bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating topical peptides into aesthetic practice and skin care routines
Authors: Bowes Lorna
Published: May 2014

As aesthetic nurses are responsible for offering evidence-based skin care advice to patients, it is important that they fully understand the ingredients and formulations at their disposal. This is the first of a series of articles looking at the skin care ingredients available to nurses in aesthetic practice. The approach of this series is two-fold: firstly an in-depth look at the target ingredient or cosmeceutical category, covering topics such as development and technology, mechanisms of action, side effects and variations; and, secondly, exploring vital points of patient communication that need to be relayed during consultations. Part one of this series will explore, what peptides are, how they work, what their effects are, why they are becoming increasingly common in skin care, and how they can be successfully integrated into patients’ skin care regimens.
The role of mentorship during the transition from NHS nursing to private practice
Authors: Thorns Marea Brennan
Published: May 2014

Nursing theory suggests that, when an experienced nurse moves into a new clinical area, there is a regression of practice equivalent to that of a novice nurse. This event is likely to generate significant demands on the nurse as he/she strives to regain their previous professional standing; for example, the nurse will be required to develop new clinical skills and adapt to a new working environment. When the move is from the NHS into private practice, demands may be particularly high, as the nurse is faced with the challenges of acquiring business skills and adjusting to unfamiliar methods of working. These skills are not the prerequisite of an NHS-based nurse. There is vast evidence to support that mentorship plays a significant role during the transitional period from nurse to graduate nurse, and from novice to expert. This study will explore the role of mentorship during the transitional period from NHS nurse to aesthetic nurse in private practice and aim to identify if mentorship is able to play a part in this transitional journey.
Keeping it simple: guidance on reflection and clinical supervision for aesthetic nurses
Authors: Soutter-Green Jeannie
Published: May 2014

Knowledge and experience brings with it a wide repertoire of ‘ways of doing’, which can create confusion in aesthetic nurses' daily working environment. However, it is these very situations where nurses are systematically exposed through reflection that enable reflection, practice-generated theory and understanding. Nevertheless, reflection and supervision for aesthetic nurses poses various problems in terms of access and application; It can feel uncomfortable and often has a reputation of being seen as critical, intrusive and time-consuming. In the author's opinion, as supervision is about growth and learning, it needs to be simple and flexible. It is about questioning and understanding practice and evaluating the intuitive aspects of aesthetic nursing. In this article, the author proposes a ‘mix’ of models which allow a simple understanding of how supervision may apply to aesthetic practice.
Managing post-partum striae gravidarum and striae distensae in cosmetic practice
Authors: Brackenbury Julie
Published: May 2014

Commonly known as stretch marks, striae are a cosmetically undesirable skin condition that can be a source of great distress to patients. Given that 90% of women develop striae during pregnancy, aesthetic nurses are likely to see several patients presenting with this cosmetic problem. Therefore, it is vital to know what treatment options are available to sufferers. Striae is a challenging cosmetic problem for medical aesthetic practitioners to treat, as various treatment modalities have been applied but, to date, have not been satisfactory. Although there are many products and treatments on the market claiming to remove striae, there is often a lack of clinical evidence to support these claims. This article will help to dispel the myths and provide aesthetic nurses with a further insight into the cause, management and treatment to enable their patients to be educated ethically, accordingly and appropriately.
Providing mesotherapy to prevent and treat hair loss in aesthetic practice
Authors: O'mahony Malti
Published: May 2014

Although the hair growth cycle causes individuals to lose some hair every day, some people may experience excessive hair loss. In the author's experience, of the many treatments available for this indication, mesotherapy is highly effective for both the prevention and treatment of hair loss. Mesotherapy specifically targets the site of pathology and delivers therapies directly to it. The substances injected into the scalp include mixtures of natural plant extracts, homoeopathic agents, vitamins, vasodilators and medications which stimulate hair growth. As the mesotherapy cocktail reaches the target directly, avoiding metabolism by the digestive system, doses can be minimal. In this article, the author, who has been treating various hair conditions for 10 years, provides background information on hair anatomy, the hair growth cycle, hair loss, products commonly used and techniques of administration. She will also reflect on her personal experience with clients using a random sample of 50 clients. Descriptive study results are presented in this article, and the data presented can be interpreted as inferring that the treatment is associated with a high level of client satisfaction and is well tolerated.
Aesthetics Conference and Exhibition 2014: Business Design Centre, London
Authors: Tonks Sarah
Published: May 2014

With over 1600 visitors and standing room only at some sessions, this is one of the largest aesthetics events in the UK for good reason, says Sarah Tonks. There were free masterclasses and paid-for lectures to keep everyone up to date clinically, while a parallel business track championed excellence in practice. An exhibition displayed the latest products and Question Time focused on the lack of regulation in aesthetics
Royal College of Nursing discriminates against aesthetic nurses—again
Authors: Collier Helena
Published: May 2014

