bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical experience with an antimicrobial hydrogel dressing on recalcitrant wounds
Authors: Wood L. , Wood Z. , Davis P. , Wilkins J. 
Published: May 2014

Objective To assess the performance of a newly-introduced, iodine-based antimicrobial wound dressing (Iodozyme) within normal clinical practice. Method 51 case records were collected from 30 wound care locations in England. Reporting clinicians used Iodozyme on one or more difficult wounds of their own choice (of various aetiologies) from their current case loads. Basic patient-specific data were collected, relating to both their own and their patients' experience with the product over a 6-week period of treatment (or less, if healing was achieved earlier). In every case, the wound continued to be treated in accordance with local ‘best practice’, in accordance with the manufacturer's instructions and by the same clinician. Each wound was assessed in terms of size, condition (margins and wound bed), exudate (type and amount), comfort/pain, overall satisfaction (by patient and clinician) and healing status (in terms of healed, improved, static or deteriorated). In addition, clinicians were asked to use their own local criteria and parameters where possible, with general guidance as and when it was needed. Results The mean duration of all wounds was 25.8 months (median 13 and range 1–312). Nine patients had a wound of less than six months' duration, and 17 had one of two years' or more duration. Within the 6-week study period, 6 wounds healed fully, 37 were judged to have improved, 7 remained static and 1 deteriorated. Overall, the majority of clinicians and patients were ‘satisfied’ or ‘very satisfied’ with product performance and 77% of clinicians concluded that the dressing was ‘better’ or ‘much better’ than other dressings they had previously used on similar wounds. Conclusion While we cannot generalise from this study, the encouraging clinical results and positive patient and clinician feedback lead us to believe that Iodozyme is a dressing worthy of consideration when treating chronic wounds. These encouraging preliminary fi ndings are now to be followed up with a randomised control trial. Declaration of interest All authors are either previous or current employees of Archimed.
Resistance carrying plasmid in a traumatic wound
Authors: Alavi M.R. , Ravizee A. , Burgess R. , Antonic V. , Izadjoo M. , Stojadinovic A. 
Published: May 2014

Objective To isolate and identify antibiotic-resistant bacteria from the exudate of a complex wound and determine if antibiotic resistance genes are chromosomal or plasmid borne. Method Antibiotic resistant bacteria from wound exudate of a single clinical sample were selected on agar media with ampicillin. A single colony was further screened for resistance to kanamycin by antibiotic-supplemented agar and to other antibiotics by an automated Phoenix instrument. Identifi cation of the isolate was carried out by biochemical profi ling and by 16S rDNA analysis. Results Approximately 51% of total bacteria in the wound exudate with identical colony morphotype were resistant to 100μg/ml of ampicillin. A single colony from this population also demonstrated resistance to 50μg/ml of kanamycin on kanamycin-supplemented agar. Further antimicrobial sensitivity testing by the Phoenix instrument indicated resistance to inhibitory concentrations of amoxicillinclavulanate, ampicillin-sulbactam, cefazolin, gentamicin, nitrofurantoin, tobramycin, and trimethoprimsulfamethoxazole. Biochemical and 16S rDNA analysis identifi ed this bacterial isolate as a member of genus Enterobacter. A plasmid preparation from this isolate successfully transferred ampicillin and kanamycin resistance to E. coli competent cells. E. coli transformants displayed two resistance phenotypes and the plasmids from these transformants displayed two different restriction type patterns, with one correlating to ampicillin and kanamycin resistance and the other only to ampicillin resistance. Conclusion A multiple antibiotic-resistant Enterobacter spp. from the wound fluid of a clinical sample was found to carry an antibiotic-resistant plasmid in a closely related species E. coli. The presence of antibiotic resistance plasmid in Enterobacteria that are part of the normal microbial flora of the human gut and skin could lead to the spread of resistance phenotype and emergence of antibiotic resistant pathogens. This study suggests normal human microbial fl ora could be a potential reservoir for resistance genes. Declaration of interest None.
Complex lower extremity wounds treated with skin grafts and NPWT: a retrospective review
Authors: Ross R.E. , Aflaki P. , Gendics C. , Lantis J.C. 
Published: May 2014

