bluuebunny/crossref_metadata_2025 huggingface dataset:
An in-vitro model for comparing the efficiency of wound-rinsing solutions
Authors: Kaehn K.
Published: May 2014

Objective:

To develop an in-vitro model to evaluate the efficiency of wound-rinsing solutions in removing adherent, hydrophobic, denatured proteins. We hypothesised that saline solutions would be less effective than surfactant-containing solutions in removing denatured proteins.

Method:

Prepared slides containing dried blood plasma or fibrin were incubated for up to one hour in histological troughs filled with one of four test solutions: physiological saline solution, Ringer's solution, a surfactant-containing solution and an antiseptic. The concentration of dissolved proteins was measured using a modified Biuret test. Results were analysed by plotting protein concentration against the incubation time.

Results:

During the incubation period, the protein concentration increased in all of the test solutions, with the lowest concentration reported in the two saline-based solutions. These stayed clear, while the surfactant-containing solution become opaque, indicating that the surfactant had encased hydrophic substances, such as denatured proteins.

Conclusion:

Ringer's solution and saline are inappropriate solvents for adhering wound coatings. A sterile, surfactant-containing wound rinsing solution contains the essential properties for thorough and gentle cleansing of chronic wounds.

Declaration of Interest:

None.
An in vitro evaluation of the cell toxicity of honey and silver dressings
Authors: Du Toit D. F. , Page B. J.
Published: May 2014

Objective:

To establish whether honey and silver-impregnated dressings used by wound-healing practitioners are cytotoxic in vitro to human skin keratinocytes and dermal fibroblasts.

Method:

Human keratinocyte and fibroblast tissue cultures were established in vitro. Untreated cultures served as controls (group I). Small dressing implants of monofloral, medicinal honey (L-Mesitran) (group 2) and nanocrystalline silver (Acticoat) (group 3) were placed in test wells and cocultured with each of the two cell lines. Morphological changes, including cell toxicity, were assessed using inverted microscopy, trypan blue staining and the Rosdy and Clauss cell toxicity scoring system.

Results:

Untreated cultures consisting of both keratinocytes and fibroblasts (group 1) were established in 90% of all cases. In group 2, cultures with honey-impregnated implants, cell proliferation remained present at two and four months. Cell viability remained intact and cell toxicity was not evident at four months after continuous tissue culture. In group 3, marked toxicity was observed with high non-viability staining and cell-scoring counts compared with groups 1 and 2 (p<0.05). This demonstrates that the silver interfered with epidermal cell proliferation and migration, implying that it contains cytotoxic material.

Conclusion:

The honey-based product showed excellent cytocompatibility with tissue cell cultures compared with the silver dressing, which demonstrated consistent culture and cell toxicity. Further studies are needed to assess if these comparative in-vitro findings should influence a clinician's choice of wound dressing.

Declaration of interest:

None.
Salvage of Charcot foot neuropathy superimposed with osteomyelitis: a case report
Authors: Ramanujam C.L. , Zgonis T.
Published: May 2014

The risk of amputation is dramatically increased in diabetic patients with osteomyelitis of the foot complicated by Charcot neuroarthropathy. Antibioticimpregnated cement beads have been widely reported in the treatment of deep soft tissue and bone infections. This case report demonstrates that this approach can also aid the management of infected, unstable diabetic Charcot foot
Ward nurses' use of wound dressings before and after a bespoke education programme
Authors: Smith G. , Greenwood M. , Searle R.
Published: May 2014

A survey of ward nurses in medical, surgical, orthopaedic and rehabilitation specialties in relation to their care of wounds and their choice and use of wound dressings was carried out in May and August 2009 at St Mary's Hospital. Isle of Wight, UK. The objectives were to find out the distribution of wound types, and their characteristics, that were treated by ward nurses in the hospital, and to assess clinical practice in the use of wound dressings, before and after a bespoke programme of education and training. A visual framework to aid the ward nurses in the choice of dressings and frequency of change was introduced after the May 2009 survey. Following the nurses' education and training programme a repeat survey, using the same methodology, was conducted in August 2009.
Sorbion sachet S: clinical application and results
Authors: Butcher Martyn
Published: May 2014

Sorbion sachet S was designed to bestow a range of clinical advantages across a number of indications, particularly in moderately to highly exuding wounds. This paper explores the evidence
Role of oxygen in wound healing: a review of evidence
Authors: chambers A.C , leaper D.J
Published: May 2014

objective: To review the evidence regarding the infuence of oxygen as an intrinsic factor on cutaneous wound healing. Method: A literature search was performed using Ovid and the Cochrane Database with the search terms: ‘Wound healing’, ‘Oxygen’, ‘Collagen’, ‘Angiogenesis’, ‘Infammation’ and ‘Surgical Site Infection’. Human and animal studies were included if relevant and examined for methodological quality. results: There are no meta-analyses of the use of oxygen in wound healing and only two randomised controlled trials (RCTs). Studies vary in methodological quality. The majority of the data comes from animal models. In total 1568 studies on wound healing and oxygen were found. conclusion: Oxygen is vital throughout wound healing, especially in the infammatory and proliferative phases. Research suggests that patient supplementation with oxygen could enhance bacterial killing and angiogenesis, reduce surgical site infection rates and increase wound tensile strength, facilitating improved healing. confict of interest: None.
Defning a holistic pain-relieving approach to wound care via a drug free polymeric membrane dressing
Authors: Davies S.L. , White R.J.
Published: May 2014

