized controlled trial that included a population with chronic venous disease. METHODS Individuals were randomized to a leg cooling intervention or placebo treatment group to daily self-monitor and record lower leg skin temperature over a 9-month period on monthly paper study logs. Returned study logs for the first 100 completed participants (n=54 cooling intervention, n=46 control) were reviewed for quality and accuracy. Adherence was determined from evaluating the accuracy of participant documentation. To examine potential outcome bias in treatment effect, mean between group and within group comparisons of the before and after treatment differences were conducted using an intention-to-treat (ITT) versus a modified intention-to-treat (mITT) analysis approach with an 85% accuracy cut-off rate. Data were collected in 2011-2014. RESULTS Of the expected 900 study logs, 91.8% (826/900) were returned and 8.2% (74/900) were not. Non-mutually exclusive main error types in returned documentation included: 59.2% (489/826) white-outs, cross-off and/or overwrites, 34.9% (288/826) entries omitted, 29.4% (243/826) no performance of daily self-monitoring, 28.7% (237/826) no performance of the treatment intervention per the prescribed protocol regime, 26.8% (221/826) extraneous data, 8.6% (71/826) suspected fabrication, and 7.6% (63/826) questionable validity. Under ITT analysis, 38.4% (346/900) of all returned logs were <85% accurate, 25.0% (225/900) were 85%-99% accurate, and 36.6% (329/900) were 100% accurate. Mean overall participant adherence rates were: 22.0% at <85% accuracy, 53.0% at 85%-99% accuracy, and 25.0% at 100% accuracy. Under the mITT analysis, 54.0% (483/900) of returned logs were deemed adherent with ≥85% accuracy. CONCLUSION This study found good rates of adherence. Under ITT analysis, 78.0% of participants were deemed adherent to the study protocol with ≥85% accuracy in documenting daily self-monitoring of skin temperatures in response to a topically applied experimental cooling cuff intervention for the prevention of venous leg ulcers.
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Affiliation(s)
- Teresa J Kelechi
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
- Correspondence: Teresa J Kelechi, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC 29425-1600, USA, Tel +1 843 792 4602, Fax +1 843 792 2104, Email
| | - Mohan Madisetti
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Mary Dooley
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Margaret Prentice
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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