The Royal College of Nursing (RCN) is in a pickle over its indemnity scheme. Originally designed as an incentive to join, it has turned out to be a financial burden and has had to be modified. But the decision to exclude self-employed aesthetic nurses is a modification too far, argues Helena Collier, a depressing repeat of the RCN's failure to take aesthetic medicine and its practitioners seriously
Avoiding litigation: what aesthetic nurses need to know about capacity to consent
Authors: LUCKMAN MANDY
Published: May 2014

During the consultation process, medical aesthetic practitioners are responsible for considering whether the patients they see have the capacity to make decisions related to cosmetic procedures. In the third of this series of legal articles, Mandy Luckman explains the basic principles of capacity, defines the responsibilities of aesthetic practitioners and presents capacity as an ongoing consideration
Training for the enhanced role: a practitioner's perspective
Authors: Pritchard Angela
Published: May 2014

Since the undergraduate operating department practitioner (ODP) programme at Edge Hill University became a degree pathway, students completing the course are required to undertake some enhanced skills, such as skin preparation, draping, retracting tissue, cutting superficial sutures, assisting with haemostasis and camera manipulation. This article aims to highlight the ‘support package’ I developed to assist students to achieve these skills in clinical placement in my home trust. This package can also be used in other hospital trusts.
Health visitors' interprofessional working experiences: Implications for their collaborative public health role
Authors: Machin Alison I , Pearson Pauline
Published: May 2014

Interprofessional working is key to delivering positive public health outcomes and reducing health inequalities, which requires a whole system effort. Health visitors are key public health practitioners who can make a significant contribution to interprofessional teams working with individuals, families and communities to improve public health. However, interprofessional relationships in a health visiting context are not well understood. This paper presents data from a larger grounded theory study reported elsewhere ( Machin et al, 2012 ), which included evidence of health visitors' interprofessional interactions. Theoretical sampling resulted in 20 interviews and 10 observations from 17 health visitors in different work roles, in 2 community health-care organisations. The category ‘interprofessional working’ emerged from constant comparative analysis as one of four key data categories. Lack of role awareness and role overlap were identified as factors affecting the health visitors' interprofessional working relationships with doctors, nurses, nursery nurses and in interagency working. Interprofessional learning in health visitors' education and a health visitor commitment to workplace interaction with others, may improve clarity and awareness of their role, their experience and outcomes of their interprofessional public health working.
The Family Partnership Model: Evidence-based effective partnerships
Authors: Day Crispin , Harris Lucy
Published: May 2014

The Family Partnership Model is an evidence-based framework for partnership practice. The model is proven to be effective, particularly with families with long standing difficulties. Crispin Day and Lucy Harris provide a summary of the model.
The practice of prevention: The Family Nurse Partnership programme
Authors: Rowe Ann
Published: May 2014

The Family Nurse Partnership programme is a preventive programme for young first time mothers. Ann Rowe discusses the opportunities that a rigorously developed, evidence based programme offers for bringing about change.
Parent-infant relationships: Supporting parents to adopt a reflective stance
Authors: Underdown Angela
Published: May 2014

This article draws on current research, highlighting the importance of parents being able to ‘mentalise’—to make sense of their own and their child's mental state. Parents who ‘hold their child in mind’ are likely to be able to interpret behaviour in terms of his or her underlying feeling states. It is argued that health visitors and early years workers are ideally placed to explicitly ‘scaffold’ parents to adopt a reflective stance when trying to make sense of their infant's behaviour. A range of interventions is discussed, beginning in the prenatal period. In conclusion, the opportunities for practitioners to reflect on and be affirmed in their own practice are highlighted.
A journey that gives back to humanity
Authors: Halls, Victoria
Published: May 2014

Every year, Journal of Health Visiting (JHV) will welcome a newly qualified health visitor, fresh from their training, onto the editorial board for one year. Throughout the year, they will provide JHV with an insight into their training and a roundup of their first year in practice. For 2013, JHV is delighted to introduce Victoria Halls, a health visitor from White City, London who completed her training in September 2012. Victoria talks to JHV about her training experiences, her first few months in practice, and what she hopes to achieve in 2013.
Creating a compassionate and caring NHS: A view on the Francis Report
Authors: Wallbank, Sonya , Procter, Susan
Published: May 2014

Providing a good care experience and making a difference to children and families is at the core of health visiting practice. Sonya Wallbank and Susan Procter discuss the importance of understanding what is meant by compassionate care.
Going from strength to strength: A progress report on the iHV
Authors: Adams, Cheryll
Published: May 2014

Three months on since the launch of the iHV-a UK centre of excellence supporting high-quality health visiting practice-and all seems to be progressing smoothly. Founder, Cheryll Adams, identifies their progress and highlights what the future entails.
The family nurse workforce study: Assessment of the FNP programme
Authors: Robinson Dilys , Miller Linda
Published: May 2014

