bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure sore survey Part 3: locus of control
Authors: Maylor M. , Torrance C.
Published: May 2014

This is the third in a three-part article which investigates the prevalence, knowledge and attitudes to pressure sores in one NHS trust. This study describes the methodology used in choosing and developing attitude scales to explore whether there are any relationships between the locus of control and pressure sore prevention. Factors to do with attitude and the value associated with pressure sore prevention have a central role. Attitudes and beliefs affect what we do and may contribute to pressure sore development.
Graduated compression and the prevention of deep vein thrombosis (Part 3)
Authors: Thomas S.
Published: May 2014

The third of this three-part literature review discusses the effects of external compression on deep vein thrombosis formation and suggests design criteria for antiembolism stockings
The use of larval therapy in wound management in the UK
Authors: Courtenay M.
Published: May 2014

This study identifies hospitals and institutions in the UK using larval therapy, and determines how this therapy is clinically managed in 23 of them. A qualitative approach was adopted, with the collection of documentary evidence and data from semi-structured interviews. Larval therapy is currently used in over 350 hospitals and institutions in the UK in the treatment of a variety of wound types. It was evident from the findings that it is generally used as a last resort. However, in two hospitals, this treatment method Is part of the hospital's wound management policy. Nurses were able to identify wounds that have a better response to larval therapy and recognise symptoms that may occur during treatment. A number of wound types were found to be ‘difficult’ with regards to larvae application, and nurses had developed their own practices involving the application of dressings and the length of time larvae were left on wounds. Patients receiving this treatment reported few symptoms. It was claimed that larval therapy is particularly effective against methicillin-resistant Staphylococcus aureus (MRSA).
The management of fungating wounds
Authors: Grocott P.
Published: May 2014

A critical overview of approaches to the management of fungating lesions.
The identification and treatment of slough
Authors: Tong A.
Published: May 2014

A review of the problems encountered by clinicians in identifying slough in wounds and selecting debridement therapies for its removal.
The role of the specialist nurse in diabetic foot ulceration
Authors: Rayman A.
Published: May 2014

A review discussing the evolving role of the diabetes specialist nurse in the foot clinic
Developing skills in leg ulcer nursing: the lessons learned
Authors: Loftus S. , Wheatley C.
Published: May 2014

The high treatment costs of inappropriate leg ulcer management are well referenced. Wide variations in practice have also been reported. A training programme for community nurses has been in place in Leicestershire and Rutland NHS Trust for five years. Its objective is to promote evidence-based leg ulcer management.

The aim of this prospective audit was to assess and compare the effectiveness of the compression bandage systems used in the trust: the original Charing Cross system (August 1996 to September 1997) and Robinson's Ultra Four kit (October 1997 to December 1998). All patients with leg ulceration were assessed using the Leicestershire leg ulcer assessment form. This was submitted along with an audit tool to the tissue viability service in exchange for a 12-week supply of compression bandages. The audit form was resubmitted after each subsequent 12-week period until the patient either had healed or was withdrawn from the audit.

Differences between the two groups in mobility, previous deep vein thrombosis, fixed ankle deformity, the male to female ratio, duration of ulcer and ulcer surface area were noted. Patients using the Ultra Four kit had faster healing times than those given the Charing Cross system, but this was not statistically significant. Cost comparisons between the previous dressing regimen and compression bandaging showed a significance difference (p<0.001). There was also a significant reduction in nurse time (p<0.001).

The audit results showed that compression bandaging therapy was an effective method of achieving healing in patients with venous leg ulcers and that significant cost savings were made in terms of dressing cost and nurse time. Furthermore, there were potential benefits in continuing compression therapy for the group of non-healers.
Alginate dressings in surgery and wound management: part 2
Authors: Thomas S.
Published: May 2014

This second in a three-part series looks at the use of seaweed-derived dressings in specific types of wounds
Hypergranulation tissue at gastrostomy sites
Authors: Rollins H.
Published: May 2014

This paper looks at some of the wound-care issues surrounding enteral tube feeding, and questions the evidence base for current practices, which can be ritualistic
Developing a new wound care formulary and guidelines
Authors: Westwood R.
Published: May 2014

Following an audit of the existing would care formulary and guidelines, an updated version was developed, containing additional products and information. This was revised following advice from a range of professionals, then pilot tested on ward-based nurses. The nurses found the updated formulary useful. and made recommentations for changes to the wound care ordering system in the trust. Future guidelines will be regularly updated as developments in would care occur.
Should burn blisters be left intact or debrided?
Authors: Flanagan M. , Graham J.
Published: May 2014

The management of burn blisters is surrounded by controversy and the literature is divided on whether they should be left intact or debrided. This review explores the research evidence.
Hospital-acquired heel ulcers: a common but neglected problem
Authors: Donnelly J.
Published: May 2014

The development of hospital-acquired pressure ulcers on the heel is a growing problem. The best way of preventing this is to ensure the heel is completely free from pressure.
Knowledge is power
Authors: Vowden K.R. , Vowden P.
Published: May 2014

Only by setting up national benchmarking with detailed information on patients, treatments and outcomes will the care of chronic wounds improve
Cleansing traumatic wounds with swabs, water or saline
Authors: Towler Jo
Published: May 2014

