bluuebunny/crossref_metadata_2025 huggingface dataset:
Necrotising fasciitis
Authors: Neal M.S.
Published: May 2014

A review of the causes and types of necrotising fasciitis together with a discussion of diagnostic methods and appropriate treatments.
A non-comparative multi-centre clinical evaluation of a new hydropolymer adhesive dressing
Authors: Taylor A. , Lane C. , Walsh J. , Whittaker S. , Ballard K. , Young S.R.
Published: May 2014

This study evaluates the performance of a new hydropolymer adhesive dressing in the treatment of chronic or acute wounds, in the presence of blood and/or low levels of exudate, in 74 patients, in a five-site multi-centre non-comparative clinical trial of four weeks' duration. The primary efficacy variable was defined as the incidence of central island dressing adherence to the wound bed in the final stages of healing

The hydropolymer dressing performed extremely well with 98.4% (240 out of 244) of the dressings not adhering to the wound bed.
The economics of preventing and treating pressure ulcers: a pilot study
Authors: Thomson J.S. , Brooks R.G.
Published: May 2014

A pilot economic evaluation of a projected pressure ulcer prevention policy was carried out in a 252-bed geriatric unit in Glasgow. The aim was to set up a framework for evaluating and comparing the costs and benefits of current care and a potential prevention programme. Data were collated from prevalence and incidence studies. Prevalence results showed that 41% of the patient population suffered pressure damage to some extent and incidence data showed that 45% of these were potentially preventable. Evaluation of the costs and benefits shows that the prevention programme would be cost-effective. The cost would be between £17,606 and £28,669 but the benefits would range from £305,506 to £342,510. The authors conclude that economic appraisal is feasible.
Wound closure techniques
Authors: Gottrup F.
Published: May 2014

A review of the principles of wound closure, the materials used and the techniques employed.
The Dutch experience of pressure ulcers — a personal view
Authors: Haalboom J.R.E.
Published: May 2014

This paper describes how pressure ulcers became a priority in healthcare in the Netherlands and highlights the issues that had to be addressed before they were recognised as a problem
Evidence and wound care: What is it?
Authors: Harding Keith
Published: May 2014

If research into wound care is to make a real difference to the way we treat patients, it must be undertaken by practitioners at all levels, argues Keith Harding
Effects of adhesive dressings on the stratum corneum of the skin
Authors: Dykes P.J. , Heggie R. , Hill S.A.
Published: May 2014

Two human models were developed to quantify the stratum corneum removed by different adhesive dressings and to measure the peel force of dressing removal and relate this to stratum corneum removal. The first was an open study designed to compare the effects of applying Mepiform Safetac, Tielle and Duoderm Extra Thin to the skin of 12 normal volunteers aged 19–53 years. Treatments were applied once (one 24-hour application) or three times (three × 24-hour applications) to forearm skin which had been prestained with methylene blue. After dressing removal the dye left on the skin was sampled using the skin surface biopsy method and measured spectrophotometrically.

The results show that, after one and three applications, the Mepiform Safetac sites had a higher level of dye than those on which the other dressings had been applied (p<0.05, after three applications). Based on the assumption that the more dye is left on the skin, the less damage is caused, this suggests that Mepiform Safetac is less damaging to the skin surface than the other products tested.

In the second study the peel force needed to remove adhesive dressings from prestained skin was measured and related to the amount of stratum corneum removed. Mepilex Border Safetac, Duoderm Extra Thin, Allevyn Adhesive, Biatain Adhesive and Tielle Hydropolymer Dressing were compared in 20 normal volunteers aged 23–64 years. Three consecutive 24-hour applications of each product were made, with measurements of peel force at 24, 48 and 72 hours. The amount of dye remaining on the skin at 72 hours was assessed by the surface biopsy method.

Statistically significant differences between products were observed in terms of both peak force and steady state force of removal. Differences in the level of damage to the superficial stratum corneum were also detected. However, low levels of peel force were not always associated with low damage and, therefore, other factors must contribute to stratum corneum removal in this model.
Using wound fluid analyses to identify trace element requirements for efficient healing
Authors: Jones P.W. , Taylor D.M. , Williams D.R. , Finney M. , Iorwerth A. , Webster D. , Harding K.G.
Published: May 2014

A series of wound fluid and blood plasma samples from 20 patients with breast cancer were analysed by Potentiometric Stripping Analysis and computer-aided chemical speciation to quantify the concentrations of the trace elements of copper and zinc in the samples and to investigate the individual species of copper and zinc present.
Centralising supply of a trust's pressure-relieving equipmentrs
Authors: Birchall L.
Published: May 2014

This paper discusses the development of a centralised service by one large acute teaching hospital over a three-year period and the new system's impact on incidence and types of pressure ulcers.
The role of povidone-iodine in podiatric chronic wound care
Authors: Close-Tweedie J.
Published: May 2014