The Family Nurse Partnership National Unit (FNP NU) commissioned the Institute for Employment Studies (IES) to carry out a study of the family nurse (FN) workforce in 2012 ( Robinson et al, 2013 ). The focus of the study was different from other research conducted in this area (e.g. Barnes et al, 2011 ), which explored the impact and effectiveness of the FNP programme on the client population—young, first-time mothers and their children. The study brief was to explore workforce issues, especially recruitment, retention and job satisfaction, among FNs and their supervisors. The rationale behind this workforce study was that if the FNP programme is to be successful in the longer term, it is important to be assured that staff find the FNP attractive, are well prepared for and able to cope with the role, find the role rewarding and therefore are likely to be retained in the long term, and be positive advocates for working in the FNP. An online survey of FNs and supervisors, focus groups and telephone interviews revealed that FNs and supervisors were consistently positive about all aspects of the FNP. Although the role is demanding, many feel that they do not want to do anything else in the foreseeable future. However, opportunities for career progression need to be addressed. A continuing challenge is the integration of the FNP with universal services; where services are more integrated and accepted, an encouraging degree of shared learning and collaboration appears to be developing.
When the going gets tough
Authors: Lavery Donna
Published: May 2014

Many new mothers struggle to make an emotional connection with their newborn. This month, Ruth Donnelly talks to Donna Lavery, who gives an honest account of those early months and how her health visitor helped her through.
Biliary atresia: Early intervention and working with expert parents
Authors: Houston Anna
Published: May 2014

This article offers a review of the significance of early diagnosis of neonatal jaundice through a case study of biliary atresia. It defines the expert parent and draws attention to the supporting role of health visitors when working with parental expertise. The article discusses the importance of early diagnosis of neonatal jaundice and the relevance of communication links between parents and professionals. In this case study, the parents have offered their perspective on the essential need for the right type of early support when dealing with the challenge of an infant who was seriously ill.
Research roundup: January 2014
Authors: Lewis Lisa , Condon Louise , Murray Joy , Branson Kathy , Whiting Julia
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 specialist health visitor when working with Gypsy and Traveller families
Authors: Lally Sheila
Published: May 2014

Gypsies and Travellers experience wide-ranging social inequalities and they belong to a community that is the most excluded in the UK. A review of the literature suggests the health status of this group is considerably poorer than other ethnic groups living in the UK; this is supported by data gathered in the 2011 census. Gypsies and Travellers continue to be the group against which it is still deemed acceptable to be discriminatory. Focusing on the South West of England, this article discusses the role of the specialist health visitor in reducing health inequalities and the role of health champions and health trainers as a way forward in designing and delivering culturally sensitive and appropriate health services.
Understanding why parents disengage in child health surveillance reviews: A health visitor's perspective
Authors: Johnson Joanne
Published: May 2014

Parental disengagement in child health services can have an adverse affect on a child's health and, in some cases, may have serious implications for their safety. Current health policy recommends routine surveillance reviews of the health and development for every child by the end of their first year of life, and at 2–2½ years of age. Health visitors are the lead professionals in delivering the core requirements of this policy. Coverage of routine health checks decreases as children age, is generally lower in deprived areas and fundamentally relies on parental engagement, particularly for children who are disadvantaged socially, economically or psychologically. Health visitors from a single NHS Trust participated in a focus group to share their opinions and thoughts on why parents disengage in child health surveillance reviews, with a particular emphasis on the 2–2½ year review. This research illustrates the value of the relationship with the health visitor in engaging parents in interventions such as child health surveillance reviews. It also supports existing literature stating that vulnerable families can be difficult to engage with and emphasises the importance of health visitors adopting creative and flexible practice to engage parents in child health surveillance.
Weight management of obese patients on the renal ward
Authors: MacLaughlin Helen , Greenwood Sharlene
Published: May 2014

The worldwide increase in obesity has occurred alongside rising rates of chronic kidney disease. Here Helen MacLaughlin and Sharlene Greenwood explain the link between obesity and renal disease and outline strategies for weight management of obese or overweight patients with chronic kidney disease.
The role of albumin:creatinine ratio in detecting renal disease
Authors: Harris Beverley
Published: May 2014

Beverley Harris describes how urinary albumin:creatinine ratio (ACR), a simple urinary test, can be used to detect early onset of chronic kidney disease in patients at particular risk, e.g. those with diabetes or hypertension. She explains the vital facts as well as the key policies relating to ACR.
Generic immunosuppression: to embrace or dismiss?
Authors: Popat Reena
Published: May 2014

The advent of generic alternatives for transplant immunosuppressant drugs has engendered concern and discussion. In this article, Reena Popat explains which of the available branded transplant drugs have safe and effective generic alternatives, which may be substantially less expensive and result in effective cost-cutting, and which drugs in particular cannot be substituted so easily.
Stressors experienced by nurses working in a dialysis setting
Authors: Goode Pandora
Published: May 2014

