bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burnout in physiotherapists: Use of clinical supervision and desire for emotional closeness or distance to clients
Authors: Fischer Marcel , Mitsche Marion , Endler Peter Christian , Mesenholl-Strehler Elke , Lothaller Harald , Roth Roswith 
Published: May 2014

Aims: This study aimed to investigate burnout among physiotherapists in hospitals within four health districts in South Tyrol (the German and Italian speaking area of Italy). Method: Data were collected anonymously by envelope. The German version of the Maslach Burnout Inventory (MBI-D) ( Büssing and Perrar, 1992 ; Büssing and Glaser, 1998 ), socio-demographic, occupational data, the use of clinical supervision or support and the desire for emotional distance and closeness to clients were recorded. Questionnaires were sent to 191 physiotherapists in South Tyrol; and 132 participated in the study (return rate 69.63%). Results: In the MBI-D, which contains three scales: ‘emotional exhaustion’, ‘depersonalisation’ and ‘personal accomplishment’; the risk of burnout is reflected in high values in the emotional exhaustion and the depersonalisation scales and low values in personal accomplishment. The present study found that about 35% of the physiotherapists who responded to the questionnaire showed burnout risk in emotional exhaustion, 18% in depersonalisation and 14% in personal accomplishment. This is in agreement with many other studies conducted among health professionals. Gender differences were observed only on the depersonalisation scale, with men scoring higher than women. No differences were found regarding length of stay in the profession. Only one third of physiotherapists are offered clinical supervision or support by their employer but about 50% of physiotherapists sought psychological support. The use of supervision or support was 2.72 times more likely when available at work than not. Contrary to expectations, the impact of supervision or support did not reach significance in the burnout scales. The desire for more closeness is predicted by gender (male), higher emotional exhaustion and depersonalisation, and the desire for more distance is predicted by higher emotional exhaustion. Conclusions: More attention to mental hygiene and support in the workplace and during training would help to prevent burnout among physiotherapists, and benefit the profession, patients and organisations.
Development and evaluation of the Primary Healthcare-based Physiotherapy Intervention and its effects on selected indices of stroke recovery
Authors: Olaleye Olubukola A , Hamzat Talhatu K , Owolabi Mayowa O 
Published: May 2014

Aim: To develop a Primary Healthcare-Based Physiotherapy Intervention (PHCPI) that requires simple, inexpensive, easy-to-use equipment for stroke rehabilitation and evaluate its effects on selected clinical indices of recovery among post-acute stroke survivors over a 10-week period. Methods: Three databases (Medline, Pubmed and PEDro) were used to identify treatment approaches with proven efficacy. The authors synthesised these treatment approaches to develop the PHCPI, which was used in a repeated measure design involving 25 (mean age=60.6 ± 10.2 years) consenting individuals with first-incidence stroke. These individuals were treated at a primary health centre, twice weekly for 10 consecutive weeks. Outcomes were assessed using the Modified Motor Assessment Scale (MMAS), the Short Form Postural Assessment Scale for Stroke (SF-PASS) and the Reintegration to Normal Living Index (RNLI), before the intervention and fortnightly thereafter. Walking speed and quality of life were also assessed before the intervention and at week 10 of it. Results: Within-subject multivariate analysis, after controlling for gender, showed a significant increase in motor function, postural balance, walking speed and quality of life. Their community reintegration scores also improved over the period. Conclusion: The PHCPI resulted in improved motor function, community reintegration, walking speed, postural balance and quality of life among community-dwelling stroke survivors. This intervention can be used for stroke rehabilitation at primary health centres.
Cardiac rehabilitation programmes for low-risk patients and leisure athletes: A potential paradox
Authors: Bjerke Wendy , Steinman Stu , Cotto Vincent 
Published: May 2014

