bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitamin D supplementation: Putting recommendations into practice
Authors: McGee, Eleanor , Shaw, Nick
Published: May 2014

A recognised resurgence of symptomatic vitamin D deficiency in children and adolescents in the UK has once again focused attention on vitamin D supplementation. Although national recommendations for pregnant women and breastfed infants have been in place for many years they were not widely implemented by health professionals. In order to address this issue, a multidisciplinary vitamin D steering group was developed by a Birmingham Primary Care Trust (PCT). Regular meetings of this group identified obstacles and practical issues in ensuring vitamin D supplementation was available. A policy of universal supplementation of all pregnant and breastfeeding women and their infants, regardless of ethnic group or mode of feeding, was funded by the PCT and launched as a campaign in 2006. There has been a gradual increase in the uptake of healthy start preparations and a case finding survey identified a 59% reduction in the incidence of symptomatic vitamin D deficiency in young children. This article reviews this campaign and identifies the need for a regular strategy to ensure that vitamin D supplementation is maintained.
Enhancing health visiting practice and improving the quality of our service
Authors: Oldman, Crystal
Published: May 2014

With the help of JHV, sourcing comprehensive research based evidence has improved. Crystal Oldman reflects on how times have changes since the health visiting courses in the 1980s.
The management of atopic eczema in infants and children
Authors: Myers Joan
Published: May 2014

Atopic eczema is a chronic inflammatory, dry skin condition characterised by an itchy red rash ( National Institute for Health and Clinical Excellence, 2007 ). The role of the health visitor is important in supporting parents who have children with atopic eczema, as they are often the first health professional to see the infant's skin and hear about the concerns of the parent. Emollients are effective when treating and managing atopic eczema, and topical corticosteroids are effective for the management of acute flare-up as they can relieve symptoms of itching and treat inflammation. However, it is also important to consider trigger factors such as food allergens. Giving parents information on trigger factors and how to manage these will empower them to gain control of their infant or child's atopic eczema.
Egg consumption in pregnancy and infant diets: How advice is changing
Authors: Gray Juliet , Gibson Sigrid
Published: May 2014

Eggs are a nutrient-dense, relatively inexpensive and convenient food, suitable for consumption by pregnant and breastfeeding women and infants. However, there appears to be some confusion among the public regarding the safety of egg consumption by these groups. Some evidence suggests that delayed introduction of potential food allergens such as eggs during weaning may be counterproductive for allergenic risk, and that introduction of the allergenic protein during a proposed ‘critical window’, at 4–7 months, may be necessary to induce tolerance. This hypothesis is currently being tested by two major studies, while two expert committees (Scientific Advisory Committee on Nutrition and Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment) are also reviewing evidence on complementary feeding and allergic risk, respectively. This article discusses historic and current advice on egg consumption during pregnancy and breastfeeding and in complementary feeding. It examines the evidence base for the advice in the context of both the microbiological safety of eggs and risks of egg allergy in these groups, presents a new analysis of nationally representative infant feeding data and reviews the latest nutritional composition data for British eggs in the context of the maternal and infant diet. It appears that historic concerns about food safety and allergy may have resulted in unnecessary avoidance of eggs during the introduction of complementary feeding.
Supporting parents and parenting practices: The health visiting context
Authors: Whittaker Karen
Published: May 2014

Parenting is a crucial factor in child outcomes, so parenting support is a core responsibility for health visitors. Parenting styles have traditionally been categorised as authoritative, authoritarian, permissive or neglectful, but contemporary research has moved away from fixed categorisation. Support for parenting may be informal, semi-formal or formal, and can be delivered in a variety of methods and locations. There is evidence to suggest that approaches that combine different strategies for intervention in parenting are most likely to be effective in improving outcomes for the child.
Helping children cope with renal disease: the role of play specialist
Authors: Gill Cathy
Published: May 2014

Cathy Gill gives an overview of the role of the hospital play specialist in working closely as part of the multidisciplinary renal team. She explains the importance of play as a way to distract children from pain and anxiety, express emotions and process complex information relating to renal disease.
Back to basics: anaemia of chronic kidney disease
Authors: Jenkins Karen
Published: May 2014

Karen Jenkins covers the fundamental nursing aspects of anaemia of chronic kidney disease—its definition, the processes in the body that lead to it and its sign and symptoms. Nurses will also find up-to-date information about the various forms of iron and erythropoietic therapy currrently available.
The role of the anaemia nurse as part of the multidisciplinary renal team
Authors: Wittwer Iain E
Published: May 2014

Iain Wittwer describes his role as an anaemia support nurse at a renal unit in Oxford. He outlines tasks such as giving information and support to patients, providing a single point of contact and monitoring the effectiveness of the agreed treatment plan to help manage renal-related anaemia.
Who makes the renal outpatient clinic work?
Authors: S Pabani Aysha
Published: May 2014

Guy's Hospital renal outpatients clinic handles educational sessions and appointments for up to 150 patients a day. Doctors and nurses could not manage alone. So who are the other members that help turn potential chaos into the smoothly-run kidney clinic we see today? Aysha Pabani went to visit and spoke with support staff of Guy's multidisciplinary renal outpatients team.
Health promotion in long-term transplant patients
Authors: Frame Sharon
Published: May 2014