Wound care practice continuously demonstrates that healing cannot be adequately controlled if a patient's experience of pain is not managed effectively. Current pain management guidelines do not account for the holistic treatment of pain emanating from a wound — an environment of uncontrolled or rogue inflammation, neuropathy and neuroischaemia. This article investigates how polymeric membrane dressings can interact with the pathology of wounds to correct abnormalities in pain pathways of the nervous system and dampen problematic ongoing pain to enhance the clinical picture of wound healing.
Clinical evaluation of a PHMBimpregnated biocellulose dressing on paediatric lacerations
Authors: Alblas J.G. , Andriessen A. , Klicks R.J. , Wiersema A.M. , Doorn J.van , Elzinga G. , Spits H. , Post A. , Gent M.van
Published: May 2014

Objective: To evaluate the clinical benefits, primarily tolerability and reduction in pain levels, associated with the use of a PHMB-impregnated biosynthetic cellulose dressing (Suprasorb X + PHMB) on paediatric heel lacerations. Method: These lacerations were caused when children, who were being transported on their parents’ bicycles, got their heels trapped in the wheel spokes. Where these injuries just comprised skin contusion and laceration, treatment had previously comprised cleansing followed by application of conventional dressings and moist wound healing dressings. However, the high incidence of infection necessitated regular dressing changes, which caused parents and children stress and anxiety. This clinical evaluation assessed the benefits of a new treatment protocol, where the PHMB-impregnated biocellulose dressing was applied and left in situ until epithelialisation occurred. A cork splint was used for 3 days to prevent pes equinus and to let the ankle joint rest. Change in wound size (cm2), incidence of local infection, wound bed characteristics and pain levels (measured on a 0-10 paediatric pain scale) were assessed at 3-day intervals during the 14-day treatment period. Satisfaction with the dressing was also evaluated. Results: Twenty children (mean age 5.6 years (±1.33) were recruited into the study and included in the analysis. The mean baseline wound area was 8.60cm2 (±6.57). The mean time to complete wound closure was 12.95 days (±7.69) with a mean total of 4.70 visits (±1.56). The mean VAS pain score was 9.55 (±0.69), compared with 0.15 (± 0.37) on day 14 (p<;0.003). At the second visit (after 3 days) 17 of the 20 children were reported to be free of pain. No cases of local infection were noted. Conclusion: The dressing was found to be child and parent friendly. The evaluation also showed that it was well tolerated and achieved good healing outcome. It has now been incorporated into the clinic's treatment protocol for these wounds. Conflict of interest: None. The authors have no relevant financial interest in this article. All authors were involved in the critical revision of the manuscript for important intellectual content.
Green foam, black foam or gauze for NWPT: effects on granulation tissue formation
Authors: Malmsjö M. , Ingemansson R.
Published: May 2014

Objective: To compare the effects of green foam with black foam and gauze during negative pressure wound therapy (NPWT), with regard to wound bed appearance and granulation tissue formation, and monitoring of wound exudate. Method: Wounds on the backs of eight pigs underwent 72 hours of NPWT plus either green polyurethane foam with an open pore structure, black polyurethane foam with an open pore structure or saline-moistened AMD gauze. Sections of biopsies from the wound bed, including the overlying dressing, were examined histologically with regard to microdeformation of the wound bed and granulation tissue formation. The force required to remove the wound fillers was measured. Results:Wound exudate and bleeding could be easily seen when using gauze and green foam, but were not visible under the black foam. Such visibility facilitates monitoring of the wound status. No difference was found in the quantity or characteristics of the granulation tissue formed under the green foam or black foam. Both green foam and black foam resulted in more pronounced granulation tissue formation than gauze under negative pressure. There was also more leucocyte infiltration and tissue disorganisation under green foam and black foam than under gauze. All three wound fillers created microdeformation within the wound bed surface. Similar forces were required to remove green foam and black foam (5.0 ± 0.6 N for green foam and 4.0 ± 0.4 N for black foam), while less force was needed for gauze (2.1 ± 0.2 N). This may be a result of tissue ingrowth into the foam (357 ± 12pm for green foam and 362 ± 14pm for black foam), but not into gauze (0pm), as shown by examination of biopsy sections from the wound bed. Conclusion: Green foam and black foam have similar biological effects on the wound bed. Bleeding and exudate can be more easily monitored when using green foam or gauze. Differences in the wound bed tissue morphology when using foam or gauze plus NPWT support clinical observations that granulation tissue under foam is thick but fragile, whereas that under foam is thinner but denser. Conflict of interest: The study was supported by Molnlycke Health Care AB.
Nutrition and wound healing
Authors: Sherman A.R. , Barkley M.
Published: May 2014

