Conectar
Limited evidence exists regarding the effectiveness of learning approaches in supporting interprofessional wound care education transnationally. The aim of this pilot study was to explore the feasibility and preliminary impact of an international, online interprofessional masterclass in supporting baccalaureate health students' learning about wound care. Data were collected using multiple methods including quantitative survey, qualitative focus groups, and interviews with baccalaureate nursing, pharmacy, dietetics, podiatry and paramedicine students from two universities based in Australia and Northern Ireland. A retrospective pre-test design was used. A survey retrospectively assessed students' self-reported confidence and understanding before and after the masterclass, while qualitative methods explored students' experiences of interprofessional learning and wound care. Self-reported improvements in students' understanding of wound assessment and management, as well as heightened awareness of interprofessional contributions to patient care indicated the potential value of this interprofessional and international collaboration in supporting wound care education. Qualitative analysis identified four themes: recognising a wound is a person's wound; comparing international healthcare practices; fostering learner engagement; interprofessional recognition, acknowledgment, and understanding of each profession's roles, contributions and expertise. This pilot study has highlighted key issues to be addressed in future research examining the impact of a collaborative online international initiative on baccalaureate students' interprofessional learning about wound care.
Pressure injuries (PIs) remain a problem for patient safety and the sustainability of healthcare systems. Difficulties persist in their assessment, prevention and monitoring by multidisciplinary teams. International recommendations point to this problem as a priority area for resolution in terms of patient safety. Research on the subject has been positive, resulting in several guidelines for clinical practice, but professionals' adherence remains below what is expected for their implementation. This scoping review aimed to identify interventions that increase multidisciplinary teams' adherence to the prevention and management of PIs between hospitals and the communities. The search was carried out in the MEDLINE (via PubMed), CINAHL, Scopus, Web of Science, JBI, Cochrane and grey literature databases by two independent reviewers, and led to the identification of 16 articles that met the eligibility criteria and made it possible to answer the research question. Strategies to improve adherence by health professionals include the creation and training of multidisciplinary teams, the implementation of new risk assessment models, Wound Boards, injury prevention reminders, video consultation apps, multidisciplinary rounds, documentation and recording. No studies were identified that assessed staff adherence to interventions aimed at preventing and managing PIs in the continuum between hospitals and communities, which is suggestive of the need for further research in this area.
This scoping review investigates the use of point-of-care infrared thermography devices for assessing various wound types. A comprehensive search across four databases yielded 76 studies published between 2010 and 2024 that met the inclusion criteria. The review highlights thermography applications in burns, surgical wounds, diabetic foot ulcers, pressure injuries, and other lower limb wounds. Key findings indicate its effectiveness in detecting early signs of inflammation and healing delays, facilitating timely interventions. The technology shows promise in accurately predicting wound healing trajectories and assessing treatment outcomes. Recent advancements have made thermographic devices more affordable and user-friendly, expanding their clinical potential. However, challenges persist, including reimbursement, training requirements, and integration with electronic medical records (EMRs), with EMR integration identified as a critical barrier to widespread adoption. While preliminary findings are promising, the current evidence base is constrained by small sample sizes, retrospective study designs, and limited consideration of skin tone variability. Large, prospective studies are essential to validate the clinical utility of thermography in wound care and to inform the development of standardised protocols that support equitable, bias-reduced assessment across diverse populations. Addressing these gaps is critical for advancing research, enhancing clinician training, and improving patient outcomes in wound care. Overall, point-of-care thermography demonstrates significant potential to enhance wound assessment and monitoring, thereby elevating care quality and patient outcomes.
Cutaneous anthrax is a zoonotic bacterial infection that mostly involves the head, neck, and upper extremities. Periorbital involvement of cutaneous anthrax is a rare presentation that can lead to severe irreversible complications. Herein, we describe a 2.5-year-old girl with periorbital anthrax cellulitis. She presented with a severe swelling on the right side of her face and an ulceronecrotic lesion above the right eyebrow. After receiving an appropriate antibiotic regimen, her condition improved and she was discharged without any intraocular complications.
