bluuebunny/crossref_metadata_2025 huggingface dataset:
Back to basics: pregnancy and dialysis
Authors: Ellis Peter
Published: May 2014

While the mean and median age of people on dialysis in the UK is in excess of 65 years, there remain some patients who are young enough to be of child-bearing age. This paper will discuss some of the issues that arise for dialysis nurses when a patient in their care either wishes to become, or is already, pregnant.
Nutritional requirements in acute kidney injury
Authors: Kariyawasam Deepa
Published: May 2014

Patients with acute kidney injury are often very ill and their metabolisms under great stress, resulting in the need for extra calories and extra protein. The renal team needs be alert to these patients’ nutritional requirements in order to support their immune system function, accelerate recovery and reduce mortality. An early dietary intervention by the renal team may prevent malnutrition—even death.
Back to basics: acute kidney injury III
Authors: Ellis Peter
Published: May 2014

In the two previous papers in this series, Peter Ellis identified the three main classifications of acute kidney injury (AKI) as being pre-renal, renal (or intrinsic) and post-renal. In this third and final paper, the author will consider how the causes of AKI episodes indicate how they should be managed in clinical practice.
Acute kidney injury guidelines: an overview of the recommendations
Authors: Davies Annette
Published: May 2014

On 29 August 2013, the National Institute for Health and Care Excellence published its much-needed guideline on diagnosis and management of acute kidney injury. In this article, Annette Davies provides an overview of the guideline's rationale and recommendations, and reflects on the responses of both key opinion leaders and daily newspapers.
MyKidneyCare App: using smartphone technology to engage young adults in their kidney care
Authors: Nottage Clare , Tibbles Rosamund , Cox Sue
Published: May 2014

Patient engagement, in self-managing a long-term kidney condition and for continued communication with healthcare providers, is well recognised as being a key influencing factor in treatment concordance and improved health outcomes. The ability to adapt care and services to maintain relevance for patient groups is a constant challenge to those caring for young adults. Identifying innovative solutions and collaborative working with both patients and multi-agencies is pivotal in bringing young adult services into line with modern technology and communication methods. The MyKidneyCare app is a handheld patient record, communication and self-management tool. Using mobile technology aims to support young adults with their transition from paediatric to adult kidney services, aid self-management of their kidney condition and signpost them to important information resources.

Smartphone technology was identified by young adults as being relevant and useful as a means of managing their own kidney care needs and promoting better self-awareness and communication with their multidisciplinary healthcare team. MyKidneyCare app is a self-management tool, which complements a range of age-appropriate services and tools designed to increase the likelihood of young adult engagement with their kidney care teams and concordance with treatment regimens.
Understanding the new NHS healthcare leadership model
Authors: Ellis Peter , Abbott Jane
Published: May 2014

The new NHS Healthcare Leadership Model is made up of nine dimensions of leadership that work independently and together to enhance leadership. In this second article on the subject, Peter Ellis and Jane Abbott consider four of these dimensions: leading with care, sharing the vision, engaging the team, and influencing for results.
A computerised leg ulcer database with facilities for reporting and auditing
Authors: Taylor R.J. , Taylor A.D. , Marcusson R.W.
Published: May 2014

A review of a new computerised reporting and auditing system.
Management of a neonatal wound on a newborn infant
Authors: Irving V.
Published: May 2014

A report on the care given to a newborn infant with a congenital wound managed with a hydrocolloid dressing.
The effect of hydrogel dressings on maggot development
Authors: Thomas S. , Andrews A.
Published: May 2014

The effect of six different hydrogels on the development of sterile larvae (Lucilia sericata) was examined in a laboratory study. Five of the products had a marked adverse effect on maggot survival but one appeared to facilitate growth of the larvae when compared to control values. These results are consistent with clinical observations that larvae may not survive well in wounds containing residues of some hydrogel dressings.
Pressure sore prevention in hospital patients: a clinical audit
Authors: Grewal P.S. , Sawant N.H. , Deaney C.N. , Gibson K.M. , Gupta A.M. , Haverty P.F. , Panditaratne H.G. , Samarasinghe S.R. , Sharma A. , Singh S. , Turner S.A. , Wilkinson S.L. , Wood S.P. , Glickman S.
Published: May 2014

Pressure sores cause significant mortality and morbidity as well as being a financial burden on health-care services. Reduction of pressure sore incidence is a Department of Health priority. Pressure sores are accepted as largely preventable complications of illness and disability and the means to achieve prevention are available. The aim of this clinical audit was to identify potential contributing factors to pressure sore acquisition in an acute hospital setting. The results suggest that substantial changes in the approach to clinical management may be needed.
The use of aromatherapy in wound care
Authors: Asquith S.
Published: May 2014

A review of the potential role of aromatherapy in assissting wound healing.
Autologous keratinocytes cultured on benzylester hyaluronic acid membranes in the treatment of chronic full-thickness ulcers
Authors: Hollander D. , Stein M. , Bernd A. , Windolf J. , Pannike A.
Published: May 2014

Keratinocytes were obtained from three patients with chronic full-thickness ulcers of different aetiologies. The cells were isolated, cultured and then seeded on to a membrane composed of benzylester hyaluronic acid. Once the keratinocytes had become subconfluent, the keratinocyte-containing matrix sheets were then applied as autologous grafts to the patients' ulcers.

