Treatment Of Pressure Injuries Research Articles

EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial

BackgroundProphylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients.MethodsThis is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses.DiscussionThis trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19.Trial registrationANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019

Nurse-led coaching of shared decision-making for wound treatment of pressure injury: A pilot study of a randomized trial.

International guidelines for managing pressure injury (PI) and ulcers recommend that family members and caregivers should be involved in making decisions for appropriate wound care. However, the effect of shared decision-making (SDM) in the context of PI remains unknown. This study investigated the efficacy of nurse-led medical SDM for PI treatment. We constructed a patient decision aid (PDA) for PI treatment on the basis of nursing evidence. Subsequently, we conducted a pilot randomized controlled trial to evaluate the efficacy of SDM compared with that of usual care (control group, [CG]) for PI treatment. Participants with stage 3, stage 4, or unstageable PI were included and randomized into two groups. In the SDM group (SDMG), 10 participants received the SDM intervention for PI before treatment. All participants were followed up for 4 weeks. Primary outcomes were measured using the nine-item SDM Questionnaire (SDM-Q-9) and Decisional Conflict Scale (DCS). Secondary outcomes included wound size and cost of wound management. The expert validity (medical professors and general population) of the PDA designed for PI was measured, and the content validity index was 0.96-0.97. A total of 20 participants were enrolled (10 received SDM and 10 received usual care). The mean age of the participants was 55.7 ± 8.8 years. No significant difference in baseline characteristics (sex, age, staging, or wound area) was observed between the two groups. The SDMG had higher SDM-Q-9 (P < 0.001) and DCS (P < 0.01) scores than did the CG. For the secondary outcomes, the SDMG had a decreased change of wound size and lower wound management costs than did the CG; nevertheless, the differences were not statistically significant. We constructed a PDA for PI treatment, which can be applied in clinical care. The pilot test results revealed that the participants had a lower cost related wound treatment and decreasing wound size in SDMG than CG after the intervention of SDM-PI for 4 weeks. In the future, clinical studies should conduct large-scale randomized trials based on the results of this pilot study.

Critical Care Nurses' Knowledge, Attitudes, and Practices Regarding Pressure Injury Treatment: A Nationwide Cross-Sectional Survey.

Pressure injury is a common problem in intensive care units. Critical care nurses play an important role in multidisciplinary teams performing pressure injury treatment. Identifying the clinical status of pressure injury treatment may contribute to improving care quality. To identify the knowledge, attitudes, and practices regarding pressure injury treatment in critical care nurses. A cross-sectional survey. Secondary data were extracted from a multicenter clinical trial. Knowledge and attitudes toward pressure injury treatment were assessed through a self-administered eight-item questionnaire. The observed practices were recorded using a case report form. The report was in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. A total of 950 critical care nurses in 15 hospitals from six provinces/municipalities of China were investigated. The mean knowledge score was 2.89 ± 1.16 (95% confidence interval: 2.82-2.97) out of a possible total of 5 points. The correct rates of selecting wound dressings and pain management were 34.4% and 45.6%, respectively. The mean attitude score was 9.07 ± 1.09 (95% confidence interval: 9.00-9.13) out of a possible total of 12 points. A total of 2092 patient days of pressure injury treatment practices were observed and recorded. Repositioning was the most commonly employed treatment measure (98.8%). Foam dressing was the common dressing for stage I (53.6%), stage II (47.5%), and more severe pressure injury (67.9%), including stage III, IV, unstageable, and suspected deep tissue injury. Critical care nurses exhibited a generally low level of knowledge and moderate attitudes regarding pressure injury treatment. Practices of pressure injury treatment were generally acceptable.

Pressure injury screening in the emergency department: A concept analysis.