Antimicrobial resistance is increasing due to an overreliance on antimicrobials to treat and manage infections. Chronic wounds are particularly vulnerable to infections and harbour complex microbial communities, increasing the risk of secondary infections caused by antimicrobial resistant bacteria. Accurate and early diagnosis of infection ensures appropriate treatment interventions and a reduction in the likelihood that antibiotic use is required. Despite this, the overuse of antibiotic treatment in wound care is still evident. Antimicrobial stewardship describes a structured approach to managing antimicrobial resistance through educating healthcare professionals about antimicrobial use to improve patient outcomes and minimise the spread of infections. However, the evidence suggests that healthcare professionals experience barriers when attempting to implement such strategies in their practice. It is essential that the principles of antimicrobial stewardship are embedded into wound care treatment and management. This review aimed to explore the current barriers to antimicrobial stewardship in wound care clinical practice and discuss the strategies that can be applied to successfully maximise infection prevention. There is a need to further educate wound care practitioners about antimicrobial stewardship and future research should concentrate on understanding how healthcare professionals can work collaboratively to implement such strategies in their practice.
Empathy plays an important role in delivering healthcare, influencing both patient outcomes and satisfaction. However, its role, impact, and barriers to implementation in wound care remain underexplored. This scoping review aims to synthesise existing literature on empathy in wound care, highlighting its contributions to person-centred healing. Following the Joanna Briggs Institute methodology, a systematic search was conducted across multiple databases in English, French, German and Italian. Eighteen studies published between 1946 and 2024 met the inclusion criteria. The review identified empathy as a fundamental element in wound care, improving adherence to treatment, reducing psychological distress, and enhancing wound healing through physiological and psychological mechanisms. However, systemic challenges including time constraints, lack of training, and resource limitations hinder its consistent application in clinical practise. This review highlights the need for enhanced education, training, and systemic support to integrate empathy into wound care. Future research should focus on developing validated strategies to adopt empathetic care, ensuring a holistic approach to patient management.
Chronic wounds can impact the quality of life of working-age individuals. However, the specific challenges and burdens these patients face in the workplace remain understudied. This study aimed to 1) investigate how chronic wounds affect work life and 2) develop a screening tool for identifying highly affected patients. In total, 51 patients with chronic wounds answered a questionnaire on demographics, employment status, wound-related limitations, workplace conditions, social welfare use and subjective burden of disease. To assess the subjective burden, we developed a specific research tool on employment and chronic wounds (REACH Score) to measure and quantify the impact of the chronic wound on working patients. The patients, who answered the questionnaire, were employed (78%), on sick leave (18%) or retired (4%). They spent an average of 5.3 h per week on wound-related activities. Regarding workplace stressors, we found that taking breaks when needed was correlated with less time off sick and better work-related quality of life. Patients reported career concerns and reduced productivity. The REACH score was significantly correlated with sick leave, work difficulties, time consumed by the wound and overall quality of life. According to our pilot-study, the impact of chronic wounds on patients of working age is most evident in the form of sick leave and reduced work performance and in a reduced quality of life. It is crucial to identify the key factors contributing to stress in the work environment in a larger sample in order to improve the working conditions of patients and detrimental socioeconomic effects on the workforce. The REACH score is a novel tool to screen employed patients with chronic wounds for reduced work capacity and quality of life.
Open incision negative pressure wound therapy (NPWT) combines delayed closure with negative pressure to prevent surgical site infection (SSI). Its effectiveness in preventing SSI remains unclear, complicating its risk–benefit assessment. PubMed and Web of Science databases were searched for relevant English studies. Two reviewers independently screened titles and abstracts using the ASReviewer tool. Full-text articles were assessed for eligibility. Eight studies were included in the systematic review and five were pooled in the meta-analysis. Data extraction followed the PRISMA guidelines, and the risk of bias was assessed. A meta-analysis was performed using a random-effects model for SSI occurrence. Eight studies (three RCTs and five cohort studies) with 1655 patients were included. Studies were pooled based on control interventions: primary closure (PC) or delayed primary closure (DPC). Pooled odds ratio (OR) estimates favoured NPWT over PC for SSI reduction (OR, 0.15; 95% CI, 0.02–0.87). No significant SSI risk difference was found between the NPWT and DPC groups (OR, 0.28; 95% CI, 0.06–1.27). Preventive NPWT is associated with a reduced risk of SSI in abdominal surgery compared to PC. Our findings indicate that standardising treatment and reporting protocols could improve future evaluations of NPWT effectiveness.