Results indicate that autologous grafting of keratinocytes cultured on benzylester hyaluronic acid membranes provides improved graft handling, reduces total time required for tissue cultivation and enhances cellular vitality because of the possibility of grafting at a subconfluent non-differentiated stage.
Foot impulse technology in arteriovenous disease
Authors: Hutcheson F.
Published: May 2014

A review exploring the use of a mechanical impulse system in patients with chronic venous and/or arterial insufficiency.
How effective is the Abbreviated Burn Severity Index in predicting patient mortality?
Authors: Tejero-Trujeque R.
Published: May 2014

The Abbreviated Burn Severity Index is used in the prognosis of patients with burn injuries. This review explores the effectiveness of the Index's five variables in predicting the risk of mortality.
Studies of a new multi-layer compression bandage for the treatment of venous ulceration
Authors: Scriven J.M. , Bello M. , Taylor L.E. , Wood A.J. , London N.J.M.
Published: May 2014

This study aimed to develop an alternative graduated compression bandage for the treatment of venous leg ulcers. Alternative bandage components were identified and assessed for optimal performance as a graduated multi-layer compression bandage. Subsequently the physical characteristics and clinical efficacy of the optimal bandage combination was prospectively examined.

Ten healthy limbs were used to develop the optimal combination and 20 limbs with venous ulceration to compare the physical properties of the two bandage types. Subsequently 42 consecutive ulcerated limbs were prospectively treated to examine the efficacy of the new bandage combination.

The new combination produced graduated median (range) sub-bandage pressures (mmHg) as follows: ankle 59 (42–100), calf 36 (27–67) and knee 35 (16–67). Over a seven-day period this combination maintained a comparable level of compression with the Charing Cross system, and achieved an overall healing rate at one year of 88%.

The described combination should be brought to the attention of healthcare professionals treating venous ulcers as a possible alternative to other forms of multi-layer graduated compression bandages pending prospective, randomised clinical trials.
Pulse oximetry: a new tool to assess patients with leg ulcers
Authors: Bianchi J. , Douglas W.S. , Dawe R.S. , Lucke T.W. , Loney M. , McEvoy M. , Urcelay M.
Published: May 2014

A study investigating whether pulse oximetry could be a useful way of assessing whether patients with leg ulcers are suitable for treatment by graduated elastic compression.

The objective of the study was to investigate pulse oximetry as a guide to assessing patients with leg ulcers before treatment. Graduated elastic compression is the treatment of choice for uncomplicated venous leg ulcers, but is contra-indicated in patients with significant arterial disease. The standard assessment of arterial insufficiency by Doppler ultrasound ankle brachial pressure index (ABPI) has shortcomings which prompted this investigation of pulse oximetry as a possible additional, or alternative, method of assessment of patients with leg ulcers, prior to treatment with compression.

The study, carried out on a population of patients attending hospital leg ulcer clinics, was designed to evaluate pulse oximetry assessment in the selection and monitoring of patients with venous leg ulceration leading to a prospective controlled study of ulcer healing in groups of patients with reduced and normal ABPI, selected for compression therapy by pulse oximetry criteria.

Outcome measurement required followup of patients selected for compression therapy by pulse oximetry to record time to healing and rate of healing of leg ulcers.

Results from the study show a fair correlation between the toe-finger oximetry index (TFOI) and Doppler ABPI. There is no difference between ulcer healing in patients with reduced and normal ABPI selected for treatment on the basis of pulse oximetry maximum compression pressure (MCP).

In conclusion, pulse oximetry is an aid to the selection of patients who will benefit from compression therapy, but would be excluded on the basis of Doppler ABPI.
New hydrofibre and hydrocolloid dressings for chronic wounds
Authors: Russell L. , Carr J.
Published: May 2014

A report on how the combination of a new hydrofibre dressing covered with a thin hydrocolloid improved the quality of life of an elderly man with chronic bilateral ulcers on both his feet
Treatment of diabetic foot ulcers with hyperbaric oxygen
Authors: Senior C.
Published: May 2014

The delivery of oxygen to the wound site is crucial in healing diabetic foot ulcers, and impairment of this process in people with diabetes leads to delayed wound repair. Hyperbaric oxygen therapy works by elevating the plasma oxygen level. Fibroblasts synthesise and modify collagen, and both these activities require relatively high partial pressures of oxygen. Hyperbaric oxygen can promote healing by stimulating fibroblast activity and collagen formation. Increasing oxygen tensions also has a direct and toxic effect on anaerobes, therefore hyperbaric oxygen therapy has a special role in treating diabetic foot infections. Studies on hyperbaric oxygen therapy in general show it to be a beneficial adjunctive therapy for diabetic foot ulcers. However much of the work is anecdotal and more controlled trials are required.
High-pressure water jet injuries: a surgical emergency
Authors: Tejero-Trujeque R.
Published: May 2014

