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General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Incipient pressure ulcers can be detected by thermography on hospital admission. Even under non-ideal thermographic conditions with room temperatures between 18°C and 29°C (64.4°F and 84.2°F) and an “acclimatization time” as short as 30 seconds, a temperature difference between a pressure area and the surrounding unaffected skin can detect possible decubiti. Differential temperatures between –2.5°C and –6°C (–4.5°F and –10.8°F) are found in ischemic conditions, while temperatures between +0.8°C and +2°C (+1.4°F and +3.6°F) indicate reactive inflammation from partial ischemia or perhaps infected skin areas.42 In the absence of infection, decubitus-prone areas appearing hyperthermic indicate patent subdermal vasculature capable of supplying the skin when pressure is relieved. A cooler decubital area indicates damage to the subdermal vasculature and a poorer prognosis for circulatory recovery.43
Caring for people with impaired mobility
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Rowena Slope, Katherine Hopkinson
Pressure ulcers can occur anywhere on the body. Pressure ulcers can be caused by the weight of the body or persistent contact with a medical device, or shearing and friction forces associated with poor manual handling. The most vulnerable areas of skin are around bony prominences, especially if they are in contact with hard surfaces such as an operating table or standard hospital mattress. People nursed in the supine position may develop pressure ulcers on the back of the heels and ankles; the area around the buttocks (ischial tuberosity), the elbows and shoulder blades, and the occiput (back of the head) (EPUAP 2015). Individuals nursed in the prone position are vulnerable to pressure ulcers on the toes, knees, hips, elbows and ribs (EPUAP 2015). Stephen-Haynes and Maries (2020) recommend the use of specialist equipment, silicone padding, careful positioning, and close attention to skin care for people nursed in the prone position. Wheelchair-bound individuals are at risk of developing pressure sores on their buttocks, spine, elbows, heels, back of the knees, palms and genitals (Stephens and Bartley 2018). Comprehensive assessments and care plans should be carried out for wheelchair users and their carers, which include equipment, positioning, cushions, and environment (Stephens and Bartley 2018). Medical devices and associated lines and tubes may cause pressure injuries wherever they are in contact with the skin (NPIAP 2020).
Wound healing and ulcers
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
The treatment of pressure ulcers depends on the stage of an ulcer. Stages 1 and 2 can be treated conservatively by moist wound dressing, while stages 3 and 4 require surgical intervention such as flap reconstruction. Antibiotics are used if the wound is infected.
Clinical trials for neuroregenerative therapies for spinal cord injury: what have we learnt so far?
Published in Expert Review of Neurotherapeutics, 2023
Raymond Wong, Nader Hejrati, Michael G. Fehlings
Second, older patients are more likely to experience complications after surgery and during rehabilitation [77]. Thus, clinical studies should investigate how to enhance the various strategies of the treatment protocol that can help reduce such complications, including: 1) pre-operative optimization to ensure that underlying medical problems are sufficiently managed (e.g. comorbidities such as heart disease or diabetes, nutritional and hydration status); 2) early mobilization and rehabilitation to prevent common surgical complications (e.g. pneumonia, deep vein thrombosis); 3) nutritional support to ensure adequate calories and protein to facilitate wound healing and prevent muscle wasting; 4) prevention of pressure ulcers via approaches such as regular repositioning, skin care, and using pressure-relieving devices; and 5) pain management via both pharmacological and non-pharmacological approaches to encourage engagement in rehabilitation [78]. For example, urinary tract infections (UTIs) are a major problem particularly among older patients with SCI. It would be important to assess the currently used prevention strategies to reduce the incidence of UTI in this cohort of patients, which include a combination of proper bladder management, catheterization management, hydration, hygiene, use of antibiotic prophylaxis, and urine culture monitoring [79].
Stem cell and tissue engineering approaches in pressure ulcer treatment
Published in The Journal of Spinal Cord Medicine, 2023
Silvia Perez-Lopez, Marcos Perez-Basterrechea, Jose Maria Garcia-Gala, Eva Martinez-Revuelta, Angeles Fernandez-Rodriguez, Maria Alvarez-Viejo
Pressure ulcers are today still a major healthcare problem, especially for those patients with limited mobility and/or sensation such as SCI patients. Treatments are usually based on PU stage and patient characteristics, and span from simple skin wound care in mild cases to surgery in the more severe PU. Advanced therapy medicinal products are innovative complex biological products that are being examined in preclinical studies, and many are also being translated to the clinical setting as alternative therapeutic tools for several diseases. Among these diseases, PUs will especially benefit from these scientific advances, as for the more severe or complex injuries, standard of care treatment is not always successful. Taking in mind the characteristics of PUs, especially those with larger dimensions, where cell treatment may not be possible, tissue engineering approaches arise as the most promising option. Although several scaffolds, combined or not with cells, have been assayed, both in pre-clinical and clinical studies, its use in daily clinical practice have not been achieved. In this sense, further research is needed, with special attention to the development of new natural scaffolds, some of which could be obtained autologously, avoiding some safety and biocompatibility concerns.
Validating a wheelchair in-seat activity tracker
Published in Assistive Technology, 2022
Nauman Ahad, Sharon E. Sonenblum, Mark A. Davenport, Stephen Sprigle
Wheelchair users, especially users with spinal cord injuries, experience limited sensory cues to move within their chairs. This leads to extended periods of stationary sitting (Sonenblum et al., 2016) which causes extensive loading of body tissues, particularly around the ischial tuberosities and sacrum and coccyx. Increased loading of tissues, both in magnitude and duration, can hinder blood and oxygen supply to tissues which can cause pressure ulcers. About 46% of 300,000 people with spinal cord injuries in the United States experience pressure ulcers (N.S.C.I.S.C, 2015). After sustaining spinal cord injuries, more than 20% require costly surgeries to manage these ulcers (Saunders et al., 2012). The recurrence rate for pressure ulcers can be up to 79% which further adds to healthcare costs (Bates-Jensen et al., 2009). These pressure ulcers can become infected, leading to life-threatening complications such as sepsis – such complications are associated with mortality rates of 48%.(N.S.C.I.S.C, 2015).