Incidence and risk factors of operating room-acquired pressure injury: a cross-sectional study.

BACKGROUND: Operating room-acquired pressure injury (PI) is defined as PI that develops within the first 48 to 72 hours after surgery. PURPOSE: To determine the incidence and risk factors of operating room-acquired PI. METHODS: This descriptive cross-sectional study was conducted at a university hospital in Turkey between May 20, 2021, and December 20, 2021, and included 309 patients who met the inclusion criteria. The study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. RESULTS: Operating room-acquired PI developed in 5.8% of the patients in this study. Moreover, 54.4% of the patients had medical devices, and medical device-acquired PI occurred in 4.2% of these patients (7/168). Patient age, hemodynamic parameters, and albumin level, as well as duration of surgery, were found to affect the development of operating room-acquired PI. CONCLUSION: Surgical nurses are responsible for both recognizing situations that may result in perioperative PI and taking necessary precautions. It is recommended that nurses identify existing and potential preoperative, intraoperative, and postoperative risks that impair skin integrity and affect tissue oxygenation to reduce the risk of operating room-acquired PI.

The effect of web-based training given to nurses on the prevention of pressure injury in patients hospitalized in the anesthesiology and reanimation intensive care unit: quasi-experimental pre-test post-test research.

BACKGROUND: The knowledge, attitudes, and behaviors of intensive care nurses concerning the prevention of pressure injury (PI) may be positively affected by education. PURPOSE: To evaluate the effect of web-based training given to nurses on their knowledge of, attitudes about, and behaviors in the prevention of PI. METHODS: This study was conducted between May 2019 and December 2019 with a pre-test and post-test design. The study sample consisted of 22 nurses and 80 patients. A link to the educational video prepared for the prevention of PIs was sent to the nurses' mobile phones. RESULTS: The training had a significant positive effect on nurses' level of knowledge of and attitudes toward PI prevention (P < .001 and P = .042, respectively). In group 1, comprising 40 patients who received treatment before nurses' training, 2.5% of patients had stage 1 PI on day 1 and 7.5% had stage 1 PI on day 7, and 2.5% had stage 4 PI on day 7. In group 2, comprising 40 patients who received treatment after nurses' training, 2.5% of patients had stage 1 PI on day 1 and 2.5% had stage 1 PI on day 7. CONCLUSION: Nurses' knowledge of and attitudes and behaviors toward PI prevention were improved following the web-based training, and the stage and rate of PI were lower in patients who received care after nurses received the training.

Cross-setting Comparison of Risk Factors for Pressure Injuries Acquired in Post-Acute Care.

GENERAL PURPOSE: To provide information on the association between risk factors and the development of new or worsened stage 2 to 4 pressure injuries (PIs) in patients in long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), and skilled nursing facilities (SNFs). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Compare the unadjusted PI incidence in SNF, IRF, and LTCH populations.2. Explain the extent to which the clinical risk factors of functional limitation (bed mobility), bowel incontinence, diabetes/peripheral vascular disease/peripheral arterial disease, and low body mass index are associated with new or worsened stage 2 to 4 PIs across the SNF, IRF, and LTCH populations.3. Compare the incidence of new or worsened stage 2 to 4 PI development in SNF, IRF, and LTCH populations associated with high body mass index, urinary incontinence, dual urinary and bowel incontinence, and advanced age.

Pressure Injuries and Skin Failure.

Pressure injuries are a common chronic wound in the older adult. Care of pressure injuries is an interprofessional effort and involves physicians, nurses, registered dieticians, rehabilitation therapists, and surgical subspecialties. Numerous treatment modalities exist but have varying evidence to substantiate their efficacy. All primary and other care providers, particularly geriatricians, need to be aware of current evidence-based prevention and treatment standards. When healing is not expected, palliative care should be considered to avoid futile procedures and preserve dignity and quality of life.

Nurses' experiences of hospital-acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework.

We investigated nurses' experiences of hospital-acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence-based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital-acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self-blame related to PI identification, and exacerbating impacts of the COVID-19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital-acquired PI.

Effects of a mattress cover with special airflow technology on the structure and function of the sacral and heel skin during loading: A two-arm exploratory crossover trial.

