bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring student nurses educational needs in relation to end-of-life care in children
Authors: Thompson Lucy , Hall Carol 
Published: May 2014

Children’s nurses are most likely to have long involvement with the care of dying children in hospital and at home. As students they expect to be taught how to manage the complex technical needs of children, however, the needs of dying children may not receive the same degree of attention. Review of the literature revealed that student nurses may be exposed to the death of a child with little education to help them deal with specific needs of the children and minimal preparation in coping with personal emotional reactions. This study closely examined student nurses’ educational needs in relation to end-of-life care for children. Eight semi-structured interviews were conducted with final-year child-branch students to identify their experiences and perceptions. Themes identified included: anxieties regarding providing end-of-life care to children; negative aspects of end-of-life education; positive aspects of end-of-life education; and perceptions of how end-of-life education could be improved. Students perceived that education could be improved to fully prepare them to care for children at the end of life. Additionally, students identified some of the strengths of their education including providing practical nursing care to children at the end of life and receiving good support from both university and clinical staff.
Childhood cancer: The need for shared care
Authors: Hughes Mary 
Published: May 2014

Childhood cancer is not only a devastating diagnosis for the child, but also for parents and siblings. As treatment protocols develop, influencing the rate of survival from childhood cancer, this paper examines the literature on parents’, children’s and siblings’ perspectives of the cancer experience. Literature search using CINAHL, PubMed and Science Direct databases including parents’, children’s, sibling’s and health-care professionals’ perspectives on the shared care model of treatment. The review concentrates on the pertinent studies surrounding the shared care model, from an international perspective. Key words used in the search strategy were: childhood cancer; shared care; children; parents; siblings; healthcare professionals. The management of childhood cancer has changed dramatically in the last 20 years, to provide primary, secondary and tertiary care for children with cancer, their parents and their siblings. Several studies are reviewed to elicit the effectiveness of this new model of care from the perspectives of the service users and providers. It is clear that the care of children with cancer affects the lives of the children, their parents and siblings profoundly. Further investigation on the shared care model is required in order to discover the perception of the service users and health care professionals involved in the delivery of care.
Clinical evaluation of a new pressure-relieving mattress
Authors: Bale S. , Price P. , Crook H. , Morgan T. , Harding K.G. 
Published: May 2014

In introducing a new mattress into practice it is important to evaluate its performance from both the patient's and nurse's perspective. A total of 20 patients admitted to the integrated medical unit were recruited and nursed on a new pressure-relieving mattress offering two modes of pressure relief (Duo). All patients had been recently admitted to hospital and were considered to be ‘at very high risk’ of developing a pressure ulcer, with an initial Waterlow score >20. Data were collected on admission, mid-point (three to four days) and study exit (seven days). The primary objective was to investigate the condition of patients' skin and the mode of choice for pressure relief. The secondary objective was to investigate reasons for nurses' and patients' choices. Structured interviews were conducted with the patient, ward nurse and research nurse whenever possible. Nineteen patients maintained or improved their skin condition during the evaluation.
Accessing wound-care information on the Internet: the implications for patients
Authors: Bovill E.S. , Hormbrey E. , Gillepsie P.H. , Banwell P.E. 
Published: May 2014

The Internet and the World Wide Web have revolutionised communication and provide a unique forum for the exchange of information. It has been proposed that the Internet has given the public more access to medical information resources and improved patient education. This study assessed the impact of the Internet on the availability of information on wound care management. The search phrases ‘wound care’, ‘wound healing’ and ‘wounds’ were analysed using a powerful Metacrawler search engine ( www.go2net.com ). Web site access was classified according to the target audience (wound-care specialists, other health professionals, patients) and the author (societies, institutions or commercial companies). The largest proportion of web sites were commercially based (32%). Of the total number, 23% specifically targeted patients, mostly by advertising. Only 20% were aimed at wound specialists. Extensive surfing was required to obtain wound-care information, and objective information sites were under-represented. Regulated, easily accessible, objective information sites on wound-healing topics are needed for improved patient education and to balance the existing commercial bias.
Effect of glucose concentration on the growth of normal human dermal fibroblasts in vitro
Authors: Han J. , Hughes M.A. , Cherry G.W. 
Published: May 2014