Nursing patients who are on dialysis is demanding, and renal nurses working in a dialysis setting experience a multitude of stressors daily. This US review, conducted by Pandora Goode, examines the stressors that affect the mental and physical welfare of dialysis nurses, including stressors that relate to increasing workloads, staff issues, infectious diseases and patient–nurse relations.
Improving patient safety and avoiding incidents in renal units
Authors: Rylance Paul B.
Published: May 2014

The Renal Association Patient Safety Project has identified that renal patients have been exposed to incidents and risks from failure of dialysis equipment or disposables, or from use error. Blood loss on haemodialysis, particularly from venous needle dislodgement, as well as haemolysis associated with haemodialysis, are risks for potential fatal outcomes. Solutions to these incidents and risks have been formulated and circulated, and guidelines for water treatment quality have been developed. Renal patients are susceptible to infection and also are at risk when admitted as acutely ill. Attention to the influence of ‘human factors’ on safety of renal patient care should be emphasised, especially in communication, handover and team-working. Incident reporting through hospital reporting systems within a ‘no blame’ culture is essential in order to learn from incidents. Incidents and risks related to medical devices should also be reported to the Medicines and Healthcare Products Regulatory Agency (MHRA). Sharing of incidents, risks, solutions and best practice can be rapidly achieved through the Renal Association Patient Safety Project and is being further developed in a multidisciplinary approach through collaboration with the British Renal Society and the Association of Renal Technologists.
The use of gentamicin to treat a urinary tract infection in an older patient with renal impairment
Authors: Coleman Adrian , Yau Ting Yee
Published: May 2014

This drug focus article looks at the use of gentamicin, an aminoglycoside antibiotic, in a patient with a urinary tract infection and renal impairment. Adrian Coleman and Ting Yee Yau discuss the indications, mechanisms of action, dosing and side effects of this commonly used antibiotic.
Graduated compression and the prevention of deep vein thrombosis (Part 1)
Authors: Thomas S.
Published: May 2014

The first in a three-part article reviewing the literature on graduated compression and the prevention of deep vein thrombosis.
The management of a patient with complex wounds
Authors: Scott F.
Published: May 2014

A case study describing the care of a patient with renal failure who developed leg ulcers of mixed aetiology
Developing guidelines for pressure ulcer prevention and management
Authors: Clark M.
Published: May 2014

A review of the current pressure ulcer prevention guidelines.
The role of honey in the management of wounds
Authors: Molan P.C.
Published: May 2014

A review of the evidence on the advantages of using honey as a topical wound treatment together with practical recommendations for its clinical use.
Adsorption of serum-derived proteins by primary dressings: implications for dressing adhesion to wounds
Authors: Rogers A.A. , Walmsley R.S. , Rippon M.G. , Bowler P.G.
Published: May 2014

Using an in vitro immunolocalisation technique, an exploratory study was carried out into the serum-derived protein adsorption capacity and the cell adherence of a traditional gauze dressing versus a new gelling fibre gauze dressing. We found that the traditional gauze dressing adsorbed protein more readily than the new dressing. The findings indicate that reduced binding of serum proteins to the surface of the gelling fibre dressing may help reduce the adherence characteristics for this type of dressing, minimising trauma and possibly reducing the acute pain experienced during dressing changes.
The management of chronic wounds: factors that affect nurses' decision-making
Authors: Boxer E. , Maynard C.
Published: May 2014

This study sought to determine how registered nurses make decisions regarding the management of chronic wounds. A self-administered questionnaire consisting of both Likert-type and open-ended questions was used to survey registered nurses working in hospitals and community services in a large Australian city. A total of 140 questionnaires were returned from a variety of clinical settings.

The study revealed that registered nurses had a significant role in chronic wound management. However, they relied primarily on their own experience and that of colleagues for decision making in which they had varying degrees of autonomy. The authors conclude that nurses and medical staff require more objective, research-based education on wound assessment and management.
Comparison of two dressings in the management of partial-thickness donor sites
Authors: Martini L. , Reali U.M. , Borgognoni L. , Brandani P. , Andriessen A.
Published: May 2014

This study evaluated and compared the performance of an adhesive hydrocellular dressing with that of a paraffin gauze dressing in the treatment of partial-thickness skin-graft donor site wounds. Fifty patients were included in the study, each acting as his/her own control. Donor site area ranged from 20cm2 to 71cm2; half the area of each patient's donor site was treated with the trial dressing, the other half with paraffin gauze. Outcome measures assessed were: time to complete epithelialisation; ease of dressing removal; pain on removal; and appearance of the wound bed. The trial dressing demonstrated a significantly faster healing time (p < 10-6) and enhanced patient comfort.
The use of silicone gel sheeting in the management of hypertrophic and keloid scars
Authors: Poston J.
Published: May 2014

A systematic review of the use of a topical silicone gel therapy in the management of abnormal scarring.
Using an esterified hyaluronan fleece to promote healing in difficult-to-treat wounds
Authors: Hollander D. , Schmandra T. , Windolf J.
Published: May 2014

