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Wound Manag Prev 2019 Apr;65(4):42-47

University of Miami Miller School of Medicine, Miami, FL.

A paucity of research exists on medical student pressure ulcer education.

Purpose: This study examines medical student competency outcomes following implementation of a competency-based curriculum that included a pressure ulcer component in its educational intervention.

Methods: Over a 5-year period, 645 medical students completed the curriculum, which included a preceptor-led didactic session, online study resources, clinical experiences, and a brief online competency assessment. Read More

Am J Hosp Palliat Care 2019 Apr 16:1049909119838969. Epub 2019 Apr 16.

3 Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.

In 2012, we published a study in this journal exploring the emergence of unique skin changes in end-of-life patients admitted to a palliative care unit. The purpose of the study was to describe the skin changes and identify the relationship between these changes and time of death. In the above study of 80 patients, the skin changes were found to be unique and different from Kennedy terminal ulcers and deep tissue injuries. Read More

Wounds 2019 Mar 15. Epub 2019 Mar 15.

Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University, Dayton, OH.

Introduction: Chronic wounds are physically debilitating and painful and are responsible for the addition of more than $25 billion annually in health care costs in the United States. Extracellular matrix (ECM) replacements have been demonstrated to aid in wound healing by providing an optimal environment to facilitate the healing process.

Objective: This study examines the healing rates of stage 4 pressure ulcers using combination of a commercially available porcine-based wound matrix dressing alongside negative pressure wound therapy (NPWT) versus using NPWT alone. Read More

Int Wound J 2019 Apr 16. Epub 2019 Apr 16.

Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.

The majority of pressure ulcers (PUs) including deep tissue injuries (DTIs) are preventable, and even reversible if detected in their early phase. One of the greatest barriers in PU prevention is that clinicians traditionally depended on subjective and qualitative techniques, particularly routine visual skin assessments that would only document existing, macroscopic PUs/DTIs, rather than preventing them or detecting them at their microscopic phase. At the early phase of cell damage, when a forming PU is still microscopic, there is a local increase in extracellular fluid contents within affected tissues, which is called sub-epidermal moisture (SEM). Read More

Am J Clin Dermatol 2019 Apr 15. Epub 2019 Apr 15.

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Dermatologists encounter patients with a variety of lower extremity ulcers including those related to venous insufficiency and peripheral arterial disease. Vascular studies, including ankle brachial pressure index, toe pressure, toe brachial index, Doppler arterial waveform, Duplex ultrasonography, and angiography, play an essential role in the prevention, diagnosis, and management of vascular diseases. In fact, dermatologists are often the first medical providers to see patients with complex vascular conditions. Read More

J Health Serv Res Policy 2019 Apr 12:1355819619837288. Epub 2019 Apr 12.

4 Professor of Applied Health Research, Faculty of Medicine and Health, University of Leeds, UK.

Objectives: To evaluate the effect of Care Quality Commission external inspections of acute trusts on adverse event rates in the English National Health Service.

Methods: Interrupted time-series analysis including all acute NHS trusts in England ( n = 155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of Care Quality Commission inspections as an intervention. Read More

J Wound Care 2019 Apr;28(Sup4):S23-S30

Physician, Department of Intensive Care Units, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Xiasha Campus; The First Affiliated Hospital and First Clinical College of Zhejiang Chinese Medical University, Hangzhou, 310018, Zhejiang, China.

Objective: To verify the feasibility of treating pressure ulcers (PUs) with autologous platelet-rich fibrin-based (PRF) bioactive membrane, both in vitro and in vivo.

Method: An animal model using adult male Sprague-Dawley rats was used. Pressure was periodically exerted on the skin to induce localised ischaemia by using an external magnet and transplanted metal disc. Read More

J Wound Care 2019 Apr;28(Sup4):S18-S22

Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Objective: Ultrasonography is suitable for assessing pressure ulcers, and several features of ultrasonographic images that indicate abnormalities have been reported. However, no study has compared ultrasonographic images between normal and pressure-loaded skin and subcutaneous tissue from the same patients. This study aimed to assess lateral thoracic tissue using ultrasonography for both pre- and postoperative conditions and investigate changes in the tissue caused by loading. Read More

J Wound Care 2019 Apr;28(Sup4):S4-S11

Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.

Objective: This article compares the results from a recent pressure ulcer (PU) prevalence audit at the Sheikh Khalifa Medical City (SKMC) hospital in Abu Dhabi to identify the impact of new prevention initiatives introduced around 2013 and establish the effectiveness of PU prevention strategies, judged quality of nursing care, and costs associated with patients developing a hospital-acquired pressure ulcer (HAPU).