Continued research and development in the field of wound healing holds the potential to affect both quality of life and incidence of mortality. For the health care provider to promote successful wound healing, an understanding of the function of nutrients in inflammation and tissue growth is helpful. The intent of this paper is to discuss the metabolic and cellular pathways crucial to wound healing and identify appropriate nutritional interventions and clinical applications.
Mood disorders in patients with acute and chronic wounds: a health professional perspective
Authors: Upton D. , Hender C. , Solowiej K.
Published: May 2014

Objective:

This exploratory study surveys a group of practitioners to discover their perspectives on the prevalence of stress, anxiety and mood disorders among their patients with acute and chronic wounds.

Method:

a questionnaire survey was sent to an convenience sample of 81 health professionals. The questionnaire included items about the health professionals’ perceptions of the prevalence of mood disorders among their patients, and their perceptions of potential contributory factors and treatments.

Results:

Thirty-nine health professionals (48%), including tissue viability nurses, nurses and podiatrists, responded to the survey. The majority of respondents believed that 50–75% of their patients with chronic wound were suffering from mood problems related to their condition. Despite this, most practitioners believed that few of their patients were actually receiving treatment for these mood-related problems. one quarter of patients with acute wounds were considered to have related problems with mood. Practitioners believed anxiety and feeling helpless were the most common mood problems among their patients, while chronic pain/discomfort of the wound and inability to complete everyday tasks were potential contributory factors to these problems.

Conclusion:

The findings suggest that the health professionals who responded to the survey were aware of behavioural signs of stress, anxiety and mood problems in their patients with chronic wounds. Furthermore, the majority of practitioners did not feel that their patients were receiving help or treatment for these problems. It is therefore suggested that increased awareness of the behavioural signs of stress, anxiety and mood problems among patients with wounds could help to improve the patient's experience of wound care, as acknowledgement of mood problems could lead to the most appropriate form of treatment or help for individual patients.

Declaration of interest:

This study was commissioned by Mölnlycke Health Care. none of the authors work for Mölnlycke or have any financial interests with the company. There are no additional conflicts of interest to declare.
Symmetrical peripheral gangrene and the use of systemic hyperbaric oxygen therapy
Authors: Stewart S.
Published: May 2014

Symmetrical peripheral gangrene (SPG) is a rare but devastating condition when two or more distal sites become gangrenous, as the result of severe illness and treatment in critical care. The striking factor in SPG is that there is no occlusion of the major blood vessels to the affected limbs; the pathogenesis of the condition is not well understood and there are high reported mortality and amputation rates. Here we report the chronological progress report of a case of SPG, which affected both forefeet. This case report supports the view that early amputation should be avoided allowing for stabilisation of the gangrene so that no viable tissue is sacrificed. Further research is necessary to establish the pathogenesis and suitable treatment pathways.
The challenges of managing a complex stoma with NPWT
Authors: Valiente L. Herrero , García-Alcalá D.G. , Paz P. Serrano , Rowan S.
Published: May 2014

This paper reports the clinical experience of a 71-year-old female with resection of the colon, who subsequently developed postoperative complications. A colostomy was carried out; necrosis of the colostomy edges and stoma retraction complicated optimal stoma appliance placement. It was possible to treat the resulting cavity with negative pressure wound therapy (NPWT) by isolating the stoma and treating the peristomal wound area. The wound was treated with NPWT for 30 days; at day 20, the patient was discharged to home to continue with NPWT for a further 10 days by community nurses, with regular follow-up visits in the outpatient clinic. The patient improved steadily and achieved complete closure of the wound.
Management of diabetic foot ulcers with a TLC-NOSF wound dressing
Authors: Richard J.L. , Martini J. , Faraill M.M. Bonello , M’Bemba J. , Lepeut M. , Truchetet F. , Ehrler S. , Schuldiner S. , Sauvadet A. , Bohbot S.
Published: May 2014

Objective:

To evaluate the efficacy, tolerance and acceptability of UrgoStart Contact (Laboratoires Urgo), a new wound dressing impregnated with NOSF, as an MMP regulator in the management of neuropathic diabetic foot ulcers.

Method:

A multicentre, pilot, prospective, non-controlled open-label clinical trial. Adult patients with type 1 or 2 diabetes mellitus, who had a grade 1A (Texas classification), uninfected, neuropathic foot ulcer, 1–15cm2 in size and of 1–20 months' duration (mean 6.7±5.2 months) were included in the study. The primary endpoint was the relative reduction of the wound surface area (%) at the end of the study. Secondary endpoints included rate of complete healing, and tolerability and acceptability of the dressing. The wound dressing was changed regularly at the investigator's discretion, in accordance with the wound status and exudate level. Patients were followed up every 2 weeks for a 12-week period. At each visit, patients underwent clinical assessments, and ulcer surface area was measured by planimetry and photographs.

