bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of a new foam mattress with the standard hospital mattress
Authors: Gray D.G. , Smith M. 
Published: May 2014

This study evaluates pressure ulcer incidence rates and comfort perceptions in 100 subjects admitted to a district general hospital. Subjects were divided into two groups, Group A using the standard hospital mattress (Transfoam), which had been in use in the hospital for three years, and Group B using the study mattress (Transfoamwave), which was new at the beginning of the trial. Due to the low observed incidence of pressure ulcers, it has not been possible to determine whether there is a difference in the clinical performance of the mattresses. Both appear to provide similar levels of comfort. Seat cushions were provided for each trial subject but staff failed to make good use of them, which suggests that more education is required in this area.
Randomised controlled trial of two pressure-relieving systems
Authors: Russell L. , Reynolds T.M. , Carr J. , Evans A. , Holmes M. 
Published: May 2014

A study comparing the efficacy of two alternating-cell mattress and cushion combinations in the treatment of pressure ulcers in hospital patients The primary objective of this randomised controlled trial was to determine whether there were significant differences between two pressure-relieving systems. A secondary aim was to investigate whether the availability of extra pressure-relieving equipment would reduce the incidence of ulcers in an acute hospital setting. A total of 141 patients in a care-of-theelderly unit, who were assessed to have a high risk of developing pressure ulcers using the Waterlow score, were recruited; 70 were nursed using Huntleigh Nimbus 3 in conjunction with the Aura cushion (Group A), and 71 using the Pegasus Cairwave Therapy System in conjunction with the Proactive 2 Seating cushion (Group B). The main outcome measure was visual assessment, supported by a photographic record. There were three main findings: for nonheel ulcers and overall improvement, there was no statistically significant difference between the two products tested; for heel ulcers there was a significant difference (P = 0.019) with more patients healing in Group A than in Group B. The average length of stay of patients who completed the trial was 21.6 days (Group A) and 21.7 days (Group B) for patients completing alive (range 1-121 days) and for patients who died 29.7 days (Group A) and 24.3 days (Group B). Routine monitoring showed that, before the trial, the incidence of hospital-acquired pressure ulcers (Torrance grade 2+) was 0.2%; during the trial, this dropped to 0.13%. The study showed differences in the efficacy of different mattress products; with a sufficiently large study, it is possible to demonstrate statistically significant results. Provision of extra pressure-relieving equipment can reduce the incidence of pressure ulcers but may not influence length of stay.
Alginate dressings in surgery and wound management — part 1
Authors: Thomas S. 
Published: May 2014

The first article in a series of three looks at the history and use of seaweed-derived dressing Large quantities of alginate dressings are used each year to treat exuding wounds, such as leg ulcers, pressure sores and infected surgical wounds. Originally these dressings were a loose fleece formed primarily from fibres of calcium alginate. More recently they have been developed so that the fibres have been entangled to form a product with more cohesive structure, which increases the fabric's strength when it is soaked with exudate or blood. Some products also contain a significant proportion of sodium alginate to improve the gelling properties of the dressing in use. Other dressings have been produced from freeze-dried alginate. Once in contact with an exuding wound, an ion-exchange reaction takes place between the calcium ions in the dressing and sodium ions in serum or wound fluid. When a significant proportion of the calcium ions on the fibre have been replaced by sodium, the fibre swells and partially dissolves forming a gellike mass. The degree of swelling is determined principally by the chemical composition of the alginate, which depends on its botanical source. Although it is recognised that the differences between the various brands of dressings may influence their handling characteristics – particularly when wet – it is generally assumed that these differences are of limited relevance to the dressing's performance clinically or at a cellular level. There is some evidence to suggest, however, that these assumptions may be wrong and that alginates may influence wound healing in a number of ways not yet fully understood. This three-part review of the literature encompasses the history, origin, structure, chemistry and clinical applications of alginates and alginate dressings. This review reveals that, despite their widespread use, alginates have been the subject of very few well-controlled clinical studies. There is fairly convincing evidence, however, that they do offer advantages over more traditional dressings for at least some clinical indications. It has also become obvious that there is a general lack of understanding about the importance of secondary dressing systems that must be used in with alginate dressings. Careful examination of the design and outcomes of the published studies suggests that the choice of both the primary alginate dressing and the secondary dressing can play a major role in determining treatment outcomes.
The impact of minor acute wounds on quality of life
Authors: O'Flynn L. 
Published: May 2014

