bluuebunny/crossref_metadata_2025_split huggingface dataset:
Administering subcutaneous injections to children: what does the evidence say?
Authors: Cocoman Angela , Barron Carol 
Published: May 2014

The administration of subcutaneous injections to babies, children and adolescents is a fundamental nursing task and one that should be underpinned by an evidenced-based practice. The subcutaneous route is used routinely with children to administer a wide variety of pharmacological preparations including vaccinations, anticoagulants, analgesics, insulin, growth hormones and some anti-carcinogen agents (Torben et al, 2006). These medications are predominantly administered via injection or continuous infusion. Subcutaneous injection technique varies greatly among nurses and children who self-administer, ranging from the angle of insertion (a 45-degree angle to a 90-degree angle) to the use of an elevated skin-fold or not. The variation in the selection of needle lengths may also result in the possibility of intramuscular injections rather than achieving a true subcutaneous injection (Prettyman, 2005). Paediatric nursing text books (Trigg and Mohammed, 2006), journal articles (Annersten and Willlman, 2005; Tubiana-Rufi et al, 1999) and patient instruction leaflets often give conflicting or inconsistent advice regarding subcutaneous injection technique. The administration of subcutaneous injections can cause stress, anxiety and pain to children (Trigg and Mohammed, 2006) often leaving them apprehensive about receiving future medications, or even becoming noncompliant with medical care (Ellis and Bentz, 2007). Injection pain is often the result of injury to the nerve fibre endings located in the skin and tissue from mechanical trauma caused by the needle puncture. Kuzu and Ucar (2001) have noted that site-pain causes the patient physical and psychological discomfort and bruising often limits possible sites for subsequent injections. This article examines the literature that guides clinical practice and considers recent changes in relation to the administration of subcutaneous injection in children, while acknowledging that there is little evidence-based practice to support the formulation of recommendations regarding the technical aspects of subcutaneous administration (Annersten and Willman, 2005). This paper examines the nurse’s role in administration of subcutaneous medications.
The management of chronic wounds: factors that affect nurses' decision-making
Authors: Boxer E. , Maynard C. 
Published: May 2014

This study sought to determine how registered nurses make decisions regarding the management of chronic wounds. A self-administered questionnaire consisting of both Likert-type and open-ended questions was used to survey registered nurses working in hospitals and community services in a large Australian city. A total of 140 questionnaires were returned from a variety of clinical settings. The study revealed that registered nurses had a significant role in chronic wound management. However, they relied primarily on their own experience and that of colleagues for decision making in which they had varying degrees of autonomy. The authors conclude that nurses and medical staff require more objective, research-based education on wound assessment and management.
The influence of four wound dressings on the kinetics of human walking
Authors: Chockalingam N. , Ashford R.L. , Dunning D. 
Published: May 2014

Objectives: This in vivo study (the second phase of a research project first described in the February issue of Journal of Wound Care) reports on the influence of various wound dressings on the dynamics of human walking. Allevyn (Smith and Nephew), Biatain (Coloplast), Lyofoam (Seton Scholl) and Tielle (Johnson and Johnson) were used in this study. The investigation aimed to assess the ground reaction forces in the foot while the dressings were applied to the plantar surface of the foot. Method: A strain gauge force plate system was used. Six subjects with ‘normal’ gait patterns and no foot pathology were recruited into the study. Eight trials were recorded for each subject. The peak push-off force, in the vertical component of the ground reaction force, and the maximum braking and propulsive forces in the medial-lateral component of the ground reaction force were estimated and reported. Results: Among the various dressings tested, Allevyn performed closest to barefoot in the peak push-off force and demonstrated an increased braking force at the deceleration point in the gait cycle. Conclusion: These findings may have implications for clinicians selecting wound dressings for the treatment of certain foot ulcerations. However, further clinical research is warranted in this area. Declaration of interest: Study was sponsored by Smith and Nephew.
Healing venous ulcers with cycloidal multidirectional vibration therapy
Authors: Wilson J.M. , Arseculeratne Y.M. , Yang Y. , Cherry G.W. 
Published: May 2014

