bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational intervention in the management of acute procedure-related wound pain: a pilot study
Authors: Gibson, M.C. , Keast D. , Woodbury M.G. , Black J. , Goettl L. , Campbell K. , O’Hara S. , Houghton P. , Borrie M. 
Published: May 2014

Objective: This report describes the pilot testing of an educational intervention to manage acute pain associated with wound care in an outpatient clinic. The intervention included essential elements of pain education identified in the acute pain literature: provision of information; pain measurement; establishing expectations; treatment planning; teaching environment. Method: The intervention was tested on five patients attending a wound clinic for scheduled treatment. Patients were aged 65 years or older and had a history of experiencing pain during treatment procedures such as dressing changes and debridement. Before the intervention, the study nurse gave the patients information about the procedure, discussed strategies they could use to make it as comfortable as possible, and explained how they could use a rating scale to denote any physical and emotional distress. Results: All patients used the intervention strategies. Three out of five reported reduced pain and/or distress following the intervention. Conclusion: The pilot study supported the use of education as a pain control strategy in wound care and illuminated key methodological issues for further research on this topic. Declaration of interest: None.
Influence of dressing changes on wound temperature
Authors: McGuiness W. , Vella E. , Harrison D. 
Published: May 2014

Objective: When wound-tissue temperature falls below 33ºC neutrophil, fibroblast and epithelial cell activity decreases. This study examined the influence of dressing changes on wound temperature. Method: The wound-bed temperatures of patients with a wound resulting from trauma or surgical debridement were measured immediately before and after dressing changes using a DermaTemp infrared body surface scanning device. The temperature on the surface of the dressing product was measured immediately before the dressing change and then every five minutes it until the pre-procedural temperature was reached. Results: A total of 133 dressing episodes were measured, yielding 266 wound-bed temperature measurements and 619 external dressing temperature measurements. Pre-procedural temperatures showed that the wound beds were on average marginally below the 33ºC threshold immediately after dressing takedown (mean: 32.7ºC). This figure dropped two degrees on average as a result of the dressing-change procedure (mean: 29.9ºC). Reapplied wound-dressing products return to the pre-procedural temperature within 30 minutes (mean: 23 minutes). Conclusion: This study provides baseline data for future research aimed at promoting maintenance of a normothermic wound bed. Declaration of interest: None.
Evaluation of SurePress Comfort: a new compression system for the management of venous leg ulcers
Authors: Polignano R. , Guarnera G. , Boneado P. 
Published: May 2014

Objective: The primary aim was to compare the healing of venous leg ulcers after management with either a new compression stocking (SurePress Comfort, ConvaTec) or a standard short-stretch bandage system (Comprilan, BSN Medical GmbH & Co). Secondary parameters included healing rate, ease of application and removal, comfort during wear, local pain levels and concordance. Method: This was a prospective multicentre open-label comparative randomised controlled parallel-group pilot trial of 12 weeks’ duration. Results: The proportion of ulcers that healed in 12 weeks (44.4% versus 17.2%, p=0.027) and the average time to healing (72 ±5 days versus 101 ±7 days, p=0.0265) were significantly better with SurePress Comfort than the comparator. All the secondary parameters (except concordance) also showed statistically significant differences for the stocking over the comparator. Conclusion: SurePress Comfort stocking system is more effective than a standard short-stretch compression bandage in healing venous leg ulcers and in reducing associated pain. It is well accepted by patients due to its ease of use and comfort, and its safety profile is comparable to that of a standard compression system. It may therefore provide an effective solution for the delivery of graduated compression and has the potential to improve concordance, compared with short-stretch bandages. Declaration of interest: This study was sponsored by ConvaTec.
The release of zinc ions from and cytocompatibility of two zinc oxide dressings
Authors: gren M.S. , Mirastschijski U. 
Published: May 2014

