bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of diabetic foot ulceration during treatment with insulin glargine and NPH insulin
Authors: Kostev K. , Dippel F.W. , Rockel T. , Siegmund T. 
Published: May 2014

Objective: To evaluate the effect of the long-acting basal insulin analog glargine compared with neutral protamine Hagedorn (NPH) insulin on the incidence of diabetic foot ulceration (DFU) in patients with diabetes in Germany. Method: A retrospective cohort study was performed using a representative German database (IMS Disease Analyzer) of patients with type 2 diabetes, who started a basal insulin therapy with either insulin glargine or NPH insulin, between July 2000 and September 2007, and continued this therapy for at least 24 months, and whose data were continuously documented. The occurrence of DFU was recorded beginning in the third year after therapy initiation and Kaplan-Meier curves were generated and compared using log-rank tests. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (CI) for the incidence of DFU. Results: Patients who fulfilled the inclusion criteria (n=23 395) had started either on insulin glargine (n=9638) or on NPH insulin (n=13 757). After adjustment for demographic and clinical variables, it was demonstrated that the relative risk to diabetes patients of developing DFS is 64% lower with insulin glargine than with NPH insulin therapy (HR=0.611; p=0.0405). Conclusion: The results suggest that, compared with NPH insulin, insulin glargine therapy significantly reduces the risk of DFS in patients with diabetes under real life conditions. Prospective long-term trials are needed to confirm these secondary data analysis results. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The impact of water mattresses on incidence of PUs in patients with spinal cord injuries in Nigeria
Authors: Nwadinigwe C.U. , Anyaehie U.E. , Onyegbule E.C. 
Published: May 2014

Objective: To evaluate the impact of water mattresses on the incidence of pressure ulcers and length of hospitalisation in patients with spinal cord injuries in Nigeria. Method: A retrospective review was conducted of all patients who presented and were managed for complete traumatic spinal cord injury between January 2005 and December 2008. This period included 2 years prior to, and 2 years following, the introduction of water mattresses to the ward; patients from these periods were grouped as A and B, respectively. Information collated from the medical records included demographic data, wound aetiology, time to presentation, level of injury, complications, treatment, and duration of hospitalisation and follow-up. Outcome measures were presence or absence of pressure ulcers and length of hospital stay. Results: In total, 201 patients were treated within the study period. Of these, 99 patients met the inclusion criteria; 35 patients (19 paraplegics and 16 tetraplegics) were managed between 2005 and 2006 (group A), while 64 patients (28 paraplegics and 36 tetraplegics) were managed in 2007 and 2008 (group B). The age range of the included patients was 9–76 years (39.0 ± 4.6 years and 41.5 ± 3.2 years for groups A and B, respectively) and all were male. Patient characteristics were similar for the two groups; however, there was a significant difference between the two groups in terms of presence of pressure ulcers, deteriorating of existing ulcers and condition of the patient on discharge (p < 0.05). Conclusion: The majority of pressure ulcers are preventable and a simple support surface, such as water mattresses, can reduce the incidence and magnitude of pressure ulceration, thus reducing hospital stay. Declaration of interest: The authors do not have any financial relationship with any organisation that manufactures water mattresses, either locally or overseas. There were no external sources of funding for this study.
Relative cost-effectiveness of a skin protectant in managing venous leg ulcers in the UK
Authors: Guest J.F. , Taylor R.R. , Vowden K. , Vowden P. 
Published: May 2014

