Wound Clinic Research Articles

Energy-protein intake and meal frequency in diabetic foot patients at the wound clinic of Dr. Rafael Hernández L Hospital, Panama

Energy-protein intake and meal frequency in diabetic foot patients at the wound clinic of Dr. Rafael Hernández L Hospital, Panama

Audit of Antimicrobial Prescribing Trends in 1447 Outpatient Wound Assessments: Baseline Rates and Impact of Bacterial Fluorescence Imaging.

Background/Objectives: In the field of wound care, the prescription of antibiotics and antimicrobials is haphazard and irrational, which has led to unchecked overprescribing. Recent Joint Commission guidelines mandate that hospital outpatient clinics develop and implement antimicrobial stewardship programs (ASPs). Yet few ASPs exist in wound clinics across the United States (US). Understanding baseline prescribing practices and rates in the US is a critical first step toward rational antimicrobial use and effective ASPs. Methods: This prospective study was conducted across eight outpatient wound clinics from January-December 2022. Data from consecutive patients attending single-time-point initial visits were recorded, including clinical findings, antimicrobial prescribing trends, and sampling practices. Results: A total of 1438 wounds were included; 964 were assessed by clinical examination (standard of care, SoC), and 474 by clinical examination plus fluorescence imaging. SoC patients were prescribed more concurrent medications on average than fluorescence patients (1.4 vs. 1 per patient). Prescriptions were preferentially topical in the fluorescence group (92% vs. 64%, p > 0.0001), and systemic antibiotics represented 36% of the single items prescribed under SoC (vs. 8% in fluorescence group p < 0.0001). Conclusions: Fluorescence imaging provided objective and actionable information at the bedside, which led to a decrease in the use of antibiotics. Real-time diagnostic technologies are essential in establishing a meaningful ASP.

Quality of Life in Patients with Malignant Wounds Treated at a Wound Care Clinic.

Malignant wounds can present in up to 14.5% of patients with advanced cancer, significantly reducing quality of life (QoL). Management of malignant wounds is generally palliative, with the goal of improving or maintaining QoL. There is a lack of data on the impact of wound care clinics on QoL in patients with malignant wounds. We sought to assess the QoL in patients with malignant wounds attending a wound care clinic. We also aimed to describe the baseline QoL, trends in QoL, physical symptoms, and treatment modalities that affect QoL in patients with malignant wounds over time. This retrospective observational study included 36 patients attending a wound care clinic at an oncologic hospital from 1/1/2016-4/1/2023. As part of the standard of care, these patients complete a Skindex-16 QoL survey at each visit. The Skindex-16 is a validated instrument to measure the effects of skin diseases on QoL. Data were extracted from the electronic medical record. Descriptive statistics, graphical methods, and random effects models for change were used to describe the patient population and the QoL measures over time. Of the 36 patients who completed at least one Skindex-16 questionnaire, 69.4% were female, and 50.0% developed malignant wounds from breast cancer, 30.5% from nonmelanoma skin cancer, and 8.3% from sarcoma. At the initial visit, 86.1% of patients had exudate associated with their malignant wound, 52.7% of patients had malodor, 63.9% had bleeding, 69.4% had pain, and 50% had pruritus. The mean baseline Skindex-16 score was 54.5, falling into the "extremely severe" category, with a mean score of 15.4, 18.8, and 20.3 for the symptoms, emotions, and functioning domains, respectively. Nineteen patients completed at least one additional Skindex-16 questionnaire at follow-up visits (visit two 52.8%, visit three 33.3%, visit four 19.4%, visit five or greater 13.9%). Compared to the mean Skindex-16 score at baseline, there was an 18.5 point improvement at visit 2 (95% CI: 3.3-33.7, p = 0.018). Malignant wounds severely adversely affect patients' quality of life. However, patients experienced improved quality of life after being treated at a dedicated wound clinic.

Glycemic Control in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes

ObjectiveOur aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019. MethodsWe conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound and wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test. ResultsTwo hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively. ConclusionsThis retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.

