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Natarajan J, Joseph MA, Al Alawi R, Al Bulushi T, Al Alawi I, Al Junaibi SM, Thanka AN, Al Balushi LD, Al Ismaili IS, Shummo M, Al Nabhani SST. A domain specific health-related quality of life of omani patients living with chronic wounds. J Tissue Viability 2024; 33:393-398. [PMID: 38762367 DOI: 10.1016/j.jtv.2024.05.004] [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: 11/13/2023] [Revised: 02/12/2024] [Accepted: 05/15/2024] [Indexed: 05/20/2024]
Abstract
AIM Chronic wounds, defined as wounds that do not heal in a logical set of stages, impact patients' quality of life by disrupting their self-esteem, sleep, social interaction, work capacity, and psychological well-being. Chronic wounds are a prevalent problem in Oman due to the high number of patients with diabetes, sickle cell disease, road traffic accidents, and decubitus ulcer. Therefore, it is paramount to analyse the health-related quality of life (HRQOL) of these patients with chronic wounds. MATERIAL AND METHODS An observational, cross-sectional, descriptive study with a quantitative approach was conducted among 275 adult patients with chronic wounds in three tertiary hospitals of Muscat from June to December 2021 using a self-reported Cardiff life wound impact questionnaire and the Bates-Jensen wound assessment tool. Data were analysed with IBM SPSS version 23 using inferential statistics and chi-square test. RESULTS We found that the majority of participants were men (178; 64.7 %), aged between 41 and 60 years (107; 38.9 %), predominantly with diabetic wounds (80; 29.1 %). Respondents reported poor HRQOL across all domains: well-being (63.24 ± 18.092), physical (53.24 ± 18.387), and social (59.54 ± 19.025). Statistically significant poorer HRQOL was observed among the elderly above 60 years, illiterates, those with traumatic wounds, and those receiving medication and dressing as treatment. CONCLUSIONS Our findings indicate that Omani patients with chronic wounds experience low HRQOL. It is imperative for healthcare providers to offer comprehensive care to these patients. To enhance their quality of life and alleviate suffering, evaluating both the wounds and HRQOL is essential. Such assessments will enable the optimisation of treatment and coping strategies for patients.
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Affiliation(s)
- Jansirani Natarajan
- School of Health in Social Science, The University of Edinburgh, Scotland, United Kingdom
| | - Mickael Antoine Joseph
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman.
| | - Rashid Al Alawi
- Surgery Department, Royal Hospital, Muscat, Sultanate of Oman
| | - Taimoor Al Bulushi
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | - Suad Moosa Al Junaibi
- Adult Health Nursing Department, Oman College of Health Sciences, Muscat, Sultanate of Oman
| | - Anitha Nesa Thanka
- Fundamentals and Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | | | - Moath Shummo
- Department of Plastic and Reconstructive Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Sen CK. Standardized Wound Care: Patchwork Practices? Adv Wound Care (New Rochelle) 2024. [PMID: 38940743 DOI: 10.1089/wound.2024.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Standardized care is crucial in health care for ensuring consistent, safe, high-quality, efficient, and evidence-based practices. Care pathways that standardize procedures promote adherence to best practices, reduce variability in treatment, and encourage collaboration among health care teams. This approach ultimately improves patient outcomes, enhances safety, and boosts the overall effectiveness of health care services. However, despite these benefits being widespread across most of the U.S. health care system, wound care stands out as an area where standards can vary significantly. The inconsistency in wound care standards in the United States can be traced to several factors. These include limited structured clinical wound care education, the discretion of health care providers in different business environments, differences in wound care settings, varying access to advanced treatments and technology, patient demographics and socioeconomic status, as well as differences in state laws and regional or institutional practices. Addressing these disparities requires a comprehensive approach that considers the complex interplay of the abovementioned factors. Active measures are needed to improve access, equity, and the quality of wound care services for all patients, regardless of where they live, their socioeconomic status, their health care coverage, or the business interests of providers and their institutions as well as of vendors marketing wound care products inconsistent with evidence-based practice. By understanding and actively addressing these factors, we can work toward achieving more standardized, evidence-based, and patient-centered practices in wound care across the nation.
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Affiliation(s)
- Chandan K Sen
- PittMcGowan Wound Research Consortium, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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3
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Simonsen NV, Klassen AF, Rae C, Mundy LR, Poulsen L, Pusic AL, Fan KL, Sørensen JA. The WOUND-Q Function and Symptoms Scales for Chronic Lower Extremity Wounds: A Validation Study. Adv Wound Care (New Rochelle) 2024. [PMID: 38775456 DOI: 10.1089/wound.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: Determine the validity and reliability of the LIMB-Q scales, Function, and Symptoms in patients with chronic lower extremity wounds. Approach: Cognitive debriefing interviews with people with current or previous wounds were conducted to examine content validity. Scales were field-tested in an international sample of people with chronic lower extremity wounds sourced from an online platform (i.e., Prolific). Psychometric properties were examined using the Rasch Measurement Theory analysis. A test-retest reproducibility study was performed, and construct validity was examined. Results: Content validity was established after 10 cognitive interviews. A total of 233 people with lower extremity wounds (age 19-80 years, mean 39.3) participated in the field test. All 25 items tested demonstrated good fit to the Rasch model with ordered thresholds. One item had a fit residual outside ±2.5, but no items had significant χ2 values after Bonferroni adjustment. Reliability was high with the person separation index, Cronbach alpha, and intraclass correlation coefficient values >0.8. Strong correlations were found between the Function and Symptoms scales and EQ-5D dimensions measuring similar constructs as well as the EQ-5D global score. All hypotheses for construct validity were confirmed. Innovation: Patient-reported outcome measures are an important component of patient-centered care, as they capture the patient's perspective in a rigorous and reproducible way. Adding these two scales to the WOUND-Q provides a means to measure function and symptoms associated with lower extremity wounds. Conclusion: These new WOUND-Q scales can be used to measure outcomes important to patients with lower extremity wounds in clinical settings and research studies.
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Affiliation(s)
- Nina Vestergaard Simonsen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Denmark
| | - Andrea L Pusic
- Department of Surgery and Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Maryland, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar, MedStar Plastic and Reconstructive Surgery, Washington, USA
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Department of Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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4
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Hu Y, Yu L, Dai Q, Hu X, Shen Y. Multifunctional antibacterial hydrogels for chronic wound management. Biomater Sci 2024; 12:2460-2479. [PMID: 38578143 DOI: 10.1039/d4bm00155a] [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: 04/06/2024]
Abstract
Chronic wounds have gradually evolved into a global health challenge, comprising long-term non-healing wounds, local tissue necrosis, and even amputation in severe cases. Accordingly, chronic wounds place a considerable psychological and economic burden on patients and society. Chronic wounds have multifaceted pathogenesis involving excessive inflammation, insufficient angiogenesis, and elevated reactive oxygen species levels, with bacterial infection playing a crucial role. Hydrogels, renowned for their excellent biocompatibility, moisture retention, swelling properties, and oxygen permeability, have emerged as promising wound repair dressings. However, hydrogels with singular functions fall short of addressing the complex requirements associated with chronic wound healing. Hence, current research emphasises the development of multifunctional antibacterial hydrogels. This article reviews chronic wound characteristics and the properties and classification of antibacterial hydrogels, as well as their potential application in chronic wound management.
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Affiliation(s)
- Yungang Hu
- Department of Burns Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
- Clinical Center for Wounds, Capital Medical University, Beijing, 100035, China
| | - Lu Yu
- Department of Burns Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
- Clinical Center for Wounds, Capital Medical University, Beijing, 100035, China
| | - Qiang Dai
- Department of Burns Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
- Clinical Center for Wounds, Capital Medical University, Beijing, 100035, China
| | - Xiaohua Hu
- Department of Burns Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
- Clinical Center for Wounds, Capital Medical University, Beijing, 100035, China
| | - Yuming Shen
- Department of Burns Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
- Clinical Center for Wounds, Capital Medical University, Beijing, 100035, China
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Sharma A, Shankar R, Yadav AK, Pratap A, Ansari MA, Srivastava V. Burden of Chronic Nonhealing Wounds: An Overview of the Worldwide Humanistic and Economic Burden to the Healthcare System. INT J LOW EXTR WOUND 2024:15347346241246339. [PMID: 38659348 DOI: 10.1177/15347346241246339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Chronic wounds have long been a significant public health concern, but the true impact of these wounds is unknown since research designs and measuring techniques vary, leading to inconsistent estimates. The definition of a wound is a loss of epithelial continuity caused by damage to the tissue. The following conditions can cause chronic wounds: panniculitis, pyoderma gangrenosum, traumatic, neurological, metabolic, hematologic, neoplastic, or infection-related. The growing global incidence of diabetes and the aging population necessitate greater attention to chronic wounds. Regrettably, it is sad that significant healthcare institutions have overlooked wound research. The study of health-related illnesses and occurrences in particular populations, including their distribution, frequency, and determinants, and the application of this research to control health problems.
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Affiliation(s)
- Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ravi Shankar
- Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashish Kumar Yadav
- Centre of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Arvind Pratap
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mumtaz Ahmad Ansari
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vivek Srivastava
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Berry-Kilgour C, Wise L, King J, Oey I. Application of pulsed electric field technology to skin engineering. Front Bioeng Biotechnol 2024; 12:1386725. [PMID: 38689761 PMCID: PMC11058833 DOI: 10.3389/fbioe.2024.1386725] [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] [Received: 02/15/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Tissue engineering encompasses a range of techniques that direct the growth of cells into a living tissue construct for regenerative medicine applications, disease models, drug discovery, and safety testing. These techniques have been implemented to alleviate the clinical burdens of impaired healing of skin, bone, and other tissues. Construct development requires the integration of tissue-specific cells and/or an extracellular matrix-mimicking biomaterial for structural support. Production of such constructs is generally expensive and environmentally costly, thus eco-sustainable approaches should be explored. Pulsed electric field (PEF) technology is a nonthermal physical processing method commonly used in food production and biomedical applications. In this review, the key principles of PEF and the application of PEF technology for skin engineering will be discussed, with an emphasis on how PEF can be applied to skin cells to modify their behaviour, and to biomaterials to assist in their isolation or sterilisation, or to modify their physical properties. The findings indicate that the success of PEF in tissue engineering will be reliant on systematic evaluation of key parameters, such as electric field strength, and their impact on different skin cell and biomaterial types. Linking tangible input parameters to biological responses critical to healing will assist with the development of PEF as a sustainable tool for skin repair and other tissue engineering applications.
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Affiliation(s)
- C. Berry-Kilgour
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - L. Wise
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - J. King
- Department of Food Sciences, University of Otago, Dunedin, New Zealand
- Riddet Institute, Palmerston North, New Zealand
| | - I. Oey
- Department of Food Sciences, University of Otago, Dunedin, New Zealand
- Riddet Institute, Palmerston North, New Zealand
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Gomes FJP, Henriques MAP, Baixinho CL. The effectiveness of nursing interventions in adherence to self-care for preventing venous ulcer recurrence: A systematic literature review. Int Wound J 2024; 21:e14454. [PMID: 37986660 PMCID: PMC10895201 DOI: 10.1111/iwj.14454] [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: 09/11/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023] Open
Abstract
Venous ulcers affect up to 3% of the global population, with a high impact on economies and quality of life. This is exacerbated by its recurrence rates, which reach 70% at 12 months after healing. The perpetuation of these cycles of healing and recurrence is not interrupted or even attenuated by the self-care activities recommended and directed toward their prevention. In this context, we sought to identify the effectiveness of interventions that promote adherence to self-care to prevent venous ulcer recurrence. In August 2022, we conducted a literature search via EBSCO in the following databases: CINAHL Complete, MEDLINE Complete, Cochrane Database of Systematic Reviews, Scopus, and Web of Science. The inclusion criteria were researched in the form of randomised controlled trials or systematic literature reviews, and 99 studies were identified. During the different times of selection, four studies met the defined inclusion criteria and were included. As the main conclusions, the emphasis goes to the importance of the use of compression and the greater effectiveness of higher compression classes for the prevention of recurrence. Different educational methodologies seem to be important to increase knowledge about prevention, specifically regarding the aetiology of recurrence and the implementation of prevention measures.
