bluuebunny/crossref_metadata_2025 huggingface dataset:
Composition of zircons from the Cornubian Batholith of SW England and comparison with zircons from other European Variscan rare-metal granites
Authors: Breiter Karel , Müller Axel , Shail Robin , Simons Beth
Published: December 2016

Zircon from 14 representative granite samples of the late-Variscan Cornubian Batholith in SW England was analysed for W, P, As, Nb, Ta, Si, Ti, Zr, Hf, Th, U, Y, La, Ce, Pr, Nd, Sm, Gd, Dy, Er, Yb, Al, Sc, Bi, Mn, Fe, Ca, Pb, Cu, S and F using electron probe microanalyses. Zircons from the biotite and tourmaline granites are poor in minor and trace elements, usually containing 1.0–1.5 wt.% HfO2, <0.5 wt.% UO2 and P2O5, <0.25 wt.% Y2O3, <0.2 wt.% Sc2O3 and Bi2O3 and <0.1 wt.% ThO2. Zircon from topaz granites from the St. Austell Pluton, Meldon Aplite and Megiliggar Rocks are slightly enriched in Hf (up to 4 wt.% HfO2), U (1– 3.5 wt.% UO2) and Sc (0.5–1 wt.% Sc2O3). Scarce metamictized zircon grains are somewhat enriched in Al, Ca, Fe and Mn. The decrease of the zircon Zr/Hf ratio, a reliable magma fractionation index, from 110–60 in the biotite granites to 30–10 in the most evolved topaz granites (Meldon Aplite and Megiliggar Rocks), supports a comagmatic origin of the biotite and topaz granites via long-lasting fractionation of common peraluminous crustal magma. In comparison with other European rare-metal provinces, the overall contents of trace elements in Cornubian zircons are low and the Zr/Hf and U/Th ratios show lower degrees of fractionation of the parental melt.
Splicing factor gene mutations in hematologic malignancies
Authors: Saez Borja , Walter Matthew J. , Graubert Timothy A.
Published: December 2016

Alternative splicing generates a diversity of messenger RNA (mRNA) transcripts from a single mRNA precursor and contributes to the complexity of our proteome. Splicing is perturbed by a variety of mechanisms in cancer. Recurrent mutations in splicing factors have emerged as a hallmark of several hematologic malignancies. Splicing factor mutations tend to occur in the founding clone of myeloid cancers, and these mutations have recently been identified in blood cells from normal, healthy elderly individuals with clonal hematopoiesis who are at increased risk of subsequently developing a hematopoietic malignancy, suggesting that these mutations contribute to disease initiation. Splicing factor mutations change the pattern of splicing in primary patient and mouse hematopoietic cells and alter hematopoietic differentiation and maturation in animal models. Recent developments in this field are reviewed here, with an emphasis on the clinical consequences of splicing factor mutations, mechanistic insights from animal models, and implications for development of novel therapies targeting the precursor mRNA splicing pathway.
A systematic review of randomised controlled trials examining the therapeutic effects of adult bone marrow-derived stem cells for non-ischaemic dilated cardiomyopathy
Authors: Lu Yi , Wang Yiqin , Lin Menglu , Zhou Jiale , Wang Zi , Jiang Meng , He Ben
Published: December 2016

Background

Certain early-phase clinical trials have suggested that bone marrow-derived stem cell transplantation might improve left ventricular function in patients with non-ischaemic dilated cardiomyopathy (NIDCM), whereas others trials have revealed no benefit from this approach. We sought to evaluate the therapeutic effects of bone marrow-derived stem cell therapy on NIDCM.

Methods

We searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases (through February 2016) for randomised controlled clinical trials that reported on bone marrow-derived stem cell transplantation for patients with NIDCM with a follow-up period ≥12 months. The co-primary endpoints were changes in mortality rate and left ventricular ejection fraction (LVEF); the secondary endpoints were changes in the 6-minute-walk test (6MWT) and left ventricular chamber size. Seven trials involving bone marrow-derived stem cell therapy that included 482 patients satisfied the inclusion and exclusion criteria.

Results

Subjects who received bone marrow-derived stem cell therapy exhibited a significant reduction in mortality rate (19.7% in the cell group vs. 27.1% in the control group; 95% confidence interval (CI) –0.16 to –0.00, I2 = 52%, p = 0.04). Bone marrow-derived stem cell therapy tended to produce LVEF improvement within 6 months (1.83% increase; 95% CI –0.27 to 3.94, I2 = 74%, p = 0.09) and significantly improved LVEF after mid-term (6–12 months) follow-up (3.53% increase; 95% CI 0.76 to 6.29, I2 = 88%, p = 0.01). However, this therapy produced no significant benefit in the 6MWT (p = 0.18). Finally, the transplantation of increased numbers of stem cells resulted in no observable additional benefit with respect to LVEF.