Trial Registration: PROSPERO identifier: CRD42024401669
Due to limited data on the epidemiology of diabetic foot ulcers (DFU) in Germany, especially for those infected, the study determined the prevalence and incidence of DFU and the associated medical burden. Anonymised claims data of 3.3 million insured lives were sourced from a statutory health insurance fund. Patients with DFU between 04/01/2016 and 12/31/2019 were selected (n = 7764) and divided into patients with/without infection/with prophylactic use of antibiotics. Outcome variables were described categorically. Two-sided t-tests and chi-squared tests (p < 0.05) were performed. The prevalence and incidence in patients with DFU was 4.6% and 2.1%, respectively. The mean Charlson Comorbidity Index was 7.9, significantly higher in those infected than in those uninfected (8.1% vs. 7.2%, p < 0.0001). Amputations occurred significantly more often in DFU patients with infection than in those without (minor 25.4% vs. 3.0%, p < 0.0001; major 6.7% vs. 1.2%, p < 0.0001). The 5-year mortality rate was significantly higher in patients with infection than in those without (64.0% vs. 51.3%, p < 0.0001). The occurrence of comorbidities and complications associated with DFU, in particular the high overall medical burden and mortality rate—especially in DFU patients with infections—underscores the importance of prevention and early, appropriate treatment.
Toxic epidermal necrolysis (TEN) is a severe skin reaction caused by extensive epidermal and mucosal necrosis. This clinical phenomenon is known as an acute syndrome of apoptotic pan-epidermolysis (ASAP). The ASAP phenomenon is observed in conditions that mimic TEN, highlighting the challenge in distinguishing these conditions. While TEN is a well-recognized entity, distinguishing it from other TEN-like conditions presents significant diagnostic and treatment challenges. These conditions include drug rash with eosinophilia and systemic symptoms (DRESS), generalized bullous fixed drug eruption (GBFDE), acute generalized exanthematous pustulosis (AGEP), TEN-like methotrexate toxicity, mustard gas toxicity, pseudoporphyria, mycoplasma-induced rash and mucositis (MIRM), multisystem inflammatory syndrome in children (MIS-C), graft versus host disease (GVHD), and acute cutaneous lupus erythematosus and subacute cutaneous lupus erythematosus. This review explores these ten separate entities and debates their clinical features, pathophysiology, diagnosis and management.
One of the key measures to prevent pressure ulcer is to identify the factors that influence them. This study aimed to assess the occurrence of pressure ulcers and their related risk factors in patients admitted to specialized care units. This research is a retrospective cohort study that was conducted in the critical care units of hospitals affiliated to Ardabil University of Medical Sciences. A total of 1158 patient records who were hospitalized in the intensive care unit (ICU) between 2021 and 2022 were selected from the research population using the available sampling method and based on the inclusion criteria. Data was collected using a researcher-made checklist between April 2021 and December 2022. Data were analysed using analytical tests (chi-squared test, regression test) and descriptive statistics (prevalence, mean, standard deviation, and median) tests. All 1158 patient files were examined without any sample loss. The average age of the patients was 58.59 ± 19.73 years. The study found a significant association between the occurrence of pressure ulcers and age, duration of hospitalization, weight, body temperature, and male gender (p-value <0.001). Additionally, there was a significant association between the occurrence of pressure ulcers and the use of pain relievers, vasopressors, alpha-blockers, calcium blockers, and angiotensin (p-value 0.001). The study also investigated the association between nursing care practices and the development of pressure ulcers. The findings revealed that changing the angle of the bed, using a wavy mattress, repositioning the patient every 2 h, using a CPR bed for mobility, providing protective equipment, and applying physical restraint to the patient were all significantly associated with the likelihood of pressure ulcers (p < 0.001). The study showed that pressure ulcers in ICU patients are influenced by the type of disease and clinical factors in individuals. However, considering the conflicting results of this study with some other studies, more research is needed on this subject. It is suggested that appropriate measures be taken based on the patient's condition to prevent pressure ulcers in those admitted to the ICU.
In the ongoing challenge to reduce burn-associated mortality rates, this study explores the predictive capacity of clinical factors in burn patients, focusing on vitamin D, calcium, and serum albumin levels during hospitalisation in cases with Pseudomonas aeruginosa infection. Our research involves a comprehensive analysis of 100 burn patients, encompassing crucial clinical parameters such as the burn severity index, serum albumin, vitamin D, and calcium levels at admission. Data were meticulously entered into IBM Statistics SPSS software version 28 and subjected to statistical analysis. The study reveals an average patient age of 39.75 years and a notable 34% mortality rate. Additionally, the average lengths of hospital and intensive care unit (ICU) stays are determined to be 11.33 and 7.79 days, respectively. Significantly, a correlation between calcium and albumin variables and treatment outcomes is established, showcasing their potential to predict variable changes in patient mortality rates. Furthermore, a noteworthy association is observed between serum calcium levels and the duration of ICU hospitalisation. In conclusion, albumin and calcium variables emerge as sensitive and specific indicators for predicting outcomes in burn patients. Importantly, the independence of these factors from the physician's experience and diagnosis reduces human error and thus increases the accuracy of mortality prediction in this patient population.
