bluuebunny/crossref_metadata_2025 huggingface dataset:
How to make a good start to the New Year
Authors: Glover Deborah
Published: May 2014

The vagarious nature of publishing means most of you will be reading this January issue while still fretting about last-minute Christmas presents*, or if you have a Scrooge-like nature, wondering why the government hasn’t intervened to ban it on the grounds that the mass slaughter of turkeys only interests a few upper-class folk.
A short report on the prevention of slippage in donor site dressings
Authors: Kairinos N.
Published: May 2014

The most common method of dressing donor sites in the UK is with an alginate such as Kaltostat (ConvaTec) due to its haemostatic properties. The dressing is covered with gauze and secured with crepe bandage. It is then left on the wound until healing occurs. Although this practice is contrary to the manufacturer’s instructions, there have been reports in the literature that healing occurs even though the dressing is allowed to dry out.
A time for reflection and anticipation
Authors: Glover Deborah
Published: May 2014

Here endeth another year for JWC. It always seems strange to be reflecting on the past year in mid- October, but given the propensity for shops to only stock basic foodstuffs in festive ranges such as ‘Yuletide’ milk and ‘reindeer cheese’ footballs from early September to mid-January, perhaps I shouldn’t feel so odd.
A draft guideline with room for improvement
Authors: Glover Deborah
Published: May 2014

I’m writing this on 24 January, which is apparently the most depressing day of the year as we have all broken our New Year resolutions, are fed-up at work, and the weather, well, it’s not summer is it?
The role of pressure-redistributing equipment in the prevention and management of pressure ulcers
Authors: Bell J.
Published: May 2014

In response to a focus on education and research in pressure ulcer prevention, this paper reviews the evolution of pressure-redistributing mattresses and explores the effectiveness of interface pressure measurement in mattress development
A victory against MRSA
Authors: Cowan T.
Published: May 2014

A protocol devised and implemented by two wound care nurses has virtually eliminated cases of methicillin-resistant Staphylococcus aureus (MRSA) at percutaneous endoscopic gastrostomy (PEG) sites within Doncaster Health Authority. It is being used in nursing homes throughout the health authority, with the result that it is now rare for a patient to be transferred to hospital with a PEG-site infection.
Editorial: Become a pioneer
Authors: Glover Deborah
Published: May 2014

If any of you reading this remember the first issue of JWC, you’ve been in wound care for too long! Incredibly, the journal is 15 this year. It barely seems five minutes since we held our 10th birthday celebrations. Clearly, the journal, and wound care, have come a long way thanks to the early pioneers who were willing to do the work and publish it.
The clinical and psychosocial challenges associated with bilateral hand traumas.
Authors: Harper R. , Lanson L.
Published: May 2014

A patient was admitted to the Royal Melbourne Hospital after sustaining serious bilateral hand injuries caused by a wood laminating machine. The care received from the multi disciplinary team is described from the time of the first operation, directly from the emergency department, to the ongoing rehabilitation seven months postinjury. Emphasis is placed on the following key challenges presented (Table 1):
Editorial: Let’s take action to avert the coming crisis
Authors: Glover Deborah
Published: May 2014

Will 2007 herald a crisis in tissue viability services? I only ask because it seems to be going through a slight meltdown at the moment. Practitioners have had to deal with ‘evidence’ presented (by a commercial company) to the Health Committee1 suggesting there is ‘a lack of awareness about [dressing] costs, and that they were subject to a ‘consumer sell’ by large companies.’ Also, apparently, tissue viability nurses are paid to ‘lecture at conferences and publish papers intended to influence decision making of less experienced practitioners… which frequently contain product promotions’. The implication is clear — practitioners can be bought and there is no ‘unbiased’ evidence out there (not even in JWC apparently).
Let’s work together for the greater good
Authors: Glover Deborah
Published: May 2014

Felicitations to the Tissue Viability Society (TVS). 2006 marks their 25th anniversary. That the TVS is still going strong is testament to the cohesion of its 1500 grassroot members and the vision and tenacity of its founding and existing councillors. Not only have they promoted excellent clinical standards, but they have also contributed to policy development, provided education for patients and professionals, and raised the discipline’s profile. I suspect the exhibitor stands at the TVS conference on 26–27 April will be ‘out-silvered’ by that of the TVS!
Making good choices
Authors: Zeiger Barbara
Published: May 2014

As a clinician who reads this journal, you make informed decisions that affect the lives you touch. Your practice decisions are evidence-based, allowing administration of care with confidence in the outcomes. There are rules and protocols to follow — that is, until a patient flouts ‘typical’ and prescribed management does not achieve desired outcomes. Then science yields to art, with individual clinician ingenuity and determination trumping literature. Some call this off-label usage.
Coordination and management of TNP from acute to primary care: overcoming the issues
Authors: Davis L. , Barker A.
Published: May 2014

It has been estimated that the annual cost of wound care to the NHS is in the region of £1 billion. With the rapid growth in the number of wound-care products, companies are endeavouring to produce high-quality products that promote an optimal healing environment and are acceptable to patients, user-friendly and cost effective.
Salvage of infected dermal collagen implants with topical negative pressure therapy
Authors: Ahmed S. , Webber J. , Fu B. , Banwell P. , Tiernan E. , Chave H.
Published: May 2014