Objective:These in vitro studies examined the release of zinc ions from and the response of human dermal fibroblasts to two zinc oxide-medicated dressings: one with zinc oxide in an ointment base and one using polyvinylpyrrolidone (PVP), a hydrophilic polymer for the binding of zinc oxide particles.Method:Zinc release from the dressings in buffered-saline (pH 7.4) was studied through a high-pore-density membrane (pore size, 0.40µm) in a two-compartment model at 37°C for three hours. Cytocompatibility of the dressings and 500µmol/l of zinc ions was assessed using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay after exposure to monolayers of confluent normal human dermal fibroblasts to the dressing extracts for four hours.Results:The zinc release rate from PVP-bound zinc oxide was more than two-fold higher than from zinc oxide in the ointment. Extract of the zinc oxide ointment, containing 150µmol/l solubilised zinc, elicited a cytotoxic reaction, while the zinc oxide-PVP extract, containing 410µmol/l solubilised zinc, and 500µmol/l zinc chloride were non-cytotoxic to the fibroblasts.Conclusion:Zinc release in a simulated wound milieu appears to be inhibited when zinc oxide is incorporated in a lipophilic vehicle. It is hypothesised that the ointment vehicle induced cytotoxicity rather then the solubilised zinc oxide.Declaration of interest:None.
Comparing the contractile properties of human fibroblasts in leg ulcers with normal fibroblasts
Authors: Viennet C. , Armbruster V. , Gabiot A.C. , Gharbi T. , Bride J. , Humbert P. 
Published: May 2014

Objective: The tissue contraction phenomenon associated with wound healing is of prime importance for wound closure. Contractile properties of human fibroblasts from chronic venous leg ulcers were compared with those of normal fibroblasts using in vitro models. Method: Biopsies were taken from the uninvolved skin of the thigh, the epithelialised ulcer edge and the non-epithelialised ulcer centre in four patients (average age: 78 years). Fibroblasts were obtained by an explant technique and expanded in vitro in Dulbecco’s Modified Eagle’s Medium supplemented with 10% foetal calf serum and used for the assays at their fourth passage. Intracellular alpha-smooth muscle actin expression (αSM-actin) was studied by immunofluorescence labelling of cells cultured in monolayer. Contractile properties were evaluated using three-dimensional collagen lattices. Results: Fibroblasts from the ulcer centre were the richest cells in actin filaments. Both populations of venous ulcer fibroblasts contracted more rapidly and to a greater extent than normal fibroblasts. The peak contractile forces developed by fibroblasts from the ulcer centre and the ulcer edge were 30% and 18% greater than normal fibroblasts respectively. Conclusion: Some functions of fibroblasts, in particular the generation of contractile forces and the formation of cytoplasmic actin filaments, seem not to be affected in chronic venous ulcers. Declaration of interest: This study was supported by the Fondation Coloplast pour la Qualite de la Vie of France.
Prognostic factors for venous ulcer healing in a non-selected population of ambulatory patients
Authors: Meaume S. , Coullier D. , Vin F. 
Published: May 2014

Objective: To identify wound prognostic indicators in a non-selected patient population with leg ulcers. Method: This was a prospective observational survey involving 151 physicians. Ambulatory patients with venous leg ulcers were treated with a non-adherent foam dressing and usual leg ulcer management. At follow-up after three to six weeks, ulcer healing parameters and local treatment tolerability were recorded and concordance with compression therapy was validated. Results: A≥40% reduction in the largest wound length was selected as an indicator of a favourable healing outcome. A total of 330 patients were included and seen at follow-up. The mean largest wound length was 4.9 ± 3.6cm. A≥40% decrease in this parameter was noted in 178 patients. Dressing acceptability and tolerability were excellent. Compression therapy, while heterogeneous among physicians, was used regularly and applied correctly (by patients and practitioners) in 81.2% of patients. Predictors for not reaching the main outcome were the presence of an arterial lower limb disease, an ulcer duration of more than three months and an initial ulcer length of 10cm or more. Linear regression showed that old age and a high body mass index were independent predictors of a poor outcome. Conclusion: Clinical indicators such as simple ulcer length measurement and ulcer duration may help physicians to detect patients with a prognosis of poor healing. Declaration of interest: Sponsored by Laboratoires Coloplast.
Determining pain levels in patients treated with maggot debridement therapy
Authors: Steenvoorde P. , Budding T. , Oskam J. 
Published: May 2014

