Wound Care Clinic Research Articles

Association of wound healing with quality and continuity of care and sociodemographic characteristics

To evaluate the association between clinics' wound healing performance and clinic-level measures of care continuity, clinical quality, and sociodemographic characteristics of the population in their catchment areas. In this cross-sectional analysis, we analyzed electronic health records for 180,336 chronic wounds from 480 wound care clinics during the 2018 calendar year. We measured healing performance using a clinic's observed to expected (O/E) ratio, which is based on the rate at which chronic wounds were predicted to heal within 12 weeks given its case mix and the actual healing rate. We compared the top and bottom quintiles, in terms of the O/E ratio, of clinics. Multivariable regression was used to estimate the effect of the clinic-level measures on the O/E ratio. Clinics in the top quintile had higher rates of care continuity and quality measures, as well as a lower proportion of disadvantaged populations in their catchment areas. In the regression model, 10% increases in a clinic's rate of weekly provider visits, nurse visits, and debridement were associated with 2.5%, 3.0% and 0.7% increases, respectively, in the O/E ratio. The weekly provider visit rate had a greater marginal effect when the proportion of African American residents in the clinic's catchment area was larger. Clinic-level measures of care continuity, clinical quality, and sociodemographic composition of their catchment areas' population explain a meaningful part of differences in clinics' wound healing performance. Better care continuity appears to have a greater beneficial effect in disadvantaged populations.

Management of the wound care clinic during the novel coronavirus pneumonia pandemic period: Sharing of management experience in a general hospital of China

With the surge in the confirmed cases of the novel coronavirus pneumonia, medical resources in many countries have been put on red alert levels. The operation management systems of hospitals, including wound care clinics, must be innovated to ensure the normal operation of the hospital and meet the medical care needs of the people. At the same time, scientific control measures are also required to prevent the spread of the novel coronavirus pneumonia in the hospital. Actually, during the novel coronavirus pneumonia pandemic, emergency management methods for wound care clinics such as online appointments and remote online diagnosis and treatment, the rational arrangement of human resources, the scientific implementation of epidemic prevention and control measures, and the strict implementation of the management of the clinic environment and item disinfection measures to strengthen the management of protective materials, wound care materials, and dressing equipment by partition have been introduced and innovated, thus helping reduce the gathering of people in wound care clinics, create a safe medical environment, and avoid the spread of the novel coronavirus pneumonia caused by diagnosis and treatment.

Background pain in persons with chronic leg ulcers: An exploratory study of symptom characteristics and management.

This exploratory descriptive study aimed to describe characteristics and management of background pain related to chronic leg ulcers. A total of 121 participants were recruited from two wound care clinics using a consecutive sampling method. Data were obtained through screening interview, clinical examination, and questionnaires. The mean average background pain intensity was 4.5 (SD 2.56) (CI 95% 4.0‐5.0). Pain interfered mostly with general activity (mean 4.3), sleep (mean 4.1), and walking ability (mean 4.0) (0‐10 NRS). The most frequently reported descriptors of background pain were ‘tender’, ‘stabbing’, ‘aching’, and ‘hot‐burning’. Most of the participants stated that the pain was intermittent. Less than 60% had analgesics prescribed specifically for ulcer related pain, and the respondents reported that pain management provided a mean pain relief of 45.9% (SD 33.9, range 0‐100). The findings indicate that ulcer related background pain is a significant problem that interferes with daily function, and that pain management in wound care is still inadequate.

Self Care Nursing: Teleassessment Nursing with Chatbot Application the Coronavirus Disease-19 Pandemic Period in North Sumatra

