Pressure Ulcer Scale Research Articles

Ingestion of bioactive collagen hydrolysates enhanced pressure ulcer healing in a randomized double-blind placebo-controlled clinical study

We conducted a double blind, multi-centric, placebo-controlled, randomized trial to compare the Pressure Ulcer Scale for Healing (PUSH) and Pressure Sore Status Tool (PSST) scores and wound area measurements at 16 weeks of subjects with pressure ulcers who were given standard care plus one of two types of collagen hydrolysate (CH-a), which contained low levels of prolylhydroxyproline (Pro-Hyp) and hydroxyprolylglycine (Hyp-Gly), and CH-b, which contained high levels of Pro-Hyp and Hyp-Gly) with the placebo group. A total of 120 subjects with stage II or III pressure ulcers were entered into the trial and 112 subjects completed the study. The subjects were randomized to receive CH-a (n = 39), CH-b (n = 39), or a placebo (n = 42) twice daily (10 g per day) for 16 weeks. The PUSH score, PSST score, and wound area of the CH-b group were significantly lower than the placebo group at week 16 (PUSH score, P < 0.001; PSST score, P < 0.01; wound area, P < 0.05). The PUSH score of the CH-a group was significantly lower than the placebo group at week 16 (P < 0.05). This study demonstrated that CH-b ingestion helps healing of pressure ulcers as an add-on to the standard therapy.

Effects of Hydrogel With Enriched Sodium Alginate in Wounds of Diabetic Patients.

Objective of this study was to evaluate the efficacy of the autolytic debridement promoted by hydrogel with sodium alginate enriched with fatty acids and vitamins A and E in the healing of foot wounds in diabetic patients. A clinical study was conducted at an outpatient clinic of medical specialties. The sample comprised 8 patients supervised for a 3-month period, from April to July 2017, by means of a clinical history, photographic record, planimetry, and classification of the wound severity by the Pressure Ulcer Scale for Healing (PUSH) system. Of the 8 patients supervised, 1 dropped out and 7 were followed up for 12 weeks. Only 2 had complete wound healing, but all presented a reduction of the lesion area of approximately 22.2% and PUSH score of 9.8 to 6.6. This study found that hydrogel showed good results for the treatment of diabetic feet, reducing the area and overall PUSH score of the wounds.

CICATRIZAÇÃO DE LESÕES POR PRESSÃO EM PACIENTES ACOMPANHADOS POR UM SERVIÇO DE ATENÇÃO DOMICILIAR

RESUMO Objetivo: avaliar a cicatrização de lesões por pressão em pacientes na atenção domiciliar. Método: estudo longitudinal observacional com amostra intencional de 38 pacientes conduzido em um serviço de atenção domiciliar. Foram coletados dados sociodemográficos, clínicos e as características das lesões no período de abril a outubro de 2015. A cicatrização foi avaliada pelo instrumento Pressure Ulcer Scale for Healing, por planimetria e pela profundidade das lesões por pressão. A coleta de dados ocorreu durante as visitas domiciliares realizadas na admissão do paciente no serviço e após quatro e seis semanas. Dados em prontuário também foram coletados. A comparação das variáveis referentes à cicatrização foi realizada pelo Teste de Friedman e a probabilidade de cicatrização, pelo método Kaplan-Meier. Resultados: dos pacientes, 50% eram mulheres e 60,5%, idosos. A mediana de lesões por paciente foi 2. Predominaram os estágios 2 (48,3%) e 3 (35,6%), e 47,1% das feridas cicatrizaram. O escore do Pressure Ulcer Scale for Healing, a planimetria e a profundidade variaram significativamente no período do estudo (p&lt;0,05). A probabilidade de cicatrização aumentou com o passar do tempo, sendo a mediana de cicatrização 44 dias. Conclusão: houve evolução favorável na cicatrização de acordo com os métodos de mensuração utilizados.

Effects of Low-Power Light Therapy on the Tissue Repair Process of Chronic Wounds in Diabetic Feet.

