bluuebunny/crossref_metadata_2025_split huggingface dataset:
Choice of dressing has a major impact on blistering and healing outcomes in orthopaedic patients
Authors: Cosker T. , Elsayed S. , Gupta S. , Mendonca A.D. , Tayton K.J.J. 
Published: May 2014

Objective: To investigate the effect of three postoperative dressings on orthopaedic wound healing. Method: Three hundred orthopaedic patients were divided into three treatment groups and allocated to management with one of three dressings: Primapore, Tegaderm with pad, and OpSite Post-Op. Staff completed a questionnaire to evaluate the wound progression. Outcome measures were the presence of infection, blistering and the number of dressing changes required. Results: There was a significantly lower incidence of blistering with OpSite Post-Op (6%) than Tegaderm with pad (16%) and Primapore (24%) (p<0.001). Patients in the OpSite Post-Op group had the lowest exudate levels. Conclusion: Dressings that employ a clear film and have a high moisture vapour transmission rate have been shown to reduce both the rate of blistering and wound discharge. The additional expense inherent in using such dressings may, in reality, prove cost-effective because of the reduced need for dressings changes and the subsequent earlier discharge of these patients from hospital with an uncomplicated wound. Declaration of interest: All dressings were supplied by the manufacturers. However, they had no contact with the wards or the authors once the study started.
Evidence-based practice and support surfaces: are we throwing the baby out with the bath water?
Authors: Clark M. , Hiskett G. , Russell L. 
Published: May 2014

Objective: This study aimed to explore aspects of the effectiveness of three pressure-redistributing support surfaces in routine clinical practice. Method: A non-randomised prospective cohort study was used, with skin outcomes reported for 219 subjects at risk of pressure ulcer development. Results: Few instances of new pressure damage were observed; these related to specific clinical issues, such as incontinence and inadequate use of cushions when sitting. Of the 77 subjects (33.3%) with pressure ulcers on recruitment into the study, most (n=70) either improved or remained unchanged following allocation of the support surface. Conclusion: Cohort studies do not indicate the efficacy of an intervention but may give an indication of effectiveness — that is, the clinical outcomes that may be observed in routine clinical practice. Declaration of interest: This work derives from a study funded by Huntleigh Healthcare.
Prevalence, incidence and predictors of pressure ulcers in a tertiary hospital in Singapore
Authors: Chan E-Y. , Tan S-L. , Lee C.K-S. , Lee J-Y. 
Published: May 2014

Objective: In 2002 the hospital under study implemented a pressure ulcer standard care plan. This follow-up study aimed to determine the prevalence and incidence of pressure ulcers, whether demographic characteristics and medical diagnosis differed between those individuals who did and those who did not develop ulcers and the predictors of pressure-ulcer formation. Method: The prevalence study used a cross-sectional design, while the incidence study was a prospective cohort study. Participants were scored using the Braden scale and were examined for the presence of pressure ulcers. Those who were ulcer free were monitored twice weekly until they were discharged or for 28 days. Results: The prevalence of pressure ulcers was 18.1% (95% CI: 15.5–20.9%), while the incidence was 8.1% (95% CI: 6.1–10.4%). Participants with ulcers were older, had a longer mean length of hospital stay, lower Braden scores and were diagnosed with or had a history of cardiovascular diseases or sepsis. Logistic regression found that the total Braden score was the only significant predictor of pressure ulcers. Compared with scores 16–23, the odds ratios were 7.7 (95% CI: 3.5–17.1, p<0.001) and 12.5 (95% CI: 4.5–34.6, p<0.001) for scores 12–15 and 6–11 respectively. Demographic characteristics, diagnosis and length of hospital stay were not significant predictors. Conclusion: The study identified a modest decrease in incidence and improvements in nursing care following the implementation of the care plan. It suggests that Braden scores are predictive of those at-risk of developing pressure ulcers. Declaration of interest: This study was supported by a grant from the Ministry of Health Nursing Research Committee.
Assessing the primary nurse role in the wound healing process
Authors: Huynh T. , Forget-Falcicchio C. 
Published: May 2014