Method: The methods used were based on a previous point prevalence study involving 441 acute care patients, who were assessed using the International Pressure Ulcer Prevalence (IPUP) Survey. Following pre-selection of a 24-hour period for data capture, hospital staff collected PU data. Read More

Int J Prev Med 2019 15;10:26. Epub 2019 Feb 15.

Nursing and Midwifery Care Research Center, Department of Critical Care, Nursing and Midwifery School, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Detecting pressure ulcer is an important nursing diagnostic and care requirement in patients hospitalized in Intensive Care Unit (ICU). The purpose of this study is to examine the effect of Lawsonia plant on pressure ulcer grade one in ICU patients.

Methods: In this clinical trial, 72 patients eligible for hospitalization in hospitals of Isfahan University of Medical Sciences were divided randomly into two control and intervention groups. Read More

BMJ Open 2019 Apr 9;9(4):e026727. Epub 2019 Apr 9.

Heart Center, Beijing Chaoyang Hospital affiliated with Capital Medical University, Beijing, China.

Introduction: Pressure ulcers (PUs) are associated with substantial health burden. Patients in intensive care units (ICUs) are at high risk for developing PU. In the absence of large randomised controlled trials (RCTs) that compare commonly known interventions for preventing PU in ICUs, uncertainty remains around the best practice strategy for PU management in adult ICUs. Read More

Foot (Edinb) 2019 Feb 2;39:37-44. Epub 2019 Feb 2.

Department of Plastic and Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.

Forefoot ulcerations in patients with diabetes are quite common. Underlying mechanical deformities of the foot in combination with neuropathy are the most important risk factors for ulcer development and adequate offloading is the mainstay of management. Most ulcers heal with local wound care, adequate blood supply, and pressure relief. Read More

Adv Drug Deliv Rev 2019 Apr 6. Epub 2019 Apr 6.

Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore; Skin Research Institute Singapore, Clinical Sciences Building, 11 Mandalay Road, 308232, Singapore. Electronic address:

Acute wound healing is an orderly process of four overlapping events: haemostasis, inflammation, proliferation and remodelling. A drug delivery system with a temporal control of release could promote each of these events sequentially. However, acute wound healing normally proceeds very well in healthy individuals and there is little need to promote it. Read More

Adv Skin Wound Care 2019 Apr 2. Epub 2019 Apr 2.

At the Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia, Stephen Sprigle, PhD, PT, is a Professor; and Sharon Sonenblum, PhD, is a Senior Research Scientist.

Objective: To visually assess and report the influence of supine positioning and sacrum and coccyx anatomy on tissue deformation.

Methods: A convenience sample of three participants was scanned using MRI. All participants were scanned in a supine position with a rig oriented in a flat or horizontal position and with the torso portion of the rig elevated to 30° to simulate head-of-bed elevation. Read More

Adv Skin Wound Care 2019 Apr 2. Epub 2019 Apr 2.

At the Guilan University of Medical Sciences, in Rasht, Iran, Mostafa Soodmand, MSc, is a medical-surgical nursing student, School of Nursing and Midwifery; Mohammad Taghi Moghadamnia, PhD, is Assistant Professor of Health in Disasters and Emergencies, Department of Medical-Surgical Nursing, School of Nursing and Midwifery; Iraj Aghaei, PhD, is Assistant Professor of Neurosciences, Social Determinants of Health Research Center; Golshan Ghasemzadeh, BSN, is a researcher, Healthy Heart Research Center, Heshmat Hospital; Ehsan Kazemnejad Lili, PhD, is Associate Professor of Biostatistics, School of Nursing and Midwifery; and Enayatollah Homaie Rad, PhD, is Assistant Professor of Health Economics, Social Determinants of Health Research Center.

Objective: To investigate the roles of hemodynamic factors and oxygenation on the incidence of pressure ulcers in patients in the ICU on mechanical ventilation.

Methods: This prospective analytical cross-sectional study was performed in several ICUs for a period of 8 months in Iran. Researchers checked patients for pressure ulcers on a daily basis. Read More

J Am Med Dir Assoc 2019 Apr 3. Epub 2019 Apr 3.

University of Chicago, Chicago, IL.

Background: Pressure ulcers pose an important quality-of-care challenge in nursing homes, with serious consequences for residents' health. We assessed the scalability of the On-Time Pressure Ulcer Prevention (On-Time) intervention strategy, developed by the Agency for Healthcare Research & Quality, in nursing homes nationwide.