To analyze the efficacy of the therapeutic use of Low-Level Laser Therapy (LLLT) on the tissue repair process of chronic wounds in patients with diabetic feet through the analysis of Pressure Ulcer Scale for Healing (PUSH) scales, pain and the measurement done using the ImageJ© software. This clinical trial was carried out with 18 patients 30-59 years of age, who had chronic wounds on their foot due to complications of diabetes mellitus. The patients were randomly allocated in two different groups of equal numbers: Control and Laser Groups. The LLLT equipment used in the research has a wavelength of 660 nm, 30 mW power, continuous mode emission, 6 J/cm2 dosimetry, 48/48 h in a 4-week period. Measurement and the aspect of wounds were noted in the PUSH scale and the pain was evaluated weekly. The Mann-Whitney U nonparametric test was used to compare groups. The Laser Group presented a significant increase of the tissue repair index when compared with the Control Group, with a significant statistical difference (p < 0.013). There was no significant difference between the groups in all the weeks using the PUSH scale. The use of LLLT on chronic wounds in a diabetic foot demonstrated efficacy on the progression of the tissue repair process in a short period.

Prospective randomized control study comparing gauze-based with foam-based negative pressure wound therapy for the stage 4 pressure injuries

Background: Negative pressure wound therapy (NPWT) has been used to accelerate the formation of granulation tissue and to promote wound closure in the treatment of difficult-to-heal wounds. This study compared the effectiveness between gauze- and foam-based NPWT for stage 4 pressure injuries. Materials and Methods: A total of 38 patients with 48 wounds of stage 4 pressure injuries were recruited and randomly divided into gauze-based and foam-based groups. After initial debridement therapy, gauze-based and foam-based fillers were used, and clinical observations were recorded when dressings were changed, twice a week for 3 weeks. The system was connected to a 1-bottle water-seal chest drainage system and standard wall suction at 125 mmHg negative pressure. The percentages of wound area reduction (PWAR), the scores of Pressure Ulcer Scale for Healing (PUSH) tool and the scores of Bates-Jensen wound assessment tool (BWAT) were used to evaluate wound healing activity. Results: Both groups showed significant changing trends in the wound assessments of PWAR, PUSH, and BWAT during follow-up. However, the area of healing at each clinical observation was consistently greater in the foam group than in the gauze group during the follow-up period, while the PUSH score was consistently greater in the gauze group than that in the foam group. The declining trends of BWAT were alike in both groups. Conclusion: Gauze-based therapy is noninferior to foam-based therapy with respect to PWAR, PUSH, and BWAT for stage 4 pressure injuries.

Effects of vacuum sealing combined with NovaBay on improving diabetic foot wound healing

Objective To explore the effects of vacuum sealing combined with NovaBay on improving diabetic foot wound healing, and to offer new insights and methods for treating chronic aporetic wounds. Methods Totally 130 patients with diabetic foot ulcer admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University between November 2015 and November 2016 were randomly and equally divided into two groups. Patients in the treatment group received 5 ml NovaBay for twice a day on the basis of vacuum sealing drainage (VSD) , and received drainage 5 min after treatment with NovaBay, while patients in the control group received vacuum sealing drainage with 5 ml 0.9% sodium chloride solution for twice a day, and received drainage 5 min after treatment of sodium chloride solution. The intervention time of the patients in both groups were 12 days, with NovaBay and ducts replaced every 3 days. The patients in the two groups were evaluated with Pressure Ulcer Scale for Healing (PUSH) and the coverage rate of granulation tissue was calculated 0, 6, and 12 days after the intervention. And the positive rate of bacteria was tested at the end of the intervention. Results The PUSH scores of the patients in the two groups decreased as time went by, indicating that the wound healing was effective (P<0.001) . The coverage rate of granulation tissue rose with time, and that of the patients in the treatment group rose more obviously (P<0.001) . 12 days after the intervention, the patients in the treatment group (4.62%) showed a lower positive rate of bacteria (P<0.001) than the patients in the control group (47.70%) . Conclusions Vacuum sealing combined with NovaBay shows remarkable effects in cleaning infection of chronic and aporetic wounds, thus a new and effective way to improve the growth of granulation tissue and wound healing. Key words: Diabetic foot; Vacuum sealing; Liquid dressing; Wound healing

Quality of life in patients with chronic wounds: magnitude of changes and predictive factors.

