Treatment Of Pressure Ulcers Research Articles

Evaluation of the Knowledge Levels of Family Medicine Assistants Receiving Specialty Training in İzmir About Pressure Ulcer

This study aims to assess the knowledge levels regarding pressure ulcers among family medicine residents undergoing specialty training in Izmir. This study is a cross-sectional study. 216 family medicine residents who received specialization training at Izmir Katip Çelebi University (IKÇÜ), Dokuz Eylül University(DEU), Izmir Bozyaka Training and Research Hospital and Tepecik Training and Research Hospital were included in our study after giving their permission to participate. The participants were administered a sociodemographic data survey prepared by the researchers after reviewing the relevant literature and the ‘Pressure Ulcer Prevention Knowledge Assessment Survey’. Data were evaluated using the SPSS 22 (Statistical Package for the Social Sciences) package program. The mean age of the participants was 30.12±5.81 years, the median number of years spent in the profession was 4 years, and the median time spent in residency (months) was 17 months. When evaluated statistically, the scores of the Knowledge Assessment Questionnaire on Pressure Ulcer Prevention (KAPQ) were found to be significantly higher in physicians who used a source for pressure ulcers (38.9%, n=81), received training on the diagnosis, treatment, and prevention of pressure ulcers (37.5%, n=81), worked in a home health unit during their residency (53.7%, n=116), encountered pressure ulcers frequently (25.9%, n=56), and used a scale for the assessment of pressure ulcers (31.5%, n=68). The aim of family medicine specialization training is to train physicians who can provide primary health care services through theoretical and practical training. Pressure ulcers are one of the most common diagnoses encountered during mandatory and elective clinical rotations. Our study shows that family medicine assistants' awareness and knowledge about pressure ulcer, which is a preventable health problem, are not at a sufficient level. In this context, necessary arrangements should be made in educational curricula and applied training programs.

Consequences of pressure ulcer among bedridden patient in ATBUTH Bauchi, Bauchi State, Nigeria

This study explores the extensive consequences of pressure ulcers among bedridden patients. Pressure ulcers, also known as bedsores or pressure sores, pose significant health challenges for individuals with limited mobility. The research investigates the physical, psychological, and economic impacts of pressure ulcers on patients and the healthcare system. Physically, pressure ulcers can cause tissue damage and infections due to prolonged pressure on specific areas, leading to skin deterioration. Psychologically, patients suffering from pressure ulcers may experience pain, discomfort, anxiety, depression, and a reduced quality of life. Economically, managing pressure ulcers incurs substantial treatment costs, including specialized wound care products and frequent medical consultations. This study highlights the burden placed on healthcare systems and caregivers due to the demanding care required for the prevention and treatment of pressure ulcers. Pressure ulcers are a prevalent and debilitating complication among bedridden patients, leading to significant morbidity, mortality, and healthcare costs. This study investigates the consequences of pressure ulcers on bedridden patients, identifies risk factors associated with their development, and explores demographic factors that increase their risk. Our findings indicate that pressure ulcers significantly impact patients' physical and psychological well-being, healthcare utilization, and quality of life. We identified key risk factors, including immobility, sensory impairment, poor nutrition, and inadequate care practices. Additionally, our analysis reveals significant demographic associations, with older adults, females, and those with comorbid diseases being more susceptible. This study highlights the urgent need for proactive prevention strategies, timely detection, and effective management to mitigate the consequences of pressure ulcers and improve patient outcomes.

An Off-the-Shelf Artificial Proregenerative Macrophage for Pressure Ulcer Treatment.

