护理领域文献阅读汇编

Dermatologists have expertise in diagnosing and managing many ulcerative conditions. However, dermatology training often lacks substantial teaching or hands-on experience in wound care. Proper wound management begins with accurately identifying the underlying cause of a wound, along with any patient-specific factors that may impede healing. These factors help guide the selection of appropriate wound care techniques and dressings. The main categories of dressings include films, foams, alginates, hydrogels, hydrocolloids, gelling fibers, and super-absorbents. For critically colonized wounds, or those at higher risk of infection, antimicrobial-impregnated dressings may be utilized. Highly exudative wounds require absorptive dressings, whereas dry wounds benefit from dressings that provide and maintain moisture. Importantly, addressing patient-specific concerns, such as the frequency of dressing changes, cost, ease of application, and comfort, is essential for promoting adherence and improving quality of life. This report provides guidance on the clinical assessment of wounds, key considerations in dressing selection based on wound characteristics, and a summary of traditional wound dressings and their indications.

Biological products, including tissue-engineered skin tissue and growth factors, have become important treatment options for wound repair and regeneration. Tissue-based products include components that replicate the properties of normal human skin, such as fibroblast and keratinocyte cell culture, to promote healing and remodeling. These products can generally be categorized as epidermal, dermal, or composite skin replacements, and more recently as cellular, acellular, and matrix-like products (CAMPs). Selection is based on wound type, location, dimension, presence of undermining, and condition of the periwound skin. Despite multiple studies on cost-effectiveness, drawbacks to tissue-based products and advanced wound therapies include high cost, limited access, short shelf-life, specific storage requirements, and restricted indications. This review provides a summary of the indications and limitations of the types of CAMPs and biomaterials available for the treatment of wounds.

The management of heavily exuding infected wounds is complicated by excessive exudates, persistent bacterial colonization, and secondary trauma during dressing changes. Here, we develop a bioinspired "liquid-solid" biphasic dressing designed to address these challenges simultaneously. This dressing integrates a hylarana guentheri mucus-inspired medical antibacterial oil (guest phase) within a concave nanofiber membrane that mimics the structure of octopus suckers (host phase). This unique architecture enables an exudate-triggered self-adaptive gating mechanism, where the oil-filled concaves act as pressure-deformable gates. High hydrostatic pressure from excess exudate opens the gates for unidirectional transport, while low pressure maintains a closed state, thus dynamically regulating moisture and creating an optimal healing environment. The integrated oil, infused with thymol, establishes a synergistic "defend-and-attack" antibacterial barrier, preventing biofilm formation and neutralizing planktonic E. coli and S. aureus. The same oil layer provides a low-adhesion interface, enabling nearly painless dressing changes with minimal peeling force. In an infected wound model, the dressing accelerates healing, suppresses inflammatory cytokine expression, and reduces bacterial burden. This "liquid-solid" strategy offers a promising paradigm for developing next-generation smart biomaterials for complex wound care.

Lateral quadratus lumborum block (QLB) is a potential alternative to intrathecal morphine (ITM) for analgesia after Caesarean delivery. We compared quality of recovery (QoR) and analgesia with lateral QLB, ITM, or ITM+QLB. In this randomised, double-blind, placebo-controlled trial, women undergoing Caesarean delivery under spinal anaesthesia were allocated to (1) bilateral lateral QLB with 20 ml 0.5% ropivacaine; (2) 100 μg preservative-free ITM with sham QLB; or (3) ITM+QLB. The primary outcome was the QoR-40 score at 24 h. Secondary outcomes included pain scores, opioid consumption, and adverse effects. Given three-group comparisons, statistical significance was set at P<0.017. Fifty-eight women were analysed. Noninferiority testing for QoR-40 at 24 h between ITM and QLB was inconclusive (mean difference -0.9; 90% confidence interval [CI] -0.9 to 13.5). QLB reduced the resting pain score at 6 h compared with ITM (mean difference 2.9 [95% CI 1.3, 4.5]; P<0.001). Compared with ITM alone, ITM+QLB reduced the resting pain at 6 h (mean difference 3.3 [1.9, 4.8]; P<0.001), coughing pain at 6 h (3.0 [1.4, 4.7]; P<0.001), and worst pain at 24 h (1.8 [0.6, 3.1]; P=0.006). Oxycodone consumption and nausea or vomiting did not differ between groups. Pruritus was more frequent with QLB and ITM+QLB compared with ITM alone but was predominantly mild. Noninferiority of QLB vs ITM for QoR-40 at 24 h was inconclusive. However, QLB reduced early resting pain vs ITM, whereas ITM+QLB further reduced early resting and coughing pain and worst pain at 24 h vs ITM alone. Larger trials are needed to confirm these findings. NCT02871713 (https://clinicaltrials.gov/study/NCT02871713).