Objective: To estimate the clinical and cost-effectiveness of using a skin protectant (Cavilon No Sting Barrier Film [NSBF] or Cavilon Durable Barrier Cream [DBC]; 3M) compared with not using a skin protectant in the management of venous leg ulcers (VLUs), in the UK. Method: A decision model was constructed depicting the patient pathways and associated management of a cohort of patients with and without a Cavilon formulation, plus dressings and compression. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database, who were first diagnosed with a VLU between 1 Jan 2008 and 31 Dec 2009. The model estimated the costs and outcomes of patient management over 6 months and the cost-effectiveness of using a Cavilon formulation relative to not using a skin protectant. Results: Patients' mean age was 80.2 years and 61% were female. Sixty-five per cent (n=166) of Cavilon patients received NSBF, and 35% received DBC. Between 6% and 9% of VLUs were healed at 6 months and 53–66% became infected. Healing was affected by a patient's age (OR: 0.944 for each additional year), but not by gender, level of exudate or wound size. There was a significantly greater reduction in wound size among patients in the NSBF group than in the other two groups (p < 0.001). Additionally, there was no significant difference in the initial wound size of those VLUs that did and did not heal in the two Cavilon groups; however, initial size of the VLUs that healed in the control group was significantly smaller than those that did not (p<0.001). Resource use was similar between the three groups. Patients were predominantly managed by practice nurses, with a mean 37–38 nurse visits over the study period. Patients' dressings were changed, on average, every 4–5 days, with a mean of 3 dressings under a compression bandage. The total 6-monthly NHS cost of managing a VLU was ∼£2200. Practice nurse visits were the primary cost driver, accounting for up to 58% of the 6-monthly NHS cost, whereas dressings accounted for < 10% of the cost. Conclusion: Use of NSBF leads to significantly greater wound size reduction than that observed in the other two groups and may facilitate the healing of larger wounds without increasing costs. Hence, use of NSBF for peri-wound skin protection in patients with exuding VLUs is the preferred treatment strategy. Declaration of interest: This study was sponsored by 3M Health Care, manufacturers of Cavillon NSBF and Cavillon DBC. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
Clinical and cost-effectiveness of absorbent dressings in the treatment of highly exuding VLUs
Authors: Panca M. , Cutting K. , Guest J.F. 
Published: May 2014

Objective: To estimate the clinical effectiveness and cost effectiveness of using a sodium carboxymethylcellulose dressing (CMC [Aquacel]) and four superabsorbent dressings (DryMax Extra [DM], Flivasorb [F], Kerramax [K] and sachet S [S]) in the treatment of highly exuding chronic venous leg ulcers (VLUs) in the UK, from the perspective of the National Health Service (NHS). Method: A decision model was constructed depicting the patient pathways and associated management of a cohort of 439 patients with highly exuding chronic VLUs of ≥ 3 months of age. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database (a nationally representative database of patients registered with general practitioners (GPs) in the UK) who were treated with one of the five dressings. The model estimated the costs and outcomes of patient management over 6 months and the relative cost-effectiveness of using each dressing. Results: Patients' mean age was 73.1 years, and 46% were female. Between 39% and 56% of VLUs healed by 6 months. CMC-treated wounds that remained unhealed increased in size by 43% over the study period, whereas unhealed wounds treated with the other dressings decreased in size by a mean 34%. Consequently, CMC was excluded from the cost-effectiveness analysis. The 6-monthly NHS cost of managing a VLU with S was £3700 per patient, which was 15–28% lower than the cost of managing patients with the other three superabsorbents. Additonally, use of S improved patients' health status to a greater extent than the other three superabsorbents, since S-treated patients accrued 0.3–3% more QALYs. Starting treatment with S was the preferred strategy followed by DM, K and F in that order. Conclusion: Within the limitations of the data set, S affords the NHS a cost-effective treatment for managing highly exuding chronic VLUs of ≥3 months of age, compared with DM, F, K and CMC. Declaration of interest: This study was funded with an unrestricted research grant from Sorbion GmbH & Co. KG, Senden, Germany, manufacturers of sachet S. However, Sorbion did not have any control of the methodology, conduct, results or conclusion of this study, or editorial involvement in this manuscript. The authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility
SAP-containing dressings exhibit sustained antimicrobial effects over 7 days in vitro
Authors: Wiegand C. , Abel M. , Muldoon J. , Ruth P. , Hipler U.C. 
Published: May 2014