Results:

Thirty-four diabetic patients with a neuropathic foot ulcer were included but only 33 cases were analysed, as data were completely lost for one patient. At baseline, mean surface area was 2.7±2.4cm2. At the 12-week follow-up, the median surface area reduction was 82.7% (mean reduction 62.7±49.9%) and in 10 of the 33 analysed patients (30%) the wound was healed. Only two of the seven documented local adverse events were deemed to be dressing related. According to the nursing staff, acceptability was considered very satisfactory, particularly in term of conformability and ease of use.

Conclusion:

This pilot study indicates that use of the new UrgoStart Contact dressing, combined with offloading and debridement,may help promote the healing process of the neuropathic diabetic foot ulcers, and was well tolerated and accepted.

Declaration of interest:

This study was supported by grants from Laboratoires URGO pharmaceutical company. S. Bohbot is an employee of Laboratoires URGO; J.L. Richard has received monetary compensation as a consultant and speaker for Laboratoires URGO. Data management and statistical analysis were carried out by StatMed (Villemoirieu, France).
Thermographic findings in a case of type 2 diabetes with foot ulcer and osteomyelitis
Authors: Oe M. , Yotsu R.R. , Sanada H. , Nagase T. , Tamaki T.
Published: May 2014

Using thermography, skin temperature was evaluated in a 76-year-old patient with type II diabetes mellitus, presenting with diabetic foot ulceration on the right hallux and a corn on the left fourth toe. Increased skin temperature was observed in both the right hallux and the left fourth toe, though there were no visible clinical signs of infection. Unexpectedly, the high temperature area was seen to extend from the left fourth toe to the ankle. The patient was later diagnosed with osteomyelitis, due to the presence of a high-intensity area on T2-weighted magnetic resonance imaging, suggesting the elevated skin temperature was due to osteomyelitis. Based on these observations, thermography could prove useful for screening for foot ulcers with osteomyelitis.
Management of chronic wounds with an innovative absorbent wound dressing
Authors: Meaume S. , Perez J. , Rethore V. , Sebbane G. , Dompmartin A. , Bressieux J.M. , Leguyadec T. , Tacca O. , Bohbot S.
Published: May 2014

• Objective: To evaluate the efficacy and tolerability of an innovative absorbent wound dressing (UrgoClean; Laboratoires Urgo) in the local management of venous leg ulcers and pressure ulcers, during the sloughy stage of the healing process. • Method: A pilot, prospective, non-controlled open-label clinical trial held in 21 investigating centres. Adult patients, presenting with either a venous leg ulcer (VLU) or a category III/IV pressure ulcer (PU) with more than 50% of the surface area covered with sloughy tissue, a duration of less than 24 months, and no clinical signs of infection were included in the study. Patients were followed over a 6-week period with weekly visits, which included a physical examination, wound-area tracings and photographs by the investigating physician. Evaluations by the nursing staff and by the patients were made at each dressing change. • Results: Fifty patients with either a VLU (n=35) or a PU (n=15) were recruited. At baseline, mean wound surface area was 11.9 ± 11.3 cm2and 12.5 ± 10.7 cm2, with a mean duration of 8.3 ± 6.4 months and 2.9 ± 3.0 months in the VLU and PU groups, respectively. Wounds in both groups were covered with more than 70% sloughy tissue, and the peri-lesional skin was considered to be healthy in 19 patients. By 6 weeks, mean wound surface area reduction in the VLU and PU groups was 23.7% and 29.2%, respectively, with full healing in 6 patients. All treated wounds were considered to be debrided by week 3 (< 40% slough for all wounds) and the median relative decrease of the sloughy tissue, at week 6, in the VLU and PU groups was 75% and 89%, respectively. Dressing acceptability was documented as being very good for both patients and nursing staff, particularly conformability and ease of use, with no residue left on the wound bed at dressing removal and the dressing also remained in one piece. Seven local adverse events were deemed to be potentially related to the trial dressing. • Conclusion: The results suggest that the dressing promoted the healing process of chronic wounds, showing itself to be a credible therapeutic alternative for the sloughy stage of the wound-healing process. It also demonstrated good tolerance and acceptability. • Declaration of interest: This study was sponsored by a grant from Laboratoires Urgo pharmaceutical company. S. Bohbot and O. Tacca are employees of Laboratoires Urgo. S. Meaume has received monetary compensation as a speaker for Laboratoires Urgo. Data management and statistical analyses were conducted by Vertical (Paris, France).
An RCT to compare a bio-cellulose wound dressing with a non-adherent dressing in VLUs
Authors: Alvarez O.M. , Phillips T.J. , Menzoian J.O. , Patel M. , Andriessen A.
Published: May 2014

Objective:

To compare the efficacy of a bio-cellulose dressing (BWD) versus a non-adherent wound contact layer in venous leg ulcer (VLU) outpatients.