Prolonged mechanical loading of the skin and underlying soft tissue cause pressure ulceration. The use of special support surfaces are key interventions in pressure ulcer prevention. They modify the degree and duration of soft tissue deformation and have an impact on the skin microclimate. The objective of this randomized cross-over trial was to compare skin responses and comfort after lying for 2.5 h supine on a support surface with and without a coverlet that was intended to assist with heat and moisture removal at the patient/surface interface. In addition, physiological saline solution was administered to simulate an incontinence episode on the mattress next to the participants' skin surface. In total, 12 volunteers (mean age 69 years) with diabetes mellitus participated. After loading, skin surface temperature, stratum corneum hydration and skin surface pH increased, whereas erythema and structural stiffness decreased at the sacral area. At the heel skin area, temperature, erythema, and stratum corneum hydration increased. These results indicate occlusion and soft tissue deformation which was aggravated by the saline solution. The differences in skin response showed only minor differences between the support surface with or without the coverlet.

Improving pressure injury risk assessment using real-world data from skilled nursing facilities: A cohort study.

This study aimed to improve the predictive accuracy of the Braden assessment for pressure injury risk in skilled nursing facilities (SNFs) by incorporating real-world data and training a survival model. A comprehensive analysis of 126 384 SNF stays and 62 253 in-house pressure injuries was conducted using a large calibrated wound database. This study employed a time-varying Cox Proportional Hazards model, focusing on variations in Braden scores, demographic data and the history of pressure injuries. Feature selection was executed through a forward-backward process to identify significant predictive factors. The study found that sensory and moisture Braden subscores were minimally contributive and were consequently discarded. The most significant predictors of increased pressure injury risk were identified as a recent (within 21 days) decrease in Braden score, low subscores in nutrition, friction and activity, and a history of pressure injuries. The model demonstrated a 10.4% increase in predictive accuracy compared with traditional Braden scores, indicating a significant improvement. The study suggests that disaggregating Braden scores and incorporating detailed wound histories and demographic data can substantially enhance the accuracy of pressure injury risk assessments in SNFs. This approach aligns with the evolving trend towards more personalized and detailed patient care. These findings propose a new direction in pressure injury risk assessment, potentially leading to more effective and individualized care strategies in SNFs. The study highlights the value of large-scale data in wound care, suggesting its potential to enhance quantitative approaches for pressure injury risk assessment and supporting more accurate, data-driven clinical decision-making.

Complications in spinal cord injury persons with "traditional" colostomy: a case series.

INTRODUCTION: Neurogenic bowel dysfunction is a frequent consequence of spinal cord injury/disease (SCI/D). A colostomy is considered when conservative treatments fail [1, 2]. In the last year we observed several SCI/D persons with colostomy, admitted to our institution with multiple complications. CASE PRESENTATION: We present four cases of SCI/D persons treated with Hartmann's procedure and admitted to our institution for pressure ulcer (PU) treatment. All patients underwent PU surgery with good results. All patients reported a subjective good evacuation setting. No one assumed laxative therapies at home. At admission, all patients underwent abdominal radiography that showed an important constipation, with cases of sub-occlusion or complete occlusion with gastroparesis. One person presented a parastomal, strangulated hernia and underwent hernia reduction and patch positioning around the stoma. During hospital stay, bowel management required an important administration of laxatives and frequent, almost daily, stoma washes. DISCUSSION: Some considerations must be made regarding the use of traditional techniques in SCI/D people, such as Hartmann's, leaving a large part of the colon and the anatomical position of the stoma itself represent limitations to fecal progression and may cause constipation. A specific approach, tailored on the SCI/D patients' characteristics, such as the one described by our group, should be considered. Even if colostomy has been performed, appropriate therapies and health education on how to manage the stoma are fundamental to prevent complications.

Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting.

PURPOSE: The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting. PARTICIPANTS AND SETTING: This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones. APPROACH: The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis. OUTCOMES: Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period. IMPLICATIONS FOR PRACTICE: The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.

Rate of skin and nerve complications as a result of cutaneous traction with modern foam boots.