Objective: This preliminary study combined compression bandaging with cycloidal vibration to determine whether this would enhance the rate of healing of venous leg ulceration. Method: Twenty-one patients with venous ulceration were enrolled into a 12-week trial. The vibration device was used three times daily for 30 minutes on each occasion, along with compression bandaging. Results: Ulcers of 13 patients (62%) healed within 12 weeks. The remaining eight patients completed the 12-week study with a 31–90% reduction in ulcer size. A reduction in pain was observed in 17 out of 21 patients (81%). Ultrasound measurements showed reduced fluid content in the upper dermis in patients whose ulcers had healed and in others whose ulcers were improving. Conclusion: This preliminary study shows that gentle cycloid vibration, combined with standard compression bandaging, enhances the healing rate of venous ulcers and helps to relieve pain. Declaration of interest: This study was supported by an educational grant from Vibrant Medical, UK.
Advanced wound care materials: developing an alginate fibre containing branan ferulate
Authors: Miraftab M. , Qiao Q. , Kennedy J.F. , Groocock M.R. , Anand S.C. 
Published: May 2014

Objective: This laboratory-based study set out to establish whether branan ferulate — a polysaccharide compound available in gels such as as Sterigel (SSL International, UK) — could be successfully added to the fibre of an alginate dressing to provide a superior wound-care dressing. Method: A wet extruder (Howden Engineering Services, UK) was used to produce the fibres. Researchers examined the effect of spinning-bath calcium chloride concentration (used as the coagulant in the fibre-spinning process) on the tensile and absorption properties of alginate fibres containing 25% w/w branan ferulate. Sodium alginate and branan ferulate were separately dissolved in de-ionised water and then stirred together to make up a 5% dope solution. The dope was then forced through a spinneret and into the calcium chloride bath, where fibres were precipitated and then carried over the first set of rollers. The fibres were washed in the next bath and drawn at different rates to enhance their tensile properties. At the ‘winding-up’ stage the filaments were either passed over a contact heater and into a furnace (dry pick-up) or transferred into acetone baths of increasing concentrations of 50, 80 and 100% aqueous acetate to remove the water (wet pick-up). The moisture content of standard alginate fibres and those with branan ferulate were measured and compared. Breaking load, tenacity and breaking extension, and the quantity of branan ferulate in the fibres were also measured. The process was repeated four times, using different strengths of calcium chloride. Using various draw ratios, the effects of liquid uptake were measured using water, saline and a solution called A (to mimic human blood and exudate-type fluids). Results: Out of the four calcium chloride concentrations used, 1% concentration appeared to give the highest and most conclusive results for fibre-breaking load, tenacity and breaking extension. Conclusion: A 1% w/v concentration of calcium chloride provides the optimum conditions for achieving suitably strong fibres with adequate absorption capacity, while allowing the least branan ferulate loss during wash and post-production treatments. In a laboratory setting the product showed promise. Research is now needed in a clinical setting and for comparison with existing wound-care products. Declaration of interest: This study was funded and sponsored by SSL International, Oldham, UK.
Healing process in the ureter: an experimental study in dogs
Authors: Bhatnagar B.N.S. , Chansouria J.P.N. 
Published: May 2014

Objective: This study set out to describe the basic milestones in the pattern of healing in the ureter in order to understand why problems in healing arise when the ureter is severed, usually through anastomotic leakage or stricture formation. Method: Transection and anastomosis of the ureter were performed on dogs. The anastomotic segment was removed at days 6, 14, 21 and 42. Mucopolysaccharide levels, collagen content and breaking strength were measured on these samples and on anatomically similar segments from normal dogs. A minimum of five observations were carried out at each time point. The mean values of the estimations in various groups were compared. Differences were considered significant at p≤0.05. Results: Mucopolysaccharide levels peaked at day 6 and then fell gradually to near normal (p>0.05) by day 42. The collagen content rose to a maximum at day 14 and then fell to near normal levels (p>0.05) by day 21. Breaking strength rose gradually to peak by day 21 and then fell to reach day 6 level (>0.05) at day 42. At no time point did it reach anywhere near normal value. Full healing in the ureter takes at least six weeks. Conclusion: The healing process in the injured ureter is different to that in other tissues. It is probable that clues to anastomotic healing problems of the ureter lie in the paradoxical pattern of collagen formation. Declaration of interest: None.
Effect of curcumin on radiation-impaired healing of excisional wounds in mice
Authors: Jagetia G.C. , Rajanikant G.K. 
Published: May 2014