Objective: Pain as a complication of maggot debridement therapy (MDT) has been a topic of some controversy. This study set out to determine pain levels in patients treated with MDT. Method: A retrospective analysis using a visual analogue scale (VAS) was performed: 41 patients were treated with MDT for non-healing wounds (22 men and 19 women; average age: 67 years). Average wound duration was 14 months (range: two weeks to 132 months). Maggots were applied using the contained or the free-range techniques. Paracetamol (1g three times daily) and Durogesic plaster (25µg every three days and 50µg the day before the maggot change) were given for pain relief in the outpatient clinic. Results: Diabetic patients experienced the same amount of pain before and during MDT. Eight out of 20 non-diabetic patients experienced more pain during MDT than before; the remaining non-diabetic patients had the same amount of pain before and during the therapy. The difference between diabetic and non-diabetic patients was statistically significant (p<0.05) for all applications combined. Conclusion: In 78% of patients (29/37) pain can be adequately treated with analgesic therapy. However, if pain is unmanageable in the outpatient department, we believe that options include hospital admission, using the contained method of application or, in the worst case scenario, cessation of treatment. A standardised but individually tailored pain management protocol is mandatory. Declaration of interest: None
A pilot study to determine whether a static magnetic device can promote chronic leg ulcer healing
Authors: Eccles N.K. , Hollinworth H. 
Published: May 2014

Objective: To determine if UlcerCare, a specialised self-securing static magnetic device, can promote the healing of chronic leg ulcers. Method: This double-blind placebo-controlled pilot study involved 26 patients with chronic leg ulcers, receiving care consistent with RCN guidelines, who were randomly allocated to receive either UlcerCare leg wrap (treatment) or an identical sham non-magnetic device (control). Wounds were assessed for 12 weeks at four weekly intervals using digital photography, Verge Videometer analysis and patient questionnaires to determine changes in ulcer size, level of pain and function. Results: Statistically significant reductions in ulcer measurement were noted in the treatment group when compared with the placebo group. Conclusion: The results demonstrate a significant healing effect in the treatment group. A larger randomised controlled study is recommended to investigate the effects on ulcer-associated pain and quality of life. Declaration of interest: The study was supported by Magnopulse, Bristol, UK.
Does the use of a cleanser on skin surrounding pressure ulcers in older people promote healing?
Authors: Konya C. , Sanada H. , Sugama J. , Okuwa M. , Kitagawa A. 
Published: May 2014

Objective: To determine whether the use of a skin cleanser on the skin surrounding pressure ulcers helps to promote healing. Method: The study was conducted over a two-year period in patients with stage II or more pressure ulcers. All subjects were at least 65 years of age and resident in a long-term care hospital. During the first year, skin was cleansed with normal saline. In year two, a pH-balanced cleanser was used. The healing times for the two methods were then compared. Results: Healing time was shorter in the group using the cleanser for every stage of ulcer, with an especially significant difference for stage II ulcers (p=0.002). Analysis using the Cox proportional hazards model found a 1.79-fold improvement in the healing rate of stage II ulcers when the surrounding skin was washed with the cleanser. Conclusion: Cleaning the surrounding skin with a cleanser rather than normal saline promotes the healing of pressure ulcers. Declaration of interest: None.
Compression and peri-ulcer skin in outpatients’ venous leg ulcers: results of a French survey
Authors: Dereure O. , Vin F. , Lazareth I. , Bohbot S. 
Published: May 2014