Injuries from high-pressure jet devices are surgical emergencies characterised by small entry wounds with extensive internal damage. Three factors are involved in these injuries. Physical injury can include local soft tissue disruption and vascular and nerve damage; chemical properties of the injectate can exacerbate compressive vascular injuries with increased oedema and inflammation; water-jet injuries can be contaminated by virulent organisms and foreign matter which can lead to unusual infections. Management is usually similar to that for injuries caused by high-velocity missiles, and involves aggressive debridement, irrigation and decompression followed by careful monitoring, and appropriate antibiotic therapy.
Vacuum-assisted closure to treat deep sternal wound infection following cardiac surgery
Authors: Tang A.T.M. , Okri S.K. , Haw M.P.
Published: May 2014

Deep sternal wound infection is a devastating and potentially lethal complication following cardiac surgery. Established treatment may involve debridement, packing, delayed closure, plastic reconstruction, re-wiring and irrigation, depending on the severity of infection. Vacuum-assisted closure (VAC) of complex infected wounds has recently gained popularity among various surgical specialties. This article describes the successful application of this novel technique in a patient with infected sternal dehiscence who had failed to respond to conventional treatment
A comparison of three primary non-adherent dressings applied to hand surgery wounds
Authors: Terrill P.J. , Varughese George
Published: May 2014

This study reports the results of a prospective randomised controlled trial that compared three non-adherent wound dressings applied to hand surgery wounds. Paraffin-impregnated gauze (Jelonet) was compared with a cellulose, acetate fibre dressing coated with a petrolatum emulsion (Adaptic) and a polyamide net dressing impregnated with silicone gel (Mepitel). The dressings were assessed for their ease of application and removal, pain on removal and wound appearance.

Results from 99 patients were available for analysis. Adaptic was significantly easier to remove (p<0.01), required less soaking (p<0.05), was less painful to remove (p<0.05) and caused less wound maceration (p<0.05) than Jelonet, but was significantly more difficult to apply (p<0.05). Mepitel was also easier to remove but this did not reach statistical significance. It was also more difficult to apply than Jelonet (p<0.05).

We recommend that Adaptic should be used routinely as the non-adherent dressing for incisions or traumatic wounds on the hand. The slight increased difficulty in applying the dressing is outweighed by the major advantages associated with its removal.
Take action to protect yourself
Authors: Hadfield-Law L.
Published: May 2014

An increasing numberof litigation proceedings involve wound-care practitioners. Here expert witness, Lisa Hadfield-Law, says that, with a little extra thought, many such cases can be avoided.
Benefits of hyperbaric oxygen therapy for diabetic foot lesions
Authors: Neal M.S.
Published: May 2014

This review highlights evidence showing that adjunctive use of hyperbaric oxygen therapy can reduce the major amputation rate among patients with diabetic foot lesions.
Is tap water a safe alternative to normal saline for wound irrigation in the community setting?
Authors: Griffiths R.D. , Fernandez R.S. , Ussia C.A.
Published: May 2014

Objective:

This double-blind randomised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds.

Method:

The trial was conducted in two metropolitan community health centres in New South Wales, Australia. Thirty-five patients with 49 acute or chronic wounds were randomised to receive wound irrigation with either normal saline or tap water.

Results:

Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water.

Conclusion:

Although the small sample size is a limitation of this study, the researchers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients.

Declaration of interest:

None
An in-vitro study of the pressure-relieving properties of four wound dressings for foot ulcers
Authors: Ashford R.L. , Freear N.D. , Shippen J.M.
Published: May 2014

This in-vitro study reports on a selection of mechanical tests on four wound dressings: Allevyn (Smith and Nephew), Biatain (Coloplast), Lyofoam (Seton Scholl) and Tielle (Johnson and Johnson). The aim of the study was to investigate these dressings in the laboratory by subjecting them to dry and wet compression tests, shearing tests and a cyclical test.

As predicted, all dressings performed differently in the range of tests, with Lyofoam deforming the most when subjected to compression testing (5.6mm). During wet compression, differences in the physical properties of all the materials tested were identified. During shearing testing, Allevyn and Tielle withstood the greatest shear deflection before failure, but Biatain withstood the greatest force before failing. During the cyclical testing, Lyofoam only reduced by 1% of its original thickness, while Biatain reduced by 30%.

No one dressing performed better in all the tests. However, as an all-round ‘pressure-relieving’ dressing, Allevyn consistently outperformed the others in the study.
Nutrition and wound healing: what is the link?
Authors: Gray D. , Cooper P.
Published: May 2014

Given the important role played by nutrients in wound healing, all patients with wounds should receive a nutritional assessment. Action must then be taken to address any deficiency.
How do fibroblasts interact with the extracellular matrix in wound contraction?
Authors: Tejero-Trujeque R.
Published: May 2014

Two strong yet contradictory theories exist on how wound contraction occurs. This article, in two parts, reviews the research on both sides and discusses the limitations of non-human experiments.
‘Universal’ concepts
Authors: Collier M.
Published: May 2014

It is assumed that the concepts of moist wound healing and wound-bed preparation are universally accepted and practised. However, the reality is that they are too often ignored, says Mark Collier
Understanding the final stages of wound contraction
Authors: Tejero-Trujeque R.
Published: May 2014