AIM: Patients and families can independently identify health conditions through the chatbot teleassessment nursing application. METHODS: Design descriptive with a cross-sectional approach. The sampling technique used in this study was a purposive sampling technique. Setting at African Social Research Initiative (ASRI) Wound Care Pancing Medan, North Sumatra. One hundred and forty-seven at ASRI wound care clinic and 107 samples with characteristics that all people who have Android and have a telegram application. Data were processed and carried out by descriptive statistical tests. Tested the use of chatbots on outpatients at the ASRI wound care clinic. Participants are first taught how to use the application. This was carried out for 5 months from March to July by testing the use of a chatbot on outpatients at the ASRI wound care clinic. RESULTS: The results of research on teleassessment nursing found that 73 respondents (68%) could do it independently and 34 respondents (32%) could not do it due to their first experience of using chatbots, unstable internet networks, not yet proficient in using applications due to age and low educational background. The study also identified the respondent’s ability to make decisions about using health services. CONCLUSION: The telassessment nursing chatbot application allows patients and families to assess general conditions, danger signs and make decisions to use health services. TRIAL REGISTRATION TRIAL: Nursing Health Research Ethics Commission University of North Sumatera with number 2165/VI/SP/2020.

Outpatient Wound Clinics During COVID-19 Maintained Quality but Served Fewer Patients.

ObjectiveTo evaluate the impact of COVID-19–related disruptions on care continuity and outcomes of chronic wounds.DesignRetrospective cohort study.Setting and ParticipantsElectronic medical records for 152,225 chronic wounds from a network of 488 wound care clinics in 45 US states and the District of Columbia.MethodsWound and patient characteristics, the number of chronic wounds newly seen at the clinics, and 12-week healing rates were compared between the first 2 quarters of 2019 and 2020. Multivariable regression models were constructed to evaluate whether the pandemic was associated with a statistically significant change in the probability of 12-week wound healing after risk adjustment.ResultsDuring the pandemic, wound and patient characteristics did not change compared to the previous year. Case volume dropped as much as 40% in April 2020 but returned to the previous year's level by June. No systematic changes in measures of care continuity were observed. Unadjusted 12-week healing rates remained stable at 0.502 in 2019 and 0.503 in 2020. Likewise, risk-adjusted 12-week healing rates were 0.504 and 0.505 in 2019 and 2020, respectively, but the difference was not statistically significant. States with stricter lockdowns saw a greater decline in case volume. However, the pandemic was not associated with a statistically significant change in the probability of 12-week wound healing in most states. The percentage of wounds with 1 or more telehealth visits increased from 0.14% in 2019 to 1.04% in 2020.Conclusions and ImplicationsDespite COVID-19–related disruptions, our results suggest that wound care clinics maintained standards of care and outcomes for patients who sought care. This positive result should not detract from the problem that the number of new wounds seen at the clinics dropped sharply. Further research should evaluate outcomes in patients with unattended chronic wounds.

Powerless in the Virgin Islands: Emergency Department and Wound Care Clinic Utilization Following the 2017 Hurricanes Irma and Maria on St. Thomas, U.S. Virgin Islands.

The main objective of this work was to characterize the prevalence of acute medical needs by examining emergency department (ED) and outpatient wound care clinic (WCC) visits before, during, and after the 2017 Hurricanes Irma and Maria, in St. Thomas, United States (U.S.) Virgin Islands. Descriptive statistics and logistic regression were used to assess associations between the occurrence of the storms and visits due to injuries and chronic conditions presented to the ED and WCC from September 1, 2016 to May 31, 2018. ED visits increased and the rate of injury care was higher during the storms (12 patient visits per day) than before or after the storms (9 patient visits per day). WCC visits increased during (12%) and after the storms (45%), and were associated with patients 60 years and older. The odds of ED and WCC visits due to injury during the storms were significantly higher (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.17, 1.40) than prior to the storms. The odds for visits due to injuries were 1.19 (95% CI: 1.12, 1.28) times higher after the storms. Increases occurred in ED and WCC visits for injury care during the storms and in WCC visits after the storms. Public health preparedness mandates understanding how major hurricanes impact the prevalence of acute medical needs, and the factors that influence decisions to seek medical care, in their wake.

