bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skin grafting the contaminated wound bed: reassessing the role of the preoperative swab
Authors: Aerden D. , Bosmans I. , Vanmierlo B. , Spinnael J. , Keymeulen B. , Van den Brande P. 
Published: May 2014

Objective: To investigate use of the preoperative wound swab to predict graft failure compared with establishing the indication for skin grafting on clinical grounds alone. Method: Patients requiring meshed split-thickness skin grafting were prospectively included; the indication for grafting was established on clinical grounds exclusively. A preoperative swab of the wound bed was taken, but its result was concealed to prevent it influencing clinical decision-making. Negative pressure wound therapy (NPWT) was used for both wound bed preparation and graft fixation. After 2 months, graft area take percentage was measured using digital image processing software and the results validated against the result of the preoperative wound swab. Results: Eighty-seven wounds were included in the study. Mean graft area take percentage was 88%, with five grafts considered complete failures (< 25% take). A posteriori analysis of the wound cultures showed that 53% had been contaminated on grafting, but these did not fare any worse than near-sterile wounds. Qualitative analysis of cultures showed that wounds containing either Pseudomonas aeruginosa or Staphylococcus aureus did have inferior outcome (mean take percentage 78.9% vs 91.3%; p=0.038). Diabetes was also a deteriorating factor (mean take percentage 83.0% vs 90.7%; p=0.004). Conclusion: Establishing the indication for skin grafting on clinical grounds exclusively does not yield grossly inferior results. In light of recent advances in skin grafting, including use of NPWT as adjuvant therapy, the requirement for routine preoperative wound swabs may be questioned. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Spirituality and subjective wellbeing in patients with lower-limb ulceration
Authors: Salomé G.M. , Pereira V.R. , Ferreira L.M. 
Published: May 2014

Objective:To assess subjective wellbeing and spirituality in patients with either venous leg ulcers (VLUs) or diabetic foot ulcers (DFUs).Method:This was a prospective, descriptive, analytical study conducted from December 2011 to October 2012. The study was approved by the Institutional Research Ethics Committee. A convenience, non-probability sample of 80 patients with either VLUs (n=40) or DFUs (n=40) were consecutively selected from an outpatient clinic of a university hospital in the city of Pouso Alegre, Brazil. Most participants were practising Catholics. The Subjective Wellbeing Scale and Spirituality Self-Rating Scale were administered to all participants.Results:Thirty-two (80%) patients with foot ulcers and 22 (55%) patients with leg ulcers reported going to church sometimes or rarely. Most participants regarded religiosity and spirituality as synonymous, and living with the ulcers was seen as a punishment. The mean scores on the positive affect, negative affect, and life satisfaction components of the Subjective Wellbeing Scale were 2.48, 1.57 and 1.88, respectively, for patients with DFUs, and 2.55, 1.55 and 1.50, respectively, for patients with VLUs, with significant difference in life satisfaction between groups (p=0.003). The mean score on the Spirituality Self-Rating Scale was 11.40 for patients with VLUs and 12.85 for those with DFUs, showing that the participants had low levels of spirituality.Conclusion:VLUs and DFUs had a negative impact on subjective wellbeing and spirituality, but patients with DFUs showed poorer subjective wellbeing and spirituality than those with VLUs.Declaration of interest:The authors have no conflict of interests or competing financial interests to declare with regard to this manuscript. V.R. Pereira would like to acknowledge the scholarship from the Undergraduate Scholarship Program (PROBIC) of the Sapucaí Valley University (UNIVÁS). The scholarship sponsor had no roles in the design and conduct of the study, including collection, management, analysis and interpretation of data, preparation, review, and approval of the article.
Pressure ulcer prevalence and quality of care in stroke patients in an Indonesian hospital
Authors: Amir Y. , Halfens R. J. G. , Lohrmann C. , Schols J. M.G.A. 
Published: May 2014

