New articles published by the Journal of Wound Management
Authors: Anika Fourie, Dimitri Beeckman
First published 5 July 2021
This article should be referenced as: Fourie A, Beeckman D: Protecting patients’ skin during prone ventilation - the PRONEtect practice guidance document, Journal of Wound Management, 2021
Background: Ventilating the critically ill patient with acute respiratory distress syndrome in the prone position is a lifesaving strategy, but it is coupled with adverse consequences such as the development of pressure ulcers.
Aim: To develop evidence-based recommendations for critical care clinicians in a concise, simple and visual practice guidance document.
Methods: A gap analysis study conducted by the Skin Integrity Research Group and the Swedish Centre for Skin and Wound Research (currently submitted to a peer-reviewed international journal) formed the basis for the practice guidance document. The gap analysis study reviewed which guidelines, equipment/devices and other digital resources were available during a systemic, comprehensive literature and digital search conducted between August and November 2020. An international expert panel reviewed the identified gaps and provided their feedback. The information from the comprehensive search provided the foundation for the design of the practice guidance document.
Findings: The “PRONEtect (Prone & Protect) practice guidance document – skin care considerations for the patient in the prone position” was developed by the research team, reviewed and approved by the expert panel and then launched on public platforms in December 2020.
Conclusions: The PRONEtect document’s recommendations could assist clinicians in reviewing key considerations for tissue damage prevention in patients in the prone position.
Implications for clinical practice: To date, the document has been translated into eight languages, and some critical care units have updated their prone protocols according data presented in this document. This will be a dynamic document and revised as more evidence-based practices and technologies become available, specifically for prone ventilation and the prevention of tissue damage.
Authors: Peter Thomas Murphy, Aaron Liew, Brian E. McGuire, John Bogue, Monika Pilch, Sean Dinneen, Aonghus O’Loughlin, Anne Doherty, & Sínead Conneely
First published 1 July 2021
This article should be referenced as: Murphy PT, Liew A, McGuire BE, Bogue J, Pilch M, Dinneen S, O’Loughlin A, Doherty A, Conneely S: Do personality and mood difficulties predict foot self-care in diabetes?, Journal of Wound Management, 2021
Background: The literature indicates the impact of psychological factors on the development and course of diabetes remains unclear.
Aim: To explore personality, depression, diabetes-related distress and illness beliefs in adults attending routine diabetes clinics and investigate whether the extent of these difficulties can predict foot self-care.
Methods: Participants were consecutive patients with diabetes attending diabetes outpatient and podiatry clinics in hospitals who completed self-administered questionnaires to access personality traits and evaluate them for personality disorders, depression, diabetes-related distress, beliefs about illness and foot self-care.
Results: Approximately 1 in 5 participants screened positive for Type D personality, personality disorders and diabetic-related distress; 8% screened positive for major depression. A standard multiple regression model determined whether foot self-care was predicted by these variables. The results were non-significant, F (13, 106) = 1.63, p = .09. Having macrovascular complications was significantly positively related to foot self-care (r(118) = .20, p = .027). Participants with a current and/or past history of DFU had higher BMI, longer duration of diabetes, were more likely to be on insulin therapy and to have concomitant microvascular complications.
Conclusion: Personality and mood disorders are prevalent in people attending diabetes clinics, but the variables measured here do not predict foot self-care.
Implications for clinical practice: Adults attending specialist podiatry/diabetes clinics need clinical pathways to mental health support.
Authors: Alberto Piaggesi, Alessia Scatena, Sara Sandroni and Stefano Gasperini
First published 29 June 2021
This article should be referenced as: Piaggesi A, Scatena A, Sandroni S, Gasperini S: The HERMES Study – blue ligHt photobiomodulation thErapy on neuRoischeMic patiEntS – Experimental Design and Study Protocol, Journal of Wound Management, 2021
Aims: To evaluate the safety and effectiveness of photobiomodulation1 therapy in addition to the standard of care (SoC) for managing diabetic foot ulceration (DFU), we designed a prospective randomised double-blind trial for neuro-ischemic patients (HERMES study), whose design and study protocol we describe in this paper.
