bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wounds scrutiny in a Swedish hospital: prevalence, nursing care and bacteriology, including MRSA
Authors: Lindholm C. , Andersson H. , Fossum B. , Jörbeck H. 
Published: May 2014

Objective:To identify all wounds, wound types and wound characteristics; to identify bacteria in all wounds, particularly MRSA, VRE and multi-resistant Gram-negative rods;.Method:All patients admitted to or visiting hospital clinics were examined. If the patient had a wound, a questionnaire was filled in by a nurse, and if the wound met the inclusion criteria swabs were taken.Results:A total of 2172 patients were admitted to or visited the hospital; 408 (19%) had a total of 668 wounds. Of this number, 248 were cultured. Thirty-seven patients had pressure ulcers, 83 had leg and foot ulcers and 288 patients had other types of wounds. Nursing care varied according to wound type and ward. Fifty-eight different types of wound dressings were used. Cleansing was performed with saline in 58% of the wounds. The mean number of dressing changes was once daily. Wounds were painful in 37% of the cases, with a predominance of leg and foot ulcers (51%). Many patients did not receive analgesia. MRSA was identified in two patients. No VRE was identified, and there was a low prevalence of multi-resistance in Enterobacteriaceae and Pseudomonas aeruginosa.Conclusion:The study provided important information for future improvement of wound care in a university hospital. Fewer resistant bacteria, particularly MRSA, were identified than expected.Declaration of interest:None.
Enzymatic versus autolytic debridement of chronic leg ulcers: a prospective randomised trial
Authors: König M. , Vanscheidt W. , Augustin M. , Kapp H. 
Published: May 2014

Objective: A randomised clinical trial (n=42) compared the effectiveness of two approaches to debriding chronic leg ulcers: TenderWet 24, which is designed to support the autolytic degradation process, and Iruxol N (Santyl), an enzymatic treatment claimed to enhance the degradation process. Method: Patients were randomly assigned to one of the two treatment groups for three weeks. Wounds were evaluated weekly for the amount of eschar/slough, the area of healthy granulation and the re-epithelialised area. Results: During days 1–14 slough within the groups was reduced by almost 19% for TenderWet 24 and by 9% for Iruxol N, followed by an increase of 26% and 10% respectively in granulation tissue. These effects were less accentuated during days 7–21. There was a further 11% improvement in tissue debridement for the TenderWet 24 group and a relapse (+9.1%) in the Iruxol N group. Conclusion: Although TenderWet 24 appeared to be more efficient in a few cases, the general efficacy of the two products appeared to be almost the same as no statistically significant superiority of either product was found. Declaration of interest: This study was sponsored by Paul Hartmann AG, Heidenheim, Germany.
Diabetic foot ulcers in Cameroon: can microflora prevalence inform probabilistic antibiotic treatment?
Authors: Kengne A.P. , Choukem S.P. , Deyahem Y.M. , Simo N.L. , Fezeu L.L. , Mbanya J.C. 
Published: May 2014

Objective: To determine the clinical features, regularly associated microorganisms and their susceptibility to antibiotics, and the clinical outcomes of foot ulcers in patients with diabetes at the Yaounde Central Hospital, Cameroon. Method: A retrospective analysis of routinely collected hospital data, and data validation by survey of clinical notes was conducted from November 1999 to October 2002 for adult diabetic patients with foot ulcers. Clinical data were recorded for each patient, followed by a record of microbiological investigations where available. Results: Of 503 patients with diabetes admitted during the study period, 54 (10.7%) had foot ulcers. Male subject represented 66.7% of this population. The mean age of the study population was 59.66 ± 1.52 years. The foot ulcer led to the diagnosis of diabetes in six patients in whom the condition was previously unidentified. Of the 54 patients with foot ulcers, nine (16.7%) were selected for surgery and the remaining 45 were managed conservatively. Microbiological investigations were available for 21 patients. Proteus mirabilis was the most frequent microorganism yielded, and was regularly associated with Staphylococcus aureus. All the microorganisms isolated showed high sensitivity to second-generation quinolone antibiotics and were regularly sensitive to aminoglycoside antibiotics. Nine (16.7%) patients died and seven (13%) were discharged at their own request. Conclusion: The mortality rate among our diabetic patients with foot ulcers is high and the combination of second-generation quinolone and aminoglycoside antibiotics can be proposed as a probabilistic antibiotic approach to treating foot infection. Declaration of interest: None.
An educational intervention for district nurses: use of electronic records in leg ulcer management
Authors: Lagerin A. , Nilsson G. , Törnkvist L. 
Published: May 2014

