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Evans CJF, Glastras SJ, Tang O, Figtree GA. Therapeutic Potential for Beta-3 Adrenoreceptor Agonists in Peripheral Arterial Disease and Diabetic Foot Ulcers. Biomedicines 2023; 11:3187. [PMID: 38137408 PMCID: PMC10740412 DOI: 10.3390/biomedicines11123187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Annually, peripheral arterial disease is estimated to cost over USD 21 billion and diabetic foot disease an estimated at USD 9-13 billion. Mirabegron is a TGA-approved beta-3 adrenoreceptor agonist, shown to be safe and effective in the treatment of overactive bladder syndrome by stimulating bladder smooth muscle relaxation. In this review, we discuss the potential use of beta-3 adrenoreceptor agonists as therapeutic agents repurposed for peripheral arterial disease and diabetic foot ulcers. The development of both conditions is underpinned by the upregulation of oxidative stress pathways and consequential inflammation and hypoxia. In oxidative stress, there is an imbalance of reactive oxygen species and nitric oxide. Endothelial nitric oxide synthase becomes uncoupled in disease states, producing superoxide and worsening oxidative stress. Agonist stimulation of the beta-3 adrenoreceptor recouples and activates endothelial nitric oxide synthase, increasing the production of nitric oxide. This reduces circulating reactive oxygen species, thus decreasing redox modification and dysregulation of cellular proteins, causing downstream smooth muscle relaxation, improved endothelial function and increased angiogenesis. These mechanisms lead to endothelial repair in peripheral arterial disease and an enhanced perfusion in hypoxic tissue, which will likely improve the healing of chronic ulcers.
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Affiliation(s)
- Cameron J. F. Evans
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Sarah J. Glastras
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW 2065, Australia
| | - Owen Tang
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Gemma A. Figtree
- Kolling Institute, University of Sydney, Sydney, NSW 2006, Australia; (S.J.G.); (O.T.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW 2065, Australia
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Fu H, She D, Zhang H, Guo J, Zhang G, Ma Y, Han L. Epidemiological characteristics of pressure injury and the predictive validity of Braden scale among the older hospitalized patients: A cross-sectional study. J Clin Nurs 2023; 32:7802-7811. [PMID: 37644731 DOI: 10.1111/jocn.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/28/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
AIMS AND OBJECTIVES To investigate the epidemiological characteristics of pressure injury (PI) in older inpatients and predictive validity of the Braden scale. DESIGN Cross-sectional study. METHODS Conducted in a 2600-bed tertiary hospital in Northwestern China from January to June 2022, the study included older patients (≥60 years). The Braden scale was used for the risk assessment of PI, and the epidemiological characteristics of PI were observed. The contributing factors of PI in older inpatients were examined using univariate and multiple or multivariable logistic regression analysis. The predictive validity and optimal cut-off value were assessed using receiver operating curve (ROC). RESULTS The study included 13,064 older patients, with a PI incidence of 0.20%, with the highest incidence (0.95%) in those aged ≥80. Age, BMI, Braden score and length of hospital stay were related to PI occurrence. The Braden scale showed an AUC of 0.905 for predicting PI in older inpatients, with a sensitivity of 84.6% and specificity of 86.4%. The optimal cut-off value of 19 yielded the best predictive performance with a Yoden index of 0.710. CONCLUSION PI is most likely to occur in older inpatients with older age, longer hospital stay, lower BMI and Braden score. The Braden scale demonstrated good suitability for predicting PI risk in this population, with an optimal cut-off value of 19 showing improved predictive accuracy. PATIENT OR PUBLIC CONTRIBUTION Throughout the investigation, patients or family members cooperated to complete all data investigation and evaluation, and nurses assisted in PI risk assessment, skin evaluation and other work.