Much research has been undertaken to improve our understanding of the processes of wound contraction. This article, the second in a two-part series, focuses on granulation tissue modulation.
How can we improve prevalence and incidence monitoring?
Authors: Fletcher J.
Published: May 2014

Many studies have attempted to calculate pressure ulcer occurrence rates, but their results cannot be compared due to variations in the methodologies used. How can this problem be overcome?
Measuring the incidence of lower limb ulceration in the Chinese population in Hong Kong
Authors: Wong I.
Published: May 2014

Objective:

This retrospective study set out to examine the incidence, patient characteristics and current practice among patients with ulcers on the lower leg and foot who were under the care of the community nursing service of a regional hospital in Hong Kong. There is no clear differentiation between leg ulcers and foot ulcers in local practice in Hong Kong.

Method:

The nursing records of 819 subjects receiving treatment at home from the regional hospital's community nursing service were reviewed. All were active cases on 31 October 2000.

Results:

The patients' median age was 76 (range: 36–100); 86% were aged over 65. Seventy-five percent of the patients had dressings changed daily, with 28 types of dressing being used. Nurses changed dressings in the patients' homes or in residential homes. Of the 94 patients with ulcers on the lower leg and foot, 75% had their dressings changed daily and only six less than three times a week. Fifty-four percent received regular podiatry clinic follow-up.

Conclusion:

Care of patients with ulcers on the lower limb represents a considerable workload for community nurses in Hong Kong, where little attention has been paid to the problem and current treatments. The number of patients with these ulcers cared for by community nurses in Hong Kong was high, with wide variations in management. Further investigation into evidence-based practice is needed to develop clinical guidelines and protocols that will achieve quality care. Research is now required in a clinical setting and for comparison with existing wound-care products.

Declaration of interest:

None.
Clinical trials in wound care I: the advantages and limitations of different clinical trial designs
Authors: Venkatraman P. , Anand S. , Dean C. , Nettleton R.
Published: May 2014

Clinical trials need to be robust if practitioners are to apply their recommendations into practice. This article describes the various research designs used in wound care and the pitfalls that may compromise the reliability and validity of the results.
Modulating the hypermetabolic response to burn injuries
Authors: Williams G.J.P. , Herndon D.N. , Jones Jesse H.
Published: May 2014

A huge rise in metabolic rates occurs following a burn injury. Practitioners can alleviate this problem by controlling the patient environment and providing appropriate nutritional support. Drug therapy is likely to be a future option.
Clinical trials in wound care II: achieving statistical significance
Authors: Venkatraman P. , Anand S. , Dean C. , Nettleton R.
Published: May 2014

Clinical trials must be well designed in order to produce statistically and clinically significant results. This article describes the randomisation techniques that can prevent bias, the importance of sample size and the concept of power analysis.
Postoperative wound blistering: is there a link with dressing usage?
Authors: Gupta S.K. , Lee S. , Moseley L.G.
Published: May 2014

Practitioners on an orthopaedic ward used three different types of dressing on two groups of 100 patients who had undergone hip or knee operations, and compared the number of blisters that resulted. They describe their findings.
Developing a trust-wide centralised approach to the use of VAC
Authors: Birchall L. , Street L. , Clift H.
Published: May 2014

Use of topical negative pressure, also known as VAC, gradually increased throughout a trust following its success in a burns and plastic surgery unit. A trust-wide centralised approach set out to standardise its use and to reduce costs
A survey of tissue viability nurses' role and background in one region
Authors: Austin L.
Published: May 2014

The shift in NHS service provision towards primary care has made investigation of clinical nurse specialists' role in this setting an important issue. This article reports the findings of a preliminary survey of tissue viability nurses in one region
Controversies in classifying and assessing grade I pressure ulcers
Authors: Bethell E.
Published: May 2014

There is more uncertainty on how to define a grade I pressure ulcer than any other type. The confusion will need to be dispelled and a consensus reached if a national grading system is to be implemented. This review explores the options.
The role of neutrophil apoptosis in influencing tissue repair
Authors: Sylvia C.J.
Published: May 2014

Neutrophils and macrophages are involved in inflammation. Neutrophils debride the area of local contamination and then die (apoptosis) after being engulfed by macrophages. This is vital before the wound can move to the next stage of healing.
The cost-effectiveness of topical negative pressure versus other wound-healing therapies
Authors: Neubauer G. , Ujlaky R.
Published: May 2014

The high daily cost of topical negative pressure may partly explain why it is not widely used. However, an analysis of three case studies that assessed the financial and clinical effects of the therapy shows it is cost-effective in the long term.
Can a decision tree help nurses to grade and treat pressure ulcers?
Authors: Verdu J.
Published: May 2014

Objective:

This study investigated whether a decision tree can aid pressure ulcer management. It hypothesised that nurses who use a decision tree in pressure ulcer care assess wound grade more accurately and select more appropriate dressings.

