bluuebunny/crossref_metadata_2025 huggingface dataset:
A new role for nurses: PD catheter insertion using local anaesthetic
Authors: Bowes Elaine
Published: May 2014

Elaine Bowes, a senior peritoneal dialysis (PD) sister, describes her experience of being trained to perform percutaneous PD catheter insertions under local anaesthetic. Here she shares her exciting experience, advocating this new role to help facilitate a nurse-led PD service.
book reviews
Authors: Jones Chris
Published: May 2014

Renal palliative care has come into focus lately with renal specific palliative care nurses a fairly common sight in units across the country. This stems from the realisation that renal replacement therapy (RRT) may not be the most appropriate treatment for some patients. Research into the field has suggested that for some, RRT does not prolong life any longer than purely supportive ‘palliative’ care. However, this has been shown for a very small proportion of patients, those who are very elderly with very significant comorbid illness. One could quite rightly express concern that palliative or ‘conservative care’ has perhaps reached the point whereby it is seen as a modality, such as peritoneal dialysis or haemodialysis, when in actual fact it should be held in reserve for those with very poor prognosis.
Common psychological problems experienced by renal patients
Authors: Major Beth , Glass David
Published: May 2014

Beth Major and David Glass give an overview of the psychological and social consequences patients with chronic kidney disease may experience. They describe each of the potential psychological and social problems renal disease, dialysis and transplantation may lead to and what can be done to help.
Acute peritoneal dialysis: expanding the treatment options
Authors: Peto Phillipa
Published: May 2014

Philippa Peto looks at the treatment options for late-referred patients with chronic kidney disease. She examines why haemodialysis is often the main treatment option for these patients and argues that with the right awareness and training, peritoneal dialysis is a safe and effective alternative.
The role of the social worker on the renal unit
Authors: Latchford Jenny , Corley Debbie , Hallatt Julie
Published: May 2014

Jenny Latchford, Debbie Corley and Julia Hallat, three renal social workers in York, explain the role of renal social workers on the multidisciplinary team and how they contribute to the wellbeing and care of renal patients. They also highlight that more renal social workers are needed in the UK.
Giving everyone a voice: the role of renal healthcare assistant
Authors: Culpitt Tracie
Published: May 2014

Here Tracey Culpitt gives an account about her role as healthcare assistant (HCA) at the Dartford haemodialysis unit. With enthusiam and passion she describes her role as HCA and the challenges she and her HCA colleagues are presented with on a daily basis.
Identifying and influencing cultures of care in the renal unit
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Peter Ellis and Jane Abbott explain how renal unit managers can influence the culture they work in, taking into account the feelings and observations of all stakeholders in the renal unit. They further establish the need to develop good values within the team, with a focus on good care outcomes.
Dropsy, nephrosis, nephrotic syndrome: First treatment for an ancient problem, 1950
Authors: Turner Neil
Published: May 2014

Dropsy is an ancient word (first recorded about 1290 AD) meaning oedema. Generalized oedema can be caused by heart, liver or kidney disease, or by malnutrition. In all of these it was a pretty bad sign in ancient medicine as it meant the patients had advanced disease that was likely to kill them. By the early 1800s, it was realized that some patients with dropsy had albumin in their urine. Richard Bright, working at Guy's Hospital in London, showed that kidney disease could cause dropsy. His studies, published in 1827, were mostly postmortem, and his patients had advanced renal failure, but he also realized that some patients had low levels of albumin in their blood because it was leaking from their kidneys. What we now call glomerulonephritis was for over a century known as Bright's Disease.
The climate or kidney care: which one should we change?
Authors: Connor Andrew
Published: May 2014

Andrew Connor's article provides a simple explanation of climate change and outlines how and why renal medicine has been among the first specialties to begin to pursue the necessary changes in infrastructure and practice to develop more sustainable healthcare.
Assessing patients with anaemia in chronic kidney disease
Authors: Pickard Susan
Published: May 2014

Susan Pickard explains how to assess anaemia in patients with chronic kidney disease (CKD). The patient assessment process is informed by an understanding of the multiple possible causes of anaemia in kidney patients. Susan Pickard describes the recommended and relevant laboratory investigations and how to interpret the results.
My cousin—the doctor and donor
Authors: Scoble Derek , Scoble John
Published: May 2014

Derek and John are cousins—when Derek developed kidney disease he turned to John, who happens to be a kidney consultant, for help and support. When transplantation became the only option to save Derek's life, John volunteered to become Derek's live kidney donor—putting theory into practice.
How I became a peer supporter
Authors: Sweetinburgh Tracy
Published: May 2014

Lucy Jolin spoke with Tracey Sweetingburgh who became a peer supporter for life-transplant patients after she underwent her own successful kidney and pancreas transplant. Here she tells us how she first found out that she suffered from kidney disease and her extraordinary journey to recovery.
Renal social workers: vital members of the renal multidisciplinary team
Authors: Murdoch Ann
Published: May 2014