To assess health-related quality of life, its predictors and magnitude of changes in health-related quality of life in patients with chronic wounds receiving specialized outpatient treatment. Secondary, retrospective, descriptive, quantitative study with patients with chronic wounds from two specialized outpatient services in Brazil assessed through Ferrans & Powers Quality of Life Index-Wound Version, Visual Analog Pain Scale, Global Assessment Scale, Pressure Ulcer Scale for Healing, sociodemographic and clinical questionnaires at baseline and after 60 days of treatment. Data were analyzed by ANOVA, Spearman Coefficient, Mann-Whitney test and multivariate logistic regression. Twenty-seven patients participated in the study. The overall health-related quality of life scale, health and functioning subscale and socioeconomic subscale scores increased after 60 days of treatment compared to baseline. Pain reduction was a predictor of changes in overall health-related quality of life score as well as religious practice in the family subscale. 92.6% patients perceived moderate to extensive changes in health-related quality of life. there was improvement of health-related quality of life for the sample studied in the period; pain and religious practice have emerged as predictors of changes in health-related quality of life.

Case series of 18 patients with lower extremity wounds treated with a concentrated surfactant–based gel dressing

The purpose of this case series was to assess the performance of a concentrated surfactant-based gel (CSG) dressing on 18 patients in the outpatient setting over 4weeks. Wounds selected were full thickness, had been presented for greater than 4weeks, and were located on the lower extremities. Patients were given the CSG dressing and instructed on its use. On follow-up clinic visits, the wound was assessed, measurements were obtained, Pressure Ulcer Scale for Healing (PUSH) Tool scores completed, and satisfaction with the dressing was solicited. Individual analysis of each subject's wound was conducted to determine if there was a healing trend over time with a decrease in total PUSH score. Descriptive statistics were used to analyze the results. Eighteen patients participated in this case series involving 9 women and 9 men with a mean age of 66 years (range from 52 to 91). All 18 of the patients had a primary diagnosis of peripheral vascular disease with 7 patients having venous leg ulcers and 11 patients with lower extremity arterial ulcers. The mean Total PUSH score before the CSG dressing was applied was 10.7 (range from 5 to 15) (standard deviation [SD] 3.09) and posttreatment was 8.3 (range from 0 to 14) (SD 4). All 18 patients had a decrease in their pretreatment score from the first clinic visit compared with the posttreatment PUSH Tool score, indicating that the CSG dressing may be an effective dressing in the management of lower extremity wounds.

The Development and Preliminary Validity Testing of the Healing Progression Rate Tool.

Accurate assessment and clear documentation are important aspects of wound care; they provide a basis for appropriate patient care decisions and reimbursement. A descriptive, qualitative study was conducted to develop and provide preliminary evidence of the validity of a new tool to measure wound healing (the Healing Progression Rate [HPR]), a modified version of the Pressure Ulcer Scale for Healing (PUSH). Three (3) groups of current and future practitioners participated in the instrument development and evaluation process: 1) 3 wound care experts/authors (2 physical therapists, 1 nurse) with a minimum of 15 years of experience, 2) 6 additional wound care experts (4 nurses and 2 physical therapists) with a minimum of 10 years experience, and 3) 120 participants (77 [64.2%] RNs, 2 [1.7%] nursing students, 12 [10%] physical therapists [PTs], and 29 [24.2%] PT students). After the instrument was developed, the first group of 3 wound care experts used 2 photos of the same pressure injury at different points in time for 30 different wound cases to determine wound status (improved, worse, or the same) using the HPR and PUSH tools. The 6 experts from group 2 completed a similar exercise and, after completing a demographic questionnaire, the nonexpert participants scored 20 randomly selected cases (10 with the PUSH and 10 with the HPR) followed by a 4-question survey about the instruments. All data were collected on spreadsheets. Descriptive statistics were generated and mean HPR and PUSH scores for each image were compared to expert scores using a paired t-test. If the mean of participants' image scores was significantly higher or lower than that of the experts, it was placed in the "higher" or "lower" group. If the difference was not statistically significant, the image was placed in the "same" group. Chi-squared tests (χ2) were used to compare the frequency distribution within each of these 3 groups for the HPR and PUSH tools. Due to violations of normality, the nonparametric Friedman's analysis of variance and Wilcoxon signed rank test were used to compare the experts' votes on which tool they thought captured the difference between the pre- and post-wound pictures and to perform post hoc testing, respectively. Qualitative data from the exit survey were reviewed and grouped into common themes. In 8 cases, a statistically significant difference was found among the number of votes (from the 6 experts) for which tool best reflected the change in wound status (χ2 (2) = 11.20; P = .004). Post hoc comparison revealed experts believed the change in HPR score better reflected the change in wound status compared to the PUSH tool (P = .026). Almost 75% of nonexpert participants preferred the HPR, rating it as more objective (73%). The results of this preliminary validation study suggest that further validation and reliability testing is warranted.