Transplant patients experience many health complications, either from their immunosuppressive drugs therapy, their primary disease or time spent on dialysis. Some of these complications can be prevented by early detection and prompt management. Here, Sharon Frame describes a new clinic offering a complete health review for patients who had a kidney transplant for over 10 years.
Back to basics: practice guidelines for correct hand hygiene
Authors: Jenkins Karen
Published: May 2014

Hands play a main role in the transmission of infection. To prevent infections, all health professionals need to understand the importance of hand hygiene. Renal patients are particularly susceptible to health care associated infections, so everyone coming into contact with these vulnerable patients needs to be able to perform the relevant hand hygiene procedures correctly. This is Karen Jenkins' overview.
The UK's first dialysing canoeist
Authors: MacRae Martin
Published: May 2014

Martin MacRae reflects on his transformation from a healthy oil engineer to being diagnosed with chronic kidney disease, fighting his fear of needles and being the first man in the UK to dialyse in the great outdoors on a remarkable six-day, cross-Scotland, canoe trip.
Working smarter as a renal matron in a busy renal department
Authors: Bailey Leo
Published: May 2014

Leo Bailey gives an overview of how she as a Renal Matron employs new ways of working to meet the current NHS challenges. Staying accessible, visible and approachable to her staff and patients, she embraces delegating to team members as well as using new technology to create a renal department that is happy and forward thinking, delivering patient-centred care wherever it is needed most.
Practical advice for returning to school after a kidney transplant
Authors: Walsh Grainne , Gamston Fiona , Roberts Denise
Published: May 2014

Going back to school after a kidney transplant can present many challenges for the children, their parents, teachers and friends. School days missed may be difficult to make up, infections can pose threats to the new kidney, and anti-rejection medication may change the child's body. Grainne Walsh, Fiona Gamston and Denise Roberts outline how to support children re-integrating into normal life.
Back to basics: the complications of long-term haemodialysis
Authors: Ellis Peter
Published: May 2014

With this back-to-basics-article, Peter Ellis highlights the most common complications associated with long-term haemodialysis. Dialysis nurses caring for patients with chronic kidney disease need a good understanding of the potential problems and complications they have to look out for and help manage. Awareness and knowledge of potential problems contributes to continually improving patient care.
The challenges facing renal nurse managers
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Peter Ellis and Jane Abbott outline the dilemmas and problems renal nurse leaders and managers face at work. These challenges range from being the right role model for their staff and visible to everyone on the ward to communicating well and motivating team members—even difficult ones. Perhaps the most difficult challenge is to understand and implement change, a permanent feature of health care.
Acute kidney injury (AKI): current guidelines and changes
Authors: Lewington Andrew JP
Published: May 2014

In this article, Andrew Lewington gives a definition and overview of acute kidney injury (AKI), including the changes made in the revised clinical guidelines published by the Renal Association and Kidney Disease: Improving Global Outcomes (KDIGO), as well as other helpful AKI guidance. These changes will enable the earlier recognition of patients at risk and result in better patient outcomes.
Improving patients outcomes: acute kidney injury
Authors: Patel Ankur
Published: May 2014

Acute kidney injury (AKI) is a serious illness that can develop suddenly, even in previously healthy patients. Recovery may be slow and, in some patients, AKI can lead to chronic kidney disease (CKD) and death. Ankur Patel describes the urgency of this illness—for the patient as well as society in general—and describes ways to improve diagnosis and management of this life-threatening illness.
Developing a dialysis access service: the role of the dialysis access nurse
Authors: Grieve Rona
Published: May 2014

Rona Grieve describes how the expansion of a haemodialysis service was facilitated by a new dialysis access nurse role. The author outlines key objectives of this designated role and reports how, through the use of audit, these objectives are being met to date. In particular, the service, which involves a one-stop access clinic and link nurses in each dialysis unit, has worked to reduce tunnelled line rates.
The effect of smoking on the kidneys
Authors: Cope Graham F
Published: May 2014

Graham Cope outlines the ways in which smoking impairs both kidney function and prognosis in kidney disease. Knowledge of the negative impact of cigarette smoking in renal disease can assist the nurse in educating and supporting patients in smoking cessation.
Pregnancy after renal transplantation
Authors: Chowdhury Paramit , Harding Kate , Nelson-Piercy Catherine
Published: May 2014

Renal transplantation offers women with end-stage kidney disease the opportunity to become pregnant with a high chance of successful outcomes. However, data reveal a high rate of complications, including pre-eclampsia, pre-term delivery and low birth weight. Careful consideration needs to be given to the potential conflict between safety of the fetus and of the allograft, particularly in the choice of immunosuppressants. To optimise the chances of a successful outcome, pregnancies should be carefully planned at a time of graft stability and medication changed to minimise the risk of congenital malformations.
Disease profile: idiopathic retroperitoneal fibrosis
Authors: Cope Graham
Published: May 2014

