Effect evaluation of different classification wounds with pressure ulcer scale for healing / 医学研究生学报

It is becoming a new trend in wound care field to do quantitative evaluation for the effect of wounds.The pressure ulcer scale for healing (PUSH) made by national pressure ulcer advisory panel (NPUAP) was used to evaluate the effect of pressure ulcers quantitatively at first and then it was used to different classification wounds.This article reviews the advancement of validity and reliability of PUSH in inter-professional research and clinical application in order to provide reference data for correctly using the tool.

Different off-loading mattresses with different repositioning intervals for preventing pressure ulcers in criti-cal patients:A randomized controlled trial / 医学研究生学报

Objective The incidence rate of pressure ulcer is high in critical patients and off-loading mattresses and reposi-tioning are known as effective interventions for the prevention of pressure ulcers .However, evidence is lacking for selection of the right type of mattresses and suitable interval of repositioning .This study was to compare the effects of two types of off-loading mattresses with two different repositioning intervals in preventing pressure ulcers in critical patients . Methods According to the design of this ran-domized controlled trial , we made a training plan concerning the participants , methods of intervention and comparison , criteria and methods of observation , and methods of recording , and trained 26 nurses from 7 hospitals .Using non-inferiority design and the method of stratified blocked randomization , we divided 1194 patients with the risk of pressure ulcer into a trial group ( n=596) and a control group ( n=598) , a viscoelastic sponge mattress with every-four-hours repositioning used for the former and an automatic aeration mat-tress with every-two-hours repositioning for the latter , both for 7 successive days .We examined the patients every day , recorded the in-cidence and stages of pressure ulcer , and compared the data obtained between the two groups of patients . Results The total inci-dence rate of pressure ulcer was 1.09%(13/1194), significantly lower in the trial than in the control group (0.34%[2/596] vs 1.84%[11/598], P=0.012). Conclusion A viscoelastic sponge mattress with every-four-hours repositioning is superior to an automatic aeration mattress with every-two-hours repositioning and therefore is preferred to the latter in preventing the incidence of pressure ulcer in critical patients in the ICU .

Effects of semirecumbent positions of different degrees on mechanical ventilation and prevention of compli-cations for ventilated patients / 医学研究生学报

Objective Mechanical ventilation is an important life support treatment in ICU, however, patients are at high risk for ventilator?associated pneumonia(VAP) and other complications which can increase the risk of death. In the article, comparative investigation was made on ventilation effects of different degrees of semirecumbent positions and preventive effects of VAP and pressure ulcers in order to provide evidence for preferred position. Methods 46 patients were divided into 30° group and 45° group in halves according to the angle of semirecumbent position. Patient position changes were performed among semirecumbent, right and left laterally inclined positions every two hours in both groups for consecutive 7 days. The peak airway pressure (PAP) and minute ventilation (MV) changes were measured every half an hour in two hours after semire?cumbent positioning every day during ventilation. The pressure of arte?rial oxygen(PaO2), pressure of arterial carbenoxide (PaCO2) and PaO2/FiO2(fraction of inspired oxygen,FiO2) were tested every day during intervention, along with the observation on the incidence of VAP and pressure ulcers. Results MV at each time point was normal in two hours after semirecumbent positioning in both groups with no changes to prolonged time ( P0.05). Conclusion Both 45° and 30°semirecumbent po?sitions can be applied in ventilated patients and the patient′s medical condition and tolerance are the keys when choosing preferred posi?tion and duration.

