Evaluating the effectiveness of echocardiographic guidance in diminishing postoperative wound complications for left atrial appendage closure: A clinical retrospective study

Echocardiographic guidance in left atrial appendage (LAA) closure procedures is increasingly recognized for its potential to enhance patient outcomes in atrial fibrillation (AF). This retrospective study assesses its impact on hospital stay duration, readmission rates and surgical site wound complications in 200 AF patients. Divided equally into an echocardiographically guided group (Group E) and a non-guided group (Group N), the analysis focused on detailed patient data encompassing hospital stay, 30-day readmission and wound complications. Findings revealed that Group E experienced a significantly shorter average hospital stay of 3.5 days, compared with 6.5 days in Group N, along with a lower 30-day readmission rate (5% vs. 18% in Group N). Furthermore, Group E showed a considerable reduction in surgical site wound complications, such as infections and hematomas. The study concludes that echocardiographic guidance in LAA closure procedures markedly improves postoperative wound outcomes, underscoring its potential as a standard practice in cardiac surgeries for AF patients. This approach not only optimizes patient safety and postoperative recovery but also enhances healthcare resource utilization.

Acute care nurses' experience in providing evidence-based care for patients with laparotomy wounds: A scoping review

To systematically search and synthesise available literature on barriers and enablers to evidence-based care for patients with laparotomy wounds reported by acute care nurses. Specifically, we focused on wound assessment, infection control techniques, wound products used, escalation of care, dressing application, documentation and holistic care. The Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews Checklist and explanation documents directed the review. The methodology framework created by Arksey and O'Malley, updated by Levac et al., and the Joanna Briggs Institute were utilised to assist the scoping review process. Data synthesis was guided by the Theoretical Domains Framework. Six qualitative and mixed methods studies were selected for the review. Most reported barriers and enablers were mapped to knowledge, skills, beliefs about consequences, environmental context and resources and beliefs about capability domains. The main barriers were limited access to and utilisation of wound assessment tools and clinical practice guidelines for wound management and suboptimal time management skills. Inconsistent management of laparotomy wounds was related to ward culture and nurses' lack of knowledge and skills in surgical wound assessment and aseptic technique during wound encounters. The reported enablers were knowledge of multi-factorial risk factors for surgical wound recovery, valuing education and reflective practice and believing that protocols should be utilised alongside comprehensive wound assessments. Holistic wound care included patient education on the role of mobilisation and nutrition in wound healing. Acute care nurses do not routinely incorporate comprehensive, evidence-based care recommendations for laparotomy wound management. Further research on evidence-based care behaviours in managing laparotomy wounds is required. The results indicate a need for standardising the practice of laparotomy wound management while acknowledging the current challenges faced in the ward environment.

Effect of wound drainage on the wound infection and healing in patients undergoing spinal surgery: A meta-analysis

A meta-analysis was conducted to comprehensively evaluate the impact of wound drainage on postoperative wound infection and healing in patients undergoing spinal surgery. Computer searches were performed, from database inception to October 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for studies related to the application of wound drainage in spinal surgery. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 11 articles involving 2102 spinal surgery patients were included. The analysis showed that, compared to other treatment methods, the use of wound drainage in spinal surgery patients significantly shortened the wound healing time (standardized mean difference [SMD]: -1.35, 95% confidence intervals [CI]: -1.91 to -0.79, p < 0.001). However, there was no statistical difference in the incidence of wound infection (odds ratio: 1.35, 95% CI: 0.83-2.19, p = 0.226). This study indicates that wound drainage in patients undergoing spinal surgery is effective, can accelerate wound healing and is worth promoting in clinical practice.

[Deep Learning-Based Identification of Common Complication Features of Surgical Incisions]

Objective

In recent years, due to the development of accelerated recovery after surgery and day surgery in the field of surgery, the average length-of-stay of patients has been shortened and patients stay at home for post-surgical recovery and healing of the surgical incisions. In order to identify, in a timely manner, the problems that may appear at the incision site and help patients prevent or reduce the anxiety they may experience after discharge, we used deep learning method in this study to classify the features of common complications of surgical incisions, hoping to realize patient-directed early identification of complications common to surgical incisions.

Methods

A total of 1 224 postoperative photographs of patients' surgical incisions were taken and collected at a tertiary-care hospital between June 2021 and March 2022. The photographs were collated and categorized according to different features of complications of the surgical incisions. Then, the photographs were divided into training, validation, and test sets at the ratio of 8∶1∶1 and 4 types of convolutional neural networks were applied in the training and testing of the models.

