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Prevention of pressure ulcers is fundamental to safe care of nursing home residents yet the role of hydration in pressure ulcer prevention has not been systematically examined. This randomized clinical trial was undertaken to determine whether administration of supplemental fluid to nursing home residents at risk for pressure ulcers would enhance collagen deposition, increase estimated total body water, augment subcutaneous tissue oxygenation, and was safe. After a baseline period, 64 subjects were randomized to receive the fluid volume prescribed or additional fluid (prescribed plus 10 mL/kg) for 5 days. Participants' potential to heal as measured with hydroxyproline was low at baseline and did not increase significantly during treatment when additional fluid was systematically provided. Fluid intake increased significantly during treatment. Estimates of total body water and subcutaneous oxygen did not increase, indicating hydration was not improved. Supplemental fluid did not result in overhydration as measured by clinical parameters. Further work is needed to examine the relationship between fluid intake and hydration in nursing home residents as well as the role of hydration in pressure ulcer prevention. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify potential future means of monitoring injury and repair in critical illness. DESIGN: Review of the literature. RESULTS: Critically ill patients are monitored extensively and intensively by such means as hemodynamics, laboratory values, and radiologic studies. In general, however, the goal of monitoring has been to measure the degree of injury and to prevent further injury, rather than to measure repair. Measures of repair have been limited to phenotypic end points such as return of organ function, as measured by blood chemistry. In this article, I examine how it may be possible in the future to monitor the progress of repair using genomic and proteomic biomarkers. These types of monitors would enable clinicians to control the healing environment using real time, rapid biomarkers, and sophisticated techniques to target therapy to the patient's current inflammatory state, taking into account the genetic makeup of the patient and his or her likely response to a given drug. CONCLUSIONS: The rapidly evolving sciences of genomics, proteomics, computational biology, and complex system theory can be used a) to model critical illness; b) to model adaptive and maladaptive responses to critical illness; c) to tailor treatments to create an ideal inflammatory environment for repair and regeneration, taking into account the individual genetic contribution; and d) to monitor the progress of repair. The major obstacles to reaching these goals are technological, and experience suggests that they will be overcome. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To define injury and repair in the context of critical illness. DESIGN: Review of the literature. RESULTS: The medical practice of critical care medicine has long been one of aggressive assistance and support: utilizing state of the art technology to support the functions of the human body until homeostasis is again achieved and the patient is functioning sufficiently to allow the support to discontinue. Injury is defined as the disruption of molecular, cellular, or organ functions resulting from an external or internal stimulus. Repair is defined as an adaptive process that occurs in response to injury and involves both local and systemic responses that serve to restore structure and regulation for the purpose of organ/tissue function. The study of injury in critical illness is now occurring 'upstream,' at the genetic and cellular levels, to understand how damaging effects of acute inflammation from injury can be prevented or modulated. CONCLUSION: To treat the patient with critical illness more effectively, it is important to understand both the cause of the insults and the repair processes triggered by the insults because both processes affect the eventual course of the critical illness. [ABSTRACT FROM AUTHOR]

The Wound Healing Society guidelines for the treatment of arterial insufficiency ulcers were originally published in 2006, with the last update in 2014. These guidelines provided recommendations, along with their respective levels of evidence, on seven categories: diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy and long-term maintenance. Over the last 9 years, additional literature regarding these aspects of arterial ulcer management has been published. An advisory panel comprised of academicians, clinicians and researchers was chosen to update the 2014 guidelines. Members included vascular surgeons, internists, plastic surgeons, anaesthesiologists, emergency medicine physicians and dermatologists, all with expertise in wound healing. The goal of this article is to evaluate relevant new findings upon which an updated version of the guidelines will be based., (© 2024 The Author(s). Wound Repair and Regeneration published by Wiley Periodicals LLC on behalf of The Wound Healing Society.)