Background Athletes are enrolled in cardiac rehabilitation (CR) programmes in small numbers and require unique diagnostic testing and training considerations. Additionally, many physiotherapists, exercise physiologists, athletic trainers and physicians lack experience treating athletes in CR due to their limited exposure to these types of patients. Content This analysis distinguishes athletes from typical CR patients within the context of diagnostic testing, assessment, exercise prescription, and management. Several case studies present unique challenges and approaches to the rehabilitation of athletes in a CR setting. Conclusions Athletes enrolled in CR should be treated and trained according to their abilities and goals. Combining traditional guidelines with alternative approaches may be the optimal manner to treat these unique patients.
Effect of glycaemic control on apoptosis in diabetic wounds
Authors: Rai N.K. , Ansari M. , Kumar M. , Shukla V.K. , Tripathi K. 
Published: May 2014

Objective:To study the effect of glycaemic control on apoptosis in chronic ulcers in diabetic patients and the differential roles of insulin and oral hypoglycaemic agents (OHAs).Method:Ten non-diabetic (group I) and 20 diabetic patients (groups II and III), with a wound of more than four weeks’ duration, who were attending the wound clinic at University Hospital, Varanasi, India were recruited. The 10 patients in group 11 received insulin and the 10 in group III an oral hypoglycaemic agent; all had diabetic foot ulcers. Wound biopsy and other routine investigations were performed. Both DNA fragmentation and morphological changes under light microscopy (apoptotic index) were used as determinants of apoptosis. Different variables, including fasting and post-prandial blood sugar, serum low-density lipoprotein (LDL) and markers of microangiopathy, such as proteinuria and diabetic retinopathy, were compared with apoptosis.Results:DNA fragmentation in groups I, II and III was 40.00 ± 2.97, 45.26 ± 3.21 and 60.8 ± 3.13 respectively (p<0.01). Near linear correlation was observed with blood sugar level, particularly post-prandial blood sugar (p<0.05) and DNA fragmentation. DNA fragmentation was significantly correlated with serum LDL and proteinuria, and it was much greater in the OHA group than in the insulin group (p<0.05). Similarly, in the diabetic patients with background retinopathy the DNA fragmentation was 46.50 ± 3.42 (n=3) in the insulin group and 66.70 ± 6.48 (n=4) in the OHA group (p<0.05).Conclusion:There is a significant increase in apoptosis in diabetic wounds with poorly controlled blood sugar and microangiopathy. This increase was greater in patients on OHAs than those on insulin, and it contributes to delayed wound healing. Morphological markers do not appear to be a reliable index of apoptosis in the diabetic wound.Declaration of interest:None.
A prospective study on the use of a non-adhesive gelling foam dressing on exuding leg ulcers
Authors: Vanscheidt W. , Münter K-C. , Klövekorn W. , Vin F. , Gauthier J-P. , Ukat A. 
Published: May 2014

Objective: This non-comparative phase II study aimed to evaluate the safety and performance of a non-adhesive gelling foam dressing (GFD-N) in leg ulcer management. Method: Forty-six subjects with moderately to heavily exuding leg ulcers were treated with a regimen including GFD-N. Dressings were changed at least every seven days for four weeks or until healing. Results: Mean GFD-N wear time was 3.2 days per subject. Mean wound area decreased from 10.1cm2 at baseline to 5.1cm2 at four weeks (p<0.001) and healed in five subjects (11%). The surrounding skin improved or remained stable in all but one subject. When compared with pre-study dressings, ulcer pain decreased for GFD-N, both with the dressing in place (p<0.001) and on dressing removal (p<0.001). Of final investigator ratings for 45 subjects, most were ‘excellent’ for ease of application (89%), ease of removal (96%), conformability (67%) and overall performance (58%). Five subjects experienced adverse events; none were serious or dressing-related. Conclusion: This small study demonstrates that GFD-N was safe, effective and convenient for wound healing, exudate management, pain/comfort and ease of use. Declaration of interest: This study was sponsored by a clinical grant from ConvaTec, a division of ER Squibb & Sons, Princeton, New Jersey, US.
Honey promotes angiogeneic activity in the rat aortic ring assay
Authors: Rossiter K. , Cooper A.J. , Voegeli D. , Lwaleed B.A. 
Published: May 2014