Objective: To investigate the antimicrobial activity of SAP-containing wound dressings in vitro over a prolonged period of time (7 days) and to assess their ability to sustain the antimicrobial effect. Method: SAP dressings were tested according to the JIS L 1902:2002 against the pathogens Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans. Additionally, effect on S. aureus and P. aeruginosa growth was investigated after a prolonged incubation period of 7 days. Furthermore, both SAP dressings were repeatedly inoculated with P. aeruginosa suspension and, after 7 days, microbial growth under the dressings was evaluated. Results: Both SAP-containing wound dressings tested exhibited a significant to strong antimicrobial activity against Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Candida albicans in vitro. Moreover, it could be shown that they were able to sustain antibacterial efficacy over a prolonged period of time. Using a direct incubation method with repeated re-inoculation of the dressing samples, it could be shown that growth of P. aeruginosa was reduced after 4 days of treatment and completely inhibited after 7 days. No significant differences were observed between the two SAP-dressings tested. Conclusion: These in vitro experiments impressively demonstrated the antimicrobial mechanism of SAP-containing wound dressings: rapid up-take of fluid, binding of microorganisms to the SAP-core, and retention of the bacteria inside the dressing. Moreover, it could be shown that they are able to exhibit their antimicrobial activity over a prolonged period of time unless the amount of fluid present exceeds their fluid-handling capacity. Declaration of interest: This work was supported by Lohmann & Rauscher GmbH & Co KG. Authors M. Abel and P. Ruth are employees of Lohmann & Rauscher; J. Muldoon is an employee of Activa Healthcare UK, a company of Lohmann & Rauscher. C. Wiegand received travel grants from Lohmann & Rauscher, to participate at wound healing conferences.
Binding and inhibition of protease enzymes, including MMPs, by a superabsorbent dressing in vitro
Authors: Wiegand C. , White R.J. 
Published: May 2014

Objective: To demonstrate the binding and inactivation action of a superabsorbent dressing on proteolytic enzymes MMP-2, MMP-9 and collagenase using an established methodology. Method: An in vitro assay of MMP binding and collagenase inactivation has been conducted using the superabsorbent wound dressing (Eclypse; Advancis Medical UK). Dressings in this category, and other absorbents, have been claimed to possess MMP-binding characteristics; however, for most there is no published evidence as yet. In this series of experiments, we have used validated experimental techniques to evaluate such activity. Results: Results show that the superabsorbent dressing does have a statistically-significant effect in binding two of the most important MMPs, MMP-2 and MMP-9, as well as inhibiting collagenase. Conclusion: These results support this activity for the superabsorbent dressing and indicate a probable beneficial clinical action in reducing the influence of these enzymes in delayed wound healing. Declaration of interest: This study was funded by an unrestricted grant from Wound Resources Ltd. The authors have no financial interests in the products concerned. RW is a consultant to numerous wound products companies, including Advancis Medical. CW carried out all experimental tests and data analysis. The analysis of data and manuscript does not imply approval or endorsement of any products mentioned.
The effects of focused-rigidity casts on forefoot plantar pressures: a pilot investigation
Authors: Dagg A.R , Chockalingam N. , Branthwaite H. 
Published: May 2014

Objective: To establish if focused rigidity casts (FRCs) reduce forefoot pressures in healthy participants, and to examine the effects of FRCs on contact area, contact pressure, peak pressure and force–time integral on the forefoot and the plantar pressures of the whole foot in participants with differing foot posture. Method: Thirty-one healthy participants were recruited from a convenience sample of university staff and students. This study employed a repeated measures design, where walking in FRCs was compared with a control (canvas shoe). An in-shoe pressure measuring system was used to record changes in plantar pressure and the foot posture index was used to record foot posture. Results: A statistically significant reduction in contact pressure (p ≤ 0.000; n=31) and peak pressures (p ≤ 0.002; n=31) was observed in the forefoot. A statistically significant reduction in contact area and contact pressure over the whole foot and rear foot when participants wore the FRC was also found. The greatest decrease occurred in participants with a supinated foot posture while the least occurred in participants with a pronated foot posture. An increase in peak pressure was found in the mid foot for participants with a normal and supinated foot postures when the FRC was worn. Conclusion: The results suggest that FRCs are an effective way of reducing forefoot pressures when compared with the control shoe. FRC's work by redistributing pressure away from the forefoot to the area of increased rigidity beneath the cast. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
A pilot study on the potential of remote support to enhance wound care for nursing-home patients
Authors: Vowden K. , Vowden P. 
Published: May 2014

