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Daijiro Haba,1,2 Mizuho Itabashi,1,3 Nao Tamai,2,4,5 Hiromi Tobe,2,6 Hiromi Sanada,1,2,6 Gojiro Nakagami1,2 1Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan; 2Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan; 3Department of Gerontological Nursing, Graduate School of Nursing Science, St. Luke’s International University, Chuo-ku, Tokyo, Japan; 4Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan; 5Department of Nursing, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan; 6Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, JapanCorrespondence: Gojiro Nakagami, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan, Tel/Fax +81-3-5841-341, Email gojiron@g.ecc.u-tokyo.ac.jpAbstract: Diminished peripheral blood flow at the wound site remains a key hindrance to effective wound healing. Hard-to-heal wounds are defined as wounds that fail to heal with standard therapy. Vibration therapy may help promote the healing of hard-to-heal wounds such as pressure injuries, diabetic foot ulcers, and venous leg ulcers by improving blood flow. However, evidence supporting its effectiveness on hard-to-heal wounds is inadequate. This scoping review focuses on studying the effectiveness of vibration therapy for healing hard-to-heal wounds by compiling all available research. The following databases were systematically reviewed from 1980 to 2023: MEDLINE, EMBASE, Cochrane Library, Ichu-shi-Web, IEEE, CINAHL, Scopus, Web of Science, and PEDro. The search terms included “wound”, “ulcer”, “hard-to-heal”, “vibration therapy”, and “wound healing”. Two authors independently screened the articles based on inclusion criteria, and the lead author performed data extraction and analysis. A total of 1036 articles were identified, and five articles were eligible to be included in this review. The results suggested that low-frequency and low-intensity vibration therapies helped effectively treat wounds (including pressure injuries, diabetic foot ulcers, and venous leg ulcers) by improving blood flow, relieving pain, reducing exudate, removing necrotic tissue, and increasing the expression of nitric oxide associated with wound healing. This study will inform the treatment choices of clinicians who manage patients with hard-to-heal wounds and researchers who plan to conduct clinical trials using vibration therapy. Further studies on vibration therapy must be performed to gather evidence to support the clinical application of vibration therapy to improve healing time and outcomes in individuals with hard-to-heal wounds.Keywords: vibration, physical therapy, hard-to-heal wound, chronic wound, wound healing

Mao Kunimitsu,1 Gojiro Nakagami,1,2 Aya Kitamura,1 Yuko Mugita,1 Kaname Akamata,3 Sanae Sasaki,4 Chieko Hayashi,4 Yukie Mori,1 Hiromi Sanada1,2 1Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 3Department of Dermatology, The University of Tokyo Hospital, Tokyo, Japan; 4Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan Objective: Evaluating the bacterial bioburden of pressure ulcers through bacterial count and pathogenicity is important but is currently difficult to perform in the clinical setting. In order to address this problem, we proposed two methods: 1) measurement of bacterial count using a quantitative device and 2) detection of biofilm formation by wound blotting. The purpose of this study was to investigate the relationship between the bacterial bioburden, assessed by combining these two methods, and the presence of wound inflammation.Patients and methods: The participants of this cross-sectional study were patients aged >20years with category II, III, IV, or unstageable pressure ulcers examined during a routine round in an interdisciplinary pressure ulcer team between July 2014 and April 2018. Relevant clinical information, including bacterial count, biofilm formation, and presence of inflammation, was collected from the pressure ulcer round record. The relationship between the bacterial bioburden and the presence of inflammation was analyzed using multilevel logistic regression analysis.Results: We included 273 samples obtained from 98 patients. High bacterial count was significantly associated with wound inflammation (P=0.009) and positive biofilm formation tended to be associated with wound inflammation (P=0.076). In terms of combining these parameters, high bacterial count and positive biofilm formation were significantly associated with wound inflammation (OR: 4.61, 95% CI: 1.37–15.46, P=0.013).Conclusion: Assessment using both bacterial count and biofilm detection parameters may provide more accurate evaluation of the bacterial bioburden of the wound and contribute to appropriate wound care. Keywords: wound infection, wound assessment, critical colonization, wound blotting, thermography