Renal social work is vital in helping the multidisciplinary team to provide good holistic care to renal patients. Ann Murdoch explains the role of social workers and how they are supporting patients on renal replacement therapy, illustrating this with two case histories. She also points out how across Great Britain renal work is under-sourced, and not enough support is delivered to patients.
The foundation of good nursing practice: effective communication
Authors: Jones Ann
Published: May 2014

Ann Jones looks at communication—one of the fundamentals underpinning good nursing practice. Effective communication is particularly needed in the renal setting where patients are often ill long term, have complicated medical histories and need the help of a multidisciplinary team. It is at the heart of holistic patient care. Communication skills can be developed and useful tools are available.
On the agenda: shared haemodialysis care
Authors: Dainton Marissa , Wilkie Martin
Published: May 2014

More and more renal units at hospitals in the UK encourage patients to participate in their own treatments. This is a natural follow-on from the Department of Health's agenda of increasing patients’ involvement in their own health care. Here Marissa Dainton and Martin Wilkie relate their experiences of promoting self care and shared care at their hospitals’ renal units.
Common medications prescribed for transplantation patients
Authors: Coleman Adrian
Published: May 2014

Organ rejection is a major barrier to renal transplantation and the cost of immunosuppressants used for maintenance has been estimated at around £5000 per patient per year. In this article, pharmacist Adrian Coleman defines three classes of immunosuppressant medication, their mechanisms of action and their side effect profiles.
Measurement of breast skin viscoelasticity and a pilot study on the potential radioprotective effect of a zinc-based cream
Authors: Gorodetsky R. , Andriessen A. , Poliansky I. , Vexter A.
Published: May 2014

Radiation-induced late skin effects were studied in patients with breast cancer in relation to different protocols of fractionated radiotherapy in three different medical centres, in Israel, the UK and the USA. The mechanical properties of skin were evaluated in breasts of healthy volunteers, and non-irradiated and irradiated breasts of patients, using a newly developed viscoelasticity skin analyser (VESA). The increase of the dose of radiation per fraction was found to have more impact on the development of radiation-induced late skin effects than the elevation of the total dose given.

In addition, a pilot study on the possible radioprotective effect of external application of a cream containing zinc oxide on radiation-induced early skin changes in patients with breast cancer was initiated. Non-invasive measurement of trace elements and zinc pharmacokinetics in the skin of healthy controls following the application of the zinc oxide cream were performed by unique diagnostic X-ray spectrometry (DXS). Application of the cream, followed by thorough skin cleansing, significantly increased the amount of residual zinc in the skin, but continuous daily treatment did not cause further build-up of the dermal zinc level. The radioprotective effect of the zinc oxide cream on the skin is now being studied.
Graduated compression and the prevention of deep vein thrombosis (Part 2)
Authors: Thomas S.
Published: May 2014

The second of this three-part literature review discusses the effects of external compression on blood flow.
Pharmacological treatments for venous leg ulcers
Authors: Renton E.J.
Published: May 2014

A review of drug therapies used in the management of venous leg ulcers.
Leg ulcer care in the community
Authors: Carnegie A.
Published: May 2014

This case study reports on the assessment and treatment at home of an elderly man with a venous leg ulcer.
Using information technology in wound management
Authors: Russell L.
Published: May 2014

The use of a hospital information system to improve wound documentation and assessment.
The supply of dressings by hospital pharmacy departments in Wales
Authors: Thomas S.
Published: May 2014

A research project to examine the dressings and wound management materials supplied by pharmacy departments in Wales was carried out. Data were collected from the NHS computer database, which contains information on 17 hospitals, servicing 80-90% of the Welsh population. Over a 12-month period, hospital pharmacy departments throughout Wales issued dressings and related materials costing £2.1m. As not all pharmacy departments supply the full range of dressings used in hospitals, and only one issues surgical sutures, this sum probably represents less than half of the total expenditure in Wales on this commodity group.

Existing methods for recording the issue of dressings do not provide reliable information either on the range of products used or the total quantities issued throughout Wales. Despite expectations to the contrary, hospital use of dressings did not appear to have a major influence over prescribing patterns in the primary sector. The amount of cavity wound dressings that are supplied on an outpatient basis suggests a real need for these items to be available in the community. (Since completion of this study, cavity wound dressings have been added to the Drug Tariff.)
The use of proteases as prognostic markers for the healing of venous leg ulcers
Authors: Hoffman R. , Noble J. , Eagle M.
Published: May 2014

Abnormally high levels of some proteases are associated with pathological changes in the wound bed of venous leg ulcers. This study involved two experiments which measured proteases in wound fluid harvested from leg ulcers in order to predict healing. In the first experiment, neutrophil elastase, a protease, was harvested from wound fluid extracted from the bandages of seven patients with leg ulcers. This was undertaken once a week over a period of up to six weeks. The amount of elastase recovered from the bandages showed wide variation between patients and there was no consistent correlation between the activity of elastase and healing of the ulcers, as determined nine months after sampling for the enzyme.

