Relationship Between Caregiver Attendance at Wound Clinic Visits and Wound Healing in Patients With Diabetes: A Retrospective Multicenter Evaluation

BACKGROUND: Lower extremity wounds in patients with diabetes are significant and burdensome. PURPOSE: To evaluate retrospectively the correlation between lower limb wound outcomes in patients with diabetes and the presence of a caregiver during clinic visits. METHODS: The study was conducted in 3 outpatient wound centers in North Carolina. Patients (N = 85) were categorized into 2 groups: those who were accompanied by a caregiver at 50% or more of their visits to the wound clinic (n = 30) and those accompanied by a caregiver at fewer than 50% of their visits (n = 55). Data were evaluated using descriptive statistics and 2 sample t-tests. RESULTS: Although significant findings between the 2 groups were seen in age, race, Visit Count, Weeks in Service, Accompanied Count, and percentage of visits accompanied, the strongest meaningful correlation was in the Accompanied group between Percent Accompanied and Visit Count. In this group, the number of accompanied visits was 7.47 (range [standard deviation], 1–23 [5.2]) and the percentage was 87% (range [standard deviation], 52–100 [15]). This was stastically significant and with a moderately negative correlation (P = .04; r = -0.38). CONCLUSION: Despite negative predictors of healing, those who were accompanied by a caregiver at 50% or more of their visits demonstrated a higher healing rate and a lower number of total visits than those who were accompanied by a caregiver at fewer than 50% of their visits.

Effect of a Mobile Patient Education Application on Adjustment to Stoma and Development of Peristomal Skin Lesions: A Quasi-Experimental Study

BACKGROUND: Patients with a stoma face difficulties in everyday life. A mobile application (app) may assist them in managing their stoma and adjusting to change. PURPOSE: This study developed a mobile app for patients with a stoma and evaluated its effectiveness in improving psychosocial adjustment, self-care, and prevention of peristomal skin lesions. METHODS: The research utilized a quasi-experimental design and was conducted using a posttest control group. The study consisted of 60 patients who had undergone surgery in 3 university hospitals in Istanbul, Turkey, from November 2018 through December 2019. The experimental group (n = 30) used the STOMA-M mobile app, and the control group (n = 30) used an educational booklet that contained images and text that correlated to the content found in the app. Data collection was carried out using an individual characteristics assessment form, Ostomy Adjustment Inventory (OAI-23), Peristomal Skin Lesions Assessment and Classification Instrument, and a stoma care training evaluation form in the first and third months after discharge. Data were analyzed using IBM SPSS Statistics 22.0 software. RESULTS: Sociodemographic characteristics of individuals in the experimental and control groups were similar; 70% (n = 42) required stoma placement because of cancer treatment. More than half of the participants (53.3%; n = 32) had an ileostomy, and 78.3% (n = 47) had a temporary, open stoma. The experimental group’s OAI-23 score, social engagement subscale score, stoma care status, and satisfaction with education e high. The OAI-23 scores in the control group were not significant, and their anger subscale score and the score of item 16, Caring for my stoma is difficult, decreased in the third month compared with baseline. Peristomal skin lesions did not develop in the control group at the third month of follow-up. CONCLUSION: The levels of adjustment to stoma, ability to care for the stoma themselves, and satisfaction with education received were higher in individuals using the mobile app compared with those using the printed booklet. However, the app was not effective in preventing peristomal skin lesions. Additional studies are needed to determine what features of a mobile app may be useful for preventing such lesions.

Third-Degree Burn on the Neuropathic Lower Extremity in a Patient With Diabetes While Wearing a Copper–Containing Compression Sock: A Case Report

BACKGROUND: Many patients who have diabetes and peripheral neuropathy wear compression socks, which are widely available and may be purchased with a copper component. There is also a well-documented history of patients with neuropathy developing thermal burns from heat sources. Patients with diabetes are at an increased risk of complications when they sustain burns. PURPOSE: To describe a patient with diabetes and neuropathy who developed third-degree burns while wearing a copper-containing compression sock. CASE REPORT: A 68-year-old man with type 2 diabetes and peripheral neuropathy wore a copper-containing compression sock while sitting in the sun for several hours. Afterward, he noted severe blistering and was ultimately diagnosed with several areas of second- and third-degree burns. Wound treatment included sharp debridement, dressing management, and tubular compression. All wounds were healing well when the patient was lost to follow-up. CONCLUSION: This case report illustrates the risk of burn injury when wearing compression socks infused with copper in a situation in which the sock could absorb heat, especially in persons with neuropathy. This report and previous studies showing the increased risk of burn injury complications in persons with diabetes underscore the importance of burn prevention education in this population. Future research to examine the thermal conductivity of metal-containing clothing is recommended.