Implanted prosthetic materials such as polypropylene (Prolene) and polyester mesh are routinely used in surgical abdominal hernia repair. These materials provide strength, permit tension-free repair and are associated with lower rates of hernia recurrence than when open suture techniques are used. However, complications include:
Steady progress on the road to achieving their Scholarship goals
Authors: Bethell Elaine , Evans J.
Published: May 2014

It is now three months since my last Journal of Wound Care/Tendra Scholarship update, and much activity has been taking place behind the scenes. I am busy networking—never having been one to be backwards in coming forwards—finding out who is interested in sharing their guidelines and current practice on neo natal care. The aim is to ascertain best practice and develop guidelines in my trust and perhaps evolve them for use on a regional and then national level.
Congratulations to a new wave of Scholarship winners
Authors: Cowan Tracy
Published: May 2014

The enthusiasm and enterprising spirit of wound-care practitioners, novice and experienced, were celebrated at the 2006 Journal of Wound Care/Mölnlycke Scholarships lunch held in the House of Commons on a brilliantly sunny day on 11 May.
Guest editorial: Wanted! Expert clinical advice on seating
Authors: Collins Fiona
Published: May 2014

One of the clinical areas that the National Institute of Clinical Excellence (NICE) guidelines on pressure ulcer management considers is seating. But as insubstantial evidence exists on the efficacy of one cushion over another, it neither gives advice on the suitability of individual cushions, nor information on the materials they are constructed from and how their design might influence function.
A determination to make a difference
Authors: Glover Deborah
Published: May 2014

In this issue you will find the final reports from our 2005/06 Scholarship winners. Undoubtedly, it has been a year of mixed fortunes for Elaine and Julie. Page 3 exposure kicked off Julie’s journey. No, not that page 3 — it was the Ross Gazette, and the photographer/reporter had just spent the morning at some kind of cattle-based event (trust me, Ross-on-Wye is in the middle of farming country — when I visited Julie it took two train journeys and a lift on a combine harvester).
A challenging and exciting year beckons for our Scholarship winners
Authors: Brown Annemarie , Curry Catriona , Middleton Heather , Geraghty Jemel , Rivers Christine
Published: May 2014

Time has flown by since the Journal of Wound Care/Mölnlycke Health Care Scholarship awards ceremony in May. However, I can still vividly recall my feelings of immense surprise and delight at being awarded the Experienced Practitioner Scholarship. It was covered in several local newspapers and on our trust website, and I have been touched by the congratulatory messages received from colleagues, friends, members of the public and patients alike.
A review of evidence on red vine leaf extract in the prevention and management of venous disease
Authors: Butcher M.
Published: May 2014

Chronic venous insufficiency (CVI) is mainly caused by venous and capillary hypertension — an inadequate venous return and reduced venous pressure by activation of the musculoskeletal pump in the affected limb areas. This leads to a persistent, chronic, venous stasis in the skin of the lower leg. Typical CVI complaints such as tired, heavy and swollen legs, tension and pain in the legs do not only influence well-being, but are also warning signs of a progressive, chronic condition.
A stimulating and successful conference for the EPUAP in Berlin
Authors: Cowan Tracy
Published: May 2014

Delegates from Europe, the US (boosted by a delegation from the National Pressure Ulcer Advisory Board Panel, [NPUAP]), Australia, Japan, Korea and China met together last month in Berlin at the ninth European Pressure Ulcer Advisory Panel (EPUAP) open meeting.
An unexpected side-effect of a dermal regeneration dressing
Authors: Dadban A. , Luong M.S. , Téot L. , Dereure O. , Guillot B.
Published: May 2014

Wide surgical excisions performed for skin tumour removal often need a graft to obtain good quality closure. In some cases, a residual depression is observed, leading to a poor cosmetic result. Recently, the use of a dermal regeneration template-type dressing (Integra, Integra Lifescience Corp, Plainsboro, NJ, US) has been proposed to give a better functional and cosmetic result of the graft. We report here on an unexpected side-effect observed in a patient who underwent surgery for a malignant melanoma and was subsequently treated with this dressing.
Editorial: An inspiration to us all
Authors: Glover Deborah
Published: May 2014

As I write, no doubt you are still up to your ears in last-minute shopping and hoping for a surprise snowstorm that will miraculously prevent the influx of people you foolishly invited for Christmas lunch back in April. Failing such a welcome act of nature, you can always dip into this issue of JWC for some light relief.
Editorial: The prerequisites for optimal pain relief
Authors: Glover Deborah
Published: May 2014

I have just returned from the 11th Conférence Nationale des Plaies et Cicatrisations (that’s the 11th National Conference on Wounds and Healing for those of us who are unable to understand anything in French other than vin, pain and fromage). Nearly 1300 delegates, mainly nurses, attended the three-day event, which was supported by an excellent exhibition.
Evaluation of a new silver foam dressing in patients with critically colonised venous leg ulcers
Authors: Lazareth I. , Ourabah Z. , Senet P. , Cartier H. , Sauvadet A. , Bohbot S.
Published: May 2014

Objective:

To evaluate the performance (efficacy and safety) of an absorbent dressing impregnated with silver salts (UrgoCell Silver) in the management of leg ulcers with clinical signs of critical colonisation.

