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Background Pyoderma gangrenosum (PG) is a rare ulcerative skin condition with no current standardized outcomes or outcome measures. With a rich investigational therapeutic pipeline, standardization of outcomes and improvement of data quality and interpretability will promote the appropriate and consistent evaluation of potential new therapies. Core outcome sets (COS) are agreed, standardized sets of outcomes that represent the minimum that should be measured and reported in all clinical trials of a specific condition. Objectives To identify and reach a consensus on which domains (what to be measured) should be included in the Understanding Pyoderma Gangrenosum: Review and Analysis of Disease Effects (UPGRADE) core domain set for clinical trials in PG. Methods Collaborative discussions between patients and PG experts, and a systematic review of the literature identified items and prospective domains. A three-round international eDelphi exercise was performed to prioritize the domains and refine the provisional items (consensus: ≥ 70% of participants rating a domain as 'extremely important' and < 15% of participants voting 'not important'), followed by an international meeting to reach consensus on the core domain set (consensus: < 30% disagreement). Item-generation discussions and consensus meetings were hosted via online videoconferences. The eDelphi exercise and consensus voting were performed using Qualtrics survey software. Participants were adults with PG, healthcare professionals, researchers and industry representatives. Results Collaborative discussions and systematic reviews yielded 115 items, which were distilled into 15 prospective domains. The eDelphi exercise removed the three lowest-priority domains ('laboratory tests', 'treatment costs' and 'disease impact on family') and ranked 'pain', 'quality of life' and 'physical symptoms' as the highest-priority prospective domains. Consensus was reached on the domains of 'pain', 'quality of life' and 'clinical signs'. The domain of 'disease course/disease progression' narrowly failed to reach consensus for inclusion in the core set (32% of participants voted 'no'). Refinement of this domain definition will be required and presented for consideration at future consensus meetings. Conclusions The UPGRADE core domain set for clinical trials in PG has been agreed by international multistakeholder consensus. Future work will develop and/or select outcome measurement instruments for these domains to establish a COS. [ABSTRACT FROM AUTHOR]

The major populations at risk for developing pressure ulcers are older adults who have multiple risk factors that increase their vulnerability, people who are critically ill and those with spinal cord injury/disease. The reported prevalence of pressure ulcers in the United States is 2.5 million. However, this estimate is derived from acute care facilities and does not include people who are living at home or in nursing facilities. Despite the implementation of hospital and facility‐based preventive measures, the incidence of pressure ulcers has not decreased in decades. In addition to the burden of pain, infection and death, it is estimated that hospital‐acquired pressure ulcers cost the health system $26.8 billion annually with over 50% of the cost attributed to treating Stage 3 and 4 pressure injuries. Thus, it is critical to examine the literature and develop guidelines that will improve the outcomes of this complex and costly condition. This guideline update is a compendium of the best available evidence for the treatment of Pressure Ulcers published since the last update in 2015 and includes a new section based on changing demographics entitled 'Palliative wound care for seriously ill patients with pressure ulcers'. The overall goal of the Wound Healing Society Guideline project is to present clear, concise and commercial free guidelines that clinicians can use to guide care, that researchers can use to develop studies that will improve treatment and that both clinicians and researchers can use to understand the gaps in our knowledge base. [ABSTRACT FROM AUTHOR]

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Background: The National Health Service (NHS) is suffering from a workforce crisis of mental and physical sickness and attrition following the COVID-19 pandemic. An in-depth understanding of healthcare workers' (HCWs) experiences during the pandemic is required to understand the impacts on their mental health in this challenging work environment. This qualitative study explores HCWs' concerns during the COVID-19 pandemic-expressed in real time during an active mental health crisis., Design: This study involved analysis of data from 'Shout', a text message-based, UK-wide mental health support service which, during the pandemic, was advertised to HCWs specifically. Pseudorandom sampling of scripts of anonymised text message conversations between HCWs and Shout Volunteers from April 2020 to March 2021 was undertaken, with data fully anonymised by Shout before researchers accessed them on a secure purpose-built platform. Following application of exclusion and inclusion criteria, 60 conversations were coded to develop a thematic framework and analysed using grounded theory, with subthemes triangulated to create final themes. Quotes extracted from this process were then synthesised for publication., Results: Three themes emerged from the data: (1) poor mental health, subthemes-(a) overwhelming negative feelings or emotional distress experienced, and; (b) active crisis/resurgent symptoms. (2) Negative work experiences, subthemes: (a) negative NHS work culture and expectations; (b) inadequate structures and arrangements for support; (c) trauma at work, and (d) abuse at work. (3) The impact of the COVID-19 pandemic, subthemes: (a) additional work pressure and (b) isolation and risk., Conclusion: This study explores the challenges and mental health concerns in HCWs during an active crisis. Organisational stressors, mental health provision and additional resources for HCWs to recover from the pandemic remain a vital issue in current NHS service provision., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Non-healing wounds are particularly prevalent in older adults and in patients with multiple comorbidities and represent a significant medico-economic burden. Autologous split-thickness skin grafts (STSG) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell-suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS versus STSG., Study Design: Seven patients treated with ASCS were propensity-matched to 7 control patients who received STSG according to age and gender. The ASCS was prepared using the RECELL System and applied either alone as spray only ("ASCS alone", off-label) or combined with a widely meshed STSG ("ASCS+STSG", 3:1). The primary outcome was time to complete wound healing. Secondary outcomes included donor site healing, pain, and total number of visits. Statistical analyses included descriptive statistics, univariate analyses, and mixed-effect regression modeling to assess the impact of treatment on wound healing., Results: A total of 14 patients and 17 wounds (10 treatment vs 7 control) were included. Demographics were well-matched between cohorts. The overall mean wound healing time was 85.6±11.2 days. Wounds treated with ASCS (both ASCS groups) healed faster than STSG (75.9±4.5 vs 99.4±26.7 days). Wounds treated with ASCS alone healed in 80.8±5.1 days, while those treated with ASCS and STSG healed in 68.5±7.6 days., Conclusions: This study suggests ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared to traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Diabetic foot ulcers (DFUs) pose a significant challenge in wound care due to their chronic nature and impaired healing processes. This study examines the biogenic amines and small molecule metabolites present in DFU wound exudates to identify their potential roles in wound healing. Under an IRB-approved protocol, wound fluid samples were collected from 25 diabetic patients and analyzed using ultrahigh-pressure liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry. The analysis identified 721 metabolites, with 402 confirmed through stringent criteria. Key metabolites significantly contributing to the wound exudates include betaine, lactic acid, carnitine, choline, creatine, and metformin (a widely used first-line treatment for type 2 diabetes). These molecules are known to influence wound healing processes, such as collagen synthesis, angiogenesis, inflammation modulation, and energy metabolism. Notably, the presence of drugs such as metformin and beclomethasone in the exudates suggests significant pharmacodynamic interactions that could influence wound healing. Specifically, we discovered that the combined use of insulin and metformin administered systemically significantly increased the concentration of metformin in the wound exudates (from 0.3% ± 0.0 to 3.1% ± 3.4; p = 0.00 49). This study highlights the complexity of DFU exudate composition and underscores the potential for targeted metabolic profiling to develop personalized wound care strategies., Competing Interests: The authors declare the following competing financial interest(s): Morteza Mahmoudi discloses that (i) he is a co-founder and director of the Academic Parity Movement (www.paritymovement.org), a non-profit organization dedicated to addressing academic discrimination, violence and incivility; (ii) he is a co-founder of Targets Tip; and (iii) he receives royalties/honoraria for his published books, plenary lectures, and licensed patents., (© 2024 The Authors. Published by American Chemical Society.)