• Objective: to evaluate the effectiveness of a Telehealth system, using digital pen-and-paper technology and a modifed smartphone, to remotely monitor and support the effectiveness of wound management in nursing home residents. • Method: A randomised controlled pilot study was conducted in selected nursing homes in bradford, which were randomised to either the control or evaluation group. All patients with a wound of any aetiology or severity, resident in the selected nursing homes were considered eligible to participate in the study. residents in the control homes who had, or developed, a wound during the study period, continued to receive unsupported care directed by the nursing home staff (defined as ‘standard care’), while those in the evaluation homes received standard care supported by input from the remote experts. • Results: thirty-nine patients with a wound were identified in the 16 participating bradford nursing homes. Analysis of individual patient management pathways suggested that the system provided improved patient outcomes and that it may offer cost savings by improving dressing product selection, decreasing inappropriate onward referral and speeding healing. Despite initial anxiety related to the technology most nursing-home staff found the system of value and many were keen to see the trial continue to form part of routine patient management. • Conclusion: the current study supports the potential value of telemedicine in wound care and indicates the value that such a system may have to nursing-home staff and patients. • Declaration of interest: this study was funded by a regional Innovation Fund grant from the Yorkshire and Humberside Strategic Health Authority. the authors have no conflict of interest to declare with respect to the article or its contents.
Evaluation of two fibrous wound dressings for the management of leg ulcers: Results of a European randomised controlled trial (EARTH RCT)
Authors: Meaume S. , Dissemond J. , Addala A. , Vanscheidt W. , Stücker M. , Goerge T. , Perceau G. , Chahim M. , Wicks G. , Perez J. , Tacca O. , Bohbot S. 
Published: May 2014

Objective:To evaluate the performance (efficacy, safety and acceptability) of a new micro-adherent absorbent dressing (UrgoClean®) compared with a hydrofiber dressing (Aquacel®) in the local management of venous leg ulcers, in their debridement stage.Method:A non-inferiority European randomised controlled clinical trial (RCT) was conducted in 37 centres, on patients presenting with venous or predominantly venous, mixed aetiology leg ulcers at their sloughy stage (with more than 70% of the wound bed covered with slough at baseline). Patients were followed over a 6-week period and assessed weekly. The primary judgement criteria was the relative regression of the wound surface area after the 6-week treatment period. Secondary endpoints were the relative reduction of sloughy tissue and the percentage of patients presenting with a debrided wound.Results:Altogether, 159 patients were randomised to either UrgoClean (test group; n=83) or Aquacel (control group; n=76) dressings. Regarding the wound healing process predictive factors (wound area, duration, ABPI value, recurrence), at baseline, the two groups were well balanced, for both wound and patient characteristics. Compression therapy was administered to both groups and after a median 42-day treatment period, the percentage of relative reduction of the wound surface area was very similar (-36.9% vs -35.4% in the UrgoClean and control groups, respectively). When considering the secondary criteria at week 6, the relative reduction of sloughy tissue was significantly higher in the UrgoClean group than in the control group (-65.3% vs -42,6%; p=0.013). The percentage of debrided wounds was also significantly higher in the test group (52.5% vs 35.1%; p=0.033).Conclusion:This ‘EARTH’ RCT confirmed that the UrgoClean dressing has similar efficacy and safety compared to Aquacel. However, UrgoClean also showed better autolytic properties than the control group in the management of venous leg ulcers at the sloughy stage. The new UrgoClean dressing therefore represents a promising therapeutic option within the current range of autolytic dressings available.Declaration of interest:This study was sponsored by a grant from the pharmaceutical company Laboratoires Urgo. S. Bohbot and O. Tacca are employees of Laboratoires Urgo. S. Meaume, J. Dissemond and G. Perceau have received monetary compensation as presenters for Laboratoires Urgo. Data management and statistical analyses were conducted independently by Vertical (Paris, France).
Negative pressure wound therapy in the management of postoperative infections after musculoskeletal tumour surgery
Authors: Anagnostakos K. , Mosser P. 
Published: May 2014

