bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing serious accidental injuries among children under five
Authors: Phillips Katrina
Published: May 2014

Preventable accidents are a leading cause of serious injury among children under five. Some common accidents have a lifelong impact on the child and their family, causing disability and disfigurement. There is a strong link between accidental injury and inequality, with children from the most disadvantaged families far more likely to be killed or seriously injured. Health visitors are in a strong position to raise parental awareness of risks and provide clear, practical, accurate safety advice. This article provides an overview of childhood accidents, key safety messages, advice on engaging parents and the opportunities presented by Child Safety Week (24–30 June 2013).
Autism in infants and toddlers: Health visitors' role in early detection
Authors: Reynolds Kate E
Published: May 2014

Autism spectrum disorders affect about 1% of children in the UK. Research shows that an early diagnosis of the condition along with educational and social interventions optimise the life chances of those affected. Health visitors are in a key position to identify the signs of autism in infants and toddlers and make timely referrals to specialist services. This article outlines the early markers of autism to support health visitors' practice in this vital role.
Sleep management in infants and devising a sleep programme
Authors: Griffiths Valmai
Published: May 2014

Parents frequently raise the issue of sleep difficulties with health visitors, but the newly qualified practitioner will have had little, if any, formal instruction and may have limited knowledge of sleep or sleep issues. This article aims to equip the practitioner with the knowledge needed to promote good sleeping patterns from early infancy, and to provide some strategies available for parents of children under two years old when difficulties arise. Detailed information about setting up good bedtime routines is given, along with a list of sleep hygiene tips for adults.
Some mothers do ‘ave’ em
Authors: Donnelly Ruth
Published: May 2014

Many newborn babies suffer from colic; others have reflux which causes them distress. And some just scream for no discernible reason. This month, Ruth Donnelly tells her own story of struggling to cope with her newborn baby's screaming and explains how her local health visiting team helped her to keep her cool in a very trying situation.
Prolonged jaundice in neonates
Authors: Trappes-Lomax Catherine Ruth , Paul Siba Prosad
Published: May 2014

Jaundice is common in the neonatal period and is primarily considered to be physiological, due to the breakdown of haemoglobin. It is considered to be prolonged if it lasts more than 2 weeks in full-term babies (or more than 3 weeks in preterm babies) and is fairly commonly seen by health visitors. Most babies with prolonged neonatal jaundice have the condition due to breast milk; however, serious pathologies are sometimes seen and health visitors should consider these when assessing babies with prolonged jaundice. This article suggests some useful tools to help health visitors to decide which babies may be safely managed in the community without being put through invasive tests. Detection of red-flag symptoms should initiate an urgent referral to paediatric services for further management. As mothers of babies with breast-milk jaundice are at risk of giving up breastfeeding, they will usually require support and encouragement following an investigation for prolonged neonatal jaundice.
Health visitor V100 prescribing: Considering the six Cs
Authors: Nuttall Dilyse
Published: May 2014

In light of the Francis report and the introduction of the six Cs, it is imperative that health professionals evidence compassion in practice. Dilyse Nuttall considers V100 prescribing as a relevant example of how health visitors can embed and champion the six Cs in a changing NHS.
Reflecting on personal experience through professional training
Authors: Payne Naomi
Published: May 2014

Having struggled to breastfeed her children, Naomi Payne lacked confidence in her ability to support other mothers. Specialist breastfeeding-support training not only helped to develop her skills, but changed her perception of her own experiences.
Submission period open for Marcé Society conference
Authors: Hanley Jane
Published: May 2014

This September, the International Marcé Society's Biennial Scientific Meeting will take place at Swansea University in Wales, and health visitors are now invited to submit abstracts. With a theme of ‘Creating Change in Perinatal Mental Health’, the event will provide an unrivalled opportunity to learn and share best practice.
How video interaction guidance can promote attuned parenting
Authors: Celebi Monika
Published: May 2014

This article gives an overview of video interaction guidance (VIG) and how it is especially suited to working with parents and infants in the perinatal period. VIG is an evidence-based short-term intervention, based on theories of intersubjectivity. It combines the positive feedback from a benign visual image with an attuned relationship with the professional; this encourages parental attunement and sensitive responsiveness. Training is being developed for health visitors to qualify as VIG guiders and enhance their practice.
Early intervention by public health nurses in the USA and Norway: what works?
Authors: Seal Joanne
Published: May 2014

In this section, a range of brief synopses of recently published articles that may be of interest to health visitors is presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
The development of intuition alongside a knowledge base
Authors: Payne Naomi
Published: May 2014

There is a lot to learn as a SCPHN student, both in theory and practice, but it's not all about building knowledge. Naomi Payne reflects on realising the power of intuition.
Guidance on managing anaemia in patients with chronic renal disease
Authors: Jenkins Karen
Published: May 2014

This article provides the rationale for the implementation of the National Institute for Health and Clinical Excellence (NICE) anaemia guidance for people with chronic kidney disease. It also gives an overview of the differences between NICE guidance and other guidelines.
Renal nursing basics: functions of the skin and bed bathing.
Authors: Mackie Sarah
Published: May 2014