Objective: To explore the quality of pressure ulcer (PU) care in stroke patients in an Indonesian stroke-specialised hospital. The prevalence, prevention, wound treatment and hospital facilities related to PU structural quality indicators at the ward and institutional levels were assessed. Method: A multi-level cross-sectional survey was performed over three days in an Indonesian stroke-specialised hospital. All stroke patients present on the day of the measurement were included. The European Pressure Ulcer Prevalence Study Minimum Data Set and the Dutch National Prevalence Measurement of Care Problems (Landelijke Prevalentiemeting Zorgproblemen, LPZ) questionnaire were used. Results: The prevalence rates of PUs, including and excluding Category I were high in this hospital (28% and 17%, respectively). More than half of the patients/families (56%) received education about PU prevention and 74% of the patients were repositioned, although irregularly, by nurses or families. No treatment was applied to Category I PUs. Category II PUs were treated by using NaCl 0.9% solution to cleanse the wound without dressings. Category III PUs were mainly treated by using anti-microbial gauze dressing. No patient suffered a Category IV PU. Only a few structural quality indicators of PU care at ward and hospital level were met. Conclusion: PUs were quite prevalent in these stroke patients. The quality of PU care in this hospital could be improved, especially in the areas of prevention, treatment and structural quality indicators. Declaration of interest: Y. Amir received a grant from the Directorate General of Higher Education, Ministry of National Education and Culture of Indonesia. The authors have no conflicts of interest to declare.
Sterile-water negative pressure instillation therapy for complex wounds and NPWT failures
Authors: Fluieraru S. , Bkara F. , Naud M. , Herlin C. , Faure C. , Trial C. , Téot L. 
Published: May 2014

Objective: To investigate use of negative pressure wound therapy (NPWT) combined with instillation for patients either presenting with a complex wound or after failure of classic NPWT. Method: A retrospective case series study conducted on patients treated using an NPWT instillation system (V.A.C. Instill; KCI Inc.) from January to December 2012. The instillation machine was used with pure saline so as not to interfere with local antibacterial solutions. Two clinical indications—patients presenting either large undermining, deep inaccessible wounds or infected wounds and those for whom conventional NPWT had proved ineffective, were analysed—with efficacy of the promotion of granulation tissue as the primary outcome. length of instillation time, the rhythm and the amount of liquid to be injected compared with the estimated volume of the cavity were also evaluated. Results: Twenty-four patients were included in this series—12 post-NPWT failures and 12 complex wounds—with positive outcomes in 23 cases. Surgical closure was realised after promotion of granulation tissue, using either flaps or skin grafts alone, or combined with previous application of a dermal substitute. No complications linked to instillation were observed during the period of use. Conclusion: The results of this case series suggests that use of NPWT combined with pure saline instillation could have a positive impact on the healing trajectory of patients with complex wounds or after failure of classic NPWT. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The prevalence of pressure ulceration among Jordanian hospitalised patients
Authors: Tubaishat A. , Aljezawi M. 
Published: May 2014

Objective: To measure the prevalence rate of pressure ulcers (PUs) among hospitalised patients and to assess the adequacy of preventative care provided to patients at-risk for PUs.Method: A cross-sectional survey was conducted by inspecting the skin of each patient included; if a PU was noted, it was classified according to the European Pressure Ulcer Advisory Panel grading system. Risk was assessed using the Braden scale and the use of preventative interventions was also documented.Results: The sample included was 295 patients; mean age of the patients was 49.1 ± 18.6 years (range 18–87 years) and 55% (n=162) were male. The prevalence rate was 16% (8.8% excluding category I). Category I was the most common grade of PU (n=22; 46%). The heels were the most commonly affected sites (n=23; 49%). Only 19% of patients in need of prevention actually received proper adequate prevention.Conclusion: PU prevalence rate was lower than published rates in studies that employed the same method. The young age and general health of our sample could be the best explanation. A very small percentage of at-risk patients receive adequate prevention. This should open the door to scrutinising the provision of PU prevention in Jordan.Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Pedal osteomyelitis in patients with diabetes: a retrospective audit from Saudi Arabia
Authors: Malone M. , Gannass A. , Descallar J. , Bowling F.L. , Dickson H.G. 
Published: May 2014

