bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people
Authors: Takahashi, J. , Yokota O. , Fujisawa Y. , Sasaki K. , Ishizu H. , Aoki T. , Okawa M. 
Published: May 2014

Objective:To compare the effectiveness of polyvinylidene (PVL) food wrap as a dressing material versus conventional ointments and gauze dressings for pressure ulcers in patients aged 60 years or over.Methods:A prospective open controlled trial was conducted. The severity of pressure ulcers in both groups was evaluated using the DESIGN system. Scores were compared at baseline, four, eight and 12 weeks.Results:Twenty-five patients were treated with the PVL film (test) dressings and 24 with the conventional treatment (control). The test group showed greater improvement in DESIGN scores than the control group throughout the observation period, and the difference reached statistical significance at 12 weeks (p<0.05). The incidences of local wound infection in the two groups were not statistically different (p>0.999).Conclusion:The PVL film dressing was more effective than conventional treatment in the management of severe pressure ulcers.Declaration of interest:This work was partly supported by a research grant from the Zikei Institute of Psychiatry.
Effect of a new silver dressing on chronic venous leg ulcers with signs of critical colonisation
Authors: Jørgensen B. , Bech-Thomsen N. , Gottrup F. , Grenov B. 
Published: May 2014

Objective: To investigate the clinical performance and safety of a new silver-containing wound-contact layer, Physiotulle - Ag (Coloplast), in the treatment of chronic venous leg ulcers with delayed healing and signs of critical colonisation. Method: This was an open prospective non-comparative multicentre clinical study. Patients were treated for four weeks with Physiotulle - Ag, which was covered by Alione Hydrocapillary Dressing (Coloplast). Results: Thirty patients were recruited into the study. One ulcer healed after three weeks of treatment. The mean relative ulcer area reduced by 55% after four weeks. Over the study period the mean amount of healthy granulation tissue increased from 26% to 62%, and the mean amount of fibrin decreased from 63% to 32%. The ratio of malodorous wounds was 50% at inclusion, 20% after one week and 3% after four weeks. The dressing was considered easy or very easy to apply in 100% and easy to remove in 89% of dressing evaluations. The dressing combination showed good exudate-management properties. Incidence and severity of maceration, erythema and eczema decreased during the study and no device-related adverse events were recorded. Conclusion: Physiotulle - Ag is safe and easy to use in chronic venous leg ulcers in which healing is delayed and with signs of critical colonisation. Declaration of interest: The study was supported by Coloplast.
Accurate diagnosis and effective treatment of leg ulcers reduce prevalence, care time and costs
Authors: Öien R.F. , Ragnarson Tennvall G.J. 
Published: May 2014

Objective:This long-term follow-up recorded the prevalence, aetiology and treatment of hard-to-heal leg and foot ulcers, and an estimated nurses’ time spent providing care, for the years 1994–2005.Method:A questionnaire was sent to all district and community nurses in the county of Blekinge, Sweden, during one week in 1994, 1998, 2004 and 2005. Calculating the costs of hard-to-heal leg and foot ulcer care was not a primary aim, but the reduction in prevalence and time spent on wound management suggested it was important to illustrate the economic consequences of these changes over time.Results:Estimated prevalence of hard-to-heal leg and foot ulcers reduced from 0.22% in 1994 to 0.15% in 2005. Treatment time decreased from 1.7 hours per patient per week in 1994 to 1.3 hours in 2005. Annual costs of leg and foot ulcer care reduced by SEK 6.96 million in the study area from 1994 to 2005.Conclusion:Improved wound management was demonstrated; leg and foot ulcer prevalence and treatment time were reduced. The results could be attributed to an increased interest in leg and foot ulcer care among staff, which was maintained by repeated questionnaires, continuous education, establishment of a wound healing centre in primary care and wound management recommendations from a multidisciplinary group. The improved ulcer care reduced considerably the annual costs of wound management in the area.Declaration of interest:None.
Antimicrobial and barrier effects of silver against methicillin-resistant Staphylococcus aureus
Authors: Edwards-Jones V. 
Published: May 2014