The second experiment determined the stability of neutrophil elastase that was added to bandages for one week. The stability was found to vary from approximately 50% to 100%, depending on the type of bandage used.

In addition to the possibility of using protease measurements to predict healing, the procedure was found to be simple, non-invasive and relatively inexpensive, and could be performed routinely in the clinic.
The challenge of outcome measures in chronic wounds
Authors: Price P.
Published: May 2014

A review of the methods that are available for the evaluation of treatments and services for patients with wounds.
A clinico-epidemiological profile of non-healing wounds in an Indian hospital
Authors: Saraf S.K. , Shukla V.K. , Kaur P. , Pandey S.S.
Published: May 2014

One hundred patients with non-healing wounds of more than six weeks' duration were studied for clinico-epidemiological factors and their correlation with healing time. The majority of subjects were aged 30–59 years; those aged 50 and over had significantly delayed healing. The majority of subjects were farmers and physical labourers. Leprosy was the most common cause of non-healing wounds, followed by diabetes, trauma and venous ulcers; the lower limbs were the most common site of involvement. Diabetic wounds were more common in those aged 40 years and above. Diabetic wounds were slower to heal than others. The duration of wound did not alter the healing time. The others were lost to follow-up or excluded for other reasons.
Flap monitoring after head and neck reconstruction: evaluating an observation protocol
Authors: Devine J.C. , Potter L.A. , Magennis P. , Brown J.S. , Vaughan E.D.
Published: May 2014

This study evaluated the postoperative free-flap monitoring frequency protocol used in a maxillofacial unit for patients receiving free-tissue transfer for reconstruction following orofacial cancer. All free-tissue transfers undertaken in the unit between January 1992 and October 1998 were reviewed retrospectively.

Of the 370 patients evaluated, 46 returned to theatre with compromised free flaps. The compromise was purely venous in origin in 37 of these cases, arterial in three and due to a combination of arterial and venous problems in six. Thirty-five of the flaps were successfully salvaged. On average, the clinical manifestation of the problem occurred 25.5 hours postoperatively. However, there was a significant time difference between flaps that were salvaged successfully and those that were not: in the salvaged group the compromise was identified 17.5 hours postsurgery compared with 51 hours for the unsuccessful group. The timing of the return to theatre following the identification of the compromise was a significant factor in the success rate: 71 minutes for those salvaged and 103 minutes for those not salvaged.

It is recommended that flaps are monitored hourly for the first 72 postoperative hours and observations recorded on a chart.
Collaboration is the best way to avoid duplication
Authors: Baxter H.
Published: May 2014

Too many trusts are developing guidelines and initiatives already in place elsewhere. A co-ordinated network of regional groups with a remit to develop national strategies and guidelines may help avoid this.
Malignant wound management: what dressings do nurses use?
Authors: Wilkes L. , White K. , Smeal T. , Beale B.
Published: May 2014

This paper reports on the findings from the first part of a three-phase project that aimed to identify nursing strategies used in the management of malignant wounds. The difficulties relating to the management of these wounds and the significant physical and psychological impact on patients are described.

A quantitative postal survey aiming to identify the types of dressing used in the care of malignant wounds was sent to specialist nurses working in oncology and palliative care in New South Wales, Australia. Additional qualitative data showed that the major issues were coping with odour and meeting the financial costs of the dressing products. The long list of products compiled for this research demonstrates the complexities nurses face when selecting dressings for the management of malignant wounds. Furthermore, there are no clear recommendations to guide nursing practice.

This study provides a framework for subsequent phases of the project and will hopefully lead to the development of guidelines for best practice in malignant wound management.
Nurses' evaluation of a new four-layer bandage system
Authors: Lane C. , Franks P.J.
Published: May 2014

This small study was undertaken to evaluate a new four-layer bandage (4LB) system (Ultra Four, Robinson). The aim was to provide initial user information about the product and compare it with the previously used original Charing Cross 4LB system. Subjective evaluations of the comparative performance of the Ultra Four system were assessed using a weekly treatment questionnaire in 30 patients. Both patients and nurses commented on the usability of each individual layer and the overall performance of the new system over a period of up to 12 weeks or until healing.
How we keep the truth from patients the NICE way
Authors: Bennett G.
Published: May 2014

The NICE guidelines on pressure ulcer assessment and prevention do not go far enough in encouraging practitioners to accept responsibility for poor-quality care, argues Gerry Bennett
Tissue viability programmes at the University of Hertfordshire
Authors: Flanagan M.
Published: May 2014

Good practice requires an in-depth understanding of wound management and tissue repair, as well as critical-thinking skills. These education programmes give students an opportunity to develop these qualities.
Questions & Answers
Authors: Baxter H.
Published: May 2014

The editor welcomes readers' questions.These should be sent to the Journal of Wound Care. Fax: +44 (0)20-7874 0386. Email: jwc@emap.com
From the journals
Authors: Baxter Helena
Published: May 2014