Objective: Glucose requirements increase in tissue repair as glucose is an energy source for cell proliferation and the formation of extracellular matrix components. Glucose concentrations in leg ulcer wound fluid are lower than in normal human serum, with a median of 0.7mM (range: 0.3–1.2mM). This study investigated the effect of such low concentrations on the growth of fibroblasts in vitro. Method: Fibroblasts from 50-year-old and 87-year-old subjects were used. Growth in medium with various concentrations of glucose was determined by a colorimetric assay and microphotography. Results: Up to day 6, there were minimal differences in growth, but after day 6 a clear dose-dependent increase in growth was observed. In the lower dose range (up to 2.3mM), growth was highly dose-dependent (r2=0.981), with an increase of 1.8mM stimulating cell growth by day 10 up to 163% of the controls (p<0.0001). Concentrations of 5.5–25.5mM glucose stimulated cell growth by day 10 to about 210% of the controls (p<0.0001), with little difference between these concentrations. Conclusion: These results suggest that glucose enhancement to cells involved in healing might serve as an adjunctive treatment for chronic wounds. Declaration of interest: None.
Evaluation of a new silver foam dressing in patients with critically colonised venous leg ulcers
Authors: Lazareth I. , Ourabah Z. , Senet P. , Cartier H. , Sauvadet A. , Bohbot S. 
Published: May 2014

Objective: To evaluate the performance (efficacy and safety) of an absorbent dressing impregnated with silver salts (UrgoCell Silver) in the management of leg ulcers with clinical signs of critical colonisation. Method: This was a prospective multicentre non-comparative phase III clinical trial. Patients were assessed weekly for up to four weeks. Assessment included clinical assessment of critical colonisation (severe spontaneous pain between dressing changes, erythema, oedema, malodour and heavy exudate), wound area tracing and photography. Acceptability was documented by the nursing staff when dressings were changed between two weekly evaluations. Results: Forty-five leg ulcers were included. At baseline the mean number of clinical signs of critical colonisation per ulcer was 3.6 ± 0.7, which decreased to 1.2 ± 1.2 at the end of the fourth week of follow-up (an average reduction of 2.3 ± 1.3, p<0.001). Oedema, malodour, erythema and spontaneous pain disappeared at the fourth week in 80%, 70%, 69% and 65% of the treated ulcers respectively. Compared with baseline, the mean reduction in ulcer area was 35.0 ± 58.0% (median 33%, p<0.001) after the four weeks treatment. Granulation tissue covered a mean 77% of the ulcer surface area at four weeks, compared with 41% at baseline. Only three local events were documented: contact dermatitis, a burning sensation and erythema. Conclusion: The results suggest that the test dressing had a favourable influence on the wound prognosis, and was well tolerated and accepted in the treatment of venous leg ulcers with clinical signs of critical colonisation. Declaration of interest: This study was sponsored by Laboratoires Urgo, Chenôve, France.
Pain and quality of life in patients with vascular leg ulcers: an Italian multicentre study
Authors: Guarnera G , Tinelli G , Abeni D , Di Pietro C , Sampogna F , Tabolli S 
Published: May 2014

Objective:To assess pain and quality of life in patients with chronic vascular leg ulcers.Method:A multicentre cross-sectional study was conducted. A questionnaire to assess quality of life and report the experience of pain was developed. It incorporated the SF-12 questionnaire and a visual analogue scale (VAS) for the assessment of pain during the day, night and at dressing change.Results:A total of 381 patients (233 females, 148 males) were observed from September to November 2006. The patients had venous (52%), ischaemic (11%), mixed aetiology (10%), hypertensive (2%), microangiopatic (2%), diabetic (9%) and other (14%) types of ulcers. Women experienced more pain and had a worse quality of life than men. Venous ulcers had high mean VAS values during the day (44.4) and night (44.9). However, a higher mean value was recorded at dressing change, when it was similar to the mean for vascular ulcers (57.5 versus 56.3). There was a direct correlation between pain and quality of life, which was worse for ulcers with a longer duration and larger area. Ulcers of less than three months’ duration had mean VAS values of 38.7, 36.9, 46.8 compared with 53.8, 53.9, 62.9 for ulcers of over 12 months’ duration. Mean SF-12 values for the physical component of the questionnaire also showed that patients whose ulcers had a longer duration had a poorer quality of life (35.9) than patients whose ulcers were more recent (40.9).Conclusion:Vascular leg ulcers are very painful and result in a poor quality of life, with a direct correlation with both ulcer duration and ulcer area. Pain relief is required, particularly at dressing changes, as is the selection of advanced wound dressings.Declaration of interest:None.
Propagation of anaerobic bacteria within an aerobic multi-species chronic wound biofilm model
Authors: Sun Y. , Smith E. , Wolcott R. , Dowd S.E. 
Published: May 2014