Objective: To study the effect on wound contraction of pretreatment with various doses of curcumin (the most important active ingredient of the spice turmeric) in mice exposed to 6Gy whole-body y radiation. Method: A full-thickness skin wound was produced on the dorsum of Swiss albino mice treated with and without 25, 50, 100, 150 or 200mg/kg body weight of curcumin before exposure to 6Gy g radiation. Progression of wound contraction was monitored using video images of the wound at various days post-irradiation until full healing occurred. Mean wound healing times were also calculated. Results: Irradiation caused significant delay in wound contraction and healing times. However, treatment with curcumin resulted in a dose-dependent increase in contraction when compared with a control. Greatest contraction was observed for 100mg/kg curcumin, with statistically significant results at days three (p<0.009), six (p<0.05) and nine (p<0.05) post-irradiation for this dose. Complete healing was achieved by day 23 post-irradiation in the curcumin-treated irradiation group. Conclusion: Pretreatment with curcumin has a conducive effect on irradiated wounds. It could be a substantial therapeutic agent for ameliorating radiation-induced delay in wound repair in cases of combined injuries. Declaration of interest: None.
Using Urgotul dressing for the management of epidermolysis bullosa skin lesions
Authors: Blanchet-Bardon C. , Bohbot S. 
Published: May 2014

Objective: To evaluate the acceptability, tolerance and efficacy of Urgotul wound dressing in the management of epidermolysis bullosa (EB) skin lesions. Method: This was an open-label uncontrolled clinical trial involving 20 patients (11 adults and nine children) with EB simplex or dystrophic EB. Patients were selected from the register of EB patients at the investigating centre and included if they presented with at least one skin lesion requiring management with a non-adherent wound dressing. Lesions were treated with the study dressing for a maximum of four weeks. All dressing changes, wound parameters, pain and effect on quality of life were recorded. Results: All patients completed the trial. Nineteen out of 20 wounds healed within 8.7 ± 8.5 days. Overall, 11 patients (55%) considered that their quality of life had improved following use of the dressing, which was also reported to be pain free and ‘very easy’ or ‘easy’ to remove at most dressing changes. Nineteen out of 20 patients stated that they would use the study dressing to manage their lesions in future. Conclusion: This study confirmed the very good acceptability and efficacy of Urgotul in the treatment of skin lesions in patients with EB. Declaration of interest: This study was sponsored by Laboratoires Urgo (Dijon, France).
The effectiveness of a hyper-oxygenated fatty acid compound in preventing pressure ulcers
Authors: Torra i Bou J-E. , Segovia Gómez T. , Verdú Soriano J. , Nolasco Bonmatí A. , Rueda López J. , Arboix i Perejamo M. 
Published: May 2014

Objective: To compare the effects of Mepentol, a hyperoxygenated fatty acid preparation, with a placebo treatment in preventing the development of pressure ulcers. Method: The research study consisted of a multicentre double-blind randomised clinical trial. The incidence of pressure ulcers, relative risk (RR), preventable fraction and number necessary to treat (NNT) were calculated. In addition, Kaplan-Meier survival curves, with log-rank test, and Cox’s proportional hazards regression model were used to compare both groups. Results: A total of 331 patients completed the study: 167 in the control group and 164 in the study group. Pressure-ulcer incidence during the study was 7.32% in the intervention group versus 17.37% in the placebo group (p0.006). These results show that for each 10 patients treated with Mepentol one pressure ulcer was prevented (NNT = 9.95). Survival curves and the regression model showed a significant statistical difference for both groups (p≤0.001). The average cost of Mepentol during the study was ₠7.74. Conclusion: Mepentol is an effective measure for pressure ulcer prevention. It was more effective than a greasy placebo product, and was found to be cost-effective. Declaration of interest: This study was sponsored by Laboratorios Bama-Geve SA, Barcelona, Spain.
Evaluation of hypochlorous acid washes in the treatment of chronic venous leg ulcers.
Authors: Selkon J.B. , Cherry G.W. , Wilson J.M. , Hughes M.A. 
Published: May 2014

