bluuebunny/crossref_metadata_2025 huggingface dataset:
Haemodialysis access: what the radiologist has to offer
Authors: Jason Wilkins C , Ammar Thoraya
Published: May 2014

Jason Wilkins and Thoraya Ammar discuss the role of the interventional radiologist in vascular access care and illustrate the variety of techniques that exist for access preservation. The article helps promote a greater understanding of the methods and benefits of the range of radiological procedures that may be carried out on patients undergoing haemodialysis.
Why not change the organ donation system to presumed consent?
Authors: Biela Chris
Published: May 2014

Despite a small rise in donations in the UK last year, the demand for organs is still far greater than the supply. Many believe that an overhaul of the present opt-in organ donation system to an opt-out system may boost UK donation rates, which currently lag behind the US and many other European countries. Chris Biela explores the current arguments and ethical issues relevant to this debate.
Back to basics: complications of haemodialysis
Authors: Ellis Peter
Published: May 2014

Peter Ellis provides an overview of a common complication associated with haemodialysis known as intradialytic hypotension (IDH). Dialysis patients experiencing IDH (a decrease in systolic blood pressure) display a number of signs and symptoms, which either need to be prevented, or recognized and managed right at the onset. This article will help renal nurses refresh their knowledge about IDH.
User consultation: one way of improving renal services
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Consultations have become a popular way of gathering information, finding out what is important to whom and helping to shift control to users, in this setting, medical staff and renal patients. Peter Ellis and Jane Abbott give an overview of what consultation actually means, why it is necessary and the benefits it may hold for health professionals and patients, if conducted appropriately.
Disease profile: pyelonephritis
Authors: Chai Mee Onn , Amir-Ansari Behzad
Published: May 2014

Mee Onn Chai and Behzad Amir-Ansari give an overview of pyelonephritis—an infection that in general terms has reached the kidneys. They look at the common causes, symptoms, diagnoses and treatment options. Pyelonephritis requires prompt treatment to avoid long-term damage.
Patients perception of dialysis education versus the dialysis reality
Authors: Hillary Ruth
Published: May 2014

In the case of uncertainty, which accompanies renal disease in particular, expectation is what is considered the most likely to happen. Expectations may or may not be realistic, as they are centred on the future. If patients’ expectations are not realistic and cannot be met, it can give rise to disappointment and more ill health. Ruth Hillary writes about a study that examined this further.
Examining the effectiveness of a diabetic nephropathy clinic
Authors: Glover Ruth , Thangavelu Anita , Kumwenda Mick
Published: May 2014

The management of people with diabetic nephropathy includes control of risk factors such as blood pressure, cholesterol levels and body weight in addition to good glycaemic control. Audit data from the authors’ clinic—run jointly by a nephrologist and diabetes specialist nurse, supported by specialist renal nurses and a dietician—revealed good control of cardiovascular risk factors, especially, cholesterol and blood pressure. The reason for better outcomes in this cohort of patients is thought to be due to the close collaboration between renal and diabetes teams in delivering structured care.
Does home haemodialysis produce better outcomes for patients?
Authors: Miller Jennifer
Published: May 2014

Demand for renal replacement therapy (dialysis and transplantation) is projected to rise by approximately 5% every year until at least 2030. Therefore, particular attention should be paid to areas in which significant increases in demand are likely to lead to further pressure on services. There is evidence to support higher patient survival rates in home haemodialysis compared with those that receive hospital- or satellite-based haemodialysis. Jenny Miller explain why home haemodialysis may be at least as effective as and less costly than hospital or satellite unit haemodialysis.
Providing nutrition support in pre-dialysis chronic kidney disease
Authors: Campbell Katrina L
Published: May 2014

Nutrition support in chronic kidney disease (CKD) is a cornerstone treatment for end-stage kidney disease (ESKD) and there is growing awareness this is also essential in the pre-dialysis or pre-dialysis period. Current treatment strategies and practice guidelines are based on either evidence from dialysis populations or from a limited range of studies in pre-dialysis. This paper will review the literature regarding the nutritional management in chronic kidney disease, to identify effectiveness of nutrition support and supplementation in pre-dialysis.
Highlights from the Anaemia Nurse Specialist Association conference
Authors: Benton Sharon , Hipkiss Vicki
Published: May 2014

This year, the 12th annual Anaemia Nurse Specialist Association (ANSA) conference ‘The Dilemma of Treating Anaemia’ was held in Birmingham on 19 April. President Sharon Benton and President Elect Vicki Hipkiss give an overview of the event's highlights, which included a lecture from a kidney transplant patient and workshops based on ‘real life’ care scenarios.
Back to basics: deceased-donor kidney transplantation
Authors: Curran David
Published: May 2014

In the first part of this series on types of donors, David Curran encourages health professionals to be aware of developments in guidance about the transplantation waiting list. Patient education is also vital to ensure they are prepared when they receive a call for a kidney from a deceased donor.
The role of the renal palliative care clinical nurse specialist
Authors: Watson Sarah , Yeboah Winifred
Published: May 2014