Hyaluronic acid enhances angiogenesis and promotes re-epithelialisation and scar formation. Two case studies illustrate how a dressing that creates a hyaluronan-rich environment at the wound surface achieved full healing in two patients with underlying physiological problems.
The prevention of pressure ulcers through risk assessment
Authors: Scott E.M.
Published: May 2014

A multidisciplinary approach to aid understanding of the risk assessment process
Pressure ulcer classification: the Torrance system
Authors: Harker Judy
Published: May 2014

A wide variety of pressure ulcer classification systems are in use but most have grading systems which are subjective and open to different interpretations. This review discusses the advantages and disadvantages of the Torrance classification system, and argues that this highlights the need for a national grading tool
The responsibility is yours
Authors: Flanagan M.
Published: May 2014

Outdated practice in wound care is largely due to practitioners' reluctance to make informed clinical judgements and use problem-solving skills
2: Management options
Authors: Kerstein M.D. , Reiss E.D.
Published: May 2014

Various disorders and risk factors prevent wound healing in patients with peripheral vascular disease. These mostly can be treated with non-pharmacological interventions, such as smoking cessation and diabetes management.
Specific growth factors and the healing of chronic wounds
Authors: Krishnamoorthy L. , Morris H.L. , Harding K.G.
Published: May 2014

Part II of this two-part review focuses on the function of specific growth factors in wound healing and considers the results of clinical trials of their use in chronic wounds.
Doppler and the ABPI: how good is our understanding?
Authors: Vowden K. , Vowden P.
Published: May 2014

This paper discusses the origins of the ABPI, examines a number of failings in how practitioners use Doppler and highlights the need for a deeper understanding of the procedures involved
Removal of perforated adhesive tape: dry versus solvent-assisted
Authors: Sylaidis P. , Clibbon J. , Eagling V. , King C.
Published: May 2014

This study compared the speed of dry removal of perforated adhesive tape from skin with some of the more commonly used solvents, namely acetone, arachis (peanut) oil, paraffin oil and saline. Twenty healthy volunteers had each of the solvents used on separate adhesive tapes applied circumferentially to their arms. Time to removal was recorded and analysed using the non-parametric sign test.
Angiogenesis: is it the key to controlling the healing process?
Authors: Neal M.S.
Published: May 2014

Much research has been undertaken on the complex processes involved in angiogenesis. This may lead to the development of new treatments that help to improve patients' quality of life
The influence of four wound dressings on the kinetics of human walking
Authors: Chockalingam N. , Ashford R.L. , Dunning D.
Published: May 2014

Objectives:

This in vivo study (the second phase of a research project first described in the February issue of Journal of Wound Care) reports on the influence of various wound dressings on the dynamics of human walking. Allevyn (Smith and Nephew), Biatain (Coloplast), Lyofoam (Seton Scholl) and Tielle (Johnson and Johnson) were used in this study. The investigation aimed to assess the ground reaction forces in the foot while the dressings were applied to the plantar surface of the foot.

Method:

A strain gauge force plate system was used. Six subjects with ‘normal’ gait patterns and no foot pathology were recruited into the study. Eight trials were recorded for each subject. The peak push-off force, in the vertical component of the ground reaction force, and the maximum braking and propulsive forces in the medial-lateral component of the ground reaction force were estimated and reported.

Results:

Among the various dressings tested, Allevyn performed closest to barefoot in the peak push-off force and demonstrated an increased braking force at the deceleration point in the gait cycle.

Conclusion:

These findings may have implications for clinicians selecting wound dressings for the treatment of certain foot ulcerations. However, further clinical research is warranted in this area. Declaration of interest: Study was sponsored by Smith and Nephew.
Management of a heavily exuding, painful wound with necrotising subcutaneous infection
Authors: Ovens N. , Fairhurst J.
Published: May 2014

Wounds with necrotising fasciitis are often malodorous and produce copious exudate. Selecting appropriate dressings can alleviate these symptoms and improve the patient's quality of life within a short time period
DVT: the forgotten factor in leg ulcer prevention
Authors: Lindholm C.
Published: May 2014

Although deep vein thrombosis is often a primary cause of venous leg ulceration, many nurses are unaware of how it can be prevented. More attention must be paid to this area of practice, says Christina Lindholm.
Healing venous ulcers with cycloidal multidirectional vibration therapy
Authors: Wilson J.M. , Arseculeratne Y.M. , Yang Y. , Cherry G.W.
Published: May 2014

Objective:

This preliminary study combined compression bandaging with cycloidal vibration to determine whether this would enhance the rate of healing of venous leg ulceration.

Method:

Twenty-one patients with venous ulceration were enrolled into a 12-week trial. The vibration device was used three times daily for 30 minutes on each occasion, along with compression bandaging.

Results:

Ulcers of 13 patients (62%) healed within 12 weeks. The remaining eight patients completed the 12-week study with a 31–90% reduction in ulcer size. A reduction in pain was observed in 17 out of 21 patients (81%). Ultrasound measurements showed reduced fluid content in the upper dermis in patients whose ulcers had healed and in others whose ulcers were improving.