This article reviews current methods of cleansing and irrigating topical wounds, highlighting the limitations of existing research and the need to develop a set of expert guidelines for practitioners
Burn wound management in patients with epilepsy: adopting a multidisciplinary approach
Authors: Josty I.C. , Mason W.T.M. , Dickson W.A.
Published: May 2014

Many burns that occur following an epileptic seizure are deep due to prolonged contact with the thermal source. Primary care staff need to be aware of this and ready to refer patients to a burns unit.
Is there a role for sustainable medicine in wound care?
Authors: Cavicchioli A.
Published: May 2014

Is it ethical to prolong life by providing aggressive palliative care to chronically ill patients with a short life expectancy? Here, Andrea Cavicchioli argues that epidemiology studies can help us to resolve this difficult ethical dilemma.
The healing properties of Promogran in venous leg ulcers
Authors: Vin F. , Teot L. , Meaume S.
Published: May 2014

Objective:

To evaluate the healing rate of venous leg ulcers treated with Promogran.

Method:

Patients with stagnating venous leg ulcers were recruited. Target wounds were ≥2cm but ≤10cm in any one dimension. Subjects were randomly allocated to receive either Promogran or a non-adherent dressing (Adaptic) with a secondary dressing of gauze followed by short-stress compression (Biflex). Weekly wound assessments occurred over 12 weeks and dressings were changed twice weekly by the investigator and/or nurse team. Planimetry tracings and photographs were blindly reviewed and assessed by two independent investigators. An intent-to-treat analysis was performed.

Results:

Seventy-three patients were included. Thirty-seven were randomly allocated Promogran and 36 Adaptic. Twenty-nine patients completed the 12-week follow-up visit, 25 healed before week 12 and 19 stopped follow-up before week 12 for reasons unrelated to healing. Significantly more patients in the Adaptic group than in the Promogran group switched to another dressing (22.2% versus 5.4%; p=0.035). Eleven venous leg ulcers healed in the control group (31%) and 15 in the Promogran group (41%) (p=0.373). Overall, 15 venous leg ulcers healed or improved in the control group (42%) and 23 in the Promogran group (62%) (p=0.079). Surface area decreased, on average, by 36.5 ±11.4% (median decrease: 44.6%) in the Adaptic group and by 54.4 +10.9% (median decrease: 82.4%) in the Promogran group (p<0.001). A ≤20% surface area reduction was observed in 15 patients in the Adaptic group and in seven in the Promogran group (42% versus 19%; p=0.034). No severe local adverse events were noted in either group, although poor tolerability caused a dressing switch in five patients in the control group and three in the Promogran group. Dressing acceptability was good or excellent in more than 60% of subjects in both groups.

Conclusion:

The results suggest that Promogran may accelerate healing in venous leg ulcers and was well tolerated compared with the current standard of care.

Declaration of interest:

This study was funded by Johnson and Johnson Wound Management, France.
Questions & answers
Authors: Butcher 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
Questions & answers
Authors: Vowden K.
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
Vacuum-assisted complex wound closure with elastic vessel loop augmentation: a novel technique
Authors: Moran S.G. , Windham S.T. , Cross J.M. , Melton S.M. , Rue III L.W.
Published: May 2014

Patients with serious abdominal or soft-tissue injuries may require multistaged surgical management. The Vacuum-Assisted Closure device, used in combination with a shoelace technique, can promote fascial and soft-tissue approximation
Putting words into action: the JWC/Mölnlycke Scholarship from the winner's perspective
Authors: King B.
Published: May 2014

Last September Brenda King won the Journal of Wound Care/Mölnlycke Scholarship, which consists of a professional and personal development programme to achieve individual goals. Funding of up to £2500 is available to support this. Here, Brenda describes the goals she set herself and how the programme is helping her to achieve them.
Importance of holistic nutritional assessment in wound healing
Authors: McIlwaine C.
Published: May 2014

Nurses have a key role to play in nutritional assessment of patients with chronic wounds. This paper argues that a holistic assessment of a patient's dietary history, with weekly or monthly weighing, should identify most cases of malnutrition.
Three centres of excellence for care of lymphoedema patients
Authors: King B.
Published: May 2014

Journal of Wound Care/Mölnlycke Scholarship winner Brenda King presents another progress report of her project to gain further information and education on lymphoedema, with a view to improving services in her locality.
The benefits of applying wound-bed preparation into practice
Authors: Fletcher J.
Published: May 2014

Are we proactive enough in our management of chronic wounds? Wound-bed preparation encourages practitioners to take multiple steps to identify the cause of delayed healing, making it easier to decide on the appropriate course of action.
Use of a Vacuum Assisted Closure device in pilonidal disease
Authors: Duxbury M.S. , Finlay I.G. , Butcher M. , Lambert A.W.
Published: May 2014

Pilonidal disease is a debilitating condition that can be difficult to treat. This case report shows how Vacuum Assisted Closure, which can be used on an outpatient basis, led to full wound healing in a patient with a recurrent form of this disease
Reliability and validity of DESIGN, a tool that classifies pressure ulcer severity and monitors healing
Authors: Sanada, H. , Moriguchi T. , Miyachi Y. , Ohura T. , Nakajo T. , Tokunaga K. , Fukui M. , Sugama J. , Kitagawa A.
Published: May 2014

Objective:

This study reviews the validity and reliability of DESIGN, a tool for classifying pressure ulcer severity and monitoring progression towards healing. Only the tool’s healing progression component was evaluated.