Calcinosis cutis in systemic sclerosis: a conundrum

Calcinosis cutis (CC) is an autoimmune disorder that presents with a wide range of systemic manifestations. Respiratory and gastrointestinal tracts along with skin are affected. Skin manifestations can progress to significant deformities, causing discomfort to patients severely affecting quality of life. Management of patients with Scleroderma requires a multidisciplinary approach in order to attain the best possible outcomes. Wound care is not yet standardized and multiple approaches exist with varying degrees of success. Surgical approaches vary based on anatomical location along with the depth and area of the wound. It is imperative to provide continuity of care with this patient population. If there is not adequate communication with regards to expectations, the disease burden may progress and ultimately prolong patient treatment. We presented the case of a 65 year old female with scleroderma that is followed within our wound care clinic for long term care of cutaneous lesions. Wound healing varied throughout the duration of treatment with moderate success seen with the use of wound vac therapy.

The Quality of Life of Patients with Colorectal Cancer and a Stoma in China: A Quantitative Cross-sectional Study.

To explore quality of life (QOL) in patients with colorectal cancer and a stoma and factors associated with their QOL. A quantitative cross-sectional study was carried out in the stoma and wound care clinic of a cancer hospital in China. Participants were recruited from clinic patients. Investigators collected demographic data and clinical information; QOL was measured using a Chinese version of the stoma-QOL scale. In total, 359 participants took part; 161 (44.8%) had an ileostomy, whereas the others had a colostomy, and about half of the participants (46.5%) had a permanent stoma. The mean age was 57.86 ± 11.92 years. The QOL scores of most participants were poor, with a median value of 49.44. Participants whose stoma was cared for by others had a significantly lower QOL score than those who cared for their own stomas (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.05-2.38; P = .029). Participants with a temporary stoma had a lower QOL score than those with a permanent stoma (OR, 2.08; 95% CI, 1.275-3.40; P = .004). Further, participants with a complication had a lower QOL score than those without (OR, 1.62; 95% CI, 1.07-2.43; P = .022). These findings suggest a need for well-developed interventions to improve the QOL of these patients. This study provides valuable insights to inform the development of future clinical practice and research in this area in China and beyond.

THE RELIABILITY OF VIBRATION BASED MOBILE PHONE IN DETECTING PERIPHERAL NEUROPATHY IN PATIENT WITH DIABETIC FOOT ULCERS

The aim of this study was to evaluate the reliability of mobile phone vibrations in detecting peripheral neuropathy in diabetic foot wound patients between the nurse and the patient's family. The design of this study was a pilot study with a cross sectional study approach. The study was conducted on 37 respondents in four wound care clinics in Makassar City and its surroundings. The instrument used is a mobile phone vibration using the vibrations-test application. Interater reliability analysis test used cohen's kappa test. The results showed that 67.6% of the patients did not feel the vibrations of the mobile phones performed by the nurses, while 70.3% of the patients did not feel the vibrations of the cellphones carried out by the family. Interrater reliability examination of diabetic feet using a mobile phone vibration shows an almost perfect agreement, namely (k = 0.973). The reliability of mobile phone vibrations using the vibrations-test application is quantitatively reliable. Thus, mobile phone vibrations can be used as an alternative screening tool to detect neuropathy in Diabetes Mellitus patients in the community.

Multicenter cross-sectional investigation on the cleaning status and influencing factors of skin cleaning outside the wound in adult trauma patients

