The study under review, in this case, is an empirical study on the assessment of pressure sore generation and their healing. The study focuses on the need for clinicians and nurses to have an effective way of assessing the healing process of pressure wounds. The effectiveness of a treatment method can be evaluated through the assessment of healing processes, and this requires the existence of accurate techniques. The most popular assessment tool consists of a non-allergic liquid and an acetate sheet used for measuring wound volume and perimeter. However, since healing mostly occurs in the deep tissue and is not visible to the naked eye, more effective methods are necessary. The case of pressure ulcers is significantly more critical because it may involve acute wounds that can develop within the deep tissue or superficially depend on the causes (Alison et al 2013 p 3).
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In patients who have mobility challenges or limited capacity to sense injury, the early detection of decubitus ulcers can be significantly challenging. It is a problem because, in such patients, the ulcers are mostly detected when they reach advanced stages especially if they are in the deep tissue as opposed to superficial (Tannen, et al 2010 p 1514). The treatment and welfare costs on the patient can be reduced with an effective monitoring system that could assess the advancement of the injuries using imaging techniques.
Research Objective, Questions or Hypotheses
The objective of the study was to evaluate the effectiveness of a high-frequency ultrasound technique for monitoring wounds. The authors were interested in assessing the applicability of high-frequency ultrasound for monitoring the development of decubitus ulcers and their healing phenomenon. The aim of the study was to assess whether the HFU technique was effective in diagnosing the presence of decubitus ulcers and monitoring the healing progress to evaluate the effectiveness of the treatment strategies applied. The study was also designed to develop a quantitative HFU wound analysis approach that does not require the user to have prior knowledge of evaluating ultrasound results (Moghimi et al 2010 p 105).
The hypothesis of this research posits that the use of a high-frequency ultrasound device canto identify a change in pressure sores during their formation and healing. It posits that clinicians can extract parameters from the tissue texture and echogenicity to assess tissue status.
Literature Review
The author presents a review of the literature on pressure sores, wound healing, and monitoring methods in the introduction section of the study. The author presents theoretical and empirical research on non-invasive methods of monitoring skin conditions. It involves assessment of the theoretical literature on the skin and would healing as well as pressure ulcers. The empirical literature on non-invasive would assessment is used extensively in this paper to highlight the result of other researchers. Studies such as Foster et al. (Forster et 1990 p 48) were used in the article to highlight the properties of wounds and different tissues about acoustic reflection. The author also presents studies comparing the findings of ultrasound assessment and histology as they relate to the monitoring of wound healing processes and advancement. Journal articles and other peer reviewed work such as conference papers form the bulk of the literature to inform the strategies adopted for the study and the expectations. The authors also apply the findings of prior studies on pressure wounds and their pathogenesis. Recent studies addressing the same issue are used in the literature to assess the issue and show the effectiveness of the HFU in monitoring different types of tissue in both human and animal subjects. The authors highlight the weaknesses of the available studies and present the case for the development of their approach to addressing them. The case for numerical analysis is adequately presented in this assessment to highlight the benefits expected from its application regarding effectively monitoring and diagnosing decubitus ulcers.
Protection of Human Participants
The issue of human subjects was not a problem in this study because it did not involve human participants. The experimental conditions were tested on healthy male albino guinea pigs. The use of such participants in the study was beneficial because it does not put human subjects at unnecessary risk. The study also provides an efficient way of generating the pressure sores in a controlled way and assessing their healing and advancement. Using animal subjects in the study allowed the researcher to produce the pressure sores and observe their healing without unnecessarily having ethical dilemmas.
Data Collection
The load was kept constant at 400 g for as period of five hours over the trochanter region of the animal’s hind limb. Then it was monitored over a period of 21 days with measurements being taken on the third, seventh, fourteenth, and twenty-first days. The size of the imaging window is clearly indicated in the research in the data analysis segment with the authors indicating that the monitoring was limited to the muscle fascia (Moghimi et al 2010 p 106). The focus of the analysis and the data collected was the alteration of the echographic structures of the skin and other parts of the wound. The co-occurrence matrix from the scans taken on the wound was used to determine the contrast, correlation and angular second moment. The echogenicity was considered as a key dependent variable and was determined by calculating the root mean square of the pixel values in the scans.
A modified fractal signature was applied in the study to assess the surface area of the wound. This was applied as a texture descriptor in the analysis. The article indicates how the differences in the dependent variables were calculated for each pair of the test days. The collected data was derived from the ultrasound scans and used to determine the healing v functions and assess their applicability in assessing overall outcomes.
