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Lu X, Wu B, Li Q, Wang X, Fan L, Li M, Wang L. A survey of skin failure perceptions amongst pressure injury management staff in China: A cross-sectional study. Int Wound J 2024; 21:e14890. [PMID: 38682890 PMCID: PMC11057374 DOI: 10.1111/iwj.14890] [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: 01/09/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
This study sought to evaluate the perceptions of pressure injury (PI) management staff regarding skin failure (SF). Additionally, an analysis of influencing factors based on the collected data was conducted to establish a foundation for targeted SF training. A descriptive, cross-sectional survey was undertaken in October-November 2023, utilising a convenience sampling method involving selected management staff of PI from 16 provinces in China. A total of 501 nursing participants were included, exhibiting an overall perception level that was moderately low. Although the majority were aware of the possibility of SF (n = 417, 83.23%), only 60% reported an understanding of the fundamentals of SF, with the lowest level of comprehension observed in differentiating between SF and PI (n = 212, 42.31%). Overall attitudes were generally positive. Regarding behaviour, active learning was more prevalent (n = 340, 67.86%), but training is less (n = 287, 57.29%). Family education (n = 401, 80.04%) and nursing record monitoring (n = 426, 85.03%) demonstrated better behaviour. Further analysis revealed that training (t = 13.937, p < 0.001) and professional title (F = 4.681, p = 0.010) had a significant effect on participants' perceptions. These findings underscore that there remains a substantial lack of perception about SF amongst participants. Overall, participants exhibited a positive attitude towards SF, highlighting the need for future improvements in SF training.
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Affiliation(s)
- Xiaodan Lu
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Bingbing Wu
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Qian Li
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Xuyang Wang
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Li Fan
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Min Li
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Lizhu Wang
- Department of NursingThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
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Examining Violaceous Skin Discoloration during the COVID-19 Pandemic: Conducting Research in Resource Scarcity. Adv Skin Wound Care 2023; 36:137-141. [PMID: 36812078 DOI: 10.1097/01.asw.0000911988.75204.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To describe the observed patterns and presentations of violaceous discoloration that appeared to be related to the COVID-19 disease process. METHODS This retrospective observational cohort study included adults who were COVID-19 positive with purpuric/violaceous lesions in pressure-adjacent areas of the gluteus without preexisting pressure injury. Patients were admitted to an ICU at a single quaternary academic medical center between April 1 and May 15, 2020. Data were compiled by review of the electronic health record. The wounds were described by location, tissue type (violaceous, granulation, slough, eschar), wound margin (irregular, diffuse, nonlocalized), and periwound condition (intact). RESULTS A total of 26 patients were included in the study. Purpuric/violaceous wounds were found predominantly on White (92.3%) men (88.0%) aged 60 to 89 years (76.9%) with a body mass index 30 kg/m2 or higher (46.1%). The majority of wounds were located on the sacrococcygeal (42.3%) and fleshy gluteal regions (46.1%). CONCLUSIONS Wounds were heterogeneous in appearance (poorly defined violaceous skin discoloration of acute onset), and the patient population had clinical characteristics similar to acute skin failure (eg, concomitant organ failures and hemodynamic instability). Additional larger population-based studies with biopsies may assist in finding patterns related to these dermatologic changes.