Objective:To evaluate district nurses’ management of leg ulcer patients and the effects of an in-service education programme led by district nurses as local educators at primary health-care centres.Method:Data were collected from electronic patient records (EPRs), both before and after the educational intervention. Nineteen district nurses undertook a one-day course focusing on four themes: Doppler assessment and measurement of ankle brachial pressure index; compression treatment; patient education; nursing documentation. Fourteen acted as in-service educators; 12 educators completed the intervention. The EPRs were scrutinised with an audit tool.Results:The documentation on the selected key areas for the management of patients with leg ulcers was generally sparse, although the educational intervention resulted in statistically significant effects on documentation in three areas.Conclusion:Further improvements in care are necessary, as are qualitative and quantitative studies to explore the large discrepancies between guidelines and everyday clinical practice in this field.Declaration of interest:The study was financed by a Pickup Grant from the FoUU Administration in Stockholm.
Use of Dermabond tissue adhesive in hand surgery
Authors: Hancock N.J , Samuel A.W 
Published: May 2014

Objective: To assess the efficacy and safety of a tissue adhesive for wound closure in elective hand surgery. Method: A prospective observational study of the use of Dermabond for wound closure was undertaken. The cohort consisted of a consecutive case series of 105 patients and 114 surgical wounds. Surgeon and patient assessment was undertaken at a mean of 20 days (10 to 56 days) postoperatively. Results: Wound complication rate was low (one adverse event) and all patients were satisfied (46%) or very satisfied (54%) with wound healing and cosmesis. Conclusion: Dermabond use in hand surgery is safe and well tolerated by patients. Routine postoperative wound review in these patients may not be needed thereby saving time and resources. Declaration of interest: None
Antibacterial properties of whole body extracts and haemolymph of Lucilia sericata maggots
Authors: Huberman L. , Gollop N. , Mumcuoglu K.Y. , Block C. , Galun R. 
Published: May 2014

Objective: To partially characterise maggot-secreted antibacterial substances and determine their range of activity against different bacteria. Method: Sterile and non-sterile maggots maintained in the laboratory and taken from chronic wounds of treated patients were used. Whole body extracts and haemolymph were fractionated and their range of activity against bacteria was tested using the zone of inhibition assay. The mode of action of bacterial destruction was examined by viable counts, influx of K+ and changes in the membrane potential by scanning electron microscope (SEM). Results: Extracts of sterile and non-sterile maggots showed an activity of 200 arbitrary units (AU)/ml and 400AU/ml respectively. Maggots removed from chronic wounds had an activity of 1200AU/ml. Injuring sterile maggots with a sterile needle doubled the antibacterial activity within 24 hours, while the antibacterial activity of haemolymph increased fourfold after injury with a sterile needle and sixteenfold with an infected needle. The fractions with a molecular weight of <1kDa and 3–10kDa showed antibacterial activity against Gram-positive and Gram-negative bacteria including Pseudomonas aeruginosa, Klebsiella pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) isolated from wounds. The fraction with a molecular weight of <1kDa lysed over 90% of the bacteria within 15 minutes by causing an influx of K+ and changing the membrane potential of bacteria. Conclusion: The nature of the antibacterial materials extracted from maggots not only indicates their ability to ingest the necrotic tissue on the wound, but also their potential significance in wound healing, Declaration of interest: None.
Can cycloidal vibration plus standard treatment reduce lower limb cellulitis treatment times?
Authors: Johnson S. , Leak K. , Singh S. , Tan P. , Pillay W. , Cuschieri R.J. , Mostyn E. 
Published: May 2014

