bluuebunny/crossref_metadata_2025_split huggingface dataset:
An RCT on the effects of topical CGP on surgical wound appearance and residual scarring in bilateral total-knee arthroplasty patients
Authors: Ong A. , Orozco F. , Sheikh E.S. , Anmuth C. , Alfaro A. , Kathrins R. , Grove G.L. , Zerweck C. , Madden A.M. , Raspa R. , Weis M.T. 
Published: May 2014

Objective: To test the hypothesis that topically applied calcium glycerophosphate (CGP) would improve the appearance of the wound following bilateral knee replacement. Method: Healthy patients, aged 45–75 years, scheduled for bilateral total-knee replacement surgery were recruited into the study. one knee was randomly assigned to the treatment group, while the contralateral knee was designated the control (standard care). Subjects were instructed to apply a preparation of 10% CGP in an aqueous lotion to the treated knee once daily for 42 days, starting at the third postoperative day. Functional sealing and cosmetic appearance of the incision were evaluated by two surgeons by direct examination of the patient and then by two experienced assessors from photographs. The investigators qualitatively scored the intensity and extent of erythema along the incision and over the entire knee, the appearance of visible oedema along the incision and over the knee, and the overall clinical impression of wound healing. All four assessors were blinded to the subjects’ allocation and the latter two assessors to the initial investigators’ assessments. Subjects were also followed up for an additional 46 weeks, giving a total study duration of 12 months. Results: Twenty patients completed the study. Statistical analysis showed that both the area and intensity of erythema along the incision were significantly reduced in the treated vs untreated knee over the entire study period. The analysis further showed that treatment significantly reduced oedema, both along the incision and across the entire knee. The differences were most marked at the seventh postoperative day and diminished with time. no adverse effects were observed for any patient, in either treated or untreated knees. Conclusion: These data demonstrate that postoperative application of 10% CGP could improve the appearance of the wound following total knee arthroplasty. Declaration of interest: This study was supported by a grant from AkPharma Inc. Dr M.T. Weis has performed paid consultant work for AkPharma during past 10 years. no person or institution performing work on this study has any financial connection with AkPharma Inc., or any financial interest in the outcome of this study, or in the components used in this study.
Effect of amelogenin ECM protein on the healing of chronic leg ulcers with atrophie blanche
Authors: Fogh K. , Nielsen C.B. , Dam W. 
Published: May 2014

• Objective: To determine the effect of topically applied amelogenin extracellular matrix protein (AEMP) in patients with non-healing venous leg ulcers combined with atrophie blanche. • Method: This retrospective case series of patients with non-healing venous leg ulcers with atrophie blanche of the distal proportion of their lower legs, where non-healing was defined as no progress toward healing for 3 months previously, under standard therapy. Patient records were reviewed for associated diseases, wound diagnoses, distal blood pressure, previous treatments and changes in wound area. Patients were treated with AEMP once a week, for a period of 12 weeks, or until full healing. • Results: Eleven patient records were reviewed retrospectively. The median age of the patients was 81 years (range 40–95 years), with a mean wound size of 4.7 ± 3.5cm2 and median wound duration of 6 months (range 3–444 months). All patients had venous or combined arterial/venous insufficiency. After 12 weeks' treatment with AEMP, complete healing, defined as 100% re-epithelialisation, was documented in four patients (36%), marked improvement (> 50% epithelialisation) in three patients (54%, 55% and 83% wound closure, respectively), slight improvement in one patient (9.4% wound closure), no change for two patients and worsening in one. AEMP was well tolerated, and no patients reported side effects. • Conclusion: The results of this retrospective study suggest that AEMP improves healing in chronic venous leg ulcers combined with atrophie blanche. • Declaration of interest: Amelogenin extracellular matrix protein (XelmaR) was provided by Mölnlycke Health Care, Denmark. There were no external sources of funding for this study and Mölnlycke Health Care had no role in the study design or data collection. The authors have no conflicts of interest to declare.
The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers
Authors: Leigh B. , Desneves K. , Rafferty J. , Pearce L. , King S. , Woodward M.C. , Brown D. , Martin R. , Crowe T.C. 
Published: May 2014

