A study of the utility and equivalency of 2 methods of wound measurement: digitized tracing versus digital photography

Assessing the benefits of digital twins in neurosurgery: a systematic review

Digital twins are virtual replicas of their physical counterparts, and can assist in delivering personalized surgical care. This PRISMA guideline-based systematic review evaluates current literature addressing the effectiveness and role of digital twins in many stages of neurosurgical management. The aim of this review is to provide a high-quality analysis of relevant, randomized controlled trials and observational studies addressing the neurosurgical applicability of a variety of digital twin technologies. Using pre-specified criteria, we evaluated 25 randomized controlled trials and observational studies on the applications of digital twins, including navigation, robotics, and image-guided neurosurgeries. All 25 studies compared these technologies against usual surgical approaches. Risk of bias analyses using the Cochrane risk of bias tool for randomized trials (Rob 2) found "low" risk of bias in the majority of studies (23/25). Overall, this systematic review shows that digital twin applications have the potential to be more effective than conventional neurosurgical approaches when applied to brain and spinal surgery. Moreover, the application of these novel technologies may also lead to fewer post-operative complications.

Effects of photobiomodulation on re-epithelialization of burn wound: protocol for a randomized controlled trial

Background

Burns are a global public health problem and cause approximately 180,000 deaths annually, mainly in low- and middle-income countries. Topical antibiotics and occlusive dressing are standard treatments for burns not requiring a skin graft. However, physiotherapy has low-cost phototherapeutic and electrophysical resources (e.g., light-emitting diode [LED]) that may accelerate burn healing. This study aims to compare the re-epithelialization rate of second-degree burns, pain, pruritus, skin temperature, quality of wound healing, and scar quality and mobility among individuals undergoing treatment with red LED, infrared LED, and simulated photobiomodulation.

Methods

This is a double-blinded, three-arm parallel-group, randomized controlled superiority trial. Individuals of both sexes, aged over 18 years, and with second-degree burns will be included. The sample will be divided into three groups of 13 individuals: two will receive LED therapy (red or infrared) and one placebo. Pain, pruritus, skin temperature, and wound size will be assessed daily. Interventions will take place until complete healing, when scar mobility and quality will be evaluated. Data will be presented as mean and 95% confidence interval and analyzed using mixed linear models.

Discussion

This randomized controlled trial has minimal risk of bias and intends to identify the ideal type, procedures, and doses of photobiomodulation to heal burns, which are not standardized in clinical practice. Positive results will allow the implementation of the technique in burn and wound guidelines.

Trial registration

Brazilian Clinical Trials Registry (ReBEC) RBR-8bfznx6. Registered on October 13, 2021

DESENVOLVIMENTO DE SOFTWARE DA PRESSURE ULCER SCALE FOR HEALING (PUSH): ESTUDO DE INOVAÇÃO

Objetivo:Desenvolver software para avaliação e acompanhamento da lesão por pressão utilizando a pressure ulcer scale for healing (Push). Método:Trata-se de pesquisa metodológica de inovação tecnológica e de desenvolvimento de software. Foi desenvolvido um aplicativo para acompanhamento de lesão por pressão utilizando a Push elaborada pela National Pressure Ulcer Advisor Panel, passando pelo processo de validação de conteúdo. Resultado: Como resultado da primeira etapa, produziu-se uma revisão integrativa, em que foram identificados nove artigos entre os anos de 2012 e 2018. Na segunda etapa ocorreu o processo de construção do aplicativo. Este possui 16 telas, entre elas a escala de Push, o acompanhamento por meio de gráficos e a anamnese. Na terceira etapa houve o processo de validação de conteúdo, com escore geral de 0,95, um valor aceitável para validar um instrumento. Conclusão: Observou-se que o softwareé válido e pode servir de amparo à prática clínica do profissional de enfermagem.

SOFTWARE DEVELOPMENT OF THE PRESSURE ULCER SCALE FOR HEALING (PUSH): AN INNOVATION STUDY

Objective: To develop a software for pressure injury assessment and monitoring using the pressure ulcer scale for healing (PUSH). Method: This is a methodological research of technological innovation and software development. An application was developed to monitor pressure injuries using the PUSH created by National Pressure Ulcer Advisory Panel, and it went through the content validation process. Result: This study resulted in the first stage of an integrative review, in which nine articles were identified between the years 2012 and 2018. In the second stage, the process of building the application took place. It has 16 screens, among them PUSH scale, monitoring through graphics, and anamnesis. In the third stage, the content validation process was carried out, and it was obtained an overall content validity index of 0.95, an acceptable value to validate an instrument. Conclusion: It was observed that the software is applicable and serves as support to the clinical practice of the nursing professional.

Treatment of Diabetic Foot Ulcers With Inforatio Technique to Promote Wound Healing: A Feasibility Trial

Chronic foot ulcers have extensive consequences for diabetic patients' quality of life and increase risks of amputation and death. The aim of this trial was to assess the feasibility of conducting a larger clinical trial to evaluate the clinical effect of inforatio technique on healing of diabetic foot ulcers (DFUs). Inforatio technique is a novel minimal invasive procedure where small cuts are made on wound beds with punch biopsy tools. This study was a feasibility trial conducted at an outpatient wound care clinic at Zealand University Hospital. Twelve patients with DFUs were included. During a 90-day follow-up, participants visited the clinic 5 times and received inforatio technique twice. Feasibility was assessed with regard to recruitment, acceptability, burden, benefits, protocol adherence, and adverse events. The recruitment rate was 1 patient per eighth day (95% confidence interval [CI] = [4th-13th]), and the retention rate was 100% (95% CI = [74-100]). During follow-up, healing was observed for 4 ulcers (33%, 95% CI = [10-65]) with a mean time for healing of 59 days (range, 22-89) (95% CI = [5-113]). Five ulcers had a reduction of wound area and 3 ulcers had an increase in area from baseline to 90-day follow-up. No temporal relationship was found between inforatio application and wound area increase. There were no patient-reported harmful effects and no adverse events with probable relation to inforatio technique. Patient acceptability and participant adherence were promising. Thus, a larger clinical trial for evaluating the clinical effect of inforatio technique is considered feasible to conduct.