Medical Device-Related Pressure Injury in an Intensive Care Unit: A Cross-Sectional Study

BACKGROUND: Medical devices can cause pressure injuries. PURPOSE: This study was conducted to determine the prevalence of and factors associated with medical device-related pressure injury (MDRPI) in an intensive care unit (ICU). METHODS: A cross-sectional study was performed among adult patients (at least 18 years of age) admitted to an ICU in a referral hospital in Brazil between December 2019 and February 2020. The skin of patients who consented to participate was assessed for the presence of an MDRPI, and the use of all medical devices was noted. Other independent variables (sociodemographic variables, medical history, pressure injury risk factors, medications, and length of hospitalization) were abstracted from the medical records. Bivariate data analysis included Pearson’s chi-square test or Fisher’s exact test; odds ratio and a confidence interval of 95% also were established. Correlation among independent variables and MDRPI was determined using the ρ Spearman correlation test, and a hierarchical binary logistic regression analysis was performed using statistically significant variables from the bivariate analysis. P < .05 was considered statistically significant. RESULTS: The 125 study participants ranged in age from 15 to 97 years (mean, 63.02 ± 19.2), 76 (60.8%) were men, and 76 (60.8%) were White. Of the 125 participants, 43 (34%) experienced MDRPI; the total number of MDRPIs was 58 (3 patients had 3 injuries, and 7 patients had 2 injuries). Of those 58 MDRPIs, 46 were stage 1, and 12 were stage 2. Polypharmacy (> 4 medications) was a significant risk factor for MDRPI. Use of a nasal catheter, cord for orotracheal tube fixation, oximeter, intra-abdominal pressure equipment, and indwelling urinary catheter was significantly associated with the presence of MDRPI. Renal and respiratory diseases and the presence of infection were positively related to the presence of MDRPI. CONCLUSION: Medical device-related pressure injury was prevalent in this patient population. Most of these injuries were stage 1, which suggests that frequent monitoring and device repositioning (when possible) may help prevent more serious injuries. Additional research involving other hospitals in Brazil is needed to increase the understanding of the prevalence and risk factors of MDRPIs in patients in the ICU.

Development and Implementation of an Individualized Turning Program for Pressure Injury Prevention Using Sensor Technology in Nursing Homes: A Quality Improvement Program

BACKGROUND: Turning nursing home residents every 2 hours has been a long-held standard for pressure injury (PrI) prevention in individuals with mobility impairments although evidence to substantiate this practice is limited. New guidelines recommend personalizing turning schedules to support person-centered care but lack specific recommendations about which turning frequencies are appropriate for various risk levels. PURPOSE: This quality improvement program aimed to determine the feasibility and outcomes of using individualized turn schedules for newly admitted nursing home residents. METHODS: An expert panel of wound clinicians developed, tested, and implemented a turn frequency tool that allowed staff in 2 nursing homes to select a turning schedule of 1, 2, 3, or 4 hours based on resident risk factors. Turning schedules were operationalized using a wearable sensor-based visual cueing technology that alerted staff to resident repositioning needs. Nonparticipating resident data were collected for comparison of PrI incidence. Descriptive statistics were calculated for all covariates. Significance of differences tests were performed as appropriate. RESULTS: Over 7 months, 154 residents had their turn period individualized, with 56% qualifying for 3-hour (Q3H) or 4-hour (Q4H) schedules. Facility-acquired PrI incidence was 94% lower in participants than in nonparticipants (P < .0001). Use of 3-hour and 4-hour intervals saved roughly 21 and 35 minutes of staff time, respectively, per resident per shift. CONCLUSION: Individualizing turning schedules is feasible. Residents with longer turning intervals did not develop PrIs, supporting previous studies about safely extending turning periods for most residents.

Critical Connections Among Embedding of Childhood Adversity and Adult Chronic Gastrointestinal and Genitourinary Disorders: A Review of the Literature

BACKGROUND: A gap in the literature exists demonstrating associations between adverse child experiences (ACEs) as potential a priori contributing factors and gastrointestinal (GI)/genitourinary (GU) disorders. PURPOSE: A narrative review of the literature was conducted to explore critical connections between ACEs and GI/GU disorders with a working hypothesis of a dose–responsive relationship existing among them. METHODS: A literature search was conducted using MEDLINE, Cumulative Index of Nursing and Allied Health Literature, PubMed, and Web of Science using search terms adverse childhood experiences, childhood adversity, obesity, gastrointestinal disorders, and genitourinary disorders, and secondary searches of obesity and specific GI/GU disorders (eg, irritable bowel syndrome, pelvic pain). Duplicates and articles with inappropriate focus were discarded after review. RESULTS: A total of 58 articles were included. Research identified showed that ACEs do play a role in adult GI and GU morbidities in a dose–response manner, and selected factors such as socioeconomic status, race, gender identity, and physiologic state (eg, obesity) confer higher risk. Research also suggested that genetic/epigenetic mechanisms are at play in disease occurrence, and the impact of ACEs may be mitigated with positive life experiences. CONCLUSION: Research on the relationship between ACEs and GI/GU disorders is heterogeneous, notably due to wide variations in how types of ACEs are defined and screening methods used. Despite this limitation, associations are demonstrated. Awareness of a possible correlation between ACEs and risk of GI/GU disorders has the potential to improve patient care, especially through trauma-informed strategies.

