bluuebunny/crossref_metadata_2025 huggingface dataset:
Accurate diagnosis and effective treatment of leg ulcers reduce prevalence, care time and costs
Authors: Öien R.F. , Ragnarson Tennvall G.J.
Published: May 2014

Objective:

This long-term follow-up recorded the prevalence, aetiology and treatment of hard-to-heal leg and foot ulcers, and an estimated nurses’ time spent providing care, for the years 1994–2005.

Method:

A questionnaire was sent to all district and community nurses in the county of Blekinge, Sweden, during one week in 1994, 1998, 2004 and 2005. Calculating the costs of hard-to-heal leg and foot ulcer care was not a primary aim, but the reduction in prevalence and time spent on wound management suggested it was important to illustrate the economic consequences of these changes over time.

Results:

Estimated prevalence of hard-to-heal leg and foot ulcers reduced from 0.22% in 1994 to 0.15% in 2005. Treatment time decreased from 1.7 hours per patient per week in 1994 to 1.3 hours in 2005. Annual costs of leg and foot ulcer care reduced by SEK 6.96 million in the study area from 1994 to 2005.

Conclusion:

Improved wound management was demonstrated; leg and foot ulcer prevalence and treatment time were reduced. The results could be attributed to an increased interest in leg and foot ulcer care among staff, which was maintained by repeated questionnaires, continuous education, establishment of a wound healing centre in primary care and wound management recommendations from a multidisciplinary group. The improved ulcer care reduced considerably the annual costs of wound management in the area.

Declaration of interest:

None.
Antimicrobial and barrier effects of silver against methicillin-resistant Staphylococcus aureus
Authors: Edwards-Jones V.
Published: May 2014

Objective:

Two strains of methicillin-resistant Staphylococcus aureus (MRSA), termed epidemic strains (EMRSA-15 and EMRSA-16), were used to evaluate the antimicrobial and barrier effect of four silver dressings (two silver donating and two non-silver-donating) available in the UK at the time of the study.

Method:

The moist surface of a blood agar plate was covered with 106 colony-forming units of the respective strain of MRSA, and dressings were applied to the surface and incubated at 37°C for different time periods and the upper and lower surfaces subcultured for residual growth.

Results:

The nanocrystalline dressings (silver donating) were effective as a barrier from one hour until the study end (72 hours): no penetration of EMRSA-15 and EMRSA-16 through the dressing occurred. Moreover, the nanocrystalline dressings showed some antimicrobial activity at one hour in the areas underneath and surrounding the dressing until the study end. The remaining two dressings had no barrier effect and only demonstrated limited antimicrobial activity after 24 hours.

Conclusion:

This in vitro study suggests that the nanocrystalline dressings are more effective than other silver dressings in terms of providing a barrier function and antimicrobial activity against EMRSA-15 and EMRSA-16.

Declaration of interest:

This study was funded by a small educational grant from Smith & Nephew Healthcare.
Patients’ perceptions of the impact of treatments and products on their experience of leg ulcer pain
Authors: Briggs M. , Closs S.J.
Published: May 2014

Objective:

Very little research has explored patients’ experience of pain with different cleansing agents and dressings. We therefore undertook a longitudinal study of their impact on leg ulcer pain.

Method:

Patients with leg ulcers referred to community nurses were eligible to participate. They were followed up for six months, completing questionnaires about the impact on pain of each wound treatment used. A treatment episode was defined as the use of a wound cleansing agent, primary dressing and bandages. When one aspect of treatment changed, a new treatment episode began.

Results:

There were 210 treatment episodes for 96 leg ulcer patients. In 206 episodes cleansing agents were used. Cleansing caused pain in 22% of episodes and relieved pain in 27%. Of the five most commonly used dressing types, low-adherent dressings were the least likely to cause pain. Only 56% of patients were able to tolerate full compression bandaging and pain was the most common reason for non-compliance.

Conclusion:

A substantial proportion of patients felt that leg ulcer treatments caused pain. A greater emphasis on the impact of treatment on pain and healing is warranted both clinically and in research.

Declaration of interest:

This work was supported, in part, by an unrestricted educational grant from Johnson & Johnson Medical.
The successful management of a dehisced surgical wound with TNP following femoropopliteal bypass
Authors: Dee A.
Published: May 2014

This case report discusses the use of topical negative pressure therapy on a suture line infected with methicillin-resistant Staphylococcus aureus in a patient with diabetes who had undergone a femoropopliteal bypass using an artifi cial graft
Chronic foot ulcer management using maggot debridement and topical negative pressure therapy
Authors: Brin Y.S. , Mumcuoglu K.Y. , Massarwe S. , Wigelman M. , Gross E. , Nyska M.
Published: May 2014

Although maggot debridement therapy (MDT) was introduced in the US in 1931 by William Baer, it had been used in both the Napoleonic and American civil wars. It was largely abandoned following the introduction of antibiotics and new surgical approaches, but today it is used to debride intractable wounds and ulcers that do not respond to conventional therapy.
Venous leg ulcer treatment and practice — part 4: surgery and pharmaceutical therapies
Authors: Rajendran S. , Rigby A.J. , Anand S.C.
Published: May 2014

