bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing cost per use of 3M Cavilon No Sting Barrier Film with zinc oxide oil in incontinent patients
Authors: Baatenburg de Jong H. , Admiraal H.
Published: May 2014

Objective:

This study compares the total cost of treatment, skin-condition management and prevention of skin breakdown of perianal/buttock skin in incontinent patients receiving 3M Cavilon No Sting Barrier Film (Cavilon NSBF) and zinc oxide oil.

Method:

This single-centre open-label prospective randomised study involved 40 patients with at least moderate skin damage resulting from incontinence. Patients were randomised to receive either zinc oxide oil or Cavilon NSBF and were treated for 14 days. The study products and other treatment-related products used were recorded, as was the time needed to cleanse the application site and apply the product.

Results:

Use of both products resulted in an improvement in skin condition after 14 days, but this was significantly better with Cavilon NSBF than zinc oxide oil. Cavilon NSBF was more cost-effective as fewer applications were required, less time was spent applying the skin barrier product and faster healing rates were achieved. The cost-effectiveness ratio per treatment group showed an improvement of one point in the total score of the skin-assessment scale costs: ₠28.36 for Cavilon NSBF versus ₠98.06 for zinc oxide oil.

Conclusion:

Both products resulted in an improvement in skin condition after 14 days, but Cavilon NSBF was found to be more cost-effective.

Declaration of interest:

This study was supported by an educational grant from 3M.
Matrix metalloproteinases: their function in tissue repair
Authors: Toy L.W.
Published: May 2014

In adults, wound healing comprises a complex cascade of overlapping events and includes three distinct phases: inflammation, proliferation and remodelling. Normal healing is a controlled balance of repair processes that lead to new tissue formation and destructive processes that remove damaged tissue.
Making the case for adapting the abbreviated burn severity index to include erythroblast count
Authors: Stachon A. , Lehnhardt M. , Katzy Y. , Holland-Letz T. , Steinau H.U. , Krieg M.
Published: May 2014

The peripheral blood of healthy adults is generally free of erythroblasts (EBL), which tend to be found in patients with severe diseases, who have a relatively poor prognosis. The results of our recent retrospective studies indicate that detection of EBL may serve as an early indicator of an increased risk of mortality: on average, the presence of EBL was detected one to three weeks before death. It is worth noting that the poor prognosis associated with detection of EBL remained even in cases where, at follow-up, no EBL presence was detected.
Empowering patients to take control of leg ulcer treatment through individualised management
Authors: Hampton S. , Lindsay E.
Published: May 2014

According to Billings and Cowley, needs assessment is a priority issue in community health. Health-care team members need to examine their own areas of specialty to assess, analyse and identify different health-care needs and share their findings with the whole team.
Winter’s concept of moist wound healing: a review of the evidence and impact on clinical practice
Authors: Jones J.
Published: May 2014

Traditional dressings such as gauze and paraffin or vaseline-impregnated tulle gauze allow the wound to dry out, often resulting in trauma to the healing epidermis at dressing changes. Furthermore, they do not prevent bacterial transmission. More modern dressings have been developed to incorporate an element of moisture retention to the wound, in keeping with Winter’s theory on moist wound healing. This literature review examines Winter’s famous study and explores the concept behind his theory. The physiological affects of moisture retention on healing in superficial wounds are discussed, with a view to correlating this to dermal wounds.
The role of the fibrin cuff in the development of venous leg ulcers
Authors: Brown J.
Published: May 2014

The prevalence of venous ulcers has been quoted as between 0.15% and 1% in Europe and between 600,000 and 2.5 million in the US. The relative frequency of venous leg ulcers is thought to be decreasing due to improvements in community care, prevention and diagnosis, although the ageing population means there is a potential for numbers to increase. Despite these reductions, the economic and social impact is far-reaching — venous leg ulcers cost around £200 million per year in the UK and $1 billion in the US.
Wounds scrutiny in a Swedish hospital: prevalence, nursing care and bacteriology, including MRSA
Authors: Lindholm C. , Andersson H. , Fossum B. , Jörbeck H.
Published: May 2014

Objective:

To identify all wounds, wound types and wound characteristics; to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gram-negative rods;.

Method:

All patients admitted to or visiting hospital clinics were examined. If the patient had a wound, a questionnaire was filled in by a nurse, and if the wound met the inclusion criteria swabs were taken.

Results:

A total of 2172 patients were admitted to or visited the hospital; 408 (19%) had a total of 668 wounds. Of this number, 248 were cultured. Thirty-seven patients had pressure ulcers, 83 had leg and foot ulcers and 288 patients had other types of wounds. Nursing care varied according to wound type and ward. Fifty-eight different types of wound dressings were used. Cleansing was performed with saline in 58% of the wounds. The mean number of dressing changes was once daily. Wounds were painful in 37% of the cases, with a predominance of leg and foot ulcers (51%). Many patients did not receive analgesia. MRSA was identified in two patients. No VRE was identified, and there was a low prevalence of multi-resistance in Enterobacteriaceae and Pseudomonas aeruginosa.

Conclusion:

The study provided important information for future improvement of wound care in a university hospital. Fewer resistant bacteria, particularly MRSA, were identified than expected.