Method:

This was a prospective multicentre non-comparative phase III clinical trial. Patients were assessed weekly for up to four weeks. Assessment included clinical assessment of critical colonisation (severe spontaneous pain between dressing changes, erythema, oedema, malodour and heavy exudate), wound area tracing and photography. Acceptability was documented by the nursing staff when dressings were changed between two weekly evaluations.

Results:

Forty-five leg ulcers were included. At baseline the mean number of clinical signs of critical colonisation per ulcer was 3.6 ± 0.7, which decreased to 1.2 ± 1.2 at the end of the fourth week of follow-up (an average reduction of 2.3 ± 1.3, p<0.001). Oedema, malodour, erythema and spontaneous pain disappeared at the fourth week in 80%, 70%, 69% and 65% of the treated ulcers respectively. Compared with baseline, the mean reduction in ulcer area was 35.0 ± 58.0% (median 33%, p<0.001) after the four weeks treatment. Granulation tissue covered a mean 77% of the ulcer surface area at four weeks, compared with 41% at baseline. Only three local events were documented: contact dermatitis, a burning sensation and erythema.

Conclusion:

The results suggest that the test dressing had a favourable influence on the wound prognosis, and was well tolerated and accepted in the treatment of venous leg ulcers with clinical signs of critical colonisation.

Declaration of interest:

This study was sponsored by Laboratoires Urgo, Chenôve, France.
A Scholarship journey that is fuelling our passion for wound care
Authors: Geraghty Jemell , Brown Annemarie , Curry Catriona , Middleton Heather , Rivers Christine
Published: May 2014

Since my last report in January 2007, I have had good news and bad news. The good news is that I have secured ethics approval for my study. The bad news is that I must apply for local research and development approval before I can go ahead.
Use of a cadaveric donor fascia lata in a patient with an open knee joint following necrotising fasciitis
Authors: Steenvoorde P. , Van Doorn L.P. , Brehm V. , Verdegaal S.H. , Oskam J.
Published: May 2014

Cadaveric donor fascia lata is mainly used in the surgical treatment of pelvic floor dysfunctions, ophthalmological surgery and in penile reconstructive surgery, for example. It has also been used for the reconstruction of abdominal wall defects in children.
Make the most of the conference season
Authors: Glover Deborah
Published: May 2014

Spring appears to have sprung here in the UK. Magnolia trees are blossoming, the evenings are getting lighter and lambs are gambolling in fields, taking care to avoid any patches of mint growing nearby. Such events herald not only an end to seasonal affective disorder, but the start of the conference season. The first major conference is the European Wound Management Association’s (EWMA) 17th in Glasgow (2–4 May). Its theme is ‘Evidence, consensus and driving the agenda forward’. This is a challenge to say the least as getting ‘good’ or relevant evidence together or consensus on anything is like trying to herd cats. However, EWMA members have excellent credentials in these tricky areas, as do those of the other participating organisations, the Tissue Viability Nurses Association (TVNA), Leg Ulcer Forum (LUF), Tissue Viability Society (TVS) and National Association of Tissue Viability Nurse Specialists (Scotland) (NATVNS), so delegates shouldn’t worry unduly.
A year of professional and personal development
Authors: Brown Annemarie , Curry Catriona , Middleton Heather , Geraghty Jemell , Rivers Christine
Published: May 2014

I cannot believe how the year has flown by and that this is my final update. It has been a turbulent year for all NHS staff and some specialist nurses in particular, and 2007 is set to continue in the same vein, with many highly skilled practitioners, including tissue viability nurses, being sacrificed in the name of cost savings — what a very short-sighted view to take!
Introducing the 2007 JWC/Mölnlycke Scholarship winners
Authors: Cowan Tracy
Published: May 2014

Once again, we had an opportunity at this year’s JWC/Mölnlycke Scholarships lunch to acknowledge the huge contribution that individual practitioners are making to wound management and tissue viability. In what has become an annual tradition, the lunch was held at the House of Commons, thanks to the kind sponsorship of Andrew Selous, MP for South West Bedfordshire. The awards were presented by Deborah Glover, editor of JWC, with assistance from Janice Sigsworth, Deputy Chief Nursing Officer for England at the Department of Health.
Heralding the start of a new era for JWC
Authors: Pollard Tom
Published: May 2014

It’s true. As some of you may have already heard, major changes are afoot at JWC. And with these changes I hope you will see an exciting period of development for the journal.
Development of a pathway of care for venous leg ulcer management
Authors: Henderson V.A. , Hodgson C. , Milne J. , Robson J. , Stevens H.
Published: May 2014

While much has been written on best practice in leg ulcer management over the past decade, unnecessary patient suffering coupled with variations in standards of care and the escalating cost of leg ulcer care are still contemporary issues.
Pain and quality of life in patients with vascular leg ulcers: an Italian multicentre study
Authors: Guarnera G , Tinelli G , Abeni D , Di Pietro C , Sampogna F , Tabolli S
Published: May 2014

Objective:

To assess pain and quality of life in patients with chronic vascular leg ulcers.