Intervention: On-Time uses electronic health record reports to identify changes in resident pressure ulcer risk and facilitate multidisciplinary input into clinical decision making. Read More

BMC Health Serv Res 2019 Apr 5;19(1):218. Epub 2019 Apr 5.

School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.

Background: Post-acute care hospitals are often subject to patient flow pressures because of their intermediary position along the continuum of care between acute care hospitals and community care or residential long-term care settings. The purpose of this study was to identify patient attributes associated with a prolonged length of stay in Complex Continuing Care hospitals.

Methods: Using information collected using the interRAI Resident Assessment Instrument Minimum Data Set 2. Read More

J Tissue Viability 2019 Mar 21. Epub 2019 Mar 21.

University of Pittsburgh, Pittsburgh, PA, USA.

Pressure injuries resulting from long surgeries may be caused by prolonged ischemia. Operating table surfaces with alternating pressure (AP) features may reduce the risk of ischemia-induced pressure injuries by providing periodic relief of blood flow occlusions. Prior research investigated alternating loading applied with a single isolated rigid indenter and demonstrated increased perfusion. Read More

J Clin Transl Hepatol 2019 Mar 10;7(1):32-39. Epub 2019 Mar 10.

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.

The management of post-endoscopic variceal ligation (EVL) bleeding ulcers (PEBUs) is currently based on local expertise and patients liver disease status. The present retrospective study investigated associations between the endoscopic morphology of PEBUs and patient outcomes. Patients underwent EVL (primary or secondary), from January 2015 to January 2018, in two tertiary care hospitals in India (ILBS New Delhi and Dharamshila Narayana New Delhi). Read More

Rev Esp Salud Publica 2019 Apr 4;93. Epub 2019 Apr 4.

Departamento de Ingeniería Electrónica. Universitat de València. Valencia. España.

Objective: The Pressure Ulcer is a recognised healthcare adverse event and a public health problem. The main goal in this work was to understand the status of the Hospital Acquired Pressure Ulcer (HAPU) from the public hospitals of the Valencian Community before (2012) and during the process of implementation of a specific prevention and treatment Practice Guideline for this matter (2013-2015).

Methods: Retrospective study through the Minimum Basic Hospital Data Set (MBDS), and taking its variables as the input. Read More

J Craniofac Surg 2019 Mar 27. Epub 2019 Mar 27.

Department of Burns and Plastic Surgery.

Chest wall ulcer induced by postmastectomy radiation therapy (PRMT) remains challenging for plastic surgeons because of the reduced blood supply, fibrosis, and impaired cellular potential in the irradiated area. In this study, chest wall ulcer was treated with negative pressure wound therapy (NPWT) and the latissimus dorsi myocutaneous (LDM) flap reconstruction in 2 stages. A retrospective study was performed on consecutive patients with chronic radiation-induced ulcers in chest wall from June 2012 to June 2017. Read More

J Craniofac Surg 2019 Mar 27. Epub 2019 Mar 27.

Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington, KY.

Nasotracheal intubation is routinely used in patients undergoing oral and maxillofacial surgery when intermaxillary fixation is needed either intraoperatively or postoperative. Various complications can occur such as epistaxis, turbinectomy, retropharyngeal dissection, tympanites, and nasal alar pressure sores or necrosis, especially when there is a prolonged nasotracheal intubation. The first report of a nasal alar necrosis after prolonged nasotracheal intubation was published by Hatcher et al in 1968. Read More

J Clin Nurs 2019 Apr 2. Epub 2019 Apr 2.

Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.

Background: Pressure ulcers (PUs) represent a current issue for healthcare delivery. Nurse self-efficacy in managing PUs could predict patients' outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task-specific self-efficacy has not yet been developed. Read More

Rev Endocr Metab Disord 2019 Apr 1. Epub 2019 Apr 1.

Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.

The aim of the review is to examine the role of growth factors and cytokines in the management of Diabetic Foot Ulcers, such as platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) and Insulin like growth factor (IGF). Taking this a step further, the role of Hypoxia-inducible factors (HIFs), Transforming growth factor beta 1 (TGF-β-1) and other growth factors have also been examined, with regard to the treatment of diabetic foot ulcers. The roles of these above-mentioned growth cytokines have been analyzed by studying various scholastic articles. Read More

J Tissue Viability 2019 Mar 27. Epub 2019 Mar 27.

Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; School of Health Sciences, Örebro University, Sweden. Electronic address:

Background: Pressure ulcers have a high impact on patients and their families. Profound and up-to-date knowledge among nurses is important given the effect on attitudes and preventative behaviour. To gain insight into educational needs and priorities, regular knowledge assessments are needed. Read More

J Hosp Palliat Nurs 2019 Mar 30. Epub 2019 Mar 30.

Sharon Latimer, PhD, is research fellow (Patient Safety in Nursing), School of Nursing and Midwifery, Griffith University; and Nursing Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia. Joanie Shaw, GradCert, is nurse educator, Cancer and Specialty Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia. Tracey Hunt, MSN, is clinical nurse consultant, Diagnostics and Subspecialty Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia. Kristyn Mackrell, BSc, is senior occupational therapist, Community & Palliative Care Occupational Therapy Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia. Brigid M. Gillespie, PhD, is professor (Patient Safety in Nursing), graduate certificate, School of Nursing and Midwifery, Griffith University; and Nursing Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.

Kennedy terminal ulcers, a subset of pressure injuries, are associated with the dying process. This scoping review aimed to identify and map the published literature on Kennedy terminal ulcers in terms of its definition, prevalence, assessment, treatment, management, health care costs, and quality of life for patients in all health care settings. Using the Arksey and O'Malley scoping review framework, we systematically searched the Cochrane Library, CINAHL, EMBASE, MEDLINE, and ProQuest databases and 5 guideline repositories between 1983 and 2018. Read More

Dtsch Med Wochenschr 2019 Apr 29;144(7):484-488. Epub 2019 Mar 29.

Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg.

History And Clinical Findings:  A 75-year-old woman was admitted to our institution for acute abdominal pain. She had a history of atrial fibrillation, pacemaker implantation and diastolic heart failure. At time of admission, she was under oral anticoagulation therapy with apixaban. Read More

Br J Nurs 2019 Mar;28(6):S6-S11

Quality Consultant, Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.

A pressure ulcer prevalence of 17.3% at Odense University Hospital in Denmark in 2010 prompted action and a quality improvement project was planned. This had two aims: to reduce pressure ulcers at the hospital by 50% and to have no pressure ulcers at or above category 3. Read More

Wounds 2019 Apr;31(4):97-102

Osiris Therapeutics, Inc, Columbia, MD.

Introduction: Cryopreserved placental membrane containing viable cells (vCPM) in conjunction with standard of care (SOC) has shown clinical effectiveness in several studies for the management of acute and chronic wounds. Recently, a new lyophilization technique has been developed that allows viable tissues to be stored at room temperature as a structural and functional equivalent to vCPM.

Objective: This case series evaluates the clinical outcomes of a lyopreserved placental membrane containing viable cells (vLPM) for the management of chronic wounds of various etiologies. Read More

Wounds 2019 Apr;31(4):114-116

Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

Chronic ulcers greatly add to the clinical, economic, and patient burden on health care, increasing visits that challenge patients and strain overworked clinical centers. Telemedicine (TM) facilitates interprofessional collaboration and patient education and enables specialist bedside consults for clients without adding to their transfer and travel risks. Evidence supports improved postoperative monitoring, access to experts, and cost savings for TM-managed patients with acute or chronic wounds in a variety of settings. Read More

Health Soc Care Community 2019 Mar 27. Epub 2019 Mar 27.

Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.

Pressure ulcers can be painful and negatively affect health-related quality of life and healthcare costs. Many people living in nursing homes are at risk of developing a pressure ulcer. Nursing home staff, tissue viability nurses and researchers have co-designed the first theory and evidence-informed care bundle specifically for nursing homes, which consists of three prevention practices (skin inspection, support surfaces, repositioning) and a range of behaviour change techniques to promote these practices. Read More

J Caring Sci 2019 Mar 1;8(1):45-49. Epub 2019 Mar 1.

Department of Nursing, Nursing and Midwifery School, Iranian Research Center on Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Introduction: Pressure ulcer is one of the most common and painful complications in patients admitted to intensive care units (ICUs). This study aimed to compare the effects of tragacanth gel cushions and foam-filled ones on the prevention of pressure ulcers. This triple-blind, randomized, clinical trial was performed on 94 patients admitted to the ICU of Taleqhani Hospital of Mashhad, Iran. Read More

J Cosmet Dermatol 2019 Apr 26;18(2):495-507. Epub 2019 Mar 26.

Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.