Patients and methods: All patients with a chronic neuro-ischemic DFU wider than 1 cm2 attending the S. Donato Hospital DF Clinic in Arezzo, Italy (I), will be screened for enrolment. After two weeks, while patients are treated with SoC, those whose lesions have not decreased by 50% or more in size will be randomised into two groups: the control group will be managed with SoC, while the study group will be treated with photobiomodulation + SoC twice weekly for 20 weeks, or until healing. Both groups will be managed in the community by visiting nurses. The outcomes [healing rates at 24 weeks (primary endpoint), healing times, speed of area reduction, pain, quality of life, adverse events] will be blinded to the treatment.
Results: As a pilot study, we cannot anticipate results, but we expect a positive difference of at least 15% in the study group’s primary outcomes, compared to controls, with no worsened safety profile.
Conclusions and implications for clinical practice: The interest of the HERMES study, beyond the findings related to the efficacy and safety of photobiomodulation, lies in the characteristics of this low-cost, no-waste technology and its integration in specialist and community-based care.
Authors: Rashad A. Bishara, Amr M. Abdel-Mawgoud, Laila Al-Sabbagh, Ihab N. Hanna, Mohammed Ramadan Abdel-Mageed, Nehad A. Fouad, Ramez O. Shehata
First published 26 June
This article should be referenced as: Bishara RA, Abdel-Mawgoud AM, Al-Sabbagh L, Hanna IN, Abdel-Mageed MR, Fouad NA, Shehata RO: Health belief theories and their influence on adherence behaviours in individuals with diabetic foot ulceration: A literature review, Journal of Wound Management, 2021
Aim of the study: This study aimed to compare the results after using NPWT to standard wound care in severe DFUs, classified in the WIFI classification system as W2 and W3.
Authors: Luc Téot, Sylvie Meaume
First published 21 June 2021
This article should be referenced as: Téot L, Meaume S: How to integrate new technologies into daily practice: The clinician perspective. Journal of Wound Management, 2021
Background: The integration of new technologies can call for obeying different rules and should be considered a long-term evolutionary process that is realised step by step. Before a medical device appears in the market, a long regulatory process has been completed, including safety, experimental and preclinical studies leading to an authorisation for distribution in a national market. Depending on the target countries and their respective regulations, the need for robust clinical studies, including randomised clinical trials, is often mandatory for distribution. Post-clinical trials may be used to confirm the results obtained from a medical device. The efficacy of the introduction of new technology in daily practice is then dependent on clinicians’ perceptions of the improvement in wound-healing. Complications may occur even after a long period of time, with severe consequences for patients’ quality of life. Since the PIP (Poly Implant Prothèse) scandal, more restrictions have been imposed to prevent such failures and increase the safety for the population.
Authors: Nurul Z, Holloway S, Edney SM
First published 17 June 2021
This article should be referenced as: Nurul Z, Holloway S, Edney SM: Health belief theories and their influence on adherence behaviours in individuals with diabetic foot ulceration: A literature review, Journal of Wound Management, 2021
Background: Existing evidence suggests that adherence to treatment plans and long-term lifestyle modifications could reduce costly complications associated with diabetes, such as diabetic foot ulcers (DFU). Applying biopsychosocial models and theories to practice can help clinicians understand why individuals adopt or reject certain health behaviours.
Aims: This review explores the dynamic between patients’ psychosocial behaviours and their levels of commitment to treatment plans, discusses approaches for improving the therapeutic relationship between health care professionals (HCPs) and patients through collaborative healthcare planning and raises awareness of the importance of identifying the psychological barriers to managing outcomes of chronic illnesses.
Methods: This is a narrative exploration of health belief theories applied to managing diabetes and DFU, including a discussion of ‘compliance’, ‘adherence’ and ‘concordance’; health psychology theories on adherence behaviours; and the role of emotional responses in influencing the acceptance of long-term treatments.
Findings: Evidence highlighted the role of psychosocial factors in influencing a person’s decision-making process and noted individual differences in the willingness to conform to certain health and treatment recommendations, based on prior assumptions and know-ledge extending beyond a longer-term conception of the benefits and risks of behaviours or disease progression.