Cell therapy is a promising approach in regenerative medicine. However, maintaining the survival and function of injected or implanted therapeutic cells remains a substantial challenge to success. In vivo modulatory strategy for cell therapeutics has been recently developed, but suffers from limited regenerative efficacy in injured tissue microenvironment with chronic inflammation. Here, an off-the-shelf artificial macrophage (artM) assembled by M2 macrophages-derived lysate proteins-loaded poly (lactic-co-glycolic acid) (PLGA) microspheres coated by macrophage cell membrane is developed. The synthetic artM fabricated in batches maintains its bioactivity with long-term cryostorage. Significantly, artM recapitulates the essential inflammation-regulatory and proregenerative characteristics of endogenous macrophages, including initiating M2 macrophage polarization, resolving excessive inflammation by releasing anti-inflammatory cytokines and growth factors, neutralizing endotoxins and proinflammatory cytokines, augmenting T-helper 2 (TH2) immune response, and coordinating cell migration and proliferation. In mouse model of deep tissue pressure injury (DTPI), the artM induces tissue regeneration by modulating the inflammatory microenvironment, promoting angiogenesis, reducing scar deposition, and accelerating the renewal of skin appendages. Depletion of macrophages in mice with skin ulcers highlights the immunomodulatory and proangiogenic functions of artM as effective as autogenous macrophages. Collectively, the engineered artM represents a cell-free, proreparative alternative to immune cell therapy in chronic wound management.

Silk Sericin: A Promising Sustainable Natural Biopolymer for Pharmaceutical and Biomedical Applications

Abstract: Silk Sericin, a natural biopolymer, has gained increasing attention for its diverse applications in pharmaceuticals and biomedicine. This is an organic biomaterial derived from the Silkworm cocoon (silkworm Bombyx mori), by the degumming process, which exhibits remarkable biocompatibility, biodegradability, making it a promising candidate for various therapeutic and regenerative approaches. Sericinhas an excellent property that makes it a potential candidate for wound healing, skin care, and drug delivery applications. This hydrophilic protein is recognized as an anti-inflammatory, antioxidant, and anti-cancer agent. The high molecular weight and granular protein composition of sericin give it a sticky consistency and gelatin-like quality. The presence of many hydroxyl groups absorbs significant water from the skin, providing a natural moisturizing effect. Silk sericin presents a sustainable alternative to synthetic polymers, boasting exceptional characteristics, including minimal immune response, excellent moisture retention, and versatility in forming various structures such as films, fibers, and hydrogels. The sustained release of sericin from wound dressings can also be efficacious in providing a prolonged healing effect during the treatment of pressure ulcers. This can contribute to a more favourable environment for faster and effective wound healing. This review aims to provide a comprehensive overview of silksericin, highlighting its unique characteristics, extraction methods, and recent advancements in its utilization for pharmaceutical and biomedical purposes, along with emphasizing the significant potential of this protein as a versatile biopolymer for advanced healthcare solutions.

An Integrated Approach to Pressure Ulcer Prevention and Treatment: The Role of Physical Activity, Nutrition, Care and Modern Technologies.

Introduction: Pressure ulcers represent a significant healthcare challenge affecting patient outcomes and quality of life. This comprehensive review examines the integrated approach to pressure ulcer prevention and treatment, focusing on physical activity, nutrition, modern wound care technologies, and emerging therapeutic strategies. Materials and Methods: Literature review was conducted using databases such as PubMed, NCBI, and Google Scholar, with search terms including "pressure ulcers", "physical activity", "nutrition", "wound care", "prevention", "modern technologies" State of knowledge: Pressure ulcers develop when sustained pressure exceeds critical capillary pressures (arterial: ~32 mmHg; venous: 8-12 mmHg), leading to tissue ischemia and necrosis. Physical activity demonstrates significant benefits in wound healing through immune modulation, improved circulation, and enhanced tissue regeneration. Nutritional interventions, particularly protein supplementation (24% vs. 14% protein), show improved healing rates. Modern wound care technologies, including specialized dressings and emerging therapies like hyperbaric oxygen and stem cell treatments, demonstrate promising results. Prevention strategies incorporating risk assessment tools, proper positioning techniques, and skin care protocols significantly reduce pressure ulcer incidence. Conclusions: An integrated approach combining physical activity, proper nutrition, and advanced wound care technologies offers the most effective strategy for pressure ulcer prevention and treatment. Novel diagnostic and therapeutic approaches, including electrical impedance analysis and stem cell therapy, show promise for improving outcomes. Further research is needed to validate emerging technologies and establish standardized treatment protocols.

