bluuebunny/crossref_metadata_2025 huggingface dataset:
Science of botulinum toxin: structure, mechanisms of action and therapeutic uses
Authors: Fromage Gemma
Published: May 2014

Botulinum toxin is the exotoxin of Clostridium botulinum. The bacteria produce seven different serotypes, namely type A, B, C (C1, C2), D, E, F and G, with toxins A and B being available commercially. Both botulinum toxins A and B are 150 kD dichain polypeptides and, when activated, form a heavy chain (100 kD) and a light chain (50 kD). Activation occurs in three steps: binding and internalisation, bisulfide bond reduction and chain separation, and light chain enzymatic activity. The transport and eventual release of acetylcholine into the terminal nerve membrane is controlled by a group of proteins called the SNARE complex. All serotypes work to cleave the SNARE complex, but do so in various places. When the SNARE complex is not formed, the membranes do not fuse, acetylcholine is not released and contraction of the muscle is inhibited. Approval from the Food and Drug Administration has been granted for clinical use in a number of conditions, including blepharospasm and strabismus, dystonia, upper motor neuron syndrome, hyperhidrosis, chronic migraine, and, perhaps the most well-known, cosmetic use.
Ethnic dermatology: exploring common presentations in clinical practice
Authors: Slater Alice
Published: May 2014

The ethnic minority population in Britain is increasing every year, making the field of ethnic dermatology an emerging and important one. Statistics have shown that, owing to migration and high birth rates in the UK, Britain's ethnic minority population has grown by almost 40% since 2001. In practice, clients may present to the cosmetic clinic with skin conditions that aesthetic nurses are not familiar with. Therefore, the aim of this article is to introduce some common dermatological conditions such as acne and post-inflammatory hyperpigmentation, outline the main treatment options for each, and describe the limitations when treating these conditions within the aesthetic setting
Administering prescription-only medicines in cosmetic practice: an overview
Authors: Davies Emma
Published: May 2014

Medical professionals working in independent practice are accountable to their governing bodies and the law, and must be safe, lawful, professional and ethical. Consequently, aesthetic nurses should question everything they do with direct reference to the legislation and professional standards required by the Nursing and Midwifery Council, General Medical Council and General Dental Council. It is not good enough to follow what others do without asking why and whether how we practice is as good as it should be. Therefore, the majority of nurses working in the field of medical aesthetics would benefit from a review of the regulations that apply and reflection on how and why these regulations apply to daily practice.
Why is it that nurse independent prescribers cannot keep stock drugs?
Authors: Collier Helena
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. In the second half of this feature, Helena Collier offers her opinion on the controversial issue of nurse independent prescribers keeping stock drugs
Building supplier relationships and getting the best deal for your clinic
Authors: Deakin Barbara
Published: May 2014

In the aesthetics industry, practitioners are spoilt for choice when it comes to product selection. However, to get the most value out of working with suppliers, there are essential checkpoints to keep in mind, including price service performance. Barbara Deakin, Clinic Manager at Dr Rita Rakus Clinic in Knightsbridge, outlines the key factors to consider when managing your supplies
Keeping it relevant by updating the look and feel of your aesthetic clinic
Authors: Deakin Barbara
Published: May 2014

In medical aesthetics, presentation is everything. From the way consultation rooms look to the way staff dress while in the clinic, every business space has the potential to bring in new clients and keep existing ones coming through the door. Clinic Manager Barbara Deakin offers guidance on where to get design inspiration, getting your message right and keeping promotional material updated
Exploring the role of the aesthetic nurse in public health and patient education
Authors: Russell Nikki
Published: May 2014

The Nursing and Midwifery Council (2008) code of conduct states that all registered practising nurses have a duty to improve the health of the general public. As aesthetic nurses treat the skin, which is the most visible bodily organ, they are in a prime position to advise patients on the risks associated with smoking, as it causes significant changes to the skin's appearance and function. Aesthetic nurses are also well placed to advise patients on sun safety, which is now more important than ever considering that, over the last 30 years, the incidence rates of malignant melanoma in the UK have increased more rapidly than any of the ten most common cancers ( Cancer Research UK, 2011 ). In this article, the author will stress aesthetic nurses' role in protecting and promoting the public's health, and highlight the part they play in patient education, focusing on the prevention of damage caused to the skin by cigarette smoke and excessive sun exposure. The author will also explore the benefits of using age-progression software in practice, which has the potential to be an effective, interactive intervention tool for public health promotion.
A guide to handling customer enquiries appropriately in your aesthetic clinic
Authors: Potter Hannah
Published: May 2014

To attract new clients and deliver the best possible customer service to your existing ones, it is important to handle all enquiries in an effective and timely manner. In this article, business development specialist Hannah Potter gives aesthetic practitioners essential advice on using your voice to its advantage, effective listening techniques and turning enquiries into turnover for your clinic
Whistleblowing in medical aesthetics: genuine concern or revenge seeking?
Authors: Collier Helena
Published: May 2014

