{"title":"Patient With Sitosterolemia With Slow Healing Sternal Wound From Coronary Artery Bypass Surgery.","authors":"Catherine R Ratliff","doi":"10.1097/WON.0000000000001069","DOIUrl":"10.1097/WON.0000000000001069","url":null,"abstract":"<p><strong>Background: </strong>Sitosterolemia, also known as phytosterolemia, is a rare recessive genetic disorder characterized by accumulation of sitosterol from vegetable oils, nuts, and other plant-based foods in the body. In those with sitosterolemia, there is an increase of fatty deposits in the arteries (atherosclerosis), which may occur in early childhood, impeding blood flow and increasing the risk of a heart attack, stroke, or sudden death at a very early age. Visual signs of sitosterolemia may include small yellowish xanthomas beginning in early childhood. Xanthomas are accumulated lipids that develop in the heels, elbows, and buttocks.</p><p><strong>Case: </strong>A clinical case study of a patient with sitosterolemia with slow healing surgical wound from coronary artery bypass surgery is described. Treatment of sitosterolemia is aimed at lowering plasma plant sterol levels with dietary restriction intake of both animal- and plant-based sterols. However, plant-based products (collagen, chitosan, etc) are also used for wound dressings, so alternative wound dressings were selected to decrease the possibility of systemic absorption.</p><p><strong>Conclusion: </strong>This case study describes a young adult male with sitosterolemia who presented with a slow healing surgical incision following coronary artery bypass surgery. Sitosterolemia is often characterized by atherosclerosis of the coronary arteries that occurs in children and early adulthood, especially affecting men. Treatment is aimed at lowering plasma sterol levels with the restriction of animal and plant sterols. There is considerable interest today in natural versus synthetic wound care products. Dressings containing chitosan, cellulose, collagen, etc, to be avoided to decrease the chance of systemic absorption.</p>","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 2","pages":"152-155"},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evidence-Based Practice: What It Is and What It Is Not: A View From Here.","authors":"Pamela B DeGuzman","doi":"10.1097/WON.0000000000001065","DOIUrl":"10.1097/WON.0000000000001065","url":null,"abstract":"","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 2","pages":"96-98"},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ping Hou, Lu Chen, En Takashi, Akio Kamijo, Huiwen Xu, Daiji Miura, Hirotomo Ten, Akio Kitayama, Jianglin Fan
{"title":"Fluctuations in Detection Indicators and Their Significance for the Diagnosis of Early Pressure Injury in Rat Models.","authors":"Ping Hou, Lu Chen, En Takashi, Akio Kamijo, Huiwen Xu, Daiji Miura, Hirotomo Ten, Akio Kitayama, Jianglin Fan","doi":"10.1097/WON.0000000000001043","DOIUrl":"10.1097/WON.0000000000001043","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to identify the most meaningful diagnostic indicator for distinguishing blanchable erythema (BE) and stage 1 pressure injury (early PI) in an in vivo (rat) model.</p><p><strong>Design: </strong>A prospective case-control design was used to complete a horizontal and vertical comparison of detection indicators during the process of fading of BE or the deterioration of early PI into ulcer in rat models.</p><p><strong>Materials and setting: </strong>The sample comprised 5 hairless rats with 20 injuries, of which 10 were BE and the other 10 were early PI. Data were collected at Nagano College of Nursing in 2020 in Nagano, Japan.</p><p><strong>Methods: </strong>The BE and PI rat models were established by subjecting the dorsal skin of a hairless rat to compression between 2 neodymium magnets for 45 minutes and 3.45 hours, respectively. The affected skin was observed based on the following: (1) photography, (2) hardness, (3) temperature, (4) moisture, and (5) spectrophotometric (a* value and ultraviolet [UV] reflectance) measurements. All measurements of BE were performed at the beginning to 60 minutes after decompression, and those for early PI were performed until 48 hours after decompression.</p><p><strong>Results: </strong>Multiple BE factors, such as the degree of erythema (macroscopy and a* value), hardness, temperature, and moisture, were found to have unstable fluctuations. Only UV reflectance gradually decreased from 6 hours and decreased significantly at 48 hours after decompression (P = .001 vs 1 hour). In contrast to early PI, erythema in BE obviously faded within 10 minutes.</p><p><strong>Conclusions: </strong>Study findings indicate that a continuous decrease in UV reflectance can reflect the worsening of hemorrhage in early (stage 1) PI. In contrast, other indicators including photography, skin hardness, temperature, and moisture fluctuated and did not prove predictive for PI progression. The obvious fading of erythema in BE a short time after decompression can be used for clinical observations.</p>","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"32-38"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to Letter to the Editor: \"The Shieh Score as a Risk Assessment Instrument for Reducing Hospital-Acquired Pressure Injuries\".","authors":"David Shieh","doi":"10.1097/WON.0000000000001052","DOIUrl":"10.1097/WON.0000000000001052","url":null,"abstract":"","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"16"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review.","authors":"Deni Yasmara, Sin-Hang Tam, Su-Ying Fang","doi":"10.1097/WON.0000000000001046","DOIUrl":"10.1097/WON.0000000000001046","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this scoping literature review was to identify current knowledge related to management of malignant fungating wounds (MFWs), gaps in this knowledge, and areas for future research.