bluuebunny/crossref_metadata_2025 huggingface dataset:
National survey of Irish community nurses' leg ulcer management practices and knowledge
Authors: Barrett S. , Cassidy I. , Graham M. M.
Published: May 2014

This survey of found that while many aspects of Irish community nurses' leg ulcer management complied with current guidelines, there was a worrying lack of understanding about the key concepts underlying compression therapy
Modelling the relative cost-effectiveness of amelogenin in non-healing venous leg ulcers
Authors: Guest J.F. , Nagy E. , Sladkevicius E. , Vowden P. , Price P.
Published: May 2014

Objective:

To assess the cost-effectiveness of using amelogenin plus compression bandaging versus compression bandaging alone in treating non-healing venous leg ulcers (VLUs) of over six months' duration, from the perspective of the national health service in England.

Method:

A 12-month Markov model was constructed that depicted the management of a chronic, non-healing VLU of over six months' duration. The model considers the decision by a clinician to treat a recalcitrant VLU with amelogenin plus compression bandaging or compression bandaging alone, and was used to estimate the relative cost-effectiveness of amelogenin plus compression bandaging at 2006–2007 prices.

Results:

According to the model, 60% of all wounds treated with amelogenin plus compression bandaging are expected to heal within 12 months of the start of treatment compared with 41% of wounds treated with compression bandaging alone (p<0.01). Additionally, 23% of all amelogenin-treated wounds are expected to improve compared with 18% of wounds in the compression bandaging alone group. This difference in effectiveness between the two groups is expected to lead to a 7% improvement in health gain among amelogenin-treated patients when compared with those treated with compression bandaging alone (0.800 versus 0.746 QALYs; p<0.01) at 12 months after the start of treatment. Use of amelogenin is expected to lead a 10% reduction in NHS cost over 12 months from £4,261 (95% CI: £3,409; £5,114) to £3,816 (95% CI: £3,227; £4,405), due in part to a reduction in the requirement for nurse visits. Hence, amelogenin plus compression bandaging was found to be a dominant treatment. Moreover, use of amelogenin is expected to free-up NHS resources for alternative use within the system.

Conclusion:

Within the model's limitations, amelogenin plus compression bandaging is expected to afford the NHS a cost-effective dressing compared with compression bandaging alone in the management of chronic non-healing VLUs of more than six months' duration.

Declaration of interest:

This study was sponsored by Mölnlycke Heath Care. The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
An analysis of systematic reviews undertaken on standard advanced wound dressings in the last 10 years
Authors: Horkan L. , Stansfield G. , Miller M.
Published: May 2014

Many systematic reviews have found insufficient evidence to support claims that modern dressings promote healing, or that one particular modern dressing is more effective than another. This paper evaluates why this might be the case
Review of the relationship between stress and wound healing: part 1
Authors: Solowiej K. , Mason V. , Upton D.
Published: May 2014

While it has been suggested there is a link between stress and delayed wound healing, less is known about the role of pain as a contributor to stress. This paper reviews the evidence for this from studies of acute, surgical and chronic wounds
Malignant fungating wounds: managing malodour and exudate
Authors: Alexander S.
Published: May 2014

Contemporary wound management practices are not always applicable to the non-healing status of malignant wounds. Instead, care must be multidisciplinary, holistic and truly individual to the needs of each patient and their family
Prolonged healing of venous leg ulcers: the role of venous reflux, ulcer characteristics and mobility
Authors: Hjerppe A. , Saarinen J.P. , Venermo M.A. , Huhtala H.S. , Vaalasti A.
Published: May 2014

Objective

To assess whether a difference in venous reflux pattern, ulcer size or duration, regular medications or the daily use of walking aids can predict the healing of a chronic venous leg ulcer (VLU).

Method

In this prospective, randomised, single-centre study, 110 consecutive patients with chronic leg ulcers were assessed. Ninety-nine patients met the inclusion criteria and a controlled, conservative 3-month treatment period was initiated, in which 90 patients were managed with standardised local treatment combined with compression therapy. In this group, 62 VLUs healed within 12 weeks and 28 were still open after 12 weeks. The study group consisted of 22 patients with non-healed ulcers and a control group (n=28), which was selected randomly from the healers. In both groups, venous reflux profiles were assessed using colour-flow duplex imaging.

Results

The study and control groups did not differ in smoking habits, age, gender or daily oral medications. On average, the healing wounds were 5cm2 before starting controlled treatment (range 1–80cm2) and had been open for 7 months (range 2–48 months); the non-healing wounds were on average 11.2cm2 (range 1–31cm2) and had been open for 26 months (range 8–106 months). Venous disease severity scores were similar for both groups (12.6 vs. 13.4). Five patients (18%) with healed ulcers regularly used walking aids, the use of which was more frequent (36%) among non-healers (p<0.001). Venous reflux profiles differed significantly between the groups, with isolated superficial reflux noted in 64% of healers, compared with 36% of non-healers. In addition, isolated deep reflux was found in 14% of the healers, compared with 41% of non-healers (p=0.0002). The rate of popliteal reflux was significantly higher in non-healers (59% versus 21%; p=0.0004).