Background and Objectives: Because of the importance of and increasing competition for unpaid community faculty's time, we qualitatively evaluated the adjunct community faculty experience in order to identify mechanisms to improve the recruitment, training, and retention of these faculty members., Methods: The authors captured community faculty and key stakeholder opinion through interviews, focus groups, and a survey to elucidate their perspective of roles, responsibilities, facilitators, and barriers for providing quality teaching and learning experiences. After evaluating the data, we created an impact/effort matrix to guide suggested changes., Results: Key medical education stakeholders reported adjunct community faculty members were critical to delivery of the medical school curriculum and shared methods and barriers for retaining members. Adjunct community faculty focus groups revealed two major themes: (1) personal experience and motivation, and (2) individual advantages and institutional barriers that influence being a faculty member. The survey and impact/effort matrix led to interventions including an Office of Community Faculty to implement recruitment and retention programs and provide more comprehensive oversight, a clinical scheduling hub, improved access to specialists for community faculty, and awards to recognize the critical contributions of community faculty members., Conclusions: As competition for community placements increases, including community faculty voices to inform action is an effective investment that enables an institution to direct resources towards interventions that maximize their support and engagement. Including community faculty perspectives also increases faculty's ability to participate in training the next generation of physicians.

Objective: To determine whether women have been equitably represented among plenary speakers at the American Academy of Neurology (AAN) Annual Meeting by counting and categorizing speakers and comparing outcomes to AAN membership and US neurology workforce data., Methods: Lists of plenary speakers between 1958 and 2019 (62 years) were obtained from the AAN. The primary outcome measures were numbers and proportions of men and women in aggregate and among physicians., Results: We identified 635 plenary speakers, including 148 (23.3%) women. Specifically, women made up 14.6% (19 of 130) of presidential and 25.5% (129 of 505) of nonpresidential plenary session speakers. The inclusion of women plenary speakers was meaningfully higher ( h = 0.33; difference 14.9%; 95% confidence interval 4.2%-26.7%) for nonphysicians (27 of 74 [36.5%]) than physicians (121 of 561 [21.6%]). Although at zero levels for Annual Meetings held between 1958 and 1990 and at mostly low but varying levels thereafter, the representation of women and women physicians has been at or above their proportions in the AAN membership and US neurology workforce since 2017. Comparison of representation by plenary session name revealed an unequal distribution of women, with women physicians concentrated in the Sidney Carter Award in Child Neurology presidential session., Conclusion: Historically and recently, women and women physicians were underrepresented among AAN plenary speakers. As the AAN has taken active steps to address equity, women have been included in more representative proportions overall. However, notable gaps remain, especially in specific prestigious plenary sessions, and further research is needed to determine causality., (© 2020 American Academy of Neurology.)

Objectives: Gender disparity exists in medicine, such as differences in pay and promotion opportunities. We hypothesize that there is also a gender difference in graduate medical education as manifested by operative case volume. This study compares surgical case volume by gender for graduating US otolaryngology residents., Study Design: Cohort study., Methods: With data use approval from the Accreditation Council for Graduate Medical Education, we evaluated the key indicator case log summaries of graduating otolaryngology residents from 2009-2017. Mean and standard deviation were used for all cases, and t-tests were used to compare cases by resident gender. The Bonferroni method was used to adjust for multiple comparisons across years., Results: Data from 1740 male and 804 female residents were evaluated. Across all years, the average number of key indicator cases reported was 778.8 and 813.6 by female and male residents, respectively, with an average difference of 34.8 cases per graduating year (95% confidence interval [CI] 19.4, 50.2; P < .001). When a resident self-reported the role of resident surgeon/supervisor, the average number of key indicator cases reported was 602.6 and 643.9 by female and male residents, respectively, with an average difference of 41.3 cases per graduating year (95% CI, 28.0, 54.6; P < .001)., Conclusion: Gender-based discrepancies in surgical case volume exist among graduating otolaryngology residents. This disparity is partially attributed to the self-reported role in the surgery. This study has identified those discrepancies so that training programs can implement strategies to ensure improved gender parity., Level of Evidence: 2b Laryngoscope, 130:1651-1656, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Infections are a common complication of any surgery, often requiring a recovery period in hospital. Supplemental oxygen therapy administered during and immediately after surgery is thought to enhance the immune response to bacterial contamination. However, aerobic bacteria thrive in oxygen-rich environments, and so it is unclear whether oxygen has a net positive effect on recovery. Here, we develop a mathematical model of post-surgery infection to investigate the efficacy of supplemental oxygen therapy on surgical-site infections. A 4-species, coupled, set of non-linear partial differential equations that describes the space-time dependence of neutrophils, bacteria, chemoattractant and oxygen is developed and analysed to determine its underlying properties. Through numerical solutions, we quantify the efficacy of different supplemental oxygen regimes on the treatment of surgical site infections in wounds of different initial bacterial load. A sensitivity analysis is performed to investigate the robustness of the predictions to changes in the model parameters. The numerical results are in good agreement with analyses of the associated well-mixed model. Our model findings provide insight into how the nature of the contaminant and its initial density influence bacterial infection dynamics in the surgical wound., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