It was recognised, as far back as 2002, that patients with advanced kidney disease had palliative care needs that were not being identified or met. Sarah Watson and Winifred Yeboah discuss the importance of renal palliative care clinical nurse specialists in renal units today.
One year, one kidney
Authors: McNicoll Stephanie
Published: May 2014

Stephanie McNicoll recalls her journey from being diagnosed with immunoglobulin A nephropathy at the age of 22 years to undergoing surgery for an ABO-incompatible kidney transplant, and how her friends, family and the medical team have encouraged her to look forward to a positive future.
The invention of intravenous fluid therapy
Authors: Turner Neil
Published: May 2014

Thomas Latta first used intravenous saline in the 1832 cholera epidemic
Dietary management of hyperkalaemia in CKD patients
Authors: Kyte Laura , Taylor Angeline
Published: May 2014

Laura Kyte and Angeline Taylor discuss the role of renal dietitians in supporting patients with potassium control in chronic kidney disease. They draw from their own experiences as experts in renal care to highlight common problems that health professionals face and advise on how to ensure patients are receiving individualised and person-centred care.
Using care pathways in pressure area management: a pilot study
Authors: Springett J. , Cowell J. , Heaney M.
Published: May 2014

Care pathways are a method of managing, delivering and documenting care. A pilot study of a care pathway system in pressure area management was conducted in two clinical areas. Results from this pilot study indicate that the pathway approach to pressure area management is both useful and valid as a means to enhance clinical decision-making and to facilitate comprehensive pressure area management and the completeness of care documentation. Implementation of the pathway requires a facilitator to provide support and education and to monitor and maintain the change process.
Selecting the most appropriate armchair for patients
Authors: Collins F.
Published: May 2014

A review of the factors to consider in selecting chairs for patients with reduced mobility
Pinch graft skin transplantation for leg ulcers in primary care
Authors: Öien R.F. , Hansen B.U. , Håkansson A.
Published: May 2014

Pinch grafting offers an alternative approach to conventional management of chronic leg ulcers, and is particularly well suited for venous and diabetic ulcers. Relevant literature review from 1872–1998 was reviewed. The method of pinch grafting is described here in detail, and is illustrated by two case reports. Since pinch grafting hastens the healing of granulating wounds, is easy to perform and does not require strict immobilisation, a revival of the method, with adaptation for primary care, should be encouraged.
Pretibial lacerations in older patients: the treatment options
Authors: Bradley L.
Published: May 2014

Skin grafts and compression may be more effective than traditional sutures and dressings in speeding healing of pretibial lacerations in older patients. This review looks at the evidence.
Caring for and protecting the skin of pre-term neonates
Authors: Irving V.
Published: May 2014

Pre-term infants have very immature skin that needs special care and attention and very cautious use of products. More research and guidelines are urgently needed on managing this patient group.
Understanding research: 3 Critiquing findings and conclusions
Authors: Baxter H.
Published: May 2014

Many issues must be considered before a study's recommendations can be applied to practice. This article describes what practitioners should look out for.
Evaluating the effectiveness of a compression sleeve in managing secondary lymphoedema
Authors: Haslett M.L. , Aitken M.J.
Published: May 2014

Compression gradient wrap sleeves are an alternative to bandages in controlling lymphoedema, but there is very little data on the effectiveness of these products. This small study examined their effect on compliance and patient outcomes
Making multimedia work for you: a wound management CD-ROM
Authors: Hopkins A. , Vogel M.
Published: May 2014

The interactive nature of a CD-ROM makes it a valuable learning aid. One London trust saw this potential and developed a wound management CD-ROM that caters for the varying educational needs of its multidisciplinary team.
From the journals
Authors: Baxter Helena
Published: May 2014

Research continues apace into why some wounds fail to heal. Having identified that elevated levels of matrix metalloproteinases (MMPs) are often associated with recalcitrant healing, this Scandinavian study looked at the local profiles of MMP-9, MMP-2 and MMP-14 in normally healing skin wounds (acute) and chronic wounds of different aetiologies.
From the journals
Authors: Baxter Helena
Published: May 2014

Aprospective surveillance of hospital-acquired infection was carried out over a seven-year period in one burns intensive care unit in Brazil from 1993–1999. Data were obtained by reviewing patient records.
From the journals
Authors: Baxter Helena
Published: May 2014

The latest addition to the range of pressure-relieving mattresses on the market — the RIK (KCI) fluid mattress — is compared here with a validated alternating-pressure mattress, the Nimbus 3 (Huntleigh Healthcare).
Present angiogenesis research and its possible future implementation in wound care
Authors: Cox L.
Published: May 2014

The process of new blood vessel formation is essential for wound healing. Nurses should be aware of the latest scientific findings on angiogenesis which will enhance their understanding of how it may affect clinical practice
Group discussion that focuses the mind
Authors: Glover Deborah
Published: May 2014

What happens if you put a group of surgeons and nurses in a room together to discuss issues in current wound management? Would you get a consensus? And how much would people actually learn? These were some of the initial questions raised by the prospect of the Professional Select Committee on Wound Care, organised recently by ConvaTec.
Can debridement and the’Belfast sandwich’ avoid Ray amputation?
Authors: McConville D.O. , Lee B.
Published: May 2014