Objective To investigate possible effects of honey on angiogenesis, using in vitro analogues of angiogenesis and an endothelial proliferation assay. Method Using an in vitro rat aortic ring assay we compared pseudotubule formation by medicinal honey (Activon), supermarket honey (Rowse) and a honey-based ointment (Mesitran), with that of artificial honey (70% w/w sugar glucose/fructose). Pseudotubules were analysed using TCS Cellworks AngioSys software. The Angiokit sytem was used to validate the results. Using the MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium. Bromide] assay, toxicity was also assessed on human umbilical vein endothelial cells (HUVEC) directly adherent to plastic. Results All honey preparations stimulated pseudotubule formation, maximal at around 0.2% honey. Medicinal honeys were more active than Rowse. The effect was not attributable to the sugar content. Among the honeys tested, the Manuka-based Activon preparation reduced residual viable biomass compared with a sugar control at >0.32% v/v concentration. Rowse had a similar effect only at 2.5%, the highest dose tested. Conclusion The influence of honey constituents on angiogenesis in a wound dressing context is likely to be positive, but would depend on the effective dilution of the honey and the penetration of the active constituents against an osmotic gradient. The extent to which this occurs has yet to be established. Conflict of interest This work was conceived, designed and executed by the authors. Medical honey preparations were supplied unconditionally but free of charge by the distributors.
Predicting delayed pressure ulcer healing using thermography: a prospective cohort study
Authors: Nakagami G. , Sanada H. , Iizaka S. , Kadono T. , Higashino T. , Koyanagi H. , Haga N. 
Published: May 2014

Objective To investigate whether thermography can be used to detect latent inflammation in pressure ulcers and predict pressure ulcer prognosis in a clinical setting. Method For this cohort study, we recruited 35 patients with stage II–IV pressure ulcers on the torso, who underwent thermographic assessment on discovery of their pressure ulcer. The patients were followed up for at least 3 weeks. Thermography was performed immediately after dressing removal. Pressure ulcers were classified into two groups depending on whether or not the wound site temperature was lower or higher than the periwound skin: the low temperature group and the high temperature group respectively. A generalised estimation equation was used to estimate the relative risk of delayed healing of pressure ulcers, comparing wounds with high temperatures and low temperatures. Results Of the 35 patients, 21 had ‘low temperature’ wounds and 14 had ‘high temperature’ wounds at baseline. Two patients in the high temperature group presented with overt infection, and were excluded from further analysis. Twenty-two pressure ulcers were considered to heal ‘normally’ (that is, the wound area reduced by 30% or more within 3 weeks) and 16 did not heal. The baseline DESIGN score (a measure of gross wound status) did not differ in any subscales between the high and low temperature groups. The relative risk for delayed healing in high temperature cases was 2.25 (95% confidence intervals; 1.13–4.47, p=0.021). Sensitivity was 0.56, specificity was 0.82, positive predictive value was 0.75, and negative predictive value was 0.67. Conclusion Our results indicate that using thermography to classify pressure ulcers according to temperature could be a useful predictor of healing at 3 weeks, even though wound appearances may not differ at the point of thermographical assessment. The higher temperature in the wound site, when compared with periwound skin, may imply the presence of critical colonisation, or other factors which disturb the wound healing. Conflict of interest None.
Living with wound-associated pain: impact on the patient and what clinicians really think
Authors: Jones M. Lloyd , Greenwood M. , Bielby A. 
Published: May 2014

Objective To gain an insight into current practice and practitioner opinions on the recognition and management of wound-associated pain as compared with that previously presented in the literature. Method Delegates who attended Wound Expo 2009 and participated in the interactive learning workshops held in the wound pain educational zone were surveyed. This was therefore a convenience sample. All participants signed a consent form prior to the interactive voting session to allow their anonymous responses to be used. The survey consisted of questions that had been devised to generate a clearer insight into current practice and opinion on wound-associated pain. Questions were posed during the workshop (displayed in a PowerPoint presentation) and attendees were given 10 seconds per question to select their preferred responses, each using an individual electronic interactive voting panel. All responses were recorded electronically and the data were subsequently analysed. Results The survey identified a number of positive approaches used by the delegates in their assessment of wound-associated pain. These include a high level of continuous assessment, an awareness of the wide range of pain assessment tools available and an acknowledgement of the need for a multiprofessional approach to pain management. Conclusion The findings highlight the issues clinicians face in the recognition, assessment and management of wound-associated pain during their everyday practice. Although many of these issues are difficult to resolve entirely, a fundamental element is that the patient's experiences must be assessed and documented in a consistent and informed manner, and then appropriate management actions taken. Conflict of interest This paper was written in conjunction with the Clinical Project Team of Smith & Nephew Healthcare, who sponsored the wound pain zone workshops.
Clinical and economic evidence supporting a transparent barrier film dressing in incontinence-associated dermatitis and peri-wound skin protection
Authors: Guest J.F. , Greener M.J. , Vowden K. , Vowden P. 
Published: May 2014

