Search Results (392)

Background: Chronic wounds are a growing clinical challenge due to their prolonged healing time and associated healthcare burden. Combined therapeutic approaches, including topical oxygen therapy (TOT) and negative-pressure wound therapy (NPWT), have shown promise in enhancing wound healing. This pilot exploratory study aimed to assess the clinical effectiveness of combined TOT and NPWT in chronic wound treatment and to explore the prognostic value of selected laboratory and thermographic markers. Methods: Eighteen patients with chronic wounds due to type 2 diabetes mellitus or chronic venous insufficiency were treated with either TOT alone (control group) or TOT combined with NPWT (intervention group). Wound characteristics, thermographic data, and laboratory parameters (NLR, MLR, PLR, CRP, and total protein) were collected at baseline and during therapy. The primary endpoints were the total treatment duration and complete wound closure. Statistical analyses were exploratory and used non-parametric tests, correlation analyses, and simple linear regression. Results: Ulcer duration was significantly associated with the wound surface area. Lower serum total protein levels correlated negatively with ulcer duration, wound size, and granulation tissue area. A significant reduction in treatment duration was observed in the intervention group compared to the controls. One strong correlation was found between MLR and peripheral wound temperature on day 7 in the control group. No significant group differences were observed in wound size or thermographic measures after one week of treatment. Conclusions: Combining TOT and NPWT may reduce treatment duration in chronic wound management. Selected laboratory and thermographic markers show promise as prognostic tools. These exploratory findings require confirmation in larger, randomized trials. Full article

Background/Objectives: Pressure injuries are a significant concern among older adults, particularly in community-based long-term care settings where prolonged immobility is prevalent. This study aimed to identify factors influencing sacral interface pressure in community-dwelling older adults, with an emphasis on support surface usage and clinical risk indicators. Methods: A total of 210 participants aged 65 years and older, all receiving long-term care services in South Korea, were enrolled in this study. Sacral interface pressure was measured in the supine position using a portable pressure mapping device (Palm Q7). General characteristics, Braden Scale scores, Huhn Scale scores, and mattress usage were assessed. Data were analyzed using descriptive statistics, t-tests, chi-square tests, and logistic regression. Results: Mattress non-use was identified as the strongest predictor of elevated sacral interface pressure (OR = 6.71, p < 0.001), followed by Braden Scale scores indicating moderate risk (OR = 4.8, p = 0.006). Huhn Scale scores were not significantly associated with interface pressure. These results suggest that support surface quality and skin condition have a stronger impact on interface pressure than mobility-related risk factors. Conclusions: The findings highlight the importance of providing high-quality pressure-relieving mattresses and implementing standardized nursing assessments to reduce the risk of pressure injuries. Integrating smart technologies and expanding access to advanced support surfaces may aid in developing tailored preventive strategies for vulnerable older adults. Full article

Background/Objectives: Vedolizumab is a gut-selective anti-integrin monoclonal antibody approved for the treatment of inflammatory bowel disease (IBD). While clinical trials have demonstrated a favorable safety profile, real-world studies are essential for identifying rare adverse events (AEs) and evaluating post-marketing safety. This study assessed vedolizumab’s safety in a real-world cohort and supported the detection of potential safety signals. Methods: A retrospective chart review was conducted on adult IBD patients treated with vedolizumab at a tertiary center in the Republic of Serbia between October 2021 and August 2022. Data included demographics, AEs, and newly reported extraintestinal manifestations (EIMs). Exposure-adjusted incidence rates were calculated per 100 patient-years (PYs). Disproportionality analysis using the FDA Adverse Event Reporting System (FAERS) was performed to identify safety signals, employing reporting odds ratios (RORs) and proportional reporting ratios (PRRs) for AEs also observed in the cohort. Prior IBD therapies and reasons for discontinuation were evaluated. Results: A total of 107 patients (42.1% Crohn’s disease, 57.9% ulcerative colitis) were included, with a median vedolizumab exposure of 605 days. There were 92 AEs (56.51/100 PYs), most frequently infections (23.95/100 PYs), gastrointestinal disorders (4.30/100 PYs), and skin disorders (4.30/100 PYs). The most frequently reported preferred terms (PTs) included COVID-19, COVID-19 pneumonia, nephrolithiasis, and nasopharyngitis. Arthralgia (12.90/100 PYs) was the most frequent newly reported EIM. No discontinuations due to vedolizumab AEs occurred. FAERS analysis revealed potential signals for events not listed in prescribing information but observed in the cohort: nephrolithiasis, abdominal pain, diarrhea, malaise, cholangitis, gastrointestinal infection, blood pressure decreased, weight decreased, female genital tract fistula, respiratory symptom, and appendicectomy. Most patients had received three prior therapies, often stopping one due to AEs. Conclusions: Vedolizumab demonstrated a favorable safety profile in the IBD cohort. However, FAERS-identified signals, such as nephrolithiasis, gastrointestinal infections, and decreased blood pressure, warrant further investigation in larger, more diverse populations. Full article

