Case series of 3 Pressure Ulcers Cured with Education through Telemedicine

Hanbit Jin; Mijin Lee; Jungchul Kim; Baekki Min; Hoyoel Bang; Jungtae Leem; Jin, Hanbit; Lee, Mijin; Kim, Jungchul; Min, Baekki; Bang, Hoyoel; Leem, Jungtae

doi:10.13048/jkm.24029

JKM > Volume 45(2); 2024 > Article

Jin, Lee, Kim, Min, Bang, and Leem: Case series of 3 Pressure Ulcers Cured with Education through Telemedicine

Case Report

The Journal of Korean Medicine 2024; 45(2): 122-136.

Published online: June 01, 2024

DOI: https://doi.org/10.13048/jkm.24029

Case series of 3 Pressure Ulcers Cured with Education through Telemedicine

Hanbit Jin¹

, Mijin Lee²

, Jungchul Kim³

, Baekki Min⁴

, Hoyoel Bang⁵^{, 6}

, Jungtae Leem¹^{, 7}^{, *}

¹Department of Diagnostics, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

²Abuba Visiting Nursing Center, 388, Uijeongbu, Republic of Korea

³Kimjungchul Korean Medicine Clinic, 12-1, Daejeon, Republic of Korea

⁴Kibaek Korean Medicine Clinic, 325, Seongnam, Republic of Korea

⁵Dongbang Shintong bubu Korean Medicine Clinic, 111, Geoje, Republic of Korea

⁶Geoje Long-term care home medical center, 111, Geoje, Republic of Korea

⁷Research Center of Traditional Korean Medicine, College of Korean Medicine, Wonkwang University, Iksan, Republic of Korea

Correspondence to: Hoyoel Bang, Dongbangshintongbubu Korean Medicine Clinic, 111, Gohyeon-ro, Geoje-si, Gyeongsangnam-do, Republic of Korea, Tel: +82-55-632-4400, Fax: +82-504-010-9750, E-mail: rhrnal@daum.net

Correspondence to: Jungtae Leem, College of Korean Medicine, Wonkwang University, 460 Iksandae-ro, Iksan, 54538, Republic of Korea, Tel: +82-63-850-6914, Fax: +82-63-850-7324, E-mail: julcho@wku.ac.kr

Received February 5, 2024 Revised April 22, 2024 Accepted May 7, 2024

Abstract

Objectives

The case series with pressure ulcers who was cured by education through telemedicine will be presented as a model for how a Korean medicine doctor can participate in the telemedicine of pressure ulcers. We also aim to report on the perspectives of medical staff and patients regarding the improved telemedicine services in Korean medicine.

Methods

The study included three cases of pressure ulcers in home care, and education on pressure ulcer management was provided to patients, caregivers, and collaborators via telemedicine. Basic training was provided to teach the sealed wet dressing therapy method. After the basic training, feedback on the treatment was provided by taking photos or videos of the patient’s treatment process, and the feedback process was repeated until the dressing method was perfected.

Results

A combination of telemedicine, home visits, and home care successfully treated pressure ulcers in home care patients using a multidisciplinary approach. The education through telemedicine alone improved the National Pressure Ulcer Advisory Panel (NPUAP) stages and the total score of the Pressure Ulcer Scale for Healing (PUSH) Tool, and all three cases were finally cured with an average treatment duration of 26.7 days. The patient’s and clinician’s perspectives also showed that telemedicine can effectively engage patients, caregivers, and collaborators, and motivate them to manage pressure ulcers.

Conclusions

For patients having trouble visiting the hospital or desiring treatment at home, consideration can be given to telemedicine for traditional Korean medicine education in pressure ulcer management.

Keywords: Telemedicine, Pressure Ulcer, Korean Traditional Medicine

감사의 말씀

This work was supported by a National Research Foundation of Korea grant funded by the Korea government (No NRF-2022R1C1C2008738). This research was also supported by the Bio&Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No. RS-2023-00261934).

Notes

Supplementary video 1. Sealed Wet Dressing Therapy process:

https://www.youtube.com/watch?v=RMJBVZNZIGc

Fig. 1

Acupuncture on the buttock region of case2 patient.