Objective: Two strains of methicillin-resistant Staphylococcus aureus (MRSA), termed epidemic strains (EMRSA-15 and EMRSA-16), were used to evaluate the antimicrobial and barrier effect of four silver dressings (two silver donating and two non-silver-donating) available in the UK at the time of the study. Method: The moist surface of a blood agar plate was covered with 106 colony-forming units of the respective strain of MRSA, and dressings were applied to the surface and incubated at 37°C for different time periods and the upper and lower surfaces subcultured for residual growth. Results: The nanocrystalline dressings (silver donating) were effective as a barrier from one hour until the study end (72 hours): no penetration of EMRSA-15 and EMRSA-16 through the dressing occurred. Moreover, the nanocrystalline dressings showed some antimicrobial activity at one hour in the areas underneath and surrounding the dressing until the study end. The remaining two dressings had no barrier effect and only demonstrated limited antimicrobial activity after 24 hours. Conclusion: This in vitro study suggests that the nanocrystalline dressings are more effective than other silver dressings in terms of providing a barrier function and antimicrobial activity against EMRSA-15 and EMRSA-16. Declaration of interest: This study was funded by a small educational grant from Smith & Nephew Healthcare.
Patients’ perceptions of the impact of treatments and products on their experience of leg ulcer pain
Authors: Briggs M. , Closs S.J. 
Published: May 2014

Objective:Very little research has explored patients’ experience of pain with different cleansing agents and dressings. We therefore undertook a longitudinal study of their impact on leg ulcer pain.Method:Patients with leg ulcers referred to community nurses were eligible to participate. They were followed up for six months, completing questionnaires about the impact on pain of each wound treatment used. A treatment episode was defined as the use of a wound cleansing agent, primary dressing and bandages. When one aspect of treatment changed, a new treatment episode began.Results:There were 210 treatment episodes for 96 leg ulcer patients. In 206 episodes cleansing agents were used. Cleansing caused pain in 22% of episodes and relieved pain in 27%. Of the five most commonly used dressing types, low-adherent dressings were the least likely to cause pain. Only 56% of patients were able to tolerate full compression bandaging and pain was the most common reason for non-compliance.Conclusion:A substantial proportion of patients felt that leg ulcer treatments caused pain. A greater emphasis on the impact of treatment on pain and healing is warranted both clinically and in research.Declaration of interest:This work was supported, in part, by an unrestricted educational grant from Johnson & Johnson Medical.
Clinical effectiveness of a low-tech versus high-tech pressure-redistributing mattress
Authors: Cavicchioli A. , Carella G. 
Published: May 2014

Objective: To compare the effectiveness of a high-specification foam mattress (control) with a high-tech (Duo2, Hill Rom) alternating/continuous low-pressure mattress (treatment) in the prevention of pressure ulceration. The study also evaluated if there is a difference in performance between the two working modalities (alternating and continuous low pressure) of the high-tech mattress in a comparable sample of patients. Method: Thirty-three patients were observed for two weeks in the control group. In the treatment group, 86 patients were randomised to receive alternating low pressure and 84 continuous low pressure. Incidence of pressure ulcers in both arms was recorded. Student’s t-test was used to compare all Braden scores, and the chi-square test and Fisher’s exact test to evaluate differences between groups. Results: There was a high difference in the number of new pressure ulcers in the control group when compared with the treatment group. There was no difference in performance between the alternating and continuous low-pressure modes. However, the sample size is too small to prove or disprove a statistically significant difference between the two modalities. Conclusion: The high-tech mattress was markedly more effective than the high-specification foam mattress in preventing the onset of pressure ulcers. Initial data suggest that the use of alternating or continuous low pressure made little or no difference to the results. Declaration of interest: Hill-Rom provided the Duo2 surfaces in the two of the three hospitals involved in the trial, but no other financial support was received.
Silver dressings versus other dressings for chronic wounds
Authors: Wang J , Smith J , Babidge W , Maddern G 
Published: May 2014

