bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative estimation of exudate volume for full-thickness pressure ulcers: the ESTimation method
Authors: Iizaka S. , Sanada H. , Nakagami G. , Koyanagi H. , Konya C. , Sugama J.
Published: May 2014

Objective:

To develop an equation for the estimation of exudate volume in millilitres, for full-thickness pressure ulcers, according to wound characteristics.

Method:

In a cross-sectional study, 41 patients aged ≥ 60 years with 58 full-thickness pressure ulcers were evaluated. Exudate was collected by covering each wound with a transparent occlusive dressing and the accumulated volume was measured to estimate volume per day. The overall severity of each wound was evaluated by the DESIGN-R tool; a model was then developed to estimate the volume of exudate based on these experimental values. Linear regression analyses were performed to evaluate the precision and accuracy of the model.

Results:

The model, including exudate score, size score, and total score, showed a higher adjusted coefficient of determination (R2=0.66) than the model with only a traditional exudate score (R2=0.57). After adjustment for age, inclusion of interaction terms, and modification of bias, a model with continuous parameters was finally developed: exudate volume per day (ml/day) = exp([0.86×exudate score]+ [0.21×size score]+[0.12×total score]–[0.013×size score×total score]–[0.04×age]–3.60). Furthermore, a categorical model was developed for clinical simplicity of use. the adjusted R2 was increased to 0.73 for the continuous model and to 0.77 for the categorical model. there were no apparent biases (p > 0.05) and no correlations between residuals and measured value (p > 0.05) in these models.

Conclusion:

The equation, including the exudate score, size score and total score of DESIGN-R, as well as age, is called the ESTimation method. It will be useful for clinicians to predict the absolute volume of exudate and to select appropriate dressings for full-thickness pressure ulcers.

Declaration of interest:

The authors have nothing to declare.
The experience of patients with complex wounds and the use of NPWT in a home-care setting
Authors: Moffatt C.J. , Mapplebeck L. , Murray S. , Morgan P.A.
Published: May 2014

Objective:

To explore the experience of patients living with complex wounds and the impact of undergoing negative pressure wound therapy (NPWT) as part of their treatment.

Method:

Qualitative data were collected from eight patients, using semi-structured interviews. A purposive, stratified sampling approach was used to identify participants with a range of wound types, as well as age and gender. Participants were recruited from one primary care trust and were interviewed, following 10 days of treatment with NPWT. The matrix-based ‘Framework’ approach, from the national Centre for Social research, was used to structure the analysis.

Results:

of the eight participants recruited, five were female and three male, with an age range of 46–77 years. Five overarching categories, with their constituent themes, were identified from the data. The first, developing a wound through crisis, has three themes: a failing body, missed diagnosis and failed professional intervention. The second category, decreased control, has four related themes: poor communication; failed wound healing; poor discharge planning and failure to recover. The third category, increased control, has four themes: understanding what is happening; symptom control; positive professional relationships and returning to health. The fourth category, using NPWT, has two themes: information and understanding of NPWT and expectations and experience of NPWT. The final category sets out participant recommendations about the device and has two themes: device issues and improving professional practice.

Conclusion:

This study investigated the experience of patients undergoing NPWT for complex wounds in the home setting and reveals a number of the psychosocial effects of using this therapy in this environment. Participants saw NPWT as an active intervention, associated with improved wound healing and symptom control. The participant experience described in this study, and the recommendations they make, provide a valuable resource to inform service improvement programmes and wound research.

Declaration of interest:

This study was supported by a research grant from Smith & Nephew Ltd.
A cohort study on the efficacy of a polyhexanide-containing biocellulose dressing in the treatment of biofilms in wounds
Authors: Lenselink E. , Andriessen A.
Published: May 2014

Objective:

This cohort study evaluated the clinical efficacy of a polyhexanide-containing biocellulose dressing, Suprasorb X + PHmb (lohmann & Rauscher GmbH), for the eradication of biofilms in non-healing wounds. Polyhexanide (PHmb) has been shown to have microbicidal activity when applied to chronic wounds and burns.

Method:

Twenty-eight patients, aged over 18 years, who presented at an outpatient wound clinic with non-healing locally infected and/or critically colonised wounds of various aetiologies that showed clinical signs of biofilm were included in the study. Sixteen patients (nine females), with a mean age of 60.9 ± 21.6 years, were included in the analysis. The patients were prospectively followed for a maximum of 24 weeks or until healing for analysis of safety and efficacy endpoints. evolution of wound size was conducted with tracings and standardised digital photographs as well as for determining healing rates.

Results:

At 24 weeks,12 wounds (75%) had healed (complete epithelialisation with no drainage). of those wounds that had not closed, the mean wound area had reduced by 61% at week 24. Ten patients (63%) had a good reduction of the biofilm, five (32%) scored moderate and one (6%) had no reduction noted at week 24. The mean percentage of granulation tissue had increased significantly (p < 0.04) when comparing day 0 (38%) with week 24 (77%). Yellow tissue present in the wound bed decreased (p < 0.01): 62% (day 0) versus 23% (week 24). All patients reported reduced pain after dressing change.