This concept analysis analyzes pressure injury screening in the emergency department setting using Walker and Avant's approach. Pressure injury treatment cost in the United States totals over 11 billion dollars annually. Although a pressure injury could develop in the few hours a patient is in the emergency department, there is little guidance on how an emergency department should screen, prevent, and treat patients. Five sources resulted from database searches of CINAHL full-text, Health Business FullTEXT, and MEDLINE with Full Text. Key search terms used to narrow the search consist of the following terminology: "pressure injury" OR "pressure ulcer" AND "screening" AND "risk factors" AND "emergency room" OR "emergency department. Walker and Avant's method of concept analysis was used to clarify the concept of pressure injury screening in the emergency department. The concept analysis identified two attributes of pressure injury screening in the emergency department: patient length of stay and the cost of pressure injury treatment. Antecedents identified are patient risk factors: age, mobility status, sensory perception, comorbidities, and pre-existing pressure injuries. Positive consequences identified are increased patient comfort, increased staff satisfaction, decreased hospital-acquired pressure injuries, and increased adherence to established treatment protocols. This concept analysis may help to guide evidence-based practice for pressure injury screening in the emergency setting. Perhaps screening in the emergency department, if adopted globally, is the missing element needed to finally see a reduction in pressure injury rates.

Impact of Nutrition on the Prevention and Treatment of Pressure Injuries in Critically Ill Patients: An Integrative Review.

To review the main scientific evidence on nutrition in the prevention and treatment of pressure injuries (PIs) in critically ill adult patients. The searches were carried out in several scientific databases, namely, Scientific Electronic Library Online (SciELO), Public MEDLINE (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. The MeSH terms used were "pressure injury", "nutrition", and "intensive care". Studies published between January 1, 2005, and July 1, 2020, were included. Seven studies met the eligibility criteria and were included in this review. The searches were carried out in August 2020. The authors selected studies available in Portuguese, English, and Spanish. Two independent researchers conducted the searches and read the article titles and abstracts. The studies that met the inclusion criteria were fully evaluated. Disagreements between reviewers were resolved by consensus, and when there was no consensus, a senior researcher was consulted. Data extraction was performed using a standardized form. Level-of-evidence analysis according to the type of study followed the classification proposed by the Oxford Center Evidence-Based Medicine. The evidence available on the use of standard enteral nutrition therapy and enteral nutrition therapy enriched with hyperprotein and hypercaloric nutrition supplements as well as the addition of zinc, eicosapentaenoic acid, γ-linolenic acid, and vitamins (A, C, D, and E) is limited in terms of supporting a specific nutrition support modality in the prevention and treatment of PI in the intensive care population. Malnutrition negatively impacts both the prevention and healing of PIs. The evidence available on the use of standard enteral nutrition therapy versus enrichment with nutrition supplements is too limited to support a specific nutrition modality in the prevention and treatment of PI in the intensive care population.

Therapeutic Support for Pressure Injuries

&#x0D; Reactive air surfaces, alternating-pressure (active) air surfaces, and reactive gel surfaces may be more effective at preventing pressure injuries compared to foam surfaces. The clinical effectiveness of therapeutic support surfaces to prevent pressure injuries may be influenced by the care setting (e.g., long-term care, acute care, intensive care units) as well as follow-up time.&#x0D; An overview of reviews with a network meta-analysis did not find any significant differences between different types of support surfaces on time to pressure injury. However, limited evidence suggests there may be a difference between foam surfaces, compared to other types of foam surfaces.&#x0D; Specialized skin protection cushions may also help to prevent pressure injuries compared to standard foam cushions, though there may be no difference between different types of air cushions.&#x0D; It was unclear if there are significant differences between support surfaces for the treatment of pressure injuries. Authors of an overview of reviews stated that reactive air surfaces may be more effective than foam surfaces, but this was not statistically significant.&#x0D; Limited evidence was identified regarding adverse events and health-related quality of life, as well as for pediatric patients.&#x0D; Limited evidence was identified for support surfaces other than mattresses, beds, and overlays (e.g., cushions), as well as therapeutic small devices for prevention of pressure injuries. No studies were identified for therapeutic small devices for treatment.&#x0D;

Telemedicine for Preventing and Treating Pressure Injury After Spinal Cord Injury: Systematic Review and Meta-analysis.