Method:

A multicentre cross-sectional study was conducted. A questionnaire to assess quality of life and report the experience of pain was developed. It incorporated the SF-12 questionnaire and a visual analogue scale (VAS) for the assessment of pain during the day, night and at dressing change.

Results:

A total of 381 patients (233 females, 148 males) were observed from September to November 2006. The patients had venous (52%), ischaemic (11%), mixed aetiology (10%), hypertensive (2%), microangiopatic (2%), diabetic (9%) and other (14%) types of ulcers. Women experienced more pain and had a worse quality of life than men. Venous ulcers had high mean VAS values during the day (44.4) and night (44.9). However, a higher mean value was recorded at dressing change, when it was similar to the mean for vascular ulcers (57.5 versus 56.3). There was a direct correlation between pain and quality of life, which was worse for ulcers with a longer duration and larger area. Ulcers of less than three months’ duration had mean VAS values of 38.7, 36.9, 46.8 compared with 53.8, 53.9, 62.9 for ulcers of over 12 months’ duration. Mean SF-12 values for the physical component of the questionnaire also showed that patients whose ulcers had a longer duration had a poorer quality of life (35.9) than patients whose ulcers were more recent (40.9).

Conclusion:

Vascular leg ulcers are very painful and result in a poor quality of life, with a direct correlation with both ulcer duration and ulcer area. Pain relief is required, particularly at dressing changes, as is the selection of advanced wound dressings.

Declaration of interest:

None.
An iatrogenic enchondroma? An unusual X-ray finding
Authors: Boyce N.I , Sharif K.I , Campbell D.A , Farnell R.D
Published: May 2014

Chemical cauterisation with silver nitrate for over-granulating wounds is familiar to most surgeons. Following topical application, silver ions precipitate as either black silver proteinate or silver chloride on the tissue surface, with minimal systemic absorption. Rarely does the extent of silver deposition cause significant opacification on radiographs.
A fitting celebration of 10 years’ EPUAP activity in Europe
Authors: Cowan Tracy
Published: May 2014

The European Pressure Ulcer Advisory Panel (EPUAP) celebrated its tenth anniversary by holding its annual meeting in Oxford, the place of its birth a decade ago. Delegates from Europe, the US, Japan, Israel and southern Africa met to discuss this year’s theme, which was appropriately — Ten Years of Progress: the present and the future in pressure ulcer prevention and management.
United in their irrepressible enthusiasm for wound care
Authors: McGinnis Elizabeth
Published: May 2014

Our four Scholarship winners are now half way through their professional development programmes. Here, they outline their progress so far and describe the difference these projects will make to their services and to them personally
Quality assurance that will ensure robust and transparent guidelines
Authors: Cutting K.F. , White R.J.
Published: May 2014

The AGREE collaboration provides minimum quality standards for guidelines, yet none of the current wound-care guidelines acknowledge whether they fulfil these criteria. Only guidelines that comply with AGREE are likely to improve practice
Let's put pressure ulcers on the agenda
Authors: Cowan Tracy
Published: May 2014

I have had the pleasure of speaking to JWC readers, reviewers and advisors at recent conferences held by the EPUAP in a balmy Bruges in September and by Wounds UK in a more blustery Harrogate in November. For me, it is a valued opportunity to get feedback on the journal (gentle, constructive criticism is my usual request!) and ideas for future content. As a non-clinician, I was surprised how often I was told by advisors in the UK and elsewhere that pressure ulceration needs to be higher on the public and professional agenda.
Reaching the half-way mark of a challenging but rewarding journey
Authors: Stevens Julie
Published: May 2014

Despite the familiar obstacles of staff shortages and the resulting time constraints, our Scholarship winners are making headway with their Scholarship objectives. Here, they describe the difference this is making to them, their services and patients
A holistic approach to the management of a neuropathic plantar ulcer
Authors: McCluskey S. , Gooday C.
Published: May 2014

While pressure relief is a vital component of the treatment of neuropathic plantar foot ulcers, many patients are reluctant to wear offloading devices. Healing is more likely to occur if the patient is happy with its appearance and comfort
Safeguarding tissue viability services in today's NHS: JWC conference report
Authors: Cowan T.
Published: May 2014

The increasing business orientation of the NHS poses a challenge to wound-care practitioners. At a recent JWC conference, speakers and delegates discussed how we can adapt to this new climate to protect and expand tissue viability services
An essential service that we can preserve
Authors: Cowan Tracy
Published: May 2014

In March, JWC hosted a conference on how to safeguard tissue viability services in today’s NHS. The overwhelming message was positive — that if practitioners adapt to the current business ethos in the NHS and provide a strong business case proving that specialist practitioners deliver a vital, cost-effective service — then they can safeguard, and indeed build upon, existing services. The main challenge is to work out how we can best work together to achieve this.
A new perspective on service development
Authors: Cowan Tracy
Published: May 2014

On July 5, the NHS will celebrate its 60th birthday. While its founding principle that care should be free at the point of use and available to all is still largely true, its structure has changed beyond recognition following years of government reforms, mainly in response to unanticipated shifts in social and demographic trends in society. Indeed, for practitioners working in the NHS, it must seem that change is the only constant! Just out is the tellingly entitled NHS Next Stage Review, High Quality Care For All, which follows a year-long consultation with patients and staff by the health minister and cancer surgeon, Lord Darzi.
Propagation of anaerobic bacteria within an aerobic multi-species chronic wound biofilm model
Authors: Sun Y. , Smith E. , Wolcott R. , Dowd S.E.
Published: May 2014

Objective:

Most chronic wound biofilms have been shown to have significant populations of anaerobes. In order to better screen antimicrobial and antibiofilm therapeutics, we evaluated the ability of key anaerobes to incorporate and propagate within our aerobic chronic wound biofilm.