Method:

In a prospective, randomised, controlled multicentre study, 48 VLU patients were randomised to receive compression bandages and either standard care (non-adherent dressing; n=23) or a BWD (Suprasorb X; n=25). VLUs were evaluated for debridement efficacy, time to 75-100% granulation and ≥ 50% re-epithelialisation, reduction of ulcer size and patient-reported ulcer pain, comparing the status at day 0 and weekly, over a 12-week study treatment period.

Results:

Thirty-three patients (n=18 BWD and n=15 control dressing) were included in the analysis. Autolytic debridement was significantly faster in the BWD group, with an 84% removal of yellow tissue compared with 26% in the control group, over the 12-week period (p < 0.0001). A median of 25 days were required to achieve 75-100% granulation in the BWD group vs 36 days for controls. A median of 36 days was taken to achieve ≥ 50% re-epithelialisation in the BWD group vs 50 days for controls. Patient-reported ulcer pain reduced significantly faster in the BWD group (p < 0.05), by week 7, 100% of patients reported no pain, compared with 63% of controls.

Conclusion:

Autolytic debridement was faster and more effective in the BWD group compared with standard care, as was pain reduction. Although the time to healing was shorter with the BWD vs standard care, the difference was not statistically significant.

Declaration of interest:

This study was supported by Xylos Corporation. The study product was called X-Cell at the time, and is now available as Suprasorb X (Lohmann & Rauscher). Each principal investigator (Alvarez, Phillips, Menzoian, Etris-Brown) and respective clinical centre received funding for the conduct of the study. Each site executed a clinical study agreement independently with the sponsor. The sponsors had no role in the design and conduct of the study, in the collection, analysis, or interpretation of data, or in the preparation of the manuscript, review, or approval of the manuscript. None of the authors received administrative, technical or material support for the conduct of this study. The authors have no relevant financial interest in this article.
Meeting the challenges of wound care in Danish home care
Authors: Jørgensen S.F. , Nygaard R. , Posnett J.
Published: May 2014

Objective:

To evaluate a community-based educational intervention to improve wound-care practice, and thereby reduce the costs of care, in four communities in Denmark.

Method:

Annual wound care audits recorded patients’ ages, the number and types of wounds being treated, wound duration (days unhealed), frequency of dressing changes and nurse time per dressing change. Data were available at year 1 and year 3 post-intervention. A statistical analysis was performed, testing for changes in a range of variables between these years.

Results:

In the post-intervention period, significant reductions were found in the proportion of chronic wounds, the proportion of wounds requiring a daily dressing change, mean frequency of dressing change, mean nurse time spent in wound care per week, and the total cost of wound care per week.

Conclusion:

These results suggest that it is possible to improve wound-care practice and reduce the resource costs of wound care through a systematic programme of education and training, tailored to suit the needs of local communities.

Declaration of interest:

S.F. Jørgensen and R. Nygaard are partners of KvaliCare ApS. J. Posnett was commissioned by KvaliCare ApS to undertake the analysis of audit data.
Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab
Authors: Aerden D. , Bosmans I. , Vanmierlo B. , Spinnael J. , Keymeulen B. , Van den Brande P.
Published: May 2014

Objective:

To investigate use of the preoperative wound swab to predict graft failure compared with establishing the indication for skin grafting on clinical grounds alone.

Method:

Patients requiring meshed split-thickness skin grafting were prospectively included; the indication for grafting was established on clinical grounds exclusively. A preoperative swab of the wound bed was taken, but its result was concealed to prevent it influencing clinical decision-making. Negative pressure wound therapy (NPWT) was used for both wound bed preparation and graft fixation. After 2 months, graft area take percentage was measured using digital image processing software and the results validated against the result of the preoperative wound swab.

Results:

Eighty-seven wounds were included in the study. Mean graft area take percentage was 88%, with five grafts considered complete failures (< 25% take). A posteriori analysis of the wound cultures showed that 53% had been contaminated on grafting, but these did not fare any worse than near-sterile wounds. Qualitative analysis of cultures showed that wounds containing either Pseudomonas aeruginosa or Staphylococcus aureus did have inferior outcome (mean take percentage 78.9% vs 91.3%; p=0.038). Diabetes was also a deteriorating factor (mean take percentage 83.0% vs 90.7%; p=0.004).

Conclusion:

Establishing the indication for skin grafting on clinical grounds exclusively does not yield grossly inferior results. In light of recent advances in skin grafting, including use of NPWT as adjuvant therapy, the requirement for routine preoperative wound swabs may be questioned.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Spirituality and subjective wellbeing in patients with lower-limb ulceration
Authors: Salomé G.M. , Pereira V.R. , Ferreira L.M.
Published: May 2014

Objective:

To assess subjective wellbeing and spirituality in patients with either venous leg ulcers (VLUs) or diabetic foot ulcers (DFUs).

