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Research Spotlight

An International Partnership To Eliminate Pressure Ulcers


The UCLA School of Nursing is very proud to be hosting Gojiro Nakagami PhD, RN, Assistant Professor University of Tokyo whose Field of Study is wound infection control, and pressure ulcer prevention.

The ability to predict the development of a pressure ulcer in its early stages is a vital tool in the field of wound care. In his efforts to make this process more efficient, Dr. Gojiro Nakagami took up the chance of a lifetime to work alongside resident faculty member and renowned wound-care specialist Dr. Barbara Bates-Jensen in her research regarding wound care.

 

 

 

"Dr. Bates-Jensen is one of the most famous wound researchers in the world and her textbook "Wound Care" is a kind of bible for learning wound research," noted Nakagami.  "She has a great knowledge ranging from basic science to clinical situation and has been conducting high quality research. I wanted to see how such an excellent work can be done."

 Nakagami's research mainly focuses around effective detection of pressure ulcers and, ultimately, prevention of damage in patients with an extremely bony prominence (that is areas of the body at the greatest risk for developing pressure sores). Previous research concluded that, in Japan, pressure ulcers make up about 3% of patients in the hospital and 5% of people receiving home care. The reason for this stems from the fact that older patients tend to have more extreme bony prominences.

Nakagami additionally notes that, in Japan like in the USA, nurses are advised to turn and change a patient's position frequently so as to lessen pressure on the bony prominences. While these measures have made a significant difference to ailing patients, they are not infallible. Thus, pressure damage may arise from a variety of reason including:  misuse of medical equipment,incorrectly repositioning patients, failure to repositioning patients at routine intervals, incorrect use of support surfaces, and even poor nutrition. Unfortunately, because of how costly and devastating pressure ulcers can be to both the patient and the healthcare system, nurses are constantly faced with this problem developing with their patients.

Presently, a visual skin assessment of the patient's bony prominences is used by nurses to detect early pressure ulcers in patients. However, this type of visual assessment is difficult to conduct in persons with darkly pigmented skin because it requires the health care provider to detect redness and to analyze subjective coloring of the skin which is challenging in persons with dark skin tones. Thus, there exists a health disparity for people with dark skin tones as prevention strategies are not implemented in a timely manner.

Pressure ulcers are considered a measure of care quality in all health care settings around the world and the prevalence of pressure ulcers is likely to increase as the population ages. Thus, the subjective methods of visual assessment are no longer sufficient or effective for adequate prevention of pressure ulcers for all persons. Nakagami is currently working with Bates-Jensen to test a device that can more efficiently assess and evaluate early pressure ulcers for all patients. This device measures the amount of water in the skin and tissues in the skin in order to gauge the presence of inflammation, an early indicator of tissue damage. The ability to identify damage at such an early level may lead to interventions to prevent pressure ulcers from occurring dramatically improving the quality of life for many frail, vulnerable patients. As of late December of 2013, Nakagami and Bates-Jensen had entered the clinical stage of their research. Bates-Jensen designed the device, the SEM Scanner, with the assistance of Professors from the UCLA Wireless Health Institute (WHI). The SEM Scanner is currently being tested in a clinical setting with a variety of other instruments to determine the validity of the readings from the device. The device provides reading indicating the amount of water in the skin and tissues with higher reading indicating more water and thus, edema and early inflammation with higher likelihood of pressure damage. If the clinical testing is a success, this tool will be revolutionary in offering nurses the opportunity to react and alter preventive care of all patients and decrease health disparities in prevention care for patients with dark skin tones.  

Previous Spotlights:

Isabel Mak and Gene Therapy -
One Student's Experience In Groundbreaking Research

UCLA Nursing students are offered a unique experience very few other nursing schools offer - the chance to work on research being performed by nursing school faculty. And in this case, something groundbreaking: translational research for the development of a novel treatment for HIV cure.

As a third year Bachelors of Science student majoring in Nursing, Isabel Mak was presented with the incredible opportunity to be a part of an exciting research study that is working towards developing a genetically engineered immunity against AIDS. This opportunity arose after she inquired about the possibility of doing research with one of the School faculty and was connected with Professor Dong Sung An.


In his lab, An is attempting to develop an immunity to HIV infection via genetic engineering of blood stem cells. His research mainly revolves around the expression of small interfering RNA against CCR5 to confer HIV resistance. CCR5 (C-C chemokine receptor type 5) is one of the key molecules in the immune system HIV utilizes as a viral receptor to enter and infect human cells. Amazingly, it has been discovered that approximately one percent of the Caucasian population does not express CCR5 and they are naturally immune to HIV. Dr. An's plan is to mimic the natural HIV resistance by a gene therapy strategy to remove the HIV receptor CCR5 from patient blood stem cells and confer HIV resistance.


In the lab, Mak has learned and experienced molecular biological techniques such as how to amplify cloned plasmid DNA by transforming bacteria and how to purify the plasmid DNA. Lately, Mak has been learning DNA recombination techniques by essentially cutting and pasting to create a new DNA that will then be examined for HIV inhibition. While these techniques may seem like very basic research, each one of these steps is building towards a potential cure for HIV infection.


What Mak finds most fascinating about her research in Dr. An's lab is that her newly prepared recombinant DNAs have the potential to make an unimaginable difference -- its application could ultimately treat HIV patients in the future. Coincidentally, at the time she started working at the lab, Mak was taking a Microbiology, Immunology and Molecular Genetics course that delved into the complexities of HIV and AIDS. Suffice it to say, for Mak, this made the research opportunity all the more interesting. She can now envision that the research she has involved in can be translated into clinic in someday to cure HIV patients. What was initially a position that she acquired to gain experience turned out to be so much more fascinating, not to mention rewarding, than she had envisioned.