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Affiliation(s)
- Hongqiong Fu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Dongli She
- Gansu Provincial Hospital, Lanzhou, China
| | | | - Jiali Guo
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Guoli Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University & Gansu Provincial Hospital, Lanzhou, China
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Gokce Isikli A, Kızılcık Özkan Z. Retrospective evaluation of the effectiveness of using two different products in preventing the development of pressure injuries in patients undergoing lung lobectomy. J Tissue Viability 2023; 32:163-167. [PMID: 36351868 DOI: 10.1016/j.jtv.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
AIM This retrospective study aims to determine the impacts of two different products (barrier cream, barrier spray) routinely used before surgery on the development of postoperative pressure injuries in patients undergoing lung lobectomy. MATERIALS AND METHODS In the study, the researchers retrospectively examined the data of 60 patients who underwent lobectomy in a university hospital's thoracic surgery clinic between 12.02.2021 and 14.02.2022. The patients were divided into two groups: those to whom a barrier cream was applied (30) and those to whom a barrier spray was applied. The Patient Description Form and the Braden Risk Assessment Tool were used in data collection. The Mann-Whitney U and Kruskal-Wallis tests were conducted for statistical analyses. RESULTS In the study, the development rates of blanchable erythema and stage I pressure injuries in the sacral and dorsal regions were significantly higher in patients to whom a barrier spray was applied than in patients to whom a barrier cream was applied (p < 0.05). Pain intensity in the sacral and dorsal regions was significantly lower in patients to whom a barrier cream was applied than those to whom a barrier spray was applied (p < 0.05). CONCLUSION Blanchable erythema and intraoperative pressure injury were observed less in patients in whom a barrier cream was used before surgery. Surgical nurses should first evaluate the risk in the preoperative period in the clinics and benefit from the use of barrier cream to prevent the development of blanchable erythema and intraoperative pressure injury.
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Affiliation(s)
- Ayse Gokce Isikli
- Thoracic Surgery, Health Research and Application Center, Trakya University, Edirne, Turkey.
| | - Zeynep Kızılcık Özkan
- Department of Surgical Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey.
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Mulligan KM, O'Connell KA, da Silva A, Szeto MD, Sivesind TE, Cowdell F, Dyson J, Dellavalle RP. From the Cochrane library: Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. J Am Acad Dermatol 2022; 87:1428-1431. [PMID: 35944812 DOI: 10.1016/j.jaad.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022]
Affiliation(s)
| | - Katie A O'Connell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra da Silva
- College of Medicine, California Northstate University, Elk Grove, California
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Edgbaston, Birmingham, United Kingdom
| | - Judith Dyson
- Faculty of Health Education and Life Sciences, Birmingham City University, Edgbaston, Birmingham, United Kingdom
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Kumar T, Tirkey A, Bhattacharya PK, Suwalka U, Lakra L. High flow nasal oxygen therapy for COVID 19: an unusual complication. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2022. [PMCID: PMC9066136 DOI: 10.1186/s42077-022-00242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Acute hypoxemic respiratory failure is the most common complication of COVID 19 infection. Newer ways for oxygen therapy were explored during this pandemic. High flow nasal oxygenation (HFNO) emerged as a novel technique for oxygenation and prevented the need for invasive mechanical ventilation during hypoxia among COVID patients. Using high flow oxygen dries the nasal mucosa and leads to skin disruption. We are presenting this case as this complication has not been reported anywhere to our knowledge.
Case presentation
Here we present a case of a 62-year-old male, who was on HFNO for a long time as a part of treatment for COVID 19 and developed ulceration in the nasal septa. Patient belonged to a geriatric age group and had diabetes mellitus. Close monitoring by ICU (intensive care unit) staff was a big problem during this pandemic. Daily physical assessment, good nutrition, and daily dressing with plastic surgery consultation helped treat our patient.
Conclusions
Geriatric patients with other co-morbidities are vulnerable to mucosal injury. Even in COVID era, everyday general physical surveillance is very vital in such patients to prevent these complications. During this pandemic close monitoring of patients suffered due to scarcity of ICU staff. In spite of that, it is a must to ensure daily physical surveillance and good supplemental nutrition especially in geriatric patients.
