hard-to-heal

难以治愈
  • 文章类型: Journal Article
    为了评估胶凝纤维敷料(Biatain纤维;ColoplastA/S,丹麦)在社区护理实践中的伤口管理。
    对前瞻性,观察,进行了真实世界的VIPES(VilledesPlaiesExSudatives天文台)研究。有渗出伤口的病人,护士选择使用胶凝纤维作为主要敷料,包括在内。结果包括对伤口状况和患者/护士意见的评估。
    总的来说,包括149例急性(n=52;34.9%)或难以愈合(慢性)(n=97;65.1%)伤口的患者。在基线,平均±标准差伤口年龄为351.5±998.2天,108(72.5%)伤口中度至高度渗出,126例(84.6%)伤口床有渗出物汇集。在最后一次后续访问中,29(19.5%)伤口愈合,在36天的中位数内,64人(43.0%)进展至愈合。从基线到最后一次随访,伤口表面积显着减少(p<0.05),深度(p<0.01),渗出物水平(p<0.0001),并且观察到具有光滑组织的伤口的比例(p<0.0001)。大多数伤口在最后一次就诊时没有(n=86;58.5%(两个缺失值))或低渗出物汇集(n=45;30.6%(两个缺失值)),并且具有健康伤口边缘/伤口周围皮肤的患者比例从基线增加。在最后一次访问中,71.4%(n=105)的病例被护士认为伤口有所改善,66.7%(n=98)的病例(2例患者缺失)。
    接受胶凝纤维治疗的患者经历了一系列复杂伤口状况的改善。这项分析强调了适当渗出物管理的重要性,并指出选择合适的伤口敷料如何促进愈合进展。
    这项研究得到了ColoplastSAS实验室的资助,巴黎,法国。ColoplastA/S资助了文章的撰写和编辑,并为其内容做出了贡献。ColoplastA/S和ColoplastSAS实验室审查了该文章的科学准确性。护士因参与研究而获得经济补偿。NA是ColoplastA/S的全职员工撰写本文时,APJ是ColoplastA/S的员工。在出版物开发时,FA是ColoplastSAS实验室的全职员工。RS和CJ是CENBiotech的全职员工。AK从ColoplastA/S获得了教育补助金,以向出版物提供科学投入。作者没有其他利益冲突需要声明。
    UNASSIGNED: To evaluate the use and performance of a gelling fibre dressing (Biatain Fiber; Coloplast A/S, Denmark) in the management of wounds in community nursing practice.
    UNASSIGNED: A sub-analysis of the prospective, observational, real-world VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted. Patients with exuding wounds, for which nurses chose to apply the gelling fibre as a primary dressing, were included. Outcomes included assessments of wound condition and patient/nurse opinion.
    UNASSIGNED: Overall, 149 patients with acute (n=52; 34.9%) or hard-to-heal (chronic) (n=97; 65.1%) wounds were included. At baseline, mean±standard deviation wound age was 351.5±998.2 days, 108 (72.5%) wounds were moderately-to-highly exuding, and 126 (84.6%) showed exudate pooling in the wound bed. At the last follow-up visit, 29 (19.5%) wounds had healed, within a median of 36 days, and 64 (43.0%) were progressing towards healing. From baseline to the last follow-up visit, significant reductions in wound surface area (p<0.05), depth (p<0.01), exudate level (p<0.0001), and in the proportion of wounds with sloughy tissue (p<0.0001) were observed. Most wounds had no (n=86; 58.5% (two missing values)) or low exudate pooling (n=45; 30.6% (two missing values)) at the last visit and proportions of patients with healthy wound edges/periwound skin increased from baseline. At the last visit, wounds were considered improved by nurses in 71.4% (n=105) of cases, and by patients in 66.7% (n=98) of cases (two patients missing).
    UNASSIGNED: Patients who received treatment with the gelling fibre experienced improvements in the condition of a range of complex wounds. This analysis highlights the importance of adequate exudate management, and indicates how the selection of an appropriate wound dressing can encourage healing progression.
    UNASSIGNED: This study was financially supported by Laboratoires Coloplast SAS, Paris, France. Coloplast A/S funded the writing and editing of the article and contributed to its content. Coloplast A/S and Laboratoires Coloplast SAS reviewed the article for scientific accuracy. Nurses received financial compensation for their participation in the study. NA is a full-time employee of Coloplast A/S. APJ was an employee of Coloplast A/S when this article was written. FA was a full-time employee of Laboratoires Coloplast SAS at the time of publication development. RS and CJ are full-time employees of CEN Biotech. AK received an educational grant from Coloplast A/S to provide scientific input to the publication. The authors have no other conflicts of interest to declare.