Taichi Goto,1–3 Gojiro Nakagami,1,4 Ayano Nakai,1 Shuhei Noyori,1,5 Sanae Sasaki,6 Chieko Hayashi,6 Tomomitsu Miyagaki,7 Kaname Akamata,7 Hiromi Sanada1,4 1Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, 2Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Bunkyo-ku, 3Japan Society for the Promotion of Science, Chiyoda-ku, Japan; 4Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 5Graduate Program for Social ICT Global Creative Leaders, The University of Tokyo, 6Department of Nursing, 7Department of Dermatology, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan Introduction: Depth assessment is important for severe pressure ulcers (PUs); however, a device for the metric measurement of wounds, including depth, is lacking in clinical settings. Recent technological advancements have enabled the evaluation of the depth of wounds, and three-dimensional measurements are now available. The aim of this study was to test the utility of a newly developed three-dimensional wound measurement device in the clinical setting.Methods: We recruited three patients, each with a PU, who were being treated by a PU team at a university hospital. We measured the length, width, area, and maximal depth of the ulcers by using the device and with the conventional method. The ulcer volume was measured only with the device. The difference in measurement results of the device before and after debridement was compared in the first patient. The difference in measurement results between the conventional method and the device was compared in the second patient. Correlation coefficients between the conventional method and the device obtained from longitudinal data were calculated in the third patient.Results: The changes in measurements between before and after debridement were easily detected by the device in the first patient. Although the maximal depth was different, the length, width, and area were consistent between the conventional method and the device in the second patient. The correlation coefficients of the length, width, and area between the conventional method and the device were 0.35, 0.48, and 0.59, respectively, in the third patient whose PU exhibited a vague wound edge.Conclusion: Although two-dimensional measurements were comparable between the conventional method and the device, there were some challenges to performing three-dimensional measurement more precisely. A further study is needed to determine the specific characteristics of wounds that result in poor measurement accuracy. Keywords: three-dimensional wound measurement device, wound depth, wound volume

Toshiko Kaitani,1 Gojiro Nakagami,2 Junko Sugama,3 Masahiro Tachi,4 Yutaka Matsuyama,5 Yoshiki Miyachi,6 Takashi Nagase,2 Yukie Takemura,7 Hiromi Sanada2 1School of Nursing, Sapporo City University, Hokkaido, Japan; 2Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 3Department of Clinical Nursing, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan; 4Department of Plastic Surgery, Tohoku University Graduate School of Medicine, Miyagi, Japan; 5Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 6Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan; 7Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan Aims and objectives: We investigated the effectiveness and safety of an advanced pressure ulcer (PU) management protocol comprising 1) ultrasonography to assess the deep tissue, 2) use of a non-contact thermometer to detect critical colonization, 3) conservative sharp debridement, 4) dressing selection, 5) negative pressure wound therapy, and 6) vibration therapy in comparison with those of a conventional approach. Each protocol was followed by trained wound, ostomy, and continence nurses (WOCNs). Background: At present, there is no systematic PU management protocol for nurses that includes appropriate assessment and intervention techniques for deep tissue injury and critical colonization. In Japan, there is no such protocol that the nurses can follow without a physician’s orders. Design and methods: This was a prospective non-randomized controlled trial. Over a 3-week period, we evaluated the effectiveness of an advanced protocol by comparing the PU severity and healing on the basis of the DESIGN-R scale and presence of patients' discomfort. We recruited ten WOCNs to follow the advanced protocol and 19 others as controls. Statistical analysis included a linear mixed-effects model and a logistic regression model. Results: In week 0–1, the advanced protocol was significantly associated with prevention of PU deterioration. Using the linear mixed-effects model, we observed a greater decrease in the DESIGN-R score (healing) in the advanced protocol group. There were no reports of excessive bleeding, pain or infection with the advanced protocol. Conclusion: Using the advanced protocol, WOCNs detected PU severity, assessed PUs, and treated PUs safely. This protocol prevented PU deterioration and/or facilitated wound healing. Relevance to clinical practice: With proper training, WOCNs can assess and treat PUs safer and quicker than when a physician's assessment is required, leading to an improvement in wound healing and prevention of PU deterioration. Keywords: pressure ulcers, WOCN, interventions, protocols, deep tissue injury