BackgroundPressure injury is a common complication after a spinal cord injury. Long-term multidisciplinary follow-up is difficult after such patients have been discharged. Telemedicine promises to provide convenient and effective support for the prevention and treatment of pressure injury, but previous attempts to demonstrate that have produced inconsistent results.ObjectiveThe aim of this study is to evaluate the effectiveness of telemedicine in preventing and treating pressure injury among community-dwelling patients with spinal cord injury, and determine which telemedicine form is more effective.MethodsThis systematic review was performed according to the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analysis) standards. Ten databases were searched to identify randomized controlled trials and quasi-experimental studies related to the effectiveness of telemedicine intervention in patients with spinal cord injury. Two researchers worked independently and blindly selected studies, extracted data, and assessed the risk of bias. The results were described as relative risk (RR) and weighted mean difference and 95% CI.ResultsThe 35 studies comprised 25 randomized controlled trials and 10 quasi-experimental studies involving 3131 patients. The results showed that telemedicine can significantly (P<.05) reduce the incidence of pressure injury (RR 0.24, 95% CI 0.14-0.41; P<.05; I2=0%), promote faster healing (RR 0.73, 95% CI 0.62-0.85; P<.05; I2=0%), and yield lower scores on the pressure ulcer scale of healing (weighted mean difference=–1.98, 95% CI –3.51 to –0.46; P<.05; I2=0%). Cumulative ranking estimates showed that combining telemedicine with conventional intervention (93.5%) was the most effective approach.ConclusionsTelemedicine is a feasible way to prevent pressure injury among patients with spinal cord injuries. It can decrease the incidence and severity of pressure injury and accelerate patients’ healing without imposing economic burden. It is best used in tandem with other, more conventional interventions. Due to the limited quality and quantity of included studies, large-scale and well-designed randomized controlled trials are warranted.

Clinical Pearls.

Injuries from medical devices account for about 30% of all hospital-acquired pressure injuries. Although several professional organizations prioritize early identification and treatment of pressure injuries, those caused by endotracheal tubes (ETTs) continue to occur.Moser and colleagues examined the current evidence to identify the reported incidence of ETT-related pressure injuries and evaluate the effectiveness of prevention methods. They found Although further study with standardized measures in various patient populations is warranted, the authors recommend use of Anchor-Fast and nasal barrier dressings to reduce the incidence of pressure-related ETT injuries.See Article, pp 416-424Research has shown that use of a checklist during intensive care patient rounds can improve quality of care and reduce the incidence of adverse events. However, difficulties with interprofessional communication during rounds may contribute to differences in patients’ plans of care.Alves and colleagues developed and validated a checklist of care to improve interprofessional communication during rounds in a pediatric intensive care unit (PICU). After multiple phases of evaluation with many expert clinicians—physicians, nurses, and pharmacists—their findings include Findings suggest that a PICU checklist supports standardization of interprofessional rounds, improving communication between professionals from different disciplines to provide consensus on patients’ plans of care.See Article, pp 383-389Communication is a challenge for patients receiving mechanical ventilation. Although various nonverbal methods of communication are possible, these are challenging and often stressful for patients. Use of a speaking valve with patients who have a tracheostomy can restore the voice; however, information on the effectiveness of this device during invasive ventilation is limited.Sutt and colleagues evaluated the use of a speaking valve on successful communication with adult patients with a tracheostomy who are receiving mechanical ventilation. They found The authors suggest that restoring airflow to the upper airway with the speaking valve may improve patients’ progress toward decannulation. They recommend use of a speaking valve for better communication with adults receiving mechanical ventilation who have a tracheostomy.See Article, pp 411-415Critical access hospitals (CAHs) were established in the late 1990s to improve health care access for rural patients. Often CAHs have limited services and technology to care for the critically ill; however, end-of-life (EOL) care does occur in these settings. As EOL care is 1 of the 5 national nursing research priorities of the National Institute for Nursing Research, it is important to understand EOL care in CAHs.Beckstrand and colleagues surveyed nurses from 39 CAHs to understand their perceptions of the obstacles and helpful behaviors in EOL care. They found The findings show that CAH nurses believe they provide high-quality EOL care. The authors recommend further research to develop effective educational tools for CAH families.See Article, pp 375-382

Development and psychometric evaluation of an instrument to assess Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) in Indonesian community-dwelling older adults