Patients have the right to a high standard of personal hygiene care. Maintaining personal hygiene and appearance are important for their physical health, self-esteem and dignity. Nurses and health care assistants and play a key role in ensuring that the individual needs of the patient are met effectively.
The role of the vascular access nurse specialist
Authors: Cornall Alison J , Thomas Paula A
Published: May 2014

Alison Cornall and Paula Thomas explain why there is a need for vascular access nurse specialists and why more will be needed in the future. They highlight the benefits of employing a dedicated specialist nurse not only for the surgical, radiological and renal teams—but for wellbeing of the patients.
Improving care at the end of life for renal patients
Authors: Murtagh Fliss
Published: May 2014

In the UK, about 44,000 people are on renal replacement therapy, with more than half of these on dialysis (Ansell et al, 2008). For older patients, mortality on dialysis is high, with life expectancy much reduced when compared with the age-matched general population. Before death, some patients withdraw from dialysis, experiencing a short final illness. Others die while on dialysis, either suddenly or following more insidious decline. Some do not start dialysis at all, but opt for conservative (non-dialytic) management from the outset, and live months or maybe years before experiencing decline.
Withdrawal of dialysis: evidence and implications for practice
Authors: Murphy Emma Louise
Published: May 2014

Emma Murphy outlines why the withdrawal of dialysis is becoming a more accepted option for patients with end-stage renal disease, and why there is a consequent need for better collaborative working between renal and palliative teams to deliver quality care for this patient group.
book reviews
Authors: Jones Chris
Published: May 2014

Eating Well for Kidney Health is an absolute must for anyone who has kidney disease. For those with no specialist knowledge about diet restrictions in renal failure, this publication provides easy access to simple advice on the dietary problems commonly faced. Patients are told ‘this is good’ or ‘that is bad’ but medical staff rarely have the time (or perhaps more importantly the knowledge) to properly discuss why vitamins and minerals need close monitoring in renal disease. Renal dietetic services are often stretched and any self-help guides are much needed and help foster a feeling of self-control.
What new leaders need to understand about their teams
Authors: Ellis Peter , Abbott Jane
Published: May 2014

In the fourth article in this series, Peter Ellis and Jane Abbott help the novice nurse leaders find ways to get to know their new team, to identify the various talents that exist within their team and to lead the team successfully to achieve its common goals.
research roundup
Authors: Ellis Peter
Published: May 2014

Peter Ellis presents a synopsis of a selection of recently published research of interest to renal nurses. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the papers selected. A reference is provided for those who wish to look at the research in more detail.

In line with the theme of this issue of JRN, primary care and renal disease, three of the articles are of equal interest to nurses working outside of renal nursing. Their messages translate to areas of nursing where the detection and management of early chronic kidney disease (CKD) takes place.
Freely available online resources for renal nurses
Authors: Bastin Eli
Published: May 2014

This is a brief easy-to-read guide which features websites recommended by Eli Bastin, an Oxford-based outreach librarian. The web sites provide a guide to the NHS the best evidence-based resources available online as well as recommended patient information sites.
book reviews
Authors: Jones Chris
Published: May 2014

This book is aimed at health professionals interested in research, though I find it hard to recommend. It has a single author though provides no detail on his specialty, be it nurse, doctor, epidemiologist or social scientist. The publishers are (M&K Update) not known to me.
How accurate are single sample iohexol techniques?
Authors: Eaglestone Gillian L , Ellis Peter
Published: May 2014

Gillian Eaglestone and Peter Ellis look at the accuracy of using iohexol clearance to estimate renal function from a single blood sample. Although most studies conclude that it may be possible to produce an accurate estimation using this technique, there are also debates over its precision.
Assessing vascular risks: the NHS Health Check programme
Authors: Wilkinson Ian
Published: May 2014

The NHS Health Check programme (formerly known as ‘vascular checks’) offers preventative checks to all those aged between 40 and 74 to assess their risk of vascular disease, which includes kidney disease, followed by appropriate management and interventions. Here Ian Wilkinson outlines the programme.
book reviews
Authors: Jones Chris
Published: May 2014

This is the fifth edition of The Handbook of Kidney Transplantation, which is updated every 4 years. This is especially important in the area of transplantation as the field is moving forward quickly. The editor is a medical director and professor of transplantation, and has drawn together authors who are experts in the varied fields of nephrology, transplantation, pathology, urology, psychiatry, dietetics and social work.One area that has moved on more rapidly than most is that of immunosuppression. The chapter written by the editor is interesting, describing the history of immunosuppression, their mode of action, uses and common side effects. It also describes immunosuppression protocols and describes rejection treatments.
‘Opt out’ or donate your organs: Welsh Assembly agrees legislation
Authors: Biela Chris
Published: May 2014

On 2 July, the Welsh Assembly passed a landmark Bill to change organ donation in Wales. Now, unless you have opted out, you will have given ‘presumed consent’. Great news for the 226 people in Wales awaiting a transplant. But, as Chris Biela reports, organ donation is still a moral minefield.
Nutrition in chronic kidney disease
Authors: McAleer Nick
Published: May 2014

Dietary advice needs to be tailored to individual patients. Health professionals should try to engage patients to ensure they are involved in the development of dietary management. Nick McAleer explains how dietitians play an important role in optimising quality of life outcomes.
Review of intravenous iron medicines challenges renal practice in the UK
Authors: Jenkins Karen
Published: May 2014

