Yi-Ting Tzen, Patricia T Champagne, Jijia Wang, Merrine Klakeel, Wei-Han Tan, Kath M Bogie, Timothy J Koh
{"title":"Markers for Pressure Injury Risk in Individuals with Chronic Spinal Cord Injury: A Pilot Study.","authors":"Yi-Ting Tzen, Patricia T Champagne, Jijia Wang, Merrine Klakeel, Wei-Han Tan, Kath M Bogie, Timothy J Koh","doi":"10.1097/ASW.0000000000000253","DOIUrl":"10.1097/ASW.0000000000000253","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objective: </strong>To identify markers associated with pressure injury (PrI) history in individuals with spinal cord injury (SCI) using two approaches: skin blood flow (SBF) response toward localized heating, and serum marker for insulin resistance.</p><p><strong>Methods: </strong>For this cross-sectional, observational study of adults with chronic traumatic SCI at T12 and above, researchers recruited two groups of participants: with history of PrI (group 1), and without history of PrI (group 2). The study protocol included obtaining fasting blood samples and measurement of SBF at bilateral heels with localized heating of 42 °C for 30 minutes from all participants. Primary SBF outcomes were initial peak and plateau SBF normalized to baseline SBF. The primary outcome for insulin resistance was Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), calculated from fasting plasma glucose and insulin. Secondary outcomes included demographic and SCI information. Researchers used the Fisher exact test and Wilcoxon-Mann-Whitney test to compare the intergroup difference of categorical and continuous variables, respectively.</p><p><strong>Results: </strong>Sixteen adults completed this study (group 1, n = 7; group 2, n = 9). In comparison with group 2, group 1 had significantly higher HOMA-IR (3.90 ± 0.71 vs 1.45 ± 0.71), suggesting higher insulin resistance, and longer duration of injury (22.54 ± 7.24 vs 7.98 ± 6.58 years). There were no between-group differences in SBF or other secondary outcomes.</p><p><strong>Conclusions: </strong>HOMA-IR is a novel serum index associated with PrI history in persons with chronic SCI. Future longitudinal study is warranted to examine the role of insulin resistance in increasing PrI risk for the SCI population.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":" ","pages":"E12-E17"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Impact of Cleaning and Disinfecting on Full-Body Support Surfaces.","authors":"Kristen Thurman, Jackie Todd, Shaun Ambrose-Jones","doi":"10.1097/ASW.0000000000000268","DOIUrl":"10.1097/ASW.0000000000000268","url":null,"abstract":"","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":" ","pages":"67-70"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Investigation of Unavoidable Pressure Injuries in the Actively Dying Stage.","authors":"Masaki Fujioka","doi":"10.1097/ASW.0000000000000274","DOIUrl":"10.1097/ASW.0000000000000274","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Background: </strong>Although most pressure injuries (PIs) are healable with appropriate assessment, preventive intervention, and treatment, nursing professionals recognize that some PIs are unavoidable. Research investigating unavoidable PIs is limited because there are few clear means of determining whether these injuries are unavoidable.</p><p><strong>Objective: </strong>To clarify the reality of unavoidable PIs by analyzing the state of PIs and blood test results in patients who were actively dying.</p><p><strong>Methods: </strong>From 2018 to 2023, 904 hospitalized patients at the author's medical center developed PIs. Of these patients, 710 survived and were discharged (survival group). Of the 194 patients who died after developing a PI, 111 died more than 8 days after onset (end-of-life group), and 83 patients died within 7 days of onset (actively dying group). The researcher analyzed patients' age, weight, and height, as well as various blood work parameters at the time of PI occurrence in the survival, end-of-life, and actively dying patient groups.</p><p><strong>Results: </strong>Approximately half of patients with PIs in the actively dying stage had cancer. Total protein, albumin, and blood urea nitrogen were significantly lower among the actively dying patients compared with those who survived. Aspartate transferase, alanine aminotransferase, white blood cell count, and C-reactive protein were all significantly higher among patients in the actively dying versus the surviving group.</p><p><strong>Conclusions: </strong>It is difficult to determine whether a PI is unavoidable. However, the author believes that clinical symptoms and blood test data can help make that decision.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":"38 2","pages":"86-89"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deborah M Wendland, Kathryn Panasci, Hope A Martinez, John S Mantanona, Melinda G Powers, Rachael L Sausman, Karen A Gibbs