Method:

We had previously developed a rapid model to simulate polymicrobial chronic wound biofilms. This model incorporated meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis (VRE) and Pseudomonas aeruginosa. The model was used along with a variety of anaerobes to determine whether this biofilm model would support propagation of anaerobes similar to that we have identified in chronic wounds.

Results:

Using our previously defined Lubbock Chronic Wound Biofilm (LCWB) model combined with quantitative PCR, anaerobic bacteria were shown to proliferate through integration into the biofilm under aerobic conditions. Using electron microscopy we show close association between aerobes and anaerobes within the biofilm suggesting a synergistic relationship.

Conclusion:

We have expanded the utility of the LCBW to show the ability of clinically significant anaerobic bacteria to thrive in aerobic conditions. The expansion of this model can further simulate the functional characteristics of chronic wound pathogenic biofilms and the species that dwell within them allowing improved ability to evaluate therapeutics that target anaerobes.

Declaration of interest:

None.
TNP-assisted fascial closure in a patient with acute abdomen and abdominal compartment syndrome
Authors: Gourgiotis S. , Villias C. , Benetatos C. , Tsakiris A. , Parisis C. , Aloizos S. , Salemis N.S.
Published: May 2014

Topical negative pressure was applied to prevent abdominal compartment syndrome in a patient following surgery for an acute abdomen. It delayed fascial closure, protected the underlying bowel and facilitated abdominal re-entry
A review of the literature on topical therapies for diabetic foot ulcers. Part 2: advanced treatments
Authors: White R. , McIntosh C.
Published: May 2014

Following part one, which presented background to diabetic foot ulcers and the principles thought to explain hard-to-heal wounds, part two of this series reviews the efficacy and cost data indicating that certain wound treatments may be of benefit
Book review
Authors: Flanagan Madeleine
Published: May 2014

The contributors to this book come from the US, India, Europe and China. The text itself is divided into two parts and 12 chapters. The layout, unfortunately, is not inspiring as it opts for a small font size and black and white diagrams and photographs. Each chapter is fully referenced and ends with the author's prediction of future trends, which quickly becomes repetitive.
Local dressings for pressure ulcers: what is the best tool to apply in primary and second care?
Authors: Lohi J. , Sipponen A. , Jokinen J.J.
Published: May 2014

A vast range of dressings can be used on pressure ulcers, but despite this and the high expense often involved, there is no gold standard for the local treatment of these wounds. This literature review therefore set out to examine the evidence
Cost of wound treatment to increase significantly in Denmark over the next decade
Authors: Hjort A. , Gottrup F.
Published: May 2014

Objective

To demonstrate that changes in demography, life expectancy and incidence of background diseases (including type 2 diabetes mellitus) during the period 2009–2020 will significantly increase the costs of wound care in Denmark.

Method

A simple activity-based equation, which was applied to Danish national statistics on medical conditions and key financial figures from previously published surveys.

Results

Currently, DKK 735m (€99m) is spent each year on municipal wound care. Denmark's population is 5.4 million and about 18,000 wounds can be expected annually in the municipal sector, requiring more than three million dressing changes. These figures are expected to rise significantly upuntil 2020. The percentage of senior citizens will rise by 22% during this time and the number of patients with type 2 diabetes mellitus will increase by 22–24,000 per year. Improved treatments and longer life expectancies will increase the elderly population by 40,000. These changes will cause a gradual rise in wound care costs of up to 30%, corresponding to DKK 224m (€30m) in 2020. However, by adopting a national strategy based on best practice guidelines, it may be possible to intercept this increase in costs. A national strategy in Denmark seems to have the potential to reduce costs by a matching 30%. If Denmark fails to adopt a national strategy, an accumulated loss of DKK 1.5 billion (€206m) can be expected over the next decade.

Conclusion

Wound therapy will pose a major economic challenge to Denmark in future if no intervention is carried out. This study presents an empirical model calculating the economic consequences of future challenges such as demography, lifestyle and type 2 diabetes mellitus. It is suggested that a national strategy for wound therapy may convert a future deficit to zero-balance. Similar challenges are expected in other western European countries.

Declaration of interest

None.
An evaluation of the skin stripping of wound dressing adhesives
Authors: Waring M. , Bielfeldt S. , Mätzold K. , Wilhelm K.P. , Butcher M.
Published: May 2014

Objective:

This study looks at six different modern wound dressings to investigate how likely they are to cause skin stripping and impairment of the skin's barrier function.