A study was undertaken to explore the experiences of patients with minor acute wounds following discharge from either inpatient or day care. The sample comprised patients attending the plastic surgery dressing clinic of a district general hospital. Patients whose wounds were considered to be chronic were not included. A conceptual framework was developed from the literature, postulating that the patient is ‘eclipsed’ by the wound and enters the sick role before healing and recovery take place. A self-administered questionnaire was used to collect data for a mainly quantitative analysis, with some open questions to indicate avenues for further study. Unfortunately, the response rate was low, and insufficient data were obtained for effective analysis. Howewver, trends were identified which indicated that these wounds had a significant impact on patients and their families, and recommendations were made for future studies. The survey would need to be repeated on a larger, more representative sample and include semi-structured interviews to produce generalisable results
Evaluating a superabsorbent hydropolymer dressing for exuding venous leg ulcers
Authors: Schulze H.-J. , Lane C. , Charles H. , Ballard K. , Hampton S. , Moll I. 
Published: May 2014

A new hydropolymer dressing was compared with an alginate dressing in a multicentre, prospective, controlled, randomised, stratified, open label trial of 113 patients with exuding venous leg ulcers. The study aimed to evaluate the performance of the dressings in terms of their ability to handle exudate, patient and user acceptability and cost-effectiveness. Patients were stratified according to volume of wound exudate (moderate/heavy) and randomised to the hydropolymer dressing or the alginate plus a secondary dressing.A statistically significant difference between treatment groups was observed in mean wear time, with a longer wear time observed in the hydropolymer group (3.91 days) compared with the alginate group (3.09 days, p=0.001). In terms of patient and user acceptability, all 10 overall evaluations made by both patient and investigator were markedly in favour of the hydropolymer dressing (p<0.001 to p=0.020).The use of the hydropolymer dressing for patients with moderate to heavily exuding venous leg ulcers has statistically significant advantages over the alginate dressing in terms of wear time and investigator and patient acceptability. It is anticipated that this reduction in dressing frequency will translate into a cost-effective wound treatment.
Nurses' views about pain and trauma at dressing changes: a central European perspective
Authors: Kammerlander G. , Eberlein T. 
Published: May 2014

Objective: This study investigated nursing and medical practitioners' perceptions of pain and trauma at dressing change in three German-speaking European countries: Austria, Germany and Switzerland. It follows a similar study by Hollinworth and Collier conducted in the UK. Method: A total of 3300 questionnaires were posted to practitioners in the three countries. All of the practitioners had attended at least one educational event on wound management organised by the researchers. The questionnaire contained closed questions about the participants' experience of dressing change and pain, their place of work and their freedom to select wound management products. Results: A 15.1% response rate was achieved. The main aim at dressing change was to prevent trauma to the wound (30%) and to prevent infection (29%) and pain (21%). Dressing removal (51%) and wound cleansing (41%) were cited as the phases of dressing pain most likely to cause pain. Factors perceived to cause pain during dressing changes included dressings that adhere to the wound area (35%), particularly direct adherence to the wound (29%) and dried-out dressings (28%). Techniques used to prevent pain included rehydrating dressings. The responses also pointed to insufficient knowledge about low-adherent or non-adherent dressings among some respondents. Conclusion: The respondents perceived dressing removal and wound cleansing to be the most painful wound-care interventions. Their key objectives were to prevent pain and trauma at dressing changes. Lack of information on low- and non-adherent dressings needs to be addressed. Declaration of interest: This study was funded by Mölnlycke Health Care AG, Switzerland.
The effect of varying cuff position on recording ankle systolic blood pressure
Authors: Anderson I. 
Published: May 2014