Declaration of interest:

None.
Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial
Authors: König M. , Vanscheidt W. , Augustin M. , Kapp H.
Published: May 2014

Objective:

A randomised clinical trial (n=42) compared the effectiveness of two approaches to debriding chronic leg ulcers: TenderWet 24, which is designed to support the autolytic degradation process, and Iruxol N (Santyl), an enzymatic treatment claimed to enhance the degradation process.

Method:

Patients were randomly assigned to one of the two treatment groups for three weeks. Wounds were evaluated weekly for the amount of eschar/slough, the area of healthy granulation and the re-epithelialised area.

Results:

During days 1–14 slough within the groups was reduced by almost 19% for TenderWet 24 and by 9% for Iruxol N, followed by an increase of 26% and 10% respectively in granulation tissue. These effects were less accentuated during days 7–21. There was a further 11% improvement in tissue debridement for the TenderWet 24 group and a relapse (+9.1%) in the Iruxol N group.

Conclusion:

Although TenderWet 24 appeared to be more efficient in a few cases, the general efficacy of the two products appeared to be almost the same as no statistically significant superiority of either product was found.

Declaration of interest:

This study was sponsored by Paul Hartmann AG, Heidenheim, Germany.
Reviewing the evidence for wound bed preparation
Authors: Dowsett C. , Claxton K.G.
Published: May 2014

In an attempt to understand why a small but significant proportion of wounds fail to heal, the concept of wound bed preparation, and subsequently the TIME (Tissue management, control of Inflammation and infection, Moisture balance, and advancement of the Epithelial edge of the wound) model was developed.1 This systematic approach is an effective way to treat wounds, but is there evidence for its effectiveness?
Maggot debridement therapy to avoid prosthesis removal in an infected total knee arthroplasty
Authors: Townley W.A. , Jain A. , Healy C.
Published: May 2014

Osteoarthritis of the knee is an increasing burden in our ageing population that is often managed successfully by total knee arthroplasty (TKA). Infection following TKA is a devastating complication that accounts for significant cost and morbidity, and often requires surgery. Although modern practice has reduced the incidence of postoperative infection, reported rates still range from 1% to 2%.
Diabetic foot ulcers in Cameroon: can microflora prevalence inform probabilistic antibiotic treatment?
Authors: Kengne A.P. , Choukem S.P. , Deyahem Y.M. , Simo N.L. , Fezeu L.L. , Mbanya J.C.
Published: May 2014

Objective:

To determine the clinical features, regularly associated microorganisms and their susceptibility to antibiotics, and the clinical outcomes of foot ulcers in patients with diabetes at the Yaounde Central Hospital, Cameroon.

Method:

A retrospective analysis of routinely collected hospital data, and data validation by survey of clinical notes was conducted from November 1999 to October 2002 for adult diabetic patients with foot ulcers. Clinical data were recorded for each patient, followed by a record of microbiological investigations where available.

Results:

Of 503 patients with diabetes admitted during the study period, 54 (10.7%) had foot ulcers. Male subject represented 66.7% of this population. The mean age of the study population was 59.66 ± 1.52 years. The foot ulcer led to the diagnosis of diabetes in six patients in whom the condition was previously unidentified. Of the 54 patients with foot ulcers, nine (16.7%) were selected for surgery and the remaining 45 were managed conservatively. Microbiological investigations were available for 21 patients. Proteus mirabilis was the most frequent microorganism yielded, and was regularly associated with Staphylococcus aureus. All the microorganisms isolated showed high sensitivity to second-generation quinolone antibiotics and were regularly sensitive to aminoglycoside antibiotics. Nine (16.7%) patients died and seven (13%) were discharged at their own request.

Conclusion:

The mortality rate among our diabetic patients with foot ulcers is high and the combination of second-generation quinolone and aminoglycoside antibiotics can be proposed as a probabilistic antibiotic approach to treating foot infection.

Declaration of interest:

None.
The concept of concordance and its relation to leg ulcer management
Authors: Mandal A.
Published: May 2014

Concordance has largely been studied from the patients’ perspective without proper consideration of the relationship between the patient and the health-care professional. Numerous factors, not always directly associated with the patient’s condition, can influence concordance. For example, a patient may have been told not to stand for a long time, although their occupation may require them to do exactly that. Concordance is not a static event but can alter according to life’s demands.
Economics of pressure-ulcer care: review of the literature on modern versus traditional dressings
Authors: San Miguel L. , Torra i Bou J-E. , Verdú Soriano J.
Published: May 2014

Despite the breadth of literature on wound-care treatments, published systematic reviews of studies comparing clinical outcomes of modern versus traditional dressings on chronic wounds suggest the former did not clearly demonstrate effectiveness over the latter, mainly because the methodology used to test them was inadequate.
An educational intervention for district nurses: use of electronic records in leg ulcer management
Authors: Lagerin A. , Nilsson G. , Törnkvist L.
Published: May 2014

Objective:

To evaluate district nurses’ management of leg ulcer patients and the effects of an in-service education programme led by district nurses as local educators at primary health-care centres.

Method:

Data were collected from electronic patient records (EPRs), both before and after the educational intervention. Nineteen district nurses undertook a one-day course focusing on four themes: Doppler assessment and measurement of ankle brachial pressure index; compression treatment; patient education; nursing documentation. Fourteen acted as in-service educators; 12 educators completed the intervention. The EPRs were scrutinised with an audit tool.