Association of Tryptophan/Kynurenine Metabolites with Healing in Chronic Venous Leg Ulcers.

Objective: Chronic wound healing is a complex process that is still not well understood. The tryptophan (TRP)-l-kynurenine (KYN) pathway has recently been under increased scrutiny with regard to wound healing. The study applied metabolomics to elucidate the TRP-l-KYN pathway associated with wound healing in chronic venous leg ulcers (CVLUs). Approach: This study used a longitudinal comparative design of 60 serum samples collected from 30 older adult patients with CVLUs, receiving weekly sharp debridement at a wound clinic. The serum samples were collected at baseline and week 4 (healed wounds) or week 8 (nonhealed wounds). Liquid chromatography-mass spectrometry (LC-MS) metabolomics was used to analyze targeted metabolites. A Bayesian approach was used to examine robust correlations between changes in metabolite values and linear healing slope and to compare by group. Results: The mean age was 71.13 (±9.46 years). Half of the sample were female and the minority (17%) were Black. The mean values of evaluated metabolites for the nonhealed group were consistently lower than those for the healed group. The healed group (n = 12) had higher KYN values. Those on a healing trajectory (n = 23) had lower KYN levels and higher TRP levels at baseline and over time. There was moderate support (Bayes factor = 3.70) for a negative association between change in kynurenic acid and linear healing slope (r = -0.35, credibility intervals [CrI] = -0.62, -0.04; probability of direction [PD] = 98%). Results suggest that KYN and TRP may be markers for healing in individuals with CVLUs. Innovation and Conclusion: Gaining a better understanding of the associations between the TRP-l-KYN pathway and the healing of CVLUs may help to clarify the links of inflammation with the rate and success of wound healing. Biomarker development focused on the TRP-l-KYN pathway could be pursued, if the associations are further supported by focused research studies.

Survey on Prevalence and Impact of Chronic Non-Healing Wounds among Patients Attending Various Wound Clinics Around Trivandrum City

The survey on prevailing medical practices for non-healing chronic wounds and its impact provides valuable insights into the management and treatment strategies adopted in the context of chronic wound care. The discussion highlights key findings related to diabetes as a prevalent cause, wound location, treatment approaches, and the utilization of serological tests. Diabetes emerged as a significant risk factor for chronic wounds, with 90% of the respondents having a family history of diabetes, and 70% currently under medication for diabetes management. These findings emphasize the crucial role of diabetes in contributing to non-healing chronic wounds. Healthcare providers should prioritize diabetic patients for preventive wound care measures and regular assessments to reduce the incidence of chronic wounds. The survey reveals that a substantial proportion of chronic wounds (75%) are diabetes-related, further supporting the link between diabetes and wound development. Infection-related wounds (10%), autoimmune-related wounds (3%), and other causes (5%) also contribute to the overall burden of chronic wounds. Understanding the various causative factors allows healthcare professionals to tailor treatment plans accordingly and address the specific needs of individual patients. The location of wounds showed a gender disparity, with a higher prevalence of chronic wounds in male limbs (74%) compared to female limbs (26%). Similarly, chronic wounds in other sites were more common in males (74%) than females (26%). The reasons for these gender-based differences warrant further investigation and consideration in treatment planning. In terms of treatment and management, nearly all respondents (100%) were on multiple antibiotics for wound care, indicating the widespread use of antimicrobial therapy. Additionally, a significant portion of respondents (57%) reported trying alternative treatment approaches, suggesting the need for a more diverse and holistic approach to chronic wound management. Hospitalization for chronic wound care was common, with 80% of the respondents having been hospitalized multiple times. This suggests that chronic wounds often require extensive medical attention and resources, making the management of chronic wounds a challenging and resource- intensive aspect of healthcare. The utilization of wound-related serological tests was relatively low, with only 3% of respondents undergoing such tests. This indicates a potential gap in healthcare practices, as serological tests can provide valuable diagnostic information for guiding wound management strategies. Increased awareness and promotion of serological tests among healthcare providers could lead to better wound care outcomes. Overall, the survey findings underscore the complexities and challenges associated with non-healing chronic wounds, especially in the context of diabetes-related wounds. The study highlights the need for comprehensive and personalized wound management strategies, increased awareness about wound-related serological tests, and the exploration of alternative treatment approaches to improve the outcomes and quality of life for individuals affected by chronic wounds. Addressing these challenges would lead to better wound healing outcomes, reduced healthcare burdens, and enhanced overall patient well-being Keywords: Non-healing chronic wounds, Wounds Prevalence, Antimicrobial therapy, Alternative treatment approaches, Serological tests.

