Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study.

BACKGROUND: The incidence of frailty and non-healing wounds increases with patients' age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. METHODS: The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student's or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. RESULTS: A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8-8.8%/day). CONCLUSION: Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

A toolkit for the quantitative evaluation of chronic wounds evolution for early detection of non-healing wounds.

BACKGROUND: Chronic wounds resulting from a number of conditions do not heal properly and can pose serious health problems. Beyond clinician visual inspection, an objective evaluation of the wound is required to assess wound evolution and the effectiveness of therapies. AIM: Our objective is to provide a methodology for the analysis of wound area vs. time for the early prediction of non-healing wounds evolution. METHODS: We propose a two-step approach consisting of: i) wound area quantification from planimetries and ii) classification of wound healing through the inference of characteristic parameters. For the first step, we describe a user-friendly software (Woundaries) to automatically calculate the wound area and other geometric parameters from hand-traced planimetries. For the second, we use a procedure for the objective classification of wound time evolution and the early assessment of treatment efficacy. The methodology was tested on simulations and retrospectively applied to data from 85 patients to compare the effect of a biological therapy with respect to general basic therapeutics. RESULTS: Woundaries provides measurements of wound surface equivalent to a validated device. The two-step methodology allows to determine if a wound is healing with high sensitivity, even with limited amount of data. Therefore, it allows the early assessment of the efficacy of a therapy. CONCLUSION: The performance of this methodology for the quantification and the objective evaluation of wound area evolution suggest it as a useful toolkit to assist clinicians in the early assessment of the efficacy of treatments, leading to a timely change of therapy.

Hábitos saludables para prevenir heridas complejas en la extremidad inferior. Relevancia de recomendaciones según los expertos / Healthy habits to prevent complex lower extremity wounds. Relevance of the recommendations according to an experts

Introducción: Los programas educativos para la autocura dirigidos a personas que padecen patologías crónicas, producen una mejoría tanto en su salud como en su calidad de vida. Estos programas deben estar compuestos por consejos aceptados y validados. Objetivos: Determinar la relevancia de las recomendaciones para la prevención de heridas complejas publicadas por sociedades científicas que proporcionan los profesionales expertos en heridas; recopilar, clasificar según etiología y ordenar por relevancia estas recomendaciones. Metodología: Estudio observacional prospectivo con una encuesta a enfermeras/os expertas/os en heridas acreditados por el GNEAUPP. Se recogieron las recomendaciones publicadas por las sociedades científicas y se realizó una encuesta telemática para identificar el nivel de relevancia de estas. Variables: Años de experiencia en el tratamiento de heridas, ámbito laboral, puntuación de relevancia en una escala Likert para cada recomendación. Resultados: Participaron 40 enfermeras/os, el 88% tenía más de 5 años de experiencia y el 63%, más de 15 años. La mayoría, un 35%, desarrollaba su labor en atención primaria. Los resultados nos han permitido ordenar las recomendaciones para la autocura de las diferentes etiologías e identificar las más relevantes. Conclusiones: La identificación de las recomendaciones más relevantes permitirá focalizarnos en ellas para el programa educativo sobre hábitos saludables dirigido a los pacientes con úlceras de extremidad inferior llevado a cabo en nuestra Unidad Clínica de Heridas Complejas (AU)

Introduction: Self-care education programs for people suffering from chronic conditions improve both their health and their quality of life. These programs should be composed of accepted and validated advice. Objectives: To determine the relevance of recommendations for the prevention of complex wounds published by scientific societies and provided by professional experts in wounds; to compile, classify according to etiology and order by relevance these recommendations. Methodology: Prospective observational study with a survey of wound experts accredited by the GNEAUPP. The recommendations published by the scientific societies were collected and a telematic survey was carried out to identify their level of relevance. Variables: years of experience in wound management, work setting, relevance score on a Likert scale for each recommendation. Values collected in the data collection notebook were analyzed. Results: Forty nurses participated, 88% had more than 5 years of experience and 63% more than 15 years. Most of them, 35%, worked in primary care. The results have allowed us to order the recommendations for self-cure of the different etiologies and to identify the most relevant ones. Conclusions: The identification of the most relevant recommendations will allow us to focus on them for the educational program on healthy habits aimed at patients with lower extremity ulcers carried out in our Clinical Unit of Complex Wounds (AU)