Conclusions

Bone marrow-derived stem cell therapy might have improved prognoses and appeared to provide moderate benefits in cardiac systolic function at mid-term follow-up. However, this therapy produced no observed improvement in exercise tolerance.
A nearly analytic discrete method for solving the acoustic-wave equations in the frequency domain
Authors: Lang Chao , Yang Ding-Hui
Published: December 2016

We have developed a nearly analytic discrete (NAD) method to discretize frequency-domain acoustic-wave equations with an absorbing boundary condition. We evaluate in detail the discrete process of wave equations to derive a linear system. The sparse structure and eigenproperties of its coefficient matrix (also called the impedance matrix) were analyzed to reveal the intrinsic difficulty in solving the linear system efficiently. To accelerate the forward-modeling process in the frequency domain, we introduce a class of inexact rotated block triangular preconditioners incorporated with Krylov subspace methods to solve this linear system and test their numerical behaviors by comparing with other two commonly used preconditioners. To this end, we perform wavefield simulation by the NAD method and another two conventional numerical schemes in various media. Numerical dispersion analysis and waveform comparison are also implemented for these numerical schemes. Our results show the superiority of our proposed methods.
Comparison Between Retrograde and Antegrade Peripheral Venous Cannulation in Intensive Care Unit Patients: Assessment of Thrombus Formation
Authors: Abdelaal Ahmed Mahmoud Ahmed , El-Shafei Hassan Ismail , Yassin Hany Mahmoud , Elramely Mohamed Adly , Abdelhaq Mohamed Mohamed , El Kady Hany Wafiq , Awada Wael Nabil Fahemy
Published: December 2016

BACKGROUND:

Antegrade cannulation of peripheral veins is the usual practice. Blood stasis between a catheter and the wall of the vein or at its tip in addition to catheter-induced phlebitis may initiate a thrombosis. The use of retrograde ventriculojugular shunts against the direction of the blood flow with resultant decrease in the incidence of venous thrombosis encouraged us to compare retrograde versus conventional antegrade peripheral venous cannulation.

METHODS:

Monocentric, nonblinded, prospective observational cohort of 40 intensive care unit patients receiving 2 peripheral venous catheters in upper limbs, 1 inserted in the direction of blood flow (antegrade cannula) and the other inserted in an opposite direction to blood flow (retrograde cannula). Daily ultrasound assessment of the angle between the catheter and the vascular wall was done to detect onset and progression of thrombus formation.

RESULTS:

The study included 40 patients, aged 46.7 ± 10.132 years. The incidence of thrombus formation was 100% in both techniques. The onset time of thrombus formation between the catheter and the wall of a vein was significantly longer with the retrograde catheters than with the antegrade catheters with median time (interquartile range [range]) 6 days (5–6.75 [4–8]) with 95% confidence interval (CI), 5.58–6.42 vs 3 days (3–4 [2–5]) with 95% CI (2.76–3.24), respectively, with a P value <.001. The time needed by the recently detected thrombus to reach the catheter tip determined by ultrasound with or without catheter failure was significantly longer in the retrograde catheters than in the antegrade catheter with median time (interquartile range [range]) 9 days (8–9 [7–10]) with 95% CI, 8.76–9.24 vs 4 days (4–5 [3–6]) with 95% CI, 3.76–4.24, respectively, with a P value <.001.

CONCLUSIONS:

Retrograde cannulation did not decrease the incidence of thrombus formation, but significantly increased the onset time until thrombus formation and prolonged the time needed by the newly formed thrombus to reach the catheter tip compared with conventional antegrade cannulation.
Sedation of Patients With Disorders of Consciousness During Neuroimaging: Effects on Resting State Functional Brain Connectivity
Authors: Kirsch Muriëlle , Guldenmund Pieter , Ali Bahri Mohamed , Demertzi Athena , Baquero Katherine , Heine Lizette , Charland-Verville Vanessa , Vanhaudenhuyse Audrey , Bruno Marie-Aurélie , Gosseries Olivia , Di Perri Carol , Ziegler Erik , Brichant Jean-François , Soddu Andrea , Bonhomme Vincent , Laureys Steven
Published: December 2016

BACKGROUND:

To reduce head movement during resting state functional magnetic resonance imaging, post-coma patients with disorders of consciousness (DOC) are frequently sedated with propofol. However, little is known about the effects of this sedation on the brain connectivity patterns in the damaged brain essential for differential diagnosis. In this study, we aimed to assess these effects.

METHODS:

Using resting state functional magnetic resonance imaging 3T data obtained over several years of scanning patients for diagnostic and research purposes, we employed a seed-based approach to examine resting state connectivity in higher-order (default mode, bilateral external control, and salience) and lower-order (auditory, sensorimotor, and visual) resting state networks and connectivity with the thalamus, in 20 healthy unsedated controls, 8 unsedated patients with DOC, and 8 patients with DOC sedated with propofol. The DOC groups were matched for age at onset, etiology, time spent in DOC, diagnosis, standardized behavioral assessment scores, movement intensities, and pattern of structural brain injury (as assessed with T1-based voxel-based morphometry).

RESULTS:

DOC were associated with severely impaired resting state network connectivity in all but the visual network. Thalamic connectivity to higher-order network regions was also reduced. Propofol administration to patients was associated with minor further decreases in thalamic and insular connectivity.

CONCLUSIONS:

Our findings indicate that connectivity decreases associated with propofol sedation, involving the thalamus and insula, are relatively small compared with those already caused by DOC-associated structural brain injury. Nonetheless, given the known importance of the thalamus in brain arousal, its disruption could well reflect the diminished movement obtained in these patients. However, more research is needed on this topic to fully address the research question.
Prediction of Opioid Analgesic Efficacy by Measurement of Pupillary Unrest
Authors: Neice Andrew E. , Behrends Matthias , Bokoch Michael P. , Seligman Katherine M. , Conrad Nicole M. , Larson Merlin D.
Published: December 2016

BACKGROUND:

Pupillary unrest under ambient light (PUAL) is the fluctuation in pupil diameter in time around a mean value. PUAL is augmented by light and diminished by administration of opioids. We hypothesized that, because pupillary unrest is a marker of opioid effect, low levels of PUAL may be associated with reduced opioid efficacy, as measured by changes in the numerical rating scale (NRS) pain scores of patients in the postanesthesia care unit (PACU).

