Rehabil Nurs. 2024 Jul-Aug 01;49(4):E13-E14. doi: 10.1097/RNJ.0000000000000468.
NO ABSTRACT
PMID:38959366 | DOI:10.1097/RNJ.0000000000000468
Tag: pubmed
Rehabil Nurs. 2024 Jul-Aug 01;49(4):125-133. doi: 10.1097/RNJ.0000000000000466.
ABSTRACT
GENERAL PURPOSE: To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs).
TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.
PMID:38959364 | DOI:10.1097/RNJ.0000000000000466
Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23013.
ABSTRACT
BACKGROUND: The knowledge, attitudes, and behaviors of intensive care nurses concerning the prevention of pressure injury (PI) may be positively affected by education.
PURPOSE: To evaluate the effect of web-based training given to nurses on their knowledge of, attitudes about, and behaviors in the prevention of PI.
METHODS: This study was conducted between May 2019 and December 2019 with a pre-test and post-test design. The study sample consisted of 22 nurses and 80 patients. A link to the educational video prepared for the prevention of PIs was sent to the nurses’ mobile phones.
RESULTS: The training had a significant positive effect on nurses’ level of knowledge of and attitudes toward PI prevention (P < .001 and P = .042, respectively). In group 1, comprising 40 patients who received treatment before nurses’ training, 2.5% of patients had stage 1 PI on day 1 and 7.5% had stage 1 PI on day 7, and 2.5% had stage 4 PI on day 7. In group 2, comprising 40 patients who received treatment after nurses’ training, 2.5% of patients had stage 1 PI on day 1 and 2.5% had stage 1 PI on day 7.
CONCLUSION: Nurses’ knowledge of and attitudes and behaviors toward PI prevention were improved following the web-based training, and the stage and rate of PI were lower in patients who received care after nurses received the training.
PMID:38959350 | DOI:10.25270/wmp.23013
Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23077.
ABSTRACT
PURPOSE: This study aimed to assess nursing students’ knowledge levels and attitudes towards the etiology, risk factors, and preventive measures of incontinence-associated dermatitis (IAD) using an escape room game.
DESIGN: A mixed-method study.
SUBJECTS AND SETTING: The sample size of the study was 32 students.
METHODS: Quantitative data obtained with the Knowledge, Attitude and Practice of Nurses in Managing Incontinence-Associated Dermatitis Questionnaire (KAP-IAD-Q) and qualitative data obtained through FGDs following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist were analyzed using a thematic approach.
RESULTS: The average age of the participants was 22.63 ± 0.90, 87.5% of them were female (n=28), and 50% were third (n=16) and fourth-year students (n=16). KAP-IAD-Q total posttest score (88.06+7.00) was found to be high. Data obtained from the FGDs were categorized under 3 main themes: main focus areas during participation in the IAD-themed escape room game; advantages and disadvantages of teamwork in IAD management; and the game’s contribution to a better understanding and classification of IAD.
CONCLUSIONS: The use of the escape room game facilitated high, fast, and efficient learning of IAD knowledge and attitudes. It revealed challenges in collaborative decision-making, accurate diagnosis, distinguishing from other wounds, and attitude development in the management of IAD.
PMID:38959349 | DOI:10.25270/wmp.23077
Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.22090.
ABSTRACT
BACKGROUND: Extracorporeal shockwave therapy (ESWT) has been shown to reduce wound dimensions and healing time in chronic wounds and should be considered a valuable tool in the healing of chronic complex lower extremity wounds.
PURPOSE: The aim of this small case series was to evaluate the effect of ESWT on complex chronic wounds in patients with multiple comorbidities in a medically underserved outpatient wound care clinic setting.
METHODS: All patients had baseline wound measurements taken. Pictures of the wounds were also taken at the time of the initial visit. Patients selected for ESWT received weekly treatments for a maximum recorded duration of 12 weeks in the form of focused electro-hydraulic acoustic pulses. Wound beds were cleansed according to standard of care.