Objective: To delineate the role of the primary nurse in wound care. Method: Data were collected from patient charts within a free-standing rehabilitation hospital in a Canadian province. Within the context of a continuous quality improvement programme, a retrospective chart review was performed. An audit tool was constructed; its face validity was assessed by a panel of staff nurses. Results: Primary nurses are involved in every step of wound care: assessment, treatment, evaluation of wound status and treatment. Conclusion: Within the cycle of continuous quality improvement (CQI), this project constitutes the first essential step of assessing the primary nurse’s role in wound care. Further CQI studies such as in-service education in wound care and pre-post education evaluation projects are recommended. Declaration of interest: None.
Effect of amelogenin extracellular matrix protein and compression on hard-to-heal venous leg ulcers
Authors: Vowden P. , Romanelli M. , Price P. 
Published: May 2014

Objective: To compare hard-to-heal venous leg ulcers treated with compression therapy alone versus compression therapy with amelogenin protein. Parameters used were: percentage reduction in wound size, number of improved ulcers, pain related to the disease and at dressing changes, amount and nature of exudate, and the safety and tolerability of the two treatments. Method: This was an open randomised comparative parallel group multicentre investigation with a three-week run-in period. Inclusion criteria included adult, mobile patients with hard-to-heal venous leg ulcers that had been treated with compression therapy for at least one month prior to screening. The ulcers had to be at least six months old, with a surface area at inclusion of 10–30cm2, and not demonstrating excessive exudate or signs of infection. At the end of the run-in period, additional criteria for eligibility, such as change in wound area of ± ≥50% and a wound area between 8cm2 and 36cm2 were applied. Patients were randomised to treatment with amelogenin plus high compression bandaging or high compression bandaging alone. All participants received high compression bandaging therapy one month prior to and during the three-week run-in period, as well as throughout the 12 weeks of active treatment. Results: Eighty-three patients were randomised and received treatment: 42 with high compression plus amelogenin (amelogenin group) and 41 to high compression therapy alone (control group). The amelogenin group had a greater percentage reduction in ulcer size (mean -33.11%) compared with the control group (mean -11.07%) from baseline to the last visit (p=0.06). The number of improved ulcers was significantly greater (p=0.01) in the amelogenin group than in the control group. Compensating for baseline characteristics by multiple regression resulted in a statistically significant (p=0.03) larger reduction in change in ulcer size in the amelogenin group. Statistically significant differences in favour of the amelogenin group were also found for reduction in ulcer-related pain (p=0.01), reduction in pain at dressing changes (p=0.02) and the proportion of patients with ‘none’ or ‘low’ levels of exudate (p=0.01). Conclusion: The combination of amelogenin with high compression promotes the healing process in hard-to-heal ulcers. Application of amelogenin as an adjunct to compression results in a significant reduction in ulcer size, improvement in the state of ulcers, reduced pain and a larger proportion of ulcers with low levels of exudate. The results of this study are statistically and clinically significant. Declaration of interest: This study was funded by Mölnlycke Health Care, Gothenburg, Sweden.
Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds
Authors: Stansby G. , Wealleans V. , Wilson L. , Morrow D. , Gooday C. , Dhatariya K. 
Published: May 2014

Objective: The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver. Method: Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study. Results: Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5-55) and the final visit (15.3cm2; range 2.4-63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0-35) to final visit (5mm; range 0-35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients. Conclusion: This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT. Declaration of interest: This study was sponsored by Mölnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
Flammacrium in the formation and stabilisation of eschar in chronic wounds
Authors: Signe-Picard C. , Cerdan M-I. , Naggara C. , Trial C. , Téot L. 
Published: May 2014

Objective To determine the effectiveness of Flammacérium, a topical treatment used in the treatment of burns, in the stabilisation of necrosis in non-healing wounds. The therapy is designed to prevent the risk of infection, stop necrosis from spreading and improve the patient's quality of life. Method This retrospective survey involved patients with necrotic, non-healing wounds who had been treated with Flammacérium. In all cases, debridement was contraindicated. Available data on wound evolution were collected. Results Ninety-nine patient files were analysed and the wound aetiologies included in the survey were classified as arterial (n=42), malignant (n=5), pressure ulcers (n=30), traumatic wounds (n=10) and other wounds (n=12). The formation of a leather-like eschar induced by topical use of Flammacérium improved pain management, decreased exudate levels and malodour, and had a positive effect on quality of life, increasing patient comfort, participation in social activity and psychological wellbeing. Following application of the cream, an eschar develops that strongly adheres to wound edges. By preventing the necrosis from spreading, this gave the practitioners more time to prepare for subsequent treatment, including skin grafting. Conclusion Flammacérium seems to be effective in the stabilisation of necrosis in non-healing wounds in which debridement is contraindicated. However, this study is limited by its retrospective nature. A prospective study will hopefully confirm and strengthen these results. Conflict of interest None
The Leg Club model: a survey of staff and members' perceptions of this model of care
Authors: Stephen-Haynes J. 
Published: May 2014