Conclusions: Healthcare planning should shift from labelling patients as ‘non-compliant’ toward promoting collaborative conversations that inform choices and actions. HCPs should acknowledge the importance of patients’ knowledge and views about their health and create treatment plans that best suit these individual needs. Future research should develop health belief models to incorporate patients’ emotional responses to chronic illness.
Authors: Lee CY, Ho YY, Arasappan M, Koay YW, Abraham J
First published 20 April 2021
Background: Ischaemic wounds are notoriously difficult to treat, as poor perfusion often leads to chronic, non-healing wounds.
Aim: This case study describes the successful treatment of an ischemic ulceration in a neonate using topical oxygen therapy (TOT).
Methods: A large necrotic ulceration quickly developed over the left gluteal area in a 2-week-old child and enlarged
to cover the entire gluteal area in one week. The aetiology of the wound was ischaemic, due to internal iliac artery thrombosis after an umbilical vein catheterisation. The wound was initially managed using the standard of care and surgical debridement of the necrotic tissue with saline dressing; however, the condition worsened with the development of a new necrotic patch. Topical oxygen therapy (TOT) was applied using the M.O.I.S.T. concept. After the second surgical debridement, TOT in the form of haemoglobin spray was administered on alternate days and a moist dressing was applied.
Results / Findings: The wound healed progressively, with granulation tissue formation and epithelisation after 6 weeks.
Conclusions: Wound management in neonates is extremely challenging, due to their relatively small physical size and
the preference for less invasive management strategies.
Implications for clinical practice: TOT has proven to be an easily accessible, efficacious, non-invasive and cost-effective method for treating ischaemic wounds in neonates.
Authors: Ion A, Giurcaneanu C, Nichita M, Orzan OA, Popa LG, Beiu C, Tudose I, Mihai MM
First published 19 April 2021
This article should be referred as: Ion A, Giurcaneanu C, Nichita M, Orzan OA, Popa LG, Beiu C, Tudose I, Mihai MM: Leiomyosarcoma - A rare neoplasia arising from a chronic venous ulcer. Case report and literature review, Journal of Wound Management, 2021
Background: Long-standing wounds are at risk of developing malignant degeneration, including leiomyosarcomas. These exceedingly rare malignant tumours originate from smooth muscle cells and are considered superficial if they affect the dermis and/or subcutis.
Hypothesis: To exclude malignancy, a biopsy should be performed on chronic skin ulcers with atypical features or evolutions.
Methods: We report the case of a 62-year-old male with a history of a two-year old chronic venous ulcer who presented
with a tumour developing over three months, progressively increasing in size on the surface of the wound. As the clinical aspect strongly suggested a malignant tumour arising within a chronic venous ulcer (the initial suspicion was of squamous cell carcinoma), a biopsy from the edge of the lesion was performed.
Results: Histopathological and immunohistochemical examinations revealed a diagnosis of leiomyosarcoma.
The patient refused further medical care. The tumour arose in the context of severe cutaneous changes of venous insufficiency and had aggressive clinical behaviour.
Histopathological and immunohistochemical analysis of the tissue sample is essential for establishing the final diagnosis, as no pathognomonic clinical features of leiomyosarcoma exist.
Conclusions: Our case emphasises the importance of considering malignancy in chronic ulcers with atypical features or evolution. Biopsy of atypical skin ulcers is crucial for establishing a diagnosis and initiating therapy at the rightful moment.
Implications for clinical practice: The findings from this case highlight the importance of an early diagnosis of atypical, non-healing wounds, based on tissue samples, to decide the optimal approach. Patient denial may interfere with the proper management of this particular clinical context.