Although many issues raised by nurses are deemed to be fair and justifiable, some aesthetic practitioners may be driven by personal grievances or professional rivalry when reporting an incident to the Nursing and Midwifery Council. Aesthetic nurse and consultant editor Helena Collier stresses the importance of whistleblowing and identifies the factors that influence nurses to find the courage to file a report
‘The fact that dermal fillers are no more regulated than floor cleaner is a disgrace’
Authors: Pemberton Max
Published: May 2014

In August, doctor and journalist Max Pemberton featured in Channel 4's How Not To Get Old and expressed his concern about the lack of regulation in the medical aesthetics industry. In this interview, he talks to the journal's editor Natasha Devan about his eye-opening experience of injecting a real woman's face with a dermal filler after just 4 hours of training
Giving something for me: Working with health visitors' experiences of restorative supervision
Authors: Elliott Vicky , Wallbank Sonya
Published: May 2014

Restorative supervision is designed to support professionals working in roles with a significant emotional demand ( Wallbank, 2007 ). The programme has been piloted with a range of community, NHS and local authority staff, and quantitative analysis of data has shown reductions in stress and burnout levels alongside increases in compassion satisfaction. The current programme offers a training day followed by six individual sessions and two group sessions of restorative supervision. One Trust commissioned an independent review of health visitors' experiences in order to provide a qualitative analysis of the experience of undertaking restorative supervision. Health visitors who had undertaken the programme were invited to a refresher training day, at which a researcher took notes. Three key themes emerged: variations in organizational attachment; understanding the concept of reflecting on one's own practice; and how a busy workload affects reflective practice. This paper looks at these themes in detail and considers them alongside the quantitative analysis of data on restorative supervision.
Research roundup: August 2013
Authors: Brook Judy , Seal Joanne , Condon Louise
Published: May 2014

In this section, a brief synopsis of a range of recently published articles that may be of interest to health visitors is presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
The role of the renal pharmacist in the multidisplinary team
Authors: Chai Mee Onn
Published: May 2014

Mee Onn Chai gives a brief overview of the role of the renal pharmacist in the multidisciplinary team. She describes the other health professionals with whom pharmacists may liaise, the impact the pharmacist has on the welfare of the renal patients and the relationships formed outside the renal unit.
A new initiative in renal research and education
Authors: Noble Helen , Chamney Melissa , Jones Julia , Thomas Nicola
Published: May 2014

Helen Noble, Melissa Chamney, Julia Jones and Nicola Thomas discuss the importance of research and education in the context of the changing shape of renal nursing, and outline a new initiative aimed at enhancing research and the dissemination of knowledge to improve patient care.
Treating the different types of renal-related iron deficiencies
Authors: Bradley Rob
Published: May 2014

All evidence-based guidelines on the management of anaemia of chronic kidney disease recognize the importance of iron. But why do patients have two possible types of iron deficiency and what is the best way to prevent and treat these problems? Rob Bradley aims to clarify these questions, providing details on how oral or intravenous iron therapy is prescribed to treat anaemia of chronic kidney disease.
Erythropoietic therapy: time for some changes
Authors: Macdougall Iain C
Published: May 2014

Iain Macdougall gives an overview of four key randomized controlled trials (RCTs) that have formed and changed anaemia management in patients with chronic kidney disease (CKD). He looks at the implications of these findings and their impact on current and future best renal practice.
Understanding the cultural beliefs surrounding organ donation
Authors: Clarke-Swaby Sonia
Published: May 2014

Kidney transplant coordinator Sonia Clarke-Swaby examines the perceptions and beliefs about organ donation in African, Caribbean and Asian communities. Setting out to address a lack of awareness by offering up-to-date information regarding organ donation, her article encompasses the findings and recommendations drawn from project based in South London.
Caring for the pre-dialysis patient: the role of the clinical nurse specialist
Authors: Jones Ann
Published: May 2014

Ann Jones looks at how the concept of advanced nursing practice developed in the UK and why there is now an increased demand for advanced nursing roles. She argues that an array of titles for highly skilled nurses may lead to misunderstandings and then explains how the role of the clinical nurse specialist (CNS), such as the pre-dialysis CNS, can improve patient care and outcomes.
Home haemodialysis: a feasible treatment option for renal patients
Authors: Hignell Laura , Gladding Siobhan
Published: May 2014

Laura Hignell and Siobhan Gladding talk about their experiences setting up a home dialysis treatment programme for the Wessex Renal and Transplant Service. They explain what prompted this initiative, how they set up the pilot study, how they shaped the main programme and what amendments have been made since. They want to pass on these experiences and inspire others to do the same.
Renal nursing and the prevention of cross infection
Authors: Elliott Paul
Published: May 2014

Within the renal nursing environment, good, safe infection prevention and control practice is essential for patient survival and the health of all others who access this environment. Paul Elliott sets out to describe the standard precautions to battle infection and reflect on the factors that may impact on renal staff impeding their ability to practise safely.
Reducing haemodialysis access infection rates
Authors: Dorman Amanda , Dainton Marissa
Published: May 2014