Objective: To investigate if a lower dose of arginine in the form of an oral nutritional supplement can show similar benefit in the healing rate of pressure ulcers compared with the current evidence for 9g of arginine. Method: Twenty-three inpatients with category II, III or IV pressure ulcers were randomised to receive daily, for 3 weeks, the standard hospital diet plus 4.5 or 9g arginine in the form of a commercial supplement. Pressure ulcer size and severity was measured weekly (by PUSH tool; pressure ulcer scale for healing; 0= completely healed, 17= greatest severity). Nutritional status was determined by Subjective Global Assessment. Results: There were no significant differences in patients' age, gender, BMI, haemoglobin levels, albumin levels and diagnosis of diabetes between treatment groups. There was a significant decrease in pressure ulcer severity over time (p < 0.001), with no evidence of a difference in healing rate between the two arginine dosages (p=0.991). Based on expected healing time, patients in both treatment groups were estimated to achieve an almost 2-fold improvement compared with the historical control group. Patients categorised as malnourished showed clinically significant impaired healing rates compared with well-nourished patients (p=0.057), although this was unaffected by arginine dosage (p=0.727). Conclusion: Similar clinical benefits in healing of pressure ulcers can be achieved with a lower dosage of arginine, which can translate into improved concordance and significant cost-savings for both the health-care facilities and for patients. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
An experience with paediatric burn wounds treated with a plant-derived wound therapeutic
Authors: Mainetti S. , Carnevali F. 
Published: May 2014

Objective: To observe the efficacy of a plant-derived wound dressing (1 Primary Wound Dressing®), a mixture of hypericum and neem oil, in different types of paediatric burns. Method: A retrospective review was conducted over the complete healing course of 9 paediatric patients with a mean age of 8.17±3.35 (1–11 years), presenting mixed, partial or full-thickness burns. The treatment applied by the wound care specialist consisted of daily cleansing of the wound with a saline solution and application of 1 Primary Wound Dressing on the whole wound surface. There was no application of a secondary dressing. The time to heal, wound size, ease of handling, pain and complications were recorded. Procedural and background pain were observed in six of the patients older than 5 years (mean age 9.6±2.39, range 8–11 years). Due to the small number of patients examined during the period studied, it was not possible to perform statistical analyses. Results: The mean wound size was 50.76±48.32cm2 (4.63–132.0cm2). A rapid induction of granulation tissue and re-epithelialisation was observed. Time to complete healing was 16.6±4.69 days (10–22 days). No complications related to wound infection was observed. The 6 patients older than five years reported a strong relief of pain, from an initial value of 7–8 out of 10 to 0 out of 10 within the first week of treatment. This remained at the 0 out of 10 level during the second and third weeks of treatment. Conclusion: This retrospective, non-controlled examination suggests that 1 Primary Wound Dressing could be an effective therapy for the treatment of burn wounds, with benefits including pain reduction and simplicity of use. Further evaluations with a larger population are required to document the effectiveness of this plant-derived wound dressing in a controlled fashion. Declaration of interest: There were no external sources of funding for this study. F. Carnevali is a researcher and co-inventor of 1 Primary Wound Dressing®.
Feelings of powerlessness and hope for cure in patients with chronic lower-limb ulcers
Authors: Salomé G.M. , Alves S.G. , Costa V.F. , Pereira V.R. , Ferreira L.M. 
Published: May 2014