Vascular surgery is an option whereby defects in the superficial and perforating venous system are addressed to remove any obstruction or correct venous reflux. Venous insufficiency of the superficial and perforator veins occurs in approximately 50% of all cases of venous leg ulceration, and these patients are likely to respond to vascular surgery. Patients should be clinically assessed to identify vascular abnormalities of the arterial and venous systems before surgery. Venous insufficiency of the superficial and perforator veins can be corrected by sclerotherapy or vascular surgery, which may improve healing rates.
Rapid healing of a late diagnosed sickle cell leg ulcer using a new combination of treatment methods
Authors: Schleucher R. , Gaessler M. , Knobloch J.
Published: May 2014

Approximately 5% of the world’s population are carriers of the genetic alterations associated with sickle cell trait and thalassaemia — the percentage is as high as 25% in some regions.1 Sickle cell disorders include all states in which a sickle cell gene has been inherited, but sickle cell diseases refer to states in which a morbid condition ensues, such as haemoglobin sickle cell disease and haemoglobin S-β-thalassaemia. The term sickle cell anaemia is reserved for the homozygous state of haemoglobin S (HbSS).
Clinical effectiveness of a low-tech versus high-tech pressure-redistributing mattress
Authors: Cavicchioli A. , Carella G.
Published: May 2014

Objective:

To compare the effectiveness of a high-specification foam mattress (control) with a high-tech (Duo2, Hill Rom) alternating/continuous low-pressure mattress (treatment) in the prevention of pressure ulceration. The study also evaluated if there is a difference in performance between the two working modalities (alternating and continuous low pressure) of the high-tech mattress in a comparable sample of patients.

Method:

Thirty-three patients were observed for two weeks in the control group. In the treatment group, 86 patients were randomised to receive alternating low pressure and 84 continuous low pressure. Incidence of pressure ulcers in both arms was recorded. Student’s t-test was used to compare all Braden scores, and the chi-square test and Fisher’s exact test to evaluate differences between groups.

Results:

There was a high difference in the number of new pressure ulcers in the control group when compared with the treatment group. There was no difference in performance between the alternating and continuous low-pressure modes. However, the sample size is too small to prove or disprove a statistically significant difference between the two modalities.

Conclusion:

The high-tech mattress was markedly more effective than the high-specification foam mattress in preventing the onset of pressure ulcers. Initial data suggest that the use of alternating or continuous low pressure made little or no difference to the results.

Declaration of interest:

Hill-Rom provided the Duo2 surfaces in the two of the three hospitals involved in the trial, but no other financial support was received.
Silver dressings versus other dressings for chronic wounds
Authors: Wang J , Smith J , Babidge W , Maddern G
Published: May 2014

Objective:

To assess differences in effectiveness between silver dressings and other types of dressings in chronic wound management in the community setting.

Method:

The study used client data retrospectively collected as part of routine care management. The cohort comprised 2687 clients who received 3716 episodes of care between September 2005 and January 2006. Outcome measures were the length of time for which clients received care from community nurses for each wound and the number of visits required.

Results:

The median number of visits was statistically significantly higher for the silver-dressing users than for users of other dressings (31 versus 11, p<0.0001), while the median treatment duration was also greater (97 days versus 39 days, p<0.0001). In addition, the interval between visits was significantly shorter in the silver dressing group (p<0.001).

Conclusion:

These results question the effectiveness of silver dressing materials in the management of chronic wounds in a community care setting. However, these results need to be substantiated by prospective randomised controlled clinical trials to produce more reliable evidence.

Declaration of interest:

None.
Is chronic diabetic foot ulcer an indicator of cardiac disease?
Authors: Löndahl M. , Katzman P. , Fredholm O. , Nilsson A. , Apelqvist J.
Published: May 2014

Objective:

To evaluate presence and severity of cardiac disease in individuals with chronic diabetic foot ulcers using echocardiography.

Method:

Eighty consecutive patients with chronic foot ulcers attending the multidisciplinary diabetes foot clinic at Helsingborg Hospital underwent clinical examination, toe blood pressure measurement and a standard echocardiographic examination.

Results:

Sixty-nine percent of the patients had a history of myocardial infarction and/or hypertension and/or heart failure; 78% had signs of left ventricular dysfunction and/or left ventricular hypertrophy and/or diastolic dysfunction; 76% of the patients without a history of cardiovascular disease had signs of cardiac dysfunction on echocardiography.

Conclusion:

Cardiac dysfunction is a common occurrence present in patients with chronic diabetic foot ulcers, even in those without known cardiac disease or hypertension. Echocardiography may be recommended as a screening procedure in the management of diabetic patients with chronic foot ulcers. The present study supports the view that diabetic chronic foot ulcers ought to be seen as a sign of cardiac disease, although further research is needed to elucidate this issue.

Declaration of interest:

None.
A rapid molecular method for characterising bacterial bioburden in chronic wounds
Authors: Wolcott R.D. , Dowd S.E.
Published: May 2014

Polymerase chain reaction is a culture-free method of identifying pathogens. This case study describes how, unlike traditional culture reports, a modification of this technique rapidly determined that Pseudomonas spp. was present in a chronic wound
A study of biofilm-based wound management in subjects with critical limb ischaemia
Authors: Wolcott R.D. , Rhoads D.D.
Published: May 2014

Objective:

Bacterial biofilms cause or complicate numerous medical conditions, including chronic wounds. Biofilm-based wound care (BBWC) management strategies that suppress biofilm have been designed and are used extensively at the Southwest Regional Wound Care Center in Lubbock, Texas and are described in this article. This retrospective single-centre study was designed to evaluate the frequency of complete healing in subjects with a chronic wound in a limb with critical limb ischaemia (CLI) when managed using BBWC.