To summarise, the patient, Mr White, had a long history of neuropathic diabetic foot ulceration, and had been admitted to Belfast City Hospital Trust on three previous occasions for the management of this problem. The key features of Mr White’s medical history are:
Proteases and pH in chronic wounds
Authors: Greener B. , Hughes A.A. , Bannister N.P. , Douglass J.
Published: May 2014

Research into the chronic wound environment has led to an improved understanding of the molecular and cellular processes occurring at the wound bed, culminating in the concept of wound bed preparation. This paper discusses the role of proteases and pH in wound healing, and proposes that pH may influence healing outcomes.
A critical review of the aetiology of diabetic neuropathic ulcers
Authors: Steeper R.
Published: May 2014

Diabetic foot ulcers are the leading cause of non-traumatic lower limb amputation in the West. They are complex and multifactorial in origin, often involving ischaemic and neuropathic elements, with the latter occurring within 10–15 years of diagnosis in 50% of diabetic patients.
Using wound area measurement to predict and monitor response to treatment of chronic wounds
Authors: Moore K.
Published: May 2014

For a chronic wound to heal, it has to be converted into a physiological state that will support the cellular function that leads to wound closure. A framework of the clinical interventions needed to convert a chronic wound from a non-healing into a healing state has been incorporated into the concept of wound bed preparation. This framework comprises four components, which form the acronym of TIME:
Effect of glycaemic control on apoptosis in diabetic wounds
Authors: Rai N.K. , Ansari M. , Kumar M. , Shukla V.K. , Tripathi K.
Published: May 2014

Objective:

To study the effect of glycaemic control on apoptosis in chronic ulcers in diabetic patients and the differential roles of insulin and oral hypoglycaemic agents (OHAs).

Method:

Ten non-diabetic (group I) and 20 diabetic patients (groups II and III), with a wound of more than four weeks’ duration, who were attending the wound clinic at University Hospital, Varanasi, India were recruited. The 10 patients in group 11 received insulin and the 10 in group III an oral hypoglycaemic agent; all had diabetic foot ulcers. Wound biopsy and other routine investigations were performed. Both DNA fragmentation and morphological changes under light microscopy (apoptotic index) were used as determinants of apoptosis. Different variables, including fasting and post-prandial blood sugar, serum low-density lipoprotein (LDL) and markers of microangiopathy, such as proteinuria and diabetic retinopathy, were compared with apoptosis.

Results:

DNA fragmentation in groups I, II and III was 40.00 ± 2.97, 45.26 ± 3.21 and 60.8 ± 3.13 respectively (p<0.01). Near linear correlation was observed with blood sugar level, particularly post-prandial blood sugar (p<0.05) and DNA fragmentation. DNA fragmentation was significantly correlated with serum LDL and proteinuria, and it was much greater in the OHA group than in the insulin group (p<0.05). Similarly, in the diabetic patients with background retinopathy the DNA fragmentation was 46.50 ± 3.42 (n=3) in the insulin group and 66.70 ± 6.48 (n=4) in the OHA group (p<0.05).

Conclusion:

There is a significant increase in apoptosis in diabetic wounds with poorly controlled blood sugar and microangiopathy. This increase was greater in patients on OHAs than those on insulin, and it contributes to delayed wound healing. Morphological markers do not appear to be a reliable index of apoptosis in the diabetic wound.

Declaration of interest:

None.
Body image and acute burn injuries: a literature review
Authors: Pellard S.
Published: May 2014

The significance of body image is increasingly being recognised and is becoming central to the care offered to patients with burn injuries who have undergone an alteration in their body image. There is now a well-established understanding of the emotional problems encountered by these individuals after an acute, injury-related change in their appearance.
Presentation and management of burn injuries in Malawi
Authors: Virich G. , Lavy C.B.D.
Published: May 2014

Malawi has a population of approximately 11 million people, most of whom live in rural areas, although a significant number live in Blantyre, where the industrial, business and cultural centres are situated. These demographics are reflected in the causes and types of burns people in Malawi sustain. Since it first began treating patients in 1994, the burns unit at Queen Elizabeth Central Hospital (QECH), which serves approximately two million people, has made a significant impact on the treatment of burns in Malawi. A study by Komolafe et al. found that very young children sustained a significant proportion of burns occurring in the country and suggested a need for an effective campaign targeting the causes of burns in this subgroup.
Treating wound dehiscence with an alternative system of delivering topical negative pressure
Authors: Miller M.S. , McDaniel C.
Published: May 2014

Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy (TNP), is a topical treatment that uses negative pressure applied directly to the wound bed to promote healing in acute and chronic wounds.
Overview of current practice and future trends in the evaluation of dressings for malodorous wounds
Authors: Lee G. , Anand S.C. , Rajendran S. , Walker I.
Published: May 2014

Wound malodour can affect patients both socially and psychologically. The putrid odour is often misinterpreted as poor hygiene. It can induce constant nausea, resulting in lack of appetite, weight loss and lethargy, which all affect healing. In addition, practitioners have to manage the wound without reacting to the malodour to avoid offending or alarming the patient.
Case report and literature review of leishmaniasis as a cause of leg ulceration in the United Kingdom
Authors: Ather S. , Chan D.S.Y. , Leaper D.J. , Harding K.G.
Published: May 2014