Objective: To evaluate concordance with compression therapy in ambulatory patients with venous leg ulcers. Method: This was a prospective observational survey conducted in general practice. Consecutive patients with venous leg ulcers about to receive a non-adherent primary dressing and with no contraindication to compression bandaging were selected. At the inclusion visit, size, local aspect of the ulcer and the peri-ulcer skin were scored. Patients were asked about concordance with compression and were given a questionnaire to be completed at home. If patients were seen at a three-week followup visit, ulcer and peri-ulcer characteristics and concordance were reassessed. Results: A total of 2842 patients were included, of whom 2532 were re-evaluated at three weeks and 1397 (49%) returned their questionnaire. A compression bandage was already available for 62.9% of these patients, and 62.7% said they used it on a daily basis, 23.3% wore it one or two days per week and 13.7% wore it irregularly or never. There was a statistically significant correlation between concordance with compression and ulcer and peri-ulcer skin severity scores (p<0.001 and p=0.042 respectively). At the follow-up visit, concordance with compression therapy improved (80.1% were wearing it regularly). Ulcer, peri-ulcer skin severity scores and ulcer size were significantly lower (p<0.001) when concordance with compression therapy was good. However, 65.6% of patients considered applying compression very difficult; 45% considered it very unaesthetic and 23% judge wearing it to be very painful, while 9% thought it may worsen their ulcer. Conclusion: On a short-term basis, concordance with compression can be substantially improved by simple measures with a clear favourable consequence on both ulcer status and peri-ulcer skin aspect when a non-adherent primary dressing is used. However, the acceptability of compression to patients is poor, and continuous effort is required to convince them of its importance. Declaration of interest: This study was sponsored by Laboratories Urgo, France.
Comparison of Allevyn Adhesive and Biatain Adhesive in the management of pressure ulcers
Authors: Amione P. , Ricci E. , Topo F. , Izzo L. , Pirovano R. , Rega V. , Cocci C. , Masina M. 
Published: May 2014

Objective: The primary objective was to assess dressing delamination and the ensuing potential consequences during wear and/or removal, as well as the effect of residue remaining in the ulcer following foam breakdown. Method: In this prospective multicentre study, 32 patients with a grade II or III pressure ulcer were randomised to receive either Allevyn Adhesive or Biatain Adhesive dressing. The performance of the dressings was assessed over seven dressing changes or a maximum of six weeks. The primary efficacy variable was the proportion of patients with at least one delaminated dressing (delamination being defined as the falling apart of a dressing during wear or removal, or the presence of residue from the dressing in the ulcer). Results: Allevyn Adhesive was significantly less likely to delaminate than Biatain Adhesive: 83% of patients given Biatain Adhesive had a dressing that delaminated compared with 14% for Allevyn Adhesive (p=0.014). Furthermore, a greater proportion of the Biatain Adhesive dressings delaminated compared with the Allevyn Adhesive dressings: 50% versus 4% (p<0.001). Allevyn Adhesive performed significantly better in the following parameters: handling exudate (p=0.044), comfort (p=0.007), ease of application (p=0.004), conformability during application (p=0.003) and removal (p<0.0001), and adherence to the skin during application (p=0.003) and prior to removal (p=0.011). Three patients given Allevyn Adhesive (21%) reported three adverse events; six patients given Biatain Adhesive (33%) reported eight adverse events. Conclusion: Allevyn Adhesive is effective and well tolerated in the management of pressure ulcers and less likely to delaminate than Biatain Adhesive. Declaration of interest: This study was funded by Smith & Nephew Wound Management Division, Hull, UK.
Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection
Authors: Meaume S. , Vallet D. , Nguyen Morere M. , Téot L. 
Published: May 2014

