bluuebunny/crossref_metadata_2025_split huggingface dataset:
Degloving injuries of the abdominal wall
Authors: Veena P.W , Babu R. , Venkatesh M.S. , Udayashankar  , Deepak K.L. 
Published: May 2014

Objective:To stress the local, regional and global impact of degloving injuries of abdominal wall based on which the surgeon can design the management protocol.Method:A retrospective series of seven cases who met with high velocity run-over accidents between the year 2002 to 2007. All patients were clinically examined and the findings confirmed radiologically, which guided the management.Results:Out of the seven patients treated, six survived. All patients had open degloving injury of abdominal wall and in different areas of the lower limbs, while three had an additional closed degloving in the back, thighs and gluteal regions. All of them had pelvic fractures of various types. Three patients had peritoneal injury, of whom one had additional diaphragmatic injury. None of them had hollow viscus perforation or injury to solid viscera despite the varied severity of injuries to the abdominal wall, pelvic bone and diaphragm.Conclusion:Degloving injuries of the abdominal wall are rarely encountered in our practice. The associated morbidity and mortality are very high. However, the prognosis can be improved by successful revival and rehabilitation of these patients, which is possible by early resuscitation, recognition of all bony and soft tissue injuries, early debridement and coverage.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.
NPWT or HRT-dressing? Results of an expert panel and a Delphi panel analysis
Authors: Hermans M. H. E. , Cutting K. 
Published: May 2014

Objective: To investigate the similarities and differences between Hydration response Technology (HRT) and negative pressure wound therapy (NPWT) with regard to wound bed preparation, and to devise a set of recommendations for their use on the basis of the opinion of two panels. Method: An expert panel that analysed in vitro and clinical data as well as the similarities and differences between the two modalities was established. This culminated in a series of recommendations on which modality to use for which indication. These recommendations were presented to a Delphi panel, consisting of users of both NPWT and HRT-dressing. The panel was then asked to produce its own recommendations. Results: The outcomes and recommendations of both panels were reported. NPWT is the preferred treatment modality for abdominal dehisced wounds, and to a lesser extent, for surgical wound healing by secondary intention. For all other indications, the treatment modalities are at least equal, with HRT-dressing often being the superior mode to treat wounds such as venous leg ulcers, arterial ulcers and vasculitis. Conclusion: In the opinion of the expert panel and the Delphi panel, both modalities share a number of clinical and non-clinical properties. However, because of the numerous advantages of HRT technology, HRT dressing has the potential to replace NPWT in a number of indications, where the patient, healthcare providers and institutions may benefit. Declaration of interest: This study was sponsored by Sorbion GmbH & Co, Senden, Germany. Authors M. Hermans and K. Cutting are consultants to Sorbion GmbH & Co, Senden, Germany.
Clinical outcomes of WF10 adjunct to standard treatment of diabetic foot ulcers
Authors: Yingsakmongkol N. 
Published: May 2014

Objective: To study clinical outcomes and safety of WF10 as an adjunct to standard treatment for diabetic foot ulcers (DFU) and to determine the optimal number of WF10 cycles that should be administered. Method: A prospective, open-label study of WF10 adjunct to standard treatment for severe DFU but salvageable foot was carried out between July 2009 and June 2010. Patients were classified into three groups, according to common clinical presentations: neuropathic ulcer, ischaemic ulcer and severely infected ulcer. Ulcer assessments were monitored using the wound severity score (WSS; range 0–16). The clinical outcomes at 24 weeks were defined as ‘good’ (ulcer achieved endpoint [WSS=0–1]), ‘fair’ (improved from baseline [WSS=2–4]) and ‘poor’ (not improved or worsened [WSS > 4]). Results: From a total of 129 patients, 21 (16%) presented with neuropathic ulcers, 49 (38%) with ischaemic ulcers and 59 (46%) with severely infected ulcers. All neuropathic ulcers achieved either a good or fair outcome, with 81% achieving a good outcome, as did 49% and 81% of ischaemic and severely infected ulcers, respectively. Minor amputations were necessary for 14 patients (11%), but no major amputation was required. Twenty seven patients (21%) had transient reduction of haematocrit after WF10 therapy. One hundred and one patients (78 %) received only 1 cycle of WF10. Conclusion: WF10 as an adjunct to standard DFU treatment showed good clinical outcomes in the neuropathic ulcer group and the severely infected ulcer group. A side effect of WF10, transient reduction of haematocrit, was observed in 21% of patients. Most patients required only one cycle of WF10. Declaration of interest: There were no external sources of funding for this study. The author has no conflicts of interest to declare.
Is it time to re-appraise the role of compression in non-healing venous leg ulcers?
Authors: Guest J.F. , Charles H. , Cutting K.F. 
Published: May 2014