Objective: To evaluate a single centre experience with the use of NPWT for securing split-thickness skin grafts in the management of specifically lower extremity chronic wounds, including revascularised arterial wounds, amputations, diabetic and venous leg ulcers. Method: A seven-year retrospective review of a prospectively maintained database of all the patients who underwent primary split-thickness skin grafts (STSGs) with immediate postoperative NPWT for at least 96 hours was carried out. the percentage graft take after removal of NPWT device and clinical follow-up date were reviewed. Results: A total of 59 skin grafts procedures had adequate follow up to be reviewed. this included 39% post-debridement/ amputation wounds in patients who presented with diabetic foot infection/ gangrene, 31% venous leg ulcers, and 31% other post-surgical wounds (arterial ulcers that had undergone revascularisation). the mean percentage graft survival after removal of v.A.c. was 94%; 63% of cases had complete graft survival, 25% had 90–99% survival, and 8.5% had 80–89% survival. outpatient follow up ranged from 2 weeks to 5 years (mean of 10 months). Fifteen per cent of patients were lost to follow up, and, of the remaining patients, 76% remained completely healed, 10% remained partially healed, and 14% lost the entire STSG. Conclusion: Patients with STSGs secured with NPWT required fewer repeated grafting procedures, had very high initial graft survival with complete recipient bed coverage, and had good long-term wound closure rates compared with historical controls. While retrospective reviews, such as this, support NPWT as a good method of STSG affixation, the paucity of reviews with other study designs does not allow for good historic comparison, so a well-enrolled prospective trial would be of use. Declaration of interest: Dr J.c. lantis is a member of the speakers’ bureau, has been a site principal investigator of four multicentre trials and has been a consultant for KcI Inc. the same author has no equity in the company and has no financial benefit from positive results for the company's product(s). No external funding was sought nor obtained for this study.
Porcine urinary bladder matrix: a retrospective study and establishment of protocol
Authors: LeCheminant J. , Field C. 
Published: May 2014

Objective: To summarise our experience with porcine urinary bladder matrix extracellular matrix (UBM) for the treatment of diabetic, venous, ischaemic or decubitus ulcerations and to outline appropriate protocol for its application. Method: A retrospective review was also conducted on all patients who received UBM (MatriStem; ACell, Inc.) from January to December 2011. Information regarding patient demographics, wound aetiology and location, as well as any prior treatments and follow-up data, were collected and reviewed from patients’ medical records. Results: Thirty-four patients were evaluated for this study. Mean patient age was 62.4 ± 13.4 years (range 29–88 years) and 76% (n=26) were male. The most common comorbidities were peripheral neuropathy (n=20), diabetes mellitus type 2 (n=19) and hypertension (n=13). Mean wound duration prior to UBM application was 25.5 ± 43.5 weeks, and mean time to healing following initial application was 9.8 ± 9.3 weeks. All patients treated with UBM progressed to full healing. Conclusion: After addressing modifiable risk factors, our study suggests UBM is effective in the treatment of acute and recalcitrant diabetic or venous ulcerations when applied correctly with an appropriate dressing. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Economic analysis of soft-heel casting for diabetic foot ulcer: prevention and treatment
Authors: Craig J. , Shenton R. , Smith A. 
Published: May 2014