Method:

Sixty-six nurses were randomly assigned to two groups. Each nurse reviewed written information and pictures of three cases of pressure ulceration, and then graded and selected a dressing for the lesions. The absence or presence of a decision tree was used as an independent variable. Measurements included: mean and standard deviation; confidence intervals; percentages; Chi-square test, Pearson's correlation and Kruskal-Wallis test.

Results:

Baseline characteristics were comparable for both groups. There was no statistically significant difference between the grades selected by the two groups. But significantly more of the decision tree users selected an appropriate dressing (p<0.02). Joint scores (ranging from 0 to 6) were assigned for each accurate decision. The mean score for the experimental group was 4.47 ±1.14 (95% CI: 0.95 [4.06–4.88]) and for the control group, 3.35 ±1.30 (95% CI: 0.95 [2.90–3.81]).

Conclusion:

Decision trees could help nurses to make complex clinical decisions. Further studies undertaken in a clinical setting are needed.

Declaration of interest:

None.
The hidden side of nursing: why caring for patients with malignant malodorous wounds is so difficult
Authors: Wilkes L.M. , Boxer E. , White K.
Published: May 2014

Objective:

This cross-sectional qualitative study used semi-structured telephone interviews with palliative care nurses working in urban and rural settings in Australia to explore their experiences of dealing with patients with malignant, often malodorous, wounds.

Method:

This paper was the second phase of a research project examining the care of patients with malignant wounds. Of 71 palliative care nurses in New South Wales invited to participate, 26 took part, 17 of them working in community positions. The data from the telephone interviews were transcribed and analysed, using content analysis, and coded for themes relating to the nurses' experiences of caring for this patient group.

Results:

Nurses working in this setting strove to do the best for patients and their families under circumstances that are emotionally and physically difficult. Some of them suffered personal distress as a consequence. Patient isolation and altered body image are significant challenges for these nurses.

Conclusion:

The nature of the work these nurses do, in particular the fact that they are dealing with cancers, tends to push them into literal and practical silence. But the researchers question whether this is always the best option. They ask if hiding feelings could be bad for nurses and patients alike. In qualitative research it is not appropriate to generalise the results, although lessons can be learnt from the experience of this group.

Declaration of interest:

This research was funded by a grant from the University of Western Sydney.
Management of toxic epidermal necrolysis in a 15-year-old girl
Authors: Clennett S. , Hosking G.
Published: May 2014

Toxic epidermal necrolysis, a life-threatening reaction to certain types of drugs, is characterised by epidermal sloughing of more than 30% of the total body surface area. Patient survival depends on prompt referral to a specialist burns unit.
Effect of intermittent radiant warming on proliferation of human dermal endothelial cells in vitro
Authors: Hughes M.A. , Tang C. , Cherry G.W.
Published: May 2014

Objective:

This study investigated the effect of Warm-Up therapy on the proliferation of human microvascular dermal endothelial cells.

Method:

Endothelial cells from an adult subject were seeded in six-well plates and placed in an incubator at 32.5°C. The following day Warm-Up dressings were placed over the plates, with or without warming cards. Cards set at 38°C or 42°C raised the temperature in the medium to maxima of 34.5°C and 37.5°C respectively. Units were switched on daily for three one-hour periods. Cell numbers were counted by haemocytometer.

Results:

Maximum stimulation of endothelial cell proliferation occurred under the 38°C card, with cells numbering 135–158% of the controls (p<0.05). The 42°C card also stimulated cells (110–155%) but this did not reach statistical significance.

Conclusion:

The accelerated proliferation of microvascular dermal endothelial cells achieved by intermittent radiant warming may have contributed to the increase in granulation tissue reported previously in our clinic.

Declaration of interest:

This study was sponsored by an educational grant from Augustine Medical.
Short-stretch compression bandages and the foot pump: their relationship to restricted mobility
Authors: Lindsay E.T. , Muldoon J. , Hampton S.
Published: May 2014

Practitioners are generally advised not to use short-stretch bandages on patients who are immobile. But this appears to reflect confusion about calf muscle function, which research indicates still occurs during periods of limited mobility.
Research fraud: issues of which practitioners should be aware
Authors: Kenkre J.E. , Semple M.
Published: May 2014

Treatment and care given to patients should be evidence-based, but research results based on fraudulent findings can have a serious impact on care. This paper examines how fraud may be perpetuated and discusses standards for robust research
Contreet Foam and Contreet Hydrocolloid: an insight into two new silver-containing dressings
Authors: Lansdown A.B.G. , Jensen K. , Qvist Jensen M.
Published: May 2014

In vitro laboratory tests and preliminary clinical trials have found that two silver-containing dressings, Contreet Foam and Contreet Hydrocolloid, promote healing in infected and chronic venous leg ulcers and diabetic foot ulcers.
Personal story offers insight into living with facial disfigurement
Authors: Coull F.
Published: May 2014

This paper looks at the long-term effects of living with facial disfigurement caused by a burns injury. It applies a psychosocial model to understand how someone with such an injury confronts and adapts to living with a changed self-image.
An evaluation of the leg and foot ulcer treatment provided in Oslo
Authors: Haram R.B. , Ribu E. , Rustøen T.
Published: May 2014

Objective:

This study set out to gather more information about the treatment of leg and foot ulcers in the community in Oslo, Norway.