Peripheral circulatory failure refers to a condition in which the blood flow through superficial capillaries is markedly reduced or completely occluded. In clinical practice, nurses strictly adhere to regular repositioning protocols to prevent peripheral circulatory failure, during which the skin condition is evaluated visually. In this study, skin colour changes resulting from pressure application were continuously captured using a camera, and supervised machine learning was employed to classify the data into two categories: before and after pressure. The evaluation of practical colour space components revealed that the h component of the JCh colour space demonstrated the highest discriminative performance (Area Under the Curve (AUC) = 0.88), followed by the a* component of the CIELAB colour space (AUC = 0.84) and the H component of the HSV colour space (AUC = 0.83). These findings demonstrate that it is feasible to quantitatively evaluate skin colour changes associated with pressure, suggesting that this approach can serve as a valuable indicator for dimensionality reduction in feature extraction for machine learning and is potentially an effective method for preventing pressure-induced skin injuries. Full article

The global healthcare system faces significant challenges posed by diabetes and its complications, highlighting the need for innovative strategies to improve early diagnosis and treatment. Machine learning models help in the early detection of diseases and recommendations for taking safety measures and treating the disease. A comparative analysis of existing machine learning (ML) models is necessary to identify the most suitable model while uniformly fixing the model parameters. Assessing risk based on biomarker measurement and computing overall risk is important for accurate prediction. Early prediction of complications that may arise, based on the risk of diabetes and biomarkers, using machine learning models, is key to helping patients. In this paper, a comparative model is presented to evaluate ML models based on common model characteristics. Additionally, a risk assessment model and a prediction model are presented to help predict the occurrence of complications. Random Forest (RF) is the best model for predicting the occurrence of Type 2 Diabetes (T2D) based on biomarker input. It has also been shown that the prediction of diabetes complications using neural networks is highly accurate, reaching a level of 98%. Full article

Background/Objectives: The Jackson/Cubbin scale is a recommended tool to assess the risk of pressure injury in intensive care unit (ICU) patients. This scale is deemed to have superior predictive validity compared to the Braden scale. Many Italian nurses struggle with reading and applying the tool in English. This language barrier results in a lack of use of the Jackson/Cubbin scale clinically, meaning that patients potentially experience worse outcomes. This study aims to translate the original English version of the Jackson/Cubbin scale into the Italian language, conduct a cultural adaptation, and verify its content validity. Methods: An observational study was conducted using Beaton’s five-step methodology: (1) forward translation, (2) synthesis, (3) back-translation, (4) expert committee approval using Fleiss’ Kappa (κ) index, and (5) pre-testing, where participants assessed item clarity on a dichotomous scale (clear/unclear). Items deemed unclear by 20% or more of the sample were revised. Content validity was assessed using the Content Validity Index (CVI). Results: Fleiss’ κ index was 0.74. Item 3 “PMH-affecting condition” was unclear to 36% of the sample and required revision. The item-level CVI (I-CVI) was >0.78 for each item. The scale-level CVI (S-CVI) and the scale-level CVI using the average method (S-CVI-Ave) were 0.92 and 0.94, respectively. Conclusions: The translation process resulted in a linguistically accurate scale requiring content modifications to reflect current evidence and reduce inter-rater variability. This may improve implementation of the Jackson/Cubbin scale in clinical practice for Italian nurses and reduce the incidence of pressure injury for ICU patients. Full article