This review examines the problems and limitations of existing studies into povidone-iodine, and suggests that the product should be used carefully in the management of the diabetic foot.
An adequate service? Specialist seating provision in the UK
Authors: Collins F.
Published: May 2014

Patients who sit for long periods need seating that encourages good posture and reduces the risk of ulceration. This article, the first in a three-part series, asks why provision of specialist seating is mainly confined to wheelchair users.
Question & answer
Authors: Collier M.
Published: May 2014

The editor welcomes readers' questions and alternative answers to questions and letters.These should be sent to the Journal of Wound Care, Greater London House, Hampstead Road, London NW1 7EJ. Fax: +44 (0)20-7874 0386. Email: jwc@emap.com
A sharp debridement procedure devised by specialist nurses
Authors: Fairbairn K. , Grier J. , Hunter C. , Preece J.
Published: May 2014

In the clinical governance era, self-education is not adequate training for nurses to carry out sharp debridement, which is a risky process. Specialist nurses in south-east London drew up a workable procedure for training and practice.
Fistula management following an appendicectomy: nursing challenges
Authors: Benbow M. , Iosson G.
Published: May 2014

Preservation of skin integrity, nutritional support and removal of odour are key features of fistula management. This case study describes the care of a patient with a fistula wound that discharged copious amounts of semi-solid faecal matter.
Do continence aids help to maintain skin integrity?
Authors: Hughes S.
Published: May 2014

The third of our back to basics series reviews the efficacy of continence aids such as pads and barrier creams, and their role in maintaining skin integrity. Many studies had flaws and new research is needed to avoid subjective choice of products.
Evaluation of a new composite dressing for the management of chronic leg ulcer wounds
Authors: Daniels S. , Sibbald R.G. , Ennis W. , Eager C.A.
Published: May 2014

Objectives:

A new composite dressing (Versiva, ConvaTec) combines three technologies: hydrocolloid, hydrofibre and a foam-film layer. This study aimed to assess the safety of the dressing in the management of patients with venous leg ulcers. Clinical performance was also assessed.

Method:

This multicentre, non-randomised, open-label, phase II study assessed the safety (via adverse-effect reporting) and performance, including weartime, absorption, dressing integrity, ease of use and wound progression, of Versiva. Up to 10 dressing changes were assessed within a five-week study period.

Results:

In 75 dressing changes of 11 ulcers, the mean wear time was approximately five days. No or minimal leakage was observed in 81% of changes. In 93%, the dressing was ‘very easy’ to remove, with no trauma to surrounding skin. Most changes (77%) were painless.

Conclusion:

Versiva met or exceeded the investigators' expectations for exudate absorption, protection of peri-wound skin and reduction in wound pain and ulcer area. Healing or marked improvement was observed in 82% of leg ulcers within the five-week study. The relatively long wear-time of five days represents a cost-effective advantage for this dressing compared with other available adhesive foams for the management of chronic wounds.

Declaration of interest:

This study was sponsored by ConvaTec.
Management of chronic leg ulcers by nurses working in the community in Sweden and the UK
Authors: Hjelm K. , Rolfe M. , Bryar R.M. , Andersson B-L. , Fletcher M.
Published: May 2014

Objective:

This study compared the management of chronic leg ulcers by nurses in community, primary health care and nursing home settings in Kronoberg, Sweden, and East Riding, UK.

Method:

A questionnaire was sent to all nurses in the two areas enquiring about their occupational background, leg ulcer management, resource utilisation and education and training. It also asked about their preferred treatment choices for four types of chronic leg ulcers described in case studies. Response rates of 50% (UK) and 54% (Sweden) were achieved.

Results:

Nurses in the UK undertook diagnostic investigations of non-healing leg ulcers as part of the initial assessment, whereas in Sweden these were undertaken by physicians. In Sweden daily dressing changes were more frequent and often involved nurse auxiliaries. Patients and relatives almost never participated in dressing changes in the two countries. Sodium chloride was the most commonly used cleansing agent in the UK, as opposed to warm water in Sweden. The use of antibacterial/antiseptic dressings and antibiotics was more frequent in the UK. Nurses there also used scientific and professional literature more frequently. Swedish nurses experienced more problems in obtaining new information.

Conclusion:

Differences exist between the two countries in leg ulcer management. These may be related to differences in the health-care systems, staff training and attitudes to evidence-based practice.