Study on the wound healing efficacy of negative pressure wound therapy combined with topical oxygen therapy on the traumatic chronic wounds / 医学研究生学报

Objective To evaluate the wound healing efficacy of negative pressure wound therapy (NPWT) combined with topical oxygen therapy ( TOT ) on the traumatic chronic wounds , and to explore new conception and method for traumatic chronic wounds . Methods Sixty-four patients with traumatic chronic wounds were randomized into two groups ( n=32 ) .Patients in the control group were treated by NPWT , and those in the intervention group were treated by NPWT and NPWT with TOT 3L/min.The treatment time lasted 12 days, and the dressing and tubes were changed every three days in the two groups .After 12 days, all the pa-tients were treated by standard moist therapy or surgery until healing or three months .Indicators of observation: The pressure ulcer scale for healing (PUSH) scores and granulation covered rate at 0, 3, 6, 9, and 12 days were measured, and healing rate and healing time during three months were calculated in the two groups . Results The PUSH scores were declined with intervention time during 12 days in the two groups , indicating the treatment was effective , but there was no significant difference between the two groups ( P>0 .05 ) .The granulation covered rate was increased with intervention time , and the granulation covered rate was higher in the intervention group than in the control group(P<0.001).The healing rate was higher in the intervention group than in the control group (87.50%vs 59.38%, P<0.05 ).The healing time of 14 days was shortened in the intervention group compared with the control group (P<0.001). Conclusion NPWT combined with TOT is an effective and feasible method for complicated traumatic chronic wounds , which can en-hance granulation growth , rise healing rate and shorten healing time .

Meta-analysis of enteral nutritional support for pressure ulcer prevention / 医学研究生学报

Objective Nutrition becomes a focus to professionals as an important factor during the development of pressure ulcers.However, there is no evidence for the effectiveness of eternal nutrition support for pressure ulcer prevention .This research aimed to evaluate the effectiveness of eternal nutrition support for pressure ulcer prevention and provide evidence for patients with the risk of pressure ulcer . Methods Key words such as pressure ulcer prevention,eternal nutritional supportwere used to search information in the Cochrane Library , JBI Database of Systematic Reviews , MEDLINE, Web of Science, EMbase, CBMdisc, CNKI and Wanfang Database to collect randomized controlled trials (RCTs).The quality of RCTs was critically appraised and data were extracted by 3 reviewers independently .Meta-analyses were conducted for the eligible RCTs using RevMan 5.0 software, and Stata12.0 software was applied to detect bias or sensitivity analysis to determine the source of heterogeneity if necessary . Results 7 RCTs were includ-ed, among which 1 RCT was excluded by sensitivity analysis .6 RCTs ( n=1553 ) were finally included for meta analysis ( n=728 in trail group, n=825 in control group), and all the patients were given oral nutrition support for 7days to 26 weeks.The results showed that the ulcer incidence in the intervention group reduced by 16%in comparison to the control group (P=0.006).The protein and energy intake in intervention group were higher than those in control group , and the length of stay in hospital was shortened by 16 days. No significant difference was found in the albumin values . Conclusion The enteric nutrition support can reduce the incidence of pressure ulcer obviously with the highest level of evidence , IA .

Reliability and validity of the Chinese version of the Pressure Ulcer Scale for Healing / 医学研究生学报

Objective Pressure Ulcer Scale for Healing ( PUSH) was published in 1998 by National Pressure Ulcer Advisory Panel ( NPUAP) as a tool to evaluate the effects of pressure ulcer care.This study aimed to verify the reliability and validity of the Chi-nese version of PUSH in order to provide an efficient and reliable tool for evaluating the effects of pressure ulcer care. Methods Using the Brislin translation model, we translated the English version of PUSH into Chinese and finalized the Chinese version through modifica-tion by an advisory panel, pretests, and verification of its reliability and validity in the care of 126 cases of stage-Ⅱ-Ⅳpressure ulcers. We analyzed the reliability and validity of the scale based on its item scores, content validity, construct validity, Cronbach′s αcoeffi-cient, and test-retest reliability. Results The correlation coefficient value of the total and individual item scores was 0.616-0.963 (P0.85 and the test-retest reliabili-ty coefficients of individual items were 0.826, 0.885, and 0.958, re-spectively ( P<0.01) . Conclusion The Chinese version of PUSH, with its high validity and reliability, can be used to evaluate interven-tion effectiveness of Chinese patients with pressure ulcers.