Abordaje multidisciplinarde un paciente con una úlceraperianal asociada a pomadaantihemorroidal / Multidisciplinary approach to a patient with a perianal ulcer associated with hemorrhoidal ointment

Introducción: Hasta la fecha, la manifestación de una úlcera perianalprovocada por una pomada antihemorroidal no se ha descrito confrecuencia. Sin embargo, se ha objetivado un incremento de loscasos durante la pandemia de COVID-19. Caso clínico: Varónde 82 años independiente, que presentó una úlcera perianal de35,8 cm² sin ninguna patología ni enfermedad concomitante queexplicara su causa. La aplicación de criterios de exclusión exhaustivos,incluida una biopsia para rechazar el pioderma gangrenoso,identificó una pomada rectal hemorroidal como la causa de la úlcera.Plan de actuación: La herida curó tras aplicar una intervenciónmultidisciplinaria y una terapia con factores de crecimientoautólogos. Discusión y conclusiones: Este caso ha sido escasamentereportado en la literatura, aunque esta pomada hemorroidal secomercializa desde hace más de 40 años. Se recomienda evaluaciónmédica antes de la prescripción. (AU)

Introduction: Perianal ulcers resulting from the use of hemorrhoidalointments have been rarely reported to date. Nevertheless, therehas been a surge in the number of cases reported during theCOVID-19 pandemic. Case report: An independent 82-year-oldmale experienced a 35,80 cm² perianal ulcer, with no underlyingcondition or concomitant disease that could explain the cause ofthe ulcer. The application of thorough exclusion criteria, including abiopsy to rule out pyoderma gangrenosum, led to the identificationof a hemorrhoidal rectal ointment as the cause. Action plan: Theulcer healed completely when a multidisciplinary intervention and anautologous growth factors advanced therapy were applied. Discussionand conclusions: This case has been scarcely reported in the literature,although this hemorrhoidal ointment has been on the market for over40 years. Medical assessment before prescription and patients’ followup is recommended. (AU)

[Comparison of efficacy of heel ulcer prevention between classic padded bandage and polyurethane heel in a medium-stay hospital: randomized controlled trial]. / Prevención de las úlceras de talón en un hospital de media estancia. Estudio comparativo de vendaje clásico almohadillado respecto a las taloneras hidrocelulares de poliuretano.

INTRODUCTION: The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel. MATERIAL AND METHODS: Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes. RESULTS: Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82). CONCLUSIONS: No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these.

[Prevalence of chronic wounds in a county in the province of Barcelona (Spain)]. / Prevalencia de la heridas crónicas en una comarca de la provincia de Barcelona.

OBJECTIVES: To determine the prevalence of chronic wounds in patients in a specific region and their distribution according to health resources. To classify wound typologies and the treatment provided. To examine the use of risk assessment scales and preventive measures. METHOD: A cross sectional study was performed between June 2 and 8, 2004 that included all the health centers of the distinct health areas of Osona County (Barcelona), with a population of 128,309 persons aged more than 14 years. Data were collected on patients diagnosed with chronic wounds and on the characteristics of these wounds. RESULTS: We studied 251 patients with a mean age of 77.5 years. A total of 377 chronic wounds were identified and there were 168 pressure ulcers. The prevalence of chronic wounds was 0.29% and that of pressure ulcers was 0.13%. The proportion of patients with lower limb ulcers was significantly higher in primary care than in acute and geriatric care (p<0.005). The proportion of patients with pressure ulcers was higher in acute and geriatric care than in primary care (p<0.005). Preventive scales were applied in 81 patients (92%) with pressure ulcers. CONCLUSIONS: Applying the concept of chronic wound was useful in identifying the high prevalence of lower limb ulcers. The distribution of wounds varied according to the health resources available.