Declaration of interest:

None.
Can topical negative pressure be used to control complex enterocutaneous fistulae?
Authors: Nienhuijs S.W. , Manupassa R. , Strobbe L.J.A. , Rosman C.
Published: May 2014

Until recently, the use of topical negative pressure was contraindicated for enterocutaneous fistulae. This non-controlled study shows that, in these wounds, it can control effluent output and does not preclude spontaneous closure
The role of hyaluronic acid in wound healing’s proliferative phase
Authors: Brown J.A.
Published: May 2014

The healing process comprises a number of phases: inflammation, proliferation and maturation. Within these phases are many cellular and biochemical activities in which epithelial, endothelial and inflammatory cells, platelets and fibroblasts interact to restore ‘normality’ within the wound area. The processes by which these structures interact and support each other form a complex jigsaw, and the focus of this review is to look at one small piece of the puzzle — the role within proliferation of hyaluronic acid, or more correctly, hyaluronan.
Improving the quality of reporting in randomised controlled trials
Authors: Walker A. , Nixon J.
Published: May 2014

Wound-care journals contain abundant reports of trials, but not all report a satisfactory methodology. Systematic reviews of wound-care trials have highlighted many areas for improvement, and the National Institute for Clinical Excellence (NICE) guidelines recommend that primary research in the field of pressure ulcer prevention should adhere more closely to current methodological standards in terms of conduct and reporting. The CONSORT tool was developed to help achieve these improvements in the design and reporting of randomised controlled trials (RCTs).
Risk, prevalence and prevention of pressure ulcers in three Swedish health-care settings
Authors: Gunningberg L.
Published: May 2014

Objective:

This cross-sectional survey set out to delineate risk, prevalence and prevention of pressure ulcers in a university hospital, a general hospital and a nursing home in Sweden. It also looked at the differences in risk factors and preventive strategies between patients with and without pressure ulcers.

Method:

The one-day survey followed the methodology developed by the European Pressure Ulcer Advisory Panel (EPUAP). It was conducted on Tuesday 5 February 2002. Each patient was visited by two registered nurses, their skin was inspected and any pressure ulcer classified according to the EPUAP grading system. A total of 695 patients were included: 612 from the university hospital, 38 from the general hospital and 45 from the nursing home.

Results:

The prevalence of pressure ulcers was 23.9% (university hospital), 13.2% (general hospital) and 20.0% (nursing home). Most (60–66%) of the pressure ulcers in the hospitals were assessed as grade 1. Only half of the patients at risk or with pressure ulcers were placed on a pressure-reducing mattress and a third of these patients had a plan for repositioning. Significant variables associated with pressure ulcers were old age, geriatric care, low Braden score and incontinence.

Conclusion:

Prevalence of pressure ulcers was higher than expected. Results relating to both prevalence of pressure ulcers (grade 1 excluded) and the preventive care given to patients at risk or with pressure ulcers accord with those of a larger Dutch study. Attention must focus on the appropriate risk-assessment skills, highlighting grade 1 as pressure damage, and the use of appropriate preventive strategies, based on the level of risk.

Declaration of interest:

None.
Use of topical negative pressure therapy in postoperative dehisced or infected wounds
Authors: Morton N.
Published: May 2014

The management of acute postoperative infected and dehisced wounds varies across the UK. Options include saline-soaked gauze, alginate or hydrofibre dressings, and, more recently, topical negative pressure (TNP). Use of TNP has risen in popularity over the past five years or so, although its justification has primarily been driven by anecdotal evidence and case studies1 rather than by primary research.
Using topical negative pressure therapy to resolve wound failure following perineal resection
Authors: Jethwa P. , Lake S.P.
Published: May 2014

Postoperative perineal wounds can be difficult to manage as sepsis, dehiscence and pain commonly occur. This paper describes the management of a patient who experienced wound failure following perineal resection subsequent to irradiation and grafting. Topical negative pressure therapy resulted in wound closure and the eradication of MRSA.
Evaluation of a lipidocolloid wound dressing in the local management of leg ulcers
Authors: Meaume S. , Ourabah Z. , Cartier H. , Granel-Brocard F. , Combemale P. , Bressieux J.M. , Bohbot, S.
Published: May 2014

Objective:

To evaluate the efficacy, tolerance and acceptability of Urgotul and DuoDERM E dressings in the local management of venous or mixed-aetiology leg ulcers.

Method:

This was a prospective multicentre randomised phase IV clinical trial conducted open-label in parallel groups. It involved 20 investigating centres, including hospital dermatology and vascular medicine departments, and private practices. Dermatologists and angiologists/phlebologists took part. Subjects were adult, non-immunosuppressed patients presenting with a non-infected, non-malignant leg ulcer of predominantly venous origin (ABPI >0.8). Ulcers were between 4cm2and 40cm2in size, with granulation tissue covering more than 50% of their surface area. Ulcer duration ranged from three to 18 months. Patients were followed-up by the investigating physician for eight weeks on a weekly basis; this included clinical examination, wound area tracings and photographs. Nurses (hospital or visiting) assessed exudate volume and clinical appearance at dressing changes.