{"title":"Beyond the Case Study: Laboratory Activities to Complement Integumentary Education.","authors":"Deborah M Wendland, Kathryn Panasci, Hope A Martinez, John S Mantanona, Melinda G Powers, Rachael L Sausman, Karen A Gibbs","doi":"10.1097/ASW.0000000000000255","DOIUrl":"https://doi.org/10.1097/ASW.0000000000000255","url":null,"abstract":"<p><strong>Objective: </strong>To present a full scope of detailed and engaging laboratory activities recommended by physical therapist clinicians and educators from across the US to assist health professions faculty to develop new or improve current integumentary/wound management (IWM) instruction.</p><p><strong>Methods: </strong>A three-round Delphi survey was conducted to update IWM curriculum recommendations for entry-level doctor of physical therapy education. First-round participants provided ideas for laboratory activities. Activity responses were discussed, edited for redundancy, and clarified. Missing information (eg, estimated cost and time required) was added to increase usability.</p><p><strong>Results: </strong>A total of 139 laboratory activities were recommended by survey participants. Many of the suggestions included inexpensive and readily available, do-it-yourself wound models requiring food or other moulage techniques. These simulations are elucidated to facilitate translation of ideas into classroom and community laboratory activities to promote student learning.</p><p><strong>Conclusions: </strong>The literature supports that most entry-level healthcare profession programs report limited IWM education, emphasizing the need for effective and efficient use of IWM contact hours. Developing engaging and meaningful hands-on laboratory activities is vital to increasing student knowledge and skill in this area of clinical practice.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chia-Jung Chan, Yeu-Hui Chuang, Tsai-Wei Huang, Made Satya Nugraha Gautama
{"title":"Use of Electronic Health Records to Identify Factors Related to Skin Changes in Terminal Patients.","authors":"Chia-Jung Chan, Yeu-Hui Chuang, Tsai-Wei Huang, Made Satya Nugraha Gautama","doi":"10.1097/ASW.0000000000000260","DOIUrl":"https://doi.org/10.1097/ASW.0000000000000260","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence of skin changes at life's end (SCALE) among hospice patients and identify associated factors.</p><p><strong>Methods: </strong>The authors conducted a retrospective chart review of demographic data, medical history, Braden Scale assessment scores, Charlson Comorbidity Index, symptom records, and medical treatments of patients admitted to a local teaching hospital's hospice unit between May 2019 and April 2021.</p><p><strong>Results: </strong>Most (79%) of the 300 hospice patients included in the study had cancer. Of the 181 patients who died, 49 (60.3%) had SCALE. Logistic regression analysis revealed that greater variations in Braden Scale scores from admission to predeath (odds ratio, 1.188; 95% CI, 1.014-1.392; P = .033), higher Eastern Cooperative Oncology Group grades (odds ratio, 1.965; 95% CI, 1.241-3.109; P = .004), and elevated Charlson Comorbidity Index scores (odds ratio, 1.514; 95% CI, 1.237-1.854; P < .001) significantly increased the likelihood of developing SCALE.</p><p><strong>Conclusions: </strong>The findings suggest that the occurrence of SCALE may serve as a valuable clinical indicator for healthcare professionals to recognize that a patient is approaching the end of life. Consequently, the care approach should prioritize pain relief and promote comfort rather than wound healing in this patient population. These results provide evidence to support the integration of SCALE-related training programs for hospice care, which can increase healthcare professionals' awareness and understanding of SCALE. Ultimately, the implementation of such training programs may lead to more appropriate care for hospice patients with SCALE, enhancing their quality of life at the end of life.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Connecting Wound Bed Preparation 2024, Therapeutic Index, and Covert and Overt Infection.","authors":"R Gary Sibbald, John H Gregory","doi":"10.1097/ASW.0000000000000267","DOIUrl":"https://doi.org/10.1097/ASW.0000000000000267","url":null,"abstract":"","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":"38 1","pages":"53-55"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keith Gordon Harding, Melissa Blow, Faye Ashton, David C Bosanquet
{"title":"Neuromuscular Electrostimulation Increases Microcirculatory Flux in Mixed Etiology Leg Ulcers.","authors":"Keith Gordon Harding, Melissa Blow, Faye Ashton, David C Bosanquet","doi":"10.1097/ASW.0000000000000261","DOIUrl":"https://doi.org/10.1097/ASW.0000000000000261","url":null,"abstract":"<p><strong>Objective: </strong>To determine if intermittent neuromuscular electrostimulation (NMES) of the common peroneal nerve increases microvascular flow and pulsatility in and around the wound bed of patients with combined venous and arterial etiology.</p><p><strong>Methods: </strong>Seven consenting participants presenting with mixed etiology leg ulcers participated in this study. Microvascular flow and pulsatility was measured in the wound bed and in the skin surrounding the wound using laser speckle contrast imaging. Measurements were made at baseline and when the venous pumps of the leg were activated by 1 Hz intermittent neuromuscular stimulation of the common peroneal nerve. The nerve was stimulated transdermally at the head of the fibula.</p><p><strong>Results: </strong>When activated by NMES, wound bed flux increased by 38% (95% CI, 11%-73%; P = .023), and periwound flux increased by 19% (95% CI, 9%-32%; P = .009). Pulsatility increased in the wound bed by 214% (95% CI, 51%-985%; P = .017) and in the periwound by 122% (95% CI, 38%-299%; P = .014).</p><p><strong>Conclusions: </strong>The results indicate that NMES is effective in augmenting microvascular flow in leg ulcers with combined venous and arterial etiology.