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Affiliation(s)
- Filipe José Paulo Gomes
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR)Doctoral Program Lisbon University/Nursing School of LisbonLisbonPortugal
| | - Maria Adriana Pereira Henriques
- Nursing School of LisbonNursing School of Lisbon, Portugal/Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR)LisbonPortugal
| | - Cristina Lavareda Baixinho
- Nursing School of LisbonNursing School of Lisbon, Portugal/Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR)LisbonPortugal
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8
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Cao Z, Wang X, Jiang C, Wang H, Mu Y, Sun X, Chen X, Feng C. Thermo-sensitive hydroxybutyl chitosan/diatom biosilica hydrogel with immune microenvironment regulatory for chronic wound healing. Int J Biol Macromol 2024; 262:130189. [PMID: 38360227 DOI: 10.1016/j.ijbiomac.2024.130189] [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: 09/21/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
This study proposes a chronic wound therapeutic strategy based on extracellular matrix (ECM) biomimetics and immune regulation. The hydroxybutyl chitosan/diatom biosilica hydrogel (H/D) which can regulate the immune microenvironment, is prepared from hydroxybutyl chitosan (HBC) as matrix to construct the bionic ECM and diatom biosilica (DB) as structural active unit. The hierarchical porous structure of DB provides strong anchoring interface effect to enhance the mechanical strength of hydrogel, while maintaining its favorable temperature phase transition behavior, improving the material's fit to the wound and convenience of clinical use. Silicates released from DB in H/D accelerate the transition of wounds from inflammation to proliferation and remodeling. In cellular and diabetic rat models, H/D reduces inflammation (induces conversion of M1-type macrophages to M2-type), induces angiogenesis (1.96-fold of control), promotes fibroblast proliferation (180.36 % of control), collagen deposition, keratinocyte migration (47.34 % more than control), and re-epithelialization. This study validates a possible biological mechanism for H/D bioactive hydrogel-mediated regulation of the immune microenvironment and provides a simple synergistic dressing strategy.
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Affiliation(s)
- Zheng Cao
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China
| | - Xiaoye Wang
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China
| | - Changqing Jiang
- Qingdao Municipal Hospital, 5# Donghai Middle Road, Qingdao 266000, Shandong Province, China
| | - Haonan Wang
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China
| | - Yuzhi Mu
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China
| | - Xiaojie Sun
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China
| | - Xiguang Chen
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China; Sanya Oceanographic Institute, Ocean University of China, Yonyou Industrial Park, Yazhou Bay Science & Technology City, Sanya 572024, Hainan Province, China; Laoshan Laboratory, 1# Wenhai Road, Qingdao 266000, Shandong Province, China
| | - Chao Feng
- College of Marine Life Science, Ocean University of China, 5# Yushan Road, Qingdao 266003, Shandong Province, China; Sanya Oceanographic Institute, Ocean University of China, Yonyou Industrial Park, Yazhou Bay Science & Technology City, Sanya 572024, Hainan Province, China.
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9
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Queen D, Harding K. Estimating the cost of wounds both nationally and regionally within the top 10 highest spenders. Int Wound J 2024; 21:e14709. [PMID: 38379224 PMCID: PMC10830400 DOI: 10.1111/iwj.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 02/22/2024] Open
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Dhar A, Needham J, Gibb M, Coyne E. The client and family experience of attending a nurse-led clinic for chronic wounds. Aust J Prim Health 2024; 30:NULL. [PMID: 37925745 DOI: 10.1071/py23081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The quality of life for individuals with chronic wounds is diminished due to poor health-related outcomes and the financial burden of wound care. The literature has shown nurse-led wound care to have a positive impact on wound healing and psychosocial wellbeing. However, there is minimal research investigating the lived experience of attending a nurse-led clinic for chronic wounds. The purpose of this study was to explore the client and family experience of attending a nurse-led clinic for chronic wounds. METHODS Qualitative descriptive study. Semi-structured telephone interviews were transcribed verbatim and thematic analysis was undertaken. RESULTS Twelve clients and two family members participated, and the average length of interviews was 20min. Three main themes emerged: (1) expecting and managing pain; (2) receiving expert advice and reflecting on previous care; and (3) managing the cost of care. There was an emphasis on the impact of chronic wounds on pain and the ability to complete the activities of daily living. Expert advice, client satisfaction and physical accessibility were highlighted as benefits of the clinic. Cost and minimal client education were identified as challenges of the clinic. CONCLUSIONS The findings demonstrated that chronic wounds have a significant impact on the client and family attending the nurse-led clinic. Comprehensive pain assessment, improved social support, better client education and cost-effective care is required to optimise the experience for people attending the nurse-led clinic.
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Affiliation(s)
- Anusuya Dhar
- Griffith University, School of Nursing and Midwifery, Logan campus, Meadowbrook, Qld 4131, Australia
| | - Judith Needham
- Griffith University, School of Nursing and Midwifery, Logan campus, Meadowbrook, Qld 4131, Australia
| | - Michelle Gibb
- Wound Specialist Services Pty Ltd, Brisbane, Qld 4000, Australia
| | - Elisabeth Coyne
- Griffith University, School of Nursing and Midwifery, Logan campus, Meadowbrook, Qld 4131, Australia
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11
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Psathas E, Egger B, Mayer D. Dehydrated human amnion/chorion membrane allograft with spongy layer to significantly improve the outcome of chronic non-healing wounds. Int Wound J 2024; 21:e14356. [PMID: 37661177 PMCID: PMC10781888 DOI: 10.1111/iwj.14356] [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: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023] Open
Abstract
We investigated the healing effect of a new dehydrated amnion/chorion membrane with a spongy layer over a 30-month period in 32 patients with 53 chronic non-healing wounds of different aetiologies. Wounds with <40% surface reduction after 4 weeks of best wound treatment underwent weekly allograft application by a certified wound specialist based on national guidelines and a standardised protocol until complete healing or definite treatment interruption. The main outcome measure was the percentage of wound surface reduction from baseline calculated using digital planimetry follow-up photographs. Overall, 38 (71.7%) wounds presented a favourable outcome (70%-100% area reduction), with 35 (66%) completely healing over a median time of 77 days (range 29-350 days). Favourable outcomes were observed in 75% of traumatic wounds, surgical wounds, venous leg ulcers and pressure injuries, as well as in 50% of ischaemic wounds. Wounds being present <12 months were significantly more likely to have a favourable outcome than more long-standing wounds (χ2 = 7.799; p = 0.005; OR = 3.378; 95% CI, 1.410-8.092). Thus, treatment with dehydrated amnion/chorion membrane with a spongy layer improves the outcome of non-healing wounds of different aetiologies and, therefore, has to be considered early in the management of refractory wounds.
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Affiliation(s)
- Emmanouil Psathas
- Department of SurgeryHFR—Fribourg Cantonal HospitalFribourgSwitzerland
- Faculty of Science and MedicineUniversity of FribourgFribourgSwitzerland
| | - Bernhard Egger
- Department of SurgeryHFR—Fribourg Cantonal HospitalFribourgSwitzerland
- Faculty of Science and MedicineUniversity of FribourgFribourgSwitzerland
| | - Dieter Mayer
- Department of SurgeryHFR—Fribourg Cantonal HospitalFribourgSwitzerland
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12
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Graves N, Ganesan G, Tan KB, Goh OQ, Ho J, Chong TT, Bishnoi P, Carmody D, Yuh AS, Ng YZ, Lo Z, Enming Y, Abu Bakar Aloweni F, Zifei W, Harding K. Chronic wounds in a multiethnic Asian population: a cost of illness study. BMJ Open 2023; 13:e065692. [PMID: 37723106 PMCID: PMC10510887 DOI: 10.1136/bmjopen-2022-065692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To estimate the 'cost of illness' arising from chronic wounds in Singapore. DESIGN Incidence-based cost of illness study using evidence from a range of sources. SETTING Singapore health services. PARTICIPANTS We consider 3.49 million Singapore citizens and permanent residents. There are 16 752 new individuals with a chronic wound in 2017, with 598 venous ulcers, 2206 arterial insufficiency ulcers, 6680 diabetic ulcers and 7268 pressure injuries.Primary outcome measures expressed in monetary terms are the value of all hospital bed days lost for the population; monetary value of quality-adjusted life years (QALYs) lost in the population; costs of all outpatient visits; and costs of all poly clinic, use of Community Health Assist Scheme (CHAS) and emergency departments (EDs) visits. Intermediate outcomes that inform the primary outcomes are also estimated. RESULTS Total annual cost of illness was $350 million (range $72-$1779 million). With 168 503 acute bed days taken up annually (range 141 966-196 032) that incurred costs of $139 million (range 117-161 million). Total costs to health services were $184 million (range $120-$1179 million). Total annual costs of lost health outcomes were 2077 QALYs (range -2657 to 29 029) valued at $166 million (range -212 to 2399 million). CONCLUSIONS The costs of chronic wounds are large to Singapore. Costs can be reduced by making positive investments for comprehensive wound prevention and treatment programmes.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Ganga Ganesan
- Health Services Research, Ministry of Health, Singapore
| | - Kelvin Bryan Tan
- SingHealth Duke-NUSGlobal Health Institute, Duke-NUS Medical School, Singapore
| | - Orlanda Qm Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Jackie Ho
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Priya Bishnoi
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - David Carmody
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Ang Shin Yuh
- Nursing Division, Singapore General Hospital, Singapore
| | - Yi Zhen Ng
- A*STAR Skin Research Labs (A*SRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zhiwen Lo
- Department of Surgery, Vascular Surgery Woodlands Health, Singapore
| | - Yong Enming
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Wang Zifei
- Skin Research Institute of Singapore (SRIS), Singapore
| | - Keith Harding
- Skin Research Institute of Singapore (SRIS), Singapore
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Skórka M, Więch P, Przybek-Mita J, Malisiewicz A, Pytlak K, Bazaliński D. Nutritional Status of People with a Coexisting Chronic Wound and Extended Assessment Using Bioelectrical Impedance. Nutrients 2023; 15:2869. [PMID: 37447196 DOI: 10.3390/nu15132869] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The diagnosis of malnutrition should be one of the pillars of comprehensive patient care, especially in the case of patients with large wounds, prolonged healing, or comorbidities. The condition for a reliable and accurate nutritional diagnosis is to link it with the parameters of nutritional status assessment at the basic level (anthropometric measurements and clinical assessment) and in depth (biochemical tests and bioelectrical impedance). A prospective study included a sample of 60 patients with coexisting chronic wounds (venous ulcers, diabetic foot syndrome, pressure injury) treated at the Wound Treatment Clinic of Fr. B. Markiewicz Podkarpackie Oncology Center (Poland). The method of estimation and diagnostic survey was used; the research tool was a scientific research protocol consisting of four parts. Self-care capacity was assessed based on the Barthel scale, nutritional status using blood biochemical parameters, and electrical bioimpedance. Wounds were classified according to the extent, depth of tissue structures, and potential infection. Subjects with pressure ulcers had statistically significantly lower fat-free mass component indices compared to those with diabetic foot syndrome and venous ulceration. The subjects with pressure ulcers had significantly lower values of body composition components compared to those with diabetic foot syndrome and venous ulcers. In the group of patients with pressure ulcers, the lowest values of albumin (3.20 g/dL), hemoglobin (10.81 g/dL), and nutritional risk index (NRI) (88.13 pts.) scores were confirmed. Subjects with pressure ulcers with limited self-care presented a non-physiological nutritional status, indicating a risk of malnutrition. Local actions related to wound treatment should be preceded by a general examination, considering the state of augmented nutrition with the use of electrical bioimpedance.