Method:

A structured questionnaire on leg and foot ulcer treatment was sent to 173 community nurses in Oslo, of whom 102 responded with data on 145 patients.

Results:

Of the sample, 55.9% had leg ulcers, 32.2% had foot ulcers and 11.9% both; 26.2% had diabetes. Thirty-four per cent of the patients had not had a diagnosis of leg ulceration. Saline was the preferred cleansing solution. Compression therapy was used on all types of ulcer. Pain was a problem for 52.9% of the patients, of whom 9% did not receive analgesia.

Conclusion:

Nurses and doctors working in this community need to update their knowledge of wound treatments.

Declaration of interest:

None.
Necrotising fasciitis: its aetiology, diagnosis and management
Authors: Jallali N.
Published: May 2014

Necrotising fasciitis is a rare but serious infection. This literature review suggests that the cornerstones of its management are prompt diagnosis, surgical debridement, broad-spectrum antibiotics and mandatory re-exploration.
Use of Allevyn Heel in the management of heel ulcers
Authors: Kammerlander G. , Eberlein T.
Published: May 2014

Objective:

This small uncontrolled study examined the effectiveness of Allevyn Heel.

Method:

Twenty-two patients were recruited: 13 with heel pressure ulcers, four with diabetic heel ulcers, four with arterial heel ulcers and one ‘other’. Ulcers were assessed before treatment and after the start of the dressing regimen at weeks two and four and at the end of the study.

Results:

Patients were treated with Allevyn Heel for a mean of 47.2 days, and dressings were left in place for an average of 2.2 days before being changed. By the end of treatment, 32% of the ulcers had completely or almost healed, and a further 27% were showing evidence of granulation. Application was considered easy in 98% of instances, and 91% of the patients reported that Allevyn Heel was comfortable to wear.

Conclusion:

Allevyn Heel was found to be effective and easy to use. This extends the range of wounds that are suitable for management with Allevyn, although a larger-scale study is needed to confirm the utility of Allevyn Heel for these type of heel wounds.

Declaration of interest:

This study was supported by Smith and Nephew, Germany.
Measuring interface pressure: validity and reliability problems
Authors: Norman D.
Published: May 2014

Despite a plethora of research into the aetiology of pressure ulcer development, much is still unknown, except that it is a complex phenomenon.1 This paper focuses on the quantification of interface pressure, including the limitations and variability of current techniques, measurement tools and data analysis.
Foot ulceration due to arterial insufficiency: role of cilostazol
Authors: Zolli A.
Published: May 2014

Chronic arterial insufficiency of the lower extremities, ranging from asymptomatic arterial insufficiency to critical limb ischaemia, can lead to foot ulceration and gangrene.
Effects of ultrasound delivered through a mist of saline to wounds in mice with diabetes mellitus
Authors: Thawer H.A. , Houghton P.E.
Published: May 2014

Objective:

To examine the effects of ultrasound administered through a fine mist of saline on surgically placed full-thickness excisional wounds in mice with experimental diabetes mellitus.

Method:

Fifty male CD-1 mice received alloxan monohydrate (100mg/kg), a drug known to induce diabetes mellitus. The animals received five ultrasound (n=27) or sham (n=23) treatments for 1.5 minutes, on alternate days, for 10 days, and were then sacrificed. Following sacrifice, each animal’s wound was excised and the tissues prepared for qualitative and quantitative histological analysis.

Results:

No difference in wound-surface area was found between the groups after the treatment period. However, blinded assessment of tissue sections revealed significantly increased deposition of collagen and blood vessels in the granulation tissue of animals treated with ultrasound compared with those that received sham therapy.

Conclusion:

Ultrasound delivered through a fine mist of saline significantly altered the composition of newly formed granulation tissue in animals with experimental diabetes mellitus. Further research needs to be completed to determine other effects of this novel ultrasound therapy and to examine its clinical effectiveness.

Declaration of interest:

Equipment and grant were supplied by Celleration (Eden Prairie, USA).
Is Vacuum Assisted Closure a valid technique for debriding chronic leg ulcers?
Authors: Lorée S. , Dompmartin A. , Penven K. , Harel D. , Leroy D.
Published: May 2014

Objective:

Between May 2001 and October 2002 a prospective controlled open non-comparative study was performed to assess the effectiveness of topical negative pressure in the fibrinous debridement of chronic leg ulcers.

Method:

Fifteen leg ulcers that had not responded to several other treatment modalities were treated with the Vacuum Assisted Closure system (KCI) for six days.

Results:

The median percentage reduction in fibrinous tissue was 28% on day three and 40% on day six. Between days one and three the percentage change was ≥50% in four patients and ≥25% in six patients. Between days three and six percentages of fibrin in the wound were lower in all patients, except for two who had higher percentages and two who had the same percentage.

Conclusion:

VAC therapy was rapidly efficacious, promoting angiogenesis and the formation of healthy tissue.