Taichi Goto,1 Ayumi Naito,1,2 Nao Tamai,1 Gojiro Nakagami,1 Makoto Mo,3 Hiromi Sanada1 1Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; 2Fujisawa City Hospital, Fujisawa, Kanagawa, Japan; 3Department of Cardiovascular Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan Purpose: We aimed to identify distinguishing characteristics in thermographic images of venous leg ulcer (VLU), for objective evaluation of VLU-related nociceptive pain. Patients and methods: Secondary analysis was performed, using existing data obtained from April to November 2010, for patients with VLU. Thermographic images of wounds and their surrounding area were classified according to the periwound temperature pattern as "normal temperature" or "high temperature". These results were compared with the self-reported pain intensity assessed by the short-form McGill Pain Questionnaire. Cohen's kappa coefficients were used to evaluate the interrater reliability for temperature assessment, and Wilcoxon rank sum test was used to compare pain intensities between the two groups. Results: Among 39 thermographic examinations in eight patients, 22 were classified into the high-temperature group and 17 into the normal-temperature group. Kappa coefficients for the temperature classification were 0.90 between the wound, ostomy, and continence nurse and a wound care specialist, and 0.90 between the wound, ostomy, and continence nurse and a graduate student. The pain rating index (Z=−2.981, P=0.003), sensory pain (Z=−3.083, P=0.002), affective pain (Z=−2.764, P=0.006), and present pain intensity (Z=−2.639, P=0.006) ratings were significantly higher in the high-temperature group than in the normal-temperature group, but the visual analog scale (Z=−0.632, P=0.527) was not significantly different between the two groups. Conclusion: Thermographic pattern may reflect VLU-related nociceptive pain due to inflammation and has the possibility of being an easy and rapid tool for objective pain evaluation. Keywords: short-form McGill Pain Questionnaire, temperature, wound assessment

Objectives Complex actions are thought to be risk factors for pressure injuries (PIs) in wheelchair basketball athletes. However, no study has been conducted on the characteristics of dynamic pressure distributions during performance. This study aimed to identify the characteristics of dynamic pressure distributions and to determine the parameters that relate to PIs in wheelchair basketball athletes. Method This cross-sectional study was conducted in November 2017 at the training camp of the national team in Japan. The study participants were 14 elite wheelchair basketball athletes who had joined the training camp. A wound, ostomy and continence nurse (WOCN) and a sonographer evaluated the presence of PIs by inspection and ultrasonography. Pressure distributions under static and dynamic conditions were measured using sheet-type sensors. Results Sixteen PIs were found in five (35.7%) of the 14 participants. Participants with PIs showed distribution of high pressure in unilateral/bilateral ischium and belting regions. In three participants who had PIs on the buttocks, total high-pressure periods were 60.25, 68.33 and 155.16 seconds, respectively. Maximum high-pressure periods were 12.10, 2.53 and 23.53 seconds. The numbers of high-pressure periods were 242, 190 and 706 times. Under dynamic conditions, these parameters were higher than those of participants without PIs. Conclusions Our findings suggested that continuous and/or repetitive high-pressure loading was related to the occurrence of PIs during performance. Further prospective studies are required to establish the methods to predict and prevent PIs in wheelchair basketball athletes. [ABSTRACT FROM AUTHOR]

Aim Wound infection is a life-threatening complication of pressure injuries (PIs) and is not yet completely preventable. This study aims to explore the dissemination of microbiota between PIs and hospital beds using a culture-independent methodology. This serves as the first step towards developing a new intervention to prevent wound infection. Methods A cross-sectional study was conducted at a longterm care hospital on patients aged >65 years with PIs. The microbiota of wounds, skin and beds were identified using 16S ribosomal RNA (rRNA) gene sequencing analysis. Zero-radius operational taxonomic units (zOTUs) were used for confirming dissemination which indicates bacteria possessing identical sequences within the V3-V4 region of the 16S rRNA gene. Results Ten PIs were analysed in this study. All individuals had zOTUs common to samples from their wound, skin and bed (median: 194, interquartile range [IQR]: 121-320). Furthermore, the bed samples were classified into the same clusters as the wound samples from eight sites. [ABSTRACT FROM AUTHOR]

