bluuebunny/crossref_metadata_2025_split huggingface dataset:
The development of the Glamorgan paediatric pressure ulcer risk assessment scale
Authors: Willock J. , Baharestani M.M. , Anthony D. 
Published: May 2014

Objective: To develop a predictive pressure ulcer risk assessment scale based on patient data. Method: Detailed questionnaires, based on a review of the paediatric and adult literature and discussion with paediatric nurses with expertise in this area, were used to obtain data on patient characteristics from 265 inpatients in a children's hospital and 54 children with pressure ulcers and 17 children without pressure ulcers from 11 hospitals. These data were then combined to compare the characteristics of children with and without pressure ulcers (using the chi-square test). Results: The Glamorgan paediatric pressure ulcer risk assessment scale was developed, based on the significance values identified by the statistical analysis. Variables that were significantly (p<0.01) associated with pressure ulceration included: difficult to position, anaemia, equipment pressing or rubbing against skin, reduced mobility for age, prolonged surgery and persistent pyrexia. The sensitivity, specificity and predictive validity of the Glamorgan scale was found to be greater than those for the Braden Q scale, which is widely used to assess pressure ulcer risk in children in the US. Conclusion: Using patient data from children and young people in the development of risk assessment tools for this age group may be preferable to modifying existing adult tools. Declaration of interest: None.
Effect of elasticity on subbandage pressure of three layer tubular compression bandages in healthy volunteers: a RCT
Authors: Weller C. , Jolley D. , Wolfe R. , Myers K. , McNeil J. 
Published: May 2014

Objective To estimate the difference between mean interface sub-bandage pressures of two multilayer compression bandage systems in healthy volunteers when supine, standing, exercising and during recovery. Method Inelastic and elastic compression bandages were randomised to opposite limbs of each participant. Sub-bandage interface pressures for both bandages were compared within person. Participants and study staff were aware of the treatment. A pressure transducer measured sub-bandage pressures on the medial aspect of the lower leg, at the transition of the gastrocnemius muscle into the Achilles tendon (B1). The difference in interface pressure for the two different compression bandages was measured at level B1 during supine resting, standing, exercise and recovery. We defined the pressure difference between active standing and lying as a measure of stiffness, and amplitude as the range of pressures during plantar flexion while standing. The two bandage systems (inelastic and elastic) were applied from the base of the toes to just below knee and remained in place for the duration of the experiment. Elastic bandage consisted of three layers of graduated tubular bandage (83% cotton, 9% Lycra, 8% polyamide). Inelastic or short-stretch bandage consisted of 100% cotton crepe bandage. Results Interface sub-bandage pressures varied during different activities, but the mean difference in interface pressures between inelastic and elastic bandages was consistently at least 13mmHg. Stiffness was 7.3mmHg higher in the inelastic group (95% CI 5.1–9.5). The estimated difference in amplitude of sub-bandage pressure between the bandages during exercise was 15.5mmHg (95% CI 12.2–18.9). Conclusion We found in vivo interface sub-bandage pressures varied with the type of bandage and activity phase. Inelastic bandages resulted in an increased mean interface sub-bandage pressure when resting and recovering, which was further increased when standing or exercising. Bandage stiffness and amplitude were also greater for inelastic compared with elastic bandages. Conflict of interest None.
The clinical effectiveness of negative pressure wound therapy: a systematic review
Authors: Xie X. , McGregor M. , Dendukuri N. 
Published: May 2014

EObjective To estimate the efficacy of negative pressure wound therapy (NPWT), on the basis of a systematic review of reported randomised controlled trials (RCTs). Method A systematic literature search for relevant RCTs was carried out. The credibility of the outcome of each study was evaluated using a specially constructed instrument. Results We identified 17 RCTs, of which five had not been included in previous reviews or health technology assessments. For diabetic foot ulcers (seven RCTs), there was consistent evidence of the benefit of NPWT compared with control treatments. For pressure ulcers (three RCTs), results were conflicting. In trials involving mixed wounds (five RCTs), evidence was encouraging but of inadequate quality. Significant complications were not increased. Conclusion There is now sufficient evidence to show that NPWT is safe, and will accelerate healing, to justify its use in the treatment of diabetes-associated chronic leg wounds. There is also evidence, though of poor quality, to suggest that healing of other wounds may also be accelerated. Conflict of interest None.
Evaluation of the combined use of ultrasound irradiation and wound dressing on pressure ulcers
Authors: Maeshige N. , Fujiwara H. , Honda H. , Yoshikawa Y. , Terashi H. , Usami M. , Sugimoto M. 
Published: May 2014