A review of the risks and benefits of intravenous iron medicines undertaken by the European Medicines Agency Committee for Medicinal Products for Human Use will have a significant impact on home haemodialysis and non-dialysis patients across the UK. Karen Jenkins outlines the main recommendations and implications for renal practice
Technique survival in dialysis: incorporating the human dimension
Authors: Jayanti Anuradha , Mitra Sandip
Published: May 2014

Technique failure has been somewhat better understood in the context of peritoneal dialysis, rather than home haemodialysis (HD), and a consensus definition of what constitutes this failure in home HD remains unclear. Anuradha Jayanti and Sandip Mitra share the findings of their recently published study on technique survival rates among a total of 166 patients in Manchester.
Managing young adults with end-stage renal disease
Authors: Harden Paul N
Published: May 2014

New approaches are required to optimally manage young adult patients. Age-appropriate clinics held in youth-friendly environments can enable the development of positive peer support. Paul Harden explains how health professionals might approach managing young adult patients more effectively.
What are the perspectives of dialysis nurses towards modality selection?
Authors: Tennankore Karthik K
Published: May 2014

A recent survey study compared the modality selection preferences of home dialysis and in-centre haemodialysis nurses (n=89) at a large tertiary care centre in Canada. In this summary article, Karthik K Tennankore outlines the rationale for the study, presents the key research findings and poses critical questions about the future of dialysis nursing education.
The use of metformin in a patient with renal impairment
Authors: Coleman Adrian , Chai Mee Onn
Published: May 2014

Metformin is indicated for the treatment of type 2 diabetes mellitus, when diet management and exercise do not work alone. It can be used as a monotherapy or combined with insulin to manage blood glucose levels. Adrian Coleman and Mee Onn Chai discuss the use of metformin to treat a 70-year-old woman with lactic acidosis and acute kidney injury.
An overview of the new NHS Healthcare Leadership Model
Authors: Ellis Peter , Abbott Jane
Published: May 2014

The Francis Report on the failings at Mid Staffordshire NHS Foundation Trust found that workplace culture was a key issue in the NHS. In response, the NHS Healthcare Leadership Model was introduced, based on nine key dimensions. In the first part of this series, Peter Ellis and Jane Abbott outline the model's rationale and encourage managers to test themselves for compliance.
New online patient information resource for parents and carers
Authors: Brennan Eileen
Published: May 2014

When a child is diagnosed with renal disease, there is a lot of detailed information for parents and families to digest. To aid understanding of these conditions, all 13 UK renal units and several key associations developed infoKID—an online resource covering 22 conditions and their treatment. Eileen Brennan discusses the process of compiling this source of comprehensive information.
The cost-effectiveness of high compression
Authors: Torgerson D.J. , Nelson E.A.
Published: May 2014

A recent systematic review1 indicated that compression bandaging was an effective treatment for venous leg ulceration. The economic evaluation by Carr et al in this issue (page 243-248) suggests that a compression regimen of four-layered bandaging is resource saving, in contrast to the results of a recent randomised trial.2
The development of a leg ulcer care programme
Authors: Hopkins A. , Scott F. , Gooch S.
Published: May 2014

A discussion of the development and implementation of guidelines within a programme of care.
Prescribing for leg ulcers in general practice, Part 1
Authors: Barlow J.
Published: May 2014

A review to determine the information and factors that determine product selection by community nurses for patients with leg ulcers.
Diabetic foot ulcer associated with Wegener's granulomatosis
Authors: Murray F. , Benbow M.
Published: May 2014

A case report describing the use of conservative therapies to treat a dorso-plantar ulcer in a patient with diabetes complicated by Wegener's granulomatosis.
The role of a hydrofibre dressing in squamous cell carcinoma of the anal canal
Authors: Moore P. , Foster L. , Clark S. , Parrott D.
Published: May 2014

This report describes an unusual presentation of squamous cell carcinoma of the anal canal involving the vagina; radical surgery resulted in a large cavity wound.
Managing pressure ulcers in a nursing home patient
Authors: Hoskins A.
Published: May 2014

The management of a recurring pressure ulcer in a patient who required full nursing care
Who sets the research agenda?
Authors: Nelson E. Andrea
Published: May 2014

Too much research into wound care is undertaken on behalf of companies with commercial agendas, or by researchers simply needing to get published. If researchers want their evidence to be used to inform practice, they need to ask clinicians what questions they need to be answered, says Andrea Nelson.
Use of adjunctive therapy to heal a diabetic amputation site
Authors: Fawcett J.
Published: May 2014

Diabetes can result in a range of complications, and is responsible for many lower limb amputations. This case report discusses a diabetic patient with a complex, non-healing wound following amputation of the foot. A number of adjunctive therapies were used to promote healing, and led to the complete healing of the wound.
Influences on patient adherence with compression hosiery
Authors: Harker J.
Published: May 2014

Compression hosiery plays a vital role in preventing leg ulcer recurrence, but many patients choose not to wear it. This review identifies the factors that may be responsible for this and suggests how the problem can be overcome.
Can Traumacel be used in the treatment of chronic wounds?
Authors: Hofman D. , Wilson J. , Poore S. , Cherry G. , Ryan T.
Published: May 2014

Traumacel (calcium salt of oxidised cellulose) has previously only been used in the treatment of acute wounds. To assess its safety and effectiveness in the management of chronic wounds a 12-week pilot study was undertaken which involved 11 patients with 15 non-healing leg ulcers and assessed ulcer size, ulcer pain and degree of exudate.