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OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of new incentive system for pressure ulcer management, which focused on skilled nurse staffing in terms of rate of healing and medical costs. DESIGN, SETTING AND PARTICIPANTS: A prospective cohort study included two types of groups: 39 institutions, which introduced the new incentive system, and 20 non-introduced groups (control). Sixty-seven patients suffering from severe pressure ulcers in the introduced group and 38 patients in the non-introduced group were included. Wound healing and medical costs were monitored weekly for three weeks by their skilled nurses in charge. MAIN OUTCOME MEASURES: Healing status and related medical costs. RESULTS: The introduced group showed significantly higher rate of healing compared with the control group at each weekly assessment. Multiple regression analysis revealed that the introduction of the new incentive system was independently associated with the faster healing rate (beta=3.44, P<.001). The budget impact analysis demonstrated that introducing this system could reduce cost of treating severe pressure ulcers by 1.776 billion yen per year. CONCLUSIONS: The new incentive system for the management of pressure ulcers, which focused on staffing with skilled nurses can improve healing rate with reduced medical cost. Copyright 2009 Elsevier Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study is to identify the related factors of skin lesions found in the surrounding environment of absorbent pads by clinical investigation. Background. Most older patients with incontinence use absorbent products, therefore causing many patients to have skin lesion in the absorbent pad area. To prevent these skin lesions from occurring, it is necessary to examine the absorbent pad environment of clinical patients since there are many contributing factors that complicate the pathophysiology in this area. Design. A cross-sectional design was used. Methods. One hundred older Japanese patients with faecal and/or urinary incontinence using diapers and absorbent pads participated. Excluding blanchable erythema, the presence of skin lesions in the absorbent pad area was confirmed. Skin pH, hydration level and bacterial cultures were used to assess the skin property. Absorbent pad environment and patient demographics were also investigated. Results. The overall prevalence of skin lesions was 36%. Forty percent of the skin lesions were contact dermatitis. Multivariate logistic regression analysis revealed that only the presence of diarrhoea independently affected contact dermatitis. Conclusion. There was a significant relationship between contact dermatitis and the use of absorbent pads when the patient had diarrhoea. Although the factors related to skin lesions in the absorbent pad area are complexly intertwined, this study was the first to be able to determine diarrhoea as one specific factor in clinical setting. Relevance to clinical practice. This finding suggests that the presence of diarrhoea is significantly related with contact dermatitis. Therefore, when a patient has diarrhoea, health-care professionals should immediately implement a preventative care program which includes careful skin observation and improved skin care. It is also necessary to develop a more effective absorbent pad to protect the skin of incontinent patients who suffer from the irritating effects of liquid stool. [ABSTRACT FROM AUTHOR]

The purpose of this study is to quantify hammock effects over artificial bony prominence using a newly developed buttocks model similar to human buttocks, and examine differences between various cushions and covers. A repeated measures design was used where immersions were measured with diverse weights on each type of cushion with or without covers. Polyurethane foam and air-cell cushions were used. Elastic original covers (cover 1) were evaluated for each cushion, and another less elastic cover (cover 2) was also used for the foam cushion. 'Immersion' was defined as the difference in gauge readings between no load and each loading phase. Hammock effect was estimated by calculating the difference in load with and without a cover at any immersion from the approximate regression equation on immersion. All intraclass correlations were more than 0.99. The absolute hammock effect for each cover for each cushion increased as the immersion deepened. For the air-cell cushion, the relative hammock effect also increased and was higher than that for foam cushion at deeper immersion. For the foam cushion, the relative hammock effect on the cushion with cover 2 (160.5-188.6%) was higher than that with cover 1 (107.3-123.7%) at any immersion. The hammock effect could be quantified by the validated and reliable model. The mechanical property of the covers, the pressure redistributing property of the cushions and the length of bony prominence all influenced the intensity of the hammock effect. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study conducted to examine whether continuous interface pressure monitoring of postoperative patients in an intensive care unit is feasible in clinical practice. BACKGROUND: The interface pressure between skin and surfaces is generally evaluated for pressure ulcer prevention. However, the intensity and duration of interface pressure necessary for pressure ulcer development remains unclear because the conventional interface pressure sensors are unsuitable for continuous monitoring in clinical settings. METHODS: A total of 30 postoperative patients in an intensive care unit participated in this study in 2006-2007. A sensor was built into a thermoelastic polymer mattress. The whole-body interface pressure was recorded for up to 48 hours. Pressure ulcer development was observed during the morning bed-bath. For analysis, the intensity and duration of the maximal interface pressure was evaluated. FINDINGS: The mean age of the study group was 62.0 +/- 15.4 years. Two participants developed stage I pressure ulcer and blanchable redness at the sacrum. The longest duration of pressures greater than 100 mmHg were 487.0, 273.5 and 275.7 minutes in the pressure ulcer, blanchable redness and no redness groups respectively. CONCLUSION: Continuous monitoring of the intensity and duration of whole-body interface pressure using the KINOTEX sensor is feasible in intensive care patients. [ABSTRACT FROM AUTHOR]