To review the application of telehealth guidelines developed by Bondini et al for clinicians to determine patient suitability for telehealth in an outpatient Chronic Wound Service, including the proportion of patients suitable for telehealth, type and mode of telehealth encounters. Retrospective, random convenience sample of patients attending the Chronic Wound Service in 2021. Fifty-six patients were included, most with leg/foot wounds (93%), median age 74 [54–84], 64% male. Four patients at admission and 19 patients at review met criteria for telehealth. Six percent of encounters were telehealth; phone-only (82%), unscheduled nursing reviews (77%) in patients with healing wounds. Thirty patients (54%) received at least one telehealth encounter. Telehealth occurred 35.6 days later in the admission than face-to-face encounters (p < 0.05, 95% CI 14.9–56.3). There was a significant relationship between patients receiving telehealth and meeting telehealth suitability criteria on reviews (X 2 (1) = 19.6*, p < 0.001). Eighteen percent of patients required wound-related hospitalisation during their outpatient admission. Telehealth guidelines identified patients suitable for telehealth, although the proportion of patients was small. Telehealth was mostly utilised for nurse-led telephone calls in patients with improving wounds. Future research into use of telephone review for clinical standards of wound care is warranted.
This retrospective cohort study aims to assess whether the implementation of a multidisciplinary approach in the Gosford Hospital High-Risk Foot Clinic improved outcomes of diabetic foot ulcers. Ulceration is a common foot complication of diabetes mellitus and greatly increases patient morbidity and mortality. Patients who attended at least one appointment at the Gosford Hospital High-Risk Foot Clinic in 2017 or 2019 were identified through the Gosford Hospital Podiatry department's records. The 2017 and 2019 cohorts were compared on measures of ulcer healing, incidence of amputation, incidence of vascular intervention and surgical debridement, percentage of patients admitted to hospital due to complications and use of systemic antibiotic therapy. Sixty-one patients in 2017 and 59 patients in 2019 met inclusion criteria, and from them, 207 ulcers were included. Between 2017 and 2019, there was a 6.2-week reduction in time to 100% ulcer healing in 2019 (p = 0.021), and 10.1% more ulcers healed within 52 weeks (p = 0.22, 95% confidence interval [CI] [−5.9%, 25.5%]). Whilst there was no significant difference in incidence of patients receiving amputation, there was an increased absolute number of amputations in 2019. Implementation of a multidisciplinary approach at the Gosford Hospital High-Risk Foot Clinic led to improvements in diabetic foot ulcer healing.
Optimal management of burns begins with first aid from the first hours of injury. Adequate knowledge of how to perform first aid for burns can reduce the consequences of injury. Therefore, this study aims to determine the knowledge, attitude, and sources of information assessment towards burn First aid among people referred to a burn centre in the north of Iran. A questionnaire-based survey was conducted to assess knowledge, attitude, and sources of information towards burn first aid among people referred to a burn centre in the north of Iran in 2023. In this survey, a convenience sampling method was adopted. The variables consisted of four items on socio-demographic information, 15 items on knowledge, ten items on attitude, and one item on sources of information related to burn First aid. A total of 371 individuals responded to the survey. The mean age of participants was 31.90 ± 8.49 years old. The mean score of the total knowledge of the participants in the research was 6.04 ± 3.05. There was a statistically significant relationship between the variables of age, sex, marital status, place of residence, level of education, and history of receiving first aid training with the participants' knowledge level. The average score of the total attitude of the participants was 44.08 ± 3.88. Out of 371 participants, 214 people (57.7%) had an average attitude, and 157 people (42.3%) had a good attitude towards burn first aid. There was a statistically significant relationship between place of residence, level of education, and history of receiving first aid training with the participants' attitudes in the research. In addition, the level of knowledge had a statistically significant relationship with the participants' attitude level in the research (p-value <0.001). The majority of participants have limited knowledge of burn first aid. This lack of knowledge could lead to severe consequences. Therefore, healthcare organizations should review and promote consistent guidelines for burn first aid to tackle and minimize the effect of this grave injury.
Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic dermatosis that was difficult to diagnose in clinical practice. Today, the PARACELSUS score is a validated tool for diagnostics. Based on this score, patients with clearly diagnosed PG were examined with regard to predilection sites. In this retrospective study, the data of patients from the University Hospitals of Essen and Erlangen were analysed in whom the diagnosis of PG could be clearly confirmed using the PARACELSUS score. A total of 170 patients, 49 men (29%) and 121 women (71%) with an average age at first manifestation of 55.5 years, could be included in the analysis. The predilection sites were identified as the lower legs in 80.6% of the patients and the extensor sides in 75.2%. Other localisations of PG were the thighs in 14.1%, mammae and abdomen in 10.0% each, back and gluteal in 7.1% each, feet in 5.9%, arms in 4.7%, genital in 3.5% and head in 2.9%. This retrospective study is the first to identify a collective of PG patients with the highest data quality using the PARACELSUS score. It could be shown that PG can basically occur on the entire integument. However, the predilection sites of PG, which have now been reliably identified for the first time, are the lower legs and in particular the extensor sides.
This study aimed to develop atorvastatin-loaded emulgel and nano-emulgel dosage forms and investigate their efficiency on surgical wound healing and reducing post-operative pain. This double-blind randomized clinical trial was conducted in a surgical ward of a tertiary care hospital affiliated with university of medical sciences. The eligible patients were adults aged 18 years or older who were undergoing laparotomy. The participants were randomized in a 1:1:1 ratio to one of three following groups of atorvastatin-loaded emulgel 1% (n = 20), atorvastatin-loaded nano-emulgel 1% (n = 20), and placebo emulgel (n = 20) twice a day for 14 days. The primary outcome was the Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scores to determine the rate of wound healing. The Visual Analogue Scale (VAS) and quality of life were the secondary outcomes of this study. A total of 241 patients assessed for eligibility; of them, 60 patients completed the study and considered for final evaluation. A significant decrease in REEDA score was observed on Days 7 (63%) and 14 (93%) of treatment with atorvastatin nano-emulgel (p-value < 0.001). A significant decrease of 57% and 89% in REEDA score was reported at Days 7 and 14, respectively, in atorvastatin the emulgel group (p-value < 0.001). Reduction in pain VAS in the atorvastatin nano-emulgel was also recorded at Days 7 and 14 of the intervention. The results of the present study suggested that both topical atorvastatin-loaded emulgel and nano-emulgel 1% were effective in acceleration of wound healing and alleviation of pain of laparotomy surgical wounds, without causing intolerable side effects.
Venous ulcers affect up to 3% of the global population, with a high impact on economies and quality of life. This is exacerbated by its recurrence rates, which reach 70% at 12 months after healing. The perpetuation of these cycles of healing and recurrence is not interrupted or even attenuated by the self-care activities recommended and directed toward their prevention. In this context, we sought to identify the effectiveness of interventions that promote adherence to self-care to prevent venous ulcer recurrence. In August 2022, we conducted a literature search via EBSCO in the following databases: CINAHL Complete, MEDLINE Complete, Cochrane Database of Systematic Reviews, Scopus, and Web of Science. The inclusion criteria were researched in the form of randomised controlled trials or systematic literature reviews, and 99 studies were identified. During the different times of selection, four studies met the defined inclusion criteria and were included. As the main conclusions, the emphasis goes to the importance of the use of compression and the greater effectiveness of higher compression classes for the prevention of recurrence. Different educational methodologies seem to be important to increase knowledge about prevention, specifically regarding the aetiology of recurrence and the implementation of prevention measures.
The inaugural expert consensus and guidance for Nutrition Interventions in Adults with Diabetic Foot Ulcers (DFU) have been welcomed by clinicians internationally. This short report aimed to determine how the macronutrient and micronutrient status of individuals living with DFU compared to the American Limb Preservation Society Nutrition Interventions in Adults with DFU expert consensus and guidance. Descriptive analysis was conducted as a secondary analysis of an existing dataset. Mean (SD) dietary intake, the proportion meeting the nutrition recommendations and the proportion exceeding the upper limit (UL) for specific vitamins and minerals were reported. Most individuals with DFU do not meet current consensus guidelines for optimal dietary intake for wound healing, with inadequacies evident for fibre, zinc, protein, vitamin E and vitamin A. Future iterations of the consensus guideline should consider using evidence-informed recommendations for clinical practice, with the inclusion of all nutrients that are essential for wound healing in DFU.
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