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Affiliation(s)
- Mateusz Skórka
- St. Hedvig Clinical Provincial Hospital, 35-301 Brzozów, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Brzozów, Poland
- Institute of Health Protection, State University of Applied Sciences in Przemyśl, 37-700 Przemyśl, Poland
| | - Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Brzozów, Poland
- Center for Postgraduate Education of Nurses and Midwives, 35-083 Brzozów, Poland
| | - Anna Malisiewicz
- St. Hedvig Clinical Provincial Hospital, 35-301 Brzozów, Poland
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Brzozów, Poland
| | - Kamila Pytlak
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland
| | - Dariusz Bazaliński
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Brzozów, Poland
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland
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Froelich A, Jakubowska E, Wojtyłko M, Jadach B, Gackowski M, Gadziński P, Napierała O, Ravliv Y, Osmałek T. Alginate-Based Materials Loaded with Nanoparticles in Wound Healing. Pharmaceutics 2023; 15:pharmaceutics15041142. [PMID: 37111628 PMCID: PMC10143535 DOI: 10.3390/pharmaceutics15041142] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Alginate is a naturally derived polysaccharide widely applied in drug delivery, as well as regenerative medicine, tissue engineering and wound care. Due to its excellent biocompatibility, low toxicity, and the ability to absorb a high amount of exudate, it is widely used in modern wound dressings. Numerous studies indicate that alginate applied in wound care can be enhanced with the incorporation of nanoparticles, revealing additional properties beneficial in the healing process. Among the most extensively explored materials, composite dressings with alginate loaded with antimicrobial inorganic nanoparticles can be mentioned. However, other types of nanoparticles with antibiotics, growth factors, and other active ingredients are also investigated. This review article focuses on the most recent findings regarding novel alginate-based materials loaded with nanoparticles and their applicability as wound dressings, with special attention paid to the materials of potential use in the treatment of chronic wounds.
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Affiliation(s)
- Anna Froelich
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Emilia Jakubowska
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Monika Wojtyłko
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Barbara Jadach
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Michał Gackowski
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Piotr Gadziński
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Olga Napierała
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Yulia Ravliv
- Department of Pharmacy Management, Economics and Technology, I. Horbachevsky Ternopil National Medical University, 36 Ruska Street, 46000 Ternopil, Ukraine
| | - Tomasz Osmałek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
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15
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Shaner S, Savelyeva A, Kvartuh A, Jedrusik N, Matter L, Leal J, Asplund M. Bioelectronic microfluidic wound healing: a platform for investigating direct current stimulation of injured cell collectives. LAB ON A CHIP 2023; 23:1531-1546. [PMID: 36723025 PMCID: PMC10013350 DOI: 10.1039/d2lc01045c] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
Upon cutaneous injury, the human body naturally forms an electric field (EF) that acts as a guidance cue for relevant cellular and tissue repair and reorganization. However, the direct current (DC) flow imparted by this EF can be impacted by a variety of diseases. This work delves into the impact of DC stimulation on both healthy and diabetic in vitro wound healing models of human keratinocytes, the most prevalent cell type of the skin. The culmination of non-metal electrode materials and prudent microfluidic design allowed us to create a compact bioelectronic platform to study the effects of different sustained (12 hours galvanostatic DC) EF configurations on wound closure dynamics. Specifically, we compared if electrotactically closing a wound's gap from one wound edge (i.e., uni-directional EF) is as effective as compared to alternatingly polarizing both the wound's edges (i.e., pseudo-converging EF) as both of these spatial stimulation strategies are fundamental to the eventual translational electrode design and strategy. We found that uni-directional electric guidance cues were superior in group keratinocyte healing dynamics by enhancing the wound closure rate nearly three-fold for both healthy and diabetic-like keratinocyte collectives, compared to their non-stimulated respective controls. The motility-inhibited and diabetic-like keratinocytes regained wound closure rates with uni-directional electrical stimulation (increase from 1.0 to 2.8% h-1) comparable to their healthy non-stimulated keratinocyte counterparts (3.5% h-1). Our results bring hope that electrical stimulation delivered in a controlled manner can be a viable pathway to accelerate wound repair, and also by providing a baseline for other researchers trying to find an optimal electrode blueprint for in vivo DC stimulation.
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Affiliation(s)
- Sebastian Shaner
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
- Brainlinks-Braintools Center, Georges-Köhler-Allee 201, 79110, Freiburg, Germany.
| | - Anna Savelyeva
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
- Brainlinks-Braintools Center, Georges-Köhler-Allee 201, 79110, Freiburg, Germany.
| | - Anja Kvartuh
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
| | - Nicole Jedrusik
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
- Brainlinks-Braintools Center, Georges-Köhler-Allee 201, 79110, Freiburg, Germany.
| | - Lukas Matter
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
| | - José Leal
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
- Brainlinks-Braintools Center, Georges-Köhler-Allee 201, 79110, Freiburg, Germany.
| | - Maria Asplund
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 201, 79110, Freiburg, Germany
- Brainlinks-Braintools Center, Georges-Köhler-Allee 201, 79110, Freiburg, Germany.
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Albertstr. 19, 79104, Freiburg, Germany
- Division of Nursing and Medical Technology, Luleå University of Technology, 971 87, Luleå, Sweden
- Department of Microtechnology and Nanoscience, Chalmers University of Technology, Kemivägen 9, 412 58, Gothenburg, Sweden.
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Zulkefli N, Che Zahari CNM, Sayuti NH, Kamarudin AA, Saad N, Hamezah HS, Bunawan H, Baharum SN, Mediani A, Ahmed QU, Ismail AFH, Sarian MN. Flavonoids as Potential Wound-Healing Molecules: Emphasis on Pathways Perspective. Int J Mol Sci 2023; 24:ijms24054607. [PMID: 36902038 PMCID: PMC10003005 DOI: 10.3390/ijms24054607] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 03/02/2023] Open
Abstract
Wounds are considered to be a serious problem that affects the healthcare sector in many countries, primarily due to diabetes and obesity. Wounds become worse because of unhealthy lifestyles and habits. Wound healing is a complicated physiological process that is essential for restoring the epithelial barrier after an injury. Numerous studies have reported that flavonoids possess wound-healing properties due to their well-acclaimed anti-inflammatory, angiogenesis, re-epithelialization, and antioxidant effects. They have been shown to be able to act on the wound-healing process via expression of biomarkers respective to the pathways that mainly include Wnt/β-catenin, Hippo, Transforming Growth Factor-beta (TGF-β), Hedgehog, c-Jun N-Terminal Kinase (JNK), NF-E2-related factor 2/antioxidant responsive element (Nrf2/ARE), Nuclear Factor Kappa B (NF-κB), MAPK/ERK, Ras/Raf/MEK/ERK, phosphatidylinositol 3-kinase (PI3K)/Akt, Nitric oxide (NO) pathways, etc. Hence, we have compiled existing evidence on the manipulation of flavonoids towards achieving skin wound healing, together with current limitations and future perspectives in support of these polyphenolic compounds as safe wound-healing agents, in this review.
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Affiliation(s)
- Nabilah Zulkefli
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | | | - Nor Hafiza Sayuti
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - Ammar Akram Kamarudin
- UKM Molecular Biology Institute (UMBI), UKM Medical Center, Kuala Lumpur 56000, Selangor, Malaysia
| | - Norazalina Saad
- Laboratory of Cancer Research UPM-MAKNA (CANRES), Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Hamizah Shahirah Hamezah
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - Hamidun Bunawan
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - Syarul Nataqain Baharum
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - Ahmed Mediani
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
| | - Qamar Uddin Ahmed
- Drug Discovery and Synthetic Chemistry Research Group, Department of Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
| | - Ahmad Fahmi Harun Ismail
- Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Correspondence: (A.F.H.I.); (M.N.S.)
| | - Murni Nazira Sarian
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
- Correspondence: (A.F.H.I.); (M.N.S.)
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Bouguettaya A, Gethin G, Probst S, Sixsmith J, Team V, Weller C. How health literacy relates to venous leg ulcer healing: A scoping review. PLoS One 2023; 18:e0279368. [PMID: 36652467 PMCID: PMC9847895 DOI: 10.1371/journal.pone.0279368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The level of personal health literacy of patients with venous leg ulcers is likely to affect their ability to self-manage their condition impacting on their adherence to treatment and influences healing and recovery outcomes. OBJECTIVES To scope existing research that examined the level of health literacy in venous leg ulcer patients, to identify how this may link to self-management behaviours (particularly physical activity and compression adherence), and venous leg ulcer healing outcomes. METHODS This scoping review was based on the PRISMA-ScR six-stage framework. We searched MEDLINE, EMBASE, the Cochrane Library, PsycInfo and Health, Open Grey, and Google Scholar for publications examining general and specific health literacy in those with venous leg ulcers and for those examining any potential links of health literacy with self-management/healing generally, published between 2000-2020. This search was guided by a published protocol; studies that described other types of ulcers or did not examine health literacy were excluded. After applying inclusion and exclusion criteria the initial search identified 660 articles. RESULTS We included five articles. Four studies used randomised controlled trials or experimental designs to test the effect of specific health literacy interventions on venous leg ulcer knowledge, compression therapy use, or healing outcomes. One study was a cross- sectional survey with qualitative elements, assessing health literacy in venous leg ulcer patients. Broadly, the research suggested that health literacy was suboptimal amongst those with venous leg ulcers, and health literacy interventions had limited effects on improving key venous leg ulcer specific outcomes. CONCLUSION This review provides a synthesis of extant literature examining health literacy in patients with venous leg ulcers. We identified a dearth of literature investigating the value of general and specific health literacy interventions in this space. Most importantly, no recent research on general health literacy and venous leg ulcers was identified, despite strong theoretical utility to do so. The few studies identified largely indicated that targeting health literacy of patients with venous leg ulcers is a viable area of research and intervention, encouraging future researchers and clinicians to consider patient health literacy in venous leg ulcer management.