Conclusion

Long duration of a chronic venous ulcer may predict a poor outcome. The presence of deep venous reflux, especially in the popliteal vein, is typically found in those legs with non-healed ulcers.

Conflict of interest

None.
Heel damage and epidural analgesia: is there a connection?
Authors: Loorham-Battersby C.M. , McGuiness W.
Published: May 2014

Objective: To determine heel pressure injury prevalence in surgical patients prescribed epidural analgesia and identify intrinsic and extrinsic factors associated with heel damage in this patient cohort. Method: A descriptive study was used to investigate intrinsic and extrinsic variables associated with recorded heel observations at a private hospital in Victoria, Australia. We recruited a sample of 29 consecutive non-emergency participants undergoing general anaesthesia for major surgery, who were prescribed epidural analgesia postoperatively. A total of 58 heel observations were made. Results: Heel damage prevalence in the study sample was 13.8% (n=8). Conclusion: Intrinsic factors associated with this complication included intra- and postoperative hypotension, vascular disease, smoking, chronic obstructive pulmonary disease, and multiple disease burdens. Extrinsic factors associated with heel damage included thromboembolic deterrent stockings and the postoperative ward use of heel protectors designed for use in operating theatres. It is hoped that the study findings will assist improvements in the assessment of heel damage risk and promote the pressure prevention strategies required by this patient cohort. Conflict of interest: Four pairs of each type of heel protector were donated by the manufacturing companies. One year after the study's conclusion, financial assistance was provided by Action Products Inc. and Edwards Medical to present the research findings at the AORN conference in Denver, Colorado.
Effect of simulated leg length discrepancy on plantar pressure distribution in diabetic patients with neuropathic foot ulceration
Authors: El-nahas M.R. , Gawish H.M. , Tarshoby M.M. , State O.I. , Aboelyazid A.
Published: May 2014

Objective:

To study the effect of a minor degree of artificially induced leg length discrepancy (LLD) on plantar pressure distribution in diabetic patients with neuropathic foot ulceration.

Method:

In-shoe plantar pressure distributions were measured on the ulcerated foot during walking using F-scan (Tekscan Inc.). to simulate minor LLD, the contralateral leg length was changed by asking patients to walk under three different conditions: wearing shoe of the same sole thickness (NLLD), walking with a bare foot (20mm long leg) and wearing a 40mm-high platform-sole shoe (20mm short leg). these three different walking conditions were compared in a randomised, single-blinded crossover design.

Results:

The study included 28 diabetic patients with neuropathic foot ulcers (53.7 ± 6.8 years; 16 males, 12 female). notably, the peak pressure and pressure time integral (PTI) were the most affected parameters. PTI significantly increased beneath total foot, mid-foot, 2nd, 3rd, 4th and 5th metatarsal heads (MTHs), and 3rd toe, when the 20mm short leg was simulated (79.4 ± 21.1; 61.5 ± 32.3; 59.9 ± 36.5; 69 ± 42.1; 70.6 ± 42.3; 63.9 ± 33.7; 40.7 ± 33.2kPa·s, respectively), compared with NLLD (73.7 ± 19.9; 55.5 ± 24; 51.8 ± 30.1; 58.4 ± 37.6; 60.3 ± 39.5; 57.2 ± 32.3; 36.9 ± 33.3kPa·s, respectively).

Conclusion:

The short leg of diabetic patients with neuropathic foot ulcers will be subjected to greater pressure load, primarily beneath the total foot, mid-foot and 2nd, 3rd, 4th and 5th metatarsal heads. As such, care should be taken to avoid minor LLD, as it could inadvertently develop on using offloading devices.

Declaration of interest:

The authors have nothing to declare.
Effects of amelogenins on angiogenesis-associated processes of endothelial cells
Authors: Almqvist S. , Kleinman H.K. , Werthén M. , Thomsen P. , Ågren M.S.
Published: May 2014

Objective:

To study the effects of an amelogenin mixture on integrin-dependent adhesion, DNA synthesis and apoptosis of cultured human dermal microvascular endothelial cells and angiogenesis in an organotypic assay.

Method:

Immobilised antibodies against specific integrins (α1, α2, α3, α4, α5, αv, β1, β2, β3, β4, β6, αvβ3, αvβ5 and α5β1) were used to capture treated human dermal microvascular endothelial cells, which were detected colourimetrically. DNA synthesis of the cells was monitored by 5-bromo-2'-deoxyuridine incorporation and apoptosis by a TdT-mediated dUTP nick-end labelling technique. Tubule formation from aortic arches of 13-d-old chick embryos were followed over 48h.

Results:

The amelogenin mixture increased microvessel outgrowth by 76% (p<0.01, n=12) from the aortic explants. Also, amelogenins increased the adhesion (p<0.01, n=5) by multiple angiogenesis-associated integrin subunits and αvβ3, αvβ5 and α5β1 heterodimers on human dermal microvascular endothelial cells at a non-mitogenic concentration (100μg/ml). Conversely, amelogenins at 1,000μg/ml decreased microvessel formation possibly due to attenuation of corresponding integrins despite increasing (p<0.001, n=8) DNA synthesis. No significant apoptosis was detected in human dermal microvascular endothelial cells cultured on Matrigel with and without amelogenins.