BackgroundThe prevalence of pressure injuries among community-dwelling older adults in countries worldwide is still a serious problem. In Indonesia, older adults mostly rely on family members for (medical) care. Therefore, involving family members in the prevention and treatment of pressure injuries (PIs) could potentially decrease its prevalence rates. However, family members are usually not trained for such tasks. Hence, it is essential to first get more insight into the current state of affairs on family members’ knowledge, attitude and actual practice of preventing PIs. Due to the lack of an existing instrument to measure knowledge, attitude and practice of family caregivers in preventing PIs, this study focuses on the development and evaluation of psychometric properties of such an instrument.MethodsThree phases of instrument development and evaluation were used, including item generation, instrument construction and psychometric testing of the instrument. A total of 372 family caregivers of community-dwelling older adults who randomly selected participated in this study. Principal factor analysis, confirmatory factor analysis and Cronbach’s alpha were performed to evaluate factor structure and internal consistency of the Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) instrument.ResultsThe final version of the KAP-PI-instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach’s Alpha values of 0.83, 0.93 and 0.89, respectively. The instrument appeared to be both reliable and valid.ConclusionThe KAP-PI instrument can be used in family nursing or community nursing practice, education, and research to assess knowledge, attitude and practice of pressure injury prevention of family caregivers.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

The 2021 Update on Pressure Injuries: A Review of the Literature.

To provide a review of the recent literature on the epidemiology and treatment of pressure injuries (PIs). This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Identify risk factors for developing PIs.2. Differentiate factors that could affect the healing of PIs.3. Select strategies that have an impact on the development of PIs. Keeping up with the literature on pressure injuries is always a challenge for busy clinicians. In this article, the authors summarize six important articles published in 2021. Articles cover a range of topics including epidemiology, treatment, precision medicine, nurse staffing, and patient preferences for care. For each article, a description of the study results is provided along with a comment on why the results are important. This information is intended to help clinicians incorporate new data into their clinical practice.

Associated Risk Factors and Barriers of Pressure Injury Wound Healing Process: A Retrospective Study of Single-Center Experience

Introduction: Pressure injuries, particularly those involving dressings, are associated with high rates of morbidity, mortality, and costs. Furthermore, it has a significant impact on patients, family members, and health care systems, increasing pain symptoms, wound odor, hospital stay duration, and even mortality, all of which have a negative impact on quality of life. In the medical literature, a number of variables have been identified that predispose patients to poor wound healing. Diabetes mellitus, venous insufficiency, peripheral artery disease, tobacco smoking, low serum albumin, and inflammatory disorders are among the causes. Objectives: The main aim of this study was to identify risk factors and barriers that may confer on poor wound healing. Methods: This is a retrospective study, which was carried out in Dubai Hospital, Dubai Health Authority (DHA), for the period June 2020 until December 2020. Result: The present study consisted of 146 patients. Paired t test revealed statistically significant improvement in pressure injury healing in terms of length and width at discharge compared to pressure injury (p< 0.05). On the other hand, depth improvement was not statistically significant (p> 0.05). χ² test revealed a statistically significant relationship between pressure injury healing and low albumin levels, diabetes, and advanced age (p < 0.05), while there was no statistically significant association between the location of the pressure injury and the healing process (p> 0.05). Furthermore, there was no statistically significant relationship between Braden category, length of stay, or patient hospitalization and pressure injury healing (p> 0.05). Conclusion: The healing process might be influenced by single or multiple factors. The findings of this retrospective study revealed that low albumin levels, diabetes patients, and age all had an impact on the healing of pressure injuries. When planning and implementing a complete pressure injury treatment strategy, health care practitioners should keep these things under consideration. On the other hand, pressure injury’s location, Braden category, length of stay, and patient hospitalization did not reveal a significant effect on wound healing, despite the fact that other studies showed an effect of these factors on the healing process.

Clinical Coders' Perspectives on Pressure Injury Coding in Acute Care Services in Victoria, Australia.

Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.

Malnutrition and Pressure Injury Risk in Vulnerable Populations: Application of the 2019 International Clinical Practice Guideline.