Mak also finds the techniques that she has learned in the research lab can be applied for her future nursing practice. In order to clone DNA constructs, she has to pay attention to many details such as sterilizing techniques, personal protection and proper handling of biohazardous agents. Mak also recognizes that research requires critical thinking, rigorous data interpretation and decision making to obtaining meaningful results and that research takes a long time.


But most importantly, all of this experience is laying the groundwork for Mak to be a nurse with exceptional creativity and a strong scientific foundation.

Decision Making in Breast Cancer Treatment - Why Some Women Over 65 Say "No Thank You"

Breast cancer is the most commonly diagnosed cancer in women, and, after lung cancer, is the most deadly. In the United States alone, approximately 110 women die every day from breast cancer related complications. While no one may have a concrete answer as to why some women develop breast cancer, there are countless risk factors that can place some at a greater risk than others of being diagnosed including heredity, being overweight, gender, and age.

It is the latter of these factors - aging -- that research reveals to be quite disturbing. Of all the women who develop breast cancer, 41 percent of women are over the age of 65, and sadly, 57 percent of the women in that age group end up dying from the disease itself. This uneven distribution among the geriatric population dealing with breast cancer is largely due to a lack of optimal treatment.

The question then arises:  why are some women above the age of 65 obtaining suboptimal treatment to their life-threatening disease?  First, it is important to note that breast cancer is a group of different diseases, and, as a result, requires individualized treatment. Early stages of breast cancer can be treated with radiation, surgery chemotherapy and hormone therapy. For women over the age of 65 who are more likely to develop estrogen-related breast cancer, a very effective treatment is often the use of a hormonal therapy known as aromatase inhibitors (AI). Studies have shown that hormonal treatment can indeed increase the likelihood of disease-free survival.

But, there is an astonishing rate of women over the age of 65 who choose to stop using this life saving treatment. In fact, about 30-49% of women 65 and older have discontinued use of AI treatment within their first year. To uncover the reasoning behind this issue and what influences these women's decisions to discontinue use of the treatment, Dr. Huibrie Pieters is studying women over the age of 65 who are either currently on an AI medication or who have discontinued its prescription. Her research is primarily focused on what contributed to the women's decisions to either continue or discontinue treatment.  Women in the study, known as "In Her Own Words" will participate in in-depth interviews concentrated on how they receive, interpret, and make decisions and, eventually, how they act on the information that they receive.

Earlier studies on AI treatments have suggested that a leading cause for the discontinued use of the AI treatment for women over 65 may be partly to do with the harsh side effects of AIs, such as arthralgia syndrome, hot flashes, joint and muscle pain, loss of bone density, and heart problems. Thus, Dr. Pieters will also explore how women over the age of 65 who have attempted or discontinued the treatment have managed the side effects of the AI medication.
The long-term goal of this study is to decrease the premature mortality rates of older women by helping them to make informed decisions by addressing their issues and advising them about their options. This can ultimately lead to dealing with the discontinuation of treatment for other areas of oncology for women over 65. This study will also garner an understanding for how women over 65 interpret and act with the information that they receive and how they go about making the decision that leads to whether or not they choose to discontinue treatment for a disease. Eventually, this study can be used as a foundation on which some form of intervention can be developed to help older women through the process of deciding whether or not they should discontinue use of a treatment, especially one that can potentially be lifesaving.

 

AI SHENG NUO - LOVE, LIFE AND PROMISE FOR THOSE LIVING WITH HIV

HIV was first recognized in China in 1985 and, ever since, has become an issue of growing concern, particularly in the rural areas of China. In fact, HIV was the leading cause of deaths from infectious disease in China in 2009. It is important to note that the social stigma associated with carrying the virus keeps many a patient from being tested for HIV and, in turn, seeking treatment. Current data suggest that in the United States only about 20 percent of HIV infected individuals are even seeking treatment; the proportion is likely much greater in China.

To find a more effective strategy for delivering treatment for HIV and AIDS, Professors Ann Williams of the UCLA School of Nursing and Honghong Wang of the Xiangya School of Nursing have collaborated to seek a resolution to this crisis. The answer came in the form of their long-standing project Ai Sheng Nuo. Ai Sheng Nuo is a nurse-led intervention that provides support to people living with HIV in their homes, with the goal of empowering patients and their families. This project originated from a 15-year standing partnership between U.S. and Chinese nurses aiming to spread awareness of the HIV issue to their fellow colleagues. Eventually, it grew to include prevention and treatment options to aid at-risk individuals in China.

The aim of Ai Sheng Nuo is to improve HIV/AIDS adherence in China and, eventually, to suffering patients around the world. This is accomplished through the Adherence Through Home Education and Nursing Assessment intervention model, originally developed in the United States. Through this model, nurses work with patients and their families to identify barriers to care and to develop strategies to improve care, including adherence to life-saving medications. Through routine at-home visits, the intervention has successfully shown both an increase in the level of adherence and a decrease in long term depressive symptoms of the patients participating in the study. In the future, the project aims to expand its wings and become available to all areas of China. Through a spread of increased understanding of antiretroviral therapy adherence and the factors involved with antiretroviral resistance added to routine interventions to improve adherence, Ai Sheng Nuo will make a significant impact on HIV and AIDS adherence and treatment.

Read more about this inspiring work published in International Innovation. 

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