Method:

Inter-rater reliability was evaluated by calculating the agreement rate of scores, based on eight photos of pressure ulcers and six actual ulcers, made by a panel of seven nurses. Validity was assessed, using the same eight photos, by comparing DESIGN scores with those made using the validated Pressure Sore Status Tool (PSST).

Results:

The DESIGN inter-rater reliability results showed a high correlation of r=0.98 for the photos and r=0.91 for the real-life patients with pressure ulcers, respectively, for all seven raters based on total scores. For validity, a correlation greater than 0.91 was found between the DESIGN and PSST scores.

Conclusion:

Based on our results, DESIGN was found to have both high inter-rater reliability and high validity among the seven nurses who quantitatively evaluated the wound-healing progress of the pressure ulcers in this study.

Declaration of interest:

None.
From the journals
Authors: Baxter Helena
Published: May 2014

This paper describes a posthoc analysis of a teaching session that aimed to create a wound assessment form that would capture the dynamics of a wound’s progression or deterioration.
Nurse-led education sets out to improve patient concordance and prevent recurrence of leg ulcers
Authors: Brooks J. , Ersser S.J. , Lloyd A. , Ryan T.J.
Published: May 2014

Objective:

This study evaluated the effects of a structured nurse-led education programme that aimed to improve patient concordance and prevent venous leg ulcer recurrence.

Method:

The design was quasi-experimental. Subjects (average age: 80) had venous leg ulceration that had healed within the previous two years, and were cared for at home by a district nurse. Data were available on 49 patients with 97 legs, 72 of which had had venous leg ulcers. Patients were divided into two groups: a control group, which received ‘usual’ care, and an experimental group, which was exposed to the education programme. Recurrence rates, the effects of the education on patient behaviour and the effect on recurrence of having both ankle movement and general mobility were measured over one year.

Results:

Patients in the experimental group experienced significantly less recurrence over the year (log rank test=8.28, p=0.004). To control for differences in mobility and ankle movement in the control and experimental groups at baseline, simultaneous logistic regression analysis was undertaken. This revealed a significant advantage for patients in the experimental group (p=0.035; OR=4.45, 95% CI=1.11–17.74), who spent more time with their legs elevated each day. This difference was sustained throughout the 52 weeks (f=2.88, p=0.015). Those who had both full ankle movement (>60 degrees) and full mobility (without aid) had significantly less recurrence (p=0.042). Education had no significant effect on the amount of time patients wore compression hosiery (f=2.1).

Conclusion:

A structured nurse-led patient concordance programme is effective in preventing venous leg ulcer recurrence and increasing the time patients spend with their legs elevated at heart level. Having both full ankle movement and full mobility reduces the risk of recurrence.

Declaration of interest:

None.
Safety and performance of a new non-adhesive foam dressing for the treatment of diabetic foot ulcers
Authors: Lohmann M. , Thomsen J.K. , Edmonds M.E. , Harding K.G. , Apelqvist J. , Gottrup F.
Published: May 2014

Objective:

This study aimed to document the safety and performance of a new non-adhesive foam dressing (Biatain Non-adhesive Dressing, Coloplast A/S) in the treatment of established foot ulcers in patients with diabetes.

Method:

This was an open non-comparative prospective study. Participants had an ankle brachial pressure index score of over 0.4 (neuro-ischaemic) and an ulcer bigger than 1cm2 and less than 8cm2 in any direction. The treatment period was six weeks.

Results:

Thirty-five out of 37 patients completed the study. The mean wound area reduced from 5.4cm2 to 2.5cm2. Relative wound area reduced from 100% at baseline to 40% at week 6. ‘Wearing comfort’ improved throughout the study (p=0.039). Maceration remained stable or improved. None of the four reported adverse events were device related.

Conclusion:

This study demonstrates that treatment of diabetic foot ulcers with Biatain Non-adhesive Dressing results in considerable wound area reduction and prevents any deterioration in maceration. The dressing is safe and effective in the management of these ulcers.

Declaration of interest:

This study was support by Coloplast A/S, Humlebaek, Denmark.
How safe is silver in wound care?
Authors: Lansdown A.B.G. , Williams A.
Published: May 2014

Silver poses minimal health risks to humans through occupational or therapeutic exposure, and clinicians widely accept that it is a highly effective antibacterial agent in wound care. Silver is inert in its metallic form, but readily ionises in the presence of body fluids and wound exudate to become reactive. This activated silver ion is absorbed by a wide range of bacteria and fungi and is lethal to many pathogenic strains.
How echographic image analysis of venous oedema reveals the benefits of leg elevation
Authors: Xia Z.D. , Hu D. , Wilson J.M. , Cherry G.W. , Ryan T.J.
Published: May 2014

Objective:

Venous insufficiency, leading to venous oedema, is a key pathogenic factor for the non-healing of venous leg ulcers. This study aimed to evaluate the effects of leg elevation on venous oedema.