Infections are the second most common cause of vascular access loss in the long-term haemodialysis patient, and recent years have seen an increase in healthcare-associated infections (HCAIs) associated with vascular access. Amanda Dorman and Marissa Dainton describe infection control procedures used in their unit to battle infection.
Taking the heat out of haemodialysis machines
Authors: Campbell Fraser
Published: May 2014

It is reasonable to expect that haemodialysis machines used for treating patients with chronic kidney disease run as efficiently as possible. On closer inspection, however, the slight difference in specification of the same machine led to an interesting conclusion. Fraser Campbell explains that a modification to some haemodialysis machines leads to cutting costs and is good for the environment.
Smarter working: strategies and tactics for renal managers
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Peter Ellis and Jane Abbott identify some of the strategies and tactics renal unit managers can employ to help them work smarter. This will help renal unit managers to achieve the desired outcomes of care within the resources available to them. The authors identify seven ways in which renal unit managers can adapt their practice to gain the most from the resources available to them.
Publish or perish: getting yourself published
Authors: Costello John
Published: May 2014

A lot of research does not become public because too many nurses are afraid of the writing process. However, if research findings are not published and shared, there is almost no point to the research and no progress can be made. In this article, John Costello outlines the steps needed to write a successful research paper and find the right journal to publish it in.
Personal development planning: the role of the renal manager
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Staff development is not only crucial for individual motivation, but also for the progression and success of a team. Here Peter Ellis and Jane Abbott explore how the renal manager can assist personal development of staff with a structured approach that involves goal setting and regular review.
Rare kidney disease: too rare to care?
Authors: Wise Steven
Published: May 2014

In the past, patients affected by a rare kidney disease often experienced a frustrating long wait for the correct medical diagnosis with little support for them and their families. Health professionals often have to manage rare kidney diseases in relative isolation in their hospitals without the benefit of information sharing or existing pathways. Thanks to a growing awareness that rare diseases collectively are not that rare and deserve the attention and support of the community, national plans are being put in place that will bring together knowledge and expertise from around the country.
Three babies and a transplant
Authors: Pabani Aysha S
Published: May 2014

Emma O’Connell was 18 years old when she found out she had kidney disease. Only three months later, she found out she was pregnant. Being young and positive, she has come through the last nine years against medical odds, with three beautiful healthy children and a new kidney from her mum.
Coping with haemodialysis: a mixed method study of families in Gauteng
Authors: Mphuthi David D , Pretorius Ronel , Van Der Walt Christa
Published: May 2014

Understanding the coping behaviours of a patient's family can guide the specialist nephrology nurse in supporting both the patient and their family through haemodialysis. David Mphuthi et al outline a small-scale study undertaken in one haemodialysis unit in South Africa, which identified and explored the coping behaviours of family members.
Emotional support strategies: the assertive renal manager
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Renal managers need to develop emotional and psychological strategies for self-preservation and to support their teams. An important strategy in self-management is to understand, if not be in total control of, the response to situations that occur at work. In this three-part series, Peter Ellis and Jane Abbott will explore the fundamental elements of this response: emotional intelligence, emotional resilience and assertiveness. These may be to the advantage of the leader, team and the patients.
Non-medical prescribing and anaemia management on the unit
Authors: Gerrish Martin
Published: May 2014

Anaemia is a common consequence of chronic kidney disease that has a significant impact on patient morbidity and mortality. Treatment with erythropoietin-stimulating agents reduces the need for blood transfusions and has been shown to increase quality of life. Martin Gerrish outlines prescribing protocols that have been put in place to treat patients at the Lincoln dialysis unit.
Orthotic intervention in patients with diabetic foot ulceration
Authors: Tyrrell W.
Published: May 2014

A review of the evidence of the causes of diabetic foot ulceration and the importance of prevention strategies.
A seating assessment tool for community use
Authors: Shipperley T.F. , Collins F.
Published: May 2014

The development of guidelines to assist in the allocation of cushions for seated patients.
Assessing the seated patient for the risk of pressure damage
Authors: Collins F. , Shipperley T.F.
Published: May 2014

An update on the biomechanics involved in seating, the assessment of problems resulting from inappropriate seating, and possible pressure-relieving solutions
The use of honey as an antiseptic in managing Pseudomonas infection
Authors: Cooper R. , Molan P.
Published: May 2014

A laboratory study was undertaken to extend existing knowledge about the effectiveness of the antibacterial properties of honey against pseudomonads. To date, sensitivity testing has used non-standardised honeys, which may vary greatly in their antibacterial potency. Pure cultures of Pseudomonas spp, isolated from swabs from 20 infected wounds, were inoculated on the surface of nutrient agar plates containing various concentrations of honey in the medium. Two types of honey were used, a manuka honey and a pasture honey, each selected to have antibacterial activity close to the median for each type. The minimum inhibitory concentration of the manuka honey for the 20 isolates ranged from 5.5-8.7% (v/v) (mean 6.9% (v/v), standard deviation 1.3). The minimum inhibitory concentration of the pasture honey for the 20 isolates ranged from 5.8-9.0% (v/v) (mean 7.1% (v/v), standard deviation 1.0). Honeys with an average level of antibacterial activity could be expected to be effective in preventing the growth of pseudomonads on the surface of a wound even if the honey were diluted more than ten-fold by exudation from the wound.
Wound debridement, Part 1: non-sharp techniques
Authors: Vowden K.R. , Vowden P.
Published: May 2014