Objective: To investigate the status and influencing factors of skin cleaning outside wound (hereinafter referred to as skin) in adult trauma patients. Methods: A multicenter cross-sectional investigation was conducted. From September 1 to 30, 2020, a total of 952 adult trauma patients who met the inclusion criteria were admitted to wound care clinics or trauma surgery wards of 13 military or local Grade Ⅲ Level A hospitals, including the General Hospital of the Eastern Theater Command of People's Liberation Army and the Army Medical Center, etc. A self-designed questionnaire on cleaning status of skin in trauma patients was released through the "questionnaire star" website to investigate basic information such as gender, age, education level, living status, and self-care ability, trauma information such as cause of injury, wound duration, trauma site, trauma depth, wound pain, wound peculiar smell, and wound cleaning solution, and skin cleaning status after injury such as whether to clean or not, cleaning method, cleaning frequency, cleaning duration in each time, or reasons for not cleaning. The patients who cleaned skin regularly after injury were included in cleaning group, and the other patients were included in no cleaning group. The basic information, trauma information, and skin cleaning status after injury of patients in 2 groups were investigated. Data were statistically analyzed with chi-square test, and binary multivariate logistic regression analysis was performed on indicators with statistically significant differences between the two groups to screen the independent influencing factors of skin cleaning in trauma patients. Results: A total of 952 questionnaires were received, and the recovery rate was 100%. Three invalid questionnaires were eliminated, and 949 valid questionnaires were obtained, with an effective rate of 99.68%. In 949 patients, there were 461 (48.6%) males and 488 (51.4%) females, aged 18-100 (50±18) years. Most patients were less than 60 years old, lived with their families, and could take care of themselves completely. Nearly half of the patients were with junior high school or below education level. The main causes of injury were sharp cutting injury and falling injury, the wound duration was 2-365 days, most of the injured parts were limbs and trunk, the wound depth was mostly full-thickness injury, and most patients had wound-related pain and no peculiar smell and used 5 g/L iodophor to clean the wound. Totally 684 (72.1%) patients cleaned their skin after injury, mainly by scrubbing with warm water, the cleaning frequency was mainly once or twice a week, and the cleaning time was mainly 10 or 15 min for each time. Totally 265 (27.9%) patients didn't clean their skin after injury, and the main causes for not cleaning were following the doctor's advice, followed by worrying about wound infection and loss of self-care ability. There were significantly statistical differences in constituent ratios of education level, self-care ability, cause of injury, wound pain, and wound peculiar smell of patients in 2 groups (χ2=12.365, 24.519, 22.820, 9.572, 92.342, P<0.01). Education level, self-care ability, cause of injury, wound pain, and wound peculiar smell were potential influencing factors of skin cleaning in patients. Binary multivariate logistic regression analysis showed that self-care ability, wound pain, and wound peculiar smell were independent influencing factors of skin cleaning in patients (odds ratio=1.51, 0.52, 3.72, 95% confidence interval=1.08-2.12, 0.42-0.89, 2.66-5.22, P<0.05 or P<0.01). Conclusions: Self-care ability, wound pain, and wound peculiar smell are independent influencing factors of skin cleaning in adult trauma patients.

Prevalence and factors associated with ulcer-related pain in persons with chronic leg ulcers-an explorative study.

The aims of this study were to explore the prevalence of background pain and identify demographic, clinical and psychosocial factors associated with moderate to severe background pain in persons with leg ulcers. All chronic leg ulcers are potentially painful. Research indicates that 80% of persons with chronic leg ulcers experience wound-related background pain. However, studies on factors associated with pain have small samples and findings are inconclusive. Exploratory cross-sectional study. This quantitative study recruited persons with chronic leg ulcers (N = 252) from two wound care clinics using consecutive sampling method. Data were obtained through screening interview, clinical examination and questionnaires. Logistic regression with stepwise backwards elimination was used to identify factors associated with moderate to severe background pain. The STROBE checklist for cross-sectional studies was used for reporting this study. Background pain was reported by 64% of the participants. Inferential statistical analyses suggest that between 58% and 69% of persons with chronic leg ulcers suffer from this type of pain. Factors associated with moderate to severe pain were older age, female gender, reduced sleep quality and diminished health status. In the final model, reduced sleep quality increased the likelihood of having moderate to severe pain in persons with good health status while not in persons with diminished health status. Ulcer-related background pain is common in persons with chronic leg ulcers. Older females reporting insomnia symptoms also had increased risk of moderate to severe ulcer-related background pain. These participants also perceived their health status to be better. This study demonstrates that ulcer-related background pain and associated factors needs more attention in clinical practice. Furthermore, nurses and other healthcare professionals should integrate biopsychosocial strategies to assess and manage ulcer-related background pain.

Wounds and Skin and Soft Tissue Infections in People Who Inject Drugs and the Utility of Syringe Service Programs in Their Management.