Five ulcers healed within the study period. Significant pain relief was experienced by three patients. Use of the dressing did not appear to be related to a reduction in exudate. No patients experienced sensitisation to the product or had to be withdrawn because of adverse effects. Traumacel was found to be safe in the management of chronic ulceration, and appeared to promote healing in some recalcitrant ulcers.
Creating an optimum healing environment for a grade V pressure ulcer
Authors: Dobson J.L. , Ellis S.L.
Published: May 2014

Faced with a patient with severe pressure ulceration exacerbated by various predisposing factors, a multidisciplinary team used treatments including nutritional supplementation and irrigation with 1% aqueous povidone-iodine to achieve full healing.
Microvascular disease aetiology in diabetic foot ulceration
Authors: Murphie P.
Published: May 2014

There is compelling evidence that diabetic microvascular disease involves foot tissues, but it is not known if this is enough to precipitate foot ulceration. This review explores the current evidence.
Simple steps to improve care
Authors: Foster A.V.M.
Published: May 2014

Diabetic foot ulcers need rapid, effective care, and it cannot be left to primary care or surgeons. Every trust should have a multidisciplinary diabetic foot clinic, argues Ali Foster.
Clinical governance 1: Evidence-based practice
Authors: Baxter R. , Baxter H.
Published: May 2014

Practitioners have a responsibility to ensure their practice is based on sound clinical evidence and that the care delivered is of a high quality. What are the best ways of achieving this in the reality of the modern NHS?
Using a soft silicone-coated net dressing to manage skin tears
Authors: Meuleneire F.
Published: May 2014

Traditional management of skin tears can cause new damage and slow down healing. This paper discusses how to categorise these acute wounds and the significance of a study that used a soft silicone-coated net dressing on patients in a Belgian hospital
Larvae therapy and venous leg ulcers: reducing the ‘yuk factor’
Authors: Evans P.
Published: May 2014

When a podiatrist modified a nylon maggot therapy containment bag used to dress a wound, debridement was slower but the maggots could be more easily observed and were easier to remove. It is also more user friendly for patients and practitioners
Evaluation of Dermagraft as an alternative to grafting for open fasciotomy wounds
Authors: Omar A.A. , Mavor A.I. , Homer-Vanniasinkam S.
Published: May 2014

Wounds produced following open fasciotomy can be healed by grafting but this requires a second operation. Is Dermagraft, a tissue-engineered human fibroblast-derived dermis that can be applied on an outpatient basis, a viable alternative?
From the journals
Authors: Baxter Helena
Published: May 2014

Damage-control and decompressive laparotomies for lifethreatening haemorrhage can save the lives of severely injured patients who would have previously died. Unfortunately, many of these patients develop open abdomens, which can lead in many cases to large abdominal wall defects (ventral hernia) that require a complex repair six or 12 months after discharge.
The use of polarised polychromatic non-coherent light alone as a therapy for venous leg ulceration
Authors: Medenica L. , Lens M.
Published: May 2014

Objective:

This study assessed the effectiveness of polarised, polychromatic, non-coherent light therapy in the treatment of venous leg ulcers. Investigators in previous studies have advocated the use of light as an adjunct to other proven therapies or on its own.

Method:

This was a pilot prospective case-series study. We enrolled 25 patients with venous leg ulcers. All were treated with light only. Phototherapy (light therapy) treatments were given once a day over four weeks.

Results:

All ulcers except one (99%) had a positive value for the change in healing area at the end of the four weeks. The total number of 73 leg ulcers recorded at the beginning of the study was reduced to 51 at the end of the four weeks (p<0.01). The decrease in wound surface area following the treatment was statistically significant (mean: 57.15%; SD: 31.87%; p<0.01).

Conclusion:

Polarised, polychromatic light therapy applied as a monotherapy was associated with positive healing rates in patients with venous leg ulcers. It is a simple and non-invasive treatment. However, a well-designed randomised controlled study is needed to confirm the efficacy of this form of phototherapy and to objectively evaluate recommendations for its routine use in clinical practice.

Declaration of interest:

This research was supported by Bioptron AG, Switzerland, which supplied the Bioptron 2 light therapy system used.
Malodorous wounds — taking the patient's perspective into account
Authors: Hack A.
Published: May 2014

Foul-smelling exuding chronic wounds can be devastating for patients and their families. Both the physical and psychological effects of living with such a wound should be considered when working with the patient to devise a care plan.
Combining topical negative pressure and a Bogota bag for managing a difficult laparostomy
Authors: Steenvoorde P. , van Engeland A. , Bonsing B. , da Costa S.A. , Oskam J.
Published: May 2014

Laparostomy is a technique in which the abdomen remains open after a laparotomy. It is indicated when initial treatment is followed by abdominal compartment syndrome, or when relaparotomies for other complications are expected. Laparostomy is also effective and practical in patients with severe intra-abdominal infection.
The prevalence of pressure ulcers in hospitalised patients in a university hospital in India
Authors: Chauhan V.S. , Goel S. , Kumar P. , Srivastava S. , Shukla V.K.
Published: May 2014

Objective:

To estimate the prevalence of pressure ulcers in hospitalised patients and any underlying or predisposing factors to ulceration.