Method:

Ten patients aged 44–89 years (median: 61) with leg oedema had high-frequency B-mode ultrasound scanning and digital image analysis before and after three to four hours of leg elevation. The echographic image analysis system was used, where oedema is represented by the hypoechogenic part of the image — that is, the total number or density of low echogenic pixels (LEPs) in a particular area.

Results:

Compared with pre-elevation, the volume of the lower leg decreased by 2.9% ±0.6 (138cm3 ±39) after three to four hours’ elevation (p<0.05). After elevation, the LEPs in the upper, middle and lower sites of the limb decreased by 8.8%, 15.6% and 17.3% respectively, reaching statistical significance (p<0.05) in the lower site. The ratio of LEPs in the upper and lower dermis in the upper, middle and lower sites decreased by 30.3%, 45.8% and 22.5% respectively. This was significant in both the middle and lower sites (p<0.01). After elevation dermal thickness increased by 0.047mm, 0.194mm and 0.232mm respectively. This change was statistically significant in the middle (p<0.05) and lower sites of the limb (p<0.01).

Conclusion:

Leps Are A Sensitive Marker Of Dermal Oedema And Its Effects. Leg Elevation Is Extremely Effective In Reducing Oedema, Even If Only For Three To Four Hours.

Declaration of interest:

None.
From the journals
Authors: Baxter Helena
Published: May 2014

Wet-to-dry gauze dressings are still commonplace in the US, where guidelines continue to recommended their use for debridement. Ritualistic practice has also led to the use of gauze dressings on clean surgical wounds, resulting in pain and trauma on removal.
Our agenda is to raise the standard of venous leg ulcer care
Authors: Dowsett C.
Published: May 2014

Management of venous leg ulcers has advanced considerably over the past 10 years. This is due to various factors, from greater knowledge of the aetiology of leg ulceration, to more recent developments such as:
Promogran and complex surgical lesions: a case report
Authors: Guarnera G. , Restuccia A.
Published: May 2014

Skin ulcers of the lower limbs have a low healing rate and high recurrence. A study involving 600 patients with leg ulcers showed that a third of the ulcers had never healed and two-thirds of the patients had multiple lesions. Encouraging results reported in some clinical studies have been obtained in highly selected patients, excluding ulcers linked to non-venous pathologies or those with mixed aetiology; even in the most successful trials, 25–50% of all ulcers do not heal.
Can adults with cognitive impairment consent to take part in research?
Authors: Donnelly J.
Published: May 2014

Before embarking on the pilot of a research protocol into pressure ulcer prevention (specifically, the effects of elevation using a Heelift Suspension Boot, DM Systems), I decided not to recruit adults with cognitive impairment. Participating in research studies always carries a cost for subjects, who must be fully aware of this fact if they are to make an informed decision about taking part
Factors that affect concordance with compression therapy
Authors: Moffatt C.J.
Published: May 2014

Practitioners frequently report that patients with leg ulcers have difficulty adhering to treatment, although the extent of this remains unknown. Concordance with therapy is a complex subject and extends beyond the traditional definition of compliance, described by Haynes as: ‘The extent to which a person’s behaviour (in terms of taking medications, following diets or executing lifestyle changes) coincides with medical or health advice.’
Clinical incidence and clinical audit
Authors: Benbow Maureen
Published: May 2014

Clinical audit lies at the heart of the clinical governance process and is essential for reviewing and improving the quality of everyday care of patients with common conditions
An investigation of the long-term bioactivity of endogenous growth factor in OASIS Wound Matrix
Authors: Hodde J.P. , Ernst D.M.J. , Hiles M.C.
Published: May 2014

Objective:

To examine the retention and bioactivity of endogenous FGF-2 after prolonged storage within a complex matrix. FGF-2 is a growth factor found in Oasis Wound Matrix, a purified collagen wound-care product containing other endogenous components of the extracellular matrix.

Method:

FGF-2 content was measured by ELISA. FGF-2 activity was measured using an in vitro bioassay in rat pheochromocytoma (PC12) cells.

Results:

FGF-2 content ranged from 15.3ng/g to 84.3ng/g. The bioassay showed that the FGF-2 retained in the matrix was present in a bioactive form able to cause differentiation of cells in culture

Conclusion:

The results demonstrate that wound-care products can be developed to retain their bioactivity over time and that inherently unstable purified growth factors are preserved if stored as bound factors within their natural extracellular matrix. The results also suggest that use of acellular matrices containing active growth factors would have advantages in terms of simplicity and cost over purified recombinant growth factor therapies.

Declaration of interest:

This study was supported by Cook Biotech Inc, West Lafayette, USA.
Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients
Authors: Cosker T. , Elsayed S. , Gupta S. , Mendonca A.D. , Tayton K.J.J.
Published: May 2014

Objective:

To investigate the effect of three postoperative dressings on orthopaedic wound healing.

Method:

Three hundred orthopaedic patients were divided into three treatment groups and allocated to management with one of three dressings: Primapore, Tegaderm with pad, and OpSite Post-Op. Staff completed a questionnaire to evaluate the wound progression. Outcome measures were the presence of infection, blistering and the number of dressing changes required.

Results:

There was a significantly lower incidence of blistering with OpSite Post-Op (6%) than Tegaderm with pad (16%) and Primapore (24%) (p<0.001). Patients in the OpSite Post-Op group had the lowest exudate levels.

