bluuebunny/crossref_metadata_2025_split huggingface dataset:
In vitro interaction of chronic wound bacteria in biofilms
Authors: Malic S. , Hill K.E. , Playle R. , Thomas D.W. , Williams D.W. 
Published: May 2014

Objective: To use in vitro biofilm models of wound bacterial isolates and compare the biofilms produced for different combinations of wound bacterial species. Method: In vitro biofilms, generated by Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus oralis and Micrococcus luteus in microtitre plates and a constant depth film fermentor (cDFF), were studied. The tested isolates all originated from chronic venous leg ulcers. biofilms of individual and dual combinations of these species were generated in microtitre plate wells at 37°c for 24–96 hours and also in the CDFF for 7 days. The extent of biofilm formation from these systems was then measured using crystal violet staining and/or total viable counts. Results: All the chronic wound bacteria formed biofilms (both individually and in mixed culture) in these models. In mixed species microtitre plate biofilms, both P. aeruginosa and S. aureus appeared to antagonise biofilm formation by S. oralis and M. luteus, with P. aeruginosa completely inhibiting the growth of these organisms. Similar effects were evident in the CDFF model, when all four bacterial species were added simultaneously, with M. luteus being ‘out-competed’ by the other organisms present and occurring at numbers at the limits of detection; however, there was an apparent increase in the numbers of S. oralis compared with its single culture equivalent. Conclusion: The study highlighted differences in biofilm formation ability for the tested species in both closed and open model systems. Using dual species biofilms, distinct species antagonism was observed with apparent antagonism of pathogenic species over ‘commensal’ ones. Such a finding provides insight into possible bacterial interactions during development of ‘non-healing’ wound biofilms. Declaration of interest: The authors have no conflict of interest to declare. There were no external sources of funding for this study.
RCT to evaluate a hyaluronic acid containing gauze pad in leg ulcers of venous or mixed aetiology
Authors: Dereure O. , Mikosinki J. , Zegota Z. , Allaert F.A. 
Published: May 2014

• Objective: To investigate the efficacy and safety of an hyaluronic acid (HA)-impregnated gauze pad compared with a hydrocolloid (HC) dressing, in patients with leg ulcer of venous or mixed aetiology. • Method: A 56-day blind-observer, randomised, multicentre, controlled, non-inferiority trial. Patients were randomised to receive either an HA gauze pad (ialuset gauze pad) or an HC dressing (DuoDERM E). The primary endpoint was the difference between the groups regarding the percentages of patients achieving a reduction of at least 40% of the initial wound surface after 56 days of treatment (visit 5). Secondary endpoints included reduction of wound area, aspect of the wound (percentage of necrotic, fibrinous or granulation tissue), rate of complete ulcer healing, pain intensity, and clinical status of the peri-ulcerous skin. • Results: In total, 170 patients were included and analysed in the intention-to-treat (ITT) population; 27 patients presented at least one major protocol deviation and were excluded from the per-protocol (PP) population. Therefore, 143 patients constituted the PP population (n=72 and n=71 in the HA gauze pad group and HC dressing group, respectively). At day 56, the confidence interval of the difference between the two groups for the percentage of patients with a reduction of at least 40% of the target ulcer initial surface was [–0.128; 0.164] with a lower limit above the non-inferiority threshold (-0.15). Peri-ulcerous skin was significantly less impaired in the HA gauze pad group for oedema at day 56 (p=0.04), purpura at day 14 (p=0.009) and for maceration at day 14 (p=0.003). Other secondary endpoints were not significantly different between the two groups. Overall, both treatments were well tolerated and adverse events were comparable between the two groups regarding their pattern, frequency, likely relationship to treatment and severity which was mostly mild (grade 1) or moderate (grade 2). These results were confirmed in the overall ITT population. • Conclusion: These data support the non-inferiority of the HA gauze pad compared with HC for the primary endpoint. The significant differences in favour of HA gauze pad regarding peri-ulcerous skin changes (oedema, purpura and maceration) may suggest a trend for HA gauze pad to have a better acceptability than the reference HC dressing. • Declaration of interest: This study was sponsored by Laboratoires Genévrier. Authors received honoraria for their contributions to the study, but have no other conflicts of interests to declare.
Stress and pain associated with dressing change in patients with chronic wounds
Authors: Upton D. , Solowiej K. , Hender C. , Woo K.Y. 
Published: May 2014