Objective: To model the benefit of an innovative measure to manage patients with diabetes and a foot ulcer, or at high risk of ulceration, using a soft-heel casting, which can be applied by a podiatrist or other trained staff member and used in the hospital or community setting. Method: An audit of the patient outcomes associated with the casting at NHS Borders was undertaken for inpatients with ulcers. These data were combined with other published data and expert opinion to model the benefit of the casting for prevention and curative purposes compared to standard practice. Cost of healed and unhealed ulcers in various settings was estimated based on the treatment pathways adopted. Results: The data from the economic model suggest that soft-heel castings could reduce the costs of managing these patients by approximately 10%; about £500 per inpatient and £425 per outpatient with an ulcer, and £205 per high-risk patient, when used for prevention. Conclusion: This cost-consequence analysis suggests the intervention could save about 10% of costs for managing patients with an active ulcer in inpatients or outpatients and offers potential savings if used as a preventative measure. Further studies are required to confirm the estimated clinical benefit and reduced resource use. Declaration of interest: Funding for this study was provided by the Scottish Government Health Department. The authors have no financial or commercial conflicts of interest to declare.
Superior gluteal artery perforator flap: A reliable method for sacral pressure ulcer reconstruction
Authors: Khurram M.F. , Khan A.H. , Ahmad I. , Nanda M. , Masoodi Z. 
Published: May 2014

Objective: To study the feasibility and reliability of the superior gluteal artery perforator (SGAP) flap for the reconstruction of sacral pressure ulcers. Method: A prospective study was conducted between 2009 and 2012 where a total of 15 patients with sacral pressure ulcers underwent reconstructive surgery with an islanded pedicled SGAP flap. Success of the flap reconstruction and primary healing were defined as a healed wound within 30 days of the procedure. Reconstructive failure was defined as those cases that resulted in a non-healed wound, thereafter. Results: Of the 15 patients in the evaluation, 12 were male and 3 were female. Eleven patients were paraplegic, 3 were ambulatory and one was quadriplegic. All reconstructed flaps survived completely with no mortality or major donor site complications. Three patients had a minor infection and wound dehiscence that healed spontaneously. All wounds healed within 30 days of surgery following local wound care and culture-sensitive antibiotics. No recurrence of the pressure ulcer occurred during follow-up. The non-paraplegic patients did not develop gait disturbances following the surgery. Conclusion: These observations suggest that the islanded pedicled SGAP fasciocutaneous flap is a relatively easy flap to raise, with good reliability and minimal complications, and is therefore highly recommended for the reconstruction of the sacral pressure ulcer. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Wound ‘dechronification’ with negatively-charged polystyrene microspheres: a double-blind RCT
Authors: Shoham Y. , Kogan L. , Weiss J. , Tamir E. , Krieger Y. , Barnea Y. , Regev E. , Vigoda D. , Haikin N. , Inbal A , Arnon O. , Bogdanov-Berezovsky A. , Silberstein E. , Rosenberg N. , Govrin-Yehudain J. , Zeilig G. 
Published: May 2014

Objective: To compare the efficacy and safety of negatively-charged polystyrene microspheres (NCM) with controls (saline soaks) in the treatment of hard-to-heal wounds of various aetiologies. Method: Patients with one or more hard-to-heal wounds, defined as refractory to healing for at least 4 weeks, or those with exposed bone, tendon or ligament, were eligible for inclusion and were randomised to either NCM (PolyHeal; MediWound Ltd.) or controls, both applied twice daily for 4 weeks. Patients were monitored bi-weekly for an additional 8 weeks, while treated by standard wound care, at the investigators' discretion, and were re-evaluated 2 years after inclusion. The primary endpoint was defined as coverage of > 75% of the wound area by light-red granulation tissue after 4 weeks of treatment. Results: Fifty-eight patients completed the study, 32 in the NCM group and 26 in the control group. The two most common wound types were those with primary etiologies of venous insufficiency and post operative/post trauma. In the NCM group 47% of patients achieved > 75% light red granulation tissue after 4 weeks compared with 15% of patients in the control group (p=0.01). The mean wound surface area in the NCM group was reduced by 39.0% after 4 weeks compared with 14.9% in the control group (p=0.02). The achievement of > 75% light red granulation tissue and reduction of mean wound surface area was also observed in the two main sub-groups (venous insufficiency and postoperative/post trauma), although it was not statistically significant, possibly due to the small sample size in each sub-group. Conclusion: This study demonstrates that compared to control treatment, NCM treatment of hard-to-heal and chronic wounds improves formation of healthy granulation tissue and reduces wound size thus in fact ‘kick-starting’ the healing process and ‘dechronifying’ chronic wounds. Declaration of interest: This study was conducted with financial support from Polyheal Ltd. D. Vigoda and Y. Barnea received honorarium for their contribution to the study. Y. Shoham and Y. Barnea are paid consultants for MediWound Ltd. and Polyheal Ltd., respectively. J. Govrin-Yehudain is a board member of MediWound Ltd. and Polyheal Ltd.
Net costs of hospital-acquired and pre-admission PUs among older people hospitalised in Ontario
Authors: Chan B. , Ieraci L. , Mitsakakis N. , Pham B. , Krahn M. 
Published: May 2014