Deep tissue injury (DTI) is difficult to detect in the early phase. Creatine phosphokinase (CPK) as a muscle enzyme could represent a promising indicator of DTI. However, serum CPK levels reflect the systemic condition rather than the local wound environment. Wound exudates can be indicative of the local wound environment. This study aimed to investigate the usefulness of CPK levels in wound exudates as an indicator of DTI. Rats were divided into control, 6 hours 10-kg and 6 hours 20-kg loading groups. Serum samples were obtained before wounding, and at 8 and 12 hours, and 1, 2 and 3 days after wounding, while exudate samples were obtained on days 2 and 3. Serum CPK levels were markedly increased in the 10-kg and 20-kg groups at 8 and 12 hours after loading compared with the baseline value and control group, but decreased to the normal level on day 1. In both loading groups, exudate CPK levels were high on day 2 and decreased on day 3. Muscle necrosis was more severe in the 20-kg group than in the 10-kg group by histological examination. This is the first study to indicate the potential of CPK in wound exudates as an indicator of DTI. [ABSTRACT FROM AUTHOR]

Quorum sensing is a cell-to-cell communication that occurs via autoinducers, regulating a number of bacterial virulence factors including the opportunistic wound pathogen Pseudomonas aeruginosa, which uses the N-(3-oxododecanoyl)-homoserine lactone as one of the two main autoinducers; however, little is known about its role in chronic wound infection. This study was designed to quantify this autoinducer from P. aeruginosa-infected wounds with the aim of examining the possible use of autoinducers as an indicator of chronic wound infection. Pressure-induced ischemic wounds were infected with P. aeruginosa ( N=12) or uninfected as a control ( N=12). The autoinducer was quantified by bioassay method employing Escherichia coli DH5[alpha] (pJN105L, pSC11) or Agrobacterium tumefaciens NTL4 (pZLR4) reporter, which expresses [beta]-galactosidase when exposed to P. aeruginosa quorum sensing signals. The average concentration of autoinducer was 0.33 pmol/g at day 3 and 0.49 pmol/g at day 7 in the infected wounds, as detected from tissue samples. A linear correlation between autoinducer concentration and bacterial counts was observed. No autoinducer was detected in tissue samples from the uninfected control group. Our findings indicate that the quantification of autoinducers is possible and quorum sensing system could play a role in in vivo wound infection models, and also suggest possible clinical implications of autoinducer signal quantification in diagnosis of chronic wound infection. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an evaluation of the effectiveness of a newly developed dressing for preventing persistent erythema and pressure ulcer development and improving the water-holding capacity without increasing the skin pH in bedridden older patients. Background. Shear forces and skin dryness play important roles in persistent erythema and pressure ulcer development. To eliminate these risks, we developed a dressing to reduce shear forces and improve the water-holding capacity. However, the effects of this dressing in clinical settings remain unknown. Method. An experimental bilateral comparison study was conducted at a hospital in Japan in 2004 with 37 bedridden older patients at risk of pressure ulcer development. The dressing was randomly applied to the right or left greater trochanter for 3 weeks. No dressing was applied to the opposite side as a control. The skin was monitored weekly during the 3-week application for persistent erythema and pressure ulcer development. Skin hydration and pH were also assessed during the intervention and for 1 week after dressing removal. Findings. The incidence of persistent erythema was significantly lower in the intervention area than the control area [P = 0.007, RR 0.18 (95% CI: 0.05-0.73) and NNT 4.11 (2.50-11.63)]. No pressure ulcers occurred in either the intervention or control area. Skin hydration increased significantly during dressing application and remained high after removal (P < 0.001) relative to the control area. Skin pH decreased significantly during the application (P < 0.001) but returned to control levels after removal (P = 0.38). Conclusion. This safe and effective dressing can be used for patients with highly prominent bones and dry skin to prevent pressure ulcers. [ABSTRACT FROM AUTHOR]

