Ulcer Assessment Research Articles

Risk factors assessment of Pressure ulcers among critically ill patients

Risk factors assessment of Pressure ulcers among critically ill patients

The development and use of artificial intelligence (AI) in dermatology: a narrative review

Artificial intelligence (AI) is defined as a computer science involving program development aiming to reproduce human cognition to analyze complex data. Artificial intelligence has rapidly developed in the medical field. In dermatology, its development is relatively new and is generally used in the diagnostic, especially for skin imaging analysis and classification, and also for risk assessment. The greatest advances have been primarily in the diagnosis of melanoma, followed by the assessment of psoriasis, ulcers, and various other skin diseases. The use of AI has shown good accuracy and is comparable to dermatologists in various studies, especially related to melanoma and skin tumors. However, several obstacles exist in the application of AI to daily clinical practice, including generalizability, image standardization, the need for large data quantities, and legal and privacy aspects. In current developments, AI should be aimed at helping enhance the decision-making of clinicians.

Using Near-Infrared Spectroscopy and Education to Support Older Adults with Diabetic Foot Ulcers to Age-in-Place: A Case Series.

The objective of this article is to demonstrate the added value of foot care provided by an RN with foot care training to older adults in their home by focusing on four older adults with diabetic foot ulcers. The RN used a mobile multispectral near-infrared spectroscopy device to enhance the assessment of the diabetic foot ulcers. The Mobile Seniors Wellness Network methodically engaged with English-speaking adults 55 years and older living within a 90-minute radius of the city's community health center. Older adults were referred to the research project through various sources. The participation group included 366 participants with varying holistic healthcare concerns and financial stressors that impacted their ability to age well in place. Over the course of visits by the RN and registered social worker, positive outcomes were facilitated through the collaboration of the participant and the multidisciplinary team, thus enhancing the individual's confidence to remain at home longer. In a time of ongoing provincial health crisis, it may be cost-effective to provide in-home support to those who want to age well in their communities by deploying a Mobile Seniors Wellness Network system throughout the province and enhancing the RN's assessment of feet with a portable and innovative technology tool.

Smart diabetic foot ulcer scoring system

Current assessment methods for diabetic foot ulcers (DFUs) lack objectivity and consistency, posing a significant risk to diabetes patients, including the potential for amputations, highlighting the urgent need for improved diagnostic tools and care standards in the field. To address this issue, the objective of this study was to develop and evaluate the Smart Diabetic Foot Ulcer Scoring System, ScoreDFUNet, which incorporates artificial intelligence (AI) and image analysis techniques, aiming to enhance the precision and consistency of diabetic foot ulcer assessment. ScoreDFUNet demonstrates precise categorization of DFU images into “ulcer,” “infection,” “normal,” and “gangrene” areas, achieving a noteworthy accuracy rate of 95.34% on the test set, with elevated levels of precision, recall, and F1 scores. Comparative evaluations with dermatologists affirm that our algorithm consistently surpasses the performance of junior and mid-level dermatologists, closely matching the assessments of senior dermatologists, and rigorous analyses including Bland–Altman plots and significance testing validate the robustness and reliability of our algorithm. This innovative AI system presents a valuable tool for healthcare professionals and can significantly improve the care standards in the field of diabetic foot ulcer assessment.

Pressure Ulcer: Review Article

This article look into the etiopathogenesis, assessment, prevention and management of pressure ulcer. It also covers the role of pressure release devices and newer treatment methods in healing process of these wounds. Pressure ulcers occur from friction and shear and are progressive. It is usually found in bedridden and immobile people. Spinal cord injury patients have loss of sensation which adds on the problem. Pressure ulcers are preventable usually and based on severity management changes.

Assessment of diabetic foot ulcers: back to basics.

Diabetic foot ulceration affects up to 34% of the global diabetic population as a result of poor glycaemic control. Complications resulting from diabetic foot ulceration can be complex, expensive and challenging. It is important for risk factors to be recognised early and for regular assessment to take place. Streamlining a coordinated approach that enhances communication and guides treatment approaches can help to improve wound outcomes.