Results:

The documentation on the selected key areas for the management of patients with leg ulcers was generally sparse, although the educational intervention resulted in statistically significant effects on documentation in three areas.

Conclusion:

Further improvements in care are necessary, as are qualitative and quantitative studies to explore the large discrepancies between guidelines and everyday clinical practice in this field.

Declaration of interest:

The study was financed by a Pickup Grant from the FoUU Administration in Stockholm.
Use of Dermabond tissue adhesive in hand surgery
Authors: Hancock N.J , Samuel A.W
Published: May 2014

Objective:

To assess the efficacy and safety of a tissue adhesive for wound closure in elective hand surgery.

Method:

A prospective observational study of the use of Dermabond for wound closure was undertaken. The cohort consisted of a consecutive case series of 105 patients and 114 surgical wounds. Surgeon and patient assessment was undertaken at a mean of 20 days (10 to 56 days) postoperatively.

Results:

Wound complication rate was low (one adverse event) and all patients were satisfied (46%) or very satisfied (54%) with wound healing and cosmesis.

Conclusion:

Dermabond use in hand surgery is safe and well tolerated by patients. Routine postoperative wound review in these patients may not be needed thereby saving time and resources.

Declaration of interest:

None
Surgically induced Charcot neuroarthropathy following partial forefoot amputation in diabetes
Authors: Zgonis T. , Stapleton J.J. , Shibuya N. , Roukis T.S.
Published: May 2014

Pedal amputation is often necessary to save a limb in patients with diabetes who have an infection, peripheral vascular disease and/or non-healing foot ulcers. While there is scant literature on iatrogenic Charcot neuroarthropathy after pedal amputation, it has been reported that trauma can precipitate it. The literature supports the notion that plantar pressures and foot function may be altered after pedal amputation, making the remaining foot susceptible to mechanical trauma. It is debatable whether the Charcot event is caused by the trauma of surgery or the trauma that ensues postoperatively as a result of the altered foot function.
Antibacterial properties of whole body extracts and haemolymph of Lucilia sericata maggots
Authors: Huberman L. , Gollop N. , Mumcuoglu K.Y. , Block C. , Galun R.
Published: May 2014

Objective:

To partially characterise maggot-secreted antibacterial substances and determine their range of activity against different bacteria.

Method:

Sterile and non-sterile maggots maintained in the laboratory and taken from chronic wounds of treated patients were used. Whole body extracts and haemolymph were fractionated and their range of activity against bacteria was tested using the zone of inhibition assay. The mode of action of bacterial destruction was examined by viable counts, influx of K+ and changes in the membrane potential by scanning electron microscope (SEM).

Results:

Extracts of sterile and non-sterile maggots showed an activity of 200 arbitrary units (AU)/ml and 400AU/ml respectively. Maggots removed from chronic wounds had an activity of 1200AU/ml. Injuring sterile maggots with a sterile needle doubled the antibacterial activity within 24 hours, while the antibacterial activity of haemolymph increased fourfold after injury with a sterile needle and sixteenfold with an infected needle. The fractions with a molecular weight of <1kDa and 3–10kDa showed antibacterial activity against Gram-positive and Gram-negative bacteria including Pseudomonas aeruginosa, Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) isolated from wounds. The fraction with a molecular weight of <1kDa lysed over 90% of the bacteria within 15 minutes by causing an influx of K+ and changing the membrane potential of bacteria.

Conclusion:

The nature of the antibacterial materials extracted from maggots not only indicates their ability to ingest the necrotic tissue on the wound, but also their potential significance in wound healing,

Declaration of interest:

None.
Can cycloidal vibration plus standard treatment reduce lower limb cellulitis treatment times?
Authors: Johnson S. , Leak K. , Singh S. , Tan P. , Pillay W. , Cuschieri R.J. , Mostyn E.
Published: May 2014

Objective:

This single-centre non-blind randomised controlled trial aimed to compare clinical outcomes in terms of recovery time of standard treatment of lower limb cellulitis versus standard treatment combined with cycloidal vibration (Vibro-Pulse) therapy.

Method:

Thirty-six patients (18 per group) with lower limb cellulitis were randomised to receive either standard treatment (intravenous or oral antibiotic therapy) and bed rest or standard treatment combined with cycloidal vibration treatment three times per day, 30 minutes per treatment. The outcome measure was the daily amount of reduction in erythema/cellulitis and oedema reduction against time for up to seven days of treatment and the resources required.

Results:

There was a clinically significant difference between the two groups, with 66% of the study group fully recovering within the seven days compared with 11% of the control group.

Conclusion:

Cycloidal vibration combined with standard therapy can significantly reduce cellulitis treatment time. This can reduce both hospital bed days and the resources required.

Declaration of interest:

This study was supported by Vibrant Medical. EM was a research nurse, part-time funded by Vibrant Medical. The guarantor accepts full responsibility for the conduct of the study, had full access to the data, controlled the decision to publish, and received no funding from Vibrant Medical.
A study of the factors influencing how frequently district nurses re-apply compression bandaging
Authors: Adderley U. , Thompson C.
Published: May 2014

Objective:

This UK study aimed to identify the factors district nurses use in deciding how frequently to re-apply compression bandaging.