Background: The biological mechanisms underlying the use of platelet-rich plasma (PRP), as well as the efficacy and possible adverse effects of PRP, have not yet been fully elucidated. Prior studies have evaluated PRP for cutaneous ulceration. However, the benefits from PRP still remain controversial and few have assessed the effects of ulceration etiologies. Read More

HPB (Oxford) 2019 Mar 22. Epub 2019 Mar 22.

School of Nursing, Nantong University, Nantong city, Jiangsu province, PR China. Electronic address:

BMC Vet Res 2019 Mar 25;15(1):100. Epub 2019 Mar 25.

Department of Farm Animals, Vetsuisse-Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland.

Background: This study evaluated the clinical, laboratory, ultrasonographic and pathological findings in 87 cows aged 2 to 10 years (4.5 ± 1.5 years) with type-4 abomasal ulcer. Read More

BMJ Open 2019 Mar 23;9(3):e029185. Epub 2019 Mar 23.

School of Health Professions Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.

Introduction: Foot ulceration is a multifactorial complication of diabetes. Therapeutic insoles and footwear are frequently used to reduce elevated tissue pressures associated with risk of foot ulceration. A novel protocol using in-shoe pressure measurement technology to provide an instant optimised insole and house shoe solution has been developed, with the aim of reducing foot ulceration. Read More

Ir J Med Sci 2019 Mar 21. Epub 2019 Mar 21.

Department of Neurology, The 2nd Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, China.

Background: This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China.

Methods: Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded. Read More

Neurosurg Clin N Am 2019 Apr 18;30(2):203-209. Epub 2019 Feb 18.

Department of Neurosurgery, Vanderbilt University, 1500 21st Avenue South, The Village at Vanderbilt, Suite 1506, Nashville, TN 37212, USA.

Intrathecal baclofen infusion is an accepted treatment for spasticity. Evidence also exists for the treatment of secondary generalized dystonia with intrathecal baclofen infusion. Benefits include decreased tone, improved positioning, and decreased decubitus ulcers. Read More

Clin Biomech (Bristol, Avon) 2019 Feb 23;63:153-160. Epub 2019 Feb 23.

Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.

Background: Deep tissue injury is a type of pressure ulcer which originates subcutaneously due to sustained mechanical loading. The relationship between mechanical compression and damage development has been extensively studied in 2D. However, recent studies have suggested that damage develops beyond the site of indentation. Read More

NMR Biomed 2019 Mar 21:e4087. Epub 2019 Mar 21.

Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands.

The current state-of-the-art diagnosis method for deep tissue injury in muscle, a subcategory of pressure ulcers, is palpation. It is recognized that deep tissue injury is frequently preceded by altered biomechanical properties. A quantitative understanding of the changes in biomechanical properties preceding and during deep tissue injury development is therefore highly desired. Read More

Int Wound J 2019 Mar 20. Epub 2019 Mar 20.

Electrophysiology and Neurocognition Lab, Clinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel.

The aim of this study was to identify and characterise the association between the prevalence of pressure ulcers, spasticity levels, and advanced dementia in disable elderly patients. Data were obtained from the patient medical files. Patients were hospitalised in the geriatric skilled nursing department. Read More

Adv Skin Wound Care 2019 Apr;32(4):149

R. Gary Sibbald, MD, MEd, DSc (Hons), FRCPC (Med Derm), FAAD, MAPWCA, JM, is the co-Editor-in-Chief of Advances in Skin & Wound Care; Professor, Medicine and Public Health, University of Toronto, Toronto, Ontario, Canada; Director, International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care), Dalla Lana Faculty of Public Health, University of Toronto; Investigator, Institute for Better Health, Trillium Health Partners; Project Lead, ECHO Ontario, Skin & Wound Care; and President (2008-2012), World Union of Wound Healing Societies. Elizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN is the co-Editor-in-Chief of Advances in Skin & Wound Care; Faculty, Excelsior College School of Nursing, Albany, New York; Founder and co-Course Director, WoundPedia Manila; President, World Council of Enterostomal Therapists; President, Ayello Harris & Associates, Inc, Copake, New York; and President (1999), National Pressure Ulcer Advisory Panel.

J Trauma Acute Care Surg 2019 Mar 13. Epub 2019 Mar 13.

Division of Pediatric General Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, CA.

Background: Early tracheostomy has been associated with shorter hospital stay and fewer complications in adult trauma patients. Guidelines for tracheostomy have not been established for children with severe TBI. The purpose of this study was to 1) define nationwide trends in time to extubation and time to tracheostomy; and 2) determine if early tracheostomy is associated with decreased length of stay and fewer complications in children with severe TBI. Read More

Plast Reconstr Surg Glob Open 2018 Nov 21;6(11):e2010. Epub 2018 Nov 21.