Method:

This cross-sectional study took place in a university hospital in Varanasi, India. A total of 445 patients hospitalised in medical and surgical wards were examined in a single day for the number, site and grade of pressure ulcers. Haemoglobin, serum albumin and blood sugar levels of patients with pressure ulcers were recorded.

Results:

The prevalence of pressure ulcers was high (4.94%). Anaemia, malnutrition and diabetes were important risk factors, while morbidity due to pressure ulcers in long-stay wards, such as neurology, was exceptionally high (40.9%).

Conclusion:

Pressure ulcers remain one of the most neglected aspects of health-care provision in India and identifying their associated risk factors at an early stage may go a long way in preventing their occurrence.

Declaration of interest:

None.
Using topical aromatherapy for the management of fungating wounds in a palliative care unit
Authors: Mercier D. , Knevitt A.
Published: May 2014

Providing palliative care to patients with fungating tumours is a major challenge due to the size of the wounds, their location, exudate, bleeding and, perhaps most distressing, odour. The potentially devastating effect of these wounds on the patient’s body image, and their profound impact on sexuality and relationships must also be taken into account, as must their potential to cause emotional distress that can lead to depression.
Silver absorption and antibacterial efficacy of silver dressings
Authors: Lansdown A.B.G. , Williams A. , Chandler S. , Benfield S.
Published: May 2014

Objective:

To evaluate the patterns of silver release from selected sustained silver-release dressings and the protective role of proteins in wound exudate and wound scale. The bactericidal action of silver in chronic wound therapy is also examined.

Method:

Sequential microbiological examination of wound swabs from seven patients with chronic wounds and sampling of wound exudate and wound scale. Silver content was measured using atomic absorption spectrometry. The ability of Contreet Foam to absorb exudate and release silver was studied in punch biopsy wounds in a rodent model.

Results:

Silver accumulation in wound exudate correlated well with its viscosity and protein content. Silver bound to wound scale and debris was approximately proportional to the silver ion release from dressings. Bacterial burden was controlled, but not eliminated, following chronic silver therapy.

Conclusion:

Silver dressings (Acticoat-7, Actisorb Silver, Contreet Foam, Aquacel Ag and Flamazine) were found to be safe for use in chronic wound therapy. Excess silver ion is bound by wound exudate and wound scale as a protective mechanism. Silver-release dressings are not likely to result in germ-free wounds. Further studies are needed to examine potential silver resistance.

Declaration of interest:

Coloplast A/S supplied dressings and met the laboratory costs.
Developing an accurate system of measuring colour in a venous leg ulcer in order to assess healing
Authors: McGuiness W. , Dunn S.V. , Neild T. , Jones M.J.
Published: May 2014

Objective:

To develop a standardised method of assessing venous ulceration, based on the colour of an ulcer bed and the surrounding skin.

Method:

This pilot study involved taking three sequential digital photographs during an episode of care and measuring the colour using image analysis software. Ten episodes of care were used for data collection.

Results:

Based on previous research, a threshold of ≤3° of colour and 3% of saturation was selected to indicate the reliability of the system. The mean of the colour measurements was inside the reliability threshold when measuring an ulcer bed, but outside the threshold for measuring the surrounding skin.

Conclusion:

The results indicate that the system provides consistent visual representation of a venous leg ulcer.

Declaration of interest:

None.
Does the use of low-level laser influence wound healing in chronic venous leg ulcers?
Authors: Kopera D. , Kokol R. , Berger C. , Haas J.
Published: May 2014

Objective:

Venous leg ulcer treatment often requires months or years of regular wound care by trained staff. It has been suggested that low-level laser irradiation has a biostimulative and wound healing effect, but this has not been clinically verified by controlled studies. This study aimed to compare the effectiveness of low-level laser irradiation with that of a placebo ‘light source’.

Method:

Forty-four patients were assigned to two treatment groups (laser and placebo) or a third group (standardised treatment only) to quantify the effect of the laser therapy. Patients in all three groups received standardised wound care (disinfection, a hydrofibre dressing and compression bandaging). Ulcer size was measured at baseline (day 1), at the end of therapy (day 28) and then two months later (day 90). The relative difference in wound size was evaluated.

Results:

The difference in the reduction in wound size was not statistically significant in all three groups. A positive effect of using the non-laser device (placebo effect) was demonstrated in some patients.

Conclusion:

These study results suggest that low-level laser does not stimulate wound healing in venous leg ulcers. Further controlled studies are needed to clarify the efficacy of low-level laser treatment as a wound-healing stimulant.