The first article of a two-part update on wound debridement.
Microbial involvement in chronic wound malodour
Authors: Bowler P.G. , Davies B.J. , Jones S.A.
Published: May 2014

The role of specific micro-organisms in producing chronic wound malodour was investigated by directly comparing odour severity and microbiology in infected and non-infected leg ulcers. Malodour was most frequently associated with infected wounds involving mixed aerobic and anaerobic, Gram-positive and Gram-negative microbial populations. Infected ulcers that were not characterised by an offensive odour were rarely colonised with anaerobic bacteria. A reduced incidence of pigmented and non-pigmented Gram-negative anaerobes (Bacteroides spp, Prevotella spp, Porphyromonas spp) was evident in non-infected, non-malodorous leg ulcers.

These observations emphasise the significance of specific anaerobic bacteria in the generation of wound malodour, and it is probable that their effect is potentiated by coexistence with mixed facultative micro-organisms.
Management of wound sinuses
Authors: Butcher M.
Published: May 2014

An update on the development, assessment and management of wound sinuses.
The use of a hydrofibre dressing in wound management
Authors: Robinson B.J.
Published: May 2014

A review of the use of a highly absorptive dressing that maintains a moist wound environment
The palliative management of fungating malignant wounds
Authors: Grocott P.
Published: May 2014

A study focusing on patients' experiences of exuding wounds and investigating novel dressing systems designed to meet individual needs

This study focused on the palliative management of fungating malignant wounds and individual experiences of living with such a wound. Dressings were evaluated for the ability to contain these wounds and reduce their impact on daily life. The project extended to collaboration with industry for the development and evaluation of dressings designed to meet patient needs.

A longitudinal multiple case study design was adopted. The methodology evolved through three principal phases: quasi-experimental design; emergent collaborative design; and emergent theory-driven evaluation. The radical departure from the initial approach was in response to the methodological problems encountered in a study of individuals with uncontrolled disease.

A non-probability sampling plan was adopted, mainly because of the lack of homogeneity in the patient population; 45 participants were included. The length of time patients remained in the study depended on how long they lived. This ranged from a few days to more than two years. A sampling plan was, however, adopted for the data collection.

The study had a dual focus: methodology, and the generation of explanations for dressing performance and the management of fungating wounds. The methodological aspect included development of the Teler system as a method of measuring dressing performance against goals of optimal practice in fungating wound management. The second component was a system of reasoning developed as an analytical strategy for abstracting general issues from individual case study data in order to construct explanations. Theory was used to generalise beyond the individual cases.

Two forms of explanation for fungating wound management were constructed. These included explanations of individual experiences of living with such a wound and knowledge of the elements of fungating wound management. The impact on the individual was explained in terms of the stigma attached to public disability and a revulsion in society for uncontrolled body fluids. A pivotal relationship emerged between exudate and other wound management problems, including psychosocial aspects. A final critical explanation was developed for the qualification of the theory of moist wound healing to explain the phenomenon of exudate management in fungating and,
The use of case reports in wound care
Authors: Nelson E.A.
Published: May 2014

An update on writing case reports to illustrate clinical situations
The use of a non-adherent silicone dressing in arterial leg ulceration
Authors: Gates A.
Published: May 2014

A case report demonstrating improvement in quality of life for a patient with a non-healing leg ulcer
Cigarette smoking and its effects on wound healing
Authors: Towler J.
Published: May 2014

A review of research investigating the effect of cigarette smoking on cutaneous wound healing
Chronic leg ulcers in Sweden: a survey of wound management
Authors: Hjelm K. , Nyberg P. , Apelqvist J.
Published: May 2014

The aim of this study was to survey management of leg ulcers by staff in Swedish primary healthcare (PHC) and home care services (HCS) run by the municipalities (n=933), with emphasis on wound care and education. A questionnaire was completed by 933 staff (78% response rate).Diagnostic investigation and documentation in specific wound records was performed by 46.6% of respondents in PHC and 12.8% in HCS, most commonly by nurses in PHC compared to nurse auxiliaries (NAs) in the HCS. Topical treatment was most commonly chosen by nurses (82.1%). Nurse auxiliaries in PHC had greatest access to structured wound management programmes (40.0% compared with 30.1% in HCS, p<0.05). Instruction courses, mainly organised by pharmaceutical companies (43.2%), were the most common form of education (20.4%) identified. The most time-consuming wound dressings and the highest number of patients treated at home and by NAs were found in the municipalities. For topical treatment 29 products were identified. Nurses in both PHC and the HCS used a wider range of products, e.g. hydrocolloids and absorptive dressings, than NAs in nursing homes, who used dry gauze/protective dressings and wet saline gauze to a greater extent. Substantial differences in qualifications, wound management experience and resource utilisation were found between staff in PHC and the HCS.
The effect of a radiant heat dressing on pressure ulcers
Authors: Price P. , Bale S. , Crook H. , Harding K.G.H.
Published: May 2014