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Authors: Juan José Téllez Zaya, Elena Conde-Montero, Lorena Recarte Marín, Laura Pérez Jerónimo, Alicia Peral Vázquez, Alba Casillas Pérez, Pablo de la Cueva Dobao
First published 9 April 2021
This article should be referenced as: Zaya JJT, Conde-Montero E, Marín LR, Jerónimo LP, Vázquez AP, Pérez AC, Dobao PC: Comorbidities and clinical features of Martorell hypertensive ischemic leg ulcers: findings from a retrospective cohort study, Journal of Wound Management, 2021
Background: Martorell hypertensive ischemic leg ulcers are commonly misdiagnosed, and their prevalence may be underestimated. There are still some aspects to be defined about the aetiopathogenesis of Martorell ulcers and the risk factors that may be involved with them.
Methods: This is a single-centre retrospective case series study on the demographic characteristics and comorbidities in a series of patients with Martorell ulcer treated at a public university hospital in Madrid.
Results: Comparing our results to previous studies, which are few and include small samples, the risk factors that we outline are an average age over 70 years and high blood pressure. Only two (5%) participants had poor control of their high blood pressure.
Conclusions and Implications for Clinical Practice: Defining the epidemiological features of this type of leg ulcer may be very useful in differential diagnosis with other disorders, such as pyoderma gangrenosum.
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Patients’ perceptions of, and acceptance toward, using wearable sensor technology in wound care
Megan R. Goldrick, BSc, MSc, Georgina T. Gethin, PhD, MSc, PG, RGN, FFNM RCSI
First published 29 March 2021
This article should be referenced as: Goldrick MR, Gethin GT: Patients’ perceptions of, and acceptance toward, using wearable sensor technology in wound care, Journal of Wound Management, 2021
Background: Wearable sensor technologies for wound management have slowly found their way into healthcare systems worldwide. They aim to produce benefits in the reduction of hospitalisation time, facilitate home healthcare, mitigate loses incurred by human error, reductions in clinician and nursing efforts and the prevention of amputations. They have the ability to capture the diurnal and circadian variations of wound parameters, with patients benefitting from continuous long-term monitoring as a part of either a diagnostic procedure or the maintenance of their wounds.
Aim: This study explored the perceptions of those living with chronic wounds of the foot and lower limb toward the concept of a wearable sensor technology for wound management.
Methods: A qualitative description method was employed. Twenty-three semi-structured interviews were conducted in three geographically distinct locations in Ireland. A thematic analysis was also conducted.
Results: Four main themes emerged: the element of personal contact, the medical need for wound diagnostics, the practicalities of wearable sensor devices and the trialable nature of wearable sensor devices.
Conclusions: Most participants indicated feelings of concern toward accepting wearable sensor technology as a part of wound management and the potential loss of contact with their attending clinician. These findings contribute to understanding technology acceptance.
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By Ahmed Hussein, RN, MScN; Magdalena A. Gershater, RN, PhD
First published 25 March 2021
This article should be referenced as: Hussein A, Gershater MA: The diabetic foot in hospitalised stroke patients: Documentation of nursing actions and the need for improvement, Journal of Wound Management, 2021
Background: Patients with diabetes and stroke have a high risk of injury to the paralysed side of the body, but are incapacitated and unable to maintain their self-care. In stroke units, registered nurses can assist patients through systematic assessments and nursing interventions, including preventive footcare.
Aim: To explore the documentation of preventive nursing actions regarding the risk of developing foot ulcers in patients with diabetes and stroke at a neurology clinic’s inpatient ward.
Method: A retrospective systematic review of computerised nursing records using the Global Trigger Tool (GTT). All records (n = 101) of patients with diabetes and stroke at the clinic between 1 January and 20 December 2015 were assessed. Descriptive statistics and manifest content analysis were used.
Results: Median age: 78 years (41–93). Male/Female: n = 61/40. The records revealed insufficient documentation: Risk for foot ulcers was not documented in any of the records. The GTT showed that three patients had a documented foot ulcer, all with localisation on the same side in which the patient was paralysed. Documented nursing actions for foot ulcer prevention in bed were provided for 12 patients, but none were provided for patients sitting in a chair. Risk factors, according to the International Working Group of the Diabetic Foot, were found in 12 of the patients’ records. The nursing process was not mentioned in the records.
Conclusion: Insufficient documentation indicates that the patients’ feet are not assessed and protected.
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