Analysis and intervention of ethical problems in new technique therapy of wound care / 医学研究生学报

Objective Medical ethical problems have become underlying risks since the introduce of Negative pressure wound therapy ( NPWT) in Wound Care Center .The article was to analyze ethical problems in applying new technology in wound care and take intervention countermeasures to investigate the effects . Methods Patients treated by NPWT from January 2009 to Decem-ber 2012 were collected as objectives of investigation from the indexes of compliance rate , cure rate and adverse event rate .The ethical problems related to efficacy ,safety and conflicts of patients′economic interests during the application of NPWT were analyzed .On the basis of the ethnical core principle which was harmless , beneficial, respectful and justifiable , the details of effectiveness and safety of NPWT technique , informed consent form and emergency response protocols of the adverse events were designed according to interna -tional guidelines .Nurses received standardized training to learn new technology . Results 78 cases with chronic wounds accepted negative pressure wound therapy and all cooperated to complete treatment , compliance rate was 100%, no adverse events , the average cure rate was 91 .03%.The treatment costs are less than international and national costs from 75%to 66%. Conclusion Following the ethical principle , informed consent , good communication , strict entry system and standardized operation process make sure the safety and effectiveness of new technology and optimize patients′benefits .

Progress in the study of clinical diagnosis and influencing factors in chronic wound biofilm / 医学研究生学报

The infection of chronic refractory wound is related with bacterial biofilm .How to prevent and treat bacterial bio-film and its related damage has been a hot topic in current studies .This article provides a review on chronic wound biofilm on clinical diagnosis techniques , diagnostic criteria , bacteria identification outcomes and influencing factors .

Study on negative pressure wound therapy combined with moist wound therapy for traffic crush injury / 医学研究生学报

Objective Negative pressure wound therapy (NPWT) and moist wound therapy (MWT) are two new methods for wound care .Whether the united is better than the single .The study was to observe and compare the effects of using negative pres-sure wound therapy ( NPWT) combined with moist wound therapy ( MWT) and simple MWT in the treatment of traffic crush injuries . Methods 32 cases were randomly divided into two groups:intervention group and control group , 16 cases for each group .In interven-tion group, wounds were first treated by NPWT for 21 days, followed by standardized MWT till healing .In control group, wounds were treated by standardized MWT till healing .Consensus methods were applied in the measurements before treatment , 7 days, 14 days and 21 days after treatment .The measurements were involved in wound size , depth, undermined edge and the ratio of granulation tissue covering wound bed .Calculation were made on the construction rates of wound size , depth, volume and undermined edge along with re-cords of the time 100%granulation tissue covering wound bed and healing .The database was set up and statistical analysis were done by SPSS 16.0 software. Results The healing rate was 100%for both groups.During 21 days of treatment, the construction rates of wound size, volume, depth and undermined edge of intervention group were better than those of control group (P<0.05).The time 100%granulation tissue covering wound bed of intervention group was shorter than that of control group ([25.00 ±5.77] d vs [41.25 ±18.32]d, P=0.000).The healing time of intervention group was about two weeks shorter than of control group , but with no significance([67.63 ±22.38]d vs [83.56 ±55.31]d, P=0.597). Conclusion NPWT is applicable to traffic crush injuries in combination with MWT , which could promote the growth of granulation tissue and help construct and heal the wounds .NPWT combined with MWT has prior effects to simple MWT .

The methods and effects of specialty training for wound care / 中华护理杂志

Objective To explore the methods and effects of specialty training for wound care. Methods Fourteen nurses working and studying in the wound care center received specialty training of wound care. Their current knowledge and train-ing needs were assessed through writing test and symposium before the training. Then,the training contents and plan were de-signed. The training duration was identified as 3-6 months. The open teaching method was applied in the training directed by the entrostomal therapists(ET). According to the evaluation index,the nurses were asked to finish a reading report in the first month,a case report in the second month,and group discussion on a case of complicated wound care the third month. In ad-dition,they needed to finish the exam of wound care theory and skills every three months. The correlations between perfor-mance in the examination and the nurses' age,years of working experlence,educational level,professional title,duration and times of training by correlation analysis. Results The times of training was significantly correlated with the performance in the examination(r=-0.49,P<0.05),especially with the performance of case report,reading report,and group discussion on compli-cated wound care(r=0.51,-0.60,P<0.05). There was no correlation between the performance with nurses' age,years of working experience,educational level,professional title and duration of training. Conclusion One time of specialty training at least 3 months can achieve good effect. The times of training is correlated with the training effect,especially in case report,reading report and group discussion on complicated wound care.