Objective: Ankle brachial pressure index (ABPI) aids the diagnosis of leg ulcer aetiology, although there is potential for patient anxiety or discomfort when the cuff is placed over an ulcerated ankle. This study aimed to ascertain any differences in systolic pressure if the cuff is positioned proximal to the ankle and to determine the feasibility of varying the cuff position to avoid ulcerated areas. Method: The systolic blood pressure in the lower limbs of healthy volunteers (n=60) was measured with the cuff at two discrete sites on the lower limb. Results: There was a statistical difference in systolic blood pressure readings between the two sites (0–4mmHg; p=0.02) and a statistically significant ABPI difference (−0.08 to 0.05; p<0.002). Conclusion: Blood pressure recording is subject to considerable variation in clinical practice and the ABPI has to vary by more than 0.15 to be clinically significant. Therefore, the differences in systolic pressure between sites and the ABPI calculations are not clinically significant in this study. An additional finding was that some subjects found the upper cuff position uncomfortable during the procedure. Declaration of interest: None
Exploring the psychosocial concerns of outpatients with disfiguring conditions
Authors: Rumsey N. , Clarke A. , White P. 
Published: May 2014

Objective: This study was undertaken to establish the extent and type of psychosocial need in outpatients attending for treatment for a variety of disfiguring conditions. Method: A total of 220 outpatients receiving treatment for burns, skin conditions or head and neck cancer, together with those seeking plastic surgery for other appearance concerns, completed standardised measures of anxiety, depression, social anxiety and quality of life. Participants also completed a semi-structured interview exploring individual concerns and satisfaction with care. Results: A considerable proportion of the outpatients with disfiguring conditions experienced psychosocial difficulties, displaying raised levels of anxiety, depression, social anxiety and social avoidance and reduced quality of life. Levels of psychosocial distress were not well predicted by the severity of disfigurement. Conclusion: The psychosocial needs of these patients are not well met in the outpatient setting. Recommendations are made on how patients' concerns might be more effectively addressed. Declaration of interest: None.
The link between the peel force of adhesive dressings and subjective discomfort in volunteer subjects
Authors: Dykes P.J. , Heggie R. 
Published: May 2014

Objective: The study compared the level of discomfort experienced by healthy volunteers on the removal of a range of adhesive wounds. Method: This was an open, within subject comparative study of six adhesive dressings in 24 volunteers. The test site was the lower back. Allocation of test materials to the test sites was randomised. The peel force of removal was recorded after 24 hours of application using a device that removed the dressing at a constant speed and angle to the skin surface. The discomfort experienced at each removal was assessed by the subjects themselves using an electronic visual analogue scale. Results: Overall, Mepilex Border was given a significantly lower discomfort score (p≤0.01) by the subjects than the other dressings. There were no clear differences between the five other products tested. Tielle and Allevyn Adhesive had significantly higher (p≤0.05) peel force than the other products. Mepilex Border caused less discomfort on removal than Duoderm Extra Thin, Biatain and Versiva, even though the peel force was similar. Tielle and Allevyn had higher peel force, but the levels of discomfort were not significantly higher for these products. Conclusion: It may be that the level of discomfort experienced by subjects on removal of an adhesive dressing is not entirely dependent on the peel force and that other aspects of the interaction of the skin surface and adhesive play a role. Declaration of interest: This study was supported by a grant from Mölnlycke Healthcare AB, Gothenburg, Sweden.
A randomised controlled study of four-layer compression versus Unna’s Boot for venous ulcers
Authors: Polignano R. , Boneado P. , Gasbarro S. , Allegra C. 
Published: May 2014