Chronic leg ulceration is a common clinical problem in the UK, with a prevalence of more then 1% in the general population, rising to 2% in those over the age of 80. The commonest cause is mixed venous-arterial disease, which accounts for 67–76% of patients, with arterial disease being the cause in 9–28%. Less common diseases and presentations, such as vasculitis and malignancy, are the cause of ulceration in only 1–2% of patients (Table 1). All these ulcers are associated with considerable morbidity and the cost to the community in particular is high. It has been reported that 1.3% of the total health-care budget of the NHS is spent on the treatment of leg ulcers.
A review of the effect of tap water versus normal saline on infection rates in acute traumatic wounds
Authors: Hall S.
Published: May 2014

Wound cleansing is often undertaken as a ritualistic task rather than with an evidenced-based approach. This suggests that nurses are not questioning the need to cleanse wounds or considering what they hope to achieve by cleansing them. This has important implications for patient care and the use of resources if we are to achieve clinical effectiveness.
Identification of superficial pressure ulcers
Authors: Evans J. , Stephen-Haynes J.
Published: May 2014

Pressure ulcers can be defined as ‘an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction and/or a combination of these’. The National Institute for Health and Clinical Excellence (NICE), which is the organisation responsible for providing national guidance on the promotion of good health and the treatment of ill health in the UK, produced guidelines to help practitioners in primary and secondary care manage such ulceration.
A prospective study on the use of a non-adhesive gelling foam dressing on exuding leg ulcers
Authors: Vanscheidt W. , Münter K-C. , Klövekorn W. , Vin F. , Gauthier J-P. , Ukat A.
Published: May 2014

Objective:

This non-comparative phase II study aimed to evaluate the safety and performance of a non-adhesive gelling foam dressing (GFD-N) in leg ulcer management.

Method:

Forty-six subjects with moderately to heavily exuding leg ulcers were treated with a regimen including GFD-N. Dressings were changed at least every seven days for four weeks or until healing.

Results:

Mean GFD-N wear time was 3.2 days per subject. Mean wound area decreased from 10.1cm2 at baseline to 5.1cm2 at four weeks (p<0.001) and healed in five subjects (11%). The surrounding skin improved or remained stable in all but one subject. When compared with pre-study dressings, ulcer pain decreased for GFD-N, both with the dressing in place (p<0.001) and on dressing removal (p<0.001). Of final investigator ratings for 45 subjects, most were ‘excellent’ for ease of application (89%), ease of removal (96%), conformability (67%) and overall performance (58%). Five subjects experienced adverse events; none were serious or dressing-related.

Conclusion:

This small study demonstrates that GFD-N was safe, effective and convenient for wound healing, exudate management, pain/comfort and ease of use.

Declaration of interest:

This study was sponsored by a clinical grant from ConvaTec, a division of ER Squibb & Sons, Princeton, New Jersey, US.
A review of current objective and subjective scar assessment tools
Authors: Nguyen D.Q.A. , Potokar T. , Price P.
Published: May 2014

An ideal scar assessment tool should include both objective and subjective methods aspects of a scar. This review examines the evidence on existing tools, and emphasises the importance of taking the patient’s perspective into account
Malignancy and leg ulceration in a community-based leg ulcer clinic in New Zealand
Authors: Waters J. , Latta A. , Hartley A. , Jull A.
Published: May 2014

The high prevalence of non-melanoma skin cancers in this patient population highlights the need for early, accurate diagnosis. This can be achieved by biopsying atypical ulcers early and all chronic ulcers within three months of starting treatment
A prospective clinical audit of a new dressing design for lower limb arthroplasty wounds
Authors: Clarke J.V. , Deakin A.H. , Dillon J.M. , Emmerson S. , Kinninmonth A.W.G.
Published: May 2014

An audit of wound healing in patients undergoing total hip or knee arthroplasty in a Scottish hospital found that use of a barrier film made no difference to the effectiveness of a new Hydrofiber/hydrocolloid dressing combination
Reaching for the moon: achieving zero pressure ulcer prevalence
Authors: Bales I. , Padwojski A.
Published: May 2014

Following implementation of a programme to eradicate hospital-acquired pressure ulcers in one US hospital, prevalence fell from 9.5% in 2007 to zero in December 2008. Central to its success is that the programme was a management priority
Honey promotes angiogeneic activity in the rat aortic ring assay
Authors: Rossiter K. , Cooper A.J. , Voegeli D. , Lwaleed B.A.
Published: May 2014

Objective

To investigate possible effects of honey on angiogenesis, using in vitro analogues of angiogenesis and an endothelial proliferation assay.

Method

Using an in vitro rat aortic ring assay we compared pseudotubule formation by medicinal honey (Activon), supermarket honey (Rowse) and a honey-based ointment (Mesitran), with that of artificial honey (70% w/w sugar glucose/fructose). Pseudotubules were analysed using TCS Cellworks AngioSys software. The Angiokit sytem was used to validate the results. Using the MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium. Bromide] assay, toxicity was also assessed on human umbilical vein endothelial cells (HUVEC) directly adherent to plastic.