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Jiao Y, Yuan C, Wu T, Zhang H, Wei Y, Ma Y, Zhang X, Han L. Incidence of pressure injuries in fracture patients: A systematic review and meta-analysis. J Tissue Viability 2022; 31:726-734. [PMID: 36109261 DOI: 10.1016/j.jtv.2022.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/17/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically evaluate the incidence of pressure injuries (PIs) in hospitalized fracture patients and to provide evidence for the prevention and treatment of PIs. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were searched to collect cross-sectional studies and cohort studies related to PIs among hospitalized fracture patients. All electronic literature sources were searched from inception to March 2022, and a hand-search through references was also conducted to find relevant articles. Studies were evaluated independently by two researchers and audited by a third researcher. The data were extracted and presented in tables. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. All data analysis used Stata14.0. The I2 statistic and random-effects model were used to determine the heterogeneity. RESULTS A total of 7906 articles were screened, and 18 studies with 8956 patients were ultimately involved in this review. The pooled incidence of PIs in the fracture patients was 20.4% (95%CI: 14.9 to 25.8), and the incidence of PIs only in spinal and hip fracture patients was 23.9% (95%CI: 19.6 to 28.2). The incidence of PIs in 65 years old or over was significantly high (23.3% [95%CI: 15.3 to 31.2]). The most affected body sites were sacrococcygeal regions (56.7%) and heels (19.9%). The most common stages were stage 2 (62.2%) and stage 1 (17.4%). CONCLUSION The overall incidence of PIs in fracture patients was as high as 20.4%, significantly higher than the average incidence of adults. We found that the potential for PIs in fracture patients increases with age. Hence, our discoveries recommended that healthcare givers should consider reducing the occurrence of PIs. Additionally, more research may be conducted to improve the understanding of characteristics of PIs among fracture patients and to identify PIs risk factors to prevent and treat them effectively.
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Affiliation(s)
- Yanxia Jiao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Chenlu Yuan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Tong Wu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Yuting Wei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, 730000, #28 Yanxi Road, Chenguan District, China.
| | - Xiujuan Zhang
- Department of Respiratory, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
| | - Lin Han
- Department of Nursing, Gansu Provincial Hospital, Lanzhou City, Gansu Province, #204 Donggang Road, Chenguan District, 730000, China.
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Lee YN, Chang SO. How do wound care nurses structure the subjective frame on palliative wound care? A Q-methodology approach. BMC Nurs 2022; 21:119. [PMID: 35581636 PMCID: PMC9112521 DOI: 10.1186/s12912-022-00900-7] [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: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Palliative wound care is important for stability in terminal care. It addresses both the physical and psychological needs of patients and facilitates other aspects of terminal care. Appropriate competencies of nurses regarding palliative wound care can improve patient outcomes and raise their quality of life. The purpose of this study was to identify how wound care nurses structure the subjective frames regarding palliative wound care. Method This study utilized Q-methodology to analyze their subjective viewpoints. Forty nurses experienced in palliative wound care were asked to completely classify 35 Q-statements into a normal distribution shape. The PQ-Method program was used to conduct principal factor analysis and varimax rotation for data analysis. Results This study revealed 4 Q-factors of palliative wound care: “Focusing on care within the boundary of current patient demands,” “Comparing continuously the priorities on wound healing and disease care,” “Preparing and preventing from worsening via tracking care in advance,” and “Moving forward with a clear direction by confronting the declining condition.” Conclusion We hope that the results of this study are used in the development of nursing education that reflects professional perspectives of palliative wound care, thus helping to improve nursing competencies in palliative care.
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Affiliation(s)
- Ye-Na Lee
- Department of Nursing, The University of Suwon, Hwaseong, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, 145, Anam-ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
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Belfield-Cockings K. A new approach with a novel silicone adhesive stoma bag: a clinical study on peristomal skin and quality of life. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S40-S47. [PMID: 35333552 DOI: 10.12968/bjon.2022.31.6.s40] [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: 06/14/2023]
Abstract
The care of peristomal skin is a major challenge for people living with a stoma, as well as stoma care nurses. Peristomal skin complications include medical adhesive-related skin injuries/skin stripping, moisture-associated skin damage and contact dermatitis. There is also a limited choice of hydrocolloid adhesive stoma bags. This article reports on the introduction of Genii™, a new stoma bag that sticks with a unique breathable silicone adhesive. The study investigated the experiences of 61 colostomates over a 6-week period, examining the effect on their peristomal skin and their quality of life, in terms of sleep, self-image, social confidence and exercise, and overall product performance. The majority of study participants reported a positive experience when using the stoma bag.