Conclusion:

The results suggest that continuous application of PHMB, using a biocellulose wound dressing, reduced biofilm in the stagnating wounds treated, thus promoting healing. The treatment was comfortable, safe and reduced wound pain at dressing change. The PHmb-containing biocellulose dressing seems to be suitable for lightly to moderately exuding wounds.

Declaration of interest:

This study was supported by a scientific grant from Lohmann & Rauscher.
Efficacy of a total occlusive ionic silver-containing dressing combination in decreasing risk of surgical site infection: an RCT
Authors: Siah C.J. , Yatim J.
Published: May 2014

Objective:

To perform a comparative assessment of the efficacy of total occlusive ionic silver-containing dressing (TOISD) combination vs no dressing after colorectal surgery.

Method:

The surgical sites from both groups were swabbed and sent for culture and sensitivity upon wound closure (superficial incisional skin surface) in the operating theatre, as a baseline for bacterial colonisation. The patients’ surgical wounds in the study group were dressed with TOISD combination and the patient's surgical wounds in the control group received the conventional method of no dressing. A second swab was taken from the superficial incisional skin surface for culture and sensitivity investigation between the fifth to seventh postoperative day for comparison of the bacterial colonisation in the two groups.

Results:

one-hundred and sixty-six patients were recruited. Six patients dropped out before the fifth postoperative day, leaving 79 patients in the control group and 81 patients in the study group. microbial swab cultures revealed significant differences between the two groups (p < 0.001, mean=1.43 ± 0.63) in bacterial colonisation. The odds ratio (or) of patients with wounds in the control group was 4.1 (95%cI is 1.884, 8.964) more likely to be contaminated with bacteria compared with wounds covered with occlusive ionic silver-containing dressing.

Conclusion:

TOISD was found to be effective in reducing bacterial colonisation on the surgical site compared with no dressing. However, it properties were unable to be put into use if there were the surgical sites were not infested with bacterial. Although TOISD might not be necessarily on surgical incisional site not infested with bacteria for the initial post-operation days, it is helpful in preventing further transcription and division for opportunistic bacteria, thus might reduce the risk of superficial incisional SSI. The use of TOSID though statistically insignificant compared to no dressing, could also be possible in reducing the risk and exaceration of deep incisional SSI.

Declaration of interest:

The authors have no conflicts of interest to declare. This study was funded by a grant from the ministry of Health research committee, Singapore.
A clinical evaluation of the effcacy and safety of singlet oxygen in cleansing and disinfecting stagnating wounds
Authors: Kammerlander G. , Assadian O. , Eberlein T. , Zweitmuller P. , Luchsinger S. , Andriessen A.
Published: May 2014

Objective: This cohort study evaluated the clinical efficacy of singlet oxygen, ActiMaris (AM) a hypertonic (3%) ionised (pH 9.8) sea water solution. It was assumed that when used for wound cleansing, disinfection and the reduction of inflammation, AM would be safe and effective. Method: Between May 2008 and May 2009, ambulant patients presenting at one of four wound healing centres were included in the study. Patients had critically colonised and/or infected, malodorous wounds, covered with slough/fibrin or wounds showing inflammation of the periwound skin. Wounds were assessed in terms of percentage changes in fibrin, slough and granulation tissue, they were assessed clinically and high resolution digital photographs were scored by a physician who was blinded to treatment allocation. Results were compared at baseline (week 0) and following 42 days of AM treatment (week 6). Results: Seventy-three patients were included in the analysis. Dressing changes were at 2-day intervals on average, and the median treatment period was 46.04 days (range: 3–197). At 42 days, 33% (n=24) of included wounds had healed, 57% (n=42) had improved and 10% (n=7) remained stagnant. Cleansing and wound disinfection with AM was effective. In 31 patients (42%) wounds had showed clinical signs and symptoms of critical colonisation and/or infection at day 0, whereas at day 42 the infection was completely eradicated. Inflammation was reduced in 60% (n=44) of cases and patients did not report pain or discomfort when using AM. Conclusion: The use of singlet oxygen was shown to be safe and the results of this study indicate AM to be useful for wound cleansing, disinfection, reducing inflammation and promoting wound healing. Confict of interest: The centres were supplied with the study product by the sponsor. The authors have no financial interest in writing this article.
Are postoperative dressings necessary?
Authors: Borkar N.B. , Khubalkar M.V.
Published: May 2014

Objective: To determine whether or not the routine use of postoperative dressings prevents surgical site infection and wound dehiscence. Material and methods: Patients with clean or clean-contaminated (e.g. hernia, orchidectomy cystolithotomy, ureterolithotomy, appendectomy) sutured surgical wounds were randomised into two groups: those who did not receive postoperative dressings (the study group) and those who did (the control group). variables like adequate haemostasis, sterile techniques, obliteration of all wound cavities, and approximation of divided structures were not controlled for. Wounds were assessed after 6 and 24 hours, and on the third and fifth postoperative days for clinical signs of infection and dehiscence. Results: A total of 123 patients with 124 clean surgical wounds were recruited into the study. The mean age and ratio of men and women in each group were comparable. There was no significant difference in the rate of wound complications between the two groups: 4.76% for the study group and 4.92% for control. Conclusion: Based on these preliminary data, surgical wounds left open do not have an increased incidence of surgical site infection and wound dehiscence, compared with similar types of wounds dressed postoperatively. In a large teaching hospital, the extrapolated cost savings of dressing materials alone can be significant. Larger studies are needed to confirm these results. Conflict of interest: None.
Malignant tumours arising in chronic leg ulcers: three cases and a review of the literature
Authors: Erfurt-Berge C. , Bauerschmitz J.
Published: May 2014

