bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.
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.
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.
Evaluation of the dissemination and implementation of a nutritional guideline for pressure ulcer care
Authors: Meijers J.M.M. , Schols J.M.G.A. , Jackson P.A. , Langer G. , Clark M. , Halfens R.J.G. 
Published: May 2014

Objective: In 2004 the European Pressure Ulcer Advisory Panel nutritional working group developed a nutritional guideline for pressure ulcer prevention and treatment. This study investigated the degree to which the guideline was disseminated and implemented in clinical practice. Method: A cross-sectional study was undertaken in health-care organisations in the Netherlands, Germany and the UK. A printed, standardised questionnaire which followed Rogers’ model of the innovation-decision process was developed, translated and distributed to 1087 health-care organisations. Results: The response rate was 33% (n=363). Sixty-one per cent of respondents knew of the guideline. Twenty-five per cent had applied it to their clinical practice and used it for nutritional screening. The main barrier to the provision of nutritional support appeared to be lack of knowledge and skills. Conclusion: One year after its dissemination, more than half of respondents knew of the guideline, with one in four applying it to their practice. The guideline was better disseminated and implemented in the Netherlands and UK than in Germany, where only 4% of participants had used it. Declaration of interest: Numico Netherlands gave EPUAP an unrestricted educational grant.
Evaluation of pH measurement as a method of wound assessment
Authors: Shukla V.K. , Shukla D. , Tiwary S.K. , Agrawal S. , Rastogi A. 
Published: May 2014

Objective: To assess variations in wound pH levels and explore the relationship between wound pH and the state of wound healing. Method: Fifty patients with acute or chronic wounds attending the wound clinic at University Hospital, Varanasi, India were included. Wound pH was measured using litmus paper strips and recorded weekly. Other parameters recorded were the wound condition, exudate level and culture. Results: The baseline pH of most of the wounds was greater than 8.5. As the wound condition improved and exudate levels decreased, the pH reduced to less than 8.0. Fifty-eight per cent of the wounds were culture positive, and an association was observed between the type of organism present and the wound pH. Conclusion: Wound pH measurements can be performed efficiently and are non-invasive, causing no discomfort to the patient. As the wounds healed, the pH reduced. This change in pH can help predict the likelihood of wound healing. Declaration of interest: None.