Method:

This was a prospective, descriptive, analytical study conducted from December 2011 to October 2012. The study was approved by the Institutional Research Ethics Committee. A convenience, non-probability sample of 80 patients with either VLUs (n=40) or DFUs (n=40) were consecutively selected from an outpatient clinic of a university hospital in the city of Pouso Alegre, Brazil. Most participants were practising Catholics. The Subjective Wellbeing Scale and Spirituality Self-Rating Scale were administered to all participants.

Results:

Thirty-two (80%) patients with foot ulcers and 22 (55%) patients with leg ulcers reported going to church sometimes or rarely. Most participants regarded religiosity and spirituality as synonymous, and living with the ulcers was seen as a punishment. The mean scores on the positive affect, negative affect, and life satisfaction components of the Subjective Wellbeing Scale were 2.48, 1.57 and 1.88, respectively, for patients with DFUs, and 2.55, 1.55 and 1.50, respectively, for patients with VLUs, with significant difference in life satisfaction between groups (p=0.003). The mean score on the Spirituality Self-Rating Scale was 11.40 for patients with VLUs and 12.85 for those with DFUs, showing that the participants had low levels of spirituality.

Conclusion:

VLUs and DFUs had a negative impact on subjective wellbeing and spirituality, but patients with DFUs showed poorer subjective wellbeing and spirituality than those with VLUs.

Declaration of interest:

The authors have no conflict of interests or competing financial interests to declare with regard to this manuscript. V.R. Pereira would like to acknowledge the scholarship from the Undergraduate Scholarship Program (PROBIC) of the Sapucaí Valley University (UNIVÁS). The scholarship sponsor had no roles in the design and conduct of the study, including collection, management, analysis and interpretation of data, preparation, review, and approval of the article.
Pressure ulcer prevalence and quality of care in stroke patients in an Indonesian hospital
Authors: Amir Y. , Halfens R. J. G. , Lohrmann C. , Schols J. M.G.A.
Published: May 2014

Objective:

To explore the quality of pressure ulcer (PU) care in stroke patients in an Indonesian stroke-specialised hospital. The prevalence, prevention, wound treatment and hospital facilities related to PU structural quality indicators at the ward and institutional levels were assessed.

Method:

A multi-level cross-sectional survey was performed over three days in an Indonesian stroke-specialised hospital. All stroke patients present on the day of the measurement were included. The European Pressure Ulcer Prevalence Study Minimum Data Set and the Dutch National Prevalence Measurement of Care Problems (Landelijke Prevalentiemeting Zorgproblemen, LPZ) questionnaire were used.

Results:

The prevalence rates of PUs, including and excluding Category I were high in this hospital (28% and 17%, respectively). More than half of the patients/families (56%) received education about PU prevention and 74% of the patients were repositioned, although irregularly, by nurses or families. No treatment was applied to Category I PUs. Category II PUs were treated by using NaCl 0.9% solution to cleanse the wound without dressings. Category III PUs were mainly treated by using anti-microbial gauze dressing. No patient suffered a Category IV PU. Only a few structural quality indicators of PU care at ward and hospital level were met.

Conclusion:

PUs were quite prevalent in these stroke patients. The quality of PU care in this hospital could be improved, especially in the areas of prevention, treatment and structural quality indicators.

Declaration of interest:

Y. Amir received a grant from the Directorate General of Higher Education, Ministry of National Education and Culture of Indonesia. The authors have no conflicts of interest to declare.
Sterile-water negative pressure instillation therapy for complex wounds and NPWT failures
Authors: Fluieraru S. , Bkara F. , Naud M. , Herlin C. , Faure C. , Trial C. , Téot L.
Published: May 2014

Objective: To investigate use of negative pressure wound therapy (NPWT) combined with instillation for patients either presenting with a complex wound or after failure of classic NPWT.

Method: A retrospective case series study conducted on patients treated using an NPWT instillation system (V.A.C. Instill; KCI Inc.) from January to December 2012. The instillation machine was used with pure saline so as not to interfere with local antibacterial solutions. Two clinical indications—patients presenting either large undermining, deep inaccessible wounds or infected wounds and those for whom conventional NPWT had proved ineffective, were analysed—with efficacy of the promotion of granulation tissue as the primary outcome. length of instillation time, the rhythm and the amount of liquid to be injected compared with the estimated volume of the cavity were also evaluated.

Results: Twenty-four patients were included in this series—12 post-NPWT failures and 12 complex wounds—with positive outcomes in 23 cases. Surgical closure was realised after promotion of granulation tissue, using either flaps or skin grafts alone, or combined with previous application of a dermal substitute. No complications linked to instillation were observed during the period of use.

Conclusion: The results of this case series suggests that use of NPWT combined with pure saline instillation could have a positive impact on the healing trajectory of patients with complex wounds or after failure of classic NPWT.

Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The prevalence of pressure ulceration among Jordanian hospitalised patients
Authors: Tubaishat A. , Aljezawi M.
Published: May 2014

Objective: To measure the prevalence rate of pressure ulcers (PUs) among hospitalised patients and to assess the adequacy of preventative care provided to patients at-risk for PUs.

Method: A cross-sectional survey was conducted by inspecting the skin of each patient included; if a PU was noted, it was classified according to the European Pressure Ulcer Advisory Panel grading system. Risk was assessed using the Braden scale and the use of preventative interventions was also documented.

Results: The sample included was 295 patients; mean age of the patients was 49.1 ± 18.6 years (range 18–87 years) and 55% (n=162) were male. The prevalence rate was 16% (8.8% excluding category I). Category I was the most common grade of PU (n=22; 46%). The heels were the most commonly affected sites (n=23; 49%). Only 19% of patients in need of prevention actually received proper adequate prevention.

Conclusion: PU prevalence rate was lower than published rates in studies that employed the same method. The young age and general health of our sample could be the best explanation. A very small percentage of at-risk patients receive adequate prevention. This should open the door to scrutinising the provision of PU prevention in Jordan.

Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Pedal osteomyelitis in patients with diabetes: a retrospective audit from Saudi Arabia
Authors: Malone M. , Gannass A. , Descallar J. , Bowling F.L. , Dickson H.G.
Published: May 2014

Objective: To examine the characteristics of patients presenting to the emergency room and the specialist diabetes foot clinic with pedal osteomyelitis (PO).

Method: A retrospective study was conducted at a regional hospital. The charts of patients with suspected PO who presented during the period 1 January to 31 December 2011 were analysed. Demographics, biochemistry and microbiological data were obtained. Bone biopsies were performed by the attending clinician either during surgical removal of infected bone, or percutaneously under guided fluoroscopy through non-infected tissue.

Results: Sixty-six cases of osteomyelitis affecting 102 joints were noted. The study population consisted of 44 men, mean age 62.9 ± 11.3 years, and 22 women, mean age of 57.6 ± 10.6 years. Gram-positive bacteria were the predominating pathogens (p<0.05). Staphylococcus aureus was cultured in 36% of all bone biopsy cases. A predictive trend in HbA1C was observed, where every increase of 1% from the recommended level of 7% was associated with a 10% increase in the likelihood of receiving surgical intervention.

Conclusion: S. aureus infection is a major cause of osteomyelitis in interphalangeal joints of the feet of diabetic patients. There is an apparent association with patients who present with diabetic foot osteomyelitis and sub-optimal glycaemic control, requiring surgical intervention.

Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Methodological recommendations for comparative research on the treatment of chronic wounds
Authors: Sonnad S.S. , Goldsack J.C. , Mohr P. , Tunis S.
Published: May 2014

• Objective: to provide specific recommendations to product developers and clinical researchers on the design of comparative effectiveness studies for the treatment of chronic wounds, specifically those pertaining to arterial and venous-disease related ulcers, diabetic foot ulcers, pressure ulcers and burn wounds.

• Method: the recommendations were developed based on a process defined by the Center for medical technology policy (CMTP). After selecting the subject area, semi-structured phone interviews were conducted by one of the authors (SSS) with representatives of payers, manufacturers, clinicians, clinician/researchers and patient advocates. next, a broad range of stakeholders participated in a meeting convened by CMTP to determine their needs. A technical working group comprising key stakeholders then participated in clarifying recommendations developed by CMTP staff and adding important considerations for their implementation. the resulting draft document was finalised based on public and solicited comment from individual manufacturers; a consortium of product developers and manufacturers; and an alliance of physicians, providers, manufacturers and patient organisations. this article is a summary of the full effectiveness guidance document.

• Results: to address the needs of patients, clinicians, guideline developers, payers and other post-regulatory decision makers, this work makes ten recommendations to guide comparative effectiveness research for chronic wound care. these recommendations fall into four categories: study design, population, comparators and outcomes.

• Conclusion: this paper suggests that using the recommendations outlined to conduct comparative effectiveness research on treatments for chronic wound therapies would facilitate trials that provide patients, clinicians, and payers with the information they need to make optimal treatment decisions. these recommendations focus on design changes that would have the largest impact in improving the usability of the results by decision makers and provide specific guidance on the design of prospective studies intended to inform decision making by patients, clinicians and payers.

• Declaration of interest: there were no external sources of funding for these recommendations. the value Institute and the Center for medical technology policy (CMTP) are both private, non-profit organisations. the authors have no financial, commercial or social conflicts of interest to declare with respect to the article or its content.
Nurses' attitudes and perceived barriers to pressure ulcer prevention in Jordan
Authors: Tubaishat A. , Aljezawi M. , Al Qadire M.
Published: May 2014

• Objective: to explore Jordanian nurses' attitudes toward pressure ulcer prevention and to identify their perceived barriers to care in pressure ulcer prevention.

• Method: A cross-sectional multi-centre study was undertaken in four hospitals in Jordan. the registered nurses and nurse assistants working at these sites were requested to complete a self-administered questionnaire.