Quality of life in patients with malignant wounds treated at a wound care clinic.

e24075 Background: Malignant wounds can present in up to 14.5% of patients with advanced cancer, significantly reducing quality of life (QoL). Patients with chronic leg ulcers experienced improved QoL, as determined by a reduction in Skindex-16 score after treatment at a dedicated wound care clinic. We sought to assess the effect of wound care clinics on QoL in patients with malignant wounds. Objectives: To describe the baseline QoL, physical symptoms, and treatment modalities that affect QoL in patients with malignant wounds. To assess changes in QoL over time of patients attending a wound care clinic. Methods: This retrospective study included 36 patients seen from 1/1/2016 - 4/1/2023 at a wound care clinic at an oncologic hospital with at least one completed Skindex-16 questionnaire, which is a validated measure of the effects of skin diseases on QoL. Data were extracted from the electronic medical record. Descriptive statistics, graphical methods, and random effects models for change were used to describe the patient population and the QoL measures over time. Results: Of the 36 patients who completed at least one Skindex-16 questionnaire, 69% were female, and 50% developed malignant wounds from metastatic breast cancer, 22.2% from cutaneous squamous cell carcinoma, and 27.8% from various malignancies such as sarcoma. Most patients had advanced cancer; 9.7% were stage II, 41.9% stage III, and 48.4% stage IV. At the initial visit, patients had drainage associated with their wound 86.1% of the time, odor 47.2%, bleeding 63.9%, pain 69.4%, and itch 50% of the time. Patients were treated with dressings 100% of the time, and 88.2% of patients received topical treatment for odor, 73.9% received topical treatment for bleeding, 55.6% topical itch treatment, 44% topical pain treatment, 36% gabapentin, and 24% received an opioid. The median baseline Skindex-16 score was 59.5, falling into the “extremely severe” category, with a median score of 17.5, 21, and 23 for the symptom, emotion, and function domains, respectively. Nineteen patients completed an additional Skindex-16 questionnaire at follow up visits (visit two 52.8%, visit three 33.3%, visit four 19.4%, visit five or greater 13.9%). Compared to the median Skindex-16 score at baseline, there was a 34.5% improvement at visit two, 45.4% at visit three, 73.1% at visit four, and 83.2% improvement in QoL at visit five or more. Conclusions: Malignant wounds severely reduce patients’ quality of life; however, patients experienced significantly improved quality of life after being treated at dedicated wound clinics.

Microjet wound therapy versus sharp debridement on wound size reduction: a pilot randomised controlled trial.

There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes. A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023. A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations. This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial.

Impact of foot ulcer-related factors on quality of life in patients with diabetes: Prospective observational study.