Declaration of interest:

None.
Evaluating dressing materials for the prevention of shear force in the treatment of pressure ulcers
Authors: Ohura N. , Ichioka S. , Nakatsuka T. , Shibata M.
Published: May 2014

Objective:

Shear force is believed to affect pressure ulceration. Therefore, dressing materials that reduce shear force may prevent ulceration and facilitate healing.

Method:

We measured the following three properties: the coefficient of friction between the outer layer of the dressings and the patient’s clothes; the degree of adhesiveness between the inner layer of the dressing and the patient’s skin; the transmissibility of shear force of the dressing.

Results:

The coefficients of static friction were 1.01 for hydropolymer, 0.72 for hydrofoam and 0.48 for hydrocolloid. Adhesiveness was tested by rolling different sized ball bearings down a slope and over the adhesive lining under both wet and dry conditions. Under dry conditions, the heaviest ball bearing that stopped rolling for five seconds was 111.9g for both hydrofoam and hydrocolloid. Under wet condition, it was 11.9g for hydrofoam and under 1g for hydrocolloid. Tests showed the very low transmissibility (1N buffer) of shear force for hydrofoam, with significant differences between the dressings. Clinical observation has identified good results for hydrofoam when used under highly exuding conditions and for hydrocolloid when used with relatively slight or decreased exudate.

Conclusion:

Existing dressing materials are being developed and evaluated for wound healing. However, if innovations in the raw materials from which dressings are manufactured could lead to a reduction in shear force and the prevention of pressure ulcers, then dressing materials could be discussed from a viewpoint that is quite different from wound healing.

Declaration of interest:

None.
Determining venous incompetence: a report from a specialised leg ulcer clinic
Authors: Bjellerup M.
Published: May 2014

Objective:

To analyse the diagnosis, treatment and prognosis in patients attending a specialised leg ulcer clinic at a dermatology department.

Method:

In total, 345 patients were investigated and 332 registered and followed up prospectively. All patients had their arterial and venous circulation assessed with a hand-held Doppler ultrasound.

Results:

The most frequent diagnosis was venous ulceration (153 patients, 46%) followed by hydrostatic ulceration (70 patients, 21%). Venous incompetence was classified as isolated superficial (n=86) or deep venous incompetence (n=57) in 143 out of the 153 patients. Previous deep vein thrombosis (DVT) was more frequent in patients with deep venous incompetence. Of patients with venous ulcers, 38 (25%) healed within 92 days, 77 (50%) within 155 days and 115 (75%) within 329 days. Healing time was influenced by patient age, ulcer duration and ulcer area, but not by type of venous incompetence or ankle brachial pressure index. After healing, 19% of venous patients (28/144), dominated by those with superficial disease, were subject to venous vascular surgery.

Conclusion:

Classification of venous insufficiency should be mandatory in patients with venous ulcers since it determines suitability for venous surgery.

Declaration of interest:

This study has been made possible by generous grants from the Gorthon Foundation, Helsingborg, Sweden.
Management of bioburden with a burn gel that targets nociceptors
Authors: Martineau L. , Dosch H-M.
Published: May 2014

Aim:

To assess the effectiveness of RescuDerm, an amorphous, water-soluble burn gel in controlling Pseudomonas aeruginosa growth in rat full-thickness wounds contaminated with 103, 105 or 107 CFU/g tissue.

Method:

Wounds were treated daily for 72 hours with a placebo gel, a 5% w/w mafenide acetate gel (Maf), or with four modalities of RescuDerm application.

Results:

All RescuDerm treatments were equally effective within 24 hours in preventing further Pseudomonas aeruginosa growth in wounds contaminated with 103 CFU/g tissue. Pseudomonas aeruginosa levels remained at or below this baseline count for 72 hours in all but one of the RescuDerm treatments. The bioburdens in Maf-treated wounds were negligible, averaging 0.14 ± 0.09 log10 CFU/g tissue. While RescuDerm and Maf remained bacteriostatic in wounds contaminated with 105 CFU/g tissue, this property disappeared at higher bioburdens.

Conclusion:

RescuDerm can be used for the management of cutaneous injuries sustained in environments deemed marginally or moderately contaminated. Heavily contaminated wounds would require irrigation prior to application to reduce their bioburden below 105 CFU/g tissue.

Declaration of interest:

This work was partly supported by NociPharm. Defence Research and Development Canada (DRDC) Toronto designed all the experimental protocols. The findings of this study were not constrained by the sponsoring body, and have never been presented at a scientific meeting or in another public context.
Use of topical corticosteroids on chronic leg ulcers
Authors: Hofman D. , Moore K. , Cooper R. , Eagle M. , Cooper S.
Published: May 2014

Objective:

Topical corticosteroids are widely used in the management of chronic wounds, yet there is little evidence to support this. This pilot study aimed to identify current practice by three specialist nurses and to assess the efficacy of topical corticosteroids.

Method:

Data on healing, pain relief, exudate reduction and control of hypergranulation tissue were collected on 34 patients whose wounds were treated with topical corticosteroids prospectively in three centres over a three-month period.

Results:

Twenty-seven patients (79%) benefited from the application of topical corticosteroid either in terms of healing, pain relief, exudate reduction or the control of hypergranulation tissue. Two wounds deteriorated and treatment was immediately withdrawn.