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Affiliation(s)
- Ayoub Bouguettaya
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
- * E-mail: (CW); (AB)
| | - Georgina Gethin
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Sebastian Probst
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Care Directorate, University Hospital Geneva, Geneva, Switzerland
| | - Jane Sixsmith
- School of Health Sciences, National University of Ireland, Galway, Ireland
| | - Victoria Team
- Wound Research Group, School of Nursing and Midwifery, Monash University Melbourne, Victoria, Australia
| | - Carolina Weller
- Wound Research Group, School of Nursing and Midwifery, Monash University Melbourne, Victoria, Australia
- * E-mail: (CW); (AB)
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18
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Campanholi KDSS, da Silva Junior RC, Gonçalves RS, de Oliveira MC, Pozza MSDS, Leite AT, da Silva LH, Malacarne LC, Bruschi ML, Castilha LD, dos Santos TC, Caetano W. Photo-Phytotherapeutic Gel Composed of Copaifera reticulata, Chlorophylls, and k-Carrageenan: A New Perspective for Topical Healing. Pharmaceutics 2022; 14:pharmaceutics14122580. [PMID: 36559074 PMCID: PMC9785472 DOI: 10.3390/pharmaceutics14122580] [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] [Received: 10/15/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic wound healing represents an impactful financial burden on healthcare systems. In this context, the use of natural products as an alternative therapy reduces costs and maintains effectiveness. Phytotherapeutic gels applied in photodynamic therapy (PDT) have been developed to act as topical healing medicines and antibiotics. The bioactive system is composed of Spirulina sp. (source of chlorophylls) and Copaifera reticulata oil microdroplets, both incorporated into a polymeric blend constituted by kappa-carrageenan (k-car) and F127 copolymer, constituting a system in which all components are bioactive agents. The flow behavior and viscoelasticity of the formulations were investigated. The photodynamic activity was accessed from studies of the inactivation of Staphylococcus aureus bacteria, the main pathogen of hospital relevance. Furthermore, in vivo studies were conducted using eighteen rabbits with dermatitis (grade III and IV) in both paws. The gels showed significant antibiotic potential in vitro, eliminating up to 100% of S. aureus colonies in the presence or absence of light. The k-car reduced 41% of the viable cells; however, its benefits were enhanced by adding chlorophyll and copaiba oil. The animals treated with the phytotherapeutic medicine showed a reduction in lesion size, with healing and re-epithelialization verified in the histological analyses. The animals submitted to PDT displayed noticeable improvement, indicating this therapy's viability for ulcerative and infected wounds. This behavior was not observed in the iodine control treatment, which worsened the animals' condition. Therefore, gel formulations were a viable alternative for future pharmaceutical applications, aiming at topical healing.
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Affiliation(s)
- Katieli da Silva Souza Campanholi
- Chemistry Department, State University of Maringá, Maringá 87020-900, PR, Brazil
- Correspondence: (K.d.S.S.C.); (W.C.); Tel.: +55-44-3011-5153 (K.d.S.S.C. & W.C.)
| | | | - Renato Sonchini Gonçalves
- Laboratory of Chemistry of Natural Products, Department of Chemistry, Center for Exact Sciences and Technology, Federal University of Maranhão, São Luís 65080-805, MA, Brazil
| | - Mariana Carla de Oliveira
- Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State University of Maringá, Maringá 87020-900, PR, Brazil
| | | | - Angela Tiago Leite
- Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State University of Maringá, Maringá 87020-900, PR, Brazil
| | | | | | - Marcos Luciano Bruschi
- Laboratory of Research and Development of Drug Delivery Systems, Department of Pharmacy, State University of Maringá, Maringá 87020-900, PR, Brazil
| | | | | | - Wilker Caetano
- Chemistry Department, State University of Maringá, Maringá 87020-900, PR, Brazil
- Correspondence: (K.d.S.S.C.); (W.C.); Tel.: +55-44-3011-5153 (K.d.S.S.C. & W.C.)
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Stephens M, Wynn M, Pradeep S, Bowshall J. Frugal innovation in wound care: a critical discussion of what we can learn from low-resource settings. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S16-S23. [PMID: 36370401 DOI: 10.12968/bjon.2022.31.20.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Frugal innovation is a common philosophy in low-income settings due to limited access to resources. However, with both the increasing prevalence and clinical acuity of patients with wounds in the UK, it is essential that alongside innovation such as harnessing cutting-edge new technologies, frugal innovation is also pursued. This may improve both economic efficiency and patient outcomes. Frugal innovations were adopted throughout the COVID-19 pandemic and included opportunistic solutions such as video-conferencing services to run clinics. However, there are many more opportunities for frugal innovation in wound care, including the use of smartphone technology, which is already accessible to 99.5% of UK clinicians caring for wounds, or the simplification of wound-assessment processes using pulse oximeters as an alternative to dopplers, as in the Lanarkshire Oximetry Index. This article explores what frugal innovation is and how it could improve UK wound services. The authors invite clinicians working in wound care to consider their access to existing resources that may not be considered useful for wound-care processes and explore how these could be used to improve clinical outcomes.
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Affiliation(s)
- Melanie Stephens
- Senior Lecturer in Adult Nursing, School of Health and Society, University of Salford
| | - Matthew Wynn
- Lecturer in Adult Nursing, School of Health and Society, University of Salford
| | - Sheba Pradeep
- Lecturer in Adult Nursing, School of Health and Society, University of Salford
| | - Janine Bowshall
- Lecturer in Adult Nursing, School of Health and Society, University of Salford
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He M, Chen T, Lv Y, Song P, Deng B, Guo X, Rui S, Boey J, Armstrong DG, Ma Y, Deng W. The role of allogeneic platelet-rich plasma in patients with diabetic foot ulcer: Current perspectives and future challenges. Front Bioeng Biotechnol 2022; 10:993436. [PMID: 36246379 PMCID: PMC9557159 DOI: 10.3389/fbioe.2022.993436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
The frequency of chronic cutaneous wounds are sharply increasing in aging populations. Patients with age-related diseases, such as diabetes, tumors, renal failure and stroke are prone to soft tissue and skin injury, compounded by slowed healing in aging. Imbalance of wound inflammation, loss of growth factor secretion, and impairment of tissue repair abilities are all possible reasons for failed healing. Therefore, it is vital to explore novel approaches to accelerate wound healing. Platelet-rich plasma (PRP) as a cell therapy has been widely applied for tissue repair and regeneration. PRP promotes wound healing by releasing antimicrobial peptides, growth factors and micro-RNAs. Medical evidence indicates that autologous platelet-rich plasma (au-PRP) can promote wound healing effectively, safely and rapidly. However, its clinical application is usually restricted to patients with chronic cutaneous wounds, generally because of other severe complications and poor clinical comorbidities. Allogeneic platelet-rich plasma (al-PRP), with abundant sources, has demonstrated its superiority in the field of chronic wound treatment. Al-PRP could overcome the limitations of au-PRP and has promising prospects in clinical applications. The aim of this review is to summarize the current status and future challenges of al-PRP in chronic cutaneous wound management. We also summarized clinical cases to further describe the application of al-PRP for chronic wounds in clinical practice.
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Affiliation(s)
- Min He
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
- General Practice Department, Chongqing Southwest Hospital, Chongqing, China
| | - Tianyi Chen
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yuhuan Lv
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Peiyang Song
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Bo Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xuewen Guo
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Shunli Rui
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Johnson Boey
- Department of Podiatry, National University Hospital, Singapore, Singapore
| | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Yu Ma
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
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21
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Ivory JD, Finn DP, Vellinga A, Butler K, Sezgin D, O'Loughlin A, Carr P, Healy C, Gethin G. Topical interventions for the management of pain in chronic wounds: A protocol for a systematic review. HRB Open Res 2022; 5:58. [PMID: 36106311 PMCID: PMC9445559 DOI: 10.12688/hrbopenres.13560.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Venous, arterial, diabetic and pressure ulcers, collectively known as chronic wounds, negatively impact individuals across psychological, social and financial domains. Chronic wounds can be painful and the nature, frequency and impact of pain can differ depending on wound aetiology, wound state and on numerous patient factors. While systemic pharmaceutical agents have some effect in managing pain, there is a need to examine topical agents applied to the wound bed for pain relief. The objective of this study is to examine and synthesise existing literature on the effectiveness of topical agents in managing pain in venous, diabetic, pressure, arterial and mixed venous/arterial ulcers. Methods: We will use Cochrane Systematic Review methodology to identify and synthesise eligible randomised controlled trials (RCTs) evaluating the effectiveness of topical agents in reducing pain in chronic wounds. Embase, Medline, PubMed, CENTRAL, CINAHL, Scopus and Web of Science will be searched from inception to end of June 2022 without language limits. We will independently extract data on the pharmaceutical agent, participant demographics, aetiology, condition of the wound, and type, nature and frequency of pain using a pre-designed data extraction form. Subgroup and sensitivity analysis will be performed to address heterogeneity across studies if appropriate. Further stratification and analyses will be based on included study variables and outcomes. Discussion: Wound pain is primarily managed
via systemic pharmaceutical agents. However, patients express reluctance regarding systemic analgesic drugs, fearing addiction. Additionally, persons with chronic wounds have co-morbidities including hypertension, diabetes, or cardiovascular disease and are already taking multiple medications. Topical analgesia can potentially mitigate some of the perceived disadvantages of systemic agents but the available range of these agents and their effectiveness in managing pain in chronic wounds is not so well understood. This review will focus on such agents across a range of the most common chronic wounds.
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Affiliation(s)
- John D. Ivory
- School of Nursing & Midwifery, University of Galway, Galway, H91TK33, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), University of Galway, Galway, H91TK33, Ireland
- Irish Research Council (IRC), Dublin, D04C2Y6, Ireland
| | - David P. Finn
- Irish Research Council (IRC), Dublin, D04C2Y6, Ireland
- Pharmacology & Therapeutics, School of Medicine, University of Galway, Galway, H91TK33, Ireland
- Galway Neuroscience Centre, University of Galway, Galway, H91TK33, Ireland
- Centre for Pain Research, University of Galway, Galway, H91TK33, Ireland
| | - Akke Vellinga
- Alliance for Research and Innovation in Wounds (ARIW), University of Galway, Galway, H91TK33, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, D04V1W8, Ireland
| | - Karen Butler
- School of Nursing & Midwifery, University of Galway, Galway, H91TK33, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), University of Galway, Galway, H91TK33, Ireland
| | - Duygu Sezgin
- School of Nursing & Midwifery, University of Galway, Galway, H91TK33, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), University of Galway, Galway, H91TK33, Ireland
| | - Aonghus O'Loughlin
- Alliance for Research and Innovation in Wounds (ARIW), University of Galway, Galway, H91TK33, Ireland
- School of Medicine, University of Galway, Galway, H91TK33, Ireland
- University Hospital Galway, Galway, H91YR7, Ireland
| | - Peter Carr
- School of Nursing & Midwifery, University of Galway, Galway, H91TK33, Ireland
| | - Catherine Healy
- Pharmacology & Therapeutics, School of Medicine, University of Galway, Galway, H91TK33, Ireland
- Galway Neuroscience Centre, University of Galway, Galway, H91TK33, Ireland
- Centre for Pain Research, University of Galway, Galway, H91TK33, Ireland
| | - Georgina Gethin
- School of Nursing & Midwifery, University of Galway, Galway, H91TK33, Ireland
- Alliance for Research and Innovation in Wounds (ARIW), University of Galway, Galway, H91TK33, Ireland
- School of Nursing & Midwifery, Monash University, Melbourne, Victoria, 3800, Australia
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Soares Dantas J, Silva CCM, Nogueira WP, de Oliveira e Silva AC, de Araújo EMNF, da Silva Araújo P, Freire MEM. Health-related quality of life predictors in people with chronic wounds. J Tissue Viability 2022; 31:741-745. [DOI: 10.1016/j.jtv.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
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Abstract
Chronic wounds are characterized by their inability to heal within an expected time frame and have emerged as an increasingly important clinical problem over the past several decades, owing to their increasing incidence and greater recognition of associated morbidity and socio-economic burden. Even up to a few years ago, the management of chronic wounds relied on standards of care that were outdated. However, the approach to these chronic conditions has improved, with better prevention, diagnosis and treatment. Such improvements are due to major advances in understanding of cellular and molecular aspects of basic science, in innovative and technological breakthroughs in treatment modalities from biomedical engineering, and in our ability to conduct well-controlled and reliable clinical research. The evidence-based approaches resulting from these advances have become the new standard of care. At the same time, these improvements are tempered by the recognition that persistent gaps exist in scientific knowledge of impaired healing and the ability of clinicians to reduce morbidity, loss of limb and mortality. Therefore, taking stock of what is known and what is needed to improve understanding of chronic wounds and their associated failure to heal is crucial to ensuring better treatments and outcomes.