Objective: To examine the characteristics of patients presenting to the emergency room and the specialist diabetes foot clinic with pedal osteomyelitis (PO). Method: A retrospective study was conducted at a regional hospital. The charts of patients with suspected PO who presented during the period 1 January to 31 December 2011 were analysed. Demographics, biochemistry and microbiological data were obtained. Bone biopsies were performed by the attending clinician either during surgical removal of infected bone, or percutaneously under guided fluoroscopy through non-infected tissue. Results: Sixty-six cases of osteomyelitis affecting 102 joints were noted. The study population consisted of 44 men, mean age 62.9 ± 11.3 years, and 22 women, mean age of 57.6 ± 10.6 years. Gram-positive bacteria were the predominating pathogens (p<0.05). Staphylococcus aureus was cultured in 36% of all bone biopsy cases. A predictive trend in HbA1C was observed, where every increase of 1% from the recommended level of 7% was associated with a 10% increase in the likelihood of receiving surgical intervention. Conclusion: S. aureus infection is a major cause of osteomyelitis in interphalangeal joints of the feet of diabetic patients. There is an apparent association with patients who present with diabetic foot osteomyelitis and sub-optimal glycaemic control, requiring surgical intervention. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Methodological recommendations for comparative research on the treatment of chronic wounds
Authors: Sonnad S.S. , Goldsack J.C. , Mohr P. , Tunis S. 
Published: May 2014

• Objective: to provide specific recommendations to product developers and clinical researchers on the design of comparative effectiveness studies for the treatment of chronic wounds, specifically those pertaining to arterial and venous-disease related ulcers, diabetic foot ulcers, pressure ulcers and burn wounds. • Method: the recommendations were developed based on a process defined by the Center for medical technology policy (CMTP). After selecting the subject area, semi-structured phone interviews were conducted by one of the authors (SSS) with representatives of payers, manufacturers, clinicians, clinician/researchers and patient advocates. next, a broad range of stakeholders participated in a meeting convened by CMTP to determine their needs. A technical working group comprising key stakeholders then participated in clarifying recommendations developed by CMTP staff and adding important considerations for their implementation. the resulting draft document was finalised based on public and solicited comment from individual manufacturers; a consortium of product developers and manufacturers; and an alliance of physicians, providers, manufacturers and patient organisations. this article is a summary of the full effectiveness guidance document. • Results: to address the needs of patients, clinicians, guideline developers, payers and other post-regulatory decision makers, this work makes ten recommendations to guide comparative effectiveness research for chronic wound care. these recommendations fall into four categories: study design, population, comparators and outcomes. • Conclusion: this paper suggests that using the recommendations outlined to conduct comparative effectiveness research on treatments for chronic wound therapies would facilitate trials that provide patients, clinicians, and payers with the information they need to make optimal treatment decisions. these recommendations focus on design changes that would have the largest impact in improving the usability of the results by decision makers and provide specific guidance on the design of prospective studies intended to inform decision making by patients, clinicians and payers. • Declaration of interest: there were no external sources of funding for these recommendations. the value Institute and the Center for medical technology policy (CMTP) are both private, non-profit organisations. the authors have no financial, commercial or social conflicts of interest to declare with respect to the article or its content.
Nurses' attitudes and perceived barriers to pressure ulcer prevention in Jordan
Authors: Tubaishat A. , Aljezawi M. , Al Qadire M. 
Published: May 2014