Results

All honey preparations stimulated pseudotubule formation, maximal at around 0.2% honey. Medicinal honeys were more active than Rowse. The effect was not attributable to the sugar content. Among the honeys tested, the Manuka-based Activon preparation reduced residual viable biomass compared with a sugar control at >0.32% v/v concentration. Rowse had a similar effect only at 2.5%, the highest dose tested.

Conclusion

The influence of honey constituents on angiogenesis in a wound dressing context is likely to be positive, but would depend on the effective dilution of the honey and the penetration of the active constituents against an osmotic gradient. The extent to which this occurs has yet to be established.

Conflict of interest

This work was conceived, designed and executed by the authors. Medical honey preparations were supplied unconditionally but free of charge by the distributors.
Predicting delayed pressure ulcer healing using thermography: a prospective cohort study
Authors: Nakagami G. , Sanada H. , Iizaka S. , Kadono T. , Higashino T. , Koyanagi H. , Haga N.
Published: May 2014

Objective

To investigate whether thermography can be used to detect latent inflammation in pressure ulcers and predict pressure ulcer prognosis in a clinical setting.

Method

For this cohort study, we recruited 35 patients with stage II–IV pressure ulcers on the torso, who underwent thermographic assessment on discovery of their pressure ulcer. The patients were followed up for at least 3 weeks. Thermography was performed immediately after dressing removal. Pressure ulcers were classified into two groups depending on whether or not the wound site temperature was lower or higher than the periwound skin: the low temperature group and the high temperature group respectively. A generalised estimation equation was used to estimate the relative risk of delayed healing of pressure ulcers, comparing wounds with high temperatures and low temperatures.

Results

Of the 35 patients, 21 had ‘low temperature’ wounds and 14 had ‘high temperature’ wounds at baseline. Two patients in the high temperature group presented with overt infection, and were excluded from further analysis. Twenty-two pressure ulcers were considered to heal ‘normally’ (that is, the wound area reduced by 30% or more within 3 weeks) and 16 did not heal. The baseline DESIGN score (a measure of gross wound status) did not differ in any subscales between the high and low temperature groups. The relative risk for delayed healing in high temperature cases was 2.25 (95% confidence intervals; 1.13–4.47, p=0.021). Sensitivity was 0.56, specificity was 0.82, positive predictive value was 0.75, and negative predictive value was 0.67.

Conclusion

Our results indicate that using thermography to classify pressure ulcers according to temperature could be a useful predictor of healing at 3 weeks, even though wound appearances may not differ at the point of thermographical assessment. The higher temperature in the wound site, when compared with periwound skin, may imply the presence of critical colonisation, or other factors which disturb the wound healing.

Conflict of interest

None.
Living with wound-associated pain: impact on the patient and what clinicians really think
Authors: Jones M. Lloyd , Greenwood M. , Bielby A.
Published: May 2014

Objective

To gain an insight into current practice and practitioner opinions on the recognition and management of wound-associated pain as compared with that previously presented in the literature.

Method

Delegates who attended Wound Expo 2009 and participated in the interactive learning workshops held in the wound pain educational zone were surveyed. This was therefore a convenience sample. All participants signed a consent form prior to the interactive voting session to allow their anonymous responses to be used. The survey consisted of questions that had been devised to generate a clearer insight into current practice and opinion on wound-associated pain. Questions were posed during the workshop (displayed in a PowerPoint presentation) and attendees were given 10 seconds per question to select their preferred responses, each using an individual electronic interactive voting panel. All responses were recorded electronically and the data were subsequently analysed.

Results

The survey identified a number of positive approaches used by the delegates in their assessment of wound-associated pain. These include a high level of continuous assessment, an awareness of the wide range of pain assessment tools available and an acknowledgement of the need for a multiprofessional approach to pain management.

Conclusion

The findings highlight the issues clinicians face in the recognition, assessment and management of wound-associated pain during their everyday practice. Although many of these issues are difficult to resolve entirely, a fundamental element is that the patient's experiences must be assessed and documented in a consistent and informed manner, and then appropriate management actions taken.

Conflict of interest

This paper was written in conjunction with the Clinical Project Team of Smith & Nephew Healthcare, who sponsored the wound pain zone workshops.
Retrospective study of pressure ulcer prevalence in Dutch general hospitals since 2001
Authors: Amir Y. , Meijers J. , Halfens R.
Published: May 2014