A Survey on Impact of Internet of Medical Things Against Diabetic Foot Ulcer

INTRODUCTION: In this study, we explore the intricate domain of Diabetic Foot Ulcers (DFU) through the development of a comprehensive framework that encompasses diverse operational scenarios. The focus lies on the identification and classification assessment of diabetic foot ulcers, the implementation of smart health management strategies, and the collection, analysis, and intelligent interpretation of data related to diabetic foot ulcers. The framework introduces an innovative approach to predicting diabetic foot ulcers and their key characteristics, offering a technical solution for forecasting. The exploration delves into various computational strategies designed for intelligent health analysis tailored to patients with diabetic foot ulcers.
 OBJECTIVES: The primary objective of this paper is to present a technical solution for forecasting diabetic foot ulcers, utilizing computational strategies for intelligent health analysis.
 METHODS: Techniques derived from social network analysis are employed to conduct this research, focusing on diverse computational strategies geared towards intelligent health analysis for patients with diabetic foot ulcers. The study highlights methodologies addressing the unique challenges posed by diabetic foot ulcers, with a central emphasis on the integration of Internet of Medical Things (IoMT) in prediction strategies.
 RESULTS: The main results of this paper include the proposal of IoMT-based computing strategies covering the entire spectrum of DFU analysis, such as localization, classification assessment, intelligent health management, and detection. The study also acknowledges the challenges faced by previous research, including low classification rates and elevated false alarm rates, and proposes automatic recognition approaches leveraging advanced machine learning techniques to enhance accuracy and efficacy.
 CONCLUSION: The proposed IoMT-based computing strategies present a significant advancement in addressing the challenges associated with predicting diabetic foot ulcers. The integration of advanced machine learning techniques demonstrates promise in improving accuracy and efficiency in diabetic foot ulcer localization, marking a positive stride towards overcoming existing limitations in previous research.

Improving Patient Safety: Learning from Reported Hospital-Acquired Pressure Ulcers.

A hospital-acquired pressure ulcer (HAPU) is a localized lesion or injury to the underlying tissue (wound) while the patient is on admission. It occurs when standardized nursing care is not correctly followed in the presence of friction and shear, leading to skin or underlying tissue breakdown. Unfortunately, inadequate knowledge of nurses to assess and provide standardized care for pressure ulcers or manage HAPUs results in patient harm. We aim to share lessons from a reported HAPU incident and address the knowledge gap in patient safety risk assessment, identification, and wound management at Nyaho Medical Centre (Accra, Ghana). A review of HAPU incidents was conducted using quality improvement tools such as cause-and-effect analyses to identify contributing factors and root causes. Subsequently, plan-do-study-act (PDSA) cycles were used to test interventions to improve pressure ulcer assessments and wound management. A run chart was used to analyze and evaluate the interventions over 12 weeks (Aug-Oct 2021). Development of policies and a standard operating procedure for pressure ulcers and wounds improved accuracy in identifying pressure ulcer risks and management of wounds. Eighty-three patients were assessed with the pressure ulcer assessment tool. Complete (100%) adherence to the pressure ulcer and wound policy and standard operating procedure (SOP) was achieved, and the number of HAPUs decreased from five to one during the study period. This study demonstrated that the combined use of quality methods and tools can be suitable for improving processes and outcomes for patients at risk for HAPUs.

Effect of the "aSSKINg" Model in Reducing Pressure Ulcer Risk: A Comparative Study Using the Braden Risk Assessment Score.

Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.

Integrated Artificial Intelligence Approach for Diabetic Foot Ulcer Assessment: A Comprehensive Solution for Precision Diagnosis and Patient Care

Diabetic Foot Ulcers (DFUs) pose significant healthcare challenges, often resulting in severe complications and amputations. Timely and accurate assessment of wound severity is crucial for effective treatment and improved patient outcomes. This study presents an innovative approach to the automated detection of vascular disorders in diabetic feet utilizing infrared thermography. The study employs a dataset comprising 710 thermal images acquired from Al_Wafa Specialized Center for Diabetes and Endocrinology and Bartella General Hospital, which has been meticulously curated for research purposes. To address the specific challenges encountered in diabetic foot imaging and diagnosis, have been introduced three tailored Convolutional Neural Network (CNN) architectures, each designed to identify different risk levels associated with diabetic foot complications. Low-level Diabetic Foot Infection Network (LL-DFI-Net): This architecture is aimed at the detection of low-risk groups, Medium-Level Diabetic Foot Infection Network (ML-DFI-Net) Designed for the medium-risk group, this model targets neuropathic individuals who do not exhibit signs of ischemia.