Method:

Of the 4500 subjects admitted with wounds between August 2002 and January 2006, 1400 subjects’ TCpO2 levels were measured, and 266 included were identified as having CLI (TCpO2 <20mmHg). Of these, 190 subjects were considered in the analysis because they received a substantial course of therapy (more than five visits). Each subject was individually managed to reinforce natural healing and suppress bacterial biofilm. Successful healing was defined as complete closure by March 2007.

Results:

Of the 190 subjects with CLI, 146 (77%) healed completely, and 44 (23%) were categorised as non-healing. The healed group included 47% (68/146) with osteomyelitis and 69% (101/146) with diabetes mellitus. In the non-healed group, 75% (33/44) had osteomyelitis and 77% (34/44) had diabetes mellitus. Ninety-one per cent (30/33) of the subjects without osteomyelitis or diabetes mellitus healed, and 67% (53/79) of the subjects with both osteomyelitis and diabetes mellitus healed.

Conclusion:

When comparing the healing frequency in this study with a previously published study, BBWC strategies significantly improved healing frequency. These findings demonstrate that effectively managing the biofilm in chronic wounds is an important component of consistently transforming ‘non-healable’ wounds into healable wounds.

Declaration of interest:

Randall Wolcott has patented the combination of lactoferrin and xylitol discussed in this article.
RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation
Authors: Gollins S. , Gaffney C. , Slade S. , Swindell R.
Published: May 2014

Objective:

Radiotherapy-induced moist desquamation is a significant problem but there is a paucity of randomised data on which to base treatment decisions. The current prospective randomised trial compared gentian violet (GV) to a hydrogel dressing in this context.

Method:

Thirty patients undergoing radiotherapy to the head and neck region or breast who had developed moist desquamation in the radiotherapy field were randomised to treatment with 0.5% aqueous gentian violet (GV) (n=16) or a hydrogel dressing (n=14). The area of desquamation was regularly measured until healing or withdrawal from the study.

Results:

The likelihood of healing with the hydrogel was greater than GV with a hazard ratio for healing of 7.95 (95% CI 2.20–28.68; p=0.002). The median time to healing for hydrogel was 12 days but had not been reached for GV by 30 days. Over the first 14 days the median ‘area under curve’ of moist desquamation for GV was 82.6 cm2 (range 31.8–320.7cm2) and that for hydrogel 20.0 cm2 (range 3.8–301.0cm2) (difference significant at p=0.003). Ten of 16 patients treated with GV withdrew from the study (due to stinging in five and failure to heal in five) compared with two of the 14 treated with hydrogel (difference significant at p=0.021).

Conclusion:

Hydrogel dressings are more likely to heal radiotherapy-induced moist desquamation and are better tolerated than GV.

Declaration of interest:

None.
Circumferential application of VAC on a large degloving injury on the lower extremity
Authors: Barendse-Hofmann M.G. , van Doorn L. , Steenvoorde P.
Published: May 2014

Full healing was achieved following the circumferential application of VAC therapy to prepare a large lower-extremity wound involving both soft-tissue injury and femoral fractures for grafting. No complications were reported
Monitoring the microcirculation to evaluate dressing performance in patients with venous leg ulcers
Authors: Andriessen A. , Polignano R. , Abel M.
Published: May 2014

Objective:

To compare the effect on the microcirculation in venous leg ulcers (VLUs) of two treatment regimens that promote a moist wound environment versus paraffin gauze. The hypothesis is that moist wound dressings are more likely to stimulate the microcirculation and therefore angiogenesis.

Method:

Patients with non-healing VLUs were randomised to receive either a foam dressing (Suprasorb P), a collagen dressing (Suprasorb C) plus the foam dressing, or paraffin gauze (control). All patients wore short-stretch high compression bandages. Parameters used to measure the effects of the treatments on the microcirculation were: TcPO2 measurements, video laser Doppler measurements and the number of capillaries in the wound bed. The progression towards healing was measured by the reduction in ulcer area and formation of granulation tissue. The treatment period was four weeks.

Results:

Significant increases in TcPO2 values were reported between baseline and week 4 for patients receiving the foam dressing only or the collagen plus foam dressing combination (p<0.008 versus p<0.003 respectively). There was also a significant increase in the number of capillaries for the collagen plus foam treatment only (p<0.002).

Conclusion:

This pilot study suggests that a moist wound environment stimulates perfusion of blood and oxygen to the wound tissue, thereby promoting angiogenesis. The collagen and foam dressing combination demonstrated superior results to the control and the foam dressing only. Monitoring the microcirculation may help to assess the effect of dressings on VLU healing, although more research is needed.