• Objective: to evaluate the role of compression in non-healing venous leg ulcers (VLUS) of > 3 months’ duration. • Method: patients’ records from three independent data sets of non-healing VLUS of > 3 months’ duration were re-analysed. Two data sets were separate audits of clinical practice and the third comprised patients’ records from a randomised controlled trial. Some patients in each data set were never treated with compression. the effect of compression on healing at 6 months was tested with logistic regression. • Results: In each data set, patients in the compression and no-compression groups were matched according to ulcer size and duration; there were no differences in comorbidities. Comparing the no-compression with the compression groups, the healing rate at 6 months was 68% vs 48% in study 1, 12% vs 6% in study 2, and 26% vs 11% in study 3. Use of compression was found to be an independent predictor of not healing with an odds ratio of 0.422, 0.456 and 0.408 in studies 1, 2 and 3 respectively. • Conclusion: the healing rate of non-healing VLUs of > 3 months’ duration in the no-compression groups was double that of VLUs in the compression groups. these findings have the potential for treatment modification if confirmed in a prospective trial. • Declaration of interest: there were no external sources of funding for this study. the authors have no conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
W.A.R. scores in patients with chronic leg ulcers: Results of a multicentre study
Authors: Jockenhöfer F. , Gollnick H. , Herberger Katharina , Isbary G. , Renner R. , Stücker M. , Valesky E. , Wollina U. , Weichenthal M. , Karrer S. , Stoffels-Weindorf M. , Dissemond J. 
Published: May 2014

Objective: To assess the individual patient's risk of wound infection using the wounds-at-risk (W.A.R.) score developed by a group of interdisciplinary experts. Method: The W.A.R. score is a clinical test in which, based on anamnestic and clinical criteria, wound patients are assigned point values, where a score of ≥3 indicates a need for antimicrobial treatment. Results: :The data of 970 patients (553 women, 417 men) with chronic leg ulcers were evaluated at 10 dermatological wound clinics in different regions within Germany. The age of the patients was between 10 and 100 years (mean of 69.8 years); the duration of the wounds was between 2 months and 68 years (mean of 41.1 months). Wound sizes were between 1 and 736 cm² (mean of 42.8 cm²). Overall, W.A.R. scores of <3 points were found in 26.9% of patients and scores of ≥3 were found in 73.1% of patients. There were significant differences in W.A.R. scores by regions with respect to the bacterial species detected and the aetiologies of the wounds. Conclusion: Our multicentre study is the first evaluation of clinical data using the newly established W.A.R. scores. We were able to show that the W.A.R. scores are able to identify a segment of the patient population for whom it can be assumed that they are prone to an increased risk of wound infections unless appropriate antimicrobial action is taken. The W.A.R. score is a simple clinical score that identifies patients with an increased risk of wound infection. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The influence of different dressings on the pH of the wound environment
Authors: Milne S.D. , Connolly P. 
Published: May 2014

Objective: This study examines the effect of various wound dressings on the pH levels of a wound, using a simulated wound environment. Method: The pH levels of a 4 different wound dressings (manuka honey dressing, sodium carboxymethylcellulose hydrofiber dressing, polyhydrated ionogen-coated polymer mesh dressing, and a protease modulating collagen cellulose dressing) were tested in a simulated horse serum wound environment. The effect of local buffering was observed and pH changes in real time were measured. Results: All dressings were found to have low pH (below pH 4), with the lowest being the protease modulating collage cellulose dressing, with a pH of 2.3. The dressing with the strongest acid concentration was the polyhydrated, ionogen-coated, polymer mesh dressing. Conclusion: The low pH and strong acidic nature of the dressing investigated indicate that they may play a role in influencing the healing process in a wound. Declaration of interest: The authors have no conflicts of interest to declare. This study was funded by the EPSRC.
Factors in rehospitalisation for severe pressure ulcer care in spinal cord injury/disorders
Authors: Goodman B.L. , Schindler A. , Washington M. , Bogie K.M. , Ho C.H. 
Published: May 2014