World Health Organization and the United States Center for Disease Control have recently recommended the use of 0.8 FIO 2 in all adult surgical patients undergoing general anaesthesia, to prevent surgical site infections. This recommendation has arisen several discussions: As a matter of fact, there are numerous studies with different results about the effect of FIO 2 on surgical site infection. Moreover, the clinical effects of FIO 2 are not limited to infection control. We asked some prominent authors about their comments regarding the recent recommendations.

The genetics of microbial pathogens have been extensively studied, but there has been little work on human genetic susceptibility to surgical site infection (SSI). We analyzed a large genealogical population database to study the familial contribution to SSI. We analyzed 651 individuals with International Classification of Disease, Ninth Revision codes indicating the presence of SSI. Matched hospital controls were randomly selected from the database based on birth year, sex, and birthplace. The average relatedness of all possible pairs of cases and separately of controls (×1000 sets) was compared empirically. The relative risk (RR) for SSI was estimated by comparing the number of observed affected individuals among the relatives of cases to the number of affected individuals observed among relatives of matched hospital controls. The genealogical index of familiality test for patients with SSI showed significant excess relatedness (p < 0.010); this excess was still observed when close relationships were ignored (p =  0.019). The RR for third-degree relatives of cases was significantly elevated (1.62, p = 0.029). The significant excess relatedness and the significantly elevated RR to distant relatives support a genetic predisposition to acquiring SSI., (© 2013 by the Wound Healing Society.)

Significance: A review of therapeutic effects in preclinical and clinical studies suggests that concordance between large animal (pig=78%), small laboratory animal (53%) and in vitro (57%) results with those observed in humans is only partial. Pig models of wound healing provide major advantages over other animal models. Since the vast majority of wound-healing research is done in rodents and in vitro , the low concordance rate is a significant impediment to research that will have any clinical impact., Critical Issues: To generate clinically relevant experimental data, hypothesis generation should begin, or at least involve human wound tissue samples. Such tissue could be used to test a predetermined hypothesis generated based on, say, murine data. Alternatively, such tissue could be analyzed using high-throughput cell biology techniques ( e.g ., genomics, proteomics, or metabolomics) to identify novel mechanisms involved in human wounds. Once the hypothesis has been formulated and confirmed using human samples, identification of these same mechanisms in animals represents a valid approach that could be used for more in-depth investigations and experimental manipulations not feasible with humans., Future Directions: This consensus statement issued by the Wound Healing Society symposium strongly encourages all wound researchers to involve human wound tissue validation studies to make their animal and cell biology studies more translationally and clinically significant.

Problem wounds represent a significant and growing challenge to our healthcare system. The incidence and prevalence of these wounds are increasing in the population, resulting in growing utilization of healthcare resources and dollars expended. Venous leg ulcers represent the most common lower-extremity wound seen in ambulatory wound care centers, with recurrences frequent and outcomes often less than satisfactory. Pressure ulcers are common in patients in long-term institutional care settings adding significant increases in cost, disability and liability. Foot ulcers in patients with diabetes contribute to more than half of lower-extremity amputations in the United States in a group at risk, representing only 3 percent of the population. In response to this challenge, specialized programs have emerged designed to identify and manage these patients, using standardized protocols and a variety of new technologies to improve outcomes. Hyperbaric oxygen treatment (HBO2T) has been increasingly utilized in an adjunctive role in the care of many of these patients, coinciding with optimized patient and local wound care.