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Barie PS, Brindle ME, Khadaroo RG, Klassen TL, Huston JM. Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services. Surg Infect (Larchmt) 2023; 24:6-18. [PMID: 36580648 DOI: 10.1089/sur.2022.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Active and recent coronavirus disease 2019 (COVID-19) infections are associated with morbidity and mortality after surgery in adults. Current recommendations suggest delaying elective surgery in survivors for four to 12 weeks, depending on initial illness severity. Recently, the predominant causes of COVID-19 are the highly transmissible/less virulent Omicron variant/subvariants. Moreover, increased survivability of primary infections has engendered the long-COVID syndrome, with protean manifestations that may persist for months. Considering the more than 600,000,000 COVID-19 survivors, surgeons will likely be consulted by recovered patients seeking elective operations. Knowledge gaps of the aftermath of Omicron infections raise questions whether extant guidance for timing of surgery still applies to adults or should apply to the pediatric population. Methods: Scoping review of relevant English-language literature. Results: Most supporting data derive from early in the pandemic when the Alpha variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) predominated. The Omicron variant/subvariants generally cause milder infections with less organ dysfunction; many infections are asymptomatic, especially in children. Data are scant with respect to adult surgical outcomes after Omicron infection, and especially so for pediatric surgical outcomes at any stage of the pandemic. Conclusions: Numerous knowledge gaps persist with respect to the disease, the recovered pre-operative patient, the nature of the proposed procedure, and supporting data. For example, should the waiting period for all but urgent elective surgery be extended beyond 12 weeks, e.g., after serious/critical illness, or for patients with long-COVID and organ dysfunction? Conversely, can the waiting periods for asymptomatic patients or vaccinated patients be shortened? How shall children be risk-stratified, considering the distinctiveness of pediatric COVID-19 and the paucity of data? Forthcoming guidelines will hopefully answer these questions but may require ongoing modifications based on additional new data and the epidemiology of emerging strains.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mary E Brindle
- Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Surgery Strategic Clinical Network, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada
| | - Rachel G Khadaroo
- Surgery Strategic Clinical Network, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada.,Departments of Surgery and Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tara L Klassen
- Surgery Strategic Clinical Network, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Surgery, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jared M Huston
- Departments of Surgery and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Institute of Bioelectronic Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
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Narayan M, Leahy N, Alqunaibit D, An A, de Angelis P, Bronstein M, Eachempati S, Gibson C, Kelly A, Minneman JA, Shou J, Smith KE, Villegas C, Winchell RJ, Witenko C, Barie PS. Thrombotic Events and Anticoagulation-Related Bleeding Complications in Critically Ill Patients with Coronavirus Disease 2019. Surg Infect (Larchmt) 2022; 23:705-711. [PMID: 36083247 DOI: 10.1089/sur.2022.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Thrombosis (T) is common in coronavirus disease 2019 (COVID-19) patients, and d-dimer concentrations correlate with outcomes. Controversy exists with regards to anticoagulation (AC) for patients. We implemented a full-heparinization AC protocol from the onset of the pandemic and hypothesized that a safety signal would be undetectable. Patients and Methods: Prospective evaluation of 111 patients with COVID-19 critical illness hospitalized from March to June 2020. All patients received therapeutic heparinoid-based AC from admission. Incidences of T, bleeding (B), or both (BT) were noted. The primary outcome was mortality. Kruskal-Wallis test and logistic regression were performed. Results are expressed as n (%), median (interquartile range) and odds ratios with 95% confidence intervals. Alpha was set at 0.05. Results: Thirty-two patients (28%) had T, 23 (20%) had B, and 14 (12%) had BT; 42 (40%) patients were unaffected. Two logistic regression models (outcome = mortality) evaluated BT as T, or BT as B. For BT as T, neither T, B, nor male gender predicted mortality; similarly, for BT as B, neither T, B, nor male gender predicted mortality. Factors associated with higher odds of death included higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00-1.13; p = 0.0045), higher d-dimer concentration (OR, 1.00; 95% CI, 1.00-1.01; p = 0.043), and higher activated partial thromboplastin time (aPTT; OR, 1.09; 95% CI, 1.02-1.16; p = 0.010). Conclusions: Neither T nor B predicted mortality in this prospective cohort of anticoagulated patients with COVID-19 critical illness. These data support continued full-dose heparinoid prophylaxis.
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Affiliation(s)
- Mayur Narayan
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Nicole Leahy
- Trauma Program, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Dalia Alqunaibit
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paolo de Angelis
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Bronstein
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Soumitra Eachempati
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Cameron Gibson
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anton Kelly
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer A Minneman
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jian Shou
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kira E Smith
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Cassandra Villegas
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert J Winchell
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Corey Witenko
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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