Objective: This single-centre non-blind randomised controlled trial aimed to compare clinical outcomes in terms of recovery time of standard treatment of lower limb cellulitis versus standard treatment combined with cycloidal vibration (Vibro-Pulse) therapy. Method: Thirty-six patients (18 per group) with lower limb cellulitis were randomised to receive either standard treatment (intravenous or oral antibiotic therapy) and bed rest or standard treatment combined with cycloidal vibration treatment three times per day, 30 minutes per treatment. The outcome measure was the daily amount of reduction in erythema/cellulitis and oedema reduction against time for up to seven days of treatment and the resources required. Results: There was a clinically significant difference between the two groups, with 66% of the study group fully recovering within the seven days compared with 11% of the control group. Conclusion: Cycloidal vibration combined with standard therapy can significantly reduce cellulitis treatment time. This can reduce both hospital bed days and the resources required. Declaration of interest: This study was supported by Vibrant Medical. EM was a research nurse, part-time funded by Vibrant Medical. The guarantor accepts full responsibility for the conduct of the study, had full access to the data, controlled the decision to publish, and received no funding from Vibrant Medical.
A study of the factors influencing how frequently district nurses re-apply compression bandaging
Authors: Adderley U. , Thompson C. 
Published: May 2014

Objective: This UK study aimed to identify the factors district nurses use in deciding how frequently to re-apply compression bandaging. Method: Qualitative observational data from district nurses’ visits to patients and subsequent team meetings were used to structure in-depth interviews with nurses. Data were analysed according to the principles of grounded theory. Results: Ten factors emerged as influences on the frequency of re-application. These included knowledge of leg ulcer care, recognition of the symptoms of wound deterioration, confidence, time management, patient preferences and sources of information. Conclusion: The influences reported and observed are likely to be of use in designing future bandaging trials and in the delivery of leg ulcer education. The research identifies links between frequency of bandaging and resource awareness, clinical expertise, patient preference and research evidence. Decision-makers could be taught to organise large numbers of factors into several smaller categories that might result in more accurate decision-making regarding the frequency of re-bandaging. Declaration of interest: None.
Retrospective study of factors affecting non-healing of wounds during hyperbaric oxygen therapy
Authors: Oubre C.M. , Roy A. , Toner C. , Kalns J. 
Published: May 2014

Objective:To identify potential factors, including cigarette smoking and diabetes status, that affect wound-healing outcomes during a six-week course of hyperbaric oxygen therapy (HBOT).Method:Seventy-three patients with 85 non-healing lower extremity wounds were treated with hyperbaric oxygen therapy (100% oxygen, 2.4 atmosphere absolute, (ATA), for 90 minutes). The wound area was evaluated over the six-week treatment period.Results:A non-hierarchical clustering analysis of normalised wound-area data revealed that healing responses could be segregated into three groups: robust healing (n=31, over 50% reduction in area), minimal healing (n=33, 15% reduction) and non-healing (n=21, 60% increase in area). Further analysis revealed that cigarette smoking was associated with poor response (p<0.0001), whereas diabetes was not. Robust responders had higher blood levels of creatinine and urea nitrogen, increased peripheral oxygenation (TcpO2), and were younger than less responsive patients.Conclusion:The results suggest that response to HBOT is variable and some patients do not benefit from it. Clinicians should evaluate available laboratory values, age and social history to determine if a patient is likely to benefit from HBOT.Declaration of interest:This research was funded by a contract from the US Air Force, 311thHuman Systems Wing, contract #FA8900-06-D to Hyperion Biotechnology.
Phase I trial on the safety of topical rhVEGF on chronic neuropathic diabetic foot ulcers
Authors: Hanft J.R. , Pollak R.A. , Barbul A. , Gils C.van , Kwon P.S. , Gray S.M. , Lynch C.J. , Semba C.P. , Breen T.J. 
Published: May 2014