The use of heat in wound healing has been demonstrated to aid oxygen flow and hence healing in acute wounds. However, the situation in chronic wounds is less clear. This study was designed to investigate the benefits of using a radiant heat therapy system in the treatment of Stage 3 and 4 pressure ulcers. Despite randomisation, patients receiving radiant heat therapy were more infirm than those receiving standard treatment. This prospective, single-centre, randomised trial resulted in an accelerated rate of healing for those receiving heat therapy compared to a standard treatment: time difference to 75% of original area = 6.4 days (p=0.057), to 50% of original area = 9.6 days (p=0.039), time to 25%= 7.2 days (p=0.01). This new development warrants further investigation to fully assess the role of a thermoregulation system in chronic wound healing.
Comparison of the healing rates and complications of three four-layer bandage regimens
Authors: Vowden K.R. , Mason A. , Wilkinson D. , Vowden P.
Published: May 2014

This randomised controlled study compares the healing rates, complication and patient and staff acceptability of three four-layer bandage regimens for leg ulcers. A total of 149 patients were recruited into the study, of whom 50 received the original Charing Cross system (Parema) and 49 a commerically available kit, Robinson Ultra Four (Robinson).

No significant difference was found in the healing rates of the three systems. Overall 12 weeks' healing was 65%, while the 20-week healing rates for the individual systems were 87% (CX4L), 84%(Parema) and 83% (Robinson). Analysis of known risk factors for delayed healing showed that no bandaging systems had an advantage over the others. Staff familiarity resulted in an initial preference for teh CX4L but there was no bandage preference by the end of the study. The data suggest that none of the systems has an advantage over the others and that cost savings can be made by pursuing a competitive pricing policy.
The physiology of wound healing
Authors: Flanagan M.
Published: May 2014

It is vital that practitioners are able to relate their knowledge of wound physiology to everyday clinical practice. This review therefore summarises the main features of the physiology processes of wound healing.
Macrovascular disease aetiology and diabetic foot ulceration
Authors: Murphie P.
Published: May 2014

This is the first of two literature reviews exploring the role of large and small vessel disease in the development of diabetic foot lesions. It describes the aetiology of macrovascular disease and the contentious issues surrounding this mechanism of tissue damage in people with diabetes.
Hyperbaric oxygen therapy: what is the case for its use?
Authors: Rowe K.
Published: May 2014

Hyperbaric oxygen therapy can be used for a variety of indications, ranging from decompression sickness to thermal burns. This article explains why it may improve healing in diabetic foot ulcers.
Cadexomer-iodine in the treatment of venous leg ulcers: what is the evidence?
Authors: Bianchi J.
Published: May 2014

Studies on the use of cadexomer-iodine in venous leg ulcers have found some evidence of its benefits over other treatments, but most are dated and some used products now contraindicated.
Occlusion versus air exposure on full-thickness biopsy wounds
Authors: Ågren M.S. , Karlsmark T. , Hansen J.B. , Rygaard J.
Published: May 2014

The benefits of moisture-retaining dressings on wound healing are well documented in experimental animal models but not in humans. To examine the effect of occlusion, the effects of three brands of synthetic occlusive dressings (Comfeel Plus, DuoDerm CGF, OpSite) were compared with air exposure in epithelial resurfacing and proliferation in acute, full-thickness skin wounds in humans.
Living with a chronic leg ulcer: an insight into patients' experiences and feelings
Authors: Douglas V.
Published: May 2014

Objectives:

This study sought to ascertain patient need and help health-care professionals to understand the effects of chronic leg ulceration from a patient's perspective.

Method:

A qualitative grounded theory approach was used. A purposeful sample of eight participants (six females and two males) was selected. All were under the care of a district nurse and had over a year's history of venous leg ulceration. Data were collected by interview.

Results:

Five major categories developed, relating to the ‘physical experience’, ‘loss of control’, ‘vision of the future’, ‘carer's perspective’ and ‘health-care professional and patient relationship’.

Conclusion:

Although the physical and psychological effects of leg ulceration featured prominently in this study, these were heavily influenced by the relationship between the participant and the health-care professional.

Declaration of interest:

None.
Using an artificial neural network to predict healing times and risk factors for venous leg ulcers
Authors: Taylor R.J. , Taylor A.D. , Smyth J.V.
Published: May 2014

Objectives:

This study aimed to identify the risk factors that influence the healing process of venous leg ulcers treated with compression bandaging, with a view to predicting healing time.

Method:

A retrospective cohort study was performed on data collected prospectively on 325 consecutive patients presenting with 345 venous ulcers at the Salford Primary Care Trust leg ulcer clinic between January 1997 and December 1999. Use of an artificial neural network (ANN) technique accurately predicted the healing times for 68% of the patients.