Idiopathic retroperitoneal fibrosis is an uncommon but important disease that causes hardening of the tissues that surround the kidneys and major blood vessels. It can result in hydronephrosis and vascular aneurysms. Its diagnosis relies on radiography and treatment requires prompt surgical and drug interventions to halt its progression. Graham Cope gives an outline.
The causes of drug-induced acute kidney injury
Authors: Ashley Caroline
Published: May 2014

Caroline Ashley gives an overview of drug-induced acute kidney injury (AKI), listing the causes and drugs that can potentially injure the kidneys and explaining the mechanisms by which the injury may be caused. Knowing the risk factors that increase the incidence of AKI after drug exposure and taking measures that help reduce risks will help prevent this potentially life-threatening emergency.
Hyper (high), kalium (potassium), aemia (in blood): hyperkalaemia
Authors: Jackson Helena
Published: May 2014

In this article, Helena Jackson explains what hyperkalaemia is and why renal patients are at an increased risk of developing this condition. She outlines the management of hyperkalaemia, which usually involves a low potassium diet. As potassium is ubiquitous in the diet, an awareness of potassium sources in the diet can help in restricting potassium intake. Renal nurses need to be aware of the wider implications of dietary restriction for the renal patient and the potassium-lowering diet should be regularly reviewed and individualised to optimise choice, palatability and nutritional quality.
The challenges of chronic kidney disease-mineral and bone disorder
Authors: Sharples Edward
Published: May 2014

Chronic kidney disease-mineral and bone disorder (CKD-MBD) occurs when the kidneys fail to maintain the proper levels of calcium and phosphorus in the blood. CKD-MBD is a common problem in people with kidney disease and affects almost all patients receiving dialysis. Edward Sharples in this article points to the guidelines available to manage this patient group and outlines the challenges and complexities of the available therapies and interventions.
Protein intake and the renal patient
Authors: Cope Graham
Published: May 2014

The dietary advice about protein intake for patients with chronic kidney disease is controversial. Here Graham Cope offers his insights about protein and protein-related diets for renal patients. However, the views expressed in this article may not necessarily be shared with all authorities.
Back to basics: acute kidney injury II
Authors: Ellis Peter
Published: May 2014

This is the second of a series of articles looking at acute kidney injury (AKI). Here Peter Ellis explains the policy context that underpins the management of AKI in the UK, as well as the national and international guidelines and the diagnostic and staging criteria that relate to AKI.
In the media: the Liverpool Care Pathway for the Dying Patient
Authors: Davies Annette
Published: May 2014

The Liverpool Care Pathway for the Dying Patient (LCP) was designed to allow people with a terminal illness to die with dignity. However, allegations have been made that people may have been placed on the LCP without their consent or knowledge, and sinister motives for doing so were quoted in a number of newspapers. Here Annette Davies discusses these accusations.
Body composition monitoring to manage fluid status in haemodialysis
Authors: Lindley Elizabeth , Keane David
Published: May 2014

Haemodialysis patients with little or no urine output usually experience periods of overhydration as they accumulate fluid between treatments through intake of salt and water. Many are also dehydrated when fluid is removed during dialysis. The time-averaged deviation from normal hydration will depend on the patient's fluid status after dialysis and his or her interdialytic fluid gains. Attempts to minimise the adverse effects of abnormal hydration begin by setting patients' ‘target’ weight to optimise their post-dialysis fluid status. However, the clinical indicators that are traditionally used to adjust target weight can be ambiguous or misleading. Body composition monitoring using multifrequency bioimpedance measurements can now provide an objective assessment of fluid status. The measurements are non-invasive and can be made in a few minutes before or after dialysis. If added to the complete clinical picture, this technology can improve outcomes and quality of life for patients.
Paste-impregnated bandages
Authors: Eagle M.
Published: May 2014

A review of the uses of bandages impregnated with paste and their application in the treatment of leg ulceration.
How compression therapy works
Authors: Williams R.J. , Wertheim D. , Melhuish J. , Harding K.G.
Published: May 2014

A review of some of the basic theories of compression therapy and identification of areas for ongoing research
The development of an in-house leg ulcer management course
Authors: Day S.
Published: May 2014

A description of a course designed to standardise leg ulcer management.
A comparison of sub-bandage pressures produced with two multi-layer bandaging systems
Authors: Taylor A.D. , Taylor R.J.
Published: May 2014

Fourteen nurses with experience in the use of high-compression bandaging were asked to bandage the same limb with two different bandaging systems: the ‘Charing Cross’ four-layer regimen (System A), and a modified system incorporating two new bandages (System B). A sub-bandage pressure monitor was used to quantify the efficacy of the resulting bandaging for the two systems.