Significance: Opioid use disorder and transition to injection drug use (IDU) are an urgent, nationwide public health crisis. Wounds and skin and soft tissue infections (SSTIs) are common complications of IDU that disproportionately affect people who inject drugs (PWID) and are a major source of morbidity and mortality for this population.Critical Issues: Injections in a nonsterile environment and reusing or sharing needles facilitates bacterial inoculation, with subsequent risk of serious complications such as sepsis, gangrene, amputation, and death. PWID are susceptible to infections with a wide spectrum of organisms beyond common culprits of SSTI, including Clostridium and Bacillus spp., as well as Candida.Recent Advances: Syringe services programs (SSPs) are cost-effective and successful in reducing harms associated with IDU. SSPs provide new equipment to PWID and aid in discarding used equipment. SSPs aim to reduce the risks of unhygienic injecting practices, which are associated with transmission of infections and blood-borne pathogens.Future Directions: Concurrently run SSPs and wound care clinics are uniquely positioned to facilitate care to PWID. Providing new, sterile equipment as well as early wound care intervention can reduce morbidity and mortality as well as health care expenditures by reducing the number of SSTI and injection-related wounds that require hospital admission. Establishment of wound care clinics as part of an SSP represents an untapped potential to reduce harm.

Treatment of Diabetic Foot Ulcers With Inforatio Technique to Promote Wound Healing: A Feasibility Trial.

Chronic foot ulcers have extensive consequences for diabetic patients' quality of life and increase risks of amputation and death. The aim of this trial was to assess the feasibility of conducting a larger clinical trial to evaluate the clinical effect of inforatio technique on healing of diabetic foot ulcers (DFUs). Inforatio technique is a novel minimal invasive procedure where small cuts are made on wound beds with punch biopsy tools. This study was a feasibility trial conducted at an outpatient wound care clinic at Zealand University Hospital. Twelve patients with DFUs were included. During a 90-day follow-up, participants visited the clinic 5 times and received inforatio technique twice. Feasibility was assessed with regard to recruitment, acceptability, burden, benefits, protocol adherence, and adverse events. The recruitment rate was 1 patient per eighth day (95% confidence interval [CI] = [4th-13th]), and the retention rate was 100% (95% CI = [74-100]). During follow-up, healing was observed for 4 ulcers (33%, 95% CI = [10-65]) with a mean time for healing of 59 days (range, 22-89) (95% CI = [5-113]). Five ulcers had a reduction of wound area and 3 ulcers had an increase in area from baseline to 90-day follow-up. No temporal relationship was found between inforatio application and wound area increase. There were no patient-reported harmful effects and no adverse events with probable relation to inforatio technique. Patient acceptability and participant adherence were promising. Thus, a larger clinical trial for evaluating the clinical effect of inforatio technique is considered feasible to conduct.

The Audible Handheld Doppler Facilitates Virtual and Blended Care Models During COVID-19

