Skin Care
Nearly half of all individuals living with a permanent stoma have a skin disorder that could be avoided by regular visits to a specialist nurse, according to results of a study presented at the annual conference of the Wound, Ostomy and Continence Nurses Society in Minneapolis, MN.
The OstomySkinStudy, which investigated a diverse group of 101 men and 101 women with ostomies living in the community, found that 45% of participants had skin disorders around their stoma. Unfortunately, many of these people did not realize they had a skin disorder and more than 80% had not sought treatment.
The study was performed during a 1-year period from 2003 to 2004 by stoma care nurses and physicians in association with Coloplast, Humlebaek, Denmark. Stoma-care nurses who examined patients in the study recommended annual follow-up visits to their local stoma-care clinic for all people living with ostomies.
Animal Bite Wounds
Dog and cat bites to the hand can result in serious injuries and wounds, even hospital admission and surgery, according to a study published in the March 2006 issue of The Journal of Hand Surgery. An estimated 2 million Americans are bitten by a domestic animal each year, but many cases of these injuries can be lessened or prevented through early treatment and more careful animal handling. The study was an extensive review of 111 cases of dog (71) or cat (40) bites to the hand area and concluded that injuries ranged from minor wounds to major injuries that included open fractures, persistent deep infections, osteomyelitis, nerve laceration, or tissue loss. Approximately two thirds of patients studied required hospital admission for intravenous antibiotics. The researchers found that many cases could have been less severe had the patient sought earlier treatment. Within the study group, the average time from injury to evaluation by an orthopedic hand surgeon was nearly 8 days. Immediate emergency department treatment for animal bites was recommended.
Source: Benson LS, Edwards SL, Schiff AP, Williams CS, Visotsky JL. J Hand Surg [Am]. 2006;31:468-73.
Diabetes
In the June 2006 issue of Diabetes Care, a study of 1666 consecutive patients with diabetes reported the risk factors for foot infections. The participants were enrolled in a managed care-based outpatient clinic in a 2-year longitudinal outcomes study. Patients received a standard medical examination, detailed foot assessment, and education about proper foot care at enrollment: they were screened at scheduled intervals. The patients were also seen if they developed a foot problem.
The researchers reported that 151 of the patients studied developed 199 foot infections, with all but 1 infection involving a wound or penetrating injury. Although most infections involved only soft tissue, 19.9% of patients had bone cultures showing osteomyelitis. Patients who developed foot infections were at significantly greater risk for hospitalization and amputation than those who did not.
Independent risk factors found to be significant for foot infection included wounds that penetrated to bone, wounds with a duration greater than 30 days, recurrent wounds, wounds with a traumatic etiology, and presence of peripheral vascular disease.
Source: Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29:1288-93.
A study published in the August 2006 issue of Diabetes Care compared the use of different outcome measures in the management of diabetic foot ulcers. By collecting data from patients who were referred to a specialist foot care clinic during a 3-year period, the researchers were able to evaluate outcomes according to ulcer-related and patient-related measures. A single index ulcer was selected for each patient. In 449 patients (63.7% male, mean age 66.7 +/- 13.2 years), 352 patients had superficial ulcers; 134 of those were neither ischemic nor infected. A total of 183 ulcers were clinically infected, and 216 study patients had peripheral arterial disease.
Of the ulcers, 247 and 296 healed without amputation by 6 and 12 months, respectively; of all index ulcers, 5.8% and 8.0% were resolved by amputation, and 6.2% and 10.9% by death at the same time points, respectively. Evaluation of patient-related outcomes, however, showed greater morbidity and mortality: only 202 of the 449 patients were alive, without amputation, and ulcer-free at 12 months. This group had had 272 days without any ulcer; during the study, 48 patients had some form of amputation and 75 had died.
The researchers suggested that greater emphasis on patient-related outcome measures may be needed when comparing the effectiveness of management in different centers to give a truer picture of morbidity and mortality.
Source: Jeffcoate WJ, Chipchase SY, Ince P, Game FL. Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care. 2006;29:1784-7.