Prevención de las úlceras de talón en un hospital de media estancia. Estudio comparativo de vendaje clásico almohadillado respecto a las taloneras hidrocelulares de poliuretano / Comparison of efficacy of heel ulcer prevention between classic padded bandage and polyurethane heel in a medium-stay hospital: Randomized controlled trial

Introducción. El presente estudio tiene como objetivo comparar la incidencia de úlceras por presión de talón (UPPT) de 2 sistemas de prevención para UPPT: el vendaje clásico almohadillado y las taloneras de poliuretano. Material y métodos. Estudio de intervención prospectivo controlado y aleatorizado en un hospital de media-larga estancia de todas las personas ingresadas que no presentaban UPPT y tenían riesgo de desarrollar UPPT según la escala de Braden o criterio clínico. Los pacientes fueron aleatorizados al tratamiento con vendaje clásico almohadillado o taloneras de poliuretano. La variable resultado fue la incidencia de UPPT para cada grupo de estudio, que se registró cada 15 días o si hubo cambios clínicos. Resultados. De los 940 pacientes evaluados, 409 fueron incluidos en el estudio, con una edad media de 80,5 años; 59,1% eran mujeres; el 78% tenía Barthel≤30; el 28,6% demencia, el 37,6% síndrome confusional; el 27,6% diabetes, y el 19,6% otras UPP. La incidencia global de UPPT fue del 2,9%; 2,49% en el grupo de almohadillado clásico y, 3,37% en el grupo de talonera de poliuretano (p=0,82). Conclusiones. No se han observado diferencias estadísticamente significativas entre el grupo de vendaje clásico y el de taloneras de poliuretano. La utilización de múltiples medidas para la prevención de UPPT consigue una baja incidencia de las mismas(AU)

Introduction. The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel. Material and methods. Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes. Results. Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82). Conclusions. No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these(AU)

Prevalencia de la heridas crónicas en una comarca de la provincia de Barcelona / Prevalence of chronic wounds in a county in the province of Barcelona (Spain)

Objetivos. Conocer la prevalencia de pacientes con heridas crónicas en una comarca y su distribución según el tipo de recursos asistenciales. Clasificar la tipología de dichas heridas y la terapéutica utilizada. Revisar la utilización del uso de las escalas de valoración de riesgo y las medidas de prevención. Método. Se presenta un estudio transversal, realizado entre el 2 y el 8 de junio de 2004, que comprende a todos los centros de los diferentes ámbitos asistenciales sanitarios de la comarca de Osona (Barcelona), con una población de mayores de 14 años de 128.309. Se recogió información acerca de los pacientes diagnosticados de heridas crónicas y las características de éstas. Resultados. Se estudiaron 251 pacientes con una edad media de 77,5 años. Se identificaron 377 heridas crónicas, concretamente 168 úlceras por presión. La prevalencia de las heridas crónicas fue de 0,29% y de las úlceras por presión de 0,13%. La proporción de pacientes atendidos de úlceras de extremidades inferiores en atención primaria era significativamente superior a la de los atendidos en los centros de agudos y sociosanitarios (p<0,005). La proporción de los atendidos en los centros sociosanitarios y de agudos, por úlceras por presión, era superior a la de los atendidos en atención primaria (p<0,005). Se aplicaron escalas de prevención a 81 (92%) de los pacientes que presentaron úlceras por presión. Conclusiones. La utilización del concepto de herida crónica evidencia una alta prevalencia de úlceras en extremidades inferiores, observándose una distribución diferente de ellas según los recursos asistenciales (AU)

Objectives. To determine the prevalence of chronic wounds in patients in a specific region and their distribution according to health resources. To classify wound typologies and the treatment provided. To examine the use of risk assessment scales and preventive measures. Method. A cross sectional study was performed between June 2 and 8, 2004 that included all the health centers of the distinct health areas of Osona County (Barcelona), with a population of 128,309 persons aged more than 14 years. Data were collected on patients diagnosed with chronic wounds and on the characteristics of these wounds. Results. We studied 251 patients with a mean age of 77.5 years. A total of 377 chronic wounds were identified and there were 168 pressure ulcers. The prevalence of chronic wounds was 0.29% and that of pressure ulcers was 0.13%. The proportion of patients with lower limb ulcers was significantly higher in primary care than in acute and geriatric care (p<0.005). The proportion of patients with pressure ulcers was higher in acute and geriatric care than in primary care (p<0.005). Preventive scales were applied in 81 patients (92%) with pressure ulcers. Conclusions. Applying the concept of chronic wound was useful in identifying the high prevalence of lower limb ulcers. The distribution of wounds varied according to the health resources available (AU)