Objective: To assess differences in effectiveness between silver dressings and other types of dressings in chronic wound management in the community setting. Method: The study used client data retrospectively collected as part of routine care management. The cohort comprised 2687 clients who received 3716 episodes of care between September 2005 and January 2006. Outcome measures were the length of time for which clients received care from community nurses for each wound and the number of visits required. Results: The median number of visits was statistically significantly higher for the silver-dressing users than for users of other dressings (31 versus 11, p<0.0001), while the median treatment duration was also greater (97 days versus 39 days, p<0.0001). In addition, the interval between visits was significantly shorter in the silver dressing group (p<0.001). Conclusion: These results question the effectiveness of silver dressing materials in the management of chronic wounds in a community care setting. However, these results need to be substantiated by prospective randomised controlled clinical trials to produce more reliable evidence. Declaration of interest: None.
Is chronic diabetic foot ulcer an indicator of cardiac disease?
Authors: Löndahl M. , Katzman P. , Fredholm O. , Nilsson A. , Apelqvist J. 
Published: May 2014

Objective: To evaluate presence and severity of cardiac disease in individuals with chronic diabetic foot ulcers using echocardiography. Method: Eighty consecutive patients with chronic foot ulcers attending the multidisciplinary diabetes foot clinic at Helsingborg Hospital underwent clinical examination, toe blood pressure measurement and a standard echocardiographic examination. Results: Sixty-nine percent of the patients had a history of myocardial infarction and/or hypertension and/or heart failure; 78% had signs of left ventricular dysfunction and/or left ventricular hypertrophy and/or diastolic dysfunction; 76% of the patients without a history of cardiovascular disease had signs of cardiac dysfunction on echocardiography. Conclusion: Cardiac dysfunction is a common occurrence present in patients with chronic diabetic foot ulcers, even in those without known cardiac disease or hypertension. Echocardiography may be recommended as a screening procedure in the management of diabetic patients with chronic foot ulcers. The present study supports the view that diabetic chronic foot ulcers ought to be seen as a sign of cardiac disease, although further research is needed to elucidate this issue. Declaration of interest: None.
A study of biofilm-based wound management in subjects with critical limb ischaemia
Authors: Wolcott R.D. , Rhoads D.D. 
Published: May 2014

Objective: Bacterial biofilms cause or complicate numerous medical conditions, including chronic wounds. Biofilm-based wound care (BBWC) management strategies that suppress biofilm have been designed and are used extensively at the Southwest Regional Wound Care Center in Lubbock, Texas and are described in this article. This retrospective single-centre study was designed to evaluate the frequency of complete healing in subjects with a chronic wound in a limb with critical limb ischaemia (CLI) when managed using BBWC. Method: Of the 4500 subjects admitted with wounds between August 2002 and January 2006, 1400 subjects’ TCpO2 levels were measured, and 266 included were identified as having CLI (TCpO2 <20mmHg). Of these, 190 subjects were considered in the analysis because they received a substantial course of therapy (more than five visits). Each subject was individually managed to reinforce natural healing and suppress bacterial biofilm. Successful healing was defined as complete closure by March 2007. Results: Of the 190 subjects with CLI, 146 (77%) healed completely, and 44 (23%) were categorised as non-healing. The healed group included 47% (68/146) with osteomyelitis and 69% (101/146) with diabetes mellitus. In the non-healed group, 75% (33/44) had osteomyelitis and 77% (34/44) had diabetes mellitus. Ninety-one per cent (30/33) of the subjects without osteomyelitis or diabetes mellitus healed, and 67% (53/79) of the subjects with both osteomyelitis and diabetes mellitus healed. Conclusion: When comparing the healing frequency in this study with a previously published study, BBWC strategies significantly improved healing frequency. These findings demonstrate that effectively managing the biofilm in chronic wounds is an important component of consistently transforming ‘non-healable’ wounds into healable wounds. Declaration of interest: Randall Wolcott has patented the combination of lactoferrin and xylitol discussed in this article.
RCT on gentian violet versus a hydrogel dressing for radiotherapy-induced moist skin desquamation
Authors: Gollins S. , Gaffney C. , Slade S. , Swindell R. 
Published: May 2014