Objective: This study set out to compare healing rates, handling properties and patient comfort of a four-layer bandage system (Profore) and Unna’s Boot in the treatment of venous leg ulcers. Method: This was a prospective randomised parallel-group trial. Patients with venous leg ulcers from four centres in Italy were randomised to receive treatment with either Unna’s Boot or Profore. Time to healing was recorded for a maximum of 24 weeks. Pain was assessed using a visual analogue scale. Staff assessed ease of application, while patients rated comfort. Results: Data were available for 68 patients with 68 wounds. At 24 weeks complete healing was seen in 74% of the Profore group compared with 66% of the Unna’s Boot group. The median time spent in the study was 50 days (range: 7–175 days), corresponding to 51 days (range: 7–175 days) for Profore patients and 49 days (range: 7–168 days) for Unna’s Boot patients. There was no difference (p=0.13) between the groups in time to closure. Overall, more Profore than Unna’s Boot applications were rated as excellent. There was a significant difference, in favour of Profore, in ease of application at the final application (p=0.013). At the initial application, there was a significant difference in bandage appearance (p=0.04), again favouring Profore, but this was not sustained at the final application (p=0.18). Conclusion: Profore is as effective as Unna’s Boot in the treatment of venous leg ulcers. Declaration of interest: This study was funded by Smith and Nephew.
A trial to determine the role of placental extract in the treatment of chronic non-healing wounds
Authors: Shukla, V.K. , Rasheed M.A. , Kumar M. , Gupta S.K. , Pandey S.S. 
Published: May 2014

Objective: To investigate the effect of topical placental extract in the treatment of non-healing wounds. Method: One hundred patients attending the wound clinic at University Hospital, Varanasi, India, with wounds of more than six weeks’ duration were recruited. Fifty patients were treated with placental extract, and 50 were controls. Wound biopsy and swab culture and sensitivity were performed and the area surrounding the wound was X-rayed. Wound size was measured and the rate of epithelialisation assessed at weekly follow-ups. In nine cases biopsies were repeated after two weeks of treatment and sent for histopathological examination, including angiogenesis. Results: Thirty patients dropped out, leaving 40 cases in the treatment group and 30 in the control group. Over an eight-week period, 27 patients (67.5%) in the treatment group showed more than 50% epithelialisation, compared with only seven patients (23.3%) in the control group. Conclusion: Placental extract has a beneficial role to play as a topical agent in the management of chronic non-healing wounds. Declaration of interest: None.
Study to determine the efficacy of topical morphine on painful chronic skin ulcers
Authors: Vernassiere C. , Cornet C. , Trechot P. , Alla F. , Truchetet F. , Cuny J.F. , Commun N. , Granel Brocard F. , Barbaud A. , Schmutz J.L. 
Published: May 2014

Objective: To assess the efficacy of the topical application of morphine on painful chronic skin ulcers. Method: A prospective bi-centric controlled double-blind randomised study was conducted involving 24 patients with painful chronic skin ulcers using topically applied morphine versus placebo. Ten milligrams of morphine hydrochloride with Intrasite Gel or Intrasite Gel with placebo were applied daily for five days. All patients were treated with a level II analgesic treatment. A numeric pain scale lower than 4/10 and no need for a ‘rescue’ treatment (morphine sulphate) indicated that the treatment was successful. Local and systemic tolerance of the treatments was analysed daily. Results: Twenty-four patients were included in the study, but only 18 started the protocol. Only 2/11 patients were completely relieved in the morphine group compared with 1/7 in the placebo group. Local and general tolerance of morphine was good. The peripheral efficacy of morphine is under discussion. Conclusion: The results suggest that topical morphine cannot be an alternative to morphine administered by other routes (subcutaneously or orally) in painful chronic skin ulcers. Stimulation of peripheral morphine receptors by systemic morphine could explain the difference between these results and those of previous studies. Declaration of interest: This study was supported by the University Hospital of Nancy and the Association Lorraine d’Etude et de Recherche en Dermatologie, France.
The effects of non-steroidal anti-inflammatory drug application on incisional wound healing in rats
Authors: Krischak G.D. , Augat P. , Claes L. , Kinzl L. , Beck A. 
Published: May 2014

