Subjects: Nursing >> Nursing submitted time 2023-05-12
Abstract： Electric injury is one of the common injuries, accompanied by passage of high-voltage current through the body, usually with one entrance and multiple outlets. It easily leads to destructive injury, severe post-traumatic stress response and secondary infection, and the condition changes rapidly. Blood pressure monitoring is a common method to accurately and timely determine the condition. This article analyzed and compared the results of invasive and noninvasive blood pressure monitoring in a patient with bilateral upper limb and right lower limb amputation after high-voltage electrical injury, and summarized and discussed the differences between invasive and noninvasive blood pressure monitoring through literature review, providing references for clinical effective monitoring of blood pressure in patients with severe trauma.
Peer Review Status:
Awaiting Review
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-06-09 Cooperative journals: 《中国全科医学》
Abstract： Background Trauma is a highly prevalent and costly global health problem. prevention and control of infection is a major challenge in the management of traumatic wounds，while prolonged absence of skin washing after trauma will increase the incidence of wound infection，as well as the discomfort. Although many patients are willing to take a bath after trauma，the timing and method of bathing remains unclear. Therefore，it is necessary to build an appropriate scheme of bathing with wounds to keep the skin and wounds clean. Objective To construct a bathing with wounds at home scheme suitable for patients with traumatic wounds in China，and to provide a feasible care scheme for keeping the skin of trauma patients clean and improving the outcome of wound healing. Methods Database at home and abroad were searched to obtain original literature，the first draft of the items of bathing with wounds at home scheme for patients with traumatic wounds was formulated through evidence#2;based analysis，generalization，group discussion. Fifteen wound care experts with associate or higher titles were included，and Delphi consultation was used to modify and improve the bathing with wounds scheme，with an interval of one week for each round of correspondences，the reliability of the consultation results was evaluated by the expert positive and authority coefficients. The consistency of the consultation results was evaluated by the coefficient of variation，a revised draft was formulated with terminated consultation when the coefficient of variation less than 0.25，which means that the expert opinions tend to be consistent. Thirty patients with traumatic wounds were enrolled in the pre-test，Likter 5-point scale was used to verify the convenience，safety and patient compliance of the bathing with wounds scheme，and the final scheme was developed after discussion and modification. Results After the inclusion of 23 related papers，the first draft of bathing with wounds scheme was developed through evidence#2;based analysis and discussion，involving three first-level items（including preparation befor bathing，bathing operation and treatment after bathing），eight second-level items，nine third-level items and three fourth-level items. The opinions of the 15 experts converged after 2 rounds of correspondence，with recall rates of 93.75% and 100%，with authority coefficients of 0.947 and 0.957，respectively. The variation coefficients of importance and maneuverability of each item in the first round were 0~0.25 and 0~0.23，and those in the second round were 0.09-0.18 and 0.07-0.14，respectively，a total of 2 items were deleted，5 items were modified and 2 items were added，resulting in a revised draft. The 30 enrolled patients with traumatic wounds took baths （2.70±0.47） times per week according to the bathing scheme.，with the average bath time of 10~15min，convenience and compliance scores of （4.67±0.48） and （4.70±0.47），and no bathing-related adverse events and wound infection occurred. Conclusion In the construction process of the bathing with wounds scheme for traumatic wound patients，the positive and authority coefficients of experts are high，which has been unanimously approved by corresponding experts. The compliance of 30 patients with traumatic wounds in the pre-test was high，suggesting that the bathing with wounds scheme is safe and convenient，which can be applied to bathing with wounds at home for patients with traumatic wounds in China.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2022-10-28 Cooperative journals: 《中国全科医学》
Abstract： Background With the aging characteristics of dry, loose, inelastic and decreased tolerant skin, the elderly are more vulnerable to pressure injury by pressure. Appropriate decompression mattress is the key to prevent pressure injury. Objective The decompression effects of two types of mattresses were evaluated by analyzing the pressures and temperatures of sacrococcygeal skins in elderly bedridden patients in the supine position. Methods A total of 45 hospitalized elderly bedridden male patients who met the criteria from January 2021 to March 2022 were divided into two groups: Patients in group A used gel decompression mattresses (n=23); Patients in group B (n=22) used air decompression mattresses. The patients from both groups were repositioned every 2 hours for 7 days. Maximum sacrococcygeal pressure was measured using a continuous bedside pressure mapping system, and the skin temperature in the same location was measured using a hand-held thermometer. The linear mixed effect model was used to analyze and compare the skin pressure and temperature changes from two types of mattresses in the sacrococcygeal regions of the elderly bedridden patients to compare the decompression effect. Results The pressures and temperatures from these two group patients were comparable at baseline. The sacrococcygeal maximum pressure values increased by 1.29±1.25mmHg and 7.38±1.28mmHg respectively at 1h time points in spine position by two types of mattresses compared with baseline (P＜0.01); increased by 4.51±1.28mmHg and 14.96±1.31mmHg respectively in 2h time points (p<0.001). The pressures of the sacrococcygeal regions increased from both types of mattresses with the extension of time. However, the average increase ratio of pressure from the gel mattresses was less than that from the air mattresses (p<0.01). Sacrococcygeal skin temperatures increased by 0.07±0.04°C and 0.27±0.04°C from baseline at 1h time points in spine position from both group patients respectively (p<0.01). Also, temperatures increased by 0.18±0.06°C and 0.68±0.06°C at 2h time points, respectively (p<0.001). The skin temperature of the sacrococcygeal region increased with the extension of time. The average increase ratio of the temperature in the gel mattress group patients was less than that in the air mattress group (p<0.01). There was no resultant pressure injury in both group patients during the intervention. Conclusions The pressures and skin temperatures of sacrococcygeal regions of hospitalized elderly bedridden male patients increased in supine position in 1h and 2h time points using two kinds of decompression mattresses. However, the increased ratios of pressures and temperatures from gel decompression mattresses were less than that from air decompression mattresses. The results demonstrated that the gel decompression mattress is superior to the air decompression mattress in preventing the pressure injury.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-11-16 Cooperative journals: 《中国全科医学》