Abstract Background Most older adults with urinary incontinence use absorbent pads. Because of exposure to moisture and chemical irritating substances in urine, the perineal skin region is always at risk for development of incontinence-associated dermatitis (IAD). The aim of this study was to examine the efficacy of an improved absorbent pad against IAD. Methods A cluster randomized controlled design was used to compare the efficacy of two absorbent pads. Female inpatients aged ≥65 years who had IAD and used an absorbent pad or diaper all day were enrolled. Healing rate of IAD and variables of skin barrier function such as skin pH and skin moisture were compared between the usual absorbent pad group (n = 30) and the test absorbent pad group (n = 30). Results Thirteen patients (43.3%) from the test absorbent pad group and 4 patients (13.3%) from the usual absorbent pad group recovered completely from IAD. Moreover, the test absorbent pad group healed significantly faster than the usual absorbent pad group (p = 0.009). On the other hand, there were no significant differences between the two groups in skin barrier function. Conclusion The test absorbent pad for older adults with urinary incontinence might be more efficacious against IAD than usual absorbent pad. Trial registration UMIN-CTR: UMIN000006188

Incontinence-associated dermatitis (IAD) is one of the most serious complications in older people with incontinence. Controlling urine property in absorbent pads could be effective for preventing IAD caused by bacterial urine. However, no animal model has been established to evaluate their effectiveness. This study aimed to induce IAD-like skin changes using absorbent pads containing bacterial urine and to confirm their pathophysiology in rats. Hairless Wistar Yagi rats were divided into the bacteria-containing urine (BU) and the bacteria-free urine (U) groups. A 10-h-attachment of absorbent pads containing artificial urine with/without bacteria to the skin pretreated with sodium lauryl sulfate was performed repeatedly for 5 days. Macroscopic findings and skin barrier function were examined every day, and histological changes, inflammatory responses and bacterial quantification in tissue samples were examined on Day 5. The BU group exhibited significant skin redness from Day 3, significant elevation of transepidermal water loss from Day 1, and histological changes, including significantly thickened epidermis, abnormal keratinocyte differentiation and erythrocyte leakage. Inflammation, confirmed by higher myeloperoxidase-positive cells, elevated tumour necrosis factor-α expression, and vascular endothelial damage, indicated by CD31 and pentraxin 3-positive cells, were observed in the BU group. The bacterial quantification showed no significant difference between the groups. IAD-like skin changes including histological changes and inflammation were suggested to be caused by urine properties altered by bacteria. This study proposed a new animal model for evaluating the effectiveness of absorbent pads in controlling the urine properties of bacterial urine on preventing IAD., (© 2024 The Author(s). Experimental Dermatology published by John Wiley & Sons Ltd.)