Declaration of interest:

This pilot study was supported by a limited grant from Lohmann & Rauscher GmbH, Germany.
The resource impact of wounds on health-care providers in Europe
Authors: Posnett J. , Gottrup F. , Lundgren H. , Saal G.
Published: May 2014

Most of the literature focuses on the resources required to manage particular wound types, rather than the cost of wounds to health-care organisations. Until this information is available, wound care is unlikely to be a management priority
Use of platelet rich plasma and hyaluronic acid on exposed tendons of the foot and ankle
Authors: Cervelli V. , Lucarini, L. , Spallone D. , Brinci L. , de Angelis B.
Published: May 2014

Platelet rich plasma was used as an autologous scaffold for cellular growth, in combination with hyaluronic acid as a temporary dermal substitute. This aided healing of acute and chronic open wounds of the foot and ankle
Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics
Authors: Wolcott R.D. , Cox S.B. , Dowd S.E.
Published: May 2014

Objective

To compare healing outcomes at a wound healing centre both before and after the introduction of molecular pathogen diagnostics.

Method

An IT consultant was recruited to analyse the medical records of patients at a wound healing centre, comparing patient groups from 2007 and 2009 — before and after the introduction of comprehensive molecular pathogen diagnostic methods.

Results

Before the implementation of molecular diagnostics, 244/503 patients (48.5%) healed completely, while after implementation 298/479 patients (62.4%) healed. Furthermore, based on survival analysis and after controlling for potential confounding factors, time to healing was significantly shorter in 2009 than 2007 (p<0.05). Specifically, biofilm-based wound care, along with the implementation of comprehensive molecular diagnostics for venous leg ulcers, pressure ulcers and diabetic foot ulcers and all wounds combined showed, respectively, 21%, 23%, 25% and 22% reductions in the time to healing. In addition, after implementing molecular diagnostics, the use of expensive first-line antibiotics also declined in 2009, while a broader range of targeted antibiotics was used.

Conclusion

The results of modern molecular pathogen diagnostic applications allow comprehensive evaluation of the microbial bioburden in chronic wounds. This comprehensive diagnostic in turn has led to a more precise and targeted therapeutic approach to wound care. With the comprehensive nature of molecular diagnostics future advances in topical patient specific therapeutics are now possible.

Declaration of interest

SED and RDW are owners of Pathogenius diagnostics, a clinical diagnostic facility. SED is director of Research and Testing Laboratory, which develops molecular diagnostics. Analysis was performed and approved by outside consultant SBC, who indicates no conflict of interest.
A possible animal model for critical colonisation
Authors: Ueda K. , Akase T. , Nakagami G. , Nagase T. , Minematsu T. , Huang L. , Sagara H. , Ohta Y. , Sanada H.
Published: May 2014

Objective

To develop a critical colonisation model in rats that will facilitate investigation of its pathophysiology and the development of new and effective diagnosis and treatment protocols.

Method

Three groups of rats were given full-thickness dorsal wounds: a control group received phosphate-buffered saline; an experimental group was inoculated with Pseudomonas aeruginosa; an infection group with streptozotocin-induced diabetes was also inoculated with P. aeruginosa. All groups were assessed on a number of parameters at days 1, 3, 5 and 7 following wounding. Parameters included gross observations, histopathological observations, quantification of redness and swelling, serum C-reactive protein (CRP) measurement and tissue bacterial counts.

Results

Healing was delayed in the experimental group when compared with the control group, with no signs of inflammation. Although the numbers of bacteria were similar in the experimental and infection groups, polymorphonuclear neutrophil (PMN) infiltration was localised to granulation tissue in the experimental group, whereas it extended to muscular tissue in the experimental group. CRP levels remained low in the experimental group.

Conclusion

These findings suggest that the inoculation of bacteria provides a possible model of critical colonisation in rats. We believe this will contribute to a better understanding of critical colonisation.

Declaration of interest

None.
Negative pressure wound therapy as an adjunct to compression for healing chronic venous ulcers
Authors: Kieser D.C. , Roake J.A. , Hammond C. , Lewis D.R.
Published: May 2014

Objective: To determine the efficacy of negative pressure wound therapy (NPWT), when used in combination with compression bandaging, for healing chronic resistant venous ulcers. Method: In this pilot study, seven patients (with a total of 12 chronic resistant venous ulcers) received adjunctive NPWT and compression bandaging for 4 weeks. Their wounds were monitored for a total of 12 weeks. Results: Dormant ulcers were seen to rapidly develop into healthy wounds, with a granulating base. Conclusion: This regimen may have a role in stimulating chronic venous ulcers into healing wounds, or in preparing them for skin grafting.
Survey of fungi and yeast in polymicrobial infections in chronic wounds
Authors: Dowd S.E. , Delton Hanson J. , Rees E. , Wolcott R.D. , Zischau A.M. , Sun Y. , White J. , Smith D.M. , Kennedy J. , Jones C.E.
Published: May 2014