The results indicated that there was no significant difference between site sub-bandage pressures achieved using the two bandaging systems. Sub-bandage pressure profiles, however, fluctuated with patient posture, the best profiles being obtained with System B and the patient in the sitting position.
The prevention of pressure ulcers in the operating department
Authors: Scott E.M.
Published: May 2014

An innovative approach using a multiple-study research programme that incorporated five individual projects, each of which can be interpreted independently or as an integral part of the whole
A non-healing leg ulcer associated with malignant lymphoma
Authors: Natarajan S. , Makhdoomi K.R. , Turner A.R.
Published: May 2014

A case report highlighting the need to consider unusual causes when treating patients with non-healing venous leg ulcers
When is reduced-compression bandaging safe and effective?
Authors: Arthur J. , Lewis P.
Published: May 2014

During a one-year period 44 patients were treated with reduced-compression bandaging in the vascular unit at a district general hospital in the UK. Twenty patients with venous ulcers were referred from community leg ulcer clinics because they could not tolerate standard compression bandaging (group 1). A further 24 patients had mixed aetiology leg ulcers (group 2), and high-compression bandaging was not attempted because of significant peripheral vascular disease (ankle brachial pressure index <0.8).

Forty-two patients tolerated reduced-compression bandaging without discomfort or skin pressure changes. Healing was achieved in 32 patients (13 in group 1 and 19 in group 2). All non-healed ulcers were considered smaller at the time of final follow-up and had less exudate.

Reduced-compression bandaging has been shown to be effective and well tolerated by patients with venous ulcers who cannot comply with high-compression bandaging. With close supervision, it is safe to use in patients with significant peripheral vascular disease.
Wound care guidelines and formulary for community nurses
Authors: Baeyens T.A.
Published: May 2014

A handbook developed by systematic evaluation of research has been given to every community nurse in one primary care trust to help shift decision-making towards an objective approach

Community nursing is experiencing significant change as a result of developments such as improved technology, care in the community and earlier discharge of patients from hospital. Because of this, increasingly complex clinical care is required in the community, and it has been noted that community nurses are ‘under considerable pressure’ and show ‘evidence of high stress and low morale’.3

Wound care is one area in which community nurses constantly battle to keep abreast of continual change. Growing product availability and diversity of use, changes in dressing techniques and the ever-increasing costs associated with wound care mean decision-making in wound care is often a complex task.

In the Grampian region, a handbook of evidence-based practice guidelines with a product formulary was developed and distributed to all community nurses. The handbook was designed to ease the decision-making process by evaluating evidence-based practice and local preferences to recommend and guide nurses towards effective clinical practice and cost efficiency.

All grades of district nurse in the region have been issued with their own copy of the handbook. It is presented in an A5 ringbinder format to make it easy to carry and to facilitate updating using loose-leaf inserts. The use of logos, extra information boxes and colour coding makes it easy for users to find specific areas of interest in the handbook. The success of the handbook has led to debate on the potential for development of a similar resource for use by practice nurses and in local community hospitals.
The use of pressure therapy to treat hypertrophic scarring
Authors: Rayner K.
Published: May 2014

A review of the evidence regarding pressure therapy to minimise burn scars
Recovering maxillofacial trauma patients: the hidden problems
Authors: Sen P. , Ross N. , Rogers S.
Published: May 2014

This longitudinal study highlights the psychological and functional problems that can result from maxillofacial trauma. This is the first study to report outcome at one year. A total of 147 patients admitted for surgery following facial trauma were recruited over a seven-month period. Three questionnaires were used to record patient-derived levels of dysfunction: the Hospital Anxiety Depression scale, a modified University of Washington Quality of Life questionnaire and five non-validated facial trauma items.

At one year 46 patients (31%) responded. Although there were significant improvements in scores from pre-operatively to one year, with all patients being discharged from outpatient follow-up, there was a substantial level of subjective symptomatology. Most notable was the level of anxiety and depression, which were present in 30% of the sample at both time points.

Health-care professionals tend to underestimate the long-term effects of maxillofacial trauma. To improve patient care, greater appreciation of these problems is required at the time of initial management.
The K-Four bandage system: evaluating its effectiveness on recalcitrant venous leg ulcers
Authors: Vowden K.R. , Wilkinson D. , Vowden P.
Published: May 2014

This evaluation examined the effectiveness of the K-Four (Parema) high compression bandage system on 50 patients with recalcitrant ‘hard-to-heal’ venous leg ulcers and relates the outcome to an earlier randomised study which compared three other four-layer bandage systems.
How a discipline came of age: a history of wound care
Authors: Baxter H.
Published: May 2014

As the Journal of Wound Care celebrates its tenth anniversary, now is a good time to reflect on how our discipline has grown over the years. Here, Helena Baxter charts the advances in wound management that have made such a difference to our day-to-day practice and describes the exciting developments that lie ahead.
Why do some cavity wounds treated with honey or sugar paste heal without scarring?
Authors: Topham J.
Published: May 2014

As well as having antimicrobial properties, honey and sugar paste are associated with scarless healing in some cavity wounds. This article uses evidence to suggest why these products can modify excessive collagen production to prevent scarring.
Identifying protein production in wound healing: current techniques
Authors: Pleat J.M. , Hebestreit H.F. , Dwek R. A.
Published: May 2014

Proteins regulate wound healing. Knowledge of the proteins present in poorly healing wounds may reveal new targets for treatment. This article describes how proteomics can be used to help identify the proteins involved in wound healing.
A histological comparison of acute inflammatory responses with a hydrofibre or tulle gauze dressing
Authors: Hoekstra M.J. , Hermans M.H.E. , Richters C.D. , Dutrieux R.P.
Published: May 2014

Objective:

This study analysed the physical properties of Aquacel hydrofibre dressing in rat partial-thickness wounds, focusing on the acute inflammatory infiltrate of granulocytes and macrophages in the wound and the dressing.