Conclusion:

Increased surface expression of integrins on endothelial cells may contribute to the proangiogenic property of amelogenins.

Conflict of interest:

Drs. Almqvist and Werthén are employees of Mölnlycke Health Care AB. The studies were supported by the Swedish Research Council (grant K2009-52X-09495-22-3), Hjalmar Svensson Foundation, Mölnlycke Health Care AB, the VINNOVA VinnVäxt Program Biomedical Development in Western Sweden, Region Västra Götaland and the Danish Medical Research Council (22-02-0287).
Clinical efficacy of a new variant of a foam-based NWPT system
Authors: Bondokji S. , Rangaswamy M. , Reuter C. , Farajalla Y. , Mole T. , Cockwill J. , Smith J.
Published: May 2014

Objective:

To evaluate the clinical efficacy of a new variant of a foam-based negative wound pressure wound therapy (NPWT) system.

Method:

A newly available polyurethane foam-based NPWT system (RENASYS-F, Smith & Nephew) was used to treat 18 patients in a prospective, multi-centre study. The patients had a variety of wound types including pressure ulcers, diabetic foot ulcers, traumatic and surgical wounds.

Results:

The mean patient age was 48.3 years (range 25–72). Mean treatment duration was 14.6 days (range 5–29). At the end of therapy, 83% (15) wounds had progressed sufficiently, leading to a change in treatment from NPWT. Median reductions in wound area, depth and volume of 31.3%, 45.5% and 74.2% respectively were observed over the course of therapy. This equated to a weekly reduction in area, depth and volume of 12.9%, 20.0% and 32.1% respectively. Exudate level (p=0.013) and wound malodour (p=0.03) were significantly reduced between the onset and the end of NPWT. The percentage cover of ‘beefy’ red granulation tissue in the wound bed was significantly increased (p<0.001) and non-viable tissue significantly reduced (p=0.008) between the onset and the end of NPWT.

Conclusion:

These data demonstrate that an alternative foam-based NPWT system (RENASYS-F) is able to address the common treatment goals associated with application of NPWT including reduction in wound dimensions, reduction in exudate levels and an improvement in wound bed quality.

Conflict of interest:

Funding for this study was provided by Smith & Nephew. Authors TM, JC and JS are all employees of Smith & Nephew.
Mucormycosis of the anterior chest wall presenting as a soft tissue tumour
Authors: Jain S.K. , Kaza R.C.M. , Tanwar R.
Published: May 2014

Mucormycosis is a fungal infection caused by order Mucorales in humans. It commonly affects immunocompromised individuals, usually following trauma, and is associated with high rates of mortality despite the use of modern antifungal therapy and debridement. This report describes a case of the mucormycosis that presented as a non-healing ulcer over the chest wall (an extremely rare site for this lesion) which appeared to be a soft tissue tumour. The patient was immunocompetent and had no history of trauma. Repeated biopsies suggested there were only inflammatory changes but a fungal culture confirmed Rhizopus microsporus. The ulcer was managed successfully with high doses of intravenous Amphotericin B and aggressive surgical debridement.
Inception and validation of a pressure ulcer risk scale in oncology
Authors: Fromantin I. , Falcou M.C. , Baffie A. , Petot C. , Mazerat R. , Jaouen C. , Téot L. , de Rycke Y.
Published: May 2014

Objective: To create and validate a specific tool to evaluate the pressure ulcer risk in cancer patients. Method: The Pressure Ulcer Scale in Oncology (PUSO) was developed and subsequently validated against the Norton and Braden scales in order to efficiently and reliably evaluate the pressure ulcer risk in adult cancer patients, with various sites and stages of the illness (both curative and palliative phases). Two series of prevalence surveys (three surveys over two days, at two-month intervals) were conducted in one and then two French Cancer Centres in 2002 and 2009, respectively. The surveys investigated a total of 933 patients. Results: Multivariate logistic regression analysis identified three key items as being predictive of the development of pressure ulcers in cancer patients (mobility, incontinence and moisture/shearing), all with similar odds ratio weighting. A score was defined using this logistic model, the PUSO score (0-3) = bedridden/chair-ridden + incontinence + moisture/shearing. Conclusion: The extreme simplicity of this scale may appear disconcerting, but the PUSO is a simple, reliable and validated tool, which allows standardised evaluation of each patient's risk and, thereby, rapid introduction of appropriate measures. Conflicts of interest: None
Necrosis in breast cancer patients with skin metastases receiving bevacizumab-based therapy
Authors: Cottu P.H. , Fourchotte V. , Vincent-Salomon A. , Kriegel I. , Fromantin I.
Published: May 2014

Objective:

Bevacizumab has entered daily practice in advanced breast cancer patients, in whom skin metastases occurrence is a common event. Wound healing impairment has been described with bevacizumab, and this study looks at possible deleterious side effects of bevacizumab in patients with skin metastases.

Method:

We retrospectively reviewed a series of 12 patients with advanced breast cancer presenting extensive skin metastases, and who received bevacizumab based therapy.