Results:

The ANN demonstrated that healing was significantly related to a history of previous leg ulceration, ‘quite wet’ ulcer exudate, high body mass index, large initial total ulcer area, increasing age and male gender.

Conclusion:

The ability to identify at presentation ulcers that might be resistant to standard therapy would allow early consideration of more radical treatments such as hospitalisation, wound debridement or venous surgery.

Declaration of interest:

None.
Venous leg ulcer recurrence: prevention and healing
Authors: Poore S. , Cameron J. , Cherry G.
Published: May 2014

After a leg ulcer has healed, well-fitting compression stockings, patient education and regular check-ups are the basis for preventing recurrence. This article examines patterns in recurrence and subsequent healing among patients at an ulcer clinic.
Silver 2: toxicity in mammals and how its products aid wound repair
Authors: Lansdown A.B.G.
Published: May 2014

The second article examining the role of this metallic element in a wound environment discusses toxicity in individual cells, animals and humans and considers how different silver-based dressings assist in wound healing.
Measuring the size of ulcers by planimetry: a useful method in the clinical setting
Authors: Öien R.F. , Håkansson A. , Hansen B.U. , Bjellerup M.
Published: May 2014

Objective:

The aim of this study was to compare four measurement methods. Digital planimetry was compared with mechanical planimetry, placing the film over graph paper and counting the squares (grid tracing), and multiplying the two maximal perpendicular diameters of the ulcer (diameter product).

Method:

Twenty patients with 50 chronic leg ulcers of various aetiology and sizes (20 ulcers were ≤3cm2, 15 ulcers were >3cm2 and ≤10 cm2, and 15 ulcers were >10cm2) were enrolled consecutively into this study. Ulcer area was calculated from film transparency tracings using a digital planimeter, a mechanical planimeter, grid tracing and diameter product.

Results:

The mean difference of digital planimetry versus mechanical planimetry, grid tracing and diameter product was 0.51cm2, 0.72cm2 and −5.38cm2, respectively. For all methods difference tended to increase with ulcer size.

Conclusion:

Digital and mechanical planimetry, together with grid tracing, appear to be appropriate means of obtaining accurate surface area measurements. Digital planimetry is a quick and practical method and could therefore be recommended in the clinical setting.

Declaration of interest:

The digital planimeter was loaned by Mölnlycke Health Care
Inflammation 1: its role in the healing of acute wounds
Authors: Hart J.
Published: May 2014

The inflammatory response is an essential part of the wound-healing process. This article discusses inflammation in acute wounds and the part played by the migration of cells including neutrophils, macrophages and T-lymphocytes.
The cellular proliferative phase of the wound repair process
Authors: Stephens P. , Thomas D.W.
Published: May 2014

The proliferative — or new-tissue formation — phase of wound healing is complex. This article examines the changes that occur to cells during this stage and the effect on the extracellular matrix environment.
Topical negative pressure (TNP): the evolution of a novel wound therapy
Authors: Banwell P.E. , Téot L.
Published: May 2014

Topical negative pressure is a novel non-pharmacological therapy that is now being adopted as a standard of care in wound care management programmes. This review assesses where and how it can be best used.
Tropical ulcers: a condition still hidden from the Western world
Authors: MacDonald P.
Published: May 2014

Tropical ulcers cause great pain and often lead to terrible deformities and amputations among very poor patients. Theories exist about their cause and treatments, but this literature review shows an urgent need for more research into this Cinderella area
An in vitro analysis of the antimicrobial properties of 10 silver-containing dressings
Authors: Thomas S. , McCubbin P.
Published: May 2014

The variation in the structure and properties of the many silver dressings now on the market might be expected to affect their antimicrobial properties. This study, which follows up a paper published last March, compares their performance.
A trial to assess the efficacy and tolerability of Hyalofill-F in non-healing venous leg ulcers
Authors: Colletta V. , Dioguardi D. , Di Lonardo A. , Maggio G. , Torasso F.
Published: May 2014

Objective:

This single-centre, open, uncontrolled pilot clinical trial set out to assess the efficacy and tolerability of Hyalofill-F (a partial benzyl ester derivative of hyaluronan), used in combination with compression bandaging, in the treatment of venous leg ulcers.

Method:

The 20 patients enrolled into the study had venous insufficiency and a leg ulcer that had been refractory to treatment for one month. Treatment was continued for eight weeks, with weekly assessments.

Results:

During the study period four of the patients' ulcers healed completely. An average wound area reduction of 53.5% was seen in the ulcers that did not heal. Differences in ulcer area and ulcer depth between the initial and final visit were significant (p<0.01, p=0.03). The average healing rate (cm2/week reduction) was 1.26 ±1.7 (standard deviation). A calculated prognostic index was used to identify patients at high risk of a poor response to compression therapy (10% probability of wound closure at 120 weeks). These patients demonstrated a mean 63% decrease in wound area after eight weeks of treatment with Hyalofill-F plus compression bandaging. All wounds showed a positive response in terms of granulation-tissue formation. The comfort of the dressing was described as excellent.