Objective: To assess pain and stress experienced by patients with chronic wounds at dressing change and to examine how this may be related to long-term chronic stress. Method: The study recruited 43 outpatients, with a mean age of 71.7 ± 14.6 years. The sample included 18 male (42%) and 25 female (58%) patients from Wrexham and Salford (UK), all with chronic wounds that required frequent dressing changes. Physiological and psychological measurements of pain and stress, including numerical ratings (for stress and pain), heart rate, blood pressure, respiration rate, and a questionnaire survey of state and trait anxiety and of chronic stress were recorded at dressing change and in a control condition (at least 24 hours before/after dressing change during a period of rest). Results: Mean heart rate measurements were significantly higher at dressing change, while there was also a trend for higher numerical pain ratings, numerical stress ratings and state anxiety scores at this time. a significant, positive relationship was found between chronic stress and acute episodes of stress experienced at dressing change. Similarly, although not significant, a positive relationship was observed between chronic stress and acute pain reported at dressing change. Conclusion: This study provides a basis for understanding how increased acute pain and stress at dressing change may be related to chronic stress, which has been shown in the literature to contribute to delayed wound healing. The impact of these implications on cost of care and quality of life are also discussed. Declaration of interest: This study was commissioned by Mölnlycke Health Care ltd. none of the authors work for Mölnlycke Health Care or have any financial interests with the company. There are no additional conflicts of interest to declare.
Use of specialist knowledge and experience to manage patients with mixed aetiology leg ulcers
Authors: Neill K. , Turnbull K. 
Published: May 2014

Objective: To discuss the role of the clinical nurse specialist in managing patients with ulceration caused by mixed venous arterial disease. Method: A small scale retrospective audit study of eight mixed aetiology patients drawn from the caseload of leg ulcer patients within a specialist leg ulcer service in Ayrshire, Scotland was conducted by two specialist nurses with over 8 years' experience in specialist leg ulcer management. Patients were individually assessed using Doppler ultrasound and a rigorous set of validated risk factor criteria. Where Doppler ultrasound was considered to be unreliable, due to an inability to detect sounds, or where further diagnostic information was required in order to safely plan care, arterial duplex scanning was carried out by the cardiac department at Ayr Hospital. All patients were treated with a cohesive inelastic compression bandage system and closely observed by the specialist nurse. Results: All eight patients with mixed aetiology leg ulcers were reported to experience complete ulcer healing within 6–30 weeks after first application of the inelastic bandage system. The regimen was well tolerated by all patients and no adverse events were recorded. Conclusion: With accurate assessment and treatment by a specialist team, patients with mixed venous arterial disease were safely and successfully managed where they may have remained unhealed. Declaration of interest: This was an independent retrospective audit study conducted by two clinical nurse specialists, with educational support by Activa Healthcare to assist in bringing it to print.
Enhancing patient recovery following lower limb arthroplasty with a modern wound dressing: a prospective, comparative audit
Authors: Hopper G.P. , Deakin A.H. , Crane E.O. , Clarke J.V. 
Published: May 2014