Conclusion:

This preliminary study shows that gentle cycloid vibration, combined with standard compression bandaging, enhances the healing rate of venous ulcers and helps to relieve pain.

Declaration of interest:

This study was supported by an educational grant from Vibrant Medical, UK.
Incidence and prevalence data: can we ensure greater accuracy?
Authors: Bethell E.
Published: May 2014

Practitioners in the UK will only know if they are meeting targets on pressure ulcer reduction if they provide valid and reliable prevalence and incidence data. But all too often, published data contain inconsistencies and can be misleading.
Advanced wound care materials: developing an alginate fibre containing branan ferulate
Authors: Miraftab M. , Qiao Q. , Kennedy J.F. , Groocock M.R. , Anand S.C.
Published: May 2014

Objective:

This laboratory-based study set out to establish whether branan ferulate — a polysaccharide compound available in gels such as as Sterigel (SSL International, UK) — could be successfully added to the fibre of an alginate dressing to provide a superior wound-care dressing.

Method:

A wet extruder (Howden Engineering Services, UK) was used to produce the fibres. Researchers examined the effect of spinning-bath calcium chloride concentration (used as the coagulant in the fibre-spinning process) on the tensile and absorption properties of alginate fibres containing 25% w/w branan ferulate. Sodium alginate and branan ferulate were separately dissolved in de-ionised water and then stirred together to make up a 5% dope solution. The dope was then forced through a spinneret and into the calcium chloride bath, where fibres were precipitated and then carried over the first set of rollers. The fibres were washed in the next bath and drawn at different rates to enhance their tensile properties. At the ‘winding-up’ stage the filaments were either passed over a contact heater and into a furnace (dry pick-up) or transferred into acetone baths of increasing concentrations of 50, 80 and 100% aqueous acetate to remove the water (wet pick-up). The moisture content of standard alginate fibres and those with branan ferulate were measured and compared. Breaking load, tenacity and breaking extension, and the quantity of branan ferulate in the fibres were also measured. The process was repeated four times, using different strengths of calcium chloride. Using various draw ratios, the effects of liquid uptake were measured using water, saline and a solution called A (to mimic human blood and exudate-type fluids).

Results:

Out of the four calcium chloride concentrations used, 1% concentration appeared to give the highest and most conclusive results for fibre-breaking load, tenacity and breaking extension.

Conclusion:

A 1% w/v concentration of calcium chloride provides the optimum conditions for achieving suitably strong fibres with adequate absorption capacity, while allowing the least branan ferulate loss during wash and post-production treatments. In a laboratory setting the product showed promise. Research is now needed in a clinical setting and for comparison with existing wound-care products.

Declaration of interest:

This study was funded and sponsored by SSL International, Oldham, UK.
Meeting the complex care needs of a patient with Darier's disease
Authors: Wicks G.
Published: May 2014

An interdisciplinary team reduced the cost and duration of hospital care for a patient with this debilitating skin disease, with the help of an air-fluidised bed. Nursing time was reduced, yet the patient's quality of life improved dramatically.
Suitable dressings for toenail bed wounds: a literature review
Authors: King B.
Published: May 2014

This literature review considers potential dressing options for toenail avulsion. It forms part of the preparatory work for a prize-winning paper describing a qualitative study on pain experience, previously published in Journal of Wound Care.
Healing process in the ureter: an experimental study in dogs
Authors: Bhatnagar B.N.S. , Chansouria J.P.N.
Published: May 2014

Objective:

This study set out to describe the basic milestones in the pattern of healing in the ureter in order to understand why problems in healing arise when the ureter is severed, usually through anastomotic leakage or stricture formation.

Method:

Transection and anastomosis of the ureter were performed on dogs. The anastomotic segment was removed at days 6, 14, 21 and 42. Mucopolysaccharide levels, collagen content and breaking strength were measured on these samples and on anatomically similar segments from normal dogs. A minimum of five observations were carried out at each time point. The mean values of the estimations in various groups were compared. Differences were considered significant at p≤0.05.

Results:

Mucopolysaccharide levels peaked at day 6 and then fell gradually to near normal (p>0.05) by day 42. The collagen content rose to a maximum at day 14 and then fell to near normal levels (p>0.05) by day 21. Breaking strength rose gradually to peak by day 21 and then fell to reach day 6 level (>0.05) at day 42. At no time point did it reach anywhere near normal value. Full healing in the ureter takes at least six weeks.

Conclusion:

The healing process in the injured ureter is different to that in other tissues. It is probable that clues to anastomotic healing problems of the ureter lie in the paradoxical pattern of collagen formation.

Declaration of interest:

None.
Effect of curcumin on radiation-impaired healing of excisional wounds in mice
Authors: Jagetia G.C. , Rajanikant G.K.
Published: May 2014

Objective:

To study the effect on wound contraction of pretreatment with various doses of curcumin (the most important active ingredient of the spice turmeric) in mice exposed to 6Gy whole-body y radiation.