Results:

Nine patients who initially presented with erosive skin lesions developed extensive and durable skin necrosis, as well as delayed healing of surgical flaps, despite early discontinuation of bevacizumab therapy and intensive skin care in a specialised unit. Skin necrosis was usually associated with extensive tumoural involvement of the skin.

Conclusion:

Bevacizumab may be harmful in selected breast cancer patients with metastatic cutaneous involvement.

Conflict of interest:

None.
Introducing a new paradigm for bioburden management
Authors: Butcher Martyn
Published: May 2014

The prevention and management of infection relies largely on the use of topical antimicrobial dressings. These treatments achieve their effects by killing bacteria, but this results in the presence of bacterial cell debris in the wound and the release of endotoxins, which may prolong inflammation. An alternative approach, where bacteria and fungi bind irreversibly to the wound dressing as a result of a hydrophobic interaction and are then removed at dressing change, avoids the risk of prolonged inflammation and the potential for resistance. A further benefit is that there is no risk of toxicity to healthy tissue or systemic absorption
Optimum microcurrent stimulation intensity for galvanotaxis in human fibroblasts
Authors: Sugimoto M. , Maeshige N. , Honda H. , Yoshikawa Y. , Uemura M. , Yamamoto M. , Terashi H.
Published: May 2014

Objective:

In this study, we develop methods to measure galvanotaxis of fibroblasts and determined the optimum conditions of electrical stimulation.

Method:

an inverted 35mm dish containing cell suspensions (3×10 5 primary human skin fibroblasts, DMEM, and 10% FBS) was placed on the centre of a 100mm dish. The 35mm dish was removed 24 hours later, and culture medium was added to the 100mm dish. Fibroblasts were randomised (double-blind) into three groups, where electrical stimulation was given at varying intensities: 0μa (control), 50μa, and 100μa. Electrical stimulation (frequency = 0.3Hz) was conducted, for a duration of 4 hours, with platinum electrodes in a Co2 incubator. We took pictures immediately before and 20 hours after stimulation. We calculated the migration ratio to the negative pole by dividing the area of attached fibroblasts after stimulation with that before stimulation.

Results:

The migration ratio to the negative pole was significantly higher in the 100μa group than in the control group (p < 0.05). The ratios were 0.902 ± 0.292 in the control group, 1.128 ± 0.253 in the 50μA group, and 1.245 ± 0.300 in the 100μA group.

Conclusion:

This study observed the change in cell proliferation during the initial 24-hour period after plating and was thus able to quantitatively evaluate the migration. The results suggest that a low-intensity direct current promotes migration to the negative pole of human dermal fibroblasts, which is charged with positive electricity. Several clinical reports using the methods in this study showed the microcurrent efficacy for pressure ulcer healing. Electrical stimulation based on our in vitro experiment might be important for the development of physical therapy for pressure ulcers.

Declaration of interest:

The authors have no conflict of interest to declare. There were no external sources of funding for this study.
Yakult: a role in combating multi-drug resistant Pseudomonas aeruginosa?
Authors: Thomson C.H. , Hassan I. , Dunn K.
Published: May 2014

Presence of extremely drug resistant metallo-β-lactamase (MBL VIM) Pseudomonas aeruginosa in a patient presenting with 54% deep-dermal and full-thickness flame burns to her neck, chest, upper abdomen and upper limbs, appeared to coincide with wound breakdown and non-healing. This organism was also seen to colonise the patient's gastrointestinal tract, which was thought to act as a reservoir for re-infection of her wounds. Oral treatment with a probiotic drink (Yakult yoghurt) was commenced in order to alter gut flora. Two weeks after this regimen began, P. aeruginosa grown from wound swabs was seen to change from multi-drug resistant to multi-drug sensitive strains. This change persisted through to patient discharge home from hospital. The temporal relationship seen between commencement of once-daily probiotic and change of the organism from multi-drug resistant to multi-drug sensitive suggests that this may have been an effective intervention.
Amniotic membrane reduces wound size in early stages of the healing process
Authors: Nordback P.H. , Miettinen S. , Kääriäinen M. , Pelto-Huikko M. , Kuokkanen H. , Suuronen R.
Published: May 2014

Objective:

To investigate the effects of dispase de-epithelialised, glycerol cryopreserved amniotic membrane (AM) on full-thickness skin defects, using a rat model.

Method:

Skin defects of 15mm diameter were surgically created and measured on the scalps of 53 male rats. Animals were divided into two groups and followed for 0, 3, 7, 14 or 21 days. AM group wounds were covered with de-epithelialised AM and sodium chloride-moistened Aquacel (ConvaTec Inc.); control group wounds were covered with sodium chloride-moistened Aquacel alone. After the follow-up, wounds were measured again, serum samples were taken and wound sites were harvested for histological analysis. Systemic interleukin-4 (IL-4) levels were analysed from serum.

Results:

On day 3, a statistically significant difference (p < 0.01) was observed in mean wound size, with wound size in the AM group smaller than in the control group (60 ± 12% vs 81 ± 13% of the original size); other time points showed no significance difference in wound size between the two groups. We could not detect differences between the groups in histological parameters or serum IL-4 levels.