Chronic pain has historically been managed with pharmacological therapies, including opioids that provide potent analgesia, but their sustainability is limited by dose-dependent risks of misuse, addiction, and overdose. Electroceuticals offer a non-pharmacologic alternative by modulating neural pathways through electrical stimulation, but current invasive systems require surgery and clinical supervision, whereas non-invasive devices suffer from poor therapeutic efficacy caused by unstable skin-electrode impedance. Here, we present a thermoresponsive, electrically conductive adhesive microneedle (TEAM) electroceutical that integrates low-impedance microneedle arrays and conductive hydrogel coatings within a compact wireless platform enabling IoT-based telemedicine for safe, remotely managed pain therapy with robust therapeutic outcomes. Experimental and analytical results demonstrate that TEAM improves charge injection efficiency and neural activation while maintaining electrical and thermal safety. The device achieves superior analgesic efficacy compared to conventional gel-based transcutaneous electrical nerve stimulation in preclinical models, with performance comparable to pharmacological analgesics. IoT-enabled demonstrations further validate the feasibility of remote and scheduled therapy, as well as proof-of-concept automatically triggered neuromodulation guided by physiological pain-induced stress markers in human subjects. TEAM provides a foundation for scalable electroceutical therapy and holds promise for future preclinical-to-clinical translation toward real-world digital pain management.

Heart failure with reduced ejection fraction causes high mortality and recurrent hospitalizations in India. We evaluated the effectiveness of the collaborative care model in improving days alive and out of the hospital and overall survival. We conducted a parallel-group, cluster-randomized controlled trial involving 1507 adults with heart failure with reduced ejection fraction across 22 centers in India (CTRI/2021/11/037797). Centers were randomized 1:1 to the intervention or usual care. Participants were followed up for 2 years. The intervention included risk stratification, lifestyle and pharmacological optimization, and a nurse-coordinated, mobile health-supported disease management program with self-care education, active follow-up, and continuous outpatient monitoring throughout the study period. The primary outcome was days alive and out of the hospital, and all-cause mortality was assessed as a secondary outcome. Days alive and out of the hospital was analyzed with a one-inflated β model. All-cause mortality was analyzed with Cox proportional hazards models adjusted for the clustered study design. Among 1507 participants (752 usual care; 755 intervention), the mean age was 61.9 years, and 77.6% were men. All participants except one completed 24 months of follow-up. Most participants (70%) had low educational attainment; 57.3% lived in rural areas; and ischemic heart disease was the predominant cause (77.4%). Baseline characteristics were comparable between the intervention and usual care groups. In the one-inflated β model, the probability of surviving up to 730 days without hospitalization was 79.4% (95% CI, 77.7%-81.2%) in the usual care group and 84.0% (95% CI, 82.2%-85.8%) in the intervention group. Participants in the intervention group had 78% higher odds of achieving a percent days alive and out of the hospital of exactly 1 (730/730 days) compared with those in the usual care group (odds ratio, 1.78 [95% CI, 1.42-2.23]). There were 201 deaths (26.73%) in the usual care group compared with 163 deaths (21.59%) in the intervention group (risk ratio, 0.80 [95% CI, 0.67-0.97]). In the multivariable Cox proportional hazards model, the intervention group had a 22% lower mortality risk than the usual care group (hazard ratio, 0.78 [95% CI, 0.63-0.95]; P=0.028). A nurse-coordinated, mobile health-supported collaborative care model for heart failure with reduced ejection fraction in India increased the number of days alive and out of hospital, raised the absolute probability of remaining out of hospital by 4.5 percentage points, and reduced all-cause mortality by 22%. URL: www.ctri.nic.in; Unique identifier: CTRI/2021/11/037797.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis frequently associated with systemic comorbidities such as inflammatory bowel disease (IBD), arthritis, and hematologic disorders. Management remains challenging due to heterogeneous presentations and treatment responses. To propose a comorbidity-guided therapeutic framework. A clinical review of clinical trials, case series, and real-world reports on PG management was conducted. Emphasis was placed on immunopathologic pathways linking PG with major comorbidities and on therapeutic strategies employing biologic and small-molecule agents tailored to these associations. Comorbidity-directed therapy, such as TNF inhibition for IBD-associated PG, IL-1 blockade for autoinflammatory syndromes, and Janus kinase (JAK) inhibition for arthritis overlap, resulted in higher healing rates and lower relapse risk across studies. Real-world cases demonstrate that individualized therapy addressing the underlying systemic drivers of skin disease may yield more durable ulcer healing than empiric therapy alone. A comorbidity-guided approach personalizes PG therapy, aligning dermatologic and systemic management to improve healing, minimize recurrence, and optimize patient outcomes.