Table 1

Baseline Characteristics of the Included Patients

	Case 1	Case 2	Case 3
Collaborators	Visiting nursing center(Nurse), Caregiver	Home visiting healthcare service(KMD), Caregiver	Caregiver
Sex	Female	Male	Female
Age	80s	20s	80s
Pressure ulcer history	None	Two times	Unknown
Cardiopulmonary disease	Yes	None	Yes
Urinary and fecal incontinence	Yes	Yes	Yes
Neurodegenerative diseases	Yes	None	Yes
Reduced physical activity	Yes	Yes	Yes
Onset date	2023.03	2023.04	2023.07
Start date for telemedicine	2023.08.30	2023.09.12	2023.08.31
End date for telemedicine	2023.09.25	2023.09.25	2023.10.10
Treatment duration	21 days	22 days	37 days
Number of telemedicine	3 times	2 times	1 time
Cure date	2023.09.20	2023.10.04	2023.10.10
NPUAP Pressure ulcer stages (first visit)	2 stage	2 stage	3 stage
Location of pressure ulcer	Coccyx	Buttocks	Sacrum
Number of pressure ulcer	1	1 for each	1
PUSH Tool 3.0 (first visit)
Length x Width	1.1^*1.9 (2.09)	Rt 1.4^0.3 (0.42) Lt 2.3^1 (2.3)	Unknown
Exudate amount	3	Rt 2 Lt 2	Unknown
Tissue type	2	Rt 2 Lt 2	3
Total score	10	Rt 6 Lt 9	Unknown

KMD; Korean Medicine Doctor, NPUAP; The National Pressure Ulcer Advisory Panel, PUSH; The Pressure Ulcer Scale for Healing

Table 2

The National Pressure Ulcer Advisory Panel Pressure Ulcer (NPUAP) Stages/Categories(2007)

Stage	Categories
1	Non-blanchable erythema Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Painful, firm, soft, warmer or cooler as compared to adjacent tissue
2	Partial thickness Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. An intact or open/ruptured serum-filled or serosanguinous filled blister. shiny or dry shallow ulcer without slough or bruising*.
3	Full thickness skin loss Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
4	Full thickness tissue loss Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling.

* bruising indicates deep tissue injury.

Table 3

Pressure Ulcer Scale for Healing (PUSH Tool 3.0)

Length x Width (cm²)	0	1	2	3	4	5
	0	0 ~ 0.2	0.3 ~ 0.6	0.7 ~ 1.0	1.1 ~ 2.0	2.1 ~ 3.0
		6	7	8	9	10
		3.1 ~ 4.0	4.1 ~ 8	8.1 ~ 12.0	12.1 ~ 24.0	>24

Exudate amount	0	1	2	3
Exudate amount	None	Light	Moderate	Heavy

Tissue type	0	1	2	3	4
Tissue type	Closed	Epithelial tissue	Granulation tissue	Slough	Necrotic tissue

Total score

Table 4

Clinical courses of Case 1

Case1	2023. 08. 30.	2023. 09 .06.	2023. 09. 11.	2023. 09. 20.
NPUAP stages	2	2	2	End of treatment
Length x Width (cm²)	1.1^*1.9	0.9^*1.1	0.6^*0.9	End of treatment
Exudate amount	3	2	1	End of treatment
Tissue type	2	1	1	End of treatment
Total score	10	6	4	End of treatment
Photograph
Photograph

The photo shows a horizontal and vertical view of the same area.

NPUAP; The National Pressure Ulcer Advisory Panel

Table 5

Clinical courses of Case 2 (Left buttock)

Case2	2023. 09. 11.	2023. 09. 20.	2023. 09. 25.	2023. 10. 04
NPUAP stages	2	2	2	End of treatment
Length x Width (cm²)	2.3^*1.0	1.5^*0.8	1.0^*0.5	End of treatment
Exudate amount	2	2	1	End of treatment
Tissue type	2	1	1	End of treatment
Total score	9	7	4	End of treatment
Photograph

NPUAP; The National Pressure Ulcer Advisory Panel

Table 6

Clinical courses of Case3

Case3	2023. 09. 01.	2023. 09. 26.	2023. 10. 10
NPUAP stages	3	2	End of treatment
Length x Width (cm²)	Unknown	Unknown	End of treatment
Exudate amount	3	1	End of treatment
Tissue type	3	1	End of treatment
Total score	Unknown	Unknown	End of treatment
Photograph

NPUAP; The National Pressure Ulcer Advisory Panel

참고문헌

1. Seo HS, Yoon HJ, Ko WS, Kim KJ, Kim NG, Kim YB, et al. Text of Traditional Korean Dermatology & Surgery. 1st ed. Busan:Sunwo Publishing Co;(2007). p. 376-80. (n.d.