Objective: To assess the incidence, abundance and species diversity of fungi in chronic wounds, as well as to describe the associations of major fungi populations. Method: Comprehensive molecular diagnostic reports were evaluated from a total of 915 chronic wounds in a retrospective study. Results: Of the 915 clinical specimens, 208 (23%) were positive for fungal species. These samples were further compared in a compiled dataset, and sub-classified among the four major chronic wound types (decubitus ulcer, diabetic foot ulcer, non-healing surgical wound, and venous leg ulcer). The most abundant fungi were yeasts in the genus Candida; however, Curvularia, Malessezia, Aureobasidium, Cladosporium, Ulocladium, Engodontium and Trichtophyton were also found to be prevalent components of these polymicrobial infections. A notable bacterial/fungal negative correlation was found to be apparent between Staphylococcus and Candida. There were also significant relationships between both bacterial and fungal genera and patient metadata including gender, diabetes status and cardiovascular comorbidities. Conclusion: This microbial survey shows that fungi are more important wound pathogens and opportunistic pathogens than previously reported, exemplifying the impact of these under-reported pathogens. With the application of modern cost-effective and comprehensive molecular diagnostics, clinicians can now identify and address this significant component of chronic wound bioburden with targeted therapies, thereby improving healing trajectories. Conflict of interest: SED and RW are owners of Pathogenius Diagnostics which is a clinical diagnostic laboratory, SED and RW are owners of Research and Testing Laboratory which develops molecular methods for clinical diagnostics. JK and CEJ are owners of SEMT which licenses lipogels for wound care.
Modelling the cost-effectiveness of electric stimulation therapy in non-healing venous leg ulcers
Authors: Taylor R.R. , Sladkevicius E. , Guest J.F.
Published: May 2014

Objective:

To estimate the cost-effectiveness of using electric stimulation (ES) therapy (Accel-Heal) plus dressings and compression bandaging compared with dressings and compression bandaging alone in treating chronic, non-healing venous leg ulcers (VlUs) of > 6 months’ duration from the perspective of the national Health Service (NHS) in the UK.

Method:

A 5-month Markov model was constructed, depicting the management of a chronic, non-healing VlU of > 6 months’ duration. the model considers the decision by a clinician to continue with a patient's previous care plan (comprising dressings and compression bandaging) or treating with ES therapy plus dressings and compression bandaging. The model was used to estimate the relative cost-effectiveness of eS therapy at 2008–2009 prices.

Results:

According to the model, 38% of VlUs are expected to heal within 5 months after starting eS therapy, with a further 57% expected to improve. this improvement in clinical outcome is expected to lead to a 6% health gain of 0.017 QAlYs (from 0.299 to 0.316 QAlYs) over 5 months. the model also showed that using eS therapy instead of continuing with a patient's previous care plan is expected to reduce the nHS cost of managing them by 15%, from £880 to £749, due in part to a 27% reduction in the requirement for nurse visits (from mean 49.0 to 35.9 visits per patient) over the frst 5 months after the start of treatment. Hence, use of eS therapy was found to be a dominant treatment (improved outcome for less cost).

Conclusion:

Within the model's limitations, use of eS therapy potentially affords the nHS a cost-effective treatment, compared with patients remaining on their previous care plan in managing chronic, non-healing vlUs of > 6 months’ duration. However, this is dependant on the number of eS therapy units per treatment, the unit cost of the device, and the number of nurse visits required to manage patients in clinical practice.

Declaration of interest:

This study was sponsored by Synapse Microcurrent ltd., manufacturers of Accel-Heal. the authors have no other conficts of interest that are directly relevant to the content of this manuscript. In particular, Synapse Microcurrent ltd. had no role in the study design, in the collection, analysis and interpretation of data, or in writing the manuscript.
In vitro interaction of chronic wound bacteria in biofilms
Authors: Malic S. , Hill K.E. , Playle R. , Thomas D.W. , Williams D.W.
Published: May 2014

Objective:

To use in vitro biofilm models of wound bacterial isolates and compare the biofilms produced for different combinations of wound bacterial species.

Method:

In vitro biofilms, generated by Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus oralis and Micrococcus luteus in microtitre plates and a constant depth film fermentor (cDFF), were studied. The tested isolates all originated from chronic venous leg ulcers. biofilms of individual and dual combinations of these species were generated in microtitre plate wells at 37°c for 24–96 hours and also in the CDFF for 7 days. The extent of biofilm formation from these systems was then measured using crystal violet staining and/or total viable counts.

Results:

All the chronic wound bacteria formed biofilms (both individually and in mixed culture) in these models. In mixed species microtitre plate biofilms, both P. aeruginosa and S. aureus appeared to antagonise biofilm formation by S. oralis and M. luteus, with P. aeruginosa completely inhibiting the growth of these organisms. Similar effects were evident in the CDFF model, when all four bacterial species were added simultaneously, with M. luteus being ‘out-competed’ by the other organisms present and occurring at numbers at the limits of detection; however, there was an apparent increase in the numbers of S. oralis compared with its single culture equivalent.

Conclusion:

The study highlighted differences in biofilm formation ability for the tested species in both closed and open model systems. Using dual species biofilms, distinct species antagonism was observed with apparent antagonism of pathogenic species over ‘commensal’ ones. Such a finding provides insight into possible bacterial interactions during development of ‘non-healing’ wound biofilms.