Objective: The aim of the present retrospective study was to report on the effectiveness of the negative pressure wound therapy (NPWT) in the treatment of infected wounds after musculoskeletal tumour surgery. Method: A total of 12 patients (10 male, 2 female, mean age 44.9 years with 9 early and 3 late infections) were included in the study. Patient parameters measured include age, gender, tumour diagnosis and localisation, pathogen organism, foam used, pressure height and modus, number of NPWT dressings changes, total duration of NPWT, need for secondary wound closure, length of hospitalisation, complications, and follow-up. Results: The NPWT dressings were changed on average 6.7 (SD±6.9) times after a mean duration of 5.6 (SD±2.4) days. The total duration of NPWT was 37.7 (SD±32.9) days. The mean hospital stay was 77.5 (SD±58.8) days. In 7 out of 12 cases, a split-thickness skin graft transplantation was performed. In these cases, no seroma or hematoma formation beneath the skin graft could be observed. At a mean follow-up 39.2 (range: 9–73) months, no reinfection or infection persistence was apparent. Conclusion: NPWT can be of valuable assistance in the treatment of infected wounds following musculoskeletal tumour surgery. The patients should be informed about the long treatment period. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
Neonatal necrotising fasciitis managed conservatively: An experience from a tertiary centre
Authors: Pandey V. , Gangopadhyay A.N. , Gupta D.K. , Sharma S.P. , Kumar V. , Tiwari P. 
Published: May 2014

Objective:Conventional therapy for neonatal necrotising fasciitis (NF) involves resuscitation and aggressive surgical debridement of necrotic tissue. This approach adds surgical stress in septicaemic neonates with low reserves. The present study reports a more conservative approach to the management of neonatal NF.Method:A prospective study was conducted between July 2010 and June 2013 and included 11 cases of neonatal NF. Demographic characteristics of patients were noted. No debridement was performed. Dressings were applied after cleaning with normal saline every 24 hours. The necrotic slough was allowed to separate spontaneously. A record was made of type and duration of supportive modalities and complications. The primary outcome was recorded as final recovery, need of surgical intervention or need of grafting.Results:Out of 11 neonates, 6 were males and 5 were females. Age ranged from 13 to 24 days (mean age 18.45±3.24 days), and weight varied from 1.8 to 2.6 kg (mean weight 2.12±0.24kg) at presentation. Duration of illness before admission to hospital ranged from 3 to 9 days (mean 4.84±2.13 days). The most common site of the initial involvement was the neck and upper thoracic region (n=4), scalp (n=3), lower back (n=2), face (n=1) and extremities (n=1). In all cases, the wound was cleaned with normal saline, dressed, necrotic slough was allowed to separate spontaneously and granulation tissue was allowed to develop; this took approximately 14 to 28 days (mean 20.45±5.78 days).Conclusion:As opposed to the conventional approach of aggressive debridement in neonatal NF, these cases can be managed conservatively without increase in morbidity or mortality. This approach also minimises the surgical risk and requirement of blood transfusion. Antifungal drugs have a definitive role in management of these immunologically deficient babies.Declaration of interest:There were no external sources of funding for this study. The authors have no conflicts of interests to declare.