Objective:To evaluate the effect of ultrasound irradiation when used alongside standard care in the treatment of pressure ulcers; outcome measures were reduction in wound size and exudate weight.Method:Five patients (two male and three female, age range: 76–92 years) with seven ulcers participated in this study. They had National Pressure Ulcer Advisory Panel (NPUAP) stage III or IV pressure ulcers. We conducted an ABABA study (A: standard treatment with dressings that promote a moist wound healing environment; B: ultrasound irradiation administered to the pressure ulcer through the same dressing used in period A; each period lasted 2–4 weeks). Six ulcers each were randomised to either the treatment group or control group. One ulcer was not randomised, but was the first to receive ultrasound in the BABA sequence, with a view to determining if the pilot was feasible. The control group received sham ultrasound in period B. Pulsed ultrasound (20% duty cycle, 0.5W/cm2on the wound surface, 1MHz or 3MHz, for 10 minutes) was applied five times weekly.Results:In the treatment group, two ulcers markedly decreased in size after 3–4 weeks of US treatment, one ulcer decreased in size soon after initiation of treatment and one ulcer showed no clear reduction in size. The volume of exudate was greater in period B than A in two ulcers that reduced markedly in size after 3–4 weeks of US treatment. None of the ulcers in the control group decreased markedly in size.Conclusion:This pilot study suggests that US used alongside standard treatment might promote the healing of pressure ulcers. However, larger studies are required to determine the effi cacy and mechanism of US treatment for PUs.Declaration of interest:None.
Effect of an arginine-containing nutritional supplement on pressure ulcer healing in community spinal patients
Authors: Brewer S. , Desneves K. , Pearce L. , Mills K. , Dunn L. , Brown D. , Crowe T. 
Published: May 2014

ObjectiveTo determine whether or not the use of an arginine-containing nutritional supplement could result in signifi cantly shorter pressure ulcer (PU) healing times in people with spinal cord injuries living in the community, compared with a comparative historical control group.MethodEighteen spinal-cord-injured patients (all part of a hospital spinal outreach service) received 9g of a commercial powdered arginine supplement per day until full PU healing occurred. Healing rates were compared against 17 historical control patients (as assessed by medical history audit).ResultsBaseline characteristics (age, gender, injury level and time) were similar between groups. Mean ulcer healing times were 10.5 ± 1.3 weeks versus 21 ± 3.7 weeks (p<0.05) in the intervention and control groups respectively. Comparison of healing rates in the intervention group against expected healing rates derived from the medical literature showed that intervention patients had a significantly shorter mean healing time (category 2 PU: 5.5±1.3 weeks versus 13.4 weeks; category 3 PU: 12.5 ± 1.9 weeks versus 18.2 weeks; category 4 PU: 14.4 ± 4.8 weeks versus 22.1 weeks). A diagnosis of diabetes did not significantly alter healing rates in either group.ConclusionResults from this observational study show a promising benefit of arginine supplementation on PU healing for individuals with spinal cord injury living in the community.Declaration of interestNone of the authors have any financial or relationship conflicts of interest in presenting this paper. The authors would like to thank the Eirene Lucas Foundation for funding the project. The Foundation had no involvement in the study design, data collection, data analysis and interpretation, writing of the manuscript, or decision to publish the manuscript.
Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window
Authors: Wolcott R.D. , Rumbaugh K.P. , James G. , Schultz G. , Phillips P. , Yang Q. , Watters C. , Stewart P.S. , Dowd S.E. 
Published: May 2014