Theoretical and practical investigation on the perioperative nursing diagnosis / 医学研究生学报

Objectives:To evaluate the nursing diagnostic items in perioperative patients, its indication and clinical directive effect. To explore the conception and goal of perioperative nursing diagnosis and the method of making diagnosis from theories, identifying and using them from theories and practice, and to discuss the training method and positive outcomes from quality management. Methods: One thousand and fifty items of nursing diagnosis were collected from 10 surgical units and 20 items were screened from them. Continuous practice and improvement was done by a cycling model: training nurses use items examine nurses analyze outcome find out problems and causes plan and apply interventions. The consistency of the diagnosis and the outcomes of the patients were also compared. Results: The nursing quality of 10 surgical units was improved markedly from 2001 to 2002. Conclusions:The screened 20 items are commonly used in perioperative patients. If used correctly, they could play a strong pragmatic and directive role in nursing practice. Theoretical training and practice are the key to the correct diagnosis and nursing care.

Role of moist therapy in curing dermal radio lesions / 医学研究生学报

Objective: To study the effect of moist therapy on dermal radio lesions. Methods:13 located dermal radio lesions about Ⅲ-Ⅳ stage from 12 cases were treated with moist therapy. Wound managing steps for each time: The first step was to measure the size of wounds and take photos, and then evaluate individual pain level by a numeric pain scale. The second step was to assess and analyze the factors affecting wounds healing, including nutrition, sleeping, activity, psychological condition. After that the individualized plans about nutrition, activity, and psychological care were made. While exchanging dressings, the implementation and effects of the plans must be evaluated and adjusted. The mechanical debridement combined with autolyzing debridement was used for wounds managing. Then the wounds were saturated with bFGF and normal saline, and wetly covered with occlusive dressings. Wounds were managed every two days until wounds healed. Results: All 13 wounds were cured. The average healing time was (10?6)d and the average cost was (202?48)yuan. The pain level after moist therapy was significantly lowered than before(P

Method and effect of scar prepared for surgery / 医学研究生学报

Objective: To survey the condition of bacteria on the scar area; to improve the method and outcome of skin with scar prepared for plastic surgery. Methods: 49 patients were divided into group A and B randomly. 24 patients in group A were enrolled in control group and 25 patients in group B were designed for investigation group. Each scar was taken 3 samples to be cultured and submitted for sensitive test on admission day, before and after the skin with scar prepared. Each case was observed on the types and the condition of bacteria distribution on the scar. The outcome of cleaning and disinfection from the area was recorded. The relationship between the bacteria reproduction and types of scar was analyzed, and the observation of the postoperative temperature was made and the duration of antibiotics used and surgical site healing were recorded. Results: The positive rate of bacterial culture was reached 83.33% -88.00%. Two methods of skin prepared can diminish the bacteria reproduction. The outcomes of Group B was better than Group A. The temperature and wound healing days had no significant difference between the two groups. The days used of antibiotics in group B were significantly shorter than group A. Conclusion: The more effective method can improve the clean ingress of the skin than with usual method. 60% bacteria on the area removed was benefit to prevent wound infection and healing.

Establishment functions and processes in the Wound Care Center / 医学研究生学报

Objective: To investigate the reasonable establishment of functions and processes in the Wound Care Center,and discuss the duties and roles of its enterostomal therapists(ET).Methods: According to the army's related infection management rules and nosocamiol infection control criteria,our Wound Care Center is divided into 8 areas,each with its set function and corresponding equipment and materials.We have laid out the consulting process for patients,stoma and wound management processes for nurses,responsibilities for ET and an operation mode for the Wound Care Center.The targets attained in work,teaching and research in the previous two years were analyzed and compared.Results: The index of the attainment of the tangets increased dramatically,with a growth rate of more than 20% in 8 of the 9 targets,most obviously in teaching and research.Conclusion: The division of the functional areas has proved to be reasonable,each operational process capable of meeting patients' needs and technical requirements,which enables ET to play important professional roles in the specialized field.