Conclusion:

Dressings that employ a clear film and have a high moisture vapour transmission rate have been shown to reduce both the rate of blistering and wound discharge. The additional expense inherent in using such dressings may, in reality, prove cost-effective because of the reduced need for dressings changes and the subsequent earlier discharge of these patients from hospital with an uncomplicated wound.

Declaration of interest:

All dressings were supplied by the manufacturers. However, they had no contact with the wards or the authors once the study started.
Announcing the 2005 JWC/Tendra Scholarships and Honours winners
Authors: Glover Deborah
Published: May 2014

What a pleasure it is to be able to poke a metaphorical stick in the eye of all the harbingers of doom who like nothing more than slating standards of health care. The 2005 JWC/Tendra (Mölnlycke) Scholarships and Honours proved without a doubt that there is some fantastic practice happening within wound care and tissue viability, and that there are practitioners who are champing at the bit to develop both themselves and, more importantly, practice to improve the lot of their patients.
Evidence-based practice and support surfaces: are we throwing the baby out with the bath water?
Authors: Clark M. , Hiskett G. , Russell L.
Published: May 2014

Objective:

This study aimed to explore aspects of the effectiveness of three pressure-redistributing support surfaces in routine clinical practice.

Method:

A non-randomised prospective cohort study was used, with skin outcomes reported for 219 subjects at risk of pressure ulcer development.

Results:

Few instances of new pressure damage were observed; these related to specific clinical issues, such as incontinence and inadequate use of cushions when sitting. Of the 77 subjects (33.3%) with pressure ulcers on recruitment into the study, most (n=70) either improved or remained unchanged following allocation of the support surface.

Conclusion:

Cohort studies do not indicate the efficacy of an intervention but may give an indication of effectiveness — that is, the clinical outcomes that may be observed in routine clinical practice.

Declaration of interest:

This work derives from a study funded by Huntleigh Healthcare.
Treatment of diabetic foot ulcers with total contact casts: a critical review of the current literature
Authors: Pizarro-Duhart G.
Published: May 2014

Peripheral neuropathy is a common complication of diabetes and may lead to ulcers, often resulting in amputations. Total contact casts are advocated for healing neuropathic ulcers but there are serious reservations about its use
Let’s tackle errors and omissions head-on
Authors: Glover Deborah
Published: May 2014

Being involved in wound care is a little weird. We look at wounds with interest and morbid fascination. But perhaps this dispassionate approach makes us forget that there is a patient fixed around the hole.
Using cycloidal vibration to heal venous leg ulcers: a cost-analysis based on retrospective data
Authors: Cherry G.W. , Ryan T.J.
Published: May 2014

Leg ulceration places a heavy financial burden on health-care systems around the world in terms of materials (dressings, bandages and analgesics) and nursing time. Venous hypertension, the main cause of venous ulceration, can be improved by:
How can we make pressure ulcer prevention and management truly multiprofessional?
Authors: Clark M.
Published: May 2014

There is scope for allied health professionals to become more involved in pressure ulcer management. This can be achieved by giving them more say in the running of wound-care organisations and by encouraging more dialogue between professions
How multidisciplinary is pressure ulcer care?
Authors: Glover Deborah
Published: May 2014

l like May. Not only does it bring two bank holidays in one month, lambs and frenetic nest-building activity, it also holds endless possibilities: will it snow or rain over that long-awaited bank holiday? Will Arsenal win the FA Cup? What will be the hot topic at the wound societies’ conferences this year?
Colloid or crystalloid for resuscitation of major burns?
Authors: Hemington-Gorse S.J.
Published: May 2014

A burn injury is one of the most severe insults to the body. Burns are more than just a skin injury: the visible injury is one part of a disease process that can have devastating consequences. Even a small burn can be life-threatening.
Review
Authors: Collier Mark
Published: May 2014

Further to the release of the NICE guideline on pressure ulcer prevention in 2003 (www.nice.org.uk), this DVD — produced under the auspices of a well-respected practitioner/educator in the field of tissue viability — is both informative and accessible to the intended audience, unqualified carers. Patients and their relatives will also find it useful as an information resource. This is in line with the Department of Health benchmarking process, which started in 2002.
An eventful year comes to an end
Authors: Fraser D. , Collier M.
Published: May 2014

I can hardly believe it’s time to write my final Scholarship update as I still have things to do, places to go to and people to see. Even though this is my last report, I will continue to work on achieving my objectives.
Prevalence, incidence and predictors of pressure ulcers in a tertiary hospital in Singapore
Authors: Chan E-Y. , Tan S-L. , Lee C.K-S. , Lee J-Y.
Published: May 2014

Objective:

In 2002 the hospital under study implemented a pressure ulcer standard care plan. This follow-up study aimed to determine the prevalence and incidence of pressure ulcers, whether demographic characteristics and medical diagnosis differed between those individuals who did and those who did not develop ulcers and the predictors of pressure-ulcer formation.

Method:

The prevalence study used a cross-sectional design, while the incidence study was a prospective cohort study. Participants were scored using the Braden scale and were examined for the presence of pressure ulcers. Those who were ulcer free were monitored twice weekly until they were discharged or for 28 days.