Results:

Ninety-one patients were included: 47 in the Urgotul group and 44 in the DuoDERM E group. Baseline patient demographic data and wound characteristics were comparable in the two groups. After eight weeks of treatment wound surface area had reduced by a mean of 61.3% in the Urgotul group and 52.1% in the DuoDERM E group (NS); dressings were changed more frequently in the DuoDERM E group (2.54 ± 0.57 times per week versus 2.31 ± 0.45 in the Urgotul group, p=0.047). Thirty-three local adverse events were recorded in 27 patients: 10 in the Urgotul group and 23 in the DuoDERM E group (p=0.039). Nurses reported better acceptability for the Urgotul dressing, based on pain on removal, maceration and odour (p<0.0001).

Conclusion:

Both dressings showed similar efficacy for the local treatment of venous leg ulcers. Nevertheless, medical and nursing staff reported better tolerance and acceptability for the Urgotul dressing.

Declaration of interest:

This study was sponsored by Laboratoires Urgo, Dijon, France.
The non-pressurised boot dressing: an alternative for use in managing diabetic foot ulceration
Authors: Wilson D.J.
Published: May 2014

Diabetic foot disease causes more nontraumatic lower limb amputations than any other lower limb disease, of which, 85% are preceded by foot ulceration. Loss of protective sensation due to neuropathy, a reduction in arterial perfusion caused by ischaemia, and infection all contribute to the underlying aetiology of diabetic foot ulceration.
Can translocated bacteria reduce wound infection?
Authors: Nikitenko V.I.
Published: May 2014

Swab cultures from acute surgical wounds showed that Bacillus subtilis was the most common bacteria present. The investigators propose that the bacteria, which originate in the gastrointestinal tract, play an anti-infective role in the wound site
Use of autologous platelet-rich fibrin on hard-to-heal wounds
Authors: Steenvoorde P. , van Doorn L.P. , Naves C. , Oskam J.
Published: May 2014

This retrospective study found that use of autologous platelet-rich fibrin on a range of hard-to-heal wounds achieved full healing or a significant reduction in wound diameter with no adverse effects. Prospective studies are now needed
Microbial investigation of venous leg ulcers
Authors: Howell-Jones R.S. , Baker I.B. , McNulty C.A.M.
Published: May 2014

Objective:

To investigate microbiology laboratory reporting policies, whether practitioners working in primary care adhered to the relevant guidelines when submitting swabs from venous leg ulcers (VLUs), and the impact of laboratory reports on antibiotic usage for VLUs.

Method:

Questionnaires were sent to all microbiology laboratories in England and Wales, and to clinicians who had submitted VLU swabs to one laboratory.

Results:

Ninety-five (47%) laboratories responded. Laboratories processed a mean of 7.3 leg ulcer swabs/100,000 population/week but were often unable to identify the leg ulcer aetiology from the clinical details provided. All laboratories stated that they routinely reported group A haemolytic streptococci and meticillin-sensitive and resistant Staphylococcus aureus; 75% always reported antibiotic susceptibility for these isolates. The majority reported other beta-haemolytic streptococci. A total of 126 clinicians (64%) returned their questionnaires; 100 had confirmed in their swab submission that the ulcer was of venous aetiology and so were included in the analysis. Eighty per cent of the swabs were submitted in accordance with guidelines, with increased pain (61%) being the most common reason. Discharge/exudate (52%) and malodour (41%) were common reasons for swab submissions, even though the guidelines do not cite them as clinical signs of infection. Reporting of antibiotic susceptibilities was associated with increased antibiotic usage.

Conclusion:

Clinicians in primary care generally adhere to guidelines when submitting VLU specimens for microbiological investigation. Clinicians need to include clinical information with the swab so that laboratories can interpret the microbiology results. To reduce the use of antibiotics in the management of VLUs, laboratories need to be selective in their organism and antibiotic-susceptibility reporting.

Declaration of interest:

None.
Open study on the topical treatment of interdigital fungal infections in diabetic patients
Authors: Johansson A. , Ljungh Å. , Apelqvist J.
Published: May 2014

A high proportion of diabetic patients experience fungal infections, and pharmaceutical strategies have varying success rates. A new alternative method, hydrophobic interaction, may provide a valuable treatment for these infections
A hydrocellular foam dressing versus gauze: effects on the healing of rat excisional wounds
Authors: Kunugiza Y. , Tomita T. , Moritomo H. , Yoshikawa H.
Published: May 2014

Objective:

Hydrocellular foam dressings are characterised by their ability to create a moist wound healing environment and absorb high amounts of exudate. In this study, we examined the effect of a hydrocellular foam dressing on the healing of rat excisional wounds.

Method:

One full-thickness wound was made on the back of rats and wounds were treated with hydrocellular foam dressing or gauze dressing. To examine the histology of the wound, haematoxylin and eosin (HE) staining was performed. Gene expression of vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), hepatocyte growth factor (HGF) and hypoxia inducible factor-1 alpha (HIF-1α) in granulation tissue was examined by real-time reverse transcription polymerase chain reaction (real-time RT-PCR). VEGF protein was measured by ELISA.