Incidence of incontinence-associated dermatitis in the pediatric intensive care unit

Objective To describe the incidence of incontinence-associated dermatitis (IAD) in the pediatric intensive care unit (PICU) in a tertiary hospital, and to explore relevant influencing factors. Methods Totally 268 children in the pediatric intensive care unit in a tertiary hospital were selected by convenience sampling between September and December 2016 and investigated with the General Information Questionnaire, Braden Q Pressure Ulcer Scale, Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) , Bristol Stool Scale and Incontinence-Associated Dermatitis Scale (IADS) . Then the data were analyzed by the rank sum test, Superman rank correlation analysis and stepwise multiple regression analysis. Results The incidence of IAD was 36.2%, and the IADS score was (1.63±3.54) . The Braden Q score was negatively correlated with the IADS score (r=-0.230, P<0.05) , while the STAMP score was positively correlated with the IADS score (r=0.204, P<0.05) . According to the multiple regression analysis, stool type, Braden Q score, edema and age were the influencing factors to the severity of IAD (P<0.05) . Conclusions The PICU sees a high incidence of IAD, but a low IADS score. And stool type, Braden Q score, edema and age are related to the severity of IAD. Key words: Child; Intensive care unit; Incontinence-associated dermatitis; Risk factors

Analysis of risk factors of pressure ulcer healing

Objective To investigate the risk factors of wound healing 30 days after treatment in patients with pressure ulcer. Methods Two hundred and forty-five hospitalized patients with pressure ulcer between January 2015 and October 2016 were selected. They were divided into the healed group and the unhealed group 30 days after the treatment. The influencing factors 13 indexes including age, gender, edema, the number of diseases, the number of pressure ulcer, the size of pressure ulcer, PUSH score (Pressure Ulcer Scale Healing), hemoglobin, serum albumin, low density lipoprotein cholesterol and blood homocysteine underwent single factor and Logistic regression analysis. Results Single factor analysis of 12 indicators of risk factors affecting healing were age, Hb, Alb, Hcy, area of ulcer and PUSH scores of the 6 indicators in the regression equation (Z=3.11-6.63, All P < 0.01), gender also entered the regression equation (χ2 = 0.19, P < 0.01); further multivariate regression analysis showed that there were statistically significant differences in PUSH score index (χ2=10.47, P<0.01, OR=0.001, 95% confidence interval were 0.001-0.037). Conclusions Age, gender, Hb, Alb, Hcy and PU area were the risk factors of pressure ulcer healing. Key words: Pressure ulcer; Pressure ulcer scale healing; Wound healing; Regression analysis

Impact of Educational Video Film for Nurses Caring Elders Suffering From Pressure Ulcer about Applying Cutimed Sorbact Dressing On Wound Healing