RETRACTION: Reliability of Evidence Supporting the Role of Electrical Stimulation in the Treatment of Pressure Ulcers

RETRACTION: X. Qin, H. Shen, R. Chen, R. Ye, and C. Hu, “,” International Wound Journal 21, no. (2024): , https://doi.org/10.1111/iwj.14620. The above article, published online on 31 January 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons Ltd. Following an investigation by the publisher, all parties have concluded that this article was accepted solely on the basis of a compromised peer review process. The editors have therefore decided to retract the article. The authors did not respond to our notice regarding the retraction.

RETRACTION: Clinical Effects of Acupuncture for the Treatment of Pressure Ulcers: A Comprehensive Systematic Review and Meta‐Analysis

RETRACTION: Y. Guo, P. Qiao, K. Zhang, G. Sun, R. Wang, and X. Yang, “,” International Wound Journal 21, no. (2024): , https://doi.org/10.1111/iwj.14694. The above article, published online on 28 January 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons Ltd. Following an investigation by the publisher, all parties have concluded that this article was accepted solely on the basis of a compromised peer review process. The editors have therefore decided to retract the article. The authors did not respond to our notice regarding the retraction.

Hydrofibre technology with silver ions in the treatment of wound; evaluation of a case report

Pressure ulcers in bedridden individuals can cause significant morbidity and mortality. Also, they can lead to pain and are associated with being prone to infection. For this reason, special dressings have been developed to accomplish these patients' wound healing. We report a case of a patient with an infected pressure ulcer, which was successfully treated with Hydrofiber wound dressing. A 69-year-old female patient, in a physical examination; Body Mass Index: 32.7 kg/m2 (obese). Stage 4 pressure wounds were detected in the left gluteal region with a width of 10x6 cm and a depth of 4 cm. Daily wound care was performed using a Hydrofiber material with a silver content and on top a foam (hydro polymer) cover. Dressing changes were performed every 72 hours during the treatment period. Dressing continued for 21 days. Then, silver sulfadiazine cream 2x1 was applied daily. At the end of 25 days of wound care, the patient's current pressure ulcers decreased to 6x3 cm and 2 cm deep. A pressure ulcer is regressed from stage 3 to stage 1. The application of silver wound dressing is an important treatment for the successful outcome of modern treatment of pressure ulcers.

Comparison of the incidence of pressure ulcers among patients admitted to the palliative care service from different providers

Introduction: The aim was to evaluate the prevalence of pressure ulcers among centers providing palliative care. Methods: This study was conducted among patients admitted to the palliative care center of the Health Sciences University Bursa High Specialization Training and Research Hospital between 2019 and 2020. Medical data of 217 patients who met the definition of palliative care patients admitted from intensive care, home, and wards were retrospectively scanned. Demographic data, diagnoses, chronic diseases, and characteristics of pressure sores of the patients were recorded. Results: The incidence of pressure ulcers in palliative care patients admitted from intensive care is significantly higher than in patients admitted from home and wards. Conclusions: In intensive care units, it is more difficult to monitor and care for patients who meet the definition of palliative care patients in terms of pressure ulcers compared to homes and wards. Providing this service to patients who meet the definition of palliative care, especially at home, is important for the prevention and treatment of pressure ulcers.

The Efficacy of Low-Temperature Atmospheric-Pressure Plasma (LTAPP) in the Multicenter Treatment of Pressure Ulcers: A Randomized Controlled Trial

Introduction This study is to examine the reduction in wound size between the LTAPP and the control group and also investigate the wound healing effect factor. Methods A randomized controlled trial was conducted at five study centers. Participated patients were between 18–80 years old who had pressure ulcer wound(s) and excluded patients with high risk or receiving other treatment such as previous radiation therapy in the affected area, pregnancy, sepsis, and immunocompromised host. The study divided participant into LTAPP group and standard of care (SOC) group, the LTAPP group would received a dressing of non-Ag materials and administer LTAPP for 1 min per 1 cm 2 (maximum of 20 min). The SOC group would received standard dressing wound protocol. Both groups would be followed until the end of study (ninth visit) or until the wound healed. Results When considering patients who attended follow-up ≥4 visits, only 45 ulcers were eligible, of which consisted of 21 ulcers in the LTAPP group and 24 ulcers in the SOC group. The results showed significant healing rate of the LTAPP group, whether to be the wound size: wound area and wound volume, wound healing: exudate reduction, granulation and lesser necrotic tissue or Pressure Ulcer Scale for Healing (PUSH) score. The LTAPP group had better bacterial load reduction without the use of tropical antibiotic, this also signified the quality in bacterial eradication of LTAPP. Conclusion LTAPP showed outstanding performance in treating pressure ulcer wounds. The LTAPP gave greater outcome in wound size, wound healing indicators, microbiological analyses and cost-effective comparison. Although, the absence of statistical significance, it did not affect the outcome trends. This study suggested further investigation of the potential role of LTAPP therapy in different wound types in near future.