Results:

The hydrocellular foam dressing promoted formation of granulation tissue and significantly promoted wound closure. A scab formed on the surface of granulation tissue in the gauze-treated wounds, which disturbed epithelialisation. In addition, the expression of VEGF and mRNA was higher in the gauze-treated wounds.

Conclusion:

These results supports the hypothesis that gauze encourages scab formation, which impairs epithelialisation and increases VEGF expression. In contrast, hydrocellular foam dressing accelerates epithelialisation and new vessel formation in granulation tissue.

Declaration of interest:

None.
Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds
Authors: Stansby G. , Wealleans V. , Wilson L. , Morrow D. , Gooday C. , Dhatariya K.
Published: May 2014

Objective

The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver.

Method

Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study..

Results

Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5–55) and the final visit (15.3cm2; range 2.4–63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0–35) to final visit (5mm; range 0–35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients.

Conclusion

This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT.

Declaration of interest

This study was sponsored by Mölnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
Wound healing following combined radiation and cetuximab therapy in head and neck cancer patients
Authors: Dean N.R. , Sweeny L. , Harari P.M. , Bonner J.A. , Jones V. , Clemons L. , Geye H , Rosenthal E.L.
Published: May 2014

objective: This study set out to determine if cetuximab treatment increases the risk of wound healing complications when combined with radiation therapy. Method: We performed a retrospective chart review of head and neck cancer patients who received salvage neck dissections between 1999 and 2007, at two academic tertiary care centres. Complications from wound healing were compared between radiation and combined therapy groups. results: a total of 35 patients received radiation (n=20) or combined radiation and cetuximab therapy (n=15) prior to neck dissection. The treatment groups were similar in regard to demographic and primary tumour-related characteristics. The time between treatment and salvage neck dissection did not differ between the radiation (3.9 months) and combination treatment (3.0 months) groups (p=0.15).Wound healing complications occurred in 13% (2/15) of the patients treated with radiation and cetuximab and there were no complications in patients who received radiation alone (p=0.20). conclusion: Cetuximab did not significantly increase the risk of post-surgical wound complications, although a higher absolute number of wound complications was observed in the group treated with cetuximab and radiation therapy, compared with the group treated with radiation alone. confict of interest: This work was supported by a grant from the national institute of Health(2T32 Ca091078–06). one of the authors, JaB, is an occasional consultant and honoraria for imClone and Bristol-Meyers Squibb.
Flexible and rigid casting tape as a novel approach to offloading diabetic foot ulcers
Authors: Malone M. , Gannass A. Al , Bowling F.
Published: May 2014

Offloading diabetic ulceration is a key component to the success in healing ulcers on the plantar aspect of the foot. New advances in offloading techniques allow for differing approaches in sometimes complex diabetic foot pathologies with associated ulceration. This case study looks at the use of flexible and rigid casting technique as part of the treatment in offloading plantar foot ulceration.
An approach to assessing evidence that can inform clinical decision-making
Authors: White Richard
Published: May 2014

Following the Cochrane meta-analyses findings, doubts are being expressed about efficacy of silver dressings. However, the need for topical antimicrobials has not diminished, and the evidence for non-silver agents is no better than that for silver. This article describes an alternative system to Cochrane for analysing the evidence base, and suggests a practical approach to making a case for silver to procurement managers
The psychosocial impact of chronic wounds on patients with severe epidermolysis bullosa
Authors: Adni T. , Martin K. , Mudge E.
Published: May 2014

• Objective:

To explore the lived experience of individuals with chronic wounds associated with dystrophic and junctional epidermolysis bullosa (EB), to improve understanding and, therefore, enhance the care provided to this group of patients by acquiring in depth data on the psychosocial issues that affect them.

• Method:

A phenomenological study using interpretive phenomenological analysis was employed. A purposive sampling method was used with six individuals replying to postal invitation to participate.

• Results:

Following one-to-one interviews, six superordinate themes were identified. These were: coping, pain, perceptions, emotional impact, social impact and support network, each with subordinate themes. All of the superordinate themes have been identified by previous research into chronic wounds, burns and disfiguring conditions; however, new subordinate themes arose.

• Conclusion:

This study highlighted the need for individuals with EB to have a multidisciplinary approach to their care with a particular need for pain management, psychological intervention and nursing support from those whom clients perceive as understanding the requirements of patients with EB. Further research into identity issues in individuals with EB is advocated.

• Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Feelings of powerlessness in patients with venous leg ulcers
Authors: Salomsé G.M. , Openheimer D.G. , de Almeida S.A. , Bueno M.L.G.B. , Dutra R.A.A. , Ferreira L.M.
Published: May 2014

Objective:

To assess feelings of powerlessness in patients with venous leg ulcers.