Method:

Qualitative observational data from district nurses’ visits to patients and subsequent team meetings were used to structure in-depth interviews with nurses. Data were analysed according to the principles of grounded theory.

Results:

Ten factors emerged as influences on the frequency of re-application. These included knowledge of leg ulcer care, recognition of the symptoms of wound deterioration, confidence, time management, patient preferences and sources of information.

Conclusion:

The influences reported and observed are likely to be of use in designing future bandaging trials and in the delivery of leg ulcer education. The research identifies links between frequency of bandaging and resource awareness, clinical expertise, patient preference and research evidence. Decision-makers could be taught to organise large numbers of factors into several smaller categories that might result in more accurate decision-making regarding the frequency of re-bandaging.

Declaration of interest:

None.
Fulminant infection of the lower limb in a diabetic patient
Authors: Kircheva A. , Paskalev D.
Published: May 2014

The pathogenesis of surgical site infection (SSI) involves the complicated inter action of many risk factors, each of which has a different impact on the local tissue status. Risk factors responsible for SSIs are classified as definitive, probable or possible. Diabetes mellitus is classified as an important ‘probable’ risk factor that can be overcome with therapeutic control of glycaemic imbalance. A significant correlation has been found between higher levels of glycated haemoglobin A1C (HBA1C) and SSI frequency in patients undergoing coronary artery bypass surgery, while a significant increase in SSI morbidity was noted in diabetic patients compared with non-diabetic patients.
The influence of essential oils on the process of wound healing: a review of the current evidence
Authors: Woollard A.C. , Tatham K.C. , Barker S.
Published: May 2014

The management of wounds over the millennia of medical history reads like a catalogue of human ingenuity, a combination of trial and error, word of mouth and quizzical speculation. Since Flemming stumbled across the mould that changed the face of mankind’s battle with infection, antibiotics have been a mainstay of the treatment of infected wounds. However, they only help to combat one of the factors that prevent wounds from healing instead of truly accelerating the speed of tissue recovery. As we approach an era when pathogens are increasingly immune to our arsenal of antibiotics and their ability to mutate1 is outstripping our inventiveness in creating new ones, many ‘forgotten’ remedies are once again gaining appeal.
Retrospective study of factors affecting non-healing of wounds during hyperbaric oxygen therapy
Authors: Oubre C.M. , Roy A. , Toner C. , Kalns J.
Published: May 2014

Objective:

To identify potential factors, including cigarette smoking and diabetes status, that affect wound-healing outcomes during a six-week course of hyperbaric oxygen therapy (HBOT).

Method:

Seventy-three patients with 85 non-healing lower extremity wounds were treated with hyperbaric oxygen therapy (100% oxygen, 2.4 atmosphere absolute, (ATA), for 90 minutes). The wound area was evaluated over the six-week treatment period.

Results:

A non-hierarchical clustering analysis of normalised wound-area data revealed that healing responses could be segregated into three groups: robust healing (n=31, over 50% reduction in area), minimal healing (n=33, 15% reduction) and non-healing (n=21, 60% increase in area). Further analysis revealed that cigarette smoking was associated with poor response (p<0.0001), whereas diabetes was not. Robust responders had higher blood levels of creatinine and urea nitrogen, increased peripheral oxygenation (TcpO2), and were younger than less responsive patients.

Conclusion:

The results suggest that response to HBOT is variable and some patients do not benefit from it. Clinicians should evaluate available laboratory values, age and social history to determine if a patient is likely to benefit from HBOT.

Declaration of interest:

This research was funded by a contract from the US Air Force, 311thHuman Systems Wing, contract #FA8900-06-D to Hyperion Biotechnology.
Pressure ulcers and deep tissue injury: a bioengineering perspective
Authors: Agam L , Gefen A
Published: May 2014

Pressure ulcers are one of the most serious complications in paralysed and immobilised patients, with severe consequences such as sepsis, osteomyelitis, renal failure and myocardial infarction. Literature reviews usually focus on physiology, covering aetiology, prevalence, risk factors and prevention and treatment. Recent studies, however, have indicated that the onset of this physiological problem has a biomechanical origin, and that knowledge about the mechanical deformations and stresses that occur inside soft tissues is of vital importance in prevention. Researchers have invested vast knowledge, long hours, large budgets and the finest, most modern methods toward solving the intriguing puzzle of pressure ulcer origin and progression. This review aims to provide clinicians and engineers with a comprehensive perspective of the biomechanical aspects of pressure ulceration.
Phase I trial on the safety of topical rhVEGF on chronic neuropathic diabetic foot ulcers
Authors: Hanft J.R. , Pollak R.A. , Barbul A. , Gils C.van , Kwon P.S. , Gray S.M. , Lynch C.J. , Semba C.P. , Breen T.J.
Published: May 2014

Objective:

To assess the safety/tolerability and perform a preliminary efficacy evaluation of a multiple-dosing regimen of recombinant human vascular endothelial growth factor (VEGF165or rhVEGF; telbermin) applied topically to chronic diabetic neuropathic foot ulcers.