Objective: To summarise the clinical and economic literature relating to the effect of Cavilon No Sting Barrier Film on the incidence of incontinence-associated dermatitis, which is a risk factor for pressure ulceration and exudate-related peri-wound skin damage. Method: A systematic literature search was performed using available computerised databases for publications on Cavilon barrier film and other relevant terms. Six clinical studies were identified providing data on 1,563 patients treated with the barrier film or a comparator. The publications comprised prospective studies, randomised and non-randomised studies, multicentre trials, single-centre reports and a volunteer study. Due to the nature of the comparators, five studies were open-label. Differences in methodology and outcomes made a qualitative review the most appropriate analysis. Results: The barrier film was at least as effective as petroleum ointments and more effective than zinc oxide formulations in preventing incontinence-associated dermatitis. The barrier film was also effective in peri-wound skin protection, although its clinical efficacy was not significantly different to that of petroleum ointments and zinc oxide formulations. Nevertheless, the barrier film was more cost-effective than either petroleum ointments or zinc oxide formulations in managing incontinence-associated dermatitis and peri-wound skin protection, largely due to savings in nursing time. Conclusion: The barrier film is at least as clinically effective and potentially more cost-effective in incontinence-associated dermatitis prophylaxis and peri-wound skin protection than petroleum ointments or zinc oxide formulations, releasing health care resources for alternative use. Further studies are required to quantify the relative efficacy and cost-effectiveness of the barrier film and other barrier formulations in different clinical settings and enhance the quality of the evidence base. Conflict of interest: This review was sponsored by 3M Health Care, manufacturers of Cavilon barrier film. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
Post-surgical scalp wounds with exposed bone treated with a plant-derived wound therapeutic
Authors: Läuchli S. , Hafner J. , Wehrmann C. , French L.E. , Hunziker T. 
Published: May 2014

Objective: To evaluate the efficacy of a plant-derived wound dressing, a mixture of hypericum oil (Hypericum perforatum) and neem oil (Azadirachta indica), in scalp wounds with exposed bone. Method: A retrospective review was conducted of all patients presenting with scalp wounds with exposed bone following the excision of skin tumours and treated with a plant-derived wound dressings (1 Primary Wound Dressing; Phytoceuticals AG), from January to July 2011. Time to healing, wound size, area of exposed bone, ease of handling, pain and complications were evaluated. Results: Nine consecutive patients were analysed retrospectively. The patients' mean age was 81.2 ± 8.5 years (63–90 years), with a mean wound size of 13.2 ± 6.8cm2 (0.4–22.6cm2) and 6.8 ± 6.5cm2 (0.3–20.7cm2) of exposed bone. The time to complete healing by secondary intention was 4–20 weeks. A rapid induction of granulation tissue was observed, which covered the entire exposed bone surface in six out of nine cases (67%) after 4 weeks, and showed a reduction in the mean area of exposed bone of 95%. Dressing change was easy and without pain and there were no complications. Conclusion: This retrospective, non-controlled analysis suggests that ONE is a very simple to use, safe and potentially effective therapy for the treatment of scalp wounds with exposed bone. Declaration of interest: There were no external sources of funding for this study. The authors have no conflict of interest to declare.
Role of early radical debridement and skin cover in diabetic foot ulceration
Authors: Ahmad I. , Akhtar S. , Masoodi Z. 
Published: May 2014