Declaration of interest:

None.
Using a new lipidocolloid dressing in paediatric wounds: results of French and German clinical studies
Authors: Letouze A. , Voinchet V. , Hoecht B. , Muenter K.C. , Vives F. , Bohbot S.
Published: May 2014

Objective:

To evaluate the efficacy, tolerance and acceptability of a lipidocolloid dressing, Urgotul (Laboratoires Urgo), in the local treatment of acute and chronic paediatric wounds.

Method:

Two non-comparative multicentre prospective clinical studies were conducted using the same protocol in France and Germany. A total of 100 patients were recruited from 16 centres (11 in France and five in Germany), and followed up for four weeks. Seventy wounds (55 burns and 15 other wounds) from France and 30 from Germany (22 burns and eight other wounds) were evaluated by nursing staff at every dressing change and by the medical investigator on a weekly basis.

Results:

In the French study population, 86% of the burns (superficial and deep partial-thickness) and 53% of the other wounds healed completely within the four weeks. Figures for the German study population were 100% and 88% respectively. Pain was evaluated using pain scales adapted to the patient’s age (objective pain scale, faces scale for pain and a visual analogue scale) at each dressing change. Dressing removal was non-traumatic, inducing very limited pain. Minor local adverse events were reported in four children.

Conclusion:

Urgotul is not only efficacious, but also well-tolerated and accepted by children with acute and chronic wounds. The dressing, therefore, might be an appropriate and highly promising alternative to conventional dressings.

Declaration of interest:

This study was sponsored by Laboratoires Urgo.
Perspectives on concordance in leg ulcer management
Authors: Moffatt C.J.
Published: May 2014

Practitioners often say that patients with leg ulcers are not concordant with therapy. Little research has been done to examine the credibility of such statements or to determine whether concordance is a major issue in leg ulcer management. It is possible that such negative attitudes reflect the complex interactions between practitioners and patients whose ulcers do not heal as expected.
Spotlight on the World Union of Wound Healing Societies’ Meeting
Authors: Glover D.
Published: May 2014

All the exciting, crowd-pulling events happen every four years: the Olympics, the World Cup — and the World Union of Wound Healing Societies’ (WUWHS) Meeting. During the six-day congress held in Paris in July over 250 plenary sessions, symposia, workshops, oral presentations and posters provided delegates with information on clinical and research innovations, wound-management challenges and answers, and insights into the patient experience.
The effectiveness of a hydrogel dressing compared with standard management of pressure ulcers
Authors: Kaya A.Z. , Turani N. , Akyüz M.
Published: May 2014

Objective:

To compare a hydrogel dressing with a conservative topical wound-care regimen (gauze with povidone-iodine) for the treatment of pressure ulcers.

Method:

A prospective study comprising 27 (24 male and three female) spinal-cord injury patients with a total of 49 pressure ulcers. Wounds were randomised into a treatment group (n=25) or control group (n=24). The primary outcome measure was the rate of wound healing (cm2/days).

Results:

Healing rates in the treatment group were higher than in the control group, although this was not statistically significant. Some 84% of the wounds in the treatment group and 54% in the control group epithelialised, which was statistically significant (p=0.04). The mean healing time in the treatment group was 48 days compared with 45 days for the controls.

Conclusion:

Our results suggest that hydrogel occlusive wound dressings facilitate healing by promoting more rapid epithelialisation of pressure ulcers, when compared with conservative wound care.

Declaration of interest:

None.
Spotting the signs: a case of late diagnosed painful calciphylaxis
Authors: Payasli C. , Hosnuter M. , Babuccu O. , Kargi E. , Kocak E. , Isikdemir A.
Published: May 2014

Although the number of cases of calciphylaxis is increasing, it is often not diagnosed until a late stage, increasing the risk of mortality. A characteristic is purple, mottled and painful lesions, which have a tendency to become necrotic
Qualitative and quantitative evaluation of a new regimen for malignant wounds in women with advanced breast cancer
Authors: Lund-Nielsen B. , Müller K. , Adamsen L.
Published: May 2014

Objective:

To determine if UlcerCare, a specialised self-securing static magnetic device, can promote the healing of chronic leg ulcers.

Method:

This double-blind placebo-controlled pilot study involved 26 patients with chronic leg ulcers, receiving care consistent with RCN guidelines, who were randomly allocated to receive either UlcerCare leg wrap (treatment) or an identical sham non-magnetic device (control). Wounds were assessed for 12 weeks at four weekly intervals using digital photography, Verge Videometer analysis and patient questionnaires to determine changes in ulcer size, level of pain and function.

Results:

Statistically significant reductions in ulcer measurement were noted in the treatment group when compared with the placebo group.

Conclusion:

The results demonstrate a significant healing effect in the treatment group. A larger randomised controlled study is recommended to investigate the effects on ulcer-associated pain and quality of life.