The aims of this qualityimprovement programme, undertaken at Maitland District Hospital, Australia, were to reduce infection rates following joint replacement in line with ‘international best practice’ rates (0.69–1.77%) within three months and to 0% within one year.
Therapeutic management of problematic superficial wounds: a patient-centred approach
Authors: Natsui M.
Published: May 2014

Wounds involving surface tissue loss often present in clinical practice. These case studies describe how a treatment regimen that allowed practitioners to change from one dressing to another faciliated healing in problem wounds of this type.
A reappraisal of the role of cerium in burn wound management
Authors: Lansdown A.B.G. , Myers S.R. , Clarke J.A. , O'Sullivan P.
Published: May 2014

A rare earth element, cerium, was introduced as an antibacterial agent in 1976 but has rarely been used due to the emphasis on wound excision. Used in combination with silver sulphadiazine, it may improve patient survival when excision is not possible.
Are honey and sugar paste alternatives to topical antiseptics?
Authors: Booth S.
Published: May 2014

Using topical antiseptics on critically colonised wounds is controversial as they can damage the host tissue. Honey, when diluted, produces the antiseptic hydrogen peroxide at a low concentration that does not threaten cellular viability
Nutritional supplementation for diabetic foot ulcers: the first RCT
Authors: Eneroth M. , Larsson J. , Oscarsson C. , Apelqvist J.
Published: May 2014

Objective:

To determine if oral nutritional supplementation improved wound healing in malnourished patients with diabetic foot ulcers when compared with a placebo.

Method:

This prospective randomised controlled double-blind trial involved patients aged over 60 with diabetes mellitus and a Wagner grade I–II foot ulcer of over four weeks’ duration. Patients received either 400ml (400kcal) oral nutritional supplementation (n=26) or 400ml placebo (n=27) daily for six months. Patients were followed monthly for six months and after one and two years.

Results:

A third of the patients were classified as having protein-energy malnutrition at inclusion, with no difference between the two groups. Critical leg ischaemia was more common in the intervention group than in the placebo group (p=0.008). Nine patients in the intervention group (35%) and four in the placebo group (15%) dropped out of the study (not significant). Of those who completed the study, the wound had healed at six months in eight out of 23 patients (41%) (placebo) and in seven out of 17 (35%) (intervention) (not significant). Twenty-four per cent of patients with protein-energy malnutrition at inclusion had healed at six months compared with 50% of those without it (not significant).

Conclusion:

This is the first study to evaluate the possible benefits of nutritional supplementation on diabetic foot ulcers. A third of patients were malnourished. We encountered several methodological problems and were unable to demonstrate an improved wound healing rate in these patients.

Declaration of interest:

This study was sponsored by a grant from Nutricia AB, Netherlands.
Pressure ulcer prevention: nurses’ knowledge, attitudes and behaviour
Authors: Moore Z.
Published: May 2014

Pressure ulcers are localised areas of tissue damage caused by excess pressure, shearing or friction forces. They occur in individuals who cannot tolerate the effect of these forces, with older people being the most vulnerable group. Despite advances in modern technology and the huge array of preventive equipment available, pressure-ulcer incidence is not declining.
Effects of diabetes mellitus on wound healing: an update
Authors: Lioupis C.
Published: May 2014

Many factors contribute to impaired wound healing in diabetic patients. This paper examines the effect of diabetes mellitus on wound healing and how vascular, neuropathologic, cellular, immune function and biochemical abnormalities affect the wound-healing process.
Evaluation of the quality of venous leg ulcer care given in a multidisciplinary specialist centre
Authors: Kjaer M.L. , Sorensen L.T. , Karlsmark T. , Mainz J. , Gottrup F.
Published: May 2014

Objective:

To determine the quality of venous leg ulcer care given in a multidisciplinary, specialist wound-healing centre and to identify problem areas that might affect it.

Method:

The case records of 90 consecutive patients with venous leg ulcers, diagnosed and treated at the Copenhagen Wound Healing Centre, Denmark, were retrospectively audited by a Scandinavian cross-sectional and multidisciplinary expert panel. Quality of care was audited in each case using implicit criteria. The experts then formulated key recommendations for good clinical practice for patients with venous leg ulcers.

Results:

Quality of care was satisfactory in 74 patients (82%). The one-year healing rate was 77% (69/90), with a three-month recurrence rate of 12% (11/90). Identified problem areas included the lack of systematic assessment of patients’ suitability for surgery; lack of systematic, duplex-verified diagnoses of venous aetiology; and the lack of systematic examination of distal arterial pressure. The recommendations include the need for venous diagnosis, differential diagnosis, compression therapy, surgery, systemic treatment, access to venous leg ulcer care and better communication.

Conclusion:

The quality of venous leg ulcer care given in this multidisciplinary centre was satisfactory.

Declaration of interest:

None.
Wound pain: the need for a more understanding approach
Authors: Clay C.S. , Chen W.Y.J.
Published: May 2014

Many patients with wounds suffer from chronic pain that causes considerable distress and disruption. Studies have attempted to quantify the number of patients who experience pain, as well as its level and nature. They have also considered the attitudes of caregivers and the methods used to alleviate pain caused during wound manipulation, such as dressing changes.
The impact of warming on pain and wound healing after hernia surgery: a preliminary study
Authors: Melling A.C. , Leaper D.J.
Published: May 2014

Objective:

To determine whether the application of warmth after hernia surgery reduces pain and aids wound healing.