Results:

The prevalence of pressure ulcers was 18.1% (95% CI: 15.5–20.9%), while the incidence was 8.1% (95% CI: 6.1–10.4%). Participants with ulcers were older, had a longer mean length of hospital stay, lower Braden scores and were diagnosed with or had a history of cardiovascular diseases or sepsis. Logistic regression found that the total Braden score was the only significant predictor of pressure ulcers. Compared with scores 16–23, the odds ratios were 7.7 (95% CI: 3.5–17.1, p<0.001) and 12.5 (95% CI: 4.5–34.6, p<0.001) for scores 12–15 and 6–11 respectively. Demographic characteristics, diagnosis and length of hospital stay were not significant predictors.

Conclusion:

The study identified a modest decrease in incidence and improvements in nursing care following the implementation of the care plan. It suggests that Braden scores are predictive of those at-risk of developing pressure ulcers.

Declaration of interest:

This study was supported by a grant from the Ministry of Health Nursing Research Committee.
Assessing the primary nurse role in the wound healing process
Authors: Huynh T. , Forget-Falcicchio C.
Published: May 2014

Objective:

To delineate the role of the primary nurse in wound care.

Method:

Data were collected from patient charts within a free-standing rehabilitation hospital in a Canadian province. Within the context of a continuous quality improvement programme, a retrospective chart review was performed. An audit tool was constructed; its face validity was assessed by a panel of staff nurses.

Results:

Primary nurses are involved in every step of wound care: assessment, treatment, evaluation of wound status and treatment.

Conclusion:

Within the cycle of continuous quality improvement (CQI), this project constitutes the first essential step of assessing the primary nurse’s role in wound care. Further CQI studies such as in-service education in wound care and pre-post education evaluation projects are recommended.

Declaration of interest:

None.
Using image analysis to determine cause, severity, status and healing prognosis in wound management
Authors: Russell L. , Reynolds T.M.
Published: May 2014

The visual appearance of a wound is considered to contain a wealth of information about its cause, severity, change in status and prognosis for healing. Various methods have been used to evaluate the status of skin tissue, including simple visual observation. However, human vision lacks precision and human memory is inconsistent; therefore, slow or subtle changes may be difficult to quantify. In addition, visual assessment of wound appearance in photographs is difficult because wound boundaries may vary between each individual image, making size/ area estimation difficult, while variability in colour vision/colour interpretation between individuals may render assessments imprecise.
Topical negative pressure versus closed surgical wound drainage: a difference in philosophy
Authors: Banwell P.E. , Ahmed S. , Téot L.
Published: May 2014

Vacuum force (suction) is commonly used in wound management strategies. Topical negative pressure wound therapy and closed surgical wound drainage both use vacuum force but each have different modus operandi
Late presentation of abdominal aortic occlusion in a patient with spinal cord injury.
Authors: Al-Alawi S. , Graham A.
Published: May 2014

Leriche’s syndrome is caused by distal abdominal aortic obstruction, mainly due to arteriosclerosis and, less commonly, external compression from mass lesions, embolism or aortic dissection. It was first described in 1814 by Robert Graham, then physician at Glasgow Royal Infirmary, but is more commonly attributed to René Henri Marie Leriche, who reported the symptoms in a young male in 1940. Common symptoms include:
Research in wound healing and tissue repair - whose baby is it?
Authors: Mani R.
Published: May 2014

In 1981–1982 I was working on a simple test, the ankle brachial pressure index (ABPI), to identify the presence of peripheral ischaemia in patients with clinically diagnosed venous leg ulcers. During this time, a consultant dermatologist showed me a patient with a chronic wound on a ward round. The patient, who was in the autumn of her life, had a lower extremity wound that virtually covered her lower leg. The tendons were exposed and she was in much pain. However, while she was grateful for the bedrest, she wanted to be home so she could care for her disabled husband. The clinical team discussed treatment options, and the plan was to cover the wound with paraffin gauze and a light bandage, and to allow her freedom to walk around the ward.
Editorial: Getting the message across is no mean feat
Authors: Glover Deborah
Published: May 2014

If one wants to change or develop something, communication is the key. Some use the direct approach, ‘We will be doing this in future because I say so’. Some use a more circuitous approach, ‘I’d be awfully grateful if you could consider this, if you have time of course’. Some tell everybody, whether they are involved or not. Some tell only a few key people and leave those that should know completely in the dark. Very, very few have it sussed and manage the in-between but very effective approach. But let’s be honest, it isn’t easy. If one considers all the people one has to communicate with on a daily basis — patients, carers, colleagues and external agencies — is it any wonder that, at times, we don’t get the message across appropriately, or indeed are misinterpreted?
Necrotising fasciitis of the leg following a simple pelvic fracture: case report and literature review
Authors: Rozeboom A.L. , Steenvoorde P. , Hartgrink H.H. , Jukema G.N
Published: May 2014