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Affiliation(s)
- Karen Belfield-Cockings
- Colorectal and Stoma Clinical Nurse Specialist, Bedford Hospital, Bedfordshire Hospitals NHS Foundation Trust
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Soldera D, Soares CF, Girondi JBR, Salum NC, Stein M, Amante LN, Sebold LF, Miranda GM. PREVENÇÃO DE LESÕES POR PRESSÃO NA PRONAÇÃO DE PACIENTES COVID-19: CONSTRUÇÃO DE UMA NARRATIVA GRÁFICA. ESTIMA 2022. [DOI: 10.30886/estima.v19.1136_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:construir e validar o conteúdo de uma narrativa gráfica sobre a prevenção de Lesão por Pressão na posição prona em pacientes acometidos pelo Coronavírus. Método: estudo metodológico descritivo. Para a construção da narrativa gráfica, foi realizada a revisão de escopo. A validação de conteúdo da narrativa foi realizada por enfermeiros atuantes em unidades de terapia intensiva respiratória estomaterapeutas de Santa Catarina, os quais responderam a um formulário no Googleforms® com opções de resposta de discordo a concordo. A análise de dados foi realizada por meio do Índice de Validade de Conteúdo, considerando adequado > 0,80%. Resultados: os cuidados elencados para compor a narrativa foram: avaliação da pele; manutenção da pele limpa e hidratada; utilização de dispositivos de redistribuição de pressão; utilização de espumas de silicone, filmes transparentes, spray formador de barreira e silicone sobre as proeminências ósseas, sob dispositivos médicos e em face. A posição recomendada é a do nadador, reposicionando o paciente a cada duas horas. Conclusão: a narrativa gráfica foi validada para enfermeiros experts cujo destaque está para os cuidados preventivos no sentido de promover o engajamento da equipe de Enfermagem frente à importância da prevenção da Lesão por Pressão no cuidado ao paciente com Coronavírus e pronado.
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Soldera D, Soares CF, Girondi JBR, Salum NC, Stein M, Amante LN, Sebold LF, Miranda GM. PREVENTION OF PRESSURE INJURIES IN THE PRONATION OF COVID-19 PATIENTS: CONSTRUCTION OF A GRAPHIC NARRATIVE. ESTIMA 2022. [DOI: 10.30886/estima.v19.1136_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective:build and validate the content of a graphic narrative on the prevention of Pressure Injury in the prone position in patients affected by the Coronavirus. Method: descriptive methodological study. For the construction of the graphic narrative, a scope review was carried out. Narrative content validation was performed by nurses working in stomatherapists in respiratory intensive care units in Santa Catarina, who responded to a form on Googleforms® with response options from disagree to agree. Data analysis was performed using the Content Validity Index, considering appropriate > 0.80%. Results: the care listed to compose the narrative were: skin assessment; keeping the skin clean and hydrated; use of pressure redistribution devices; use of silicone foams, transparent films, barrier-forming spray and silicone on bony prominences, under medical devices and on the face. The recommended position is that of the swimmer, repositioning the patient every two hours. Conclusion: the graphic narrative was valid for expert nurses whose emphasis is on preventive care in order to promote the engagement of the Nursing team in the face of the importance of Pressure Injury prevention in the care of patients with Coronavirus and prone.
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Gefen A. The bioengineering theory of the key modes of action of a cyanoacrylate liquid skin protectant. Int Wound J 2020; 17:1396-1404. [PMID: 32488944 DOI: 10.1111/iwj.13401] [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] [Received: 03/22/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
The objective of this article is to formulate a new bioengineering theoretical framework for modelling the biomechanical efficacy of cyanoacrylate skin protectants, with specific focus on the Marathon technology (Medline Industries, Inc., Northfield, Illinois) and its modes of action. This work details the bioengineering and mathematical formulations of the theory, which is based on the classic engineering theories of flexural stiffness of coated elements and deformation friction. Based on the relevant skin anatomy and physiology, this paper demonstrates: (a) the contribution of the polymerised cyanoacrylate coating to flexural skin stiffness, which facilitates protection from non-axial (eg, compressive) localised mechanical forces; and (b) the contribution of the aforementioned coating to reduction in frictional forces and surface shear stresses applied by contacting objects such as medical devices. The present theoretical framework establishes that application of the cyanoacrylate coating provides considerable biomechanical protection to skin and subdermally, by shielding skin from both compressive and frictional (shearing) forces. Moreover, these analyses indicate that the prophylactic effects of the studied cyanoacrylate coating become particularly strong where the skin is thin or fragile (typically less than ~0.7 mm thick), which is characteristic to old age, post-neural injuries, neuromuscular diseases, and in disuse-induced tissue atrophy conditions.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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