Objective:To assess the safety/tolerability and perform a preliminary efficacy evaluation of a multiple-dosing regimen of recombinant human vascular endothelial growth factor (VEGF165or rhVEGF; telbermin) applied topically to chronic diabetic neuropathic foot ulcers.Method:Subjects with type 1 or 2 diabetes mellitus were randomised to receive either topical applied telbermin (72µg/cm2) (n=29) or placebo (n=26) treatment to the foot ulcer surface in conjunction with standard ulcer care. Subjects received treatment every 48 hours (maximum three doses per week) for up to six weeks. Weekly 35mm photography, quantitative planimetry and physical examinations documented the ulcer appearance, surface area and stage. Safety endpoints included incidence of clinically significant hypotension, adverse events and ulcer infection. Exploratory efficacy endpoints included percentage reduction in total ulcer surface area, incidence of complete ulcer healing and time to complete ulcer healing.Results:Incidence of adverse events was comparable in the two treatment groups. None of the adverse events were attributed to study drug, and no hypotension was observed as a result of telbermin treatment. Occurrence of infected study ulcers appeared to be balanced between the treatment groups. Positive trends suggestive of potential signals of biological activity were observed for incidence of complete ulcer healing (41.4% telbermin versus 26.9% placebo at day 43 [P=0.39]) and time to complete ulcer healing (25th percentile of 32.5 days telbermin versus 43.0 days placebo [log-rank P=0.13]).Conclusion:The topical application of telbermin 72µg/cm2 three times a week for up to six weeks appeared to be well tolerated. Further studies are required to characterise the safety/efficacy of telbermin more completely.Declaration of interest:Paul S. Kwon, Sarah M. Gray and Christopher J. Lynch are employed by Genentech, and own Genentech stock. Tim J. Breen was employed by Genentech before February 2006 and owns Genentech stock. Charles P. Semba was employed by Genentech before December 2007 and owns Genentech stock.
Effect of Octenisept antiseptic on bioburden of neoplastic ulcers in patients with advanced cancer
Authors: Sopata M. , Ciupińska M. , Głowacka A. , Muszyński Z. , Tomaszewska E. 
Published: May 2014

Objective: To assess the effect of octenidine dihydrochloride (Octenisept, Schülke & Mayr) on the clinical condition and bacterial flora in neoplastic ulcers. Method: Twenty-one patients with advanced cancer and neoplastic ulcers were included in the study. Octenisept-moistened gauze dressings were applied to the ulcers three times daily. The clinical and bacteriological status of the wounds were assessed at baseline and after three weeks of treatment. Results: Thirty-three bacterial strains were cultured at baseline. After three weeks of treatment, the tests were repeated on 16 patients. Clinical observations confirmed an improvement in the clinical condition of the ulcers, characterised by a reduction in necrosis, exudate levels, erythema and oedema. According to the bacteriological assessment, Staphylococcus aureus, Staphylococcus epidermidis and Proteus mirabilis were eradicated from the wounds. Enterococcus faecalis persisted in two patients, Escherichia coli in one patient and Pseudomonas aeruginosa in another patient. Conclusion: Octenispet was an effective antimicrobial: Staphylococcus aureus and Proteus mirabilis were eradicated in all ulcers. After three weeks of treatment, none of the ulcers developed an infection and there was an improvement in their clinical condition. Declaration of interest: Materials were supplied by Higiena Company, Warsaw, Poland.
Benefits of an oral nutritional supplement on pressure ulcer healing in long-term care
Authors: Heyman H. , Van De Looverbosch D.E.J. , Meijer E.P. , Schols J.M.G.A. 
Published: May 2014

Objective: To investigate the effects of an oral nutritional supplement (ONS) plus standard care on the healing of pressure ulcers in long-term nursing home residents in addition to standard care. The ONS (Cubitan, Nutricia Advanced Medical Nutrition) was high in energy and protein, and enriched with arginine, vitamin C and zinc. Method: A total of 245 patients with grade II–IV pressure ulcers were enrolled into this open study at 61 long-term-care facilities, which reflect the nursing-home population of Luxembourg and Belgium. Residents received the ONS daily for nine weeks, along with their normal diet or enteral feed and standard pressure care. Pressure ulcer area (mm2) and condition were assessed after three and nine weeks. Data were analysed using ANOVA and expressed as mean ± SD. Results: The patients’ age was 82.2 ± 10.1 years. Sixty-seven patients (27%) had been previously treated with the ONS. The majority of pressure ulcers were located at the sacrum (54%) and heel (32%). The average intake of the 200ml ONS was 2.3 ± 0.56 servings daily, which corresponds to 46g protein, 6.9g arginine, 575mg vitamin C, 87mg vitamin E and 21mg zinc. After nine weeks’ nutritional support, the average pressure ulcer area reduced significantly from 1580 ± 3743mm2 to 743 ± 1809mm2, which is a reduction of 53% (p<0.0001). Complete wound closure occurred after three and nine weeks in 7% and 20% of the pressure ulcers respectively. The amount of exudation (assessed subjectively) also decreased after specialised nutritional support (p<0.0001). Conclusion: A high-protein ONS enriched with arginine, vitamin C, vitamin E and zinc, when used with standard pressure ulcer care, significantly reduced the mean pressure ulcer area of long-term nursing home residents. Declaration of interest: This study was supported by Nutricia Belgium.
An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers
Authors: Flack S. , Apelqvist J. , Keith M. , Trueman P. , Williams D. 
Published: May 2014