Moderate trauma is the major cause of pelvic fractures in older people. The incidence is about 20–30 per 100,000, and the female-to-male ratio is about 3:1. Most fractures can be treated conservatively. This paper reports a rare complication of this fracture — necrotising fasciitis of the leg. The patient presented at our hospital with a simple closed pelvic fracture. The fracture caused a perforation of the small bowel and subsequent necrotising fasciitis of the left upper leg. A segment of small bowel was removed and the necrotising fasciitis was treated with repeated surgical debridement, broadspectrum antibiotic therapy, maggot debridement therapy (MDT) and topical negative pressure (TNP) therapy. The wound finally closed and the patient became mobile. The case is described and relevant literature is reviewed.
Do malnutrition and nutritional supplementation have an effect on the wound healing process?
Authors: Mandal A.
Published: May 2014

The orchestration of wound healing and tissue repair following traumatic or iatrogenic injury can be markedly affected by nutritional status. Nutrition as an extrinsic factor in the regulation of wound healing has been predicated on two concepts:
Editorial: expert advice that must be given now
Authors: Glover Deborah
Published: May 2014

There is no doubt that we have a lot to be proud of in terms of improvements in our understanding of the wound healing process, the development of dressings that facilitate healing, and the myriad of interventions that heal acute or chronic wounds or enable patients to cope with wounds that are unlikely to heal.
Use of topical negative pressure to close a large MRSA-infected groin wound following vulvectomy
Authors: Dhar R. , Copson D. , Williamson K. , Nunns D.
Published: May 2014

The rate of wound infection in groin wounds is high, and such wounds are difficult to treat. Topical negative pressure (TNP) has become the mainstay in the treatment of these wounds.
Let’s get to the heart of the matter
Authors: Glover Deborah
Published: May 2014

Following on from the farewell write-ups from the 2005 Scholarship winners in September, 1 this month we feature the first reflections from the 2006 winners (see page 398). As you will see, they are a diverse group of practitioners working in a variety or organisations, but all have a passion for and commitment to their area of interest and what they can do to improve the patient experience.
Dressing remedies: a concept for improving access to and use of dressings in nursing homes.
Authors: Clarkson A.
Published: May 2014

Wound-care products account for a significant proportion of the prescriptions made in general practice in England. In 1997 the cost of prescribing them was estimated to be over £80 million.
Role of topical negative pressure in pressure ulcer management
Authors: Mandal A.
Published: May 2014

Pressure ulcers are acknowledged as clinical, financial and emotional challenges for both patients and health systems. These ulcers, whose prevalence is rising globally, most commonly affect older people, patients with severe acute illnesses and patients with neurological problems such as spinal cord injuries. Recent data suggest that the cost of treating ulcers varies from £1064 for a grade 1 to £10,551 for a grade IV ulcer, with total annual costs in the UK estimated as £1.4–2.1 billion, the equivalent of 4% of the total NHS expenditure. Projections for expenditure on pressure ulcer prevention are in the same range, amounting to a total annual cost of £120–400 million.
Experiences of developing a collaborative educational wound-care formulary and resource file
Authors: Douglas V.J. , Way L.C.
Published: May 2014

The costs of wound care and emphasis on delivering a seamless service between primary and secondary care mean that a collaborative, systemic practice framework is required. Such a framework:
An assertive approach will pay dividends
Authors: Glover Deborah
Published: May 2014

Bit of a brouhaha in the media today regarding the cost to the NHS of branded drugs. According to the Office of Fair Trading (OFT), the NHS is paying too much for such drugs and the Pharmaceutical Price Regulation Scheme (PPRS), a body charged with setting the prices, should be overhauled. Add to this organisations that are removing light bulbs from corridors, those that are asking staff to save £2.50 per day per person and those asking clinicians to work for a day for free, and one might wonder if the NHS is in a state of financial crisis.
Effect of amelogenin extracellular matrix protein and compression on hard-to-heal venous leg ulcers
Authors: Vowden P. , Romanelli M. , Price P.
Published: May 2014

Objective:

To compare hard-to-heal venous leg ulcers treated with compression therapy alone versus compression therapy with amelogenin protein. Parameters used were: percentage reduction in wound size, number of improved ulcers, pain related to the disease and at dressing changes, amount and nature of exudate, and the safety and tolerability of the two treatments.

Method:

This was an open randomised comparative parallel group multicentre investigation with a three-week run-in period. Inclusion criteria included adult, mobile patients with hard-to-heal venous leg ulcers that had been treated with compression therapy for at least one month prior to screening. The ulcers had to be at least six months old, with a surface area at inclusion of 10–30cm2, and not demonstrating excessive exudate or signs of infection. At the end of the run-in period, additional criteria for eligibility, such as change in wound area of ± ≥50% and a wound area between 8cm2 and 36cm2 were applied. Patients were randomised to treatment with amelogenin plus high compression bandaging or high compression bandaging alone. All participants received high compression bandaging therapy one month prior to and during the three-week run-in period, as well as throughout the 12 weeks of active treatment.

Results:

Eighty-three patients were randomised and received treatment: 42 with high compression plus amelogenin (amelogenin group) and 41 to high compression therapy alone (control group). The amelogenin group had a greater percentage reduction in ulcer size (mean -33.11%) compared with the control group (mean -11.07%) from baseline to the last visit (p=0.06). The number of improved ulcers was significantly greater (p=0.01) in the amelogenin group than in the control group. Compensating for baseline characteristics by multiple regression resulted in a statistically significant (p=0.03) larger reduction in change in ulcer size in the amelogenin group. Statistically significant differences in favour of the amelogenin group were also found for reduction in ulcer-related pain (p=0.01), reduction in pain at dressing changes (p=0.02) and the proportion of patients with ‘none’ or ‘low’ levels of exudate (p=0.01).