The Wound Bed Preparation (WBP) paradigm was first published in 2000. The paradigm was introduced to highlight the treatment of the “whole patient” and not just “the hole in the patient.” The key messages are to identify/treat the wound cause and examine patient-centered concerns; practitioners should determine if the wound is healable before focusing on the local wound and surrounding region. There is also an emphasis on monitoring the rate of healing, identifying stalled but healable wounds for potential adjunctive therapies, and the need for healthcare systems to facilitate coordinated and integrated interprofessional care. Sufficient blood supply is needed for a wound to heal, and technology can assist in new ways of identifying adequate circulation. Times change, and in this 2021 version of WBP, we have introduced a new way to identify the cause by examining arterial wave forms with a commonly available handheld portable 8-MHz bedside Doppler (audible handheld Doppler [AHHD]) as an alternative to the traditional ankle-brachial pressure index (ABPI). Dr Dieter Meyer has recorded a helpful video outlining the AHHD procedure that can be accessed at https://journals.lww.com/aswcjournal/Pages/videogallery.aspx?videoId=20. There are several advantages of the AHHD versus the traditional ABPI: It is quicker because the patient does not need to be recumbent for 10 to 20 minutes; if needed, the test can be performed with the patient sitting on a chair. There is no squeezing of the calf muscle, which can cause increased pain for the patient. The result is never falsely inflated by calcification of the arteries (ABPI ≥1.3) because the waveform is independent of arterial calcification. Any multiphasic (biphasic or triphasic) wave will result in an AHHD value equivalent to an ABPI >0.9. Comparing AHHD with great toe pressure (>55 mm Hg) is 97.55% specific as an alternative method to rule out arterial disease.1 The screening for arterial disease with only monophasic waveforms triggering an automatic sequential Duplex lower leg Doppler can save healthcare system dollars. The AHHD signal will correctly identify the absence of arterial disease in most persons tested.1 However, there are always exceptions to the rule, including angiosomal (segmental arterial) defects or aberrant arteries. The absence of arterial disease should be confirmed with a physical examination.2 Further, not all patients are mobile or can attend wound care clinics in the community. Given the added risk of novel coronavirus 2019 (COVID-19) infection, and to facilitate virtual and blended care models, the AHHD signal can be recorded by a healthcare professional on a cell phone and transmitted to healthcare facilities with interprofessional wound care experts for leg and foot ulcer care. That is, patient data can be gathered at the bedside by a visiting nurse or qualified healthcare professional with secure connectivity. A comprehensive interprofessional assessment can be completed synchronously or asynchronously. The advantage of a synchronous assessment is that the patient can hear the Doppler sounds and participate in ensuing discussion. The patient can approve management options to adequately address his/her specific concerns. Practitioners can advise patients about realistic outcomes based on their blood supply and ability to manage the wound cause. Although most wounds are healable, practitioners must tailor their approaches to maintenance and nonhealable wounds to emphasize patient-centered concerns.3 With COVID-19 delaying routine patient care and the possibility of viral mutation threatening the continued need for safe interactions, procedures for virtual care and lessons learned from COVID-19 need to be embedded in healthcare systems. Blended care can be combined with WBP principles to optimize wound treatment for improved patient outcomes and lower costs. R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN

A Comparative Analysis of Antibiotic Usage in Diabetic Foot Infections Against Healing Time

The study aimed to analyze bacterial flora in diabetic foot infection, empiric and targeted antibiotic therapy, and factors influencing wound healing duration. The study we undertook a review analysis of data in 118 cases of diabetic foot among 98 patients who reported to the Wound Care Clinic in Warsaw, Poland between 01/2014 and 12/2018. Collected data included sociodemographic data, wounds information, used treatment, results of the microbiological examination, and empiric and targeted antibiotic therapy. For purposes of identifying the empirical and targeted antibiotic compatibility, the patients were divided into subgroups: ETA+ (compatibility of empiric-targeted antibiotic), ETA- (non-compatibility of empiric-targeted antibiotic), NEA (no empiric antibiotic), and NTA (no targeted antibiotic). The study group consisted of men, N = 71 (72.4%) and women, N = 27 (27.6%). Twenty patients (20.4%) were diagnosed as obese according to the body mass index classification. Staphylococcus aureus and Enterococcus faecalis were identified in most cases [N = 53 (24.4%), and N = 41 (18.9%), respectively]. Sixteen patients (13.6%) received gentamycin locally. Amoxicillin with clavulanic acid, clindamycin, and levofloxacin were the most frequently used antibiotics as empiric therapy; meanwhile, in targeted therapy, amoxicillin with clavulanic acid and levofloxacin were most frequently used. Empiric and targeted antibiotic therapies were compatible in 65 (55.1%) cases. The duration of healing did not differ between selected subgroups, and was longer in obese patients (p = .001). Other variables did not influence the healing time. The use of empiric antibiotic therapy before targeted therapy and the topical use of gentamycin did not reduce the healing time of diabetic foot infection. The healing time of diabetic foot infection was longer in obese patients than in nonobese patients.

Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound

Background: Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. Objectives: To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. Methods: The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. Results: All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. Conclusions: We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.

Body Image as a Mediator Between Gender and Quality of Life Among Patients With Diabetic Foot Ulcers in Indonesia.