Objective To determine the Leg Club members' perceptions of the Leg Club as a model for delivery of service. Method An explorative qualitative approach was used. All members and staff at two Leg Clubs in the UK were invited to participate. They were asked to nominate five key words that described their views of the Leg Club model of care. The researcher and a research supervisor then counted them and decided on categories. Members' themes were verified by 10 randomly chosen Leg Club members and staff themes by five randomly chosen staff. Results All of the 85 Leg Club members and 15 staff approached agreed to take part. Categories identified for the Leg Club members were: sociability, enabling, knowledge and experience, interpersonal relationships, caring and quality. Categories identified for Leg Club staff were: camaraderie, education, empowerment, sociability and tiredness. Conclusion These results indicate that the community Leg Club environment provides benefits in addition to those of guidelines, wound care expertise and evidence-based care. While the small sample size limits the generalisability of these exploratory data, the results identify the positive views of Leg Club members and highlights the need for further research. Similar data is not available for other health care delivery methods, so this also warrants further exploration. Conflict of interest This study was unsupported by any commercial sponsorship but was supported by Leg Club and Leg Club Life President, Mrs Ellie Lindsay.
A comparison of the antimicrobial efficacy of two silver-containing wound dressings on burn wound isolates
Authors: Thomas J.G. , Slone W. , Linton S. , Corum L. , Okel T. , Percival S.L. 
Published: May 2014

Objective: To evaluate and compare the efficacy of a silver alginate (SA) dressing and a silver carboxymethyl cellulose (SCMC) dressing on burn isolates grown within the quasi/non-biofilm state and the biofilm phenotypic states. Method: Antimicrobial activity was tested using 46 burn wound isolates with a corrected zone of inhibition (CZOI) assay on agar (quasi/non-biofilm) and poloxamer (biofilm). Results: All Gram-negative and positive isolates evaluated were found to be sensitive to both silver containing wound dressings, although superior antimicrobial activity was observed for a select number of specific bacteria when grown in the quasi/non-biofilm phenotypic state, for the SCMC dressing. However, the majority of isolates demonstrated reduced sensitivity to silver when grown as a biofilm, compared with growth in the quasi/non-biofilm phenotypic state. both dressings demonstrated equivalent antimicrobial activity on Gram-negative isolates grown in the biofilm phenotypic state. For the Gram-positive isolates growing in the biofilm phenotypic state, there appeared to be greater sensitivity to the SA dressing compared with the SCMC dressing, although this result was not statistically significant. Conclusion: This study demonstrated the antimicrobial effectiveness of an SA and SCMC dressing in inhibiting the growth of burn isolates residing in both the quasi/non-biofilm and biofilm phenotypic states. It also suggests the SA dressing could be more effective on Gram-positive isolates grown in the biofilm phenotypic state, compared with SCMC dressing. Declaration of interest: This research was supported by a grant provided by Advanced medical Solutions ltd.
The psychological impact of split-thickness skin grafts
Authors: Hansen E.L.E. , Clarke A. , Austin-Parsons N. , Butler P.E.M. 
Published: May 2014

Objective: To measure the psychological distress associated with a split-thickness skin graft (STSG). Method: A retrospective postal questionnaire survey of 102 patients who had undergone a STSG procedure within the last 3.5 years. Outcome measures included the Hospital Anxiety and Depression Scale (HADS), Derriford Appearance Scale (DAS-59) and subjective ratings scales (SRS) of noticeability and worry about the grafted and donor area. Results: Scores on the SRS correlated positively with HADS and DAS-59 scores. Rates of anxiety were higher than depression (19% vs 13%, respectively). Greater than 10% of the sample experienced significant appearance-related distress when compared to standardised test norms. Concerns about the grafted area were higher than for the donor site, but those concerned about the graft were also likely to be concerned about the donor area. Age (< 60 years) and reason for surgery (trauma as opposed to cancer) were associated with significantly higher scores on appearance measures. Conclusion: STSG is not associated with high levels of psychological distress. However, there is a small but significant minority who experience appearance-related distress, low mood and anxiety who would benefit from targeted psychological intervention. Demographic factors, such as age or gender, and length of time since surgery, are not useful discriminators in identifying vulnerable individuals. Simple SRS of visibility and worry correlate significantly with standardised psychosocial measures. These can be used as a short and effective screening tool to identify individuals who would benefit from postoperative psychological input. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The psychological wellbeing of patients following excision of a pilonidal sinus
Authors: Stewart A.M. , Baker J.D. , Elliott D. 
Published: May 2014