Method:

An exploratory, descriptive, analytic, cross-sectional study was conducted at the Plastic Surgery outpatient Clinic of the São Paulo Hospital (HSP) and at the outpatient Wound-Care Clinic of the Sorocaba Hospital Complex (CHS), brazil, from may 2010 to April 2012. Sixty patients with venous leg ulcers (VLUs), of both sexes, aged s≥18 years, from the two outpatient wound-care clinics were selected to participate in the study. All participants responded to the Powerlessness Assessment Tool (PAT) for adult patients. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test and Kruskal-Wallis test at a significance level of 5% (p<0.05).

Results:

Forty-four (73%) patients were women and 38 (63%) were aged 61–70 years. Eight (13%) patients were alcoholics and 46 (77%) were smokers. Thirty-two (53%) patients had a VLU for more than 10 years; the ulcer area ranged from 11–20 cm2 in 19 (32%) patients and was s>30 cm2 in 18 (30%) patients. Mean total PAT score was 47.83 s± 7.99 and ranged from 51–60 for 31 (52%) patients and from 41–50 for 19 (32%) patients.

Conclusion:

Most patients with venous leg ulcers reported high PAT scores, revealing the presence of strong feelings of powerlessness.

Declaration of interest:

The authors have no conflicts of interest to declare.
Letters
Authors: White R.
Published: May 2014

An open response to the technology scoping report examining the clinical and cost effectiveness of silver
Providing world-class care through clinical leadership
Authors: Sibson, Lynda , Walker Alison , Marsh Anthony
Published: May 2014

The need for appropriately trained clinical leaders with experience and influence at all levels in the ambulance service is paramount. Here, Lynda Sibson, Alison Walker and Anthony Marsh discuss the establishment of a National Steering Group on Clinical Leadership and the launch of a strategic framework document.
Improving survival from out-of-hospital cardiac arrest
Authors: Lyon Richard , Sinclair Neil , Henderson Craig
Published: May 2014

Out-of-hospital cardiac arrest (OHCA) is a leading cause of prehospital mortality and serious neurological morbidity. Survival from OHCA almost entirely depends on prehospital intervention by ambulance personnel. Recent evidence has shown the importance of good quality cardio-pulmonary resuscitation (CPR) in improving outcome from OHCA. Recent studies have suggested that intubation, intravenous cannulation and drug administration may distract from basic CPR and be associated with poor outcomes following OHCA. This article reviews the latest evidence on prehospital OHCA management and presents the case for a ‘back to basics’ approach.
Professional doctorates for paramedics: a personal journey
Authors: Halliwell David
Published: May 2014

This article explores the journey of the author, a paramedic educator, who is undertaking a professional doctorate programme (DProf). He compares it with the more traditional PhD route, and looks at the differences in approach and the complexities involved in doctoral study. Professional practice is at the heart of a DProf programme, as its aim is to develop researching professionals rather than professional researchers. The author argues that paramedicine is a practice-based discipline, and doctoral research is aimed at creating practice improvement and continued service development. The author chose to study a DProf as the focus was on research and practice development shaped by personal experiences (reflexivity). Reflexivity can be personal or epistemological, with the latter stance encouraging students to reflect upon assumptions they have made during their research. The author hopes to inspire other paramedics to undertake DProf study while remaining grounded within their own practice.
Outlining the Diploma in Immediate Medical Care
Authors: Rutherford Gary , Inglis Drew
Published: May 2014

The Diploma in Immediate Medical Care (Dip IMC) awarded by the Royal College of Surgeons of Edinburgh (RCSEd) was initiated in 1988 with the aim of providing a structured assessment of those practicing in pre-hospital care.
Analysing Thurstone and Likert attitude scales as data collection methods
Authors: Thomas Jo
Published: May 2014

The development of the paramedic as a health care professional and the movement of paramedic education into the higher education setting has resulted in the need for paramedics and student paramedics to be aware of and understand research methods. This article does not explore or apply the entire research process, as it focuses on a specific part of the research. The article explores and contrasts two different data collection methods used to measure attitudes, one of which will be familiar to most healthcare professionals: the Likert Scale. Less frequently used is the Thurstone method and reasons for this are discussed. The author offers an example how these methods might be used to measure attitudes about the preparedness of paramedics to address end of life care issues.
I.F.E.A.R reflection: an easy to use, adaptable template for paramedics
Authors: Smart Gary
Published: May 2014