• Objective: to explore Jordanian nurses' attitudes toward pressure ulcer prevention and to identify their perceived barriers to care in pressure ulcer prevention. • Method: A cross-sectional multi-centre study was undertaken in four hospitals in Jordan. the registered nurses and nurse assistants working at these sites were requested to complete a self-administered questionnaire. • Results: In total, 428 completed questionnaires were returned. the participant nurses hold positive attitudes regarding pressure ulcers prevention (mean=3.91). the only factor that seems to have an effect on the positive attitude was the experience of the participants (χ 2 [2, n=227]=6.38; [=0.041). the positive attitude was enhanced with increased number of years of experience. Several barriers to good practice were reported by the participants, including: lack of staff (86.2%), time (83.6%), and patient conditions (68.6%). • Conclusion: Findings of this study suggest that positive attitudes are not enough to change practice. Several barriers need to be resolved first if effective prevention is to be provided. this should form a reference dataset that needs to be addressed in the tissue viability field in Jordan, which is still in its infancy. • 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 article or its content.
Ulcer piercing: Cleansing of complicated diabetic neuropathic foot ulcers by positive pressure irrigation
Authors: Cavallini M. 
Published: May 2014

Objective: To demonstrate the efficacy of the ulcer piercing procedure, which allows constant cleansing of the ulcer and facilitates a positive pressure irrigation of any pierced hidden tracts, in order to reduce the negative impact of stasis on wound healing. Method: We designed a surgical procedure of ulcer piercing and drainage with a silastic tube, which allows positive pressure irrigation of any pierced tracts. This procedure was performed in a continuous series of 25 selected diabetic patients affected by a Wagner stage 3 ulcer of the toe (n=16), metatarsal midfoot (n=5) and plantar Charcot foot (n=4), and with adequate foot arterial blood supply. Results: Within 6 months of the ulcer piercing procedure, 23/25 of ulcers had completely healed. In two further cases, the ulcer piercing ring was still in place after 3 and 5 months, progressively healing with no active signs of infection. Conclusion: Taking into consideration the advantages and the lack of side effects afforded by this procedure, ulcer piercing represents a small but effective step towards an easier and safer approach to treating complicated diabetic neuropathic foot ulcers with adequate arterial blood supply. Declaration of interest: There were no external sources of funding for this study. The author has no conflicts of interest to declare with regard to the manuscript or its content.
Knowledge and practice of foot self-care among Jordanians with diabetes: An interview-based survey study
Authors: Abu-Qamar M. Z. 
Published: May 2014

Objective: To examine knowledge and practice of foot care among Jordanian patients with diabetes. Method: An ethically-approved Arabic language questionnaire was used to interview participants version 16). Total scores for knowledge and practice were computed, and were classified as poor (<50%), satisfactory (50–70%) or good (>70%). Results: Out of 1085 participants, 51.1% were males and 48.8% were females. The average age was 53.3 years (SD = 13.3 years), with over half (54.0%) were between 41–60 years of age. More than half of knowledge scores were within the range “good”, in which there was around 6% of the practice scores. Those classified as having poor knowledge amounted to 7.2%, whilst those classified as exercising poor practice amounted to 42%. Statistically significant associations were established between level of education and knowledge (p<0.00l) as well as practice (p<0.006). Conclusion: The study demonstrated discrepancies between knowledge and practice in relation to foot care. Efforts are required to reduce these discrepancies between knowledge and the real practice of foot self-care, taking into account the patients' levels of education and the cultural context. Declaration of interest: The study was funded by a grant allocated by the Abdul Hameed Shoman Fund for Supporting Scientific Research, Amman, Jordan.
Is prehospital thrombolysis beneficial to patients suffering acute MI?
Authors: Wood Bartholomew 
Published: May 2014

Prehospital thrombolysis (PHT) plays an important role in enabling health care trusts to achieve the call-to-needle time of 60 minutes in England and Wales, but its potential value for each patient must be weighed up by the attending paramedic, taking into account local demographics, availability of alternatives such as primary coronary angioplasty (PCA) and the restrictions of the JRCALC guidelines regarding eligibility of the patient. In light of the deteriorating effectiveness of PHT over time and its expense, in some areas money may well be better spent educating the public to call for help at an earlier stage, as well as encouraging direct admission where available to PCA by paramedics as an alternative to PHT. However, until there is an equal eligibility of patients for thrombolysis in both the prehospital and hospital settings, it is difficult for paramedics in the field to weigh up the relative effectivenes of one against the other.
Accuracy of bag ventilation in simulated resuscitation
Authors: Nehme Ziad , Boyle Malcolm J 
Published: May 2014