INTRODUCTION: Cutaneous traction is used to temporize lower extremity fractures and relies on friction between the skin and surrounding material to apply a longitudinal force. This circumferential compressive force can lead to pressure sores, skin sloughing, or compressive neuropathies. These complications have been reported in up to 11% of patients when the cutaneous traction relies on adhesive tapes, plaster, and rubber bandages being in immediate contact with the skin. The rates of these complications are not well documented when using modern foam boots. METHODS: A retrospective chart review was performed on all orthopedic trauma patients who suffered pelvic or lower extremity injuries between March 1st, 2020 and April 30th, 2021 at a single Level-1 trauma center. We included all patients with femoral fractures, axially unstable pelvic ring and/or acetabular fractures, and unstable hip dislocations temporized with the use of cutaneous traction. All patients had intact skin and lower extremity nerve function prior to application. RESULTS: There were 138 patients identified with 141 lower extremities. The average patient age was 50.7 (6-100) years. Mean traction weight of 9.8 (5-20) pounds. Average traction duration was 20.9 (2.3-243.5) hours. At the time of traction removal, there was 1 (0.7%) new skin wound and 0 nerve palsies. The new skin wound was a stage one heel pressure sore and did not require further treatment. CONCLUSION: Cutaneous traction with a modern foam boot was found to have a skin complication rate of 0.7% and a nerve palsy complication rate of 0% for an overall complication rate of 0.7%, which has not been previously established and is lower than historically reported complication rates of 11% when utilizing adhesive and plaster directly on skin. Foam boot Cutaneous traction may be considered a safe option for traction placement.

Knowledge and Attitudes Toward Pressure Ulcer Prevention Evidence-based Guidelines among Nursing Students at Jazan University, Saudi Arabia.

BACKGROUND: Pressure ulcers (PUs) are a common global problem. They affect health-care costs and patient health because of increased morbidity and mortality rates. Critically ill patients are more prone to acquiring PUs than other patients. As the prevalence of PUs is high in Saudi Arabia, more attention is required for PU prevention. Nurses' knowledge and attitudes toward PU prevention are crucial. AIMS: This study aimed to assess the knowledge and attitudes of nursing students regarding PU prevention evidence-based guidelines. SETTING AND DESIGN: This descriptive, cross-sectional study was conducted among nursing students at Jazan University. MATERIALS AND METHODS: Data were collected using an electronic questionnaire. STATISTICAL ANALYSIS USED: Data were entered, coded, and analyzed using the SPSS version 23. RESULTS: A total of 378 participants were included. The mean age was 22.4 ± 3.4 years, and the mean knowledge score was 7.6 ± 2.64 (range = 0-16). Of the participants, 365 (96.6%) and 13 (3.4%) were considered to have poor and good knowledge about PUs, respectively. Only 72 (19%) correctly identified a lack of oxygen as the cause of PUs; other participants answered malnutrition and moisture. Conversely, 200 (52.9%) participants indicated that recent weight loss below patients' ideal weight increases the risk for PUs. Concerning knowledge about preventive measures, 64 (16.9%) participants correctly answered that a backward sitting position, with both legs resting on a footrest, can reduce the amount of pressure. Meanwhile, 169 (44.7%) participants correctly selected thick air cushion as a means to reduce the magnitude of pressure when patients are sliding down on a chair. Some participants answered that PUs can be reduced if patients are mobilized. Seventy-two (19%) participants indicated that patients laying on a visco-elastic foam mattress should be repositioned every 2 h to reduce the duration of pressure. Age, year of education, training experience, and department were not significantly associated with knowledge about PUs (P = 0.333, P = 0.370, P = 0.700, and P = 0.810, respectively). CONCLUSIONS: The general knowledge and attitudes toward PUs of the nursing students at Jazan University were poor. Nevertheless, they had an average knowledge level regarding PU prevention. Age and training experience were not significantly associated with knowledge about PUs.