Background: Pressure ulcers (PUs) remain a prevalent complication in intensive care unit (ICU) settings, especially among immobilized patients. The impact of structured, nursing-led mobilization protocols on PU prevention and recovery remains underexplored. Objective: To evaluate the impact of nursing-led mobilization protocols on the incidence and progression of PUs in critically ill patients. Methods: In this retrospective observational cohort study, 188 ICU patients were admitted during one of two consecutive periods of care: conventional care (6-hourly repositioning) and an advanced nursing-led protocol (3-hourly repositioning with support surfaces and specialized nurse training), which replaced conventional care as standard in our institution. The primary outcome included new PU development for patients with no pre-existing ulcers or worsening/non-progression of pre-existing ulcers at discharge; ICU mortality was evaluated as a secondary outcome. Results: Among patients without pre-existing ulcers (n = 155), new PU incidence did not significantly differ between groups, even after adjusting for SOFA score (OR 0.40, 95% CI: 0.05 TO 3.17; p = 0.374). However, in patients with pre-existing ulcers (n = 33), the advanced care group showed improvement (53.3% versus 0% in the conventional group, OR 0.07, 95% CI: 0.01–0.64; p = 0.012); this effect was independent of initial SOFA score. Mortality was associated with the SOFA score, but not with the type of care. Conclusions: While advanced nursing-led mobilization did not reduce PU incidence, it significantly improved existing ulcer outcomes. Findings support the integration of structured protocols for high-risk ICU patients, especially those with existing ulcers. Full article

Diabetic foot ulcers (DFUs) represent a critical global health issue, necessitating the development of advanced smart, flexible, and wearable sensors for continuous monitoring that are reimbursable within foot orthotics. This study presents the design and characterization of a pressure sensor implemented into a shoe insole to monitor diabetic wound pressures, emphasizing the need for a high sensitivity, durability under cyclic mechanical loading, and a rapid response time. This investigation focuses on the electrical and mechanical properties of carbon nanotube (CNT) composites utilizing Ecoflex and polydimethylsiloxane (PDMS). Morphological characterization was conducted using Transmission Electron Microscopy (TEM), Laser Confocal Microscopy, and Scanning Electron Microscopy (SEM). The electrical and mechanical properties of the CNT/Ecoflex- and the CNT/PDMS-based sensor composites were then investigated. CNT/Ecoflex was then further evaluated due to its lower variability performance between cycles at the same pressure, as well as its consistently higher capacitance values across all trials in comparison to CNT/PDMS. The CNT/Ecoflex composite sensor showed a high sensitivity (2.38 to 3.40 kPa⁻¹) over a pressure sensing range of 0 to 68.95 kPa. The sensor’s stability was further assessed under applied pressures simulating human weight. A custom insole prototype, incorporating 12 CNT/Ecoflex elastomeric matrix-based sensors (as an example) distributed across the metatarsal heads, midfoot, and heel regions, was developed and characterized. Capacitance measurements, ranging from 0.25 pF to 60 pF, were obtained across N = 3 feasibility trials, demonstrating the sensor’s response to varying pressure conditions linked to different body weights. These results highlight the potential of this flexible insole prototype for precise and real-time plantar surface monitoring, offering an approachable avenue for a challenging diabetic orthotics application. Full article

Chronic wounds, such as diabetic ulcers and pressure injuries, remain a major global health burden, affecting over 40 million people worldwide and imposing significant socioeconomic strain. Hydrogel-based wound dressings have gained clinical attention for their ability to maintain moisture, mimic the extracellular matrix, and support tissue regeneration. However, traditional hydrogels often lack the mechanical robustness, antimicrobial efficacy, and dynamic responsiveness needed to treat complex wound environments effectively. To address these limitations, nanohybrid hydrogels, composite systems that integrate functional nanomaterials into hydrogel matrices, have emerged as intelligent platforms for advanced wound care. These systems enable multifunctional therapeutic action, including antibacterial activity, antioxidant regulation, angiogenesis promotion, immune modulation, and stimuli-responsive drug delivery. This review synthesizes recent advances in nanohybrid hydrogel design, beginning with an overview of traditional polymeric systems and their constraints. We categorize functional mechanisms according to biological targets and classify nanohybrid architectures by material type, including metal-based nanoparticles, nanozymes, carbon-based nanomaterials, polymeric nanogels, and metal–organic frameworks. Representative studies are summarized in a comparative table, and challenges related to biosafety, clinical translation, and design optimization are discussed. Nanohybrid hydrogels represent a rapidly evolving frontier in wound care, offering bioresponsive, multifunctional platforms with the potential to transform chronic wound management. Full article