Method:

Forty-five patients were recruited and randomised to receive either no warming; two hours of warming immediately after surgery; or seven days of warming.

Results:

Postoperative pain scores were significantly lower after two hours of warming immediately after surgery compared with the non-warmed patients (p<0.05). Pain scores were lower on each of the first seven postoperative days in the warmed groups compared with the non-warmed subjects. Patients in the warmed groups also had lower ASEPSIS wound scores.

Conclusion:

Warming may allow wounds to heal with fewer complications. In addition, warming for only two hours immediately after surgery may provide similar benefits to seven days of warming.

Declaration of interest:

This study is part of a research programme part-funded by a competitive research grant from Augustine Medical, which also provided warming equipment at no cost. Since the study was conducted, DJL has become an independent adviser to Arizant (formerly Augustine Medical).
Biophysical effects of repetitive removal of adhesive dressings on peri-ulcer skin
Authors: Zillmer R. , Agren M.S. , Gottrup F. , Karlsmark T.
Published: May 2014

Objective:

To study the effect of repeated removal of four different adhesive dressings on peri-ulcer skin using quantitative non-invasive techniques.

Method:

Forty-five patients with open (n=29) or healed (n=16) venous leg ulcers were included. Peri-ulcer skin was treated for 14 days with patches of two different hydrocolloid-based adhesive dressings, one polyurethane adhesive and one soft silicone adhesive dressing. Normal skin of the patients’ ventral forearm was also treated identically. Adhesive patches of the dressings were replaced every second day. The skin barrier function was assessed by measuring transepidermal water loss and stratum corneum hydration by measuring electrical conductance.

Results:

Thirty-nine patients completed the study. The hydrocolloid adhesives increased transepidermal water loss and conductance while the polyurethane and soft silicone adhesives did not influence these parameters significantly compared with adjacent non-treated peri-ulcer skin. For normal forearm skin, similar relative effects among the four adhesives were found.

Conclusion:

Repetitive treatment with hydrocolloid-based adhesive dressings induced major functional alterations of the stratum corneum. In contrast, a polyurethane adhesive and a soft silicone adhesive dressing did not alter transepidermal water loss or conductance of peri-ulcer skin.

Declaration of interest:

This study was funded by Mölnlycke Health Care AB, Göteborg, Sweden.
Effect of enzymatic debridement with collagenase on acute and chronic hard-to-heal wounds
Authors: Marazzi M. , Stefani A. , Chiaratti A. , Ordanini M.N. , Falcone L. , Rapisarda V.
Published: May 2014

Objective:

A large retrospective analysis was performed to assess the outcomes of burns and chronic ulcers treated with collagenase in an outpatient setting. No cost comparison was performed.

Method:

Of 979 patients entered into the analysis, 647 had burns affecting ≤15% body surface area (BSA) and 332 had chronic ulcers of various aetiologies. All were treated with collagenase-based ointments once daily (Noruxol or Iruxol, Smith & Nephew). Treatment was continued until complete healing was achieved.

Results:

In burns patients the overall average healing time was 17.9 days in the paediatric population and 23.6 days in adults. Burn depth and presence of eschar were the main factors affecting healing probability. The chronic ulcers were predominantly of diabetic, venous and mixed aetiology. Average healing time was 15.4 weeks, with ulcers of mixed aetiology showing the shortest average healing time (9.2 weeks). There was a positive correlation between wound area and healing time. The topical application of collagenase-based ointments was well tolerated by patients and caregivers.

Conclusion:

This large retrospective analysis shows that collagenase treatments in outpatient clinics are effective and well accepted in patients with burns affecting ≤15% BSA or with chronic ulcers of various aetiologies. Implementation of collagenase treatments in outpatient clinics has the potential to improve wound healing and may also decrease the cost of wound care.

Declaration of interest:

The statistical evaluation was supported by Smith & Nephew. All materials were hospital acquired and the authors have no conflict of interest.
Effect of placental-extract gel and cream on non-healing wounds
Authors: Tiwary S.K. , Shukla D. , Tripathi A.K. , Agrawal S. , Singh M.K. , Shukla V.K.
Published: May 2014

Objective:

To compare the effects of topical placental-extract gel and cream in the treatment of chronic non-healing wounds with regard to wound healing and discomfort during dressing change.

Methods:

A sample of 120 patients attending the wound clinic at University Hospital, Varanasi, India, with wounds of more than six weeks’ duration were enrolled into the study. They were alternately allocated to group A (topical application of placental-extract gel) or group B (placental-extract cream). Wound biopsy was performed, and swab culture and sensitivity were taken. Wound size was measured, and visual analogue scale (VAS) scores for pain and discomfort at dressing change were recorded at weekly follow-up in both groups. Biopsy was repeated after two weeks of treatment and sent for histopathological examination for assessment of angiogenesis in 25 cases from each group.