Problem Statement in PICOT Format
The problem in this study is associated with diagnosis or assessment of the development and healing of decubitus ulcers in hospitalized patients. It focuses on assessing the effectiveness of high-frequency ultrasounds and numerical analysis of the images to evaluate the healing function.
Population: it focuses on the hospitalized or bed-ridden patients who are the most likely candidates of decubitus ulcers that develop from their prolonged stay in the hospital.
Intervention: the intervention considered in this case is the application of as high-frequency ultrasound to assess the development of decubitus ulcers and their healing over a period of 21 days. The pressure ulcers were induced in controlled conditions and scanned using the HFU on four occasions in the span of 21 days.
Comparison: after four days the determination of correlation, contrast, and angular second moments, from the ultrasound scans was done. These values were compared to the period of the study and used to develop the quantitative healing function.
Outcome: the result sought in this study was the development of an efficient strategy for assessing the healing or advancement of pressure wounds in hospital settings. The focus is to develop an efficient quantitative approach relying on high-frequency ultrasounds to assess the healing of pressure wounds.
Timeframe: the timeframe considered for this study was 21 days in which the healing of the pressure wounds was assessed, and the healing function developed to predict it accurately.
Data Analysis
The alteration in the echographic structure of the wounds during their generation and healing was the focus of the analysis with ultrasound scans being used to assess the changes in the texture of the wound and its constituents. The co-occurrence matrix derived from the HFU scanner were used to calculate the different features used in the analysis (Moghimi, et al., 2010). The features calculated in the analysis were the angular second moments, correlation and contrast. The author clearly indicates how a mask matrix was used for reducing the gray areas. The article also shows clearly how the fractal analysis was applied and the development f the quantitative healing function including the weights used in its calculation. The paper is rather technical, and the authors spend time trying to explain each step. Since the article relies solely on measurements derived from the HFU scanner, the issue of researcher bias was avoided. The methods used for the analysis are robust and have been applied in prior research.
Quality of Study
The study was undertaken effectively using a clearly outlined strategy. Its experimental nature and application of clear data collection and measurement strategies present a good way of understanding how the outcomes were generated and evaluated. This study applied an experimental strategy using animal subjects in a controlled environment (Moghimi, et al., 2010). Since the researcher induced the wounds in a controlled way and the resulting data from the ultrasound scans evaluated statistically, the resulting healing function is efficient in presenting an effective assessment of the healing process.
Implications for Practice and Future Research
The results of the research indicate that the HFU is an effective approach for assessing decubitus ulcers quantitatively through the development of the healing functions. The ultrasound shows clear differences and changes in the features of the wounds over the period. The analysis highlights the significance of the features and their differences over the time of the assessment. This study indicates the applicability of the high-frequency ultrasounds in wound analysis since it enables assessment of the deep tissue developments. The report clearly shows how the healing function varies over the period of the analysis and the differences in the variables of interest over the period. The findings present a clear way that can be used to assess the development of pressure ulcers and how they heal over time. The authors acknowledge the need for further research using histological studies to validate the results.
Conclusion
This study shows the applicability of a high-frequency ultrasound for assessment of decubitus ulcers and their healing over a period of 21 rays. The focus of the research was to assess the development of a healing function from the results of the ultrasound scans. The results of the analysis indicate that the ultrasound scans present a clear and effective strategy for assessing how the wounds develop and heal through assessment of deep tissue changes. Overall, the findings of the study are valid in indicating the applicability of the method as an evaluation strategy for decubitus ulcers.
Works Cited
1.Alison, P. et al., “Do High-Frequency Ultrasound Images Support Clinical Skin Assessment?” ISRN Nursing, 2013, pp. 1-5.
2. Tannen, A. et al. “Diagnostic accuracy of two pressure ulcer risk scales and a generic nursing assessment tool: A psychometric comparison.” Journal of Clinical Nursing, vol. 19, 2010, pp. 1510–1518.
3. Moghimi, S., Baygi, M. H., Torkaman, G., & Mahloojifar, A. “Quantitative assessment of pressure sore generation and healing through numerical analysis of high-frequency ultrasound images.” Journal of Rehabilitation Research and Development, vol. 47 no. 2, 2010, pp. 99-108.
4. Forster, F. K., Oledrud, J. E., Riederer-Henderson, M. A., & Holmes, A. W. “Ultrasonic assessment of skin and surgical wounds utilizing backscatter acoustic techniques to estimate attenuation.” Ultrasound Medical Biology. Vol. 16 no. 1, 1990, pp. 43–53.
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