Method:

Healthy volunteers had each dressing applied, removed and reapplied to the skin on their back over the study period of 15 days. Skin barrier function was investigated using the amount of transepidermal water loss (TEWL) and then related to the amount of skin stripping, investigated by measuring stained skin removal, the thickness of the stratum corneum after treatment, and the amount of skin attached to the removed dressings. General signs of trauma, such as skin dryness and erythema, were investigated by subjective and objective parameters.

Results:

TEWL values measured on the untreated test area, as well as after application of Urgotul trio, remained relatively unchanged and mepilex border decreased slightly (~1g/m2/h), while all other dressings displayed an increased in TEWL: Allevyn Adhesive (5g/m2/h), versiva XC (14g/m2/h), Comfeel plus (22g/m2/h) and Biatain (28g/m2/h). By the end of the study, only the untreated area (mean 43% dye remaining), Mepilex border (76%) and Urgotul trio (34%) areas had visible dye remaining. It is interesting to note that the untreated site had a colour change, suggesting loss of stratum corneum, due to the shedding of skin cells from the surface. The increase in total skin colour for Comfeel plus and Biatain after day 8 might be assigned to an increased redness due to erythema. All the dressings showed evidence of stratum corneum attached to the adhesive, except Mepilex border, which appeared to be free of any attached stratum corneum.

Conclusion:

Overall the best performance in terms of skin protection and failure to cause skin trauma was found to be for Mepilex border.

Conflict of interest:

This project was funded by a grant from Mölnlycke Healthcare Ltd.
The effect of continuous pressure monitoring on strategic shifting of medical inpatients at risk for PUs
Authors: Motamedi S.M. , de Grood J. , Harman S. , Sargious P. , Baylis B. , Flemons W. , Ghali W.A.
Published: May 2014

• Objective:

To assess the impact of continuous pressure imaging technology on strategic turning of patients by health professionals.

• Method:

This pilot study of a newly-developed continuous pressure imaging technology (XSENSOR ForeSite Patient Turn System) involved two phases of videotaped observation of medical inpatients, with each patient serving as his/her own control: a control phase in which continuous pressure imaging was not available to health-care providers and an intervention phase where it was. The primary outcome was to determine whether access to the technology influenced the rate of patient turns/shifts by nursing staff. Secondary outcomes included a comparison of the rates of other care provider shifts, patient self-shifts, and family assisted shifts. Qualitative data regarding nurse and patient/family perspectives were also obtained.

• Results:

Complete control/intervention data were available for nine patients. The mean rate of two-person assisted turns was 0.274 ± 0.087 turns per hour in the control phase versus 0.413 ± 0.091 turns per hour in the intervention phase (p=0.08). For the combined endpoint of two-person assisted turns or patient transfers off the bed into a wheelchair/chair, there was a statistically significant difference in the mean number of turns per hour: mean of 0.491 ± 0.271 turns per hour for the intervention group versus 0.327 ± 0.235 turns per hour for the control group (p=0.04). Provider interviews confirmed that nurses used information from the technology to inform their patient shifting strategies and behaviours.

• Conclusion:

This pilot study provides some initial data supporting the hypothesis that continuous pressure imaging technology could positively impact the frequency of patient turns by care providers, as well as provide impetus to inspect specific skin locations, thereby providing a potential targeted risk mitigation strategy for the development of pressure ulcers.

• Declaration of interest:

Funding for the study was obtained from PreCarn Inc., an independent, nonprofit company supporting the pre-commercial development of new technologies, and from the Alberta Enterprise and Advanced Education (formally Alberta Advanced Education and Technology). The industry partner, XSENSOR, was involved in setup and maintenance of the technology, but was not involved in the evaluative research protocol. Specifically, XSENSOR personnel were not involved in the collection, coding, or analysis of outcome data, nor in the compilation and writing of this paper. None of the listed authors have any conflicts of interest, financial or otherwise, relating to the technology tested.
A clinical case-series evaluation of a superabsorbent dressing on exuding wounds
Authors: Hindhede A. , Meuleneire F.
Published: May 2014

• Objective:

To evaluate the capacity of a superabsorbent dressing (DryMax Extra; Absorbest AB) to manage excessive exudate, thereby protecting peri-wound skin and facilitating wound healing.

• Method:

Patients with acute and chronic wounds of various aetiology were assessed, and treatment of their wounds with the superabsorbent dressing was evaluated. The starting point for this study was the needs of individual patients and, therefore, the study includes patients with exuding wounds of various aetiologies, which were not progressing towards healing with their previous treatment.

• Results:

Thirty patients, aged 23-94 years, were included in this case series, between December 2008 and September 2009. Dressings were changed from daily to once a week, based on the clinician's judgment and the needs of the individual patient. In many patients, frequent dressing changes were needed initially but, after a while, the exudate levels decreased and the dressing could be changed at longer intervals. Inspection of the saturation was possible without removing the dressing. The absorbing efficiency of the dressing was considered to be very good by the investigating clinician, even under compression, and blood, stool and urine was seen to be absorbed by the dressing. Prior to using the superabsorbent, many patients suffered from painful wounds and maceration, irritation, eczema and itching in the surrounding skin, caused by the wound exudate. As the exudate levels decreased and the wounds started healing, the patients felt less pain and less itching in the surrounding skin.