Objective: To assess current wound care practice, implement a potentially improved regimen and re-evaluate practice. Method: Two prospective clinical audits were performed over a 6-month period, involving 100 patients undergoing hip or knee arthroplasty. Fifty consecutive patients with traditional dressings (Mepore; Mölnlycke) were evaluated prior to a change in practice to a modern dressing (Aquacel Surgical; ConvaTec). Fifty consecutive patients were then evaluated with the new dressing to complete the audit cycle. Clinical outcome measures were wear time, number of changes, blister rate and length of hospital stay. Statistical comparisons were performed using Mann Whitney or Fisher's exact test (statistical significance p < 0.05). Results: Wear time for the traditional dressing (2 days) was significantly shorter than for the modern dressing (7 days; p < 0.001), and required more changes (0 vs 3; p < 0.001). Twenty per cent of patients developed blisters with the traditional dressing compared with 4% with the modern dressing (p=0.028). Median length of stay was the same for the modern dressing (4 days) compared with the traditional dressing (4 days). In the modern dressing group, 75% of patients were discharged by day 4, whereas in the traditional group this took until day 6. Conclusion: This audit highlights the problems associated with traditional dressings with frequent early dressing changes, blistering and delayed discharge. These adverse outcomes can be minimised with a modern dressing specifically designed for the demands of lower limb arthroplasty. Units planning to implement enhanced recovery regimens should consider adopting this dressing to avoid compromising patient discharge. Declaration of interest: There were no external sources of funding for this audit; however, one author (JC) received reimbursement of expenses to attend and present work at educational conferences from ConvaTec.
An exploration of fourth-year undergraduate nurses' knowledge of and attitude towards pressure ulcer prevention
Authors: Gill E. Cullen , Moore Z. 
Published: May 2014

Objective:To determine undergraduate nurses' knowledge of and attitudes towards pressure ulcer prevention.Method:A quantitative, cross-sectional survey design was used for this study. Ethical approval was received. A convenience sample of fourth-year undergraduate nurses was selected to participate (n=60). Data were collected using a pre-designed questionnaire.Results:Overall, the participants showed a positive attitude towards pressure ulcer prevention but displayed poor knowledge of pressure ulcer prevention. Interestingly, having a high level of competency corresponded with having a positive attitude towards pressure ulcer prevention, but did not equate to possessing knowledge of pressure ulcer prevention.Conclusion:The findings of this study suggest that fourth-year undergraduates have a positive attitude but lack adequate knowledge on the prevention of pressure ulcers.Declaration of interest:There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Orthopaedic nurses’ knowledge about pressure ulcers in Iran: a cross-sectional study
Authors: Iranmanesh S. , Tafti A Abdoli , Rafiei H. , Dehghan M. , Razban F. 
Published: May 2014

Objective: To assess nurses’ knowledge about pressure ulcers in an Iranian orthopaedic ward. Method: A cross-sectional, self-report questionnaire study using Pieper´s Pressure Ulcer Knowledge Test (PUKT). Orthopaedic nurses’ knowledge about pressure ulcers was examined in two teaching hospitals in Iran. The questionnaire consisted of 41 true or false assertions, categorised according to pressure ulcer classification and onset, wound characteristics and preventive measure. Results: Of 68 nurses, 57 participated in this study (response rate of 84%); of the respondents, 68% (n=39) were women and 32% (n=18) were men. Mean age of participants was 30.2 ± 5.1 years and mean years of experience was 6.9 ± 4.6 years. The overall rate of correct responses by nurses was 70.1%. Nurses had the highest level of knowledge in the pressure ulcer prevention category and the lowest in the pressure ulcer categorisation and onset section. No relationship was found between level of knowledge and nurses’ years of experience. Conclusion: Pressure ulcer prevention is one of the most important roles of nurses in an orthopaedic setting. The results of this study suggest that orthopaedic nurses in Iran were not sufficiently knowledgeable about pressure ulcers. Therefore, there is a need to improve their knowledge with some targeted, educational programmes. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
A review of PU prevalence and incidence across Scandinavia, Iceland and Ireland (Part I)
Authors: Moore Z. , Johanssen E. , Etten M. van 
Published: May 2014

