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Chronic wounds represent a substantial socioeconomic, financial, and psychological burden. We examine preclinical and clinical evidence assessing the impact of chronic wounds on negative affect, cognition, and quality of life and discuss potential mechanisms underlying the link between chronic wounds and negative affect and cognition. There is limited preclinical evidence examining negative affect and wounds, but anxiety-related behaviour has been reported in a rat incisional wound model. The incidence of anxiety and depression in people with chronic wounds varies considerably. Potential mechanisms underlying the link between chronic wounds and negative affect include the immune system, pain, metabolic dysfunction, inflammation, and vascular damage. There is a paucity of both preclinical and clinical studies examining the effect of chronic wounds on cognition, highlighting a need for more studies in this area. Research suggests that there are deficiencies in the management of anxiety, depression, and cognitive impairment in people with chronic wounds, but developing and administering therapies that target these comorbidities may have a positive impact on quality of life and wound healing. Integration of mental health and cognition screening into wound care protocols would provide substantial benefits both socioeconomically and to individuals with chronic wounds.
Electrical burns are among the most severe burn injuries, often leading to deep tissue damage, systemic complications, and prolonged hospitalisation. In Lebanon, limited national data on electrical burn injuries limits the understanding of their epidemiology and management. This study aims to assess the prevalence and characteristics of electrical burns in patients admitted to the specialised burn care unit in Geitaoui Hospital in Lebanon. A retrospective observational study was conducted by reviewing the medical records of patients admitted from 1st January 2011 to 31st December 2024. Data on demographics, burn characteristics, hospitalisation outcomes, infections, surgical interventions, and laboratory findings were extracted and analysed using SPSS version 26. Thirty patients were included, with a male predominance (96.7%) and the mean age was 29.6 years. Third-degree burns were observed in 70.0% of cases, and 66.7% of patients had burns affecting 10%–30% of their total body surface area. High-voltage injuries accounted for 50.0% of cases. Upper extremities were the most commonly affected site (93.3%). The mean hospital stay was 25.69 days, and the mortality rate was 10.0%. Infection was documented in 43.3% of cases. The most frequently isolated pathogens were Acinetobacter (20.0%) and Pseudomonas aeruginosa (16.7%). Surgical intervention was required in 63.3% of patients, most frequently skin grafting (36.7%). This study contributes national data on electrical burns and emphasises the importance of preventive and multidisciplinary care strategies.
This study investigates the knowledge, attitudes, and practices of the Lebanese population regarding thermal burns to inform targeted interventions. Using a cross-sectional design, data was collected from 1090 participants though a structured questionnaire. Key findings revealed a mean knowledge score of 14.89/20, indicating moderate understanding, with gaps in identifying third-degree burns and optimal cooling durations. Attitudes scores averaged 36.97/50, reflecting a strong support for burn prevention but low confidence in first aid. Practices scored 12.37/20, with many participants adhering to safety measures but relying on unverified remedies and lacking emergency preparedness. Significant correlations were found between the three domains, particularly between knowledge and practices (r = 0.328, p < 0.001), emphasising the role of education and attitudes in shaping behaviours. Multivariate analysis identified formal first aid training, education, and urban residency as strong predictors across all three domains, while older age negatively influenced knowledge. These results underscore the need for culturally tailored education and enhanced training to address gaps in burn prevention and management among the Lebanese population.
Remote assessment of surgical site infection(SSI) lacks sensitivity for the diagnosis of SSI, but current evidence has not evaluated whether a combination of photographs and questionnaires improves diagnostic accuracy. This study aims to develop a remote diagnostic measure to identify SSI. A two-phase mixed methods study was conducted. In phase I, five clinicians reviewed the Bluebelle wound healing questionnaire(WHQ) on a five-point Likert scale of agreement for inclusion in a remote measure. Discussion generated a hypothesis as to which items should be included. In phase II, a cohort study, whereby clinicians evaluated patient's wound images and patients completed the WHQ, were reviewed for scale structure. Principal component analysis (PCA) with scree plot examination and maximum likelihood of estimation (MLE) for one, two and three factors were evaluated. Internal consistency was assessed with Cronbach's α. Phase I: hypothesis generation estimated a measure containing between 10 and 12 items would include all relevant items without ambiguity or redundancy. Phase II: a combined sample of 570 responses provided clinician reviewed images and patient responses. PCA suggested that a 12-item measure with a combined variance of 60.2% would have the best model fit. Cronbach's α was high at 0.841. One included item was highlighted as potentially ambiguous in phase I (wound pain), providing an additional model with this removed. MLE for one, two and three factors suggested measures with 8, 10 and 11 items, respectively. Total variances were low at 29.7%, 39.8% and 41.4% and Cronbach's α were high at 0.838, 0.827 and 0.823, respectively. Three potential models for a remote diagnostic measure were identified. Each is shorter than alternative available measures, which have not been designed for combined use, ensuring this is easy to use. Further evaluation for reliability and diagnostic accuracy is needed to validate a final measure that can be implemented in clinical practice.
This descriptive, cross-sectional study aimed to identify whether having a chronic leg ulcer (CLU), in addition to diabetes, contributed to frailty in individuals ≥65 years old. It also explored the associations between frailty, pre-frailty and other factors. 125 participants aged ≥65 attending outpatient clinics in Ireland were categorised into three groups: (1) diabetes-only and no CLU, (2) CLU-only and no diabetes, and (3) diabetes and CLU. Frailty status was identified using the Groningen Frailty Indicator (GFI) and the Physical Frailty Phenotype (PFP). The mean age was 76.09 ± 7.31. Overall, 90 (72%) had diabetes, and 89 (71.2%) had CLU in the past 6 months. While 124 (99.2%) were frail according to the GFI, 122 (97.6%) were either physically frail (n = 40, 32%) or pre-frail (n = 82, 65.6%) based on the PFP. There was no difference between the three groups regarding general frailty status (p > 0.05). However, being aged ≥75, having CLU and having CLU in addition to diabetes were associated with frailty severity (p < 0.05). Slow gait, inability to go to the toilet and dress/undress independently were the common factors contributing to frailty. Age, comorbidities and CLU were associated with frailty severity. Incorporating multidimensional frailty screening into regular clinic visits for older adults with CLU is recommended.
We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.
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