Objective: Most chronic wound biofilms have been shown to have significant populations of anaerobes. In order to better screen antimicrobial and antibiofilm therapeutics, we evaluated the ability of key anaerobes to incorporate and propagate within our aerobic chronic wound biofilm. Method: We had previously developed a rapid model to simulate polymicrobial chronic wound biofilms. This model incorporated meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis (VRE) and Pseudomonas aeruginosa. The model was used along with a variety of anaerobes to determine whether this biofilm model would support propagation of anaerobes similar to that we have identified in chronic wounds. Results: Using our previously defined Lubbock Chronic Wound Biofilm (LCWB) model combined with quantitative PCR, anaerobic bacteria were shown to proliferate through integration into the biofilm under aerobic conditions. Using electron microscopy we show close association between aerobes and anaerobes within the biofilm suggesting a synergistic relationship. Conclusion: We have expanded the utility of the LCBW to show the ability of clinically significant anaerobic bacteria to thrive in aerobic conditions. The expansion of this model can further simulate the functional characteristics of chronic wound pathogenic biofilms and the species that dwell within them allowing improved ability to evaluate therapeutics that target anaerobes. Declaration of interest: None.
Cost of wound treatment to increase significantly in Denmark over the next decade
Authors: Hjort A. , Gottrup F. 
Published: May 2014

ObjectiveTo demonstrate that changes in demography, life expectancy and incidence of background diseases (including type 2 diabetes mellitus) during the period 2009–2020 will significantly increase the costs of wound care in Denmark.MethodA simple activity-based equation, which was applied to Danish national statistics on medical conditions and key financial figures from previously published surveys.ResultsCurrently, DKK 735m (€99m) is spent each year on municipal wound care. Denmark's population is 5.4 million and about 18,000 wounds can be expected annually in the municipal sector, requiring more than three million dressing changes. These figures are expected to rise significantly upuntil 2020. The percentage of senior citizens will rise by 22% during this time and the number of patients with type 2 diabetes mellitus will increase by 22–24,000 per year. Improved treatments and longer life expectancies will increase the elderly population by 40,000. These changes will cause a gradual rise in wound care costs of up to 30%, corresponding to DKK 224m (€30m) in 2020. However, by adopting a national strategy based on best practice guidelines, it may be possible to intercept this increase in costs. A national strategy in Denmark seems to have the potential to reduce costs by a matching 30%. If Denmark fails to adopt a national strategy, an accumulated loss of DKK 1.5 billion (€206m) can be expected over the next decade.ConclusionWound therapy will pose a major economic challenge to Denmark in future if no intervention is carried out. This study presents an empirical model calculating the economic consequences of future challenges such as demography, lifestyle and type 2 diabetes mellitus. It is suggested that a national strategy for wound therapy may convert a future deficit to zero-balance. Similar challenges are expected in other western European countries.Declaration of interestNone.
An evaluation of the skin stripping of wound dressing adhesives
Authors: Waring M. , Bielfeldt S. , Mätzold K. , Wilhelm K.P. , Butcher M. 
Published: May 2014

Objective:This study looks at six different modern wound dressings to investigate how likely they are to cause skin stripping and impairment of the skin's barrier function.Method:Healthy volunteers had each dressing applied, removed and reapplied to the skin on their back over the study period of 15 days. Skin barrier function was investigated using the amount of transepidermal water loss (TEWL) and then related to the amount of skin stripping, investigated by measuring stained skin removal, the thickness of the stratum corneum after treatment, and the amount of skin attached to the removed dressings. General signs of trauma, such as skin dryness and erythema, were investigated by subjective and objective parameters.Results:TEWL values measured on the untreated test area, as well as after application of Urgotul trio, remained relatively unchanged and mepilex border decreased slightly (~1g/m2/h), while all other dressings displayed an increased in TEWL: Allevyn Adhesive (5g/m2/h), versiva XC (14g/m2/h), Comfeel plus (22g/m2/h) and Biatain (28g/m2/h). By the end of the study, only the untreated area (mean 43% dye remaining), Mepilex border (76%) and Urgotul trio (34%) areas had visible dye remaining. It is interesting to note that the untreated site had a colour change, suggesting loss of stratum corneum, due to the shedding of skin cells from the surface. The increase in total skin colour for Comfeel plus and Biatain after day 8 might be assigned to an increased redness due to erythema. All the dressings showed evidence of stratum corneum attached to the adhesive, except Mepilex border, which appeared to be free of any attached stratum corneum.Conclusion:Overall the best performance in terms of skin protection and failure to cause skin trauma was found to be for Mepilex border.Conflict of interest:This project was funded by a grant from Mölnlycke Healthcare Ltd.
The effect of continuous pressure monitoring on strategic shifting of medical inpatients at risk for PUs
Authors: Motamedi S.M. , de Grood J. , Harman S. , Sargious P. , Baylis B. , Flemons W. , Ghali W.A. 
Published: May 2014