Objective To investigate the hypothesis that newly formed wound biofilms (or bioburdens) are more susceptible to antimicrobial treatment. Method Four separate and distinct models were performed by four separate biofilm research laboratories to evaluate the resistance of biofilms to antimicrobial treatments over time. These included a drip-flow biofilm model along with a hydrodebridement study, a porcine skin punch biopsy ex vivo model, a mouse chronic wound model and clinical longitudinal debridement study. Results All four models showed that, within the first 24 hours, the biofilm community was more susceptible to the selected antibiotics, and after maturing for up to 48 hours became increasingly tolerant. In each model, there was at least a 24-hour period in which the biofilms were more resistant to antibiotics. Each of the models utilised showed a significant decrease in the resistance of the biofilm/burden to gentamicin for up to 24 hours with a confidence interval of at least 95%. The resistance increased in each of the models by 48 hours and reached original resistance levels by 72 hours. Conclusion These data suggest the principles of biofilm-based wound care, along with the use of serial debridement to continually remove mature biofilm, followed by biofilm wound management strategies, including topical antibiotics while the bioburden is still immature and more susceptible, are valid. Conflict of interest SED is director of Research and Testing Laboratory, a commercial laboratory that develops molecular methods for diagnosis of wounds and infections and CEO of Pathogenius Laboratories, which is a molecular pathogen diagnostic company with a focus on chronic wounds. RDW is medical director of Southwest Regional Wound Care Center and inventor of biofilm-based wound care principles.
Hydroxyurea-induced foot ulcer in a case of essential thrombocythaemia
Authors: Tsuchiya S. , Ichioka S. , Sekiya N. 
Published: May 2014

Objective To illustrate the association between hydroxyurea and the development of ulcers. Method Method: A case study is presented, in which histological changes, mean corpuscular volume (MCV) and transcutaneous oxygen tension (TcPO2) were all measured and analysed, both during hydroxyurea treatment and following it's discontinuation. Results Two months following the cessation of hydroxyurea therapy, the patient's ulcer had healed completely. Biopsy specimens taken before and after its discontinuation showed a considerable improvement in vascularity, with a capillary density 6.28 times higher after discontinuation of the drug. TcPO2 was just 8mmHg at the first measurement, and this increased to 65mmHg at the second. Conclusion These findings suggest deficient neovascularisation and circulation during hydroxyurea treatment. Changes in MCV also appeared to have an effect on the progress of wound healing, which supports the hypothesis that macroerythrocytosis may be involved in the development of these rare ulcers, via impairment of the microcirculatory rheology. Conflict of interest None.
Quantitative estimation of exudate volume for full-thickness pressure ulcers: the ESTimation method
Authors: Iizaka S. , Sanada H. , Nakagami G. , Koyanagi H. , Konya C. , Sugama J. 
Published: May 2014

Objective: To develop an equation for the estimation of exudate volume in millilitres, for full-thickness pressure ulcers, according to wound characteristics. Method: In a cross-sectional study, 41 patients aged ≥ 60 years with 58 full-thickness pressure ulcers were evaluated. Exudate was collected by covering each wound with a transparent occlusive dressing and the accumulated volume was measured to estimate volume per day. The overall severity of each wound was evaluated by the DESIGN-R tool; a model was then developed to estimate the volume of exudate based on these experimental values. Linear regression analyses were performed to evaluate the precision and accuracy of the model. Results: The model, including exudate score, size score, and total score, showed a higher adjusted coefficient of determination (R2=0.66) than the model with only a traditional exudate score (R2=0.57). After adjustment for age, inclusion of interaction terms, and modification of bias, a model with continuous parameters was finally developed: exudate volume per day (ml/day) = exp([0.86×exudate score]+ [0.21×size score]+[0.12×total score]–[0.013×size score×total score]–[0.04×age]–3.60). Furthermore, a categorical model was developed for clinical simplicity of use. the adjusted R2 was increased to 0.73 for the continuous model and to 0.77 for the categorical model. there were no apparent biases (p > 0.05) and no correlations between residuals and measured value (p > 0.05) in these models. Conclusion: The equation, including the exudate score, size score and total score of DESIGN-R, as well as age, is called the ESTimation method. It will be useful for clinicians to predict the absolute volume of exudate and to select appropriate dressings for full-thickness pressure ulcers. Declaration of interest: The authors have nothing to declare.
The experience of patients with complex wounds and the use of NPWT in a home-care setting
Authors: Moffatt C.J. , Mapplebeck L. , Murray S. , Morgan P.A. 
Published: May 2014