The precancerous potential of chronic leg ulcers is well-established but the number of reported cases overall is small. Delay in diagnosis may result in a worse prognosis, loss of the affected limb or occurrence of metastases. We report a case series of three patients with long-standing history of recalcitrant leg ulcers, which finally showed malignancy when histologically investigated. In addition, we discuss the literature concerning malignant transformation of chronic leg ulcers and try to bring forward the controversial question of how to differentiate primary and secondary malignancies in chronic ulcers. Although hypotheses about altered wound healing mechanisms, influence of chronic inflammation and irritation or tissue damage through infections are conclusive, further investigations are necessary to clarify the exact pathogenetic mechanisms of tumour development in chronic wounds.
Wound healing through synergy of hyaluronan and an iodine complex
Authors: Cutting K.F.
Published: May 2014

Hyaluronan, a glycosaminoglycan (GAG), is a polysaccharide found in many locations in the human body, such as eye, skin and soft tissue. It is also found in other mammals and bacteria. As a component of the extracellular matrix, its role in wound repair, among others, is that of providing a temporary structure to support new tissue formation. Harnessing the therapeutic action of hyaluronan into a topical application of proven clinical benefit has proved challenging. A new development in hyaluronan technology, comprising sodium hyaluronate and iodine complex, offers a novel approach in exploiting the benefits of hyaluronan and delivering real clinical benefits for a wide range of wound types.
Comparison of PHMB-containing dressing and silver dressings in patients with critically colonised or locally infected wounds
Authors: Eberlein T. , Haemmerle G. , Signer M. , Gruber-Moesenbacher U. , Traber J. , Mittlboeck M. , Abel M. , Strohal R.
Published: May 2014

Objective:

This study compares treatment with a polihexanide-containing biocellulose wound dressing (BWD+PHMB) versus the best local standard of silver dressings (Ag) in painful, critically colonised (wounds-at-risk) or locally-infected wounds.

Method:

Patients with wounds of various aetiologies, a baseline VAS pain score ≥4 and a semi-quantitative bacterial load of ++ or higher were randomly allocated to receive treatment with either BWD+PHMB or Ag. Patients with systemic infections and/or using systemic antibiotics were excluded. The primary endpoint, patient-reported pain (VAS total pain, including the sub-scores pain at night, during the day, before, and 15min after dressing changes), was compared between treatment groups and scored on days 0, 1, 3, 7, 14, 21 and 28. Secondary outcomes of bacterial load, wound bed and periwound skin condition, quality of life and dressing handling were assessed at the same visits.

Results:

Thirty-eight patients (BWD+PHMB, n=21 [24 wounds]; Ag, n=17 [18 wounds]) were included in the analyses. Baseline variables showed no significant differences. Wound pain was reduced significantly in both groups, with a better pain reduction noted for BWD+ PHMB (p < 0.001) before dressing changes. Compared with Ag, in the BWD+PHMB group critical colonisation and local wound infection had been reduced significantly faster and better (p < 0.001) over the 28-day study period. Improved quality of life, good tolerability and no adverse events were demonstrated for both groups.

Conclusion:

Both BWD+PHMB and AG were effective in reducing pain and bacterial burden. However, that BWD+PHMB was significantly faster and better in removing the critical bacterial load, makes this dressing an attractive therapeutic option to treat critically colonised and locally-infected wounds.

Declaration of interest:

This was sponsored by a clinical research grant from Lohmann & Rauscher GmbH & Co. KG. G. Haemmerle, M. Signer, U. Gruber-Moesenbacher and M. Mittlboeck have no conflict of interest to report. T. Eberlein, J. Traber and R. Strohal serve in the speakers bureau of Lohmann & Rauscher GmbH & Co KG. In addition, T. Eberlein and R. Strohal also work as consultants for Lohmann & Rauscher GmbH & Co KG. M. Abel is an employee of Lohmann & Rauscher GmbH & Co KG.
Cryoglobulinaemic leg ulcers associated with transient ischaemic attack
Authors: Altunay I. , Ates B. , Atis G. , Ton O.
Published: May 2014

This study report an 87-year-old male patient with multiple, superficial non-healing leg ulcers and transient ischaemic attack. Testing for serum cryoglobulins returned positive and for serum immunofixation electrophoresis displayed increased monoclonal IgG-kappa. Histological examination revealed epidermis ulceration, accumulations of neutrophils with nuclear dust or debris (leukocytoclasia) and PAS positive homogen eosinophilic fibrin deposition in the vessel wall. Leucocytoclastic vasculitis was diagnosed pathologically. Direct immunofluorescence testing was performed for confirmation of the diagnosis of cutaneous vasculitis, with intravascular deposition of IgA, IgG, IgM and C3 in the walls of vessels of papillary and reticular dermis. There was no underlying disease and the patient was diagnosed with cryoglobulinaemia type I. Leg ulcers responded successfully to treatment with high dose steroids and anticoagulant agents and healed within 2 months.
Red flags and alarm bells: an atypical lesion masquerading as a diabetic foot ulcer
Authors: Koo E. , Walsh A. , Dickson H.
Published: May 2014