Surgical Wound Dehiscence Treatment With Low-Level Laser Therapy and Barbatimão: A Case Report

BACKGROUND: Low-level laser therapy (LLLT) and a gel containing an extract of Barbatimão, a native Brazilian tree, have shown promising results in both preclinical and clinical wound healing studies. PURPOSE: To describe the treatment of surgical wound dehiscence with LLLT and Barbatimão gel. CASE STUDY: A 54-year-old woman without comorbidities underwent abdominoplasty at another health facility. Three (3) weeks later she presented to the authors’ clinic after an episode of syncope, abrupt dyspnea, purulent exudate, and necrotic tissue in the surgical incision. She reported that wound redness, warmth, and swelling started 8 days postoperatively. The patient was admitted; on day 3 of that hospital stay, her condition improved and surgical debridement was performed. Follow-up care of wound dehiscence was provided in the outpatient clinic. The treatment involved daily application of Barbatimão gel and weekly application of LLLT. The wound healed after 84 days. CONCLUSION: This case report suggests that LLLT may be a beneficial adjunctive therapy, together with Barbatimão gel, for the treatment of surgical wound dehiscence.

Effect of Preoperative Skin Preparation Methods on Sternotomy Surgical Site Infection Rates: A Quasi-Experimental Study

BACKGROUND: A surgical site infection (SSI) reduces patient quality of life, increases morbidity and mortality rates, and increases health care costs. Results of studies comparing the effects of preoperative skin preparations are contradictory. PURPOSE: This study aimed to determine the effect of different preoperative skin preparation methods on the rate of SSIs in patients undergoing sternotomy. METHODS: A quasi-experimental study was conducted among 96 male patients undergoing sternotomy. The control group (CG) (n = 34) received routine care consisting of shaving body hair with a razor blade followed by instructions to take a bath or shower. In the intervention groups, patients received education about SSI prevention and body hair was removed with an electric clipper, followed by bathing with daphne soap containing olive oil (IG-1) (n = 31) or 2% chlorhexidine solution (IG-2) (n = 31). Patient demographic, medical history, surgical, and wound assessment variables were obtained. Potential SSI signs and symptoms were assessed for up to 90 days following surgery. RESULTS: Patient demographic, medical history, and surgical variables did not differ among the 3 groups. Sternal SSI occurred in 10.4% of all study patients; 8.8% of the CG patients, 12.9% of the IG-1 patients, and 9.7% of the IG-2 patients developed an SSI (P > .05). CONCLUSION: There were no significant differences in the rate of sternotomy SSI among the 3 groups. Randomized controlled trials with large samples are needed to compare these methods to determine optimal and affordable preoperative skin preparation methods.

Healing of a Chronic Pressure Injury in a Patient Treated With Medical Cannabis for Pain and Sleep Improvement: A Case Report

BACKGROUND: A small body of evidence suggests medical cannabis may facilitate wound healing, but the exact mechanism of this effect is unclear. PURPOSE: This case report describes a patient with a pressure injury (PI) who received cannabis oil treatment for pain management and sleep improvement. METHODS: A 37-year-old woman with multiminicore disease, scoliosis, short-chain acyl-CoA dehydrogenase deficiency, and epilepsy presented to the Neurology Centre of Toronto with chronic pain and sleep disturbance, including difficulty initiating and maintaining sleep. She also had a 5-year history of a PI between her right iliac crest and right rib cage that had progressively worsened. The patient received a medical cannabis oil protocol that used a combination of cannabidiol and tetrahydrocannabinol. RESULTS: Cannabis oil was effective in treating pain and sleep difficulties. Unexpectedly, during the first 2 weeks of treatment, the PI started to heal and was almost completely closed at the 2-month follow-up. CONCLUSION: Although it is unknown if the observed healing of this refractory PI was indirectly or directly related to the cannabidiol and tetrahydrocannabinol treatment, the potential relationships among pain, sleep disturbance, cannabis treatment, and healing should be explored.

Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.