Development and psychometric evaluation of the patient knowledge of,and attitudes and behaviours towards pressure ulcer prevention instrument (KPUP)

The Patient Knowledge of, and Attitude and Behaviour towards Pressure Ulcer Prevention Instrument (KPUP) was developed and validated using a two‐stage prospective psychometric instrument validation study design. In Stage 1, the instrument was designed, and it is psychometrically evaluated in Stage 2. To establish content validity, two expert panels independently reviewed each item for appropriateness and relevance. Psychometric evaluation included construct validity and stability testing of the instrument. The questionnaire was administered to a convenience sample of 200 people aged more than 65 years, living independently in the community; reliability and stability were assessed by test/retest procedures, with a 1‐week interval. Mean knowledge scores at ‘test’ were 11.54/20 (95% CI = 11.10‐11.99, SD: 3.07), and ‘retest’ was 12.24 (95% CI = 11.81‐12.66, SD: 2.93). For knowledge, correlation between the test/retest score was positive (r=. 60), attitude section‐inter‐item correlations ranged from r = −.31 to r = .57 (mean intraclass correlation coefficient of r = .42), and internal consistency for the retest was the same as the test (α = .41 for the eight items). For health behaviours, individual inter‐item correlations for test items ranged from r = −.21 to r = .41 for the 13 standardised items. Psychometric testing of the KPUP in a sample of older persons in the community provided moderate internal consistency and general high test‐retest stability.     

The great imitator with no diagnostic test: pyoderma gangrenosum

Pyoderma gangrenosum is a rare, neutrophil‐mediated, auto‐inflammatory dermatosis that wound care specialists must be prepared to recognise. This condition has clinical features analogous to infectious processes. There is no specific diagnostic test and the diagnosis is usually obtained from exclusion. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential to improve the quality of life and the prognosis of patients.     

Efficacy of Maitland joint mobilization technique on pain intensity,mouth opening,functional limitation,kinesiophobia, sleep quality and quality of life in temporomandibular joint dysfunction following bilateral cervicofacial burns

BackgroundBilateral cervicofacial burn contracture initially affects facial expressions and later affects tempero mandibular joint (TMJ) function of the patient. It further tightens the ligaments and capsules around the TMJ and leads to tempero mandibular dysfunction. The consequences of temporomandibular joint dysfunction will be pain, limitation of mouth opening, functional disability and poor quality of life (Qol). However, studies examining the efficacy of Maitland joint mobilization technique in this population are lacking.ObjectivesTo find the short term effects of Maitland joint mobilization technique on pain, mouth opening, functional limitation, kinesiophobia, sleep quality and Quality of life in tempero mandibular joint dysfunction following bilateral cervicofacial burns.MethodsThirty subjects with temporomandibular joint dysfunction following cervicofacial burn (N = 30) were allocated to Maitland joint mobilization group (n = 15) and home based training group (n = 15) randomly to receive Maitland joint mobilization technique and home based training for 4 weeks. All the participants received ultrasound therapy as common treatment. Primary (Numeric Pain Rating Scale – NPRS, maximal mouth opening – MMO & Tempero mandibular disability index – TDI) and secondary (Tampa Scale of Kinesiophobia – TSK-17, Sleep quality questionnaire – SSQ & Global Rating of Change – GRC) outcome measures were measured at baseline, after four weeks and three months follow up. Repeated measures of ANOVA and independent t test were performed for analyzing the dependent variables in both groups.ResultsBaseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following different training protocols Maitland joint mobilization group shows more significant changes in pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and Qol than home based training group (p ≤ 0.05). Also Maitland joint mobilization group show significant improvement in study variables than home based training group (p ≤ 0.05) at three months follow up.ConclusionBoth groups improved over time, however, differences between the groups were noticed small. However, physiotherapy management which includes Maitland joint mobilization technique and therapeutic exercise program has an effective strategy in the treatment of tempero mandibular joint dysfunction following cervicofacial burns.     

Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries

ObjectiveTo describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration.MethodsTwenty-two cases with systemic sclerosis (12 limited and 10 diffuse) were recruited for the study. All patients fulfilled the American Rheumatism Association (ACR) criteria for the classification of SSc. For all patients routine laboratory investigations were performed including complete lipid profile. Computed tomography angiography (CTA) studies for the whole upper limb arterial tree were performed for both upper limbs in all cases.ResultsCTA studies showed involvement of subclavian arteries in 3 cases and axillary artery was involved in five cases. Brachial artery was affected in 5 cases. In the forearm the radial artery was affected in 4 cases with bilateral involvement in two cases (6 vessels), while ulnar artery was affected in five cases. Unilateral non visualization of the superficial palmar arch was observed in two cases with limited disease, while thinning out of the vessel wall with poor distal run off in 18 cases. A higher number of arterial vasculopathy was significantly associated with systolic pulmonary artery pressure (P = 0.001).ConclusionsMacrovascular arterial vasculopathy of upper limbs may occur in SSc irrespective of the disease pattern. Major arteries can be affected in association with other medium sized arteries of the forearms and microvascular arterial branches of the hands.     