Paramedics are required by the Health Professions Council, as a condition for maintaining their registration, to maintain high clinical standards and continuously engage in their own professional development. Similarly, student paramedics are required to provide a portfolio of evidence that demonstrates their development and eventual competency. One means of engaging with this process is to apply a formal reflection process to emergency calls attended. Reflection is a hot-topic in paramedic education. However, it is known that for some, reflection can be daunting. Concerns about the academic process, writing and knowing where to begin are often articulated by students attending higher education programmes. This article outlines a suggested reflective framework adapted from Gibbs (1985) reflective cycle. It outlines a series of applicable, sequential questions. Reflection is about using questions to retell a story; it’s about answering these questions critically and, in so doing, often results in a well structured, reflective case-study; as well as improving one’s own clinical understanding and practice. In practice, we have found that both experienced practitioners and student paramedics have been able to use these steps to shape their writing. For those new to writing reflective case studies, the questions help to provide the muse for overcoming the ‘blank-sheet-of-paper’ inertia that can accompany portfolio building.
Paramedic ultrasound: a tool of the future?
Authors: Prescott Charlotte
Published: May 2014

Spotlight on Research is edited by Julia Williams, Principal Lecturer, Paramedic Science, University of Hertfordshire, Hatfield, Hertfordshire UK. To find out how you can contribute to future issues, please email her at j.williams@herts.ac.uk (to avoid disappointment or duplication we recommend an initial email before beginning any writing).
Management of the ruptured abdominal aortic aneurysm: challenges facing paramedics
Authors: Smith Neil
Published: May 2014

An abdominal aortic aneurysm (AAA) is a localized dilatation of the abdominal aorta resulting from degenerative cardiovascular disease. Such aneurysmal arteries pose few problems for many patients and are simply monitored and managed conservatively within the community. However, the ruptured abdominal aortic aneurysm is a time-critical medical emergency requiring timely surgical intervention in order to offer any chance of survival. Even when recognized early, 90% of patients will suffer an out-of-hospital cardiac arrest before arriving at the emergency department and of those who reach theatre, only 40% will survive. This article aims to increase the paramedic practitioner's knowledge and understanding of AAA through a holistic discussion of the prehospital recognition and early management. Particular emphasis will be placed on fluid replacement therapy and analgesia with specific reference to the issues associated with aggressive fluid resuscitation, and the potential benefits elicited through the use of opiate analgesia and subsequent pharmacologically induced hypotension. This article further aims to set the prehospital management into the wider context, thus providing paramedic practitioner's with an insight into how prehospital interventions affect the patients’ ultimate outcome and postoperative quality of life.
Legislation surrounding the administration of medicines by paramedics
Authors: Davies Janice
Published: May 2014

Paramedics routinely administer medicines that are otherwise restricted by law. The aim of this article is to provide an awareness of the legal classification of some of the drugs that you commonly use, provide an overview of the legal framework that allows you to administer medicines to patients, explain the meaning of the ‘marketing authorisation’ (product licence) and highlight the possibility of paramedic prescribing in the future.
Determining the paediatric educational needs of prehospital providers: part 1
Authors: Breon Alia , Yarris Lalena , Law Junwen , Meckler Garth
Published: May 2014

Caring for paediatric patients presents unique challenges to prehospital personnel who may have limited training, experience and confidence caring for children. The State of Oregon recently increased its paediatric training requirements for prehospital providers; however, little is known about the specific educational needs, barriers, and preferences of providers in this largely rural state. Objectives: the purpose of this study was to characterize the paediatric educational needs, barriers, and preferences of prehospital providers in Oregon. Methods: this was a qualitative analysis of 9 focus group discussions with a total of 64 prehospital providers from the State of Oregon. An iterative process of theme identification was used to generate themes, and then inter-rater checking was applied to confirm themes and assure inter-rater reliability. Results: participants identified a need for more paediatric training. They described knowledge gaps in assessing medically ill children, working with children with long-term medical conditions, and dealing with issues related to communication and the emotional difficulty of caring for children. Distance and cost were identified as barriers to attaining paediatric education, especially for rural providers. Other barriers included finding time for training and courses that are not designed specifically for the prehospital provider. Providers recommended increasing time spent with children during training by involving local schools and paediatricians. They recommended expanding the courses to include the areas where they felt less comfortable and increasing hands-on training opportunities. Simulation and online training were suggested as effective modalities to augment their trainings. Conclusion: our findings support previous studies that show prehospital providers feel less comfortable providing care to children.The specific barriers that our respondents identified can be related to the demographics of Oregon.To address the needs of prehospital providers in caring for children, we recommend: 1) expanding the curriculum to involve more time with children and an increased emphasis on assessing medically complicated children; 2) take measures to assure that the training is affordable and accessible to providers in different practice settings, and does not require long distance travel to attend; and 3) use online training modules and simulation to bring flexible ‘hands-on’ training to providers.
Improving the assessment and referral of mental health patients
Authors: Palmer Andrew
Published: May 2014