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  • 文章类型: Journal Article
    在以前的研究中,发现静脉性溃疡(VU)更常见于社会经济地位较低的患者.这项研究的目的是探讨社会经济因素是否会影响浅静脉介入后转诊血管服务的延迟或愈合时间。
    在这项前瞻性研究中,患者回答了一份关于他们的VU的持续时间和复发的问卷,合并症,体重指数(BMI),吸烟,酒精,社会和体育活动,卧床状态,教育,婚姻状况,住房,感知的经济地位和对家庭护理的依赖。术后并发症,浅静脉介入后一年,发现VU愈合和复发。
    本研究共纳入63名患者(30名女性和33名男性),平均年龄71.2岁(范围:37-92岁)。患者当前VU的持续时间为:48%<3个月;27%为3-6个月;11%为6-12个月;14%为>12个月。在单变量分析中,延迟转诊的危险因素是复发性VU(比值比(OR):4.92;p=0.021);步行障碍(OR:5.43;p=0.009)和对家庭护理的依赖性(OR:4.89:p=0.039)。后者是具有社会经济危险因素的多变量分析中唯一有意义的发现(OR:4.89;p=0.035)。在85%的患者中,在1年随访期间,他们的VU愈合无复发.如果患者:年龄较大(p=0.033);BMI正常(独立样本t检验,p=0.028);患有复发性VU(OR:5.00;p=0.049);或行走障碍(Fishers精确测试,OR:9.14;p=0.008),但没有发现显著的社会经济危险因素。
    在这项研究中,社会经济因素不是VU患者延迟转诊或浅静脉介入治疗后愈合时间延长的重要危险因素.
    这项工作得到了斯堪的纳维亚静脉曲张和其他静脉疾病研究基金会(SFV)以及厄勒布罗县地区的ALF资助。作者没有利益冲突要声明。
    UNASSIGNED: In previous studies, venous ulcers (VUs) have been found to occur more often in patients with lower socioeconomic status. The aim of this study was to explore if socioeconomic factors influence the delay of referral to a vascular service or the time to healing after superficial venous intervention.
    UNASSIGNED: In this prospective study, patients answered a questionnaire about the duration and recurrence of their VU, comorbidities, body mass index (BMI), smoking, alcohol, social and physical activities, ambulatory status, education, marital status, housing, perceived economic status and dependence on home care. Postoperative complications, VU healing and recurrence were noted one year after superficial venous intervention.
    UNASSIGNED: A total of 63 patients were included in this study (30 females and 33 males), with a mean age of 71.2 years (range: 37-92 years). Duration of the present VU in patients was: <3 months in 48%; 3-6 months in 27%; 6-12 months in 11%; and >12 months in 14%. Risk factors for delayed referral were recurrent VU (odds ratio (OR): 4.92; p=0.021); walking impairment (OR: 5.43; p=0.009) and dependence on home care (OR: 4.89: p=0.039) in a univariable analysis. The latter was the only significant finding in a multivariable analysis with socioeconomic risk factor (OR: 4.89; p=0.035). In 85% of patients, their VU healed without recurrence during one year follow-up. Healing took longer if the patients: were of older age (p=0.033); had a normal BMI (independent samples t-test, p=0.028); had a recurrent VU (OR: 5.00; p=0.049); or walking impairment (Fishers exact test, OR: 9.14; p=0.008), but no significant socioeconomic risk factors were found.
    UNASSIGNED: In this study, socioeconomic factors were not important risk factors for delayed referral of VU patients to a vascular service or prolonged healing time after superficial venous intervention.
    UNASSIGNED: This work was supported by the Scandinavian Research Foundation for Varicose Veins and other Venous Diseases (SFÅV) and by ALF funding from Region Örebro County. The authors have no conflicts of interest to declare.
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  • 文章类型: Journal Article
    评估使用TKKT01(用于制备PRP凝胶的伤口护理设备)制备的富血小板血浆(PRP)凝胶在患有难以治愈的糖尿病足溃疡(DFU)且对≥4周的标准护理(SoC)反应不足的患者中的愈合结果。
    这个开放标签,单臂,在日本的15个中心进行了多中心研究.符合条件的患者每周接受两次PRP凝胶治疗,持续八周,完成第8周(第57天)后进行最终评估。主要终点是最终评估时伤口半径减少≥50%的患者百分比(成就标准,≥60%的患者)。次要终点包括:伤口面积和体积减少率;次要意图可能的伤口闭合时间;使用相对简单的程序可能的伤口闭合时间(例如,皮肤移植和缝合);以及最终评估的安全性。
    共有54名患者被纳入完整的分析集,每个方案集包括47例患者;在最终评估时达到≥50%伤口半径减小的38/47(80.9%)(95%置信区间:66.7-90.9%)患者达到主要终点.在最终评估中观察到高比率的伤口面积(72.8%)和体积(92.7%)减少。通过次要意图和使用相对简单的程序可能闭合伤口的中位时间为57天和43天,分别。在最终评估中,27名(57.4%)患者实现了完全伤口闭合。没有提出安全问题。
    在这项研究中,我们的研究结果证实了在日本使用TKKT01进行PRP凝胶治疗难以治愈的DFU患者的有效性和安全性.