An 88-year-old male presented at a high-risk foot service with a non-healing, plantar wound on his right foot, which had the appearance of a neuropathic ulcer. On further examination, the lesion was confirmed asymmetrical in shape and atypical in appearance. It also presented with surrounding violaceous, pigmented nodules in the arch of the foot, and several small, similar nodules on the plantar surface of the contralateral foot, giving the appearance of an exophytic lesion and suggesting melanoma. Following biopsy, it was diagnosed as classic Kaposi sarcoma.
Efficacy of two compression systems in the management of VLUs: results of a European RCT
Authors: Lazareth I. , Moffatt C. , Dissemond J. , Padieu A.S. Lesne , Truchetet F. , Beissert S. , Wicks G. , Tilbe H. , Sauvadet A. , Bohbot S. , Meaume S.
Published: May 2014

• Objective:

To evaluate the efficacy, tolerance and acceptability an innovative two-layer system (KTwo; Laboratoires URGO) versus an established four-layer bandage system (Profore; Smith & Nephew) in the local management of venous leg ulcers.

• Method:

A non-inferiority European randomised controlled trial, conducted in 37 centres, in three countries (France, UK and Germany), on patients presenting with venous leg ulcers (VLUs). Participants were adult, non-immunosuppressed patients who presented with non-infected, non-malignant leg ulcers, predominantly of venous origin (ABPI > 0.8), with a surface area of 2–50cm2 and duration 1-24 months. Patients were followed-up every 2 weeks for a period of 12 weeks, or until full closure. Visits included a clinical examination, wound area tracings and photographic evidence. The primary endpoint was the percentage of leg ulcers healed after the 12 weeks, with secondary endpoints of relative wound area reduction (RWAR), absolute wound area reduction (AWAR) and the percentage of wounds with RWAR ≥ 40%.

• Results:

In total, 187 patients were randomised to either the two-layer bandage (2LB, n=94) or four-layer bandage (4LB; n=93) system. The two groups were comparable, with regard to wound and patient characteristics, at baseline. By week 12, 44% of VLUs in the 2LB group and 39% in the 4LB group had healed (intention-to-treat [ITT] analysis). The per-protocol (PP) analysis showed that complete wound closure was obtained in 48% and 38% of the 2LB and 4LB groups, respectively. A non-inferiority margin within -10% is considered as demonstrating a 95% and 97.5% confidence interval (p=0.001). The AWAR was 6.6cm2 in the test and 4.9cm2 in the control group. The percentage of wounds with a RWAR ≥ 40% was 47% and 44% for the 2LB and 4LB systems, respectively. Pain between dressing changes was reported in 27% of the test and 40% of the control group, and the incidence of adverse events was 17% and 25%, respectively. The 2LB compression system was considered to be significantly easier to apply than the 4LB (p=0.038).

• Conclusion:

The 2LB system (KTwo) was not seen to be any less effective than a well-known 4LB system (Profore) in the management of VLUs. Furthermore, the 2LB system was considered to be easier to apply, representing an alternative to the conventional treatment with 4LB currently available.

• Declaration of interest:

This study was sponsored by a grant from Laboratoires URGO, manufacturers of KTwo. S. Bohbot and A. Sauvadet are employees of Laboratoires Urgo. S. Meaume has received monetary compensation as a speaker for Laboratoires Urgo. Data management and statistical analyses were conducted by Vertical (J.C. Kerihuel; Paris, France).
Effcacy of a silver lipidocolloid dressing on heavily colonised wounds: a republished RCT
Authors: Lazareth I. , Meaume S. , Sigal-Grinberg M.L. , Combemale P. , Guyadec T. Le , Zagnoli A. , Perrot J.L. , Sauvadet A. , Bohbot S.
Published: May 2014

Objective:

To assess the ability of a silver lipidocolloid contact layer to promote the healing process of venous leg ulcers (VLUs) presenting inflammatory signs, suggesting a heavy bacteria colonisation, and then delayed healing, in comparison with the same wound dressing not impregnated with silver salts.

Method:

This was an open-labelled, randomised, controlled trial. VLU presenting at least 3 out of 5 clinical signs suggesting heavy bacterial colonisation were recruited. Patients were treated with contact-layer silver-dressing (ClS; Urgotul Silver [URGO Laboratories]) or contact-layer dressing (Cl; Urgotul [URGO laboratories]) for 4 weeks, then all treated ulcers were treated with CL for 4 additional weeks. Wound evaluation and area measurements were conducted weekly, during the first 4 weeks, and then at weeks 6 and 8. Main efficacy criterion was absolute wound area decrease (AD) at week 4 and week 8.