Results

Through the training of multiple convolutional neural networks and the testing of the model performance on the basis of a test set of 300 surgical incision images, the average accuracy of the four ResNet classification network models, SE-ResNet101, ResNet50, ResNet101, and SE-ResNet50, for surgical incision classification was 0.941, 0.903, 0.896, and 0.918, respectively, the precision was 0.939, 0.898, 0.868, and 0.903, respectively, and the recall rate was 0.930, 0.880, 0.850, and 0.894, respectively, with the SE-Resnet101 network model showing the highest average accuracy of 0.941 for incision feature classification.

Conclusion

Through the combined use of deep learning technology and images of surgical incisions, problematic features of surgical incisions can be effectively identified by examining surgical incision images. It is expected that patients will eventually be able to perform self-examination of surgical incisions on smart terminals.

Wound pH and temperature as predictors of healing: an observational study

OBJECTIVE

The aim of this study was to measure wound pH, wound temperature and wound size together to gain further understanding of their impact as predictors of wound healing outcomes.

METHOD

This study employed a quantitative non-comparative, prospective, descriptive observational design. Participants with both acute and hard-to-heal (chronic) wounds were observed weekly for four weeks. Wound pH was measured using pH indicator strips, wound temperature was measured using an infrared camera and wound size was measured using the ruler method.

RESULTS

Most of the 97 participants (65%, n=63) were male; participant's ages ranged between 18 and 77 years (mean: 42±17.10. Most of the wounds observed were surgical 60%, (n=58) and 72% (n=70) of the wounds were classified as acute, with 28% (n=27) classified as hard-to-heal wounds. At baseline, there was no significant difference in pH between acute and hard-to-heal wounds; overall the mean pH was 8.34±0.32, mean temperature was 32.86±1.78°C) and mean wound area was 910.50±1132.30mm2. In week 4, mean pH was 7.71±1.11, mean temperature was 31.90±1.76°C and mean wound area was 339.90±511.70mm2. Over the study follow-up period, wound pH ranged from 5-9, from week 1 to week 4, mean pH reduced by 0.63 units from 8.34 to 7.71. Furthermore, there was a mean 3% reduction in wound temperature and a mean 62% reduction in wound size.

CONCLUSION

The study demonstrated that a reduction in pH and temperature was associated with increased wound healing as evidenced by a corresponding reduction in wound size. Thus, measuring pH and temperature in clinical practice may provide clinically meaningful data pertaining to wound status.

The effect of inflammation management on pH, temperature, and bacterial burden

The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n = 19) were male, and most wounds were acute (70%; n = 19) and included surgical and trauma wounds, the remaining (30%; n = 8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.

Multicentre Cross-Sectional Study Describing Postoperative Wound Care Practice in Northeast Ethiopia

Background

Postoperative care is the management of a patient after surgery that includes care given during the immediate postoperative period. Postoperative complications are continuing to be a major source of morbidity following operative procedures. Postoperative wound infection delays the patient's recovery, increases discomfort, and prolongs the hospital stay.

Objective

The study aimed to assess among nurses working in governmental hospitals in the south Wollo zone and Oromia special zone, northeast Ethiopia, 2020.

Methods

Institution-based cross-sectional study design was conducted on governmental hospitals in the south Wollo zone and Oromia special zone. Variables in multivariable logistic regression, p-value < 0.05 was used to declare statistical significance.

Result

From a total of 411 samples, 402 nurses responded to the questionnaire, with a response rate of 97.81%. This study showed that 49.8% of participants had good practice. The availability of a wound management tool was 1.6 times more likely to promote good practice than the lack of a wound assessment tool. Nurses who had documented their wound assessment and management activities were 2.1 times more likely to have good practice than those who hadn't documented.

Conclusion

This study showed that half of the participants had poor wound care practices. Regarding associated factors, the availability of wound management tools and documentation of wound assessment and management had a significant association with the nurse's poor wound care practice. On the basis of these results, health policymakers and hospital administrators should develop a program to train nurses in wound care practice, and it helps as a reference for the researchers to further study.

The state of wound assessment tools in Singapore: an evaluation study

OBJECTIVE

Variations in wound assessment and documentation remain an issue for clinicians despite efforts to standardise practices using national guidelines such as the Wound Care Assessment Minimum Data Set (WCA-MDS). As little is known about the quality of the wound assessment tools (WATs) used in Singapore, this study aimed to determine whether the existing WATs used meet the WCA-MDS criteria and clinicians' needs.