Method:

Partial-thickness wounds (2×2cm) were made on the back of 60 anaesthetised male Wistar rats and covered with Aquacel (n=30) and tulle gauze (n=30). The rats were killed on postoperative days one, two, three, four, seven and 10 (10 animals per day and five per dressing). Re-epithelialisation and Polymorphonuclear (PMN), fibronectin and macrophage activity were then analysed.

Results:

PMN leucocytes (granulocytes) were captured in the dressing and remained active there, resulting in a reduced number in the wounds when compared with tulle gauze. A fibrin layer formed between the dressing and the wound, creating a physical barrier. Macrophages infiltrated the wound bed but could not be detected in the dressing. Little inflammation was observed in the wound bed and the macrophages operated primarily in the repair mode. Active PMNs in the dressing provided an appropriate antimicrobial environment. Tulle materials became embedded in wounds and were associated with a more disturbed pattern of epithelial outgrowth. Aquacel stayed ‘on top’ of wounds, with only minimal incorporation into the superficial epidermis.

Conclusion:

The observations of the physical properties of different materials and their histological consequences correlate well with published clinical results, particularly in relation to the speed of re-epithelialisation and the level of scarring.

Declaration of interest:

None.
Effect of bacteriological status on pressure ulcer healing in patients with advanced cancer
Authors: Sopata M. , Luczak J. , Ciupinska M.
Published: May 2014

Objectives:

This study aimed to identify the quantitative and qualitative bacteriological status of pressure ulcers in patients with advanced cancer, and the effects on the healing process.

Method:

We recruited 34 patients with advanced cancer who had 38 superficial grade II and III pressure ulcers. Patients were randomly allocated to treatment with Lyofoam/polyurethane foam dressing (Seton) or Aquagel/hydrogel dressing (Wytw.Opatrunków). Efficacy, treatment times and healing rates were noted. Qualitative studies were undertaken on 38 pressure ulcers and quantitative bacteriological studies on 19 ulcers.

Results:

There was no statistical difference between the two treatment groups in efficacy, healing rates and treatment times. Bacteriological assessment identified 92 species.

Conclusion:

The bacteria did not cause any clinical signs of infection. Variations in the number and types of bacteria in individual wounds did not correlate to the grade of ulcer or the dressing used.

Declaration of interest:

None.
Insight into the development of non-adherent, absorbent dressings
Authors: Rajendran S. , Anand S.C.
Published: May 2014

Objective:

This study aimed to develop a variety of wound dressing materials, made from standard natural fibres, that have high absorption and non-adherent characteristics.

Method:

A total of 21 dressings were made using knitted and crochet technologies and their absorbency was tested. Five non-adherent recipes were selected from a range of chemical formulations and the optimised non-adherent finishes were applied to the four best dressings. Their absorbency and non-adherent properties were evaluated.

Results:

The study demonstrated that rib cotton (RC), rib viscose (RV), crochet cotton medium (CCM) and crochet viscose medium (CVM) dressings possess high absorption and that five finishing recipes, C+D, A+G, I, I+N and I+G, impart high absorption as well as non-adherent properties. The finish I+G is superior in imparting non-adherence to RV dressing, both in dry and moist conditions. This means that irrigation with water, saline or sodium citrate solution before removing the dressing from a wound is not needed.

Conclusion:

A number of novel knitted and crochet structures with enhanced absorbency have been designed for wound management using standard bleached fibres. Novel non-adherent finishes for the developed structures have been formulated for the developed dressings, and offer an alternative to existing non-adherent dressings.

Declaration of interest:

This was jointly funded by Alcare Co. Ltd., Japan and Bolton Institute, UK.
From the journals
Authors: Baxter Helena
Published: May 2014

Microvascular disease in the diabetic foot is a wellknown complication, but there are arguments as to whether or not this phenomenon actually exists. However, it is agreed that functional abnormalities do occur in the microcirculation, such as compromised vasodilatory response.
The use of oxidised cellulose as a topical haemostatic dressing on a bleeding stomal wound
Authors: Lawrentschuk N. , Hewitt P.M.
Published: May 2014

Surgical staff were unable to obtain haemostasis using standard methods, such as suturing, in a patient undergoing stomal construction. Topical application of oxidised cellulose stopped the haemorrhaging within seconds with no ill effects.
Implementation of pressure ulcer guidelines: what constitutes a successful strategy?
Authors: Tooher R. , Middleton P. , Babidge W.
Published: May 2014

Various guidelines on pressure ulcer prevention and management have been produced but their recommendations are not always applied to practice. Does the literature provide any evidence on how they can best be implemented?
Pressure-relieving properties of a intra-operative warming device
Authors: Baker E.A. , Leaper D.J.
Published: May 2014

Objectives:

The primary objective of this study was to determine differences in interface pressure between four mattress combinations: a standard operating table mattress, a pressure-relieving gel pad and an under-patient warming device set at 38°C (Pegasus Inditherm System) and at ambient temperature. The secondary objective was to determine whether the warming device remains stable in extreme surgical positions.