Investigating the effects of walnut ointment on non-healing burn wounds

Effective treatments for non-healing burn wounds are an unmet need for 95% of burn sufferers. Approaches currently available to treat non-healing burn wounds are not satisfactory due to undesirable side-effects or expense. The anti-oxidation and antibacterial activities of walnuts are recommended for treating chronic diseases. Walnut ointment has been developed and successfully applied to treat non-healing burn wounds in our hospital for decades. We report herein a detailed retrospective case review examining patients' response to the walnut ointment. The walnut ointment has shortened healing time of non-healing burn wounds and improved clinical outcomes. In order to investigate the mechanism of action, walnut ointment has been applied on wounds of porcine full-thickness burn wound models. Histological and immunohistochemical analysis indicated our walnut ointment supports wound healing through promoting keratinocyte proliferation and differentiation. Taken together, we recommend the walnut ointment offers an effective and economical treatment for patients presenting with non-healing burn wounds.

Workflow Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper

With the advent of digital cameras, there has been an explosion in the number of medical specialties using images to diagnose or document disease and guide interventions. In many specialties, these images are not added to the patient's electronic medical record and are not distributed so that other providers caring for the patient can view them. As hospitals begin to develop enterprise imaging strategies, they have found that there are multiple challenges preventing the implementation of systems to manage image capture, image upload, and image management. This HIMSS-SIIM white paper will describe the key workflow challenges related to enterprise imaging and offer suggestions for potential solutions to these challenges.

Development and validation of an algorithm for laser application in wound treatment

OBJECTIVE

To develop and validate an algorithm for laser wound therapy.

METHOD

Methodological study and literature review. For the development of the algorithm, a review was performed in the Health Sciences databases of the past ten years. The algorithm evaluation was performed by 24 participants, nurses, physiotherapists, and physicians. For data analysis, the Cronbach's alpha coefficient and the chi-square test for independence was used. The level of significance of the statistical test was established at 5% (p<0.05).

RESULTS

The professionals' responses regarding the facility to read the algorithm indicated: 41.70%, great; 41.70%, good; 16.70%, regular. With regard the algorithm being sufficient for supporting decisions related to wound evaluation and wound cleaning, 87.5% said yes to both questions. Regarding the participants' opinion that the algorithm contained enough information to support their decision regarding the choice of laser parameters, 91.7% said yes. The questionnaire presented reliability using the Cronbach's alpha coefficient test (α = 0.962).

CONCLUSION

The developed and validated algorithm showed reliability for evaluation, wound cleaning, and use of laser therapy in wounds.

Review of local wound management for scleroderma-associated digital ulcers

Digital ulcers (DU) are a common clinical problem in systemic sclerosis (SSc); however, there is no standardization of local wound care protocols for management of these lesions. There is a well-recognized need to develop and standardize non-pharmacological management of DU in patients with SSc, and to adopt these protocols in future clinical trials that focus on DU healing. The purpose of this review is to outline the types of DU that occur in SSc, and provide an update on the principles of wound management for these lesions based on the current literature and expert opinion.

Photographing Injuries in the Acute Care Setting: Development and Evaluation of a Standardized Protocol for Research, Forensics, and Clinical Practice

BACKGROUND

Photographing injuries in the acute setting allows for improved documentation as well as assessment by clinicians and others who have not personally examined a patient. This tool is important, particularly for telemedicine, tracking of wound healing, the evaluation of potential abuse, and injury research. Despite this, protocols to ensure standardization of photography in clinical practice, forensics, or research have not been published. In preparation for a study of injury patterns in elder abuse and geriatric falls, our goal was to develop and evaluate a protocol for standardized photography of injuries that may be broadly applied.

METHODS

We conducted a literature review for techniques and standards in medical, forensic, and legal photography. We developed a novel protocol describing types of photographs and body positioning for eight body regions, including instructional diagrams. We revised it iteratively in consultation with experts in medical photography; forensics; and elder, child, and domestic abuse. The resulting protocol requires a minimum of four photos of each injury at multiple distances with and without a ruler/color guide. To evaluate the protocol's efficacy, multiple research assistants without previous photography experience photographed injuries from a convenience sample of elderly patients presenting to a single large, urban, academic emergency department. A selection of these patients' images were then evaluated in a blinded fashion by four nontreating emergency medicine physicians and the inter-rater reliability between these physicians was calculated.

RESULTS

Among the 131 injuries, from 53 patients, photographed by 18 photographers using this protocol, photographs of 25 injuries (10 bruises, seven lacerations, and eight abrasions) were used to assess characterization of the injury. Physicians' characterizations of the injuries were reliable for the size of the injury (κ = 0.91, 95% confidence interval [CI] = 0.77 to 1.00), side of the body (κ = 0.97, 95% CI = 0.88 to 1.00), precise location of the injury (κ = 0.74, 95% CI = 0.63 = 0.81), and type of abrasion (κ = 0.76, 95% CI = 0.45 to 1.00). The exact shape of the injury (κ = 0.44, 95% CI = 0.17 to 0.51), and the primary color of bruises (κ = 0.37, 95% CI = 0.25 to 0.48) were not as reliably characterized.

CONCLUSIONS

Standardizing the documentation of injuries with photographs for clinical and research assessment can be conducted by nonprofessional photographers. A photography protocol will ensure that this important mechanism for documentation is optimized.