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de Almeida EF, Goulart J, Moraes JT, Lanza FM, Cortez DN. Calidad de vida asociada con polifarmacia en personas con lesiones cutáneas crónicas. J Wound Care 2022; 31:34-40. [PMID: 36787947 DOI: 10.12968/jowc.2022.31.latam_sup_6a.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Analizar la asociación entre el uso de polifarmacia y la calidad de vida de personas con lesiones cutáneas crónicas. Método: Estudio transversal con una muestra conformada por 146 personas afectadas por lesiones cutáneas crónicas, vinculadas con la atención primaria de salud. La recolección de datos se realizó entre julio de 2017 y febrero de 2018. La información se recopiló mediante un cuestionario sociodemográfico y el cuestionario Cardiff Wound Impact Schedule (CWIS). Resultados: Hubo predominio de hipertensión arterial sistémica en 86 personas (58,9%) y de diabetes mellitus en 50 (34,2%). La etiología de la lesión cutánea predominante fue vasculogénica (38,4%), y se identificó polifarmacia en el 46,7% de los pacientes. En el cuestionario CWIS, el dominio con el puntaje promedio más bajo fue el bienestar (promedio de 46,2±17,9). Hubo asociación estadísticamente significativa (p<0.05) entre polifarmacia y las siguientes variables: dominio de “síntomas físicos/vida diaria", dominio de “vida social” y “autosatisfacción con la calidad de vida". Conclusión: La polifarmacia está asociada con un detrimento en la calidad de vida de personas con lesiones cutáneas crónicas. Por lo tanto, los profesionales de la salud que trabajan en la atención primaria deberían considerar la terapia farmacológica en sus planes de atención, coordinar con asistencia médica y farmacéutica la elaboración de estrategias de monitoreo de los riesgos que involucran la polifarmacia, y evaluar sus impactos en la calidad de vida. Conflicto de interés: Ninguno.
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Affiliation(s)
| | - Jéssica Goulart
- Universidade Federal de São João del-Rei/Campus Centro Oeste, Minas Gerais, Brasil
| | | | - Fernanda Moura Lanza
- Universidade Federal de São João del-Rei/Campus Centro Oeste, Minas Gerais, Brasil
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de Almeida EF, Goulart J, Moraes JT, Lanza FM, Cortez DN. Calidad de vida asociada con polifarmacia en personas con lesiones cutáneas crónicas. J Wound Care 2022; 31:34-40. [PMID: 36789904 DOI: 10.12968/jowc.2022.31.latam_sup_6.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objetivo: Analizar la asociación entre el uso de polifarmacia y la calidad de vida de personas con lesiones cutáneas crónicas. Método: Estudio transversal con una muestra conformada por 146 personas afectadas por lesiones cutáneas crónicas, vinculadas con la atención primaria de salud. La recolección de datos se realizó entre julio de 2017 y febrero de 2018. La información se recopiló mediante un cuestionario sociodemográfico y el cuestionario Cardiff Wound Impact Schedule (CWIS). Resultados: Hubo predominio de hipertensión arterial sistémica en 86 personas (58,9%) y de diabetes mellitus en 50 (34,2%). La etiología de la lesión cutánea predominante fue vasculogénica (38,4%), y se identificó polifarmacia en el 46,7% de los pacientes. En el cuestionario CWIS, el dominio con el puntaje promedio más bajo fue el bienestar (promedio de 46,2±17,9). Hubo asociación estadísticamente significativa (p<0.05) entre polifarmacia y las siguientes variables: dominio de “síntomas físicos/vida diaria", dominio de “vida social” y “autosatisfacción con la calidad de vida". Conclusión: La polifarmacia está asociada con un detrimento en la calidad de vida de personas con lesiones cutáneas crónicas. Por lo tanto, los profesionales de la salud que trabajan en la atención primaria deberían considerar la terapia farmacológica en sus planes de atención, coordinar con asistencia médica y farmacéutica la elaboración de estrategias de monitoreo de los riesgos que involucran la polifarmacia, y evaluar sus impactos en la calidad de vida. Conflicto de interés: Ninguno.
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Affiliation(s)
| | - Jéssica Goulart
- Universidade Federal de São João del-Rei/Campus Centro Oeste, Minas Gerais, Brasil
| | | | - Fernanda Moura Lanza
- Universidade Federal de São João del-Rei/Campus Centro Oeste, Minas Gerais, Brasil
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PATRICK MELONNEY, WAN MOHD ZOHDI WANNAJWA, ABD MUID SUHAILA, OMAR EFFAT. ALPHA-MANGOSTIN (Garcinia mangostana Linn.) AND ITS POTENTIAL APPLICATION IN MITIGATING CHRONIC WOUND HEALING. MALAYSIAN APPLIED BIOLOGY 2022; 51:1-8. [DOI: 10.55230/mabjournal.v51i2.2227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Wound healing is a complex and dynamic cellular process to restore tissue function. Current treatments for chronic wounds especially diabetic ulcers are expensive, with adverse effects. Recently, numerous researchers have focused on the potential effect of natural products on wound healing. One of them is mangosteen (Garcinia mangostana Linn). It is a well-known tropical fruit that is native to Southeast Asia. The active ingredient of mangosteen pericarp contains xanthones that exhibit a wide range of pharmacological activities, including anti-inflammatory and anti-bacterial properties which are the core elements needed in wound healing. Firstly, this review discusses the concepts of abnormal and normal wound healing mechanisms. Then an in depth observation of the pharmacological activities of mangosteen and its derivatives was presented to study their potentially beneficial applications in the treatment of chronic wound healing which is a contemporary medical issue.
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Abolkheirian S, Sadeghi R, Shojaeizadeh D. What do parents of children with autism spectrum disorder think about their quality of life? A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:169. [PMID: 35847126 PMCID: PMC9277726 DOI: 10.4103/jehp.jehp_887_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/29/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Living with children with autism spectrum disorder (ASD) can affect different aspects of parents' physical and mental health and quality of life. This study aimed to identify parents' perceptions of their quality of life and factors influencing such perceptions and investigate how they cope with difficulties in their daily lives. MATERIALS AND METHODS This study was conducted using a qualitative research design to gain insight into how children with ASD may influence their parents' quality of life. A total of 31 parents and school counselors were selected by the snowball sampling method in autism schools in Tehran in the academic year 2018-2019. Semi-structured interviews were used to collect the data. Each interview was held based on a preprepared guideline by the researchers. In-depth questions were also asked as needed. Finally, the data were analyzed using the content analysis approach. RESULTS The participants reported a variety of difficulties and crises to cope with in their daily lives. The factors reported to decrease the quality of life were categorized into six main themes and 20 subthemes. The main themes included "family interactions," "parenting," "daily living," "health," "financial issues," and "community-related." CONCLUSIONS Due to the diversity and multilevel factors affecting the quality of life of parents having children with ASD, it is essential to adopt a comprehensive approach with the participation of all stakeholders in the development, design, and implementation of future interventions.
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Affiliation(s)
- Samaneh Abolkheirian
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Davoud Shojaeizadeh
- Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Clark RK, Stampas A, Kerr KW, Nelson JL, Sulo S, Leon‐Novelo L, Ngan E, Pandya D. Evaluating the impact of using a wound-specific oral nutritional supplement to support wound healing in a rehabilitation setting. Int Wound J 2022; 20:145-154. [PMID: 35684975 PMCID: PMC9797929 DOI: 10.1111/iwj.13849] [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] [Received: 03/16/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 01/07/2023] Open
Abstract
Chronic wounds adversely affect patient quality of life, increase the risk of mortality, and impose high costs on healthcare systems. Since protein-energy malnutrition or specific nutrient deficiencies can delay wound healing, nutritionally focused care is a key strategy to help prevent or treat the occurrence of non-healing wounds. The objective of our study of inpatients in a rehabilitation hospital was to quantify the effect of daily wound-specific oral nutritional supplementation (WS-ONS) on healing chronic wounds. Using electronic medical records, we conducted a retrospective analysis of patients with chronic wounds. We identified records for (a) a treatment group who received standard wound care + usual hospital diet + daily WS-ONS for ≥14 days, and (b) a control group who received standard wound care + a usual hospital diet. We collected data for demographics, nutritional status, and wound-relevant health characteristics. We examined weekly measurements of wound number and sizes (surface area for superficial wounds or volume for non-superficial wounds). There were 341 patients identified, 114 with 322 wounds in the treatment group and 227 patients with 420 wounds in the control group. We found that rehabilitation inpatients who were given nutritional support had larger wounds and lower functional independence on admission. At discharge, wound area reduction (percent) was nearly two-fold better in patients who were given daily WS-ONS + usual hospital diet compared to those who consumed usual diet only (61.1% vs 34.5%). Overall, weekly wound improvement (lowered wound area or wound volume) was more likely in the WS-ONS group than in the Control group, particularly from the start of care to week 2. Inpatients with largest wounds and lowest functional independence on admission were most likely to be given WS-ONS, an indication that caregivers recognised the need for supplementation. Week-to-week improvement in wound size was more likely in patients who received WS-ONS than in those who did not. Specifically, wound areas and wound volumes were significantly lower at discharge among patients who were given specialised nutritional support. More research in this field is needed to improve care and reduce healthcare costs.
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Affiliation(s)
- Rya K. Clark
- Clinical NutritionTIRR Memorial Hermann HospitalHoustonTexasUSA
| | - Argyrios Stampas
- Spinal Cord Injury Medicine ResearchTIRR Memorial Hermann HospitalHoustonTexasUSA
| | - Kirk W. Kerr
- Scientific and Medical AffairsAbbott LaboratoriesColumbusOhioUSA
| | | | - Suela Sulo
- Scientific and Medical AffairsAbbott LaboratoriesColumbusOhioUSA
| | - Luis Leon‐Novelo
- School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Esther Ngan
- School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Dehuti Pandya
- Department of PharmacyTIRR Memorial Hermann HospitalHoustonTexasUSA
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Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Ruíz-Antúnez E, Nieto-García A, Alonso-Sardón M. Clinical Burden of Inpatient Wound Care in Internal Medicine Units During the First Wave of COVID-19 Outbreak. Adv Skin Wound Care 2022; 35:1-7. [PMID: 35426846 DOI: 10.1097/01.asw.0000824564.25976.c8] [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: 01/28/2023]
Abstract
OBJECTIVE To explore the clinical burden and epidemiologic profile of hospitalized patients with wounds during the first wave of COVID-19. METHODS A retrospective and observational study was conducted to analyze the inpatient episodes of wound care in the University Hospital of Salamanca (Spain) during the initial COVID-19 crisis from March 1, 2020, to June 1, 2020. Data were collected from nursing care reports and clinical discharge reports. Included patients were 18 years or older, had a hospital length of stay of 1 day or longer, and were hospitalized in an internal medicine unit. Surgical and traumatic wounds and pediatric patients were excluded. RESULTS A total of 116 patients and 216 wounds were included. The overall wound prevalence was 7.6%, and incidence was 3.5% in the internal medicine units. Pressure injuries (PIs) were the most common wound type, and patients with COVID-19 had significantly higher PI risk (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-4.0; P = .042). Significant differences in PI staging were noted: 83.2% of wounds in patients with COVID-19 were stages I-II versus 67.8% in patients without COVID-19; the probability of stage III-IV PIs among patients without COVID-19 was doubled (OR, 2.3; 95% CI, 1.2-4.5; P = .009). The probability of acute wounds tripled in patients with COVID-19 (OR, 3.7; 95% CI, 2.1-6.6; P < .001). Patients with COVID-19 also had longer mean hospital stays and higher ICU admission rates. No case fatality rate differences were observed. CONCLUSIONS In this context of clinical practice, protocolized assessment and implementation of preventive measures must be ensured among older adult populations, patients with associated comorbidities, and ICU patients.