Pressure ulcer is a serious and common health problem in critical care setting; it has been described as one of the most costly and physically debilitating complications in the 20th century. The prevalence of advanced pressure ulcer is high in older persons; about 70% occur in patients 65 years or older peaking in those between age 70 and 80 years. Most pressure ulcers are believed to be treated if the appropriate measures are implemented to maintain skin integrity by applying the cutimed sorbact dressing. Objectives: to determine the impact of an educational video film for nurses caring elders suffering from pressure ulcer about applying cutimed sorbact dressing on wound healing. Materials and Method. A quasi experimental design used in this study, the study carried in the intensive Care Units of the Specialized Medical Hospital, Emergency Hospital and General Mansoura Hospital in Dakhalia governorate, the study subjects included in this study are 76 elderly patients and 69 nurses. Three tools were used in this study namely; Structured interview schedule sheet, Pressure Ulcer Scale for Healing, Video Film about prevention and applying cutimed sorbact dressing. Results: There is improvement in wound healing of pressure ulcer after applying Cutimed Sorbact dressing compared to the usual dressing. Moreover, the nurses became more knowledgeable after the educational video film concerning caring of elderly suffering from pressure ulcer. Conclusion and recommendation: This study concluded that the elderly patients suffering from pressure ulcers when applying the Cutimed Sorbact dressing intervention faster wound healing and free from bacteria than those who receive usual dressing, moreover, the nurse's knowledge improved after displaying the educational video film program Also, it recommended using the cutimed dressing in treatment of pressure ulcer as aresult of  his fast effect on wound healing.

Moist exposed burn ointment for treating pressure ulcers: A multicenter randomized controlled trial.

Background:Pressure ulcers often seriously affect the quality of life of patients. Moist Exposed Burn Ointment (MEBO) has been developed to treat patients with pressure ulcers. The present study aimed to evaluate the efficacy and safety of MEBO in the treatment of pressure ulcers in Chinese patients.Methods:Seventy-two patients with pressure ulcers were randomly assigned to 2 groups who received a placebo or MEBO for 2 months. The primary outcomes included the wound surface area (WSA) and pressure ulcer scale for healing (PUSH) tool. The secondary outcomes included a visual analog scale (VAS), questionnaire of ulcer status, and adverse effects.Results:Sixty-seven patients completed the study. After 2 months of treatment, the difference of mean change from the baseline was greater for MEBO (vs placebo) for WSA mean (SD) −6.0 (−8.8, −3.3), PUSH Tool −2.6 (−4.7, −1.5), and VAS score −2.9 (−4.4, −1.7). On the basis of the questionnaire, the pressure ulcers were “completely healed” (50.0% vs 16.7%) (P < .05) in patients after 2 months of treatment with MEBO versus placebo. No major adverse effects were found in the 2 groups.Conclusion:We showed that MEBO is effective and well tolerated for improving wound healing in Chinese patients with pressure ulcers.

Efficacy of arginine-enriched enteral formulas for the healing of pressure ulcers: a systematic review.

Arginine improves healing and modulates inflammation and the immune response. This systematic review aimed to assess the effect of arginine-enriched enteral formulas in pressure ulcer (PU) healing. Systematic computerised searches of PubMed, Web of Knowledge, Scopus, ENTRAL and CINAHL databases were performed from their inception to 20 January 2016. Randomised controlled trials (RCTs) were included in this systematic review. We used the Jadad scale as a quality assessment tool. There were seven RCTs with 369 patients included in this systematic review; four RCTs assessed healing by PU area reduction. All of them reported arginine-enriched enteral nutrition led to a significant improved PU healing compared with standard hospital diet in 2-12 weeks follow-up. Among these four RCTs, one enrolled malnourished patients, one enrolled non-malnourished patients, and the other two studies did not restrict the nutritional status of the patients. Using the Pressure Ulcer Scale for Healing (PUSH) four RCTs assessed healing of PU, all reporting arginine-enriched enteral nutrition resulted in a significant PUSH score improvement compared with control at follow-up. Using the Pressure Sore Status Tool (PSST) one RCT assessed healing of PUs, finding patients receiving arginine had the lowest PSST scores compared with controls. An RCT compared healing with two doses of arginine (4.5g versus 9g), but no difference was found between the doses. Evidence showed that arginine-enriched enteral nutrition led to a significant improvement in PU healing. It was effective not only in malnourished patients, but also in non-malnourished patients.