自制简易翻身单在长期卧床护理的应用和效果分析

目的：探讨自制简易翻身单在长期卧床护理的应用和效果分析。方法：选取2012年1-9月新丰县人民医院外科术后卧床患者、昏迷患者300例,分为试验组240例和对照组60例,试验组患者采用本科自制简易翻身单进行翻身,对照组患者采用传统的徒手翻身法进行翻身。观察并比较两组患者翻身所用时间、护理人员劳动强度、患者褥疮发生率、皮肤损伤发生率以及患者舒适度和安全感。结果：相比于对照组,试验组患者进行翻身所用时间明显缩短、护理人员劳动强度明显降低,差异有统计学意义（P〈0.05）;试验组患者褥疮发生例数为0例,而对照组患者褥疮发生例数为7例,发生率为11.67%,两组间比较差异有统计学意义（P〈0.05）;试验组患者皮肤损伤发生例数0例,而对照组患者皮肤损伤发生例数为13例,发生率为21.67%,两组间比较差异有统计学意义（P〈0.05）。结论：自制翻身单能有效缩短翻身时间,降低护理人员劳动强度,提高工作效率。同时,自制翻身单能有效减少长期卧床患者褥疮的发生,能有效避免因翻身操作而导致患者皮肤损伤的发生,值得临床护理推广。     

Long-term outcomes of extracorporeal shockwave therapy for chronic foot ulcers

Background

Recent studies showed that extracorporeal shockwave therapy (ESWT) is effective in the treatment of chronic foot ulcers in short term. However, the long-term effects of ESWT in chronic foot ulcers are unknown. The purpose of this study was to evaluate the long-term outcomes of ESWT in chronic foot ulcers with 5-y follow-up.

Methods

The study cohort consisted of 67 patients with 72 ulcers including 38 patients with 40 ulcers in the diabetes mellitus (DM) group and 29 patients with 32 ulcers in the non–diabetes mellitus (non-DM) group. Each patient received ESWT to the affected foot twice per week for 3 wk for a total of six treatments. The evaluations included clinical assessment for the ulcer status, local blood flow perfusion, and analysis of mortality and morbidity.

Results

The results showed completely healed ulcers in 55.6% and 57.4% of total series, 48% and 43% of DM group, and 66% and 71% of non-DM group at 1 and 5 y (P = 0.022 and P = 0.027), respectively. The mortality rate was 15% in total series, 24% in DM group, and 3% in non-DM group (P = 0.035). The rate of amputation was 11% in total series, 17% in DM group, and 3.6% in non-DM group (P = 0.194). The blood flow perfusion rate significantly increased after ESWT for up to 1 yr but decreased from 1–5 y in both groups. However, the non-DM group showed significantly better blood flow perfusion than the DM group at 5 y (P = 0.04).

Conclusions

ESWT appears effective in chronic diabetic and nondiabetic foot ulcers. However, the effects decreased from 1–5 y after treatment.     

Predictors of diabetes foot complications among patients with diabetes in Saudi Arabia

AimsTo identify risk factors and clinical biomarkers of prevalent diabetes foot complications, including foot ulcers, gangrene and amputations among patients with diabetes in Jeddah, Saudi Arabia.Methods598 diabetes patients from Jeddah participated in the current study. Patients were considered to have diabetes foot complications if they reported diagnosis of foot ulcers or gangrene or amputations in a questionnaire administered by a physician and confirmed by clinical exams. Information on socio-demographic and lifestyle variables was self-reported by patients, and several clinical markers were assessed following standard procedures.ResultsThe prevalence of diabetes foot complications in this population was 11.4%. In the multivariable model without adjustment for PAD (peripheral artery disease) and DPN (diabetes peripheral neuropathy), non-Saudi nationality, longer diabetes duration and insulin use was significantly associated with higher diabetes foot complications prevalence. Each 1 g/L increase of hemoglobin was associated with 2.8% lower prevalence of diabetes foot complications. In the multivariable model adjusting for PAD and DPN, the previously observed associations except for nationality were no longer significant. Patients with both DPN and PAD had 9.73 times the odds of diabetes foot complications compared to the patients with neither condition.ConclusionIn this population, longer diabetes duration, insulin use, lower hemoglobin levels and non-Saudi nationality were associated with higher prevalence of foot complications. These associations were largely explained by the presence of DPN and PAD except for non-Saudi nationality. Diabetes patients with both DPN and PAD had nearly 10-fold increased risk of foot complications than those with neither condition.     

Diabetic foot ulcers treated with hyperbaric oxygen therapy: a review of the literature

Hyperbaric oxygen therapy (HBO) has been used as an adjunct for healing diabetic foot ulcers (DFUs) for decades. However, its use remains controversial. A literature search was conducted to locate clinical studies and assess the available evidence. Ten prospective and seven retrospective studies evaluating HBO for DFUs were located. These were reviewed and the outcomes were discussed. One study reported no difference in outcomes between patients receiving hyperbaric oxygen and the control group. However, their regime differed from all other studies in that the patients received hyperbaric oxygen twice rather than once daily. Reduced amputation rates and improved healing were the most common outcomes observed.     

Encouraging patients to self‐care – the preliminary development and validation of the VeLUSET©, a self‐efficacy tool for venous leg ulcer patients,aged 60 years and over

Venous leg ulceration has a high recurrence rate. Patients with healed or frequently recurring venous ulceration are required to perform self‐care behaviours to prevent recurrence or promote healing, but evidence suggests that many find these difficult to perform. Bandura's self‐efficacy theory is a widely used and robust behaviour change model and underpins many interventions designed to promote self‐care in a variety of chronic conditions. By identifying areas where patients may experience difficulty in performing self‐care, interventions can be developed to strengthen their self‐efficacy beliefs in performing these activities successfully. There are currently a variety of self‐efficacy scales available to measure self‐efficacy in a variety of conditions; but not a disease‐specific scale for use with venous ulcer patients. The aim of this study, therefore, was to develop and validate a disease‐specific, patient‐focused self‐efficacy scale for patients with healed venous leg ulceration. This scale will need further validation studies; however, it is ready for use in clinical practice and will enable practitioners to identify those patients who may need additional support in performing self‐care activities to prevent recurrence.