Objective: To assess feelings of powerlessness and hope for cure in patients with chronic venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). Method: A clinical, analytical, descriptive study was conducted from April to September 2012 in a wound-care clinic in Brazil, on consecutive patients presenting with VLUS and DFUS. The Powerlessness Assessment Tool for Adult Patients (PAT) and the Herth Hope Index (HHI) were used. Total PAT scores range 12–60 and the higher the score, the stronger the feelings of powerlessness. The HHI ranges 12–48, with higher scores indicating higher levels of hope Results: In total, 80 consecutive patients were recruited (40 VLU and 40 DFU). Mean PAT score was 53.3 ± 9.6 (range 21–60) for DFU patients and 34.3 ± 7.7 (range 21–60; p=0.001) for VLU patients, suggesting these individuals had strong feelings of powerlessness. The mean HHI was 16.5 ± 16.5 (range 12–40) for DFU patients and 27.5 ± 27.5 (range 12–40; p=0.001) for patients with VLUs, indicating low levels of hope. Conclusion: The results suggest that patients with DFUs had stronger feelings of powerlessness regarding their condition and less hope of recovery compared with patients with VLUs. Declaration of interest: There were no external sources of funding for this study. SGA and VFC received a scholarship from the Research Support Foundation of the State of Minas Gerais (FAPEMIG). The scholarship provider had no roles in the design and conduct of the study, including collection, management, analysis and interpretation of data, preparation, review, and approval of the article. The authors have no conflicts of interest to declare.
Management of post road traffic accident compound leg defects using fasciocutaneous flaps
Authors: Masoodi Z. , Ahmad I. , Khurram F. , Haq A. 
Published: May 2014

Objective: To highlight the role of fasciocutaneous flaps in the management of leg and foot defects sustained after trauma, in rural India. Method: This was a prospective study conducted on patients with traumatic defects of the leg and foot, admitted between May 2001 and April 2007. Selection of flaps was done on the basis of defect size, site and condition of surrounding tissue. Ipsilateral flaps (proximally- and distally-based), contralateral-leg flaps and free flaps (anterolateral thigh and radial forearm) were raised according to standard techniques and wounds resurfaced accordingly. The outcome was considered ‘excellent’ when there was no flap necrosis and no donor site morbidity, ‘good’ when there was some infection, either at the donor or recipient site, but no necrosis, ‘satisfactory’ when partial flap necrosis and ‘poor’ when there was flap loss. Results: One-hundred and ten patients (86 males and 24 females) with post-traumatic leg defects underwent reconstruction with different fasciocutaneous flaps. The ages of the patients ranged from 6 years to 58 years, with a mean age of 28.2 ± 11.5 years. Forty cases (37%) underwent immediate reconstruction within the first 72 hours and in 70 cases (63%) delayed reconstruction was done. Hospital stay of the patients ranged from 8 days to 54 days, with a mean of 20.2 ± 1.9 days. There were no complications recorded at donor site. The overall results were considered excellent in 92 cases (84%), good in 12 (11%), satisfactory in four (3.6%) and poor in two cases (1.8%), where flap necrosis occurred. Conclusion: Our results suggest fasciocutaneous flaps are convenient, simple, reliable and easy to manage. The majority of compound leg defects can be reconstructed with fasciocutaneous flaps either from the ipsilateral leg, contralateral leg or in the form of free flaps. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Evaluation of a pilot Pressure Ulcer Prevention Initiative (PUPI) for patients with traumatic spinal cord injury
Authors: Cobb J.E. , Bélanger L.M.A. , Park S.E. , Shen T. , Rivers C.S. , Dvorak M.F. , Street J.T. , Noonan V.K. 
Published: May 2014