RESULTS: Thirteen patients were followed with a total of 18 wounds treated. After retrospectively analyzing the data, 3 subjects and a total of 5 wounds were excluded, leaving 10 total subjects and 13 wounds. Out of these wounds, 12 healed completely by or before week 12 of ESWT. All wounds demonstrated significant wound dimension reduction during the first 12 weeks of treatment.
CONCLUSION: ESWT could offer accessible, fast, safe, and cost-effective management of some complex chronic wounds. Further research is needed to validate these findings.
PMID:38959347 | DOI:10.25270/wmp.22090
Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23028.
ABSTRACT
BACKGROUND: The management of chronic wounds presents a challenge for surgeons. In this pilot study, the authors established a novel auto-grafting approach for chronic wounds and evaluated its efficacy.
PURPOSE: The objective of this pilot study was to observe the clinical efficacy of granulation-embedded skin grafting for the treatment of chronic wounds at high altitudes.
METHODS: The data of 45 patients with chronic wounds were obtained from the medical records of the Yushu People’s Hospital. Patients were divided into stamp skin-grafting and granulation-embedded skin-grafting groups. Skin graft survival rate, wound coverage rate, and wound-healing time were observed and recorded. The length of hospital stay and 1% total body surface area (TBSA) treatment cost were compared.
RESULTS: Significant differences were noted in skin graft survival rate (94% ± 3% vs 86% ± 3%, P < .01), wound coverage rate on postoperative day 7 (61% ± 16% vs 54% ± 18%, P < .01), and wound-healing times (23 ± 2.52 days vs 31 ± 3.61 days, P < .05). The length of hospital stay and 1% TBSA treatment cost were significantly reduced in the granulation-embedded skin grafting group (P < .05).
CONCLUSIONS: Granulation-embedded skin grafting can improve the healing of chronic wounds at high altitudes. These findings provide a new approach to the clinical treatment of chronic wounds.
PMID:38959346 | DOI:10.25270/wmp.23028
Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.23037.
ABSTRACT
BACKGROUND: Operating room-acquired pressure injury (PI) is defined as PI that develops within the first 48 to 72 hours after surgery.
PURPOSE: To determine the incidence and risk factors of operating room-acquired PI.
METHODS: This descriptive cross-sectional study was conducted at a university hospital in Turkey between May 20, 2021, and December 20, 2021, and included 309 patients who met the inclusion criteria. The study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
RESULTS: Operating room-acquired PI developed in 5.8% of the patients in this study. Moreover, 54.4% of the patients had medical devices, and medical device-acquired PI occurred in 4.2% of these patients (7/168). Patient age, hemodynamic parameters, and albumin level, as well as duration of surgery, were found to affect the development of operating room-acquired PI.
CONCLUSION: Surgical nurses are responsible for both recognizing situations that may result in perioperative PI and taking necessary precautions. It is recommended that nurses identify existing and potential preoperative, intraoperative, and postoperative risks that impair skin integrity and affect tissue oxygenation to reduce the risk of operating room-acquired PI.
PMID:38959344 | DOI:10.25270/wmp.23037
Wound Manag Prev. 2024 Jun;70(2). doi: 10.25270/wmp.22081.
ABSTRACT
BACKGROUND: CSG dressing is water-soluble and helps to hydrate the wound, control exudate, and provide gentle debridement by virtue of a high concentration of surfactant micelles. The primary objective of this retrospective case series is to report on the feasibility of CSG use in pediatric wounds and its mechanism of action. The secondary aim was to measure pain during application and removal of CSG.
METHODS: Eight pediatric patients ranging in age from newborn to a few months old with wounds requiring medical intervention were treated with CSG. The CSG dressing was applied twice daily at initiation of treatment in some patients, but mostly once daily. NIPS was utilized for pain measurements.
RESULTS: Near-complete healing of wounds was observed by the end of treatment duration, which was only a few days. The calm temperament of these patients during dressing changes and objective NIPS suggested minimal to no pain. None of the patients experienced any adverse events related to the use of this dressing.
CONCLUSION: The CSG dressing could be the dressing of choice in this population to enhance debridement and maintain moist healing and support granulation, either proactively or if other treatments fail.