Method:

Interface pressures obtained with all four combinations were measured in 10 healthy volunteers using force sensing array technology.

Results:

The warming device demonstrated better or equivalent pressure relief when compared with the standard gel pad. There was no significant difference in subject position ‘shift’ between the mattress, the gel pad and the warming device for either the Trendelenberg or reverse Trendelenberg positions.

Conclusion:

Both pressure-relieving mattresses and warming reduce intra-operative pressure damage. A mattress with both properties may further reduce pressure damage postoperatively. The warming device used in this study appears stable — subject ‘slippage’ was minimal in extreme positions. Research needs to be conducted among real anaesthetised patients to support these conclusions.

Declaration of interest:

This study was funded by a research grant from Pegasus Ltd. The study design, conduct and presentation remain the sole responsibility of the authors.
A review of research investigating pain and wound care
Authors: King B.
Published: May 2014

Health-care professionals need to understand pain development and assessment, which should be undertaken at every treatment. This review outlines available research findings and highlights the problems that exist in measuring pain.
An investigation into the wound-healing properties of essential oil of Ocimum gratissimum Linn
Authors: Orafidiya L.O. , Agbani E.O. , Abereoje O.A. , Awe T. , Abudu A. , Fakoya F.A.
Published: May 2014

Objective:

To investigate the effects of Ocimum oil and two antibacterial preparations, Cicatrin (GlaxoWellcome) and Cetavlex (AstraZeneca), on the healing of full-thickness excisional and incisional wounds, created under anaesthesia, on the back of test and control groups of adult albino rabbits.

Method:

Treatment was by topical application of the test substances onto the wound surface for 15 days. Observation continued for a further six days. Quantitative parameters of wound healing were determined daily. Swabs were taken from wound sites that appeared not to be healing for identification of wound contaminants and sensitivity tests.

Results:

There was a marked enhancement in the inflammatory and proliferative phases of wound healing in the rabbits treated with Ocimum oil, suggesting that the oil facilitated the healing process to a greater extent than the control and reference products. Wounds treated with Cetavlex showed no sign of healing for eight days but responded to Ocimum oil after a three-day wash-out period.

Conclusion:

The essential oil Ocimum gratissimum can promote wound healing. However, large studies will need to be carried out using domestic pigs, followed by clinical trials on human wounds.

Declaration of interest:

None.
A randomised controlled trial comparing Drawtex with standard dressings for exuding wounds
Authors: Reynolds T. , Russell L. , Deeth M. , Jones H. , Birchall L.
Published: May 2014

Objective:

This randomised controlled clinical trial compared a capillary dressing (Drawtex, now rebranded as Vibriant RCD [Vibriant Technology Services]) with routine practice for exuding wounds greater than 2.5 x 2.5cm.

Method:

The target population was 300 control and 300 test subjects across three sites in the UK, but recruitment difficulties resulted in only 125 patients being evaluable. Wound progress was recorded by nurses’ perception of the progress of wound healing and by objective digital imaging. In the final analysis digital images were randomised (in time order) and a panel of nurses who were not otherwise involved in the research project graded the wound’s progress.

Results:

After deconvolution of the data, the subjective (nurse perception) method of evaluation determined that the new dressing resulted in wound improvement in 12.7% more patients than did routine practice, but the blinded assessment method (based on the digital images) showed that routine practice was better by 6.6%.

Conclusion:

Evaluation of wound progress is clearly difficult. Human nature makes us favour novelty if we believe it is going to be better. Making interpretation more objective removed that bias and did not demonstrate a significant advantage for the test dressing. The findings suggest that unblinded assessment by trial nurses is unacceptable on its own. Blinded assessments may miss finer nuances of wound progression, but are likely to be more accurate. The authors suggest that the true result lies somewhere in the middle, with the trial dressing likely to be as effective as, but not more effective than, a standard dressing.

Declaration of interest:

This trial was funded by Vibriant Technology Services.
Phytotherapy: an alternative treatment for non-healing ulcers
Authors: Avijgan M.
Published: May 2014

At the time of death, 24% of Americans have at least one grade II or higher pressure ulcer. The loss of skin integrity has significant consequences not only for the individual, but also for the community, with pressure ulcer care reportedly costing $8.5 billion.
Pressure ulcers and nutrition: a new European guideline
Authors: Clark M. , Schols J.M.G.A. , Benati G. , Jackson P. , Engfer M. , Langer G. , Kerry B. , Colin D.
Published: May 2014

The European Pressure Ulcer Advisory Panel (EPUAP) has developed a new practice guideline covering the role of nutrition in pressure ulcer prevention and treatment. This guideline highlights that until now there has been no strong scientific evidence of a direct relationship between poor nutrition and pressure ulceration. Nevertheless, mal nutrition is considered to play a role in pressure ulcer development and healing.
Foreword
Authors: Glover Deborah
Published: May 2014