    这项研究由Rohto制药公司资助,Ltd.,日本。NO已由RohtoPharmaceuticalCo.支付咨询费,Ltd.KH是Rohto制药的首席医疗官。Co.,其他作者没有利益冲突声明。
    UNASSIGNED: To evaluate the healing outcome of a platelet-rich plasma (PRP) gel prepared using TKKT01 (a wound care device to prepare the PRP gel) in patients with hard-to-heal diabetic foot ulcers (DFUs) and who showed an inadequate response to ≥4 weeks of standard of care (SoC).
    UNASSIGNED: This open-label, single-arm, multicentre study was conducted in 15 centres in Japan. Eligible patients received PRP gel treatment twice a week for eight weeks, followed by a final evaluation after the completion of week 8 (day 57). The primary endpoint was the percentage of patients who achieved ≥50% reduction in wound radius at the final evaluation (achievement criterion, ≥60% of patients). Secondary endpoints included: wound area and volume reduction rates; time to possible wound closure by secondary intention; time to possible wound closure using a relatively simple procedure (e.g., skin graft and suture); and safety at the final evaluation.
    UNASSIGNED: A total of 54 patients were included in the full analysis set, with 47 patients included in the per protocol set; the primary endpoint was met in 38/47 (80.9%) (95% confidence interval: 66.7-90.9%) patients who achieved ≥50% wound radius reduction at the final evaluation. High rates of wound area (72.8%) and volume (92.7%) reduction were observed at the final evaluation. The median time to possible wound closure by secondary intention and by use of a relatively simple procedure was 57 and 43 days, respectively. Complete wound closure at the final evaluation was achieved in 27 (57.4%) patients. No safety concerns were raised.
    UNASSIGNED: In this study, the efficacy and safety of PRP gel treatment with TKKT01 in patients with hard-to-heal DFUs in Japan were confirmed by our findings.
    UNASSIGNED: This study was funded by Rohto Pharmaceutical Co., Ltd., Japan. NO has been paid a consulting fee by Rohto Pharmaceutical Co., Ltd. KH is the Chief Medical Officer of Rohto Pharmaceutical. Co., Ltd. The other authors have no conflict of interest to declare.
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  • 文章类型: Journal Article
    为了确定治疗21天后糖尿病足溃疡(DFU)的初始血清25-羟基维生素D(25(OH)D)水平与肉芽生长之间的相关性。
    这项队列研究涉及在医院接受DFU治疗的2型糖尿病患者。入院时从患者身上采集血液样本。化学发光免疫测定技术用于测量25(OH)D水平。通过比较从初始治疗到治疗第21天的照片来分析肉芽组织生长。
    初始治疗时25(OH)D水平的中值为8ng/ml。结果显示25(OH)D水平与DFU中的颗粒生长之间没有相关性(p=0.86)。
    初始血清25(OH)D水平与DFU中肉芽组织的生长无关。
    UNASSIGNED: To determine the correlation between initial serum 25-hydroxyvitamin D (25(OH)D) levels with granulation growth in diabetic foot ulcers (DFUs) after 21 days of treatment.
    UNASSIGNED: This cohort study involved patients with type 2 diabetes who had a DFU treated at hospital. Blood samples were taken from patients on admission. The chemiluminescent immunoassay technique was used to measure 25(OH)D levels. Granulation tissue growth was analysed by comparing the photographs from the initial treatment to day 21 of treatment.
    UNASSIGNED: The median value of 25(OH)D levels at initial treatment was 8 ng/ml. The result showed no correlation between 25(OH)D levels and the granulation growth in DFUs (p=0.86).
    UNASSIGNED: The initial serum 25(OH)D level was not correlated with the growth of granulation tissue in DFUs.