METHODS:

We used an infrared pupillometer to measure PUAL in patients recovering from ambulatory surgery at 2 different institutions. At both sites, PUAL was quantified using spectral analysis of the Fourier transform of pupil diameter versus time. We measured PUAL and pain scores before and after opioid administration. Protocols for total capture time and lighting conditions varied between the 2 sites. Correlations between PUAL and change in NRS scores were examined using significance testing of Pearson correlation coefficients. Correlations between change in PUAL and change in NRS scores were also examined. Patients were divided into high and low PUAL groups, and high and low response to opioid. A Fisher exact test was used to determine whether there was a significant association between PUAL and opioid response.

RESULTS:

For patients with pain in the PACU, low levels of pupillary unrest before opioid therapy were associated with minimal or no reduction in pain scores after opioid administration. We noted a significant correlation at both sites between PUAL and pain score reduction with opioids (r = 0.59, P = .0053, and r = 0.57, P = .022.) The Fisher exact test confirmed that patients with PUAL levels above the mean had a more beneficial analgesic effect from opioids than those with low PUAL levels (P = .018). We also noted that change in PUAL was significantly correlated with change in pain score at both sites (r = 0.56, P = .03 and r = 0.55, P = .01).

CONCLUSIONS:

We observe that the pretreatment magnitude of PUAL is correlated with the analgesic response to opioid therapy, and that patients who exhibit higher levels of PUAL change after opioid administration have a more beneficial analgesic effect from opioids. Larger studies with uniform measurement protocols are required to confirm these preliminary results.
The eIF3 complex of Trypanosoma brucei: composition conservation does not imply the conservation of structural assembly and subunits function
Authors: Li Kunrao , Zhou Shuru , Guo Qixuan , Chen Xin , Lai De-hua , Lun Zhao-rong , Guo Xuemin
Published: December 2016

The multisubunit eukaryotic initiation factor 3 (eIF3) plays multiple roles in translation but is poorly understood in trypanosomes. The putative subunits eIF3a and eIF3f of Trypanosoma brucei (TbIF3a and TbIF3f) were overexpressed and purified, and 11 subunits were identified, TbIF3a through l minus j, which form a tight complex. Both TbIF3a and TbIF3f are essential for the viability of T. brucei. RNAi knockdown of either of them severely reduced total translation and the ratio of the polysome/80S peak area. TbIF3f and TbIF3a RNAi cell lines were modified to express tagged-TbIF3a and -TbIF3f, respectively. RNAi in combination with affinity purification assays indicated that both subunits are variably required for TbIF3 stability and integrity. The relative abundance of other subunits in the TbIF3f-tag complex changed little upon TbIF3a depletion; while only subunits TbIF3b, i, and e copurified comparably with TbIF3a-tag upon TbIF3f depletion. A genome-wide UV-crosslinking assay showed that several TbIF3 subunits have direct RNA-binding activity, with TbIF3c showing the strongest signal. In addition, CrPV IRES, but neither EMCV IRES nor HCV IRES, was found to mediate translation in T. brucei. These results together imply that the structure of TbIF3 and the subunits function have trypanosome-specific features, although the composition is evolutionarily conserved.
Fixing the stimulus-as-fixed-effect fallacy in task fMRI
Authors: Westfall Jacob , Nichols Thomas E. , Yarkoni Tal
Published: December 2016

Most functional magnetic resonance imaging (fMRI) experiments record the brain’s responses to samples of stimulus materials (e.g., faces or words). Yet the statistical modeling approaches used in fMRI research universally fail to model stimulus variability in a manner that affords population generalization, meaning that researchers’ conclusions technically apply only to the precise stimuli used in each study, and cannot be generalized to new stimuli. A direct consequence of this stimulus-as-fixed-effect fallacy is that the majority of published fMRI studies have likely overstated the strength of the statistical evidence they report. Here we develop a Bayesian mixed model (the random stimulus model; RSM) that addresses this problem, and apply it to a range of fMRI datasets. Results demonstrate considerable inflation (50-200% in most of the studied datasets) of test statistics obtained from standard “summary statistics”-based approaches relative to the corresponding RSM models. We demonstrate how RSMs can be used to improve parameter estimates, properly control false positive rates, and test novel research hypotheses about stimulus-level variability in human brain responses.
Increased brake qualities vehicles.
Authors: Баранов Юрий , Baranov Yuriy , Самусенко Владимир , Samusenko Vladimir , Сакович Наталия , Sakovich Nataliya , Никитин Антон , Nikitin Anton
Published: December 2016

The brake device in which high quality brake achieved through a set of moving and stationary discs interacting braking. The efficiency of the proposed braking device is exposed experimental results.
Improving the reliability and security of transport and lifting machines.
Authors: Случевский Александр , Sluchevskiy Aleksandr , Сакович Наталия , Sakovich Nataliya , Беззуб Юрий , Bezzub Yuriy
Published: December 2016