Objective: Hypochlorous acid (HOCl) is a highly microbiocidal agent active against bacteria, viruses and fungi. Using quantitative microbiology, preliminary studies showed it achieved an appreciable reduction in the bacterial burden in chronic venous leg ulcers. The study aimed to determine whether it has a role as an additional treatment for chronic venous ulcers that have not healed with conventional treatment. Method: On the basis of previous reports we designed a study in which patients acted as their own controls, in that only patients who failed to achieve a 44% reduction in wound size with standard treatment (compression bandaging) received HOCl washes. Results: Of 30 patients admitted to the study, 10 achieved a 44% ulcer reduction after three weeks of standard treatment. In addition to the standard compression treatment, the remaining 20 patients were given HOCl washes over 12 weeks. Of the 20 ulcers, nine (45%) healed and five (25%) reduced in size by over 60%. All patients became free of pain. Conclusion: These findings confirm the clinical efficacy of treating venous leg ulcers with hypochlorous washes. Use of HOCl washes as an adjunctive therapy for recalcitrant venous leg ulcers appreciably increases healing and rapidly relieves pain. Declaration of interest: This study was supported by a grant from Sterilox Technologies International, Stafford, England.
Measuring sub-bandage pressure: comparing the use of pressure monitors and pulse oximeters
Authors: Satpathy A. , Hayes S. , Dodds S.R. 
Published: May 2014

Objective: To test the use of low-cost sub-bandage pressure monitors and pulse oximeters as part of a quality-control measure for graduated compression bandaging in leg ulcer clinics. Method: Twenty-five healthy volunteers (mean age 40 years) providing 50 limbs were bandaged with a four-layer compression bandaging system. The ankle systolic pressure (ASP) was measured using a pulse oximeter (Nellcor NBP-40) before applying the graduated compression bandages. Interface pressure was measured by placing pressure sensors on the skin at three points (2cm above the medial malleolus; the widest part of the calf; and a point midway between them) in the supine and standing positions. The ASP was measured again with the pulse oximeter after the bandage had been applied, and the effect of the bandage on the ASP was recorded. The actual pressure created by the bandage was compared with the required pressure profile. Results: Interface pressures varied with change of position and movement. With the operator blinded to the pressure monitors while applying the bandages, the target pressure of 35–40mmHg at the ankle was achieved in only 36% of limbs ([mean ± 95% confidence interval]; 32.3 ± 1.6mmHg [supine]; 38.4 ± 2.4mmHg [standing position]). With the help of the pressure monitors, the target pressure was achieved in 78% of the limbs. There was no correlation between the pressure monitors and pulse oximeter pressures, demonstrating that the pulse oximeter is not a useful tool for measuring sub-bandage pressures. Conclusion: The results suggest a tool (interface pressure monitors) that is easy to operate should be available as part of quality assurance for treatment, training of care providers and education. Declaration of interest: None.
An in vitro study of antimicrobial activity and efficacy of iodine-generating hydrogel dressings
Authors: Thorn R.M.S. , Greenman J. , Austin A.S. 
Published: May 2014

