Early Detection and Wound Monitoring of Pressure Ulcers

压疮的早期检测和伤口监测

基本信息

批准号：
8525180
负责人：
Royce W Johnson
金额：
$ 17.51万
依托单位：
APPLIED NANOTECH, INC.
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-18 至 2014-08-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8525180
关键词：
Acute Address Administrator Admission activity Affect Amputation Analytical Chemistry Biological Markers Biomechanics Businesses California Caring Cessation of life Classification Clinical Communities Contracts Coupled Decubitus ulcer Detection Development Devices Direct Costs Early Diagnosis Ensure Expenditure Face Facilities and Administrative Costs Failure Gases Health Care Costs Health care facility Healthcare Healthcare Systems Hip Fractures Hospitals Housing Human Incontinence Infection Injury Institution Intensive Care Units Intervention Ions Judgment Lead Long-Term Care Measurable Membrane Metabolism Methodology Methods Microclimate Modeling Monitor Motivation Nanotechnology Nursing Process Nutritional status Outcome Oxidative Stress Pathology Patients Pattern Performance Phase Physiological Positioning Attribute Pre-Clinical Model Predictive Value Preparation Process Research Risk Sampling Sepsis Services Signal Transduction Site Skin Small Business Innovation Research Grant Specificity Spectrometry Staging Stress Surface System Technology Testing Time Tissues Translations Ulcer Universities Work base bench to bedside clinical care commensal microbes commercialization cost design economic impact experience high risk improved instrument instrumentation ion mobility medical specialties older patient patient home care preference pressure public health relevance screening sensor tool wasting wound

项目摘要

DESCRIPTION (provided by applicant): Pressure ulcers are a serious problem in clinical care. They are caused by immobility, moisture, and patient pathologies (Reddy 2006). They cause many poor outcomes including infection and amputation, and costs of $1B in the US and $3B-$5B worldwide (Salcido 2012, Russo 2006). Nursing processes use repositioning, skin checks, specialty support surfaces, and incontinence management. Risk scales such as those of Norton and Braden (NPUAP 1989, Bergstrom 1987) are currently used to identify patients at higher risk. While these processes and scales are valid, their ability to predict and manage ulcer occurrence are modest at best (Schoonhoven 2002) and pressure ulceration remains a significant healthcare cost and cause of poor outcomes. Skin metabolites are known to contain volatiles produced by tissue metabolism and commensal bacteria of the skin (Gallagher 2008). Many of these are markers of oxidative stress (Pabst 2007, Aghdassi 2000, Dumelin 1977); therefore multiple markers are anticipated to be affected by the physiologic stresses which lead to pressure ulceration and to show unique spectral patterns for injury vs. those of intact skin. In order to ensure that ulceration-specific signals are sampled, in preference to systemic or environmental signals, it is important to sample and analyze markers obtained at high-risk skin sites. This will be done by use of polydimethylsilicone (PDMS) membrane methods (Thomas 2010) coupled with a proprietary ion-mobility sensor technology developed by Applied Nanotech, Inc. (EZKnowz"). An inexpensive system will be developed for early detection of pressure ulceration by profiling of volatile markers with a portable, bedside analysis product. The near-real-time results of the analyses will be provided to the clinical team to guide the use of interventions. Specific Aim 1 is to develop and optimize VOC trapping methods with PDMS membranes. Specific Aim 2 is to develop an extraction interface and verify the biomarker analyses with the EZKnowz" technology. Specific Aim 3 is to test the feasibility of the approach in a pre- clinical model of pressure ulceration. An early-detection capability for pressure ulcers will allow for more appropriate use of interventions such as pressure relief and microclimate control surfaces or aggressive repositioning leading to better care for lower costs. One example of this is in distinguishing pre-emergent, community-acquired ulcers upon admission of a patient to a healthcare facility from those appear during in-house care. Correct classification will allow healthcare facility administrators to appropriately obtain reimbursement for treating them rather than have the ulcers classed as nosocomial ulcers, thereby losing out on reimbursement coverage. Patient outcomes will be improved by reduced ulceration rates and more timely interventions.

描述（由申请人提供）：压疮是临床护理中的一个严重问题。它们是由动静，水分和患者病理引起的（Reddy 2006）。它们导致许多不良的结果，包括感染和截肢，在美国的成本为1B $ 1B，在全球范围内$ 3B- $ 5B（Salcido 2012，Russo，2006年）。护理过程使用重新定位，皮肤检查，专业支持表面和失禁管理。诺顿和布雷登（Npuap 1989，Bergstrom 1987）等风险量表目前用于识别风险较高的患者。尽管这些过程和量表是有效的，但它们的预测和管理溃疡发生的能力充其量是适度的（Schoonhoven 2002），压力溃疡仍然是巨大的医疗保健成本和结果不佳的原因。已知皮肤代谢物包含组织代谢和皮肤共生细菌产生的挥发物（Gallagher 2008）。其中许多是氧化应激的标记（Pabst 2007，Aghdassi 2000，Dumelin 1977）；因此，预计多种标记会受到导致压力溃疡的生理应力的影响，并显示出损伤与完整皮肤的光谱模式。在为了确保对特定于全身或环境信号进行采样溃疡特异性信号，重要的是要采样和分析在高危皮肤部位获得的标记。这将通过使用聚二甲基硅酮（PDMS）方法（Thomas 2010）以及由Applied Nanotech，Inc。（Ezknowz）开发的专有离子移动传感器技术结合。提供给临床团队以指导使用干预措施1。具体目的3是在压力溃疡的临床模型中测试该方法的可行性。压力性溃疡的早期检测能力将允许更适当地使用诸如压力缓解和微气候控制表面或积极重新定位等干预措施，从而更好地护理较低的成本。一个例子是在接受医疗机构的患者和内部护理期间出现的医疗机构后，区分出爆发前的，社区获得的溃疡。正确的分类将使医疗机构管理员能够适当地获得治疗它们的报销，而不是将溃疡归类为医院溃疡，从而在报销覆盖范围内损失。溃疡率降低和更及时的干预措施将改善患者的结果。