Method:

Subjects with type 1 or 2 diabetes mellitus were randomised to receive either topical applied telbermin (72µg/cm2) (n=29) or placebo (n=26) treatment to the foot ulcer surface in conjunction with standard ulcer care. Subjects received treatment every 48 hours (maximum three doses per week) for up to six weeks. Weekly 35mm photography, quantitative planimetry and physical examinations documented the ulcer appearance, surface area and stage. Safety endpoints included incidence of clinically significant hypotension, adverse events and ulcer infection. Exploratory efficacy endpoints included percentage reduction in total ulcer surface area, incidence of complete ulcer healing and time to complete ulcer healing.

Results:

Incidence of adverse events was comparable in the two treatment groups. None of the adverse events were attributed to study drug, and no hypotension was observed as a result of telbermin treatment. Occurrence of infected study ulcers appeared to be balanced between the treatment groups. Positive trends suggestive of potential signals of biological activity were observed for incidence of complete ulcer healing (41.4% telbermin versus 26.9% placebo at day 43 [P=0.39]) and time to complete ulcer healing (25th percentile of 32.5 days telbermin versus 43.0 days placebo [log-rank P=0.13]).

Conclusion:

The topical application of telbermin 72µg/cm2 three times a week for up to six weeks appeared to be well tolerated. Further studies are required to characterise the safety/efficacy of telbermin more completely.

Declaration of interest:

Paul S. Kwon, Sarah M. Gray and Christopher J. Lynch are employed by Genentech, and own Genentech stock. Tim J. Breen was employed by Genentech before February 2006 and owns Genentech stock. Charles P. Semba was employed by Genentech before December 2007 and owns Genentech stock.
Effect of Octenisept antiseptic on bioburden of neoplastic ulcers in patients with advanced cancer
Authors: Sopata M. , Ciupińska M. , Głowacka A. , Muszyński Z. , Tomaszewska E.
Published: May 2014

Objective:

To assess the effect of octenidine dihydrochloride (Octenisept, Schülke & Mayr) on the clinical condition and bacterial flora in neoplastic ulcers.

Method:

Twenty-one patients with advanced cancer and neoplastic ulcers were included in the study. Octenisept-moistened gauze dressings were applied to the ulcers three times daily. The clinical and bacteriological status of the wounds were assessed at baseline and after three weeks of treatment.

Results:

Thirty-three bacterial strains were cultured at baseline. After three weeks of treatment, the tests were repeated on 16 patients. Clinical observations confirmed an improvement in the clinical condition of the ulcers, characterised by a reduction in necrosis, exudate levels, erythema and oedema. According to the bacteriological assessment, Staphylococcus aureus, Staphylococcus epidermidis and Proteus mirabilis were eradicated from the wounds. Enterococcus faecalis persisted in two patients, Escherichia coli in one patient and Pseudomonas aeruginosa in another patient.

Conclusion:

Octenispet was an effective antimicrobial: Staphylococcus aureus and Proteus mirabilis were eradicated in all ulcers. After three weeks of treatment, none of the ulcers developed an infection and there was an improvement in their clinical condition.

Declaration of interest:

Materials were supplied by Higiena Company, Warsaw, Poland.
Topical therapies for diabetic foot ulcers: standard treatments
Authors: White R. , McIntosh C.
Published: May 2014

This paper is the first in a two-part series reviewing the evidence on standard and advanced treatments for diabetic foot ulcers. Both clinical studies and economic models are evaluated. The first part concentrates on standard topical therapies
Benefits of an oral nutritional supplement on pressure ulcer healing in long-term care
Authors: Heyman H. , Van De Looverbosch D.E.J. , Meijer E.P. , Schols J.M.G.A.
Published: May 2014

Objective:

To investigate the effects of an oral nutritional supplement (ONS) plus standard care on the healing of pressure ulcers in long-term nursing home residents in addition to standard care. The ONS (Cubitan, Nutricia Advanced Medical Nutrition) was high in energy and protein, and enriched with arginine, vitamin C and zinc.

Method:

A total of 245 patients with grade II–IV pressure ulcers were enrolled into this open study at 61 long-term-care facilities, which reflect the nursing-home population of Luxembourg and Belgium. Residents received the ONS daily for nine weeks, along with their normal diet or enteral feed and standard pressure care. Pressure ulcer area (mm2) and condition were assessed after three and nine weeks. Data were analysed using ANOVA and expressed as mean ± SD.

Results:

The patients’ age was 82.2 ± 10.1 years. Sixty-seven patients (27%) had been previously treated with the ONS. The majority of pressure ulcers were located at the sacrum (54%) and heel (32%). The average intake of the 200ml ONS was 2.3 ± 0.56 servings daily, which corresponds to 46g protein, 6.9g arginine, 575mg vitamin C, 87mg vitamin E and 21mg zinc. After nine weeks’ nutritional support, the average pressure ulcer area reduced significantly from 1580 ± 3743mm2 to 743 ± 1809mm2, which is a reduction of 53% (p<0.0001). Complete wound closure occurred after three and nine weeks in 7% and 20% of the pressure ulcers respectively. The amount of exudation (assessed subjectively) also decreased after specialised nutritional support (p<0.0001).

Conclusion:

A high-protein ONS enriched with arginine, vitamin C, vitamin E and zinc, when used with standard pressure ulcer care, significantly reduced the mean pressure ulcer area of long-term nursing home residents.