Declaration of interest:

The authors have no conflict of interest to declare. There were no external sources of funding for this study.
Analgesic efficacy of an ibuprofenreleasing foam dressing compared with local best practice for painful exuding wounds
Authors: Arapoglou V. , Katsenis K. , Syrigos K.N. , Dimakakos E.P. , Zakopoulou N. , Tsoutsos D. , Gjødsbøl K. , Glynn C. , Schäfer E. , Petersen B.
Published: May 2014

Objective: To examine if wound aetiology has an effect on the pain-relieving properties of an ibuprofen-releasing foam dressing, which was previously shown to reduce pain in wounds of various aetiologies, compared with local best practice (LBP). Method: This was a secondary analysis of data from a multicentre, randomised, parallel group trial of patients with painful exuding wounds of various aetiologies. Wound aetiology was determined at enrolment. Of 853 patients enrolled into the trial, 688 belonged to a wound aetiology subgroup that included > 25 patients and were included in the analysis reported here. Patients were randomised to a dressing containing 112.5mg of ibuprofen (ibuprofen foam) or to LBP for 5 days. Patients recorded pain relief and pain intensity daily. The main endpoint was the proportion of patients who, from day 1 to day 5, reported a summed pain relief score > 50% of the total maximum pain relief score (TOTPARD5>50%) and the corresponding number needed to treat (NNT) for each wound aetiology subgroup. Further analyses included the proportion of patients who, on a daily basis, reported pain relief > 50% of the maximum daily pain relief, the proportion of patients who, on day 5, experienced a reduction in pain intensity of > 50% of the maximum score (PIDD5>50%), and if PIDD5>50% was related to baseline pain intensity. Results: Patients were categorised by the following five wound types: arterial, venous, and mixed arterial-venous leg ulcers, vasculitis and traumatic ulcers. The ibuprofen foam dressing was associated with significantly greater pain relief than LBP in all different wound aetiology subgroups, whether chronic or traumatic (acute). Overall, TOTPARD5>50% was 55% in the ibuprofen foam group and 24% in the LBP group (p < 0.0001; NNT, 3.2). The pain intensity evaluations revealed similar results in favour of ibuprofen foam compared with LBP. No correlation was observed between PIDD5>50 and initial pain intensity. Conclusion: In this study, the ibuprofen foam dressing was shown to consistently relieve wound pain in exuding wounds of various aetiologies, irrespective of basal pain intensity. The data suggest that local pain relief by an ibuprofen foam dressing is possible in the most common, painful, exuding, chronic and acute/traumatic wounds and so is a safer alternative to systemic pain treatment. Conflicts of interest: of the ten authors involved in the preparation of this manuscript, seven declare that they have no conflicts of interest. one is a member of the Wound Advisory Forum for Coloplast A/S, Denmark. Two are employees of Coloplast A/S, Denmark.
RCT to evaluate a hyaluronic acid containing gauze pad in leg ulcers of venous or mixed aetiology
Authors: Dereure O. , Mikosinki J. , Zegota Z. , Allaert F.A.
Published: May 2014

• Objective:

To investigate the efficacy and safety of an hyaluronic acid (HA)-impregnated gauze pad compared with a hydrocolloid (HC) dressing, in patients with leg ulcer of venous or mixed aetiology.

• Method:

A 56-day blind-observer, randomised, multicentre, controlled, non-inferiority trial. Patients were randomised to receive either an HA gauze pad (ialuset gauze pad) or an HC dressing (DuoDERM E). The primary endpoint was the difference between the groups regarding the percentages of patients achieving a reduction of at least 40% of the initial wound surface after 56 days of treatment (visit 5). Secondary endpoints included reduction of wound area, aspect of the wound (percentage of necrotic, fibrinous or granulation tissue), rate of complete ulcer healing, pain intensity, and clinical status of the peri-ulcerous skin.

• Results:

In total, 170 patients were included and analysed in the intention-to-treat (ITT) population; 27 patients presented at least one major protocol deviation and were excluded from the per-protocol (PP) population. Therefore, 143 patients constituted the PP population (n=72 and n=71 in the HA gauze pad group and HC dressing group, respectively). At day 56, the confidence interval of the difference between the two groups for the percentage of patients with a reduction of at least 40% of the target ulcer initial surface was [–0.128; 0.164] with a lower limit above the non-inferiority threshold (-0.15). Peri-ulcerous skin was significantly less impaired in the HA gauze pad group for oedema at day 56 (p=0.04), purpura at day 14 (p=0.009) and for maceration at day 14 (p=0.003). Other secondary endpoints were not significantly different between the two groups. Overall, both treatments were well tolerated and adverse events were comparable between the two groups regarding their pattern, frequency, likely relationship to treatment and severity which was mostly mild (grade 1) or moderate (grade 2). These results were confirmed in the overall ITT population.

• Conclusion:

These data support the non-inferiority of the HA gauze pad compared with HC for the primary endpoint. The significant differences in favour of HA gauze pad regarding peri-ulcerous skin changes (oedema, purpura and maceration) may suggest a trend for HA gauze pad to have a better acceptability than the reference HC dressing.

• Declaration of interest:

This study was sponsored by Laboratoires Genévrier. Authors received honoraria for their contributions to the study, but have no other conflicts of interests to declare.
Stress and pain associated with dressing change in patients with chronic wounds
Authors: Upton D. , Solowiej K. , Hender C. , Woo K.Y.
Published: May 2014

Objective:

To assess pain and stress experienced by patients with chronic wounds at dressing change and to examine how this may be related to long-term chronic stress.