Objective: There is evidence that non-steroidal anti-inflammatory drugs (NSAIDs) delay both epithelialisation and angiogenesis in the early phases of wound healing because of an antiproliferative effect. We investigated the influence of diclofenac, a non-selective NSAID, on incisional wound healing. Method: Ten male Wistar rats were given 5mg diclofenac per kg bodyweight per day; 10 rats were given placebo pellets. After 10 days, unimpaired healing occurred independently of drug treatment both macroscopically and microscopically. Histomorphometry revealed a significant reduction (p=0.006) in fibroblasts after diclofenac application (median 3166 cells per mm2) compared with the placebo group (median 3940 cells per mm2). Epidermal thickness was not statistically different between the two groups. Results: Diclofenac diminished the amount of fibroblasts in connective tissue, reflecting the known antiproliferative effect of NSAIDs on fibroblasts. Clinical healing was not affected. Conclusion: We recommend short-term diclofenac application for post-surgical and post-traumatic patients with wounds who would benefit from its antiphlogistic and analgesic effect. However, if wound healing is disturbed, the negative effect of diclofenac on fibroblasts should be considered. This is particularly relevant for patients with chronic wounds or conditions such as diabetes which can delay wound healing. Declaration of interest: Novartis Pharma (Nuremberg, Germany) provided financial support.
Wound-healing activity of Morinda citrifolia fruit juice on diabetes-induced rats
Authors: Nayak B.S. , Isitor G.N. , Maxwell A. , Bhogadi V. , Ramdath D.D. 
Published: May 2014

Objective: Morinda citrifolia L. is a traditional Polynesian medicinal plant which is apparently useful for bowel disorders, skin inflammation, infection, mouth ulcers and wound healing. This study aimed to evaluate the wound-healing activity of Morinda citrifolia fruit juice in streptozotocin-induced diabetic rats. Method: An excision wound model was used. The animals were weight-matched and placed into three groups (n=6 per group). Group 1 animals served as normal controls, while animals in groups 2 and 3 served as diabetic controls and experimental diabetic animals respectively. All animals were anaesthetised and a full-thickness excision wound (circular area of 300mm2 and 2mm deep) was created. Group 3 animals were given the juice of Morinda citrifolia fruit (100ml per kilogram of body weight) in their drinking water for 10 days. Wound area measurements were taken on days 1, 5 and 11. Blood samples were collected simultaneously for glucose measurement. Granulation tissue that had formed on the wound was excised on day 11 and processed for histological and biochemical analysis. Results: The wound area of the Morinda citrifolia-treated group reduced by 73% (p<0.001) when compared with the diabetic controls (63%). Significant increases in the weight of granulation tissue (p<0.001) and hydroxyproline content (p<0.001, 92.16 ± 4.02) were observed. The protein content was moderately high. Histological studies showed that collagen was laid down faster in the experimental diabetic animals than in the normal control and diabetic control groups. Fasting blood glucose values in the diabetic experimental group had reduced by 29% (p<0.001) compared with the diabetic control animals. There was a good correlation between the wound contraction rate and blood glucose values. Conclusion: This study demonstrates that the juice of Morinda citrifolia fruit significantly reduces blood sugar levels and hastens wound healing in diabetic rats. Declaration of interest: None.
Oral transmucosal fentanyl citrate versus placebo for painful dressing changes: a crossover trial
Authors: MacIntyre P.A. , Margetts L. , Larsen D. , Barker L. 
Published: May 2014

Objective: Fentanyl is a potent opioid that is well absorbed via the oral mucosa. It can be given as an oral lozenge. The onset of analgesia is rapid and matches the pain profile observed at dressing changes. Method: Patients experiencing pain during daily dressing changes were given entonox plus either placebo or oral transmucosal fentanyl citrate (OTFC) for two consecutive dressing changes in a randomised double-blind placebo-controlled crossover trial. Results: Nine patients were recruited. The mean worst pain score during dressing changes was 7/10 with placebo and 4/10 with OTFC; the reduction in pain achieved with OTFC was significant. The mean number of breaths of entonox taken during the dressing change was 27.67 with placebo and 4.67 with OTFC; the reduction in the number of entonox breaths with OTFC was significant. One patient in the OTFC group suffered nausea. Conclusion: Compared with placebo, OTFC improved analgesia during painful dressing changes without an increase in side-effects. Declaration of interest: None.