Prevalence of Bedsores Among Elderly Hospitalized in Imam Reza Hospital in Kermanshah: A Cross-sectional Study

Introduction: Pressure ulcer is one of the serious complications of patients, especially the elderly during hospitalization, which increases the cost of health care and decreases the quality of life of the patient, and often results from long stay in the hospital. Therefore, this study was conducted with the aim of determining the prevalence of bedsores among elderly hospitalized in Imam Reza hospital in Kermanshah. Methods: This cross-sectional study was conducted on 5698 patients referred to Imam Reza hospital between 2019 and 2022. The inclusion criteria were more than 65 years old. Wound assessment was performed based on Braden criteria and wound grading by trained experts. After entering the SPSS version 16 software, the data were analyzed using a chi-square test. Results: The average age of the participants in the study was 77.02 ± 8.27 years, and the highest frequency of bedsores (22.3%) was reported in the age group of 65 to 69 years. Wound grades 1 and 4 had the highest and lowest frequency respectively. The chi-square test analysis showed that the degree of wound and the risk assessment of pressure ulcers were not significant according to gender (P<0.05). Conclusion: According to the results of this study, the prevalence of bedsores in Imam Reza hospital in Kermanshah is high, therefore, health and medical units can play an important role in preventing bedsores by knowing about the at-risk populations and implementing appropriate preventive strategies.

Instrumentos para a avaliação do risco de lesões por pressão para adultos em situação crítica: scoping review*

Objective: to map the instruments for risk assessment of pressure ulcers in adults in critical situation in intensive care units; identify performance indicators of the instrument, and the appreciation of users regarding the instruments’ use/limitations. Method: a scoping review. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews in the writing of the study. We carried out the searches in the EBSCOhost search tool for 8 databases, resulting in 1846 studies, of which 22 studies compose the sample. Results: we identified two big instrument groups: generalist [Braden, Braden (ALB), Emina, Norton-MI, RAPS, and Waterlow]; and specific (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi and Sanada, and COMHON index). Regarding the predictive value, EVARUCI and CALCULATE presented better results for performance indicators. Concerning appreciation/limitations indicated by users, we highlight the CALCULATE scale, followed by EVARUCI and RAPS-ICU, although they still need future adjustments. Conclusion: the mapping of the literature showed that the evidence is sufficient to indicate one or more instruments for the risk assessment of pressure ulcers for adults in critical situation in intensive care units.

The evolution of leg ulcer guidelines and recommendations.

Clinical guidelines aim to consolidate and incorporate the latest evidence and opinion to improve patient outcomes and reduce variations in practice. This article will examine the evolution of clinical guidelines and recommendations in leg ulcer assessment and management, from the seminal Royal College of Nursing clinical guideline (1998) to the current Leg Ulcer Recommendations from the National Wound Care Strategy Program (2023). The evolving definitions of leg ulcers will be discussed, as well as the multidisciplinary approach needed to manage the underlying aetiology of this condition. A national appetite for improving leg ulcer assessment and treatment, is being informed by clinical guidelines and recommendations. The cornerstones of assessment and management remain constant, although some fundamental elements around ankle brachial pressure index ranges, historically used to aid diagnosis of leg ulcer aetiology, have been omitted in the recent recommendations.

Pengaruh Mastery Learning terhadap Kompetensi Perawat Melakukan Pengkajian dan Perawatan Luka Ulkus Diabetikum: Tinjauan Literatur

Competence regarding the assessment and care of diabetic ulcer wounds in nurses is needed so that wound care can be carried out properly. Research on mastery learning in learning for nurses has been carried out a lot. However, there is still a lack of a literature review that looks at how effective this learning is in increasing the competence of nurses regarding the assessment and care of diabetic ulcers. The research method used is a systematic review by identifying journal articles published online consisting of English in 2018-2023. Articles were retrieved using the search engine tools Sciencedirect, Pubmed, and ProQuest. There are 4 journals based on inclusion criteria. The results of the study show that there is an influence of mastery learning in increasing the knowledge, attitudes and skills of nurses in carrying out clinical practice.