• Conclusion:

This case series suggests that the superabsorbent dressing promoted wound healing in patients with highly exuding wounds, where previous therapy had failed. More research and evaluation comparing the capacities of various superabsorbent dressings in vitro and in vivo and the clinical implications of their special properties is needed.

• Declaration of interest:

These studies were sponsored by Absorbest AB, manufacturers of DryMax Extra. A. Hindhede is an independent consultant who received a fee for her contribution. F. Meuleneire completed a clinical case-series in agreement with the sponsor and received funding for conduct of the study. The sponsors had no role in study design, or collection or analysis of the data.
Patient perspectives of their leg ulcer journey
Authors: Green J. , Jester R. , McKinley R. , Pooler A.
Published: May 2014

Objective:

To understand the personal impact of venous leg ulceration from the patients' perspective.

Method:

Face-to-face, unstructured interviews were conducted with nine patient participants with venous leg ulcers. The interviews were digitally recorded, transcribed verbatim and, using thematic analysis, the themes and subthemes which impacted on quality of life were identified.

Results:

Four core themes were identified: the ulcer, symptoms, wound management and effects on daily life, with 16 subthemes that negatively impacted on quality of life (QoL) also identified.

Conclusion:

This qualitative study offers a valuable insight into the complex issues that impact on daily living for this patient group. The implications of the findings are far reaching and suggest that proactive symptom management and the fostering of a patient focus to consultations may improve QoL and encourage the patient to engage as an active partner in his/her management plan; both of which are explored in the subsequent phases of the larger study.

Declaration of interest:

This study was funded by West Midlands Strategic Health authority. The authors have no conflicts of interest to declare.
Novel materials for moist wound management: Alginate-psyllium hybrid fibres
Authors: Mahsood R. , Miraftab M.
Published: May 2014

Objective:

To assess the feasibility of producing high absorbing, high gelling hybrid fibres made from alginate and psyllium.

Method:

Three methods of psyllium extraction were attempted: the hot, cold and hydrolysed method. The extracted psyllium was sieved before addition to the alginate dope. To assess feasibility, each dope was in turn extruded on a bench-top extruder and then on a pilot-size wet extruder. Calcium chloride solution was used as the coagulation medium for all the extrusions. The produced fibres were subsequently assessed for their linear density, tensile strength, absorption characteristics and swelling behaviour. Optical microscopy was also used to illustrate hybrid fibre swelling behaviour under different conditions

Results:

This feasibility study has shown that hybrid fibres can be produced when using different methods of psyllium extraction, proving the feasibility of the proposed methodology. However, based on physical and functional assessment of the fibres, it was found that the cold water extraction method leads to better hybrid fibres with superior tensile properties, liquid absorption and swelling, which would render them most suitable for heavily exudating wounds.

Conclusion:

The cold water route is found to be the most effective way of producing polysaccharide-based hybrid fibres. This method is also the least expensive, both in terms of room temperature preparations and functional effectiveness, using only 0.75% psyllium. This fibre is therefore recommended for wound dressing applications.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Negative pressure wound therapy with Bio-Dome dressing technology in the treatment of complex wounds: A case series
Authors: Penny H.L. , Spinazzola J. , Green A. , Rifkah M. , Faretta M. , Youshaw D. , Weaver A. , Zaki P.
Published: May 2014

The treatment of complex wounds is difficult and not always effective. Various treatment options are used with varying degrees of success. Negative pressure wound therapy (NPWT) is a cost-efficient and effective way to help treat these wounds. The use of a vacuum device applies the negative pressure to the site of the wound and promotes waste removal and increases circulation and tissue formation. While various NPWT systems are currently on the market, we utilised the ConvaTec Engenex® system with Bio-Dome™ technology; however, our case study is not intended to advocate the specific use of this system, but instead focusses on the use of NPWT as a viable option for wound healing. Each of the following case study patients presented with difficult-to-heal wounds that failed traditional therapeutic approaches. Through the use of NPWT, our patients saw major wound size reductions. Each patient exhibited at least a 94% reduction in wound area, wound volume or both.
A guide to reading scientific journal articles
Authors: Sibson Lynda
Published: May 2014

This article provides an overview of how to read and review a journal article for a range of purposes. Articles are read for a variety of reasons, such as to support the review of a specific subject area, for a research study or academic research. Reading articles on a regular basis will not only improve your academic reading skills but also will begin to develop your skills in critical analysis of journal articles and their application to practice.

A breakdown is provided of different aspects of an article with some suggested questions to ask in order to ensure that you get the most from the article. Several types of journal article are outlined, including case studies, literature reviews and research articles. Also highlighted are some of the pitfalls when reading articles and suggestions for ways to develop confidence in critical reading and share expertise and experience to inform clinical practice.
The new era in paramedic education
Authors: Start Kath
Published: May 2014

Kath Start reflects on the changing face of education for practitioners in prehospital emergency and unscheduled care
Working as a forensic paramedic
Authors: Knox Chris
Published: May 2014

Chris Knox discusses the role of the paramedic in the custody care system, together with his personal experience of the work.
Managing childhood fever in a prehospital setting
Authors: Cook Kerry
Published: May 2014

In 2007, the National Institute for Health and Clinical Excellence (NICE) produced guidelines on feverish illness in children concentrating specifically on assessment and initial management in children under 5 years. Fever has been identified as one of the most common reasons for children to be taken to their GP or the emergency department and a principal rationale for admission to children's wards. Usually fever indicates some underlying viral or bacterial infection, which is predominantly self-limiting. However, a few are serious in nature requiring urgent treatment, such as meningitis, septicaemia, urinary tract infection and pneumonia.