Introduction: Detection of critical colonization is gaining importance in wound management, but its pathophysiology remains unclear. We previously clarified that a dysbiotic wound microbiota differing from skin commensal microbiota may be involved in critical colonization and that such wounds contain fewer Forkhead box protein P3 (FOXP3)-positive cells in the tissue. However, it is not clear whether FOXP3-positive cells contribute to the development of critical colonization. Here, we examined whether inhibition of FOXP3-positive cell could induce critical colonization when the commensal microbiota was present in the wounds., Methods: Sprague-Dawley rats were administered FK506 or vehicle to inhibit differentiation into FOXP3-positive cells. Full-thickness wounds were made on the dorsal skin and inoculated with bacterial solution (dysbiosis group) or Luria-Bertani medium (commensal group). A bacterial solution was prepared by anaerobically culturing bacteria from the skin of donor rats on an artificial dermis in Luria-Bertani medium for 72 hours. Tissues were collected on day 4 postwounding for histological evaluation., Results: After microbiota transplantation, excessive inflammation occurred in the FK506 + commensal group. In contrast, wounds with transplanted dysbiotic microbiota showed the same level of neutrophil infiltration, regardless of FK506 administration. Furthermore, the wound area was larger in the FK506 + commensal group than in the vehicle + commensal group on day 4 postwounding ( P = 0.01). This area was also significantly larger in both the vehicle + dysbiosis ( P = 0.01) and FK506 + dysbiosis groups ( P = 0.03) than in the vehicle + commensal group., Conclusions: This study has shown that dysbiosis may be at least related to developing critical colonization, and the results suggest that FOXP3-positive cells are involved in this process. Our study may contribute to establishing new interventions that prevent critical colonization by correcting wound microbiota., Competing Interests: Conflicts of interest and sources of funding: T.M. and S.K. are members of the Department of Skincare Science, which receives financial support from Saraya Co, Ltd., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: In older adults, pressure injuries (PIs) are common and, despite advancements in PI care, are associated with increased complications in patients with dementia for whom standardized treatments are unavailable. Herein, we aimed to examine the influence of dementia status on the care practice pattern and healing outcomes for PI on discharge., Methods: This retrospective cohort study used data from the Diagnosis Procedure Combination database for 2014-2015 and the Annual Report for Functions of Medical Institutions and included patients aged ≥65 years. The DESIGN-R (depth, exudates, size, inflammation/infection, granulation, necrosis and rating) classification system was used to determine PI severity, and the Dementia Scale was used to assess dementia status. The measured outcomes included advanced PI care and healing upon discharge. Multivariable logistic regression, accounting for hospital-related clustering, was used to examine the association of dementia with these outcomes., Results: Among 20 386 patients from 1198 hospitals included in the analysis, 32.5%, 20.1% and 47.3% had no, mild and severe dementia, respectively. After adjustment for patients' and hospital characteristics, compared with those without dementia, patients with severe dementia were significantly less likely to undergo advanced treatments, such as skin grafts (adjusted odds ratio [aOR], 0.62 [95% confidential interval [CI], 0.40-0.97]; P = 0.034) and flap surgeries (aOR, 0.57 [95% CI, 0.42-0.77]; P < 0.001), and had a reduced likelihood of PI healing (aOR, 0.80 [95% CI, 0.72-0.90]; P < 0.001)., Conclusions: Severe dementia was associated with poor PI healing outcomes, indicating potential treatment disparities. Thus, PI treatment should be provided according to the severity of dementia. Geriatr Gerontol Int 2024; ••: ••-••., (© 2024 The Author(s). Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.)

Introduction: Pelvic floor muscle training (PFMT) for urinary incontinence (UI) is recommended in combination with biofeedback to visualize pelvic floor muscles. The focus is on non-invasive hand-held ultrasound (US) measurement methods for PFMT, which can be performed at home. Recently, self-performed US measurements in which the patient applies the US to themself have gradually spreading. This study aimed to develop an educational program for the biofeedback method using self-performed US and to evaluate its feasibility., Methods: This study was an observational study. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) was utilized to create an e-learning program for women aged ≥40 years with UI. Participants self-performed bladder US via e-learning, using a hand-held US device with a convex probe. The primary outcome was the number of times the bladder area was successfully extracted using an existing automatic bladder area extraction system. The secondary outcome was the total score of the technical evaluation of the self-performed US, which was evaluated across three proficiency levels. Descriptive statistics were conducted for participant characteristics, presenting categorical variables as percentages and continuous variables as means ± SD., Results: We included 11 participants with a mean age of 56.2 years. Nine participants were able to record US videos, and two were unable to record bladder videos. Regarding the technical evaluation scores, all participants scored ≥80%; four had perfect scores., Conclusions: This study showed that transabdominal self-performed bladder US can be performed in 81.8% of women with UI in their 40-60s by using an e-learning program., (© 2024 The Author(s). Japan Journal of Nursing Science published by John Wiley & Sons Australia, Ltd on behalf of Japan Academy of Nursing Science.)