Method:

The study recruited 43 outpatients, with a mean age of 71.7 ± 14.6 years. The sample included 18 male (42%) and 25 female (58%) patients from Wrexham and Salford (UK), all with chronic wounds that required frequent dressing changes. Physiological and psychological measurements of pain and stress, including numerical ratings (for stress and pain), heart rate, blood pressure, respiration rate, and a questionnaire survey of state and trait anxiety and of chronic stress were recorded at dressing change and in a control condition (at least 24 hours before/after dressing change during a period of rest).

Results:

Mean heart rate measurements were significantly higher at dressing change, while there was also a trend for higher numerical pain ratings, numerical stress ratings and state anxiety scores at this time. a significant, positive relationship was found between chronic stress and acute episodes of stress experienced at dressing change. Similarly, although not significant, a positive relationship was observed between chronic stress and acute pain reported at dressing change.

Conclusion:

This study provides a basis for understanding how increased acute pain and stress at dressing change may be related to chronic stress, which has been shown in the literature to contribute to delayed wound healing. The impact of these implications on cost of care and quality of life are also discussed.

Declaration of interest:

This study was commissioned by Mölnlycke Health Care ltd. none of the authors work for Mölnlycke Health Care or have any financial interests with the company. There are no additional conflicts of interest to declare.
Use of specialist knowledge and experience to manage patients with mixed aetiology leg ulcers
Authors: Neill K. , Turnbull K.
Published: May 2014

Objective:

To discuss the role of the clinical nurse specialist in managing patients with ulceration caused by mixed venous arterial disease.

Method:

A small scale retrospective audit study of eight mixed aetiology patients drawn from the caseload of leg ulcer patients within a specialist leg ulcer service in Ayrshire, Scotland was conducted by two specialist nurses with over 8 years' experience in specialist leg ulcer management. Patients were individually assessed using Doppler ultrasound and a rigorous set of validated risk factor criteria. Where Doppler ultrasound was considered to be unreliable, due to an inability to detect sounds, or where further diagnostic information was required in order to safely plan care, arterial duplex scanning was carried out by the cardiac department at Ayr Hospital. All patients were treated with a cohesive inelastic compression bandage system and closely observed by the specialist nurse.

Results:

All eight patients with mixed aetiology leg ulcers were reported to experience complete ulcer healing within 6–30 weeks after first application of the inelastic bandage system. The regimen was well tolerated by all patients and no adverse events were recorded.

Conclusion:

With accurate assessment and treatment by a specialist team, patients with mixed venous arterial disease were safely and successfully managed where they may have remained unhealed.

Declaration of interest:

This was an independent retrospective audit study conducted by two clinical nurse specialists, with educational support by Activa Healthcare to assist in bringing it to print.
Enhancing patient recovery following lower limb arthroplasty with a modern wound dressing: a prospective, comparative audit
Authors: Hopper G.P. , Deakin A.H. , Crane E.O. , Clarke J.V.
Published: May 2014

Objective:

To assess current wound care practice, implement a potentially improved regimen and re-evaluate practice.

Method:

Two prospective clinical audits were performed over a 6-month period, involving 100 patients undergoing hip or knee arthroplasty. Fifty consecutive patients with traditional dressings (Mepore; Mölnlycke) were evaluated prior to a change in practice to a modern dressing (Aquacel Surgical; ConvaTec). Fifty consecutive patients were then evaluated with the new dressing to complete the audit cycle. Clinical outcome measures were wear time, number of changes, blister rate and length of hospital stay. Statistical comparisons were performed using Mann Whitney or Fisher's exact test (statistical significance p < 0.05).

Results:

Wear time for the traditional dressing (2 days) was significantly shorter than for the modern dressing (7 days; p < 0.001), and required more changes (0 vs 3; p < 0.001). Twenty per cent of patients developed blisters with the traditional dressing compared with 4% with the modern dressing (p=0.028). Median length of stay was the same for the modern dressing (4 days) compared with the traditional dressing (4 days). In the modern dressing group, 75% of patients were discharged by day 4, whereas in the traditional group this took until day 6.

Conclusion:

This audit highlights the problems associated with traditional dressings with frequent early dressing changes, blistering and delayed discharge. These adverse outcomes can be minimised with a modern dressing specifically designed for the demands of lower limb arthroplasty. Units planning to implement enhanced recovery regimens should consider adopting this dressing to avoid compromising patient discharge.

Declaration of interest:

There were no external sources of funding for this audit; however, one author (JC) received reimbursement of expenses to attend and present work at educational conferences from ConvaTec.
The cost of pressure ulcers in the United Kingdom
Authors: Dealey C. , Posnett J. , Walker A.
Published: May 2014

Objective: To provide an estimate of the costs of treating pressure ulcers in the UK at August 2011 prices, as a means of highlighting the importance of pressure ulcer prevention. Method: Resource use was derived from a bottom-up methodology, based on the daily resources required to deliver protocols of care reflecting good clinical practice, with prices reflecting costs to the health and social care system in the UK. This approach was used to estimate treatment costs per episode of care and per patient for ulcers of different severity and level of complications. Results: The cost of treating a pressure ulcer varies from £1214 (category 1) to £14 108 (category IV). Costs increase with ulcer severity because the time to heal is longer and the incidence of complications is higher in more severe cases. Conclusion: Pressure ulcers represent a significant cost burden in the UK, both to patients and to health-care providers. Without concerted effort, this cost is likely to increase in the future as the population ages. The estimates reported here provide a basis for assessment of the cost-effectiveness of measures to reduce the incidence of hospital-acquired ulcers. Declaration of interest: Heron evidence Development ltd. was funded for this work by Mölnlycke Health Care (UK). The authors have no other conflicts of interest to declare.
An exploration of fourth-year undergraduate nurses' knowledge of and attitude towards pressure ulcer prevention
Authors: Gill E. Cullen , Moore Z.
Published: May 2014

Objective:

To determine undergraduate nurses' knowledge of and attitudes towards pressure ulcer prevention.