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Affiliation(s)
- Leticia Nieto-García
- Leticia Nieto-García, RN, PT, is PhD Student and Research Nurse, Institute for Biomedical Research of Salamanca, Spain. At the University Hospital of Salamanca, Adela Carpio-Perez, MD, PhD, is Internal Medicine Physician; Maria Teresa Moreiro-Barroso, MD, is Internal Medicine Physician; Emilia Ruíz-Antúnez, RN, is Nurse, Department of Training, Development and Innovation; and Ainhoa Nieto-García, is Social Worker and Nursing Student. Montserrat Alonso-Sardón, MD, PhD, MPH, is Full Professor of Preventive Medicine, Epidemiology and Public Health, University of Salamanca. The authors have disclosed no financial relationships related to this article. Submitted June 24, 2021; accepted in revised form November 2, 2021; published online ahead of print April 15, 2022
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Weigelt MA, Lev-Tov HA, Tomic-Canic M, Lee WD, Williams R, Strasfeld D, Kirsner RS, Herman IM. Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine. Adv Wound Care (New Rochelle) 2022; 11:330-359. [PMID: 34128387 DOI: 10.1089/wound.2020.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.
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Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. David Lee
- Precision Healing, Inc., Newton, Massachusetts, USA
| | | | | | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ira M. Herman
- Precision Healing, Inc., Newton, Massachusetts, USA
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
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Raepsaet C, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Santamaria N, Sharpe A, Swanson T, Woo K, Beeckman D. Clinical research on the use of bordered foam dressings in the treatment of complex wounds: A systematic review of reported outcomes and applied measurement instruments. J Tissue Viability 2022; 31:514-522. [DOI: 10.1016/j.jtv.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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32
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Gupta S, Mujawdiya P, Maheshwari G, Sagar S. Dynamic Role of Oxygen in Wound Healing: A Microbial, Immunological, and Biochemical Perspective. ARCHIVES OF RAZI INSTITUTE 2022; 77:513-523. [PMID: 36284982 PMCID: PMC9548270 DOI: 10.22092/ari.2022.357230.2003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/26/2022] [Indexed: 01/24/2023]
Abstract
A wound is a temporary break in the continuity of the protective skin barrier. Wound healing is central in maintaining the body's normal homeostatic mechanism, and open wounds raise the risk of microbial infection and amputation. A successful wound healing event is achieved through a series of evolutionarily conserved biochemical pathways orchestrated by various cytokines, growth factors, and immune cells. Chronic wounds are generally oxygen-deficient, and wound hypoxia impairs the wound healing process. Therefore, the use of external oxygen may improve wound health by reducing wound hypoxia, promoting tissue regeneration and granulation tissue formation, reducing anaerobic bacteria colonization, and promoting the growth of beneficial aerobic bacteria. Relevant data were searched and gathered from scientific databases, including PubMed, ScienceDirect, and Google Scholar using relevant keywords, such as "Chronic Wounds", "Topical Oxygen Therapy", "Inflammatory Markers/ Lactate/ Matrix Metalloproteinase", "Collagen", and "Wound Healing". Relevant articles were shortlisted and used in the present study. Chronic wounds show higher expression of pro-inflammatory mediators, such as C-reactive protein, and higher levels of tissue-degrading matrix metalloproteinases. In addition, chronic wounds are generally oxygen-deficient, and wound hypoxia is directly associated with wound deterioration. Several microbial, immunological, and biochemical markers show a direct association with the oxygen availability in the wound. Therefore, a detailed understanding of these microbial, immunological, and biochemical markers will certainly help clinicians understand the interplay between various factors and topical oxygen therapy and may improve patient outcomes.
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Affiliation(s)
- S Gupta
- Inochi Care Private Limited, C-10 (Basement), Malviya Nagar, New Delhi, India
| | - P Mujawdiya
- Inochi Care Private Limited, C-10 (Basement), Malviya Nagar, New Delhi, India
| | - G Maheshwari
- Inochi Care Private Limited, C-10 (Basement), Malviya Nagar, New Delhi, India
| | - S Sagar
- Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
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Abstract
OBJECTIVE To explore the factors influencing quality of life in patients with chronic wounds. METHODS A total of 138 patients with chronic wounds were included and completed the Chinese version of the Cardiff Wound Impact Schedule, the Hospital Anxiety and Depression Scale, and the Medical Coping Modes Questionnaire after researchers assessed their wound severity. RESULTS The mean scores of physical symptoms and everyday living, social life, and well-being on the Chinese version of the Cardiff Wound Impact Schedule were 55.65 ± 15.82, 52.69 ± 16.46, and 40.75 ± 13.82, respectively. Multiple regression analysis revealed that depression, coping style, and education level were the primary factors, explaining 51.7% of the variance in physical symptoms and everyday living. Depression and coping style explained 49.6% of the variance in social life. Anxiety and primary disease explained 36.2% of the variance in well-being. CONCLUSIONS The factors influencing quality of life for these Chinese patients with chronic wounds included education level, primary disease, anxiety, depression, and coping style. Speaking with patients about living with a chronic wound and their potential for healing, understanding their fears about significant changes to their life, and encouraging them to accept such changes can be important for patients and their recovery.
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34
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Finlayson KJ, Parker CN, Miller C, Edwards HE, Campbell J. Decreased mobility, lack of social support, haemosiderosis and use of antidepressant medications may predict recurrent venous leg ulcers within 12 months of healing: A prospective longitudinal study. Phlebology 2021; 37:206-215. [PMID: 34965772 DOI: 10.1177/02683555211063986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify clinical, medical and psychosocial predictors of venous leg ulcer recurrence within 12 months of healing. METHODS A multi-site study was conducted in Australia in community and hospital outpatient settings. Adults with venous leg ulcers were recruited within 4 weeks of healing and data were collected on preventative treatments and health, medical, clinical and psychosocial factors. Follow-up data on recurrences were collected every 3 months until ulcer recurrence, or until 12 months after healing pending which occurred first. Factors associated with time to recurrence were analysed using a Cox proportional hazards regression model. DESIGN Secondary data analysis of a multi-site, prospective longitudinal study to validate a risk assessment tool for recurrence. RESULTS A sample of 143 participants was recruited (51% male, Mage = 73 years, SD 13.6). Almost half (49.6%) had an ulcer recurrence within 12 months, with a mean time to ulcer recurrence of 37 weeks (SE 1.63, 95% CI 33.7-40.1). Factors measured at the time of healing that were significant independent predictors of recurrence were: prescribed antidepressant medications (p = .035), presence of haemosiderosis (p = .006), decreased mobility (longer sitting times) (p = .007) and lower social support scale scores (p = .002). Participants who wore compression systems providing 20 mmHg or higher for at least 5 days/week were less likely to recur, although not reaching statistical significance (p = .06). CONCLUSION Results provide evidence that antidepressant medications, haemosiderosis, decreased mobility and lack of social support are risk factors associated with ulcer recurrence; therefore, these variables are modifiable and could guide early intervention.
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Affiliation(s)
- K J Finlayson
- Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Healthcare Transformation, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - C N Parker
- Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Healthcare Transformation, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - C Miller
- 2080La Trobe University, Melbourne, VIC, Australia
| | - H E Edwards
- Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia.,Centre for Healthcare Transformation, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - J Campbell
- Menzies Health Institute Queensland, 97562Griffith University, Gold Coast, QLD, Australia
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Ivory JD, Vellinga A, O'Gara J, Gethin G. A scoping review protocol to identify clinical signs, symptoms and biomarkers indicative of biofilm presence in chronic wounds. HRB Open Res 2021; 4:71. [PMID: 35224441 PMCID: PMC8847728 DOI: 10.12688/hrbopenres.13300.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction:
Wound healing is characterised by haemostatic, inflammatory, proliferative and remodelling phases. In the presence of comorbidities such as diabetes, healing can stall and chronic wounds may result. Infection is detrimental to these wounds and associated with poor outcomes. Wounds are contaminated with microbes and debris, and factors such as host resistance, bacterial virulence, species synergy and bioburden determine whether a wound will deteriorate to critically colonised/infected states. Biofilms are sessile microbial communities, exhibiting high-level antibiotic tolerance and resistance to host defences. Biofilm in critically colonised wounds can contribute to delayed healing. Little is known about clinical presentation and diagnosis of wound biofilms. Objective:
To
identify from the literature clinical signs, symptoms and biomarkers that may indicate biofilm presence in chronic wounds. Methods:
This review will be guided by the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR), and the Joanna Briggs Institute Manual for Evidence Synthesis. Studies of any design in any language recruiting adult patients with venous, diabetic, pressure or mixed arterial-venous ulcers and reporting data on clinical signs/symptoms of biofilm are eligible. Searches of Medline, Embase, CINAHL, Cochrane Central and BASE will be conducted from inception to present. Reference scanning and contact with content experts will be employed. Title/abstract screening and full text selection will be executed by two reviewers independently. Discrepancies will be resolved by discussion between reviewers or through third party intervention. Data will be extracted by a single reviewer and verified by a second. Clinical signs and symptoms data will be presented in terms of study design, setting and participant demographic data. Discussion:
Understanding biofilm impact on chronic wounds is inconsistent and based largely on
in vitro research. This work will consolidate clinical signs, symptoms and biomarkers of biofilm in chronic wounds reported in the literature.
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Affiliation(s)
- John D. Ivory
- School of Nursing & Midwifery, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- Alliance for Research & Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- CDA Diabetic Foot Disease: from PRevention to IMproved patient Outcomes (CDA DFD-PRIMO) Program, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- Irish Research Council, 3 Shelbourne Buildings, Crampton Avenue, Ballsbridge, D04 C2Y6, Ireland
| | - Akke Vellinga
- Alliance for Research & Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- School of Medicine, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
| | - James O'Gara
- Alliance for Research & Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- CDA Diabetic Foot Disease: from PRevention to IMproved patient Outcomes (CDA DFD-PRIMO) Program, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- Microbiology, School of Natural Sciences, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
| | - Georgina Gethin
- School of Nursing & Midwifery, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- Alliance for Research & Innovation in Wounds (ARIW), National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- CDA Diabetic Foot Disease: from PRevention to IMproved patient Outcomes (CDA DFD-PRIMO) Program, National University of Ireland, Galway, Galway, Galway, H91TK33, Ireland
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
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Preparation of W/O Hypaphorine-Chitosan Nanoparticles and Its Application on Promoting Chronic Wound Healing via Alleviating Inflammation Block. NANOMATERIALS 2021; 11:nano11112830. [PMID: 34835594 PMCID: PMC8625710 DOI: 10.3390/nano11112830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022]
Abstract
Chronic wound repair is a common complication in patients with diabetes mellitus, which causes a heavy burden on social medical resources and the economy. Hypaphorine (HYP) has good anti-inflammatory effect, and chitosan (CS) is used in the treatment of wounds because of its good antibacterial effect. The purpose of this research was to investigate the role and mechanism of HYP-nano-microspheres in the treatment of wounds for diabetic rats. The morphology of HYP-NPS was observed by transmission electron microscopy (TEM). RAW 264.7 macrophages were used to assess the bio-compatibility of HYP-NPS. A full-thickness dermal wound in a diabetic rat model was performed to evaluate the wound healing function of HYP-NPS. The results revealed that HYP-NPS nanoparticles were spherical with an average diameter of approximately 50 nm. The cell experiments hinted that HYP-NPS had the potential as a trauma material. The wound test in diabetic rats indicated that HYP-NPS fostered the healing of chronic wounds. The mechanism was through down-regulating the expression of pro-inflammatory cytokines IL-1β and TNF-α in the skin of the wound, and accelerating the transition of chronic wound from inflammation to tissue regeneration. These results indicate that HYP-NPS has a good application prospect in the treatment of chronic wounds.