Objective: Radiotherapy-induced moist desquamation is a significant problem but there is a paucity of randomised data on which to base treatment decisions. The current prospective randomised trial compared gentian violet (GV) to a hydrogel dressing in this context. Method: Thirty patients undergoing radiotherapy to the head and neck region or breast who had developed moist desquamation in the radiotherapy field were randomised to treatment with 0.5% aqueous gentian violet (GV) (n=16) or a hydrogel dressing (n=14). The area of desquamation was regularly measured until healing or withdrawal from the study. Results: The likelihood of healing with the hydrogel was greater than GV with a hazard ratio for healing of 7.95 (95% CI 2.20–28.68; p=0.002). The median time to healing for hydrogel was 12 days but had not been reached for GV by 30 days. Over the first 14 days the median ‘area under curve’ of moist desquamation for GV was 82.6 cm2 (range 31.8–320.7cm2) and that for hydrogel 20.0 cm2 (range 3.8–301.0cm2) (difference significant at p=0.003). Ten of 16 patients treated with GV withdrew from the study (due to stinging in five and failure to heal in five) compared with two of the 14 treated with hydrogel (difference significant at p=0.021). Conclusion: Hydrogel dressings are more likely to heal radiotherapy-induced moist desquamation and are better tolerated than GV. Declaration of interest: None.
Monitoring the microcirculation to evaluate dressing performance in patients with venous leg ulcers
Authors: Andriessen A. , Polignano R. , Abel M. 
Published: May 2014

Objective: To compare the effect on the microcirculation in venous leg ulcers (VLUs) of two treatment regimens that promote a moist wound environment versus paraffin gauze. The hypothesis is that moist wound dressings are more likely to stimulate the microcirculation and therefore angiogenesis. Method: Patients with non-healing VLUs were randomised to receive either a foam dressing (Suprasorb P), a collagen dressing (Suprasorb C) plus the foam dressing, or paraffin gauze (control). All patients wore short-stretch high compression bandages. Parameters used to measure the effects of the treatments on the microcirculation were: TcPO2 measurements, video laser Doppler measurements and the number of capillaries in the wound bed. The progression towards healing was measured by the reduction in ulcer area and formation of granulation tissue. The treatment period was four weeks. Results: Significant increases in TcPO2 values were reported between baseline and week 4 for patients receiving the foam dressing only or the collagen plus foam dressing combination (p<0.008 versus p<0.003 respectively). There was also a significant increase in the number of capillaries for the collagen plus foam treatment only (p<0.002). Conclusion: This pilot study suggests that a moist wound environment stimulates perfusion of blood and oxygen to the wound tissue, thereby promoting angiogenesis. The collagen and foam dressing combination demonstrated superior results to the control and the foam dressing only. Monitoring the microcirculation may help to assess the effect of dressings on VLU healing, although more research is needed. Declaration of interest: This pilot study was supported by a limited grant from Lohmann & Rauscher GmbH, Germany.
Healing and healing rates of chronic wounds in the age of molecular pathogen diagnostics
Authors: Wolcott R.D. , Cox S.B. , Dowd S.E. 
Published: May 2014

Objective To compare healing outcomes at a wound healing centre both before and after the introduction of molecular pathogen diagnostics. Method An IT consultant was recruited to analyse the medical records of patients at a wound healing centre, comparing patient groups from 2007 and 2009 — before and after the introduction of comprehensive molecular pathogen diagnostic methods. Results Before the implementation of molecular diagnostics, 244/503 patients (48.5%) healed completely, while after implementation 298/479 patients (62.4%) healed. Furthermore, based on survival analysis and after controlling for potential confounding factors, time to healing was significantly shorter in 2009 than 2007 (p<0.05). Specifically, biofilm-based wound care, along with the implementation of comprehensive molecular diagnostics for venous leg ulcers, pressure ulcers and diabetic foot ulcers and all wounds combined showed, respectively, 21%, 23%, 25% and 22% reductions in the time to healing. In addition, after implementing molecular diagnostics, the use of expensive first-line antibiotics also declined in 2009, while a broader range of targeted antibiotics was used. Conclusion The results of modern molecular pathogen diagnostic applications allow comprehensive evaluation of the microbial bioburden in chronic wounds. This comprehensive diagnostic in turn has led to a more precise and targeted therapeutic approach to wound care. With the comprehensive nature of molecular diagnostics future advances in topical patient specific therapeutics are now possible. Declaration of interest SED and RDW are owners of Pathogenius diagnostics, a clinical diagnostic facility. SED is director of Research and Testing Laboratory, which develops molecular diagnostics. Analysis was performed and approved by outside consultant SBC, who indicates no conflict of interest.
A possible animal model for critical colonisation
Authors: Ueda K. , Akase T. , Nakagami G. , Nagase T. , Minematsu T. , Huang L. , Sagara H. , Ohta Y. , Sanada H. 
Published: May 2014