Objective: To determine the net cost of hospital-acquired and pre-admission pressure ulcers (PUs) in an acute-care setting in Ontario, Canada. Method: Cases of PUs were identified among hospitalised patients using Ontario Case Costing Initiative (OCCI) data from 2002–2006. Inpatient costs included direct and overhead costs. To determine the net cost of PUs, cases were matched controlling for age, gender, most responsible diagnosis and comorbidity. Mean net costs were estimated using Bayesian linear mixed models methods. Results were also reported by PU severity. Results: In our study, there were 1351 cases of hospital-acquired PUs and 2523 cases of pre-admission PUs over 5 years. Net cost of hospital-acquired PU ranged between CA$44 000 for a category II PU to CA$90 000 for a category IV PU. For pre-admission PU net cost was between CA$11 000 to CA$18 500 for category II and category IV PU, respectively. The net cost of treating hospital-acquired PU is higher than pre-admission PU. Costs increase with increasing PU severity. Conclusion: The total net adjusted hospitalisation cost of a hospital-acquired PU in Ontario was CA$44 000–90 000, compared with CA$11 000–18 500 for a pre-admission PU. Future studies should determine the attributable cost of PU using patient-level data to verify the accuracy of the study results. Declaration of interest: No authors received any payment for services from a third party for any aspect of this study. At the time of this study, B. Chan was funded by the Ontario neurotrauma Foundation for his doctoral studies.
Assessing quality of life in patients with hard-to-heal ulcers using the EQ-5D questionnaire
Authors: Öien R.F. , Åkesson N. , Forssell H. 
Published: May 2014

• Objective:To assess health-related quality of life (HRQoL) in an unselected patient population with hard-to-heal ulcers from baseline through healing and at follow-up 6 months after healing. • Method:Fifty patients were recruited and the sex and age of the patient and the ulcer aetiology, duration, and size were recorded. The generic instrument EQ-5D was used for two purposes. The first was to investigate the feasibility of this instrument for assessing HRQoL in this patient group. The second was to see if the EQ-5D results would add information to the Swedish Registry of Ulcer Treatment (RUT), a national quality registry which includes variables for pain, disturbed sleep, and mobility. • Results:We found a significant difference in HRQoL between patients with an open ulcer and those with a healed ulcer (p=0.02), but no significant difference between patients with a just-healed ulcer and patients at follow-up six months after ulcer healing (p=0.08). Sex, age, and length of ulcer duration at inclusion did not influence HRQoL (p=0.55, p=0.4, and p=0.9, respectively). Ulcer size seemed to influence HRQoL, though not significantly (p=0.07). • Conclusion:This study confirms that HRQoL was improved after ulcer healing. Pain, as one of the five constructs measured by the EQ-5D, was significantly associated with open ulcers. The results from the EQ-5D questionnaire were hard to interpret in terms of capturing HRQoL in this unselected patient population. Despite some limitations, we consider that the simplicity of EQ-5D could make it feasible to use in the clinical setting. However, the results from EQ-5D did not add consistent information to RUT; therefore, this questionnaire will not be included in the registry. • Declaration of interest: This study was partly funded by Blekinge County Council and by the Council of Sciences in Blekinge County. The authors have no conflicts of interest to declare.
Maggot debridement therapy for the treatment of diabetic foot ulcers: a meta-analysis
Authors: Tian X. , Liang X.M. , Song G.M. , Zhao Y. , Yang X.L. 
Published: May 2014