This article discusses a report which sought to examine how patients with mental health (MH) problems were treated by South West Ambulance Service Trust (SWAST); particularly in cases of threatened suicide and/or deliberate self harm, the strongest predictor of suicide ( Hawton et al, 2003 ), and compared the findings with the national picture. SWAST had similar organizational difficulties in that MH service providers’ boundaries do not match theirs, so a pan-trust policy is hard to achieve. There are some local arrangements in existence, although this report sought to pursue uniformity in approach rather than reinforcing the notion of the ‘postcode lottery’ of healthcare delivery.
Preventing prehospital hyperoxygenation during acute exacerbation of COPD
Authors: Fitzpatrick David , Duncan Edward , Maguire Donogh
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a long-term, incurable lung condition. Acute exacerbations are frequently encountered by ambulance clinicians and are routinely treated with oxygen therapy and nebulised drugs. Yet, delivering the appropriate amount of oxygen to these patients is challenging, and the effects of getting it wrong are significant. Hyperoxygenation of patients with acute exacerbation of COPD leads to a significantly increased rate of mortality and morbidity. This article outlines the pathology of COPD and relevant clinical guidelines. It proposes a multi-modal intervention as a solution to the challenge of ensuring the appropriate delivery of oxygen therapy to patients who are experiencing an acute exacerbation of their COPD.
Carbon monoxide poisoning: a comprehensive review for prehospital specialists
Authors: Whitson Caroline , Lim Rodrick , Poonai Naveen
Published: May 2014

As one of the leading causes of poisonings worldwide, it is imperative that prehospital specialists are aware of carbon monoxide (CO) poisoning and its management. Awareness of the epidemiology, and the common presentations of CO poisoning may lead to prompt evaluation and early initiation of life-saving therapy. Children under 5 years of age have the highest incidence of CO-related ER visits and are at greatest risk of CO toxicity. The clinical features are nonspecific and misdiagnoses are common. Therefore, prehospital providers should have a high index of suspicion for CO intoxication in patients that experience headache, vomiting, or altered level of consciousness following exposure to hydrocarbon combustion within an enclosed space. A carboxyhaemoglobin level is a quick and reliable way to diagnose CO exposure. To prevent complications such as altered cerebellar function, seizures, rhabdomyolysis and dysrhythmias, early recognition and treatment is imperative. Removal from the source of exposure and the provision of 100% oxygen form the cornerstone of management. Preventive strategies should also be explored in susceptible populations.
Pre-hospital thrombolysis: end of an era?
Authors: Cooke Justin
Published: May 2014

For much of the last 20 years thrombolysis has been the preferred initial treatment for ST segment elevation myocardial infarction (STEMI). This treatment was originally given in hospital but was later used extensively and successfully before hospital admission. Primary percutaneous coronary intervention (PPCI) has proved itself to be more efficacious than thrombolysis, if it can be delivered within two hours, despite the extra time it takes to take patients to a Heart Attack Centre. Giving thrombolysis prior to the PPCI does not buy time safely. Prehospital thrombolysis still has a role when events long journies prevent timely access to the catheter laboratory.
The seizurogenecity of naloxone in tramadol overdose
Authors: Cowley Alan
Published: May 2014

Tramadol is the most widely prescribed opiate analgesic ( National Treatment Agency for Substance Misuse, 2011 ) and, as a result, is present in a large number of overdoses that present in the pre-hospital arena. Naloxone is indicated for use by ambulance personnel where the GCS is reduced due to a known, or possible, overdose of an opiate containing substance ( JRCALC (Joint Royal Colleges Service Liaison Committee), 2006 ).

A case study of a tramadol overdose shows a close temporal relationship between naloxone administration and a seizure. While seizure is a symptom of tramadol intoxication (Saidi et al, 2008), the speed with which it occurred after naloxone administration seemed too fast to be merely coincidence. A study of the literature shows evidence that naloxone can instigate seizure in the case of a tramadol overdose ( Rehni et al, 2008 ; Raffa and Stone, 2008 ).

This information is particularly pertinent to the ambulance clinician as the consequence of a seizure can be important, both practically and clinically. The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose.
Patient comfort in prehospital emergency care: a challenge to clinicians
Authors: Melby Vidar , Deeny Pat , Hagiwara MagnusAndersson , Jonsson Anders , Kängström Anna , Kernohan W George , Suserud Björn-Ove
Published: May 2014

Aim:

The aim of this paper is to report on a study that compared ambulance clinicians’ views of two different types of patient coverings, focusing on core caring concepts such as comfort, dignity, and safety.

Design:

Ambulance clinicians’ views were gathered in respect of two types of patient coverings, and 128 ambulance patients were randomly distributed into a control or experimental group receiving respectively either the traditional cotton blanket or a multi-layered TelesPro rescue covering. Views were gathered using a short questionnaire developed by the authors.

Findings:

Ambulance clinicians, in their own view, maintained the core caring concepts no matter which type of covering was used. Findings suggest strongly that the rescue covering provided for a superior patient experience in respect of all core concepts and one functional aspect.

Conclusions:

Ambulance clinicians undertake caring that encompasses the core caring concepts of comfort, safety, and dignity, while remaining vigilant to threats to these constituents of caring.