• Results: In total, 428 completed questionnaires were returned. the participant nurses hold positive attitudes regarding pressure ulcers prevention (mean=3.91). the only factor that seems to have an effect on the positive attitude was the experience of the participants (χ 2 [2, n=227]=6.38; [=0.041). the positive attitude was enhanced with increased number of years of experience. Several barriers to good practice were reported by the participants, including: lack of staff (86.2%), time (83.6%), and patient conditions (68.6%).

• Conclusion: Findings of this study suggest that positive attitudes are not enough to change practice. Several barriers need to be resolved first if effective prevention is to be provided. this should form a reference dataset that needs to be addressed in the tissue viability field in Jordan, which is still in its infancy.

• Declaration of interest: there were no external sources of funding for this study. the authors have no conflicts of interest to declare with regard to the article or its content.
Ulcer piercing: Cleansing of complicated diabetic neuropathic foot ulcers by positive pressure irrigation
Authors: Cavallini M.
Published: May 2014

Objective:

To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing.

Method:

We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply.

Results:

Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection.

Conclusion:

Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply.

Declaration of interest:

There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.
Knowledge and practice of foot self-care among Jordanians with diabetes: An interview-based survey study
Authors: Abu-Qamar M. Z.
Published: May 2014

Objective:

To examine knowledge and practice of foot care among Jordanian patients with diabetes.

Method:

An ethically-approved Arabic language questionnaire was used to interview participants version 16). Total scores for knowledge and practice were computed, and were classified as poor (<50%), satisfactory (50–70%) or good (>70%).

Results:

Out of 1085 participants, 51.1% were males and 48.8% were females. The average age was 53.3 years (SD = 13.3 years), with over half (54.0%) were between 41–60 years of age. More than half of knowledge scores were within the range “good”, in which there was around 6% of the practice scores. Those classified as having poor knowledge amounted to 7.2%, whilst those classified as exercising poor practice amounted to 42%. Statistically significant associations were established between level of education and knowledge (p<0.00l) as well as practice (p<0.006).

Conclusion:

The study demonstrated discrepancies between knowledge and practice in relation to foot care. Efforts are required to reduce these discrepancies between knowledge and the real practice of foot self-care, taking into account the patients' levels of education and the cultural context.

Declaration of interest:

The study was funded by a grant allocated by the Abdul Hameed Shoman Fund for Supporting Scientific Research, Amman, Jordan.
Safeguarding children part 2: reporting and acting on abuse
Authors: Sibson Lynda , Brain Laura
Published: May 2014

This second of two articles, highlighting child abuse, focusing on the practical aspects of the recognition and the management of child abuse. The article outlines some of the obstacles, looking at alerting features and also some of the clinical presentations to alert health professionals to potential child abuse. The article also set out an action plan – to assist practitioners in managing this difficult aspect of clinical care. This second article also refers to looking after yourself and the role of some of the other agencies involved in child protection, including the role of child protection conferences.
The role of the paramedic in health promotion
Authors: Smart Gary
Published: May 2014

‘The role of the paramedic in health education’, is a subject area identified in the College of Paramedics Paramedic Curriculum Guidance and Competence Framework (College of Paramedics, 2007). There is no specific guidance on the content or context of this particular subject; therefore student paramedics and paramedic lecturers have interpreted this and linked it to health topics seen as relevant to young people. It is known that people can die for want of first-aid and that many people do not know how to perform first-aid. Two innovative 1-hour workshops have been designed for delivery to secondary school children in which the topic of emergency first-aid is linked with knife crime and drug and alcohol abuse. This article describes the rationale and design of the programme and reports on its initial feedback. It is a programme that shows great promise, but will require further evaluation before it can be rolled-out further.
An introduction to pharmacokinetics
Authors: Young Simon
Published: May 2014

This article illustrates the important principles of pharmacokinetics: the effect that the body has on drugs or other foreign chemicals. A basic understanding of this aspect of clinical pharmacology will assist health professionals in understanding the action of drugs they may administer, and ensure safe and effective practice.
Is prehospital thrombolysis beneficial to patients suffering acute MI?
Authors: Wood Bartholomew
Published: May 2014

Prehospital thrombolysis (PHT) plays an important role in enabling health care trusts to achieve the call-to-needle time of 60 minutes in England and Wales, but its potential value for each patient must be weighed up by the attending paramedic, taking into account local demographics, availability of alternatives such as primary coronary angioplasty (PCA) and the restrictions of the JRCALC guidelines regarding eligibility of the patient.

In light of the deteriorating effectiveness of PHT over time and its expense, in some areas money may well be better spent educating the public to call for help at an earlier stage, as well as encouraging direct admission where available to PCA by paramedics as an alternative to PHT. However, until there is an equal eligibility of patients for thrombolysis in both the prehospital and hospital settings, it is difficult for paramedics in the field to weigh up the relative effectivenes of one against the other.