Objective: To assess the potential efficacy of maggot debridement therapy (MDT) compared with standard care for diabetic foot ulcers (DFUs). Method: A meta-analysis was performed on the evidence for MDT for DFUs. Databases, including PubMed, Web of Science, the Cochrane library, EMbase, EBSCohost, Springer link, ScienceDirect and Ovid-Medline, were electronically searched for randomised controlled trials, case-control studies and controlled clinical trials, up to 31 December 2012, and relevant references of the included articles were also manually searched. the literature was screened, the data were extracted and the methodological quality of the included studies was assessed. meta-analyses were performed on the included data, for the outcomes healing rate, time to healing, incidence of infection, amputation rate and antibiotic-free days or antibiotics usage. Results: Overall, four studies comparing MDT with standard therapy on a total of 356 participants were included. the results of meta-analyses suggested that the MDT group was significantly superior to the control group in the percentage of DFUs to achieve full healing (RR=1.8, 95%CI=1.07; 3.02; p=0.03), amputation rate (RR=0.41, 95%CI=0.20; 0.85; p=0.02), time to healing (RR=–3.70, 95%CI=–5.76; –1.64; p=0.0004) and number of antibiotic-free days (126.8 ± 30.3 days vs 81.9 ± 42.1 days; p=0.001); however, collated differences in incidence of infection after intervention revealed no evidence of a difference between the MDT and control groups (RR=0.82, 95%CI=0.65; 1.04, p=0.10). Conclusion: Although MDT may be a scientific and effective therapy in treatment of DFUs, the evidence is too weak to routinely recommend it for treatment. large studies and sample sizes are needed to assess the efficacy and safety of MDT in the treatment of DFUs. 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 this work or its contents. X. Tian and X.M. Liang contributed equally to this work.
Inhibition of biofilms of Pseudomonas aeruginosa by Medihoney in vitro
Authors: Cooper R. , Jenkins L. , Hooper S. 
Published: May 2014

Objective: Pseudomonas aeruginosa has been linked to chronic wound infections, where its ability to form biofilms and to tolerate antimicrobial agents helps to facilitate its persistence. This study aimed to investigate the susceptibility of biofilms of Pseudomonas aeruginosa to Medihoney™ in vitro. Method: Biofilms were cultivated in microtitre plates with and without a range of concentrations of Medihoney, and effects on biofilm were monitored by optical density (at 650nm), biomass (by staining with crystal violet), metabolic activity (using an esterase assay) and viability (by determining total cell counts). Structural effects on established biofilms were examined by scanning electron microscopy and epifluorescence following staining by LIVE/DEAD® BacLight™, which also showed effects on vitality. Results: The lowest concentration of Medihoney found to prevent biofilm formation was 17%(w/v), whereas on average 35.5%(w/v) of Medihoney was required to inhibit established biofilms. Susceptibility did not vary with length of biofilm establishment between 24 and 72 hours. Extensive structural changes in established biofilms were seen in the sample with ≤30%(w/v) Medihoney using scanning electron microscopy and loss of viability was found in test samples with ≤20%(w/v) Medihoney concentration using fluorescent staining, together with loss of biofilm structure. Conclusion: Using a range of methods to evaluate biofilm integrity, this study demonstrates that Medihoney inhibits Pseudomonas aeruginosa biofilms in vitro at concentrations that are attainable in clinical use. Whether Medihoney has the potential to disrupt Pseudomonas aeruginosa biofilms in cutaneous wounds must now be tested in patients. Declaration of interest: This study was sponsored by Derma Sciences Inc, NJ. An unrestricted grant was provided and the sponsors were not involved in the design of the experiments or the preparation of this manuscript.