• Objective: To assess the impact of continuous pressure imaging technology on strategic turning of patients by health professionals. • Method: This pilot study of a newly-developed continuous pressure imaging technology (XSENSOR ForeSite Patient Turn System) involved two phases of videotaped observation of medical inpatients, with each patient serving as his/her own control: a control phase in which continuous pressure imaging was not available to health-care providers and an intervention phase where it was. The primary outcome was to determine whether access to the technology influenced the rate of patient turns/shifts by nursing staff. Secondary outcomes included a comparison of the rates of other care provider shifts, patient self-shifts, and family assisted shifts. Qualitative data regarding nurse and patient/family perspectives were also obtained. • Results: Complete control/intervention data were available for nine patients. The mean rate of two-person assisted turns was 0.274 ± 0.087 turns per hour in the control phase versus 0.413 ± 0.091 turns per hour in the intervention phase (p=0.08). For the combined endpoint of two-person assisted turns or patient transfers off the bed into a wheelchair/chair, there was a statistically significant difference in the mean number of turns per hour: mean of 0.491 ± 0.271 turns per hour for the intervention group versus 0.327 ± 0.235 turns per hour for the control group (p=0.04). Provider interviews confirmed that nurses used information from the technology to inform their patient shifting strategies and behaviours. • Conclusion: This pilot study provides some initial data supporting the hypothesis that continuous pressure imaging technology could positively impact the frequency of patient turns by care providers, as well as provide impetus to inspect specific skin locations, thereby providing a potential targeted risk mitigation strategy for the development of pressure ulcers. • Declaration of interest: Funding for the study was obtained from PreCarn Inc., an independent, nonprofit company supporting the pre-commercial development of new technologies, and from the Alberta Enterprise and Advanced Education (formally Alberta Advanced Education and Technology). The industry partner, XSENSOR, was involved in setup and maintenance of the technology, but was not involved in the evaluative research protocol. Specifically, XSENSOR personnel were not involved in the collection, coding, or analysis of outcome data, nor in the compilation and writing of this paper. None of the listed authors have any conflicts of interest, financial or otherwise, relating to the technology tested.
A clinical case-series evaluation of a superabsorbent dressing on exuding wounds
Authors: Hindhede A. , Meuleneire F. 
Published: May 2014

• Objective: To evaluate the capacity of a superabsorbent dressing (DryMax Extra; Absorbest AB) to manage excessive exudate, thereby protecting peri-wound skin and facilitating wound healing. • Method: Patients with acute and chronic wounds of various aetiology were assessed, and treatment of their wounds with the superabsorbent dressing was evaluated. The starting point for this study was the needs of individual patients and, therefore, the study includes patients with exuding wounds of various aetiologies, which were not progressing towards healing with their previous treatment. • Results: Thirty patients, aged 23-94 years, were included in this case series, between December 2008 and September 2009. Dressings were changed from daily to once a week, based on the clinician's judgment and the needs of the individual patient. In many patients, frequent dressing changes were needed initially but, after a while, the exudate levels decreased and the dressing could be changed at longer intervals. Inspection of the saturation was possible without removing the dressing. The absorbing efficiency of the dressing was considered to be very good by the investigating clinician, even under compression, and blood, stool and urine was seen to be absorbed by the dressing. Prior to using the superabsorbent, many patients suffered from painful wounds and maceration, irritation, eczema and itching in the surrounding skin, caused by the wound exudate. As the exudate levels decreased and the wounds started healing, the patients felt less pain and less itching in the surrounding skin. • Conclusion: This case series suggests that the superabsorbent dressing promoted wound healing in patients with highly exuding wounds, where previous therapy had failed. More research and evaluation comparing the capacities of various superabsorbent dressings in vitro and in vivo and the clinical implications of their special properties is needed. • Declaration of interest: These studies were sponsored by Absorbest AB, manufacturers of DryMax Extra. A. Hindhede is an independent consultant who received a fee for her contribution. F. Meuleneire completed a clinical case-series in agreement with the sponsor and received funding for conduct of the study. The sponsors had no role in study design, or collection or analysis of the data.
Patient perspectives of their leg ulcer journey
Authors: Green J. , Jester R. , McKinley R. , Pooler A. 
Published: May 2014

Objective: To understand the personal impact of venous leg ulceration from the patients' perspective. Method: Face-to-face, unstructured interviews were conducted with nine patient participants with venous leg ulcers. The interviews were digitally recorded, transcribed verbatim and, using thematic analysis, the themes and subthemes which impacted on quality of life were identified. Results: Four core themes were identified: the ulcer, symptoms, wound management and effects on daily life, with 16 subthemes that negatively impacted on quality of life (QoL) also identified. Conclusion: This qualitative study offers a valuable insight into the complex issues that impact on daily living for this patient group. The implications of the findings are far reaching and suggest that proactive symptom management and the fostering of a patient focus to consultations may improve QoL and encourage the patient to engage as an active partner in his/her management plan; both of which are explored in the subsequent phases of the larger study. Declaration of interest: This study was funded by West Midlands Strategic Health authority. The authors have no conflicts of interest to declare.