A prospective evaluation of methylene blue and gentian violet dressing for management of chronic wounds with local infection.

The objective of this prospective, non‐randomised study was to evaluate the performance of an antibacterial foam dressing containing methylene blue and gentian violet (Hydrofera Blue Classic dressing®) for the management of chronic wounds with local infection. Patients in this study were ≥18 years of age (n = 29), and each had at least one chronic wound ≥1 cm2 in size that showed signs of localised infection or critical colonisation but with good potential for healing based on clinical assessment. To all of these wounds, the dressing was applied and changed three times per week over the 4‐week study period. The primary endpoints of the study were: (i) changes in wound surface area measurement, (ii) changes in Pressure Ulcer Scale for Healing (PUSH) scores, (iii) changes in percent surface area of devitalised tissue (i.e., yellow slough or other necrotic tissue) and (iv) changes in clinical signs associated with localised wound infection/critical colonisation. Participants were evaluated at presentation (week 0 = baseline), week 2 and at week 4 (end of the study). The 29 patients completed the study, and at week 4, the following wound improvements were observed: (i) baseline mean wound surface area was significantly reduced by 42·5%, from 21·4 to 12·3 cm2 at week 4 (P = 0·005); (ii) baseline mean PUSH score decreased significantly from 13·3 to 10·7 at week 4 (P < 0·001); (iii) baseline mean wound coverage by devitalised tissue (%) was significantly reduced, from 52·6 % to 11·4% at week 4 (P < 0·001) and (iv) the mean UPPER and LOWER wound infection scores were reduced from 3·6 at baseline to 0·9 at week 4 (75%; P < 0.001). These results indicate that the Hydrofera Blue Classic dressing was effective at managing these chronic wounds and helped them progress onto a healing trajectory.

Value of combined exercise and ultrasound as an adjunct to compression therapy in chronic venous leg ulcers

IntroductionChronic venous leg ulcers are very difficult to treat and take very long time to heal. Compression therapy remains the mainstay of venous ulcer conservative treatment.AimThe aim of this study was to evaluate the effectiveness of combined therapeutic exercises and ultrasound as an adjunct to compression therapy for the treatment of chronic venous leg ulcers.Settings and designThis study is a prospective randomized case-controlled one.Patients and methodsSeventy-two patients with chronic venous leg ulcers were recruited from outpatient clinics. Weallocated patients to four groups of 15 patients each. Group I was treated with therapeutic exercise program in addition to compression therapy. Group II was treated with underwater ultrasound and compression therapy. Group III was treated with therapeutic exercises as in group I and underwater ultrasound as in group II, in addition to compression therapy. Group IV was treated with compression therapy. The duration of follow-up was 12 weeks. Treatment outcome was assessed using the visual analogue scale for pain, ulcer size, the pressure ulcer scale for healing, maximum ankle dorsiflexion and plantar flexion using a plastic goniometer.ResultsVenous ulcer healing was greatest in patients receiving combined exercise and ultrasound in addition to compression therapy. Combined therapeutic exercises and ultrasound were well tolerated and no adverse reactions were noted. Patients receiving therapeutic exercises alone or ultrasound alone showed lesser degrees of improvements. No significant improvements were observed in any variable in patients who received compression therapy alone.ConclusionCombined prescription of exercises and ultrasound as an adjunct to compression therapy would be a more effective means of promoting chronic venous ulcer healing, when standard compression therapy have failed. It is safe, easy and well tolerated and should be considered as adjunctive therapy in patients with venous leg ulcers.

The reality of routine practice: a pooled data analysis on chronic wounds treated with TLC-NOSF wound dressings.