Nutrition plays a vital role in promoting skin integrity and supporting tissue repair in the presence of chronic wounds such as pressure injuries (PIs). Individuals who are malnourished are at greater risk of polymorbid conditions, adverse clinical outcomes, longer hospital lengths of stay, PI development, and mortality, and incur increased healthcare costs compared with patients who are adequately nourished. In addition, some patient populations tend to be more vulnerable to PI formation, such as neonates, patients with obesity, older adults, and individuals who are critically ill. Accordingly, this article aims to review the latest nutrition care recommendations for the prevention and treatment of PIs, including those recommendations tailored to special populations. A secondary objective is to translate nutrition recommendations into actionable steps for the healthcare professional to implement as part of a patient plan of care.Implementing an evidence-based plan of care built around individualized nutrition interventions is an essential step supporting skin integrity for these populations. The 2019 Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline (CPG) affirms that meeting nutrient requirements is essential for growth, development, maintenance, and repair of body tissues. Many macronutrients and micronutrients work synergistically to heal PIs. Registered dietitian nutritionists play an important role in helping patients identify the most nutrient dense foods, protein supplements, and oral nutrition supplements to meet their unique requirements.

The efficacy and safety of moxibustion for pressure injury: A protocol for systematic review and meta-analysis.

Background:Pressure injury is an important global health issue characterized by the high incidence, rapid progression, and difficult healing. How to perform timely treatment and care have been the current focus and challenge for health care professionals. Moxibustion can improve skin microcirculation, promote blood circulation, activate tissue cells, inhibit, and kill bacteria on the wounded surface, thus promoting wound healing. However, the clinically reported efficacy of moxibustion in the treatment of pressure injuries varies a lot and lacks evidence-based medical evidence. Therefore, this meta-analysis aims to evaluate the efficacy and safety of moxibustion on the treatment of pressure injuries.Methods:Randomized controlled trials (RCTs) reporting the moxibustion for pressure injury published before January 2022 will be searched in online databases, including the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science. References of eligible literatures will be manually reviewed. According to inclusion and exclusion criteria, literature screening, data extraction and quality assessment will be independently performed by 2 reviewers, and meta-analysis of relevant data will be conducted using Stata14.0 software.Results:The study will provide a high-quality convincing assessment of efficacy and safety of moxibustion for pressure injury.Conclusion:The results of this study will provide the latest evidence support for judging the efficacy and safety of moxibustion on the treatment of pressure injury.OSF Registration number:DOI 10.17605/OSF.IO/T543Y.

Pressure injuries in Australian public hospitals: A cost of illness study

BackgroundPressure injuries are a leading hospital adverse event, yet they are mostly preventable. Understanding their financial costs will help to appreciate the burden they place on the health system and assist in better planning and management of health expenditures to prevent pressure injuries. ObjectiveTo estimate the cost of pressure injuries in Australian public hospitals in 2020 demonstrating its economic burden in a well–resourced health system. MethodsA cost of illness study with a 12-month time horizon was conducted. Resource use for the treatment of pressure injuries and productivity loss due to pressure injuries were derived using a bottom-up approach. Parameters of the cost estimates were obtained from secondary sources and literature syntheses. A simulation with 10,000 draws was used to generate statistical properties of the cost estimates. ResultsBased on a prevalence of 12.9%, the total cost of pressure injuries in Australian public hospitals was $9.11 billion [95% confidence intervals: 9.02, 9.21]. The two largest shares of costs were accounted for by the opportunity cost of excess length of stay of $3.60 billion [3.52, 3.68] and treatment costs of $3.59 billion [3.57, 3.60]. Productivity loss associated with pressure injuries amounts to $493 million [482, 504]. Hospital-acquired pressure injuries account for a total of $5.50 billion [5.44, 5.56], whereas pressure injuries present on admissions costed $3.71 billion [3.70, 3.72]. In terms of severity, Stage 2 pressure injuries contributed the most to total treatment costs, total excessive length of stay, and total loss of healthy life years. Australian society is willing to pay $1.43 billion [1.40, 1.45] to save 6,701 [6,595; 6,807] healthy life years lost by pressure injury. ConclusionsReducing preventable pressure injuries and stopping the progression of Stage 1 pressure injuries will likely result in an immense cost-saving for Australia and will likely have similar benefits for other countries with comparable profiles. Tweetable abstractAustralian public hospital study provides comprehensive analysis of the cost of pressure injury, including estimates of direct and indirect medical costs, and indirect non-medical costs - such as productivity and quality of life.