Conclusion:

According to this study, AM enhances early stage wound healing in terms of wound size but its effect decreases in later phases. The IL-4 results provide no clear evidence that IL-4 contributes to the effect of AM on wound healing.

Declaration of interest:

This study was financially supported by the Competitive Research Funding of the Tampere University Hospital (Grant 9H041, 9J047). The authors have no additional conflicts of interest to declare.
Pressure ulcers in cervical spine immobilisation: a retrospective analysis
Authors: Walker J.
Published: May 2014

• Objective: To determine the incidence of pressure ulceration in patients treated with cervical spine immobilisation. • Method: A retrospective case note analysis was conducted of all patients presenting with cervical spine injuries, who were treated with cervical spine immobilisation. • Results: Ninety consecutive patients were analysed retrospectively. Multiple level injuries were the most common reported injury and mean time until definitive treatment was 7.4 days. Halo immobilisation was used most frequently, with the mean time in halo vest immobilisation being 74 days. One patient was reported to have a pressure ulcer to the scapula relating to the use of halo immobilisation. No pressure ulcers were reported in patients immobilised with the use of cervical collar or occipito-cervico-thoracic immobilisation devices. • Conclusion: Patients with cervical spine immobilisation have an increased risk of developing pressure ulcers. All patients with cervical immobilisation devices require close monitoring to monitor the risk of developing pressure ulcers as well as the overall management of the medical condition. • Declaration of interest: There were not external sources of funding for this study. The author has no conflicts of interest to declare.
Taking the trauma out of wound care: the importance of undisturbed healing
Authors: Rippon M. , Davies P. , White R.
Published: May 2014

Significant advances in wound dressing technology have resulted in a myriad of dressing choices for wound-care clinicians, providing more than just an inert wound cover. The establishment of a moist wound environment under modern wound dressings and the optimisation of the healing response are now the goals expected of these dressings. However, the use of wound dressings, particularly traditional dressings such as gauze, frequently results in wound and peri-wound tissue damage that impairs the wound healing response, counteracting any of the dressings' healing benefits. Therefore, in order to maximise the healing benefits wounds covered by today's wound dressings must minimise tissue disturbance (physical as well as chemical). This review aims to consider the ways traditional, as well as modern, wound dressings may disturb wounds, summarising the potential areas of wound disturbance, and suggesting how best to address this aspect of the use of wound dressings to treat acute as well as chronic wounds.
An experimental study of prescribed walking in the management of venous leg ulcers
Authors: Meagher H. , Ryan D. , Clarke-Moloney M. , O'Laighin G. , Grace P.A.
Published: May 2014

Objective:

To determine the relationship between the level of patient activity in the form of walking and the rate of venous leg ulcer (VLU) healing.

Method:

Forty patients with newly diagnosed VLUs were recruited to the study and randomly allocated to either control or exercise groups. All patients were treated with multilayer compression bandaging for 12 weeks, or until their ulcer had fully healed. Daily stepping rate was recorded at initial assessment and following 4 weeks of treatment. Participants in the exercise group were encouraged to increase their daily steps with a target of 10 000 steps per day. The control group were not asked to change their daily steps.

Results:

In total, 33% of the exercise group achieved an average of 10 000 steps per day. Participants who took more steps at both the baseline and 4-week assessment healed more quickly than those who took fewer steps (p=0.052 and p=0.008 for baseline and week 4, respectively). Sixty-seven per cent of the participants who increased their daily steps had venous ulcers, which were healed by week 8, compared with 35% of those who did not.

Conclusion:

Participants who took more steps per day showed faster venous ulcer healing times when compared with those who took fewer steps, emphasising the benefit of walking in this patient group. Further studies are necessary to confirm these early findings.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflict of interest to declare.
Hemisoleus muscle flap in the reconstruction of exposed bones in the lower limb
Authors: Ahmad I. , Akhtar S. , Rashidi E. , Khurram M. F.
Published: May 2014

Objectives:

To evaluate the efficacy of soleus muscle flap for covering complex defects of the middle and lower leg. The study also outlines functional gain after the reconstructive procedure, the donor site morbidity and the technical details of the operative procedure.

Method:

This prospective study consists of a total of 40 patients with middle and lower third defects with exposed bone present in the leg. In all cases, a proximally-based hemisoleus flap was used. All patients were between 15–65 years of age. Depending upon the position of the defect and ease of rotation, either the medial or lateral hemisoleus was used to cover the defects. In 7 patients with large defects, both the hemi-gastrocnemius and hemisoleus flap were used.

Results:

Most of the patients studied (52.5%) had defects in the middle third of their leg. A further 12(30%) patients had defects over the upper part of the lower third of the leg and 7(17.5%) cases involved large defects exposing bones comprising both the middle and lower thirds of the leg. All the flaps survived well except 5 which developed partial skin graft loss, and 1 where complete flap loss was observed. Out of 5 patients who developed partial graft loss, 3 patients achieved complete healing by regular dressings and 2 required regrafting. The patient who developed complete flap loss required below knee amputation. No donor site morbidity was observed, except minimal depression in the posterior leg.