Background: Distant healing intention (DHI) is one of the most common complementary and alternative medicine (CAM) healing modalities, but clinical trials to date have provided ambivalent support for its efficacy. One possible reason is that DHI effects may involve variables that are sensitive to unknown, uncontrolled, or uncontrollable factors., Objective: To examine 2 of those potential variables-expectation and belief-we explored the effects of DHI on objective and psychosocial measures associated with surgical wounds in 72 women undergoing plastic surgery., Design: Participants were randomly assigned to 1 of 3 groups: blinded and receiving DHI (DH), blinded and not receiving DHI (control), and knowing that they were receiving DHI (expectancy). Outcome measures included collagen deposition in a surrogate wound and several self-report measures. DHI was provided by experienced distant healers. No differences in the main measures were observed across the three groups., Results: Participants' previous belief in the efficacy of DHI was negatively correlated with the status of their mental health at the end of the study (P = .04, 2-tailed), and healers' perceptions of the quality of their subjective "contact" with the participants were negatively correlated both with change in mood (P = .001) and with collagen deposition (P = .04). A post-hoc analysis found that among participants assigned to receive DHI under blinded conditions, those undergoing reconstructive surgery after breast cancer treatment reported significantly better change in mood than those who were undergoing purely elective cosmetic surgery (P = .004)., Conclusion: If future DHI experiments confirm the post-hoc observations, then some of the ambiguity observed in earlier DHI studies may be attributable to interactions among participants' and healers' beliefs, their expectations, and their motivations., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Measurement of individual organ tissue oxygen levels can provide information to help evaluate and optimize medical interventions in many areas including wound healing, resuscitation strategies, and cancer therapeutics. Echo planar (19) F MRI has previously focused on tumor oxygen measurement at low oxygen levels (pO(2)) <30 mmHg. It uses the linear relationship between spin-lattice relaxation rate (R(1)) of hexafluorobenzene (HFB) and pO(2). The feasibility of this technique for a wider range of pO(2) values and individual organ tissue pO(2) measurement was investigated in a rat model. Spin-lattice relaxation times (T(1) = 1/R(1)) of hexafluorobenzene were measured using (19) F saturation recovery echo planar imaging. Initial in vitro studies validated the linear relationship between R(1) and pO(2) from 0 to 760 mmHg oxygen partial pressure at 25, 37, and 41°C at 7 Tesla for hexafluorobenzene. In vivo experiments measured rat tissue oxygen (ptO2) levels of brain, kidney, liver, gut, muscle, and skin during inhalation of both 30 and 100% oxygen. All organ ptO(2) values significantly increased with hyperoxia (P < 0.001). This study demonstrates that (19) F MRI of hexafluorobenzene offers a feasible tool to measure regional ptO2 in vivo, and that hyperoxia significantly increases ptO2 of multiple organs in a rat model., (Copyright © 2011 Wiley Periodicals, Inc.)

Objective: The aim of the study was to examine the effect of external pressure of the bed surface on heel skin temperature in adults in the first 3 days after hip surgery., Design: A quasi-experimental study in a prospective, within-subjects, repeated-measures design., Setting: This study was performed at 2 acute-care hospitals., Participants: Eighteen subjects (9 men and 9 women) with a mean age of 58.3 (±16.1) years were recruited after hip surgery at the 2 hospitals., Methods: Temperature sensors were placed on the plantar surface of each foot, close to the heels. Measures were taken when the heels were (1) suspended above the bed surface for 20 minutes (preload), (2) on the bed surface for 15 minutes (loading), and (3) suspended again above the bed surface for 15 minutes (unloading)., Main Outcome Measures: Heel skin temperature and demographic data., Results: Heel temperature increased during loading and unloading in both legs on postoperative days 1 (P = .003) and 3 (P = .04) but not on postoperative day 2. Heel temperature in the nonoperative leg decreased in the first 3 minutes of unloading on postoperative days 2 (P = .02) and 3 (P = .01)., Conclusion: Heel temperature increased with loading and unloading on postoperative days 1 and 3. Upon immediate unloading, hyperemic response was present only in the nonoperative leg. Keeping the heels off the bed surface at all times may avoid heel skin temperature changes and prevent tissue damage. Further research is needed to identify the mechanisms that explain the effect of external pressure on heel temperature.