METHOD

The study adopted an action evaluation methodology to evaluate seven well-established WATs, such as the Applied Wound Management (AWM) and National Wound Assessment Form (NWAF), and eight locally-designed WATs against the 34-item WCA-MDS criteria. Two clinicians reviewed the WATs using a self-developed audit form between June and July 2020.

RESULTS

The results show that only five WATs met at least 50% of the 34 criteria indicators, with the MEASURE assessment framework achieving the most at 68%, followed by TIME-CDST at 65%, Hospital C WAT at 56%, NWAF at 53%, and AWM form at 50%. The five most common criteria indicators included wound type/classification, date and time of wound, wound size, wound bed tissue type, and exudate information. Most criteria indicators under the 'patient information' and 'specialist's referral' subdomains were omitted, reflecting the lack of focus on these areas in the local WATs.

CONCLUSION

Despite advances in WAT development in the literature, the current state of wound assessment and documentation across healthcare institutions remains inconsistent. There is a need to focus on clinician training and establishing a nationally-validated WAT in Singapore.

Reshaping wound care: Evaluation of an artificial intelligence app to improve wound assessment and management amid the COVID-19 pandemic

Wound documentation is integral to effective wound care, health data coding and facilitating continuity of care. This study evaluated the usability and effectiveness of an artificial intelligence application for wound assessment and management from a clinician‐and‐patient user perspective. A quasi‐experimental design was conducted in four settings in an Australian health service. Data were collected from patients in the standard group (n = 166, 243 wounds) and intervention group (n = 124, 184 wounds), at baseline and post‐intervention. Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively, and bivariate statistics were used to determine between‐group differences. Thematic analysis of interviews was conducted. Compared with the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% vs 70%, P < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99%). Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. The use of the application facilitated remote patient monitoring and reduced patient travel time while maintaining optimal wound care.

Efficacy comparison of chlorhexidine and iodine preparation in reduction of surgical site infection: A systemic review and meta-analysis

BACKGROUND

Chlorhexidine and povidone-iodine are the most common disinfectants used in preoperative skin preparation. However, there is no consistent conclusion regarding the prevention of surgical site infection (SSI) and bacterial culture data.

OBJECTIVE

To assess the efficacy of chlorhexidine and povidone-iodine in the prevention of postoperative SSI and relevant bacterial data.

DESIGN

Systematic Review and Meta-Analysis SETTINGS: N/A PARTICIPANTS: N/A METHOD: Literature relevant to "skin antisepsis" and "surgical site infections" was retrieved from PUBMED, Web of Science, EMBASE, CINHAL and CNKI. The incidence of SSI was the primary outcome, while the secondary outcome was bacterial data from the infected incision. All data were analyzed with Revman 5.3 and Stata Statistical Software.

RESULTS

A total of 36 studies were identified in this study, which included 16,872 participants. This study revealed that chlorhexidine is superior to povidone-iodine in the prevention of postoperative SSI (risk ratio [RR], 0.73; 95% confidence interval [CI], 0.61-0.87; p = 0.019, I² = 39%). Further meta-regression analysis revealed that the effect of chlorhexidine was directly associated with the type of incision, but failed to differentiate between the subgroups divided according to the type of incision. With respect to bacteria colonization, the most common bacteria for chlorhexidine arm were propionibacterium's, while the most common bacteria for the iodine arm were staphylococci species.

CONCLUSION

In comparison to povidone-iodine, chlorhexidine showed better results in preventing postoperative SSI.

Computer Vision Challenges for Chronic Wounds Assessment

Chronic wound assessment and wound healing are important for diagnostic, follow up and wound treatment. However, this growing disease affecting nearly 2 thousand million and 5.7 million people in the USA and Europe, costing around $20 billion and $8 thousand million USD per year, still relies on subjective human assessment of wounds. A scoping review allowed us to identify 109 articles that map the literature on the topic of computer vision for chronic wound assessment and healing. These results were carefully analyzed and mapped into relevant clinical challenges associated with this field, identifying the maturity of each different computer vision challenge that needs addressing. Results show that wound size and tissue type classification already have interesting work, but various other clinical areas are in need of larger datasets and computer vision research efforts for achieving a relevant impact in today's clinical routine.

Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice

BACKGROUND

Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal.

AIMS

The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections.

METHODS

This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data.

RESULTS

The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation.