Method:

A full-thickness skin wound was produced on the dorsum of Swiss albino mice treated with and without 25, 50, 100, 150 or 200mg/kg body weight of curcumin before exposure to 6Gy g radiation. Progression of wound contraction was monitored using video images of the wound at various days post-irradiation until full healing occurred. Mean wound healing times were also calculated.

Results:

Irradiation caused significant delay in wound contraction and healing times. However, treatment with curcumin resulted in a dose-dependent increase in contraction when compared with a control. Greatest contraction was observed for 100mg/kg curcumin, with statistically significant results at days three (p<0.009), six (p<0.05) and nine (p<0.05) post-irradiation for this dose. Complete healing was achieved by day 23 post-irradiation in the curcumin-treated irradiation group.

Conclusion:

Pretreatment with curcumin has a conducive effect on irradiated wounds. It could be a substantial therapeutic agent for ameliorating radiation-induced delay in wound repair in cases of combined injuries.

Declaration of interest:

None.
An exploration of two opposing theories of wound contraction
Authors: Norman D.
Published: May 2014

The processes of wound contraction are still not fully understood. Tejero-Trujeque suggested this is because there is not yet a true skin-equivalent in vitro model that resembles all of the complex phenomena that occur during wound healing.
Understanding the underlying causes of chronic leg ulceration
Authors: Moloney M. Clarke , Grace P.
Published: May 2014

Leg ulcers affect 1–2% of the adult population of the UK and Ireland. Prevalence is greater in women aged over 70 years as increasing age is associated with delayed cellular migration, proliferation, metabolic response and matrix biosynthetic response.
Prevention of non-healing wounds through the prediction of chronicity
Authors: Boyd G. , Butcher M. , Glover D. , Kingsley A.
Published: May 2014

Aseries of practitioner-focused educational meetings held across the UK and facilitated by Johnson and Johnson, raised a number of issues pertinent to delegates:
Is there enough clinical evidence to use honey to manage wounds?
Authors: Gethin G.
Published: May 2014

Honey has been used in wound healing for centuries. Over the past decade, the antibacterial properties of this ancient remedy have been researched again. This paper reviews and analyses the few randomised controlled trials on the use of honey in wound care. It also presents outcomes of case reports. While the latter are not generalisable, their data are useful in studying the effectiveness of honey.
Developing a tool to diagnose cases of necrotising fasciitis
Authors: Poromanski I. , Andriessen A.
Published: May 2014

Necrotising fasciitis is a rare, life-threatening infection that causes necrosis of the skin, the subcutaneous tissue and fasciae. Its incidence in adults has been reported to be 0.40 cases per 100,000 population, with an incidence of 0.08 cases per 100,000 in children worldwide.
Using Urgotul dressing for the management of epidermolysis bullosa skin lesions
Authors: Blanchet-Bardon C. , Bohbot S.
Published: May 2014

Objective:

To evaluate the acceptability, tolerance and efficacy of Urgotul wound dressing in the management of epidermolysis bullosa (EB) skin lesions.

Method:

This was an open-label uncontrolled clinical trial involving 20 patients (11 adults and nine children) with EB simplex or dystrophic EB. Patients were selected from the register of EB patients at the investigating centre and included if they presented with at least one skin lesion requiring management with a non-adherent wound dressing. Lesions were treated with the study dressing for a maximum of four weeks. All dressing changes, wound parameters, pain and effect on quality of life were recorded.

Results:

All patients completed the trial. Nineteen out of 20 wounds healed within 8.7 ± 8.5 days. Overall, 11 patients (55%) considered that their quality of life had improved following use of the dressing, which was also reported to be pain free and ‘very easy’ or ‘easy’ to remove at most dressing changes. Nineteen out of 20 patients stated that they would use the study dressing to manage their lesions in future.

Conclusion:

This study confirmed the very good acceptability and efficacy of Urgotul in the treatment of skin lesions in patients with EB.

Declaration of interest:

This study was sponsored by Laboratoires Urgo (Dijon, France).
The effectiveness of a hyper-oxygenated fatty acid compound in preventing pressure ulcers
Authors: Torra i Bou J-E. , Segovia Gómez T. , Verdú Soriano J. , Nolasco Bonmatí A. , Rueda López J. , Arboix i Perejamo M.
Published: May 2014

Objective:

To compare the effects of Mepentol, a hyperoxygenated fatty acid preparation, with a placebo treatment in preventing the development of pressure ulcers.

Method:

The research study consisted of a multicentre double-blind randomised clinical trial. The incidence of pressure ulcers, relative risk (RR), preventable fraction and number necessary to treat (NNT) were calculated. In addition, Kaplan-Meier survival curves, with log-rank test, and Cox’s proportional hazards regression model were used to compare both groups.