Objective: Repeated hospital admissions (RHA) for ongoing pressure ulcer (PU) care remains a significant challenge in the clinical management of the spinal cord injury/disorders (SCI/D) population. The current study investigated the significance of risk factors for PU treatment and RHA. Method: A retrospective chart review of veterans admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) Spinal Cord Injury (SCI) unit for Category III or IV PUs was carried out. A random sample of 105 individuals with SCI/D, evaluated by the Wound Care Team (WCT) from 2006 to 2009 was assessed. Multiple PU development risk factors were extracted from the electronic health record system using standardised data collection forms and entered into the Spinal Cord Injury Pressure Ulcer Database (SCIPUD). Potential associations with RHA were analysed. Results: Twenty variables were initially identified as potentially related to PU development. Descriptive statistics and statistically significant associations between risk factors and RHA were determined. Demographic factors showed no significant association with RHA. Duration of injury, power wheelchair use and sub-optimally managed spasticity (SMS) were significantly associated with higher RHA. Suboptimally managed neurogenic bowel (SMNB) at admission was significantly associated with reduced RHA. Conclusion: Factors previously found to be predictive of initial PU development may not, in fact, be predictive of RHA. Some protective trends were observed, such as polypharmacy and marital status, but these did not reach statistical significance in this preliminary study of admission characteristics, warranting further research. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
Nutrition-related status and granulation tissue colour of pressure ulcers evaluated by digital image analysis in older patients
Authors: Iizaka S. , Koyanagi H. , Sasaki S. , Sekine R. , Konya C. , Sugama J. , Sanada H. 
Published: May 2014

Objective:Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting.Method:The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) was calculated.Results:Haemoglobin levels were positively associated with %GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with %GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower %GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, %GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher %GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127).Conclusion:Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.Declaration of interest:This study was funded by a grant from the Japanese Society of Pressure Ulcers and a Grant-in-Aid for Fellows of Japan Society for the Promotion of Science (#22-2766). The funding organisations had no role in the design, data collection, analysis, review, or approval of the manuscript. The authors report no relevant conflict of interests.
Bacterial colonisation of the burn wound: A UK experience
Authors: Alrawi M. , Crowley T.P. , Pape S.A. 
Published: May 2014

Objective: Bacterial colonisation of the burn wound remains a major source of morbidity and mortality in burns patients. This study aimed to determine the presence of different micro-organisms in a UK regional burns centre and to examine the relationships between bacterial colonisation, burn size, length of hospital stay and delayed referral. Method: A retrospective review of microbiology surveillance swab results on all adult patients admitted to a regional burns centre over a 12-month period was performed. Results: 139 adult patients were included in the study. Approximately 68% of patients showed evidence of burn wound colonisation at some point during their inpatient stay. The remaining 32% had negative microbiology swabs throughout their hospital stay. A total of 202 micro-organisms were isolated. Staphylococcus aureus was found to be the most common micro-organism, found in 79% of patients with positive swab results. A direct link was found between an increased incidence of bacterial colonisation and delay in referral of >24 hours, larger burn size and length of hospital stay. Conclusion: By understanding the potential sources of bacteria and the effect of patient factors on their susceptibility to bacterial colonisation, we can form better management and treatment strategies to reduce morbidity and mortality from burns wound sepsis. 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 contents.
The theory and application of pulse oximetry
Authors: Mildenhall Joanne L 
Published: May 2014

Pulse oximetry is widely used in the prehospital environment, yet researchers question whether health professionals fully understand the theory to support the practical application of its use. This article explores the fundamental theory of pulse oximetry to give applied understanding. From a prehospital perspective, it details and examines the advantages and limitations of this observational aid, which must be considered when making clinical decisions regarding a patient's care.
Which paediatric weight formula is best suited for the out-of-hospital field?
Authors: Winship Christian , Williams Brett , Boyle Malcolm 
Published: May 2014