This paper studies conducted reliability and safety of hydraulic drives hydroficated machines used in road construction. Substantiated reasons sawing dump truck platform vehicles and trailers, proposed engineering solutions to address this issue.
Development of algorithms of the automated data collection and analysis system with a machine tool CNC.
Authors: Петрешин Дмитрий , Petreshin Dmitriy , Федонин Олег , Fedonin Oleg , Карпушкин Владимир , Karpushkin Vladimir
Published: December 2016

Described the use of automated systems to provide data collection and analysis with CNC machine tools. The structure of an automated system to collect and analyze data from the CNC. Describes the purpose of the constituent elements of the automated system. Considered a flowchart of the automated system for the collection and analysis of relevant data with CNC machine tools. Describes the operating modes of the system.
A carbon budget for the Amundsen Sea Polynya, Antarctica: Estimating net community production and export in a highly productive polar ecosystem
Authors: Yager PL , Sherrell RM , Stammerjohn SE , Ducklow HW , Schofield OME , Ingall ED , Wilson SE , Lowry KE , Williams CM , Riemann L , Bertilsson S , Alderkamp A-C , Dinasquet J , Logares R , Richert I , Sipler RE , Melara AJ , Mu L , Newstead RG , Post AF , Swalethorp R , van Dijken GL
Published: December 2016

Polynyas, or recurring areas of seasonally open water surrounded by sea ice, are foci for energy and material transfer between the atmosphere and the polar ocean. They are also climate sensitive, with both sea ice extent and glacial melt influencing their productivity. The Amundsen Sea Polynya (ASP) is the greenest polynya in the Southern Ocean, with summertime chlorophyll a concentrations exceeding 20 µg L−1. During the Amundsen Sea Polynya International Research Expedition (ASPIRE) in austral summer 2010–11, we aimed to determine the fate of this high algal productivity. We collected water column profiles for total dissolved inorganic carbon (DIC) and nutrients, particulate and dissolved organic matter, chlorophyll a, mesozooplankton, and microbial biomass to make a carbon budget for this ecosystem. We also measured primary and secondary production, community respiration rates, vertical particle flux and fecal pellet production and grazing. With observations arranged along a gradient of increasing integrated dissolved inorganic nitrogen drawdown (ΔDIN; 0.027–0.74 mol N m−2), changes in DIC in the upper water column (ranging from 0.2 to 4.7 mol C m−2) and gas exchange (0–1.7 mol C m−2) were combined to estimate early season net community production (sNCP; 0.2–5.9 mol C m−2) and then compared to organic matter inventories to estimate export. From a phytoplankton bloom dominated by Phaeocystis antarctica, a high fraction (up to ∼60%) of sNCP was exported to sub-euphotic depths. Microbial respiration remineralized much of this export in the mid waters. Comparisons to short-term (2–3 days) drifting traps and a year-long moored sediment trap capturing the downward flux confirmed that a relatively high fraction (3–6%) of the export from ∼100 m made it through the mid waters to depth. We discuss the climate-sensitive nature of these carbon fluxes, in light of the changing sea ice cover and melting ice sheets in the region.
Anxiety and anxiety disorders: an introduction
Authors:   Anxiety UK
Published: December 2016

In this article, charity Anxiety UK looks at anxiety and anxiety disorders, which it believes are are treatable and manageable. Anxiety is a normal part of life and can affect us in various ways, at various times, the charity says. It looks at some of the common symptoms of anxiety, which it divides into three: physical symptoms, such as increased heartrate and tightness around the chest; psychological symptoms, such as thinking you are losing control or wanting to run away or escape from the situation. The most common behavioural symptom is avoidance. Some common examples—obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and phobias—are looked at. Anxiety treatment and management is discussed.
Obtaining informed consent to treatment: new legal dimensions
Authors: Tingle John
Published: December 2016

John Tingle, Reader in Health Law at Nottingham Trent University, discusses the guidance on consent to treatment issued by the Royal College of Surgeons, which takes the implications of a landmark legal case into account
From staff nurse to nurse consultant
Authors: Fowler John
Published: December 2016

John Fowler, Independent education consultant, continues to explore the importance of leadership for clinically based nurses
Letters
Authors: J. Moffatt Christine , Franks Peter J. , Stevens Julie , Horner Joe , Thomas Steve , Keachie Julia , Vowden Kathryn
Published: December 2016

COMMUNITY CLINICS FOR LEG ULCERS

COMMUNITY CLINICS IMPROVE HEALING RATES AND QUALITY OF LIFE

ABSORBENCY OF PERFORATED FILM WOUND DRESSINGS

CORRECT TECHNIQUE FOR ABPI MEASUREMENT
High-compression bandages
Authors: Thomas S.
Published: December 2016

This report describes the results of a programme of tests carried out on a new high-compression bandage, with two application aids designed to produce specific pressures on normal-size and oedematous limbs. The product was tested to examine its performance in relation to the specified criteria of a Type 3c compression bandage and other pre-defined features. The results show that, with the use of both application aids, the bandage can provide the target pressure of 40mmHg±10% on ankles ranging from 21-26cm and 27-33cm in circumference. Ankles with circumferences between 26 and 27cm will fall marginally outside the design criteria (40±6mmHg).
The use of antiseptics in wound care: Critique III
Authors: Moore D.J.
Published: December 2016