Conclusion:

Due to a high degree of reliability, versatility, minimal donor site morbidity, less operating time, low cost and good functional gain, this procedure is highly suitable for the treatment of complex middle and lower leg defects.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Development of an algorithm as an implementation model for a wound management formulary across a UK health economy
Authors: Stephen-Haynes J.
Published: May 2014

This article outlines a strategic process for the evaluation of wound management products and the development of an algorithm as an implementation model for wound management. Wound management is an increasingly complex process given the variety of interactive dressings and other devices available. This article discusses the procurement process, access to wound management dressings and the use of wound management formularies within the UK. We conclude that the current commissioners of tissue viability within healthcare organisations need to adopt a proactive approach to ensure appropriate formulary evaluation and product selection, in order to achieve the most beneficial clinical and financial outcomes.
Pantoea agglomerans as an indicator of a foreign body of plant origin in cases of wound infection
Authors: Vaiman M. , Abuita R. , Lazarovich T. , Lotan G.
Published: May 2014

Objective:

To investigate the role of Pantoea agglomerans as an infectious agent that causes infection in a wound even after the wound was managed at the emergency department.

Method:

A retrospective cohort study, reviewing the medical records of patients with traumatic wounds that were admitted to the emergency department from 2007–2012 and had signs of wound infection for more than 10 days after the wound was managed. Bacteriological results, clinical picture, and treatment results were obtained.

Results:

Nine cases were identified. Pantoea agglomerans was detected in all cases. After 1–2 months of ineffective treatment, patients were hospitalised and surgical revisions of the wounds were performed. In all cases, small foreign bodies of plant origin were detected. After surgical revision, wounds were healed in 2–3 days.

Conclusion:

In cases of prolonged healing of post-traumatic wounds, the presence of foreign bodies of plant origin infected with Pantoea agglomerans should be taken into account. Removal of such foreign bodies leads to rapid healing of the wounds.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Patients' experiences of NPWT in an outpatient setting in Denmark
Authors: Ottosen B. , Pedersen B.D.
Published: May 2014

Objective:

To study patients' experiences of negative pressure wound therapy (NPWT) used for wounds of various aetiologies in the outpatient setting and the influences on daily life.

Method:

In this qualitative study, a phenomenological-hermeneutic approach was used. Ten patients underwent qualitative interviews regarding their NPWT treatment. The French philosopher, Ricoeur's, theory of interpretation guided the data analysis, which included three levels: naïve reading, structural analysis and critical interpretation and discussion.

Results:

The patients experienced a high level of dependency on the equipment and a greater confidence as treatment proceeded. There is a link between treatment and tolerance. Duration of treatment influenced the patients' ability to cope with it and the patients gradually developed an acceptance of the technology. The support of relatives was important, particularly after delivery of a baby and wound treatment following caesarean section. Some patients were embarrassed due to the appearance and smell of the exudate.

Conclusion:

Use of NPWT clearly influences patients' daily life. Patients have a feeling of being dependent on and attached to the equipment, and they experienced embarrassment about odour, anxiety and uneasiness in relation to complications, a need for relatives' support and other social-relation issues. It was important to include relatives as a resource and make use of the opportunity they presented to assist patients during information sessions about treatment.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to report.
Do ready-made compression stockings fit the anatomy of the venous leg ulcer patient?
Authors: Nørregaard S. , Bermark S. , Gottrup F.
Published: May 2014

Objective:

How usable two standardised measuring methods are for the selection of three different brands of ready-made below-knee compression stockings. Furthermore, this study aims to determine how many of the included patients fit into a ready-made compression stocking in a limited selection of brands.

Method:

Consecutive patients suffering from venous insufficiency and treated at a specialised wound healing centre were included in this prospective comparative study. Two standardised measuring methods were used to evaluate the suitability of three different brands of ready-made below knee compression stockings. The circumference was measured at three points and seven points below the knee. The results of these measurements were compared to three selected brands of ready-made compression stockings.

Results:

Together, 43 consecutive patients (25 men and 18 women) were included in the study. When the leg was measured at three points, 53.5%, 34.9% and 0% of the patients fitted into brand 1, brand 2 and brand 3 of the ready-made compression stockings, respectively. When measured at seven points, only 4.7% of the patients fitted into brand 1, 7% in brand 2 and 0% of the patients fitted into brand 3.

Conclusion:

These results demonstrate that there is a need to standardise measuring methods in the selection of ready-made below-knee compression stockings and a need for an evaluation of the present stocking sizes in relation to the anatomy of the venous leg ulcer patient. This study has shown that ready-made compression stockings presently prescribed will not properly fit the majority of patients to prevent oedema and ulcer recurrence. Further studies focused on the development of new sizes or changes in fitting recommendations may help solve these problems.

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 manuscript or its content.
Aqueous oxygen peroxide treatment of VLUs in a primary care-based randomised, double-blind, placebo-controlled trial
Authors: O'Halloran P.D. , Winter P.K. , Otter J.A. , Adams N.M.T. , Chewins J.
Published: May 2014

Objective:

To evaluate a novel aqueous oxygen peroxide (AOP) wound therapy (BioxyQuell) in a multi-centre, primary care-based, randomised, double-blind, placebo-controlled, parallel-group trial, monitoring long-term healing outcomes over 12 months.