Conclusion:

The hyaluronan derivative showed promising results in initiating the healing process in chronic venous ulcers. It was found to be well tolerated and safe to use. However, further clinical trials should be performed involving a control group to verify these data.

Declaration of interest:

This study was sponsored by Fidia Advanced Biopolymers, Italy.
Open surgical wounds: how does Aquacel compare with wet-to-dry gauze?
Authors: Cohn S.M. , Lopez P.P. , Brown M. , Namlas N. , Jackowski J. , Li P. , Mishkin D. , Lopez J.M.
Published: May 2014

Objective:

To compare the healing rates of a hydrofibre dressing (Aquacel) and normal wet-to-dry gauze in the treatment of open surgical wounds.

Method:

Fifty patients with open surgical wounds were randomised to receive either saline-moistened gauze or Aquacel. The rate of wound healing was measured as ml/day (deep wounds) or cm2/day (superficial wounds) at each dressing change until an investigator blinded to the patient group diagnosed the wounds as having healed or the patient was withdrawn from the study.

Results:

Of the 50 patients, seven were withdrawn from the study after the first evaluation. Of the remaining 43 patients, 21 had been randomly allocated to the gauze group and 22 to the Aquacel group. For deep wounds, a mean change in the wound healing rate of 1.9 ±1.3cm3/day was reported for the gauze group and 2.9 ±2.3cm3/day for the Aquacel group. These results approach statistical significance (p=0.082). For superficial wounds, the mean change in the healing rate was 1.6 ±1.5cm2/day for the gauze group and 1.9 ±2.2cm2/day for the Aquacel group, but this was not statistically significant.

Conclusion:

Aquacel appears to be at least as effective as wet-to-dry gauze in the healing of open surgical wounds.

Declaration Of Interest:

This study was funded by ConvaTec and the University of Miami School of Medicine, US.
How patients with diabetes who have foot and leg ulcers perceive the nursing care they receive
Authors: Ribu L. , Wahl A.
Published: May 2014

Objective:

This Norwegian study set out to explore the nursing care experienced by patients with diabetes who have a foot and/or leg ulcer.

Method:

A qualitative method was used, with in-depth recorded interviews of patients living at home and receiving district nursing care. Seven patients were interviewed at home for 45 minutes to two hours. Interviews were transcribed and analysed using Kvale’s thematic and meaning analysis.

Results:

Several themes emerged, even though sample was not a homogeneous group: the expert patient (where patients acquired knowledge about their treatment and then passed this on to new and inexperienced nurses); fragmented nursing care (caused by lack of continuity in care); impersonal nursing care (where nurses did not view the patient as an individual, but focused solely on their wound); the ideal nurse (nursing attributes the patients valued most highly, such as engaging with them and attempting to understand their situation).

Conclusion:

Crucial to the successful treatment of patients with diabetes who have foot and/or leg ulcers is an understanding of their feelings about their ulcer and its impact on their quality of life. Further research in this area is recommended.

Declaration of interest:

None.
Pressure ulcer prevention: evaluation of an education programme for Swedish nurses
Authors: Gunningberg L.
Published: May 2014

Objective:

To investigate the effect of an education programme for 20 registered nurses on the following three areas: nurses’ knowledge of pressure ulcer risk and prevention; nursing documentation of ulcer prevention; routine use of prevention strategies.

Method:

The study had a quasi-experimental design. Data were collected immediately before and after the education programme and at eight-month follow-up. To measure knowledge of pressure ulcer management, a questionnaire was distributed to course participants (n=19) pre- and post-education. Nursing documentation (n=138) was audited pre- and post-education. To gain information on the routine use of prevention strategies, head nurses (n=20) were interviewed and the patients’ care environment (n=21) was observed pre-education, while a nurse questionnaire was completed (n=15) at the eight-month follow-up.

Results:

In relation to pressure ulcer prevention, nurses’ knowledge, documentation and ward routines were unsatisfactory before the education programme. However, the eight-month follow-up showed that 11 nurses (55%) had implemented new ward routines. Documentation was still lacking after the programme, although it was more detailed.

Conclusion:

The education programme succeeded in encouraging and empowering the nurses to change clinical practice.

Declaration of interest:

None.
Factors influencing concordance with compression stockings after venous leg ulcer healing
Authors: Jull A.B. , Mitchell N. , Aroll J. , Jones M. , Waters J. , Latta A. , Walker N. , Aroll B.
Published: May 2014

Objective:

To investigate the factors influencing patient concordance with compression stockings after venous leg ulcer healing.

Method:

In 2001 patients discharged from a specialist leg ulcer service in New Zealand were approached to participate in a structured interview about their use of compression stockings in the first six months following venous leg ulcer healing. Univariate analyses were performed to identify significant associations between factors and stocking use. Multiple logistic regression was employed to model the factors associated with frequency of stocking use.