Quality of life (QOL) may be impacted by foot ulcer-related factors, with prevention of diabetes-related foot ulcers or more effective early healing helping to improve overall patient QOL. This study, which examined the relationship between foot ulcer-related factors and QOL in patients with diabetes, was conducted as a secondary analysis of a prospective observational study entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers". We investigated EQ-5D-5L, patient characteristics and foot ulcer-related factors of 73 patients with diabetes-related foot ulcers who visited one wound clinic in Indonesia between August 2020 and February 2021. Results showed that the mean health utility was 0.294 ± 0.371. Factors selected for the multiple regression analysis included inflammation/infection of DMIST, first-ever foot ulcer, and size of DMIST. First-ever foot ulcer (β = 0.309, p = 0.003) and size of DMIST (β = -0.316, p = 0.015) were significantly associated with the health utility (p < 0.001). Significant improvement in the health utility of 15 patients was observed when the ulcer healed (Wilcoxon signed-rank sum test, p = 0.001). In conclusion, not only ulcer severity but also the first-ever foot ulcer itself affected the QOL in patients with diabetes. These results suggest there will be a greater impact on the QOL of patients who develop diabetes-related foot ulcers for the first time, along with the importance of prevention and early healing, through early infection control and wound size reduction.

Differences in characteristics between first-ever foot ulcer and recurrent foot ulcer in patients with diabetes: Prospective observational study.

More effective preventive care can potentially be provided if the characteristics of both the first ever and the recurrent foot ulcers can be clarified. The purpose of this study was to characterize first ever and recurrent foot ulcers in diabetic patients. This study was conducted as a secondary analysis of a prospective study that was entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers." In 73 diabetes-related foot ulcer patients who visited one wound clinic in Indonesia between August 2020 and February 2021, we investigated characteristics of the patients and wounds, healing period, and cost. Trauma was shown to be the primary cause of the diabetic foot ulcer in both the first ever foot ulcer (n = 48) and recurrent foot ulcer (n = 25) patient groups (95.8% and 100.0%, respectively). The DMIST score for the first ever foot ulcer patients was significantly higher than the DMIST score for the recurrent foot ulcers. This was found to be especially the case in the first ever foot ulcer patients, as not only were there signs of inflammation (45.8%), but there were also signs of local infection (35.4%), or osteomyelitis and signs of local infection (14.6%) present. In the eightfirst ever foot ulcer patients and in the ninerecurrent ulcer patients who were able to be followed through complete healing, the costs found for the first ever foot ulcer patients were significantly higher as compared to the costs for the recurrent foot ulcer patients. To avoid diabetes-related foot ulcers, specialized educational programs on trauma prevention need to be established. Moreover, patients without diabetes-related foot ulcer histories should be educated regarding the need to undergo early consultations before developing any infections.

Identification of vanA gene on Vancomycin-Resistant Staphylococcus aureus from Diabetic Ulcer Isolate at Lampung Province

Staphylococcus aureus is a type of bacteria that causes an increasing number of infections in hospitals, particularly in diabetic ulcers. Over the last few decades, there has been an alarming increase in the prevalence of pathogen strains of Staphylococcus aureus resistant to antibiotics such as Vancomycin. This study aimed to identify the presence of the vanA gene, which is responsible for the mode of Vancomycin resistance in Staphylococcus aureus Lampung isolate. Ulcer swab was collected from 32 patients with ulcer complications from surgical Installation, Internal Medicine, Home Diabetes Wound Clinic and Diabetes Wound Center in Bandar Lampung. Among the total ulcer swab, 12 samples of S. aureus were identified and subjected to the Minimum Inhibitory Concentration test to identify Vancomycin Resistant Staphylococcus aureus and evaluated the vanA gene by Polymerase Chain Reaction. To detect the presence of the vanA gene, a Polymerase Chain Reaction was performed on Staphylococcus aureus, Vancomycin-Resistant Staphylococcus aureus, and Vancomycin-intermediate Staphylococcus aureus using a specific primer arrangement. There were two samples of Vancomycin- Resistant Staphylococcus aureus and one sample of Vancomycin-intermediate Staphylococcus aureus from the Minimum Inhibitory Concentration test but only one sample tested positive for the vanA gene on Polymerase Chain Reaction. There is Staphylococcus aureus resistance to Vancomycin in Lampung isolate and the vanA gene was detected in some resistant isolates. The arrangement of the vanA gene in the Lampung isolate is different from that of the vanA gene in other places isolates.