Declaration of interest:

This study was supported by Nutricia Belgium.
An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers
Authors: Flack S. , Apelqvist J. , Keith M. , Trueman P. , Williams D.
Published: May 2014

Objective:

To determine the cost-effectiveness of Vacuum Assisted Closure (VAC) therapy (KCI Medical), based on a comparison with both traditional and advanced wound dressings, for the treatment of diabetic foot ulcers in the US.

Method:

A Markov model was designed to estimate the cost per amputation avoided and the cost per quality-adjusted life year (QALY) of VAC therapy, compared with both traditional and advanced dressings. Over a one-year period the Markov model simulated 1000 patients using transition probabilities obtained from the literature. The health states used in the model were: uninfected ulcer; infected ulcer; infected ulcer post-amputation; healed; healed post-amputation; amputation; and death. Patients initially treated with VAC switched to the advanced dressing after three months of treatment if their wound remained unhealed. Patients treated with traditional or advanced dressings were assumed to continue with their treatment for the full 12 months if they remained unhealed.

Results:

The model results demonstrate improved healing rates (61% versus 59%), more QALYs (0.54 versus 0.53) and an overall lower cost of care ($52,830 versus $61,757 per person) for patients treated with VAC therapy compared with advanced dressings. Vacuum Assisted Closure was also shown to be a dominant intervention when compared with traditional dressings.

Conclusion:

The model results indicate that VAC therapy is less costly and more effective than both traditional and advanced dressings. The results are robust to changes in key parameters, including the transition probabilities, the cost of VAC therapy and the utility weights applied to health states.

Declaration of interest:

KCI USA Inc provided financial support for the study.
Exudate-handling mechanisms of two foam-film dressings
Authors: Thomas S. , Young S.
Published: May 2014

Objective:

To investigate the fluid-handling mechanisms of film-backed foam dressings.

Method:

The fluid-handling properties of two dressings (ActivHeal Foam Island, Advanced Medical Solutions, and Allevyn Adhesive, Smith & Nephew) were compared using a standard laboratory technique, which provided comparative data on the dressings’ absorbency and moisture vapour transmission. Movement of exudate through one of the dressings was also investigated in vivo using ultrasound. The fluid-handling data obtained in the laboratory were compared with exudate rates for various wound types reported in the literature to predict wear times for above products.

Results:

Absorbencies of the two dressings were broadly comparable. After 24 hours, under the test conditions, ActivHeal retained a mean of 3.44g (SD 0.04) of the test solution and Allevyn Adhesive 4.32g (SD 0.04), but a major difference was detected in the permeability of the two products: 12.35g (SD 0.42) of the test solution evaporated through the back of Allevyn over 24 hours compared with 1.67g (SD 0.11) through ActivHeal (p<0.0001). The results of the preliminary ultrasound study suggest that, in the clinical situation, exudate migrates away from the wound surface and accumulates beneath the outer film.

Conclusion:

The difference in fluid-handling properties of the two dressings was due to the presence in one of an ‘intelligent’ polyurethane film component, the permeability of which varied in response to the presence of liquid. The data suggested that the film’s permeability was such that the product might be expected to cope with even the most heavily exuding wounds for an extended period, but this performance would be influenced in vivo by factors such as the size of the dressing relative to the wound, and local environmental conditions, which would affect moisture vapour transmission. The somewhat unexpected finding that fluid tended to accumulate beneath the outer film during clinical use suggested the possibility of an ‘osmotic pump’ effect.

Declaration of interest:

The laboratory data on which the absorbency figures are based were produced by an independent accredited test facility under the terms of a commercial testing contract. The ultrasound work conducted by SY was funded by a research grant from Smith & Nephew, and the manuscript was produced by ST for a professional fee as a medical device consultant/medical writer.
The development of the Glamorgan paediatric pressure ulcer risk assessment scale
Authors: Willock J. , Baharestani M.M. , Anthony D.
Published: May 2014

Objective:

To develop a predictive pressure ulcer risk assessment scale based on patient data.

Method:

Detailed questionnaires, based on a review of the paediatric and adult literature and discussion with paediatric nurses with expertise in this area, were used to obtain data on patient characteristics from 265 inpatients in a children's hospital and 54 children with pressure ulcers and 17 children without pressure ulcers from 11 hospitals. These data were then combined to compare the characteristics of children with and without pressure ulcers (using the chi-square test).

Results:

The Glamorgan paediatric pressure ulcer risk assessment scale was developed, based on the significance values identified by the statistical analysis. Variables that were significantly (p<0.01) associated with pressure ulceration included: difficult to position, anaemia, equipment pressing or rubbing against skin, reduced mobility for age, prolonged surgery and persistent pyrexia. The sensitivity, specificity and predictive validity of the Glamorgan scale was found to be greater than those for the Braden Q scale, which is widely used to assess pressure ulcer risk in children in the US.

Conclusion:

Using patient data from children and young people in the development of risk assessment tools for this age group may be preferable to modifying existing adult tools.