Results:

One hundred patients completed the study. More than 50% wound healing was observed after eight weeks in 72% of group A patients and 74% of group B patients (p=0.75). Microscopic angiogenesis grading system (MAGS) scores were similar in both groups (not statistically significant, p=0.92). The VAS scores for pain and discomfort were lower in group B (statistically significant, p<0.02).

Conclusion:

Placental-extract gel and cream are both effective topical agents for chronic non-healing wounds. However, there is less pain and discomfort during dressing change with the placental-extract cream, which we thus recommend for topical application in chronic non-healing wounds.

Declaration of interest:

None.
An unexpected effect of Dermacyn on infected leg ulcers
Authors: Steenvoorde P. , van Doorn L.P. , Jacobi C.E. , Oskam J.
Published: May 2014

Dermacyn Wound Care (Oculus Innovative Sciences, California, US) is a superoxidised water proven capable of destroying bacteria, viruses, moulds and spores at an efficient rate in vitro, while studies undertaken by the manufacturer have found no toxic side-effects. The product’s promotional literature claims it can heal diabetic foot ulcers and facilitate faster hospital discharge of children with burn injuries.
The effect of adhesive dressing edges on cutaneous irritancy and skin barrier function
Authors: Dykes P.J.
Published: May 2014

Objective:

To assess the effect of repeated application and removal of adhesive edges from wound- care products on cutaneous irritancy and barrier function in normal volunteer subjects.

Method:

This was a study using a ‘repeat-insult patch test’. Adhesive edges from six commonly used wound-care products were applied continuously to the same site (six applications over a 14-day period) in 30 normal volunteer subjects. The test sites were assessed clinically before product reapplication using established ranking scales for cutaneous erythema. The cumulative irritancy score (CIS) for each test site was determined by adding the erythema scores at days 3, 5, 8, 10, 12 and 15. At the study end the barrier function of each test site was assessed by measuring transepidermal water loss (TEWL).

Results:

The CIS showed that the products fall into two distinct groups, with Mepilex, Tielle and Allevyn giving low scores and Biatain, Comfeel and Duoderm higher scores. Statistical analysis indicated significant differences (p<0.05) between Mepilex and Biatain, Mepilex and Comfeel, Mepilex and Duoderm, Tielle and Biatain, Allevyn and Biatain. The mean TEWL values also indicated that the products fall into two distinct groups: Mepilex, Tielle and Allevyn with low mean values close to that of normal adjacent back skin and Biatain, Comfeel and Duoderm with much higher mean values. Statistical analysis indicated that Mepilex, Tielle and Allevyn were not significantly different from normal skin (p<0.05), whereas Biatain, Comfeel and Duoderm were significantly higher than normal skin and the other products tested.

Conclusion:

The results show clear differences between products; the clinical scores and TEWL measurements indicate that the products fall into two distinct groups. This novel approach seems able to discriminate between adhesive borders and may be useful during product development and in selecting products for clinical trials.

Declaration of interest:

This study was supported by a research grant from Mölnlycke Health Care AB, Göteborg, Sweden.
The effects of onion extract on hypertrophic and keloid scars
Authors: Hosnuter M. , Payasli C. , Isikdemir A. , Tekerekoglu B.
Published: May 2014

Objective:

To evaluate the therapeutic activity of topical onion extract in gel form on hypertrophic and keloid scars, focusing on problems such as elevation, redness, hardness, itching and pain.

Method:

This comparative prospective study assigned 60 patients to three groups. Group 1 was treated with onion extract alone, group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet.

Results:

In the group comparisons, a significant difference was observed at the end of six months in the colour parameter between group 1 and group 2 and in the height parameter between group 1 and group 3 (ANOVA post-hoc Tukey’s test, p<0.01 and p<0.05 respectively). The onion extract was more effective in relation to scar colour, while the silicon gel sheet was superior in decreasing the height of scar (paired sample t-test, p<0.001). In addition, the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3.

Conclusion:

Onion extract improved hypertrophic and keloids scars via multiple mechanisms. However, it was statistically ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height.

Declaration of interest:

None.
Efficacy, safety and acceptability of a new two-layer bandage system for venous leg ulcers
Authors: Benigni J.P , Lazareth I , Parpex P. , Gerard J.L , Alves M , Vin F , Meaume S , Senet P , Allaert F.A , Sauvadet A , Bohbot S
Published: May 2014

Objective:

To evaluate the efficacy, tolerability and acceptability of a new two-bandage compression system in the local management of venous or mixed aetiology ulcers predominantly of venous origin.

Method:

This was a prospective non-comparative open label phase III clinical study. Forty-two patients were recruited from 12 centres. Inclusion criteria included ulcers with at least 50% granulation tissue, a surface area of 2–20cm2, an ulcer duration of 1–24 months, an ankle circumference of less than 28cm, and no history of deep vein thrombosis in the three months before enrolment. The primary endpoint was reduction in ulcer surface area, and secondary endpoints were the evolution of leg oedema and patient comfort. During the six-week follow-up, patients underwent weekly clinical assessments and their ulcer surface area was measured by planimetry and photography every alternate week.