Leaper and his colleagues were a seminal force in challenging and changing wound care practice. Three key issues emerge from their paper1, each of which warrants reconsideration today. First, the basis of their philosophy about the use of chemical agents in open wounds; second, the research evidence they used to support their case; and third, why the nursing profession reacted so positively to their message.
Managing sloughy pressure sores
Authors: Colin D. , Kurring P.A. , Quinlan D. , Yvon C.
Published: December 2016

This clinical investigation compares the performance of an amorphous hydrogel and a dextranomer paste in the management of sloughy pressure sores in the hospital environment. Specific parameters measured during the study were efficacy, safety, ease of handling and patient comfort. The clinical investigation was restricted to the debridement of sloughy non-viable tissue only. The amorphous hydrogel and dextranomer paste performed to a similar standard in terms of debridement of non-viable tissue. At day 21, however, the median reduction in wound area was 35% in the amorphous hydrogel group compared with 7% in the dextranomer paste group.
The management of extensive pressure sores
Authors: Bale S.
Published: December 2016

A case report describing the management of a patient presenting with severe skin excoriation and neglected pressure sores
Protein levels and the aetiology of pressure sores
Authors: Lewis B.
Published: December 2016

This review considers studies which have investigated the role of nutrition and, in particular, of proteins in the development and healing of pressure sores
The management of leg ulcers
Authors: Nelson E.A. , Ruckley C.V. , Dale J. , Morison M.
Published: December 2016

Two algorithms are presented as aids to diagnosis and appropriate treatment decisions for leg ulcers
Generic tools
Authors: Franks P.J.
Published: December 2016

Health is a complex concept. In 1946, the World Health Organization (WHO) defined it as ‘a state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity’1. ‘Ill’ health could thus be defined as feelings of pain and discomfort or change in usual functioning and feeling.
Using cost-effectiveness in allocating resources
Authors: Pritchard C.
Published: December 2016

A review of the use of quality-of-life measures in the assessment of the cost-effectiveness of health-care interventions
Caring for children with wounds
Authors: Bale S. , Jones V.
Published: December 2016

An update on the problems associated with managing children with wounds and their families
Trace element starvation and wound healing problems
Authors: Williams D.R.
Published: December 2016

Trace elements are essential for wound healing, and practitioners should consider whether patients need trace element supplements via either oral or topical routes
Four-layer bandaging and healing rates of venous leg ulcers
Authors: Thomson B. , Hooper P. , Powell R. , Warin A.P.
Published: December 2016

This paper reports the healing rates of venous leg ulcers in a community setting (Exeter and District Community Health Services NHS Trust) using the Charing Cross four-layer compression system.

We report on 514 venous leg ulcers and show healing rates of 40% at 12 weeks, 50% at 17 weeks, 57% at 24 weeks and 80% predicted at 2 years.

Patients were treated in one of 16 community leg ulcer clinics or in their homes. Nurses were allowed to use this system only after full training by the leg ulcer management service. Nurses had to prove their competence in leg ulcer assessment, Doppler measurement and the technique of four-layer compression.

Even in patients whose leg ulcers did not heal, it was felt that the four-layer compression system was comfortable, convenient and cost effective with only weekly changes of bandages being necessary.
Individual considerations in wound management
Authors: Hagelstein S. , Ivins N. , Morgan T.
Published: December 2016

The following two case reports describe wound management strategies used to improve the quality of patient care
Letters
Authors: Lowthian Peter , Scales John T. , Collier Mark , Farleigh Jane , Williams Clare , Thomas Steve
Published: December 2016

CONSIDERATION OF BED-BASES

PRESCRIBED GUIDE IS VALUE FOR MONEY

DURABILITY OF HYDROGELS

CHARCOAL DRESSINGS
Postoperative wound infection: Critique III
Authors: Gilchrist B.
Published: December 2016

There can be few single-centre studies that have a sample population of nearly 63 000 and few investigators who have the resilience to continue collecting data for 10 years. For these reasons alone, this work by Cruse and Foord1 demands attention; it has had considerable influence on our examination of the risk factors associated with surgical wound infections, and the way in which we have taught students about the aetiology of such infections.
The treatment of wounds of the gastrointestinal tract
Authors: Irvin T.T.
Published: December 2016

This update reviews the management of certain types of gastrointestinal wounds and the complications which may affect healing
Editorial
Authors: Caine Suzie
Published: December 2016

Wound care awards

Hand care
Managing pressure sores in palliative care
Authors: Sopata M. , Luczak J. , Glocwacka A.
Published: December 2016

This report discusses improvements in the prevention and management of pressure sores among patients with terminal illnesses
Crab collagenase in wound debridement
Authors: Glyantsev S.P. , Vishnevsky A.V. , Adamyan A.A. , Vishnevsky A.V. , Sakharov I. Yu.
Published: December 2016

A comparative study was performed of the caseinolytic, necrolytic and fibrinolytic activities of a crab collagenase product prepared from the hepatopancreas of the king crab (Paralithodes camtschatica) and four enzyme preparations (trypsin/chymotrypsin and protease complexes isolated from Aspergillus terricola, Carica papaya and pseudomonodaceae). This paper reports an in vitro investigation, an in vivo study with rats and a clinical evaluation. It was found that crab collagenase has the highest proteolytic activity measured with respect to fibrin clot and necrotic eschar in vitro although its caseinolytic activity is the lowest. A clinical trial involving 21 patients with leg ulcers confirmed the clinical efficiency of crab collagenase compared with trypsin/chymotrypsin. The results suggest that crab collagenase is useful in wound debridement.
Assessment of ischaemic feet in diabetes
Authors: Wall Barbara
Published: December 2016