Method:

Sixty-one patients with chronic, stable venous leg ulceration were treated with either AOP solution or sterile water placebo applied as a lavage over 2 weeks. The patients’ wounds were dressed weekly and assessed fortnightly over the following 6 weeks. Patients who completed the initial 8-week trial were invited into a 10-month follow-up trial. The primary endpoints of the study were wound healing at 8 weeks, 12 weeks, 6 months and 12 months, and wound size reduction during the treatment phase. Secondary endpoints were reductions in wound bioburden and pain.

Results:

Patients treated with AOP were more likely to heal at 6 months (p=0.014) and 12 months (p=0.006), but not at 8 weeks (p=0.979) or 12 weeks (p=0.263). Patients treated with AOP had greater wound area reduction (p=0.015), reductions in pain measured on a 100-point scale (p=0.001) and wound bioburden reduction (p=0.005) during the treatment phase.

Conclusion:

The addition of AOP treatment provides substantial benefits to patients with chronic venous leg ulceration compared with current best practice.

Declaration of interest:

This work was supported by Bioquell UK Ltd, manufacturers of the BioxyQuell system. Authors P. Winter, J. Otter, N. Adams and J. Chewins are employees of Bioquell UK Ltd.
Clinical supervision and internal locus of control
Authors: Thomas Steve
Published: May 2014

The concept of Locus of Control (LOC) has been written about extensively since the term was first introduced by Rotter in 1966. Locus of control and a person's position along a bipolar scale of internalism to externalism has been shown to have effect on many aspects of one's life. Position on the scale varies according to the aspect of an individual's personality that is being examined, for example occupational, educational, health etc. This article will examine the benefit of an internal locus of control (iLOC) for an individual (a supervisee) in relation to clinical supervision and continuing professional development.
Safeguarding children: role of health professionals
Authors: Sibson Lynda , Brain Laura
Published: May 2014

This article serves as an introduction and an outline of the related terms in child abuse, explaining different types. This article should be read in conjunction with a number of other key documents that will be highlighted. Taking action in response to child abuse is never easy, but one of the worst things you can do is nothing. This begins with recognizing and reporting any concerns or suspicions and may involve contributing to assessments, child protection conferences and core groups. Child protection comes before all other considerations, including patient confidentiality and your relationship with a child's parents. Remember there is no such thing as a wrong referral—it is only wrong not to do one. Part two of this series will explain how to report and manage suspected child abuse.
Arterial blood gas and electrolyte measurement on air ambulances
Authors: Williams Hannah M , Bleetman Anthony
Published: May 2014

Arterial blood gas and electrolyte analyses are routinely conducted for critically unwell patients in the hospital setting. Modern and portable point-of care analysers now allow these tests to be performed in the pre-hospital setting. A small number of studies have looked at the potential for performing these tests in the prehospital setting and identified that on-scene testing can alter management of these critical patients.

Aims

To look at the feasibility of introducing a point-of-care arterial blood gas and electrolyte analyser onto a medically-led air ambulance service.

Methods

A retrospective review of the mission data for Warwickshire and Northamptonshire Air Ambulance (WNAA) for all missions between 1st January 2007 and 31st December 2007 was conducted. Patients who could potentially benefit from pointof- care analysis were identified. The physical properties of the i-STAT machine were analysed, specifically the operating temperature range. Air ambulance crew members were asked for their opinions on the potential of point-of-care analysers.

Results

The i-STAT machine could potentially have been used in 174 out of 414 patients (42%) transferred by the air ambulance. The most common indication for use would have been head-injured patients. The operating temperature range of the point-of-care analyser (16–30°C) and the associated temperature drop when the aircraft is flying at 1000 feet means that the machine would only be functional between June and late August (assuming normal seasonal maximum temperatures). Crew members felt that due to the short flight time for primary transfer to hospital, the impact on patient outcome would not be significant for the majority of patients.

Conclusions

The benefit of performing point-of-care analysis on air ambulance patients remains uncertain. The operating temperature range will also limit the i-STAT machine use on air ambulances.
Looking towards a model of advanced practice in the UK
Authors: Mursell Ian
Published: May 2014

The agenda for ambulance service provision in the UK has developed rapidly over previous years, with a focus on role redesign and development to improve access to health care and service provision for patients. This blurring of traditional boundaries has empowered healthcare practitioners to adapt and take on responsibilities that challenge pre-existing roles. The emergent role of the advanced practitioner has been recently established in the nursing field however, within ambulance services it is very much in its infancy. This article will discuss and analyse the role of the advanced practitioner, looking at theories and evidence to underpin advancing roles. While the focus of this piece is advanced practice in critical care, many of the concepts are strongly applicable to any advanced role with prehospital care.
Spinal injury: how should we immobilize in the prehospital environment?
Authors: Warner Stuart
Published: May 2014