Declaration of interest:

None.
Clinical experiences of using a cellulose dressing on burns and donor site wounds
Authors: Alves H.R.N. , de Almeida P.C. Cavalcante , Grillo V.A.T. , Smaniotto P. , Santos D.V. , Ferreira M.C.
Published: May 2014

These preliminary results suggest this temporary skin substitute reduces pain and achieves comparable healing rates to other dressings. Furthermore, its transparency enables regular inspection of the wound bed for signs of infection
Management of ileocutaneous fistulae using TNP after surgery for abdominal malignancy
Authors: Martínez A. , Ferron G. , Le Gal M. , Torrent J. José , Capdet J. , Querleu D.
Published: May 2014

Enteric fluids produced by enterocutaneous fistulae can cause severe inflammation in the surrounding skin. By removing these corrosive fluids, topical negative pressure can help maintain skin integrity and promote spontaneous closure
The effects of smoking on the wound healing process
Authors: Kean J.
Published: May 2014

Cigarette smoking is associated with delayed healing, wound infection and dehiscence. Smokers with wounds can avoid these risks if they refrain from smoking, even if only for a short-term period while the wound is healing
Effect of elasticity on subbandage pressure of three layer tubular compression bandages in healthy volunteers: a RCT
Authors: Weller C. , Jolley D. , Wolfe R. , Myers K. , McNeil J.
Published: May 2014

Objective

To estimate the difference between mean interface sub-bandage pressures of two multilayer compression bandage systems in healthy volunteers when supine, standing, exercising and during recovery.

Method

Inelastic and elastic compression bandages were randomised to opposite limbs of each participant. Sub-bandage interface pressures for both bandages were compared within person. Participants and study staff were aware of the treatment. A pressure transducer measured sub-bandage pressures on the medial aspect of the lower leg, at the transition of the gastrocnemius muscle into the Achilles tendon (B1). The difference in interface pressure for the two different compression bandages was measured at level B1 during supine resting, standing, exercise and recovery. We defined the pressure difference between active standing and lying as a measure of stiffness, and amplitude as the range of pressures during plantar flexion while standing. The two bandage systems (inelastic and elastic) were applied from the base of the toes to just below knee and remained in place for the duration of the experiment. Elastic bandage consisted of three layers of graduated tubular bandage (83% cotton, 9% Lycra, 8% polyamide). Inelastic or short-stretch bandage consisted of 100% cotton crepe bandage.

Results

Interface sub-bandage pressures varied during different activities, but the mean difference in interface pressures between inelastic and elastic bandages was consistently at least 13mmHg. Stiffness was 7.3mmHg higher in the inelastic group (95% CI 5.1–9.5). The estimated difference in amplitude of sub-bandage pressure between the bandages during exercise was 15.5mmHg (95% CI 12.2–18.9).

Conclusion

We found in vivo interface sub-bandage pressures varied with the type of bandage and activity phase. Inelastic bandages resulted in an increased mean interface sub-bandage pressure when resting and recovering, which was further increased when standing or exercising. Bandage stiffness and amplitude were also greater for inelastic compared with elastic bandages.

Conflict of interest

None.
The clinical effectiveness of negative pressure wound therapy: a systematic review
Authors: Xie X. , McGregor M. , Dendukuri N.
Published: May 2014

EObjective

To estimate the efficacy of negative pressure wound therapy (NPWT), on the basis of a systematic review of reported randomised controlled trials (RCTs).

Method

A systematic literature search for relevant RCTs was carried out. The credibility of the outcome of each study was evaluated using a specially constructed instrument.

Results

We identified 17 RCTs, of which five had not been included in previous reviews or health technology assessments. For diabetic foot ulcers (seven RCTs), there was consistent evidence of the benefit of NPWT compared with control treatments. For pressure ulcers (three RCTs), results were conflicting. In trials involving mixed wounds (five RCTs), evidence was encouraging but of inadequate quality. Significant complications were not increased.

Conclusion

There is now sufficient evidence to show that NPWT is safe, and will accelerate healing, to justify its use in the treatment of diabetes-associated chronic leg wounds. There is also evidence, though of poor quality, to suggest that healing of other wounds may also be accelerated.

Conflict of interest

None.
Evaluation of the combined use of ultrasound irradiation and wound dressing on pressure ulcers
Authors: Maeshige N. , Fujiwara H. , Honda H. , Yoshikawa Y. , Terashi H. , Usami M. , Sugimoto M.
Published: May 2014

Objective:

To evaluate the effect of ultrasound irradiation when used alongside standard care in the treatment of pressure ulcers; outcome measures were reduction in wound size and exudate weight.

Method:

Five patients (two male and three female, age range: 76–92 years) with seven ulcers participated in this study. They had National Pressure Ulcer Advisory Panel (NPUAP) stage III or IV pressure ulcers. We conducted an ABABA study (A: standard treatment with dressings that promote a moist wound healing environment; B: ultrasound irradiation administered to the pressure ulcer through the same dressing used in period A; each period lasted 2–4 weeks). Six ulcers each were randomised to either the treatment group or control group. One ulcer was not randomised, but was the first to receive ultrasound in the BABA sequence, with a view to determining if the pilot was feasible. The control group received sham ultrasound in period B. Pulsed ultrasound (20% duty cycle, 0.5W/cm2on the wound surface, 1MHz or 3MHz, for 10 minutes) was applied five times weekly.

Results:

In the treatment group, two ulcers markedly decreased in size after 3–4 weeks of US treatment, one ulcer decreased in size soon after initiation of treatment and one ulcer showed no clear reduction in size. The volume of exudate was greater in period B than A in two ulcers that reduced markedly in size after 3–4 weeks of US treatment. None of the ulcers in the control group decreased markedly in size.