Objective: The purpose of this study was to determine whether implementation of a Pressure Ulcer Prevention Initiative (PUPI) changed the assessment and treatment of patients with a traumatic spinal cord injury (SCI) in an acute care setting, and improved patient outcomes. Method: The success of implementation was evaluated by examining the percentage of patients with completed occupational therapist (OT) skin care assessments and prescriptions for therapeutic support surfaces (TSS; i.e., mattresses) before implementation (historical, cohort 1) and after implementation (experimental, cohort 2). Patient outcomes were evaluated by examining changes in PU incidence, severity, timing and recurrence, as well as PU prevalence and satisfaction with life in the community. Results: Final analysis included 70 patients in cohort 1 and 73 in cohort 2. OT skin care assessment documentation (31% to 60%; p<0.001) and TSS prescriptions (31% to 60%; p=0.02) signifcantly increased following the implementation. The PU incidence based on patient charts (both nursing and OT assessments) did not increase signifcantly (26% to 36%; p=0.2). However, documented PU incidence according to OT assessments showed a substantial increase (14% to 33%; p=0.002). No effect of the PUPI was seen on immediate or long-term patient outcomes during the study period. Conclusion: PUPI was successful in changing clinical practice in PU prevention but no statistically signifcant improvements in PU-related patient outcomes were demonstrated. Results from this study identifed facilitators and barriers to implementation and highlighted the complexity and diffculty of instituting effective preventative or therapeutic interventions for this population in an acute care setting. This information will assist with refnements of the PUPI and inform similar future initiatives. Declaration of interest: This study was supported by fnancial contribution from the Government of Canada through Health Canada and Western Economic Diversifcation Canada. The views expressed herein represent the views of the authors. JC, LB, MD, JS are employees of the study hospital. S P, CR, TS and VN are employees of the Rick Hansen Institute.
The use of a specialised amino acid mixture for pressure ulcers: A placebo-controlled trial
Authors: Wong A. , Chew A. , Wang C.M. , Ong L. , Zhang S.H. , Young S. 
Published: May 2014

Objective: To compare pressure ulcer healing rates in patients supplemented with a specialised amino acid mixture containing β-hydroxy β-methylbutyrate (HMB), arginine and glutamine, and standard oral nutritional supplements versus patients supplemented with oral nutritional supplements and a placebo mixture. Method: Twenty-three inpatients with stage II, III or IV pressure ulcers in an acute care hospital were randomised to recieve (A) a HMB, arginine and glutamine mixture twice daily alongside oral nutritional supplements (n=11) or (B) standard nutritional care alongside oral nutritional supplements (n=12) for 2 weeks. Pressure ulcers were measured weekly for area, depth and Pressure Ulcer Scale for Healing (PUSH) scores. The proportion of viable tissue was determined based on area of wound tracing. Weekly laboratory tests were performed to measure C-reactive protein and pre-albumin levels. This trial is registered at http://ClinicalTrials.gov under NCT01090076. Results: There was no difference between anthropometrical measurements, biochemical parameters and nutritional intake pre- and post- study. Wound area did not decrease significantly in the short term for both groups. The proportion of viable tissues increased within 2 weeks on HMB, arginine and glutamine supplementation (p=0.02). PUSH scores showed significant improvement within 1 week of supplementation for the experimental group (p=0.013). Conclusion: The use of specialised amino acid does not appear to reduce wound size and PUSH scores but may improve tissue viability after 2 weeks. Further confirmation on a larger scale is required to determine the benefits of supplementing additional HMB, arginine and glutamine in patients with pressure ulcers. Declaration of interest: This study was supported in part by Abbott Laboratories (Singapore) Pte Ltd. The authors have no conflicts of interests to declare. pressure ulcer; wound healing; arginine; glutamine; beta-hydroxy beta-methylbutyrate; HMB.
An introduction to CPD for paramedic practice
Authors: Sibson Lynda 
Published: May 2014

This article outlines the concept of continuing professional development (CPD) and its application to the paramedic. CPD has long been an aspect of other health care professions, but is relatively new to the paramedic profession. The Health Professions Council (HPC) standards mean that paramedics will have to provide evidence of CPD from August 2009. The standards apply not only to those in clinical practice, but also to those working in research, management or education. CPD can initially appear daunting. However, it can, and should be, an enjoyable aspect of developing yourself and your professional practice. This article therefore aims to suggest some CPD activities for paramedic practice, with reference to some of the HPC guidelines and learning from other health care professionals.
How to carry out a search of a bibliographic database
Authors: Lahlafi Alison 
Published: May 2014