Objective: To determine the cost-effectiveness of Vacuum Assisted Closure (VAC) therapy (KCI Medical), based on a comparison with both traditional and advanced wound dressings, for the treatment of diabetic foot ulcers in the US. Method: A Markov model was designed to estimate the cost per amputation avoided and the cost per quality-adjusted life year (QALY) of VAC therapy, compared with both traditional and advanced dressings. Over a one-year period the Markov model simulated 1000 patients using transition probabilities obtained from the literature. The health states used in the model were: uninfected ulcer; infected ulcer; infected ulcer post-amputation; healed; healed post-amputation; amputation; and death. Patients initially treated with VAC switched to the advanced dressing after three months of treatment if their wound remained unhealed. Patients treated with traditional or advanced dressings were assumed to continue with their treatment for the full 12 months if they remained unhealed. Results: The model results demonstrate improved healing rates (61% versus 59%), more QALYs (0.54 versus 0.53) and an overall lower cost of care ($52,830 versus $61,757 per person) for patients treated with VAC therapy compared with advanced dressings. Vacuum Assisted Closure was also shown to be a dominant intervention when compared with traditional dressings. Conclusion: The model results indicate that VAC therapy is less costly and more effective than both traditional and advanced dressings. The results are robust to changes in key parameters, including the transition probabilities, the cost of VAC therapy and the utility weights applied to health states. Declaration of interest: KCI USA Inc provided financial support for the study.
Exudate-handling mechanisms of two foam-film dressings
Authors: Thomas S. , Young S. 
Published: May 2014

Objective: To investigate the fluid-handling mechanisms of film-backed foam dressings. Method: The fluid-handling properties of two dressings (ActivHeal Foam Island, Advanced Medical Solutions, and Allevyn Adhesive, Smith & Nephew) were compared using a standard laboratory technique, which provided comparative data on the dressings’ absorbency and moisture vapour transmission. Movement of exudate through one of the dressings was also investigated in vivo using ultrasound. The fluid-handling data obtained in the laboratory were compared with exudate rates for various wound types reported in the literature to predict wear times for above products. Results: Absorbencies of the two dressings were broadly comparable. After 24 hours, under the test conditions, ActivHeal retained a mean of 3.44g (SD 0.04) of the test solution and Allevyn Adhesive 4.32g (SD 0.04), but a major difference was detected in the permeability of the two products: 12.35g (SD 0.42) of the test solution evaporated through the back of Allevyn over 24 hours compared with 1.67g (SD 0.11) through ActivHeal (p<0.0001). The results of the preliminary ultrasound study suggest that, in the clinical situation, exudate migrates away from the wound surface and accumulates beneath the outer film. Conclusion: The difference in fluid-handling properties of the two dressings was due to the presence in one of an ‘intelligent’ polyurethane film component, the permeability of which varied in response to the presence of liquid. The data suggested that the film’s permeability was such that the product might be expected to cope with even the most heavily exuding wounds for an extended period, but this performance would be influenced in vivo by factors such as the size of the dressing relative to the wound, and local environmental conditions, which would affect moisture vapour transmission. The somewhat unexpected finding that fluid tended to accumulate beneath the outer film during clinical use suggested the possibility of an ‘osmotic pump’ effect. Declaration of interest: The laboratory data on which the absorbency figures are based were produced by an independent accredited test facility under the terms of a commercial testing contract. The ultrasound work conducted by SY was funded by a research grant from Smith & Nephew, and the manuscript was produced by ST for a professional fee as a medical device consultant/medical writer.