Diabetic wounds are highly susceptible to bacterial infection and exhibit impaired healing largely driven by defective neutrophil function. Herein, we developed an immunomodulatory hydrogel hybridized with a diselenide-bridged polymer (HHD) to regulate neutrophil fate for effective wound management. HHD demonstrates stepwise, glucose- and ROS-responsive drug release. The initially released L-arginine and pyridoxamine improve wound microenvironment by promoting angiogenesis and suppressing advanced glycation end products. Upon infection, this remodeled microenvironment enhances the recruitment and antibacterial capacity of neutrophils, enabling diabetic wounds to regain the ability to form early inflammatory zones and promptly clear invasive bacteria. Furthermore, excessive ROS generated from antimicrobial immunity degrades neutrophil-targeted polymers, releasing an NLRP3 inhibitor that suppresses inflammasome overactivation and accelerates neutrophil apoptosis, thereby facilitating macrophage efferocytosis to initiate tissue repair. We tracked HHD-shaped neutrophils and confirmed their efficacy in preventing infection and accelerating wound healing. Collectively, HHD represents a promising treatment platform for neutrophil-dependent diabetic wound care. STATEMENT OF SIGNIFICANCE: Neutrophil dysfunction is a key factor leading to infection and impaired healing of diabetic wounds. Significant challenges remain in achieving comprehensive regulation of neutrophil fate. In this work, we construct an immunomodulatory composite hydrogel to regulate neutrophil fate in diabetic wounds: 1) Improving the wound microenvironment, enhancing neutrophil recruitment, and strengthening its antibacterial activity; 2) Inducing neutrophil apoptosis through the neutrophil-targeting polymer; 3) Facilitating macrophage efferocytosis and phenotypic switching via apoptotic neutrophils, thereby expediting tissue repair.

Diabetes during pregnancy, whether gestational (GDM) or pre-existing, is associated with increased maternal and neonatal risks. Remote care has shown promise in diabetes management, however, its impact on antenatal diabetes care remains unclear. This review evaluates its impact compared with usual care for pregnant women with diabetes, using the Institute of Medicine's healthcare quality framework: effectiveness, safety, efficiency, timeliness, patient-centredness, and equity. A systematic review and meta-analysis was conducted. Seven electronic databases (MEDLINE, EMBASE, CINAHL, MIDIRS, Scopus, Cochrane, and Global Health) were searched for studies published between January 01, 2005 and April 30, 2026, with no geographic or language restrictions. Two independent reviewers screened studies and assessed quality using Cochrane tools. A narrative synthesis and meta-analyses were performed. This review was registered with PROSPERO (CRD420251024685). Of 1106 unique studies retrieved, 45 were included (n = 26,562), comprising 20 randomised controlled trials (RCTs) and 25 non-randomised studies. Most studies focused on GDM only (n = 37), with the remainder including mixed GDM and pre-gestational diabetes (n = 6) or pre-gestational diabetes only (n = 2). Remote care was generally comparable to usual care across most effectiveness and safety outcomes. In non-randomised studies, remote care was associated with lower unspecified caesarean section rates (relative risk [RR] 0.95, 95% CI 0.91-0.99), postpartum HbA1c (MD -0.08%, 95% CI -0.15 to -0.01), and postpartum 2-h post-prandial glucose levels (MD -1.04 mmol/L, 95% CI -1.59 to -0.48). In RCTs, remote care was associated with reduced emergency caesarean section (RR 0.59, 95% CI 0.38-0.92) and neonatal intensive care unit (NICU) admission (RR 0.73, 95% CI 0.57-0.92). For patient-centredness, patient satisfaction was consistently high. Efficiency findings (cost savings and appointment frequency) were mixed. Three studies assessed timeliness, with no differences observed. Equity outcomes were rarely quantified, though several interventions incorporated cultural, linguistic, or technological adaptations to improve accessibility. Remote care is a safe and effective alternative to usual care for pregnant women with diabetes, with safety advantages including reduced emergency caesarean sections and NICU admissions. Further research is required to evaluate long-term postpartum outcomes and equitable adoption across diverse populations. This study was supported by the National Institute for Health and Care Research (NIHR) North West London Patient Safety Research Collaboration (NIHR NWL PSRC, NIHR204292).