Foot ulcers cause women in Indonesia to lose opportunities to participate in religious and cultural activities due to the inability to wear certain footwear. This study examined body image as a mediator in the relationship between gender and quality of life (QoL) among patients with diabetic foot ulcer (DFU) in Indonesia. A cross-sectional design with convenience sampling was used to recruit participants at the Surgical Outpatient Department and Wound Care Clinic in Bali, Indonesia. The Diabetic Foot Ulcer Scale-Short Form and the body image domain of the Body Investment Scale were administered. We found gender differences in participants' (n = 201) QoL and body image (p < .05). Body image fully mediated the effect of the relationship between gender and QoL (B = 6.68; 95% confidence interval [3.14, 10.52]) and explained 39.13% of the variance. Health care providers should consider patients' religious beliefs in DFU education and consider women's body image issues. Diabetes foot ulcer may prevent women from performing religious rituals, thus, influencing their QoL. Protective strategies to prevent DFU among women in Indonesia warrant further development.

Real time reorientation and cognitive load adjustment allow for broad application of virtual reality in a pediatric hospital

With a new generation of affordable portable virtual reality (VR), clinicians are discovering more utility for VR, while also identifying opportunities for improvement, such as the inability to reorient the horizon line during repositioning or transport, or modulate cognitive load in real time. At our institution, this lack of functionality prohibited or decreased VR usage in some clinical scenarios such as dressing changes with dynamic positioning. The purpose of this brief report is to describe the development and use of a VR application that is optimized for the healthcare setting and report historical effects of patients who utilized VR as supplement to Child Life procedures. Eligible affects per chart review included Happy, Relaxed, Anxious, Distressed, Unable to Assess. Given the need for real-time reorientation and cognitive load modulation, we created the Space Pups™ VR application. The experience was launched as part of the Stanford Chariot Program in the summer of 2017, and its usage was tracked through the electronic medical record and a VR application dashboard. Chart review was queried from 3 January 2018 to 9 August 2021 for pediatric patients who used VR with real-time reorientation and cognitive load modulation as a supplement to their Child Life interventions. The Space Pups™ experience has been successfully used in a variety of settings, including perioperative care, vascular access, wound care, and ENT clinic, a total of 1696 times. Patients ranged from 6 years to 18-year old, with no reports of side effects. Significant results (P<0.001) were observed pre- and post-VR use for affect improvements in Happy, Relaxed, and Anxious, but not for Distressed. The ability to reorient VR experiences in real time has increased functionality where other applications have failed. While more studies are needed to quantify the anxiolytic and pain-reducing effect of Space Pups™, our report demonstrates the feasibility of this VR experience as a non-pharmacological modality to safely increase patient cooperation in a wide variety of clinical settings.

Vascular Assessment in Patients With a Lower Limb Wound: A Correlational Study of Photoplethysmography and Laser Doppler Flowmetry Toe Pressure Techniques.

Vascular assessment of the lower limbs is essential in patients with diabetes. In the presence of noncompressible arteries, the ankle brachial index (ABI) can either be inconclusive or provide false-positive results. Toe pressure measurement has been suggested as an alternative as a noninvasive method for detecting peripheral arterial disease (PAD). Toe pressure measurement can be performed either by photoplethysmography (PPG) or by Laser Doppler flowmetry (LDF). The aim of this study was to determine correlations between the two techniques in order to promote the use of PPG in clinical practice. This was a prospective correlational study of 108 consecutive recruited adult patients, with and without diabetes, with at least one lower limb wound from a University-affiliated hospital wound care clinic. Toe pressure measurements were both performed with PPG and LDF devices. Mean toe pressure values for PPG and LDF were, respectively, 83.7 (SD 35.4) and 79.5 (SD 32.0) mmHg (with a paired t-test 3.969, P < 0.01). In patients with at least one lower limb wound, a strong linear relation was found between PPG and LDF toe pressure techniques with a Pearson's r correlation coefficient of 0.920 (P < 0.001). PPG and LDF toe pressure techniques are equivalent in patients with at least one lower limb wound, irrespective of the presence of diabetes. Therefore, in the presence of an ABI with inconclusive results, such as in a patient with noncompressible vessels, both toe pressure techniques can be used for assessing the vascular supply of the lower limb with a wound.

Specialised wound care clinics in Spain: distribution and characteristics.

To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.