Objective: To provide a critical appraisal and synthesis of the published literature pertaining to pressure ulcer (PU) prevalence, incidence and prevention practices from the context of Scandinavia, Iceland and Ireland. Method: An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU prevalence or incidence in adults or children, in any care setting, were included. Results: Fifty-five papers were data extracted, quality appraised and included in the qualitative synthesis of the review. Mean prevalence in norway was 17% (4.8–29%) in Ireland was 16% (4–37%), in Denmark was 15% (2.2–35.5%) and in Sweden was 25%, (0.04–42.7%). Prevalence in Iceland was 8.9%. In acute care, mean prevalence was 21% (0–42.7%) and in long stay was 12% (2.4–23.7%). Prevalence among hospice patients was 35.7%, and in community care was 0.04% and 4%. No incidence study from Iceland was identified; the single incidence study from norway noted a figure of 16.4%. The mean incidence from Ireland was 11% (8–14.4%) from Sweden was 20% (3.1–49%) and Denmark was 1.8% (1.4–2.7%). Mean incidence in acute care setting was 17.6%, (1.4–49%); in long stay was 6.63% (3.1–8.4%). Incidence in the hospice setting was 20.4%. No study reported PU incidence figures from the community setting. Conclusion: Figures for both prevalence and incidence were similar in Ireland and norway and highest in Sweden, whereas Denmark demonstrated the lowest incidence rates and Iceland demonstrated the lowest prevalence rates. Figures were consistently highest in acute care and hospice settings, and lowest in the care of the older person setting. Declaration of interest: This work is partly funded by a research grant from the Norwegian College of Nursing (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.
Point prevalence of wounds and cost impact in the acute and community setting in Denmark
Authors: Gottrup F. , Henneberg E. , Trangbæk R. , Bækmark N. , Zøllner K. , Sørensen J. 
Published: May 2014

• Objective: To estimate the wound-care related costs in two hospitals in Denmark. • Method: A point-prevalence survey with a focus on resource consumption was carried out during a representative 1-week period in March 2010, in two hospitals in Denmark: Regional Hospital viborg, in the Viborg Municipality and Hillerød Hospital, in the Hørsholm Municipality. Data were collected during a 2-day period for inpatients and outpatients in the hospitals and over a full week in the municipalities. The survey included information on the numbers, types and locations of the wounds, as well as resource consumption related to dressing changes. The estimation of costs was based on representative cost levels, including the salaries of health professionals or nurses and the cost of dressings and hospitalisation provided. • Results: In total, 33% (n=830) of inpatients had a wound. The majority of these were surgical/trauma wounds (25%), while pressure ulcers, leg ulcers and diabetic foot ulcers accounted for 3.3%, 1.7% and 1.6%, respectively. In the municipalities, there was a wound patient prevalence of 2.8 per 1000 population (1/1000 acute wounds, 0.7/1000 pressure ulcers, 0.5/1000 leg ulcers and 0.3/1000 diabetic foot ulcers). The extrapolated figures for nurse time related to wound care per year was equivalent to 10 full-time nurse positions in Hillerød Hospital, three in Viborg Hospital, 17 in Viborg Municipality and three in Hørsholm Municipality. The total annual costs related to wound care was estimated as 3.6 million for Viborg Hospital, 4.1 million for Hillerød Hospital, 1.2 million for Viborg Municipality and 232 548 for Hørsholm Municipality, accounting for approximately 1.8% (Viborg), 1.6% (Hillerød), 2.4% (Viborg) and 1.5% (Hørsholm) of the total annual budgets. • Conclusion: In the survey, 33% of the patients treated in the hospitals had a wound. Primary costs were defined as hospitalisation costs and nurse time related to dressing changes. Total annual costs of treatment, including hospitalisation, were estimated as approximately 1.6–1.8% for the hospitals and 1.5–2.4% for the municipalities. The level of costs support the relevance of increased efforts to secure better wound prevention and treatment to reduce the staff-time consumption and hospitalisation costs. • Declaration of interest: This survey was initiated by the European Wound Management Association (EWMA) and Danish Wound Healing Society (DWHS). It was supported by unrestricted grants from ConvaTec, Mölnlycke Healthcare, KCI and Smith & Nephew. The authors have no commercial or social conflicts of interest with respect to the article or its content.
Photographic assessment of burn size and depth: reliability and validity
Authors: Hop M.J. , Moues C.M. , Bogomolova K. , Nieuwenhuis M.K. , Oen I.M.M.H. , Middelkoop E. , Breederveld R.S. , Baar M.E. van 
Published: May 2014