</p><p><strong>Methods: </strong>This was a scoping literature review.</p><p><strong>Search strategy: </strong>Six electronic databases (Embase, MEDLINE, Cochrane (CENTRAL), CINAHL, Scopus, and Web of Science) were searched spanning the years 1987 and 2022. The initial electronic database search retrieved 6041 studies. The search is based on 60 articles published between 1987 and 2022, along with 14 additional studies were based on search of reference lists of key articles.</p><p><strong>Findings: </strong>Studies were divided into 2 main domains; the vast majority (65 of 72, 87.8%) focused on symptom impact, measurement, and management. The remaining articles (n = 9, 12.2%) focused on caring for patients with MFW; these studies focused on nursing care experiences and competencies, along with lay caregiver experiences. Findings indicated that instruments have been developed to evaluate symptoms of MFW but only a few have been validated. Most of the studies reviewed evaluated the influence of MFW on physical and psychosocial function. Local and systematic symptom managements such as modern dressings, wound care strategies, surgery, and radiotherapy as well as chemotherapy were found to be effective in alleviating symptoms. Findings also indicated that families and nurses encounter obstacles and burdens when caring for patients with MFW; limited studies were retrieved that investigated the competence and needs of nurses in their caring journey.</p><p><strong>Implications: </strong>Future studies should focus on: (1) using better designs to evaluate and compare topical agents and dressings to control odor, (2) validating assessment tools specific to MFW, (3) qualitative studies designed to enhance understanding family and nurses' experiences, and (4) improving the nurse's ability to care for patients with MFWs and their responses to managing these challenging patients.</p>","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"19-25"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monica Waidley, Nikki Taylor, Leah L Shever-Doletzky
{"title":"Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting.","authors":"Monica Waidley, Nikki Taylor, Leah L Shever-Doletzky","doi":"10.1097/WON.0000000000001048","DOIUrl":"10.1097/WON.0000000000001048","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting.</p><p><strong>Participants and setting: </strong>This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.</p><p><strong>Approach: </strong>The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.</p><p><strong>Outcomes: </strong>Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.</p><p><strong>Implications for practice: </strong>The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.</p>","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"26-31"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of a Peristomal Abscess in a Patient With an Ileostomy: A Case Study.","authors":"Huiyan Wei, Jin Qiu, Aini Li, Hongyang Hu","doi":"10.1097/WON.0000000000001047","DOIUrl":"10.1097/WON.0000000000001047","url":null,"abstract":"<p><strong>Background: </strong>Peristomal abscess (PA) is an uncommon but challenging peristomal skin complication. The initial treatment of the PA usually includes incision and drainage of the abscess, resulting in a peristomal wound. The presence of the wound makes it difficult to maintain a seal between the ostomy skin barrier and the peristomal skin resulting in frequent removal and application of the skin barrier to prevent leakage and allow for daily wound care.</p><p><strong>Case: </strong>Ms T was a 52-year-old woman with an ileostomy resulting from a prior left hemicolectomy for colon cancer who developed a PA. Treatment of the PA was implemented, along with a modified 2-piece skin barrier that allowed access to the peristomal wound for daily dressing changes while maintaining a seal around the ostomy.</p><p><strong>Conclusion: </strong>The modified 2-piece skin barrier technique proved a successful treatment for the management of the PA without frequent changes of the ostomy pouching system.</p>","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"74-77"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Time to Rejuvenate: The New Norm.","authors":"Vittoria Vicky Pontieri-Lewis","doi":"10.1097/WON.0000000000001049","DOIUrl":"10.1097/WON.0000000000001049","url":null,"abstract":"","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"13-14"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review.","authors":"","doi":"10.1097/WON.0000000000001055","DOIUrl":"10.1097/WON.0000000000001055","url":null,"abstract":"","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"E1"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Back to the Future in Wound Care: A View From Here.","authors":"Lia van Rijswijk","doi":"10.1097/WON.0000000000001050","DOIUrl":"10.1097/WON.0000000000001050","url":null,"abstract":"","PeriodicalId":49950,"journal":{"name":"Journal of Wound Ostomy and Continence Nursing","volume":"51 1","pages":"17-18"},"PeriodicalIF":2.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139433082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}