Conclusion:

This pilot study suggests that US used alongside standard treatment might promote the healing of pressure ulcers. However, larger studies are required to determine the effi cacy and mechanism of US treatment for PUs.

Declaration of interest:

None.
Hyperbaric oxygen therapy: an overview
Authors: Kuffler D.P.
Published: May 2014

Oxygen is required for angiogenesis, collagen deposition, re-epithelialisation and oxidative killing of bacteria. This paper gives a brief overview of the evidence on the benefits of hyperbaric oxygen therapy in promoting wound healing
Effect of an arginine-containing nutritional supplement on pressure ulcer healing in community spinal patients
Authors: Brewer S. , Desneves K. , Pearce L. , Mills K. , Dunn L. , Brown D. , Crowe T.
Published: May 2014

Objective

To determine whether or not the use of an arginine-containing nutritional supplement could result in signifi cantly shorter pressure ulcer (PU) healing times in people with spinal cord injuries living in the community, compared with a comparative historical control group.

Method

Eighteen spinal-cord-injured patients (all part of a hospital spinal outreach service) received 9g of a commercial powdered arginine supplement per day until full PU healing occurred. Healing rates were compared against 17 historical control patients (as assessed by medical history audit).

Results

Baseline characteristics (age, gender, injury level and time) were similar between groups. Mean ulcer healing times were 10.5 ± 1.3 weeks versus 21 ± 3.7 weeks (p<0.05) in the intervention and control groups respectively. Comparison of healing rates in the intervention group against expected healing rates derived from the medical literature showed that intervention patients had a significantly shorter mean healing time (category 2 PU: 5.5±1.3 weeks versus 13.4 weeks; category 3 PU: 12.5 ± 1.9 weeks versus 18.2 weeks; category 4 PU: 14.4 ± 4.8 weeks versus 22.1 weeks). A diagnosis of diabetes did not significantly alter healing rates in either group.

Conclusion

Results from this observational study show a promising benefit of arginine supplementation on PU healing for individuals with spinal cord injury living in the community.

Declaration of interest

None of the authors have any financial or relationship conflicts of interest in presenting this paper. The authors would like to thank the Eirene Lucas Foundation for funding the project. The Foundation had no involvement in the study design, data collection, data analysis and interpretation, writing of the manuscript, or decision to publish the manuscript.
Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window
Authors: Wolcott R.D. , Rumbaugh K.P. , James G. , Schultz G. , Phillips P. , Yang Q. , Watters C. , Stewart P.S. , Dowd S.E.
Published: May 2014

Objective

To investigate the hypothesis that newly formed wound biofilms (or bioburdens) are more susceptible to antimicrobial treatment.

Method

Four separate and distinct models were performed by four separate biofilm research laboratories to evaluate the resistance of biofilms to antimicrobial treatments over time. These included a drip-flow biofilm model along with a hydrodebridement study, a porcine skin punch biopsy ex vivo model, a mouse chronic wound model and clinical longitudinal debridement study.

Results

All four models showed that, within the first 24 hours, the biofilm community was more susceptible to the selected antibiotics, and after maturing for up to 48 hours became increasingly tolerant. In each model, there was at least a 24-hour period in which the biofilms were more resistant to antibiotics. Each of the models utilised showed a significant decrease in the resistance of the biofilm/burden to gentamicin for up to 24 hours with a confidence interval of at least 95%. The resistance increased in each of the models by 48 hours and reached original resistance levels by 72 hours.

Conclusion

These data suggest the principles of biofilm-based wound care, along with the use of serial debridement to continually remove mature biofilm, followed by biofilm wound management strategies, including topical antibiotics while the bioburden is still immature and more susceptible, are valid.

Conflict of interest

SED is director of Research and Testing Laboratory, a commercial laboratory that develops molecular methods for diagnosis of wounds and infections and CEO of Pathogenius Laboratories, which is a molecular pathogen diagnostic company with a focus on chronic wounds. RDW is medical director of Southwest Regional Wound Care Center and inventor of biofilm-based wound care principles.
Hydroxyurea-induced foot ulcer in a case of essential thrombocythaemia
Authors: Tsuchiya S. , Ichioka S. , Sekiya N.
Published: May 2014

Objective

To illustrate the association between hydroxyurea and the development of ulcers.

Method

Method: A case study is presented, in which histological changes, mean corpuscular volume (MCV) and transcutaneous oxygen tension (TcPO2) were all measured and analysed, both during hydroxyurea treatment and following it's discontinuation.

Results

Two months following the cessation of hydroxyurea therapy, the patient's ulcer had healed completely. Biopsy specimens taken before and after its discontinuation showed a considerable improvement in vascularity, with a capillary density 6.28 times higher after discontinuation of the drug. TcPO2 was just 8mmHg at the first measurement, and this increased to 65mmHg at the second.

Conclusion

These findings suggest deficient neovascularisation and circulation during hydroxyurea treatment. Changes in MCV also appeared to have an effect on the progress of wound healing, which supports the hypothesis that macroerythrocytosis may be involved in the development of these rare ulcers, via impairment of the microcirculatory rheology.

Conflict of interest

None.