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Kapp S, Santamaria N. The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 1-Development, pilot and refinement of the checklist. Int Wound J 2021; 19:705-713. [PMID: 34427975 PMCID: PMC8874096 DOI: 10.1111/iwj.13666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022] Open
Abstract
Patients who have chronic wounds such as leg ulcers should be active participants in their treatment and care. This participation may include self‐treatment of the wound which involves the patient cleaning the wound, applying and removing wound dressings, and/or applying and removing compression therapy. The aim of the study was to develop a Checklist to assist nurses to appraise the conduct of wound treatment when undertaken by the patient. A three‐phase mixed methods study was conducted. A systematic and evidence‐based approach to developing and using structured observations for the study of health behaviour guided the process of developing, piloting and refining the Checklist. The resulting “Self‐Treatment of Wounds for Venous Leg Ulcers Checklist” (STOW‐V Checklist V1.0) can assist the nurse to evaluate the conduct of key self‐treatment behaviours in the areas of equipment and workspace, hand hygiene, wound dressing removal, skin care, wound cleansing and debridement, wound assessment, wound dressing application, and compression therapy application. The growing recognition that patients can benefit when involved in care, the need to enact self‐management because of COVID‐19, and the ever present competition for healthcare funding and resources are compelling reasons for patients, care providers, and healthcare services to afford the self‐management approach, and associated interventions such as self‐treatment, greater consideration. It is recommended that the STOW‐V Checklist is used with patients in a shared‐care model, with nurses and other healthcare professionals providing supervision and oversight of self‐treatment practices whenever this is feasible and acceptable to the patient.
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Affiliation(s)
- Suzanne Kapp
- Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Nick Santamaria
- Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
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Kapp S, Prematunga R, Santamaria N. The "self-treatment of wounds for venous leg ulcers checklist" (STOW-V Checklist V1.0): Part 2-The reliability of the Checklist. Int Wound J 2021; 19:714-723. [PMID: 34427976 PMCID: PMC8874117 DOI: 10.1111/iwj.13668] [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: 05/02/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022] Open
Abstract
The “Self‐Treatment of Wounds for Venous Leg Ulcers Checklist” (STOW‐V Checklist V1.0) is an evidence‐based, standardised tool designed to assist nurses to appraise the conduct of wound treatment when undertaken by patients who have venous leg ulcers. A prospective reliability study was conducted to determine the reliability of the STOW‐V Checklist V1.0. Video‐recordings of patients who self‐treated their leg ulcer were obtained (n = 5) and nurses (n = 15) viewed each video‐recording three times and concurrently completed the Checklist. Internal consistency, inter‐rater reliability and intra‐rater reliability were evaluated. Cronbach's alpha for items in the Checklist was 0.792, 0.791 and 0.783 for Occasions 1, 2 and 3, respectively, indicating good reliability. Inter‐rater reliability was 0.938, 0.958 and 0.927 for Occasions 1, 2 and 3, respectively; these results were statistically significant and indicative of excellent reliability. Intra‐rater reliability was 0.403 to 0.999; these results were statistically significant and meeting or exceed adequacy in the case of all except two raters. The study provides preliminary evidence that the Checklist is measuring the concepts that it intends to measure and that there is a high level of agreement among raters. It is recommended that the STOW‐V Checklist V1.0 is utilised with patients in a shared‐care model, with nurses and other healthcare professionals providing supervision and oversight of self‐treatment practices whenever this is feasible and acceptable to the patient.
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Affiliation(s)
- Suzanne Kapp
- Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Parkville, Australia
| | - Roshani Prematunga
- Faculty of Medicine Dentistry and Health Sciences, Centre for Mental Health Nursing, The University of Melbourne, Parkville, Australia
| | - Nick Santamaria
- Faculty of Medicine Dentistry and Health Sciences, Department of Nursing, The University of Melbourne, Parkville, Australia
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Ivory JD, Vellinga A, O'Gara J, Gethin G. A scoping review protocol to identify clinical signs, symptoms and biomarkers indicative of biofilm presence in chronic wounds. HRB Open Res 2021; 4:71. [DOI: 10.12688/hrbopenres.13300.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Wound healing is characterised by haemostatic, inflammatory, proliferative and remodelling phases. In the presence of comorbidities such as diabetes, healing can stall and chronic wounds may result. Infection is detrimental to these wounds and associated with poor outcomes. Wounds are contaminated with microbes and debris, and factors such as host resistance, bacterial virulence, species synergy and bioburden determine whether a wound will deteriorate to critically colonised/infected states. Biofilms are sessile microbial communities, exhibiting high-level antibiotic tolerance and resistance to host defences. Biofilm in critically colonised wounds can contribute to delayed healing. Little is known about clinical presentation and diagnosis of wound biofilms. Objective: To identify from the literature clinical signs, symptoms and biomarkers that may indicate biofilm in chronic wounds. Methods: This review will be guided by the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR), and the Joanna Briggs Institute Manual for Evidence Synthesis. Studies of any design in any language recruiting adult patients with venous, diabetic, pressure or mixed arterial-venous ulcers and reporting data on clinical signs/symptoms of biofilm are eligible. Searches of Medline, Embase, CINAHL, Cochrane Central, Scopus, Web of Science, Google scholar and BASE will be conducted from inception to present. Reference scanning and contact with content experts will be employed. Title/abstract screening and full text selection will be executed by two reviewers independently. Discrepancies will be resolved by discussion between reviewers or through third party intervention. Data will be extracted by a single reviewer and verified by a second. Clinical signs and symptoms data will be presented in terms of study design, setting and participant demographic data. Discussion: Understanding biofilm impact on chronic wounds is inconsistent and based largely on in vitro research. This work will consolidate clinical signs, symptoms and biomarkers of biofilm in chronic wounds reported in the literature.
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40
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Gomes J, Sousa P, Pereira F, Queirós C, Neves H, Silva C, Silva APE, Parente P, Sousa P, Brito A, Silva APE, Morais EJ, Cardoso A, Cruz I, Machado N, Oliveira F, Bastos F, Prata P, Sequeira C. Nursing knowledge on skin ulcer healing: a living scoping review protocol. JBI Evid Synth 2021; 20:164-172. [PMID: 34149023 DOI: 10.11124/jbies-20-00512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review aims to continuously map the nursing knowledge on skin ulcer healing in any context of care. INTRODUCTION Chronic wounds are an increasing concern for society and health care providers. Pressure ulcers and venous ulcers, among others, have devastating effects on morbidity and quality of life and require a systematic approach. The nursing process is an important method that allows a better organization and overall care quality for a systematic and continuous professional approach to nursing management of skin ulcers. The integration of this nursing knowledge in informatics systems creates an opportunity to embed decision-support models in clinical activity, promoting evidence-based practice. INCLUSION CRITERIA This scoping review will consider articles that focus on nursing data, diagnosis, interventions, and outcomes focused on the person with skin ulcers in all contexts of care. This review will include quantitative, qualitative, and mixed methods study designs as well as systematic reviews and dissertations. METHODS JBI's scoping review guidance, as well as the Cochrane Collaboration's guidance on living reviews, will be followed to meet the review's objective. Screening of new literature will be performed regularly, with the review being updated according to new findings. The search strategy will map published and unpublished studies. The databases to be searched include: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier), JBI Library of Systematic Reviews, and Cochrane Central Register of Controlled Trials. Searches for unpublished studies will include OpenGrey and Repositórios Científicos de Acesso Aberto de Portugal. Studies published in English and Portuguese since 2010 will be considered for inclusion. REGISTRATION Open Science Framework: https://osf.io/f6s4e/.
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Affiliation(s)
- João Gomes
- Abel Salazar Biomedical Sciences Institute - University of Porto, Porto, Portugal CIDESI-ESEP: ICN-Accredited Centre for Information Systems and ICNP Research and Development of Porto Nursing School, Porto, Portugal Porto Nursing School Porto, Portugal Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal Universidade Católica Portuguesa, Institute of Health Sciences, Porto, Portugal ACES Alto Ave, Guimarães, Portugal
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Reinboldt-Jockenhöfer F, Babadagi Z, Hoppe HD, Risse A, Rammos C, Cyrek A, Blome C, Benson S, Dissemond J. Association of wound genesis on varying aspects of health-related quality of life in patients with different types of chronic wounds: Results of a cross-sectional multicentre study. Int Wound J 2021; 18:432-439. [PMID: 33398926 PMCID: PMC8273619 DOI: 10.1111/iwj.13543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 01/06/2023] Open
Abstract
Patients with chronic wounds are significantly impaired in their health‐related quality of life (HRQoL). The validated Wound‐QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life‐related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross‐sectional, multicentre study, Wound‐QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life‐related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound‐QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient‐oriented treatments, the Wound‐QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health‐related quality of life. Validated Wound‐QoL questionnaire is a quick and easy‐to‐use instrument for daily practice. Wound‐related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound‐related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health‐related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument.
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Affiliation(s)
- Finja Reinboldt-Jockenhöfer
- Department of Dermatology, Venereology and Allergology, Initiative Chronische Wunden (ICW) e.V, University Hospital of Essen, Germany
| | | | | | - Alexander Risse
- Department of Diabetology, Klinikum Dortmund, Dortmund, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Germany
| | - Anna Cyrek
- Division of Vascular and Endovascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing, German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, Initiative Chronische Wunden (ICW) e.V, University Hospital of Essen, Germany
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Vogt TN, Koller FJ, Santos PND, Lenhani BE, Guimarães PRB, Kalinke LP. Quality of life assessment in chronic wound patients using the Wound-QoL and FLQA-Wk instruments. INVESTIGACION Y EDUCACION EN ENFERMERIA 2020; 38:e11. [PMID: 33306901 PMCID: PMC7885545 DOI: 10.17533/udea.iee.v38n3e11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate changes in the quality of life of patients with chronic wounds. METHODS Quantitative research with a cross-sectional design performed with 100 patients with chronic wounds from a university hospital and a Basic Health Unit in southern Brazil. The mean values of the domains of the instruments Wound Quality of Life (Wound-QoL) and Freiburg Life Quality Assessment Wound were compared with sociodemographic variables of age, sex and education. RESULTS The average age of the participants was 60.98 years old; 41% (n = 41) had diabetic ulcers and 83% (n = 83) treated the wounds for more than 24 months. The total quality of life value was below the mean with 37.50/100 with (Wound-QoL) and 44.20/100 with (FLQA-Wk). The variables of gender, and educational level were not correlated with either of the two instruments used to assess the quality of life. The age variable was significantly correlated with the satisfaction item of the FLQA-Wk. CONCLUSIONS The quality of life of patients with chronic wounds was considered poor. The age variable was correlated with the satisfaction domain, showing that the older the age, the lower the satisfaction. The use of instruments to evaluate the quality of life of patients with chronic wounds may help an effective treatment plan.