On 21 and 22 January 2004 more than 100 specialist nurses and health-care experts from across the UK met at the Marriott Forest of Arden Hotel and Country Club, Warwickshire, for the third Science of Surfaces conference sponsored by Hill-Rom.
A critical review of the literature on pressure ulcer aetiology
Authors: Thompson D.
Published: May 2014

Pressure ulceration is commonly ascribed to pressure and shear forces, yet its development is caused by a complex multifactorial series of events. This paper concentrates on areas that have been subjects of controversy:
Preventing the occurrence of pressure ulceration in hospitalised elderly patients
Authors: Meaume S. , Colin D. , Barrois B. , Bohbot S. , Allaert F.A.
Published: May 2014

Objective:

To determine which factors contribute to the development of pressure ulcers and to evaluate the role of topical agents in preventing their occurrence.

Method:

An observational, prospective survey covered 36 care of the elderly wards and involved 1121 patients at high or very high risk of pressure ulceration. The patients, of whom 667 (59.6%) received a gentle application of a topical agent to at-risk areas, were followed up for eight weeks.

Results:

Of the patients, 15.7% developed a pressure ulcer. The use of a corpitolinol 60-based topical agent (Sanyrène/Corpitol) significantly reduced the incidence of pelvic pressure ulcers (p=0.04) when used with recognised prevention strategies. This was identified by undertaking a logistic regression analysis. The resulting odds ratio of 0.61 indicates that the intervention helped to reduce the number of pressure ulcers by 40%.

Conclusion:

The results of this observational study can provide a useful guide to the design of further randomised controlled trials.

Declaration of interest:

Sponsored by Laboratoires Urgo (France).
Estimating costs of pressure area management based on a survey of ulcer care in one Irish hospital
Authors: Gethin G. , Jordan-O’Brien J. , Moore Z.
Published: May 2014

Objective:

Pressure ulceration remains a significant cause of morbidity for patients and has a real economic impact on the health sector. Studies to date have estimated the cost of management but have not always given a breakdown of how these figures were calculated. There are no published studies that have estimated the cost of management of pressure ulcers in Ireland. A two-part study was therefore undertaken. Part one determined the prevalence of pressure ulcers in a 626-bed Irish acute hospital. Part two set out to derive a best estimate of the cost of managing pressure ulcers in Ireland.

Method:

The European Pressure Ulcer Advisory Panel (EPUAP) minimum data set tool was used to complete the prevalence survey. Tissue viability nurses trained in the data-collection tool collected the data. A cost was obtained for all items of care for the management of one patient with three grade IV pressure ulcers over a five-month period.

Results:

Of the patients, 2.5% had pressure ulcers. It cost ₠119,000 to successfully treat one patient.

Conclusion:

We estimate that it costs ₠250,000,000 per annum to manage pressure ulcers across all care settings in Ireland.

Declaration of interest:

None.
Efficacy of advanced dressings in the treatment of pressure ulcers: a systematic review
Authors: Bouza C. , Saz Z. , Muñoz A. , Amate J.M.
Published: May 2014

A meta-analysis of published research enabled dressing efficacy to be estimated. Comparisons showed greater efficacy of hydrocolloid dressings but failed to confirm advantages of other advanced dressings compared with conventional ones.

Local care of pressure ulcers is an essential aspect of their treatment. However, and despite great progress in knowledge of the biology of healing, the local management of pressure ulcers is not standardised, nor are there definitive data on the best way to treat them.
The effects of malodorous fungating malignant wounds on body image and quality of life
Authors: Young C.V.
Published: May 2014

Malodour is a common symptom of fungating malignant wounds. This paper reviews the literature to explore the transition, caused by malodour, from normal to altered body image, and the assessment strategies that can be used by nurses
Ingredient-based wound dressing classification: a paradigm that is passe and in need of replacement.
Authors: van Rijswijk L.
Published: May 2014

Much has changed since honey, lint, and grease were recorded in 1650 as the standard treatment for wounds.1 However, Hippocrates, not unlike today’s practitioners, struggled with the concept of ‘wet and dry’.2 For example, he observed that ‘we must avoid wetting ulcers except with wine unless the ulcer be situated in a joint…’ but recognised that ‘dried up ulcers prevent them from healing by getting into a state of putrefaction and corruption.’
Effect of window casts on healing rates of diabetic foot ulcers
Authors: Agas C.M. , Bui T.D. , Driver V.R. , Gordon I.L.
Published: May 2014

Management of diabetic neuropathic foot ulcers is based on certain principles: effective pressure offloading from the wound using specialised shoes, cast braces, or casts; removal of infected or necrotic tissue using surgery or nonsurgical methods, such as topical protease therapy; optimisation of wound healing by interventions such as nutritional support, optimal moisture balance and growth factor therapy.
Honey dressing versus paraffin tulle gras following toenail surgery
Authors: McIntosh C.D. , Thomson C.E.
Published: May 2014

Objective:

Anecdotal reports suggest that certain honey dressings have a positive effect on wound healing. However, there is limited empirical evidence supporting its use. This double-blind randomised controlled trial investigated the effect of a honey dressing on wound healing following toenail surgery with matrix phenolisation.