Background: Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drug dosages, fluid therapy and defibrillation. In the pre-hospital field the treatment of a patient needs to occur in a timely and accurate fashion, this necessity drives the need for an accurate weight estimation formula. The objective of this study was to identify a paediatric weight estimation formula relevant to the pre-hospital field. Methods: A literature review was undertaken using a variety of electronic medical databases from their commencement date until the end of May 2012. Keywords used in the search included: Weight estimation, drug calculations, pediatric, paediatric, EMS, EMT, paramedic, emergency medical service, emergency medical technician, pre-hospital, out-of-hospital and ambulance. The keywords were used individually and in combination. The inclusion criterion was any study type that described the development or evaluation of a paediatric weight calculation in the pre-hospital or hospital setting. Findings: There were 635 articles located with 25 meeting the inclusion criteria. The commonly used APLS weight estimation formula significantly underestimates a child’s weight. The best guess formula appears to be more accurate at estimating the weight; however more research needs to be conducted to validate this method for the pre-hospital field. Conclusion: As the average weight of children increases, the accuracy of weight estimation formulas decreases, suggesting that these methods will be unable to sufficiently adjust to deal with future rises in average weights of children. Further research is required to determine the most appropriate formula for paramedics to use in the pre-hospital setting.
Lactate measurement in pre-hospital care: a review of the literature
Authors: McClelland Graham , Younger Paul , Byers Sonia 
Published: May 2014

Background:Lactate has been identified as a useful marker of shock. Lactate can be measured in the pre-hospital environment rapidly and accurately.Method:A comprehensive literature search was conducted using a targeted search strategy. Additional literature was located through reference list searching and prior awareness by the authors. This identified a number of papers which were appraised for relevance. This appraisal identified 29 papers which were included in the review.Conclusion:Lactate has been shown to be measurable in the pre-hospital environment and to be prognostic of mortality. Lactate measurement needs to be linked to specific treatment algorithms with improved outcomes for patients in order to justify inclusion in pre-hospital practice.
Paramedics' ‘end-of-life’ decision making in palliative emergencies
Authors: Wiese Christoph HR , Taghavi Mahmoud , Meyer Nicole , Lassen Christoph , Graf Lassen 
Published: May 2014

Background: Paramedics in Germany routinely treat palliative care patients at the end-of-life (EoL). For this, they play a legally significant role in EoL decision making in the outpatient emergency setting. This study was undertaken to determine paramedics’ understanding of their role in withholding or withdrawing resuscitation/EoL-treatment of palliative care patients when an advance directive is present. Methods: Using a self-administered survey, participants/paramedics were asked about (1) ‘their occupational experience’ (less/more than 10 years, (2) ‘emergency responses’ (less/more than 100/month), (3) ‘their experiences in palliative emergencies’ (less/more than 10 palliative emergencies/year), (4) ‘palliative emergency sheets concerning end-of-life decisions’, and (5) ‘their treatment options during resuscitation’. Participants were paramedics from two cities in Germany. Results: Overall, 728 questionnaires were returned (response rate: 81%). Seventy-three percent of respondents were older than 20 years, 98.5% were male. Most paramedics dealt with palliative emergencies and terminally ill patients during their work (71%). Work experience and training in palliative care shows statistically significant differences concerning our dependent variables. Conclusions: Our results underline the necessity for more training in EoL. Paramedics stated that improved guidelines regarding EoL decisions/advance directives and the possibility to withdrawing resuscitation for appropriative cases are necessary. The treatment of terminally ill patients by paramedics may present an ethical problem: if paramedics honour patients' wishes, they will violate juridical regulations. In future, a change concerning current regulations seems to be necessary as well.
The art and science of mentorship in action
Authors: Jones Paul , Comber Jason , Conboy Adrian 
Published: May 2014

The authors have collaborated to produce this article bringing together more than 60years of combined experience of paramedic practice, education and management. All maintain their paramedic registration and have among their goals the advancement and development of knowledge, skills and professionalism to promote an effective contemporary paramedic who continues to meet the care needs of the communities they serve. Practice mentors are pivotal to the success of a modern, fit-for-purpose paramedic curriculum that requires a significant proportion of learning and assessment to take place in the practice setting. This article focuses on the support that is needed for mentors during major professional and organisational change. Change which is aligned to localised multifaceted organisational strategies and change which includes supporting mentors, enabling them to carry out their function professionally, effectively and with confidence. This article discusses experiences of a collaborative, structured approach to mentorship support which is achieved through organisational, educational and professional alliances. It also explores other approaches and suggests a way forward in terms of a national governance framework.