2. Haesler E, editor. (2019). Prevention and treatment of pressure ulcers/injuries: Clinical practice guideline: the international guideline. 3. editionEpuap, European Pressure Ulcer Advisory Panel.

3. Mervis JS, & Phillips TJ. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology;81(4):881-890. https://doi.org/10.1016/j.jaad.2018.12.069

4. Brown J. (2016). The role of dressings in the prevention of pressure ulcers. British Journal of Nursing (Mark Allen Publishing);25(15 Suppl):S6-S12. https://doi.org/10.12968/bjon.2016.25.15.S6

5. Moon M. (2013). The characteristics related to the development of pressure ulcers in long term care facilities: The use of 2009 National Patient Sample. Journal of Korea Academia-Industrial cooperation Society;14(7):3390-3399. https://doi.org/10.5762/KAIS.2013.14.7.3390

6. Park KH, Kim JY, Park OK, Park JH, Lee YJ, & Hwang JH. (2019). Updates of Nursing Practice Guideline for Pressure Injury. Journal of Korean Clinical Nursing Research;25(1):67-79. https://doi.org/10.22650/JKCNR.2019.25.1.67

7. Doh G, & Heo C-Y. (2021). Pathogenesis and prevention of pressure ulcer. Journal of the Korean Medical Association;64(1):16-25.

8. Webster P. (2020). Virtual health care in the era of COVID-19. Lancet (London, England);395(10231):1180-1181. https://doi.org/10.1016/S0140-6736(20)30818-7

9. Kwon C-Y, Kwak H-Y, & Kim JW. (2020). Using Mind-Body Modalities via Telemedicine during the COVID-19 Crisis: Cases in the Republic of Korea. International Journal of Environmental Research and Public Health;17(12):4477https://doi.org/10.3390/ijerph17124477

10. Jang S, Kim D, Yi E, Choi G, Song M, & Lee E-K. (2021). Telemedicine and the Use of Korean Medicine for Patients With COVID-19 in South Korea: Observational Study. JMIR Public Health and Surveillance;7(1):e20236https://doi.org/10.2196/20236

11. Mun S-K. (2023). Non-face-to-face Treatment in Korea: Suggestions for Essential Conditions. The Korean Journal of Medicine;98(1):1-3. https://doi.org/10.3904/kjm.2023.98.1.1

12. National Evidence-based Healthcare Collaborating Agency. n.d. Research to explore application needs based on characteristics of telemedicine healthcare services. Retrieved December 4, 2023, from https://www.khidi.or.kr/board/view?pageNum=4&rowCnt=20&no1=555&linkId=48893885&menuId=MENU01522&maxIndex=00488963709998&minIndex=00488851739998&schType=0&schText=&schStartDate=&schEndDate=&boardStyle=&categoryId=&continent=&country=

13. Hong S. (2020). Design and implementation of healthcare system based on non-contact biosignal measurement. The Journal of The Korea Institute of Electronic Communication Sciences;15(1):185-190. https://doi.org/10.13067/JKIECS.2020.15.1.185

14. Woolhead G, Calnan M, Dieppe P, & Tadd W. (2004). Dignity in older age: What do older people in the United Kingdom think? Age and Ageing;33(2):165-170. https://doi.org/10.1093/ageing/afh045

15. World Health Organization. (2007). Global Age-friendly Cities: A Guide. World Health Organization.

16. Kim GH, Lee JY, Kim J, Kim HJ, & Park J-U. (2019). Prevalence of Pressure Injuries Nationwide from 2009 to 2015: Results from the National Inpatient Sample Database in Korea. International Journal of Environmental Research and Public Health;16(5):704https://doi.org/10.3390/ijerph16050704