Results:

Patients (n=102) were randomised and treated. ulcers were present for nearly 11 months on average; 65% were recurrent and mean area was 20.0 ± 17.8cm2. almost 80% of the treated VLU were stagnating/aggravating with their previous treatment. by week 4, mean surface area decreased by 6.5 ± 13.4cm2 (median: 4.2cm2) and 1.3 ± 9.0cm2 (median: 1.1cm2) in ClS and CL groups, respectively (p=0.023). at week 8, median decrease was 5.9cm2 vs 0.8cm2 (p=0.002), with a wound percentage decrease of 48% and 5.6% (p=0.036). Median closure rate was 0.145cm2/day vs 0.044cm2/day (p=0.009) at week 4 and remained higher in the ClS group up to week 8, even after switching to CL dressing in these patients (p=0.001). odds ratio (multinomial logistic regression) of the chance to reach a ≥40% wound area reduction was 2.7 (95%CI: 1.1;6.7, p=0.038) for silver-treated ulcers. Dressing tolerance was good in both groups.

Conclusion:

a 4-week treatment with silver-releasing lipidocolloid contact layer promotes a sustained increase of closure rate of venous leg ulcers presenting inflammatory signs, suggesting a high bacterial load.

Declaration of interest:

This study was funded by a grant from URGO laboratories. Dr Meaume and Dr Lazareth have served as paid speakers for URGO Laboratories. Dr Sauvadet and Dr Bohbot are employees of URGO Laboratories.
Potential implications of biofilm in chronic wounds: a case series
Authors: Hurlow J. , Bowler P.G.
Published: May 2014

Bacterial biofilm is increasingly suspected as being a significant barrier to wound healing. Bacteria predominantly attach to surfaces in their natural habitats and form biofilm; in this state they adapt to, and tolerate, the hostilities in their surrounding environment. The purpose of this clinical observational study was to consider chronic wound biofilm in relation to other factors that are implicated in wound recalcitrance, such as peripheral arterial disease, wound infection, osteomyelitis and moisture imbalance. Based on our clinical observations, it is possible that links exist between wound biofilm and other underlying pathophysiological factors, and that biofilm may also provide clues to the involvement of such factors. Recognising and managing these factors collectively may be important in addressing recalcitrance and facilitating wound progression.
A systematic review of the ASEPSIS scoring system used in non-cardiac-related surgery
Authors: Siah C.J. , Childs C.
Published: May 2014

Objective:

To assess the validity, reliability and sensitivity of the ASEPSIS scoring system, used to assess non-cardiac related surgery for surgical wound infection.

Method:

Five studies were included in this review. One study discussed the development of the ASEPSIS scoring system; two studies were on its reliability, one study on the sensitivity and the final compared the ASEPSIS scoring system against other surgical wound infection criteria and definitions. Due to variation in study designs, the findings were summarised and presented in a narrative format.

Results:

Validity and reliability were not established in assessing non-cardiac surgical sites. Sensitivity level was reported for non-cardiac surgical sites, but its reliability level declined as the severity of infection worsened.

Conclusion:

This review revealed that there are limited choices of scoring systems to assess different surgical sites for surgical wound infection. Currently, only the ASEPSIS scoring system is available, but it is not validated for use with non-sternal wounds. Therefore, it should be used cautiously when assessing non-cardiac surgical wound infection.

Declaration of interest:

The authors have no conflict of interest to declare. There were no external sources of funding for this systematic review.
Efficacy and safety of hyaluronic acid in treatment of leg ulcers: a double-blind RCT
Authors: Dereure O. , Czubek M. , Combemale P.
Published: May 2014

Objective:

To investigate the efficacy and safety of hyaluronic acid in the local treatment of leg ulcers of venous or mixed aetiology, compared with a neutral vehicle.

Method:

A 60-day double-blind, randomised, multicentre, controlled superiority trial. The primary endpoint was the percentage wound size reduction after 45 days of treatment. Secondary endpoints included pain intensity, rate of complete ulcer healing, and aspect of the wound (percentage of necrotic, fibrinous or granulation tissue) and of the peri-ulcer skin.

Results:

A total of 101 patients were randomised and analysed in the intention-to-treat (ITT) population (50 in the hyaluronic acid; 51 in the control group). Seventy-five patients were considered in the per protocol (PP) population (38 vs 37, respectively). At day 45, the percentage of ulcer surface reduction was significantly greater in the hyaluronic acid treatment group (39 ± 6%) compared with the neutral vehicle (control) group (5 ± 9%) (p=0.002). A similar result was obtained at day 15, day 30 and day 60. From day 0 to day 45, pain intensity (VAS) decreased by mean 9.8 ± 3.5mm in the hyaluronic acid group, but slightly increased by 0.8 ± 3.2mm in the control group (p=0.029). Burden of pain, as estimated by the area under the curve of daily pain (from day 0 to day 60), was significantly lower in the hyaluronic acid group (121.9 ± 20.7mm2) than in the control group (207.4 ± 32.9mm2; p=0.028). Other secondary endpoints (rate of complete healing, characteristics of the wound and peri-ulcer skin) were not significantly different between the two groups. Treatments were well tolerated and adverse events were comparable between the two groups in terms of their frequency, relationship to treatment and severity.

Conclusion:

Hyaluronic acid cream was significantly more effective than the neutral vehicle in the local treatment of leg ulcers of venous or mixed aetiology, in terms of wound size reduction and reducing the burden of pain, with a good safety profile.