Objective: The aim of this study was to examine the reliability and validity of using photographs of burns to assess both burn size and depth. Method: Fifty randomly selected photographs taken on day 0–1 post burn were assessed by seven burn experts and eight referring physicians. Inter-rater reliability in both groups (experts vs. referrers) was calculated. The validity of burn size assessment was calculated using live assessment as the gold standard, and of burn depth using clinical assessment in combination with laser Doppler imaging as the gold standard. The validity of the photographically-assessed indication for surgery was calculated using laser Doppler imaging and actual treatment as the gold standard. Finally, agreement in referral indication was calculated. Results: Using photographs, burn size could be assessed reliably and validly by experts (ICCs of 0.83 and 0.87), but not by referrers (ICCs of 0.68 and 0.78). Photographic assessment of burn depth was neither reliable nor valid, with ICCs respectively of 0.38 and 0.28 for experts and 0.24 and 0.13 for referrers. The indication for surgery could also not be assessed validly. Agreement between assessors regarding referral indication was low. Conclusion: Burn size, but not burn depth, can be assessed reliably and validly by experts using photographs of the burn wound. We recommend exploring other forms of telemedicine, like live interactive video, to investigate whether this leads to an improved burn depth assessment where clinical assessment is not possible. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to the manuscript or its content.
Perceptions of doctors in prehospital care: a study
Authors: Skeldon Rebekah , Donald Michael , Paterson Brodie 
Published: May 2014

The Tayside Trauma Team has been providing a physician-staffed primary retrieval service in Angus and Tayside for many years. This study aims to explore the experiences and current opinions of paramedics and ambulance technicians in Tayside and Angus regarding the role of physicians in prehospital care as well as their understanding of what physicians bring to the on-scene management of trauma patients. Methods An anonymous questionnaire was devised and circulated electronically to all paramedics and ambulance technicians in Tayside and Angus. Results More than three quarters of respondents agreed that the ability of physicians to perform specific advanced practical procedures were advantageous on scene. Most disagreed that doctors carried out unnecessary interventions on scene and that a doctor's presence prolonged scene times, compromised scene safety or meant patient care was ‘taken over’. Discussion There appears to be a high level of understanding of the role of physicians in prehospital care among paramedics and ambulance technicians in Tayside and Angus. The majority of ambulance crews recognize that there are a key set of skills that a doctor can provide on scene to trauma patients.
Ambulance CPAP Saves Lives: why don't we use it?
Authors: Mullen Robert 
Published: May 2014

Continuous positive airway pressure (CPAP) is an established in-hospital therapy for the treatment of multiple aetiologies of breathlessness, primarily for acute cardiogenic pulmonary oedema (ACPE) due to acute exacerbations of congestive heart failure (CHF), but also (amongst others): exacerbations of chronic obstructive pulmonary disease (COPD), asthma and pneumonia ( Gray et al, 2009 ; Wesley et al, 2011 ). The use of CPAP as an adjunctive treatment for ACPE patients in front-line ambulances has been proven to improve patient outcome, preventing them from reaching the ‘point of no return’ and a downward spiral into total respiratory failure. This article will discuss current UK ambulance practice and examine the issues surrounding the introduction and use of CPAP as an adjunctive therapy in the treatment of ACPE, secondary to acutely exacerbated CHF, whilst also briefly discussing its use in other aetiologies of breathlessness.
Pre-hospital femoral neck fracture management: A review of the literature
Authors: Perillo Samuel , Boyle Malcolm J 
Published: May 2014

Introduction: Falls are a common incident in the pre-hospital setting with a significant number resulting in fractures to the femoral neck. There is some disagreement as to the best way to manage this injury, especially the immobilisation of the affected leg. The objective of the study was to review the literature evaluating the best practice management of patients who present with a femoral neck fracture in the Australian pre-hospital setting. Methods: A literature search was conducted using medical electronic databases, Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from the beginning of each database until the end of September 2012. Articles were included if they reported the pre-hospital management of a patient with a femoral neck fracture. Non-English and hospital-based articles were excluded. References from articles retrieved were reviewed. Results: There were 49 articles located with five articles meeting the inclusion criteria. All five articles described the evaluation of pain management techniques for patients presenting with injuries to the femoral neck. There were no studies that investigated the immobilisation of a femoral neck fracture. Conclusions: This study found a lack of evidence for the management of pre-hospital femoral neck fractures in Australia. Further pre-hospital studies are required to determine the most effective pain management technique as well as the best method to immobilise a femoral neck fracture.