• Objective: To explore the effects of a pilonidal sinus wound on patients' psychological wellbeing. • Method: An interpretive descriptive approach, using the Model of Living conceptual framework, guided data collection and analysis. The Model of Living was chosen to elicit information on how a pilonidal sinus wound affected activities of living. Participants were recruited from a database of a community nursing service, using purposive sampling, until data saturation was evident. Semi-structured interviews were used to collect the data. Data were examined for frequent patterns, which were organised into themes. • Results: Seven males and four females with ages ranging 17–39 years were selected through purposive sampling. Five participants reported that their wound affected their psychological wellbeing. Three themes and eight subthemes were identified from the data: adaption, perception and control. Depression and stress were associated with pain, physical inactivity, body weight changes and delayed wound healing. • Conclusion: A pilonidal sinus wound can affect the psychological wellbeing of patients through pain, physical inactivity, changed body weight and delayed wound healing. Pre-existing conditions could also be exacerbated by the wound. • Declaration of interest: The study was part of the requirement of a Master of Nursing, and a scholarship of $2000 was granted by Regal Health Services to assist with the study. The authors have no conflicts of interest to declare.
Review of emergency department wound management in soft tissue trauma — is there a plan?
Authors: Jones A.P. , Barnard A.R. , Allison K. , Wright H. 
Published: May 2014

Objective: To assess current acute wound management in English emergency departments. Method: All English emergency departments including minor injury units (n=207) were successfully contacted and a telephone questionnaire was completed. This considered wound treatment policy; management including cleansing, analgesia, dressing selection, suturing, referral patterns, medical photography and antibiotic use. Results: There was a 100% response. Only 40% of departments had a wound treatment policy. Most had implemented staff training, however the nature and timing of this was variable. Wound cleansing was performed by all departments. Most administered analgesia. Suturing was selectively performed by all departments. There was great diversity regarding dressing selection. The most common reasons for referral to specialist units were the complexity of injury and cosmetically sensitive areas. Photographs were regularly taken in one third of units questioned. Conclusion: This study confirmed an absence of a standard protocol for early soft tissue wound management in the emergency department setting. Key areas that could be improved are dressing simplification, more defined referral criteria and introduction of standardised protocols with structured teaching programmes. We propose a simple approach to management of acute soft tissue wounds that can be applied to most situations. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Modulation of cutaneous wound healing by silymarin in rats
Authors: Oryan A. , Naeini A. Tabatabaei , Moshiri A. , Mohammadalipour A. , Tabandeh M.R. 
Published: May 2014

Objective: To investigate the effect of topical application of silymarin on full-thickness cutaneous wounds in rats. Method: A full-thickness cutaneous defect (2×2cm) was induced on the back of 85 male and female Wister rats. The animals were randomly divided into four groups (n=20 in each group), treated with 1ml basal cream (placebo group), low-dose (6mg/ml/rat) and high-dose (12mg/ml/rat) silymarin, and untreated (control). Five rats remained uninjured to serve as comparisons for biomechanical analysis. Wounds were evaluated 10, 20 and 30 days after injury, through histopathologic, biochemical and biomechanical analyses. Results: There was a significant (p < 0.05) increase observed in the amount of glycosaminoglycans and collagen present on days 10, 20 and 30 for both low-dose and high-dose silymarin groups. Low-dose silymarin reduced the number of lymphocytes and enhanced the number of fibrocytes at the earlier stages of wound healing; however, high-dose silymarin reduced both lymphocytes and macrophages, and increased number of fibrocytes at the later stages of wound healing. Silymarin significantly improved alignment of the healing tissue, enhanced maturity of the collagen fibres and fibroblasts (p < 0,05), and increased the ultimate tensile strength and stress of the healing tissue. Conclusion: The results suggest that topical application of silymarin improved the morphological, biochemical and biomechanical properties of experimentally-induced wound defects in rats. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.