Declaration of interest:

This study was sponsored by Laboratoires Genévrier. The authors received honoraria for their contributions to the study, but have no other conflicts of interests to declare.
Some wounds are hard to heal: an interesting presentation of Ehlers-Danlos syndrome
Authors: Ryan N. , Walkden G. , Akbar S.
Published: May 2014

A 17-year-old female patient was admitted for an elective mini laparotomy and cystectomy of the right ovary for the treatment of chronic supra-pubic abdominal pain. The procedure went without complication and she was discharged the next day. She was re-admitted a month later as an acute case with wound dehiscence. HIV serology, thyroid function, immunoglobulin, protein electrophoresis and electrolyte levels were all normal. There were no obvious signs of infection and the bacterial swabs failed to culture an organism. Despite conservative measures with regular dressing, oral antibiotics and input from the tissue viability team the wound failed to epithelialise. The wound was debrided and re-sutured a total of three times and the patient received 24 days of intravenous antibiotics. After input from various teams a diagnosis of Ehlers-Danlos syndrome was made, allowing for appropriate management and wound healing.
Negative pressure wound therapy: improving the patient experience Part 1 of 3
Authors: Upton D. , Andrews A.
Published: May 2014

Negative pressure wound therapy (NPWT) is an effective treatment for healing wounds, which may have additional benefits, such as reduced time spent in hospital and fewer dressing changes. However, as with most wound treatments, NPWT can be painful for some patients. Research has shown that the pain and accompanying stress of wound care can impair patient quality of life and delay the healing process, highlighting the need to explore ways in which the patient experience of NPWT might be improved. This article presents part one of three studies which aimed to investigate the above. In the present study, an online survey was used to explore the views of wound care clinicians worldwide (n = 221) on NPWT and levels of pain, stress and skin trauma in patients during the different stages of treatment. Findings suggest that, in the opinion of clinicians, patients’ pain levels vary during the different stages of NPWT and that removal of the wound fillers and dressings or covering films are the most painful stages.
The Explorer study: the first double-blind RCT to assess the efficacy of TLC-NOSF on DFUs
Authors: Shanahan D.R.
Published: May 2014

Urgo Medical recently announced the launch of the Explorer study, a large, Europe-wide, clinical study on the efficacy and tolerability of UrgoStart Contact, a lipidocolloid technology dressing impregnated with nano-oligosaccharide factor, in the treatment of diabetic foot ulceration. The number of patients, investigating centres and countries involved, as well as the length of treatment and patient follow-up, make this an ambitious, double-blind, randomised controlled trial.
Prospective RCT comparing two hydrocolloid dressings in acute trauma wounds in South Korea
Authors: Kim S.W. , Lee J.H. , Seo B.F. , Rhie J.W.
Published: May 2014

Objective:

To compare the efficacy of two hydrocolloid dressings (Medifoam H; Genewel Co. Ltd. and DuoDERM; ConvaTec Inc.) for the management of lacerations, abrasions, and minor operation incisions.

Method:

Patients with lacerations, abrasions, and minor operation incisions were randomly allocated to receive either Medifoam H or DuoDERM. Data collected included wound assessment (amount of exudate, wound infection, rate of wound closure, and the percentage of necrotic, sloughy, fibrous, granulation, and epithelial tissue present in the wound bed) and patient evaluation of itching, burning, leakage of exudate, pain and discomfort incurred from dressing and dressing change.

Results:

In total, 66 patients were included in the study. No significant difference in wound assessment or in patient evaluation was detected between two groups.

Conclusion:

The data collected from this study gave no evidence for any difference in efficacy between Medifoam H and DuoDERM for minor, acute trauma wound management.

Declaration of interest:

This study was supported by The Medical Devices Clinical Comparison and Performance Evaluation Support Project, which was sponsored by small and medium business administration grants and conducted by the Korea Medical Devices Industrial Cooperative Association (project number ND322759). The authors have no conflicts of interest to report.
Review of patients' experiences with fungating wounds and associated quality of life
Authors: Gibson S. , Green J.
Published: May 2014

Objective:

To investigate the evidence exploring the experiences of patients with fungating wounds and associated quality of life, and to subsequently provide recommendations to how these implications may be addressed in practice.

Method:

Using a systematic approach, a comprehensive literature search was conducted to investigate the most appropriate and relevant evidence regarding the experiences of patients with fungating wounds.

Results:

Studies unveiled the enormity of the unrelenting, unique and devastating consequences that these wounds have on an individual's life and that every domain of their life is negatively affected.

Conclusion:

These findings must galvanise nurses to become aware of the extent of the devastation experienced and aspects of life affected by these wounds. The issues raised have multifaceted and challenging implications for practice; however, all aspects need to be addressed and satisfied in an attempt to improve the quality of life of individuals with fungating wounds.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
An evaluation of dehydrated human amniotic membrane allografts in patients with DFUs
Authors: Zelen C.M.
Published: May 2014

Objective: To evaluate healing of chronic diabetic foot ulcers (DFUs) with use of dehydrated human amniotic membrane (dHAM) in patients failing under standard of care treatment.