Licensed, ready-to-administer injectable medicines can reduce medication errors, minimise waste, and streamline perioperative workflows, but higher acquisition costs have limited uptake in England. This study evaluated the economic impact of switching selected anaesthetic and critical care medicines from conventional ampoules and vials to licensed prefilled syringes within NHS practice. An economic model compared current mixed-use practice with a hypothetical switch to 100% licensed ready-to-administer products for eight medicines: epinephrine 1 mg in 10 ml, ephedrine 30 mg, atropine 3 mg, rocuronium 100 mg in 10 ml, lidocaine (1% and 2%), and midazolam (5 mg in 5 ml and 50 mg in 50 ml). Modelled cost components included medicine acquisition, wastage, nursing preparation time, consumables and preventable adverse drug events. Preparation time reductions were interpreted as capacity release rather than workflow substitution. Deterministic sensitivity analyses explored variation in key assumptions and procurement thresholds. Under the modelling assumptions, epinephrine, ephedrine, atropine and lidocaine 2% were associated with reduced overall system costs of more than £5.3 million annually, largely driven by reduced wastage, preparation workload and modelled adverse drug events. Rocuronium and midazolam were associated with increased costs because of higher acquisition prices despite operational advantages. Sensitivity analyses did not alter the direction of findings. Substantial price reductions would be required for certain medicines to achieve cost neutrality. Licensed ready-to-administer injectable medicines can provide safety and workflow advantages and be associated with economic benefit. Acquisition cost remains a barrier, but broader adoption and market development could improve affordability.

Population-based sex differences in large vessel occlusion (LVO) screening and thrombectomy use for acute ischemic stroke are not well understood. We compared the detection of LVO, thrombectomy use, and long-term clinical outcomes in female versus male patients with cerebral ischemia in Ontario, Canada. This retrospective cohort study used data from the Ontario Stroke Registry linked with health administrative data. We included adult patients hospitalized for cerebral ischemia within the first 24 hours of last seen normal time during 2 fiscal years (2019/2020 and 2022/2023). We used modified Poisson regression models to evaluate sex differences in intracranial neurovascular imaging, thrombolysis, or thrombectomy. Among patients with LVO, we used Cox proportional hazard and cause-specific hazard models to compare female versus male patients long-term mortality, readmission, or nursing home admission until 2025, stratified by thrombectomy treatment. Among 16 935 eligible patients (47% female patients; median age, 76 [interquartile range, 65-84] years), female patients were less likely than male patients to receive intracranial neurovascular imaging (83.6% female versus 87.8% male; P<0.01). Among those who underwent imaging, 19.3% of female patients had an LVO compared with 15.9% of male patients (P<0.01). Thrombectomy use was higher in female patients than male patients in the overall cohort (adjusted relative risk, 1.08 [1.01-1.16]), but, once restricted to those with LVO, thrombectomy use was similar (adjusted relative risk, 0.98 [0.93-1.03]). Adjusted hazard of the composite outcome was lower in female patients with LVO treated with thrombectomy compared with their male counterparts (adjusted hazard ratio, 0.88 [0.77-0.99]). Female patients with acute cerebral ischemia were less likely than male patients to receive intracranial neurovascular imaging but more likely to have an LVO, and long-term mortality was lower in female patients with LVO treated with thrombectomy. Stroke outcomes' research must account for neurovascular imaging and LVO status to accurately identify sex-based disparities in stroke care and outcomes.

While opioids remain the primary pharmacological intervention for cancer pain management, their clinical utility is frequently compromised by dose-limiting toxicities. This study aimed to determine the comparative efficacy, opioid-sparing potential, and clinical hierarchy of non-opioid adjuvant drug classes. The study was structured around the PICO framework to evaluate the pharmacological strategies currently utilized in multimodal clinical oncology. A systematic search of electronic databases (PubMed, Embase, Cochrane) was conducted for randomized controlled trials (RCTs) published between 2000 and 2025. The primary outcome was global analgesic efficacy (standardized mean difference [SMD]), while secondary outcomes included the opioid-sparing effect, defined as the percentage reduction in morphine equivalent daily dose (MEDD) and the incidence of treatment-emergent adverse events (Harms). A Bayesian network meta-analysis (NMA) was performed to rank treatments using SUCRA values. The methodological quality was assessed using the Cochrane Risk of Bias (RoB 2.0) tool. Twenty-three RCTs (n = 1845) met the inclusion criteria. Nonsteroidal anti-inflammatory drugs (NSAIDs) (-1.10) and anticonvulsants (-1.06) demonstrated the most robust analgesic effects. The SUCRA ranking confirmed a clear hierarchy, with the combination of anticonvulsants and antidepressants showing the highest probability of efficacy. A significant opioid-sparing effect was observed for gabapentinoids and ketamine, facilitating MEDD reduction. While serious adverse events were rare, minor harms (somnolence, dizziness) were more frequent in the most effective classes. Our NMA provides a robust evidence base for a "Clinical Tier" system, ranking adjuvants by their balance of efficacy and safety. These findings support the early integration of Tier I agents (anticonvulsants and NSAIDs) to optimize pain control and reduce opioid-related toxicities in chronic cancer pain management.