Résumé Contexte:Les ulcères de pression (UP) sont un problème mondial courant. Ils affectent les coûts de santé et la santé des patients en raison de l'augmentation des taux de morbidité et de mortalité. Les patients gravement malades sont plus susceptibles de développer des UP que d'autres patients. Comme la prévalence des UP est élevée en Arabie saoudite, une attention accrue est nécessaire pour la prévention des UP. Les connaissances et attitudes des infirmiers en matière de prévention des UP sont cruciales.Objectifs:Cette étude visait à évaluer les connaissances et attitudes des étudiants en soins infirmiers concernant les directives de prévention des UP basées sur des preuves. Cadre et conception : Cette étude descriptive et transversale a été menée auprès des étudiants en soins infirmiers de l'Université de Jazan.Matériels et méthodes:Les données ont été collectées à l'aide d'un questionnaire électronique. Analyse statistique utilisée: Les données ont été saisies, codées et analysées à l'aide de la version 23 du logiciel SPSS.Résultats:Au total, 378 participants ont été inclus. L'âge moyen était de 22,4 ± 3,4 ans et le score moyen de connaissance était de 7,6 ± 2,64 (plage = 0-16). Parmi les participants, 365 (96,6 %) avaient une connaissance médiocre et 13 (3,4 %) une bonne connaissance des UP. Seuls 72 (19 %) ont correctement identifié un manque d'oxygène comme étant la cause des UP; les autres participants ont répondu la malnutrition et l'humidité. En revanche, 200 (52,9 %) participants ont indiqué qu'une perte de poids récente en dessous du poids idéal des patients augmente le risque de UP. En ce qui concerne les connaissances sur les mesures préventives, 64 (16,9 %) participants ont répondu correctement qu'une position assise inclinée vers l'arrière, avec les deux jambes reposant sur un repose-pieds, peut réduire la pression. Pendant ce temps, 169 (44,7 %) participants ont correctement sélectionné un coussin d'air épais comme moyen de réduire l'ampleur de la pression lorsque les patients glissent sur une chaise. Certains participants ont répondu que les UP peuvent être réduits si les patients sont mobilisés. Soixante-douze (19 %) participants ont indiqué que les patients allongés sur un matelas en mousse viscoélastique devraient être repositionnés toutes les 2 heures pour réduire la durée de la pression. L'âge, l'année d'éducation, l'expérience de formation et le département n'étaient pas significativement associés aux connaissances sur les UP (P = 0,333, P = 0,370, P = 0,700 et P = 0,810, respectivement).Conclusions:Les connaissances générales et les attitudes à l'égard des UP des étudiants en soins infirmiers de l'Université de Jazan étaient médiocres. Néanmoins, ils avaient un niveau de connaissance moyen concernant la prévention des UP. L'âge et l'expérience de formation n'étaient pas significativement associés aux connaissances sur les UP.

Decreasing Intraoperative Skin Damage in Prone-Position Surgeries.

OBJECTIVE: To determine if subepidermal moisture (SEM) measures help detect and prevent intraoperative acquired pressure injuries (IAPIs) for prone-position surgery. METHODS: In this clinical trial of patients (n = 39 preintervention, n = 48 intervention, 100 historical control) undergoing prone-position surgery, researchers examined the use of multidimensionally flexible silicone foam (MFSF) dressings applied preoperatively to patients' face, chest, and iliac crests. Visual skin assessments and SEM measures were obtained preoperatively, postoperatively, and daily for up to 5 days or until discharge. Electronic health record review included demographic, medical, and surgery data. RESULTS: Of the 187 total participants, 76 (41%) were women. Participants' mean age was 61.0 ± 15.0 years, and 9.6% were Hispanic (n = 18), 9.6% were Asian (n = 18), 6.9% were Black or African American (n = 13), and 73.8% were White (n = 138). Participants had a mean Scott-Triggers IAPI risk score of 1.5 ± 1.1. Among those with no erythema preoperatively, fewer intervention participants exhibited postoperative erythema on their face and chest than did preintervention participants. Further, fewer intervention participants had SEM-defined IAPIs at all locations in comparison with preintervention participants. The MFSF dressings overcame IAPI risk factors of surgery length, skin tone, and body mass index with fewer IAPIs in intervention participants. CONCLUSIONS: Patients undergoing prone-position surgeries developed fewer IAPIs, and SEM measures indicated no damage when MFSF dressings were applied to sites preoperatively. The SEM measures detected more damage than visual assessment.