Method: The study population was identified from patients with chronic DFUs enrolled in a randomised trial comparing standard care with standard care with the addition of dHAM. The present study included patients that failed to heal (defined as <50% decrease in wound size after 6 weeks, or not completely healed by 12 weeks of treatment) with standard care. One week after withdrawal from the randomised trial, these patients were offered treatment with standard care and bi-weekly application of dHAM. Subsequent evaluation of clinical records was made with IRB approval and patient consent. Each patient was used as their own control to compare wound size reduction between treatment periods, and healing rates within the 12-week dHAM treatment period.

Results: Eleven patients were included in the study. Mean wound chronicity was 21.1 ± 12.4 weeks (range 11–54 weeks) and mean wound size was 4.7 ± 5.0cm 2 , at baseline. Complete healing was achieved in 55% by 4 weeks, 64% by 6 weeks and 91% by 12 weeks with bi-weekly dHAM application. Mean weeks to complete healing was 4.2 ± 3.1 weeks for the 10 patients healed. After 4 weeks of standard care, wounds had decreased in size an average of 26.8 ± 45.3% versus 87.6 ± 16.0% after 4 weeks of dHAM treatment (two applications; p <0.001).

Conclusion: This study provides evidence that the incorporation of dHAM into standard of care for patients with chronic DFUs can be beneficial. The results suggest that dHAM is a viable option for the treatment of recalcitrant DFUs

Declaration of interest: This study was sponsored and funded by MiMedx. The Professional Education and Research Institute received research funds to conduct the trial. The author has no conflicts of interest to declare.
Sleep disruption in patients with chronic leg ulcers
Authors: Upton D. , Andrews A.
Published: May 2014

• Objective:To investigate the incidence of sleep disruption in people with chronic leg ulcers and to explore which factors may contribute to sleep problems.

• Method:A questionnaire survey was completed by a convenience sample of 52 leg ulcer patients attending community-based Leg Clubs in England and Wales. the questionnaire assessed wound pain, quality of sleep, factors contributing to sleep disruption and general health.

• Results:Sixty-nine per cent (n=36) of leg ulcer patients reported sleep disruption, with 88% stating that they wake at least once during the night. General wound pain was the most frequently-cited cause (58%), while pain associated with treatment affected the sleep of 38% of respondents. Additionally, nearly a third (n=14) expressed that worrying about their wound impacted on their sleep. A significant correlation was found between wound pain and sleep disruption.

• Conclusion:The findings suggest that the majority of leg ulcer patients suffer sleep disruption, either as a direct consequence of wound pain or due to treatment-related or psychological issues associated with the wound. This has important implications for patient quality of life and also for the healing process; therefore, assessment and management of sleep problems in leg ulcer patients is essential.

• Declaration of interest:This study was supported by a financial grant from Mölnlycke Health Care. The authors have no commercial or social conflicts of interest with respect to the article or its content.
Wound pruritus: prevalence, aetiology and treatment
Authors: Upton D. , Richardson C. , Andrews A. , Rippon M.
Published: May 2014

• Objective: to review the literature into itching or pruritus, in relation to burns or other types of wound, with a focus on the physiological mechanisms underlying itching and the issues associated with itching in people with wounds.

• Method: A literature search was conducted using pubmed, meDlIne and Google Scholar, including english-language papers published up to 2012. the search terms used were: [‘pruritus’ or ‘itching’] or [‘chronic’] AnD [‘wounds’ or ‘burns’]. Studies were included in the review if they addressed the implications of pruritus in relation to burns and acute or chronic wounds.

• Results: All types of wound may be associated with acute or chronic itching, depending on their pathology and the severity of the trauma. burns have a very high incidence of itch and this can be an issue many years after healing in some patients. the impact of itch can be severe, leading to issues such as anxiety, depression, reduced sleep, and impaired quality of life. Furthermore, scratching may lead to infection recurrence and delayed healing through exacerbating the patient's physical and psychological condition.

• Conclusion: Itching is a signifcant issue for people with burns and other types of wound, causing a range of physical and psychological difficulties, impairing quality of life, and potentially leading to delayed healing. It is therefore essential that clear guidelines are developed in relation to treatment options for people with burns and other wounds who experience itching.

• Declaration of interest: this study was supported by a financial grant from mölnlycke Health Care. m. rippon is an employee of mölnlycke Health Care; D. Upton, C. richardson and A. Andrews have no commercial or social conflicts of interest with respect to the article or its content.
Treatment for wound pruritus following burns
Authors: Richardson C. , Upton D. , Rippon M.
Published: May 2014

Objective:

To review the current literature on the treatment of itching, or pruritus, in people with burn wounds.

Method:

A literature search using the databases PubMed, MEDLINE and Google Scholar was undertaken. Studies were included in the review if they discussed or evaluated different treatment options for pruritus in patients with burn wounds.

Results:

A variety of treatments are available for the relief of pruritus in patients with burns wounds, ranging from antihistamines and topical emollients to psychological therapies, massage and dermatological treatments. Oral antihistamines are used most commonly, yet research indicates that these are not always effective. Few studies are methodologically robust. In recent years, there has been an attempt to design and implement treatment strategies and algorithms, however, there is currently no agreed and consistent management plan for the treatment of pruritus due to burn injury.