Conclusion:

Suppression of inflammation plays an important role in healing and pain relief. Applying topical corticosteroids to the wound can accelerate healing and reduce pain in certain cases. However, careful monitoring is essential as there is a risk of sensitisation with prolonged use as well as a potential increased risk of infection.

Declaration of interest:

None.
Tissue viability in tomorrow's NHS
Authors: White R.
Published: May 2014

This article is based on the inaugural lecture of the UK’s first and only Professor of Tissue Viability, Richard White, given at the University of Worcester in January. In it he asks how our discipline can best adapt to meet existing and future needs
Safety and efficacy of a new honey ointment on diabetic foot ulcers: a prospective pilot study
Authors: Abdelatif M. , Yakoot M. , Etmaan M.
Published: May 2014

Objective:

To study the effectiveness and safety of PEDYPHAR ointment (a new ointment prepared from natural royal jelly and panthenol in an ointment base) in the treatment of patients with limb-threatening diabetic foot infections.

Method:

Sixty patients presenting with limb-threatening diabetic foot infection were categorised into three groups, based on the severity of the lesions. Group 1: full-thickness skin ulcer (Wagner grades 1 and 2); group 2: deep tissue infection and suspected osteomyelitis (grade 3); group 3: gangrenous lesions (grades 4 and 5). They were treated with PEDYPHAR ointment after irrigation and cleansing with normal saline, and surgical debridement if required. The lesions were covered with dressings and patients were followed up for six months or until full healing occurred. No other specific treatment was given apart from insulin treatment to control the diabetes. The primary endpoint was the clinical response at weeks 3, 9 and 24 from the start of treatment.

Results:

Ninety-six per cent of the patients in groups 1 and 2 responded well, with a complete cure, defined as ‘complete closure of the ulcer without signs of underlying bone infection’ by the end of week 9 and for the duration of the six-month follow-up period. All of the ulcers in group 1 healed, as did 92% of those in group 2. All patients in group 3 healed following surgical excision, debridement of necrotic tissue and conservative treatment with PEDYPHAR ointment.

Conclusion:

We can conclude from our pilot study that PEDYPHAR ointment may be a promising, safe conservative local treatment. However, further double-blind randomised controlled studies are needed to confirm this.

Declaration of interest:

Pharco Pharmaceutical supported us in the preparation of the ointment by supplying the raw materials.
Should evidence dictate clinical practice or support it?
Authors: Cutting K.F.
Published: May 2014

Evidence-based practice is widely held to be the benchmark for care, but what constitutes suitable evidence for practice is still the subject of heated debate
Pain-relieving properties of topically applied morphine on arterial leg ulcers: a pilot study
Authors: Jansen M.M. , van der Horst J.C. , van der Valk P.G. , Kuks P.F. , Zylicz Z. , van Sorge A.A.
Published: May 2014

Objective:

To assess whether topical morphine is pharmacologically effective in relieving pain from ulcers caused by arterial insufficiency and identify whether this effect is centrally or peripherally mediated.

Method:

The analgesic effect of a topically applied hydrogel containing 0.5% of morphine was evaluated in a double-blind, placebo-controlled, three-way crossover pilot study involving nine patients with painful arterial leg ulcers. All patients had a baseline pain intensity of at least 5 on a 10-point numeric rating scale. They received the following three treatments in random order: morphine hydrogel plus a subcutaneous (SC) placebo infusion; placebo gel plus a SC infusion of 5mg morphine over six hours and a placebo gel plus a SC placebo infusion. Each treatment lasted one day. Pain was assessed during the first 24 hours after application of the hydrogel and the start of the subcutaneous infusion.

Results:

There was a statistically significant difference between average baseline pain scores and those reported during treatment, but this difference was not clinically relevant. The three treatments did not differ in terms of the pain relief provided.

Conclusion:

Topical morphine does not have a clinically relevant analgesic effect in patients with painful arterial leg ulcers. Further research should focus on ulcers of other aetiology.

Declaration of interest:

None. The Graseby syringe drivers were supplied by Smith & Nephew.
Effectiveness of topical application of amino acids to chronic wounds: a prospective observational study
Authors: Cassino R. , Ricci E.
Published: May 2014

Objective:

To evaluate whether the topical application of an amino acid dressing, Vulnamin, aids the management of chronic wounds.

Method:

A total of 160 patients with non-infected cutaneous chronic wounds were recruited. Before treatment, wound size was assessed using digital planimetry. Treatment lasted for a maximum of six weeks. Wound area measurements were repeated two and six weeks after starting treatment.

Results:

There was a significant reduction in the mean wound area after two weeks (7.4 ± 8.7cm2) and six weeks (4.6 ± 6.3cm2) of treatment, when compared with baseline (11.2 ± 12.1cm2, p<0.01). At the final follow up, 23% of patients (n=36) healed and 34% (n=54) achieved a greater than 60% reduction in wound size. Seventy-six per cent (n=120) achieved positive outcomes (defi ned as a greater than 40% reduction in the ulcer size).

Conclusion:

Although further investigations on the potential effects of this product on chronic wound healing are required, these data suggest it may promote healing in venous, pressure and diabetic ulcers.