Results:

The mean ulcer surface area at inclusion was 7 ± 6cm2. The mean surface reduction after six weeks was 58.5%, with 24% of the treated wounds healing in a mean time of 25.9 ± 9.46 days. The patients considered that the new compression system had a better effect on quality of life, evaluated by parameters such as pain, heat, itching and general comfort, than the system worn before entry into the study. Patient concordance with the new system was excellent and 86% of leg ulcers improved or healed after six weeks. Local tolerance was considered very good.

Conclusion:

This new two-bandage compression system is effective and well accepted by patients.

Declaration of interest:

This study was sponsored by Laboratoires Urgo, Chenôve, France.
Can duplex arterial ultrasonography reduce unnecessary angiography?
Authors: Elgzyri T. , Ekberg G. , Peterson K. , Lundell A. , Apelqvist J.
Published: May 2014

Objective:

To assess the value of arterial duplex ultrasound, which assesses the location and severity of arterial disease, in determining whether invasive vascular intervention is required.

Method:

A total of 166 consecutive diabetic patients presenting at a multidisciplinary foot clinic with severe peripheral vascular disease, with or without a foot ulcer, were included in this prospective study. The choice of vascular intervention was based on the results of a duplex ultrasound examination. Subjects were followed up for two years, and their clinical management, vascular assessments and interventions given, and patient outcomes were recorded in a specially designed protocol.

Results:

Based on findings of the duplex ultrasound, it was recommended that 55 patients (33%) should undergo angioplasty (percutaneous transluminal angioplasty [PTA] and/or subintimal recanalisation), 64 patients (39%) diagnostic angiography and 47 patients (28%) medical treatment only, thereby avoiding unnecessary angiography and its potential complications. Diagnostic angiography was recommended when the duplex ultrasound results were inconclusive. Fifty-two of the 55 patients recommended angiography with simultaneous angioplasty had an angiography; of these, 42 (81%) then had an angioplasty. Fifty-seven of the 64 patients with inconclusive results had an angiography. Of these, 23 (40%) subsequently had angioplasty, only 10 (18%) had reconstructive surgery and 24 (42%) had a diagnostic angiography only.

Conclusion:

Arterial duplex ultrasound may assist evaluations of the need for and type of invasive vascular intervention in patients with an ischaemic diabetic foot. It can thus help avoid diagnostic angiographies that do not result in vascular intervention. However, such decision-making remains at the discretion of the vascular surgeon and radiologist.

Declaration of interest:

None.
A national prevalence study of pressure ulcers in French hospital inpatients
Authors: Barrois B. , Labalette C. , Rousseau P. , Corbin A. , Colin D. , Allaert F. , Saumet J.L.
Published: May 2014

Objective:

To ascertain pressure ulcer prevalence rate in French hospitals.

Method:

In 2004, a cross-sectional study was conducted in all French hospitals, except university hospitals. The National Pressure Ulcer Advisory Panel (NPUAP) staging was used. Data were collected using two self-administered questionnaires.

Results:

A total of 37,307 inpatients in 1170 wards in 1149 hospitals were assessed, representing a response rate of 93.5%. Their mean age was 72.3 years and 62% were females. In all, 3314 patients had at least one pressure ulcer, giving a prevalence rate of 8.9%. A total of 4991 pressure ulcers were recorded; 64% of the patients had only one pressure ulcer. Fifty-five per cent of the patients had at least two concomitant diseases. When patients with only one ulcer were assessed, the most common locations were the heels (53%) and sacrum (29%). Heel pressure ulcers were more common in patients with obliterative arterial disease, and sacral pressure ulcers were more frequent in incontinent (urine, faecal and double incontinence) patients. Patients with multiple pressure ulcers had more severe lesions.

Conclusion:

These results indicate that the prevalence of pressure ulcers in French hospital inpatients has remained stable since the last prevalence study undertaken 10 years before, when the rate was 8.9%. Such studies should be encouraged in all health-care settings as a means of improving the care provided.

Declaration of interest:

None.
Is TNP in the open abdomen safe and effective?
Authors: Trevelyan S.L. , Carlson G.L.
Published: May 2014

Much of the evidence for the use of TNP in the open abdomen comes from data on trauma patients. In view of the potentially severe complications, much greater evidence is needed for its application on patients with abdominal sepsis
The EWMA Patient Outcome Group
Authors: Gottrup F.
Published: May 2014

Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives
Malignant fungating wounds: epidemiology, aetiology, presentation and assessment
Authors: Alexander S.
Published: May 2014

These wounds can be devastating for patients and challenging for practitioners. This article, the first in a series, examines the research literature on their aetiology and presentation, and suggests how they might be most effectively assessed
Are bioploymers potential deodourising agents in wound management?
Authors: Lee G. , Anand S.C. , Rajendran S.
Published: May 2014

Objective:

To investigate the odour-adsorbing properties of biopolymers, with a view to using the findings to develop a novel dressing with odour-adsorbing properties.