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  • 文章类型: Journal Article
    难以治愈的(慢性)伤口在糖尿病患者中很常见,并且与生活质量(QoL)下降有关。病原菌通常定植于难以愈合的伤口并阻碍愈合过程,这对(全身性)感染构成高风险。在这项研究中,我们的目标是证明益生菌能够取代人类致病菌,改善炎症并积极影响皮肤和粘膜的微环境/微生物组。
    在这项试点研究中,糖尿病患者和2~120个月难以愈合的伤口接受口服多品种益生菌治疗,为期6个月.口腔的变化,粪便和伤口微生物组进行了调查,以及益生菌干预对伤口愈合的影响,在整个临床研究过程中,对牙周炎和伤口特异性生活质量(Wound-QOL-17)进行了分析。
    总共,纳入的20例患者中有7例无法完成研究.在其余13名患者中有5名口服益生菌补充剂六个月后,伤口完全愈合了。大多数患者报告伤口特异性QoL有所改善,对疼痛和流动性有特别积极的影响。微生物组分析显示金黄色葡萄球菌和铜绿假单胞菌减少,和表皮葡萄球菌愈合的伤口。
    这项研究的发现提供了证据,证明了在糖尿病和难以愈合伤口的患者中,口服多物种益生菌超过六个月对伤口闭合的有益效果。伤口微生物模式,QoL,和牙齿健康。一个随机的,安慰剂对照,需要双盲临床试验来验证结果.
    UNASSIGNED: Hard-to-heal (chronic) wounds are common in patients with diabetes and are associated with a decrease in quality of life (QoL). Pathogenic bacteria often colonise hard-to-heal wounds and hinder the healing process which poses a high risk for (systemic) infections. In this study, we aim to prove that probiotics are capable of displacing human pathogenic bacteria, ameliorating inflammation and positively influencing the microenvironment/microbiome of skin and mucosa.
    UNASSIGNED: In this pilot study, patients with diabetes and hard-to-heal wounds with a duration of 2-120 months received an oral multispecies probiotic daily for six months. Changes in oral, stool and wound microbiome were investigated, and the effects of the probiotic intervention on wound healing, periodontitis and wound-specific quality of life (Wound-QOL-17) were analysed throughout the course of this clinical study.
    UNASSIGNED: In total, seven of the 20 patients included were unable to complete the study. After six months of oral probiotic intake supplementation in five out of the remaining 13 patients, the wounds had healed completely. Most patients reported an improvement in wound-specific QoL, with particular positive effects on pain and mobility. Microbiome analysis revealed a reduction in Staphylococcus aureus and Pseudomonas aeruginosa, and Staphylococcus epidermis in healed wounds.
    UNASSIGNED: This findings of this study provide evidence for the beneficial effects of the oral application of a multispecies probiotic over six months in patients with diabetes and hard-to-heal wounds on wound closure, wound microbial pattern, QoL, and on dental health. A randomised, placebo-controlled, double-blinded clinical trial is required to verify the results.
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  • 文章类型: Journal Article
    有几种治疗难以愈合(慢性)伤口的方法,每个人在效率方面都不同,选择性,速度,成本和痛苦。目的是激活伤口以启动愈合级联。在这项初步研究中,我们评估了与标准锋利清创术相比,新的微喷射伤口治疗技术在伤口结局中的可行性。
    随机,控制,开标试验研究于2022年3月至2023年5月在瑞士西部的一家伤口门诊进行.
    共有13名连续患者被随机分配接受微喷射伤口治疗(n=5)或标准器械机械清创(n=8)。作为可行性研究,没有足够的能力来检测组间的显著差异.然而,在干预组中,我们的分析可能表明伤口面积的减少略有加快。Microjet伤口治疗似乎可以缓解患者的焦虑,并因缩短时间而节省成本。以及所需治疗的数量。这意味着总体磋商较少。
    这项研究强调了一个趋势,可能表明微喷射疗法在促进难以愈合的伤口更快愈合方面具有价值,它为足够有力的多中心试验提供了可行性依据.
    UNASSIGNED: There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes.
    UNASSIGNED: A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023.
    UNASSIGNED: A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations.
    UNASSIGNED: This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial.
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  • 文章类型: Case Reports
    生物外科(幼虫疗法)已经使用了几个世纪。然而,最近,这种治疗已被使用抗生素治疗伤口所取代。由于抗生素耐药性的增加,幼虫疗法再次成为一种有效和高效的治疗方法。由于人口老龄化,随着动脉闭塞性疾病患者的增加,糖尿病和不动,伤口难以愈合的患者数量将会增加。与伤口相关的压力源,如疼痛,有限的物理功能,抑郁和社交退缩,对患者生活质量有负面影响。此病例报告记录了患有多种疾病的患者的生物外科手术的性能。
    Biosurgery (larval therapy) has been used for centuries. However, in recent times, this treatment has been replaced with the use of antibiotics for the treatment of wounds. Due to increasing antibiotic resistance, larval therapy is once again coming to the fore as an effective and efficient treatment. Due to the increasing ageing population, along with an increase in patients with arterial occlusive disease, diabetes and immobility, the number of patients with hard-to-heal wounds will increase. The stressors associated with wounds, such as pain, limited physical functionality, depression and social withdrawal, have a negative impact on patient quality of life. This case report documents the performance of biosurgery in a patient with multimorbidities.