Vaccine effectiveness (VE) estimates are needed to determine the effectiveness of respiratory syncytial virus (RSV) vaccinations during their first season of availability among populations at high risk for severe RSV. To assess RSV VE against RSV-associated outcomes for nursing home residents. This retrospective cohort study of Medicare fee-for-service beneficiaries used electronic medical claims data from September 10, 2023, to March 30, 2024. A cohort was created for each outcome: an RSV-associated hospitalization cohort; an RSV-associated death cohort; a severe RSV-associated outcome cohort; and an RSV-associated thromboembolic event cohort. To be eligible for inclusion in a cohort, a Medicare fee-for-service beneficiary must be aged 65 years or older, reside in a US nursing home during the study period for at least 1 day, have continuous enrollment in Medicare Parts A and B (365 days prior to the index date), and have continuous enrollment in Part D (beginning on June 21, 2023). RSV vaccination. Outcomes were RSV-associated hospitalization, RSV-associated death, severe RSV-associated outcomes (intensive care unit or critical care unit admission, medical ventilator use, or RSV-associated death), and RSV-associated thromboembolic event. RSV diagnoses and outcome definitions were based on claims with relevant International Classification of Diseases and Related Health Problems, Tenth Revision codes. RSV vaccine doses were determined from Medicare Part D claims using the National Drug Code Directory. Hazard ratios (HRs) from multivariable Cox proportional hazards models compared the times to first outcomes among RSV vaccinated beneficiaries and unvaccinated beneficiaries. VE was calculated as (1-HR) × 100%. Of 597 430 included Medicare beneficiaries (66% female; median age, 82 [IQR, 75-88] years), RSV VE against RSV-associated hospitalizations was 73% (95% CI, 65%-79%). Among beneficiaries aged 65 to 74 years VE was 60% (95% CI, 35%-76%), 75% (95% CI, 67%-82%) among beneficiaries 75 years or older, 67% (95% CI, 55%-76%) among short-stay residents (<100 cumulative days), and 80% (95% CI, 68%-87%) among long-stay residents (≥100 cumulative days). VE against RSV-associated death was 56% (95% CI, 39%-69%), VE against severe RSV-associated outcomes was 59% (95% CI, 44%-70%), and VE against RSV-associated thromboembolic events was 66% (95% CI, 44%-79%). In this study, in the first season of availability, RSV vaccines were associated with improved RSV-associated outcomes among US Medicare beneficiaries residing in nursing homes.

Translational simulation is an emerging approach that operationalises simulation as a tool to explore and improve healthcare systems. Anaesthesia represents a well-suited context for translational simulation; however, the applications, processes, outcomes, and factors influencing the implementation of translational simulation in anaesthesia are poorly characterised. MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched for studies using translational simulation approaches to explore or improve multidisciplinary anaesthetic care. Two independent reviewers performed study selection. Data extraction and risk of bias assessment were performed using Thomas and Harden's approach to inductive qualitative synthesis. Of 5760 unique citations, 149 were included, involving more than 3300 anaesthesia staff across 37 countries. Most studies used translational simulation to identify latent safety threats and optimise protocols, resulting in structural or procedural modifications in 113 studies. A total of nine process domains, including 90 translational processes, were identified. Applications of translational simulation predominantly focused on crisis management rather than routine perioperative care, and the involvement of conceptual frameworks and contemporary safety sciences (e.g. Safety-II) was infrequent. Although signals of improved patient outcomes were reported, causal attribution remains limited by a predominance of quasi-experimental designs. Implementation relied heavily upon executive sponsorship and integration into clinical governance to overcome workforce and logistical barriers. Translational simulation has been widely operationalised in anaesthesia as a pragmatic systems engineering tool. To mature as a scientific discipline, future translational simulation initiatives must adopt standardised nomenclature, explore high-volume routine perioperative care, and transition from ad hoc projects to theory-informed programmes embedded within hospital quality and safety structures. PROSPERO CRD420251013645.