Abstract： Background Skin flap transplantation is a common method for surgical repair of various types of wounds. The temperature of the skin flap reflects the blood supply and venous reflux of it，which can help detect vascular crises in the early stage. However，how to accurately measure the temperature of skin flap and its specific predictive role in vascular crises remains unclear. Objective To explore the difference in flap temperature between the “five point” and “single point” flaps and their accuracy and optimal cut-off values in predicting vascular crisis. Methods Adult inpatients who underwent flap transplantation surgery from January 2021 to July 2023 were included. Beginning on day 1 after surgery，non-contact infrared thermometers were used every 2 hours to measure the skin flap temperature using the “five points method” at the center point，edge at 12 o'clock，3 o'clock，6 o'clock，and 9 o'clock of the skin flap，the temperature readings were obtained by pausing for 3 seconds at a distance of 3cm from each site，and the average temperature of the “five points” was taken to compare with the center single point temperature of the skin flap. The “cotton buds-press method” was simultaneously used to monitor the capillary response of the skin flap and observe the color of skin flap for 5 consecutive days. Results A total of 66 patients with various types of skin flap surgeries were included，with males and females accounting for 59.09%（39/66），39/66 and 40.91% （27/66），respectively. The average age was （45.17±16.77） years. The changes of the "five point" flap temperature and the "single point" flap temperature from 1-5 days after surgery were the lowest on the first day after surgery，and gradually increased thereafter. The incidence of vascular crisis was 15.15% （n=10） and，which occurred mainly within 3 days after surgery，and the "five-point" flap temperature was lower than the "single-point" flap temperature（P<0.001）. The receiver operating characteristic（ROC） curves of "five-point" flap temperature and "single point" flap temperature predicting vascular crisis were plotted and the results showed that the area under curve（AUC） of "five points" flap temperature predicting vascular crisis was 0.87 （95%CI: 0.74-0.99），the sensitivity and specificity were 90% and 75%，the Youden index was 0.65，and the optimal cut-off value was 35.96 ℃ . The AUC of "single point" flap temperature predicting vascular crisis was 0.76 （95%CI 0.61-0.91），the sensitivity and specificity were 70% and 71%，the Youden index was 0.41，and the optimal cut-off value was 36.18℃ . Conclusion The "five points" flap temperature was lower than that of the "single point" flap temperature，the accuracy and authenticity of the former is slightly better than the latter in predicting vascular crisis.
Subjects: Physics >> General Physics: Statistical and Quantum Mechanics, Quantum Information, etc. submitted time 2022-11-22 Cooperative journals: 《中国全科医学》
Abstract：
Objective:To investigate the epidemiological characteristics of pressure injury in 46 tertiary hospitals in 13 provinces and analyze the predictive role of Braden scale and its six subscales in predicting the risk of pressure injury and hospital- acquired pressure injury. Methods:In total, 46 hospitals were recruited to participate in the cross-sectional survey. A total of 1060 nurses who were trained and qualified adopted convenient sampling, and used consistent survey tools, methods and procedures in the same time. Hospitalized patients with 18 years old and over were included. The skin was examined from head to toes for pressure injury. The Braden scale was used to assess the risk of pressure injury from the six subscales of sensory perception, moist, activity ability, mobility, nutrition ,shear and friction, with a total score of 6-23. The lower the score is, the higher the risk of pressure injury. Statistical software was used to analyze the AUC and its sensitivity, specificity and Youden index of Braden scale and its six subscales for predicting pressure injury and hospital -acquired pressure injury. Results: In total,60555 cases of valid data were obtained, including 32518 males (53.70%) and 28037 females (46.30%), with an average age of 55.88 ± 17.16 years. The total prevalence of pressure injury was 1.67% (n = 1010), of which the prevalence of hospital -acquired pressure injury was 0.74% (n = 448). The prevalence of male was higher than that of female (2.08% vs 1.19%), and the prevalence of pressure injury in ICU and those with 80 years old and over was higher (10.58% and 5.98%). The AUC of Braden Scale for predicting adults pressure injury and hospital -acquired pressure injury were 0.95 and 0.91, the sensitivity was 0.92 and 0.90, the specificity was 0.87 and 0.79, and the Youden index was 0.79 and 0.69, respectively. The cut-off value of Braden scale ≤ 19 predicted the maximum AUC and Youden index (0.83 and 0.51) for the predictive of pressure injury, and the AUC (0.92-0.81) and Youden index (075-0.71) for the predictive of pressure injury with the cut-off value of activity，mobility, friction and shear force. Conclusion: Braden scale is suitable for predicting risk of pressure injury among Chinese adult inpatients in tertiary hospitals. The total score ≤ 19 has a better predictive effect, of which the activity ability, friction and shear force, and mobility subscales have the largest predictive effect. The three subscales can be used to assess and predict the risk of pressure injury in special environments, which can improve efficiency and save time.
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