Transcutaneous oximetry, laser Doppler flowmetry and ankle brachial systolic pressure indices were used to investigate blood flow to the feet in 26 subjects with diabetes mellitus and peripheral arterial disease. A total of 21 critically ischaemic feet and 15 non-critically ischaemic feet were investigated. Using laser Doppler flowmetry, non-critically ischaemic feet demonstrated a significant increase in maximum blood flow, and percentage increase in flow following local heating (p=0.038, p=0.012) in comparison with critically ischaemic feet. These statistically significant differences reflect an increased hyperaemic response in non-critically ischaemic feet.
Nutrition and age in the aetiology of pressure sores
Authors: Lewis B.
Published: December 2016

A review of studies investigating the role of nutritional status in the assessment of pressure sore risk in older people
Cellulose dressings
Authors: Lawrence J.C.
Published: December 2016

Two critiques review the classic paper cited below and discuss its influence on the development of surgical dressings
Cellulose dressings: Critique II
Authors: Thomas S.
Published: December 2016

Wood reported, possibly for the first time, that gauze applied directly to a wound surface left behind fibres that could become incorporated into granulation tissue and interfere with normal healing. Unfortunately, his paper contains several inaccuracies and unsubstantiated statements and he also appears to have been confused about the structure and composition of the products to which he refers.
Acute lymphoblastic leukaemia
Authors: Creevy J.
Published: December 2016

This study describes the management of a baby with acute lymphoblastic leukaemia, who developed a lesion in the natal cleft
The application of a cellulose-based fibre dressing in surgical wounds
Authors: Foster L. , Moore P.
Published: December 2016

In this randomised prospective parallel-group controlled study, a modern cellulose-based fibre dressing was compared with a traditional ribbon gauze and proflavine dressing, used intra- and post-operatively. The study evaluates each treatment for the reduction in pain, improvement in the quality of treatment and patient satisfaction. Forty patients, with wounds left to heal by secondary intention, were studied.

The results show several significant advantages for the cellulose-based fibre dressing. Pain levels on removal at the first dressing change were significantly reduced in the cellulose-based fibre dressing group (p = 0.002); the ribbon gauze patients routinely required analgesia before removal of the first dressing. At one week, a significantly greater number of patients in the cellulose-based fibre dressing group stated that they would be happy to have their first dressing change carried out at home without analgesia compared to the ribbon gauze group. This would enable patients to be discharged earlier and could represent a considerable financial saving to the hospital.
Letters
Authors: Bliss M.R. , Graham Allison , Davis Eleanor
Published: December 2016

SPINAL INJURY AND PRESSURE SORE PREVENTION

TREATMENT FOR OVERGRANULATION
Single-layer and multilayer bandaging in the treatment of venous leg ulcers
Authors: Stockport J.C. , Groarke L. , Ellison D.A. , McCollum C.
Published: December 2016

This study compares levels of compression achieved in the application of both multilayer compression bandage systems and single-layer bandages by practitioners who are experienced with levels achieved by those who are inexperienced. Nineteen practitioners experienced in compression bandaging (13 nurses, six doctors) and 18 inexperienced (12 nurses, six doctors) participated in the study.

Both experienced and inexperienced practitioners achieved a pressure of 40mmHg more consistently when applying multilayer compression bandage systems than in the application of single-layer bandages. Compression bandaging experience does not result in significantly better sub-bandage pressures when using a multilayer system.

Inexperienced practitioners are more likely to apply dangerously high levels of pressure with single-layer bandages than with a multilayer system. Single-layer compression bandages should be applied only by those health-care professionals with extensive experience of applying compression bandages.
Reviews
Authors: Cutting K.F.
Published: December 2016

WOUND MANAGEMENT
Tissue viability education
Authors: Gilchrist Brian , Nelson E.A.
Published: December 2016

In recent years there has been a considerable increase in the number of nurses in the UK who have adopted the title ‘tissue viability nurse’. Who are they, and what do they do?
Managing symptoms in terminal illness
Authors: Melvin H. , Ivins N.
Published: December 2016

This case report illustrates the long-term wound problems faced by many patients who are terminally ill and examines the management options available
Peripheral arterial disease 1: Functional investigations
Authors: Vowden P.
Published: December 2016

The first article of a two-part Update describing and explaining the techniques available for the correct diagnosis of arterial disease, an essential prerequisite for treatment planning
A profile of the nurse specialist in tissue viability in the UK
Authors: Flanagan M.
Published: December 2016

A postal survey was conducted to develop a profile of practising tissue viability clinical nurse specialists in the UK. The aims of the study were to establish baseline data on the role and conditions of employment and identify any discrepancies. A sample of 110 practitioners were identified, of whom 87 replied.

Prior to appointment, respondents had between 2-36 years (mean 13 years; SE 0.754) post-registration experience; the first appointment was in 1983 and there has been a steady increase; geographical distribution is uneven tending to cluster around metropolitan areas and on the south coast. The majority of practitioners are appointed in the area of general wound management; 36% have budget responsibility for tissue viability services, mostly for the provision and supply of pressure sore preventive equipment.