Repositioning Guidelines to Decrease Pressure Injury in the Pediatric Intensive Care Unit: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement (QI) project was to develop and implement repositioning guidelines that reduce pressure injury (PI) in hemodynamically unstable pediatric intensive care unit (PICU) patients. PARTICIPANTS AND SETTING: All PICU patient ages 0 to 36 months who required sedation for invasive mechanical ventilation and had a Braden Q score ≤ 18 were eligible for inclusion. The project was implemented in 116 patients preimplementation and 100 postimplementation. Their median t age was 5 months (interquartile range 2-13 months). The QI project setting was an academic hospital PICU with a Level I trauma center located in the Mid-Atlantic Region of the United States. APPROACH: A pre-post observational design was used to compare the at-risk population for 21 weeks before (August-December 2018) and after (August-December 2019) implementing repositioning guidelines. Turn attempts were undertaken every 2 hours. Repositioning attempts were defined as (1) full (30°); (2) partial (15°); (3) unable to turn owing to hemodynamic instability; or (4) noncompliance. The primary outcome was incidence of Stage II or higher PI. OUTCOMES: We found a significant reduction in the incidence of PI before and after implementation of the repositioning intervention (16.4% vs 2.0%, P = .0003). IMPLICATIONS FOR PRACTICE: A structured intervention for repositioning hemodynamically unstable PICU patients has the potential to significantly lower PI incidence in a group of hemodynamically unstable children.

Hospital-associated complications in frail older adults.

As the Japanese population continues to age steadily, the number of older adults requiring healthcare has increased. Evidence demonstrates that hospitalization for acute care has a negative impact on the health outcomes of older adults. Frail older adults tend to have multifactorial conditions collectively known as "geriatric syndromes." When those with these premorbid conditions are hospitalized for acute care, they tend to develop new problems such as delirium and new functional impairments. Adverse consequences of hospitalization include the risk of loss of functional independence and chronic disability. In 2019, the new concept of "hospital-associated complications" (HACs) was proposed to describe these new problems. HACs comprise five conditions: hospital-associated falls, delirium, functional decline, incontinence, and pressure injuries. This review discusses the important issues of HACs in relation to their classification, prevalence, risk factors, prevention, and management in older adults hospitalized for acute care. Robust prevention and management are imperative to address the serious consequences and escalating medical costs associated with HACs, and a multidimensional and multidisciplinary approach is key to achieving this goal. Comprehensive geriatric assessment (CGA) is the cornerstone of geriatric medicine and offers a holistic approach involving multidisciplinary and multidimensional assessments. Considerable evidence is accumulating regarding how CGA and coordinated care can improve the prognosis of hospitalized older adults. Further research is needed to understand the occurrence of HACs in this population and to develop effective preventive measures.

Gentiopicroside injection promotes the healing of pressure injury wounds by upregulating the expression of bFGFR1.

OBJECTIVE: To observe the therapeutic effect of gentiopicroside, as the main component of Gentianaceae, on wounds in pressure injury (PI) model rats and explore its mechanism. METHOD: Male Sprague Dawley rats were randomly divided into control group, model group and gentiopicroside groups (50, 100 and 200 mg·kg-1·d-1 for 9 consecutive days). The mice's skeletal muscle fibroblast line NOR-10 cells were collected after being treated with gentiopicroside (0.2~5.0 M) and basic fibroblast growth factor receptor 1 (bFGFR1) inhibitor (5.0 M SU5402) for 7 days. RESULTS: Compared to the model group, the gentiopicroside groups showed significantly increased wound healing rates, reduced inflammatory cells in the wound tissues, and significantly increased expression levels of proliferating cell nuclear antigen (PCNA) and bFGFR1, accompanied by increased proliferation of new myofibroblasts. Gentiopicroside upregulated the mRNA expression of bFGFR1 and PCNA in NOR-10 cells in a dose-dependent manner; however, SU5402 reversed the effect of gentiopicroside. CONCLUSION: Gentiopicroside may promote myofibroblast proliferation by upregulating the expression of bFGFR1 and PCNA and ultimately accelerating the healing of PI wounds.

PTGS2 as target of compound Huangbai liquid in the nursing of pressure ulcer.