LINKING EVIDENCE TO ACTION

The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.

Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis

OBJECTIVE

To identify the key components of a surgical wound assessment tool that nurses in Vietnam could use when conducting a surgical wound assessment. The study also explored Vietnamese nurses' perceptions of current practices in surgical wound assessment and assessed their requirements for a surgical wound assessment tool.

METHOD

Registered nurses from surgical wards in a Vietnamese hospital were invited to participate in this descriptive, qualitative study. A combination of the think-aloud technique and semi-structured interviews was undertaken. Transcribed responses were analysed using inductive content analysis to indicate how Vietnamese nurses undertook wound assessment and the data they collected.

RESULTS

A total of 13 nurses took part. Data from both the think-aloud process and interviews indicated that nurses evaluated surgical wounds based on their experience and observation without using standard guidelines. Some components, such as wound edge, periwound skin, exudate volume and signs of infection, were identified by the nurses. Other wound characteristics, such as wound site, wound bed, exudate and pain, and risk factors were less frequently collected. Nurses expressed their need for a tool with comprehensive content, precise terms, user-friendly language and a scoring system to facilitate their wound assessment.

CONCLUSION

Hospitals in Vietnam need a standard tool to help nurses improve surgical wound assessment in daily nursing practice, and to enhance multidisciplinary communication and patient care.

Contradictions in information technology mediated work in long-term care: An activity theoretic ethnographic study

BACKGROUND

The growing demand for aged care services coupled with a global shortage of skilled nursing staff has hindered long-term care facilities' ability to provide necessary services to their residents. Healthcare information technology is expected to mitigate this challenge by streamlining nursing work, while also improving quality of care and productivity.

OBJECTIVES

This study set out to examine how nurses and care workers work, the role of information technology (IT) in their work and what contradictions they face in their IT mediated work.

DESIGN

Ethnographic study informed by six components of activity theory: subject, object, tool, rule, community and division of labor.

SETTING

Eight care units in two long-term care facilities in Australia.

PARTICIPANTS

Eleven staff from two long-term care facilities including registered nurses (n = 2), endorsed enrolled nurses (n = 5) and personal care workers (n = 4) participated in this study.

METHODS

Participants were shadowed during morning shifts (6:30 am to 3:00 pm). A total of 24 morning shifts were observed over four months. Field notes were created based on observational data and informal interviews, in addition to document review.

RESULTS

Through the lens of activity theory, the work activity system of nurses and care workers in the long-term care facilities consisted of the subject (nurses and care workers), their object (resident care), tools used for work including IT, rules of work, community, and division of labor. These components interacted through work processes; therefore, a "process" component was added in the activity system. Special attention was given to the role of IT as the conduit of information in the work processes. Although IT helped track medication rounds, automated documentation and communication among the staff, it introduced contradictions. Seven contradictions involving IT were identified, including contradictions within the IT tool, between the IT tool and the object of work, between the subjects and documentation rules, between the work activity system using paper records and the system using IT, and between the activity system within the long-term care facility and the pharmacists' work activity system outside the facility.

CONCLUSIONS

Activity theory provided a theoretic framework to model the work activity system of nurses and care workers. Information technology played an important role in supporting information flow in this system, however it also caused contradictions.

Assessing knowledge of wound care among cardiothoracic nurses

AIMS

to explore cardiothoracic nurses' knowledge and self-reported competence of wound care following cardiac surgery and to ascertain if there were any differences in knowledge between nurses working in public and private hospitals.

BACKGROUND

cardiothoracic nurses are the main providers of wound care for patients post cardiac surgery, however, there is a lack of research about their knowledge of wound care.

DESIGN

a descriptive, quantitative design was used in the form of a cross-sectional, self-reported questionnaire.

METHOD

the questionnaire was developed to ascertain nurses' knowledge of cardiac wound management. Census sampling was used and the questionnaire was distributed to 503 nurses in 6 hospitals in the Republic of Ireland. Total knowledge scores were calculated and data analysed using descriptive and inferential statistics.

RESULTS

the response rate was 31.2% (n=158). The main knowledge deficits identified were wound healing, the signs and symptoms of surgical site infection and cardiac-specific wound care. Some nurses reported using inappropriate products for cleansing wounds and variable time for initial postoperative dressing removal.

CONCLUSION

the combination of low total knowledge scores and requests for further training and education suggest the need for ongoing wound care education. Audit of the use of wound cleansing products, support bras and wound assessment charts is recommended.