The appointment was a new post for 90% of respondents, highlighting the lack of available role models and the potential isolation of the position. Most practitioners are working full-time (90%) and 62% are on Grade H; 28% are graduates with a further 19% studying for a first degree; 6% already hold a master's degree while 20% are undertaking courses at this level. However, 39% have no academic qualifications and only 34% had completed ENB courses in tissue viability.
Microbiological aspects of leg ulcers
Authors: Hayes M.
Published: December 2016

In the second part of a review of leg ulcer studies, the significance of microbial colonisation is explored and suggestions are offered for the direction of future research
Pressure area care and estimating the cost of pressure sores: Critique 2
Authors: Brooks R. , Thomson J.
Published: December 2016

This study was an important landmark in pressure area management, and in bringing attention to previously largely neglected economic factors. The study states that ‘the first aim of pressure area care must be the prevention of pressure sores’.
Should iodine be reconsidered in wound management?
Authors: Gilchrist B.
Published: December 2016

A report of a consensus meeting on the use of iodine in wound care
Chronic ulceration of the leg: Critique 2
Authors: Keachie J.
Published: December 2016

The aim of the study was to identify those providing care within the Lothian and Forth Valley health districts and all patients receiving treatment for chronic leg ulceration. Questionnaires were sent to all community and hospital services. Respondents were asked to identify all patients who were then undergoing treatment for active chronic leg ulceration or who had received treatment in the previous three months. A postal survey is cheaper than using clinical examination but the results are dependent on response rates and the validity of the questionnaire. To ensure maximum response rates follow-up letters were sent out and telephone calls made to non-responders.
From the Journals
Authors: Nelson E.A. , Lewis B.K.
Published: December 2016

LOCAL COMPRESSION AND BLOOD FLOW

UNDERNUTRITION OF HOSPITAL PATIENTS
Ageing and wounds Part 1: foetal and postnatal healing
Authors: Desai H.
Published: December 2016

The first in a two-part series of reviews outlines the physiology of wound healing in the normal adult and discusses how it differs from that of the foetus
Reviews
Authors: Fletcher J. , Nelson E.A.
Published: December 2016

PRESSURE SORE PREVENTION

RESEARCH MINDEDNESS FOR PRACTICE: AN INTERACTIVE APPROACH FOR NURSING AND HEALTH CARE
Management of a fungating breast wound
Authors: Shutler S.D. , Jones M. , Thomas S.
Published: December 2016

This case report provides an outline and brief background to current treatment options and details the management of a patient with a novel hydrogel dressing
Monitoring wound healing by odour
Authors: Greenwood J.E. , Crawley B.A. , Clark S.L. , Chadwick P.R. , Ellison D.A. , Oppenheim B.A. , McCollum C.N.
Published: December 2016

A pilot study using electronic aroma detection was performed over a six-month period to assess the aroma of chronic non-healing venous leg ulcers and the effect of appropriate antibiotic therapy on modification of the aroma. Deep infection with pathogenic organisms was found on biopsy culture in 13 out of 15 patients. Odour analysis was performed at weekly intervals on the ulcer dressings using an AromaScan instrument. Data points on the aroma maps moved from their pre-treatment presentation.

Alterations in aroma data correlated well with the progress of the ulcers. Aroma analysis is shown to be a potential tool in monitoring the progress towards healing of chronic venous ulcers.
Pain in venous leg ulcers
Authors: Hofman D. , Ryan T.J. , Arnold F. , Cherry G. W. , Lindholm C. , Bjellerup M. , Glynn C.
Published: December 2016

A prospective study was conducted to assess the prevalence, severity and diagnostic utility of pain in patients with venous leg ulcers. A semi-structured questionnaire was completed by 140 consecutive patients in two specialist centres caring for patients with leg ulcers. A high proportion (64%) of the 94 patients with ulcers of purely venous aetiology reported severe pain; 50% of these patients were taking either mild analgesia or none at all. In 10 of 72 cases, leg elevation made the pain worse.

Venous ulcers are painful. Pain in three distinct locations was reported by patients - within ulcers, around ulcers and elsewhere in the leg. The presence of severe pain does not necessarily indicate arterial disease or infection. Pain is, in general, inadequately controlled in these patients.
Care of the diabetic foot
Authors: Knowles E.A. , Jackson N.J.
Published: December 2016

An update on the assessment and treatment of foot lesions in people with diabetes
Leg ulcer management in a nurse-led, hospital-based clinic
Authors: Vowden K.R. , Barker A. , Vowden P.
Published: December 2016

This paper describes the clinical outcomes from a nurse-led leg ulcer clinic over a period of three and a half years. Leg ulcers were assessed in a structured way and venous ulcers were treated with four-layer compression bandaging.

The study involved retrospective analysis of 159 patients with 180 venous leg ulcers. Overall healing rates were 64.5% at 12 weeks, 84.1% at 24 weeks and 91.4% at 36 weeks. Healing rates were not affected by a history of previous ulceration or by bilateral limb ulceration. However, healing rates varied with previous ulcer duration, ulcer size and patient mobility.
Resection and reconstruction of the chest wall
Authors: Hurren J. , Heriot A.G. , Wells F.C. , Lamberty B.G.H.
Published: December 2016

A review of the thoracic and plastic surgical techniques used in chest wall reconstruction
Knowledge base and use in the management of pressure sores
Authors: Maylor M.E.
Published: December 2016

A review of the literature on how the education of nurses might affect clinical practice
Epidermal-derived factors in the treatment of a chronic leg ulcer
Authors: Wood F. , Griffiths T.A. , Stoner M.
Published: December 2016

An illustration of the problems associated with the management of chronic wounds and a novel approach using autologous epidermal-derived factors
Managing pressure relief in a special needs nursing scheme
Authors: Knowles C.
Published: December 2016

People admitted to the Royal Devon and Exeter Hospital, who require continued longterm nursing care and fulfil at least one of seven identified criteria, can be referred to a special needs scheme for placement in a private local nursing home supported by education, free loan of electronic pressure-relieving equipment and visits to monitor progress. A clinical nurse specialist in tissue viability is also available for advice and the supply of equipment to any residents with tissue viability problems who are referred by nursing home staff.