Objective: To determine the antimicrobial activity and efficacy of different formulations of novel bioxygenating hydrogel dressings (which deliver both iodine and oxygen into the wound) against various target organisms by means of an in vitro test system that more effectively mimics the conditions encountered when dressings are in contact with wounds. Method: Three bioxygenating hydrogels were tested: Oxyzyme, which releases low levels of iodine into the wound, and Iodozyme 402 and Iodozyme 401, which release higher levels of iodine, with Iodozyme 402 releasing twice the amount of 401. Cellulose filter disks (n=32) were inoculated with indicator species and placed equidistant from each other as a matrix onto agar test beds. Cut squares of control or test dressings were placed on top of each disk. Kill curves were constructed from determinations of the numbers of survivors (log cfu per disk) over time by removing disk samples at various time points. Results: Significant differences (p<0.05) were observed between the controls and test samples. The order of sensitivity for Oxyzyme was Fusobacterium nucleatum, Bacteroides fragilis, Propionibacterium acnes, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Candida albicans and Pseudomonas aeruginosa. The order of efficacy of the three hydrogel dressings (Iodozyme 402, followed by Iodozyme 401 and then Oxyzyme) was the same regardless of the target species. Conclusion: The novel hydrogel skin surface wound dressings are broad-spectrum in activity, encompassing antibiotic-resistant organisms, anaerobes and yeasts; their antimicrobial function appears to be rapidly effective. Declaration of interest: The authors wish to thank Insense for supplying various hydrogel test dressings and for summer studentship financial support (for RMS Thorn).
A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers
Authors: Gordon L. , Edwards H. , Courtney M. , Finlayson K. , Shuter P. , Lindsay E. 
Published: May 2014

Aim: To conduct a cost-effectiveness analysis based on data from a randomised controlled trial comparing traditional community home nursing with a community Leg Club model for chronic venous leg ulcer management in the south-east metropolitan area of Queensland, Australia. Method: Participants were randomised to the Leg Club (n=28) or home visits (n=28). Data were obtained on resources/related costs incurred by the service provider, clients and carers, and the community. Results: From the collective perspective (service provider, clients and carers, and the community), at six months the incremental cost per healed ulcer was $AU515 (₠318) and the incremental cost per reduced pain score was $AU322 (₠199). For the service provider, Leg Club intervention resulted in cost savings and better health effects when compared with home nursing. Conclusion: On both clinical and economic grounds, the Leg Club model appears to be more cost-effective than traditional home nursing for the treatment of chronic venous leg ulcers. However, clients and the local community contribute substantial financial and in-kind support to the operation of both services. Declaration of interest: This project has been supported by a grant from the Queensland Nursing Council, Australia. The views expressed do not necessarily represent the views of the Council or the members, executive officer or staff of the Council.
An exploration of current leg ulcer management practices in an Irish community setting
Authors: Clarke-Moloney M. , Keane N. , Kavanagh E. 
Published: May 2014

Objective: To establish the prevalence of leg ulceration in the Irish Health Service Executive (HSE) mid-western region and to determine the level of assessment and treatment patients have been receiving in the local community. Method: Before the introduction of a Doppler training programme, all public health and community health nurses working in the Irish HSE mid-western area were requested to complete an audit form on each patient being treated for leg ulceration during a predefined one-week period. This form recorded details on patient demographics, ulcer aetiology, assessment and treatment. Out of 97 nurses, 96 responded to this audit, giving a response rate of 98.9%. Results: A total of 429 patients with 449 leg ulcers were identified. Mean age was 75.5 years (standard deviation 10.7). Overall prevalence was 0.12%, which increased to 1.2% in those aged 70 years and over. Women were almost twice as likely as men to be affected (ratio of 1.8:1). The main causes of ulceration were reported as venous incompetence accounting for 63.3% (284/449) and arterial insufficiency accounting for 8% (36/449) of all ulcers. Only 59.9% (269/449) of all ulcerated limbs had ABPI measurements performed. Of those reported as venous in origin, 71.8% (204/284) had ABPI measurements recorded. Evidence-based care was generally apparent in this group, with 47.5% (97/204) receiving high compression and 18.1% (37/204) receiving reduced compression. However, in venous leg ulcers where ABPIs were not recorded (n=80) care appeared haphazard and inappropriate. Conclusion: Our study has identified the benefit of ABPI Doppler assessment. This assessment could be done in local health centres by trained nurses who could provide more appropriate and timely care to patients, thereby improving outcomes and relieving pressure on acute hospital clinics. Declaration of interest: None.