Investigating the potential of collagen/carrageenan trilayer sponges with optimal therapeutic and physical properties for the treatment of pressure ulcers.

Investigating the potential of collagen/carrageenan trilayer sponges with optimal therapeutic and physical properties for the treatment of pressure ulcers.

Therapeutic potential of Brazilian green propolis and oregano (Origanum vulgare) extracts in collagen hydrogel for pressure ulcer repair: an experimental study in an animal model

This study investigated the effects of incorporating Brazilian green propolis ethanolic extract and oregano (Origanum vulgare) methanolic extract into type I collagen hydrogel to enhance pressure ulcer healing in mice. Forty-four mice were divided into four groups: untreated control, plain collagen hydrogel, collagen hydrogel with 1% green propolis extract, and collagen hydrogel with 1% oregano extract. Pressure ulcers were induced on their dorsal skin, followed by a 14-day assessment of wound area, contraction, re-epithelialization, dermal collagen density, and levels of reactive oxygen species and nitrite. Results showed significant tissue repair promotion by both propolis and oregano extracts, with oregano exhibiting superior wound contraction. These hydrogels also facilitated skin layer reorganisation and reduced reactive oxygen species and nitrite production. Collagen hydrogels containing these extracts show promising therapeutic potential for pressure ulcer treatment.

Honduran nursing care to pressure injuries in patients with invasive mechanical ventilation: A qualitative study.

Although substantial evidence exists regarding the treatment of pressure ulcers, there is a lack of studies demonstrating a comprehensive nursing approach for managing pressure ulcers in the ICU, particularly among patients with invasive mechanical ventilation from developing countries like Honduras. This gap in research is significant as the risk and impact of pressure ulcers on health recovery cannot be disregarded. This study aimed to analyze Honduran nursing care for pressure ulcers in patients with invasive mechanical ventilation admitted to Intensive Care Units. A qualitative study approach was used, with in-depth interviews conducted with 12 critical care nurses from July to September 2022. The interviews were recorded, and data analysis was performed using the participants' narratives following Colaizzi's steps. Three themes were obtained, which provide insight into the phenomenon: "The strengths in Honduran nursing interventions," "Negligence in the Honduran nursing care processes," and "Vulnerabilities in the organizational structures." Nurses' experiences highlighted their timely reports and comprehensive, holistic care. However, they undergo negligence in their caring processes, such as low frequency of repositioning, lack of caring plans, and absence of self-training, leading to interdisciplinary work codependency for decision-making. Allocating resources toward nursing care and their professional growth is an investment in providing humane treatment and ensuring the prevention and management of pressure injuries in critical care patients. This study highlights the importance of comprehensive training and standardized protocols for intensive care nurses to improve pressure injury prevention and management in mechanically ventilated patients, emphasizing the need for regular patient repositioning, effective communication, and adequate resources to enhance patient care quality.

Nutritional Support in the Prevention and Treatment of Pressure Ulcers in Healthy Aging: A Systematic Review of Nursing Interventions in Community Care.