Conclusion:

The combination of amelogenin with high compression promotes the healing process in hard-to-heal ulcers. Application of amelogenin as an adjunct to compression results in a significant reduction in ulcer size, improvement in the state of ulcers, reduced pain and a larger proportion of ulcers with low levels of exudate. The results of this study are statistically and clinically significant.

Declaration of interest:

This study was funded by Mölnlycke Health Care, Gothenburg, Sweden.
Effects of honey and sugar dressings on wound healing
Authors: Mphande A.N.G. , Killowe C. , Phalira S. , Wynn Jones H. , Harrison W.J.
Published: May 2014

Objective: To investigate whether there is a difference between the efficacy of honey and sugar as wound dressings. Method: Patients with open or infected wounds were randomised to receive either honey or sugar dressings. Bacterial colonisation, wound size, wound ASEPSIS score and pain were assessed at the start of treatment and at weekly intervals until full healing occurred. Results: Forty patients were enrolled; 18 received sugar dressings and 22 honey dressings. In the honey group, 55% of patients had positive wound cultures at the start of treatment and 23% at one week, compared with 52% and 39% respectively in the sugar group. The median rate of healing in the first two weeks of treatment was 3.8cm2/week for the honey group and 2.2cm2/week for the sugar group. After three weeks of treatment 86% of patients treated with honey had no pain during dressing changes, compared with 72% treated with sugar. Conclusion: Honey appears to be more effective than sugar in reducing bacterial contamination and promoting wound healing, and slightly less painful than sugar during dressing changes and motion. Declaration of interest: None.
Practice based commissioning: implications for community wound-care practitioners
Authors: King B.
Published: May 2014

The reconfiguration of the way in which health care is commissioned for patients in the community was outlined in Commissioning a Patient-led NHS. This reinforced the government’s commitment to move forward with practice based commissioning (PBC), which aims to devolve power to local GPs and nurses, thus facilitating service provision closer to the patient’s home, reducing waiting times, shortening patient journeys and aligning local clinical and financial responsibilities.
Effect of medical honey on wounds colonised or infected with MRSA
Authors: Blaser G , Santos K , Bode U , Vetter H , Simon A
Published: May 2014

In hospitals, nursing homes and home-care facilities the emergence and dissemination of antibiotic-resistant bacteria is causing increasing problems in wound care. Methicillinresistant Staphylococcus aureus (MRSA) is one of the most prevalent and recalcitrant pathogens compromising wound healing. Aside from the microenvironmental problem, it is having a big impact on health-care costs.
A testament to their commitment to their work and specialty
Authors: McGinnis Elizabeth , Stevens Julie , Barker Nicola , Price Stephen
Published: May 2014

Scholarships are an excellent way of benchmarking your practice against that of other professionals. They offer an opportunity to discuss new ideas, thoughts and solutions with people you do not meet in your day-to-day work, and enable you to undertake projects not normally available in your organisation. Most importantly, they give professionals a chance to showcase their work, skills and abilities. This is essentially why I applied for a JWC Scholarship.
It’s Your Turn to get involved in this pressure ulcer campaign
Authors: Doyle Maggie
Published: May 2014

Eighteen months ago, leading woundcare groups including the Tissue Viability Society, Wound Care Society and Tissue Viability Nurses Association, joined forces to launch ‘Your Turn’, a national campaign to raise awareness on the dangers of pressure ulcers. The campaign is spearheaded by Dr Michael Clark, Senior Research Fellow at the Wound Healing Research Unit at Cardiff University and a world authority on pressure ulcer prevention and management.
Ultrasonographic evaluation of an unusual peri-anal induration: a possible case of deep tissue injury
Authors: Nagase T , Koshima I , Maekawa T , Kaneko J , Sugawara Y , Makuuchi M , Koyanagi H. , Nakagami G. , Sanada H.
Published: May 2014

Recent technical advances in ultrasonography, such as a frequency higher than 10MHz, has enabled its application to the skin and subcutaneous tissues. The pressure ulcer team at the University of Tokyo Hospital routinely uses the ECHOPAL II ultrasound scanner (Hitachi Medical Systems, Japan), which has a 10MHz probe, to assess superficial tissue damage during its wound-care rounds. It is especially useful for evaluating latent subcutaneous tissue damage underneath seemingly superficial pressure ulcers (National Pressure Ulcer Advisory Panel [NPUAP] stage I–II). Using the 10MHz probe, we can obtain a reasonable resolution of an image 20–30mm below the skin surface. The dermis and the subcutaneous fatty tissue can also be clearly detected in normal tissue (Fig 1a).
Editorial: Lessons in research evaluation
Authors: Pollard Tom
Published: May 2014

It will come as something of a blow to enthusiasts of topical negative pressure therapy (TNP) that a recent review in Drug and Therapeutics Bulletin casts doubt on the therapy’s effectiveness in treating chronic wounds. The review is critical of the relatively little research that has been done to support it, and contains lessons for all researchers in wound care as well as those who use research evidence to support practice.