Conclusion:

Simple single therapies should be the frst line therapy for the treatment of pruritus due to burns, however, if these are unsuccessful, combination therapy should be introduced early to try to reduce the onset of chronic itch. Current algorithms and treatment plans based on the stage of healing show promise but need further modifcation and testing before they can be recommended for common use.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conficts of interests to declare.
The production and measurement of sub-bandage pressure: Laplace's Law revisited
Authors: Thomas S.
Published: May 2014

Objective:

The present study was undertaken to demonstrate that the pressures produced by multiple layers of compression bandages applied to artificial limbs of known circumference with predetermined levels of tension can be predicted accurately using the modified Laplace equation.

Method:

Up to four layers of different bandage types were applied in a carefully controlled fashion to cylinders of known circumference, with tensions ranging from around 200–2000 grams/10cm width. The pressures generated were measured using pneumatic pressure sensors previously shown to possess the required degree of accuracy for this type of experimental system.

Results:

Good correlation was observed between the mean and standard deviation of each pair of experimental and calculated pressure values for all combinations of bandage type, application tension and cylinder circumference. Over the clinically relevant range of pressures, the difference between data sets was generally less than 1.0mmHg.

Conclusion:

The results of this experimental study unequivocally prove that provided accurate values for all the relevant variables are known, it is possible to predict the pressure that will be developed by a compression bandage on a limb of known size. However, it is important to recognise that other factors such as the elastomeric properties of the fabric will have a major effect upon the ability of a bandage system to sustain initial compression values. Furthermore, the variation in radius of curvature around a limb will mean that point pressures readings recorded at individual locations around the circumference may vary dramatically from the average value predicted by the modified Laplace equation, calling into question the value of sub-bandage pressure measuring devices for this application.

Declaration of interest:

This project was generously supported by 3M Healthcare who provided a small research grant to assist with the costs associated with the construction of the test equipment.
Elements of a valid consent to treatment in capable adults
Authors: Griffith Richard
Published: May 2014

In his first article on consent, Richard Griffith outlines the elements of a valid consent and how important obtaining consent is to the appropriateness of a paramedic's practice.
Transforming stroke care: pivotal role of the ambulance services pivotal role
Authors: Davis David , South Adrian
Published: May 2014

Stroke is the brain equivalent of a heart attack. With 1.9 million neurons being lost every minute, early access to acute care is critical. Ambulance clinicians have a vital role in ensuring the rapid assessment and transfer of patients to an acute stroke centre, as the principle barrier to delivering thrombolysis is enabling treatment within the narrow therapeutic time window. Timely management of transient ischaemic attacks (TIAs) reduces mortality, morbidity and use of precious NHS resources. Ambulance services need to develop pathways that embrace the vision of the National Stroke Strategy, risk stratifying patients and facilitating immediate hospital admission or referral to timely clinics.
Research and development: a new direction for NEAS
Authors: McLure Sally , Marley George , Cessford Colin , Clarke Tom , Dorgan Sharon , Atkinson Lorraine , Smith Justine , O'Neill Seamus
Published: May 2014

The Department of Health has recently introduced a new national strategic direction for research and development (R&D) across the National Health Service (NHS). One of the major developments is the National Institute for Health Research (NIHR) which provides a framework to position, manage and maintain world-class research, staff and infrastructure in the NHS. This national framework is having a substantial effect on driving and shaping the infrastructure of R&D departments within Ambulance NHS Trusts. This article provides an overview of the national development and highlights some of the major consequential developments for the North East Ambulance Service NHS Trust (NEAS).
Modular treatment units for prehospital care
Authors: Hignett Sue , Jones Anna , Benger Jonathan
Published: May 2014

In recent years UK government policy has increased the provision of urgent care in the community. As part of this initiative, the ambulance service is gradually changing from an organization designed to convey patients to hospital, to a professional group capable of assessing and delivering appropriate treatment to the patient at scene. This paper explores the technology requirements needed to support new professional roles and draws on examples from ambulance trusts (emergency care practitioners), primary care (out-of-hours general practitioners and minor injuries units) and acute trusts (emergency departments). It describes the iterative process used to develop the design specification for modular treatment units for both vehicle and built environments, using a qualitative exploratory methodological framework. Data were collected with 125 staff and 88 patients over 18 months in five phases using stakeholder workshops (2007 and 2008); portable technology audits; treatment observations in emergency departments and walk-in centres; and design decision groups. The results were thematically coded and triangulated to define the functional design requirements for the modular treatment units. The results are discussed as a technology system for personal kit, assessment packages (and storage for other clinical treatment packages) and a modular clinical workspace.
Will a new election bring change?
Authors: Gregory Pete
Published: May 2014

At the time of writing, only 3 weeks remain until a general election that could see a major shift in the political landscape of the UK. The first ever live television prime ministerial debate has just taken place and more than 9 million viewers witnessed the emergence of the Liberal Democrat leader, Nick Clegg, as a serious political voice in the election. Yet, does the political landscape of the UK really matter to the frontline practitioner who is faced with an ever-increasing demand upon already stretched services? Do we really need to be sitting down and reading the manifestos of the main protagonists? In reality, the answer has to be yes because as public servants, the policies of the government of the day will have a very significant impact upon the way we work, the way we are measured and the level of remuneration we receive for our efforts.