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  • 金属基纳米颗粒(MNPs)作为治疗细菌感染的有效化合物和抗生素的可能替代品被推广。已知这些MNPs使用多种策略影响广谱的微生物,包括活性氧的诱导和与细菌细胞内部结构的相互作用。这篇综述的目的是总结有关金属基纳米颗粒对伤口中形成的致病性细菌生物膜的影响的最新研究。以革兰氏阳性菌金黄色葡萄球菌和革兰氏阴性菌铜绿假单胞菌为例,以及提供可能的临床应用的概述。
    Metal-based nanoparticles (MNPs) are promoted as effective compounds in the treatment of bacterial infections and as possible alternatives to antibiotics. These MNPs are known to affect a broad spectrum of microorganisms using a multitude of strategies, including the induction of reactive oxygen species and interaction with the inner structures of the bacterial cells. The aim of this review was to summarise the latest studies about the effect of metal-based nanoparticles on pathogenic bacterial biofilm formed in wounds, using the examples of Gram-positive bacterium Staphylococcus aureus and Gram-negative bacterium Pseudomonas aeruginosa, as well as provide an overview of possible clinical applications.
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  • 文章类型: Journal Article
    这种成本效益分析的目的是估计获得健康益处所需的货币成本。一种分析模型,用于评估包含透明质酸和氨基酸混合物的局部医疗设备(HAAA医疗设备)(Vulnamin,专业营养学SpA,意大利)与难以治愈(慢性)伤口的护理标准(SoC)相比。
    分析了一组患者的回顾性数据以及已发表文献的信息。对于每一张纸,我们提取了以下信息:每个治疗组纳入的患者数量和预设的回顾结局的结果.
    共有6项涉及378名患者的研究纳入了该汇总分析。研究结果表明,用HA+AA医疗器械治疗具有降低资源消耗的潜力。关于伤口愈合,在表面和深层伤口中,HA+AA医疗器械的治疗益处包括:快速减小伤口尺寸;更快的愈合;减少敷料更换;降低感染风险;和降低治疗成本。结果显示,在治疗难以愈合的伤口(选定的时间范围=六个月)中,HAAA医疗设备的成本效益比比较者高32%。
    这项分析的结果表明,使用HAAA医疗设备进行治疗是SoC护理的有效替代方案,因为它更便宜,它的效用和有效性更大。此外,分析结果显示,达到完全愈合的时间与费用的增加有直接关系(增加达到完全愈合的时间会增加与治疗相关的费用).
    UNASSIGNED: The aim of this cost-effectiveness analysis was to estimate the monetary cost required to achieve a gain in health benefit. An analytic model to evaluate the cost-effectiveness of a topical medical device comprising a mixture of hyaluronic acid and amino acids (HA+AA medical device) (Vulnamin, Professional Dietetics SpA, Italy) as compared to standard of care (SoC) for hard-to-heal (chronic) wounds is presented.
    UNASSIGNED: Retrospective data was analysed from a cohort of patients as well as information from published literature. For each paper, the following information was extracted: number of patients enrolled in each treatment arm and the results of prespecified reviewed outcomes.
    UNASSIGNED: A total of six studies involving 378 patients were included in this pooled analysis. Findings showed that treatment with the HA+AA medical device has the potential to lower consumption of resources. With regards to wound healing, in both superficial and deep wounds, treatment benefits of the HA+AA medical device included: rapid wound size reduction; faster healing; reduction of dressing changes; reduced infection risk; and reduced treatment costs. Results showed the HA+AA medical device to be 32% more cost-effective than comparators in the treatment of hard-to-heal wounds (time horizon selected=six months).
    UNASSIGNED: The findings of this analysis showed that treatment with the HA+AA medical device is a valid alternative to SoC care because it is cheaper, and its utility and effectiveness are greater. In addition, the results of the analysis showed a direct relationship between the time to complete healing and the increase in costs (increasing the period of time to reach complete healing increases the costs associated with the treatment).
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  • 文章类型: Journal Article
    作者没有利益冲突要声明。
    UNASSIGNED: The authors have no conflicts of interest to declare.
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