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Bondini CM, Sage S, Wilson BP, Hall MR, Wallis EAR. Modified telehealth for care of chronic wounds during the Coronavirus disease 2019 pandemic: A rapid literature review of alternative care modalities. Int Wound J 2020; 17:1960-1967. [PMID: 32902172 DOI: 10.1111/iwj.13488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 01/18/2023] Open
Abstract
Due to the changes in delivering medical care during the Coronavirus disease 2019 (COVID-19) pandemic, such as the heavy reliance on telehealth, it is worth exploring if this is suitable when treating complex wounds. A literature rapid review was performed to explore the existing evidence around alternative service delivery modalities. While there are organisations that have successful telehealth systems and infrastructure, for services that do not already widely use telehealth it is difficult to implement a standardised system in the current state of emergency. The evidence reviewed demonstrates that telehealth appears to currently have a limited place in chronic wound management; therefore, standardisation on determining suitability in conjunction with evaluation of telehealth during this period is needed to shape implementation of telehealth systems in the future.
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Affiliation(s)
- Carla M Bondini
- Chronic Wound Service/Wound CNC team, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sarah Sage
- Chronic Wound Service/Wound CNC team, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Brent P Wilson
- Chronic Wound Service/Wound CNC team, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Maire R Hall
- Chronic Wound Service/Wound CNC team, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elizabeth A R Wallis
- Chronic Wound Service/Wound CNC team, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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44
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Graves N, Maiti R, Aloweni FAB, Yuh AS, Lo ZJ, Harding K. Pressure injuries among admissions to a hospital in the tropics. Int Wound J 2020; 17:1659-1668. [PMID: 32720433 DOI: 10.1111/iwj.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
We report incidence rates for pressure injuries seen in an acute hospital in Singapore that were classified as Stage 3 or Stage 4. The characteristics of patients and the factors that explain variation in the primary outcome of duration of hospital stay are summarized. Existing data were available from Singapore General Hospital for all admissions from January 2016 to December 2019. Univariable analysis was done and a multivariable Poisson regression model estimated. Incidence rates declined from 4.05 to 3.4 per 1000 admissions in the 48 months between 2016 and 2019. The vast majority were community acquired with 75% in admission from the patients' home. Factors that explain variation in length of stay were, ethnicity; site of injury; community versus healthcare associated; inter-hospital transfer; fracture as reason for admission; and the number of days between admission and assessment of wound by specialist nurse. Stage 3 and 4 injuries arise in a home environment most often and are subsequently managed in acute hospital at high cost. These are novel epidemiological data from a hospital in the tropics where the potential to improve outcomes, implement screening and prevention, and thus increase the performance of health services is strong.
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Affiliation(s)
- Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore.,Wound Care Innovation for the Tropics Programme, Singapore
| | - Raju Maiti
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | | | - Zhiwen Joseph Lo
- Vascular Surgery Service, Tan Tock Seng Hospital, Singapore.,Nanyang Technological University Lee Kong Chian School of Medicine Centre for Population Health Sciences, Singapore
| | - Keith Harding
- Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore.,Wound Care Innovation for the Tropics Programme, Singapore
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45
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Krupová L, Pokorná A. Quality of life in patients with non-healing wounds, with particular focus on assesment tools - a literature review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2020. [DOI: 10.15452/cejnm.2020.11.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kapp S, Santamaria N. The effect of self-treatment of wounds on quality of life: a qualitative study. J Wound Care 2020; 29:260-268. [PMID: 32421484 DOI: 10.12968/jowc.2020.29.5.260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Skin wounds, such as leg ulcers and pressure ulcers (PUs), can have a negative effect on quality of life (QoL). This effect has been confirmed among self-treaters of wounds, specifically. The aim of the study was to investigate the effect of self-treatment of wounds on the physical, emotional, lifestyle and financial domains of QoL. The findings of the study may be used to optimise the wellbeing of people who have wounds. METHOD A qualitative study was conducted with people who were 18 years of age or older; lived in Victoria, Australia; spoke English; and had a wound that they had self-treated. Participants were interviewed and the data thematically analysed to identify themes that represented the effect of self-treatment on the physical, emotional, lifestyle and financial domains of QoL. RESULTS The participants (n=25) averaged 71 years of age and the majority (n=20) had leg wounds. Participants described mostly positive effects on QoL that were attributable to self-treatment. Self-treatment improved physical wellbeing because it resulted in better pain management and wound healing; however, it was a physical challenge for some. Self-treatment enhanced emotional wellbeing because it helped to manage worry about infection and resolve dissatisfaction with professional care. Self-treatment lessened the social consequences of the wound by enabling participants to create an acceptable appearance, maintain their lifestyle and minimise time receiving professional care. Self-treatment reduced the financial cost of wound dressings and the expense associated with receiving professional care. CONCLUSION As an approach to care, self-treatment of wounds may offer QoL gains that might otherwise be unachievable. The importance of engaging patients in their own management, and the increasing accountability of healthcare providers to report consumer-focused outcomes, are further reasons to consider self-treatment of wounds as an approach to care in the community setting.
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Affiliation(s)
- Suzanne Kapp
- The University of Melbourne, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, Victoria, Australia
| | - Nick Santamaria
- The University of Melbourne, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, Department of Nursing, Victoria, Australia
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Dhar A, Needham J, Gibb M, Coyne E. The outcomes and experience of people receiving community-based nurse-led wound care: A systematic review. J Clin Nurs 2020; 29:2820-2833. [PMID: 32279369 DOI: 10.1111/jocn.15278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/28/2020] [Accepted: 03/13/2020] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To review the literature related to the outcomes and experience of people receiving nurse-led care for chronic wounds in the community. BACKGROUND Chronic wounds lead to a poor quality of life and are an economic burden to the Australian healthcare system. A lack of awareness into the significance of chronic wounds leads to limited resources being available to facilitate the provision of evidence-based care. The majority of chronic wounds are managed by nurses in the community, and a better understanding into current models of care is required to inform future practice. DESIGN A systematic quantitative literature review. METHODS A systematic search was conducted in four electronic databases, and the inclusion criteria were as follows: English language, peer-reviewed, published from 2009-2019 and primary research. The data were compiled into an Excel database for reporting as per the Pickering and Byrne (Higher Education Research & Development, 33, 534.) method of systematic quantitative literature review. This review used the PRISMA checklist. The Mixed Methods Appraisal Tool was used for quality appraisal. RESULTS Twelve studies were included in the review. Home nursing care, social community care and nursing within a wound clinic were identified as three types of nurse-led care in the literature. The findings demonstrate that nurse-led care was cost-effective, reported high levels of client satisfaction and contributed to improved wound healing and reduced levels of pain. CONCLUSIONS Nurse-led care is a positive experience for people with chronic wounds and leads to better outcomes. The findings suggested a need for further client education and specialised training for healthcare practitioners managing chronic wounds. RELEVANCE TO CLINICAL PRACTICE This review demonstrates that nurse-led care for people with chronic wounds in the community is cost-effective and improves client outcomes. Raising awareness into the significance of chronic wounds aims to promote the resources required to facilitate evidence-based care.
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Affiliation(s)
- Anusuya Dhar
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - Judith Needham
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - Michelle Gibb
- Wound Specialist Services Pty Ltd, Brisbane, QLD, Australia
| | - Elisabeth Coyne
- School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
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Ruseckaite R, Richards C, Rutherford C, Team V, Turnour L, Franks P, Weller C. A conceptual framework of patient-reported outcomes in people with venous leg ulcers. Wound Repair Regen 2019; 28:355-363. [PMID: 31794080 DOI: 10.1111/wrr.12787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
Venous leg ulcers (VLUs) are a common chronic often undertreated condition, which affects individual's health-related quality of life (HRQoL). Numerous patient-reported outcome measures (PROMs) have been validated to capture HRQoL in patients with VLUs. However, available instruments contain many items, are hard to use in clinical practice, and present with weak responsiveness. This study aims to determine clinical utility of an existing VLU-QoL instrument and to develop a comprehensive PROs assessment framework to guide clinical practice treatment in people with VLUs in Australia. Semi-structured qualitative interviews were conducted with VLU patients (N = 13) and their managing clinicians (N = 6) in Victoria, Australia. Interview topics covered content and face validity, appropriateness, and acceptability of the VLU-QoL instrument to determine suitable and appropriate for use in clinical practice. Clinicians and patients agreed that a VLU-QoL instrument was needed in clinical practice. Both clinicians and patients agreed it would be appropriate to answer PROMs questions prior to consultation with clinicians every 3-6 months. However, patients considered that some of the questions are ambiguous and too technical. Patients reported that it would be useful to include additional items relating to daily wound care, compression bandaging, and dressings. Clinicians reported that the VLU-QoL instrument was too long and required restructuring to facilitate utility in practice. A conceptual framework for HRQoL in VLUs included traditional HRQoL components and VLU-specific issues. Overall, the VLU-QoL was well accepted, although changes to make it more concise, comprehensive, and to clearly reflect consumers' perspectives were lacking. The proposed conceptual framework will inform the development of a new PROM for use by clinicians and patients in clinical settings.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catelyn Richards
- Wound Research Unit, Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia.,Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Team
- Wound Research Unit, Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Louise Turnour
- Wound Research Unit, Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Peter Franks
- Centre for Research and Implementation of Clinical Practice, London, United Kingdom
| | - Carolina Weller
- Wound Research Unit, Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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Weller CD, Richards C, Turnour L, Patey AM, Russell G, Team V. Barriers and enablers to the use of venous leg ulcer clinical practice guidelines in Australian primary care: A qualitative study using the theoretical domains framework. Int J Nurs Stud 2019; 103:103503. [PMID: 31931442 DOI: 10.1016/j.ijnurstu.2019.103503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers. OBJECTIVE We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice. DESIGN We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers. SETTING(S) We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia. PARTICIPANTS We recruited general practitioners (15) and practice nurses (20). METHODS We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains. RESULTS Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes. CONCLUSIONS We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.
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Affiliation(s)
- C D Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - C Richards
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - L Turnour
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - A M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - G Russell
- Department of General Practice, Southern Academic Primary Care Research Unit, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, 3168, Melbourne, Australia.
| | - V Team
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
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50
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Kielo E, Suhonen R, Salminen L, Stolt M. Competence areas for registered nurses and podiatrists in chronic wound care, and their role in wound care practice. J Clin Nurs 2019; 28:4021-4034. [DOI: 10.1111/jocn.14991] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/29/2019] [Accepted: 06/30/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Emilia Kielo
- Department of Nursing Science University of Turku Turku Finland
- Turku University Hospital Turku Finland
| | - Riitta Suhonen
- Department of Nursing Science University of Turku Turku Finland
- Turku University Hospital Turku Finland
- City of Turku, Welfare Division Turku Finland
| | - Leena Salminen
- Department of Nursing Science University of Turku Turku Finland
| | - Minna Stolt
- Department of Nursing Science University of Turku Turku Finland
- Turku University Hospital Turku Finland
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