It is imperative that prehospital health practitioners (paramedic technicians, emergency care practitioners, nurse practitioners) have an ability to think critically about the potential aetiologies displaying this clinical feature, an understanding of current evidence-based management guidelines and a commitment to standardize practice. The aim of this article is to explore and incorporate the NICE guidelines into an appraisal of the ill child presenting with a fever, using the SOAP (subjective, objective, assessment, plan) model of assessment (Weed, 1969) for structure. Furthermore, the physiology of fever will be outlined briefly to provide baseline underpinning knowledge and understanding.
Working as a critical care paramedic
Authors: Page Mike , Jolin Lucy
Published: May 2014

Mike Page talked to Lucy Jolin about the evolving role of the critical care paramedic and his personal experiences of the job
Anaphylaxis: symptoms, signs and management
Authors: Snowden Rachael
Published: May 2014

Anaphylaxis is a severe and life-threatening hypersensitivity reaction. As it is a common presentation, it is vital that ambulance clinicians can recognize the signs and symptoms of this serious condition to enable the prompt and safe administration of life-saving treatment. This article presents an overview of the normal immune response and aims to provide clinicians with an increased understanding of the pathophysiology of anaphylaxis and its signs and symptoms. The pharmacology and the evidence base behind the interventions currently recommended to treat this condition are also discussed and some suggestions are made for future paramedic practice.
Exploring the accuracy of triage after disaster
Authors: Williams Julia
Published: May 2014

Kahn et al conducted a retrospective study exploring the use of the triage algorithm ‘Simple Triage and Rapid Treatment’ (START) following a rail crash involving a commuter train carrying 262 people and a freight train carrying two people.
Q waves: do they indicate full thickness infarcts?
Authors: Hitt Andy
Published: May 2014

The link between pathological Q waves and myocardial necrosis was first observed at autopsy in the early 20th century, an observation that has continued to influence ECG interpretation to the present day. As students we are taught that pathological Q waves on an electrocardiogram (ECG) represent permanent, full thickness myocardial necrosis thus implying that the damage is done and subsequent treatment futile: but could advancing technology challenge this widely held perception? With the development of cardiac magnetic resonance imaging (CMRI) and positron emission tomography (PET) the question regarding the significance of Q waves has been asked at a new level.

The purpose of this article is to compare theory, pathological observations, CMRI/PET studies and to discuss how myocardial stunning and hibernation are influencing our perception of the Q wave. There are many factors that can influence QRS manifestation which may or may not exhibit Q waves that are permanent or transient, sinister or benign and by oversimplifying the significance of these Q waves many patients could be denied life changing treatment.
NWAS Library and Information Service
Authors: Holland Matt
Published: May 2014

Matt Holland is Outreach Librarian in the North West Ambulance Service. Here he explains his unique role, and the steps involved in the development of a Library Information Service.
Is it curtains for Nellie?
Authors: Williams Julia
Published: May 2014

People frequently suggest singing Nellie the Elephant (Nellie) to help maintain good compression rates during cardiopulmonary resuscitation (CPR), but is this practice evidence-based? This prospective randomized crossover trial included 130 people who had little or no previous experience of CPR. Having given participants a brief training in chest compression they were asked to perform three sequences, pre-randomized for order, of 1-minute per sequence of continuous chest compressions on a skill meter resuscitation manikin accompanied by: repeated choruses of Nellie (105 beats per minute); repeated choruses of That's the Way (I like it) (109 beats per minute); and to no music at all.
The future of the ambulance service in the NHS
Authors: Kendall Liz
Published: May 2014

Liz Kendall explains how the Ambulance Service Network fits into the bigger picture, and outlines the vision for the role of the ambulance service in the UK
Heliox in acute severe asthma in the A&E setting: a review
Authors: Scholes Steven
Published: May 2014

Heliox (HeO2) is a mixture of helium and oxygen, often mixed in 80:20 or 70:30 ratios for use in medicine and clinical investigations. Heliox has been available for use in the UK since 2002 and is supplied as Heliox 21 (21% oxygen and 79% helium) by BOC Gases for medical use in asthma, croup, chronic obstructive pulmonary disease and other medical procedures. Heliox use in asthma exacerbations remains largely experimental owing to the limited number of randomized controlled trials. This review aims to critically analyse the efficiency of Heliox use in acute asthma exacerbations in the Accident and Emergency (A&E) setting, evaluate its effectiveness as a medium for nebulization, and assess potential benefits to clinical practice. Prehospital application will also be discussed in moderate-severe asthma exacerbations. It is envisaged that the factors relating to Heliox use in asthma are focused to provide an additional therapy to the current choice of therapies for prehospital clinicians.