A number of randomised controlled trials (RCT) have compared control groups with TLC-NOSF dressings (UrgoStart) on chronic wounds. Our aim was to determine whether the clinical trials' results translate into routine management of such wounds, by pooling the data from real-life observational studies. Observational studies, conducted in France and Germany, evaluating current practices in patients suffering from non-selected chronic wounds treated with a TLC-NOSF dressing were identified. Demographic data, baseline description of wounds and description of their evolution during treatment were extracted and combined. We used two main indicators of clinical outcomes to measure the impact of the TLC-NOSF dressing on this population: time to wound closure and time to 50% reduction of the Pressure Ulcer Scale for Healing (PUSH) score. In total, data from 10,220 patients were included, with 7903 leg ulcers (LUs), 1306 diabetic foot ulcers (DFUs) and 1011 pressure ulcers (PUs). The overall closure rate was 30.8 % [95 % confidence interval (CI): 29.9-31.7 %]. While the country, patient age, and number of wounds were identified as independent prognosis factors of healing, the most significant were wound duration and baseline area. The delay in initiating TLC-NOSF dressings treatment was also found to be significant. Overall the average time to complete closure was 112.5 days [95%CI: 105.8-119.3] for LUs, 98.1 days [95 %CI: 88.8-107.5] for DFUs and 119.5 days [95%CI: 94.6-144.3] for PUs. Based on a subgroup analysis of the French cohort, time to closure is substantially shorter for wounds treated with the TLC-NOSF dressing as a first-line intervention compared with those where it has been prescribed as a second-line intervention. Compared with available data on time to complete closure of chronic wounds managed by 'standard' care, the data from this pooled data analysis showed healing time is reduced, which is consistent with the results of RCTs on TLC-NOSF. That these data are in agreement with those from the RCTs is testimony to their generalisability and important for routine practice. This indicates that using TLC-NOSF dressings in routine wound management can reduce the healing time of LUs, DFUs and PUs. These data also suggest that the earlier the decision to use this dressing, the shorter the time to closure, whatever the severity and the nature of these chronic wounds.

Comparing turmeric extract plus animal butter synthetic poultice effect in two home-based and aseptic-based preparation methods in terms of microbial load

Background and Objective: Based on increase in individuals' inclinations toward the use of natural and traditional products in curing some diseases in a systemic and localized manner, the survey of the pathogenic factors which are transferred through such products is of a great importance from the health perspectives. Furthermore, because the emergence of infections due to nonstandard method of preparing some of these natural drugs has not been accurately determined, a poultice mixture consisting of turmeric extract and animal butter was compared in two home-based and aseptic-based preparation methods in terms of microbial load and their effects on the process of pressure ulcer healing is investigated in this study. Materials and Methods: In this study, two poultice mixtures were initially prepared in a home-based method and the other under aseptic conditions, transferred to the laboratory where the specimens were cultured under sterile conditions, in microbe-culturing plates under microbiological hood with a dilution rate of 1–10. After the specified time duration elapsed, the plates containing the culture media were evaluated in terms of bacterial and fungal growth. To prepare a poultice based on standardized methods, turmeric was sufficiently bought from the medicinal herbs market and then put in ethanol 95% v/v. Animal butter underwent separation during a 24 h period in rotary evaporation device under reduced condensation pressure, and after its water was oozed out in 70°C, the concentrate was placed in the incubator. Turmeric extract and animal butter were mixed under bacteriology hood with sterilized wheat flour in autoclave. Finally, the poultice prepared aseptically was tested on seven human specimens and the results were evaluated using pressure ulcer scale for healing (PUSH). Results: Based on the experiments, the homemade poultice mixture was found contaminated with Gram-positive microbial factors, but when the poultice mixture was prepared seven times in the laboratory, no microbial load was found (above USP standard). The mean area of the ulcer was 13.41 before the study, but in the last evaluation, value decreased to 2.21. PUSH mean score from the 1st day until the 4th week reduced from 13.42 to 5.85. It was shown that the ulcer recovery trend decreased considerably. Furthermore, regarding the tissue surveys through observing the samples at the end of intervention, it was seen that the ulcer was free of necrosis and granulated tissues were visible on the ulcer. Conclusion: The aseptic specimen was found in an standard level in terms of microbial load and practically caused effective recovery of the pressure ulcer through increasing the circulation in blood veins, reducing the secretions and edema, and is not indicative of traces of any infection; thus the consumption of this poultice was recognized as safe in improving the pressure ulcers.