PMID:38959343 | DOI:10.25270/wmp.22081
Proc Natl Acad Sci U S A. 2024 Jul 9;121(28):e2306800121. doi: 10.1073/pnas.2306800121. Epub 2024 Jul 3.
ABSTRACT
Understanding the genesis of shared trial-to-trial variability in neuronal population activity within the sensory cortex is critical to uncovering the biological basis of information processing in the brain. Shared variability is often a reflection of the structure of cortical connectivity since it likely arises, in part, from local circuit inputs. A series of experiments from segregated networks of (excitatory) pyramidal neurons in the mouse primary visual cortex challenge this view. Specifically, the across-network correlations were found to be larger than predicted given the known weak cross-network connectivity. We aim to uncover the circuit mechanisms responsible for these enhanced correlations through biologically motivated cortical circuit models. Our central finding is that coupling each excitatory subpopulation with a specific inhibitory subpopulation provides the most robust network-intrinsic solution in shaping these enhanced correlations. This result argues for the existence of excitatory-inhibitory functional assemblies in early sensory areas which mirror not just response properties but also connectivity between pyramidal cells. Furthermore, our findings provide theoretical support for recent experimental observations showing that cortical inhibition forms structural and functional subnetworks with excitatory cells, in contrast to the classical view that inhibition is a nonspecific blanket suppression of local excitation.
PMID:38959037 | DOI:10.1073/pnas.2306800121
JAMA Surg. 2024 Jul 3. doi: 10.1001/jamasurg.2024.2162. Online ahead of print.
ABSTRACT
IMPORTANCE: Roux-en-Y gastric bypass (RYGB) is associated with reduced cardiovascular (CV) risk factors, morbidity, and mortality. Whether these effects are specifically induced by the surgical procedure or the weight loss is unclear.
OBJECTIVE: To compare 6-week changes in CV risk factors in patients with obesity undergoing matching caloric restriction and weight loss by RYGB or a very low-energy diet (VLED).
DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized controlled study (Impact of Body Weight, Low Calorie Diet, and Gastric Bypass on Drug Bioavailability, Cardiovascular Risk Factors, and Metabolic Biomarkers [COCKTAIL]) was conducted at a tertiary care obesity center in Norway. Participants were individuals with severe obesity preparing for RYGB or a VLED. Recruitment began February 26, 2015; the first patient visit was on March 18, 2015, and the last patient visit (9-week follow-up) was on August 9, 2017. Data were analyzed from April 30, 2021, through June 29, 2023.
INTERVENTIONS: VLED alone for 6 weeks or VLED for 6 weeks after RYGB; both interventions were preceded by 3-week LED.
MAIN OUTCOMES AND MEASURES: Between-group comparisons of 6-week changes in CV risk factors.
RESULTS: Among 78 patients included in the analyses, the mean (SD) age was 47.5 (9.7) years; 51 (65%) were women, and 27 (35%) were men. Except for a slightly higher mean (SD) body mass index of 44.5 (6.2) in the RYGB group (n = 41) vs 41.9 (5.4) in the VLED group (n = 37), baseline demographic and clinical characteristics were similar between groups. Major atherogenic blood lipids (low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, lipoprotein[a]) were reduced after RYGB in comparison with VLED despite a similar fat mass loss. Mean between-group differences were -17.7 mg/dL (95% CI, -27.9 to -7.5), -17.4 mg/dL (95% CI, -29.8 to -5.0) mg/dL, -9.94 mg/dL (95% CI, -15.75 to -4.14), and geometric mean ratio was 0.55 U/L (95% CI, 0.42 to 0.72), respectively. Changes in glycemic control and blood pressure were similar between groups.
CONCLUSIONS AND RELEVANCE: This study found that clinically meaningful reductions in major atherogenic blood lipids were demonstrated after RYGB, indicating that RYGB may reduce CV risk independent of weight loss.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02386917.
PMID:38959017 | DOI:10.1001/jamasurg.2024.2162