Declaration of interest:

The study was supported by Magnopulse, Bristol, UK.
Measuring quality of life in patients with pressure ulcers to include in economic evaluations
Authors: Fleurence R.L.
Published: May 2014

Policy-makers are increasingly using economic evaluations to help prioritise health-care interventions in the context of limited resources. Regulatory bodies such as the UK’s National Institute of Clinical Excellence (NICE) require quality of life measures to be incorporated into economic evaluations conducted as part of their technology appraisals.
The positive experience of using a growth-factor product on deep wounds with exposed bone
Authors: Ichioka S. , Ohura N. , Nakatsuka T.
Published: May 2014

Trafermin is a human recombinant form of basic fibroblast growth factor (bFGF). It promotes tissue regeneration, and gained approval for use in Japan in 2001. Basic FGF has a number of functions:
Use of porcine renal capsule matrix as a full-thickness dermal wound-healing material in rats
Authors: Suckow M.A. , Hodde J.P. , Wolters W.R. , Hiles M.C.
Published: May 2014

Objective:

To compare the utility of porcine renal capsule matrix (RCM) with porcine small intestinal mucosa (SIS) in a rat full-thickness skin wound model.

Method:

Groups of rats had surgically-created wounds filled with either SIS or RCM. On each rat a contralateral wound was left unfilled (RCM-U or SIS-U). Wound diameter was measured 3, 7, 12, 17, 26 and 30 days after creation. Wound sites sampled 3, 7, 14, 28, 42 and 56 days after wound creation were numerically graded for degree of histologic change and for collagen content, based on intensity of trichrome staining.

Results:

Wounds in all groups rapidly contracted to less than 50% of the original diameter within 12 days. There were no differences in wound diameter between RCM- and SIS-treated wounds at any time point, but these wounds had significantly greater (p<0.001) diameters than their unfilled counterparts on days 7, 12 and 17. There were no differences in histologic scores or trichrome-staining scores between RCM- and SIS-treated wounds and their unfilled counterparts at any time point, except for a greater (p<0.05) histologic score in SIS-treated wounds compared with unfilled controls on day 14. In both treatment groups an acute inflammatory response at the wound site was soon replaced by an influx of macrophages and fibroblasts.

Conclusion:

The results show that RCM is equivalent to SIS for the treatment of full-thickness wounds and that these materials may enhance wound healing in terms of wound-tissue collagenisation and maturation. These materials therefore merit further study in other wound-care models.

Declaration of interest:

Cook Biotech provided a research grant and supplied the SIS and RCM.
A comparison of laser Doppler imaging with other measurement techniques to assess burn depth
Authors: Hemington-Gorse S.J.
Published: May 2014

Accurate diagnosis of burn depth is difficult even for experts in burn care. Clinical assessment of burn depth is highly subjective and has an accuracy of only 60–80%.2-4 Yet in most UK burn care units this is the only method available to determine burn wound depth.
Prevention of surgical wound infection: prophylactic antibiotics in colorectal surgery
Authors: Tweed C.
Published: May 2014

Colorectal surgery is associated with a very high risk of surgical wound infection due to contamination by endogenous bacteria from the large bowel. Antibiotic prophylaxis can help prevent this. However, the importance of timing, selection and route of administration have not been addressed until relatively recently.
Should we include deep tissue injury in pressure ulcer staging systems? The NPUAP debate
Authors: Donnelly J.
Published: May 2014

This year's annual conference of the US National Pressure Ulcer Advisory Panel (NPUAP) included a consensus meeting to evaluate the current NPUAP pressure ulcer staging system. Jeannie Donnelly recounts the lively debate that ensued
Comparison of two peri-wound skin protectants in venous leg ulcers: a randomised controlled trial
Authors: Cameron J. , Hoffman D. , Wilson J. , Cherry G.
Published: May 2014

Objective:

A randomised controlled trial was designed to determine whether or not early intervention with a suitable skin barrier preparation could prevent skin breakdown. This study was conducted to compare the efficacy and cost-effectivenss of two skin protectants, Cavilon No Sting Barrier Film (NSBF) (3M Health Care) and zinc paste compound, in the management of maceration and irritation of the peri-wound area of venous leg ulcers.

Method:

Thirty-five patients with venous leg ulcers and surrounding skin problems were randomised to receive either NSBF or zinc paste compound. The preparation was then applied at each dressing change for 12 weeks. All patients had been receiving compression bandaging before entering the study and continued wearing it throughout the 12-week study period.

Results:

The decrease in wound area was 5.11 ± 8.39cm2 in the NSBF group and 4.59 ± 5.83cm2 in the zinc paste group. The healing rate was 0.046cm per week with NSBF and 0.039cm per week with zinc paste. There was a significant difference in the time required to remove and re-apply the skin protectants: an average of 0.19 (± 0.17) minutes in the NSBF group and 5.53 (± 2.10) minutes in the zinc paste group (p<0.0001).

Conclusion:

Both products were effective barrier preparations. However, NSBF was easy to apply and transparent. The zinc paste was messy to apply and difficult to remove, and thus took up considerably more nursing time than NSBF.

Declaration of interest:

This study was supported by 3M Health Care.
Antibiotic treatment of infected diabetic foot ulcers
Authors: Sheppard S.J.
Published: May 2014

If left undetected or treatment is delayed or inappropriate, diabetic foot ulcers can become limb- and life-threatening. In an attempt to reduce morbidity and mortality rates, efforts are being made, through good glycaemic control and patient/staff education, to prevent diabetic foot ulcers occurring. When this approach fails, effective diagnostic, prognostic and therapeutic strategies must be employed to reduce the human and financial costs.