Background: Patients in the urology ward often require peripheral intravenous catheters for cancer chemotherapy, antibiotics to treat urinary tract infections, surgery, and other treatments. Moreover, as the elderly population within urology has a high incidence of cancer, many patients also have fragile vasculature. Proper intravenous catheter insertion and management are crucial in such cases. However, no observational studies have revealed specific practices and patient outcomes related to intravenous catheter insertion and management in urology wards. This study aimed to clarify the actual situation of peripheral intravenous catheter placements in patients hospitalized in a general urology ward and investigate the risk factors for patient outcomes such as difficult intravenous access (DIVA) and catheter failure (CF)., Methods: This was a prospective observational study. Medical record data were collected, and the actual catheter placement situation was described. A multivariate logistic regression analysis was performed to investigate the risk factors for DIVA and CF., Results: This study analyzed 180 catheters in 99 patients. The median age of the group was 70 years. The prevalence of DIVA and CF were 9.9% and 35.2%, respectively. A history of intravenous chemotherapy for cancer was positively associated with both DIVA and CF., Conclusion: This study's results demonstrate the crucial need for careful insertion and management of intravenous catheters in patients admitted to urology wards. These findings can help identify patients at high risk of DIVA and CF, while hospitalized in the urology ward., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Foot ulcerations are one of the most common complications of diabetes and one of the major initial causes of amputations. The formation of biofilms on wounds significantly contributes to infections and delayed healing. While existing methods for identifying these biofilms have limitations, there is a need for a convenient tool for its clinical application. This literature review aimed to address the problem with current clinical biofilm identification in wound care and a proposal for biofilm-detection-based wound care in diabetic foot ulcer patients. Identifying biofilms is particularly vital due to the absence of typical signs of infection in DFUs. However, current approaches, although effective, often prove invasive and technically intricate. The wound blotting technique, involving attaching a nitrocellulose membrane and subsequent staining, presents an alternative that is swift and non-invasive. Research highlights the applicability of wound blotting with alcian blue staining in clinical scenarios, consistently producing sensitive outcomes. By addressing the critical need for early biofilm detection, wound blotting holds promise for enhancing DFU management and contributing to strategies aimed at preventing amputations., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: Senescent cells, inducing a senescence-associated secretory phenotype (SASP), lead to chronic inflammation in hard-to-heal wound tissue. However, eliminating senescent cells may impede normal wound healing due to their important role in the wound healing mechanism. Accordingly, we focused on wound exudates in hard-to-heal wounds, which contain many inflammation biomarkers consistent with SASP. Therefore, we hypothesized that senescent cells might be present in the exudates and induce chronic inflammation. This study investigated the relationship between gene expression associated with cellular senescence in exudates from pressure injuries and wound healing status., Methods: This retrospective cohort study involved patients treated by a pressure injury team. We collected viable cells from wound dressings and analyzed gene expression. Pearson's correlation coefficient was calculated between cellular senescence and SASP expression. The relationship between the gene expression of cellular senescence and the wound area reduction rate by the following week was examined using a mixed-effects model., Results: CDKN1A-related to cellular senescence-was expressed in 96.3 % of 54 samples, and CDKN1A expression and SASPs positively correlated (PLAU: r = 0.68 and TNF: r = 0.34). Low CDKN1A expression was statistically associated with a large wound area reduction rate (β = 0.83, p < 0.01)., Conclusions: Gene expression of both cellular senescence and SASP factor in wound dressings suggests the presence of cellular senescence. Senescent cells in wound dressings could be associated with delayed wound healing in the following week., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system., Methods: In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points., Results: Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (<3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants., Conclusion: Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The ultrasound device with AVDS was lent for free by the Fujifilm Corporation for the study period. N.T. belonged to the laboratory (Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo) supported by Fujifilm Corporation until 2022 March. M.A. and R.M. belonged to the laboratory (Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo) supported by Terumo Corporation until 2022 March.