Introduction: Pressure ulcers (PUs) represent a significant challenge in chronic care, particularly among the elderly with reduced mobility. They result in substantial socio-healthcare costs and negatively impact patients' psychological well-being. Malnutrition is a key risk factor, hindering healing and increasing the risk of complications. As such, appropriate nutritional interventions are crucial for managing PUs. However, these interventions are often underestimated in clinical practice, underscoring the need for a more comprehensive approach to elder care and healthy aging. Objectives: The primary objective of this study was to identify the best scientific evidence on nutritional interventions implemented by nurses in community settings to prevent complications related to PUs. Additionally, qualitative and quantitative outcomes reported in the included studies were analyzed. Method: This systematic review was conducted following PRISMA international guidelines. Searches were performed in PubMed, Scopus, Embase, and CINAHL databases. A predefined search strategy using Boolean operators was employed, and two researchers independently selected papers, with a third researcher resolving any discrepancies. Additional sources and manual reviews were conducted to minimize selection bias. Results: Out of 1003 records, 6 studies were included. Findings indicate that nurses play a fundamental role in managing PUs in community settings through specific nutritional intervention assistance processes. These healthcare professionals are pivotal in the prevention, care, and rehabilitation of vulnerable individuals with PUs. Conclusions: Nurses are strategic in the management of PUs within community care for frail populations. With nutritional support that plays a key role in both preventing and accelerating the healing of PUs. Policymakers are encouraged to invest in nursing roles to enhance assistance in community contexts, supporting healthy aging and lifestyle medicine approaches.

Las úlceras por presión en la superación profesional del especialista en medicina general integral

Based on the insufficiencies in the performance of the specialist in Integral General Medicine (IGM), the objective of the research was defined: to assess the importance of integrating the prevention and treatment of pressure ulcers as content of the professional improvement process of the specialist in IGM in a new theoretical-methodological conception. The integration of the theoretical foundations showed limitations when assuming the contents of said process, from adequate didactic and methodological procedures. We conceived the methodology from the integration of quantitative and qualitative aspects with the participation of twenty specialists and six managers, with the use of different methods: survey, observation of medical practice, group interview, document analysis and socialization workshop with specialists. The foundation and the diagnosis made justified the need for a new point of view of the professional improvement process of the IGM specialist. We proposed a theoretical-methodological conception from a critical-reflexive, participatory and contextualized approach, as support for methodological procedures for its subsequent objectification. We confirmed the value and significance of the proposal.

Clinical effi cacy of specialized enteral tube feed with arginine, zinc and antioxidants compared with standard enteral feeds in complex pressure ulcers treatment: аn open-label, real-world practice, low interventional randomized parallelgroup trial

Specialised nutritional supplements that promote wound healing shorten the duration of pressure ulcer (PU) healing, but such data are limited in tube-fed patients.Material and methods. The eff ectiveness of a specialized enteral tube feed with arginine, zinc and antioxidants (Nutrison Advanced Cubison) in hospitalized patients with PUs was assessed in a multicenter, prospective, randomized, open-label, parallel-group study involving 67 adult patients with stroke or traumatic brain injury with stage 2–3 pressure ulcers. Tube feed using a specialized product (SpP) was compared with standard enteral tube feed (StdP).Results. Over 28 days, the PU area in the SpP group decreased by an average of 76.9% while in the StdP group by 51.3%; the difference was 26% (95% CI from 5.9% to 45.3%; p = 0.013). By the end of the trial, a decrease in the average PU area by 20% and more from the initial size occurred in most patients in both groups, while the difference between the groups was statistically insignificant (SpP 86.2% vs StdP 69.2%; p > 0.05). The change in total score and components of PUSH© score over 28 days was significant for intragroup changes in both groups (p < 0.001), but intergroup change was statistically insignificant. By the end of the study, complete healing of the PU occurred in 62% of patients in the SpP group compared with 34.6% of patients in the StdP group (diff erence 27%, 95% CI from 1,6% to 56,5%; p = 0.04). The mean time for complete PU healing was reduced by 3.2 days (SpP 21,3 days vs StdP 24,4 days, 95% CI 1.4 to 4.9; p = 0.005).Conclusion. Specialised enteral tube feed stimulates PU healing in hospitalised patients compared with a standard tube feed.

Recent advances in the development of hydrogel dressings for the treatment of pressure ulcers/injuries.

Pressure ulcers, also known as pressure injuries, are common conditions that result from chronic bedrest. These ulcers significantly affect quality of life and substantially burden individuals and society with health costs. The prevention and treatment of pressure ulcers is a primary concern for health care professionals. Dressings play a crucial role in the treatment of pressure ulcers. Hydrogels are innovative safe materials that show great promise for clinical applications. Recent research has demonstrated the potential of hydrogel dressings to promote the healing of pressure ulcers and chronic wounds. This review aims to summarize the mechanisms and effects of hydrogel dressings and to discuss considerations for their use in patients with pressure injuries under different circumstances. Hydrogel dressings, especially loaded with unique cargo, may represent promising new options for the treatment of pressure ulcers. However, additional clinical studies are urgently needed to validate the efficacy and accessibility of hydrogels in clinical practice.