Method:

Participants (n=100) were randomly assigned to receive either an active manuka honey dressing (n=52) or paraffin-impregnated tulle gras (n=48). The primary outcome was time (days) taken for complete re-epithelialisation of the nail bed.

Results:

Mean healing times were 40.30 days (SD 18.21) for the honey group and 39.98 days (SD 25.42) for the paraffin tulle gras group. Partial avulsion wounds healed statistically significantly faster (p=0.01) with paraffin tulle gras (19.62 days, SD 9.31) than with the honey dressing (31.76 days, SD 18.8), but no significant difference (p=0.21) was found following total avulsion when comparing honey (45.28 days, SD 18.03.) with paraffin tulle gras dressings (52.03 days, SD 21.3).

Conclusion:

The results suggest that patients may benefit more from paraffin tulle gras dressings than honey dressings following partial toenail avulsion. No statistically significant difference was found for healing times after total toenail avulsion, although the marginal benefit of the honey dressing on these healing times warrants further investigation.

Declaration of interest:

None.
Clinical efficacy of horsechestnut seed extract in the treatment of venous ulceration
Authors: Leach M.J. , Pincombe J. , Foster G.W.
Published: May 2014

Objective:

To evaluate the clinical efficacy of orally administered horsechestnut seed extract in the treatment of venous leg ulcers.

Method:

In a prospective triple-blind randomised placebo-controlled trial, 54 patients with venous leg ulcers from a large South Australian community nursing service were randomly allocated to receive horsechestnut seed extract (n=27) or placebo (n=27) for 12 weeks. Ulcers were assessed at weeks 0, 4, 8 and 12 utilising a wound assessment tool and the Alfred/Medseed Wound Imaging System.

Results:

The difference between groups in the number of healed leg ulcers and change in wound surface area, depth, volume, pain and exudate was not statistically significant. However, horsechestnut seed extract did have a significant effect on the percentage of wound slough over time (RM-ANOVA F=2.76, p=0.045) and on the number of dressing changes at week 12 (t=-2.71, p=0.009).

Conclusion:

Even though horsechestnut seed extract is likely to attenuate the pathogenesis of venous insufficiency and, in turn, facilitate venous ulcer healing, the current study did not statistically support such a claim. However, taking into account the small sample and insufficient power of the trial, and the significant improvement in wound slough and visit frequency, it appears that it may be useful in the management of venous leg ulcers.

Declaration of interest:

None.
Evaluation of two absorbent silver dressings in a porcine partial-thickness excisional wound model
Authors: Bell A , Hart J
Published: May 2014

Objective:

To investigate and compare the performance of two widely used silver-containing, fibre-based dressings (Silvercel and Aquacel Ag) in terms of exudate management, wound-site adherence, dressing integrity, retention of dressing debris within wounds, frequency of debris-associated foreign body reactions and the impact of both debris and tissue reactions on wound-tissue integrity.

Method:

The dressings were evaluated in a porcine partial-thickness exudating wound model (an in vivo model of moderate to high exudation up to post-wounding day 4, and low exudation from days 4 to 7). Dressing performance was assessed using a panel of semi-quantitative scales. Wound-exudate retention, dressing structure following exposure to exudate, and adherence to wound tissues were compared macroscopically; the extent of trapped dressing debris, any ensuing tissue reactions and the level of resulting tissue disruption were compared histologically.

Results:

Silvercel was found to be significantly more effective in terms of wound exudate management than Aquacel Ag. On exposure to high levels of wound exudate, Silvercel retained its shape and mechanical strength, and remained at the site of application. In contrast, Aquacel Ag formed a fluid (semi-fibrous) gel, with minimal mechanical integrity and variable retention at the wound site. Silvercel was significantly more adherent to wound tissues than Aquacel Ag, but the level of trapped dressing debris, the frequency of ensuing foreign body reactions and the level of consequent wound-tissue disruption was lower, although not statistically, in the Silvercel-treated wounds.

Conclusion:

These results suggest that the potential adverse clinical consequences of unmanaged wound exudate may be less likely in Silvercel than Aquacel Ag-treated wounds. In addition, the adverse effects of dressing adherence may be less likely in Aquacel Ag-treated wounds, although such benefits may be negated by the potentially deleterious effects of elevated dressing debris deposition. In view of these findings, further development of absorbent fibre-based dressings should be directed at maximising exudate management, minimising dressing adherence and preventing dressing-debris entrapment.

Declaration of interest:

This study was funded by Johnson & Johnson Wound Management. Cica Biomedical is an independent contract research company, and neither author has any interest in the sponsor’s commercial activities.
Resin salve from the Norwegian spruce tree: a ‘novel’ method for the treatment of chronic wounds
Authors: Sipponen A. , Jokinen J.J. , Lohi J.
Published: May 2014

Infected pressure ulcers are a common clinical problem in institutions and wards that care for older patients with chronic illnesses. These ulcers are difficult to treat and are a source of hospital-acquired infection. Modern treatment options, such as hydrogels, are frequently ineffective and expensive, and patient outcomes are often poor.