Pressure ulcer dressings in critical patients: a cost analysis.

To assess the direct cost of dressings in pressure ulcer treatment. This was a descriptive observational study conducted at an intensive care unit in the Northeast region of Brazil, between November and December 2015. Data were gathered using the Pressure Ulcer Scale for Healing and a form to characterize and assess costs. Values in Brazilian reais (BRL) were converted into U.S. dollars at the exchange rate of USD 0.26/BRL. Univariate and bivariate analyses were conducted. The sample consisted of 15 patients with at least stage 2 ulcers. There was a significant reduction in costs with dressing materials between the initial and final assessments (p=0.002), with a mean of USD 11.9 (±7.4). The most common topical treatments used were essential fatty acids and papain. Cost reduction was proportional to the stage of pressure ulcer. The role of nurses in creating evidence-based care plans is crucial to improve care management. Avaliar o custo direto com curativos no tratamento de lesões por pressão. Estudo observacional descritivo, realizado em Unidade de Terapia Intensiva do nordeste do Brasil, de novembro a dezembro de 2015. Foi aplicada a Pressure Ulcer Scale for Healing e formulário para caracterização e avaliação de custos. Os valores da moeda brasileira (R$) foram convertidos para a moeda norte-americana (US$) à taxa de US$0,26/R$. Foram realizadas análises univariadas e bivariadas. Compuseram a amostra 15 pacientes com lesões, no mínimo, estágio 2. Houve redução significativa dos custos com materiais de curativos entre as avaliações inicial e final (p=0,002), com média de US$11,9 (±7,4). As terapias tópicas mais frequentes foram ácidos graxos essenciais e papaína. Verificou-se redução de custos proporcional aos estágios das lesões. Enfatiza-se o papel do enfermeiro na elaboração de planos de cuidados baseados em evidências para melhor gerenciamento do cuidado. Evaluar el costo directo de curativos para el tratamiento de lesiones por presión. Estudio observacional descriptivo en la Unidad de Cuidados Intensivos del noreste de Brasil, de noviembre a diciembre del año 2015. Se aplicó la Pressure Ulcer Scale for Healing y formulario para la caracterización y evaluación de los costos. Los valores de la moneda brasileña (Reales- R$) se convirtieron al dólar estadounidense (US$) a razón de $0.26/R$. Se realizaron análisis univariados y bivariados. La muestra consistió en 15 pacientes con lesiones al menos en Etapa 2. Hubo una reducción significativa en el costo de los materiales de curación entre las evaluaciones inicial y final (p=0,002), con un promedio de US$11.9 (±7.4). Los tratamientos tópicos más comunes son los ácidos grasos esenciales y papaína. Se verificó una reducción de los costos proporcional a las etapas de las lesiones. Se hace hincapié en el papel de los enfermeros en el desarrollo de planes de cuidados basados en la evidencia, para una mejor gestión de la atención.

The Healing Effect of Low-Temperature Atmospheric-Pressure Plasma in Pressure Ulcer: A Randomized Controlled Trial.

Pressure ulcers are difficult to treat. Recent reports of low-temperature atmospheric-pressure plasma (LTAPP) indicated its safe and effectiveness in chronic wound care management. It has been shown both in vitro and vivo studies that LTAPP not only helps facilitate wound healing but also has antimicrobial efficacy due to its composition of ion and electron, free radicals, and ultraviolet ray. We studied the beneficial effect of LTAPP specifically on pressure ulcers. In a prospective randomized study, 50 patients with pressure ulcers were divided into 2 groups: Control group received standard wound care and the study group was treated with LTAPP once every week for 8 consecutive weeks in addition to standard wound care. We found that the group treated with LTAPP had significantly better PUSH (Pressure Ulcer Scale for Healing) scores and exudate amount after 1 week of treatment. There was also a reduction in bacterial load after 1 treatment regardless of the species of bacteria identified.