Chronic wounds, including diabetic foot ulcers and pressure sores, are becoming more prevalent due to aging populations and increased metabolic problems. These wounds often persist due to impaired healing, chronic inflammation, oxidative stress, and infections caused by multidrug-resistant pathogens, making conventional treatments—including antibiotics and antiseptics—largely inadequate. This creates an urgent need for advanced, biologically responsive therapies that can both combat infection and promote tissue regeneration. Probiotics have surfaced as a viable option owing to their capacity to regulate immune responses, impede pathogenic biofilms, and generate antibacterial and antioxidant metabolites. However, their clinical application is limited by poor viability, sensitivity to environmental conditions, and short retention at wound sites. Nanotechnology-based delivery systems address these limitations by protecting probiotics from degradation, enhancing site-specific delivery, and enabling controlled, stimuli-responsive release. Encapsulation techniques using materials like chitosan, PLGA, liposomes, nanogels, nanofibers, and microneedles have shown significant success in improving wound healing outcomes in preclinical and clinical models. This review summarizes the current landscape of chronic wound challenges and presents recent advances in probiotic-loaded nanotechnologies. It explores various nano-delivery systems, their mechanisms of action, biological effects, and therapeutic outcomes, highlighting the synergy between probiotics and nanocarriers as a novel, multifaceted strategy for managing chronic wounds. Full article

Background: Understanding and preventing pressure ulcers is a key aspect of healthcare, with nurses playing a crucial role in their management and prevention through education and clinical practice to improve patient outcomes. Objectives: This quantitative, psychometric, cross-sectional study aimed to translate and culturally adapt the Pieper–Zulkowski Pressure Ulcer Knowledge Test and to evaluate the psychometric properties of the Croatian version of this measurement instrument. Methods: A study was conducted in a state hospital in Šibenik, Croatia, on a sample of 268 participants. Results: The content validity of the instrument, with an S-CVI of 0.981, indicates excellent validity, while its internal consistency is acceptable, as reflected in an overall KR-20 of 0.79. The maximum split-half reliability is 0.87 and Guttman Lambda 6 reaches 0.89, indicating excellent internal consistency. The overall test–retest reliability is excellent (ICC = 0.91), with the Prevention subscale showing the highest reliability (ICC = 0.88), followed by Staging (ICC = 0.86) and Wound Description (ICC = 0.84). Item-level difficulty and discrimination index were also calculated. Conclusions: The adapted, translated, and validated questionnaire represents a valuable tool for measuring knowledge about pressure ulcers among healthcare professionals, suitable for use in Croatian society. This instrument can be used to assess knowledge in clinical settings and evaluate the effectiveness of educational programs, providing valuable insights into the education and professional competence development of healthcare professionals. Full article

Plantar pressure monitoring is decisive in injury prevention, especially in at-risk populations such as people with diabetic foot. In this context, innovative solutions such as pneumatic insoles can be essential in plantar pressure management. This study describes the development of a variable pressure system that promotes the monitoring, stabilization, and offloading of plantar pressure through a pneumatic insole. This research was also intended to evaluate its ability to redistribute plantar pressure, reduce peak pressure in both static and dynamic conditions, and validate its pressure measurements by comparing the results with those obtained from a pedar^® insole. Tests were carried out under both static and dynamic conditions, before and after the pressure stabilization process by air cells and the subsequent pressure offloading. During the validation process, methods were used to evaluate the agreement between measurements obtained by the two systems. The results of the static test showed that pressure stabilization reduced pressure on the heel by 32.43%, distributing it to the metatarsals and toes. After heel pressure offloading, the reduction reached 42.72%. In the dynamic test, despite natural dispersion of the measurements, a trend to reduce the peak pressure in the heel, metatarsals, and toes was observed. Agreement analysis recorded 96.32% in the static test and 94.02% in the dynamic test. The pneumatic insole proved effective in redistributing and reducing plantar pressure, with more evident effects in the static test. Its agreement with the pedar^® system reinforces its reliability as a tool for measuring and managing plantar pressure, representing a promising solution for preventing plantar lesions. Full article