Method:

A quantitative, cross-sectional survey design was used for this study. Ethical approval was received. A convenience sample of fourth-year undergraduate nurses was selected to participate (n=60). Data were collected using a pre-designed questionnaire.

Results:

Overall, the participants showed a positive attitude towards pressure ulcer prevention but displayed poor knowledge of pressure ulcer prevention. Interestingly, having a high level of competency corresponded with having a positive attitude towards pressure ulcer prevention, but did not equate to possessing knowledge of pressure ulcer prevention.

Conclusion:

The findings of this study suggest that fourth-year undergraduates have a positive attitude but lack adequate knowledge on the prevention of pressure ulcers.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Orthopaedic nurses’ knowledge about pressure ulcers in Iran: a cross-sectional study
Authors: Iranmanesh S. , Tafti A Abdoli , Rafiei H. , Dehghan M. , Razban F.
Published: May 2014

Objective:

To assess nurses’ knowledge about pressure ulcers in an Iranian orthopaedic ward.

Method:

A cross-sectional, self-report questionnaire study using Pieper´s Pressure Ulcer Knowledge Test (PUKT). Orthopaedic nurses’ knowledge about pressure ulcers was examined in two teaching hospitals in Iran. The questionnaire consisted of 41 true or false assertions, categorised according to pressure ulcer classification and onset, wound characteristics and preventive measure.

Results:

Of 68 nurses, 57 participated in this study (response rate of 84%); of the respondents, 68% (n=39) were women and 32% (n=18) were men. Mean age of participants was 30.2 ± 5.1 years and mean years of experience was 6.9 ± 4.6 years. The overall rate of correct responses by nurses was 70.1%. Nurses had the highest level of knowledge in the pressure ulcer prevention category and the lowest in the pressure ulcer categorisation and onset section. No relationship was found between level of knowledge and nurses’ years of experience.

Conclusion:

Pressure ulcer prevention is one of the most important roles of nurses in an orthopaedic setting. The results of this study suggest that orthopaedic nurses in Iran were not sufficiently knowledgeable about pressure ulcers. Therefore, there is a need to improve their knowledge with some targeted, educational programmes.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I)
Authors: Moore Z. , Johanssen E. , Etten M. van
Published: May 2014

Objective: To provide a critical appraisal and synthesis of the published literature pertaining to pressure ulcer (PU) prevalence, incidence and prevention practices from the context of Scandinavia, Iceland and Ireland.

Method: An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU prevalence or incidence in adults or children, in any care setting, were included.

Results: Fifty-five papers were data extracted, quality appraised and included in the qualitative synthesis of the review. Mean prevalence in norway was 17% (4.8–29%) in Ireland was 16% (4–37%), in Denmark was 15% (2.2–35.5%) and in Sweden was 25%, (0.04–42.7%). Prevalence in Iceland was 8.9%. In acute care, mean prevalence was 21% (0–42.7%) and in long stay was 12% (2.4–23.7%). Prevalence among hospice patients was 35.7%, and in community care was 0.04% and 4%. No incidence study from Iceland was identified; the single incidence study from norway noted a figure of 16.4%. The mean incidence from Ireland was 11% (8–14.4%) from Sweden was 20% (3.1–49%) and Denmark was 1.8% (1.4–2.7%). Mean incidence in acute care setting was 17.6%, (1.4–49%); in long stay was 6.63% (3.1–8.4%). Incidence in the hospice setting was 20.4%. No study reported PU incidence figures from the community setting.

Conclusion: Figures for both prevalence and incidence were similar in Ireland and norway and highest in Sweden, whereas Denmark demonstrated the lowest incidence rates and Iceland demonstrated the lowest prevalence rates. Figures were consistently highest in acute care and hospice settings, and lowest in the care of the older person setting.

Declaration of interest: This work is partly funded by a research grant from the Norwegian College of Nursing (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.
Evaluation of a non-adherent, povidone-iodine dressing in a case series of chronic wounds
Authors: Campbell N. , Campbell D.
Published: May 2014

Here we report a product evaluation for a non-adherent, povidone–iodine (PVP–I) dressing, determining the clinical need for the product, performing a literature review, clinical evaluation and cost-analysis, and developing a recommendation. This evaluation included 20 patients who experienced dressing pain with the previous antimicrobial dressing. Two patients discontinued the evaluation and four ulcers were non-healing; the remaining wounds closed with the PVP–I dressing. Patients indicated a preference for the PVP–I dressing, primarily due to lack of dressing pain. The PVP–I dressing was also the most cost-efficient.