Correct spinal immobilization is key to reducing the potential for further injury to the spinal cord. Effective management of actual injuries, or the potential for injury, has led to a protracted debate on which piece of equipment is fully fit for purpose. For the past 20 years, the UK ambulance service has been regularly using the rescue board (colloquially known as the ‘spinal board’) to immobilize patients. This paper seeks to review the current equipment and debate their appropriate applications.
Prehospital treatment of hyperkalaemia
Authors: Strange Barnaby
Published: May 2014

This article explores the assessment and management considerations of patients with hyperkalaemia. Using a case study from clinical practice, the hospital treatment is reviewed with particular emphasis upon the use of calcium, insulin and dextrose. In particular, potential prehospital treatments are considered, with focus upon the use of salbutamol and furosemide. Definitions, incidence and mortality rates of hyperkalaemia are also detailed. The signs, symptoms and causes of the condition are examined, with the aim of achieving prehospital diagnosis in the absence of serum potassium levels. Hyperkalaemic electrocardiogram (ECG) changes are studied and examples are given. Conclusions are made, including a recommendation for the prehospital use of salbutamol in the treatment of hyperkalaemia.
The future of paramedic intubation: who should be responsible?
Authors: Hodkinson Mark
Published: May 2014

Prehospital airway management in trauma patients has been the subject of debate among many professionals for a number of years. At present, the gold standard for airway management and optimal ventilation is endotracheal intubation. Paramedics, as the frontline prehospital care providers, are currently able to practice endotracheal intubation in order to secure an airway, but only when the patient is comatose with no gag reflex. Training in endotracheal intubation has been under close scrutiny by regulatory bodies such as the Joint Royal Colleges Ambulance Service Liaison Committee, with emphasis on using other techniques to secure the airway, including supra-glottic airway devices. Rapid sequence induction and drug assisted airway management is only carried out by doctors working in the prehospital arena. However, a number of studies document that paramedics are more than capable of carrying out successful rapid sequence induction in trauma patients. This article considers the training received by paramedics in airway management, techniques that are employed and the influence of current literature on the debate over paramedic endotracheal intubation.
Starting young: the challenge of developing graduates' road readiness
Authors: Lazarsfeld-Jensen Ann
Published: May 2014

Australian universities, the majority of paramedic undergraduates tend to come straight from school and many programs are unable to offer early or lengthy on-road placements. This was cited as a cause of the immaturity and poor interpersonal skills raised repeatedly in focus group discussions in a year-long study of paramedic education in Australian universities. Focus groups struggled to label the missing factor in university educated paramedics. A deficit of soft skills was widely suggested, but the phrase was not adequate for the range of problems described. Soft skills is used interchangeably with employability, key skills, generic skills and graduate attributes (HEFCE, 2003; Cranmer, 2006; Treleaven and Voola, 2008), but for paramedics it boils down to road readiness. The suggestion that a new generation of paramedics has fewer relational skills than the last generation could be regarded as hollow, except for the fact that it was graduates who raised the problem in focus groups. Using sociological tools to analyse the cultural context of work, it is possible to suggest that deficits interpersonally may be influenced by an increasingly isolated and de personalised youth culture. This culture particularly affects young people who are moving into a uniquely interpersonal workplace, such as paramedic practice (Metz, 1982; Wright Mills, 2000 [1959]). Some social commentators describe the problem of youth culture as the ‘shrinking home habitat’ (Cunningham and Morpurgo, 2006), whereby changes in family structure, social isolation and parental protection, create a smaller social world for Western youth. At the same time, dependence on communication technologies has created ‘disembodied’ communities (Willson, 1997), lacking in real time contact with strangers. While young people may be ‘digital natives' (Bennett et al, 2008; Prensky, 2001) in their use of technologies and social networking, these skills do not translate into road readiness. Graduates also enter a workplace experiencing previously unknown levels of complexity, escalating diversity including ethnic and aging populations, the needs of marginalized people living in the post-institutional, post-welfare era, and high social sensitivity to issues of inclusion and risk. While social change has been incremental for existing professionals, graduates are immersed into the complexity of a social milieu they may not recognize, from the moment of recruitment.
Trauma patients who suddenly deteriorate in the care of paramedics: an Australian case
Authors: Boyle Malcolm
Published: May 2014

Investigations into the trauma patient who suddenly deteriorates while in the care of paramedics, either on scene or during transport to hospital, is limited. The objective of the study was to determine the incidence, physiological criteria for sudden deterioration, and outcome of patients who suddenly deteriorated during paramedic care. Methods: this is a secondary data analysis of an existing prehospital-based trauma dataset. The sudden deterioration dataset had been created previously by linking twelve months (2002) of an Australian Ambulance Service's trauma data with a State Trauma Registry. The sudden deterioration dataset was interrogated using predefined criteria to identify patients who suddenly deteriorated in the presence of paramedics, either on scene or enroute to hospital. Results: there were 239 patients who met the criteria for sudden deterioration, amounting to 0.45% of the total number of trauma patients transported or seen by the Victorian Ambulance Services for 2002. Four patients who suddenly deteriorated did not meet the criteria for prehospital potential major trauma. Conclusion: this study suggests that the incidence of trauma patients suddenly deteriorating in the presence of paramedics is very low and that increasing the total out-of-hospital time to get these patients to an appropriate level trauma service does not adversely affect their mortality outcome.