Sleep position recognition plays a crucial role in diagnosing and managing various health conditions, such as sleep apnea, pressure ulcers, and musculoskeletal disorders. Accurate monitoring of body posture during sleep can provide valuable insights for clinicians and support the development of intelligent healthcare systems. This research presents a comparative analysis of sleep position recognition using two distinct approaches: image-based deep learning and accelerometer-based classification. There are five classes: prone, supine, right side, left side, and wake up. For the image-based method, the Visual Geometry Group 16 (VGG16) convolutional neural network was fine-tuned with data augmentation strategies including rotation, reflection, scaling, and translation to enhance model generalization. The image-based model achieved an overall accuracy of 93.49%, with perfect precision and recall for “right side” and “wakeup” positions, but slightly lower performance for “left side” and “supine” classes. In contrast, the accelerometer-based method employed a feedforward neural network trained on features extracted from segmented accelerometer data, such as signal sum, standard deviation, maximum, and spike count. This method yielded superior performance, reaching an accuracy exceeding 99.8% across most sleep positions. The “wake up” position was particularly easy to detect due to the absence of body movements such as heartbeat or respiration when the person is no longer in bed. The results demonstrate that while image-based models are effective, accelerometer-based classification offers higher precision and robustness, particularly in real-time and privacy-sensitive scenarios. Further comparisons of the system characteristics, data size, and training time are also carried out to offer crucial insights for selecting the appropriate technology in clinical, in-home, or embedded healthcare monitoring applications. Full article

Objectives: Wheelchair seat sagging is hypothesized to increase pressure and shear forces, potentially leading to pressure injuries. The objective of this study was to assess the impact of correcting wheelchair seat sagging on ischial pressure, shear force, and posture in a population of healthy adults. Methods: A total of twenty-two participants who met the study requirements were included in the study. Participants were evaluated under two conditions: with seat base correction (With Correction) and without it (No Correction). Correction was achieved using insert panels. Ischial pressure was measured using a pressure-mapping system (CONFORMat), shear force with a specialized sensor (iShear), and posture with accelerometers (TSND151). The primary analysis compared peak pressure index (PPI), shear force, slide, and postural changes between conditions. The subgroup analysis was conducted as an exploratory approach to assess potential variation among participants with elevated shear forces. Results: There was no statistically significant difference in ischial pressure between the No Correction and With Correction conditions (p = 0.37). However, shear force and slide were significantly reduced when seat sagging was corrected (p < 0.05). Accelerometer data showed no significant difference in postural changes between conditions (p ≥ 0.05), although the With Correction condition displayed a slight trend toward greater positional variability over time. Conclusions: These findings indicate that correcting seat sagging can reduce shear force and slide, potentially lowering the risk of pressure injuries. However, because this study targeted healthy adults, further research involving older or at-risk populations is necessary. Addressing seat sagging could be an important component of comprehensive pressure injury prevention strategies. Full article

Background: Individuals receiving intensive care are particularly vulnerable to developing pressure sores. This heightened risk necessitates a thorough understanding of relevant risk factors and the time at which these injuries manifest, facilitating effective prevention. Objective: This investigation, structured as a retrospective cohort study, aimed to assess the duration until pressure sore onset and identify contributing risk factors among 50 adult patients in an intensive care unit (ICU), observed over 12 weeks. Methodology: Our analysis employed the Kaplan–Meier approach for survival analysis. We then used the log-rank test to determine significant differences in survival curves. We utilized COX proportional regression analysis to explore the associations between various factors and the development of pressure injuries during the ICU stay. Results: Data from 50 adult ICU patients showed that 29 patients developed pressure sores. Coccyx (44%) and back (6%) were most affected. The median survival time from ICU admission to the final skin examination for pressure sore development was 3 days. The multivariable Cox regression analysis revealed that males with a high BMI, increased systolic blood pressure, elevated albumin levels, and a more extended ICU stay were at a significantly higher risk of developing pressure ulcers (p-value < 0.05). Conclusions: The research highlights the need to prioritize males with high BMI, high blood pressure, and high albumin patients in preventing pressure sores in the ICU, with an extended ICU stay significantly increasing the risk. This information can be utilized to develop clinical guidelines for reducing pressure sore incidence and improving patient care. Full article