Objective: To investigate whether factors such as patient characteristics, pressure ulcer (PU) prevention strategies and the structural quality indicators used by institutions and wards can explain an apparent decline in PU prevalence from 2001 to 2008. Method: The Dutch National Prevalence Survey of Care Problems (known as LPZ) database from 2001 to 2008 was used to explore differences in patient characteristics, PU prevention strategies and structural quality indicators used by institutions and wards between two periods, 2001–2004 (PU as an internal health-care quality indicator) and 2005–2008 (PU as an external health-care quality indicator). Results: Compared with 2001–2004, fewer participants with CVA/hemiparesis (OR 0.485), infectious diseases (OR 0.861), surgery lasting >2 hours (OR 0.637), at-risk Braden scale scores (OR 0.844), and more participants with diabetes mellitus (OR 1.693) were found in the 2005–2008 group. More special beds/mattresses (OR 2.216) and special cushions in wheelchairs (OR 2.277) were used in the 2005– 2008 period, as well as slightly more repositioning, dehydration/malnutrition prevention and PU prevention and treatment information. More institutions had information leaflets (OR 5.894), PU prevention guidelines (OR 4.625), a PU committee (OR 2.503), and a PU-wound care nurse at ward level (OR 2.434) in the 2005–2008 period. Conclusion: The decline in PU prevalence at Dutch general hospitals after 2004 may be partly explained by differences in patient characteristics, improved structural quality indicators and a slight improvement in PU prevention. Further research is needed to find evidence of which individual factors can explain the decline in PU prevalence after 2004 and whether any changes in health care policy have impacted on these prevalence rates. Conflict of interest: None.
Ecthyma gangrenosum in a premature low-birth-weight newborn
Authors: Basu S. , Kumar A.
Published: May 2014

Ecthyma gangrenosum is a well-recognised cutaneous infection in critically ill and immunocompromised patients. It is commonly associated with Pseudomonas aeruginosa septicaemia. Classic lesions of ecthyma gangrenosum comprise deep ulcers with ecchymotic, gangrenous centres, bright red areolae and typical raised, purplish, indurated, rolled-out edges. We report ecthyma gangrenosum in a premature low-birth-weight neonate, delivered at home to a third gravida mother with history of chorioamnionitis. He was admitted to a private hospital on third day of life, with a diagnosis of early-onset neonatal sepsis and received multiple antibiotics over next 22 days. The infant was referred to the paediatrics emergency department of Sir Sunderlal Hospital, Banaras Hindu University in a condition of shock, pneumonitis and generalised sepsis. Two gangrenous ulcers with gray-black eschar were present, one over the neck and another over the back. He was diagnosed as a case of neonatal sepsis with ecthyma gangrenosum. Blood culture revealed growth of Pseudomonas aeruginosa, sensitive only to imipenem. The infant died the day following admission.
Clinical and economic evidence supporting a transparent barrier film dressing in incontinence-associated dermatitis and peri-wound skin protection
Authors: Guest J.F. , Greener M.J. , Vowden K. , Vowden P.
Published: May 2014

Objective:

To summarise the clinical and economic literature relating to the effect of Cavilon No Sting Barrier Film on the incidence of incontinence-associated dermatitis, which is a risk factor for pressure ulceration and exudate-related peri-wound skin damage.

Method:

A systematic literature search was performed using available computerised databases for publications on Cavilon barrier film and other relevant terms. Six clinical studies were identified providing data on 1,563 patients treated with the barrier film or a comparator. The publications comprised prospective studies, randomised and non-randomised studies, multicentre trials, single-centre reports and a volunteer study. Due to the nature of the comparators, five studies were open-label. Differences in methodology and outcomes made a qualitative review the most appropriate analysis.

Results:

The barrier film was at least as effective as petroleum ointments and more effective than zinc oxide formulations in preventing incontinence-associated dermatitis. The barrier film was also effective in peri-wound skin protection, although its clinical efficacy was not significantly different to that of petroleum ointments and zinc oxide formulations. Nevertheless, the barrier film was more cost-effective than either petroleum ointments or zinc oxide formulations in managing incontinence-associated dermatitis and peri-wound skin protection, largely due to savings in nursing time.

Conclusion:

The barrier film is at least as clinically effective and potentially more cost-effective in incontinence-associated dermatitis prophylaxis and peri-wound skin protection than petroleum ointments or zinc oxide formulations, releasing health care resources for alternative use. Further studies are required to quantify the relative efficacy and cost-effectiveness of the barrier film and other barrier formulations in different clinical settings and enhance the quality of the evidence base.

Conflict of interest:

This review was sponsored by 3M Health Care, manufacturers of Cavilon barrier film. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
Use of a new, fexible lipidocolloid dressing on acute and chronic wounds: results of a clinical study
Authors: Meaume S. , Perez J. , Descamps H. , Voinchet  , Jault P. , Saunier V. , Bohbot S.
Published: May 2014