Center for Stem Cell Research & Regenerative Medicine, Tulane University School of Medicine, New Orleans, La.

Background: Processed microvascular tissue (PMVT), a human structural allograft, is derived from lyophilized human tissue containing microcirculatory cellular components. Since PMVT serves as a source of extracellular matrix (ECM), growth factors, cytokines, and chemokines modulating angiogenesis, inflammation, apoptosis, and endogenous cell recruitment, we hypothesized its application would accelerate wound regeneration in a validated pressure ulcer (PU) model developed in C57BL/6 mice using two 24-hour cycles of skin ischemia/reperfusion created by placement and removal of external magnets.

Methods: Two identical PU injuries (n = 50 female mice) were treated with (a) topical particulate PMVT, (b) injected rehydrated PMVT, or (c) saline control injection, and assessed daily for closure rates, scab formation/removal, and temperature. Read More

J Multidiscip Healthc 2019 28;12:173-182. Epub 2019 Feb 28.

Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands,

Purpose: In a continued effort to improve the health care services, a project was set up to develop and implement a care pathway for the effective management of pressure ulcers in the St Elisabeth Hospital in Curaçao, the Dutch Caribbean. To ensure the effective implementation of our intervention, we decided to investigate what factors define the implementation climate of a health care institution within a resource-limited environment.

Methods: We used a participatory tool approach in this study, where a mixed team of health professionals worked on two parts of a health improvement project, namely: 1) workforce leadership development through a clinical leadership training program; and 2) health care quality improvement through the pressure ulcer care pathway development. Read More

Wound Repair Regen 2019 Mar 13. Epub 2019 Mar 13.

Leeds Institute of Clinical Trials Research, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom.

Patient-reported outcomes can be included as end points in pressure ulcer (PU) intervention trials to provide information to inform decision-making and improve the lives of patients. However, the challenge for researchers and clinicians is identifying and choosing an appropriate instrument for each particular application that suits their research questions and clinical context. To provide researchers and clinicians with the information needed to inform choice of patient-reported outcome measures, we compared a generic and disease-specific measures' ability to discriminate between clinical groups known to differ, and determined their responsiveness to change. Read More

J Biophotonics 2019 Mar 13:e201800454. Epub 2019 Mar 13.

Singapore Bioimaging Consortium, Singapore.

Pressure ulcer formation is a common problem among patients confined to bed or restricted to wheelchairs. The ulcer forms when the affected skin and underlying tissues go through repeated cycles of ischemia and reperfusion, leading to inflammation. This theory is evident by intravital imaging studies performed in immune cell-specific, fluorescent reporter mouse skin with induced ischemia-reperfusion (I-R) injuries. Read More

Int Wound J 2019 Apr 12;16(2):550-555. Epub 2019 Mar 12.

Department of Medicine, Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada.

Pressure ulcers (PUs) are a serious health care problem for nursing home residents and a key quality metric for regulators. Three initiatives were introduced at a 128-bed facility to improve PU prevention. First, a Quality Assurance and Performance Improvement project and a Root Cause Analysis were conducted to improve the facility's wound care programme. Read More

Plast Reconstr Surg Glob Open 2019 Jan 7;7(1):e2084. Epub 2019 Jan 7.

Department of Plastic, Aesthetic and Reconstructive Microsurgery, Hand Surgery Klinikum Ernst von Bergmann, Potsdam, Germany.

The authors present the surgical strategy in the treatment of a morbidly obese paraplegic patient with a massive sacral pressure ulcer as well as bilateral trochanteric ulcers in a 1-step leg-sacrificing procedure utilizing the "spare-part" concept. It is the intention of the authors to reinforce the use of fillet flaps as a last resort option in paraplegic patients with pressure sores. Read More

Ann Plast Surg 2019 Apr;82(4S Suppl 3):S215-S221

Department of Electrical & Computer Engineering, Worcester Polytechnic Institute.

Pressure ulcers are increasingly prevalent in an aging population. The most commonly used method of pressure ulcer prevention is pressure off-loading achieved by physically turning bedbound patients or by using expensive, single application devices such as wheelchair cushions. Our aim is to approach the problem of pressure ulcer prevention in a new way: a wireless sensor worn by the patient at locations susceptible to pressure injury. Read More