Background: Free flap failure often results from venous thrombosis. The authors developed a rabbit flap model of partial venous obstruction and evaluated four monitoring devices in detecting partial and full venous compromise., Methods: Nine skin flaps were elevated on their arteriovenous pedicles in rabbits. The flap was assessed with quantitative Doppler of arterial inflow, transcutaneous oxygen and carbon dioxide tension, near-infrared spectroscopy tissue oxygen saturation, and scanning laser Doppler imaging. After a stable baseline was achieved, the outflow vein was subjected to partial and full venous obstruction followed by release., Results: Pedicle arterial flow decreased significantly from baseline (5.9 +/- 3.0 ml/minute) during partial (4.1 +/- 2.4 ml/minute; 30.5 percent; p < 0.01) and full obstruction (0.3 +/- 0.4 ml/minute; 94.9 percent; p < 0.01). All other measures changed significantly with full obstruction: transcutaneous oxygen tension decreased by 79.6 percent; transcutaneous carbon dioxide tension increased by 69.0 percent; near-infrared spectroscopy tissue oxygen saturation decreased by 35.7 percent; and scanning laser Doppler imaging decreased by 78.8 percent. Laser Doppler imaging was the only noninvasive device that decreased significantly (p < 0.01) with partial obstruction, from 222.8 +/- 77.3 units to 186.5 +/- 73.2 units (16.3 percent)., Conclusions: The authors established a venous obstruction flap model and evaluated four clinically relevant monitoring devices during partial and full venous occlusion. All devices detected full occlusion, but only scanning laser Doppler imaging and arterial Doppler detected partial occlusion. Scanning laser Doppler imaging monitoring may allow warning of impending venous obstruction. Near-infrared spectroscopy tissue oxygen saturation varied the least between flaps and therefore may be the most easily interpreted device for full venous occlusion. Both characteristics are important for clinical application.

Transcutaneous oximetry (PtcO2) is finding increasing application as a diagnostic tool to assess the peri-wound oxygen tension of wounds, ulcers, and skin flaps. It must be remembered that PtcO2 measures the oxygen partial pressure in adjacent areas of a wound and does not represent the actual partial pressure of oxygen within the wound, which is extremely difficult to perform. To provide clinical practice guidelines, an expert panel was convened with participants drawn from the transcutaneous oximetry workshop held on June 13, 2007, in Maui, Hawaii. Important consensus statements were (a) tissue hypoxia is defined as a PtcO2 <40 mm Hg; (b) in patients without vascular disease, PtcO2 values on the extremity increase to a value >100 mm Hg when breathing 100% oxygen under normobaric pressures; (c) patients with critical limb ischemia (ankle systolic pressure of < or =50 mm Hg or toe systolic pressure of < or =30 mm Hg) breathing air will usually have a PtcO2 <30 mm Hg; (d) low PtcO2 values obtained while breathing normobaric air can be caused by a diffusion barrier; (e) a PtcO2 <40 mm Hg obtained while breathing normobaric air is associated with a reduced likelihood of amputation healing; (f) if the baseline PtcO2 increases <10 mm Hg while breathing 100% normobaric oxygen, this is at least 68% accurate in predicting failure of healing post-amputation; (g) an increase in PtcO2 to >40 mm Hg during normobaric air breathing after revascularization is usually associated with subsequent healing, although the increase in PtcO2 may be delayed; (h) PtcO2 obtained while breathing normobaric air can assist in identifying which patients will not heal spontaneously.