ObjectiveTo develop a critical colonisation model in rats that will facilitate investigation of its pathophysiology and the development of new and effective diagnosis and treatment protocols.MethodThree groups of rats were given full-thickness dorsal wounds: a control group received phosphate-buffered saline; an experimental group was inoculated with Pseudomonas aeruginosa; an infection group with streptozotocin-induced diabetes was also inoculated with P. aeruginosa. All groups were assessed on a number of parameters at days 1, 3, 5 and 7 following wounding. Parameters included gross observations, histopathological observations, quantification of redness and swelling, serum C-reactive protein (CRP) measurement and tissue bacterial counts.ResultsHealing was delayed in the experimental group when compared with the control group, with no signs of inflammation. Although the numbers of bacteria were similar in the experimental and infection groups, polymorphonuclear neutrophil (PMN) infiltration was localised to granulation tissue in the experimental group, whereas it extended to muscular tissue in the experimental group. CRP levels remained low in the experimental group.ConclusionThese findings suggest that the inoculation of bacteria provides a possible model of critical colonisation in rats. We believe this will contribute to a better understanding of critical colonisation.Declaration of interestNone.
Modelling the cost-effectiveness of electric stimulation therapy in non-healing venous leg ulcers
Authors: Taylor R.R. , Sladkevicius E. , Guest J.F. 
Published: May 2014

Objective: To estimate the cost-effectiveness of using electric stimulation (ES) therapy (Accel-Heal) plus dressings and compression bandaging compared with dressings and compression bandaging alone in treating chronic, non-healing venous leg ulcers (VlUs) of > 6 months’ duration from the perspective of the national Health Service (NHS) in the UK. Method: A 5-month Markov model was constructed, depicting the management of a chronic, non-healing VlU of > 6 months’ duration. the model considers the decision by a clinician to continue with a patient's previous care plan (comprising dressings and compression bandaging) or treating with ES therapy plus dressings and compression bandaging. The model was used to estimate the relative cost-effectiveness of eS therapy at 2008–2009 prices. Results: According to the model, 38% of VlUs are expected to heal within 5 months after starting eS therapy, with a further 57% expected to improve. this improvement in clinical outcome is expected to lead to a 6% health gain of 0.017 QAlYs (from 0.299 to 0.316 QAlYs) over 5 months. the model also showed that using eS therapy instead of continuing with a patient's previous care plan is expected to reduce the nHS cost of managing them by 15%, from £880 to £749, due in part to a 27% reduction in the requirement for nurse visits (from mean 49.0 to 35.9 visits per patient) over the frst 5 months after the start of treatment. Hence, use of eS therapy was found to be a dominant treatment (improved outcome for less cost). Conclusion: Within the model's limitations, use of eS therapy potentially affords the nHS a cost-effective treatment, compared with patients remaining on their previous care plan in managing chronic, non-healing vlUs of > 6 months’ duration. However, this is dependant on the number of eS therapy units per treatment, the unit cost of the device, and the number of nurse visits required to manage patients in clinical practice. Declaration of interest: This study was sponsored by Synapse Microcurrent ltd., manufacturers of Accel-Heal. the authors have no other conficts of interest that are directly relevant to the content of this manuscript. In particular, Synapse Microcurrent ltd. had no role in the study design, in the collection, analysis and interpretation of data, or in writing the manuscript.