OBJECTIVE: Pressure ulcer refers to ulceration and necrosis caused by local skin and cell tissues being compressed for a long time, continuous ischemia, hypoxia, and malnutrition. However, role of prostaglandin-endoperoxide synthase 2 (PTGS2) in the management of pressure ulcers in with compound Huangbai liquid is still unclear. METHODS: Traditional Chinese medicine components and related targets of compound Huangbai liquid were collected through traditional Chinese medicine systems pharmacology (TCMSP) and Batman-traditional Chinese medicine database. Disease-related targets were obtained using the Gene Cards database. The protein-protein interaction (PPI) network was constructed using the Search tool for retrieval of interacting genes (STRING) and analyzed by Cytoscape to obtain the core components. To evaluate the clinical efficacy of the compound Huangbai liquid in the treatment of pressure ulcers, 40 patients with pressure ulcers were selected and divided into an observation group and a control group, with 20 individuals in each group. The observation group received treatment with compound Huangbai liquid. RESULTS: Sixty-five components and 480 targets of compound Huangbai liquid were obtained from TCMSP and Batman - traditional Chinese medicine databases. Two hundred seventy-three pressure ulcer-related targets were obtained. Seventy-two potential targets of compound Huangbai pigment in treatment of pressure ulcer were obtained, and 2 unrelated targets were deleted. There were 70 nodes and 1167 edges in PPI network. Gene ontology (GO) function is involved in biological processes such as reactive oxygen species metabolism and cellular response to chemical stress. Cellular components such as platelet α granules lumen and membrane rafts were involved. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment results showed that compound Huangbai liquid in treatment of pressure ulcer. The clinical results indicate that the compound Huangbai liquid has a good therapeutic effect on pressure ulcers. CONCLUSION: PTGS2 may be a target for treatment of pressure ulcers with compound Huangbai liquid, providing a new direction for its treatment.

The use of a protein network analysis to explore the complexity of early skin inflammation after oronasal mask application- A pilot study.

Medical devices, such as non-invasive ventilation masks, save lives in health care settings but can be a cause of tissue injuries due to the pressure and shear loads on skin and soft tissue. These pressure injuries could be painful for the individual and cause a significant economic impact on healthcare providers. In the etiology of device related pressure ulcers, inflammation plays an important role. However, the exact nature and timing of inflammatory biomarker upregulation is still unknown in the early stages of skin damage. This study aimed to explore the inflammatory profile of vulnerable skin sites following non-invasive mask application on a convenience sample of eleven hospital patients. Seventy-one inflammatory proteins were explored from sebum sampled at the skin surface after oronasal mask application. A multivariate analysis to investigate differences between loaded and control site was conducted, with a protein network analysis used to explore interactions in the early inflammation. The study revealed that 21 cytokines and chemokines were important for the separation between loaded and control site. These proteins were associated with remodeling of tissue, vascular wound healing and/or cell death.

Smart Cushions with Machine Learning-Enhanced Force Sensors for Pressure Injury Risk Assessment.

Prolonged sitting can easily result in pressure injury (PI) for certain people who have had strokes or spinal cord injuries. There are not many methods available for tracking contact surface pressure and shear force to evaluate the PI risk. Here, we propose a smart cushion that uses two-dimensional force sensors (2D-FSs) to measure the pressure and shear force in the buttocks. A machine learning algorithm is then used to compute the shear stresses in the gluteal muscles, which helps to determine the PI risk. The 2D-FS consists of a ferroelectret coaxial sensor (FCS) unit placed atop a ferroelectret film sensor (FFS) unit, allowing it to detect both vertical and horizontal forces simultaneously. To characterize and calibrate, two experimental approaches are applied: one involves simultaneously applying two perpendicular forces, and one involves applying a single force. To separate the two forces, the 2D-FS is decoupled using a deep neural network technique. Multiple FCSs are embedded to form a smart cushion, and a genetic algorithm-optimized backpropagation neural network is proposed and trained to predict the shear strain in the buttocks to prevent PI. By tracking the danger of PI, the smart cushion based on 2D-FSs may be further connected with home-based intelligent care platforms to increase patient equality for spinal cord injury patients and lower the expense of nursing or rehabilitation care.