Managing stigma together: Relationality in the wound clinic

Our paper contributes to studies of stigma and dirty work by asking ‘how can workers and clients of dirty work manage stigma together?’ With the purpose of appreciating the worker/client relational dynamics in an organisation characterised by stigma, we conducted an ethnography in a wound healing clinic where clinicians do the dirty work of caring for patients with socially stigmatising wounds. To guide and subsequently interpret our ethnographic observations, we developed an original theoretical framework informed both by realist social theory and by extant studies of how people cope with dirty work through techniques of refocusing, reformulating and recalibrating stigma. Our findings point at three types of patient-clinician relationships: of familiality, scripted compliance and obstruction. For each type of relationship, we trace the conditions of possibility (theorised as a relational configuration) and the plausible effects (theorised as relational goods and evils) on patients’ and clinicians’ capacity to cope with stigma together. Overall, we find that the types of relations threaded by workers and clients over time can be a powerful resource (or obstacle) for managing stigma together. Our paper points to future avenues for research on the materiality of social relations and on the significance of the broader sociological context in which specific relationships are threaded between relational subjects.

Integrating new approaches to care in a vascular wound clinic

IntroductionAn evidence-based approach is essential in the treatment of wounds to optimise healing, reduce costs and improve patient outcomes. AimThis case study aimed to demonstrate our model of care, which assesses and manages patients with venous disease and complex wounds. In this case, venous leg ulcer (VLU) was treated with TLC-NOSF dressing and therapeutic compression. The wound was serially assessed using a smart App that gave the patient a graphic representation of their progress. DesignDescriptive Observational Case Study. Clinical careAn evidence-based approach for managing a chronic, severe VLU. The patient was initially seen at the Outpatient Vascular Wound Clinic twice weekly, then every two weeks for conservative sharp wound debridement, skin care, dressing change, and compression therapy using a compression (Ready) wrap. Wound progress was monitored by the digital application ‘Tissue Analytics’, a “purposedesigned digital wound management platform that records, tracks, and analyses wounds”. ResultsWeek 1: On initial review, ulcer length was 3.15cm, width was 3.1 cm, and total surface area was 6.31 cm2. The wound base was mildly sloughy (<25%), with areas of good granulation tissue on view.Week 12: Length was 1.32 cm, width 1.50 cm, and total surface area of 1.45 cm2, a 77% reduction in wound size.Week 24: The length was 0.48 cm, the width was 0.64 cm, and the total surface area was 0.18 cm2. This represented a 97% reduction in wound size.Week 36: Length was 0.01 cm, the width 0.06 cm, with a total surface area of 0.00 cm2. This represented a 99.99% reduction in wound size. ConclusionThe patient’s treatment for a complex venous leg ulcer included the application of TLC-NOSF dressing in combination with individualised therapeutic compression therapy. We found TLC-NOSF was very effective in combination with the best standard of VLU care (i.e. therapeutic graduated compression therapy). The clinician and patient were impressed with the healing rate at 12 weeks, as the wound dimensions were the lowest since the wound started six years ago. This dramatically improved patient concordance and engagement in care. Despite incomplete healing at 36 weeks, the wound-healing journey over the 36 weeks indicated wound closure was close. In addition, using a wound assessment App, the patient could immediately see the benefits of the new treatment, facilitating patient compliance with the treatment.

Evaluating the cost-effectiveness of diabetic foot ulcer management by wound care specialists in Indonesia.