The research and practice of innovation and development in nursing management in military hospital / 医学研究生学报

Objective: To explore the way of innovation and development of the pattern and means in nursing management in military hospital.Methods:Through various innovative practice from the following aspects,such as nursing service philosophy and measures for soldiers,the methods of nursing management and the elite-cultivating,nursing security management,which demonstrates the availability of innovation and development of the pattern and means in nursing management in military hospital.Results:The satisfactory rate of nursing service reached up to 99% in the examination of serving for soldiers of the whole army.The instruments which are manufactured for battle-scarred wounds and injuries use the flat of the Wound Nursing Centre,have reached the stage of clinical trial,we have completed five items of serial nursing research.The control rate of nursing quality of the whole hospital increased from 93.12% in 2003 to 98.9% in 2006,the satisfactory ratio of serious in-patient increased from 90.2% in 2003 to 96.7% in 2005.The ratio of health education achieves 100%.The satisfactory ratio of in-patient was 98.4% in September 2005,compared with 89.3% in February 2004.Conclusion:Only innovation can make nursing management develop and improve in military hospital.

Vacuum-assisted closure for chronic wounds: An analysis of 12 cases / 医学研究生学报

Objective: Vacuum-assisted closure(VAC) is a new technique for wound treatment,whose clinical application at home is but at the initial stage.The aim of this study was to investigate the procedure,therapeutic course and the effectiveness of the technique in the treatment of chronic wounds.Methods: This study included 12 cases of chronic or infected wound,which were more than 100 cm2 in size,either undermined,or drainage-obstructed,or difficult to heal despite over a month of previous treatment.We used the Freedom Negative Pressure Wounds Therapy Machine and the Ten-Step Management Procedure for a regular course of 30-50 days.We recorded and analyzed the pre-and post-treatment PUSH(pressure ulcer scale for healing) scores,healing modes,healing time and cure rate of all the cases.Results: The 12 cases were treated by VAC for(27.7 ? 22.6) days,of which 9 were cured,1 improved and 2 healed after moisture therapy followed by further treatment in the surgical department.The average healing time was(59.36 ? 22.88) days and the total cure rate was 91.7%.Age is positively correlated with healing time,but other factors showed no significant correlation with healing time and cure rate.Conclusion: The VAC technique is applicable to chronic wounds in patients of all ages,and the best therapeutic course is 30-50 days,which helps to raise the cure rate of intractable wounds.

Management of mosquito bite-induced ulcer complicated by pyoderma gangrenosum:Report of a cured case / 医学研究生学报

Objective:Pyoderma gangrenosum(PG) is regarded as a possibly immunity-mediated ulcerative skin disease,which is difficult to be managed and easy to relapse.Few cases of PG have been reported to be treated successfully in the world.This study aimed to investigate the clinical characteristics and difficulties and strategies in the management of mosquito bite-induced ulcer by PG.Methods: We analyzed the clinical characteristics and difficulties in the treatment of a case of mosquito bite-induced leg ulcer complicated by PG.Following the TIME(tissue removal,infection/inflammation control,moisture imbalance correction,and edge of wound revision) principles of wound bed preparation,we treated the ulcer by silver ion dressing + infrared rays,hypertonic saline dressing + infrared rays,hypertonic saline dressing + electrotherapy,and honey dressing + medication at different times.The ulcer size and scores on pain and healing were assessed before each wound care,and the results of each method were analyzed by the SPSS11.0 software.Results: The pain score was continuously reduced with the treatment and the ulcer size and healing score were gradually decreased in the later stage,while in the earlier stage,the ulcer size was even enlarged,with one ulcer becoming two,and the healing score obviously increased.The differences were statistically significant(P