17. Kim J-Y, Kim H-G, Kim S-G, & Lim S-H. (2019). A Review on Decubitus Ulcer treatment in Korean Medicine. The Journal of Korean Medicine Ophthalmology & Otorhinolaryngology&Dermatology;32(3):87-104. https://doi.org/10.6114/jkood.2019.32.3.087

18. Edsberg LE, Black JM, Goldberg M, McNichol L, Moore L, & Sieggreen M. (2016). Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System: Revised Pressure Injury Staging System. Journal of Wound, Ostomy, and Continence Nursing: Official Publication of The Wound, Ostomy and Continence Nurses Society;43(6):585-597. https://doi.org/10.1097/WON.0000000000000281

19. Thomas DR, Rodeheaver GT, Bartolucci AA, Franz RA, Sussman C, Ferrell BA, Cuddigan J, Stotts NA, & Maklebust J. (1997). Pressure ulcer scale for healing: Derivation and validation of the PUSH tool. The PUSH Task Force. Advances in Wound Care: The Journal for Prevention and Healing;10(5):96-101.

20. Kim K, Lee Y, Kim C, Lim H, Kang G, & Lee S. (2021). Case Report of Korean Medicine Treatment and Dressing Therapy for Grade III Trochanteric Pressure Sore. The Journal of Internal Korean Medicine;42(2):122-130. https://doi.org/10.22246/jikm.2021.42.2.122

21. Seo JB, Lee TJ, Kim KA, Lee JW, & Yoon JJ. (2022). A Case Report of 2 Cases of Severe Sacral Stage IV Pressure Ulcer in the Elderly Who Were Cured by Treatment with Jaungo and Acupuncture and Debridement. Journal of Physiology & Pathology in Korean Medicine;36(1):35-39.

22. Chae B. (1972). Korean medicine surgery. Seoul. Komoonsa;p. 311p. 312-407.

23. Lee J-C, & Kim G-J. (2015). Effects of Gamijaungo on the burn mice model and the study of hematologic, pathologic and molecular mechanism. The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology;28(1):53-67. https://doi.org/10.6114/jkood.2015.28.1.053

24. Kim K-S, Cho N-O, & Park Y-S. (n.d). A Study on Prevalence and Nursing Intervention of Bed Sore Patients who Received Regional Home Care Services. Journal of Korean Academy of Fundamentals of Nursing;4(1):43

25. Fabbri M, Caldas AC, Ramos JB, Sanchez-Ferro Á, Antonini A, Růžička E, Lynch T, Rascol O, Grimes D, Eggers C, Mestre TA, & Ferreira JJ. (2020). Moving towards home-based community-centred integrated care in Parkinson’s disease. Parkinsonism & Related Disorders;7821-26. https://doi.org/10.1016/j.parkreldis.2020.07.001

26. Ministry of Health and Welfare. n.d. Starting in January, 61 cities, counties, and districts and 83 long-term care home health centers will begin offering home health services. Retrieved January 10, 2024, from https://www.mohw.go.kr/board.es?mid=a10503000000&bid=0027&cg_code=

27. Soo-Youn J, Mina P, & Moon KJ. (2022). Effectiveness of Devices for Prevention and Treatment of Pressure Ulcers: A scoping Review. Korean Journal of Adult Nursing;34(2):123-136. https://doi.org/10.7475/kjan.2022.34.2.123

28. Kim JY, Park KH, Park OK, Park JH, Lee YJ, & Hwang JH. (2023). Updates of Evidence-Based Nursing Practice Guidelines for Pressure Injury. Journal of Korean Clinical Nursing Research;29(1):12-23. https://doi.org/10.22650/JKCNR.2023.29.1.12

29. Ministry of Health and Welfare. n.d. Third Long-Term Care Master Plan. Retrieved January 18, 2024, from https://www.mohw.go.kr/board.es?mid=a10107010100&bid=0040&act=view&list_no=1479340&tag=&cg_code=&list_depth=1

30. Kim KS, Cho NO, & Park YS. (1997). A study of pressure ulcer development and nursing interventions among home care recipients. Journal of Korean Academy of Fundamentals of Nursing;4(1):43-60.

31. Zhang X, Zhu N, Li Z, Xie X, Liu T, & Ouyang G. (2021). The global burden of decubitus ulcers from 1990 to 2019. Scientific Reports;11(1):Article 1. https://doi.org/10.1038/s41598-021-01188-4