Osteomyelitis and antibiotic treatment in patients with grade IV pressure injury and spinal cord lesion-a retrospective cohort study.

Retrospective cohort study. To analyze characteristics and treatment of osteomyelitis (OM) in the treatment of grade IV pressure injury (PI) in patients with spinal cord injury/disorder (SCI/D) following the Basel Decubitus Concept. Acute care and rehabilitation clinic specialized in SCI/D. Patients with SCI/D were admitted for grade IV PI treatment between 1st January 2010 and 28th February 2015. Patients, SCI/D, and PI characteristics were collected from chart reviews. Descriptive statistics and differences between groups with and without OM were evaluated. In total, 117 patients (87 male, 30 female) with 130 PI grade IV were included. In 95 patients (81%), OM was diagnosed histologically. In 87 cases, more than one bacterial species was involved. Out of 49 different bacterial species, Enterococcus faecalis and Staphylococus aureus were most frequently observed. Amoxicillin/clavulanic acid and ciprofloxacin were the most frequently used out of 24 different antibiotics. Length of antibiotic treatment varied between <8 days and >91 days with 31 patients receiving antibiotics for about 8 weeks. Complications occurred in all groups of antibiotic duration. Having a paraplegia, no OM and sacral PI was associated with increased complication rates, but the number of patients did not allow comprehensive risk factor analysis. Because the variety of patients concerning SCI/D, PI, and OM characteristics did not show a conclusive relation between length of antibiotic treatment and complication rates, the development of a subgroup specific treatment concept for PI in patients with SCI/D would be favorable to further optimize antibiotic treatment.

Study on the Multitarget Mechanism and Active Compounds of Essential Oil from Artemisia argyi Treating Pressure Injuries Based on Network Pharmacology.

In order to comprehensively explore multitarget mechanism and key active compounds of Artemisia argyi essential oil (AAEO) in the treatment of pressure injuries (PIs), we analyzed the biological functions and pathways involved in the intersection targets of AAEO and PIs based on network pharmacology, and the affinity of AAEO active compounds and core targets was verified by molecular docking finally. In our study, we first screened 54 effective components according to the relative content and biological activity. In total, 103 targets related to active compounds of AAEO and 2760 targets associated with PIs were obtained, respectively, and 50 key targets were overlapped by Venny 2.1.0. The construction of key targets-compounds network was achieved by the STRING database and Cytoscape 3.7.2 software. GO analysis from Matespace shows that GO results are mainly enriched in biological processes, including adrenergic receptor activity, neurotransmitter clearance, and neurotransmitter metabolic process. KEGG analysis by the David and Kobas website shows that the key targets can achieve the treatment on PIs through a pathway in cancer, PI3K-Akt signaling pathway, human immunodeficiency virus 1 infection, MAPK signaling pathway, Wnt signaling pathway, etc. In addition, molecular docking results from the CB-Dock server indicated that active compounds of AAEO had good activity docking with the first 10 key targets. In conclusion, the potential targets and regulatory molecular mechanisms of AAEO in the treatment of PIs were analyzed by network pharmacology and molecular docking. AAEO can cure PIs through the synergistic effect of multicomponent, multitarget, and multipathway, providing a theoretical basis and new direction for further study.

The role of plastic surgery in the treatment of pressure injuries: report of 38 cases in a trauma care center

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Tratamento de lesão por pressão em pessoas com diagnóstico de COVID-19 em internação hospitalar

This is an integrative literature review, which sought to highlight and discuss the possibilities of pressure injury treatment in people diagnosed with COVID-19 in hospital, based on scientific publications indexed in the Medical Literature and Retrieval System Online database. , between 2020 and 2021. 24 articles were obtained. Following the inclusion criteria, 09 studies were selected for analysis. Some evidence in the literature that suggests a significant increase in pressure injuries in patients who develop severe acute respiratory syndrome associated with COVID-19, which requires prolonged intubation, tracheostomies and prone position. Pressure injuries were pointed out in many cases as unavoidable. Treatment is essential for existing injuries, but preventive measures to combat the main extrinsic risk factors are fundamental and have always been available to everyone in the health team. Therefore, prevention is the culture of risk factor control and, regardless of the patient's condition, we must prevent pressure injuries.