Wound Bed Preparation 2024: Delphi Consensus on Foot Ulcer Management in Resource-Limited Settings.

GENERAL PURPOSE: To review a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Summarize issues related to wound assessment.2. Identify a class of drugs for the treatment of type II diabetes mellitus that has been shown to improve glycemia, nephroprotection, and cardiovascular outcomes.3. Synthesize strategies for wound management, including treatment in resource-limited settings.4. Specify the target time for edge advancement in chronic, healable wounds.

Chronic wound management in low-resource settings deserves special attention. Rural or underresourced settings (ie, those with limited basic needs/healthcare supplies and inconsistent availability of interprofessional team members) may not have the capacity to apply or duplicate best practices from urban or abundantly-resourced settings. The authors linked world expertise to develop a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. A group of 41 wound experts from 15 countries reached a consensus on wound bed preparation in resource-limited settings. Each statement of 10 key concepts (32 substatements) reached more than 88% consensus. The consensus statements and rationales can guide clinical practice and research for practitioners in low-resource settings. These concepts should prompt ongoing innovation to improve patient outcomes and healthcare system efficiency for all persons with foot ulcers, especially persons with diabetes.

Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements.

OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath an N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high-risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when performing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored, created, and tested a stepwise process to protect the skin under these masks while ensuring that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. Staff also self-reported increased comfort with less friction. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method enabling staff to apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.

Immunological changes in depression.

BACKGROUND: The role of Immune system in the pathophysiology of depressive disorders is a field of active research, however Indian literature is sparse. The present study was planned to assess the immunological response in depression. MATERIALS AND METHODS: The study comprised of 100 subjects. There were fifty cases of depression satisfying the ICD-10 criteria with no physical illness and HIV negative status and fifty age and sex matched healthy volunteers. Depression was assessed on HRSD and BDI scales. Assessment of three markers each of cellular immunity (NK cells, CD4, CD8 cells) and humoral immunity (Il-2, IL-6 and CRP) was carried out on both groups and depressed patients were reassessed on all parameters after 08 weeks of treatment with antidepressants (SSRIs or TCAs). RESULTS: NK Cells were significantly higher in the depressed group and CD 8 Cells and CD 4 Cells were higher in the control group (P = 0.001). Depressed group before treatment v/s control group differed significantly in the cell mediated immune markers. IL-2 levels were higher in the control group. The markers of cell mediated immunity i.e., NK cells, CD4, CD8 had increased significantly after treatment (P =< 0.001). The humoral immunity markers (CRP and IL-2) decreased significantly after treatment (P =< 0.001). However IL -6 levels were raised significantly in the subjects after treatment (P =< 0.001). CONCLUSION: Dysregulation of immune response occurs in depressed patients with changes in both cell mediated and humoral immunity. Further, antidepressant treatment affects the immune status of depressed patients.