This article, aimed at the novice, proposes a four-step approach to planning, undertaking and documenting the search for relevant literature, a vital part of any literature review. The main focus is on searching electronic databases to find research papers, but the principles described may also be applied to paper-based sources and the Internet (useful resources for research are considered). Examples are given to illustrate the process of searching using index terms, grouping concepts and applying limits.
Management of an isolated neck-of-femur fracture in an elderly patient
Authors: Eaton Georgette 
Published: May 2014

Femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered in a step-wise approach and should be progressive to the patients' needs. Pain relief should be sought through the variety of options open to paramedics and should be initiated immediately. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive adequate analgesia and fluid replacement before any definitive treatment at hospital.
Severe burn injury—pre-hospital paramedic response—if it goes wrong
Authors: Bourke Patrick M , Dunn Ken W 
Published: May 2014

Internationally burn injury is one of the major causes of death and disability. Serious burn injuries are devastating events that leave patients with longterm physical and psychological challenges that are recognised by paramedics worldwide as one of the most horrific and challenging injuries known to the emergency medical and rescue services. Burn injuries may be extremely complex in their presentation, and any resulting complications may extend the need for expensive long-term management from months to years. This paper provides an overview of the complication of pre-hospital response to severe burn injury, if it goes wrong.
Investigating gout: taking a new approach to an old disease
Authors: Sibson Lynda 
Published: May 2014

Gout is a very painful and common form of acute arthritis, which is becoming increasingly prevalent in many Western societies. Gout was first identified by the Egyptians and is caused by a disorder of the body’s purine metabolism, resulting in raised serum uric acid level, known as hyperuricaemia. Gout tends to affect the older population, particularly obese patients and others with rather negative lifestyle habits, such as a high alcohol intake. However, in the majority of patients suffering from idiopathic gout (75–90%) the evidence suggests that these patients may actually have a genetic disposition to the reduced renal excretion of urate acid. Gout has a rapid onset and the most commonly affected joint is the first metatarsophalangeal, although other joints can also be affected such as the mid-foot, ankle, knee, wrist, finger and elbow. Recommended gout treatment includes non-steroidal anti-inflammatory drugs, colchicine and corticosteroids. Preventative treatments include allopurinol, which aims to lower uric acid levels. The definitive diagnostic test for gout is the aspiration of the joint or tophus and the confirmed identification of monosodium urate crystals. The presence of urate crystals confirms a diagnosis of gout and the absence of evidence of infection will rule out the key differential diagnosis of septic arthritis.
Impact of increasing obesity on primary health carers: an Australian perspective
Authors: Cowley Stephen , Bowman Bindi , Leggett Susan 
Published: May 2014

Increasing levels of obesity in Australia are having a direct impact on those associated with primary care and patient transport. Whether the patient movement is undertaken in the uncontrolled environment of the home or the controlled environment of the hospital, design features generally limit the use of equipment and the application of safe handling procedures. Ambulance and fire services are increasingly developing policies and procedures that address the movement of obese and morbidly obese (bariatric) patients and the purchase and use of equipment. Yet the efficacy of these procedures is hampered by the absence of a standard definition of the term ‘bariatric’. Various definitions of ‘bariatric’ are applied in different sectors and risk-based approaches rather than those based on weight, body dimensions or BMI may be more useful. Substantially more work is required to inform the development of intervention strategies that will lead to significant and sustained risk reduction. Further work is also needed to quantify the frequency of bariatric patient movement within the emergency services across Australia. A clear representation of the journey and the interfaces between the agencies and carers and their respective roles would assist with defining the problem and understanding the solutions.
Research roundup: December 2013
Authors: Greener Mark 
Published: May 2014

In brief ■ ACE-Is and ARAs potentially account for up to 15% of the recent increase in AKI admissions ■ Treating patients taking antiepileptic drugs (AEDs) for low bone mineral density may prevent the development of fractures associated with AEDs ■ GABA analogues prescribed as anticonvulsants, muscle relaxants and to relieve neuropathic pain are being misused as recreational drugs in the UK ■ Lifestyle factors account for at least some of the increased incidence of diabetes among people with psoriasis, psoriatic arthritis and rheumatoid arthritis