Practical training reduces aspiration-linked gaps in pressure ulcer education for pharmacy students.

Expectations for pharmacists' contribution and involvement in pressure ulcer pharmacotherapy are growing. This study aimed to not only clarify the effects of incorporating practical training on the use of topical medications into clinical preparatory education but also examine the relationship between students' aspiration-or lack thereof-to pursue a career as a pharmacist. The percentage of positive responses to the questionnaire survey on knowledge, skills, and attitudes toward pressure ulcer treatment was significantly higher after the lecture than before and highest after the practical training. In addition, students who aspired to become pharmacists tended to provide a higher percentage of positive responses after the lecture. However, the gap between aspiring and non-aspiring pharmacists tended to narrow after practical training. These results suggest that incorporating practical training on pressure ulcer treatment into lectures improves students' knowledge, skills, and attitudes toward its treatment. Including practical training in pressure ulcer education may compensate for the difference in the educational effect of lectures between students who aspire to become pharmacists and those who do not, thereby improving the educational effect for the latter.

Comprehensive cost-of-illness analysis of pressure ulcer treatment: A real-world study at a Czech university hospital.

Pressure ulcers (PUs) impose a significant economic burden on healthcare systems, affecting patient quality of life and leading to substantial treatment costs. This study presents a cost-of-illness analysis of PU treatment in hospitalized patients in the Czech Republic, based on real-world clinical data. The analysis was conducted using a comprehensive methodology at a Czech university hospital, involving 304 hospitalizations. The study included all hospitalized patients with PUs. Data were collected employing a bottom-up, person-based approach, which refers to the collection and analysis of cost data at the individual patient level. This method captures detailed resource utilization for each patient. The methodology accounted for both systemic and local costs, including materials, medications, caregiver time, and procedures. The study involved 304 hospitalizations, with a mean length of stay of 13 days. The total cost of PU treatment, excluding pharmacotherapy, had a median of €678, while including pharmacotherapy, the median cost rose to €929. Younger patients incurred higher treatment costs. Significant cost variations were observed among different departments. We developed and applied a novel cost model to quantify the expenses associated with PUs, which accurately highlighted the financial burden in the hospital care setting. We present a rigorous methodology for PU cost-of-illness analysis, providing a valuable tool for future research and clinical practice. This comprehensive approach supports the development of targeted interventions to reduce the incidence and severity of PUs, ultimately improving patient care and reducing healthcare costs.

Evaluation of sacral pressure ulcers of older long-term hospital patients for five or fewer years

This study aimed to examine the statuses of sacral pressure ulcer and treatment strategies for 135 elderly patients who were long-term hospital patients. Patients with sacral pressure ulcers were divided into two groups, the cured or non-cured, and the discharged or deceased.The mean age, length of hospital stay, diagnosis, bedridden degree, nutritional status pre and post ulcer development, nutritional administration method, presence on admission or development, depth on National Pressure Ulcer Advisory Panel and treatment duration were examined.The serum albumin levels, lymphocyte counts and hemoglobin levels were calculated, and malnutrition levels were categorized into normal, mild, moderate or severe according to the Controlling Nutritional Status variant scores. The mean age of men (n=62) and women (n=73) was 80.8±4.9 and 86.2±1.2 years, and the mean length of hospital-stay was 25.1±9.6 and 27.3±4.9 months, respectively, indicating a significant difference.The diagnoses did not vary significantly between the cured (n=43) or non-cured (n=92) patients, or in those discharged (n=53) or deceased (n=82) patients.Comparison of the groups revealed that pressure ulcers were difficult to heal in patients with advanced age, those brought to hospital, bedridden degree C2 (unable to turn over), depth level III, moderate to severe malnutrition and those whose Gr did not improve.The effectiveness of gastrostomy management and the ineffectiveness of central venous nutrition were determined. Bedridden degree C2, depth level III, presence on admission, malnutrition on admission and no improvement were the factors for interruption of the healing.