Objective:To assess the efficacy of radical debridement and skin grafting in treating diabetic foot ulceration, compared with conservative wound treatment.Method:The medical notes for 30 patients who underwent skin grafting for diabetic foot ulceration (graft group) were retrospectively analysed and matched, according to age, gender, ankle brachial pressure index (ABPI) and comorbidities, with 30 other patients, who were treated conservatively (control group). Patients in the graft group underwent early, radical debridement to prepare the wound bed for grafting. Graft take, rate of ulcer recurrence and donor-site morbidity were assessed. Healing times and the length of hospital stays were compared between the two groups.Results:A 100% skin graft take was recorded in 80% of the patients on day 4, postoperatively. Ninety-three per cent of patients in the graft group completely healed, with 2 patients (6.7%) experiencing ulcer recurrence within the following 6 months. Ulcer recurrence could be due to early, non-guarded ambulation. Mean healing time and hospital stay were significantly lower in the graft group compared with the control group (4.0 ± 1.5 weeks vs 10.0 ± 1.0 weeks; p < 0.001). Mean healing time in smokers was slightly greater than non-smokers.Conclusion:Skin graft is an effective method of managing diabetic foot ulcers compared with dressings. It reduced healing times and hospital stay with minimum donor-site morbidity.Declaration of interest:There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Treatment for hypergranulation at gastrostomy sites with sprinkling salt in paediatric patients
Authors: Tanaka H. , Arai K. , Fujino A. , Takeda N. , Watanabe T. , Fuchimoto Y. , Kanamori Y. 
Published: May 2014

Objective: To estimate the efficacy of sprinkling salt treatment (SS) of hypergranulation at gastrostomy sites in paediatric patients. Method: A prospective case-series study of paediatric patients with hypergranulation at gastrostomy sites. About one-third of a 5ml-teaspoon of table salt was sprinkled over the tissue once a day, either by the doctors/nurses in the wards or doctors in the outpatient setting. Treatment was continued by the patients or carers in the home, until the hypergranulation was seen to flatten. The patients were followed up by health professionals once a month. Results: Eight paediatric patients (seven females and one male) were included in the study. The hypergranulation decreased in size and became almost flat in all patients within 3 days to 2 months (median 7 days). Five patients had a recurrence of hypergranulation, but were treated successfully by repeated SS. Skin erosion was observed in one patient when SS was continued too long; therefore, the treatment protocol was altered so that the salt was irrigated 10 minutes after SS. A biopsy of the hypergranulation tissue was taken from a patient and salt was sprinkled on the tissue in a dish to simulate SS for histopathological examination. Histopathologically, hypergranulation treated by SS exhibited reduced interstitial oedema. Conclusion: The results of this study suggest that hypertonic environment induced by SS effectively reduced the oedematous hypergranulation tissue. SS is advantageous over traditional treatment such as silver nitrate in that SS is inexpensive and can be continued by the parents and repeated if necessary at home. Declaration of interest: This study was supported by a Grant for Child Health and Development from the Ministry of Health, Labour and Welfare, Japan. The authors have no conflicts of interest to declare.
Nurse–patient consultations in primary care: do patients disclose their concerns?
Authors: Green J. , Jester R. , McKinley R. , Pooler A. 
Published: May 2014

Objective: To quantify the extent to which patients disclose their concerns to community nurses during wound care consultations. Method: Using an ‘observation checklist’ based on themes and subthemes that were identified in a previous study of the same patients, 20 wound care consultations were observed. The non-participant observer completed the checklist and made field notes regarding the context and nature of interactions. Results: Patient participants had 160 opportunities to raise concerns regarding previously-identified pain, exudate and odour, yet they did not do so on 64 (40%) occasions. They had 28, 32 and 84 opportunities to raise emotional, wound care and daily living issues, respectively, and they did not on 16 (56%), 3 (9%) and 32 (38%) occasions. Overall, patients did not raise 38% of their concerns. Of the concerns that were raised, 8% were either not acknowledged or were disregarded by their community nurse. Conclusion: If these data are representative, this has profound implications for person-centred care and shared decision-making models of care, which are predicated on patients articulating their needs. They also have implications for the development of practitioners’ communication and consulting skills. Declaration of interest: This study was funded by NHS West Midlands Strategic Health Authority. The authors have no conflicts of interest to declare.