Declaration of interest:

This study was sponsored by Professional Dietetics, Milan (Italy).
Pinch grafting of chronic leg ulcers: a retrospective analysis of 104 patients with 169 ulcers
Authors: Hjerppe A. , Sane M. , Huhtala H. , Vaalasti A.
Published: May 2014

Objective:

To compare healing rates of inpatients and outpatients with chronic leg ulcers treated with pinch grafting and to define which of these patients would benefit most from the therapy.

Method:

This retrospective analysis reports the healing rates of 104 patients with 169 ulcers treated with pinch grafting during 1997–2007 at the Department of Dermatology, Tampere University Hospital.

Results:

These relate to 17 outpatients with 18 pinch-grafted ulcers and 95 inpatients with 151 ulcers. Nine ulcers (50%) in the outpatient and 95 (62.9%) in the inpatient group healed completely. Median healing times were five and eight weeks for the outpatient and inpatient groups respectively. For the sample as a whole, 61.5% of the ulcers healed.

Conclusion:

This retrospective study found that pinch grafting is an efficient method of treating chronic leg ulcers, with an overall healing rate over 60%. Patients who complied with compression therapy were most likely to benefit from this therapy.

Declaration of interest:

None.
Managing chronic venous leg ulcers: time for a new approach?
Authors: Brown A.
Published: May 2014

Leg ulcer management focuses on healing, but if the wound does not respond to treatment, the patient may feel dejected and guilty. Centring the patient's life around treatment only makes matters worse. An alternative approach is needed
Does the postoperative dressing regime affect wound healing after hip or knee arthroplasty?
Authors: Collins A.
Published: May 2014

Objective: The aim of this literature review is to enable practitioners to make informed decisions about how to manage patients with hip or knee arthroplasty wounds. Method: A systematic critique of the evidence in relation to how the postoperative dressing regime may affect wound healing after hip or knee arthroplasty, was undertaken. Results: No single treatment emerged as the ideal postoperative dressing regime for hip and knee arthroplasty wounds. Conclusion: A selection of dressings is recommended for hip and knee arthroplasty wounds, on the basis of reducing the incidence of postoperative blistering and wound infection. Conflict of interest: None.
In vivoeffect of sustained-release silver sulphadiazine foam on bioburden and wound closure in infected venous leg ulcers
Authors: Lantis J.C. , Gendics C.
Published: May 2014

Objective:

To determine the in vivo effect of a sustained-release silver sulphadiazine powder foam dressing on the bacterial burden of venous leg ulcers (VLUs), with a view to correlating the wound closure rate with the degree of bioburden and to assess other markers of its progression towards healing.

Method:

Patients attending a tertiary care wound practice were screened for a VLU bacterial count of >105colony forming units (cfu/g) per gram of tissue. Patients were treated with the above topical dressing plus multilayer compression bandaging for 12 weeks. Quantitative cultures were taken at weeks 0, 2, 4 and 8. Wounds were assessed at each weekly visit using photography and planimetry.

Results:

Twenty-four of the 33 screened patients met the inclusion criteria. The average baseline wound size was 12.3cm2. At week 8, the bioburden had reduced to <105cfu/g in 54.2% of patients, with 41.7% achieving this reduction by week 2. At week 8, the median reduction was 0.7log10(p<0.001). The median percentage reductions in bioburden were 50.5%, 56.8% and 80.4% at weeks 2, 4 and 8 respectively. Over the study period, 79.2% of the patients had >75% wound area reduction and 45.8% achieved ulcer closure in a median of 80.5 days.

Conclusion:

Although the wound size and bacterial counts reduced significantly, there was no statistical correlation between the two. Nevertheless, the in vivo data show that this active antimicrobial dressing was associated with a very high healing rate in these hard-to-heal wounds.

Conflict of interest:

This research was supported by a grant from Smith & Nephew, Hull, UK. In addition, the principal investigator receives other grants from Smith & Nephew, Hull, UK.
Prevention and management of wound biofilms: what are the options? A round table discussion
Authors: Cowan T.
Published: May 2014

Biofilms have only recently become a topic of interest in wound care, and are attracting much debate. While the concept is gaining acceptance among clinicians, there is uncertainty as to whether wound biofilms cause chronicity and how their management can be incorporated into routine wound care. Sorbion Aktiengesellschaft sponsored a round table discussion to explore these questions
Accidental radiation exposure leading to non-healing ulcers
Authors: Gambhir S , Mangal M. , Gupta A. , Shah A.
Published: May 2014

Two patients with accidental radiation injury presented at the Sir Ganga Ram Hospital. The first patient, a 41-year-old male, presented with a large necrotic patch on his right gluteal region, which was debrided. Due to the progressive nature of the injury, he developed further necrosis and a non-healing ulcer over the right gluteal region, which was further debrided and covered with a tensor fascia lata flap. Further necrosis over the ischial region was debrided and covered with a pedicled gracilis muscle flap, following which he again required debridement and flap cover for the residual area, which then finally healed. The second patient had a history of radiation exposure followed by a non-healing ulcer on right arm. He was managed by debridement and flap coverage in a single sitting. These two cases suggest that wide excision, thorough debridement and coverage with vascularised tissue are effective in treating radiation ulcers and emphasise that all radiation sources and their management should be strictly controlled.