objective: To document the performance (effcacy, tolerability and acceptability) of Urgotul Flex, a new, more fexible version of the lipidocolloid dressing Urgotul, in the management of acute and chronic wounds. Effcacy was defned as the reduction in ulcer surface area after 4 weeks of treatment. Method: This open, non-comparative, multicentre clinical trial recruited patients from 11 centres, which included surgical, burns and rehabilitation units and paediatric, geriatric and dermatology wards. inclusion criteria were non-infected wounds of any aetiology that were <120cm2 in size. Ulcer surface area was assessed by tracing and planimetry. acceptability parameters were: ease of dressing application; pain at dressing change; dressing adherence to wound bed and bleeding at removal; maceration of surrounding skin; these were all assessed qualitatively. patients were followed up for a maximum of 4 weeks, or until they healed if this occurred frst. Effcacy and tolerability were assessed by the physicians on a weekly basis, and acceptability by the nursing staff at each dressing change. all of the physicians/ nurses had previously participated in clinical evaluations of Urgotul using the same outcomes and assessments, and so performed a retrospective assessment of the two dressings. Results: Forty-four patients from 11 investigating centres were included in the study. The mean baseline surface area at was 21cm2 and 6cm2 for the acute and chronic wounds respectively. Twenty wounds (17 acute wounds and three chronic wounds) healed. of the remainder, the mean surface area reduction was 78% and 42% for the acute and chronic wounds respectively at the end of the 4-week treatment period. only two local adverse events were reported, but these were not considered to be dressing related. Based on the 345 documented dressing changes, conformability of the new dressing was considered to be superior to that of Urgotul, particularly when used on acute wounds. Conclusion: These fndings show that the effcacy and tolerability of Urgotul Flex is similar to that reported in previous observational studies on Urgotul. However, results show it is more fexible and thus more conformable, particularly when used on wounds in awkward locations, including paediatric wounds and hand surgery. Confict of interest: This evaluation was sponsored by laboratoires UrGo, Chenôve, France.
Clinical efficacy of a new monoflament fibre-containing wound debridement product
Authors: Bahr S. , Mustafi N. , Hättig P. , Piatkowski A. , Mosti G. , Reimann K. , Abel M. , Dini V. , Restelli J. , Babadagi-Hardt Z. , Abbritti F. , Eberlein T. , Wild T. , Bandl K. , Schmitz M.
Published: May 2014

Objective: To evaluate the wound debridement efficacy (that is, achievement of 100% granulation tissue on the wound bed) of a new monofilament fibre product (Debrisoft). Method: This multicentre, prospective, observational evaluation assessed the debridement efficacy, safety, patient comfort and user satisfaction of this new product. Time taken to perform the debridement procedure was also recorded. The new product was wetted with either saline or polihexanide and applied for 2–4 minutes, following which the usual dressing regimen was applied. Clinical outcome was scored by a trained clinician. Additionally, before and after photographs were assessed by one and the same clinician, who was blinded to the treatment given. The debridement outcomes achieved with the test product were compared with results obtained using other methods of debridement, both non-surgical and surgical, taken from an electronic database but using the same scoring systems as here. Results: Sixty patients with chronic wounds requiring debridement were recruited, of whom 57 were included in the analysis. Debridement was effective in 93.4% (142/152) of the sessions, and the product remained intact in 95.4% (145/152). The average time for each debridement session was 2.51 minutes, markedly less than for the current debridement methods at the evaluation centres. visible debris and slough were successfully removed with the test product. Patients reported no pain during the procedure in 45% of cases and slight discomfort for a short duration (2.0 minutes on average) in 55% of cases. Conclusion: The results indicate the potential for this monofilament fibre product to replace several modes of debridement, based on its efficacy, short procedure, ease of use and patient comfort. Conflict of interest: The evaluation protocol was proposed and supported by Lohmann & Rauscher GmbH, who provided the evaluation products. MS and MA are employees of Lohmann & Rauscher. The other authors declare to have no relevant financial interest in the evaluation. apart from input to the protocol, the sponsors had no role in the conduct of the study, such as data collection, analysis, or preparation, review, or approval of the manuscript.
Post-surgical scalp wounds with exposed bone treated with a plant-derived wound therapeutic
Authors: Läuchli S. , Hafner J. , Wehrmann C. , French L.E. , Hunziker T.
Published: May 2014

Objective:

To evaluate the efficacy of a plant-derived wound dressing, a mixture of hypericum oil (Hypericum perforatum) and neem oil (Azadirachta indica), in scalp wounds with exposed bone.

Method:

A retrospective review was conducted of all patients presenting with scalp wounds with exposed bone following the excision of skin tumours and treated with a plant-derived wound dressings (1 Primary Wound Dressing; Phytoceuticals AG), from January to July 2011. Time to healing, wound size, area of exposed bone, ease of handling, pain and complications were evaluated.

Results:

Nine consecutive patients were analysed retrospectively. The patients' mean age was 81.2 ± 8.5 years (63–90 years), with a mean wound size of 13.2 ± 6.8cm2 (0.4–22.6cm2) and 6.8 ± 6.5cm2 (0.3–20.7cm2) of exposed bone. The time to complete healing by secondary intention was 4–20 weeks. A rapid induction of granulation tissue was observed, which covered the entire exposed bone surface in six out of nine cases (67%) after 4 weeks, and showed a reduction in the mean area of exposed bone of 95%. Dressing change was easy and without pain and there were no complications.

Conclusion:

This retrospective, non-controlled analysis suggests that ONE is a very simple to use, safe and potentially effective therapy for the treatment of scalp wounds with exposed bone.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflict of interest to declare.
Role of early radical debridement and skin cover in diabetic foot ulceration
Authors: Ahmad I. , Akhtar S. , Masoodi Z.
Published: May 2014

Objective:

To assess the efficacy of radical debridement and skin grafting in treating diabetic foot ulceration, compared with conservative wound treatment.