From a total of 293 referrals during the first four years of this scheme, 155 patients have been supported in nursing homes through the scheme. At the time of placement, 71 patients (46%) had pressure sores, all of whom received the free loan of an electronic mattress. A further 21 patients, whose skin integrity was at high risk, also received mattresses. The sores ranged from Grade 2 to Grade 4 (Stirling grading scale).

During the study period, only four patients placed under the scheme suffered deterioration in their sores (all immediately prior to death). Over the three years before the scheme began, 14 patients per year were admitted from private nursing homes to an acute hospital with a primary diagnosis of pressure sore. Since the introduction of the scheme this figure has been reduced to nil.
Local injection of phentolamine to treat digital ischaemic necrosis in Raynaud's syndrome
Authors: Sylaidis P. , Logan A.
Published: December 2016

This case report demonstrates the use of phentolamine as a digital ring block in the management of a patient with Raynaud's syndrome who developed ischaemia and necrosis in the great toe
The leg ulcer resource team: a standard of care
Authors: Kane K. , Winfield S. , Prentice M. , Wilson A.
Published: December 2016

A leg ulcer resource team was formed to introduce and Implement a standard of care for patients with leg ulcers. An audit of the standard following implementation showed that 82% of ulcers had been classified correctly, diagnostic tools had been used In 78% of cases and a clear rationale for care given in 86%. However, accurate Identification of patient needs in the care plan occurred in only 39% of cases, and only 60% of care plans had ulcer size and site recorded. Patient education was also a problem - 25% of patients did not know what type of ulcer they had and only 43% could describe care of their ulcer or Identify risk factors associated with leg ulceration.
Social support for elderly patients with chronic wounds
Authors: Keeling D. , Price P. , Jones E. , Harding K.G.
Published: December 2016

Few attempts have been made to measure the social support received by elderly patients with chronic wounds. To focus research on these issues, an established model integrating the various roles played by social support in the adaptation of patients to stressful situations was applied. Two questionnaires were used to measure perceived social support and coping in a sample of patients with leg ulcers (N = 15, mean age 70.4 years) or diabetic foot ulcers (N = 15, mean age 63.6 years) at two time-points over a four-month period. The results indicate that there were no statistical differences between the groups. The overall levels of social support were low, with emotional support recorded most frequently. The standardised scores for types of coping indicate no unusual patterns, although the scores for logical analysis were low. However, there was considerable variation in the types of coping strategies used by individuals.
Pressure sore treatment
Authors: Fletcher J.
Published: December 2016

The following three papers were presented at a recent master class held in association with Smith and Nephew. The first presents a guide to the appraisal of published data focusing on risk assessment tools and grading systems. The second highlights the need for randomised controlled clinical trials to provide high-quality evidence for the use of pressure-redistributing support surfaces, while the third paper discusses the need for the development and implementation of pressure sore guidelines that have been based on high-quality evidence.
Pressure sore treatment: Evidence of effectiveness
Authors: Clark M.
Published: December 2016

The treatment of established pressure sores in the UK has markedly changed since David et al1 reviewed this area of nursing practice in 1983. For example, the use of novel wound-management products and pressure-redistributing support surfaces has been quickly established throughout the NHS.
Pressure sore treatment: Clinical guidelines
Authors: Nelson E.A.
Published: December 2016

Clinical guidelines, like any intervention, can and should be appraised systematically. Evaluation is essential since an intervention that appears as if it will improve care may not do so in practice. Furthermore, guidelines rely on a change in behaviour on the part of practitioners and failure to achieve this may undermine potential health gains. The key areas considered here are evaluation of guidelines themselves and assessment of their impact on care.
A tool for assessing perineal trauma
Authors: Steen M. , Cooper K.
Published: December 2016

The initial aim of this study was to develop a reliable visual tool to assist in the assessment of the severity of oedema and bruising in perineal trauma, using a categorical scale of ‘none’, ‘mild’, ‘moderate’ and ‘severe’. A standardised set of photographs was selected by 10 clinically experienced midwives to represent these categories. The tool was tested in a clinical trial involving 77 women, recording and monitoring changes in the level of oedema and bruising during the first 48 hours following suturing of an episiotomy. The results demonstrated a statistically significant change for both oedema and bruising. However, the less experienced assessors reported some uncertainties in assessing a small proportion of women.

A combined method, using this tool with a categorical scoring scale, was used to minimise difficulties in the assessment. Two pairs of midwives, one pair very experienced in assessing perineal trauma and the other less experienced, evaluated the combined method. The results showed a high level of agreement. The standard set of photographs and categorical scoring scale together resulted in a reliable and sensitive assessment tool to evaluate severity of perineal trauma.
An educational initiative in pressure area management for nursing home staff
Authors: Banks V.
Published: December 2016

A description of the development of a teaching package that is inexpensive, flexible and accessible to all staff, including those who work part-time and have other commitments