The efficacy of manual bag ventilation during cardiopulmonary resuscitation (CPR) is often a difficult task to undertake, however, very little is known about its accuracy. Aims The objective of this study was to evaluate operator delivery of ventilation rate, tidal volume and minute volume in a simulated cardiac arrest using two different capacity self-inflating bags in an undergraduate paramedic cohort. Methods An observational single blinded study with third year university undergraduate paramedic students using a mechanical lung model and a simulated adult cardiac arrest to assess their ventilation ability. Students ventilated using 1600 ml and 1000 ml bag for 2 minutes at a rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated. Results Mean tidal volumes were significantly higher for the 1600 ml bag: 528.4 ml (95% CI 491.3–565.5) versus 648.7 ml (95% CI 603.7–693.7) (P < 0.0001), while no statistically significant differences were found in mean ventilation rates and minute volumes between the two bags. Conclusion Smaller self-inflating bags reduce the incidence of overzealous tidal volumes and produce greater guideline-consistent results for cardiac arrest patients.
Wound closure on scene: ethical analysis and reflection
Authors: Winch Spencer 
Published: May 2014

This case study involves the critical analysis and reflection of the ethics involved when an emergency care practitioner closed a 16-year-old patient's self-inflicted wounds at scene, rather than transporting to A&E. The article aims to show the challenges faced by ambulance personnel in the pre-hospital setting when faced with issues surrounding patient autonomy, consent and capacity and how these should be considered on a ‘case by case’ basis.
Increased threat of suicide attack: a need for NHS ambulance services to adapt?
Authors: Overton Matthew 
Published: May 2014

Suicide attacks are an emerging threat within the UK that carry with it specific risks which must be managed in order to ensure safety and minimise injury and loss of life, both to emergency services personnel and bystanders. Major incident planning is usually based on an ‘all-hazards approach’. The aim of this article is to evaluate the current ‘all-hazards’ approach taken by NHS ambulance services for responding to a major incident and recommend if any changes need to occur as a result of the current threat from suicide attacks. In the same way that chemical, biological, radiological, and nuclear (CBRN) was the new emerging threat a few years ago, it could be argued that suicide attacks are the new emerging threat that requires a rethink on how the ambulance service operates. Scene safety is the main issue raised in this article. Solutions ranged from the adoption of US-style tactical medicine allowing paramedics to work within the ‘hot zone’ to training police firearms officers in triage and more advanced skills of clinical care. Some of these solutions assume deployment to the scene in the first place and it is considered what level of risk is acceptable when operating in a hazardous area such as this. Further issues identified were adaptations required to time on scene and whether to screen casualties for explosives and firearms, so as to avoid an armed terrorist being conveyed to hospital. The recommendations from this report rely heavily on cooperation between emergency responders not only during the time of a suicide attack but also during the pre-incident planning phase. Although modifications to the ambulance service response are suggested within the recommendations they do not present a radical change to how the ambulance service operates at present.
Clinical handover of the trauma and medical patient: a structured approach
Authors: Loseby Jez , Hudson Anthony , Lyon Richard 
Published: May 2014

Handovers are vital to the continuity of patient care and can influence patient outcome. Several structures exist to facilitate handover delivery but further work is needed to prospectively evaluate them. This article advocates the implementation of a suitable pre-hospital handover template and the introduction of handover training. We believe the introduction of trauma networks into the UK provides the ideal opportunity to prompt hospitals and ambulance services to co-operate to standardise the approach to handover, improve training and carry out further prospective research into the most effective methods of patient handover.