Method:

The medical notes for 30 patients who underwent skin grafting for diabetic foot ulceration (graft group) were retrospectively analysed and matched, according to age, gender, ankle brachial pressure index (ABPI) and comorbidities, with 30 other patients, who were treated conservatively (control group). Patients in the graft group underwent early, radical debridement to prepare the wound bed for grafting. Graft take, rate of ulcer recurrence and donor-site morbidity were assessed. Healing times and the length of hospital stays were compared between the two groups.

Results:

A 100% skin graft take was recorded in 80% of the patients on day 4, postoperatively. Ninety-three per cent of patients in the graft group completely healed, with 2 patients (6.7%) experiencing ulcer recurrence within the following 6 months. Ulcer recurrence could be due to early, non-guarded ambulation. Mean healing time and hospital stay were significantly lower in the graft group compared with the control group (4.0 ± 1.5 weeks vs 10.0 ± 1.0 weeks; p < 0.001). Mean healing time in smokers was slightly greater than non-smokers.

Conclusion:

Skin graft is an effective method of managing diabetic foot ulcers compared with dressings. It reduced healing times and hospital stay with minimum donor-site morbidity.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Treatment for hypergranulation at gastrostomy sites with sprinkling salt in paediatric patients
Authors: Tanaka H. , Arai K. , Fujino A. , Takeda N. , Watanabe T. , Fuchimoto Y. , Kanamori Y.
Published: May 2014

Objective:

To estimate the efficacy of sprinkling salt treatment (SS) of hypergranulation at gastrostomy sites in paediatric patients.

Method:

A prospective case-series study of paediatric patients with hypergranulation at gastrostomy sites. About one-third of a 5ml-teaspoon of table salt was sprinkled over the tissue once a day, either by the doctors/nurses in the wards or doctors in the outpatient setting. Treatment was continued by the patients or carers in the home, until the hypergranulation was seen to flatten. The patients were followed up by health professionals once a month.

Results:

Eight paediatric patients (seven females and one male) were included in the study. The hypergranulation decreased in size and became almost flat in all patients within 3 days to 2 months (median 7 days). Five patients had a recurrence of hypergranulation, but were treated successfully by repeated SS. Skin erosion was observed in one patient when SS was continued too long; therefore, the treatment protocol was altered so that the salt was irrigated 10 minutes after SS. A biopsy of the hypergranulation tissue was taken from a patient and salt was sprinkled on the tissue in a dish to simulate SS for histopathological examination. Histopathologically, hypergranulation treated by SS exhibited reduced interstitial oedema.

Conclusion:

The results of this study suggest that hypertonic environment induced by SS effectively reduced the oedematous hypergranulation tissue. SS is advantageous over traditional treatment such as silver nitrate in that SS is inexpensive and can be continued by the parents and repeated if necessary at home.

Declaration of interest:

This study was supported by a Grant for Child Health and Development from the Ministry of Health, Labour and Welfare, Japan. The authors have no conflicts of interest to declare.
Nurse–patient consultations in primary care: do patients disclose their concerns?
Authors: Green J. , Jester R. , McKinley R. , Pooler A.
Published: May 2014

Objective:

To quantify the extent to which patients disclose their concerns to community nurses during wound care consultations.

Method:

Using an ‘observation checklist’ based on themes and subthemes that were identified in a previous study of the same patients, 20 wound care consultations were observed. The non-participant observer completed the checklist and made field notes regarding the context and nature of interactions.

Results:

Patient participants had 160 opportunities to raise concerns regarding previously-identified pain, exudate and odour, yet they did not do so on 64 (40%) occasions. They had 28, 32 and 84 opportunities to raise emotional, wound care and daily living issues, respectively, and they did not on 16 (56%), 3 (9%) and 32 (38%) occasions. Overall, patients did not raise 38% of their concerns. Of the concerns that were raised, 8% were either not acknowledged or were disregarded by their community nurse.

Conclusion:

If these data are representative, this has profound implications for person-centred care and shared decision-making models of care, which are predicated on patients articulating their needs. They also have implications for the development of practitioners’ communication and consulting skills.

Declaration of interest:

This study was funded by NHS West Midlands Strategic Health Authority. The authors have no conflicts of interest to declare.
Negative pressure wound therapy: improving the patient experience Part 2 of 3
Authors: Upton D. , Andrews A.
Published: May 2014

Despite the clear benefits of negative pressure wound therapy (NPWT) as a treatment for wounds, it is essential that greater focus is given to the patient experience of this treatment. In particular, it is important that any unpleasant consequences, such as pain, stress, and skin trauma are minimised, so as to promote quality of life and healing. This article presents part two of three studies which aim to explore ways in which the patient experience of NPWT can be improved. In this study, the views of wound care clinicians (n=12) were investigated in greater depth through semi-structured interviews. Findings indicate a pressing need to minimise pain, particularly through ongoing assessment and collaboration with patients, and also through the use of appropriate dressings, films and other products that promote patient comfort. Additionally, it is evident that greater education is needed for both nurses and patients about NPWT, in order to promote high-quality care and patient wellbeing.