Objective: To explore the experience of patients living with complex wounds and the impact of undergoing negative pressure wound therapy (NPWT) as part of their treatment. Method: Qualitative data were collected from eight patients, using semi-structured interviews. A purposive, stratified sampling approach was used to identify participants with a range of wound types, as well as age and gender. Participants were recruited from one primary care trust and were interviewed, following 10 days of treatment with NPWT. The matrix-based ‘Framework’ approach, from the national Centre for Social research, was used to structure the analysis. Results: of the eight participants recruited, five were female and three male, with an age range of 46–77 years. Five overarching categories, with their constituent themes, were identified from the data. The first, developing a wound through crisis, has three themes: a failing body, missed diagnosis and failed professional intervention. The second category, decreased control, has four related themes: poor communication; failed wound healing; poor discharge planning and failure to recover. The third category, increased control, has four themes: understanding what is happening; symptom control; positive professional relationships and returning to health. The fourth category, using NPWT, has two themes: information and understanding of NPWT and expectations and experience of NPWT. The final category sets out participant recommendations about the device and has two themes: device issues and improving professional practice. Conclusion: This study investigated the experience of patients undergoing NPWT for complex wounds in the home setting and reveals a number of the psychosocial effects of using this therapy in this environment. Participants saw NPWT as an active intervention, associated with improved wound healing and symptom control. The participant experience described in this study, and the recommendations they make, provide a valuable resource to inform service improvement programmes and wound research. Declaration of interest: This study was supported by a research grant from Smith & Nephew Ltd.
A cohort study on the efficacy of a polyhexanide-containing biocellulose dressing in the treatment of biofilms in wounds
Authors: Lenselink E. , Andriessen A. 
Published: May 2014

Objective: This cohort study evaluated the clinical efficacy of a polyhexanide-containing biocellulose dressing, Suprasorb X + PHmb (lohmann & Rauscher GmbH), for the eradication of biofilms in non-healing wounds. Polyhexanide (PHmb) has been shown to have microbicidal activity when applied to chronic wounds and burns. Method: Twenty-eight patients, aged over 18 years, who presented at an outpatient wound clinic with non-healing locally infected and/or critically colonised wounds of various aetiologies that showed clinical signs of biofilm were included in the study. Sixteen patients (nine females), with a mean age of 60.9 ± 21.6 years, were included in the analysis. The patients were prospectively followed for a maximum of 24 weeks or until healing for analysis of safety and efficacy endpoints. evolution of wound size was conducted with tracings and standardised digital photographs as well as for determining healing rates. Results: At 24 weeks,12 wounds (75%) had healed (complete epithelialisation with no drainage). of those wounds that had not closed, the mean wound area had reduced by 61% at week 24. Ten patients (63%) had a good reduction of the biofilm, five (32%) scored moderate and one (6%) had no reduction noted at week 24. The mean percentage of granulation tissue had increased significantly (p < 0.04) when comparing day 0 (38%) with week 24 (77%). Yellow tissue present in the wound bed decreased (p < 0.01): 62% (day 0) versus 23% (week 24). All patients reported reduced pain after dressing change. Conclusion: The results suggest that continuous application of PHMB, using a biocellulose wound dressing, reduced biofilm in the stagnating wounds treated, thus promoting healing. The treatment was comfortable, safe and reduced wound pain at dressing change. The PHmb-containing biocellulose dressing seems to be suitable for lightly to moderately exuding wounds. Declaration of interest: This study was supported by a scientific grant from Lohmann & Rauscher.
Efficacy of a total occlusive ionic silver-containing dressing combination in decreasing risk of surgical site infection: an RCT
Authors: Siah C.J. , Yatim J. 
Published: May 2014