Results:

A total of 163 patients were identified, of whom 129 (79%) agreed to participate. Sixty-seven (52%) reported wearing stockings every day for the first six months after their ulcers had healed, 21 (16%) stated that they had worn them most days, seven (5%) had worn them occasionally and 29 (22%) had not worn them at all after their ulcer had healed. Five (4%) did not provide data. Two factors distinguished those who wore stockings from those who did not 75% of the time: the belief that wearing stockings was worthwhile and the belief that stockings were uncomfortable to wear. Commonly cited factors, such as age, sex, difficulty in applying stockings and cosmetic appearance were not significantly related to stocking use. Cost did not seem to influence the decision to purchase compression stockings.

Conclusion:

Many factors previously thought to influence concordance appear to have little impact on compression-stocking use in people whose venous leg ulcers had healed.

Declaration of interest:

None.
An evaluation of Hyalofill-F plus compression bandaging in the treatment of chronic venous ulcers
Authors: Taddeucci P. , Pianigiani E. , Colletta V. , Torasso F. , Andreassi L. , Andreass A.
Published: May 2014

Objective:

Hyaluronan, a component of the extracellular matrix, plays a significant role in several aspects of tissue repair and the wound healing process.

Method:

In this Italian study Hyalofill-F, a partial benzyl ester derivative of hyaluronan, used in combination with compression bandaging, was compared with the well-established therapy in Italy of non-adherent gauze plus compression therapy in the treatment of chronic venous leg ulcers.

Results:

Hyalofill-F plus compression bandaging performed significantly better than non-adherent gauze plus compression bandage in all of the clinically relevant efficacy parameters. Mean reduction in ulcer area in the hyaluronan-derivative group was 8.1cm2 after eight weeks of treatment, compared with 0.4cm2 in the comparator group. The resulting difference of 7.7cm2 between the two groups was statistically significant (p=0.0019). Furthermore, statistically significant results in favour of the hyaluronan-derivative group were obtained in the following: speed of epithelialisation; levelling of the margins; degree of maceration; pain intensity and frequency.

Conclusion:

Hyalofill-F plus compression bandaging resulted in an earlier and greater decrease in ulcer area compared with non-adherent gauze plus compression bandaging, thereby supporting its use in the treatment of chronic venous ulcers.

Declaration of interest:

None.
Osteomyelitis complicating three types of traumatic hand wound
Authors: Lewis J.A. , Miller D.R. , Davies S.G.
Published: May 2014

Both patients and clinicians can underestimate the seriousness and potential complications of osteomyelitis of wounds to the hand. Osteomyelitis is often caused by delayed or inadequate treatment of wounds, but it is rare in the hand because of the extensive blood supply in this region. Once established, however, it is associated with significant morbidity and functional loss. Nearly half of all fingers affected by osteomyelitis ultimately require amputation and many others remain stiff or persistently symptomatic.
An Indian community-based epidemiological study of wounds
Authors: Gupta N. , Gupta S.K. , Shukla V.K. , Singh S.P.
Published: May 2014

Objective:

To establish the prevalence of wounds in a community, with an emphasis on chronic lower extremity wounds, and to identify the various aetiological factors involved.

Method:

A cross-sectional study was conducted to screen the population of two nearby communities (one urban and one rural) in India for wounds. This involved conducting a door-to-door survey between July 2001 and February 2003.

Results:

The prevalence of wounds in the population studied (n=6917) was 15.03 per 1000. The prevalences of acute and chronic wounds were 10.55 and 4.48 per 1000 of the population respectively.

Conclusion:

The most common site for both acute and chronic wounds was the lower extremity. In contrast to Western studies, the most common aetiology for a chronic lower extremity wound was an untreated acute traumatic wound. This in turn highlights the need to establish community-based wound-care teams in India.

Declaration of interest:

None.
The prevention of heel pressure ulcers using a hydropolymer dressing in surgical patients
Authors: Bots Th.C.M. , Apotheker B.F.G.
Published: May 2014

Objective:

A trial of a self-adhesive hydropolymer foam dressing (Tielle, Johnson & Johnson) demonstrated that it prevented the development of friction-generated pressure ulcers on the heels of ICU patients. Following the trial, use of the foam dressing became a standard preventive measure in the ICU and the prevalence of heel ulcers decreased by 72% in two years. This follow-up study evaluated the foam’s effectiveness in preventing heel pressure ulcers in surgical patients.

Method:

A total of 140 surgical patients were screened over a four-month period. They were assigned to one of two groups, depending on their pressure ulcer risk score and the anticipated length of the surgical procedure. The foam dressing was used as a barrier on the heels, depending on the patient’s risk status, which was assessed using a modified Norton scale, and the duration of their surgery. Heels were inspected on a daily basis for up to 10 days. All 23 patients in the group whose surgery lasted less than 90 minutes dropped out of the study as they were discharged with insufficient data.

Results:

A 76.7% reduction in heel pressure ulcers was achieved with this preventive measure.

Conclusion:

Use of an adhesive foam dressing on surgical patients can prevent heel ulcers. Research is needed on the effects of friction on the heel during the transfer and movement of surgical patients.

Declaration of interest:

This study was sponsored by Johnson & Johnson Medical.