Results:

A total of 331 patients completed the study: 167 in the control group and 164 in the study group. Pressure-ulcer incidence during the study was 7.32% in the intervention group versus 17.37% in the placebo group (p0.006). These results show that for each 10 patients treated with Mepentol one pressure ulcer was prevented (NNT = 9.95). Survival curves and the regression model showed a significant statistical difference for both groups (p≤0.001). The average cost of Mepentol during the study was ₠7.74.

Conclusion:

Mepentol is an effective measure for pressure ulcer prevention. It was more effective than a greasy placebo product, and was found to be cost-effective.

Declaration of interest:

This study was sponsored by Laboratorios Bama-Geve SA, Barcelona, Spain.
Skin grafting techniques for soft-tissue coverage of diabetic foot and ankle wounds
Authors: Roukis T.S. , Zgonis T.
Published: May 2014

Diabetic foot and ankle wounds frequently break down despite off-loading techniques. Skin grafting offers a simple, durable, minimally invasive and costeffective means of wound closure, resulting in a functional and sensate limb
Use of larval therapy to combat infection after breast-conserving surgery
Authors: Steenvoorde P. , Oskam J.
Published: May 2014

Wound infection after breast surgery is not uncommon and is not always simple to treat. This paper presents the case of a patient in whom the wound was successfully treated with larval debridement therapy after other methods failed
Evaluation of hypochlorous acid washes in the treatment of chronic venous leg ulcers.
Authors: Selkon J.B. , Cherry G.W. , Wilson J.M. , Hughes M.A.
Published: May 2014

Objective:

Hypochlorous acid (HOCl) is a highly microbiocidal agent active against bacteria, viruses and fungi. Using quantitative microbiology, preliminary studies showed it achieved an appreciable reduction in the bacterial burden in chronic venous leg ulcers. The study aimed to determine whether it has a role as an additional treatment for chronic venous ulcers that have not healed with conventional treatment.

Method:

On the basis of previous reports we designed a study in which patients acted as their own controls, in that only patients who failed to achieve a 44% reduction in wound size with standard treatment (compression bandaging) received HOCl washes.

Results:

Of 30 patients admitted to the study, 10 achieved a 44% ulcer reduction after three weeks of standard treatment. In addition to the standard compression treatment, the remaining 20 patients were given HOCl washes over 12 weeks. Of the 20 ulcers, nine (45%) healed and five (25%) reduced in size by over 60%. All patients became free of pain.

Conclusion:

These findings confirm the clinical efficacy of treating venous leg ulcers with hypochlorous washes. Use of HOCl washes as an adjunctive therapy for recalcitrant venous leg ulcers appreciably increases healing and rapidly relieves pain.

Declaration of interest:

This study was supported by a grant from Sterilox Technologies International, Stafford, England.
Cost of managing chronic wounds in the UK, with particular emphasis on maggot debridement therapy
Authors: Thomas S.
Published: May 2014

According to Bennett et al., approximately 412,000 individuals develop a new pressure ulcer every year in the UK, a quarter of which are European Pressure Ulcer Advisory Panel (EPUAP) grade III or IV. Management costs (excluding hotel costs) range from £1.4 billion to £2.1 billion (UK NHS costs at 2000 prices), although due to the method used to derive the mean values this probably represents an underestimate of the true values and therefore treatment costs.
Measuring sub-bandage pressure: comparing the use of pressure monitors and pulse oximeters
Authors: Satpathy A. , Hayes S. , Dodds S.R.
Published: May 2014

Objective:

To test the use of low-cost sub-bandage pressure monitors and pulse oximeters as part of a quality-control measure for graduated compression bandaging in leg ulcer clinics.

Method:

Twenty-five healthy volunteers (mean age 40 years) providing 50 limbs were bandaged with a four-layer compression bandaging system. The ankle systolic pressure (ASP) was measured using a pulse oximeter (Nellcor NBP-40) before applying the graduated compression bandages. Interface pressure was measured by placing pressure sensors on the skin at three points (2cm above the medial malleolus; the widest part of the calf; and a point midway between them) in the supine and standing positions. The ASP was measured again with the pulse oximeter after the bandage had been applied, and the effect of the bandage on the ASP was recorded. The actual pressure created by the bandage was compared with the required pressure profile.

Results:

Interface pressures varied with change of position and movement. With the operator blinded to the pressure monitors while applying the bandages, the target pressure of 35–40mmHg at the ankle was achieved in only 36% of limbs ([mean ± 95% confidence interval]; 32.3 ± 1.6mmHg [supine]; 38.4 ± 2.4mmHg [standing position]). With the help of the pressure monitors, the target pressure was achieved in 78% of the limbs. There was no correlation between the pressure monitors and pulse oximeter pressures, demonstrating that the pulse oximeter is not a useful tool for measuring sub-bandage pressures.

Conclusion:

The results suggest a tool (interface pressure monitors) that is easy to operate should be available as part of quality assurance for treatment, training of care providers and education.

Declaration of interest:

None.