Objective: To perform a comparative assessment of the efficacy of total occlusive ionic silver-containing dressing (TOISD) combination vs no dressing after colorectal surgery. Method: The surgical sites from both groups were swabbed and sent for culture and sensitivity upon wound closure (superficial incisional skin surface) in the operating theatre, as a baseline for bacterial colonisation. The patients’ surgical wounds in the study group were dressed with TOISD combination and the patient's surgical wounds in the control group received the conventional method of no dressing. A second swab was taken from the superficial incisional skin surface for culture and sensitivity investigation between the fifth to seventh postoperative day for comparison of the bacterial colonisation in the two groups. Results: one-hundred and sixty-six patients were recruited. Six patients dropped out before the fifth postoperative day, leaving 79 patients in the control group and 81 patients in the study group. microbial swab cultures revealed significant differences between the two groups (p < 0.001, mean=1.43 ± 0.63) in bacterial colonisation. The odds ratio (or) of patients with wounds in the control group was 4.1 (95%cI is 1.884, 8.964) more likely to be contaminated with bacteria compared with wounds covered with occlusive ionic silver-containing dressing. Conclusion: TOISD was found to be effective in reducing bacterial colonisation on the surgical site compared with no dressing. However, it properties were unable to be put into use if there were the surgical sites were not infested with bacterial. Although TOISD might not be necessarily on surgical incisional site not infested with bacteria for the initial post-operation days, it is helpful in preventing further transcription and division for opportunistic bacteria, thus might reduce the risk of superficial incisional SSI. The use of TOSID though statistically insignificant compared to no dressing, could also be possible in reducing the risk and exaceration of deep incisional SSI. Declaration of interest: The authors have no conflicts of interest to declare. This study was funded by a grant from the ministry of Health research committee, Singapore.
Comparison of PHMB-containing dressing and silver dressings in patients with critically colonised or locally infected wounds
Authors: Eberlein T. , Haemmerle G. , Signer M. , Gruber-Moesenbacher U. , Traber J. , Mittlboeck M. , Abel M. , Strohal R. 
Published: May 2014

Objective: This study compares treatment with a polihexanide-containing biocellulose wound dressing (BWD+PHMB) versus the best local standard of silver dressings (Ag) in painful, critically colonised (wounds-at-risk) or locally-infected wounds. Method: Patients with wounds of various aetiologies, a baseline VAS pain score ≥4 and a semi-quantitative bacterial load of ++ or higher were randomly allocated to receive treatment with either BWD+PHMB or Ag. Patients with systemic infections and/or using systemic antibiotics were excluded. The primary endpoint, patient-reported pain (VAS total pain, including the sub-scores pain at night, during the day, before, and 15min after dressing changes), was compared between treatment groups and scored on days 0, 1, 3, 7, 14, 21 and 28. Secondary outcomes of bacterial load, wound bed and periwound skin condition, quality of life and dressing handling were assessed at the same visits. Results: Thirty-eight patients (BWD+PHMB, n=21 [24 wounds]; Ag, n=17 [18 wounds]) were included in the analyses. Baseline variables showed no significant differences. Wound pain was reduced significantly in both groups, with a better pain reduction noted for BWD+ PHMB (p < 0.001) before dressing changes. Compared with Ag, in the BWD+PHMB group critical colonisation and local wound infection had been reduced significantly faster and better (p < 0.001) over the 28-day study period. Improved quality of life, good tolerability and no adverse events were demonstrated for both groups. Conclusion: Both BWD+PHMB and AG were effective in reducing pain and bacterial burden. However, that BWD+PHMB was significantly faster and better in removing the critical bacterial load, makes this dressing an attractive therapeutic option to treat critically colonised and locally-infected wounds. Declaration of interest: This was sponsored by a clinical research grant from Lohmann & Rauscher GmbH & Co. KG. G. Haemmerle, M. Signer, U. Gruber-Moesenbacher and M. Mittlboeck have no conflict of interest to report. T. Eberlein, J. Traber and R. Strohal serve in the speakers bureau of Lohmann & Rauscher GmbH & Co KG. In addition, T. Eberlein and R. Strohal also work as consultants for Lohmann & Rauscher GmbH & Co KG. M. Abel is an employee of Lohmann & Rauscher GmbH & Co KG.