Objective: To evaluate the clinical impact of using a silver-releasing hydroalginate dressing to minimise the risk of local infection in colonised chronic wounds. Method: This was a randomised (stratification according to wound type) open-label multicentre comparative two-arm parallel-group study. Thirteen centres recruited 99 patients with either a venous leg ulcer or a pressure ulcer. None of the wounds required systemic antibiotics or were associated with lymphangitis and/or fever, but at least two of the following criteria had to be present: continuous pain; erythema; oedema; heat; and moderate to high levels of serous exudate. Patients were allocated to receive either a silver-releasing hydroalginate dressing (Silvercel, the test group) or a pure calcium alginate dressing (Algosteril, the control group). Wounds were assessed daily over 14 days to complete a modified ASEPSIS index to evaluate risk of infection, and then weekly for two additional weeks. A global wound severity score and area tracings were recorded weekly. Results: Fifty-one and 48 patients were randomised in the test and control groups respectively: 28 pressure ulcers and 71 venous leg ulcers. The total mASEPSIS score over 14 days did not differ significantly between groups: 95.4 ± 62.2 and 104.2 ± 72.8 in control and test groups respectively (p=0.791). Of the patients who completed the total four-week study duration, four out of 38 (10.5%) in the control group and none of the 40 in the test group were treated with systemic antibiotics at the final visit (p=0.053). According to the investigators, fewer wounds developed a clinical infection over the four-week follow-up in the test group (33% versus 46%; p=0.223). Overall, the four-week closure rate was statistically greater in the test group (0.32 ± 0.57cm2/day versus 0.16 ± 0.40cm2/day; p=0.024). Compared with baseline, the absolute decrease in wound severity score at week four was higher in the test group (−5.6 ± 3.2 versus −4.1 ± 4.3; p=0.063); this was also true of the percentage reduction (−32 ± 17% versus −23 ± 25%; p=0.034). Poor dressing acceptability and/or tolerability was noted in five out of 48 patients (10.4%) in the control group and in five out of 51 (9.8%) in the test group. Conclusion: This study suggests that the use of silver-releasing dressings in the management of wounds at high risk of infection may have a clinically favourable influence on wound prognosis; the dressings also appeared to be well tolerated. However, the evaluation of these advantages in controlled clinical trials is complex and requires potent studies and the development of more specific endpoints than those currently used. Declaration of interest: This study was funded by a grant from Johnson and Johnson Wound Management.
Interface pressure measurement during surgery: a comparison of four operating table surfaces.
Authors: Keller B.P.J.A. , Overbeeke J. , van der Werken Chr. 
Published: May 2014

Objective: To compare the pressure-reducing and pressure-redistributing characteristics of four operating room (OR) table mattresses using interface pressure measurements, in two positions adopted for surgical procedures. Method: Support surfaces were randomly assigned to 80 patients. These were: an overlay pad filled with fibres (the standard OR mattress), a custom-made viscoelastic polyurethane foam mattress, an inflatable mattress with air-filled cells and a fluid mattress. An XSENSOR full-body pressure-mapping pad was used to record interface pressures of 40 patients in the supine position and 40 patients in the lithotomy position. Measurements were analysed for peak pressure, peak pressure index, total contact surface area and the occurrence of a significant increase in interface pressure during the surgical procedure. Results: The highest interface pressures were measured on the standard mattress, in both the supine and lithotomy position. Overall, the fluid mattress showed the best pressure-reducing and pressure-redistributing capacities. Conclusion: As long as no reference values are available for interface pressures under which no pressure-related damage will occur, clinical testing of OR table surfaces is still necessary. Declaration of interest: The test mattresses were provided free of charge and the companies provided a contribution of €2000 each for the rental of the pressure-mapping system. None of the authors had a financial interest in or link with the companies.
Can transcutaneous oxygen tension measurement determine re-amputation levels?
Authors: Keyzer-Dekker C.M.G. , Moerman E. , Leijdekkers V.J. , Vahl A.C. 
Published: May 2014

Objective: To review the preoperative transcutaneous oxygen tension (TcPO2) measurements in patients having major lower leg amputation, and also consider the re-amputation rate, wound infection and the definitive level of amputation. Method: A case-control study was performed in a consecutive cohort of 170 patients (1999–2003). Fifty-two patients underwent preoperative TcPO2 measurements (cases) and 118 patients did not (control). Multiple logistic regression analysis was performed to analyse independent risk factors associated with re-amputations. Results: Primary and definitive (in case of a re-amputation) amputation levels were lower in the TcPO2 group, although this did not reach statistical significance. The number of re-amputations in the TcPO2 group was significantly higher: 15 versus 18 patients (p=0.039). Selection of an amputation level with a TcPO2 of 30mmHg resulted in a positive predictive value of re-amputation of 41% and a negative predictive value of 90%. A cut off value of 20mmHg resulted in 41% and 77% respectively. Conclusion: The use of TcPO2 measurements for major amputation level selection resulted in an increased rate of re-amputation. However, there was a trend in gaining a more distal definitive amputation level. Selection of an amputation level solely based on a TcPO2 value is unreliable. Declaration of interest: None.