Diabetic foot ulcers affect quality of life and economically burden patients and the Indonesian healthcare system. The comparative cost-effectiveness of wound care specialists in private practices (e.g., wound clinics) and wound care nurses in national hospitals remains unknown. Thus, we used a decision tree to compare the cost and healing rates for patients after 12 weeks of wound care. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Among 89 participants (42 in the national hospital and 47 in the private practice), no significant differences were observed between the two groups in terms of sex, age, education level, smoking status, duration of diabetes, Wagner wound classification, glycated haemoglobin levels, neuropathy status, ankle-brachial index, baseline characteristics, quality of life, DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) score and wound location (p > 0.05). However, significant differences were observed for days from first visit/assessment until complete healing, mean quality of life (p ≤ 0.001) and wound size (p = 0.047). Wound care specialists in private practices had a significantly lower cost of 2,804,423.3 Indonesian rupiah compared to 6,483,493.4 Indonesian rupiah for wound care nurses in national hospitals. The incremental cost-effectiveness ratio was -165,723.9. Therefore, wound care specialists in private practices are more cost-effective for managing diabetic foot ulcers. Probability sensitivity analysis confirmed that 80%-90% of the scenarios were cost-effective. These findings may inform healthcare resource allocation in Indonesia. Additionally, evidence-based cost-effectiveness measures were strengthened in private practices and national hospitals.

Psychosocial markers of pre-hospital delay in patients with diabetic foot: A cross-sectional survey.

This study aimed to determine the psychosocial markers associated with pre-hospital delay among patients with diabetic foot (DF). This study has a cross-sectional design. The participants completed a questionnaire including pre-hospital time, demographic characteristics, Social Support Rate Scale, Brief Illness Perception Questionnaire and Type D Personality Scale-14. Bivariate and multivariate analyses were conducted to explore independent associations with pre-hospital delay. Only 1.8% (3/164) of participants arrived at the hospital for medical care in 24 h of symptom onset. Patients with low utilization of social support (p = 0.029), low negative illness perceptions (p = 0.014) and high levels of negative affectivity (p = 0.009) are likely to arrive late at the clinic. Medical staff should pay attention to identifying diabetic patients' Type D personalities and take actions to improve their social support as well as illness perception, so as to reduce the occurrence of hospital delay. Psychosocial factors play a vital role in the delay in seeking medical treatment for patients with DF. Medical staff need to improve patients' illness perception as well as self-management ability through health education. Importantly, key family members provide an emotional and psychological support system for diabetic patients. Therefore, nurses need to work with family members together to give information and psychological support during family visits. Additionally, building and maintaining trust with patients is crucial to encouraging individuals to express their concerns and worries. In this case, nurses may identify patients' negative emotions and conduct timely intervention, so as to achieve favourable outcomes. This study used a convenience sample of 164 participants with DF recruited from the wound clinic of Northern Jiangsu People's Hospital and Yangzhou Hospital of TCM in China.

TRYPTOPHAN: A POTENTIAL BIOMARKER DISTINGUISHING CHRONIC VENOUS LEG ULCERS HEALING IN OLDER ADULTS

Abstract Chronic venous leg ulcers (CVLUs) affect 2 million persons annually, including 4% of people over age 65 years. Chronic wound healing is a complex process that is still not well understood. Indoleamine 2,3-dioxygenase (IDO) activity is highly active in chronic wounds. The study aims to examine the tryptophan (TRP) L-Kynurenine (KYN) metabolic pathway as a biomarker of CVLUs healing. We collected 60 serum samples from 30 older adult patients with CVLUs receiving weekly sharp debridement at a university wound clinic. Serum samples were collected at baseline, week 4, and week 8 until wound closure. Liquid chromatography-mass spectrometry (LC-MS) metabolomics was utilized to examine targeted metabolites. A robust Bayesian approach was employed to examine correlations between change of metabolites and linear healing slope. The mean age was 71.13 (±9.46); 25 (83.3%) were white; the mean wound area was 2823.54 (±6002.93) mm2; the mean wound duration was 341.67 (±538.29) days. A total of 11 participants had healed wounds during the study period. Those with healing CVLUs had higher levels of mean TRP at baseline and over time compared to individuals with non-healing CVLUs. Change in Kynurenic Acid (r:-0.36, Bayes factor: 3.70, 95% Credibility Interval [-0.62, -0.06]) was associated with a linear healing slope. Serum tryptophan may serve as a candidate biomarker for predicting wound healing trajectories, which can guide clinicians in making treatment decisions. Specifically, decreasing metabolites associated with the downstream activity of the kynurenine pathway, a pathway for tryptophan metabolism may be an indicator of healing under sharp debridement in CVLUs.

Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association.

Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.

Epidemiology of acute infections in people who inject drugs in Australia.

People who inject drugs are at risk of acute infections, such as skin and soft tissue infections, infective endocarditis, bone and joint infections and bloodstream infections. There has been an increase in these infections in people who inject drugs internationally over the past 10 years. However, the local data regarding acute infections in Australia has not been well described. We review the epidemiology of acute infections and associated morbidity and mortality amongst people who inject drugs in Australia. We summarise risk factors for these infections, including the concurrent social and psychological determinants of health. The proportion of people who report having injected drugs in the prior 12 months in Australia has decreased over the past 18 years. However, there has been an increase in the burden of acute infections in this population. This increase is driven largely by skin and soft tissue infections. People who inject drugs often have multiple conflicting priorities that can delay engagement in care. Acute infections in people who inject drugs are associated with significant morbidity and mortality. Acute infections contribute to significant bed days, surgical requirements and health-care costs in Australia. The increase in these infections is likely due to a complex interplay of microbiological, individual, social and environmental factors. Acute infections in people who inject drugs in Australia represent a significant burden to both patients and health-care systems. Flexible health-care models, such as low-threshold wound clinics, would help directly target, and address early interventions, for these infections.

Assessing Nutrition Status in an Outpatient Wound Center: A Feasibility Study.

To explore the feasibility of using the Patient-Generated Subjective Global Assessment (PG-SGA) to assess the nutrition status of patients with chronic wounds receiving care in an outpatient wound clinic. The PG-SGA was administered to a single cohort convenience sample of adults with chronic wounds who presented to an outpatient wound clinic. The authors performed univariate descriptive analyses and calculated interrater reliability. Nutrition assessments were completed with 15 clinic patients. Patients required an average of 6.5 minutes (range, 3.5-10 minutes) to complete their component of the PG-SGA, exceeding the target goal of 5 minutes or fewer. Dietitians required an average of 2 minutes per patient to complete the professional component of the PG-SGA (physical examination). The nutrition assessment process was rated highly favorable. Resources to conduct the study at the site were available 100% of the time. The PG-SGA demonstrates promise for use in the chronic wound population and could be incorporated into clinical care in settings equipped with appropriate and adequate resources. The complexities of workforce stability and resource availability, in addition to the ongoing need to be responsive to patient challenges, must be acknowledged in the planning of future studies.

Examining the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients: A randomized control study.

One of the new types of dressings is the polyurethane dressing containing silver particles. This study was designed to evaluate the effect of polyurethane dressing containing silver particles on the rate of diabetic foot ulcer infection in hospitalized patients in a military hospital. This was a randomized clinical trial study on 48 patients with diabetic foot ulcers who were referred to the wound clinic of Shahid Dr. Chamran Hospital in 2022. The qualified samples were divided into two groups of silver polyurethane dressing and simple sterile dressing based on a randomization block method. The wounds of both groups of patients were initially cleaned with normal saline and in the first round of dressing, and a sample of tissue secretions was collected by the researcher using a sterile swab from the wounds of the patients on two occasions, superficially and deeply. The patients' wounds in the intervention group were dressed with polyurethane foam dressing containing silver particles, while the simple sterile routine dressing was used in the control group. The rate of infection and wound secretions were examined and recorded on the first, seventh, fourteenth, and twenty-first days from the start of dressing in both groups. To collect data, the IDSA tool was used. The rates of wound infection before the intervention showed no significant differences in the two groups (p = 0.242). However, these rates changed on the 7th, 14th, and 21st days after the intervention. Moreover, the infection rate was significantly lower in the polyurethane dressing group containing silver particles (p < 0.001 and F = 30.31). Using polyurethane dressing was proven to be more effective in this study on the rate of diabetic ulcer infection in patients compared to the simple sterile dressing. Thus, nurses can use this dressing for faster treatment of diabetic foot ulcers infection.