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":"38 1","pages":"25-30"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Utilizing Image Processing Techniques for Wound Management and Evaluation in Clinical Practice: Establishing the Feasibility of Implementing Artificial Intelligence in Routine Wound Care.","authors":"Mai Dabas, Suzanne Kapp, Amit Gefen","doi":"10.1097/ASW.0000000000000246","DOIUrl":"https://doi.org/10.1097/ASW.0000000000000246","url":null,"abstract":"<p><strong>Objective: </strong>To develop a generalizable and accurate method for automatically analyzing wound images captured in clinical practice and extracting key wound characteristics such as surface area measurement.</p><p><strong>Methods: </strong>The authors used image processing techniques to create a robust algorithm for segmenting pressure injuries from digital images captured by nurses during clinical practice. The algorithm also measured the real-world wound surface area. They used the hue-saturation-value color space to analyze red color values and to detect and segment the wound region within the entire image. To assess the accuracy of the algorithm's wound segmentation, the authors compared the results against wound image annotations.</p><p><strong>Results: </strong>The algorithm performed impressively, achieving an intersection-over-union score of up to 0.85 and 100% intersection with the annotations. The algorithm effectively analyzed wound images obtained during clinical practice and accurately extracted the surface area of the documented pressure injuries. These results support the feasibility and applicability of this methodology.</p><p><strong>Conclusions: </strong>Accurate determination of wound size and healing supports decision-making regarding treatment and is essential to successful outcomes. This innovative approach for visual assessment of chronic wounds highlights the potential of computerized wound analysis in clinical practice. By leveraging advanced computational techniques, healthcare providers can gain valuable insights into wound progression, enabling more accurate assessments to support their decision-making.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":"38 1","pages":"31-39"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Managing Calciphylaxis: Insights from Real-World Cases at a Tertiary Academic Center.","authors":"Kanika Kochhar, Brennen O'Dell, Garneisha Torrence, Alton Johnson, Carey Spitler, Brian Schmidt","doi":"10.1097/ASW.0000000000000263","DOIUrl":"https://doi.org/10.1097/ASW.0000000000000263","url":null,"abstract":"<p><strong>Abstract: </strong>Calciphylaxis is a rare and potentially fatal condition involving chronic, nonhealing wounds caused by microvascular calcification. There is currently no approved treatment for calciphylaxis, contributing to its devastating impacts on quality of life. In this case series, the authors highlight instances of potentially misdiagnosed calciphylaxis in a cohort of patients and emphasize the importance of accurate diagnosis through multidisciplinary management approaches.The authors report on three patients treated at a large tertiary academic center between March 2021 and March 2023. Consent was obtained from all patients, including for the use of patient images. The first and second patients, a 75-year-old man and 62-year-old woman, respectively, both underwent an extensive course of local wound care as well as sodium thiosulfate therapy. The third patient, a 61-year-old woman, was treated with a combination of medication adjustments, lymphedema therapy, pulse lavage treatment, and cadaveric skin substitute. Tissue biopsy was also obtained in two of the three subjects to aid in the diagnosis of calciphylaxis. Unfortunately, these procedures lead to diagnostic challenges and misadventures, highlighting the risks associated with biopsy of calciphylaxis.This case series demonstrates how correctly diagnosing calciphylaxis relies heavily on providers maintaining a high index of clinical suspicion based on patient history, presentation, and risk factors. The primary goals of treatment for calciphylaxis include appropriate wound care, management of infection and pain, and close monitoring.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":"38 1","pages":"E1-E5"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan S Q Geng, R Gary Sibbald, Jacqueline Slomovic, Olivia Toksarka, Gregory Schultz
{"title":"Therapeutic Indices of Topical Antiseptics in Wound Care: A Systematic Review.","authors":"Ryan S Q Geng, R Gary Sibbald, Jacqueline Slomovic, Olivia Toksarka, Gregory Schultz","doi":"10.1097/ASW.0000000000000233","DOIUrl":"10.1097/ASW.0000000000000233","url":null,"abstract":"<p><strong>General purpose: </strong>To review the therapeutic indices of topical antiseptics for bacterial species commonly isolated from chronic wounds.</p><p><strong>Target audience: </strong>This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care.</p><p><strong>Learning objectives/outcomes: </strong>After participating in this educational activity, the participant will:1. Explain the mechanisms underlying chronic wound physiology and their implications for effective wound healing and management.2. Evaluate the role of therapeutic index values for topical antiseptics in chronic wound management.3. Apply evidence-based treatment strategies for chronic wound management.</p>","PeriodicalId":7489,"journal":{"name":"Advances in Skin & Wound Care","volume":" ","pages":"10-18"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}