Sleep quality and clinical association with sleep disturbance in systemic sclerosis

BackgroundPoor sleep quality is a common and potentially debilitating problem in systemic sclerosis (SSc). To date, no data clarifies the potential factors related to poor sleep quality and the clinical associations with sleep disturbance among Thais with SSc—mainly the diffuse cutaneous SSc (dcSSc) subset. We aimed to evaluate sleep quality and identify the clinical association with sleep disturbance among SSc patients.MethodsA cross-sectional study was conducted between May 2021 and September 2021. Adult SSc patients were enrolled at the Scleroderma Clinic, Khon Kaen University, Thailand. All patients had their neck circumference measured, underwent airway evaluation using the Mallampati classification, had sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI), and the Berlin and Patient Health Questionnaire-9 completed. In addition, the clinical association with poor sleep quality (or sleep disturbance) was investigated using the PSQI.ResultsA total of 88 patients were enrolled. Forty-eight (54.6%) patients experienced poor sleep quality (95%CI 43.6–65.2). Digital ulcers and dyspepsia were associated with poor sleep quality as per a logistic regression (OR 10.73: 95%CI 1.09–106.15 and 4.60: 95%CI 1.01–20.89), respectively. Overall pain—evaluated using the visual analog scale (VAS)—was positively correlated with the PSQI score (Rho 0.2586; p = 0.02).ConclusionAround half of the SSc patients reported poor sleep quality, and the significantly associated factors were digital ulcers and dyspepsia. The PSQI scores positively correlated with overall pain as evaluated by VAS. With early assessment and treatment of digital ulcers, stomach symptoms, and pain control, sleep problems might be reduced among SSc patients.

Temporal Evaluation of the Surface Area of Treated Skin Ulcers Caused by Cutaneous Leishmaniasis and Relation with Optical Parameters in an Animal Model: A Proof of Concept.

Cutaneous leishmaniasis (CL) is a neglected disease caused by an intracellular parasite of the Leishmania genus. CL lacks tools that allow its understanding and treatment follow-up. This article presents the use of metrical and optical tools for the analysis of the temporal evolution of treated skin ulcers caused by CL in an animal model. Leishmania braziliensis and L. panamensis were experimentally inoculated in golden hamsters, which were treated with experimental and commercial drugs. The temporal evolution was monitored by means of ulcers' surface areas, as well as absorption and scattering optical parameters. Ulcers' surface areas were obtained via photogrammetry, which is a procedure that allowed for 3D modeling of the ulcer using specialized software. Optical parameters were obtained from a spectroscopy study, representing the cutaneous tissue's biological components. A one-way ANOVA analysis was conducted to identify relationships between both the ulcers' areas and optical parameters. As a result, ulcers' surface areas were found to be related to the following optical parameters: epidermis thickness, collagen, keratinocytes, volume-fraction of blood, and oxygen saturation. This study is a proof of concept that shows that optical parameters could be associated with metrical ones, giving a more reliable concept during the assessment of a skin ulcer's healing.

517-P: Machine Learning Algorithms Using Electronic Medical Record and Ultrasonography of Lower Extremities for 10-Year Risk Assessment of Diabetic Foot Ulcer in China

Objective: Accurate prediction of diabetic foot ulcer (DFU) occurrence in patients with type 2 diabetes mellitus (T2DM) is crucial for determining appropriate treatment strategy and avoiding amputation and infection. Here, we explored machine learning algorithms (ML) of electronic medical record (EMR) for predicting the incident of DFU. Methods: In this retrospective longitudinal observational cohort, 26579 cases from T2DM database of The Third Affiliated Hospital of Sun Yatsen University from Jan 2011 to Dec 2019 were screened and finally 2770 patients without DFU were enrolled. During 5.6 years of follow-up, 178 patients occurred DFU. 44 clinical parameters including EMR and imaging finding were used to develop a DFU risk prediction model using XGBoost, RF, and LR. Results: ML models were established in 178 patients with DFU (110 male, mean 61.1±12.4 years), and 2591 patients without DFU (1424 male, mean 59.0±12.1 years). XGBoost model achieved the best performance in predicting DFU occurrence with an AUC of 0.94, which is better than the performance of RF with AUC of 0.91and LR with AUC of 0.89. A DFU incident significantly increased in high-risk patients (>10%) in the next 10 years. Conclusion: Our study provided a simple and effective risk tool for the prediction of 10-year DFU risk, which can help professionals clinical screening and decision-making for T2DM patients. Disclosure L.Wu: None. Y.Liang: None. X.He: None. Y.Chen: None.

Validity and reliability of Chinese version of the new diabetic foot ulcer assessment scale.