Method:

The odour-adsorbing properties of a selection of biopolymers (aloe vera, tea tree oil, neem oil and manuka honey) and three commercially available dressings containing activated charcoal cloth (ACC) were quantitatively assessed using laboratory test equipment. An aloe vera-containing composite dressing, designed and developed by the authors, was also compared with the ACC dressings.

Results:

Aloe vera was the most adsorbent of the biopolymers and a 40% dilution had comparable values to those of the ACC dressings. Furthermore, values for the novel composite dressing were similar to those of the ACC dressings.

Conclusion:

The novel composite dressing may be a potential alternative to ACC dressings, and has the added advantages of having antimicrobial properties as well as the ability to promote a moist wound environment. However, more research is needed.

Declaration of interest:

The Engineering and Physical Sciences Research Council (EPSRC) and Lantor (UK), Bolton, supported the study. The Surgical Materials Testing Laboratory (SMTL) loaned the test equipment.
Malignant fungating wounds: key symptoms and psychosocial
Authors: Alexander S.
Published: May 2014

Living with a malignant wound can be an overwhelming experience for the patient and their family, yet the psychosocial effects are often overlooked at assessment. If care is to be holistic, then these issues must be addressed
Retrospective review of the use of daptomycin for diabetic foot infections
Authors: Johnson K. , Lamp K.C. , Friedrich L.V.
Published: May 2014

The increase in antibiotic resistance has led to a search for alternative treatments for diabetic foot infections. This retrospective review outlines the clinical outcomes reported for a lipopetide for these infections
An RCT on the effects of topical CGP on surgical wound appearance and residual scarring in bilateral total-knee arthroplasty patients
Authors: Ong A. , Orozco F. , Sheikh E.S. , Anmuth C. , Alfaro A. , Kathrins R. , Grove G.L. , Zerweck C. , Madden A.M. , Raspa R. , Weis M.T.
Published: May 2014

Objective:

To test the hypothesis that topically applied calcium glycerophosphate (CGP) would improve the appearance of the wound following bilateral knee replacement.

Method:

Healthy patients, aged 45–75 years, scheduled for bilateral total-knee replacement surgery were recruited into the study. one knee was randomly assigned to the treatment group, while the contralateral knee was designated the control (standard care). Subjects were instructed to apply a preparation of 10% CGP in an aqueous lotion to the treated knee once daily for 42 days, starting at the third postoperative day. Functional sealing and cosmetic appearance of the incision were evaluated by two surgeons by direct examination of the patient and then by two experienced assessors from photographs. The investigators qualitatively scored the intensity and extent of erythema along the incision and over the entire knee, the appearance of visible oedema along the incision and over the knee, and the overall clinical impression of wound healing. All four assessors were blinded to the subjects’ allocation and the latter two assessors to the initial investigators’ assessments. Subjects were also followed up for an additional 46 weeks, giving a total study duration of 12 months.

Results:

Twenty patients completed the study. Statistical analysis showed that both the area and intensity of erythema along the incision were significantly reduced in the treated vs untreated knee over the entire study period. The analysis further showed that treatment significantly reduced oedema, both along the incision and across the entire knee. The differences were most marked at the seventh postoperative day and diminished with time. no adverse effects were observed for any patient, in either treated or untreated knees.

Conclusion:

These data demonstrate that postoperative application of 10% CGP could improve the appearance of the wound following total knee arthroplasty.

Declaration of interest:

This study was supported by a grant from AkPharma Inc. Dr M.T. Weis has performed paid consultant work for AkPharma during past 10 years. no person or institution performing work on this study has any financial connection with AkPharma Inc., or any financial interest in the outcome of this study, or in the components used in this study.
Randomised clinical trial comparing Hydrofiber and alginate dressings post-hip replacement
Authors: Ravnskog F-A. , Espehaug B. , Indrekvam K.
Published: May 2014

Objective: To compare the performance of Hydrofiber and alginate dressings used in the treatment of primary hip arthroplasty wounds. Method: Patients were randomised into one of two groups, receiving either a Hydrofiber or an alginate dressing. outcome measures, assessed by daily observations, included skin damage (erythema, blisters and skin injuries) and the dressing's ability to handle exudates. Photos of the dressing and the skin area around wounds were taken. Patients noted skin problems, discomfort at mobilisation and pain at dressing removal. Results: In the alginate group, there were fewer blisters in the wound area compared with the Hydrofiber group (7% versus 18%, p=0.03). During dressing removal, fewer patients in the alginate group reported pain than patients in the Hydrofiber group (2.1% versus 15%, p=0.01). Conclusion: We recommend the use of both dressings following total hip arthroplasty, although the alginate would be our first choice, as we found fewer blisters when using alginate dressings as opposed to Hydrofiber dressings. Conflict of interest: None.