A specific assessment tool is urgently needed to guide effective wound care for diabetic foot ulcers. However, the tool has not been available in Chinese. We aimed to culturally translate and verify the validity and reliability of the new Diabetic Foot Ulcer Assessment Scale (DFUAS). The original scale was translated into Chinese according to the Brislin guidelines. Patients satisfying the inclusion and exclusion criteria were recruited. Each of the included foot ulcers was evaluated independently by two wound care specialists using the new DFUAS and by the third wound care specialists at the same time using the Bates-Jensen Wound Assessment Tool according to per guidelines. 210 diabetic foot ulcers were included for data analysis. The S-CVI of the Chinese version of the DFUAS was 0.96, and the I-CVIs ranged from 0.89 to 0.98. The total Cronbach's Alpha of the scale was 0.709, and the corrected item-total correlation of the items ranged from 0.4 to 0.872. The DFUAS had high inter-observer reliability of 0.997, and there were weak, moderate, and strong correlations between each pair of the items. The Bland-Altman plots showed a good agreement between the scale and the Bates-Jensen Wound Assessment Tool. We concluded that the Chinese version of the DFUAS showed good validity and reliability and is a reliable instrument for the assessment of diabetic foot ulcers.

Decubitus Ulcers in Patients with Spinal Cord Injury in Different Hospitals of Lahore

BACKGROUND: Spinal cord damage is a debilitating nervous disorder that has a significant economic, social, and psychological burden on those who are affected as well as the healthcare system. The spinal cord can be damaged due to either trauma to the cord or spinal cord dysfunctions. Pressure injuries are the leading secondary complication in patients with spinal cord injuries. OBJECTIVE: The purpose of this research was to document the prevalence of decubitus ulcers in spinal cord injury patients. METHOD: It was a cross-sectional study that included a sample of 114 patients either male or female with traumatic spinal cord injury or non-traumatic spinal cord injury with age ranging from less than 12 years to greater than 89 years from various hospitals in Lahore. The sampling technique used was non-probability convenient sampling. Written consent was taken from all patients before the collection of data. Pressure ulcer assessment was done using the European pressure ulcer prevalence study questionnaire. Data were analyzed using the IBM SPSS STATISTICS-25.0 version. Categorical variables were presented as frequencies and percentages, with the use of bar charts or pie charts. RESULTS: Out of 114 patients 68 patients were male (59.6%) and 46 were female (40.4%). This study concluded that 58.9% of patients had decubitus ulcers whether severe or at stage one of PU as a secondary complication of spinal cord injury. From the total sample of 114 patients 49.9% of participants had the most severe decubitus ulcers mostly on the sacrum which can lead to infection and requires surgical interventions such as debridement. Stage 1 decubitus ulcers were seen on the elbow and back. CONCLUSION: More than half of the patients included in this study had one or more pressure ulcers that can be damaging to their health and quality of life. In developed and developing countries pressure ulcers are widespread but are preventable.
 Key Words:
 Spinal cord injury, pressure ulcer, sacrum

Assessment of Foot Ulcer and Peripheral Neuropathy in Diabetic Patients

Background: One of the most common complications of diabetes mellitus in lower extremity is the diabetic foot ulcer. There are numerous risk factors, among those peripheral neuropathy is the most important risk factor for diabetic foot ulceration. Objectives: To assess the diabetic foot ulcer, probable risk factors and the relationship of diabetic foot ulcer with peripheral Neuropathy. Materials and methods: This cross sectional study was done in the department of General Surgery, Rangpur Medical College Hospital, Rangpur, Bangladesh between May, 2015 to November 2015. 50 patients with diabetic foot ulcer were selected by purposive sampling method. Results: In this study, 60% of patients were above 60 years of age. 82% of patients were male and 18% were female. All patients were with uncontrolled diabetes mellitus and 80% of patients had blood glucose level between 11-20 mmol/L. HbA1c level found >7 in 68% of patients. 72% patients had history of trauma. 66% of the patients were smoker. None of the patients was alcoholic. Peripheral arterial disease was present in 24% patients. 72% patients had peripheral neuropathy. Conclusion: This study may help to raise the awareness among patients and professionals, ultimately which will help to take initiatives for early diagnosis and treatment of high risk patients. KYAMC Journal Vol. 13, No. 04, January 2023: 214-217